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

Module 4: Population Health Interventions

Slide 1: Population Health Interventions:

Hello, my name is Dr. Lori Thuente, and I am here to talk about population health interventions, which is module 4 in our mini course for public health professionals.

Slide 2: Acknowledgements:

This educational module has been made possible through a cooperative agreement between the Centers for Disease Control and

Prevention and the Association for Prevention, Teaching and Research.

Slide 3: Population Health Modules:

As I said, this is module 4 in the series, and this one is titled Population Health Interventions.

Slide 4: Overall Learning Objectives

Our overall learning objective for the entire series is to provide foundational knowledge on population health science and best practices in population health, including the effective design, implementation, and evaluation of population health activities.

Slide 5: Connections to Other Modules:

This module connects to modules 1, the social determinants of health; modules 2, population health assessment; module 3, population health surveillance; and module 6, population health during a pandemic.

Slide 6: Module 4 Objectives:

This module objectives are to identify resources and partners to select or modify and evidence informed population health intervention, to address the specific health needs of a population, implement a specific evaluation process. In this example, we're going to look at “Plan-Do- Check-Act” to continuously evaluate and improve the collective impact on the population health. We're going to describe strategies for adapting evidence-informed interventions for both remote and telehealth delivery. We're also going to examine strategies to foster collaboration across multiple sectors. So within one's organization with partners and with the community that you are serving.

Slide 7: Objective 1:

Objective 1, as we said, to identify resources and partners to select or modify and evidence- informed population health intervention to address the specific health needs of a population.

Slide 8: Process for Identifying, Selecting, and Implementing an Evidence-Based Intervention (EBI):

So, what is the process that we're going to use to identify, select and implement an evidence- based intervention or an EBI? Well, first we're going to conduct a needs assessment. Then

Module 4 Transcript | 10

we're going to research and identify an evidence-based intervention. We're going to select one that fits our needs. We're going to consult with our stakeholders to ensure fit, then we may adapt it. We will train our staff and then we'll implement our evaluation and implement our intervention and evaluated.

Slide 9: Conduct a Community Health Needs Assessment:

When conducting a community health needs assessment, what we're doing here is we're identifying the gaps between what are the services that are available in the community and what are the ones that should be available. We want to look at the strengths and the resources that we already have that meet the needs of the children, youth and families of our community. Why would we want to do this? Well, because otherwise you might be wasting your time and money and providing a service that might not be needed or wanted. You may want to change a policy. For example, you may want to raise the age to buy cigarettes in your town, may want to change the system. So, for example, offering condoms through a local high school health clinic. Or we want to change an environment, for example, using a city owned land to develop a community garden.

Slide 10: 6 Steps in a Needs Assessment:

There are 6 steps in the needs assessment process. First, we're going to scope the needs assessment. We want to figure out what is the purpose of this needs assessment? Who is going to be using the results that we determine what our resources to even conduct the needs assessment? How will we involve the community and who will make the deciding make the final decisions on what we are going to do? We want to figure out what our assessment criteria are, so we're going to develop a list that are meaningful for the context of our situation. These criteria will help us evaluate and prioritize the needs of our constituents. We're going to plan for the data collection. So, we're going to identify what data do we need? Do we need qualitative data? Meaning, do we need to ask people questions and determine their thoughts and feelings on different topics? Or do we want quantitative data, numerical data, or might we use a mixed methods version? Instead, we're going to identify any existing sources of data, so we don't collect data that's already been collected. And then we're going to develop a plan for collecting and analyzing that data. We're going to implement our plan, then we're going to synthesize and present the data to the decision makers when we apply our criteria and prioritize the needs of our community. Then we're going to identify our next steps and report back, so we're going to look at issues for the prioritized needs, any risk or protective factors or causes or consequences, and we'll explore the evidence for effective interventions and approaches. But we'll report all of this back to our stakeholders.

Slide 11: Example of Needs Assessment Survey Questions:

Here's an example of a needs assessment that's already been created. For example, how would we rate the following issues for our households to be us asking our constituents. So, we would ask them, what is the availability of job training opportunities? Is this a serious problem for you? A moderate problem, not a problem, or does not apply to my household? There are quite a few needs assessment surveys already developed. So, you want to check the literature to see

if there's already something out there, so you don't have to spend the time developing your own.

Slide 12: Assemble Partners with Expertise in Providing Equitable and Culturally Relevant Services:

We're going to assemble partners with the expertise in providing equitable and culturally relevant services. So, we want to figure out who is currently experiencing this issue, who is contributing to the issue, what are the barriers to fixing this problem? And then who are the current change agents in our area that is already that are already working on this issue. These people will create a group that can both help us identify the needs and evaluate the interventions.

