CPHA CONFERENCE Strengthening Chronic Disease Prevention & Management A Regional Pilot Project

OUTLINE Overview of CPHA Pilot Project The Planning & Assessment Tool Key Findings and Next Steps The Cumberland Story

CAPACITY-BUILDING Organizational development Workforce development Resource allocation Leadership Partnership development Reference: A Framework for Building Capacity to Improve Health, NSW Health, 2001.

AIMS TO: Engage stakeholders in dialogue Promote information exchange Assess current policy, planning and practice Identify actions, roles and shared responsibilities for strengthening prevention and management of chronic disease

CRITICAL SUCCESS FACTORS 1.Common Values and Shared Goals 2.Focus on Determinants of Health 3.Leadership, Partnership and Investment 4.Public Health Capacity and Infrastructure 5.Primary Care Capacity and Infrastructure 6.Community Capacity and Infrastructure 7.Integration of Chronic Disease Prevention and Management 8.Monitoring, Evaluation and Learning

METHOD/APPROACH Evidence-Informed The Tool was developed through:  Working with an expert advisory committee  Review and synthesis of peer-reviewed, indexed journal articles and grey literature  Key Informant Interviews  Focus Groups  Piloting in Four Health Regions

WORKSHEETS AND RATING SCALES Cues to help assess current capacity Where are we now in our practice? What opportunities are there to build capacity/improve practice? Question with explanation/example Rating scale with qualitative indicators (0=nothing in place; 4=best/promising practice) Space for local indicators, notes

Chronic Disease Prevention and Management Continuum Well Population Primary Prevention At Risk Population Secondary Prevention Established DiseaseControlled Chronic Disease Surveillance of diseases & risk factors Promotion of healthy behaviours Creation of supportive environments Universal & targeted approaches Screening Case finding Periodic health examinations Early intervention Medication to control Universal & targeted approaches Treatment and acute care Complications management Self-management Continuing Care Maintenance Rehabilitation Self-Management Health Promotion Prevent movement to at-risk group Prevent progression To established disease Prevent progression to complications and/or hospitalizations Tertiary Prevention

REGIONAL PILOT PROJECT REGIONAL PARTNER SITES Health RegionContactPositionLocationGeographical Region Champlain Local Health Integration Network Karen PatzerSenior Planner Ottawa, ONCentral Cumberland District Health Authority Camille DumondHealth Promotion Coordinator Amherst, NSEastern Capital District Health Authority Dr. Gaynor Watson-Creed With Michelle Le Drew & Shannon Ryan Medical Officer of Health Halifax, NSEastern Five Hills Health Region Dr. Mark Vooght With Audrey O’Reilly & Karen Lehman Medical Officer of Health Moose Jaw, SKWestern

PROJECT OVERVIEW Engage Stakeholders, Pilot Tool, Track Learnings and Evaluate Identify four pilot sites Provided process support Partner to engage regional stakeholders Held workshops – orientation to the Tool Tracked site experiences using the Tool Facilitated learning exchange across jurisdictions

WHAT DID WE LEARN?

SELECT FINDINGS Use of tool varied with each site and depended on context Flexible, multiple approaches Complex, takes time Process was as important as the Tool itself Learnings came from engagement at project level and at the regional level Participatory approach was key Nature of engagement and support provided helped to build capacity in different ways

HOW MIGHT THE TOOL BE USED?

Our CDPM Journey Small CDPM Planning Team Small CDPM Planning Team Environmental Scan Environmental Scan Steering committee / Stakeholders – CPHA Orientation to Tool Steering committee / Stakeholders – CPHA Orientation to Tool 2 Stakeholder Forums 2 Stakeholder Forums Criteria and Priority Setting Criteria and Priority Setting Identified actions to move forward Identified actions to move forward

The CPHA Tool Common Values/ Health Goals / Integration / Determinants of Health Stakeholder Forums Poverty workshop (Multi-sectoral partners) Indirect Staff Groups, Staff Groups, Steering Committee HP Working Group Direct Dialogue Potential UnderstandingValidation Capacity Building

Poverty Reduction Forum 1. How aware are people of the link between the social determinants of health and chronic disease? How do people see the social determinants as informing approaches to this work? 2. What are some supports for taking a social determinants of health approach to addressing chronic disease in this region? 3. What are some of the barriers to taking a social determinants of health approach to addressing chronic disease prevention and management?

