Larimer County Community Health Improvement Plan 2024-2029

I am pleased to present the 2024-2029 Larimer County Community Health Improvement Plan (CHIP). To develop this CHIP, community partners, stakeholders, and agencies gathered and shared data, identified and prioritized major public health needs, and agreed upon ways to improve the health and well-being of our residents.

The plan outlines the work we will be doing alongside our partners to improve the health of this county that we call home. The CHIP was developed with the intention of strengthening existing partnerships as well as encouraging new collaborations with stakeholders who share the same collective vision for a healthier Larimer County. We understand these issues cannot be solved overnight by one entity alone. The CHIP is a living document intended to mobilize the community in areas where we can be most impactful on improving the health of our community.

Within this work, health equity is always an overarching goal, and this plan will be used as a road map for improving the health of all our residents in each of our communities. Together, we can remove barriers and make these changes a reality.

In this document, you will learn how the process for planning was conducted and discover key recommendations for action and partnership. You may also be able to identify ways that you and/or your organization might participate in and collaborate on the efforts to improve the health of all who live, learn, work, and play in Larimer County. As we move forward toward implementing this plan, we recognize that change of this magnitude takes concerted effort over time, and that your story builds our story. Together, we will strive to improve the health and well-being of all individuals and families in our communities, and we will work to achieve equitable health outcomes for a more vibrant and resilient Larimer County community.

Sincerely, 

Tom Gonzales, MPH

With the process described in more detail below, our community has identified the following priorities for the CHIP 2024 cycle.

Social Environment and Community

• • Increase access to and use of community-building spaces with an emphasis on equity.

Community-building spaces are places where our community meets and interacts, such as parks, community centers, and coffee shops to name a few. They help our community build social connections and reduce isolation and loneliness.

Mental Health

• • Increase social support and connection for older adults, youth, families, communities of color, LGBTQIA, Veterans, and persons living with disabilities with an emphasis on equity.

Social support can be a shoulder to lean on, an empathetic ear, a ride when you need it, or someone who lets you know about a resource you could use. Some individuals and communities have less access to social support and connection than others because of barriers they encounter that others don’t. A barrier could be a lack of transportation or facing discrimination in some spaces. Increasing social support can help individuals live healthier lives with less stress, especially when they may have other resources limitations like a fixed income.

The Larimer County Department of Health and Environment utilized an adapted version of the Colorado Health Assessment and Planning Process. Centering equity and community engagement through all steps of the process, the community identified 9 key themes. From those 9 themes, 2 priority areas emerged, mental health and social environment and community. With extensive input from organizational partners, key leaders, and community members, LCDHE further specified the priorities into two priority statements that align with the capacity assessment and the role of a local public health agency. These priority statements reflect the specific areas within mental health and social environment and community where the CHIP process will seek to enact focused progress.

In order to identify the selected priority statements, plan implementation, and establish evaluation frameworks, LCDHE focused on efforts on:

• Community Health Assessment: Pulling together qualitative and quantitative data to tell a story of health and wellbeing in Larimer County. (Appendix B)
• Capacity Assessment: Surveying community partners to understand current efforts, organizational priorities, and capacity for partnership within new initiatives. (Appendix C)
• Prioritizing Issues: Identifying the two key priorities for the 2024 Community Health Improvement Plan, utilizing data and input from community members, organizational partners, and key leaders (Appendix D)
• Plan, Strategize, and Evaluate: Co-creating action plans with community partners to determine how to work toward achieving our priority statements while also identifying metrics that can measure progress and communicate potential successes.

Upon reflection and evaluation of the prior CHIP processes, LCDHE wanted to make sure that the priority statements were both action oriented and attainable. For this reason, the CHIP team developed three core strategies for implementation of the 2024-2029 CHIP. These strategies are based on a continuous cycle of community improvement that will consistently reevaluate community needs and partner capacity. The three strategies are:

• Improve Access to Data and Evaluation
• Align Strategically
• Integrate Health Priorities into Policy Making

Additionally, community partners identified the need to have short term, actionable, and measurable projects within the CHIP in order to assess success and return on investment of time and resources. For CHIP 2024-2029, six to twelve month collaborative projects, focused on increasing impact and reach, are prioritized. This iterative process of convening, strategy identification, implementation, and sustainability will be continuous throughout the 5-year cycle and will enable more visible progress for the work. Advancing equity and prioritizing changes that will address the root causes of health equity is central to this work, and LCDHE has been convening community partners to work on these strategies and identify initial projects since early 2024, serving as allies alongside community organizations and groups leading this work. More information on these strategies can be found in the following sections of this document.

