Centers for Disease Control and Prevention

1. The Latest in Tools for State and Community Health Improvement PlanningMelody D. ParkerPublic Health Advisor, Health Department and Systems Development BranchDivision of Public Health Performance ImprovementOffice for State, Tribal, Local and Territorial Support2012 APHA Annual Meeting Monday, October 29, 2:30–4:00 pmSession 3316.0 Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support

2. Presenter Disclosure • Melody Parker, Centers for Disease Control and Prevention • Denise Pavletic, Association of State and Territorial Health Officials • Lowrie Ward, National Association of County and City Health Officials • Michael Bilton, Association for Community Health Improvement The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose

3. Learning Objectives At the end of this session you will be able to • List at least three questions to consider when choosing a health improvement planning tool • Identify common elements in health improvement planning models and frameworks • Find additional resources on health improvement planning from a variety of sources

4. Importance of Tools • PHAB Accreditation Program Key Elements • Standards and measures across 12 domains • 10 Essential Services, administrative capacity, and governance • Intended to provide a strong foundation for all public health programs • Three prerequisites • State or community health assessment • State or community health improvement plan • Health department strategic plan • Accreditation assessment process

5. Key Definitions (Excerpted) • Community Health Assessment—identify key health needs and issues through systematic, comprehensive data collection and analysis • Community Health Improvement Process—ongoing collaborative effort to identify, analyze, and address health problems through coordinated strategies • Community Health Improvement Plan—written document used to set priorities and coordinate resources Excerpted from PHAB Standards and Measures, Version 1.0, http://www.phaboard.org

6. Common Elements in Community Health Improvement Process Models • Prepare and organize • Engage the community • Develop a goal or vision • Conduct community health assessment(s) • Prioritize health issues • Develop community health improvement plan • Implement community health improvement plan • Evaluate and monitor outcomes

7. A Variety of Tools Over Time • PATCH (1983) • APEXPH (1991) • PACE-EH (2000) • MAPP (2001) • Catholic Health Association (updated 2010) • Association for Community Health Improvement (updated 2011) • ASTHO/CDC SHIP Framework (2011)

8. Community Health Assessment and Improvement Models: Differences to Consider • Who’s facilitating the process? • What’s the scope of collaboration? • How comprehensive are the data used and issues addressed? • Are there underlying models or concepts?

9. Thank you! Melody D. Parker, MM, MLIS Public Health Advisor, Health Department and Systems Development Branch Division of Public Health Performance Improvement Office for State, Tribal, Local and Territorial Support 404.498.0362 mparker2@cdc.gov Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support

10. The Nuts & Bolts of State Health Improvement PlanningDenise Pavletic RD, MPHDirector, Public Health Systems Improvement

11. What is a State Health Improvement Plan? • A long-term systematic effort to address issues identified by the assessment and community health improvement process • Is broader than the health department and should include partners • Considered current by PHAB if developed or updated within a 5 year time period prior to application • Based on community health assessment • Relates directly to Domain 5

12. SHIP Environmental Scan • ASTHO collaborated with Purdue University’s Healthcare TAP and the CDC in 2010 • In depth look into state health improvement planning to find trends, common themes and examples • ASTHO SHIP Guidance and Resource found at http://www.astho.org/Programs/Accreditation-and-Performance/

13. A Look at National Data State Health Improvement Plan : • 54% of states reported having a SHIP developed within the last 3 years, while 46% of states had a SHIP that was developed over 3 years ago. • 58% of states indicated SHA data was used to develop the SHIP • 63% of states reported the SHIP linked to LOCAL health improvement plans

14. Lessons Learned From the Scan Our research identified 9 Basic Components of what went into a State Health Improvement Process • Establish a Planning Process or Select Model • Identify and Engage Stakeholder in Planning and Implementation • Engage in Visioning and Systems Thinking • Collect or Analyze Data • Establish Priorities & Identify Issues Through Priority Setting • Communicate/Vet Priories • Develop Objectives, Strategies, and Measures • Develop and Implement Workplan • Monitor, Evaluate, and Update the SHIP

