CHIO Readiness – Public Health Institute of Oklahoma

Certification Readiness Assessment Tool

Completion of this form helps us to determine your readiness for CHIO Certification which connects communities to health improvement opportunities.

*Please note: Applying entities are not required to meet all CHIO Readiness elements. The CHIO Readiness Form and Application will serve as a Quality Improvement tool to assist your entity in achieving its health and wellness related goals. Recommendations will be provided by the CHIO Certification Review Committee upon review of your application.

Entity Name *

Community/County(ies) served: *

Primary Contact Name and Phone Number *

Primary Contact Email *

Where you referred by someone for the CHIO network? If so, who?

Social Media Outlets (Facebook, Instagram, TikTok, others *

Website / URL

What type of CHIO Certification are you applying for? *

community Health Improvement Organization (cHIO) Your entity (or collective) serves individuals within one specified geography. This could be at the census tract, zip code, town, city, or municipality level. Examples include: local civic groups, faith-based organizations, small non-profits, local Chambers of Commerce, Local Governments, local primary and secondary educational institutions
County Health Improvement Organization (CHIO) Your entity (or collective) serves individuals within multiple geographies but constitutes no more than 2 entire counties. This could include multiple census tracts, zip codes, towns, cities, or municipalities. Examples include: large non-profits, local coalitions and task forces, special interest groups, local clinics and FQHCs, large faith-based organizations, philanthropic organizations, large civic organizations, financial institutions, vocational education institutions, law enforcement agencies
County Health Improvement Organization + (CHIO+) Your entity (or collective) serves individuals within multiple geographies of a minimum of 3 or more counties. This could include multiple census tracts, zip codes, towns, cities, or municipalities. Examples include: large multi-county coalitions and task forces (3 or more counties served), hospitals and clinic systems, State Agencies, Tribes, Professional Associations, Special Interest Groups, financial institutions, vocational education institutions, law enforcement agencies, philanthropic organizations

Does your entity organize around health improvement priorities and/or wellness goals to support your community and your community members? *

Are you a 501(c)3 or does an external entity support your efforts? *

If no, please name the entity supporting you:

Do you serve an urban or a rural geography? *

Urban
Rural
Both

Do you have established communication channels to share information with the community? *

Do you have health care providers participating in your health related activities? *

Are you engaged or did you help with your Community Health Needs Assessment or County Health Improvement Plan activities as an entity? *

Please indicate your organization’s alignment, if any, with the Oklahoma State Department of Health’s 2023 – 2028 Oklahoma State Health Improvement Plan’s health priorities:

These priorities were analyzed and published from the State Health Assessment.

Do you have established policies and procedures or by-laws as an entity? *

Do you have a Board of Directors or a leadership structure supporting your entity? *

Does your entity support a Parent Partnership Advisory Committee?

Does your entity support a Youth Advisory Committee or youth-related programming? *

Does your entity have the capacity to recruit & supervise community volunteers? *

Does your entity have the ability to host virtual, web-based meetings? *

Is your entity interested in participating in no-cost Continuing Education? *

Please list the Top 3 health improvement goals for your entity over the next 5 years. *

Are you a member of the following Professional Organizations *

Oklahoma Primary Health Care Extension System
Rural Health Association of Oklahoma
National Rural Health Association
Rural Health Network of Oklahoma
Oklahoma Turning Point Council
Oklahoma Public Health Association
Oklahoma Center for Non-Profits
Oklahoma Primary Care Association
None of the Above

Does your entity include community members in planning and implementing health improvement activities locally? *

Does your entity remove barriers for community members to participate in planning and implementing health improvement activities locally (such as childcare, food, transportation assistance, stipend, etc)? *

Thank you for completing your CHIO Readiness Assessment. A team member with the Public Health Institute of Oklahoma will be in touch to discuss next steps for completing your full CHIO Certification Application.

CHIO Certification Timeline and Checklist:

Submit CHIO Readiness Assessment Full application assistance and next steps provided by PHIO team
Readiness Assessment reviewed and returned with recommendations by PHIO Readiness Assessments reviewed as received Next steps provided by the PHIO team.
Complete full CHIO Certification Application Please submit full applications 1 week prior to the start of each review month
CHIO Certification Applications under review Applications reviewed in: January, April, July, and October annually
Notification of CHIO Certification Certifications awarded in: February, May, August, and November
Participation in Oklahoma Primary Health Care Extension System and CHIO activities Ongoing after Certification, activities open to those with applications under review

*Please note: Applying entities are not required to meet all CHIO Certification elements. The CHIO Certification Application will serve as a Quality Improvement tool to assist your entity in achieving its health and wellness related goals. Recommendations will be provided by the CHIO Certification Review Committee upon review of your application.

Questions? Need more information? Call Laura Ross at (918) 931-9813 or email laura@publichealthok.org. You can also reach out to 405-259-6851 or info@publichealthok.org.