LCDHE has worked with community partners to create goals for 2024. Future goals will be determined based on community needs and organizational/partner capacity. The 2024 goals can be found below as well as potential goals for 2025-2029. LCDHE will be working with partners to create metrics for each goal. Updates on these can be found on this website. 

Create resources for data access, evaluation expertise, and deduplication of assessments and surveys

Improve Access to Data and Evaluation

This strategy was developed to best leverage existing resources to inform and develop projects to support community connectedness, reduce isolation and loneliness, and improve equitable access to social support. Assessment of current conditions and identification of disparities remains essential in order to initiate successful projects, but the duplication of efforts and over surveying of historically-marginalized populations can reduce the efficacy of projects, unnecessarily extend timelines, and strain resources. By collaborating across domains and disciplines to share existing data resources and reports we can maximize impact and inform current and future projects that support communities.

Why does this matter?

The CHA process and capacity assessment identified data challenges as a barrier to additional funding and grants as well as further programmatic development. Data demands included time consuming assessments, difficulties formulating evaluations for grant reporting, and a lack of awareness of other organizations' programs and priorities. Facilitating and supporting a data awareness and deduplication strategy will reduce burdens on organizations and increase impact of existing programs. Sharing data that is currently siloed within organizations or areas of expertise will additionally lead to more strategic, cross-cutting collaborations.

2024 Projects:

• Create an accessible community repository of existing data resources and reports to increase awareness of current conditions, encourage sharing of knowledge and insights across domains, deduplicate efforts, and reduce the burden of surveying on historically marginalized communities.
• A focused data collaborative, including Behavioral Health Services, Veterans Affairs (VA), law enforcement agencies, Larimer County Coroner’s Office, Larimer County Department of Health and Environment, and the Alliance for Suicide Prevention of Larimer County, is reviewing suicide deaths within the veteran community and making recommendations for supporting veterans and reducing suicide deaths in the future.

2025 - 2029 Potential Projects:

• Establish a coalition of embedded community data experts willing and able to share resources, ideas, and professional expertise with organizations that may lack this full complement of resources within their own system. Expertise may include quantitative data, qualitative data, and community-engaged research.

Align Strategically

Increase efficacy and efficiency of existing efforts by reducing duplication and identifying collaboration opportunities.

This strategy was developed because the community capacity assessment revealed that multiple overlapping coalitions and initiatives related to mental health and the social environment already existed. These community initiatives engage many community members and also leaders from multiple sectors such as government, nonprofit, public health, healthcare, education, and business. However, up until this time, there had not been an effective effort to centralize the "in-process" activities, communications and plans of various coalitions.

Why does this matter?

Leaders and community members agree there is a need to better assess and disseminate the existing work occurring within these priorities and, by extension, promote increased strategic alignment and refined resource allocation. In late 2023 and early 2024, LCDHE staff partnered with several facilitators from NOCO Works, Communities of Excellence, The Community Foundation, and The United Way, each of whom are leading community-wide initiatives which address community improvement goals, strategic priorities, and actions. This group has been working on a collective model to address CHIP priority statements by coordinating large scale initiatives in the community. LCDHE’s CHIP staff are also partnering with the Caring and Sharing Coalition, made up of on-the-ground staff from non-profit and community-based organizations who share community resources, programs, and services for under-resourced residents. LCDHE, and these partners, will be working to identify additional collaborators and facilitate conversations and strategy sessions to build processes that ensure better alignment of community-wide efforts. This alignment will increase awareness and identification of resources and thus collective impact.

2024 Projects:

• Implement a “super-convener” strategy, where 4-5 members from community-wide initiatives dedicate time to gather and communicate to the other groups and the community. This group will serve as a convener of information and data, conduct eco-mapping of projects, and share collective progress for each initiative, ensuring efficiency and clear demonstration of outcomes during the 2024-2029 CHIP cycle.
• Facilitate and support the reinvigoration of the Caring and Sharing Coalition to increase information sharing, improve partner awareness of complementary programs, and catalyze the development of novel projects related to 2024 CHIP priority statements.

