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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

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

3. Session Learning Objectives
By the end of this session, participants will be able to:
Define community health assessments (CHAs) and community health improvement plans (CHIPs) in the context of accreditation. 
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. 
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.
Name the resources available to local health departments and their partners to conduct CHAs and CHIPs for accreditation preparation.

4. 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,

5. 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)

6. 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

9. 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

10. Accreditation Prerequisites
Community Health Assessment (CHA)
Community Health Improvement Plan (CHIP)
Agency Strategic Plan

11. 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

12. Association for Community Health Improvement Framework

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

14. MAPP Overview

15. 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: 
Engage community members and local public health partners in a meaningful way;
Address the social determinants of health; and
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

22. 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

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

24. 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

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

26. 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

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

28. 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

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

30. 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

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

32. 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

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

34. 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

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