Madison County MAPP Committee March 12, 2008

1. Madison County MAPP Committee March 12, 2008

2. Introductions MAPP Team • Name, • Agency, • Interest for being on MAPP Team • Expectations • Assets and Contributions

3. Meeting Objectives • Share update of activities from the Visioning Sub-committee • Provide in-depth information about the four assessment components • Establish assessment subcommittees and review charge

4. Agenda • Welcome & Agenda Review • Introductions • Visioning Subcommittee - Update • The Four Assessments - Presentations • Assessment Subcommittees • Meeting Resources – Survey • Closing • Adjourn

5. Visioning Sub-committee

6. Local Health System Health Status The Four Assessments Community Themes & Strengths Forces of Change

7. National Public Health Performance Standards Program (NPHPSP) Local Public Health System Assessment

8. MAPP (Mobilizing for Action through Planning & Partnerships) Includes 4 assessments: Community Health Status Assessment Community Themes and Strengths Assessment Forces of Change Assessment Local Public Health System Assessment = (National Public Health Performance Standards Program)

9. National Activities

10. What is the Public Health System Assessment? GOAL: A tool designed to assess and improve the quality of public health practice and performance of public health systems by: • Providing performance standardsfor public health systems and encouraging their widespread use; • Engaging and leveraging national, state, and local partnerships to build a stronger foundation for public health preparedness; • Promoting continuous quality improvementof public health systems; and • Strengthening the science basefor public health practice improvement. Incorporates 4 Concepts:

11. 1. The 10 Essential Services as a Framework Defines all of the health activities that are required in a community health system Monitor health status Diagnose and investigate health problems Inform, educate and empower people Mobilize communities to address health problems Develop policies and plans Enforce laws and regulations Link people to needed health services Assure a competent workforce Evaluate health services Conduct research for new innovations

12. 2. Focuses on the Public or Community Health System Schools Neighborhd. Orgs. Employers Community Centers Faith Instit. Transit Elected Officials Drug Treatment Tribal Health Home Health Non-Profit Organizations Local Public Health Agency Hospitals Mental Health Civic Groups Corrections Fire Nursing Homes Law Enforcement Doctors EMS Laboratories CHCs

13. 3. Optimal Level of Performance Each performance or model standard represents the “gold standard”

14. 4. Stimulate Quality Improvement Standards should result in identification of areas for improvement • Link results to an improvement process “What gets measured gets done.” If you don’t measure results, you can’t tell success from failure. If you can’t recognize failure, you can’t correct it. If you can’t see success, you can’t learn from it

15. 10 Essential Services

16. Definition of Essential Service

17. Example of Model Standard & Ratings Model or “gold” Standard Measurement Questions

18. Key Steps in the Process How is the NPHPSP Implemented?

19. Identifying, Recruiting & Orienting Participants Key questions: Who plays a role in the public health system or providing the Essential Services? What expertise is needed? How many people should participate? A lot of work! (Phone calls, letters, promotional activities) Orient to NPHPSP, 10 Essential Services, Health System and purpose of assessment Importance of participation Planning and preparation is key to commitment and success

20. Facilitator & Recorder Roles Facilitator Review model standards, questions and obtain response decision Strong skills in leading group discussions Lead a group to consensus (manage disagreements, draw out dissenting opinion) Validate participants and get input from everyone Recognize and manage dominant personalities and those that need to be drawn out Keep focus on health “system” Keep process moving Trusted, assertive, patient, neutral Identify early and orient 2 Recorders: Record group responses to measurement questions Record key issues and qualitative information that shape group responses Assist the facilitator to manage time Parking lot issues

21. Retreat Generally 1-2 days Advantages: Short timeframe Maintains momentum Drawbacks: Requires time commitment Can be overwhelming Meeting Structure Series of Meetings Small Group Activities Advantages: • Allows for expertise, as needed • Less overwhelming Drawbacks: • Less cross-learning • Less consistency in response development Advantages: • Allows for expertise, as needed • Gets the work done in small pieces • Allows for more dialogue which is key Drawbacks: • Participation changes with meeting attendance • Process may seem to “drag on” • Create a Comfortable Environment • Stick to the timeframe

22. Process for Facilitating Discussions & Voting • Walk through questions one by one with follow up voting with color-coded cards • Discuss model standards for set period of time with follow up voting using color-coded cards • Discuss model standard for set period of time with facilitator and recorder judgment on responses Oneida County Experience: • Discussed EPHS & Model Standard • Smaller groups discuss and score some of the questions • Planning team judgment on responses for remaining questions.

23. Submitting Responses for a CDC Report Electronic Submission of responses to CDC: Automated analysis begins after all data is submitted Report is available within 2 hours Respondent accesses final report and downloadable data files from web scores for all Essential Services model standards several charts and graphs displaying the data raw data any data limitations

24. Oneida County Results

25. Summary of Performance on Model Standards EPHS Model Standard Met Model Standard Substantially Met Model Standard Partially Met Model Standard Not Met Monitor Health Status 1.1 Population-based community health profile 1.2 Access to and utilization of current technology 1.3 Maintenance of Population Health Registries Diagnose and investigate Health Problems 2.2 Plan for public health emergencies 2.4 Laboratory support for investigation of health threats Get results to participants immediately – build on momentum

26. Reminder! Data from the assessments reflects the system performance and are not intended to judge or compare organizations and public health agencies. This assessment is intended to assist in quality improvement.

