Discussion 8 health policy

Measures

VERSION 1.5 Adopted December 2013

STANDARDS Public Health Accreditation Board

&

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1 PUBLIC HEALTH ACCREDITATION BOARD Standards & Measures VERSION 1.5 APPROVED DECEMBER 2013

INTRODUCTION

This Public Health Accreditation Board (PHAB) Standards and Measures document serves as the official standards, measures, required documentation, and guidance blueprint for PHAB national public health department accreditation. These written guidelines are considered authoritative and are in effect for the application period beginning on July 1, 2014 and until a new version is released.

The Standards and Measures, Version 1.5 document provides guidance specifically for public health departments preparing for accreditation and for site visit teams that review and assess documentation submitted by applicant health departments. It also serves anyone offering consultation or technical assistance to health departments preparing for accreditation. It guides PHAB’s Board of Directors and staff as they administer the accreditation program. This document assists health departments and their Accreditation Coordinators as they select documentation for each measure. It directs site visit team members in the review of documentation and in determining whether conformity with a measure is demonstrated.

Credibility in accreditation results from consistent interpretation and application of defined standards and measures. The Standards and Measures, Version 1.5 document sets forth the domains, standards, measures, and required documentation adopted by the PHAB Board of Directors in December 2013. The document also provides guidance on the meaning and purpose of a measure and the types and forms of documentation that are accepted to demonstrate conformity with each measure.

The Standards and Measures, Version 1.5 document provides assistance to health departments as they work to select the best evidence to serve as documentation. It includes a “Purpose” statement for each standard and measure, a “Significance” statement for each measure, and narrative guidance specific to each required documentation item. PHAB strongly recommends that the health department pay close attention to this document when selecting their most appropriate documentation to meet a measure.

In general, a reference in this document to “the standards” includes references to the entire document including the domains, the standards, the measures, the required documentation, and the guidance.

Introduction

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INTRODUCTION

Domains, Standards, and Measures Domains are groups of standards that pertain to a broad group of public health services. There are 12 domains; the first ten domains address the ten Essential Public Health Services. Domain 11 addresses management and administration, and Domain 12 addresses governance.

Standards are the required level of achievement that a health department is expected to meet. Measures provide a way of evaluating if the standard is met. Required documentation is the documentation that is necessary to demonstrate that a health department conforms to a measure.

All of the standards are the same for Tribal, state, and local health departments. The majority of the measures are the same for Tribal, state, and local health departments and these are designated with an “A” for “all.” Where the measure is specific to Tribal, state, or local health departments, the measure addresses similar topics but has slight differences in wording or guidance and will be designated with a “T” for Tribal health departments, “S” for state health departments, and “L” for local health departments. Some measures are designated T/S, some are T/L, and some are S/L.

The structural framework for the PHAB domains, standards, and measures uses the following taxonomy:

Domain (example – Domain 5)

Standard (example – Standard 5.3)

Measure (example – Measure 5.3.2)

Tribal, State, Local or ALL (example – Measure 5.3.2 S for state health departments; Measure 5.3.2 L for local health departments; Measure 5.3.2 T for Tribal health departments; and Measure 5.3.2 A for all health departments.)

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INTRODUCTION

Health departments vary in size, organizational structure, scope of authority, resources, population served, governance, and geographic region. PHAB’s standards, measures, and guidance for documentation apply to all health departments.

PHAB does not intend to be prescriptive about how the health department meets the standards and measures. The health department is expected to ensure that the standards are met for the population that they serve. The focus of the standards, measures, and required documentation is that the health department ensures that the services and activities are provided to the population, irrespective of “how” those services and activities are provided or through what organizational structure or arrangement. Many health departments have formal agreements, contracts, or partnerships with other organizations or agencies to provide services. Health departments must submit to PHAB formal documentation of the partnership or assignment of responsibility to others (MOU, letter of agreement, contract, legislative action, executive order, ordinance, or rules/regulations). PHAB site visitors will want to see evidence of a formal working relationship in these cases.

Likewise, documentation may have been developed by another entity; however it must currently be utilized by the health department. The purpose of PHAB’s review of the documentation is to confirm that materials exist and are in use in the health department being reviewed, regardless of who originated the material. Documentation, therefore, may be products of other entities.

Documentation could be developed by:

• health department staff; • state health departments for use by local health departments; • community partnerships or collaborations; • partners (e.g., not-for-profits and academic institutions); or • contracted service providers.

The accountability for meeting the measures rests with the health department being reviewed for accreditation. Documentation that provides evidence of meeting the measure must be provided, even if the documentation is produced by a partner organization and not by the health department. It would be advisable for the health department to include an explanation with its documentation concerning why a measure is met with documentation developed by another organization.

Examples include:

• Health departments may have formal agreements or partnerships with other organizations to provide particular functions or activities. For example, a health department might contract with an academic institution to collect primary data. The health department is accountable and responsible for ensuring the high quality, accuracy, and utility of those data, but they do not have to collect the data themselves. They must show that there is a formal mechanism for the partnership or agreement, for example, a Memorandum of Understanding (MOU), a contract, or other written agreement.

Documentation

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INTRODUCTION

• Health Departments may share functions or services with other governmental agencies. For example, environmental public health is a function that is sometimes provided by another state or local agency. There are a number of PHAB standards and measures that include or address environmental public health. A health department’s documentation should include some examples from environmental public health and may be documents that are produced by that other agency.

• Health departments, as agencies that are a part of a larger governmental unit, may utilize the policies, procedures, or functions of that governmental unit. For example, a health department may utilize the human resources system of the government of which it is a part. In this case, the documentation for “human resource policy and procedures manual or individual policies” would be the policies and procedures of the city, county, or state government, for example.

