The Metro Denver Partnership for Health

State: CO Type: Model Practice Year: 2018

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Boulder County Public Health, Broomfield County Department of Health and Human Services, Denver Department of Public Health and Environment, Denver Public Health, Jefferson County Public Health, and Tri-County Health Department 
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The Metro Denver Partnership for Health
Brief Description The Metro Denver Partnership for Health (Partnership) is led by the six Local Health Departments (LHDs) serving the seven-county Denver Metro area, including Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas and Jefferson counties. Participating LHDs include Boulder County Public Health, Broomfield County Department of Health and Human Services, Denver Department of Public Health and Environment, Denver Public Health, Jefferson County Public Health, and Tri-County Health Department. The region includes nearly 3 million Coloradans, 60% of the state's population, with substantial diversity: 52% White, 22% Hispanic, 10% Black and 3% Asian (2015 census). The Partnership collaborates regionally on shared public health priorities and also works with regional leaders in other sectors to advance health priorities. Public health issue Public health issues such as air quality, tobacco prevention, obesity, behavioral health, and infectious diseases transcend jurisdictional boundaries. Many public health partners--including health care systems, public transportation, and the media market--are regional entities, already working across county boundaries. A regional approach to improving population health can improve efficiency and effectiveness by enhancing collaborating on common and shared priorities. Partnership goals 1. Create a formal structure to organize collaboration among six LHDs in the seven-county Denver Metro region 2. Develop and establish objectives for priority focus areas and identify opportunities to support action in each area. 3. Enhance a culture of collaboration among program leadership in each LHD. The Partnership selected four initial priority focus areas in 2015: Data sharing/capacity, Behavioral Health, Healthy Eating Active Living, and Partnership Alignment. In 2017, we selected a fifth priority area: Environmental Health/Climate Change. Implementation The Partnership was implemented through a series of strategy meetings in 2015-2016 facilitated by the Colorado Health Institute and supported by the Colorado Department of Public Health and the Environment (CDPHE). The LHD directors reviewed models of collaboration in other jurisdictions and met with leaders in health care, higher education, human services and community-based health alliances to discuss their proposed collaboration. A formal Roadmap outlining the Partnership's structure, goals and activities was finalized in May 2016 and updated at our annual retreat in January 2017. Workgroups have been established for each of the five priority areas to carry out shared activities. Results/outcomes Our framework for addressing shared priority health issues regionally has resulted in three collaborative grants. 1. Data Sharing/capacity. A two-year, $1.9 million award was received from the Colorado Health Foundation to increase access to the Colorado Health Observation Regional Data Service (CHORDS). CHORDS is a network that uses electronic health record data to support public health evaluation/monitoring and is now being used to assess prevalence of key health issues (eg, smoking, diabetes, depression) at the census tract level. 2. Behavioral Health. A three-year federal grant ($500,000/year) was received from Colorado's State Innovation Model to address behavioral health. Collaborative efforts are focused on reducing stigma around behavioral health issues via a communication campaign and on increasing access to screening, referral, and treatment. 3. HEAL. A three-year, $3 million grant was received from CDPHE to reduce obesity/chronic diseases across the region which is supporting our collaboration through our Healthy Beverage Partnership including a growing communication campaign. Our Partnership Alignment priority has successfully worked with the region's not-for-profit hospitals to inform development of their Community Benefit Plans, now focusing on behavioral health and obesity in most hospitals. We are also exploring regional collaboration with our county Departments of Human Services and have created a workgroup and objectives for our newest priority area on Climate Change. Success factors The success of the Partnership is based on several factors. First, the Partnership was built on an existing track record of informal collaboration over the years. Second, the LHDs have committed leadership at the highest levels who actively encourage strong, collaborative relationships. Third, the LHDs all share priorities (e.g., HEAL and behavioral health) in their respective Public Health Improvement Plans. Fourth, promoting a culture of collaboration among program leadership in each LHD has resulted in staff developing workgroups in other areas to develop regional approaches and leverage collective relationships (e.g., health equity, early childhood development). Public health impacts of practice The Partnership is an efficient use of limited resources, extending the reach of public health interventions by increasing and leveraging available investments. Website The Partnership does not yet have a dedicated website; however, members include the Roadmap on individual websites: Boulder County Public Health, Broomfield County Department of Health and Human Services, Denver Department of Public Health and Environment, Denver Public Health, Jefferson County Public Health, Tri-County Health Department (e.g.,http://www.tchd.org/517/Agency-Planning-Efforts) .
