1. CONDUCTED IN SUMMER 2011 Local Public Health Agencies in Colorado Baseline Review

2. Objectives Present a summary of the purpose and results of Colorado’s 2011 Baseline Review Summarize how this effort connects with other national initiatives Hear from you about how this information can be helpful

3. Why understanding public health activities, funding and staffing matters Health care and other sectors Measuring performance begins with understanding the current system Comparisons with more or less robust systems helps to provide a rationale for your needs Identifying your own capacity and needs for improvement through:  Comparisons to other, similar agencies  Information for sharing information and services with other agencies  Potential ideas for improvement or implementation that other agencies are doing

4. National Efforts RWJF investments National Surveys  NACCHO, NALBOH, ASTHO  Data Harmonization Project  PHSSR Agenda  PHAST  PHUD$  MPROVE CDC’s National Public Health Improvement Initiative (funding for this project) IOM Report on measurement

5. Similar Efforts Currently, service delivery measures are not well understood Other states have struggled to collect service delivery across their state system  Minnesota  Washington  Ohio

6. Colorado Efforts NACCHO Profile response rates NACCHO Profile testing project PHAST participation Annual report (to OPP) Baseline Review PHSSR Core Services research project MPROVE

7. Today’s Focus NACCHO Profile response rates NACCHO Profile testing project PHAST participation Annual report (to OPP) Baseline Review PHSSR Core Services research project MPROVE With a little additional information thrown in

8. Baseline Review Purpose:  Catalogue current capacity of the CO system  Inform core services and funding discussions  Identify areas for improvement  Fulfill CDC grant objectives  Serve as the Annual Report to then be updated yearly Methods:  Tool questions reviewed by PHISC and task force members  Pre-populated tool with formerly gathered data (NACCHO profile)  3-4 hour site visits March through August, 2011

9. Review Included: Core Services Sections: Assessment/Planning, Vital Records, Communicable Disease, Prevention and Population Health Promotion (Chronic Disease, Injuries, Behavioral and Mental Health, Maternal and Child Health), Environmental Health, Emergency Preparedness Other Direct Services Provided Administrative/ Governance Sections: Structure, Governance, Human Resources (workforce), Financial

10. Core Services: Core Questions 1. Who provides service in your jurisdiction 2. Do you share this service 3. Could this service be shared 4. Monitoring the service 5. FTE dedicated to service 6. Service adequately staffed 7. Trainings needed for staff dedicated to service 8. Funding for service 9. Funding % based on sources 10. Stability of funding 11. Resources that have been cut 12. Service adequacy for population 13. Additional resources needed 14. Rate CDPHE in consultation, TA and training 15. What improvements are needed in this service delivery

11. Methods: Baseline Review of LPHA’s Conducted Spring/Summer 2011 All local public health agencies participated  Extensive tool filled out prior to visit  3-4 hour interview  Directors and staff members  Board of health members (uncommon)  Data review and resubmission for any additional gaps

12. Baseline Review Tool Used existing and validated tools as a starting point for development of Baseline Review Tool  NACCHO Profile  Minnesota’s Local Public Health Planning and Performance Measurement Reporting System  Washington’s Activities and Service Inventory  McKinsey Capacity Assessment Grid

13. NACCHO Profile 2010

14. Baseline Review Tool Included all Core Services  Assessment, Planning, and Communication  Vital Records and Statistics  Communicable Disease Prevention, Investigation, and Control  Prevention and Population Health Promotion  Emergency Preparedness and Response  Environmental Health  Administration and Governance

15. Baseline Review Tool Service categories within each core service  Chronic Disease prevention within prevention and promotion Service areas within each category  Nutrition Promotion in Chronic Disease prevention Service activities within each area  Educational Materials or Policy Development within Nutrition Promotion

17. How is this service provided or assured? 3 = LPHA provides this service/activity. This includes main and satellite offices 2 = Provided by Another Agency (listed) 1 = This service/activity is needed but not available within jurisdiction 0 = This service/activity is not applicable within jurisdiction

18. Who provides a service in your jurisdiction? LPHA at Main Office Satellite Office Other County Office (please name) Obtained from another LPHA (please name) CDPHE Regional staff (CDPHE employees) CDPHE funded staff in regions Someone else (Please name) Contracted out by LPHA (Please name) Not available in jurisdiction Unknown Provided to another LPHA

19. Self-Reported Capacity For each category within core services the following question was asked:  How would you rank your jurisdiction’s capacity to implement [core service category] at this point in time?  Selection Options 1 = Clear need for increased capacity 2 = Basic level of capacity in place 3 = Moderate level of capacity in place 4 = High level of capacity in place  Adapted from McKinsey’s Capacity Grid

20. Self-Reported Capacity 4 = High level of capacity in place defined as:  Stable funding, staffing, and facilities  Majority of target population is served, including those with health disparities  Ability to measure outcomes and address needed improvements  Uses current knowledge and best practices in delivery of service  Follows current national standards [if available]  Ability to seek new initiatives and access funding based on community needs  Service is supported by elected officials and well-connected with other system partners