15. 1. Establish a Planning Process or Select Model The SHIP development process can range from 12 to 48 months. A good planning process builds commitment, engages system partners as active participants, uses time efficiently and produces a plan that can be realistically implemented. Remember to: • Identify someone to drive the development process • Engage health department leadership • Engage broad-based stakeholders early on Possible Products or Activities: • Process Timeline • Steering or Planning Committee • Asset Map (Personnel and Financial) • Communications Plan Key Components

16. 2. Identify and Engage Stakeholder in Planning and Implementation Developing a SHIP is an opportunity to drive an ongoing state collaborative improvement process. The development, implementation and monitoring of a SHIP can be led by the state health agency but should be a shared responsibility among state health system partners. • Your partners should: • Be committed • Provide a broad range of perspectives • Contribute necessary resources • Be able to impact outcomes • Be diverse • Throughout the process you should: • Evaluate partner participation Key Components

18. 3. Engage in Visioning and Systems Thinking According to the MAPP strategic tool, a vision is a picture of the future you wish to create. It can help provide focus, purpose, and direction…, and mobilize participants to collectively achieve a shared vision of the future. Identifying a vision for the state can support health improvement. • During this step, the state partners address questions such as “What would we like our state and our state’s public health to look like in 10 years?” • Points to Consider • Can other visioning efforts be incorporated? • Conducts a vision effort that includes broad state representation • Hold a visioning session • Make sure to capture information and disseminate with planning group • Use a facilitator • Refer to vision statement throughout SHIP development process Key Components

19. 4. Collect or Analyze Data There are several types of data that can be used and methods for collecting data for a SHIP. For PHAB requirements, a SHIP must be data driven (should incorporate data from the state’s community health assessment) and evidence based. Including data supports the rationale for choosing the priorities and indicators in the plan. Remember that Data Should • Align with the community/state health assessment • Include health indicator and infrastructure/system capacity data Data Can Provide Information on the Following: • Themes and Strengths • Forces of Change • Health Status • System Capacity Data (e.g., NPHPSP results) Key Components

21. 5. Establish Priorities & Identify Issues Through Priority Setting A SHIP should describe the priorities that a state chooses to address over a period of time. The information gathered in the previous steps should provide the necessary information to determine what the critical issues are that need to be addressed in the SHIP. • Priorities can center on health outcomes, as well as system or infrastructure improvements Remember to: • Identify issues through priority setting exercise(s) • Priorities are supported by data • Communicate and vet priorities among partners • Be Strategic Key Components

22. 6. Communicate/Vet Priorities To ensure momentum and support from leaders and stakeholders, build momentum for implementation, and utilize broad expertise related to the selected SHIP priorities, it is important to seek input and communicate progress throughout the SHIP planning and implementation process. Steps: • Identify who needs to be communicated with • Determine how communication will occur and if feedback is necessary • Develop a communication plan with a timeline Suggestions for Modes of Communication: • Online reports, presentations, public hearings, press releases, social media, newsletters, etc. Key Components

23. 7. Develop Objectives, Strategies, and Measures Including time-framed measurable objectives in a SHIP provides a foundation for a SHIP implementation workplan and helps states track progress on the objectives for each priority over time. • While objectives should push states toward achieving higher levels of health or performance, they should also be achievable and take into account the resources available to reach them. Tips • Use evidence based interventions • Consider time frames, resources, and policies. • Be SMART! Key Components

24. 8. Develop and Implement Workplan As states identify strategies and measures for assessing outcomes, this information should be conveyed in an implementation plan (workplan). The implementation plan should indicate which organization(s) will carry out the SHIP strategies. • Steps • Develop an implementation workplan • Identify responsible partners • Include measurable outcomes, policy changes, and guidelines for monitoring • Implement the workplan by carrying out the objectives and strategies Key Components

