The Colorado Opportunity Project
The impacts of poverty are significant. Those in poverty are more likely to have complex health conditions, and treating those conditions are expensive. Lifelong challenges through economic barriers and gaps in equitable distribution of resources are passed from one generation to the next. Poverty causes increases in stress levels which may contribute to substance abuse, violence in the home/community, and may impact a parent’s ability to be an emotional resource for their children. It’s important to identify and drive integrated solutions that rely on preventive evidence-based strategies.
Considering the cost of fragmentation and duplication, there is profound value in identifying and aligning evidence-based strategies as well as identification of gaps in equity from one population to another.
The Colorado Opportunity Project is a cross agency collaborative among the Colorado Departments of Health Care Policy and Financing (HCPF), Public Health and Environment (CDPHE), Human Services (DHS) and Labor and Employment (CDLE). It establishes a common set of indicators so government agencies and private initiatives can work toward the same goals with the same understanding of what needs to be done.
The Colorado Opportunity Project coordinates and aligns the interventions of government, private, non-profit and community partners through a life stage/ indicator-based framework. The Colorado Opportunity Project Framework creates a thoughtful, broadly integrated health care delivery system that incorporates key social determinants of health. Each life stage in the framework identifies key benchmarks or metrics that need to be met to create successful outcomes such as healthy birth weight, school readiness, social emotional health, stable housing and positive workforce development. Community access to evidence-based program bundles in a life stage model creates a synergy or increased trajectory towards successful outcomes to the next life stage.
The goal of the project is to remove road blocks to economic self-sufficiency by delivering evidence-based interventions in an integrated system of health, social, and educational well-being so everyone has the opportunity to reach and maintain their full potential.
How does the Project Work?
- Creates common indicators: The project establishes a common set of indicators to define opportunity in Colorado, so government agencies, non-profit, private and community initiatives can work toward the same goals with the same understanding of what needs to be done. The indicators are common milestones that are important to success in life, like being born at a healthy weight, being prepared for school and graduating from high school.
The project’s indicators all have strong evidence to support that they are predictive of future life success. The indicators were selected based on the availability of data in Colorado, and are based on the following factors:
- Predictive – reliably predict success in the life stages that follow
- Intuitive – make sense to policy makers and users
- Available – can be captured in existing datasets
- Feasible – work at a practical and political level
- Identify and leverage evidence-based interventions that work: The project will work with stakeholders across Colorado to identify evidence-based programs, policies, initiatives, benefits, etc. that help Coloradans achieve self-sufficiency and economic opportunity.
- Evidence-based interventions are broadly viewed as those that increase the likelihood of positive outcomes for participants. By measuring the outcomes of an intervention, policy makers can justify funding and ensure the efficient use of resources.
- The project may include many different types of proven interventions: programs, policies, initiatives, benefits, and regulations, even areas of alignment between programs, initiatives and benefits. All interventions included in the project must demonstrate direct influence on the project’s indicators.
The Opportunity Framework
At the heart of the Colorado Opportunity Project is the Opportunity Framework (Figure 1). The framework covers nine life stages from family formation to end-of-life that act as a representation of a populations life continuum. Within each life stage, a series of indicators are selected to serve as benchmarks or metrics for success. Successful outcomes in one life stage creates a solid foundation for successful entry and outcomes into the next life stage. For example, if your child has access to quality early childhood education, they are prepared to achieve successful math and reading scores in middle childhood.
Who vetted the indicators and how were they chosen?
In September of 2013, the Colorado Opportunity Project Steering Committee (COSC) was convened. The committee was comprised of leadership and program staff from policy, education, public health, human services, workforce, advocacy group and the Brookings Institution. The COSC also received technical assistance and consultation from the Laura and John Arnold Foundation (formerly the Coalition for Evidence-Based Policy), Results First Initiative out of the Governor’s Office and Blueprints for Healthy Youth Development in Boulder County. Utilizing the Social Genome Model as a starting point, the COSC spent the first 2 years examining available local data to highlight those indicators that addressed these goals, needs and disparities of our Colorado communities. Once each indicator had been thoroughly vetted, the group then began to identify those evidence-based interventions around the state that were creating outcomes for one or more of our indicators.
