1. 1 Colorado Department of Public Health and Environment Phase V: Prioritize Issues with Stakeholders

2. A GENDA Identifying issues for prioritization Identifying viable strategies Identifying prioritization process participants Organizing the prioritization process Facilitating prioritization meetings Next steps T ODAY ’ S FOCUS 2

3. W HY C HOOSE PRIORITIES ? Many health areas are important, but with limited resources it is necessary to focus on a few areas in order to make a difference. Public health can not do it alone and needs resources and energy from other sectors. Choosing priorities is a good way to engage and align partners. Identifying a few key areas to collectively focus on results in improvement plans that are realistic and impactful. 3

4. W HAT IS A CHAPS P RIORITIZATION P ROCESS ? The CHAPS Prioritization process takes a manageable number of health and capacity issues (5-10) identified during the assessments and puts them through a scoring, ranking and discussion process with partners to determine the 1-5 focus areas of the public health improvement plan. 4

5. W HEN IN CHAPS DOES A P RIORITIZATION P ROCESS O CCUR ? After Assessment Phases 3 & 4 Before the PHIP Planning Phase 6 5 PHASE VI Local Public Health Improvement Plan PHASE V Prioritization Process PHASE IV Capacity Assessment PHASE III Community Health Assessment PHASE II Identify and Engage Stakeholders PHASE I Plan the Process

6. C OMMON STRUCTURE FOR THIS PHASE Facilitator Project Management Team Steering Committee 6

7. P UBLIC H EALTH A CCREDITATION B OARD (PHAB)S TANDARDS 7 Standard 5.2: Conduct a comprehensive planning process resulting in a state/community health improvement plan 5.2.1 L Conduct a process to develop community health improvement plan that includes:  a. Broad participation of community partners  b. Information from community health assessments  c. Issues and themes identified by stakeholders in the community  d. Identification of community assets and resources  e. A process to set community health priorities

8. P RIORITIZATION P ROCESS STEPS 1. Use assessment results to identify issues for consideration 2. Identify potential strategies to address the issues 3. Develop a summary presentation of each issue 4. Determine prioritization process participants 5. Plan the prioritization process 6. Facilitate prioritization meeting(s) to determine PHIP focus areas 7. Submit and disseminate the local PHIP 8

9. S TEP 1: U SE ASSESSMENT RESULTS TO IDENTIFY 5-10 ISSUES FOR CONSIDERATION 9 Option 1: Ask the Project Management Team which 5-10 (or so) issues “rose to the top” during the assessments. For example: What core service gaps were identified? What issues are important to improving community health given the level of need, number of residents impacted or window of opportunity to address? Hint: “Cast a Wide Net” in this first round of issue identification

10. S TEP 1 U SE ASSESSMENT RESULTS TO IDENTIFY ISSUES FOR CONSIDERATION 10 Option 2: Prior to the prioritization process meeting, present assessment findings to your steering committee. Brainstorm issues based on your findings. If more than 10 arise, consider using a process (dot stickers, ranking, clicker votes) to reduce them to a manageable number for prioritization. Option 3: Combine options 1 and 2 or use a different process entirely. These are only suggestions for identifying a manageable number of issues for the prioritization process.

11. S TEP 2: I DENTIFY S TRATEGIES TO A DDRESS THE I SSUES A strategy is a new or enhanced:  Policy (seatbelt law, tobacco control ordinance, land use regulation)  System-level change (after-hours health services, shared core public health services)  Service (restaurant inspections, family planning clinic, fluoride varnish clinics)  Infrastructure/Capacity (e.g. federally qualified health center, water system fluoridation, environmental health specialist position)  Program (emergency preparedness program, food handler training) Strategy: How an Issue gets Addressed 11

12. S TEP 2: I DENTIFY S TRATEGIES TO A DDRESS THE I SSUES It is worth spending a lot of time on this step. Strategies will “make or break” a plan. Strategies that are hard to operationalize will result in the plan “sitting on a shelf.” Strategies that are ineffective will result in a waste of resources and burn out of partners. Strategies are so important, they are one criteria in the prioritization process. If there is a great need but no good way to address it, that discussion should happen during a prioritization process. CHAPS Phase V provides suggestions for researching strategies. OPP can also provide technical assistance. Strategies are sometimes called Best Practices or Interventions. 12

