PSEP Meeting – October 16 th , 2012

1. The Brownson Model: Evidence-based Public Health from Concept to Application in MCH Barbara Gabella, MSPH – Epidemiology, Planning, and Evaluation Mandy Bakulski, RD – Maternal Wellness Unit Manager PSEP Meeting – October 16th, 2012

2. Objectives • Concept: the Brownson Model of EBPH • Describe each step • Application: addressing pregnancy-related depression • Handouts: • Concise statement • Logic model • Excerpt of Action Plan

3. What and Why?Evidence-Based Public Health (EBPH) • EBPH: A systematic method to identify, prioritize, implement, and evaluate public health strategies • Applies scientific method to practice • An approach, not a bar • Why use an EBPH approach?  Informed decision making  accountable to funders • Higher likelihood of successful implementation • Greater impact on the population • Reduction in costs or leverage funding

4. Context A pilot “portfolio” project for the MCH priority: pregnancy-related depression

5. Brownson Model Brownson, RC; Fielding JE; Maylahn CM. Ann. Rev. Public Health 2009.30:189 Timeline May-Sep 2011: Steps 1-3 Aug-Sep 2011: Lit review Oct-Nov 2011: Logic model Nov 2011: Prioritization Nov-Dec 2011: Action plan Logic Model

6. timeline Pregnancy-related depression

7. Pregnancy-related Depression PRAMS: Pregnancy Risk Assessment Monitoring System

8. Step 1: Community Assessment Define the health issue according to the needs and assets of the population or community of interest • Population characteristics, needs, values, and preferences • Resources, including practitioner expertise • Environmental and organizational context

9. Step 1: Community Assessment Pregnancy-related depression Defined pregnancy-related depression: During pregnancy or postpartum, including after a pregnancy loss Persists beyond early postpartum up to one year after birth

10. Step 1: Community Assessment (cont.) Pregnancy-related depression • Recorded Structured Input at Key Stakeholder Meetings • MCH Roundtables (Sept 2010) • Capacity Issues; Local vs. State Role • Maternal Wellness Summit (Aug 2011) • Target Audience; Assets; Threats; Opportunities; Gaps; additional Concerns

11. Step 2: Quantify the issue Measure behaviors, risk factors and disease frequency in a defined population and time frame

12. Step 2: Quantify the issue Pregnancy-related depression • In Colorado, 11% of women experience postpartum depressive symptoms. • 15% among women who did not indicate that they were married • 21% among African-American women (Colorado Department of Public Health And Environment, Health Statistics Section, Pregnancy Risk Assessment Monitoring System, 2009-2010)

13. Step 3: Develop a concise statement of the issue Purpose: To build support for the issue and focus the literature review • Includes: • Health condition or risk factor considered • Population affected • Size and scope of the problem • Prevention opportunities • Potential stakeholders • Often describes gap between the current status of a program and the desired goal.

14. Step 3: Concise issue statement Pregnancy-related depression • Public Health Issue • Programmatic Issue • Program & Policy Options

15. Step 4 What we know (lit review) Determine what strategies work to address the issue(s) identified in Steps 1-3 • Objective, systematic search and summarization of previous research • Classify or rate the level of evidence

16. What is “Evidence?” Figure 2 in Brownson RC, et al. Evidence-Based Public Health. Annu. Rev. Public Health 2009: 30 Objective Scientific literature in systematic reviews Scientific literature in one or more journal articles Public health surveillance data Program evaluations Qualitative data Community members Other stakeholders Media/marketing data Word of mouth Personal experience Subjective

17. Step 4: Levels of Evidence Brownson, RC; Fielding JE; Maylahn CM. Ann. Rev. Public Health 2009.30:180

18. Step 4 – lit review Pregnancy-related depression What is and is not effective in increasing early identification of pregnancy-related depression? Focus of the literature search: • Policy • Systems-building • Population-based services aimed at prevention or early identification

19. Step 4 – Rating the literature Pregnancy-related depression

20. Step 5: Prioritization Select: • Team – include partners, stakeholders • Criteria • Tools Assemble & share information from Steps 1-4

21. Step 5: Prioritization Pregnancy-related depression Advisory group of internal and external experts and stakeholders prioritized 5 potential strategies: • Improve insurance coverage • Enhance referral network • Develop statewide training to support providers • Raise public awareness • Explore self-administered options

22. Step 5: Prioritization Pregnancy-related depression • Rated 6 criteria from “little” to “great” for each strategy: • Promise (likelihood to lower rates) • Capacity to implement • Lasting impact • Political feasibility • Return on investment • Appropriateness for state public health

23. Steps 6 & 7: Action Plan, Evaluation

24. Logic Models • Overarching Goal ~ other programs can contribute to reaching it • Impact = long-term accomplishments • Short term Outcomes = What will be different in 1-3 years? • Informs the SMART objectives in your 3-year action plan • Medium-term Outcomes = What will be different in 4-6 years? Most likely include performance measures • Outputs = Strategies & Participants (in the change that influences the outcomes) • Inputs = staff & skills, funding, previous work? Be specific. Whirlwind tour

25. Logic Model to craft Action Plan

26. Detailed Examples Logic Model Handout Action Plan Handout

27. “Portfolio” of Living documents To sustain capacity ~ tools, templates, and resulting documents: • Community assessment report • Summary data figures and tables & data analysis plan • Concise issue statement • Evidence ratings of strategies & relevant articles • List of prioritized interventions or policies • Logic model, work plan with SMART objectives • Evaluation plan

28. What are some of the challenges and barriers to using an EBPH approach?

29. Barriers and Challenges • Additional work on top of our existing commitments • Some of this work was very new • Not a lot of peer-reviewed research • Timeline for pulling together action plan was tight • Some items in action plan depended on other partners – have to be willing to adjust if their priorities change

30. What are your session takeaways? What are your next steps in applying EBPH?

31. resources Course, articles, and textbook by Ross C. Brownson, PhD et al. at Washington University in St. Louis http://prcstl.wustl.edu/EBPH/Pages/Evidence-BasedPublicHealthCourse.aspx Colorado School of Public Health, Center for Health Practice http://publichealthpractice.org/ Mobilizing for Action through Planning and Partnerships http://www.naccho.org/topics/infrastructure/mapp/ Brownson RC, Gurney JG, Land GH. Evidence-based decision making in public health. J Public Health ManagPract 1999;5:86 –97 Brownson RC, Fielding JF, Maylahn CM. Evidence-Based Public Health. Annu. Rev. Public Health 2009; 30: 175-201. Jacobs JA, Jones E, Gabella BA, Spring B, Brownson RC. Tools for Implementing an Evidence-Based Approach in Public Health Practice. Prev Chronic Dis 2012;9:110324. DOI: http://dx.doi.org/10.5888/pcd9.110324

32. Acknowledgements Team from MCH: Linda Archer, MSN, RN Mandy Bakulski, RD Julie Davis, RN Rebecca Heck, MPH Flora Martinez, MPH Technical team developed tools & trainings: Renee Calanan, PhD ~ chronic disease epidemiologist Barbara Gabella, MSPH ~ supervising epidemiologist Julie Graves, PhD (ABD) ~ evaluator Indira Gujral, PhD ~ senior epidemiologist Ashley Juhl, MSPH ~ epidemiologist Kristin McDermott, MA ~ supervising evaluator Kerry Thomson, MPH ~ senior evaluator • Dr. Ross Brownson and the Prevention Research Center in St. Louis

33. Q&A Barbara.gabella@state.co.us Mandy.bakulski@state.co.us Logic Model