Likewise, the health department may be part of a “Super Public Health Agency” (an agency that oversees public health, primary care, substance abuse, and mental health), a “Super Health Agency” (an agency that oversees public health, primary care, and Medicaid), or “Umbrella Agency” (an agency that oversees public health, primary care, substance abuse, mental health, Medicaid, and other human service programs). For the example of Measure 11.1.5 A, the health department’s human resource policy and procedures manual would be the manual of the Super Public Health Agency, Super Health Agency, or Umbrella Agency, of which it is a part.

• Tribal, local and state health departments may have agreements with each other about the responsibility for and provision of public health functions. For example, the state may provide the epidemiology function at the Tribal, state and/or local levels. If the state does not serve this function, the Tribal or local health department would need to provide it some other way. And, the Tribal, state, and local health departments need to coordinate and support one another. Therefore, even when the state, for example, has the primary responsibility to perform a function that is specified in a measure, the Tribal or local health must still provide documentation that it is being performed. The Tribal or local health department cannot dismiss its accountability for meeting the measure, even if the state health department is performing the function.

Some measures require documentation that addresses the entire population that the health department is authorized to serve. For example, the community health assessment and the community health improvement plan are both required to cover the entire health department’s population. It is acceptable if these documents cover larger geographic areas, if the parts that address the health department’s population can be identified.

Documentation continued

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INTRODUCTION

SELECTION OF DOCUMENTATION The health department should select documentation carefully to ensure that it accurately reflects the health department, how it operates, what it provides, and its performance. Site visitors will develop an overall summary of (1) the health department’s three greatest strengths, (2) the three most serious/challenging opportunities for improvement, and (3) the department as a functioning health department. They will base this summary on both the review of documentation and findings during the site visit. Therefore, it is critical that the health department select the most relevant and accurate documentation to submit to PHAB.

a. Relevant to the Domain, Standard, and Measure In order to ensure that the documentation provides evidence of conformity with a measure, the health department must consider the required

documentation within the context of the measure, standard, and domain. For example a required piece of documentation may be “documentation of communications, meetings, and/or trainings.” It is important to review the measure and standard to know what the documentation of communications, meetings, and/or trainings is meant to demonstrate (e.g., the provision of technical assistance, collaboration on an activity, or sharing of information on a particular topic).

b. Specific to “Required Documentation” and “Guidance” in the Standards and Measures Version 1.5 The documentation submitted to PHAB will be reviewed by site visitors to determine if it is in conformity with the requirements for documentation

and to determine the health department’s conformity with each measure. Therefore, the documentation that the health department selects for each piece of Required Documentation must be specific to that measure’s requirement and the guidance provided.

c. Focused Documentation should be limited to the most direct and applicable documentation available to meet the documentation requirement. Additional

information is not necessary and will not be helpful.

Health departments are encouraged to select documentation from a variety of department programs. Both administrative and program activities are appropriate for documentation to meet various measures. Documentation that is drawn from programs should be selected from a variety of programs to illustrate department-wide activity. Documentation is expected to include programs that address causes of public health issues, determinants of health, and chronic disease and must address the health of the population in the jurisdiction that the health department has authority to serve.

Additionally:

• All documentation must be in use by the health department at the time of the submission of documentation to PHAB.

• No draft documents will be accepted for review by PHAB.

• All documents must show evidence of authenticity (see “Evidence of Authenticity” section).

• All documents must include a date (see “Timeframes” section).

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INTRODUCTION

• Documentation submitted to demonstrate conformity with a measure does not have to be presented in a single document; several documents may support conformity with a single measure. An explanation should be included that describes how the documents, together, demonstrate conformity with the measure. The specific section(s) of the documents that addresses the measure must be identified.

• A single document may be relevant for more than one measure and may be submitted multiple times. The specific section(s) of the document that addresses the measure for which it is presented must be identified.

• Documentation must directly address the measure. When selecting documentation, the health department should carefully consider the standard and domain in which the measure is located, as well as the measure itself.

• Documentation should be limited to the most relevant to meet the documentation requirement; more is not better.

• Where documentation contains confidential information, the confidential information must be covered or deleted. A specific example is documents from the human resources department.

• Documents must be able to be submitted to PHAB electronically. Hard copies of documents must be scanned into an electronic format for submission. PHAB will not accept hard copies of any documentation. This applies to documentation that is submitted online to PHAB, as well as any additional documentation requested by the site visitors during the site visit.

Generally, types of documentation that may be used to demonstrate conformity include:

• Examples of policies and processes: policies, procedures, protocols, standing operating procedures, emergency response/business continuity plans, manuals, flowcharts, organization charts, and logic models.

• Examples of documentation for reporting activities, data, decisions: health data summaries, survey data summaries, data analyses, audit results, meeting agendas, committee minutes and packets, after-action reports, continuing education tracking reports, work plans, financial reports, and quality improvement reports. When minutes from meetings are used as evidence for documentation requirements, relevant attachments that are referenced in the minutes or were discussed must be included.

• Examples of materials to show distribution and other activities: email, memoranda, letters, dated distribution lists, phone books, health alerts, faxes, case files, logs, attendance logs, position descriptions, performance evaluations, brochures, flyers, website screen prints, news releases, newsletters, posters, and contracts.

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INTRODUCTION

All plans, policies, procedures, processes, contracts, MOUs, and partner agreements must be in use by the health department when they are submitted to PHAB. All programs from which documentation is selected and submitted must be in place when the documentation is submitted.

All documentation used to demonstrate conformity with measures must be dated within the timeframe indicated in the Guidance. The date indicates when the document was created, adopted, reviewed, revised, etc. Site visitors will look for the date on the document. The first purpose of documents being dated is that the dating of all documents is a best practice. Any organization, public health department or otherwise, needs to know when documents were created or last updated both in order to ensure that the information is current and for version control. This is especially true in the public health field as both best practices and populations can change quickly. The second purpose for dates on documents is to enable the PHAB Site Visit Team to assess conformity with PHAB Standards and Measures.

