Transcript filecache.drivetheweb.com

Local Public Health Agencies in
Colorado Baseline Review
CONDUCTED IN SUMMER 2011
Objectives
 Present a summary of the purpose and results of
Colorado’s 2011 Baseline Review
 Summarize how this effort connects with other
national initiatives
 Hear from you about how this information can be
helpful
Why understanding public health activities,
funding and staffing matters
 Health care and other sectors
 Measuring performance begins with understanding the
current system
 Comparisons with more or less robust systems helps to
provide a rationale for your needs
 Identifying your own capacity and needs for
improvement through:



Comparisons to other, similar agencies
Information for sharing information and services with other agencies
Potential ideas for improvement or implementation that other
agencies are doing
National Efforts
 RWJF investments
 National Surveys
 NACCHO, NALBOH, ASTHO





Data Harmonization Project
PHSSR Agenda
PHAST
PHUD$
MPROVE
 CDC’s National Public Health Improvement
Initiative (funding for this project)
 IOM Report on measurement
Similar Efforts
 Currently, service delivery measures are not well
understood
 Other states have struggled to collect service delivery
across their state system



Minnesota
Washington
Ohio
Colorado Efforts
 NACCHO Profile response rates
 NACCHO Profile testing project
 PHAST participation
 Annual report (to OPP)
 Baseline Review
 PHSSR Core Services research project
 MPROVE
Today’s Focus
 NACCHO Profile response rates
 NACCHO Profile testing project
 PHAST participation
 Annual report (to OPP)
 Baseline Review
 PHSSR Core Services research project
 MPROVE
 With a little additional information thrown in
Baseline Review
 Purpose:
 Catalogue current capacity of the CO system
 Inform core services and funding discussions
 Identify areas for improvement
 Fulfill CDC grant objectives
 Serve as the Annual Report to then be updated yearly
 Methods:
 Tool questions reviewed by PHISC and task force members
 Pre-populated tool with formerly gathered data (NACCHO
profile)
 3-4 hour site visits March through August, 2011
Review Included:
 Core Services Sections: Assessment/Planning, Vital
Records, Communicable Disease, Prevention and
Population Health Promotion (Chronic Disease,
Injuries, Behavioral and Mental Health, Maternal and
Child Health), Environmental Health, Emergency
Preparedness
 Other Direct Services Provided
 Administrative/ Governance Sections: Structure,
Governance, Human Resources (workforce), Financial
Core Services: Core Questions
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Who provides service in your jurisdiction
Do you share this service
Could this service be shared
Monitoring the service
FTE dedicated to service
Service adequately staffed
Trainings needed for staff dedicated to service
Funding for service
Funding % based on sources
Stability of funding
Resources that have been cut
Service adequacy for population
Additional resources needed
Rate CDPHE in consultation, TA and training
What improvements are needed in this service delivery
Methods: Baseline Review of LPHA’s
 Conducted Spring/Summer 2011
 All local public health agencies participated
 Extensive tool filled out prior to visit
 3-4 hour interview
Directors and staff members
 Board of health members (uncommon)


Data review and resubmission for any additional gaps
Baseline Review Tool
 Used existing and validated tools as a starting point
for development of Baseline Review Tool




NACCHO Profile
Minnesota’s Local Public Health Planning and Performance
Measurement Reporting System
Washington’s Activities and Service Inventory
McKinsey Capacity Assessment Grid
NACCHO Profile 2010
Baseline Review Tool
 Included all Core Services
 Assessment, Planning, and Communication
 Vital Records and Statistics
 Communicable Disease Prevention, Investigation, and Control
 Prevention and Population Health Promotion
 Emergency Preparedness and Response
 Environmental Health
 Administration and Governance
Baseline Review Tool
 Service categories within each core service
 Chronic Disease prevention within prevention and promotion
 Service areas within each category
 Nutrition Promotion in Chronic Disease prevention
 Service activities within each area
 Educational Materials or Policy Development within Nutrition
Promotion
How is this service provided or assured?
 3 = LPHA provides this service/activity. This
includes main and satellite offices
 2 = Provided by Another Agency (listed)
 1 = This service/activity is needed but not available
within jurisdiction
 0 = This service/activity is not applicable within
jurisdiction
Who provides a service in your jurisdiction?











