Public Health Department Accreditation: Update for CA Rural Indian Health Board Kaye Bender, PhD, RN, FAAN Joe Finkbonner, RPh, MHA July 20, 2017

Session Content General Update on PHAB’s Accreditation Work Special Overview of Planned Tribal Documentation Guidance Supplement

Major PHAB Initiatives Reaccreditation Small Health Department Technical Assistance Vital Records/Health Statistics Accreditation Module PHAB’s 10th Anniversary Tribal Documentation Guidance Supplement

Guide to National Public Health Department Reaccreditation Sets forth the process and timeframes Includes the Standards and Measures Includes description of Population Health Outcomes reporting Is available now on PHAB’s website .

Standards and measures Reaccreditation Standards and measures Increased emphasis throughout on: Collaboration and partnership Community involvement Leadership for community health development Health equity System-level actions Mobilization of the community Culture of quality improvement

Reaccreditation Standards & Measures One set of reaccreditation Standards and Measures No new topic areas (e.g., ethics, branding were added to V. 1.5) The Tell versus the Show: health departments will explain the “bigger picture” to understand who they are, what they do, and how they do it

Population Health Outcomes Health department: Will report on 5 – 10 outcomes with reaccreditation Will report on the same outcomes with each Annual Report (Section III, submitted with Section II) May add outcomes to report on with the Annual Reports if health department and community revise objectives they are tracking

Small Health Departments PHAB understands that smaller health departments sometimes struggle with accreditation requirements. PHAB will be working with NACCHO to design and plan improved and targeted technical assistance. Some of this will apply to smaller Tribal health departments as well.

Vital Records/Health Statistics Accreditation PHAB partnered with NAPHSIS, CDC, and NCHS Customized standards that NAPHSIS had already developed for use in accreditation Conducted an alpha test Will conduct a beta test in 2017-2018

PHAB’s 10th Anniversary

Special Documentation Supplement for Tribal Public Health Departments Working on Accreditation

Background The National Indian Health Board (NIHB) convened a Tribal Public Health Accreditation Advisory Board (TPHAAB) to discuss accreditation matters for Indian country. In October 2015 this group began a review of Version 1.5 of the standards and measures to identify components and language in the document that pose barriers to Tribal public health accreditation. NIHB provided a detailed report to PHAB in December 2016. PHAB and NIHB staff met on January 5, 2017 to review the report. Since that time, we have held one webinar with the TPHAAB and one discussion at the recent NIHB National Tribal Public Health Summit. PHAB is working with NIHB to finalize the document for Tribal health department use.

Overarching Comments No immediate changes in the standards and measures. Some that were recommended will be held until Version 2.0. No change in the review process. In many cases, the documentation guidance remains the same. The documentation guide that is being developed is a supplement to S/M 1.5. The documentation guide contains clarifications, changes in wording, and the inclusion of Tribal specific examples. There are definitional terms that need to be clarified/amended throughout the document.

Definitional Terms The next three slides summarize the definitional terms that pose interpretational issues for Tribes. The slides are presented in a general way, but the documentation guide will connect each specific domain/standard/measure with the guidance where these terms occur.

Definitional Terms Jurisdiction – Change to community or population served by the Tribe, in the broadest sense. The Tribe has total determination of who these individuals are and how many they are. They can select a point in time and use that number. If changes occur, then, they can revise the number with PHAB. PHAB will use the example provided by NIHB to help guide Tribes in deciding this number. Tribes will be encouraged to think about this in the broadest of terms. There are some public health services that affect more than just the individuals who receive clinical services (i.e. sewer, food inspection, Zika, etc.). Then, there are programs that are more limited to certain sectors of the population (children, elders, people with diabetes, etc.). The latter would be the sub-populations for selected programs and initiatives.

Definitional Terms Consultation - PHAB does not interpret consultation in the formal way that is described under Executive Order 13175. So PHAB proposes that two edits be made where that word occurs: Where the measure says consultation/technical assistance, it will simply say technical assistance and give some examples When the measure only says consultation, it will be changed to meaningful discussions, emails, memos, etc. It does not have to be formal like the work under EO 13175 is. It can be one-way communication. Tribes are not held responsible for what the other party does with the information. Examples will be provided.

Definitional Terms Governance - PHAB understands that all of the measures that speak to governance should reflect the Tribe’s specific governing structure. We will insert specific language that gives Tribes better guidance that PHAB is not prescribing how they should set up their governance structure. Tribes will tell PHAB what that is and we will instruct site visitors to use the Tribal specific governance structure as their basis for assessing those measures.

Data Sovereignty PHAB will insert language in the document related to data sovereignty for the Tribes. Data, reports from data analyses, and data agreements will respect this concept and will reflect that Tribes should decide who within their Tribes (as well as selected external partners) should have access to the data or reports for the purpose of improving health status of their community.

Thank you!