The specificity of the date on the document will depend on the documentation requirement and the type of document. For example, emails provide the full date and time. Policies may include the month, day, and year. Reports may include the month and year. A brochure may include only the year. In most cases the month and year will be required for reviewers to evaluate conformity with the timeframes, though in some cases (for example, brochures) only a year will be required.

Timeframes are determined by starting from the date of submission of the documentation to PHAB. For example, if the timeframe for a plan is five years, the plan must be dated within the five years previous to submission of the documentation to PHAB.

Timeframes

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INTRODUCTION

All documents must show evidence of authenticity. That is, the document must have a logo, signature, email address, or some other evidence that the document is “authentic” to the applicant health department. The purpose for this requirement is to provide PHAB site visitors with evidence that the documentation does in fact “belong” to the health department being reviewed. It is also a good business practice. In some cases, documentation will be a written policy and will include the signature of a governor, mayor, or health department director. In other cases, documentation may be an email; the “To” and “From” and the email addresses will serve as evidence that the document is “official” health department business. In other cases, a department logo will provide the evidence that the document is an official health department document. For example, a brochure will not have the health department or program director’s signature, but it will include the department’s logo. Meeting minutes are usually signed but may include the department’s logo instead, noting that it is an “official” document. Further, a document developed by a partnership or coalition of which the health department is a member, may or may not include the health department’s logo. In this case, evidence of the health department’s membership or participation in the partnership or coalition will suffice. Documentation developed by another entity (partner, governmental agency, contractor, etc.) must include evidence that the documentation has been adopted by and is in use by the applicant health department.

Evidence of Authenticity

A goal of public health department accreditation is to promote high performance and continuous quality improvement. PHAB has adopted the following definition of quality Improvement: Quality improvement in public health is the use of a deliberate and defined improvement process that is focused on activities that are responsive to community needs and improving population health. It refers to a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality in services or processes which achieve equity and improve the health of the community. (Riley, Moran, Corso, Beitsch, Bialek, and Cofsky. Defining Quality Improvement in Public Health. Journal of Public Health Management and Practice. January/February 2010).

Domain 9 focuses on the evaluation of all programs and interventions, including key public health processes, and on the implementation of a formal quality improvement process that fosters a culture of quality improvement. Additionally, PHAB has incorporated the concept of quality improvement throughout the standards and measures and throughout the accreditation process. For example, there are several measures that encourage a broad continuous improvement process of evaluation and improvement: (1) plan or develop programs, process, or interventions, (2) implement, and (3) evaluate for improvement. The accreditation process promotes quality improvement through the provision of a Site Visit Report developed by PHAB trained peer Site Visitors that includes opportunities for improvement. Additionally, accredited health departments are required to submit an annual report to PHAB that describes their progress and quality improvement.

Quality Improvement

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INTRODUCTION

PHAB Acronyms and Glossary of Terms The PHAB Standards and Measures, Version 1.5 document is accompanied by a sourced PHAB Acronyms and Glossary of Terms for many of the terms used in the Standards and Measures. The Glossary also contains a list of acronyms used in the standards. This companion document offers assistance in understanding the standards and measures.

The Public Health Accreditation Board (PHAB) is charged with administering the national public health department accreditation program. To that end, PHAB’s scope of accreditation extends only to governmental public health departments operated by Tribes, states, local jurisdictions, and territories.

PHAB’s public health department accreditation standards address the array of public health functions set forth in the ten Essential Public Health Services. Public health department accreditation standards address a range of core public health programs and activities including, for example, environmental public health, health education, health promotion, community health, chronic disease prevention and control, infectious disease, injury prevention, maternal and child health, public health emergency preparedness, access to clinical services, public health laboratory services, vital records and health statistics, management /administration, and governance. Thus, public health department accreditation gives reasonable assurance of the range of public health services that a health department should provide. The standards refer to this broad range of work as health department processes, programs, and interventions.

While some public health departments provide mental health, substance abuse, primary care, human services, and social services (including domestic violence), these activities are not considered core public health services under the ten Essential Public Health Services framework used for accreditation purposes. PHAB’s scope of accreditation authority does not extend to these areas. Documentation from these program areas generally will not be accepted for public health department accreditation. Similarly, documentation from health care facilities and professional licensing programs and the administration of health care financing systems (e.g., Medicaid) cannot

Applicability of Public Health Accreditation Standards

Research

Diagnose & Investigate

Mobilize Community Partnerships

Inform, Educate, Empower

Develop Policies

Link to / Provide Care

Evaluate

Assure Competent Workforce

Enforce Laws

Monitor Health

Sy st

em Managem

ent

The Essential Public Health Services and Core Functions Source: Core Public Health Functions Steering Committee, Fall 1994

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INTRODUCTION

be used for public health department accreditation purposes. (See the PHAB guidance one-page tip sheet on Accepted Program Areas for PHAB Documentation at www.phaboard.org).

Some program funding provides support for both population public health and also personal health care services. Documentation related to the program’s population public health activities is appropriate for PHAB documentation, while documentation related to the individual, personal, or clinical services provided by the same program, is not appropriate for PHAB documentation. That is, irrespective of the program (for example, WIC, Ryan White, dental health, healthy mothers/healthy babies), documentation of activities related to the provision of individual patient care or clinical services is not appropriate for PHAB documentation. For example, PHAB will accept documentation from a public health education program that informs the public of the need for dental hygiene; PHAB will not accept documentation from a dental clinic that provides individual dental services. Documentation of population health education about the use of condoms for disease prevention is acceptable; documentation on individual HIV testing and counseling is not. Documentation concerning population education about the importance of prenatal care is appropriate, but documentation of the actual prenatal care or well-baby clinics is not. Of course, this holds true for all PHAB Standards and Measures, Version 1.5. For example, documentation concerning client satisfaction surveys or clinic wait times would not be an appropriate example of a QI project for PHAB documentation.

