Assigment 6 modules reflexion 2-3 pages.Apa seven . All instructions attached.

Module 2: Population Health Assessment

Slide 1: Population Health Assessment:

Welcome to this session on Population Health Assessment. The is the second module of the Foundations of Population Health Science and Practice mini course for public health professionals. My name is Maureen Benjamins and I’m an epidemiologist at the Sinai Urban Health Institute in Chicago.

Slide 2: Acknowledgements:

This education module was made possible through a cooperative agreement between the Centers for Disease Control and Prevention and the Association for Prevention Teaching and Research. I would also like to acknowledge these individuals, from Rosalind Franklin University, the CDC, and ATPR, who all collaborated on this project.

Slide 3: Population Health Modules:

Today’s module follows Module 1 on the social determinants of health. There are four other modules that follow this one and I hope you will check them all out.

Slide 4: Overall Learning Objective:

The overall goal of this series is to provide a base of knowledge in population health science and best practices in population health, including the design, implementation, and evaluation of population health activities. Our target audience is public health professionals, students in public health or health professions, as well as allied health and health care providers.

Slide 5: Module 2 Objectives:

The specific objectives of this session are to:

1. Get to know what a population health assessment is and why we conduct them

2. Understand how to prioritize health issues, once you have the data

3. Finally, you will learn about community engagement strategies in order to have a community-driven assessment

Slide 6: Objective 1:

So first we will discuss what is included a population health assessment.

Slide 7: Definitions:

Before we do this, let’s define population health. Perhaps the most commonly used definition, and the simplest one, comes from Drs. David Kindig and Greg Stoddart. This definition say population health is “The health outcomes of a group of individuals, including the distribution of such outcomes within the group.”

Module 2 Transcript | 10

Slide 8: Definitions:

In addition to the health outcomes and inequities, but population health also includes a focus on the determinants (or the different factors that influence health outcomes).

Slide 9: Definitions:

And finally, the field of population health also includes a focus on strategies to improve population health, whether these are broad policies or individual interventions. I should note that there is no real consensus on a definition. That is, what you mean by the term often depends on your viewpoint (e.g. health care administrator vs researcher vs community group). The “population” part of population health could refer to a specific community or geographic area, or it could mean a group of patients, or a hospital or agency’s service area, or people with a specific health concern, for example. Your population will need to be specified.

Slide 10: Population Health =

To further enhance our understanding of the concept, I want to highlight that population health is often thought of as an approach or a strategy for improving the health of a group.

The population health framework can be thought of as an expansion of the public health agenda, such that all the factors or forces influencing health in a society can contribute or be part of working toward a common goal of improved health and health equity. CDC definition - brings significant health concerns into focus and addresses ways that resources can be allocated to overcome the problems that drive poor health conditions in the population.” ASTHO – “population health can be thought of as the science of analyzing the inputs and outputs of the overall health and well-being of a population and using this knowledge to produce desirable population outcomes.” Inputs are the risk factors, determinants. Outputs are good health outcomes, health equity.

Slide 11: Public Health =

Many of you in the audience come from the field of public health, you’re working there or you were trained in public health. The classic definition from Winslow is “The science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals.” As this implies, public health is concerned with the important functions of federal, state and local public health departments such as preventing epidemics and encouraging healthy

behaviors. However, as the second definition implies, the scope of public health is broader now, and often includes interdisciplinary work, which is closer to pop health. Public health “promotes and protects the health of people and the communities where they live, learn, work and play.” APHA website

Slide 12: Population health vs. Public health:

So, how do these two terms compare or overlap? Population health is increasingly used because it is a broad perspective. It is less tied to health departments, and it explicitly includes health care. Public health still critically important (as the Covid-19 pandemic has made very clear). Here, we generally use population health because it is a broader, more explicitly

collaborative strategy, encompassing public health, along with the healthcare system, the private sector, and the communities themselves. A similar term – community health – is often also used. The distinction is that it is almost always organized around a specific geographic area and it generally has greater involvement of the community, through community-based organizations and community health professionals. Usually involve the use of community-based interventions to improve outcomes. “ Community health is a multi-sector and multi-disciplinary collaborative enterprise that uses public health science, evidence-based strategies, and other approaches to engage and work with communities, in a culturally appropriate manner, to optimize the health and quality of life of all persons who live, work, or are otherwise active in a defined community or communities.

