1. Heidi Deutsch, NACCHO PACE EH Summit Louisville, KY March 28-29, 2006
MAPP: What, When & Why?
Heidi Deutsch, NACCHO
PACE EH Summit
Louisville, KY
March 28-29, 2006

2. MAPP is:
A community-wide strategic planning tool for improving public health.
A method to help communities prioritize public health issues, identify resources for addressing them, and take action.
State:
The MAPP acronym stands for Mobilizing for Action through Planning and Partnerships.
MAPP is a community-wide strategic planning tool for improving public health, as well as an action oriented process to help communities prioritize public health issues, identify resources for addressing them, and take action.

3. MAPP Origins: MAPP advances the thinking behind APEXPH.
The MAPP Tool was launched in 2001.
MAPP advanced the thinking behind APEXPH and shifted the focus from the health department to the community and local public health system.
APEXPH was developed to be used voluntarily by local health officials to assess the organization and management of the health department, provide a framework for working with community members and other organizations in assessing the health status of the community, and establish the leadership role of the health department in the community.
Launched in 2001, MAPP is a paradigm shift in the way LHDs do the business of Public Health

4. The MAPP Paradigm Shift
Ask: Why is MAPP such a paradigm shift?
MAPP is a paradigm shift in how we think about public health planning. It is a shift from operational to strategic planning; from a focus on the agency to a focus on the community and the entire public health system; from needs assessment to an emphasis on assets and resources; from a medically or service oriented model to a model that encompasses a broad definition of health; and from an “agency knows all” perspective to the belief that “everyone knows something.”
MAPP is a way of bringing everyone’s collective wisdom together. By gathering all of the assets and resources within the community, the community is able to determine how best to use all of the wisdom to create a healthier community.
Such a paradigm shift means that MAPP is a ‘new way of doing business.’

5. MAPP Overview
There are six phases in the MAPP process. This model shows the six phases in a linear fashion down the middle of the graphic. The four arrows surround the linear process to illustrate that the information and outcomes from the four MAPP assessments are crucial to driving the entire MAPP process.
These 4 assessments are what makes MAPP a very unique tool. It provides the public health system with a 360 view of what is needed to improve public health in their community.

6. The MAPP Assessments In these assessments, the community identifies:
1) community themes and strengths or “what is important to community members and what assets do we have?”. So it doesn’t just focus on needs, but also what the community has in hand to best address it’s needs.
2) forces of change or “what is occurring or might occur that will affect the community or public health system?”. These are the external issues that either challenge or assist in our efforts to improve our communities’ health.
3) community health status assessment – which gathers fairly typical health status data.
4) Finally, The NPHPSP local instrument piece of MAPP. This tool measures the capacity of the local public health system to conduct essential public health services

7. Three Keys to MAPP Strategic Thinking Community Driven Process
Focus on the Local Public Health System
State: There are three keys to MAPP.
The first key is strategic thinking. MAPP is unique because it is based on strategic planning concepts, and - in order to be successful - requires creative, long-term strategic thinking.
The second key to MAPP is that MAPP is a community driven process. MAPP relies on participation from a wide range of individuals, groups, and constituencies in the community. Since the community drives the process, the process has credibility, ensures buy-in and creates sustainability over time. It can also create greater advocacy for public health. This is a community driven process.
The third key to making MAPP successful is the use of a broad definition of the Local Public Health System.
Next slide

8. Local Public Health System
Home Health
Police
Community Centers
Churches
EMS
Corrections
MCOs
Health Department
Parks
Schools
Doctors
Elected Officials
Philanthropist
Hospitals
Mass Transit
Nursing Homes
This recognizes that public health is provided by more than just the local health department. Other organizations such as hospitals, businesses, faith organizations, and community-based organizations play a critical role in assuring the public’s health. The local public health system includes all public, private and voluntary entities, as well as individuals and informal associations that contribute to public health services.
A Public Health System is complex. Here is a depiction of the complexity of a public health system and examples of organizations and groups that comprise the network.
You can see many of the system partners represented who contribute to health and delivery of the Essential Public Health Services.
Environmental Health
Civic Groups
CHCs
Fire
Economic Development
Tribal Health
Employers
Laboratory Facilities
Drug Treatment
Mental Health

9. Benefits Increases visibility of public health.
Creates advocates for public health.
Anticipates and manages change.
Creates a stronger public health infrastructure.
Builds stronger partnerships.
Builds public health leadership.
The benefits of MAPP include
- Increases visibility of public health within the community.
- Creates advocates for public health which helps to put public health issues as a priority in local government decision making.
- There are so many new emergent threats, its difficult to be proactive. However, since 9/11 there has been a huge push for to be prepared. The MAPP process helps communities design plans that Anticipates and manages the change and new threats we face.
- And through the use of the Performance Standards, it creates a stronger public health infrastructure.
- Because it is not a tool for the LHD, but for all partners within the public health system to work on collaboratively, it Builds stronger partnerships.
- As partners begin to have a better understanding of their role within the LPHS (as not all of them will initially understand that what they do necessarily impacts public health) the local public health department’s leadership strengthens among is partners.

10. The Debate
vs.
Given all the information I’ve provided about MAPP, you are probably thinking there is not a whole lot of difference between MAPP and PACE…and you wouldn’t be wrong….
They are both strongly grounded in a community-based process.
They were both developed from a concern that APEX PH needed to go further. For PACE EH , the criticism was that APEX did not include an adequate EH component.
They both use a broad definition of public health.

