1. Writing the Community Health Improvement Plan California Gaining Ground Coalition Small County Learning Community January 14, 2016 Tamara Maciel Bannan, MPH

2. Roll Call

3. Objectives Understand what a Community Health Improvement Plan is Recognize the elements required to comply with Public Health Accreditation Board (PHAB) Standards and Measures Share examples from other departments Know where to go for resources

4. Audience Poll Who has read through the Public Health Accreditation Standards and Measures version 1.5 Standard 5.2? Click the “raise hand” button for yes Any thoughts or concerns?

5. PHAB’s Definition of a CHIP A community health improvement plan is a long- term, systematic effort to address public health problems on the basis of the results of community health assessment activities and the community health improvement process. A plan is typically updated every three to five years.

6. PHAB’s Definition of a CHIP (Cont’d) This plan is used by health and other governmental education and human service agencies, in collaboration with community partners, to set priorities and coordinate targeted resources. A community health improvement plan is critical for developing policies and defining actions to target efforts that promote and improve health.

7. A CHIP… …should define the vision for the health of the community through a collaborative process and should address the gamut of strengths, weaknesses, challenges, and opportunities that exist in the community to improve the health status of that community. … is more comprehensive than the roles and responsibilities of teh ehalth department alone.

8. Community Health Improvement Plan Key elements of the plan: Includes documentation of the process Uses a community-driven process to identify issues and themes based on the CHA report Provides a description of the process used to develop a set of priority local health issues Includes desired measurable outcomes or indicators of health and policy changes needed Lists individuals and organizations responsible for implementing strategies

9. FOUR MEASURES IN STANDARD 5.2

10. PHAB Measure 5.2.1 L A process to develop a community health improvement plan Purpose: Assess the local health department’s collaborative community health improvement planning process and stakeholder participation CHIP process includes: a.Broad participation of community partners b.Information from community health assessment c.Issues and themes identified by community stakeholders d.Identification of community assets and resources e.A process to set health priorities

11. Required Documentation 1.a. Participation of representatives from a variety of sectors of the local community Departments must document the process used to engage with diverse community sectors May or may not be the same group that has worked on the CHA Documentation could be, for example, participant lists, attendance rosters, minutes, or membership lists fro work groups or sub- committees. (sign-in sheets work well here)

12. Required Documentation 1.b. Data and information from the community health assessment provided to participants for use in the deliberations. Could have participants sign a sheet when receiving a hard copy, or use copies of emails sent to participants with the CHA attached or a link to it on the web.

13. Required Documentation 1.c. Provide evidence that the community and stakeholder discussions were held and that they identified issues and themes. Must include community members’ definition of health and of a healthy community. The list of issues identified by the community and stakeholders must be provided as documentation.

14. Required Documentation 1.d. A list, narrative, or chart of community assets and resources identified and considered in the community health improvement process. Could be anything in the community that could be utilized to improve the health of the community. Examples include: Skills of residents Power of local associations Local institutions, strong business community Parks Social capital, community resilience

15. Required Documentation 1.e. A description of the process used by participants to develop a set of priority health issues. Examples could include: Partner voting Consensus models used Prioritization matrix tool used

16. Discussion Questions Who has started working on the CHIP? Did you use the same group of CHA community stakeholders to participate in developing the CHIP? What process did you use to select health priorities? Were there any challenges?

17. PHAB Measure 5.2.2 L Community health improvement plan adopted as a result of the community health improvement planning process This measure is where the key elements for the CHIP are found. Has four sections to required documentation a.Desired measurable outcomes or indicators of health improvement and priorities for action b.Policy changes needed to accomplish health objectives c.Individuals and organizations that have accepted responsibility for strategy implementation d.Consideration of state and national priorities

18. Required Documentation 1.a. Desired measurable outcomes or indicators of the health improvement effort and priorities for action, from the perspective of community members The plan must include: Community health priorities Measurable objectives Improvement strategies and activities with time-framed targets Consideration of addressing social determinants of health and causes of higher health risks and poorer health outcomes (health inequities)

