Community Health Plan WICHITA KANSAS (READ ALL REQUIREMENTS)
1/7/2017 Public Health: What It Is and How It Works
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mobilization and constituency building. PATCH focuses on orienting and training community leaders and other community participants in all aspects of the community needs assessment process and includes excellent documentation and resource materials. Although originally developed by the Centers for Disease Control and Prevention (CDC) to focus on chronic health conditions and stimulate health promotion and disease prevention interventions, PATCH is flexible enough to be used in a wide variety of community health needs assessment applications.
Another important tool for addressing public health core functions and their associated processes is Model Standards, Healthy Communities.8 The steps outlined for implementation of the Model Standards process in the community link many of the various core functionrelated tools; they represent, in effect, a pathway for organizations to participate in community health improvement activities.
1. Assessment of organizational role. Communities are organized and structured differently. As a result, the specific roles of local public health organizations will vary from community to community. An essential first step is to reexamine organizational purpose and mission and develop a longrange vision through strategic planning involving its internal and external constituencies. The resulting mission statement and longrange vision serve to guide the organization (leadership and board, as well as employees) and to define it for its community partners. This critical step should be completed before the remaining steps can be successfully addressed. Part I of APEXPH and the expanded strategic planning elements of MAPP are useful in accomplishing this task. 2. Assessment of organizational capacity. After mission and role have been defined, it is necessary to examine an organization’s capacity to carry out its role in the community. This calls for an assessment of the major operational elements of the organization, including its structure and performance for specific tasks. This type of organizational and local public health system selfassessment is best carried out through broad participation from all levels. Both APEXPH and MAPP include hundreds of indicators that can be used in this capacity assessment. These indicators can be modified or eliminated if deemed inappropriate, and additional indicators can also be used. This step serves to identify strengths and weaknesses relative to mission and role. 3. Development of a capacitybuilding plan. The development of a capacitybuilding plan incorporates the organization’s strengths and prioritizes its weaknesses so that the most important are addressed first. As in any plan, specific objectives for addressing these weaknesses are developed, responsibilities are assigned, and a process for tracking progress over time is established. Again, APEXPH and MAPP are valuable tools for accomplishing this task. 4. Assessment of community organizational structure. Having looked internally at its capacity and ability to exercise its leadership role for identifying and addressing priority health needs in the community, the public health organization must assess the key stakeholders and necessary participants for a communitywide needs assessment and intervention initiative. This is often a longterm and continuous process in which the relationship of all important community stakeholders and partners (e.g., the health agency, community providers of healthrelated services, community organizations, community leaders, interest groups, the media, and the general public) is assessed. This step determines how and under whose auspices community health planning will take place within the community. Both APEXPH/MAPP and PATCH processes support the successful completion of this step. 5. Organization of community. This step calls for organizing the community so that it represents a strong constituency for public health and will participate collaboratively in partnership with the health agency. Specific strategies and activities will vary from community to community but will generally include hearings, dialogues, discussion forums, meetings, and collaborative planning sessions. The specific roles and authority of community participants should be clarified so that the process is not perceived as one driven largely by the health agency and socalled experts. Both APEXPH/MAPP and PATCH are useful for completing this step. 6. Assessment of community health needs. The actual process of identifying health problems of importance to the community is one that must carefully balance information derived from data sets with information
1/7/2017 Public Health: What It Is and How It Works
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derived from the community’s perceptions of which problems are most important. Often, community readiness to mitigate specific problems greatly increases the chances for success, as well as support for the overall process within the community. In addition to generating information on possible health problems, this step gathers information on resources available within the community. This step serves to provide the information necessary for the community’s most important health problems to be identified. The community needs assessment tools provided in both APEXPH/MAPP and PATCH can be used to accomplish this step. 7. Determination of local priorities and community health resources. After important health problems are identified, decisions must be made as to which are most important for community action. This step requires broad participation from community participants in the process so that priorities will be viewed as community rather than agencyspecific priorities. Debate and negotiation are essential for this step, and there are many approaches to coming to consensus around specific priorities. Both APEXPH/MAPP and PATCH support this step. 8. Selection of outcome objectives. After priorities are determined, the process must establish a target level to be achieved for each priority problem. For this step, the Model Standards process is especially useful in linking community priorities to national health objectives and establishing targets that are appropriate for the current status and improvement possible from a community intervention. This step also calls for negotiation within the community because deployment and reallocation of resources may be needed to achieve the target outcomes that are agreed upon. In addition to Model Standards, both APEXPH/MAPP and PATCH can be useful in accomplishing this step. 9. Development of intervention strategies. This step is one of determining strategies and methods of achieving the outcome objectives established for each priority health problem. This can be quite difficult and, at times, contentious. For some problems, there may be few or even no effective interventions. For others, there may be widely divergent strategies available, some of which may be deemed unacceptable or not feasible. After agreement is reached as to strategies and methods, responsibilities for implementing and evaluating interventions will be assigned. With communitywide interventions, overall coordination of efforts may also need to be addressed as part of the intervention strategy. 10. Implementation of intervention strategies. After the establishment of goals, objectives, strategies, and methods, specific plans of action for the intervention are developed, and specific tasks and work plans are developed. Clear delineation of responsibilities and time lines is essential for this step. 11. Continuous monitoring and evaluation of effort. The evaluation strategy for the intervention will track performance related to outcome objectives, as well as process objectives and activity measures over time. If activity measures and process objectives are being accomplished, there should be progress toward achieving the desired outcome objectives. If this does not occur, the selected intervention strategy needs to be reconsidered and revised.
Since 1990, numerous communities have used PATCH, Model Standards, and other tools (such as Healthy Cities and Healthy Communities, two similar community needs assessment processes) in community health improvement initiatives.
In 1996, and again in 2002, the IOM revisited issues addressed in The Future of Public Health report, concluding that different organizations, leadership, and political and economic realities were transforming how public health carried out its core functions and essential services.16,17 On one hand, marketdriven health care was forcing public health to clarify and strengthen its public role in a predominately private system. On the other, public health was increasingly identifying and working with a variety of entities within the community that shape community health and wellbeing. Another important IOM report18 in 1997 advanced an expanded CHIP model that extends the tools developed earlier in the decade and the steps described previously here. Its main features are its expanded perspective on the wide variety of factors that influence health, its support for broad participation by community stakeholders, and its emphasis