Local Public Health Agencies in Colorado Baseline Review

CONDUCTED IN SUMMER 2011

Local Public Health Agencies in Colorado Baseline Review

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 sectorsMeasuring performance begins with

understanding the current systemComparisons with more or less robust systems

helps to provide a rationale for your needsIdentifying 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 investmentsNational 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 ratesNACCHO Profile testing projectPHAST participationAnnual report (to OPP)Baseline ReviewPHSSR Core Services research projectMPROVE

Today’s Focus

NACCHO Profile response ratesNACCHO Profile testing projectPHAST participationAnnual report (to OPP)Baseline ReviewPHSSR Core Services research projectMPROVEWith 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. Who provides service in your jurisdiction2. Do you share this service3. Could this service be shared4. Monitoring the service5. FTE dedicated to service6. Service adequately staffed7. Trainings needed for staff dedicated to service8. Funding for service9. Funding % based on sources10. Stability of funding11. Resources that have been cut12. Service adequacy for population13. Additional resources needed14. Rate CDPHE in consultation, TA and training15. What improvements are needed in this service delivery

Methods: Baseline Review of LPHA’s

Conducted Spring/Summer 2011All 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


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


Service categories within each core service Chronic Disease prevention within prevention and

promotionService areas within each category

Nutrition Promotion in Chronic Disease preventionService 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 OfficeOther County Office (please name) Obtained from another LPHA (please name)CDPHE Regional staff (CDPHE employees)CDPHE funded staff in regionsSomeone 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

77%

23%

Have done Comprehensive Community Health Assessment in last 3 years

Have NOT done Comprehensive Community Health Assessment in last 3 years

70%

30%

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

36%

36%

16%

12%

1 = Clear need for increased capacity2 = Basic level of capacity in place3 = Moderate level of capacity in place4 = 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%

Assessment and Planning: Areas for Improvement

No

Impr

ovem

ents N

eede

d

Other

Mor

e Pa

rtne

rshi

ps

Differ

ently

Qua

lified

Sta

ff

Mor

e Tr

aini

ng fo

r Sta

ff

Mor

e Te

chni

cal A

ssista

nce

Mor

e da

ta/eva

luat

ion

Mor

e Ope

ratio

ns F

undi

ng0

10

20

30

40

Nu

mb

er

of

ag

en

cies

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


Prev

ent D

iseas

e Tr

ansm

ission

Collect

and

repo

rt d

iseas

e in

form

ation

Imm

uniza

tions

Inve

stig

ate ca

ses o

f rep

orta

ble di

seas

es0

102030405060

LPHA onlyIn Partnership (LPHA in Partnership with CD-PHE, CDPHE Regional Staff, Other LPHA or other community part-ner)

Nu

mb

er

of

Ag

en

cie

s

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

0%20%40%60%80%

100%

1 = Clear need for increased capacity 2 = Basic level of capacity in place3 = Moderate level of capacity in place 4 = High level of capacity in place

Communicable Disease: Areas for Improvement


No Improvement 3 6%


More TA 9 17%


Other 10 19%


More Staff 23 43%

More Training for staff 26 49%


Communicable Disease: Areas for Improvement

No

Impr

ovem

ents

Ne.

..

Differ

ently

Qua

lified

S...

Mor

e Te

chni

cal A

ssist

...

Other

Mor

e Pa

rtne

rshi

ps

Mor

e da

ta/e

valu

atio

n

Mor

e Sta

ff

Mor

e Tr

aini

ng fo

r Sta

ff

Mor

e Ope

ratio

ns F

un...

0

5

10

15

20

25

30

35

Nu

mb

er

of

Ag

en

cie

s

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 DiseasePercent 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