Slide 13: Overlapping Fields, Similar Goals:

So we use this diagram to help you visualize the large overlap that exists between population health and public health activities and goals.

Slide 14: Population Health Assessment =

Moving on the main topic of this module… “The measurement, monitoring, analysis, and interpretation of population health data, knowledge and intelligence about the health status of populations and subpopulations, including the social determinants of health and health inequities.” Very similar to the definition of pop health that we just discussed – this is a way to measure and monitor things that are important to population health, like health outcomes, social determinants of health, and health inequities.

Slide 15: Community Health Assessment:

There are different types of pop health assessments. One is Community Health Assessments or, more simply, a Community Assessment. Community Assessments = the process of identifying the strengths, assets, needs, and challenges of a specified community. Another related type of assessment is the CHNA.

Slide 16: Purpose:

So why do we collect this type of data about a group and what’s the value?

1. Provides a current (and comprehensive) snapshot of a population’s health –

2. By understanding what’s going on now in that community, we can determine the gaps that exist between current health status and optimal health, and how to best address that gap.

3. It also provides baseline data to evaluate if efforts are making an impact. To see if things are moving in the right direction.

Slide 17: Purpose:

An assessment also helps you identify a wide range of determinants of health, especially modifiable ones.

Understanding this factor is critical to inform health improvement plans and related decisions.

· Ensures new initiatives will be designed and planned in a way to maximize community benefit. Helps you to make logical decisions and maximize your resources.

Slide 18: Purpose:

Doing an assessment can help your organization develop new partnerships or strengthen existing ones. It can lead to greater collaboration. Allows everyone to have a common understanding of the underlying issues. Gather people with similar goals, ideally from different organizations and sectors.

Slide 19: Purpose:

Finally, both the data and the process can help serve as a call to action, to move people toward a common goal

Slide 20: Required Assessments:

The importance of this type of data has been recognized by many groups. For this reason, assessments are required for health departments and other organizations. For accreditation, PHAB requires all state, tribal, local, and territorial health departments to conduct a comprehensive health assessment and create a health improvement plan, at least once every 5 years. There are also some state-specific requirements for local health departments. Also, non-profit hospitals are required to conduct such assessments, which I’ll talk about next.

Finally, some grants require an assessment, including CDC’s community transformation grants and REACH Core grants. The Public Health Accreditation board defines community health assessment as a systematic examination of the health status indicators for a given population that is used to identify key problems and assets in a community. The ultimate goal of a community health assessment is to develop strategies to address the community’s health needs and identified issues. A variety of tools and processes may be used to conduct a community health assessment; the essential ingredients are community engagement and collaborative participation.

Slide 21: Example: IRS requirements for non-profit hospitals:

In the US, the IRS and provisions in the Affordable Care Act require tax-exempt hospital facilities to:

1. Conduct a Community Health Needs Assessment at least every three years

2. Get input from persons who represent the broad interests of the community

3. And input from persons with special knowledge of, or expertise in, public health

4. Make the assessment widely available to the public

5. Create an improvement plan (CHIP) in response to CHNA. Every year hospitals have to submit an update on their progress toward the goals of the CHIP.

Note: CDC recommends collaborative CHNAs.

Slide 22: Community Health Assessment and Implementation Pathway:

Now that you know the purpose of health assessments, I’d like to briefly summarize the process. This model from the Assoc for Comm Hlth Improvement is one of the most well-

known models. It combines the community health assessments (steps 1-6) and CHIP phases (steps 7-9).

1. This first step in this model is to reflect on any previous assessments, get feedback from key stakeholders, and then create your assessment strategy - plan assessment infrastructure, get leadership support, build team, obtain resources

2. Step 2 is to develop a community engagement approach, map assets, identify stakeholders, and form your committee

3. In Step 3, you will describe the community of focus, identify any specific population groups, identify others doing similar assessments in your area or for your population

In future slides, we’ll talk more about these steps, as well as Steps 4, 5, and 6, where you will develop a data strategy, prioritize health concerns, and disseminate the results. I’d like to start off by talking about the specific components that are included in the assessment.

Slide 23: Health Assessment Components:

So what does a population (or community) health assessment ideally include?

· Holistic view of wellbeing in the community (Not just about prevalence of diabetes, for example, or levels of premature mortality). Also looks beyond health care provision (though this is a key part of it) and individual behaviors, to understand the social and structural factors that influence health and wellbeing.

