Methodology

The Richland County Quality of Life Assessment is spearheaded by the Communities in Action (CIA) Steering Committee, a collaborative and community-drive group whose mission  is to provide a structured community platform and foster partnerships to improve quality of life in Richland County. CIA gathers partners from all sectors of Richland County to impact strategic priorities. CIA uses the Richland County Quality of Life Assessment to develop the Richland County Quality of Life Strategic Plan, a dynamic document that prioritizes community issues and develops measurable action steps to address our most pressing community issues.

CIA follows a defined process to develop these documents, utilizing two best-practice public health models.

The MAPP Process

The foundation for CIA's community building process is MAPP-Mobilizing for Action through Planning and Partnership. MAPP is a best-practice guide for conducting community health assessment (CHA) and community health improvement planning (CHIP), designed by the National Association of City and County Health Officials (NACCHO). The six phases of MAPP includes:

1. Organizing for success and partnership development;

2. Visioning;

3. Completing the four MAPP assessments, which including the Community Health Assessment (CHA);

4. Identifying strategic issues;

5. Formulating goals and strategies;

6. Take action.

CIA has undertaken several cycles of the MAPP process in the last two decades. This process develops both the Richland County Quality of Life Assessment (CHA), and the Richland County Quality of Life Strategic Plan (CHIP). The CHA includes the CASPER assessment.


CASPER-Primary data collection

CASPER stands for "Community Assessment for Public Health Emergency Response." CASPER was used as a method of primary data collection to develop the CHA.

CASPER is an epidemiologic technique designed to provide household-level information and to be efficiently and rapidly deployed with minimum resources. CASPERs can be conducted to assess the effect of a disaster on a population, to determine the health status and basic needs of an affected population, to evaluate response and recovery efforts, to gain a better understanding of the community for community health assessments, and to practice the CASPER technique as part of a preparedness exercise. The CASPER organization includes leadership, local coordination, logistics, data management, and field teams. Field teams consist of two persons with a target of 10–15 teams. A CASPER includes seven steps: 1) define the geographic area, 2) determine sampling method, 3) select instrument(s), 4) train field personnel, 5) conduct assessment, 6) analyze data, and 7) report results.

CASPER uses a two-stage cluster design based on the World Health Organization epidemiology technique for estimating vaccine coverage from small pox eradication. In the first stage of the sampling method, 20 clusters (i.e. census blocks) with ≥7 housing units (HUs) are selected with their probability proportional to the estimated number of HUs in each cluster. In the second stage, seven HUs are randomly selected in each of the 20 clusters by the field teams for the purpose of conducting the interviews with the goal of 140 completed interviews. Eighty percent completion rates allows population needs to be estimated from the sample and the estimates are usually within 10 percent.

RCHD contacted the Public Health & Safety Division at the Montana Department of Public Health and Human Services for assistance conducting a CASPER in July of 2018. Formal planning for the CASPER started immediately. RCHD initiated an incident command structure (ICS) for planning and execution of the CASPER.  RCHD roles were development of the survey instrument with community stakeholders, volunteer management, exercise logistics including data collection, and the media campaign to raise awareness of the exercise. PHSD roles were coordinating the sampling and development of cluster maps with the Centers for Disease Control and Prevention, the just-in-time training for volunteers, completion of the volunteer evaluation, and writing of the final report.

The geographic area for the CASPER included all of Richland County, which is 2,084 square miles. The main population center is Sidney with a population of 6,328. The CDC Health Studies Branch logically combined census blocks taking into account boundaries, roads, rivers, and other features to create new clusters with ≥7 HUs. In the first stage sampling, 20 clusters were randomly selected with probability proportional to the number of HUs within the merged blocks. In the second stage, field teams used a standardized method for randomization to select HUs for the seven interviews.

RCHD worked with community partners including the Sidney Health Center and Communities in Action to develop the survey instrument which was designed to capture 1) demographic information 2) health status and physical activity 3) community planning 4) access to care and preventive services 5) educational programs and 6) perceptions of community issues . On Thursday July 12, a just-in-time training session for 34 volunteers provided an overview of a CASPER, household selection, interview techniques, and safety. Twenty, 2-person teams attempted to conduct seven interviews in each of the 20 clusters selected for the sample, with a goal of 140 completed interviews. Residents of households who were at least 18 years of age were considered eligible respondents. Additionally, field teams distributed information on injury prevention, nutrition, Sidney Health Center, RCHD, Boys and Girls Club, Foundation for Community Care, Volunteer Program, injury prevention, and tobacco prevention. Data collection occurred on Thursday July 12 from 9:00 pm to 8:00 pm. All forms used during the CASPER were from the CASPER toolkit and were modified accordingly. All volunteers completed an evaluation at the end of the exercise.

Epi Info 7.1.2, a free statistical software package produced by the CDC, was used for data entry and analysis. The completion rate was calculated by dividing the number of completed interviews by 140 (i.e., the goal for completed interviews in this CASPER). To account for the probability that the responding household was selected, we created sampling weights based on the total number of occupied houses according to the 2010 Census, the number of clusters selected, and the number of interviews completed in each cluster. This weight was used to calculate all weighted frequencies and percentages presented in the CASPER report. On July 12th, the interview teams conducted 140 interviews, yielding a completion rate of 100%. The 140 interviewed households were a sample of the 5,243 total households in Richland County.

Limitations

To create sampling weights, information from the 2010 Census was used to determine the household probability of being selected. Richland County has experienced significant population changes since 2010, and thus the Census data might not be representative of the current population. The discrepancy between the 2010 Census and the current status, would not, however, affect the unweighted frequencies presented in the CASPER report.