LPHA at Main Office
Satellite Office
Other County Office (please name)
Obtained from another LPHA (please name)
CDPHE Regional staff (CDPHE employees)
CDPHE funded staff in regions
Someone else (Please name)
Contracted out by LPHA (Please name)
Not available in jurisdiction
Unknown
Provided to another LPHA
Self-Reported Capacity
 For each category within core services the following
question was asked:

How would you rank your jurisdiction’s capacity to
implement [core service category] at this point in time?
Selection Options
 1 = Clear need for increased capacity
 2 = Basic level of capacity in place
 3 = Moderate level of capacity in place
 4 = High level of capacity in place
 Adapted from McKinsey’s Capacity Grid

Self-Reported Capacity
4 = High level of capacity in place defined as:







Stable funding, staffing, and facilities
Majority of target population is served, including those with
health disparities
Ability to measure outcomes and address needed
improvements
Uses current knowledge and best practices in delivery of
service
Follows current national standards [if available]
Ability to seek new initiatives and access funding based on
community needs
Service is supported by elected officials and well-connected
with other system partners
So, What did we learn?
Assessment and Planning
 General Assessment and Planning Questions
 What assessment had been done by last summer
 Employees dedicated to Assessment and Planning
 Funding dedicated to Assessment and Planning
 Areas for improvement at the local jurisdictions
 Capacity in Assessment and Planning
Comprehensive Community Health Assessment
23%
30%
70%
77%
Have done Comprehensive Community
Health Assessment in last 3 years
Have NOT done Comprehensive Community
Health Assessment in last 3 years
Lead Comprehensive
Community Assessment
Did not Lead Comprehensive
Community Assessment
Current CHAPS Progress
Assessment and Planning: Self-Reported Capacity
Assessment & Planning
Capacity Option
#
%
1 = Clear need for increased capacity
18
36%
2 = Basic level of capacity in place
18
36%
3 = Moderate level of capacity in place
8
16%
4 = High level of capacity in place
6
12%
Assessment and Planning: Self-Reported Capacity
12%
36%
16%
36%
1 = Clear need for increased capacity
2 = Basic level of capacity in place
3 = Moderate level of capacity in place
4 = High level of capacity in place
Assessment and Planning: Areas for Improvement
Assessment & Planning
No Improvements Needed
4
8%
Other
12
24%
More Partnerships
13
25%
Differently Qualified Staff
16
31%
More Training for Staff
24
47%
More Technical Assistance
26
51%
More data/evaluation
28
55%
More Operations Funding
34
67%
More Staff
36
71%
Number of agencies
Assessment and Planning: Areas for Improvement
40
35
30
25
20
15
10
5
0
Staffing
 How many contracted staff and FTE are dedicated
to Assessment and Planning?
Mean Number of People = 2.4
 Mean FTE = 0.99
 31% did not have any staff dedicated
to Assessment and Planning

Funding
 Sources of funding for Assessment and Planning
 Percent of agencies reported by type of funding
STATE PER CAPITA (33% of agencies)
 COUNTY (22% of agencies)
 STATE DIRECT (not per capita) (18% of agencies)

Vital Records
 43% of LPHA’s provide vital records services,
directly
 57% of LPHA’s have a formal MOU with county
clerks, treasurers, etc, to perform vital records
services.
 7 counties made positive changes since the Public
Health Act by moving records out of homes.
Questions?
Thoughts?
Comments?
Communicable Disease
 General Communicable Disease Questions
 Who is doing what within Communicable Disease
 Employees dedicated to Communicable Disease
 Funding dedicated to Communicable Disease
 Areas for improvement at the local jurisdictions
 Capacity in Communicable Disease
Communicable Disease
Number of Agencies
60
50
LPHA only
40
30
In Partnership (LPHA in
Partnership with CDPHE,
CDPHE Regional Staff,
Other LPHA or other
community partner)
20
10
0
Prevent Disease Collect and Immunizations
Transmission report disease
information
Investigate
cases of
reportable
diseases
Communicable Disease: Self-Reported Capacity
Immunizations
Collect and report
disease information
and investigate
Disease transmission
Capacity Option
#
%
#
%
#
%
1
1
2%
0
0%
4
8%
2
1
2%
8
16%
19
36%
3
22
42%
24
47%
19
36%
4
29
55%
19
37%
11
21%
Communicable Disease: Self-Reported Capacity
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Immunizations
Collect and report disease
information and investigate
Disease transmission
1 = Clear need for increased capacity
2 = Basic level of capacity in place
3 = Moderate level of capacity in place
4 = High level of capacity in place
Communicable Disease: Areas for Improvement
Communicable Disease
No Improvement
3
6%
Differently Qualified Staff
6
11%
More TA
9
17%
More Partnerships
10
19%
Other
10
19%
More data/evaluation
17
32%
More Staff
23
43%
More Training for staff
26
49%
More Operations Funding
32
60%
Communicable Disease: Areas for Improvement
Number of Agencies
35
30
25
20
15
10
5
0
Staffing
 How many contracted staff and FTE are dedicated
to Communicable Disease?