· Look at demographic aspects of the population – how many people are in your population, what’s the average age, etc.

· Then, look at the factors on the right side of this diagram, which are often referred to as upstream determinants of health

Slide 24: Population Health Framework:

It is valuable to use a population health framework to help think about or organize the types of information you might want to include. Here is one example from County Health Rankings our of the University of Wisconsin. This is a good way to categorize (modifiable) determinants of health, which are shown in the blue boxes.

· Note that social and economic factors, such as income and community safety, are not easy to influence but make big contribution to health

· In fact, much of what influences health is outside traditional public health and medicine areas of influence

· Only about 20% of disease/mortality is due to genetics (see Rappaport, PLOS One, 2016)

· https:// www.countyhealthrankings.org/resources/county-health-rankings-model

· Description from the county health rankings website: “The Rankings are based on a model of population health that emphasizes the many factors that, if improved, can help make communities healthier places to live, learn, work and play.”

Slide 25: Components:

The basis of a population health assessment is data and information. This information can come in many different forms, from many different sources.

The data can be quantitative – meaning numbers-based information. With this type of data, you can use statistics, which are more generalizable. Examples: percent of population who are employed, rates of smoking, number of healthcare facilities.

The data could also be qualitative – or more narrative-based. This type of data provides important context and richer details. Example: In what ways do community members consider themselves healthy? What do they perceive as the biggest barriers to health?

Different types of data complement each other because they answer different questions. The data can come from different sources. Primary sources reflect data that you collect yourself, such as data from your organization (like a health system or health department). Secondary sources – use data from the many available existing sources of data.

Slide 26: Potential Primary Data Sources:

For example, some potential primary data sources are listed here. These are methods that you do yourself, such as by hosting focus groups for members of your population. Hospital data from your own organization may be primary source, often is a secondary source.

Slide 27: Potential Secondary Data Sources:

In contrast, secondary data sources provide existing data. Some examples are:

Surveillance data, which you will learn about in the next module, and includes things like data on sexually transmitted infections or data on outbreaks or pandemics, like Covid-19. Vital statistics provides information on births and deaths. EHR/EMR data provides information on hospitalizations for different conditions, for example. Survey data provides information on the full range of determinants and outcomes, as well as social and economic information. Other sources of data provide information on relevant factors such as the extent of air or water pollutants in an area.

Slide 28: Examples of Secondary Data:

In the US, we have many great resources to access data. Some national data sources include: CDC WONDER – comprehensive source of 20+ data sets, includes vital statistics, cancer registry, STI, environmental data, data on vaccinations, etc

CDC Places – data on health conditions, behaviors, and risk factors for local areas, like counties, census tracts, zip codes

County Health Rankings – county-level data on wide range of health outcomes and determinants,

And City Health Dashboard – is a great resource that provides the same type of data but for cities

So, when you are considering different data sources, what should the data in your assessment include?

Slide 29: Assets =

As we said earlier, assessments should not just focus on health issues, but should also assess the level of resources and the different types of assets that exist within a population.

People may be familiar with this concept if they have done a SWOT analysis, which is often used in business. In that type of assessment, you identify the Strengths, Weaknesses, Opportunities, Threats for a particular organization or project. This is similar, where a community identifies its strengths or assets.

Assets can be related to people, as in the skills and abilities of individuals.

A physical structure or place (e.g., parks, schools, hospital, place of worship, recreation center, affordable housing)

A community service – like public transportation

A business that provides jobs and supports the local economy

Civic or cultural associations (e.g., Neighborhood Watch or a Parent Teacher Association) Local private, public, and nonprofit organizations

This is important to provide a balanced view of the community. It is also critical to inform next steps.

Slide 30: Reflection Question #1:

OK, let’s stop and have a moment for you to reflect on what you’ve learned so far. Specifically, I’d like you to think of at least two potential sources of existing health-related data for your community or population. I’ll give you a little time here.

Slide 31: Reflection Question #1 – ANSWERS:

Here are some examples that you might have thought of:

· Infectious disease data from a state or local health department

· Data on the prevalence of certain health conditions from County Health Rankings or City Health Dashboard, if your population is a full county or city

· Hospital data

· Air quality data from the EPA

· Income data from the Census

Slide 32: Reflection Question #2:

OK, one more question to think about – can you think of 4 organizations that could be considered an asset to your population?