21. So, What did we learn?

22. Assessment and Planning General Assessment and Planning Questions  What assessment had been done by last summer  Employees dedicated to Assessment and Planning  Funding dedicated to Assessment and Planning  Areas for improvement at the local jurisdictions  Capacity in Assessment and Planning

23. Comprehensive Community Health Assessment

24. Current CHAPS Progress

25. Assessment and Planning: Self-Reported Capacity

27. Assessment and Planning: Areas for Improvement

28. Number of agencies

29. Staffing How many contracted staff and FTE are dedicated to Assessment and Planning?  Mean Number of People = 2.4  Mean FTE = 0.99  31% did not have any staff dedicated to Assessment and Planning

30. Funding Sources of funding for Assessment and Planning  Percent of agencies reported by type of funding  STATE PER CAPITA (33% of agencies)  COUNTY (22% of agencies)  STATE DIRECT (not per capita) (18% of agencies)

31. Vital Records 43% of LPHA’s provide vital records services, directly 57% of LPHA’s have a formal MOU with county clerks, treasurers, etc, to perform vital records services. 7 counties made positive changes since the Public Health Act by moving records out of homes.

32. Questions? Thoughts? Comments?

33. Communicable Disease General Communicable Disease Questions  Who is doing what within Communicable Disease  Employees dedicated to Communicable Disease  Funding dedicated to Communicable Disease  Areas for improvement at the local jurisdictions  Capacity in Communicable Disease

34. Communicable Disease

35. Communicable Disease: Self-Reported Capacity Immunizations Collect and report disease information and investigate Disease transmission Capacity Option#%#%#% 112%00%48% 212%816%1936% 32242%2447%1936% 42955%1937%1121%

36. Communicable Disease: Self-Reported Capacity

37. Communicable Disease: Areas for Improvement Communicable Disease No Improvement36% Differently Qualified Staff611% More TA917% More Partnerships1019% Other1019% More data/evaluation1732% More Staff2343% More Training for staff2649% More Operations Funding3260%

38. Communicable Disease: Areas for Improvement

39. Staffing How many contracted staff and FTE are dedicated to Communicable Disease?  Mean Number of People = 3.5  Mean FTE = 2.3  11% did not have any staff dedicated to Communicable Diseases

40. Funding Common sources for Communicable Disease Percent of agencies reported by type of funding  STATE DIRECT (not per capita) (43% of agencies)  COUNTY (35% of agencies)  FEDERAL, PASSED THROUGH STATE (28% of agencies)

41. Questions? Thoughts? Comments?

42. Prevention and Promotion General Prevention and Promotion Questions  Who is doing what is Prevention and Promotion  Employees dedicated to Prevention and Promotion  Funding dedicated to Prevention and Promotion  Areas for improvement at the local jurisdictions  Capacity in Prevention and Promotion

43. Prevention & Promotion

44. Prevention and Promotion: Self-Reported Capacity Communicable disease prevention Chronic disease prevention Maternal & child health Injury prevention Capacity Option #%#%#%#% 124%1325%1223%2956% 21426%2038%1325%1529% 32547%1631%2242%713% 41223%36%611%12%

45. Prevention and Promotion: Self-Reported Capacity

46. Prevention and Promotion: Areas for Improvement Prevention & Promotion No Improvements Needed00% Other36% More Technical Assistance1426% Differently Qualified Staff1731% More data/evaluation2037% More Partnerships2139% More Training for Staff2546% More Staff3769% More Operations Funding3769%

47. Prevention and Promotion: Areas for Improvement

48. Staffing How many contracted staff and FTE are dedicated to Prevention and Promotion?  Mean Number of People = 5.2  Mean FTE = 4.8  12% did not have any staff dedicated to Prevention and Promotion

49. Funding Common funding sources for Prevention and Promotion  STATE DIRECT (not per capita) (41% of agencies)  STATE PER CAPITA (31% of agencies)  COUNTY (31% of agencies)  FEDERAL, PASSED THROUGH STATE (30% of agencies)  FOUNDATIONS (30% of agencies)

50. Direct Services

51. Questions? Thoughts? Comments?

52. Environmental Health General Environmental Health Questions  What assessment have been done  Employees dedicated to Environmental Health  Funding dedicated to Environmental Health  Areas for improvement at the local jurisdictions  Capacity in Environmental Health

53. Environmental Health

54. Environmental Health: Self-Reported Capacity Sanitation of Institutional Facilities Food Safety Zoonotic and vector borne disease Air qualityWater Community design and planning WasteOther Capacity Option #%#%#%#%#%#%#%#% 1920%715%37%1329%9 20 % 1534%1637%1227% 21124%37%2043%1431%1432%1125%1126%1943% 31941%1430%1533%1533%1125%1023%1023%9 20 % 4715%2248%817%37%1023%818%614%49%

55. Environmental Health: Self-Reported Capacity

56. Environmental Health: Areas for Improvement Environmental Health No Improvements Needed24% Differently Qualified Staff59% More Technical Assistance1019% More data/evaluation1223% Other1426% More Partnerships1426% More Staff2038% More Operations Funding2445% More Training for Staff2547%

