1. Health Assessment and Improvement Planning 201: Putting it All Together Laurie Call, IPHI Jessica Solomon Fisher, NACCHO Jim Pearsol, ASTHO May 9, 2012

2. Objectives Detail the steps to health assessment and improvement planning Share stories from health departments experienced in improvement planning Plan for implementing community health improvement processes in your community 2

3. 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. 3 (Adapted from National Public Health Performance Standards Program, Acronyms, Glossary, and Reference Terms, CDC, 2007. www.cdc.gov/nphpsp/PDF/Glossary.pdf).

4. 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 4

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6. Health Improvement Process Steps Prepare and Plan 6

7. Consider resources Select model Identify related activities Plan for community and partner engagement Create a timeline 7

8. Prepare and Plan: Determine Resources People (e.g. staff, partners, consultants) Materials and supplies Expertise (e.g. community organizing, statistics,) Financial 8

9. Prepare and Plan: Select Model Who should be involved? What are key values and principles that you want to embody? What requirements, if any, need to be considered? 9

10. Prepare and Plan: Identify Related Activities Previous assessments Program-specific assessments United Way FQHCs Hospitals Others 10

11. Prepare and Plan: Partner and Community Engagement Plan, plan, plan Ensure adequate time Consider past successes and lessons learned 11

12. Prepare and Plan: Create a Timeline Part of good planning Ensures all involved are on same page Helps in monitoring progress 12

13. Story from the field: Planning and Partnership 13

14. Health Improvement Process Steps Prepare and Plan Engage the Community 14

15. “There is a critical difference between going through the empty ritual of participation and having the real power needed to affect the outcome of the process.” (Sherry Arnstein, 1969: “A Ladder of Citizen Participation”) 15

16. Engage the Community -Consumers of Non-profit -Organizations’ Services -Neighborhood Community Groups -Media -Members of Policy Advisory Committees/Commissions -Business Owners -Members of Civic Associations -Informally Recognized Community Leaders -Youth -PTA/PTO members  16

17. Schools Dentists EMS Law Enforcement Corrections Faith Instit. NGOs Labs HCP Tribal Health City Planners Transit Fire Civic GroupsEmployers Drug Treatment Elected Officials Mental HealthCHCsPublic Health Dept Parks and Rec Nursing Homes Neighborhood Associations Home Health CBOs 17

18. Engage the Community: Elected Officials Legislators Governor County Commissioners Mayors Selectmen City Council members 18

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20. Health Improvement Process Steps Prepare and Plan Engage the Community Develop a Vision 20

21. Develop a Vision What is a vision statement? A description of a future state: want you, a group, an organization, a community, or a state is striving to achieve The statement about what you want your community or state to look like A guiding force for what you are doing An important first step, prior to conducting a health assessment Provides the framework for an indicator system 21

22. Your Vision Should… Describe the desired future state Undergo periodic review and revision Be made visible throughout the community Serve as a point of reference throughout the health improvement process 22

23. “A place where all people can enjoy the best health possible, where all can live, grow and prosper in clean and safe communities. “ “Our county will be a model community, committed to empowering all residents to achieve optimal health.” 23 “We will be a community whereby all residents are guaranteed equitable healthcare, positive health outcomes, and optimal quality of life.” “A healthier future for the people of Florida.”

24. Story from the field: Visioning 24

25. Health Improvement Process Steps Prepare and Plan Engage the Community Develop a Vision Conduct Health Assessment(s) 25

26. Conduct a HA: Steps Define the population Identify indicators Collect data Analyze data Summarize key findings Report back to the community 26

27. Define the population Consider any external or internal requirements (e.g. PHAB, non-profit hospital CHNA, etc.) Ask the community Consider population or community based on*: – political/geo-political lines, – neighborhood, and – shared interests such as ethnicity, sexual orientation or occupation 27 *Fellin 2001 as cited in Minkler, et al. (Ed). (2005). Community Organizing and Community Building for Health. Rutgers University Press: New Brunswick, NJ.

28. Identify Indicators What themes, issues or goals are most important for measuring conditions that promote the health and safety of people who live, work, play, study and worship in our community/state? 28

29. Indicators and Indicator Systems Indicators: Measures/data that describe community conditions (e.g., poverty rate, homelessness rate, number of food stamp recipients, life expectancy at birth, heart disease mortality rate) currently and over time. Helps to answer the question: How are we doing regarding the community conditions we care about? Indicator Systems: Organizes multiple indicators around topics/issues (e.g., health, housing, public safety) or goals (e.g., all residents have access to health care, affordable housing needs of all residents are met, all residents are safe in their homes and within the community). Comprehensive Indicator Systems: Focus on economic, social and environmental topics/issues or goals. 29 Source: Community Indicators Consortium