Slide 33: Reflection Question #2 – ANSWERS:

Here are some examples of answers that you may have come up with:

· YMCA

· Churches

· Big employers

· Local university

· Food pantry

Slide 34: Objective 2:

The second objective of this module is to help think through the steps needed to interpret and summarize the data you have collected in order to prioritize next steps.

Slide 35: Prioritizing Health Needs:

Your population health assessment will highlight different challenges that your population faces.

Presumably, everyone has limited resources, so you can’t address all of them. So what are the criteria for deciding which issues to focus on? Who makes this decision? The process of setting health priorities should involve the participation of stakeholders (e.g. community, health care team, public health experts).

Slide 36: Criteria for Prioritization:

There are many ways, both formal and informal, to prioritize issues. NACCHO has a very helpful resource that summarizes this process and the most commonly used strategies. I’ll briefly summarize the criteria and methods. Here are some important criteria to consider:

· The impact and size of the problem

· The availability of solutions and potential resources to apply to those solutions

· The expected cost and/or return on investment for potential initiatives/policies/or programs

· And the urgency of the issue

Slide 37: Additional Criteria for Prioritization:

Assessment teams may also want to take into account some other considerations, such as are there inequities in the problem or the factors leading to it? What are the relevant community assets and opportunities for collaboration? Does your community already have existing programs or initiatives related to issue? Does the issue align with your own organization’s mission/priorities? And, does the issue leads to other problems, which may further exacerbate your population’s health?

Slide 38: Methods of Prioritization:

There are many specific methods that can help you to develop and use criteria in order to set priorities.

1. Multi-voting Technique - good to use when a long list of health problems and they must be narrowed down to a top few. This process involves multiple rounds of voting, eliminating least chosen issues each time. Sometimes a version of this is used, called the dotmocracy.

2. Nominal Group Technique – democratic process that can help to generate a lot of ideas and get a lot of input. Involves silent brainstorming, listing, discussion, and rankings.

Will talk more about Strategy Grids, the Hanlon Method, and the Prioritization Matrix next.

Slide 39: Strategy Grid Development:

Strategy Grids – help groups to focus on problems where they can have the most impact. To do this, you set up a quadrant around 2 criteria, such as need and feasibility. Or, Value vs Cost.

Once you pick the criteria, then (as a group) you write in each of your potential issues.

Slide 40: Strategy Grid:

Finally, you then would choose to focus on issues that were placed in the high need/high feasibility quadrant (in the top right). If you have more time/money/resources, you then move to the top left quadrant. And so on.

Slide 41: The Hanlon Method:

Another way to prioritize among your health issues is the Hanlon Method. This commonly used method uses explicitly defined criteria and feasibility factors to objectively assess the issues.

Note this also takes into consideration how modifiable the issue is. That is, how effective are existing interventions to address the problem?

Slide 42: Calculating Priority Scores:

Fairly complicated method compared to some of the others.

1. Pick specific criteria and then rate each health problem according to that criteria

2. Use a set of feasibility factors to screen out problems that likely can’t be addressed

3. Calculate a priority score and rank accordingly.

4. Here, the Size of the Health Problem is one criteria. Should be based on baseline data from the community.

5. Seriousness of Health Problem is based on questions like, does it require immediate attention? What is the financial burden? What is the quality of life impact? Does it lead to higher mortality, morbidity, or hospitalizations?

6. Effectiveness of Interventions – can look to resources like the CDC’s Guide to Community Preventive Services for more info on assessing intervention effectiveness.

Slide 43: Example of Calculating Priority Scores:

Then you calculate priority scores. The scoring involves some estimation. For Covid-19, we will say the prevalence is 2% (for most health issues, hopefully there is a more precise estimate).

We deem it to be relatively serious based on the transmission rate, infection fatality rate, and hospitalization rate. Let’s say the effectiveness of interventions (including mitigation, treatment, and vaccination) is 80-100% effective. Score is 171. Then do the same for the next issue that came up, such as obesity or food insecurity. Finally, rank according to scores.

Slide 44: Prioritization Matrix:

As our final example, I will describe the Prioritization Matrix. First create a matrix using however many criteria you want. Establish a weighting for each criterion if some are more important than others. Rate each health problem by the criterion you established at the start. Can be 1-3 (as shown here) or 1-5 or as you want. Calculate the priority score and then rank. As you can see, there is a subjective nature to all of these, but the steps and criteria will help you as a group make a more informed decision.

