Health Assessment and Improvement Planning 201: Putting it All Together

Health Assessment and Improvement Planning 201:

Putting it All Together

Laurie Call, IPHIJessica Solomon Fisher, NACCHO

Jim Pearsol, ASTHOMay 9, 2012

Objectives

• Detail the steps to health assessment and improvement planning

• Share stories from health departments experienced in improvement planning

• Plan for implementing community health improvement processes in your community 2

Definition: (Community) Health Improvement Process

An ongoing, collaborative, community-wide effort to identify and address health problems through coordinated activities. It may include environmental, business, economic, housing, land use, and other community issues indirectly affecting the public’s health.

3

(Adapted from National Public Health Performance Standards Program, Acronyms, Glossary, and Reference Terms, CDC, 2007. www.cdc.gov/nphpsp/PDF/Glossary.pdf).

Health Improvement Process Steps

• Prepare and Plan• Engage the Community• Develop a Vision• Conduct Health Assessment(s)• Prioritize Health Issues• Develop a Health Improvement Plan• Implement Health Improvement Plan• Evaluate and Monitor

4


• Prepare and Plan

6

Prepare and Plan

• Consider resources• Select model• Identify related activities• Plan for community and partner

engagement• Create a timeline

7

Prepare and Plan: Determine Resources• People (e.g. staff, partners,

consultants)• Materials and supplies• Expertise (e.g. community

organizing, statistics,)• Financial

8

Prepare and Plan: Select Model• Who should be involved?• What are key values and principles

that you want to embody?• What requirements, if any, need to

be considered?

9

Prepare and Plan: Identify Related Activities

• Previous assessments • Program-specific assessments• United Way• FQHCs• Hospitals• Others

10

Prepare and Plan: Partner and Community Engagement

• Plan, plan, plan• Ensure adequate time• Consider past successes and lessons

learned

11

Prepare and Plan: Create a Timeline

• Part of good planning• Ensures all involved are on same

page• Helps in monitoring progress

12

Story from the field: Planning and Partnership

13


• Prepare and PlanEngage the Community

14

“There is a critical difference between going through the empty ritual of

participation and having the real power needed to affect the outcome of the

process.”

(Sherry Arnstein, 1969: “A Ladder of Citizen Participation”) 15

Engage the Community

-Consumers of Non-profit -Organizations’ Services-Neighborhood Community Groups-Media-Members of Policy Advisory Committees/Commissions -Business Owners-Members of Civic Associations-Informally Recognized Community Leaders-Youth-PTA/PTO members

16

Schools

Dentists

EMSLaw Enforcement

Corrections

Faith Instit.

NGOs

Labs

HCP

Tribal Health

City Planners

Transit

Fire

Civic Groups

Employers

Drug Treatmen

t

Elected Officials

Mental Health

CHCs

Public Health Dept

Parks and Rec

Nursing Homes

NeighborhoodAssociations

Home Health

CBOs

17

Engage the Community:Elected Officials• Legislators• Governor• County Commissioners• Mayors• Selectmen• City Council members

18


Prepare and PlanEngage the Community

Develop a Vision

20

Develop a Vision

What is a vision statement?• A description of a future state: want you,

a group, an organization, a community, or a state is striving to achieve

• The statement about what you want your community or state to look like

• A guiding force for what you are doing• An important first step, prior to

conducting a health assessment• Provides the framework for an indicator

system21

Your Vision Should…

• Describe the desired future state• Undergo periodic review and revision• Be made visible throughout the

community• Serve as a point of reference

throughout the health improvement process

22

“A place where all people can enjoy the best health possible, where all can live, grow and prosper in clean and safe communities. “

“Our county will be a model

community, committed to empowering all

residents to achieve optimal health.”

23

“We will be a community whereby all residents are guaranteed equitable healthcare, positive health outcomes, and optimal quality of life.”

“A healthier future for the people of Florida.”

Story from the field: Visioning

24


• Prepare and Plan• Engage the Community• Develop a Vision

• Conduct Health Assessment(s)

25

Conduct a HA: Steps

• Define the population• Identify indicators• Collect data• Analyze data• Summarize key findings• Report back to the community

26

Define the population

• Consider any external or internal requirements (e.g. PHAB, non-profit hospital CHNA, etc.)

• Ask the community• Consider population or community

based on*:– political/geo-political lines, – neighborhood, and– shared interests such as ethnicity,

sexual orientation or occupation27

*Fellin 2001 as cited in Minkler, et al. (Ed). (2005). Community Organizing and Community Building for Health. Rutgers University Press: New Brunswick, NJ.

Identify Indicators

What themes, issues or goals are most important for measuring conditions that promote the health and safety of people who live, work, play, study and worship in our community/state?

28

Indicators and Indicator Systems

• Indicators: Measures/data that describe community conditions (e.g., poverty rate, homelessness rate, number of food stamp recipients, life expectancy at birth, heart disease mortality rate) currently and over time. Helps to answer the question: How are we doing regarding the community conditions we care about?

