ALIGNMENT OF NJS COUNTY CHAS & CHIPS WITH NATIONAL STANDARDS - - PowerPoint PPT Presentation

ALIGNMENT OF NJ’S COUNTY CHAS & CHIPS WITH NATIONAL STANDARDS

New Jersey Association of County and City Health Officials 4/16/2015

Who is Kevin McNally?

• 31 years at NJ Department of Health (1982-2013)
• Including four years (2004-08) in Office of Local Health
• Coordinated State Public Health System Performance Assessment (2009)
• NJDOH Accreditation Coordinator (2012-13)
• Community Volunteer, Monmouth County Health Improvement Coalition
• Completed PHAB training for document reviewer and site visitor

Presentation Contents

• Results of an assessment of existing county and

city CHAs and CHIPS in New Jersey with national public health accreditation standards

• Principles for preparing CHAs and CHIPs that

conform with accreditation standards

THE BASICS

Lingo

• Community Health Assessment (CHA)
• Community Health Needs Assessment (CHNA)
• Community Health Improvement Plan (CHIP)

Why Do a CHA/CHIP?

• Required by NJ’s Practice Standards
• Pre-requisite for obtaining national accreditation
• It’s a good idea!

Why Do a CHA/CHIP?

• Aligns local health department activities with the

needs of the community served

• Promotes understanding, support and

participation from the community in local health department initiatives

PUBLIC HEALTH PRACTICE STANDARDS OF PERFORMANCE FOR LOCAL BOARDS OF HEALTH IN NEW JERSEY (NJAC 8:52)

NJ Practice Standards Requirements

NJAC 8:52-9.2 Development and participation in community public health partnerships

(a)

Each countywide or multi-countywide area shall establish a community public health partnership representing key corporate, private, and non-profit

• entities. Each partnership shall perform a countywide or multi-countywide

community health assessment in accordance with N.J.A.C. 8:52-10 and develop a Community Health Improvement Plan in accordance with N.J.A.C. 8:52-11. Each community public health partnership shall foster relationships that impact the community's health consistent with the needs identified in the Community Health Improvement Plan.

(b)

Each local health agency shall:

• 1. Actively participate in a new or existing community health partnership

PUBLIC HEALTH ACCREDITATION BOARD (PHAB)

Administers a national accreditation process for State, local and tribal public health agencies

PHAB Pre-requisites for applying for national accreditation

• Community Health Assessment
• Community Health Improvement Plan
• Agency Strategic Plan

PHAB Standards

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

PHAB Standards

Standard 5.2: Conduct a comprehensive planning process resulting in a community health improvement plan.

NJ vs PHAB

• NJ Practice Standards are compatible with, but not

identical to, PHAB Standards.

• PHAB Standards much more detailed
• Therefore: CHAs and CHIPs that meet NJ Practice

Standards may not comply with PHAB Standards for national accreditation

Practice Standards Requirement for CHIP

(c) Each Community Health Improvement Plan shall consist of:

• 1. A countywide or multi-countywide Community Health Assessment as described at N.J.A.C. 8:52-10.2;
• 2. A Community Health Profile as described at N.J.A.C. 8:52-10.2(d)5;
• 3. A mechanism which monitors external environment for forces and trends that might impact the ability of

a local public health system to protect the health of the public;

• 4. An analysis and a prioritization of current and potential health problems based upon planning

methodologies such as those described at N.J.A.C. 8:52-10.2(d);

• 5. A plan which specifies the roles and responsibilities agreed upon by each local health agency and each

public, private, non-profit, and voluntary agency;

• 6. Specific strategies to address health problems and to sustain effective interventions;
• 7. A plan to evaluate the intervention strategies and health outcomes; and
• 8. A method that allows for changes to the plan.

PHAB Requirements for CHIP

• 1. Community health improvement plan

The local health department must provide a community health improvement plan that includes all of the following:

• a. The desired measurable outcomes or indicators of the health improvement effort and priorities for action, from the perspective of community
• members. The plan must include community health priorities, measurable objectives, improvement strategies and activities with time-framed targets that

were determined in the community planning process. In establishing priorities, the plan must include consideration of addressing social determinants of health, causes of higher health risks and poorer health outcomes of specific populations, and health inequities.

• Measurable and time-framed targets may be contained in another document, such as an annual work plan. If this is the case, the companion document

must be provided with the health improvement plan for this measure.

• Strategies may be evidence-based, practice-based, or promising practices or may be innovative to meet the needs of the community. National state-of-

the-art guidance (for example, the National Prevention Strategy, Guide to Community Preventive Services, and Healthy People 2020) should be referenced, as appropriate.