Slide 13: Evidence-Based Interventions:

What is an evidence-based intervention? It's a practice procedure program or policy that has been proven. Evidence of its effectiveness can be determined by inclusion in federal registries of evidence-based interventions, reports in peer reviewed journals, documentation and other reputable sources of information. And it can also be the consensus of experts, consensus of opinion among experts.

Slide 14: Hierarchy of Evidence:

What are the levels of the hierarchy of evidence? So, before we talk about some of the places you can go to search the literature to find evidence of successful interventions, I want to quickly talk about the hierarchy of evidence. This may be familiar to some of you, but it's important to review it when we're talking about finding evidence-based research. This hierarchy of evidence reflects the relative authority of the literature. This often is depicted in a pyramid format where the base of the pyramid includes study formats with the lowest quality of evidence and the top of the pyramid with the highest quality of evidence. And when we're talking about quality of evidence, what we're referring to is the range of bias or opportunity for a study to have a systemic error. So, for example, anecdotal or opinions and editorials could have a significant level of bias based on the author and their experience. On the other hand, a randomized controlled trial or systematic review control for bias through prescribed study methods and represent the highest levels of evidence. It's also important to note that public health evidence may not be available within some of the top-level categories of evidence.

Research is pointing to the fact that, unlike clinical medicine, public health evidence often comes from cross-sectional studies rather than so-called gold standard of randomized controlled trials. Still, there are more systemic reviews being published within the public health literature, as noted in early and successful evidence based. Public health relies on the best available evidence once we have an understanding of the relative quality of evidence in terms of the types of studies to look for. We then start the process of going out and looking to see if there is high quality information that addresses our research question or issue. Systemic reviews are generated by a team of researchers and practitioners to examine methods and findings of multiple rigorously conducted studies to summarize this evidence into recommendations for what works, such as recommendations related to worksite wellness, programs to reduce obesity. The community guide is a collection of evidence-based findings

from the Community Preventative Services Task Force is another example. And that reference can be found in the reference list on the website. Research studies refer to individual studies that test the efficacy of a specific strategy practitioner reports of implementation, including reports on the findings of an evaluation of a strategy. As a practitioner, this could be one of your own program evaluations. Program evaluations, these might be shared through reports, briefs or success stories, expert opinion or personal experience can also be recommendations made by a credible group in support of strategies that have not yet been tested. An example of this is complete street policies, which are policies and design strategies that require streets to be planned and designed and operated and maintained to be safe, convenient for all users, regardless of their mode for transportation. Many credible experts recommend complete street policies, but it will take years for these strategies to be tested. It's important to note that only the top two, the systematic reviews and research studies are generally referred to as evidence-based interventions.

Slide 15: Assess Fit of Evidence-Based Interventions (EBI):

Next, we want to assess the fit of our evidence-based intervention. We want to determine does it meet our goals and objectives? Are we addressing the right population with this intervention? Does their organization have the resources or are we able to obtain the resources to implement it? Does the evidence-based intervention require significant adaptation prior to implementation, if that may be prohibitive? Is it scientifically sound? Is it the correct delivery method? So, you have to determine whether it fits what you are able to do and does it fit your needs.

Slide 16: Choosing an EBI:

Then how do we select one? You want to select an evidence-based intervention that provides the best balance of fit and strength between the fit of the intervention and the strength of the evidence.

Slide 17: At-a-Glance: Patrick County Community Health Improvement Plan:

Here is the Patrick County Community Health Improvement Plan for a healthy Patrick County in 2020. They started out with an issue, for example, in this one, access to health care is extremely limited and insufficient to serve the population. Then they chose an objective. They determined that their objective would be to improve access to health care. How would they go about implementing their intervention? Well, they would seek grant funding for expert guidance on health care access. They would research models that are working in other rural communities, and they'd pursue funding for a chosen solution. If this got if this was chosen and implemented and evaluated, hopefully their outcome would be that all individuals will have access to the health care that they need. They also had another issue where people were unaware of the resources in the community. So, their objective was to identify and educate the community about the existing resources. They created a community directory. They put listings on partner websites, and they also created a social media page for a healthy Patrick County.

The outcome of this was that individuals became aware of the health and wellness assets in the community and used them to improve their health. The last one that they chose in their overall plan was to address the social determinants of health, for example, housing, transportation, et

cetera, make it difficult for individuals to get the health care that they need. So, their objective was to address social determinants of health by extending their partner relationships. They continue to have their monthly meetings of a healthy Patrick County, they pursued grant funding for joint projects and then they decided to prioritize all of their issues. So, this is an ongoing issue where they're working together to maximize their resources, to reduce the key social determinants of health and to ultimately create a healthier community.

