Accreditation: Why are we swimming in it—and, is a life raft on the way?? Matt Richardson, MPH Lee Lane April 22, 2010

In the Beginning, there was Snow… Broad Street pump Broad Street pump Report of the Sanitary Commission of Massachusetts: Lemuel Shattuck and “markers” of community health Report of the Sanitary Commission of Massachusetts: Lemuel Shattuck and “markers” of community health Discussion of LOCAL Public Health and the need for communities to protect it Discussion of LOCAL Public Health and the need for communities to protect it

Early 1900s… Charles Chapin, a physician, with the first survey! Charles Chapin, a physician, with the first survey! 1914 American Medical Association and the Council of Health and Public Instruction 1914 American Medical Association and the Council of Health and Public Instruction Surveyed activities for local health departments to define roles more clearly Surveyed activities for local health departments to define roles more clearly

Evolution is always controversial, even for “public health standards”… Haven Emerson and the Committee on Administrative Practice Report on Local Public Health Units Haven Emerson and the Committee on Administrative Practice Report on Local Public Health Units Six core public health activities in 1945: Six core public health activities in 1945: –Vital statistics –Sanitation –Communicable Disease Control –Maternal and child health –Health Education –Laboratory Services

1988: Game Changer Assessment Assessment Policy Development Policy Development Assurance Assurance Barriers to Effective Action listed: Barriers to Effective Action listed: –Lack of consensus on mission –Inadequate capacity –Disjointed decision-making without data –Inequity –Organizational Fragmentation –Inadequate knowledge

“Turning Points” to MAPP, and another Report? 2003—Now Turning Point effort Turning Point effort MAPP framework MAPP framework 10 Essential Services for Public Health 10 Essential Services for Public Health NPHPS NPHPS Future of Public Health in the 21 st Century Future of Public Health in the 21 st Century –First call for national accreditation! State efforts begin in earnest… State efforts begin in earnest…

Let’s go “Exploring…” Final recommendations on a voluntary system Final recommendations on a voluntary system National effort with many partners: NACCHO, ASTHO, NALBOH, CDC, RWJF National effort with many partners: NACCHO, ASTHO, NALBOH, CDC, RWJF The true genesis of national PH accreditation The true genesis of national PH accreditation

Texas Accreditation Discussions Texas Association of Local Health Officials (TALHO) agreed to convene an “Accreditation Committee” to examine the feasibility and interest in pursuing local public health accreditation Texas Association of Local Health Officials (TALHO) agreed to convene an “Accreditation Committee” to examine the feasibility and interest in pursuing local public health accreditation The Texas Association of Local Health Officials accreditation committee determined that there was a need for a neutral party and developed the Public Health Accreditation Council of Texas (PHACT) to carry out their plan. The Texas Association of Local Health Officials accreditation committee determined that there was a need for a neutral party and developed the Public Health Accreditation Council of Texas (PHACT) to carry out their plan.

Public Health Accreditation Council of Texas (PHACT) Developed in June of 2007 Developed in June of 2007 Voting Members include: Voting Members include: –School of Public Health –6 LHDs (2 small, 2 medium, 2 large) –State Association of County/City Health Officials (SACCHO) –2 DSHS (1 Central office, 1 HSR) –TPHA –THI –TMA Ex- Officio Members Ex- Officio Members

PHACT Mission “To assure and enhance the quality of public health in Texas by identifying and promoting the voluntary implementation of public health standards and evaluation of voluntary accreditation of local health departments on their ability to meet these standards.” “To assure and enhance the quality of public health in Texas by identifying and promoting the voluntary implementation of public health standards and evaluation of voluntary accreditation of local health departments on their ability to meet these standards.”

Activities of the PHACT 2008 – Standards Development Workgroup - Reviewed and commented on the National Public Health Performance Standards Program, NACCHO Operational Definition and ASTHO’s State Public Health Survey 2008 – Standards Development Workgroup - Reviewed and commented on the National Public Health Performance Standards Program, NACCHO Operational Definition and ASTHO’s State Public Health Survey Recommended standards best suited for assessing compliance with Domain measurements Recommended standards best suited for assessing compliance with Domain measurements

Activities of the PHACT PHAB made recommended changes to national standards PHAB made recommended changes to national standards. –PHACT agreed to and adopted the PHAB standards for Texas –PHAB called for national Beta site applications –1 Texas site awarded (ATCHHS) 2010 – PHAB contracts with TALHO on behalf of PHACT to conduct Think Tank Meetings to review Beta accreditation materials 2010 – PHAB contracts with TALHO on behalf of PHACT to conduct Think Tank Meetings to review Beta accreditation materials

Role of PHACT in National Accreditation Process Responsible for assisting LHDs in preparation for accreditation by: Responsible for assisting LHDs in preparation for accreditation by: –Providing technical assistance –Recruiting reviewers –Advocating for capacity building –Using the PHAB standards and processes to review and recommend accreditation (outside reviewers)

Initial Steps by PHACT Review leadership and membership for revised role Review leadership and membership for revised role Research and produce document of minimal LPH capacity levels for a well- functioning public health system Research and produce document of minimal LPH capacity levels for a well- functioning public health system Assess current state of LPH system Assess current state of LPH system Collect resources to assist LHDs in meeting accreditation standards Collect resources to assist LHDs in meeting accreditation standards

DSHS Regions? What exactly are they in this process? State Health Department accreditation assumed to be similar, yet distinct State Health Department accreditation assumed to be similar, yet distinct Not sure of PHACT role for Regions Not sure of PHACT role for Regions

Questions or comments? Thanks for listening! Thanks for listening!