25. 9. Monitor, Evaluate, and Update the SHIP SHIP efforts should be developed as part of a cycle that facilitates continuous quality improvement. A SHIP can be a guide for ongoing system performance measurement and quality improvement for each identified priority. States should also monitor progress and make changes to the process as needed. • Activities: • Determine appropriate check-in opportunities • Develop an evaluation for the SHIP • Determine who will evaluate the plan and make changes • EVALUATE the plan • Adjust plan as needed • Share updates • Use information for next process Key Components

26. More State Resources To Come… • State Health Assessment • State Health Improvement Plan • Strategic Plan

28. Thank You! For more information: Denise Pavletic dpavletic@astho.org Web address: http://www.astho.org/Programs/Accreditation-and-Performance/

29. <?xml version="1.0"?><AllQuestions /> <?xml version="1.0"?><AllResponses /> <?xml version="1.0"?><Settings><answerBulletFormat>Numeric</answerBulletFormat><answerNowAutoInsert>No</answerNowAutoInsert><answerNowStyle>Explosion</answerNowStyle><answerNowText>Answer Now</answerNowText><chartColors>Use PowerPoint Color Scheme</chartColors><chartType>Horizontal</chartType><correctAnswerIndicator>Checkmark</correctAnswerIndicator><countdownAutoInsert>No</countdownAutoInsert><countdownSeconds>10</countdownSeconds><countdownSound>TicToc.wav</countdownSound><countdownStyle>Box</countdownStyle><gridAutoInsert>No</gridAutoInsert><gridFillStyle>Answered</gridFillStyle><gridFillColor>255,255,0</gridFillColor><gridOpacity>50%</gridOpacity><gridTextStyle>Keypad #</gridTextStyle><inputSource>Response Devices</inputSource><multipleResponseDivisor># of Responses</multipleResponseDivisor><participantsLeaderBoard>5</participantsLeaderBoard><percentageDecimalPlaces>0</percentageDecimalPlaces><responseCounterAutoInsert>No</responseCounterAutoInsert><responseCounterStyle>Oval</responseCounterStyle><responseCounterDisplayValue># of Votes Received</responseCounterDisplayValue><insertObjectUsingColor>Red</insertObjectUsingColor><showResults>Yes</showResults><teamColors>Use PowerPoint Color Scheme</teamColors><teamIdentificationType>None</teamIdentificationType><teamScoringType>Voting pads only</teamScoringType><teamScoringDecimalPlaces>1</teamScoringDecimalPlaces><teamIdentificationItem></teamIdentificationItem><teamsLeaderBoard>5</teamsLeaderBoard><teamName1></teamName1><teamName2></teamName2><teamName3></teamName3><teamName4></teamName4><teamName5></teamName5><teamName6></teamName6><teamName7></teamName7><teamName8></teamName8><teamName9></teamName9><teamName10></teamName10><showControlBar>All Slides</showControlBar><defaultCorrectPointValue>0</defaultCorrectPointValue><defaultIncorrectPointValue>0</defaultIncorrectPointValue><chartColor1>187,224,227</chartColor1><chartColor2>51,51,153</chartColor2><chartColor3>0,153,153</chartColor3><chartColor4>153,204,0</chartColor4><chartColor5>128,128,128</chartColor5><chartColor6>0,0,0</chartColor6><chartColor7>0,102,204</chartColor7><chartColor8>204,204,255</chartColor8><chartColor9>255,0,0</chartColor9><chartColor10>255,255,0</chartColor10><teamColor1>187,224,227</teamColor1><teamColor2>51,51,153</teamColor2><teamColor3>0,153,153</teamColor3><teamColor4>153,204,0</teamColor4><teamColor5>128,128,128</teamColor5><teamColor6>0,0,0</teamColor6><teamColor7>0,102,204</teamColor7><teamColor8>204,204,255</teamColor8><teamColor9>255,0,0</teamColor9><teamColor10>255,255,0</teamColor10><displayAnswerImagesDuringVote>Yes</displayAnswerImagesDuringVote><displayAnswerImagesWithResponses>Yes</displayAnswerImagesWithResponses><displayAnswerTextDuringVote>Yes</displayAnswerTextDuringVote><displayAnswerTextWithResponses>Yes</displayAnswerTextWithResponses><questionSlideID></questionSlideID><controlBarState>Expanded</controlBarState><isGridColorKnownColor>True</isGridColorKnownColor><gridColorName>Yellow</gridColorName></Settings> <?xml version="1.0"?><AllAnswers /> Community Health Improvement Tools and Support from NACCHO Lowrie Ward, MPH, CPH Program Analyst, Accreditation Preparation & Quality Improvement National Association of County & City Health Officials