2025 - 2029 Potential Projects:

• Convene small groups working with specific communities of shared interest and goals (e.g. veterans of different service experiences; persons living with different disabilities).
• Convene core challenge/opportunity groups within multiple communities of interest (e.g. reducing barriers to social convening, providing alternatives to alienating systems, like car dependence, promoting face-to-face opportunities to displace smartphone time).
• Facilitate a grant identification and professional development resource for priority-statement relevant organizations with limited internal grant seeking capacity.

Integrate Health Priorities into Policy Making

Promote understanding of the policy role in community health and cooperatively consider health priorities as part of policy-making across multiple sectors.

This strategy aims to facilitate a collaborative approach within Larimer County to integrate health considerations, specifically around mental health and social support, into policy making at both the local and state level. LCDHE recognizes that no one agency can single handedly address a pervasive community issue, which is why a cross-sector approach to policy making is necessary. Building community capacity to ensure health and equity considerations are incorporated into policy discussions at the beginning means that policies can be designed to support upstream population health goals. This process is also referred to as Health in All Policies (HiAP).

Why does this matter?

HiAP is an evidence-based public health approach that fosters policy and programmatic changes by improving relationships across collaborator groups and agencies and by aligning multiple organizations' desired outcomes within the policymaking process. LCDHE knows that health is shaped by policies in many different sectors beyond public health and healthcare (e.g. transportation, education, employment), and policies within these domains can be intentionally designed to support health and health equity in our community.

Policy changes within our community can help us have a bigger impact on health outcomes by improving social determinants of health and by making healthy behaviors more accessible. Instead of waiting to address individual-level downstream outcomes like chronic disease at the doctor’s office, policy can help prevent future cases of ill health. Addressing the fundamental causes of population health challenges and inequities requires policy work that reshapes social structures, systems, and institutions.

This work takes time; policy initiatives have not been as commonplace as individually-tailored interventions like health education. For this reason, the initial goal of this strategy focuses on education about and identification of opportunities to impact policy. If successful, community partners involved in the CHIP will have a better understanding of HiAP, how it relates to their work, and to whom they should reach out to for technical assistance.

Evaluating the progress of the Community Health Improvement Plan (CHIP) over the course of five years requires that the CHIP team will examine multiple features of the proposed course of action. Fundamentally, the CHIP seeks to improve health conditions across the county at scale. Therefore, we will monitor indicators related to population level health and well-being trends. Additionally, we will need to track and assess our own activities in pursuit of CHIP goals, and this evaluation will include an assessment of our process of convening and facilitating CHIP projects as well as accounting for any initiatives across the county that support the CHIP goals. Finally, the impact of individual projects will need to be examined and specific evaluation plans will be developed for these projects. Project-specific metrics will ensure the efficient utilization of resources and the achievement of established objectives. Overall, evaluation of CHIP progress can be categorized in four areas:

• Population level changes and trends within Larimer County and its communities
• Facilitation and related process indicators based on LCDHE-lead activities
• Activity and project initiation across CHIP partners related to the priority statements
• Project-specific outcome metrics to evaluate discrete initiatives

At the county level, assessing population-level impact for mental health involves examining key indicators for social support and community building as well as downstream health burdens closely associated with the presence or absence of these features. Process measures to gauge the effectiveness of health department facilitation include:

• Evaluating stakeholder engagement and retention
• Successful establishment of collaborative partnerships
• Development of projects with collaborative CHIP groups that yield tangible, sustainable outcomes with demonstrable community benefit.

The Healthy Larimer Committee is a community-led group dedicated to empowering individuals across Larimer County to become an integral part of their environment. HLC members are committed to cultivating social connectedness and inclusivity, with a particular focus on supporting populations who experience exclusion and marginalization. By collaboratively addressing issues related to social belonging and access to health-related resources and services, HLC strives to create a more equitable and supportive community.  Members are driven by a shared passion for addressing the diverse needs of all individuals in Larimer County, while also amplifying the voices of their respective communities based on their unique identities. Their vision for the Healthy Larimer Committee is to cultivate an inclusive environment where everyone feels valued and empowered to shape their environment.

For additional information or to become a committee member, visit the Healthy Larimer page.

• The Healthy Larimer Committee reviews projects and proposals from a variety of community and partner agencies to provide their expertise in health equity and lived experience. 
• Community Partners, to request a review or to present to the Healthy Larimer Committee, please submit this form.