• Indicator Systems: Organizes multiple indicators around topics/issues (e.g., health, housing, public safety) or goals (e.g., all residents have access to health care, affordable housing needs of all residents are met, all residents are safe in their homes and within the community).

• Comprehensive Indicator Systems: Focus on economic, social and environmental topics/issues or goals.

29

Source: Community Indicators Consortium

What indicators are you considering/using?

30

Identify Indicators

• Access to care– Late or no prenatal care

• Health outcomes– Adolescent birth rate

• Physical and environmental determinants– # of Air Quality Action days per year

• Risk factors– Percent overweight and obese (school-age)

• Social determinants– High school graduation rates 31

Selecting Indicators: Community Assets

Individuals’ and population groups' skills and strengths

Specific community health resources

Local organizations or groups that can be mobilized

Local institutions and their staff and physical resources

Physical assets that may be useful health improvement resources

32

Data Collection Plan

Should include:

• Desired data

• Secondary data sources, if any

• Data collection instruments or methods for primary data, if needed

• Who will be responsible for data collection

33

Collect Data

• Quantitative• Qualitative• Primary• Secondary

34

Types of Data

• Quantitative – data you can count

Examples: rates, sums, averages; expected to be objective

• Qualitative – it feels like data

Examples: narrative, descriptive, provides human perceptions and context; expected to be subjective

35

Source: Orange County Needs Assessment, Public Health Enterprise and Association for Community Health Improvement, 2011

Story from the field: Primary Data Collection

36

Types of Data

• Primary – original data collection and analysisExamples:– A telephone survey conducted in your community can

be both quantitative and primary– Key informant interviews conducted can be both

qualitative and primary

• Secondary – source other than your own researchExamples:– Vital records are quantitative and secondary– Focus groups conducted by someone else can be

qualitative and secondary– Data from a county or state source 37


Primary data

Gain information not available in secondary data sources

Help provide context or more information on findings from secondary data analysis

Can be tailored to your particular needs

Current information

Greater control over quality

Process can increase partner engagement and support

38

Advantages Disadvantages

Can be resource-intensive (cost and time)

Bias in self-reported data

Requires technical \expertise in research


Data Collection Methods: Primary

• Quantitative Methods:

–Telephone Surveys

–Mail - Paper Surveys

–Web-based Surveys

39

Data Collection Methods: Primary

• Qualitative Methods:– Interviews

• In person

• Telephone

– Group Discussions

• Focus Groups

• Town Hall Meetings

40

Secondary Data

Reduces duplication in data collection

Less expensive than primary data collection

Frequently collected using standardized and tested research methods; provides some assurance of data quality

Often available by different geographies, e.g. census tract, zip code, or school district 41

Advantages Disadvantages Limited to data already

collected

Data may be from different time periods or geographic areas; limits comparisons

Potentially limited ability in ways data can be analyzed

Often older data


Secondary Data Sources

• Local, state, national databases• County Health Rankings• State vital records• Healthy People 2020• Behavioral Risk Factor Surveillance System• Youth Risk Behavior Survey

• Previously conducted health assessments or reports • United Way• Non-profit Hospital CHNA• FQHC CHNA• Program-specific assessments

42

Collect Data

• Partners who have access to data through their organizations

• Government agencies such as: state health agency, other cabinet agencies (environmental health , social services, etc.), courts, police, schools, libraries, parks, planners

• Non-profit organizations• Managed care organizations• Universities and colleges• Chambers of Commerce

43

Important Considerations in All Data Collection• Data quality and validity

– Reliable data source?– Appropriate data collection methods used?– Sample used?– How old is the data?– Geographic areas covered?

• Communities/groups disproportionately affected by poor health outcomes

• All data have limitations; important to be transparent about them

44


Analyze Data

• Quantitative– Organize data (e.g., by type, source,

health indicator or category)– Ensure appropriate statistical analyses– Simplify results

• Qualitative– Key themes with supporting quotes and

examples– Key conclusions

45

Summarize Key Findings

• Consider themes and findings from all assessment activity

• Identify areas of alignment and differences

46

Report Back to the CommunityI. Executive summary II. Description of CHA process

I. Individuals & organizations involvedII. How indicators were selectedIII. Data sources IV. Data analysis V. Data limitations

III. Indicators & dataI. Description of each indicatorII. Data for each indicator I. Comparisons to peer communities, state and/or national

benchmarksII. Trend dataIII. Cross tabulations (e.g. by age, race, neighborhood,

education)IV. Summary & next steps

47

PHAB Standard 1.1

Participate in or conduct a collaborative process resulting in a comprehensive community health assessment.