Statement of the Problem Multiple issues and conditions impact the public's health. They cannot be improved by one public health agency or a single health care agency. Change requires effective, mutual partnerships that align efforts to improve public health collectively. Effective regional collaboration needs to be broad-based, involving multiple sectors. The Partnership is an important and growing first step in this process, by aligning our LHDs so we can approach other partners (health care systems, human services, education, business, foundations) in a cohesive, strategic way. Our initial areas of focus include the highest priority health concerns in our region, as identified through our Public Health Improvement Plans: Behavioral Health and Healthy Eating/Active Living (HEAL). They also include opportunities to be more effective Chief Community Health Strategists, by working together to enhance Data sharing/capacity and to build strategic regional Partnership Alignment, and—most recently-- to collaborate regionally on what the American Public Health Association considers the greatest threat to public health today: Climate Change. Target population Nearly 3 million people, approximately 60% of Colorado's population, reside in the region's seven counties which includes Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas and Jefferson counties. Colorado's racial and ethnic make-up is mirrored in the seven-county region, with nearly six percent of residents being African American, around two percent Native American, over four percent Asian, and more than 20 percent Hispanic. Over 10 percent of residents in the region are foreign-born, and there are over 100 languages spoken by students in some of the school districts within the region. The percentage of residents in the region with incomes below the Federal Poverty Level ranges from four percent in Douglas County to 19 percent in Denver County; however, in some census tracts within the region, over 60 percent of families live in poverty. Regarding the percentage of the population reached, because we are not collaborating on delivery of client-specific services, a formal assessment of reach” across our population of 3 million can only be estimated. However, both of our health-topic focused efforts (Behavioral Health and HEAL) involve communication campaigns and broad partnerships, meaning that they are highly visible and wide-ranging in terms of those impacted. Likewise, our focuses on Data Sharing/capacity, Partnership Alignment, and Climate Change are producing efforts with the potential for impacting our communities very broadly. What has been done in the past Our LHDs have collaborated for many years, although primarily on an ad hoc basis when an opportunity arose (e.g., regional TB control). However, collaboration among the LHDs across the region was not a default” consideration for our departments and programs. More commonly, our LHDs worked separately, competing for resources to improve the health of our communities, which often resulted in developing duplicative systems and programs that included siloed and overlapping efforts to engage community partners (eg, health care systems). Why the Partnership is better The U.S. Department of Health and Human Services' Public Health 3.0 calls on public health departments to form vibrant, structured, cross-sector partnerships” and to foster shared funding, services, governance and collective action”. Although each of our departments have robust collaborations within our jurisdictions, our formal regional platform of public health collaboration have given us a structure to collaborate in specific priority areas and accomplish three key outcomes: (1) engaging our regional partners more systematically, (2) combining internal and securing external regional sources for funding in high priority areas, and (3) enhancing the efficiency and effectiveness of our efforts. It is clear that the collaborative framework of the Partnership has allowed us to move faster and more effectively in our priority areas of focus than we would have been able to do individually. It is also starting to change the culture of our departments, where reaching out to collaborate with others is increasingly the default” approach of the managers of our programs. Examples of this expansion of collaborative effort can be seen in efforts not initially identified by the LHD Directors as priority areas but for which our staff have come together to form regional workgroups (e.g., Health Equity, Early Childhood Development) or seek grant funding (e.g., radon exposure prevention, HPV vaccine coverage enhancement, promotion of breastfeeding, addressing food insecurity). Partnership as innovation The Partnership is an innovative, cross-jurisdictional effort in the Denver Metro area that impacts the health and well-being of over half of the Colorado population. Guided by the lessons learned and resources available from the Center for Shared Public Health Services, the Partnership's efforts cut across the spectrum of cross-jurisdictional sharing arrangements. Each public health agency is autonomous, responsible for its own jurisdiction, while also working together. The Partnership follows an informal governance structure, using the principles laid out in our Roadmap to guide our efforts. While LHDs across the country are increasingly interested in stronger partnerships, we believe that the collaboration fostered by our Partnership is a relatively unique and innovative approach to this priority. For example, in Colorado, two other public health partnerships have been formed to address rural needs and LHD capacity (e.g, West Central Public Health Partnership); however, they