27. Participant Comments & Lesson Learned • Cons/Areas for Improvement: • Challenging coming to consensus • Mix up work groups, make more diverse • Wording and phrasing of CDC questions ambiguous • Round tables to facilitate discussions • More discussion about the “public health system” • Better understanding of assessment questions and rating system • Send out assessment tool before meeting • Process seemed a little rushed • Assign a member from planning team to each table • More diverse community representation. Pros/Positives: Interactive process that engaged broad spectrum of participants Visuals and presentation of materials very helpful Facilitation Structured in a way that sparked good discussions Well-organized ; focused with clear expectations Small group discussions were non-threatening Combination of large group and small group discussions and activities Networking opportunities; learning about different organizations Better understanding of the “public health system” Expanded membership of the Health Coalition

28. NPHPSP TOOLS Several resources to assist with each step of the process • User Guide • Frequently-Asked-Questions, that can help you to think about the entire process. • Lessons Learned from Other Counties/States • Recommendations for structuring participation • Sample Orientation Presentations • Sample Recruitment and Follow-up Letters • Time and costs • Other Helpful Hints • Performance Improvement Resource Guides • Monthly Teleconference for users of the NPHPSP –Program Partners and Nationwide Users

29. The Community Themes and Strengths Assessment

30. Answers the question “What is important to community members and what assets do we have?”

31. Benefits • Community members become more vested in the process when they have a sense of ownership in and responsibility for the outcomes. This occurs when their concerns are genuinely considered. • The impressions and thoughts of community residents help pinpoint important issues and highlight possible solutions. • The themes and issues offer additional insight into the findings uncovered in other assessments.

32. Three Levels of Information • Open discussion to elicit community concerns, opinions, and comments • Perceptions regarding community quality of life • A map of community assets

33. Gather Information • Meetings • Focus groups • Forums • Door to door/intercept surveys • Mail surveys • Interviews • Utilize existing community groups and organizations • Promote broad participation • Select the best combination of techniques

34. What’s important? • Focus on: • opportunities vs. problems • investment vs. charity • people vs. programs • community organizations vs. government agencies • citizens vs. “clients”

35. Findings • Help to organize and identify key themes • Assists in addressing cross-cutting issues from other assessments • Useful for reporting back to MAPP Committee • Guides work when identifying strategic issues

36. Ensure community involvement and empowerment is sustained • Document conversations, discussions and meetings • Develop a master list of contacts

37. Health Status Assessment

38. Answers the questions: How healthy are our residents? What does the health status of our community look like?

39. Information regarding health status, quality of life, and risk factors in the community • Basis for analyzing and identifying community health issues • Useful for comparison to peer communities, state and national data.

40. Data Collection • Identify and collect data for core indicators • Access existing databases, recent assessments or reports • Organizational or Agency data • State, National, and local data • Identify new data sources/needs (social determinants) • Tailor to local needs and or issues • Identify and partner with research organizations • Build on what community has already done

41. Health Profiles • Based on data analysis and findings • Life-course based, e.g., Adult Health Profile • Develop visual aids that display data in an understandable and meaningful way • Recognize and appreciate difference between data are statistically significant and those that are important to the community • Disseminate and share with community

42. Monitoring • Establish a system to monitor the indicators over time • Ensures continuing health monitoring • Establishes baseline data upon which future trends can be identified • Instrumental in identifying the results of the MAPP process and evaluating success of MAPP activities

43. Findings • Provides a list of key challenges and opportunities related to community health status • Identify major health problems or high risk behaviors, cross-cutting issues, and opportunities for improving trends • Top 10-15 issues examined during strategic issue development • Summarized reports & profile development

44. Forces of Change

45. Answers the questions: “What is occurring or might occur that will affect the community or public health system?” “What specific threats or opportunities are generated by these occurrences?”

46. Forces of Change… • State and federal legislation, • Rapid technological advances, • Changes in the organization of health care services, • Shifts in economic forces • Migration in and out of community • Changing family structures • One-time events e.g. disaster • Discrete elements – e.g., proximity to a major waterway or highway

47. Identifying Forces of Change • Brainstorm to identify forces • MAPP Committee • Small groups • Community forum (s) • Newspaper clippings, national demographics, reports, recent events, etc. • Develop list and discuss • Consolidate like forces • Identify threats and opportunities • Summarize and report findings

48. Assessment Sub-Committees • Review project summaries and charge • Identify subcommittee members and appoint chairperson

49. Meeting Resources Survey

50. Closing: • What worked? What can be improved? • Next Meeting – April 9 • Agenda for next meeting • Adjourn