• b. Policy changes needed to accomplish the identified health objectives must be included in the plan. Policy changes may include those that are adopted

to alleviate the identified causes of health inequity. Policy changes may address social and economic conditions that influence health equity including housing, transportation, education, job availability, neighborhood safety, access to recreational opportunities, and zoning, for example.

• c. Designation of individuals and organizations that have accepted responsibility for implementing strategies outlined in the community health

improvement plan. This may include assignments to staff or agreements between planning participants, stakeholders, health care providers (community benefit), other local governmental agencies, or other community organizations. For this measure, agreements do not need to be formal, such as an MOA/MOU.

• d. Local health departments must demonstrate that they considered both national and state health improvement priorities where they have been
• established. National priority alignment could include the National Prevention Strategy and Healthy People 2020.

NJACCHO CHA/CHIP Assessment Project

• Assignment: Review the most recent CHA and CHIP for each county (and any city

that had done their own) to determine if they were in compliance with the current PHAB standards.

• Reviewed 22 CHA/CHIP pairs:
• 19 Counties
• 1 Covering 2 counties
• 2 Cities
• Review based on PHAB Standards and Measures Version 1.5 (effective June 2014)
• Assessment based on standards both for process and the completed document

NJACCHO CHA/CHIP Assessment Project

• Assessments completed between June and September 2014
• Report sent to:
• GPHP Chair or County/City Health Officer
• Partnership Coordinator
• NJACCHO project manager

First Step

• Contacted PHAB to obtain guidance as to whether New Jersey’s

requirement that local health agencies participate in a county- wide process to develop CHAs and CHIPs is acceptable under the PHAB standards.

• Obtained a written statement from PHAB’s Chief Program

Officer that a New Jersey health department could use its county CHA and CHIP to meet the pre-requisites for its accreditation application, so long as it could document that it had participated in the development and implementation of these documents.

PHAB Review Scores

• Fully demonstrated
• Largely demonstrated
• Slightly demonstrated
• Not demonstrated

CHA Process

Full Partners 50% Consulted 27% Not included 23% 0%

COMMUNITY PARTICIPATION

Hospital CHNAs

• For those counties that did not have a CHA completed within the PHAB time

frame (5 years), reviewed recent community health needs assessments completed by hospitals (where available).

• Reviewed 10 hospital CHNAs
• None met all of the PHAB requirements
• Reasons:
• Used countywide data, but otherwise focused on hospital’s service area
• Did not meet community participation standard
• Limited or no participation by local health departments

General Observations

• CHAs/CHIPs developed by Community Public Health

Partnerships (CPHPs) that compiled with the CPHP model described in the Practice Standards tended to meet more of the PHAB requirements than those where the county GPHP or Health Department lead the process.

• CHAs/CHIPs developed through collaborations between the

local health department(s) and hospitals / healthcare systems tended to meet more of the PHAB requirements than those where the hospitals were not full partners the process.

What Next?

• Implementation Plan
• PHAB Action Plan
• Local CHA/CHIP

GUIDELINES FOR DEVELOPING A PHAB- COMPLIANT CHA/CHIP

PHAB’s Fundamental Principles

• Process
• Participation
• Performance Improvement

Recommendations - Process

• Create / revitalize Community Public Health Partnerships that conform to the

model described in the Practice Standards.

• Partner with the hospitals / healthcare systems in your county
• Look for opportunities to jointly develop documents that meet State/ACA/PHAB

requirements.

• Engage the private sector / business community
• Study the requirements in the PHAB Standards and Measures document (v 1.5)

before engaging in developing the CHA and CHIP

• Research best practices and use available resources (e.g. NACCHO accreditation

website)

• Use the full MAPP process

Recommendations - CHIP

Pursue the process through to its conclusion:

• Adopt SMART objectives
• Measurable targets
• Time frame for accomplishment
• Define specific, evidence-based strategies and actions
• Determine who is responsible for implementation of every
• bjective / strategy / action

Resources for CHA and CHIP Development

• CDC Office for State, Tribal, Local and Territorial Support

Community Health Assessment and Health Improvement Planning webpage: http://www.cdc.gov/stltpublichealth/cha/index.html

• NACCHO CHA and CHIP Resource Center

Examples of High Quality CHAs and CHIPs: http://www.naccho.org/topics/infrastructure/CHAIP/guidance-and-examples.cfm

Remember

• What is expected is an on-going process, not

just documents done one time or every few years.

• Plan is only the first step of the PDCA cycle.