30. What indicators are you considering/using? 30

31. Identify Indicators Access to care – Late or no prenatal care Health outcomes – Adolescent birth rate Physical and environmental determinants – # of Air Quality Action days per year Risk factors – Percent overweight and obese (school-age) Social determinants – High school graduation rates 31

32. Selecting Indicators: Community Assets  Individuals’ and population groups' skills and strengths  Specific community health resources  Local organizations or groups that can be mobilized  Local institutions and their staff and physical resources  Physical assets that may be useful health improvement resources 32

33. Data Collection Plan Should include: Desired data Secondary data sources, if any Data collection instruments or methods for primary data, if needed Who will be responsible for data collection 33

34. Collect Data Quantitative Qualitative Primary Secondary 34

35. Types of Data Quantitative – data you can count Examples: rates, sums, averages; expected to be objective Qualitative – it feels like data Examples: narrative, descriptive, provides human perceptions and context; expected to be subjective 35 Source: Orange County Needs Assessment, Public Health Enterprise and Association for Community Health Improvement, 2011

36. Story from the field: Primary Data Collection 36

37. Types of Data Primary – original data collection and analysis Examples: – A telephone survey conducted in your community can be both quantitative and primary – Key informant interviews conducted can be both qualitative and primary Secondary – source other than your own research Examples: – Vital records are quantitative and secondary – Focus groups conducted by someone else can be qualitative and secondary – Data from a county or state source 37 Source: Orange County Needs Assessment, Public Health Enterprise and Association for Community Health Improvement, 2011

38. Primary data  Gain information not available in secondary data sources  Help provide context or more information on findings from secondary data analysis  Can be tailored to your particular needs  Current information  Greater control over quality  Process can increase partner engagement and support 38 Advantages Disadvantages  Can be resource-intensive (cost and time)  Bias in self-reported data  Requires technical \expertise in research Source: Orange County Needs Assessment, Public Health Enterprise and Association for Community Health Improvement, 2011

39. Data Collection Methods: Primary Quantitative Methods: – Telephone Surveys – Mail - Paper Surveys – Web-based Surveys 39

40. Data Collection Methods: Primary Qualitative Methods: – Interviews In person Telephone – Group Discussions Focus Groups Town Hall Meetings 40

41. Secondary Data  Reduces duplication in data collection  Less expensive than primary data collection  Frequently collected using standardized and tested research methods; provides some assurance of data quality  Often available by different geographies, e.g. census tract, zip code, or school district 41 Advantages Disadvantages  Limited to data already collected  Data may be from different time periods or geographic areas; limits comparisons  Potentially limited ability in ways data can be analyzed  Often older data Source: Orange County Needs Assessment, Public Health Enterprise and Association for Community Health Improvement, 2011

42. Secondary Data Sources Local, state, national databases County Health Rankings State vital records Healthy People 2020 Behavioral Risk Factor Surveillance System Youth Risk Behavior Survey Previously conducted health assessments or reports United Way Non-profit Hospital CHNA FQHC CHNA Program-specific assessments 42

43. Collect Data Partners who have access to data through their organizations Government agencies such as: state health agency, other cabinet agencies (environmental health, social services, etc.), courts, police, schools, libraries, parks, planners Non-profit organizations Managed care organizations Universities and colleges Chambers of Commerce 43

44. Important Considerations in All Data Collection Data quality and validity – Reliable data source? – Appropriate data collection methods used? – Sample used? – How old is the data? – Geographic areas covered? Communities/groups disproportionately affected by poor health outcomes All data have limitations; important to be transparent about them 44 Source: Orange County Needs Assessment, Public Health Enterprise and Association for Community Health Improvement, 2011

45. Analyze Data Quantitative – Organize data (e.g., by type, source, health indicator or category) – Ensure appropriate statistical analyses – Simplify results Qualitative – Key themes with supporting quotes and examples – Key conclusions 45

46. Summarize Key Findings Consider themes and findings from all assessment activity Identify areas of alignment and differences 46

47. Report Back to the Community I.Executive summary II.Description of CHA process I.Individuals & organizations involved II.How indicators were selected III.Data sources IV.Data analysis V.Data limitations III.Indicators & data I.Description of each indicator II.Data for each indicator I.Comparisons to peer communities, state and/or national benchmarks II.Trend data III.Cross tabulations (e.g. by age, race, neighborhood, education) IV.Summary & next steps 47

48. PHAB Standard 1.1 Participate in or conduct a collaborative process resulting in a comprehensive community health assessment.