Slide 45: Prioritization Process:

In summary, after you have collected data on your population, you need to prioritize amongst issues. The process should include representatives of the population at hand, as well as public health experts, and members of your own organization.

You will want to start by discussing the data, making sure data are presented in a format that is accessible for all individuals on the committee. Foster an environment for open dialogue to discuss the identified health needs thoroughly.

Take stock of what resources (staffing, in-kind, financial, etc.) could potentially be leveraged to address that need. What criteria are most important to you, and what process might work well for your group. Then document all steps to be transparent.

Slide 46: Reflection Question #3:

What are some common criteria for prioritizing health issues? Here we will stop again to have a moment for reflection.

Slide 47: Reflection Question #3 – ANSWERS:

· Impact of problem (number of people affected, seriousness of outcome)

· Potential for addressing it (available resources and expertise)

· Cost

· Urgency

Slide 48: Reflection Question #4:

Describe three of the most commonly used methods for prioritizing health issues.

Slide 49: Reflection Question #4 – ANSWERS:

· Multi-voting technique – A good way to narrow down a big list of health problems using multiple rounds of voting and eliminating the last choice each time.

· Nominal group technique – A democratic process that can help to generate a lot of ideas and get a lot of input. Involves silent brainstorming, listing, discussion, and rankings.

· Strategy grids – A way to focus on problems where they can have the most impact by putting issues into a quadrant based on two criteria, such as need and feasibility.

· The Hanlon Method – A more involved method that uses explicitly defined criteria and feasibility factors to objectively assess the issues.

· Prioritization matrix – Another method that involves creating priority scores through criteria and weights.

Slide 50: Objective 3:

In this third and final objective, will we discuss how to best incorporate community feedback and engage partners. These partners- including but not limited to, community members, organizations, government agencies, health care providers, academic institutions, and businesses.

Slide 51: Community Engagement Benefits:

Hopefully most people understand the importance of engaging community members in a population health assessment, but we want to reiterate it here.

· To begin, no one knows more about a community than those who are part of it. Thus engaging directly with your population or community of interest will allow to you have greater insight into the community, including knowledge about social risk factors, health issues and determinants, and culture

· Greater understanding of perceived needs, the availability of resources and feasibility of addressing certain needs

· Stronger ties to the community, leading to increased collaborations. More relationships with organizations or individuals who are the assets of the community.

· Finally, engagement with the community is the best way to have buy-in from that community and a shared sense of ownership of and commitment to community health

Slide 52: Community Engagement Benefits (Continued):

Moreover, engaging the community respects the rights of community members to own their stories, and envision their own future.

Because of all of this, it also produces better assessments. Community representatives can tell you when something just won’t work with their population, or, for example, they could look at the same data and respond to it very differently than an outsider. Lastly, they have more at stake and are always going to be the most invested in turning data into change.

Finally, a better assessment can guide more effective changes, resulting in healthier communities.

Slide 53: Community Engagement Spectrum:

There is a spectrum of levels of engagement by community members or members of your population.

At the far left, simply informing or seeking input through consultation is the very least of our obligation to the public.

To truly engage communities, we should strive to move as far along the continuum as possible, moving from involvement to true collaboration to the full empowerment of the community.

Slide 54: Community Engagement in Assessments:

Here is a more specific examples of what this could look like on an assessment team.

At the minimum level (on the left), you have community members as participants. In this way, you get input from community members on specific questions or topics, but they are not engaged in the full process. Community partners bring issues and concerns from the community to the group, which the group then discusses and resolves in a manner that works for both the assessment team and the community.

Next, you have community advisors who provide valuable information, recommendations, and feedback from their perspective; And they do this in an on-going manner. However, they are not fully part of the assessment team because they don’t have a say in the actual decisions. (see Neuman, Preventing Chronic Disease, 2011)

Finally, you can involve community members as full partners. This is where they are collaborators and are fully empowered members of the team. They may have shared leadership, but, at the very least, they are involved in the governing, the planning, and the decisions.

Slide 55: Community Advisory Boards (CABS):

One important way to formally engage community members is through Community Advisory Boards (CABs).

What? CABs are a mechanism to work with community members as partners on an assessment (or research project or health promotion initiative). Often used in Community Based Participatory Research. Increasingly required by funders.

Why? Like benefits discussed earlier, having a CAM can allow for stronger relationships, greater trust, and improved completeness and accuracy of your assessment.