30. <?xml version="1.0"?><AllQuestions /> <?xml version="1.0"?><AllResponses /> <?xml version="1.0"?><Settings><answerBulletFormat>Numeric</answerBulletFormat><answerNowAutoInsert>No</answerNowAutoInsert><answerNowStyle>Explosion</answerNowStyle><answerNowText>Answer Now</answerNowText><chartColors>Use PowerPoint Color Scheme</chartColors><chartType>Horizontal</chartType><correctAnswerIndicator>Checkmark</correctAnswerIndicator><countdownAutoInsert>No</countdownAutoInsert><countdownSeconds>10</countdownSeconds><countdownSound>TicToc.wav</countdownSound><countdownStyle>Box</countdownStyle><gridAutoInsert>No</gridAutoInsert><gridFillStyle>Answered</gridFillStyle><gridFillColor>255,255,0</gridFillColor><gridOpacity>50%</gridOpacity><gridTextStyle>Keypad #</gridTextStyle><inputSource>Response Devices</inputSource><multipleResponseDivisor># of Responses</multipleResponseDivisor><participantsLeaderBoard>5</participantsLeaderBoard><percentageDecimalPlaces>0</percentageDecimalPlaces><responseCounterAutoInsert>No</responseCounterAutoInsert><responseCounterStyle>Oval</responseCounterStyle><responseCounterDisplayValue># of Votes Received</responseCounterDisplayValue><insertObjectUsingColor>Red</insertObjectUsingColor><showResults>Yes</showResults><teamColors>Use PowerPoint Color Scheme</teamColors><teamIdentificationType>None</teamIdentificationType><teamScoringType>Voting pads only</teamScoringType><teamScoringDecimalPlaces>1</teamScoringDecimalPlaces><teamIdentificationItem></teamIdentificationItem><teamsLeaderBoard>5</teamsLeaderBoard><teamName1></teamName1><teamName2></teamName2><teamName3></teamName3><teamName4></teamName4><teamName5></teamName5><teamName6></teamName6><teamName7></teamName7><teamName8></teamName8><teamName9></teamName9><teamName10></teamName10><showControlBar>All Slides</showControlBar><defaultCorrectPointValue>0</defaultCorrectPointValue><defaultIncorrectPointValue>0</defaultIncorrectPointValue><chartColor1>187,224,227</chartColor1><chartColor2>51,51,153</chartColor2><chartColor3>0,153,153</chartColor3><chartColor4>153,204,0</chartColor4><chartColor5>128,128,128</chartColor5><chartColor6>0,0,0</chartColor6><chartColor7>0,102,204</chartColor7><chartColor8>204,204,255</chartColor8><chartColor9>255,0,0</chartColor9><chartColor10>255,255,0</chartColor10><teamColor1>187,224,227</teamColor1><teamColor2>51,51,153</teamColor2><teamColor3>0,153,153</teamColor3><teamColor4>153,204,0</teamColor4><teamColor5>128,128,128</teamColor5><teamColor6>0,0,0</teamColor6><teamColor7>0,102,204</teamColor7><teamColor8>204,204,255</teamColor8><teamColor9>255,0,0</teamColor9><teamColor10>255,255,0</teamColor10><displayAnswerImagesDuringVote>Yes</displayAnswerImagesDuringVote><displayAnswerImagesWithResponses>Yes</displayAnswerImagesWithResponses><displayAnswerTextDuringVote>Yes</displayAnswerTextDuringVote><displayAnswerTextWithResponses>Yes</displayAnswerTextWithResponses><questionSlideID></questionSlideID><controlBarState>Expanded</controlBarState><isGridColorKnownColor>True</isGridColorKnownColor><gridColorName>Yellow</gridColorName></Settings> <?xml version="1.0"?><AllAnswers /> • The Community Health Improvement Process