Some public health activities are population based or clinical, depending on how they are provided. For example, a clinic where personal health services are provided will provide vaccinations. This is considered a clinical service. The health department may provide vaccinations as a population based service, e.g., influenza vaccinations available to the public, measles vaccinations for an Amish population where a measles outbreak has occurred, or pertussis vaccinations available to the public due to a rise in incidence of pertussis. These are examples of population based public health services and may be used for PHAB accreditation documentation.

PHAB standards and measures are applicable to public health activities provided by another governmental department, organization, or partner through a formal written agreement. Formal arrangements may be contracts, compacts, or memoranda of agreement. When public health functions are provided by another entity, more than one entity, or through a partnership, the health department must demonstrate how the process, program, or intervention is delivered and how the health department coordinates with the other providers. The fact that an activity is provided by another entity does not abrogate the health department from the responsibility to ensure that it is provided to the population that the health department serves.

Applicability of Public Health Accreditation Standards continued

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INTRODUCTION

There are 565 federally recognized Tribes (U.S. Federal Register) in the United States, each with a distinct language, culture, and governance structure. Native American Tribes exercise inherent sovereign powers over their members and territory. Each federally recognized Tribe maintains a unique government-to-government relationship with the U.S. Government, as established historically and legally by the U.S. Constitution, Supreme Court decisions, treaties, and legislation. No other group of Americans has a defined government-to-government relationship with the U.S. Government. See U.S. Constitution Article I, Section 8.

Treaties signed by Tribes and the federal government established a trust responsibility in which Tribes ceded vast amounts of land and natural resources to the federal government in exchange for education, healthcare, and other services to enrolled members of federally recognized Tribes. The Indian Health Service (IHS), among other federal agencies, is charged with performing the function of the trust responsibility to American Indians and Alaska Natives. (See Section 3 of the Indian Health Care Improvement Act, as amended, 25 U.S.C. § 1602.) Public Law 93-638, the Indian Self- Determination and Educational Assistance Act of 1975 (ISDEAA), provides the authority for Tribes (includes Alaska Native villages, or regional or village corporations, as defined in or established pursuant to the Alaska Native Claims Settlement Act) to enter into contracts or compacts, individually or through Tribal organizations, with the Secretary of Health and Human Services to administer the health programs that were previously managed by the Indian Health Service. More than half of the Tribes exercise this authority under the ISDEAA and have established Tribal Health Departments to administer these programs, which are often supplemented by other public health programs and services through Tribal funding and other sources.

Sovereignty and Tribal Public Health Systems

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INTRODUCTION

In this document, the PHAB Standards and Measures are preceded by the domain number and brief description of the domain. The chart below provides an example of the layout for standards, measures, and required documentation, guidance, number of examples, and timeframe for required documentation.

Format for the Standards and Measures

MEASURE PURPOSE SIGNIFICANCE This section states the measure on which the health department is being evaluated.

The purpose of this measure is to assess the health department’s . . .

This section describes the public health capacity or activity on which the health department is being assessed.

This section describes the necessity for the capacity or activity that is being assessed.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

Documentation of:

This section lists the documentation that the health department must provide as evidence that it is in conformity with the measure.

The documentation will be numbered:

1. Xxx

2. Xxx

a) xxx

b) xxx

1. The health department must provide/document that . . . .

This section provides guidance specific to the required documentation. Types of materials may be described, e.g., meeting minutes, partnership member list, etc. Examples may also be provided here. This section will state if the documentation is department-wide or if a selection of programs’ documentation is required.

X examples

This section states the number of examples required

X years

This section states the time frame for the date on the documentation.

The date on the documentation must be within the number of months or years specified before the date of submission of all of the documentation to PHAB.

STANDARD: This is the standard to which the measure applies.

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DOMAIN 1 DOMAIN 2 DOMAIN 3 DOMAIN 4 DOMAIN 5 DOMAIN 6 DOMAIN 7 DOMAIN 8 DOMAIN 10 DOMAIN 11DOMAIN 9 DOMAIN 12

Domain 1 focuses on the ongoing assessment of the health of the population in the jurisdiction served by the health department. The domain includes: systematic monitoring of health status; collection, analysis, and dissemination of data; use of data to inform public health policies, processes, and interventions; and participation in a collaborative process for the development of a shared, comprehensive health assessment of the community, its health challenges, and its resources.

DOMAIN 1 INCLUDES FOUR STANDARDS:

Standard 1.1: Participate in or Lead a Collaborative Process Resulting in a Comprehensive Community Health Assessment

Standard 1.2: Collect and Maintain Reliable, Comparable, and Valid Data that Provide Information on Conditions of Public Health Importance and On the Health Status of the Population

Standard 1.3: Analyze Public Health Data to Identify Trends in Health Problems, Environmental Public Health Hazards, and Social and Economic Factors that Affect the Public’s Health

Standard 1.4: Provide and Use the Results of Health Data Analysis to Develop Recommendations Regarding Public Health Policy, Processes, Programs, or Interventions

Domain 1: Conduct and Disseminate Assessments Focused on Population Health Status And Public Health Issues Facing the Community

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DOMAIN 1 DOMAIN 2 DOMAIN 3 DOMAIN 4 DOMAIN 5 DOMAIN 6 DOMAIN 7 DOMAIN 8 DOMAIN 10 DOMAIN 11DOMAIN 9 DOMAIN 12

The purpose of the community health assessment is to learn about the community: the health of the population, contributing factors to higher health risks or poorer health outcomes of identified populations, and community resources available to improve the health status. Community health assessments describe the health of the population, identify areas for health improvement, identify contributing factors that impact health outcomes, and identify community assets and resources that can be mobilized to improve population health. Community health assessments are developed at the Tribal, state, and local levels and cover the jurisdiction served by the health department.

