Completing community health assessments and community health improvement plans for accreditation preparation: Findings from a national demonstration project Reena Chudgar Program Analyst, Assessment and Planning for Accreditation Preparation NACCHO 10/29/12

Presenter Disclosures (1)The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Reena Chudgar “No relationships to disclose”

By the end of this session, participants will be able to: 1.Define community health assessments (CHAs) and community health improvement plans (CHIPs) in the context of accreditation. 2.Discuss the lessons learned from a national demonstration project of local health departments who used MAPP and other community health improvement process frameworks/models to complete CHAs and CHIPs for accreditation preparation. 3.Assess the use of MAPP or other community health improvement process frameworks/models for their own community's efforts to prepare for public health accreditation. 4.Name the resources available to local health departments and their partners to conduct CHAs and CHIPs for accreditation preparation. Session Learning Objectives

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. (Adapted from National Public Health Performance Standards Program, Acronyms, Glossary, and Reference Terms, CDC,

Definition: Community Health Assessment A community health assessment is a process that uses quantitative and qualitative methods to systematically collect and analyze health status data within a specific community. The process should involve active community engagement. Health status data include information on risk factors, quality of life, mortality, morbidity, community assets, and other information that illustrates why health issues exist in a community. Community health assessment data inform community decision- making, the prioritization of health problems, and the development and implementation of community health improvement plans. (Issel 2004, Cibula et al 2003, Dever 1997)

Definition: Community Health Improvement Plan An action-oriented plan outlining the priority community health issues (based on the community health assessment findings and community member and LPHS partner input) and how these issues will be addressed, including strategies and performance measures, to improve the health of a community. The CHIP is developed through the community health improvement process.

7 National Context Public Health Accreditation Board Patient Protection and Affordable Care Act of 2010: IRS Community Benefit Requirement Program-specific assessments Economic Downturn Other organizations conducting similar work or CHAs (e.g., FQHCs, United Way)

8 Momentum and Opportunity Collaborate Leverage and share resources Meet multiple organizations’ requirements Increase efficiency Quality Improvement

National Accreditation of Health Departments Goal: To improve and protect the health of every community by advancing the quality and performance of public health departments (state, local, tribal, territorial) Accreditation is a status that provides public notification that an agency meets standards of quality set forth by an accrediting agency Public Health Accreditation Board’s program launched in September 2011

Accreditation Prerequisites 1.Community Health Assessment (CHA) 2.Community Health Improvement Plan (CHIP) 3.Agency Strategic Plan

Community 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  *Not required by PHAB

Association for Community Health Improvement Framework

13 Mobilizing: Engaging the community Action: Implementing a health improvement plan Planning: Applying strategic planning concepts Partnerships: Involving local public health system and community partners Mobilizing for Action Though Planning and Partnerships

14 MAPP Overview

CHAs and CHIPs for Accreditation Preparation Demonstration Project Goal: To increase the readiness of local health departments (LHDs) to apply for PHAB accreditation by building the capacity of LHDs to engage in a community health improvement process that yields a CHA and a CHIP, two of the three prerequisites for PHAB accreditation application. Funded by the Robert Wood Johnson Foundation

16 CHAs and CHIPs for Accreditation Preparation Demonstration Project Demonstration sites will produce CHAs and CHIPs that will: (1)Engage community members and local public health partners in a meaningful way; (2)Address the social determinants of health; and (3)Use quality improvement and quality planning techniques. These CHAs and CHIPs are intended to serve as exemplary CHAs and CHIPs for accreditation preparation.

17 CHAs and CHIPs for Accreditation Preparation Demonstration Project The project also aims to: Model meaningful LHD collaboration with select local public health system (LPHS) partners in the community health improvement process.

18 CHAs and CHIPs for Accreditation Preparation Demonstration Project The demonstration sites received: A $35,000 grant Comprehensive in-person and Web-based training and technical assistance

19 CHAs and CHIPs for Accreditation Preparation Demonstration Sites

20 Demonstration Site Specifics 10 of the 12 sites are using MAPP 2 of the 12 sites are using the Association for Community Health Improvement (ACHI) Framework Vary in levels of experience in completing a community health improvement process Vary in size, location and type of populations served

21 Project-specific Approaches #1: LHDs that co-lead the community health improvement process with non-profit hospital(s) to conduct a CHA and develop a CHIP that meet the requirements for this project and substantially helps the hospital(s) fulfill their community health needs assessment requirement, such as the IRS community benefit requirement. 5 Sites #2: Regional or district LHDs (i.e., single-governance entities that serve two or more counties, townships, cities, etc.) in which the CHA and CHIP reflect the needs of all governmental jurisdictions. 2 Sites #3: Two or more LHDs, with a formal agreement to share services, that jointly conduct a CHA and develop a CHIP(s) that reflect the needs of all participating jurisdictions. 2 Sites #4: LHDs that collaborate with a tribe(s) in their jurisdiction, in which the CHA and CHIP reflect the needs of the tribe as well as the broader community. 1 Site #5: LHDs that receive assistance in undertaking the community health improvement process from academic institutions. 5 Sites #6: LHDs that partner with a public health institute in the community health improvement process. 1 Site