Mean Number of People = 3.5
Mean FTE = 2.3
11% did not have any staff dedicated to Communicable
Diseases
Funding
 Common sources for Communicable Disease
 Percent of agencies reported by type of funding
STATE DIRECT (not per capita) (43% of agencies)
 COUNTY (35% of agencies)
 FEDERAL, PASSED THROUGH STATE (28% of agencies)

Questions?
Thoughts?
Comments?
Prevention and Promotion
 General Prevention and Promotion Questions
 Who is doing what is Prevention and Promotion
 Employees dedicated to Prevention and Promotion
 Funding dedicated to Prevention and Promotion
 Areas for improvement at the local jurisdictions
 Capacity in Prevention and Promotion
Prevention & Promotion
45
40
35
30
LPHA only
25
Other (could be in
partnership with LPHA)
Unknown
20
15
10
5
0
Not Available
Communicable
Chronic
Maternal and
Injury
Disease
Diseases,
Child Health Prevention and
prevention and prevention and Promotion,
Education
education
education Prevention and
Education
Prevention and Promotion: Self-Reported Capacity
Chronic
Communicable
disease
disease prevention
prevention
Capacity
Option
Maternal &
child health
Injury
prevention
#
%
#
%
#
%
#
%
1
2
4%
13
25%
12
23%
29
56%
2
14
26%
20
38%
13
25%
15
29%
3
25
47%
16
31%
22
42%
7
13%
4
12
23%
3
6%
6
11%
1
2%
Prevention and Promotion: Self-Reported Capacity
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Communicable
disease prevention
Chronic disease
prevention
Maternal & child
health
Injury prevention
1 = Clear need for increased capacity
2 = Basic level of capacity in place
3 = Moderate level of capacity in place
4 = High level of capacity in place
Prevention and Promotion: Areas for Improvement
Prevention & Promotion
No Improvements Needed
0
0%
Other
3
6%
More Technical Assistance
14
26%
Differently Qualified Staff
17
31%
More data/evaluation
20
37%
More Partnerships
21
39%
More Training for Staff
25
46%
More Staff
37
69%
More Operations Funding
37
69%
Number of Agencies
Prevention and Promotion: Areas for Improvement
40
35
30
25
20
15
10
5
0
Staffing
 How many contracted staff and FTE are dedicated
to Prevention and Promotion?



Mean Number of People = 5.2
Mean FTE = 4.8
12% did not have any staff dedicated to Prevention and
Promotion
Funding
 Common funding sources for Prevention and
Promotion