49. Measure 1.1.1S, T/L: Participate in or conduct a state/local partnership that develops a comprehensive state/community health assessment Participation of representatives of various sectors of local community Regular Meetings Description of the process used to identify health issues and assets

50. Measure 1.1.2 S, T/L: Complete a state/Tribal/local level community health assessment Dated within the last five years Documentation that data and information from various sources contributed to the CHA and how data were obtained Description of the demographics of the population of the jurisdiction served General description of health issues and specific descriptions of population groups with particular health issues Description of contributing causes of state health challenges/community health issues Description of existing state/community assets or resources to address health issues Documentation that the state population/local community at large has had an opportunity to review and contribute to the assessment 50

51. Measure 1.1.3A: Ensure that community health assessment is accessible to agencies, organizations, and the general public Documentation that the community health assessment has been distributed to partner organizations Documentation that the community health assessment and/or its findings have been made available to the population of the jurisdiction served by the health department 51

52. Health Improvement Process Steps Prepare and Plan Engage system partners Develop a Vision Conduct Health Assessment(s) Prioritize Health Issues

53. Identify issues through priority setting exercise (s) Assure that priorities are supported by data Communicate and vet priorities among partners

54. Story from the field: Prioritizing Health Issues 54

55. Health Improvement Process Steps Prepare and Plan Engage system partners Develop a Vision Conduct Health Assessment(s) Prioritize Health Issues Develop and Implement a Health Improvement Plan

56. Develop measurable and achievable goals, objectives, and strategies for priorities and link to: – The Guide to Community Preventive Services – Guide to Clinical Preventive Services – National Resource for Evidence Based Programs and Practices Develop and implement work plan to complete HIP- including partner assignments

57. Story from the field: Action Planning 57

58. Health Improvement Process Steps Prepare and Plan Engage system partners Develop a Vision Conduct Health Assessment(s) Prioritize Health Issues Develop and Implement a Health Improvement Plan Evaluate and Monitor

59. Track implementation of work plan on a regular basis Obtain periodic partner updates on their assigned activities Match implementation plan activities to primary and secondary data sources in health assessment. Report on progress and share results widely

60. PHAB Standard 5.2 Conduct a comprehensive planning process resulting in a tribal/state/community health improvement plan

61. 5.2.1S,L: Conduct a process to develop a SHIP/CHIP Documentation of a completed health improvement planning process must include: a.Broad participation of public health system partners b.Information from the health assessment c.Issues and themes identified by the stakeholders d.Identification of assets and resources e.A process to set health issue priorities

62. 5.2.2S: Produce a SHIP as a result of the health improvement planning process A SHIP dated within the last five years must include: a.Statewide health priorities, measurable objectives, improvement strategies, and performance measures with time-framed targets b.Policy changes needed to accomplish objectives c.Individual/organizations responsible for implementing strategies d.Measurable health outcomes or indicators e.Alignment between the SHIP and Tribal, local and national priorities

63. 5.2.2L: Produce a CHIP as a result of the health improvement planning process A CHIP, dated within the last 5 years, must include: a)Community health priorities, measurable objectives, improvement strategies and performance measures with measurable and time-framed targets b)Policy changes needed to accomplish health objectives c)Individuals and organizations that have accepted responsibility for implementing strategies d)Measurable health outcomes or indicators to monitor progress e)Alignment between the community health improvement plan and the state and national priorities 63

64. 5.2.3A: Implement elements and strategies of the health improvement plan, in partnership with others The health department must provide: a.Reports of actions taken related to implementing strategies to improve health, including partners involved and status of strategies – could be a work plan b.Examples of how the plan was implemented by the department and/or partners

65. 5.2.4A Monitor progress on implementation of strategies in the HIP in collaboration with broad participation from stakeholders and partners 1. Evaluation reports on progress made in implementing HIP strategies must show: a.Monitoring of performance measures b.Progress related to health improvement indicators 2. The health department must show that the health improvement plan has been revised based on the evaluation

66. State and Local Health Departments Working Together in HA and HIP Alignment – When possible HAs/HIPs at local level should align with state HA/HIP – States may also consider how they can learn from and integrate local HAs/HIPs into state work Support – Consider sharing stories and lessons learned with colleagues – States who are working to support locals can play a variety of roles Technical assistance (TA) Connecting LHDs for peer-to-peer TA Resources (technical expertise, training, financial, when possible)

67. ASTHO Resources PHAB prerequisites, http://www.astho.org/Programs/Accreditation- and-Performance/Accreditation/Preparing-for- Accreditation/ http://www.astho.org/Programs/Accreditation- and-Performance/Accreditation/Preparing-for- Accreditation/ SHIP guidance and resources, http://www.astho.org/Display/AssetDisplay.aspx?id=65 97 67

68. NACCHO Resources MAPP, www.naccho.org/mappwww.naccho.org/mapp CHA/CHIP Resource Center, www.naccho.org/chachipresources www.naccho.org/chachipresources 68

69. Laurie Call laurie@iphionline.org Jessica Solomon Fisher Jim Pearsol jfisher@naccho.org jfisher@naccho.org jpearsol@astho.orgjpearsol@astho.org For more information