Priority Areas Reorienting Health Services Reorienting Health Services  Key Strategy Areas  -Increasing Awareness  Knowledge translation Self Management Self Management  Chronic Disease Self Management  Provincial Initiative SSM  Patient data – health passports  Health Care providers

Priority Areas Community Action Community Action  Workplace Setting  Inter-sectoral Approach to SDOH / Health Inequity reduction Information Systems Information Systems IT / IM Strategic Planning IT / IM Strategic Planning  Systems and Decision support Tools  Redesign  Linking systems for information sharing across the system

Moving Forward with Integration What is moving us forward? What is moving us forward? Increased awareness - concept of Integration Increased awareness - concept of Integration Connection with CD Accreditation standards Connection with CD Accreditation standards Overlapping Collaborating committees for Self Management / Health Promotion work/CCCP Overlapping Collaborating committees for Self Management / Health Promotion work/CCCP Opportunities - Self Management training in March / Promising Health Promotion Practices Opportunities - Self Management training in March / Promising Health Promotion Practices

Moving Forward With Integration Transformation within existing structures – CCCP shift / IM srategic planning Transformation within existing structures – CCCP shift / IM srategic planning Provincial / National supports – resources, strategies, training opportunities Provincial / National supports – resources, strategies, training opportunities

Moving Forward With Integration Leadership Development and Support Leadership Development and Support Building capacity - Strong / varied partnerships and commitment – Community centre - Springhill Building capacity - Strong / varied partnerships and commitment – Community centre - Springhill Health Promotion WG meeting regularly (Multi layerd approach) Health Promotion WG meeting regularly (Multi layerd approach)

Cumberland Health Authority Draft CDPM Support Framework Nova Scotia Chronic Disease Prevention Strategy Nova Scotia Chronic Disease Prevention Strategy Health Promotion Steering Committee (CDPM) Key Systems Level Stakeholders Health Promotion Working Group Collaborating Committee of Key (Intersectoral) Stakeholders Cumb Collective Partnerships Self Management Collaborating committee Organizational Health / Workplace Coalition Communications Families Schools Workplaces CommunitiesHealthcare Settings Social inclusion and Cultural Diversity

Holding us Back A solid strategy for introducing the tool and piloting – workplan A solid strategy for introducing the tool and piloting – workplan No provincial framework yet No provincial framework yet Lack of a Communication Plan Lack of a Communication Plan Understanding the Lay of the Land – Integration points Understanding the Lay of the Land – Integration points Awareness Building is Huge – needs to come first Awareness Building is Huge – needs to come first

Overlapping responsibilities - Time Crunch – ie: Steering Committee – More streamlined support structure Structure required Overlapping responsibilities - Time Crunch – ie: Steering Committee – More streamlined support structure Structure required Need to Build more capacity – tool should be useful Need to Build more capacity – tool should be useful Competing priorities – Accreditation Competing priorities – Accreditation Ruralness of the district – travel, time Ruralness of the district – travel, time

Learning re: Using TOOL CDPM Steering Committee – Values and Role CDPM Steering Committee – Values and Role Communications is High Priority Communications is High Priority Need an Inventory of CDPM work Need an Inventory of CDPM work Develop a working group and plan for using Tool Develop a working group and plan for using Tool Tool is an extremely useful catalyst Tool is an extremely useful catalyst Potential to adapt / use tool with for integration of other priority areas - Cultural Diversity and SI discussions – ie: Common Values Potential to adapt / use tool with for integration of other priority areas - Cultural Diversity and SI discussions – ie: Common Values CDPM work needs bilateral movement of ideas CDPM work needs bilateral movement of ideas

Next Steps

 Taking a step back  Developing the bigger framework  Strategic plan / evidence / standards  Integrating priority goals and objectives  Healthy Discussions – knowledge exchange  Increasing awareness of what “integration” might look like  Looking at the Lay of the land – integration points and alignment

What will be Key Maintain Balance - Prevention with Management Maintain Balance - Prevention with Management Restructuring – system support and relationship building Restructuring – system support and relationship building Maintain focus on Stakeholder Priorities – in work- plans Maintain focus on Stakeholder Priorities – in work- plans Continued Communication and Engagement Continued Communication and Engagement Use evidence to support Decisions and Redesign Use evidence to support Decisions and Redesign Continue to Focus on the Critical Success Factors Continue to Focus on the Critical Success Factors