Slide 18: Reflection Questions:

So, these are some reflection questions that you can think about, and if you'd like to stop the slide after we go through these and look these up, you're welcome to or you can do it at the end of the module. You might want to go and locate your local health departments, community health improvement plan. Hopefully, you'll be able to identify a prior health needs that they were trying to address. You might be able to look to see if they conducted a needs assessment. If so, how did they do it and then how did they implement the evidence-based intervention that they chose?

Slide 19: Objective 2:

Objective 2 is to implement a specific evaluation process, and as I said, we're going to use “plan-do-check-act” so that we can continuously evaluate the collective impact on our population.

Slide 20: P-D-S-A:

Plan-do-check-act in this case, they call it planned, do, study, act. So, we're going to plan what we're going to do. So we're going to propose a change idea. We're going to determine how it will be tested and we're going to predict what will happen. And we're going to implement the change idea. We're going to collect the data and we're going to reflect on how well the plan was followed. This is an important piece to it. Did the plan go as outlined? Then we're going to study the data that we collected, we're going to compare the results that we got, the predictions that we made, and we're going to capture other learnings, other thoughts that we had, other findings that may not have fit neatly into our data set. And then we're going to share our final reflections. We're going to conclude whether or not we adopt this, whether we adapt it or whether we abandon this idea.

Slide 21: WIC Quality Improvement Project:

Here's an example of the Lake Cumberland District Health Department. They had a WIC quality improvement project. Their plan was to increase participation and retention rates by 10 % in three counties by 6/30/2020. Then they were going to do it. So, they identified, why are patients missing their appointments and implement text messaging reminders and more appointment ideas? Then they studied it, did the text messaging reminder system increase retention rates? And in fact, it did not. They continued to decline. So, in this case, the project was abandoned due in part to changes in state regulations, so they're going to go back to the planning stage once the state regulations are finalized.

Slide 22: Objective 3:

Objective 3 describes strategies for adapting evidence, informed interventions for remote or telehealth delivery.

Slide 23: Adapting an EBI:

So, if we need to adapt an evidence-based intervention, for example, in this case for remote delivery or telehealth delivery, we want to look at a few things. By whom are the modifications being made? Are they being made by an individual practitioner? Are they being made by the team who identified the evidence-based intervention? Are they being modified by an administrator or a program developer, etc.? What exactly is being modified? Is it the content, the content itself or that might impact aspects of how the treatment is delivered? That's an important thing to check. If you change the content, you might be actually changing the intervention. What is the context, is the context being modified in the way the overall treatment is being delivered? Again, this can change the outcome. Are we changing the training or the evaluation strategies? It's important to make sure that we are doing things the way they were laid out in the original intervention. So, for whom are the modifications being made? Are they being made for individual patients? Are they being made for groups or individual practitioners or it kind of goes micro to macro? So individuals all the way up to the system level. The context modifications are being made to which of the following? Are we changing the format, the setting? Are we changing who delivers the intervention or are we changing the population for whom the intervention is being delivered? And then what is the nature of the content modification? Are we just refining it a little bit? Are we removing things, skipping them? All of the modifications that you might make might change the intervention overall. So, you'll want to consider that before you make any modifications. If you change the intervention, you might change the results.

Slide 24: Remote or Telehealth Delivery:

When we're doing remote or telehealth delivery, first we want to start out with determining who the population is that needs the remote delivery, and we need to determine how can we deliver this information and how can they receive it. So, we want to think about what methods are we going to use to overcome the barriers, such as translators, lack of equipment, etc. This could be a problem because we might want to deliver it via the Internet, but our population does not have Wi-Fi access, for example. So, we want to think about what outcomes do we want to see? What communication preferences does your population have? If you have an elderly population, for example, you might want to actually use mail. To send educational materials, et cetera, what type of technology can be incorporated, can this be adapted for a smartphone, for an iPad? Do you need to have Wi-Fi? You need to consider all of these different issues. What is the message going to be? And is it going to be one way or two-way?

Are you going to send the message and not care if you get a message back or do you want it to be to where you send and receive? Is this going to be a private one to one intervention or is it a group intervention? And then what barriers exist, are there language barriers, are there training barriers? A lot of times we need to consider privacy. So, for example, if we are doing telehealth psychotherapy with a person on a patient on the other end, on a computer, are they

able to access a private place in order to participate in that therapy? So, all things that you need to consider.