11. Key Differences
MAPP is a tool for identifying and prioritizing public health issues.
PACE is a tool for identifying and prioritizing ENVIRONMENTAL health issues.
MAPP uses assessments for strategic planning and implementation
PACE EH is a:
assessment tool
strategic planning
and implementation tool
MAPP process focuses on strategic issues
PACE focus on tactical issues. 
The key differences between MAPP and PACE are that:
PACE EH is very similar in philosophy to MAPP, but looks more specifically (though uses a broad definition) on environmental health. What you get is a strategic plan for your EH priorities.
PACE can be considered an assessment tool where as, although the MAPP assessments are the driving force behind the tool, simply doing the assessments doesn’t really mean your doing MAPP. The MAPP assessments are not unique to MAPP – the are pulled and modified from existing approaches, both in PH and the business community. They are an important feature, but they, in and of themselves, are not MAPP. It is not until the data is brought together and priority areas are identified and acted upon that the value of MAPP really becomes apparent.
Members have stressed that the difference in their experience is that:
One user of the three tools felt that the difference is that the MAPP process focuses on strategic issues while APEX and PACE focus on tactical issues. 
With MAPP, a strategic issue was to “use data to develop programming,” while an APEX issue was to “reduce incidence of lung cancer” or a PACE issue to “reduce COPD associated with Air Quality.”) 
The key difference was in the “systems” approach of MAPP rather than the focus on specific diseases of conditions from APEX and PACE. 
Nevertheless, one thing to keep in mind is that PACE is a very flexible tool, so where as some communities might use it to develop more tactical plans, others we know have developed more strategic EH plans. Therefore your results really depend on the context in which is it applied.

12. PACE EH and MAPP Parallels
Phase 4
Identifying Strategic Issues
Phase 5
Formulate Goals & Strategies
Phase 6
Action Cycle
Plan – Implement - Evaluate
Phase 1
Org. for Success
Phase 2
Visioning
Phase 3 - LPHSA/NPHPS
Phase 3 - FoC
Phase 3 - CTSA
Phase 3 – CHSA
MAPP
Task 10 – Rank Issues
Task 11 – Priorities for Action
Task 12 – Design Action Plans
Task 13 - Evaluate Progress
Task 1 – Determine Comm. Cap.
Task 2 – Characterize Comm.
Task 3 – Assemble team
Task 4 – Define Goals, Obj/Scope
Task 5 – list EH issues
Task 7 – Develop Indicators
Task 8 – Select Standards
Task 9 – Develop Comparable Profiles
PACE EH
Task 6 – Analyze Issues
In these next few slides I show how the two instruments compare side by side.
In this slide we see MAPP and PACE as parallel processes. You can see where almost all of the MAPP phases and steps are also included in the PACE EH process. The only exception is the NPHPS, as there really isn’t a step within PACE EH that looks at the systems capacity to conduct the 10EPHS.
Pace is also looking at the whole system, but a subset being the EH system.

13. PACE EH as a MAPP Assessment
Phase 3
Assessments
Phase 1
Organizing for Success
NPHPS (LPHSA)
Comm. Themes/ Strengths
Forces of Change
Comm. Health Status
PACE EH
Task
5, 7 - 9
Phase 2
Vision
Phase 4
Identifying Strategic Issues
Phase 5
Formulate Goals and Strategies
Phase 6
Action Cycle
Plan – Implement - Evaluate
Task 2
Task 6
A second approach to seeing the connection between MAPP and PACE EH is to focus on the assessment function of PACE. Here, PACE can be incorporated into the assessment phase of MAPP. I would suggest this approach if EH is the impetus for doing a strategic planning process, but you don’t necessarily only want to look at EH data, but other community health indicators as well.
So here, you’d select MAPP as your primary tool, and incorporate PACE EH components.

14. MAPP Planning through PACE EH
Phase 3
Assessments
Phase 1
Organizing for Success
PACE EH
Either the entire process or Tasks 9-13
Phase 2
Vision
Phase 4
Identifying Strategic Issues
Phase 5
Formulate Goals and Strategies
Phase 6
Action Cycle
Plan – Implement - Evaluate
MAPP
EH is identified as a Strategic Issue
And finally, a third relationship is applying the planning function of PACE to the MAPP process. Here, if EH is identified as a strategic issue within the MAPP process, you might want to use the PACE process to really get a better understanding of what EH priorities your community has and what needs to be addressed first. San Antonio has taken this approach.
Given these comparisons said, NACCHO does not necessarily recommend doing both PACE and MAPP because these tools are very similar and, more importantly, very robust and can be daunting to do as individual tools. The communities that have done both tend to have more that one LHD staff person dedicated to the processes.

15. Tools You Can Use Publications NACCHO Staff
MAPP Web based Tool
On-Line TA Center
Peer Assistance Network
Clearinghouse
TA Web casts
Publications
MAPP Field Guide
MAPP Users Handbook
Journal of Public Health Management and Practice; MAPP Edition
NACCHO Staff
State:
NACCHO is here to support you as you consider to and implement MAPP. There are a number of tools you can use, many of which are accessible through NACCHO’s MAPP program page.
There are also some publications available through the NACCHO site, such as the MAPP field guide, a 24-page overview of the process, and the MAPP Users Handbook, a portable MAPP manual with step-by-step guidance and practical tips.
NACCHO has created a MAPP Peer Assistance Network that will help match new user of MAPP with MAPP mentors to answer their questions.
Your biggest resource will be the MAPP online tool. You should have a handout called the MAPP Web Guide to help you navigate the tool’s online resources, such as vignettes, worksheets, tip sheets and recommended reading.
Please let us know if there is anything we can do to assist you with your MAPP process. NACCHO staff are more than happy to help!

16. MAPP Contacts Julia Joh Elligers, MPH Senior Analyst, NACCHO
(202) , Ext. 245
Heidi Deutsch, MA, MSDM
Program Manager, NACCHO
(202) , Ext. 252