Who? CABs can be specific to your assessment (members that are part of the assessment committee) or they can support your broader institution. This latter structure is preferable, as involvement will generally go beyond the assessment through the CHIP phase. Having a CAB is time-intensive, resource-intensive, and requires a longer-term commitment.

We’ll talk more about who to include next.

Slide 56: Examples of Community Advisory Boards:

Here are some links to community advisory boards around the US.

Slide 57: Other Advisory Boards:

A similar concept is a patient advisory board. Could also use a Stakeholder Advisory Panel, which serve a similar function.

Stakeholder advisory panels are similar, but include a broader range of members than patient advisory boards or community advisory boards. May include leadership from healthcare or public health organizations, clinicians, patients, community members, elected officials, etc.

Slide 58: Community Engagement Process:

We all now understand the importance of community engagement and the use of Community Advisory Boards as one mechanism to facilitate the engagement. Let’s dive in deeper and talk about the engagement process. We’ll look at this in terms of formation, operation, and maintenance.

Slide 59: Identifying Potential Partners:

When determining potential partners for a population health assessment, you should start by brainstorming a list of potential partners.

In addition to getting people from the full geographic area you represent (if applicable), be sure to include a diverse group, including members of medically underserved, low income, and marginalized populations. You might want to think about other at-risk groups, such as populations with chronic diseases, if relevant.

Slide 60: Sectors and Organization Types:

In order to have a broad range of perspectives and expertise, you will want an inter-disciplinary group. Here is a list of sectors or types of organizations that you might want to pull from.

Slide 61: Selection Criteria:

· Once you have brainstormed a list of potential partners or organizations to approach, how do you narrow it down?

· Diversity of representation: Geographic, Race/ethnic, Gender identity, Age, Health status (e.g., has a disability or chronic condition), Education or socioeconomic status

· Level of community knowledge/familiarity with community

Consider that you might get more buy-in from an organization by having a senior level employee on the board.

This might mean greater potential for resource allocation (if needed), connections and greater knowledge about how the organization can contribute (if needed).

But, it might make more sense to have less senior members on the committee, depending on how well an individual knows the community. And they may have more time.

Finally, you have to weigh all of these criteria within the boundaries of your ideal committee size and the budget. Budget is important, because community members should be compensated for their time.

Slide 62: Potential Member Matrix:

One useful tool to guide this process might be to create a potential member matrix that includes factors such as type of org, etc.

A stakeholder analysis framework may also be beneficial to narrowing the initial advisory list. A general methodology can be found in the University of Kansas Community Toolbox (7 & 8).

Slide 63: Community Engagement Recruitment:

Once you have decided on the people or organizations you would most like to include, you need to plan for recruitment. Reaching out in person is especially important for bigger asks. It provides the personal connection. The trade-off is that it takes more time, and may have other expenses. Recruitment could be done at local community events, meetings, library, etc. Or by setting up meetings.

You could also recruit through phone calls or letters. Letters are the least personal option, but are nice because you can take time to perfect what you want to say, use the letters for multiple people. BUT, no dialogue, time for questions, no relationship building.

Combo- write introductory letter, follow up with call or appointment. Or meet in person, then summarize with an email.

See Community Tool Box for detailed guidance on all aspects, including concrete recommendations for things like what to cover during your first meeting with potential community advisory board members.

Slide 64: Community Engagement: Operation:

Once you have successfully recruited community members to your team, you need to be intentional about how the group operates in order to facilitate genuine engagement.

This includes establishing operating procedures, which include logistical concerns like how often the team meets, who sets the agenda, and how to ensure inclusion from everyone during the meetings or activities.

You will also need to establish principles, such as those related to shared values, mutual respect, and building trust.

Finally, determining the leadership structure is critical. You will need to balance power and ensure the decision-making process is clear. Your structure could involve having 2 co-chairs, one from the host group and one from community. Maybe your group needs to have subcommittees if it’s a large project, and this will help to decentralize the decision-making process. You can outline how voting works – maybe require 70% of group to agree. Doing this in advance takes time, but will help to head off problems later on.

Organizations need to be aware that this critical piece of the process will take considerable time and resources.

Slide 65: Operation:

Let’s dive a little deeper into operational procedures and principles.

From the start, it is important to make sure everyone is clear on their roles and expectations. Which meetings are they expected to attend? Do they need to prepare anything in advance? What else are they expected to do, and when?