STATE DIRECT (not per capita) (41% of agencies)
STATE PER CAPITA (31% of agencies)
COUNTY (31% of agencies)
FEDERAL, PASSED THROUGH STATE (30% of agencies)
FOUNDATIONS (30% of agencies)
Direct Services
Prenatal
HCP
WIC
Substance Abuse
Not Available
Other
Nurse Home Visitor
Secondary
Family Planning
Primary
Childhood Immunizations
Adult Immunizations
EPSDT
0
10
20
30
40
50
Questions?
Thoughts?
Comments?
Environmental Health
 General Environmental Health Questions
 What assessment have been done
 Employees dedicated to Environmental Health
 Funding dedicated to Environmental Health
 Areas for improvement at the local jurisdictions
 Capacity in Environmental Health
Environmental Health
50
45
40
35
30
25
20
15
10
5
0
Sanitation of Zoonotic, air, Safety of food
Protect
Land use
Waste,
institutional
water and
provided to surface and planning and recycling and
facilities other hazards the public ground water sustainability
reuse
LPHA Only
Other (could be in partnership with LPHA)
Unknown
Solid and
hazardous
waste
Not Available
Environmental Health: Self-Reported Capacity
Sanitation of
Institutional
Facilities
Food
Safety
Zoonotic
and vector
Air quality
borne
disease
Water
Community
design and
planning
Waste
Other
Capacity
Option
#
%
#
%
#
%
#
%
#
%
#
%
#
%
#
%
1
9
20%
7
15%
3
7%
13
29%
9
20
%
15
34%
16
37%
12
27%
2
11
24%
3
7%
20
43%
14
31%
14
32%
11
25%
11
26%
19
43%
3
19
41%
14
30%
15
33%
15
33%
11
25%
10
23%
10
23%
9
20
%
4
7
15%
22
48%
8
17%
3
7%
10
23%
8
18%
6
14%
4
9%
Environmental Health: Self-Reported Capacity
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Food Safety
Zoonotic Sanitation Air quality
and vector
of
borne
Institutional
disease
Facilities
Water
Community
design and
planning
Waste
Other
4 = High level of capacity in place
3 = Moderate level of capacity in place
2 = Basic level of capacity in place
1 = Clear need for increased capacity
Environmental Health: Areas for Improvement
Environmental Health
No Improvements Needed
2
4%
Differently Qualified Staff
5
9%
More Technical Assistance
10
19%
More data/evaluation
Other
12
14
23%
26%
More Partnerships
14
26%
More Staff
20
38%
More Operations Funding
24
45%
More Training for Staff
25
47%
Environmental Health: Areas for Improvement
Number of Agencies
30
25
20
15
10
5
0
Staffing
 How many contracted staff and FTE are dedicated
to Environmental Health?



Mean Number of People = 5.4
Mean FTE = 4.8
19% did not have any staff dedicated to Environmental Health
Environmental Health
Questions?
Thoughts?
Comments?
Emergency Preparedness & Response
 General Emergency Preparedness Questions
 What assessment have been done
 Employees dedicated to Emergency Preparedness
 Funding dedicated to Emergency Preparedness
 Areas for improvement at the local jurisdictions
 Capacity in Emergency Preparedness
Emergency Preparedness & Response
40
35
30
LPHA Only
25
15
Other (could be in
partnership with LPHA)
Unknown
10
Not Available
20
5
0
All Hazards
ESF-8
Communication Coordinate with
Emergency
Management
EPR: Self-Reported Capacity
Emergency Preparedness & Response
Capacity Option
#
%
1 = Clear need for increased capacity
0
0%
2 = Basic level of capacity in place
10
21%
3 = Moderate level of capacity in place
26
55%
4 = High level of capacity in place
11
23%
EPR: Self-Reported Capacity
0%
21%
24%
55%
1 = Clear need for increased capacity
2 = Basic level of capacity in place
3 = Moderate level of capacity in place
4 = High level of capacity in place
EPR: Areas for Improvement
Emergency Preparedness and Response
No Improvements Needed
4
8%
Other
4
8%
Differently Qualified Staff
5
10%
More data/evaluation
7
13%
More Partnerships
11
21%
More Technical Assistance
4
8%
More Training for Staff
22
42%
More Operations Funding
20
38%
More Staff
30
58%
EPR: Areas for Improvement
Number of Agencies
35
30
25
20
15
10
5
0
Staffing
 How many contracted staff and FTE are dedicated
to Emergency Preparedness and Response?



Mean Number of People = 3.1
Mean FTE = 1.4
2.2% did not have any staff dedicated to EPR
Funding
 Primary funding sources for EPR
 FEDERAL, PASSED THROUGH STATE (67%)
 COUNTY (13%)
 STATE DIRECT (not per capita) (13%)
 FOUNDATIONS (6%)
Questions?
Thoughts?
Comments?
Statewide: How do regions view their capacity?
 The following tables present self reported capacity by
region