A community health assessment is a collaborative process of collecting and analyzing data and information for use in educating and mobilizing communities, developing priorities, garnering resources or using resources in different ways, adopting or revising policies, and planning actions to improve the population’s health. The development of a community health assessment involves the systematic collection and analysis of data and information to provide a sound basis for decision-making and action. Community health assessments are conducted in partnership with other organizations and members of the community and include data and information on demographics; socioeconomic characteristics; quality of life; community resources; behavioral factors; the environment (including the built environment); morbidity and mortality; and other social, Tribal, community, or state determinants of health status. The Tribal, state, or local community health assessment will be the basis for development of the Tribal, state, or local community health improvement plan.

STANDARD 1.1: Participate in or lead a collaborative process resulting in a comprehensive community health assessment.

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DOMAIN 1 DOMAIN 2 DOMAIN 3 DOMAIN 4 DOMAIN 5 DOMAIN 6 DOMAIN 7 DOMAIN 8 DOMAIN 10 DOMAIN 11DOMAIN 9 DOMAIN 12

STANDARD 1.1: Participate in or lead a collaborative process resulting in a comprehensive community health assessment.

MEASURE PURPOSE SIGNIFICANCE Measure 1.1.1 S A state partnership that develops a comprehensive state community health assessment of the population of the state

The purpose of this measure is to assess the state health department’s collaborative process for sharing and analyzing data and information concerning state health, state health challenges, and state resources to develop a state level community health assessment.

The development of a state community health assessment requires partnerships with other organizations in order to access data, provide various perspectives in the analysis of data and determination of contributing factors that impact health outcomes, present data and findings, and share a commitment for using the assessment. Assets and resources in the state must be addressed in the assessment, as well as health challenges. Data are not limited to traditional public health data but may include information, for example, quality of life, attitudes about health behavior, socioeconomic factors, environmental factors (including the built environment), and social determinants of health. Data are provided from a variety of sources and through various methods of data collection.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. Participation of representatives from a variety of state sectors

1. The state health department must document that the process for the development of a state level community health assessment includes participation of partners outside of the health department that represent state populations and state health challenges.

The collaboration must include various sectors of the state, as appropriate for the state: for example, state government (for example, community development, education, aging, etc.), for-profits (for example, businesses, industries, and major employers in the state), statewide not-for -profits (for example, hospital association, Kids Count, Childhood and Women’s Death Review organizations, Cancer Society, public health institutes, environmental public health groups, groups that represent minority health, etc.), voluntary organizations, health care representatives (for example, hospital associations or primary care associations), academia, military installations in the state, and representatives of local or regional health departments in the state and of Tribal health departments in the state.

1 5 years Documentation must include the month and year.

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DOMAIN 1 DOMAIN 2 DOMAIN 3 DOMAIN 4 DOMAIN 5 DOMAIN 6 DOMAIN 7 DOMAIN 8 DOMAIN 10 DOMAIN 11DOMAIN 9 DOMAIN 12

MEASURE 1.1.1 S, continued

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

Representation of two or more populations that are at higher health risk or have poorer health outcomes must be included.

Documentation could be, for example, a membership list and meeting attendance records.

2. Regular meetings or communications with partners

2. The health department must document that the partnership meets and communicates on a regular basis to consider new data sources, review newly collected data, consider assets and resources that are changing, and conduct additional data analysis.

The frequency of meetings or communications is determined by the partnership and may change, as required by the stage of the process.

Meetings and communications may be in-person, via conference calls, or via other communication methods, for example, list-serves or other digital communication methods.

Documentation could be, for example, meeting agenda, meeting minutes, and copies of emails. Documentation could also be reports or other documents that show meeting frequency.

2 examples of meetings and commu- nications or documentation that identifies the frequency of meetings

5 years Documentation must include the month and year.

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17 PUBLIC HEALTH ACCREDITATION BOARD Standards & Measures VERSION 1.5 APPROVED DECEMBER 2013

DOMAIN 1 DOMAIN 2 DOMAIN 3 DOMAIN 4 DOMAIN 5 DOMAIN 6 DOMAIN 7 DOMAIN 8 DOMAIN 10 DOMAIN 11DOMAIN 9 DOMAIN 12

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

3. The process used to identify health issues and assets

3. The state health department must document the collaborative process used to identify and collect data and information, identify health issues, and identify existing state assets and resources to address health issues. The process used may be an accepted national model; state-based model; a model from the public, private, or business sector; or other participatory process model. When a specific model is not used, the key steps undertaken that outline the process used should be described.

National models include, for example, Mobilizing for Action through Planning and Partnerships (MAPP) (developed for local health departments but can be used in state health departments), Association for Community Health Improvement (ACHI) Assessment Toolkit, Assessing and Addressing Community Health Needs (Catholic Hospital Association of the US) (http://www.chausa.org/docs/default-source/general-files/ cb_assessingaddressing-pdf.pdf?sfvrsn=4), and the University of Kansas Community Toolbox (http://ctb.ku.edu/en/node/9).

Examples of tools or resources that can be adapted or used throughout, or as part of, the community health assessment process include NACCHO’s Resource Center for Community Health Assessments and Community Health Improvement Plans, Community Indicators process project, Asset Based Community Development model, Tribal Accreditation Readiness Guidebook and Roadmap, Inter Tribal Council of Arizona’s Tribal CHA Toolkit, National Public Health Performance Standards Program (NPHPSP), Assessment Protocol for Excellence in Public Health (APEX/PH), Guide to Community Preventive Services, and Healthy People 2020.