As part of these discussions, it may be useful to set ground rules for the group related to things like attendance and meeting expectations.

As the assessment work begins, you want to make sure everyone understands the process and its benefits.

How can the group build trust and create a cohesive team?

Are there any power imbalances in play? What does the convener need to do to address and alleviate them?

How to get on the same page regarding the actual words used to describe the goals, methodology, or outcomes?

Compensating representatives of marginalized populations needs to be a standard practice (just like you would be expected to compensate a consultant with expertise in another area) since their contribution is extremely valuable.

Slide 66: Community Health Assessment and Implementation Pathway:

Going back to the outline of health assessment steps from the Association for Community Health Improvement model, note that community engagement is depicted as the center of the process. It’s shown this way because it is an integral piece of each step. This is true for the steps we talked about already, through the end of the assessment component, which is Step 6 – documenting and communicating results.

At this step, when the assessment is complete, a CAB can provide valuable input into the dissemination process.

Slide 67: Dissemination of Findings:

What might community engagement look like at this step?

Members can help you think through the following considerations about your potential audience – who would benefit from this data? Who might be able to help use it to make real changes in the community? Who could provide useful feedback on the assessment? They can also help you think through issues related to access.

Modes: » How can you get the information to your target audiences in the community? How would different groups in the community prefer to have this information presented? Does the information need to be customized or tailored? Translated to another language? Would an audio version be useful?

» Is there a preferred length of the document that would encourage community members to read it?

In the supplemental video case study linked to this module, you can see how one group grappled with these questions when disseminating information from the Sinai Community Health Survey.

Slide 68: Community Engagement: Maintenance:

Finally, how can you maintain effective community engagement? Working with a community and collaborating with community members is not a short-term endeavor.

It is important to plan for an evaluation of the process – This could be done by observing meetings, doing a member survey, reviewing group documents, or doing key informant interviews, for example. You will want to ask how shared leadership is going, is communication sufficient, and have there been any conflicts. Also want to consider membership turn-over, how group members perceive the benefits and costs of participating, and how has community engagement been able to impact the assessment.

Sustainability also has to be planned for.– CABs ideally are not a one-time commitment and should be used to sustain engagement beyond a single assessment or initiative.

Helpful practices to help with this include regularly recognizing contributions of members, this includes financial compensation if possible. Strengthening relationship outside of assessment – going to events your partners hold in the community, helping to draw attention or resources to their needs. If funding doesn’t allow group to continue, be clear on communicating this and the timeline, leave relationship open for future collaboration

Emphasize the importance of ensuring that the community partners/organizations get something out of their participation on the board. Benefits beyond serving the community and potentially improving population health. That they may develop partnerships, identify resources that may be beneficial to their organization...

Slide 69: Key Factors for Success:

To summarize, community engagement is necessary to successfully complete a pop health assessment. Given the increasing amount of data available to include in these assessments, it is even more critical to have community engagement to ground the assessments in local knowledge and to connect with local partners.

· This engagement and collaboration will help ensure all processes and outcomes are culturally appropriate and rooted in community expertise

· Your assessment should build upon existing public health knowledge, incorporating feedback from public health experts and using evidence-based methods when available

· The assessment should incorporate a holistic view of wellbeing in the community, including the social and structural factors that influence health

· And finally, it works best when assessment goals are aligned with your organizational mission to improve sustainability

Slide 70: Population Health Assessment:

· Critical to understand health issues and determinants; be aware of community assets and resources, and have baseline data for assessing changes moving forward

Slide 71: Reflection Question #5:

Now for our last set of reflection questions. Why is community engagement a necessary piece of population health assessments?

Slide 72: Reflection Question #5 – ANSWERS:

· Community knowledge and perspectives are needed to guide the assessment, put quantitative data into context, and determine priorities.

· Engagement improves the buy-in of community members and organizations who are needed to act on the data.

Slide 73: Reflection Question #6:

What steps can be taken to facilitate trust between community members and others involved in a health assessment?

Slide 74: Reflection Question #6 – ANSWERS:

· Be clear on each members’ roles and expectations

· Provide appropriate compensation for community members’ time

· Have transparent guidelines for decision-making

· Make sure common terminology/language is used

Slide 75-end: General Population Health Assessment Resources:

That concludes Module 2. Thank you for listening. The following slides include resources for some of the topics we covered today. They are available as a separate document for your convenience, along with the video case study.