Community 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 22

23 Demonstration Site Strategies for Success During the Preparing and Planning Phase Review PHAB Standards and Measures upfront to know what is expected Choose a model/framework that works for your community Plan Plan Plan! Ensure enough time for planning and implementation Create a timeline

Community Health Improvement Process Steps  Prepare and Plan  Engage Partners and Community  Develop a Vision  Conduct Health Assessment(s)  Prioritize Health Issues  Develop a Health Improvement Plan  Implement Health Improvement Plan  Evaluate and Monitor 24

25 Demonstration Site Strategies for Success During the Engagement Phase Engage partners throughout the process, not just the start Spend ample time engaging partners upfront and explaining the value and mutual benefit Identify champions Use the process as an opportunity to increase knowledge of health department’s role in community Provide and share information in a language that everyone can understand Communicate with governing entities early and often Institutionalize partnerships by formal agreement Establish roles, responsibilities and expectations for all involved Communicate openly Balance time commitment with understanding that all are busy

Community Health Improvement Process Steps  Prepare and Plan  Engage Partners and Community  Develop a Vision  Conduct Health Assessment(s)  Prioritize Health Issues  Develop a Health Improvement Plan  Implement Health Improvement Plan  Evaluate and Monitor 26

27 Demonstration Site Strategies for Success During Developing a Vision Ensure a broad spectrum of partners are involved in visioning Consider using a neutral facilitator for the session Do not get hung up on language/wording if it is holding back progress Use the vision statement throughout the process moving forward to keep focused

Community Health Improvement Process Steps  Prepare and Plan  Engage Partners and Community  Develop a Vision  Conduct Health Assessment(s)  Prioritize Health Issues  Develop a Health Improvement Plan  Implement Health Improvement Plan  Evaluate and Monitor 28

29 Demonstration Site Strategies for Success During Conducting the CHA Do not reinvent the wheel – use data, resources, etc. that already exist Do not get caught up in collecting too much information - Ensure there’s enough time for planning and implementation Use social media to communicate out information Use qualitative, quantitative, primary, and secondary data

Community Health Improvement Process Steps  Prepare and Plan  Engage Partners and Community  Develop a Vision  Conduct Health Assessment(s)  Prioritize Health Issues  Develop a Health Improvement Plan  Implement Health Improvement Plan  Evaluate and Monitor 30

31 Demonstration Site Strategies for Success During Prioritization of Issues Involve key stakeholders to ensure buy-in Determine goals, criteria and methods in advance of the meeting Ensure all participants have access to data and other information that will be used

Community Health Improvement Process Steps  Prepare and Plan  Engage Partners and Community  Develop a Vision  Conduct Health Assessment(s)  Prioritize Health Issues  Develop a Health Improvement Plan  Implement Health Improvement Plan  Evaluate and Monitor 32

33 Demonstration Site Strategies for Success During Developing the CHIP Consider incorporating early wins Acknowledge that not everything can be accomplished so focus on the vital few among the important many Create an action plan that provides clear roles and responsibilities Plan for future meetings to check on progress

Community Health Improvement Process Steps  Prepare and Plan  Engage Partners and Community  Develop a Vision  Conduct Health Assessment(s)  Prioritize Health Issues  Develop a Health Improvement Plan  Implement Health Improvement Plan  Evaluate and Monitor 34

35 Demonstration Site Successes Use of a framework/model provided structure and access to many resources Resulted in new or strengthened partnerships Leveraging of resources Alignment of similar initiatives in community Opportunity to increase knowledge of the local health department’s role in community Received press coverage Setting the foundation Dividing and conquering for great impact Use of Quality Improvement and Quality Planning techniques Received great community response

36 Demonstration Site Challenges Time Staff/Manpower Transition in key players and partners Sustaining momentum - through process and partner engagement Diverse understanding of Social Determinants of Health

37 CHA/CHIP Resource Center Online, public resource center Provides practical, customizable tools and resources such as: Community vision statements. Advisory committee invitations. Tip sheet on prioritization methods. Contains free, archived CHA and CHIP training webinars and materials By early 2013 it will contain the example CHAs and CHIPs from the demonstration sites

38 Other NACCHO Resources MAPP Clearinghouse of Resources: Accreditation Preparation and Quality Improvement Website:

39 Reena Chudgar Program Analyst, Assessment and Planning for Accreditation Preparation NACCHO