Health Assessment and Improvement Planning 201: Putting it All Together

1. Health Assessment and Improvement Planning 201: Putting it All Together Laurie Call, IPHI Jessica Solomon Fisher, NACCHO Jim Pearsol, ASTHO May 9, 2012

2. Objectives • Detail the steps to health assessment and improvement planning • Share stories from health departments experienced in improvement planning • Plan for implementing community health improvement processes in your community

3. (Adapted from National Public Health Performance Standards Program, Acronyms, Glossary, and Reference Terms, CDC, 2007. www.cdc.gov/nphpsp/PDF/Glossary.pdf). Definition: (Community) Health Improvement Process An ongoing, collaborative, community-wide effort to identify and address health problems through coordinated activities. It may include environmental, business, economic, housing, land use, and other community issues indirectly affecting the public’s health.

4. Health Improvement Process Steps • Prepare and Plan • Engage the Community • Develop a Vision • Conduct Health Assessment(s) • Prioritize Health Issues • Develop a Health Improvement Plan • Implement Health Improvement Plan • Evaluate and Monitor

6. Health Improvement Process Steps • Prepare and Plan

7. Prepare and Plan • Consider resources • Select model • Identify related activities • Plan for community and partner engagement • Create a timeline

8. Prepare and Plan: Determine Resources • People (e.g. staff, partners, consultants) • Materials and supplies • Expertise (e.g. community organizing, statistics,) • Financial

9. Prepare and Plan: Select Model • Who should be involved? • What are key values and principles that you want to embody? • What requirements, if any, need to be considered?

10. Prepare and Plan: Identify Related Activities • Previous assessments • Program-specific assessments • United Way • FQHCs • Hospitals • Others

11. Prepare and Plan: Partner and Community Engagement • Plan, plan, plan • Ensure adequate time • Consider past successes and lessons learned

12. Prepare and Plan: Create a Timeline • Part of good planning • Ensures all involved are on same page • Helps in monitoring progress

13. Story from the field: Planning and Partnership

14. Health Improvement Process Steps • Prepare and PlanEngage the Community

15. “There is a critical difference between going through the empty ritual of participation and having the real power needed to affect the outcome of the process.” (Sherry Arnstein, 1969: “A Ladder of Citizen Participation”)

16. Engage the Community -Consumers of Non-profit -Organizations’ Services -Neighborhood Community Groups -Media -Members of Policy Advisory Committees/Commissions -Business Owners -Members of Civic Associations -Informally Recognized Community Leaders -Youth -PTA/PTO members

17. Civic Groups Employers Mental Health Parksand Rec Elected Officials Transit Public Health Dept Drug Treatment CBOs Fire Home Health CHCs Neighborhood Associations Nursing Homes HCP Faith Instit. Law Enforcement EMS Dentists Tribal Health NGOs Labs Corrections Schools City Planners

18. Engage the Community:Elected Officials • Legislators • Governor • County Commissioners • Mayors • Selectmen • City Council members

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20. Health Improvement Process Steps Prepare and Plan Engage the Community Develop a Vision

21. Develop a Vision What is a vision statement? • A description of a future state: want you, a group, an organization, a community, or a state is striving to achieve • The statement about what you want your community or state to look like • A guiding force for what you are doing • An important first step, prior to conducting a health assessment • Provides the framework for an indicator system

22. Your Vision Should… • Describe the desired future state • Undergo periodic review and revision • Be made visible throughout the community • Serve as a point of reference throughout the health improvement process

23. “A place where all people can enjoy the best health possible, where all can live, grow and prosper in clean and safe communities. “ “Our county will be a model community, committed to empowering all residents to achieve optimal health.” “A healthier future for the people of Florida.” “We will be a community whereby all residents are guaranteed equitable healthcare, positive health outcomes, and optimal quality of life.”

24. Story from the field: Visioning

25. Health Improvement Process Steps • Prepare and Plan • Engage the Community • Develop a Vision • Conduct Health Assessment(s)

26. Conduct a HA: Steps • Define the population • Identify indicators • Collect data • Analyze data • Summarize key findings • Report back to the community

27. *Fellin 2001 as cited in Minkler, et al. (Ed). (2005). Community Organizing and Community Building for Health. Rutgers University Press: New Brunswick, NJ.   Define the population • Consider any external or internal requirements (e.g. PHAB, non-profit hospital CHNA, etc.) • Ask the community • Consider population or community based on*: • political/geo-political lines, • neighborhood, and • shared interests such as ethnicity, sexual orientation or occupation

28. Identify Indicators What themes, issues or goals are most important for measuring conditions that promote the health and safety of people who live, work, play, study and worship in our community/state?

