State and Local Collaboration for Coordinated Chronic Disease Prevention: A Qualitative Analysis Alecia Kennedy, MPH, Richard W. Wilson, DHSC, MPH

Sue Thomas-Cox, RN

APHA November 3, 2015

Presenter Disclosures

(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

Alecia Kennedy, MPH

“No relationships to disclose”

Background

Coordinated Chronic Disease Prevention and Health Promotion Program (CCDP)

Kentucky’s State Categorical Programs

Bone and JointBreast and Cervical Cancer

Tobacco Control and Prevention

KBRFSS

Respiratory Disease

Coordinated School Health

Nutrition and Obesity Healthy Communities

Diabetes

Heart Disease and StrokeColon Cancer Screening

Methodology

Planning

• Focus on current collaborative efforts

• Determine interview questions

• IRB approval

Execution

• Private interviews• Recorded,

transcribed, analyzed

Accuracy Check

• Dissemination of results to stakeholders

• Feedback used for revisions

Interview Focus

• Local Health Departments (LHDs)

• Community Partners

• State Categorical Program Partners

• Differences in Partnerships

• Collaboration: Benefits and Barriers

Relationships

Local Health Departments

Community Partners

State Categorical Programs

Local Health Departments

22%

17%

17%

11%

33%

Point of Contact

Director Health EducatorSupervisor LevelNurse/Case ManagerAll Other

Work Insights

• Majority of state programs worked with LHDs on a weekly basis

• Technical assistance and training were primary services

• Requirements for operation

• Benefits for state programs and LHDs

Funding

• Block grant funding for programs

• Grant-specific projects

• Non-financial assistance

Relationships

Local Health Departments

Community

Partners

State Categorical Programs

Community Partners

• University of Kentucky and the University of Louisville are the most common community partners

• Thirty-four different community partners identified

• Most community partners were engaged on a monthly basis

Work Insights

Work on a common grant

Provide professional

development to partners

Community partner

provides advocacy assistance

Community partner

provides service

Community partner provides

network introductions

Funding

• Budget allocation to community coalitions

• Exchange training and materials for assistance in leading classes

• Grant-specific collaboration was common

• Federal money was a more common funding source than state money

Relationships

Local Health

Departments

Community Partners

State Categorical Programs

State Categorical Programs

• Tobacco Control and Prevention =Most common partner

• Grant dependent

• Physical proximity

• Uneven staffing

Work Insights

• Employee or data sharing

• Formal work on common grants or coalition work

• Informal work in the form of knowledge sharing

• Sharing information about other programs with contacts

Funding

• Unfunded collaboration

• Block Grant Uncertainty

Comparison of Partnerships

State Categorical Programs

Community Partners

Focus

Receptivity

Freedom

Comfort Level

Convenience

Themes

Primary Benefits

• Expand limited staff• Stretch financial

resources• Learn about other

programs • Access additional funding

Most Common Barriers

• Grant requirements and government restrictions

• Conflicting priorities• Time constraints

In their words

“They might do strategic planning with us. They might do other kinds of work. They do things that are bigger picture activities than their local area…Like I said, they’re almost extensions of our staff that way.”

Referencing work with LHDs“It’s just one of me and I can’t do it all…They are my staff, so to speak, because I don’t have staff to do those things with me.”

Referencing community partnerships

“ I don’t know who half the people, the directors of these programs, are. I’d love to meet them.”

New Program Coordinator

“If it hadn’t been for my partners being there to help me, I don’t know what I would have done.”

Program Coordinator with no staff

Primary Findings

• State programs already collaborate extensively with local health departments, other state programs and community partners

• There is great disparity between state programs in terms of staffing and intensity of collaboration

• Organizational structure for enhancing a more even approach to collaboration and staffing is lacking or perceived to be lacking by program coordinators

• Attitude toward increased collaboration is overwhelmingly positive if it is well-planned and managed

Recommendations

• Establish cross-agency collaboration as a standard measure of sustainability for state government health programs

• New coordinator orientation should include stakeholder collaboration training

• New coordinator orientation should include an introduction to local health department organization and operation

• Where state programs provide funding to local and regional partners, make collaboration a stipulation

• Develop and incorporate evaluation and accountability measures of collaboration into periodic performance reports required by funders