Community Health Improvement Plan with A Mental Health Priority

Below are two blank templates for you to complete. Complete one template for each priority area you select; add sections and columns for additional objectives or action steps, as needed. Adapt this tool as you see fit for your plans. [Title page] Community Health Improvement Plan Prepared by [Your Name Here] [Date] Health Issue #1 B1. PRIORITY HEALTH ISSUE: B2.

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DESIRED HEALTH OUTCOME: B3: PERFORMANCE MEASURES How will we know we are making a difference? Short-Term Indicators Long-Term Indicators B3a. Information source B3a. Frequency B3a. Information source B3a. Frequency B4. SMART (SPECIFIC, MEASURABLE, ACHIEVABLE, REALISTIC, TIME-FRAMED) OBJECTIVE #1: Objective Type: Evidence/Data Sources: Policy Change (Y/N): B5. ACTION PLAN Action Step Target Date Resources B6. PLAN FOR SUSTAINING ACTION Lead Person Anticipated Product/Result Progress Notes Health Issue #1 (contd.) B4. SMART (SPECIFIC, MEASURABLE, ACHIEVABLE, REALISTIC, TIME-FRAMED) OBJECTIVE #2: Objective Type: Evidence/Data Sources: Policy Change (Y/N): B5. Community Health Improvement Plan with A Mental Health Priority

ACTION PLAN Action Step Target Date Resources B6. PLAN FOR SUSTAINING ACTION Lead Person Anticipated Product/Result Progress Notes Health Issue #2 B1. PRIORITY HEALTH ISSUE: B2. DESIRED HEALTH OUTCOME: B3: PERFORMANCE MEASURES How will we know we are making a difference? Short-Term Indicators Long-Term Indicators B3a. Information source B3a. Frequency B3a. Information source B3a. Frequency B4. SMART (SPECIFIC, MEASURABLE, ACHIEVABLE, REALISTIC, TIME-FRAMED) OBJECTIVE #1: Objective Type: Evidence/Data Sources: Policy Change (Y/N): B5. ACTION PLAN Action Step Target Date Resources B6. PLAN FOR SUSTAINING ACTION Lead Person Anticipated Product/Result Progress Notes Health Issue #2 (contd.) B4. SMART (SPECIFIC, MEASURABLE, ACHIEVABLE, REALISTIC, TIME-FRAMED) OBJECTIVE #2: Objective Type: Evidence/Data Sources: Policy Change (Y/N): B5. ACTION PLAN Action Step Target Date Resources B6. PLAN FOR SUSTAINING ACTION Lead Person Anticipated Product/Result Progress Notes People QuickFacts Population, 2014 estimate Population, 2010 (April 1) estimates base Population, percent change – April 1, 2010 to July 1, 2014 Population, 2010 Persons under 5 years, percent, 2014 Persons under 18 years, percent, 2014 Persons 65 years and over, percent, 2014 Female persons, percent, 2014 White alone, percent, 2014 (a) Black or African American alone, percent, 2014 (a) American Indian and Alaska Native alone, percent, 2014 Community Health Improvement Plan with A Mental Health Priority

(a) Asian alone, percent, 2014 (a) Native Hawaiian and Other Pacific Islander alone, percent, 2014 (a) Two or More Races, percent, 2014 Hispanic or Latino, percent, 2014 (b) White alone, not Hispanic or Latino, percent, 2014 Living in same house 1 year & over, percent, 2009-2013 Foreign born persons, percent, 2009-2013 Language other than English spoken at home, pct age 5+, 2009-2013 High school graduate or higher, percent of persons age 25+, 2009-2013 Bachelor’s degree or higher, percent of persons age 25+, 2009-2013 Veterans, 2009-2013 Mean travel time to work (minutes), workers age 16+, 2009-2013 Housing units, 2014 Homeownership rate, 2009-2013 Housing units in multi-unit structures, percent, 2009-2013 Median value of owner-occupied housing units, 2009-2013 Households, 2009-2013 Persons per household, 2009-2013 Per capita money income in past 12 months (2013 dollars), 2009-2013 Median household income, 2009-2013 Persons below poverty level, percent, 2009-2013 Business QuickFacts Private nonfarm establishments, 2013 Private nonfarm employment, 2013 Private nonfarm employment, percent change, 2012-2013 Nonemployer establishments, 2013 Total number of firms, 2007 Black-owned firms, percent, 2007 American Indian- and Alaska Native-owned firms, percent, 2007 Asian-owned firms, percent, 2007 Native Hawaiian and Other Pacific Islander-owned firms, percent, 2007 Hispanic-owned firms, percent, 2007 Women-owned firms, percent, 2007 Manufacturers shipments, 2007 ($1000) Merchant wholesaler sales, 2007 ($1000) Retail sales, 2007 ($1000) Retail sales per capita, 2007 Accommodation and food services sales, 2007 ($1000) Building permits, 2014 Geography QuickFacts Land area in square miles, 2010 Persons per square mile, 2010 FIPS Code Metropolitan or Micropolitan Statistical Area (a) Includes persons reporting only one race. (b) Hispanics may be of any race, so also are included in applicable race categories. Community Health Improvement Plan with A Mental Health Priority

FN: Footnote on this item for this area in place of data NA: Not available D: Suppressed to avoid disclosure of confidential information X: Not applicable S: Suppressed; does not meet publication standards Z: Value greater than zero but less than half unit of measure shown F: Fewer than 100 firms Source: US Census Bureau State & County QuickFacts Benton County Orego Community Health Improvement Plan with A Mental Health Priority

n 86,316 85,581 0.9% 85,579 4.1% 16.9% 14.3% 49.9% 3,970,239 3,831,073 3.6% 3,831,074 5.8% 21.6% 16.0% 50.5% 88.2% 1.1% 0.9% 6.0% 0.3% 3.6% 7.0% 82.1% 87.9% 2.0% 1.8% 4.3% 0.4% 3.6% 12.5% 77.0% 78.5% 8.8% 12.0% 94.6% 50.0% 5,561 18.9 82.0% 9.8% 14.8% 89.4% 29.7% 323,205 22.5 37,107 57.9% 29.3% $270,500 33,384 2.42 $26,738 $48,604 22.5% 1,700,549 62.0% 23.2% $238,000 1,516,456 2.49 $26,809 $50,229 16.2% Benton County Oregon 2,081 25,350 1.5% 5,510 108,527 1,396,563 2.4% 260,438 7,157 F F 3.4% F S 348,154 1.2% 1.2% 3.6% 0.2% 3.3% QuickFacts 29.3% 29.8% 590,473 387,072 685,172 $8,398 134,027 451 66,880,653 51,910,777 50,370,919 $13,494 7,555,764 16,645 Benton County 675.94 126.6 3 Corvallis, OR Metro Area Oregon 95,988.01 39.9 41 … Community Health Improvement Plan with A Mental Health Priority