1 process 5 years

MEASURE 1.1.1 S, continued

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18 PUBLIC HEALTH ACCREDITATION BOARD Standards & Measures VERSION 1.5 APPROVED DECEMBER 2013

DOMAIN 1 DOMAIN 2 DOMAIN 3 DOMAIN 4 DOMAIN 5 DOMAIN 6 DOMAIN 7 DOMAIN 8 DOMAIN 10 DOMAIN 11DOMAIN 9 DOMAIN 12

MEASURE PURPOSE SIGNIFICANCE Measure 1.1.1 T/L Tribal/local partnership that develops a comprehensive community health assessment of the population served by the health department

The purpose of this measure is to assess the health department’s collaborative process for sharing and analyzing data and information concerning population health, health challenges, and community resources to develop a community health assessment of the population of the jurisdiction served by the health department.

The development of a Tribal/local level community health assessment requires partnerships with other members of the Tribe/community to access data, provide various perspectives in the analysis of data and determination of factors that impact health outcomes, present data and findings, and share a commitment for using the assessment. Assets and resources in the Tribal/local community must be addressed in the assessment, as well as health challenges. Data are not limited to traditional public health data but include, for example, quality of life, attitudes about health behavior, socioeconomic factors, environmental factors (including the built environment), and social determinants of health. Data are provided from a variety of sources and through various methods of data collection.

STANDARD 1.1: Participate in or lead a collaborative process resulting in a comprehensive community health assessment.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. Participation of representatives from a variety of sectors of the Tribal or local community

1. The health department must document that the process for the development of a community health assessment includes participation of partners outside of the health department that represent Tribal/community populations and health challenges.

The collaboration must include various sectors of the community, as appropriate for the community: for example, local government (for example, elected officials, law enforcement, correctional agencies, housing and community development, economic development, parks and recreation, planning and zoning, schools boards, etc.), for-profits (for example, businesses, industries, and major employers in the community), not-for- profits (for example, chamber of commerce, civic groups, hospitals and other health care providers, local Childhood and Women’s Death Review organizations, public health institutes, environmental public health groups, groups that represent minority health, etc.), community foundations and philanthropists, voluntary organizations, health care providers (including hospitals), academia, the state health department and Tribal health departments located in the health department’s jurisdiction, and military installations located in the health department’s jurisdiction.

1 5 years Documentation must include the month and year.

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MEASURE 1.1.1 T/L, continued

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

Representation of two or more populations that are at higher health risk or have poorer health outcomes must be included.

Documentation could be, for example, a membership list and meeting attendance records.

2. Regular meetings or communications with partners

2. The health department must document that the partnership meets and communicates on a regular basis to consider new data sources, review newly collected data, consider assets and resources that are changing, and conduct additional data analysis.

The frequency of meetings and communications is determined by the partnership and may change, depending on the stage of the process.

Meetings and communications may be in-person, via conference calls, or via other communication methods, for example, list-serves or other digital communication methods.

Documentation could be, for example, meeting agenda, meeting minutes, and copies of emails. Documentation could also be reports or other documents that show meeting frequency.

2 examples of meetings and commu- nications or documentation that identifies the frequency of meetings

5 years

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20 PUBLIC HEALTH ACCREDITATION BOARD Standards & Measures VERSION 1.5 APPROVED DECEMBER 2013

DOMAIN 1 DOMAIN 2 DOMAIN 3 DOMAIN 4 DOMAIN 5 DOMAIN 6 DOMAIN 7 DOMAIN 8 DOMAIN 10 DOMAIN 11DOMAIN 9 DOMAIN 12

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

3. The process used to identify health issues and assets

3. The health department must document the collaborative process used to identify and collect data and information, identify health issues, and identify existing Tribal or local assets and resources to address health issues. The process used may be an accepted national model; state-based model; a model from the public, private, or business sector; or other participatory process model. When a specific model is not used, the key steps undertaken that outline the process used should be described.

National models include, for example, Mobilizing for Action through Planning and Partnerships (MAPP), Association for Community Health Improvement (ACHI) Assessment Toolkit, Assessing and Addressing Community Health Needs (Catholic Hospital Association of the US) (http://www.chausa.org/docs/default-source/general-files/ cb_assessingaddressing-pdf.pdf?sfvrsn=4), and the University of Kansas Community Toolbox (http://ctb.ku.edu/en/node/9).

Examples of tools or resources that can be adapted or used throughout, or as part of, the community health assessment process include NACCHO’s Resource Center for Community Health Assessments and Community Health Improvement Plans, Community Indicators process project, Asset Based Community Development model, Tribal Accreditation Readiness Guidebook and Roadmap, Inter Tribal Council of Arizona’s Tribal CHA Toolkit, National Public Health Performance Standards Program (NPHPSP), Assessment Protocol for Excellence in Public Health (APEX/PH), Guide to Community Preventive Services, and Healthy People 2020, RWJ County Health Rankings and Roadmaps: Assess (http://www.countyhealthrankings.org/roadmaps/action-center/assess- needs-resources).

1 process 5 years

MEASURE 1.1.1 T/L, continued

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21 PUBLIC HEALTH ACCREDITATION BOARD Standards & Measures VERSION 1.5 APPROVED DECEMBER 2013

DOMAIN 1 DOMAIN 2 DOMAIN 3 DOMAIN 4 DOMAIN 5 DOMAIN 6 DOMAIN 7 DOMAIN 8 DOMAIN 10 DOMAIN 11DOMAIN 9 DOMAIN 12

MEASURE PURPOSE SIGNIFICANCE Measure 1.1.2 S A state level community health assessment

The purpose of this measure is to assess the state health department’s comprehensive state level community health assessment of the population of the state.

