Transcript CDC Presentation

Using an Evidence-Based Approach to
Address Maternal and Child Health
Priorities
Starr Banks
Cherie Rooks-Peck
Kathi Wilson
Community Guide Branch,
Centers for Disease Control and Prevention
September 5, 2013
Association of Maternal & Child Health Programs
Center for Surveillance, Epidemiology, and Laboratory Services (proposed)
Division of Epidemiology, Analysis, and Library Services (proposed)
Disclaimer
Any views or opinions expressed by the speaker do not
necessarily represent the views of the CDC, HHS, or any other
entity of the United States government. Furthermore, the use of
any product names, trade names, images, or commercial sources
is for identification purposes only, and does not imply
endorsement or government sanction by the U.S. Department of
Health and Human Services.
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Acknowledgements
This training is brought to you by
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AMCHP/Community Guide
2013 Webinar Series
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Part 1 (September 5):
• Why use an evidence-based approach?
• The Community Guide: a resource for evidence-based strategies.
• Locating evidence-based program and policy interventions.
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Part 2 (September 10):
• Selecting an evidenced-based option that fits your community.
• Adapting interventions to fit your community.
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Part 3 (September 13):
• Using different forms of evaluation methods.
• Assessing sustainability of your program.
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Today’s Learner Objectives
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Explain the benefits of using an evidence-based approach.
Describe the types of findings the Community Preventive
Services Task Force (Task Force) makes about the evidence.
Demonstrate how to access broad evidence-based strategies
and related Task Force findings on The Community Guide
website.
Locate specific evidence-based program and policy
interventions using the Research-Tested Intervention
Programs (RTIPs) and Center for Training and Research
Translation (Center TRT) websites.
State elements of organizational capacity affecting the use of
evidence.
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WHAT IS THE VALUE OF USING AN
EVIDENCE-BASED APPROACH TO SELECT
INTERVENTIONS?
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What is Evidence?
“The available body of facts or information
indicating whether a belief is true or valid.”
Brownson RC, Baker EA, Leet TL, Gillespie KN. 2003. Evidence-Based Public Health. New York:
Oxford University Press.
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What is Evidence in Public Health?
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Personal experience
Word of mouth
Program evaluation
An intervention research study
Systematic reviews of multiple intervention
studies
Practice-based
Research-based
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Why Use an Evidence-Based Approach?
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Allows for scarce resources to be used wisely.
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Shortens the time that it takes to develop a program
or policy.
Increases your likelihood of success.
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Funders are requiring more accountability.
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THE COMMUNITY GUIDE: A RESOURCE
FOR IDENTIFYING EVIDENCE-BASED
STRATEGIES
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The Community Guide
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Evidence-based recommendations and findings
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Provide information about the effectiveness of community preventive
programs, services, and policies.
Developed by the Community Preventive Services Task Force (Task
Force).
Systematic reviews
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Analyze all available evidence on the effectiveness of community-based
programs, services, and policies in public health.
Assess the economic benefit of all effective programs, services, and
policies.
Highlight critical evidence gaps.
Conducted, with Task Force oversight, by scientists and subject matter
experts from CDC in collaboration with a wide range of government,
academic, policy, and practice-based partners.
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What is The Community Preventive
Services Task Force?
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A non-federal, independent, rotating panel.
Internationally renowned experts in public health research,
practice, and policy.
Members are appointed by CDC Director; nominated using
broad input from throughout public health and healthcare.
Serve without payment.
 CDC is mandated to provide scientific, technical and
administrative support for the Task Force.
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More than 220 Task Force
Recommendations and Findings
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21 public health topic areas
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Adolescent Health
Alcohol - Excessive Consumption
Asthma
Birth Defects
Cancer
Cardiovascular Disease
Diabetes
Emergency Preparedness
Health Communication
Health Equity
Worksite
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HIV/AIDS, STIs, Pregnancy
Mental Health
Motor Vehicle Injury
Nutrition
Obesity
Oral Health
Physical Activity
Tobacco
Vaccination
Violence
Strategies may be informational; behavioral, social;
environmental, policy; health system-based.
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The Task Force Seeks to Answer Key
Questions about Interventions
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Do they work?
How well?
For whom?
Under what circumstance are they
appropriate (applicability)?
What do they cost?
How do they affect health equity?
Are there barriers to their use?
Are there any harms?
Are there any unanticipated outcomes?
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Findings of the Task Force
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Recommend
• Strong Evidence
• Sufficient Evidence
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Recommend against
• Strong Evidence
• Sufficient Evidence
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Insufficient evidence to
recommend for or against
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What Does Insufficient Evidence Mean?
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This does NOT mean the intervention does not work.
Insufficient evidence means that more research is needed for
the Task Force to decide if the intervention is effective or not.