19. RD 1.a. (Cont’d) Measurable and time-framed targets may be contained in a separate document, such as an annual work plan, which must be submitted along with the CHIP for this measure. Strategies may be evidence-based, practice- based, a promising practice, or innovative to meet the needs of the community. National state-of-the-art guidance should be referenced, as appropriate. National Prevention Strategy Guide to Community Preventive Services Healthy People 2020

20. Required Documentation 1.b. Policy changes needed to accomplish the identified health objectives must be included in the plan. Must include those that are adopted to alleviate the identified causes of health inequity May address social and economic conditions that influence health equity including housing, transportation, education, job availability, neighborhood safety, access to recreational opportunities, and zoning

21. Required Documentation 1.c. Designation of individuals and organizations that have accepted responsibility for implementing strategies, outlined in the community health improvement plan. May include assignments to staff or agreements between planning participants, stakeholders, health care providers (community benefit), other local governmental agencies, or other community organizations Agreements do not need to be formal, such as an MOA/MOU

22. Required Documentation 1.d. Local health departments must demonstrate that they considered both national and state health improvement priorities where they have been established. Examples of national and state priority alignment: National Prevention Strategy Healthy People 2020 Let’s Get Healthy California

23. Discussion Questions Who has read through other department’s CHIPs? Did you find all of these elements addressed? What do you see as some of the challenges to developing a CHIP?

24. PHAB Measure 5.2.3 A Elements and strategies of the health improvement plan implemented in partnership with others Purpose: to assess the local health department’s implementation of it community health improvement plan in partnership with others Has two pieces of required documentation 1.A process to track actions taken to implement strategies in the community health improvement plan 2.Implementation of the plan

25. Required Documentation 1 A process to track actions taken to implement strategies in the community health improvement plan Departments must provide a tracking process of actions taken toward the implementation of the community health improvement plan Tracking process must specify the strategies being used, the responsible partners involved, and the status of the effort or results of the actions taken Documentation could be a narrative, table, spreadsheet, or combination

26. Required Documentation 2 Implementation of the plan Health departments must document areas of the plan that were implemented by the health department and/or its partners. Documentation examples must identify a specific achievement and describe how it was accomplished.

27. PHAB Measure 5.2.4 A Monitor and revise as needed, the strategies in the community health improvement plan in collabora- tion with broad participation from stakeholders and partners Purpose: to assess the health department’s efforts to ensure that the strategies of the CHIP are assess for feasibility and effectiveness and that they are revised as indicated by those assessments Has two pieces of required documentation 1.Report on progress made in implementing the plan 2.Review and revise the CHIP as necessary based on assessment results

28. Required Documentation 1 Report on the progress made in implementing strategies in the community health improvement plan (CHIP) The health department must provide an annual report on the progress made in implementing strategies in the CHIP* Report will consider the feasibility and the effectiveness of the strategies and/or the changing priorities, resources, or community assets.

29. Required Documentation 2 Review and revision of the health improvement plan strategies based on results of the assessment The health department must document that the health improvement plan has been reviewed and revised as necessary based on the report required in 1 above. Revisions may be in the improvement strategies, planned activities, time-frames, targets, or assigned responsibilities* They may be based on achieved activities, changing health status indicators, newly developing or identified health issues, changing resources, etc.

30. Audience Poll Has anyone started planning for the ongoing reporting and monitoring of a CHIP? Does anyone have an example of a CHIP revision to share?

31. Resources Cal-PIM Network Resources Cal-PIM Network Wisconsin Template Links to many CHIPs Others not linked to this site, but worth looking at: Sonoma County San Diego County NACCHO Resources NACCHO

32. Homework (optional) Take a close look at another department’s CHIP Compare it to the PHAB requirements Determine how you would rate the conformity with this measure based on the PHAB version 1.5 standards and measures Keep in mind that some of the departments may have worked off of version 1.0, so they may be missing some of the elements Keep a list of questions so we can discuss next month

33. Questions??? Does anyone have any final questions or comments? What did you like about today’s topic? Is there anything we could do to improve?