29. Indicators and Indicator Systems • Indicators: Measures/data that describe community conditions (e.g., poverty rate, homelessness rate, number of food stamp recipients, life expectancy at birth, heart disease mortality rate) currently and over time. Helps to answer the question: How are we doing regarding the community conditions we care about? • Indicator Systems: Organizes multiple indicators around topics/issues (e.g., health, housing, public safety) or goals (e.g., all residents have access to health care, affordable housing needs of all residents are met, all residents are safe in their homes and within the community). • Comprehensive Indicator Systems: Focus on economic, social and environmental topics/issues or goals. Source: Community Indicators Consortium

30. What indicators are you considering/using?

31. Identify Indicators • Access to care • Late or no prenatal care • Health outcomes • Adolescent birth rate • Physical and environmental determinants • # of Air Quality Action days per year • Risk factors • Percent overweight and obese (school-age) • Social determinants • High school graduation rates

32. Selecting Indicators: Community Assets • Individuals’ and population groups' skills and strengths • Specific community health resources • Local organizations or groups that can be mobilized • Local institutions and their staff and physical resources • Physical assets that may be useful health improvement resources

33. Data Collection Plan Should include: • Desired data • Secondary data sources, if any • Data collection instruments or methods for primary data, if needed • Who will be responsible for data collection

34. Collect Data • Quantitative • Qualitative • Primary • Secondary

35. Types of Data • Quantitative – data you can count Examples: rates, sums, averages; expected to be objective • Qualitative – it feels like data Examples: narrative, descriptive, provides human perceptions and context; expected to be subjective Source: Orange County Needs Assessment, Public Health Enterprise and Association for Community Health Improvement, 2011

36. Story from the field: Primary Data Collection

37. Types of Data • Primary – original data collection and analysis Examples: • A telephone survey conducted in your community can be both quantitative and primary • Key informant interviews conducted can be both qualitative and primary • Secondary – source other than your own research Examples: • Vital records are quantitative and secondary • Focus groups conducted by someone else can be qualitative and secondary • Data from a county or state source Source: Orange County Needs Assessment, Public Health Enterprise and Association for Community Health Improvement, 2011

38. Advantages Disadvantages Primary data • Gain information not available in secondary data sources • Help provide context or more information on findings from secondary data analysis • Can be tailored to your particular needs • Current information • Greater control over quality • Process can increase partner engagement and support Source: Orange County Needs Assessment, Public Health Enterprise and Association for Community Health Improvement, 2011 • Can be resource-intensive (cost and time) • Bias in self-reported data • Requires technical \expertise in research

39. Data Collection Methods: Primary • Quantitative Methods: • Telephone Surveys • Mail - Paper Surveys • Web-based Surveys

40. Data Collection Methods: Primary • Qualitative Methods: • Interviews • In person • Telephone • Group Discussions • Focus Groups • Town Hall Meetings

41. Advantages Disadvantages Secondary Data • Reduces duplication in data collection • Less expensive than primary data collection • Frequently collected using standardized and tested research methods; provides some assurance of data quality • Often available by different geographies, e.g. census tract, zip code, or school district Source: Orange County Needs Assessment, Public Health Enterprise and Association for Community Health Improvement, 2011 • Limited to data already collected • Data may be from different time periods or geographic areas; limits comparisons • Potentially limited ability in ways data can be analyzed • Often older data

42. Secondary Data Sources • Local, state, national databases • County Health Rankings • State vital records • Healthy People 2020 • Behavioral Risk Factor Surveillance System • Youth Risk Behavior Survey • Previously conducted health assessments or reports • United Way • Non-profit Hospital CHNA • FQHC CHNA • Program-specific assessments

43. Collect Data • Partners who have access to data through their organizations • Government agencies such as: state health agency, other cabinet agencies (environmental health , social services, etc.), courts, police, schools, libraries, parks, planners • Non-profit organizations • Managed care organizations • Universities and colleges • Chambers of Commerce

44. Important Considerations in All Data Collection • Data quality and validity • Reliable data source? • Appropriate data collection methods used? • Sample used? • How old is the data? • Geographic areas covered? • Communities/groups disproportionately affected by poor health outcomes • All data have limitations; important to be transparent about them Source: Orange County Needs Assessment, Public Health Enterprise and Association for Community Health Improvement, 2011

45. Analyze Data • Quantitative • Organize data (e.g., by type, source, health indicator or category) • Ensure appropriate statistical analyses • Simplify results • Qualitative • Key themes with supporting quotes and examples • Key conclusions

46. Summarize Key Findings • Consider themes and findings from all assessment activity • Identify areas of alignment and differences

47. Report Back to the Community • Executive summary • Description of CHA process • Individuals & organizations involved • How indicators were selected • Data sources • Data analysis • Data limitations • Indicators & data • Description of each indicator • Data for each indicator • Comparisons to peer communities, state and/or national benchmarks • Trend data • Cross tabulations (e.g. by age, race, neighborhood, education) • Summary & next steps

48. PHAB Standard 1.1 Participate in or conduct a collaborative process resulting in a comprehensive community health assessment.

49. Measure 1.1.1S, T/L: Participate in or conduct a state/local partnership that develops a comprehensive state/community health assessment • Participation of representatives of various sectors of local community • Regular Meetings • Description of the process used to identify health issues and assets

50. Measure 1.1.2 S, T/L: Complete a state/Tribal/local level community health assessment • Dated within the last five years • Documentation that data and information from various sources contributed to the CHA and how data were obtained • Description of the demographics of the population of the jurisdiction served • General description of health issues and specific descriptions of population groups with particular health issues • Description of contributing causes of state health challenges/community health issues • Description of existing state/community assets or resources to address health issues • Documentation that the state population/local community at large has had an opportunity to review and contribute to the assessment