• Too few studies exist for the Task Force to make a decision.
• Not enough studies were of the quality needed for the Task Force to
make a decision.
• Enough studies exist, but have inconsistent results for the following
reasons:
• Variables other than the intervention could have influenced the results.
• The intervention was not carried out in the same way in all the studies.
• A substantial subset of studies show a minimal or negative effect.
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Consider:
• Do better documented alternatives exist for reaching the same goals?
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What to Do with a Recommendation
“Even if it is evidence-based,
it is not certainty.”
McGinnis and Foege, 2000
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Not a cookbook or a one-size-fits-all solution.
Users must combine scientific information (e.g., effectiveness,
cost) with other information (e.g., needs, values, capacities,
resources).
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Organizational Capacity
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Organization
• = all parent organizations or agencies in which the program is
housed.*
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Organizational capacity
• = having the internal support and resources needed to effectively
manage your program and its activities.*
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Elements of organizational capacity
• Pre-implementation – Staffing, training available, ability to recruit
• Implementation – Participant recruitment, means to track progress
• Evaluation – Knowledgeable staff, use evaluation results
*The Program Sustainability Framework, Washington University, St. Louis, MO
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Organizational Readiness Checklist
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What are your impressions of the
Organizational Readiness checklist?
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What did you learn about your
organization after completing the
Organizational Readiness checklist?
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www.thecommunityguide.org
ACCESSING EVIDENCE-BASED
STRATEGIES:
THE COMMUNITY GUIDE WEBSITE
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What do you think?
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Selecting a Strategy
1. Identify criteria to determine what may “fit” with your
audience and/or organization.
2. Acquire information about potential options from evidencebased resources, (e.g., The Community Guide).
3. Review available information about the strategies using fit
criteria (e.g., articles, implementation guides, etc.).
4. Decide which option to adopt.
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Strategy Comparison Tool
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The Community Guide: A Source of
Evidence-Based Strategies
Aim
CG Strategy
Intervention Programs
Alive!
Diet and Physical Activity Program
Increase
physical
activity
Individuallyadapted health
behavior change
programs
A New Leaf…Choices
For Healthy Living
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LOCATING EVIDENCE-BASED PROGRAM
AND POLICY INTERVENTIONS
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www.rtips.cancer.gov
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www.centertrt.org
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Activity!
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Matching Intervention Program Labels
Center TRT
RTIPS
• Setting
• Topics
• Health Equity Considerations
• Setting
• Topic
• Materials (products)
• Core Elements
• Need
• Resources
• Program (how-to)
• Implementation
• Community Preventive Services
Task Force Finding
• Evidence Summary
• Required Resources
• Potential Public Impact
• About the Study
• Intervention Materials
• Key Findings
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Additional Resources
www.researchtoreality.cancer.gov
www.cancercontrolplanet.cancer.gov
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Additional Resources (cont’d)
www.promisingpractices.net
www.cdc.gov/healthycommunitiesprogram
www.cdc.gov/healthyyouth/schoolhealth
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Intervention Comparison Tool
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Homework for Next Webinar (Sep 10)
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Scavenger Hunt Handout
1.
Explore The Community Guide website and answer questions
specific to the Task Force-recommended strategy, Behavioral and
Social Approaches to Increase Physical Activity: Individually-Adapted
Health Behavior Change Programs.
2.
Use the RTIPs and Center TRT websites to
• Select one program intervention from each that is aligned with the Task
Force-recommended strategy, Behavioral and Social Approaches to
Increase Physical Activity: Individually-Adapted Health Behavior Change
Programs.
• Answer questions for each program intervention you selected.
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Homework for Next Webinar (cont’d)
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Intervention Comparison Tool Handout
1.
Review your responses on the Organizational Readiness Checklist.
2.
Consider the information you gathered about your health priority
and community.
3.
Fill out only the first blank column “Priority Area for Our
Community” based on your community as well as your responses for
the Organizational Readiness Checklist. You will fill out the
remaining columns during our next webinar.
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Next Webinar…Why Is Understanding the
Details of Evidence-Based Options Important?
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Assess how much adaptation is needed by gauging its fit to
your community and organization.
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Review methods, facilitators’ guide
or implementation protocol to
understand the steps for delivery.
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Learn the costs of implementation.
In short, decide which program to
use.
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Questions & Discussion
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Thank you!
Starr Banks
Cherie Rooks-Peck
Kathi Wilson
Community Guide Branch,
Centers for Disease Control and Prevention
Starr Banks [email protected]
Cherie Rooks-Peck [email protected]
Kathi Wilson [email protected]
Center for Surveillance, Epidemiology, and Laboratory Services (proposed)
Division of Epidemiology, Analysis, and Library Services (proposed)