Together! Healthy Knox (T!HK) was initiated by the Knox County Health Department and was designed to create a community approach to better health. What began with a twenty partner Leadership Team quickly grew to involve over 70 community and organizational partners. The timing of this initiative was such that T!HK has provided a framework for the Knox County Health Department to partner with local not-for-profit hospital systems to satisfy new federal requirements around Community Health Needs Assessments and Community Health Improvement Plans. This partnership involves data-sharing and alignment of health improvement goals. Subsequent memorandums of agreement between the Knox County hospitals and the health department have formalized their commitment to work together on this and future assessment activities.

The T!HK initiative is based on the MAPP model (Mobilizing for Action through Planning and Partnerships) created by the National Association of County and City Health Officials (NACCHO) and the Centers for Disease Control and Prevention (CDC). MAPP is both a community-wide strategic planning tool for improving public health, and a method to help communities prioritize public health issues, identify and coordinate resources for addressing them, and take action. A successful MAPP process is driven by three key ideas:

  • strategic thinking: using data to make decisions and carefully evaluatingprocess and outcomes to inform the next iteration of the model.
  • the community as driver: decisions are made by consensus among those involved, not from the top down.
  • and a focus on the local public health system: this is all the entities with an impact on health, from the Health Department and care providers to businesses to churches to law enforcement to community groups. MAPP is most successful when stakeholders from all these groups and more are involved in planning and implementation.

MAPP is an iterative process with specific steps meant to be repeated every three to five years

  1. Organize for success: identify lead agencies or organizations and build organizational commitment to the process.
  2. Partnership development: identify stakeholder organizations, partners and community residents who will participate. Make it clear the level of commitment will need to be high.
  3. Visioning: Ask stakeholders to agree on a shared vision and common values to provide a framework for pursuing long-range community goals.
  4. Four assessments:
    1. Community Health Status Assessment: identifies priority community health and quality of life issues. Questions answered include, “How healthy are our residents?” and “What does the health status of our community look like?”
    2. Community Themes & Strengths Assessment: provides a deep understanding of the issues residents feel are important by answering the questions, “What is important to our community?” “How is quality of life perceived by our community?” and “What assets do we have that can be used to improve community health?”
    3. Local Public Health System Assessment: a comprehensive assessment that includes all of the organizations and entities that contribute to the public’s health. Answers the questions, “What are the activities, competencies, and capacities of our local public health system?” and “How are the Ten Essential Public Health Services being provided to our community?”
    4. Forces of Change Assessment: focuses on the identification of forces such as legislation, technology, and other impending changes that affect the context in which the community and its public health system operate. Answers the questions, “What is occurring or might occur that affects that health of our community or the local public health system?” and “What specific threats or opportunities are generated by these occurrences?”
  5. Identify strategic issues: participants identify linkages between the MAPP assessment results to determine the most critical issues that must be addressed for the community to achieve its vision. (In our community, the T!HK Leadership Team performed this step.)
  6. Formulate goals & strategies: participants set down how to address each strategic issue. (In our community, the T!HK Equity, Partnerships, and Policy Action Teams performed this step.)
  7. Action Cycle
    1. Plan: participants in our community created an action plan.
    2. Implement: our implementation period for this action plan is January 2013 to June 2014.
    3. Evaluate: evaluation will be an important part of implementation.