The state level community health assessment provides a foundation for efforts to improve the health of the population. It is a basis for setting priorities, planning, program development, funding applications, policy changes, coordination of resources, and new ways to collaboratively use state assets to improve the health of the population. A community health assessment provides the general public and policy leaders with information on the health of the population and the broad range of factors that impact health on the population level as well as existing assets and resources to address health issues. The health assessment provides the basis for the development of the state health improvement plan.

STANDARD 1.1: Participate in or lead a collaborative process resulting in a comprehensive community health assessment.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. A state level community health assessment that includes:

a. Data and information from various sources contributed to the community health assessment and how the data were obtained

1. The state health department must document the identification and description of the state’s health and areas of health improvement, the factors that contribute to the health challenges, and the existing state resources that can be mobilized to address them. The state’s community health assessment must include all of the following:

a. Evidence that comprehensive, broad-based data and information from a variety of sources were used to create the state health assessment.

Qualitative data as well as quantitative data must be utilized. Qualitative data may address, for example, the population’s perception of health, factors that contribute to higher health risks and poorer health outcomes, or attitudes about health promotion and health improvement. Data collection methods include, for example, surveys, asset mapping, focus groups, town forums, and state listening sessions.

1 community health assessment

5 years Documentation must include the month and year.

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REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

b. Demographics of the population

Quantitative data may, for example, include vital statistics; graduation rates; morbidity and mortality numbers and rates; and rates of behavioral risks, such as tobacco use.

The assessment must include both primary and secondary data.

Examples of sources of state secondary data include Federal, Tribal, state, and local health department data, hospitals and healthcare providers, schools, academic institutions, other departments of government (for example, departments of education, transportation, community and economic development, etc.), and statewide not-for-profits.

Data sources also include, for example, the County Health Rankings, Community Health Needs Assessment Toolkit, CDC Community Health Status Indicators, CDC Disability and Health Data System, US Census American Factfinder, Dartmouth Atlas of Health Care, National Health Indicators Warehouse, and CDC Wonder. Another data resource is ASTHO’s Public Health Data Sources and Assessment Tools: A Resource Compendium to Measure Access and Health Disparities.

Examples of primary data include surveys (for example, surveys of high school students and/or parents), focus groups (for example, to discuss community health issues), or other data that the health department collects to better understand contributing factors or elements of secondary data sets.

b. A description of the demographics of the population served by the state health department, for example, gender, race, age, socioeconomic factors, income, disabilities, mobility (travel time to work or to health care), educational attainment, home ownership, employment status, immigration status, sexual orientation, etc.

MEASURE 1.1.2 S, continued

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23 PUBLIC HEALTH ACCREDITATION BOARD Standards & Measures VERSION 1.5 APPROVED DECEMBER 2013

DOMAIN 1 DOMAIN 2 DOMAIN 3 DOMAIN 4 DOMAIN 5 DOMAIN 6 DOMAIN 7 DOMAIN 8 DOMAIN 10 DOMAIN 11DOMAIN 9 DOMAIN 12

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

c. Description of health issues and descriptions of specific population groups with particular health issues and health disparities or inequities

d. Description of factors that contribute to the state populations’ health challenges

e. Description of existing state assets or resources to address health issues

c. A description of the health issues in the state and their distribution, based on analyses of the data listed in a) above. The description must include the existence and extent of health inequities between and among specific populations or areas of the state: populations with an inequitable share of poorer health outcomes must be identified.

d. A discussion of the contributing causes of the health challenges, for example behavioral risk factors, environmental factors (including the built environment), socioeconomic factors, policies (e.g., taxation, education, transportation, insurance status, etc.), injury, maternal and child health issues, infectious and chronic disease, or the unique characteristics of the state that impact of health status. Multiple determinants of health, particularly social determinants, must be included. Health disparities and high health-risk populations must be addressed. Factors that contribute to higher health risks and poorer health outcomes in specific populations must be considered.

e. A listing or description of state assets and resources that can be mobilized and employed to address health issues. These must include other sectors. For example, a state parks system can encourage physical activity. Similarly, a department of agriculture can promote healthful eating, and a state educational policy can encourage the provision of health education.

2. Opportunity for the state population at large to review drafts and contribute to the community health assessment

2. The health department must document that the preliminary findings of the state level community health assessment were distributed to the population at large and that their input was sought. Examples of methods to seek input include: publication of a summary of the findings in the press with feedback or comment forms, publication on the health department’s website and website comment form, town forums, listening sessions, newsletters, presentations and discussions at state-wide organizations’ meetings (for example the state public health association), etc.

2 examples 5 years

MEASURE 1.1.2 S, continued

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24 PUBLIC HEALTH ACCREDITATION BOARD Standards & Measures VERSION 1.5 APPROVED DECEMBER 2013

DOMAIN 1 DOMAIN 2 DOMAIN 3 DOMAIN 4 DOMAIN 5 DOMAIN 6 DOMAIN 7 DOMAIN 8 DOMAIN 10 DOMAIN 11DOMAIN 9 DOMAIN 12

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

3. The ongoing monitoring, refreshing, and adding of data and data analysis

3. The health department must document the gathering of information, collection of data, conduct of community dialogues, and/or identification of assets specific to populations and/or geographic areas in the state where health inequities and poorer health indicators were identified in the community health assessment. Additionally, data analysis is expected to seek to understand health inequities and the factors that create them. Geographic information analysis of socioeconomic conditions would be appropriate information to include in an annual update or supplement.

A complete revision or overhaul of the community health assessment is not required, but for a continuous effort to better understand the health of the population through the collection of information and data.