010203040

LPHA onlyOther (could be in partnership with LPHA)UnknownNot Available

Prevention and Promotion: Self-Reported Capacity

Communicable disease prevention

Chronic disease prevention

Maternal & child health

Injury prevention

Capacity Option

# % # % # % # %

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

0%

20%

40%

60%

80%

100%


Prevention and Promotion: Areas for Improvement

Prevention & Promotion


Other 3 6%






More Staff 37 69%


Prevention and Promotion: Areas for Improvement

No

Impr

ovem

ents

Nee

ded

Other

Mor

e Te

chni

cal A

ssist

ance

Differ

ently

Qua

lified

Sta

ff

Mor

e da

ta/e

valu

atio

n

Mor

e Pa

rtne

rshi

ps

Mor

e Tr

aini

ng fo

r Sta

ff

Mor

e Sta

ff

Mor

e Ope

ratio

ns F

undi

ng05

10152025303540

Nu

mb

er

of

Ag

en

cie

s

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

EPSDT

Adult Immunizations

Childhood Immunizations

Family Planning

Nurse Home Visitor

Substance Abuse

WIC

HCP

Prenatal

0 5 10 15 20 25 30 35 40 45 50

Not AvailableOtherSecondaryPrimary

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


05

101520253035404550

LPHA Only Other (could be in partnership with LPHA) UnknownNot Available

Environmental Health: Self-Reported Capacity

Sanitation of

Institutional

Facilities

Food Safety

Zoonotic and

vector borne

disease

Air quality

Water

Community design

and planning

Waste Other

Capacity

Option

# % # % # % # % # % # % # % # %

1 920%

715%

3 7% 1329%

920%

1534%

1637%

1227%

2 1124%

3 7% 2043%

1431%

1432%

1125%

1126%

1943%

3 1941%

1430%

1533%

1533%

1125%

1023%

1023%

920%

4 715%

2248%

817%

3 7% 1023%

818%

614%

4 9%

Environmental Health: Self-Reported Capacity

0%10%20%30%40%50%60%70%80%90%

100%

1 = Clear need for increased capacity

2 = Basic level of capacity in place

Environmental Health: Areas for Improvement





More data/evaluation 12 23%Other 14 26%


More Staff 20 38%



Environmental Health: Areas for Improvement

No

Impr

ovem

ents

Nee

ded

Other

Differ

ently

Qua

lified

Sta

ff

Mor

e da

ta/e

valu

atio

n

Mor

e Pa

rtne

rshi

ps

Mor

e Te

chni

cal A

ssist

ance

Mor

e Tr

aini

ng fo

r Sta

ff

Mor

e Ope

ratio

ns F

undi

ng

Mor

e Sta

ff0

5

10

15

20

25

30

Nu

mb

er

of

Ag

en

cie

s

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


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


0

10

20

30

40

LPHA OnlyOther (could be in partnership with LPHA)UnknownNot Available

EPR: Self-Reported Capacity


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

21%

55%

23%


EPR: Areas for Improvement

Emergency Preparedness and Response


Other 4 8%







More Staff 30 58%

EPR: Areas for Improvement

No

Impr

ovem

ents

Nee

ded

Other

Mor

e Te

chni

cal A

ssist

ance

Differ

ently

Qua

lified

Sta

ff

Mor

e da

ta/e

valu

atio

n

Mor

e Pa

rtne

rshi

ps

Mor

e Ope

ratio

ns F

undi

ng

Mor

e Tr

aini

ng fo

r Sta

ff

Mor

e Sta

ff05

101520253035

Nu

mb

er

of

Ag

en

cie

s

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

ImmunizationsPrevent Disease

Transmission

Emergency Preparedness &

Response

Eastern Corridor

2.00 3.75 4.00 3.50 3.33

Southeast 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*Population > 70,000

State 2.04 3.22 3.49 2.70 3.02


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

*Population > 70,000

State 2.89 2.17 2.42 1.62

Safety of food

provided to the public

Sanitation of

institutional facilities

Zoonotic and vector-borne

environ. hazards

Air-borne environ. hazards

Water-borne public health

environ. hazards

and surface and ground

water

Land use planning

and sustainable developmen

t

Solid and hazardous waste and recycling and reuse

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

*Population > 70,000

State 3.11 2.52 2.61 2.18 2.50 2.25 2.14 2.11

Questions on data so far?

Ongoing data analysis

Research Projects Core Services Research Multi-network Practice and Outcome Variation

Examination (MPROVE) StudyBoth 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


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


Each Series here represents the self-reported capacity selected for

communicable disease prevention and promotion.

Series 1 = Clear need for increased capacitySeries 2 = Basic level of capacity in placeSeries 3 = Moderate level of capacity in placeSeries 4 = High level of capacity in place

Local Public Health Agencies in Colorado Baseline Review

Documents

Transcript of Local Public Health Agencies in Colorado Baseline Review