0-1.99 in red-lowest
2.00-2.99 in yellow-moderate
3.00-4.00 in green-highest
Assessment and
Planning
Collect and
report disease
info, investigate
cases of
reportable
diseases
Eastern Corridor
2.00
Southeast
Immunizations
Prevent Disease
Transmission
Emergency
Preparedness &
Response
3.75
4.00
3.50
3.33
2.17
3.20
3.50
3.00
3.00
San Luis Valley
1.67
3.00
3.50
2.17
2.83
Southwest
1.75
2.75
3.75
2.75
2.75
West Central
2.67
3.00
3.50
3.33
3.00
Northwest
1.50
2.75
3.25
2.25
3.25
Western
Corridor
1.60
3.25
3.40
2.20
2.33
South
1.67
3.75
3.50
2.75
3.25
Central
2.00
3.00
3.00
1.50
3.00
Large Agencies*
2.63
3.50
3.50
3.00
3.20
2.04
3.22
3.49
2.70
3.02
*Population > 70,000
State
Communicable
Disease prevention
and education
Chronic Diseases,
prevention and
education
Maternal and Child
Health Promotion,
Prevention and
Education
Injury Prevention
and Education
Eastern Corridor
3.00
2.50
3.50
2.00
Southeast
2.80
2.50
2.17
2.00
San Luis Valley
2.67
1.67
1.67
1.33
Southwest
2.75
2.00
2.00
1.25
West Central
3.33
2.00
2.83
1.83
Northwest
2.50
3.00
2.50
1.50
Western Corridor
2.20
1.75
2.00
1.75
South
3.00
2.75
2.50
1.25
Central
2.75
2.00
2.50
1.75
Large Agencies*
3.20
2.00
2.60
1.50
2.89
2.17
2.42
1.62
*Population > 70,000
State
Safety of
Zoonotic and
food
Sanitation of
vector-borne
provided institutional
environ.
to the
facilities
hazards
public
Water-borne
Solid and
public health Land use
Air-borne
hazardous
environ.
planning and
environ.
waste and
hazards and sustainable
hazards
recycling
surface and development
and reuse
ground water
Other public
health
threats
related to
environ.
health
hazards
Eastern
Corridor
2.33
2.33
2.33
2.33
1.67
2.33
3.00
2.33
Southeast
3.40
3.40
3.40
2.20
2.40
1.40
1.40
1.80
San Luis
Valley
2.33
1.67
2.17
1.17
1.33
1.33
1.33
1.17
Southwest
3.00
2.25
2.75
1.50
1.75
1.50
1.25
1.67
West Central
3.25
2.75
2.50
2.25
2.75
2.50
2.75
2.50
Northwest
3.50
3.50
2.00
2.50
2.50
2.50
1.50
2.00
Western
Corridor
2.40
1.60
1.80
1.80
3.00
2.20
2.40
1.40
South
3.25
2.75
2.00
2.00
2.75
2.33
2.33
2.50
Central
3.67
2.33
3.33
3.50
3.00
3.50
2.50
2.50
Large
Agencies*
3.70
2.90
3.10
2.90
3.30
3.10
2.80
2.90
2.52
2.61
2.18
2.50
2.25
2.14
2.11
*Population >
State
70,000
3.11
Questions on data so far?
Ongoing data analysis
 Research Projects
 Core Services Research
 Multi-network Practice and Outcome Variation Examination
(MPROVE) Study
 Both Projects will use collected data to find and
understand the best measures for service delivery
Your thoughts
 What uses do you see for this data?
 How can we organize the data to help you?
 What other information asked in the Baseline
Review would be useful for you in your work?
 What kind of report/reports would you like to see
out of this work?
 What kind of report would you use?
Let’s Discuss
Contact
 Kathleen Matthews
 Office of Planning and Partnership, CDPHE
 [email protected]
 Lisa VanRaemdonck
 Colorado Association of Local Public Health Officials
 [email protected]
 Sarah Lampe
 Colorado Association Local Public Health Officials
 [email protected]
Service Area in Communicable Disease
Prevention and Promotion by Capacity
Service Area in Communicable Disease
Prevention and Promotion by Capacity
Total Topic Score = The Numbered entered
into the box corresponding to that service
area.
Therefore, the higher the score the more
likely the public health agency delivers the
service
The lower the score the more likely the service
is not available within the jurisdiction
Service Area in Communicable Disease
Prevention and Promotion by Capacity
Each Series here represents the self-reported
capacity selected for communicable disease
prevention and promotion.
Series 1 = Clear need for increased capacity
Series 2 = Basic level of capacity in place
Series 3 = Moderate level of capacity in place
Series 4 = High level of capacity in place
Service Area in Communicable Disease
Prevention and Promotion by Capacity