1. Interventions and Subinterventions

2. SPHERE Framework SPHERE Uses the “Intervention Model” as the Framework for the System This model defines the scope of public health practice by: –Level of practice –Type of intervention

3. SPHERE Documents and Evaluates Public Health Activities: Using the following levels of practice:  Individual/Household (demographics & activities)  Community (activities)  System (activities) Utilizing 18 interventions

4. SPHERE Activities

5. Levels of Practice Interventions at each level of practice contribute to the overall goal of improving population health status No one level of practice is more important than another Most public health problems are addressed at all three levels, often simultaneously

6. Public Health Activities - Individual/Household Focus Changes knowledge, attitudes, beliefs, practices, and behaviors of individuals and households Directed at individuals, alone or as part of a family/household Individuals receive services because they are identified as belonging to a population-at-risk

7. Public Health Activities - Community Focus Changes community norms,attitudes, awareness, practices, and behaviors Directed toward entire populations within the community or target groups within those populations Measured in terms of what proportion of the population actually changes

8. Public Health Activities - Systems Focus Changes organizations, policies, laws, and power structures Focus is not directly on individuals and communities Focus is on the systems that impact health Effective and long-lasting way to impact population health

9. Public Health Problem Addressed at All Three Levels Problem: Smoking rates continue to rise among adolescents and low-income pregnant women

10. Smoking Rates Addressed at the Individual/Household Level WIC nutritionists counsel pregnant women enrolled in the WIC Program about the effects of smoking on their health and their baby’s health

11. Smoking Rates Addressed at the Community Level Public health nurses coordinate youth led, adult supported, social marketing campaigns intending to change the community norms regarding adolescents’ tobacco use Health Educators teach middle school health classes that –increase knowledge about the risks of smoking –change attitudes toward tobacco use –improve “refusal skills” among youth 12-14 years of age

12. Smoking Rates Addressed at the Systems Level The Health Officer facilitates community coalitions that advocate the city council to remove cigarette vending machines within the city limits

13. Interventions Actions taken on behalf of individuals, families, systems, and communities to improve or protect health status

14. Implementing Interventions Not every intervention can be applied at the individual/household, community, or systems level Interventions are not distinct from one another and overlap Interventions are grouped with related interventions –groups or “wedges” are color coordinated In SPHERE, Policy Development and Policy Enforcement are separated into two interventions

15. Minnesota Public Health Interventions Model

16. Activities defined by 18 Public Health Interventions (Minnesota Model) Surveillance Disease Investigation Outreach Case Finding Screening Delegated Function Referral/Follow-up Case Management Health Teaching Counseling Consultation Collaboration Coalition Building Community Organizing Advocacy Social Marketing Policy Development Policy Enforcement

22. Minnesota Public Health Intervention Information http://www.health.state.mn.us/divs/chs/ phn/resources.html

23. Individual/HH Activity

24. Community Activity

25. System Activity

26. Subinterventions Are specific areas/topics that are connected to each intervention Some subinterventions include more specific detailed screens

27. Interventions

28. Subinterventions

29. Detail Screens

30. SPHERE Examples Utilizing Level of Practice and Interventions

31. SURVEILLANCE Community Level –WIC Project Directors review Prenatal & Pediatric Nutrition Surveillance Data for trends –PHNs continue to study trends in the increased rate of STIs in the community Systems Level –The Regional CSHCN Center  Provides the central intake function for CSHCN for the entire region  Data is reviewed on the types of referrals received and the types of services needed.

32. DISEASE & HEALTH EVENT INVESTIGATION Individual/Household Level –Conducting a SIDS/Other Infant Death Follow-up with parents who recently lost a 4 month-old –Investigating a fever/rash illness in a 6 year-old Community Level –Staff work with people in the shelter following a tornado in the community –Concerns arise about the mental health of the children who have been displaced  Special activities are set-up for the children

33. OUTREACH

34. CASE-FINDING Operates only at the Individual/Household Level Serves as the individual/household level of intervention for –Surveillance –Disease and Other Health Event Investigation –Outreach –Screening Implemented to locate those most at risk

35. SCREENING & CASE FINDING Individual/Household PHN works with a family that has an 8 month-old child with suggested possible delays in some developmental areas –Screening  Done with Denver 2 –Case-Finding  Delays found on Denver 2  Rescreen in 1 month

36. SCREENING Individual/Household Level –WIC Nutritionist completes a Height/ Weight on a child –PHN completes an Oral Health Assessment on a 10 year-old child –Health Educator conducts a Nutrition and Physical Activity Assessment/Screening on a Pregnant Woman Systems Level –The LHD receives family planning monies  contract to a local clinic for the provision of family planning services to low-income women  LHD negotiates a requirement in the contract that the clinic must routinely screen all family planning clients for STIs

37. SCREENING VERSUS DELEGATED FUNCTIONS Many different disciplines using the system Needed to protect the practice of all disciplines and the System was designed taking that into account What is a delegated function for one discipline may not be for another but need to protect those with the strictest practice acts and laws

38. DELEGATED FUNCTIONS Individual Level –Doing a pregnancy test on a 16 year-old and providing contraceptive services –Doing a hemoglobin level on a child in the WIC Clinic –Collecting a blood specimen on a child for lead testing Community Level –An 8 year old child is diagnosed with active infectious TB  PHNs coordinate with the school nurse to screen all contacts at the child’s school

39. CASE MANAGEMENT Individual/Household Level –Perinatal Care Coordination serves are provided to 25 pregnant women not qualifying for PNCC –CSHCN Service Coordination is provided to 15 families identified with a child with special needs

40. HEALTH TEACHING Community Level –Illness Prevention is taught to Child Care Staff at the Wee Care Day Care Center –Prenatal classes are taught to low-income pregnant women –High Risk Sexual Behavior is taught to Middle and High School Health Education Classes in the community –Healthy Food Choices is taught to overweight elementary students –Proper Car Seat Installation is taught to parents in the community

41. COUNSELING Individual/Household –The WIC Nutritionist facilitates a support group for breastfeeding mothers –The Nurse Practitioner at the Family Planning Clinic counsels a 20 year-old with a positive pregnancy test regarding pregnancy outcome choices Community –The Health Educator raises community awareness about domestic violence  Goal is to change community acceptance of domestic violence through the use of radio talk shows

42. COLLABORATION Systems Level –A variety of professionals (i.e. speech and physical therapists, nurses, health educators, physicians, social workers, etc.) meet to discuss a centralized intake process to simplify access to services for children with special needs

43. ADVOCACY Individual/Household –The Public Health Nurse works with a family seeking developmental services for their child Systems –The Health Officer works with the local county board to secure funds for developmental screening of refugee children –LHD staff work with a multi-disciplinary team seeking legislative mandates for proper use of car seats for children

44. SOCIAL MARKETING Systems Level –The LHD coordinates mass media efforts on various public health and maternal and child health issues:

45. POLICY DEVELOPMENT Systems Level –Health Officer recommends to the city council that they establish an ordinance prohibiting cigarette vending machines within the city limits

46. POLICY ENFORCEMENT Individual/Household –The Health Officer enforces lead abatement orders in a house where a child with lead poisoning resides