Slide 25: Things to consider when trying to reach people:

Other things that you're going to need to consider. So, for example, if people have a phone or a computer, they if you want to deliver it via phone or computer, they have to have the ability to purchase that, to pay the ongoing bill and to buy data if we want to send it by mail. People must have an address. If they're homeless, they're probably not going to get the intervention if we send it by mail. If we try going door to door again, people must have, or both have a residence and be home. So, if we're going to go to places where people gather, so, for example, if we go to churches or schools, this might be difficult to do, for example, during a pandemic where people don't gather in public places. So you need to consider these factors as well. Here are some examples of reaching those that you're trying to serve.

Slide 26: Examples of reaching those you are trying to serve:

So, for example, the Baltimore schools partnered with Comcast and T-Mobile to provide hotspots to families who did not have Wi-Fi access. The St. Paul, Minnesota schools partnered with Comcast again to provide students with iPads and keyboards, hotspots and technical assistance so that all the students could participate in their schoolwork. The MacCracken Public Library had to limit how many people could come inside, but it kept their Wi-Fi accessible 24 hours a day so that people could sit in their cars in the parking lot or even just on the lawn in the front and access the Wi-Fi. Other public libraries have coarse packets for schools that people could pick up or deliver get delivered. They did research for students who couldn't go to the library to do it themselves. They also put out maps of local free Wi-Fi hotspots. On a different note, Chicago public schools mailed eligible students of $455 debit card so that they could purchase food for themselves and their families. They didn't want them to go hungry because hunger does not allow you to learn as well. And then the Tiller Joint Union High School District implemented a meal pick up program in home delivery program so that students would have food as well.

Slide 27: Objective 4:

Objective 4, to examine strategies that foster collaboration across multiple sectors.

Slide 28: Collaborating across Sectors:

When we're collaborating across sectors, there are several pros and cons to doing so. Some of the pros include allowing people to learn about, from, and with one another. It helps provide a holistic approach to complex situations because you have different people contributing their different experience. It prevents a siloed response. So, the response isn't just coming from one group or organization. So, it has a broader reach to it, it allows access to greater assets, some people might have technology assets, some people might have financial assets, some people might have human resource assets. And it also increases the visibility and influence of the project because there are more people to market it and to talk about it. Some of the cons include that when you collaborate, you have to have a common and valued goal because otherwise you're working for different purposes. It's going to require leadership with a growth

mindset, which means that people have to be willing to grow and change. And that is often difficult for some people. When collaborating, people must balance the needs of others with their own needs. And sometimes it's hard to figure out how to do that. And it might also require more time for planning, because the more that people talk about it and the more people involved, you'll end up probably with a better product, but it's going to take a little bit longer to get there.

Slide 29: Cross-sector partnership models:

So, some of the different cross-sector partnership models, so you might have a joint project, it's just short term. It's a one-time collaborative effort with another group and you're partnering on just a single project. Or you might partner together for multiple projects, but it's around a small single focus and with a small set of partners. And you have just a few things going on.

You might have a multistakeholder initiative where partners and resources are aligned, and this is to help drive systemic change on a common agenda. You will probably need to have a governance structure, or someone take minutes to keep track of the plans, etc. This is a much broader approach because there are many more partners involved, and then you can do a collective impact, more long-term commitments to a common agenda. You have multiple different programs and partners involved. They may act somewhat independently, but I'll be contributing to a common outcome.

Slide 30: Forming a cross-sector collaboration:

When you form a cross-sector collaboration, you want to go through several steps, you want to identify potential partners and research them to ensure that the mutual that in the relationship will be mutually beneficial. Again, that common goal, contact them, hosted an initial meeting. This is sort of a get to know you. What are the mission and visions of each of the organizations? What might the possible benefits and opportunities be? If you and your partner collaborate, you'll share some initial information, determine what details regarding expectations and what each group will do. So, for example, will one group contribute human resources, one group contribute financial resources and then evaluate to gain a better understanding of your potential alliance? It's important to note that each partner might not contribute equally, and that's important because. It may not be a 50/50 situation, and all contributing partners need to understand that, and then the group, the all the partners, will make a mutual decision about going forward. Either they'll decide to participate or not.

Slide 31: Forming a cross-sector collaboration continued…

If you continue to go forward, you're going to want to identify smart goals. Smart goals are specific, they're measurable, they're attainable, they're relevant in their time. Once you've identified these goals, you're going to prioritize them. Then you're going to identify the resources needed for each one. You'll create a timeline with specific objectives and outcomes and a strategy to achieve these, and who is the responsible party for each of these objectives? You'll present all of this information to key stakeholders for potential renegotiation and approval. It's important to note that you might need to go back to the drawing board and reconfigure some things. Because it might not be the exact perfect fit, then you'll implement it and assess it under your plan, do you study at program?