focus exclusively on provision of core public health services such as environmental health, food safety, and chronic disease prevention. We are also aware of two other cross-jurisdictional public health collaborations in other regions--the Bay Area Regional Health Inequities Initiative and the Healthy Columbia-Williamette Collaborative—both of which have been very productive. The former is a collaboration of 11 counties focused on addressing social and economic barriers to health with activities including regional health reports, aligned policy initiatives, and collaborative training opportunities, while the latter is a collaboration of 15 hospitals, 4 local public health agencies and two coordinated care organizations in the Portland metro area focusing on a collaborative Community Health Assessment. While our Partnership has similarities to both, we think we have expanded their models by developing joint programmatic efforts across several key priority areas, using our Partnership as a regional platform for collaboration with a range of other sectors, and evolving the organizational cultures within the programs of our departments where considering collaboration is increasingly becoming the norm. The Partnership's evidence-basis Collaborative frameworks such as that embodied in the Partnership are not based on formally collated evidence. They are, however, endorsed in multiple influential documents developed over the past several years. Our approach is quite similar to that promoted by the Roadmap developed by the Center for Shared Public Health Services, which endorses the three phases that we followed of Explore, Prepare and Plan, and Implement and Improve. More broadly, our Partnership has considered conceptual approaches such as Kania and Kramer's Collective Impact model (2011). This concept is at the core of the notion of LHDs serving as Chief Community Health Strategists (Resolve, 2014), endorsed by NACCHO in a Statement of Policy and also incorporated into the Public Health 3.0 framework. In addition, the programmatic efforts of each of our five priority areas of focus is built on evidence-based approaches.
Nutrition, Physical Activity, and Obesity
Partnership goals The Partnership's mission is to improve population health regionally with collective action. Our collaboration has three overarching goals: 1. Create a formal structure to organize collaboration among six LHDs in the seven-county Denver Metro region 2. Develop and establish objectives for priority focus areas and identify opportunities to support action in each area. 3. Enhance a culture of collaboration among program leadership in each LHD. Steps taken to implement the Partnership Goal 1: We initiated efforts to create a formal structure of collaboration by contracting with an external partner--Colorado Health Institute (CHI), a non-profit health policy research organization-- in 2015 to conduct a facilitated process for assessing whether a more formal collaborative structure between the six public health agencies in the Metro Denver region was needed and if so, how we should structure it. CHI conducted research on collaborative approaches taken in other regions and how their efforts were structured and also provided administrative support for scheduling meetings, taking notes, and coordinating follow up activities that resulted from planning meetings. The process included four planning meetings during which we developed a formal structure within which to organize our collaboration and also selected initial areas of priority focus. This effort was finalized with a Roadmap outlining our process and priority areas of focused collaboration in 2016. The Partnership is directed by a Steering Committee composed of the Executive Directors of the LHDs and each priority focus area is addressed by a workgroup who report to the Steering Committee via reports at our bimonthly meetings and/or on conference calls. Goal 2: During initial implementation, we identified objectives for four priority focus areas for regional collaboration: 1. Data sharing. The Partnership's objectives are to use, share and analyze cross-jurisdictional data and to gain access to a local resource that uses electronic health records for public health surveillance (CHORDS). 2. Healthy eating active living (HEAL). The Partnership's objectives include reducing consumption of sugar-sweetened beverages, identify data sources to inform efforts and engage non-profit hospitals in promoting HEAL. 3. Behavioral health. The Partnership's objectives are to target stigma reduction and improved coordination between systems of care and prevention of behavioral health issues and to engage non-profit hospitals in addressing behavioral health. 4. Partner alignment. The Partnership initial objective was to enhance engagement with our region's 14 non-profit health systems in conducting Community Health Needs Assessments and Community Benefit Plans. During the second year of the Partnership, we modified our priority areas in two ways by: (1) adding a new priority for Partnership Alignment---our county Departments of Human Services and (2) adding a fifth priority focus area, Environmental Health/Climate Change. We attempted to identify opportunities for external support for our collaborative efforts through grant writing by the workgroups whenever possible and have been successful in several areas. Goal 3: While we wanted to have a realistic number of areas of priority focus to initiate the Partnership, we also wanted to work on approaches to more broadly support collaboration among all of the core functions and activities within our departments. To enhance this effort, we convened members of the