31. Community Health Improvement Process

32. Police MCOs Philanthropist Churches Community Centers Nursing Homes Home Health Doctors LHD EMS Laboratory Facilities Parks Schools Elected Officials Hospitals Mass Transit Environmental Health Civic Groups Fire Tribal Health Employers Drug Treatment Corrections Economic Development Mental Health Local Public Health System Urban Planners

33. Common Elements in Community Health Improvement Process Models Prepare and plan Engage the community Develop a goal or vision Conduct community health assessment(s) Prioritize health issues Develop community health improvement plan Implement community health improvement plan Evaluate and monitor outcomes

34. Common Community Health Improvement Process Models/Frameworks • PRECEDE-PROCEED (1970s) • Planned Approach to Community Health (PATCH) (1983) • Healthy Communities (1980s) • Assessment Protocol for Excellence in Public Health (APEX PH) (1991) • Protocol for Assessing Community Excellence in Environmental Health (PACE EH) (2000) • Mobilizing for Action through Planning and Partnerships (MAPP) (2001) • Association for Community Health Improvement (ACHI) Toolkit • State-specific models/frameworks

35. Mobilizing for Action through Planning and Partnerships (MAPP) is… • A community-wide strategic planning process for improving public health. • A method to help communities prioritize public health issues, identify resources for addressing them, and take action.

36. Mobilizing: Engaging the community • Action: Implementing a health improvement plan • Planning: Applying strategic planning concepts • Partnerships: Involving local public health system and community partners

39. Community Health Assessment • A community health assessment is a systematic examination of the health status indicators for a given population that is used to identify key problems and assets in a community.

40. Community Health Assessment participating in a CHA process N=2,091 Source: 2010 Profile of National Health Departments

41. PHAB Standards and Measures: CHA • Standard 1.1: Participate in or conduct a collaborative process resulting in a comprehensive community health assessment • Measure: 1.1.1 T/L: Participate in or conduct a local partnership for the development of a comprehensive community health assessment • Measure 1.1.2 T/L: Complete a local community health assessment • Measure 1.1.3 A: Ensure that the community health assessment is accessible to agencies, organizations and the general public

42. Community Health Improvement Plan • 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.

43. Community Health Improvement Plan

44. PHAB Standards and Measures: CHIP • Standard 5.2: Conduct a comprehensive planning process resulting in a Tribal/state/community health improvement plan • Measure 5.2.1L: Conduct a process to develop a CHIP • Measure 5.2.2L: Produce a CHIP as a result of the community health improvement process • Measure 5.2.3A: Implement elements and strategies of the health improvement plan, in partnership with others • Measure 5.2.4A: Monitor progress on implementation of strategies in the CHIP in collaboration with broad participation from stakeholders and partners

45. CHA and CHIP Resources • NACCHO Accreditation Preparation and Quality Improvement website • www.naccho.org/accreditation

46. CHA and CHIP Resources NACCHO CHA/CHIP Resource Center www.naccho.org/chachipgeneral

47. CHA and CHIP Resources • Mobilizing for Action through Planning and Partnerships: • www.naccho.org/mapp

48. CHA and CHIP Resources • Mobilizing for Action through Planning and Partnerships: • www.naccho.org/mapp

49. Hospitals as Community Health Assessment and Improvement Partners Michael Bilton (mbilton@aha.org; 415-464-9211) Executive Director Association for Community Health Improvement (ACHI) – www.communityhlth.org American Hospital Association October 29, 2012 Prepared for the American Public Health Association (session 3316.0 SCI)

50. “Community health assessment is a critical strategic planning and management tool for health care organizations.” Community Health Assessment Checklist. VHA, Inc. 1994.