Setting the Foundation for Public Health: Foundational Public Health Services for Kansas November 17, 2016 View from Kansas Health Institute Offices, Topeka, Kansas

Kansas Health Institute Today’s agenda Background on FPHS Kansas FPHS Assessment Kansas FPHS List What’s next? Kansas Health Institute

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Kansas Health Institute 1. What are the FPHS? Kansas Health Institute

Kansas Health Institute Foundational Public Health Services The suite of skills, programs and activities that should be available in every community in Kansas through state or local public health agencies as basic components to keep the public safe and healthy. Population-based preventive health services that are best addressed by governmental public health There was a panel about the FPHS at the COPPHI meeting this week. The three states were asked what they would do differently if they could start over again- all said they would learn from other states that have done this before! (Might want to include that here as context- we are learning from what's been happening and not re-inventing the wheel, so that we can build on progress and focus on making the framework relevant for our state). Kansas Health Institute

Kansas Health Institute Foundational Public Health Services Foundational Capabilities: the cross-cutting skills that need to be present everywhere for the system to work anywhere. These are the essential skills and capacities needed to support the Foundational Areas. Foundational Areas: the substantive areas of expertise or program-specific activities. Kansas Health Institute

Kansas Health Institute Public Health National Center for Innovations (PHNCI) Kansas Health Institute

Kansas Health Institute 2. Why are we here? Kansas Health Institute

Kansas Health Institute KALHD Vision Summit Disparate visions of the purpose of public health Lack of clarity about the role of public health Kansas public health laws are insufficient Public health funding levels are inadequate Priority public health needs that require long-term focus are often unmet due to siloed or unpredictable funding. Many communities are unprepared to address issues related to the health drivers of education, income and housing. Kansas Health Institute

Kansas Health Institute “KALHD’s vision is a system of local health departments committed to helping all Kansans achieve optimal health by providing Foundational Public Health Services (FPHS).” We’ll start by talking about the FPHS. “effectiveness” In 2015, KALHD adopted the Foundational Public Health Services as their vision for public health in Kansas– their vision statement is <read>. The FPHS represent services (foundational areas) and skills (foundational capabilities) that need to be present everywhere to public health to work anywhere…. This is what KALHD has outlined as necessary for effective public health in Kansas… these should be provided to all Kansans in KALHD’s vision, and they are a uniform assurance of public health protection for all Kansans. If health departments are providing these services, and providing them well, the assumption is that they will produce the desired result of optimal health for the community. Kansas Health Institute

How We’re Organized Kansas Public Health Systems Group Michelle Ponce, KALHD, PHSG Chair KDHE, KEHA, KHI, KHA, KPHA, KSU, KU, WSU, KHF Future of Public Health in Kansas Project Active PHSG members Council on the Future of Public Health in Kansas Statewide Partners Future of Public Health in Kansas Subcommittees Standing Public Health Systems Group Work Groups Coordination & Project Management Support Ty Kane Wichita State University Assessment Subcommittee Gianfranco Pezzino, Sarah Hartsig & Jason Orr Kansas Health Institute Financial Subcommittee Sharla Smith KUMC-Wichita Legal Subcommittee Tanya Honderick & Robert Moser KS Public Health Association Policy Subcommittee Michelle Ponce Kansas Association of Local Health Departments Kansas Health Institute

Kansas Health Institute 3. FPHS Assessment: Purpose and Process We think that CJS is a strategy that can help us find efficiency in a way that can be mutually agreeable for all parties. Kansas Health Institute

Kansas Health Institute Purpose of FPHS Assessment Develop definitions of the FPHS for Kansas and identify the system’s current capacity to implement the FPHS components. There was a panel about the FPHS at the COPPHI meeting this week. The three states were asked what they would do differently if they could start over again- all said they would learn from other states that have done this before! (Might want to include that here as context- we are learning from what's been happening and not re-inventing the wheel, so that we can build on progress and focus on making the framework relevant for our state). Kansas Health Institute

Kansas Health Institute FPHS Assessment Process Literature review Key Informant Feedback FPHS List for KS Capacity Assessment Kansas Health Institute

Kansas Health Institute Assessment Process Literature Review of State Models Review “minimum package” concept Review RESOLVE FPHS Model Comparison of state models to RESOLVE Model Feedback from Key Informants Identification of “truly necessary” services Interviews on the FPHS concept Analysis of interview findings Development of FPHS Model for Kansas Draft Kansas Model from stakeholder input Gather feedback from LHDs and system partners Approval of list by KALHD board Assess Capacity to implement FPHS Survey to determine gaps Kansas Health Institute

Kansas Health Institute Literature Review Key Findings Eight states have defined a FPHS Model (‘minimum package’) Each model has varying resemblance to RESOLVE Most alignment found within Assessment and Organizational Competencies Kansas Health Institute

Kansas Health Institute Key Informant Feedback Process Foundational Capability/Area Component Kansas Health Institute

Kansas Health Institute Key Informant Feedback Process 19 Key Informants Preliminary survey to identify “truly necessary” components of each FC and FA Components identified within literature review Follow-up interview to discuss survey responses Kansas Health Institute

Kansas Health Institute Key Informant Feedback Process Kansas Health Institute

Kansas Health Institute FPHS List Kansas Health Institute

Kansas Health Institute Vetting Process Date Description September 28 & October 10 Presentation of FPHS list & Gathering feedback October 10-17 Feedback incorporated October 18, 10am-2pm KALHD Board meeting & endorsement vote Kansas Health Institute