Executive Leadership teams of all six of our departments when the Roadmap was launched, both to explain the structure of the collaboration, as well as to endorse our default” programmatic approach of collaboration whenever possible. We have seen much faster progress in this regard than we had initially expected, with our staff taking the initiative to propose to the Steering Committee the creation of workgroups in new areas (e.g., Health Equity, Early Childhood Development) or to seek grant funding (e.g., radon exposure prevention, HPV vaccine coverage enhancement, promotion of breastfeeding, addressing food insecurity). Timeframe Prior to the formal launch of the Partnership, the Executive Directors of our collaborating LHDs began quarterly information sharing meetings in 2012. When we recognized the possible synergies among our independently developed Public Health Improvement Plans in 2014, we decided to explore a path toward a more formal framework of collaboration. Facilitated planning meetings were held during 2015-2016. An initial version of the Roadmap was finalized in February 2016. The LHD's senior staff and directors convened in May 2016 to review Roadmap, discuss shared priorities and establish the vision for collaboration as a default approach among our LHDs. Workgroups that address the four priority areas meet monthly or as needed to accomplish goals and objectives and provide formal updates to the Partnership directors during conference calls or bimonthly meetings. The directors hold standing bimonthly meetings and schedule phone calls between meetings as needed. Ongoing bimonthly meetings provide opportunities to review progress, address problems, and consider new opportunities for collaboration. In 2017, the Steering Committee held an annual planning retreat and made a number of changes. In addition to the expansion of our priority areas of focus, Steering Committee meetings were expanded from two hours/quarter to three hours every two months, as well as on an as-needed basis. Stakeholder Involvement and Roles During the planning for our Roadmap, CHI conducted key informant interviews with community partners and jurisdictions already collaborating regionally to explore the successes and challenges of current collaborative efforts, identify and prioritize activities and issues for regional action, assess interest in varying levels and models of collaboration, and consider opportunities for regional public health collaboration and leadership. Stakeholders who participated in these interviews included representatives of local health alliances, county Departments of Human Services, behavioral health providers, academia, state organizations (Department of Health Care Policy and Finance, Department of Human Services, Colorado Department of Public Health & Environment) and health care providers. In addition, Partnership directors have held separate meetings with senior leadership from local non-profit health care systems to discuss how they can continue to partner and work together with community agencies and LHDs, with leaders of local health-focused foundations to discuss our collaborative model and areas of priority focus, and with county Human Services directors to discuss opportunities for regional collaboration. Fostering collaboration with community stakeholders As noted throughout this document, the Partnership is oriented around and rooted in collaborative efforts. It places public health collaboration at its core, with members serving as Chief Health Strategists for the region, and provides a foundation for expanding beyond public health to include relevant partners – human services, health care, behavioral health, business, philanthropy, education – to engage on priority initiatives. The Partnership has secured external funding over the past three years to work together regionally on a broad range of topics, including radon exposure prevention, improvement in HPV vaccine coverage, early childhood toxic stress, obesity prevention, behavioral health and data sharing. The last three grants support the Partnership's priority areas, facilitating relationship-building activities with organizations and partners throughout the region including behavioral health providers, health care providers and community organizations, providing opportunities for addressing another Partnership priority around partner alignment. As noted above, directors have shared the Roadmap with leaders in Colorado's health care systems and philanthropy community, and also with state agency directors for Medicaid, public health and human services, with a goal of soliciting feedback on how they can be engaged in Partnership work and how the Partnership can support their efforts. Partnership start-up or in-kind costs and funding services Funding to support LHD implementation of Public Health Improvement Planning has been provided to the Partnership by the CDPHE Office of Planning, Partnerships and Improvement with an annual grant of $30,000/year for the past 4 years. These funds have largely been used to work contractually with CHI to develop the Roadmap and to support the Steering Committee and our workgroups administratively and in planning. Substantial in-kind funding has been provided by each LHD through the involvement of their Executive Directors in developing the Partnership and establishing the five priority areas of focus. Significant additional in-kind funding was provided by staff working in each priority area prior to the grant funding for the first 3 areas. In-kind funding has been ongoing for three years for staff involved in hospital partnerships and for one year of staff involved in Environmental Health/Climate Change.