57. Environmental Health: Areas for Improvement

58. Staffing How many contracted staff and FTE are dedicated to Environmental Health?  Mean Number of People = 5.4  Mean FTE = 4.8  19% did not have any staff dedicated to Environmental Health

59. Environmental Health

60. Questions? Thoughts? Comments?

61. Emergency Preparedness & Response General Emergency Preparedness Questions  What assessment have been done  Employees dedicated to Emergency Preparedness  Funding dedicated to Emergency Preparedness  Areas for improvement at the local jurisdictions  Capacity in Emergency Preparedness

62. Emergency Preparedness & Response

63. EPR: Self-Reported Capacity Emergency Preparedness & Response Capacity Option#% 1 = Clear need for increased capacity00% 2 = Basic level of capacity in place1021% 3 = Moderate level of capacity in place2655% 4 = High level of capacity in place1123%

64. EPR: Self-Reported Capacity

65. EPR: Areas for Improvement

67. Staffing How many contracted staff and FTE are dedicated to Emergency Preparedness and Response?  Mean Number of People = 3.1  Mean FTE = 1.4  2.2% did not have any staff dedicated to EPR

68. Funding Primary funding sources for EPR  FEDERAL, PASSED THROUGH STATE (67%)  COUNTY (13%)  STATE DIRECT (not per capita) (13%)  FOUNDATIONS (6%)

69. Questions? Thoughts? Comments?

70. Statewide: How do regions view their capacity? The following tables present self reported capacity by region  0-1.99 in red-lowest  2.00-2.99 in yellow-moderate  3.00-4.00 in green-highest

71. Assessment and Planning Collect and report disease info, investigate cases of reportable diseases Immunizations Prevent Disease Transmission Emergency Preparedness & Response Eastern Corridor 2.003.754.003.503.33 Southeast 2.173.203.503.00 San Luis Valley 1.673.003.502.172.83 Southwest 1.752.753.752.75 West Central 2.673.003.503.333.00 Northwest 1.502.753.252.253.25 Western Corridor 1.603.253.402.202.33 South 1.673.753.502.753.25 Central 2.003.00 1.503.00 Large Agencies* 2.633.50 3.003.20 *Population > 70,000 State2.043.223.492.703.02

72. Communicable Disease prevention and education Chronic Diseases, prevention and education Maternal and Child Health Promotion, Prevention and Education Injury Prevention and Education Eastern Corridor 3.002.503.502.00 Southeast 2.802.502.172.00 San Luis Valley 2.671.67 1.33 Southwest 2.752.00 1.25 West Central 3.332.002.831.83 Northwest 2.503.002.501.50 Western Corridor 2.201.752.001.75 South 3.002.752.501.25 Central 2.752.002.501.75 Large Agencies* 3.202.002.601.50 *Population > 70,000 State 2.892.172.421.62

73. Safety of food provided to the public Sanitation of institutional facilities Zoonotic and vector-borne environ. hazards Air-borne environ. hazards Water-borne public health environ. hazards and surface and ground water Land use planning and sustainable development Solid and hazardous waste and recycling and reuse Other public health threats related to environ. health hazards Eastern Corridor 2.33 1.672.333.002.33 Southeast 3.40 2.202.401.40 1.80 San Luis Valley 2.331.672.171.171.33 1.17 Southwest 3.002.252.751.501.751.501.251.67 West Central 3.252.752.502.252.752.502.752.50 Northwest 3.50 2.002.50 1.502.00 Western Corridor 2.401.601.80 3.002.202.401.40 South 3.252.752.00 2.752.33 2.50 Central 3.672.333.333.503.003.502.50 Large Agencies* 3.702.903.102.903.303.102.802.90 *Population > 70,000 State 3.112.522.612.182.502.252.142.11

74. Questions on data so far?

75. Ongoing data analysis Research Projects  Core Services Research  Multi-network Practice and Outcome Variation Examination (MPROVE) Study Both Projects will use collected data to find and understand the best measures for service delivery

76. Your thoughts What uses do you see for this data? How can we organize the data to help you? What other information asked in the Baseline Review would be useful for you in your work? What kind of report/reports would you like to see out of this work? What kind of report would you use?

77. Let’s Discuss

78. Contact Kathleen Matthews  Office of Planning and Partnership, CDPHE  Kathleen.matthews@state.co.us Lisa VanRaemdonck  Colorado Association of Local Public Health Officials  lisa@calpho.org Sarah Lampe  Colorado Association Local Public Health Officials  sarah@calpho.org

79. Service Area in Communicable Disease Prevention and Promotion by Capacity

80. Total Topic Score = The Numbered entered into the box corresponding to that service area. Therefore, the higher the score the more likely the public health agency delivers the service The lower the score the more likely the service is not available within the jurisdiction

81. Service Area in Communicable Disease Prevention and Promotion by Capacity Each Series here represents the self-reported capacity selected for communicable disease prevention and promotion. Series 1 = Clear need for increased capacity Series 2 = Basic level of capacity in place Series 3 = Moderate level of capacity in place Series 4 = High level of capacity in place

82. Service Area in Communicable Disease Prevention and Promotion by Capacity