Kansas Health Institute FPHS Model Programs and Services Specific to Community Needs Assessment All Hazards Preparedness & Response Communications Policy Development & Support Community Partnership Development Organizational Competencies Addressing Health Equity & the Social Determinants of Health Communicable Disease Control Health Promotion and Chronic Disease & Injury Prevention Environmental Health Maternal and Child Health Access to Clinical Care Foundational Areas Foundational Public Health Services Foundational Capabilities Kansas Health Institute

Kansas Health Institute Feedback Addressed Overarching: Clarify State vs. local role “Assure” function definition Individual Components: Environmental health components - how can we assure items that are not public health’s responsibility? Immunization components Kansas Health Institute

Kansas Health Institute State vs. Local Role In Washington, model is “agnostic” about who provides the service The main question is: What should be available in every community through governmental public health? There may be some cases where state would assist with an FPHS component (e.g., epidemiological investigations) Language: “The FPHS are the suite of skills, programs, and activities that should be available in every community in Kansas through state or local public health agencies as basic components to keep the public safe and healthy.” Kansas Health Institute

Kansas Health Institute Definition of Assure To ‘assure’ means that state or local public health agencies have the primary responsibility to strategically work with community partners to ensure that that those who need the service have access to it, and that there is a plan in place to provide the service Components that begin with ‘assure’ should be directly provided by the state or local public health agencies if no other organizations are willing or able to provide the service in the community. Kansas Health Institute

Kansas Health Institute Assure Components: Communicable Disease Control Assure availability of public health laboratory services for reference and confirmatory testing related to communicable diseases. Assure availability of childhood, adolescent, and adult immunization services, including the Vaccines for Children (VFC) program, for all vaccines recommended by the Advisory Council on Immunization Practices (ACIP) Assure treatment for individuals with latent or active tuberculosis in accordance with national, state, and local mandates and guidelines. Kansas Health Institute

Kansas Health Institute Assure Components: Access to Clinical Care Assure access to family planning services. Assure access to maternal and infant services (e.g., maternity support, WIC) Assure access to STD and HIV testing and treatment. Kansas Health Institute

Kansas Health Institute Assure Components: Environmental Health Assure availability of public health laboratory services for reference and confirmatory testing related to environmental public health threats. (same language used for communicable disease control) Assure implementation of environmental public health inspections (e.g., inspection of child care facilities) in accordance with federal, state, and local laws and regulations. Assure access to elevated blood lead screenings. Prevent, reduce, or assure abatement of nuisances and environmental health hazards. Kansas Health Institute

Kansas Health Institute Additional Component: Environmental Health Coordinate and communicate with agencies that carry out environmental public health functions at the local level (e.g., inspections of food service facilities, drinking water, and liquid and solid waste streams). Kansas Health Institute

Kansas Health Institute New Foundational Capability: Addressing Health Equity and the Social Determinants of Health Key Informants were asked to reflect on this as its own distinct capability About 60 percent felt that it should become its own capability Most others were ambivalent as to integrating components elsewhere or organizing as a distinct FC Everyone agreed on the importance of the social determinants Kansas Health Institute

Kansas Health Institute New Foundational Capability: Addressing Health Equity and the Social Determinants of Health Ability to recognize and understand the determinants of health disparities within the community. Ability to coordinate programming to improve health disparities within the community. Ability to develop and advocate for policies that will promote health for all, particularly the most vulnerable Ability to provide services in culturally and linguistically appropriate and accessible formats for various communities served, in accordance with State and Federal guidelines, such as compliance with Section 508 of the Rehabilitation Act of 1973. Ability to provide public health information for the community that is stratified by demographic characteristics. Kansas Health Institute

Kansas Health Institute New Components: Mental Health and Substance Abuse Promote community mental health and well-being. Work to reduce rates of substance abuse in the community. Link community members to existing behavioral health services in the community. Several key informants noted that these issues were missing in the Resolve model Kansas Health Institute

Kansas Health Institute Other Feedback Q: How will this affect funding, staffing, and governance? A: Those are items that the PHSG plans to explore as part of this work. We don’t have answers yet, but this is not about “responsibility without resources.” Kansas Health Institute

Kansas Health Institute Review Components: FPHS List Share handout and have a discussion. Kansas Health Institute

Kansas Health Institute Discussion What questions do you still have about the FPHS model for Kansas? Kansas Health Institute

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Kansas Health Institute What’s Next? Kansas Health Institute

Kansas Health Institute FPHS Capacity Assessment List will be used to create capacity survey for LHDs What services are currently being provided? How do they align with current FPHS? What are gaps in capacity and expertise? Assessment to be distributed in early 2017 Detailed assessment of each component in the model General questions about model implementation Kansas Health Institute

Kansas Health Institute Types of Questions For each component: Current level of activity Capability (skills and knowledge) to carry out activity Capacity (resources and available staff) to carry out activity General questions Barriers other than funding and staff Possible opportunities for cross-jurisdictional sharing Kansas Health Institute

Kansas Health Institute Example: Oregon Capacity Assessment Self-Assessment: Current capacity and expertise to meet requirements Capacity: appropriate amount of staff/resources to provide service Expertise: appropriate knowledge/skills to provide service Kansas Health Institute

Kansas Health Institute FPHS Cost Assessment & Estimation Model for estimating current & needed FTEs, staffing costs and other costs for implementation of FPHS Likely through a probability sample of health departments in KS Will provide information on how we can adequately fund and staff FPHS implementation Kansas Health Institute

Kansas Health Institute What does it mean for you? The activity continues… We’ll be reaching out to HDs for assessment components in early 2017 Based on experiences from other states, full implementation may take many years PHSG partners will continue to identify the best ways of organizing and implementing the FPHS Kansas Health Institute

Thank you. ANY QUESTIONS? You can connect with us at: shartsig@khi.org or gpezzino@khi.org