What was learned? The Partnership is a work in progress and like any collaborative effort, our members are learning along the way. Key lessons learned to date include: Collaboration takes vision and leadership effort by top LHD executives. A compelling vision and supportive leadership can inspire staff. There is no free lunch. Collaboration takes time and effort and requires administrative capacity, which is currently provided by CHI and supported with resources provided by CDPHE. LHDs can be more impactful on specific priority areas of focus and in creating momentum for our work as Chief Community Health Strategists by working together ratjer than individually. Regional collaboration is perceived as an efficient and important orientation among regional partners and funders. The Partnership's progress to date on stated goals is described below. 1. Establish a formal structure of collaboration. The Partnership Roadmap outlined a process for working together and created a structure for considering new collaborative efforts. Of note, while trusting relationships among the directors was important in initiating the Partnership, there have already been two changes in leadership among the six LHDs over the past two years with no diminution of our collaborative energy. The collaborative structure has also been able to support innovation by our staff in identifying new areas of regional collaboration. 2. Identify priority areas of focus and resources to support action in each area. The Partnership identified a manageable number of important priority areas— Data sharing, Behavioral health, HEAL, and Partnership Alignment—and has secured external grant funding for the first three from state, federal, and foundation sources. In addition, direct financial support and/or aligned collaborative effort by not-for-profit hospitals in Behavioral health or HEAL is beginning to occur. Given this initial success, in 2017, new priority areas of focus—Partnership Alignment with Departments of Human Services and Environmental Health/Climate Change—were selected. 3. Enhance a culture of collaboration among program leadership in our LHDs. Creating culture change takes time but programs across a range of health topics (tobacco prevention, immunization, radon policy development, health equity, early childhood development, breastfeeding promotion, food insecurity) are beginning to spontaneously seek opportunities to work together and to gain endorsement by the Partnership. The Partnership's vision that collaboration not competition should be our default approach” is moving along faster than almost any of the LHD directors anticipated. Key milestones of progress in the Partnership's priority areas of focus are described below. 1. Data sharing A Colorado Health Foundation grant to expand access to CHORDS among Partnership members was awarded in 2016. Over the past 18 months, the Partnership's Data Sharing work group have worked closely with the CHORDS data partners to evaluate depression, hypertension, diabetes and obesity (adult and children) by various strata (county, city, demographics, census tract). The work group is currently working on opioid use, marijuana use and tobacco screening analyses. These data from electronic health records are supplementing existing chronic disease data sources to support the Partnership's programmatic efforts as well as community engagement activities and a grant to continue and expand the collaboration has been submitted. Notably, leaders from one of our members (Denver Public Health) had an opportunity during a meeting in Atlanta in September 2017 to brief CDC leaders, including Dr. Brenda Fitzgerald, new CDC Director, and Dr. Jose Montero, Director of the Office of State, Tribal, Local, and Territorial Support, about the Partnership, with a focus on our efforts to address population health issues regionally through the use of CHORDS. 2. Behavioral health The Partnership received funding through the State Innovation Model (SIM) grant to collaborate with community partners, businesses, and other organizations in the development of a messaging campaign designed to reduce stigma around behavioral health. The campaign, Let's Talk Colorado, was launched during Mental Health Month in May: it has been supported by 250+ partners, including financial support from a number of our regional not-for-profit hospitals, and is increasingly being used in other areas of the state. The Mental Health Stigma work has been supplemented by a collaboration by Tri-County Health Department on behalf of the Partnership with the Frameworks Institute resulting in a report released in August on Beyond Awareness of Stigma”. . 3. HEAL The Partnership secured a three year, $3 million award from the CDPHE through the Cancer, Cardiovascular and Pulmonary Disease Grants Program to reduce obesity and chronic diseases in seven counties in the Denver Metro region. It staffed the Healthy Beverage Partnership (HBP), a regional effort made up of the Partnership's LHDs. Each county is facilitating local coalitions to engage greater community involvement in this effort to improve dietary habits and shift norms. The HBP coordinates with 11 local coalitions, which all contribute to a regional steering committee. To date, 319 nutrition environment and policy assessments have been conducted in public venues such as government, hospital, school, daycare, recreation and museum settings. More than 61 policy and practice changes have been adopted since the initiation of this effort, reaching more than five million residents and visitors. A public information campaign was developed that has attained over 15 million impressions. In addition to the HBP, grants to address promotion of breastfeeding and food insecurity have been recently funded. 