Sample of the Family Formation life stage with identified evidence-based interventions (Figure 2):
Sample: Life Stage: Family Formation.
- Indicator #1 – Rate of low birth weight
- Interventions addressing indicator #1:
- Baby and Me Tobacco Free
- Prenatal Plus
- Indicator #2 – % FPL/Family income
- Interventions addressing indicator #2:
- Earned-Income Tax Credit
- Family Development Service/Family Resource Centers
- Indicator #3 – Maternal Depression
- Interventions addressing indicator #3:
- Temporary Assistance for Needy Families (TANF)
- Indicator #4 – Intendedness of Pregnancy
- Interventions addressing indicator #4:
- Nurse Family Partnership
- Colorado Family Planning Initiative (LARCs)
- Wyman’s Teen Outreach Program
- Indicator #5 – Single-or dual-parent household
- Interventions addressing indicator #5: (Currently under review)
- Indicator #6 – Early screening and intervention - maternal
- Interventions addressing indicator #6: (Currently under review)
Proof of Concept Period FY 2015-2017
The Department of Health Care Policy & Financing is currently partnering with the Statewide network of Region Collaborative Care Organizations (RCCO)s in a two-year proof-of-concept period to test what implementation would look like. Currently the Opportunity Project Team is creating implementation strategies for the Family Formation life stage period from conception to birth in seven diverse communities throughout Colorado (Figure 3). The seven communities were selected to represent the diverse geography and populations in Colorado, and each community was specifically selected to show the positive effects of integrated, social service delivery from both a cost savings and health outcomes perspectives. Each community also has a unique set of partners given their local dynamics. Up to now, The Colorado Opportunity Project has more than 50 state, county and/or local community partners participating.
Opportunity Liaisons were brought in to work in each of the seven RCCOs to create new systems and lift up existing processes that support a comprehensive health care delivery system through increased utilization of our evidence-based interventions. The indicators within the Family Formation life stage being elevated within these communities are: rate of Low Birth Weight, the % FPL of the household, presence of maternal depression, intendedness of the pregnancy, number of parents/caregivers in the household and Early screening and intervention - maternal. Evidence-based interventions, such as home visitation, TANF and Earned-Income Tax Credit (EITC) are being aligned within our focus communities to create a trajectory for economic success into the next life stage: Early Childhood.
The Opportunity Project team is working to increase referral, enrollment and utilization for our evidence-based interventions within our focus communities to be administered through our Accountable Care Collaborative (ACC). The Opportunity framework supports the evidence-based interventions within the Family Formation (conception to birth) life stage. The Project seeks to create packages of preventive health and social services in a data-driven, meaningful way to establish a family-centric path to self-sufficiency and economic opportunity. Clients are connected with additional resources and better coordination of care along the continuum of the life stage.
The Focus Communities and Their Projects
The Accountable Care Collaborative (ACC) is the Medicaid Health care delivery system. The focus of the work of the Opportunity Liaisons is to create a structure within the ACC that not only incorporates the social determinants of health into the current delivery system but more importantly creates a model can be sustained and evolved over time.
Project Partners and Steering Committee Members
- Department of Health Care Policy and Financing
- Department of Public Health and Environment
- Department of Human Services
- Governor’s Office
- Invest in Kids
- Department of Labor and Employment
- Department of Corrections
- Workforce Development
- Department of Higher Education
- Laura and John Arnold Foundation’s (LIAF) Evidence-Based Policy and Innovation Division
- Results First Initiative
- Blueprints for Healthy Youth Development
- Reach Out and Reach
- Hunger Free Colorado
- Colorado Opportunity Project Fact Sheet (coming soon)
- Colorado Opportunity Project Framework (coming soon)
Please continue to check this webpage for Colorado Opportunity Project updates. Should you have additional questions please contact:
Murielle Romine, MPH
Colorado Opportunity Project Manager
Department of Health Care Policy & Financing