Additional primary data was collected from:

Community Health Needs Assessment, 2019. (2019). Sidney Health Center.

Initial Assessment: Behavioral Health; Richland County, Montana 2018-2019. (2019). Sidney Health Center.

Secondary data

Secondary data was collected from a breadth of reliable sources and used in conjunction with primary data sources, including the CASPER results, to make assessments of trends in health data in Richland County.

Secondary data was retrieved from the following sources:

Data USA. Richland County, MT. (2019) Retrieved from https://datausa.io/profile/geo/richland-county-mt/#economy

Healthy People 2020. (2019). Retrieved from https://www.healthypeople.gov/2020/topics-objectives

Mental Health in America (2019). Retrieved from http://www.mentalhealthamerica.net/issues/mental-health-america-printed-reports

Montana Department of Transportation. Retrieved from https://www.mdt.mt.gov/publications/datastats/crashdata.shtml

Montana Incident-Based Reporting System. (n.d.). Retrieved from http://mbcc.mt.gov/Data/Crime-Data- Maps/MTIBRS-Online-Reporting

Montana Public Health Information System Montana's Public Health Data Resource. Retrieved from http://ibis.mt.gov/community/snapshot/Builder.html

National Cancer Institutes. (2019). State Cancer Profiles. Retrieved from https://statecancerprofiles.cancer.gov/map/map.withimage.php?30&001&001&00&0&01&0&1&5&0#results

Prevention Needs Assessment. (2018) Retrieved from the Montana Department of Health & Human Services.

Richland County Health Rankings & Roadmaps. (n.d.). Retrieved from http://www.countyhealthrankings.org/app/montana/2018/rankings/richland/county/outco mes/overall/snapshot

Sallis, J. F., Floyd, M. F., Rodríguez, D. A., & Saelens, B. E. (2012). Role of built environments in physical activity, obesity, and cardiovascular disease. Circulation, 125(5), 729–737. doi:10.1161/CIRCULATIONAHA.110.969022

State Cancer Profiles. (2011-2015). (n.d.). Retrieved from https://statecancerprofiles.cancer.gov/incidencerates/index.php?stateFIPS=30&cancer= 020&race=00&sex=0&age=001&type=incd

U.S. Census Bureau QuickFacts: Richland County, Montana. (n.d.). Retrieved from https://www.census.gov/quickfacts/richlandcountymontana

U.S Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults: A report of the Surgeon General. (2016)

U.S Health Resources & Services Administration. (2019). Retrieved from https://data.hrsa.gov/tools/shortage-area/mua-find

Youth Risk Behavior Survey. (2017). Retrieved from the Montana Department of Health & Human Services.

Additional resources

Additional information to inform the development of the Richland County Quality of Life Assessment was retrieved from:

American Service Quality Division (n.d.). Retrieved from http://asqservicequality.org/

City of Sidney Growth Policy Update. (2015). Retrieved from https://mt-richlandcounty.civicplus.com/index.aspx?nid=382

EnviroAtlas. United State Environmental Protection Agency. Retrieved from https://enviroatlas.epa.gov/enviroatlas/Tools/EcoHealth_RelationshipBrowser/index.html

Los Angeles County Department of Public Health. Social Determinants of Health: How social and economic factors affect health. (2013).

Mobilizing for Action through Planning and Partnership. (2019). Retrieved from https://www.naccho.org/programs/public-health-infrastructure/performance-improvement/community-health-assessment/mapp

Polzin, Paul. "The Economic Impact of the Bakken." Montana Business Quarterly. January 9, 2017. Retrieved from http://www.montanabusinessquarterly.com/economic-impact-bakken/

Strengths, Opportunities, Aspirations, Results (SOAR) Analysis. (2016). Retrieved from http://asqservicequality.org/glossary/strengths-opportunities-aspirations-results-soar-analysis/

UCLA Center for Health Policy Research. (2003). Retrieved from https://healthpolicy.ucla.edu/programs/health-data/trainings/Documents/tw_cba20.pdf

Using local data

We have made every effort to utilize local primary data to draw conclusions and make comparisons about the state of health and wellness in Richland County. However, there are many cases where local primary data are not available, or cases or incident rates are so small that revealing the data may compromise patient privacy. In these cases, state or regional data may be used, or the comparison of that indicator may be omitted.

Effort has also been made to provide data that tells a story and provides meaningful comparisons. We strive to use the most accurate and updated data. However, because many indicators are displayed as a rate over time, we may utilize data within the last five year to draw conclusions or provide meaningful comparisons. Data will be updated as it becomes available.

About this project

The Richland County Quality of Life Assessment project is fully developed and supported by the Richland County Health Department, with technical support from LiveStories staff.

The Richland County Health Department is committed to developing a culture of quality and cultivating individual and community involvement. We seek to accomplish this in all aspects of our health, safety, and wellness by empowering people to capitalize on available resources to achieve the highest quality of life.

The Richland County Health Department is accredited through the Public Health Accreditation Board, which means that the Department has undergone a rigorous assessment of its ability to carry out the provision of the Ten Essential Public Health Services and meet the needs of those in Richland County.

The interactive, digital Quality of Life Assessment project was developed to ensure that the Health Department is accountable to the population of Richland County in the provision of these services, including conducting health needs assessments, identifying and addressing health inequities, developing and implementing strategies to improve health status, tracking metrics and reporting progress, and assessing and reporting impact. This project ensures that our health assessment data and other metrics are accessible to agencies, organizations, and the general public. We collect feedback on this information, solicit additional local data sets, and receive requests for additional data sets continuously through the feedback survey in the top right corner of each page.