4. Partner alignment Partnership members experienced in assessment and health data had initial discussions with all 14 not-for-profit hospitals across our region and then actively partnered with the seven not-for-profit hospitals in the largest of the systems--Centura Health--by joining hospital assessment committees, providing local data and information and training hospital assessment leadership in prevention, life course perspective, and population health. To build momentum between hospital and PHIP efforts, the team also developed a menu of evidence-based strategies to inform hospital planning efforts and identify opportunities for cooperation. At least in part as a result of the collaboration, all seven Centura hospitals identified behavioral health and/or obesity as priorities for their Community Benefit Plans. There was particular interest in the mental health stigma campaign, with most of the hospitals in our area among the campaign's partners in distributing campaign materials and/or making financial contributions for its support. Our partnership with county Departments of Human Services was initiated with a planning meeting in the spring of 2017 to discuss examples of existing collaboration (e.g., data sharing, shared strategies for promoting health equity by addressing upstream determinants of health) and will be followed by a Summit in early 2018 to explore more formal collaboration. 5. Environmental Health/Climate Change. The Partnership has created a new work group on Climate Change, consisting of staff leads from each department. The work group has developed a charter and worked on three action areas in 2017: building capacity across the region, including creation of a climate change guidebook to provide resources and materials for use in local jurisdictions; planning communications and outreach to align messages across the region; and identifying policy opportunities for the Partnership to support regarding climate change mitigation and adaptation. The work group also plans to hold a Climate Change and Health summit to build knowledge, develop networking relationships and share resources among local public health agency staff and leadership. As part of our larger culture of collaboration, progress has also been made in areas other than the five areas of priority focus. The Partnership's Health Equity work group organized a summit in the fall of 2017, which was attended by approximately 100 public health staff. The goals of the summit were to build community among the Partnerships' staff working on health equity and developing internal public health resources around promoting equity. The Partnership's Early Childhood Development collaboration conducted strategic planning through the summer of 2017 to identify new goals and activities through 2018. This planning followed the conclusion of the early childhood grant funding that was supporting its previous activities and successful completion of several regional efforts including viewings of Raising of America, with facilitated discussion to raise awareness of the public health role in early childhood and development of the Raising of America Toolkit and Facilitation Guide for Public Health that has been presented and distributed on the state and national levels. The group prioritized paid family leave as a vehicle for promoting equity, health and well-being in the region. Grants to continue collaborative work in radon exposure prevention and HPV vaccine coverage enhancement have been recently funded. Partnership evaluation While the Partnership does not have a formal evaluation framework, we are evaluating our efforts over time by our ability to secure funding for and to make measurable differences in our current and future areas of priority focus and more general collaboration among the programs in our departments. We are also interested in sharing lessons from our collaborative experience more broadly across the state. For example, in addition to the broad sharing of the Raising of America Toolkit, the Lets Talk Colorado stigma reduction campaign is now being used in a number of counties across Colorado, and the HPV immunization effort has secured funding to continue its work, both in the Metro area, as well as other parts of the state.
Lessons learned in relation to practice Staff have limited capacity to expand their work portfolios and regional activities can be additive to existing tasks. Establishing regional collaboration as a leadership priority was helpful for our staff when allocating their time. Also, the Partnership has a growing need for adequate administrative support of the Steering Committee and various workgroups to ensure efficient operations, consistent communication, and effective follow-up. Lessons learned in relation to partner collaboration Local concerns (e.g., health consequences of oil and gas exploration) do not always align with regional priorities. Limiting the Partnership's activities and regional collaboration to issues with greatest alignment and allowing each LHD to establish unique parameters for participation has helped alleviate these concerns. However, as the examples of success have grown, there is increased enthusiasm for looking to collaboration as a default expectation among our broader programs. Stakeholder commitment to sustaining the Partnership LHD directors are committed to working together regionally through formal collaboration. The Partnership members have already seen definite benefits in sharing resources and approaches, the increased collaboration and sharing of information that comes from relationship development, and the increased ability to leverage the resources across the Partnership. It will be important for the Partnership to demonstrate benefit to the additional stakeholders/partners it desires to engage and involve in its ongoing efforts. These stakeholders include health care systems, human/social services organizations, education partners, business and others who, by aligning with the Partnership, can yield greater impact around shared goals. As a result of our success, the Partnership directors have identified the need to develop strategies for long term sustainability as an important priority, with options including seeking funding from Colorado health foundations, requiring dues from each member to support central functions, and using CHI as the fiscal agent for new grants to support their administrative capacity, an approach which we will be testing with our soon-to-be initiated grant on breastfeeding promotion.
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