Slide 32: Example: Say Yes Buffalo:

Here's an example. Of a cross collaboration, so it's called Say Yes, Buffalo, and this is the Buffalo College Access Network, because higher education leads to better health outcomes, something that we learned in Module 1. So, their aim was to implement strategies aimed at improving the educational outcomes across the pre-K to post-secondary continuum and specific goals. They wanted to increase post-secondary persistence. They wanted to increase post-secondary enrollment from the Buffalo public schools. And they wanted to create a data system allowing for collaboration between the public schools and institutes of higher education. So, then they implemented some strategies, they put together a near peer mentor program which paired recent alumni now in college with high school students. They implemented a mandatory college transition curriculum. They hired 11 college access counselors and they also established on campus mental health clinics.

Slide 33: Creating Healthy Communities Through Cross-Sector Collaboration White Paper: Another example is of an across cross-sector collaboration is this one, and this is about how the arts and culture are valuable and available resource and critical to advancing health in the US. So, this is the UF Center for Arts and Medicine. You can go to their website. The University of Florida and they talked about five public health issues that arts and culture can address, and this is one of those areas that people don't necessarily think about first. So, arts and culture can address collective trauma, can address racism, social exclusion, isolation, mental health and chronic disease. They talk about how it can be done and what it can do. They're very specific in their cross-collaborative work.

Slide 34: Example – Reducing Prevalence of Diabetes in a Community:

So, here's one more example of reducing the prevalence of diabetes in a community. So, as we said, you start out with conducting a systematic needs assessment. You'll utilize that data to determine the targets and outcomes, will identify and gather an entire professional group of community leaders. And experts in health, government, retail media, et cetera, but you also want to include community members, because if you don't include the members from the community with whom you're trying to address the issues, you're not going to know truly if the intervention fits. So, then you have to choose strategies that will address the targets and achieve the outcomes. So, for example, one idea is to introduce a sugar sweetened beverage tax, which has been known to reduce the consumption of sugar. You can use the funding from this tax to implement community gardens, bring in mobile farmer's markets, and to provide nutrition in education. This is a great way to use this tax because it increases the access to fresh food, which is a great strategy to reduce the prevalence of diabetes so the government will implement the tax, whether it's probably a city government, the retailers collect the tax.

The media will promote the health improvements that have been demonstrated through the tax. And then the health care providers encourage prevention and health promotion through a decreased sugar and increased vegetable intake and measure the outcomes. So, these are some examples of public health interventions that have been utilized and shown to have positive outcomes on health, I hope you enjoyed this module,

Slide 35: Resources:

We've put together some resources for you to help you with this module.

Slide 36: Examples of Needs Assessments:

Here are some examples of a needs of needs assessments. You can go to the offices for victims of crime. They've got some planning and program development information there that is helpful. University of Kansas Center for Community Health and Development put together a toolbox to assess community needs and resources. And the county of San Diego shares their community action plan.

Slide 37: Places to look for Evidence-Based Interventions:

Some places to look for evidence-based intervention, Healthy People 2020, but the evidence- based resources and the topics and objectives are helpful to you. The US Surgeon General and the US Public Health Service and Public Health Records reports always have peer reviewed journals on public health practices, research, training, and writing. The CDC is always a wonderful place to look because it highlights the public health policies and practices. The Campbell Collection is a database of social science research, and what they've done is they've synthesized the evidence and provide plain language summaries and policy briefs. We also have the community health rankings and road maps way to engage for change, and this is helpful because it's at a county level.

Slide 38: Examples of Cross-Sector Collaborations:

Some examples of cross-sector collaborations that we've provided. This first link will share five cross-sector partnerships that have different innovations to solve social problems. All hands raised is an engagement of community members that are including culturally specific partners, school staff, industry partners. And these teams identify root causes, test practices and drive change. And then Buffalo, New York has created a program called “Say Yes, Buffalo” and this is a partnership to remove barriers to educational attainment.

Slide 39:

Some additional resources, the Institute for Health Care Improvement has a quality improvement essentials tool kit, and that is very helpful as well.

Slide 40 - end: Slide References:

We've provided the references by slide in hopes that that will be helpful to you. You can see all those here. And then we also have the references alphabetically. So thank you so much for joining us. We appreciate your interest in our webinars. If we can be of more help. Please always feel free to reach out.