Measure 1.1.1S, T/L: Participate in or conduct a state/local partnership that develops a comprehensive state/community health assessment

• Participation of representatives of various sectors of local community

• Regular Meetings

• Description of the process used to identify health issues and assets

Measure 1.1.2 S, T/L: Complete a state/Tribal/local level community health assessment

• Dated within the last five years

• Documentation that data and information from various sources contributed to the CHA and how data were obtained

• Description of the demographics of the population of the jurisdiction served

• General description of health issues and specific descriptions of population groups with particular health issues

• Description of contributing causes of state health challenges/community health issues

• Description of existing state/community assets or resources to address health issues

• Documentation that the state population/local community at large has had an opportunity to review and contribute to the assessment

50

Measure 1.1.3A: Ensure that community health assessment is accessible to agencies, organizations, and the general public

• Documentation that the community health assessment has been distributed to partner organizations

• Documentation that the community health assessment and/or its findings have been made available to the population of the jurisdiction served by the health department

51


• Prepare and Plan• Engage system partners• Develop a Vision• Conduct Health Assessment(s) • Prioritize Health Issues

Prioritize Health Issues

• Identify issues through priority setting exercise (s)

• Assure that priorities are supported by data

• Communicate and vet priorities among partners

Story from the field: Prioritizing Health Issues

54


• Prepare and Plan• Engage system partners• Develop a Vision• Conduct Health Assessment(s) • Prioritize Health Issues

• Develop and Implement a Health Improvement Plan

Develop and Implement a Health Improvement Plan

• Develop measurable and achievable goals, objectives, and strategies for priorities and link to:– The Guide to Community Preventive Services– Guide to Clinical Preventive Services– National Resource for Evidence Based

Programs and Practices

• Develop and implement work plan to complete HIP- including partner assignments

Story from the field: Action Planning

57


• Prepare and Plan• Engage system partners• Develop a Vision• Conduct Health Assessment(s) • Prioritize Health Issues• Develop and Implement a Health

Improvement Plan• Evaluate and Monitor

Evaluate and Monitor

• Track implementation of work plan on a regular basis

• Obtain periodic partner updates on their assigned activities

• Match implementation plan activities to primary and secondary data sources in health assessment.

• Report on progress and share results widely

PHAB Standard 5.2

Conduct a comprehensive planning process resulting in a tribal/state/community health improvement plan

5.2.1S,L: Conduct a process to develop a SHIP/CHIPDocumentation of a completed health

improvement planning process must include:

a. Broad participation of public health system partners

b. Information from the health assessmentc. Issues and themes identified by the stakeholdersd. Identification of assets and resourcese. A process to set health issue priorities

5.2.2S: Produce a SHIP as a result of the health improvement planning process

A SHIP dated within the last five years must include:

a. Statewide health priorities, measurable objectives, improvement strategies, and performance measures with time-framed targets

b. Policy changes needed to accomplish objectivesc. Individual/organizations responsible for implementing strategiesd. Measurable health outcomes or indicatorse. Alignment between the SHIP and Tribal, local and national

priorities

5.2.2L: Produce a CHIP as a result of the health improvement planning process

A CHIP, dated within the last 5 years, must include:

a) Community health priorities, measurable objectives, improvement strategies and performance measures with measurable and time-framed targets

b) Policy changes needed to accomplish health objectivesc) Individuals and organizations that have accepted responsibility for

implementing strategiesd) Measurable health outcomes or indicators to monitor progresse) Alignment between the community health improvement plan and

the state and national priorities

63

5.2.3A: Implement elements and strategies of the health improvement plan, in partnership with othersThe health department must provide:

a.Reports of actions taken related to implementing strategies to improve health, including partners involved and status of strategies – could be a work plan

b.Examples of how the plan was implemented by the department and/or partners

5.2.4A Monitor progress on implementation of strategies in the HIP in collaboration with broad participation from stakeholders and partners

1. Evaluation reports on progress made in implementing HIP strategies must show:

a. Monitoring of performance measuresb. Progress related to health improvement indicators

2. The health department must show that the health improvement plan has been revised based on the evaluation

State and Local Health Departments Working Together in HA and HIP• Alignment

– When possible HAs/HIPs at local level should align with state HA/HIP

– States may also consider how they can learn from and integrate local HAs/HIPs into state work

• Support– Consider sharing stories and lessons learned with

colleagues– States who are working to support locals can play a

variety of roles• Technical assistance (TA)• Connecting LHDs for peer-to-peer TA• Resources (technical expertise, training, financial, when

possible)

ASTHO Resources

• PHAB prerequisites, http://www.astho.org/Programs/Accreditation-and-Performance/Accreditation/Preparing-for-Accreditation/

• SHIP guidance and resources,http://www.astho.org/Display/AssetDisplay.aspx?id=6597

67

NACCHO Resources

• MAPP, www.naccho.org/mapp

• CHA/CHIP Resource Center, www.naccho.org/chachipresources

68

Laurie [email protected]

Jessica Solomon Fisher Jim Pearsol [email protected] [email protected]

For more information

Health Assessment and Improvement Planning 201: Putting it All Together

Documents

Transcript of Health Assessment and Improvement Planning 201: Putting it All Together