13. G OOD S TRATEGY M ODEL : H EALTH I MPACT P YRAMID Counseling and EducationClinical Interventions Long-Lasting Protective Interventions not requiring ongoing clinical care Changing the context to make Individual’s default decisions healthy Address Socio-Economic Determinants of Health “Interventions (strategies) focusing on the lower levels of the pyramid tend to be more effective because they reach broader segments of society and require less individual effort.” - Dr. Thomas Frieden, CDC Director American Journal of Public Health, April 2010, Vol. 100 No. 4

14. S TEP 3: D EVELOP A P RESENTATION S UMMARIZING E ACH I SSUE FOR THE P RIORITIZATION M EETING ( S )  During the prioritization process, you will want to give participants enough information so they are able to score and rank each issue.  Use the data from your assessments.  Make sure to cover each scoring criteria... This can be done using Power Point with 3-7 slides per issue and having a discussion around strategies and capacity. 14

15. CHAPS P RIORITIZATION S CORING C RITERIA For each issue the following criteria are applied: 1. Significance to Community Health: - Prevalence of individuals affected or at risk -The degree of health disparities or impact to subpopulations 2. Ability to Impact the Issue - Existence of strategies/best practices likely to have an impact -Level of community readiness, support for change and political will 3. Capacity to Address the issue -Local organizations are prepared to take the lead -Sufficient resources (e.g., staff/dollars) are available or obtainable 15

16. S TEP 4: D ETERMINE P RIORITIZATION P ROCESS PARTICIPANTS Have been involved from the beginning and understand the issues. Can play a role in implementing the PHIP because they are: Champions, gatekeepers, policy makers, funders, and/or a lead agency Represent all issues being considered. Hint: It is okay to add new participants to the process, just make sure they are oriented before the first prioritization meeting, so they have the background necessary to score and rank issues. 16 Ideally, participants...

17. S TEP 5: P LAN THE PRIORITIZATION P ROCESS 1. Determine who will facilitate. 2. Determine the role of prioritization participants in decision making—will they choose the PHIP focus areas or make a recommendation? 3. Determine your decision making process (show of thumbs, clickers, etc.). 4. Determine your process for scoring the issues. (A scoring tool is provided which works with a clicker process or paper scoring). Hint: Using “Thumbs Up,” “Thumbs Down” & “Thumbs Sideways” to vote is an easy to way move forward by allowing someone to say they can live with a decision, even though they may not fully agree with it. 17

18. S TEP 5: P LAN THE PRIORITIZATION P ROCESS Purpose of the meeting Meeting norms (a.k.a. ground rules) Overview of decision-making roles and process Criteria for scoring Presentation/discussion on each issue (you may not get through all the issues in one meeting) Scoring of each issue Facilitated discussion on rankings Choose focus areas Identify the next steps in the planning process Hint: It may work best to score each issue immediately after it has been presented and discussed, while it is still fresh in participants’ minds. 18 6. Develop the Agenda

19. S TEP 6: F ACILITATE P RIORITIZATION M EETINGS TO D ETERMINE PHIP F OCUS A REAS You may need 1-3 meetings depending on the number of issues and participants. The meeting has four main parts: Background information Presentation of Issues Scoring/Ranking Discussion to choose Focus Areas Note: Scoring and ranking issues is not an exact science. CHAPS Phase V has sample questions to ask the group to help determine whether the ranking should stand or if some issues should be moved up or down. 19

20. T OOLS AND T EMPLATES : P HASE V W ORK P LAN Phase 5 Prioritization Results 20

21. 21 T OOLS AND T EMPLATES : S CORING T OOL T O A CCESS F ULL T OOL V ISIT “T OOLS AND T EMPLATES ” O N THE CHAPS W EBSITE Scoring on a Scale of 1 – 5: No Somewhat Yes 1 2 3 4 5

22. T ECHNICAL A SSISTANCE The Office of Planning and Partnerships is available to assist with: Strategically identifying and engaging stakeholders Identifying evidence-based strategies to address public health issues Designing a prioritization process using either an electronic response system (a.k.a. “clickers”) or other facilitation tool Identifying a facilitator 22