Examples of community dialogue include organizing a series of town meetings, conducting focus groups, participating in other state organizations’ community meetings (e.g., state injury prevention association meetings, state public health association meetings. etc.), conducting open forums, and conducting group discussions with specific populations (e.g., teenagers, young mothers, residents of a specific area, etc.).

Documentation could be, for example, reports of data and their analysis, findings from a focus group, meeting minutes where health issues or needs were discussed, reports of open forums, etc. Documentation of attendance at a meeting is not sufficient; documentation of the information gathered and analyzed is required.

2 examples

If the CHA is two years or more old, then the examples must be from two different years.

14 months –

or, if the CHA is 2 years old or older, 1 example within the last 14 months and 1 example from another year since the CHA was adopted.

MEASURE 1.1.2 S, continued

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25 PUBLIC HEALTH ACCREDITATION BOARD Standards & Measures VERSION 1.5 APPROVED DECEMBER 2013

DOMAIN 1 DOMAIN 2 DOMAIN 3 DOMAIN 4 DOMAIN 5 DOMAIN 6 DOMAIN 7 DOMAIN 8 DOMAIN 10 DOMAIN 11DOMAIN 9 DOMAIN 12

STANDARD 1.1: Participate in or lead a collaborative process resulting in a comprehensive community health assessment.

MEASURE PURPOSE SIGNIFICANCE Measure 1.1.2 T/L A Tribal/local community health assessment

The purpose of this measure is to assess the Tribal or local health department’s comprehensive community health assessment of the population of the jurisdiction served by the health department.

The Tribal or local community health assessment provides a foundation for efforts to improve the health of the population. It is a basis for setting priorities, planning, program development, funding applications, policy changes, coordination of community resources, and new ways to collaboratively use community assets to improve the health of the population. A community health assessment provides the general public and policy leaders with information on the health of the population and the broad range of factors that impact health on the population level as well as existing assets and resources to address health issues. The health assessment provides the basis for development of the Tribal/ local community health improvement plan.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. A Tribal or local community health assessment that includes:

a. Data and information from various sources contributed to the com- munity health assess- ment and how the data were obtained

1. The health department must document the identification and description of the Tribe’s or community’s health and areas for health improvement, the factors that contribute to the health challenges, and the existing community resources that can be mobilized to address them. The health assessment must include all of the following:

a. Evidence that comprehensive, broad-based data and information from a variety of sources were used to create health assessment.

Qualitative data as well as quantitative data must be utilized. Qualitative data may address, for example, the community’s perception of health, factors that contribute to higher health risks and poorer health outcomes, or attitudes about health promotion and health improvement. Data collection methods include, for example, surveys, asset mapping, focus groups, town forums, and community listening sessions.

1 community health assessment

5 years Documentation must include the month and year.

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26 PUBLIC HEALTH ACCREDITATION BOARD Standards & Measures VERSION 1.5 APPROVED DECEMBER 2013

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REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

b. Demographics of the population

Quantitative data may, for example, include vital statistics; graduation rates; morbidity and mortality numbers and rates; and rates of behavioral risks, such as tobacco use.

The assessment must also include both primary data and secondary data.

Examples of sources of secondary data include: federal, Tribal, state, and local data; hospitals and health care providers; local schools; academic institutions; other departments of government (for example, recreation, public safety, etc.); community not-for-profits.

Data sources also include, for example, the County Health Rankings, Community Health Needs Assessment Toolkit, CDC Community Health Status Indicators, County Health Rankings, CDC Disability and Health Data System, US Census American Factfinder, Dartmouth Atlas of Health Care, National Health Indicators Warehouse, CDC Wonder, and Tribal Epidemiology Centers.

Non-traditional and non-narrative data collection techniques are encouraged. For example, an assessment may include photographs taken by members of the Tribe or community in an organized assessment process to identify environmental (including the built environment) health challenges.

Examples of primary data include local surveys (for example, surveys of high school students and/or parents), focus groups (for example, to discuss community health issues), or other data that the health department collects to better understand contributing factors or elements of secondary data sets.

b. A description of the demographics of the population of the jurisdiction served by the Tribal/local health department, for example, gender, race, age, socioeconomic factors, income, disabilities, mobility (travel time to work or to health care), educational attainment, home ownership, employment status, immigration status, sexual orientation, etc.

MEASURE 1.1.2 T/L, continued

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27 PUBLIC HEALTH ACCREDITATION BOARD Standards & Measures VERSION 1.5 APPROVED DECEMBER 2013

DOMAIN 1 DOMAIN 2 DOMAIN 3 DOMAIN 4 DOMAIN 5 DOMAIN 6 DOMAIN 7 DOMAIN 8 DOMAIN 10 DOMAIN 11DOMAIN 9 DOMAIN 12

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

c. Description of health issues and specific descriptions of population groups with particular health issues and inequities.

d. Description of factors that contribute to specific populations’ health challenges.

e. Description of existing Tribal or community or assets or resources to address health issues

c. A description of the health issues of the population and their distribution, based on the analysis of data listed in a) above. The description must address the existence and extent of health disparities between and among specific populations in the community or areas in the community: populations with an inequitable share of poorer health outcomes must be identified.

d. A discussion of the contributing causes of the health challenges, for example, behavioral risk factors, environmental factors (including the built environment), socioeconomic factors, policies (e.g., zoning, taxation, education, transportation, insurance status, etc.), injury, maternal and child health issues, infectious and chronic disease, resource distribution (e.g., grocery stores), and the unique characteristics of the community that impact on health status. Multiple determinants of health, especially social determinants, must be included. Health disparities and high health-risk populations must be addressed. Community factors that contribute to higher health risks and poorer health outcomes of specific populations must be considered.

e. A listing or description of the assets and resources that can be mobilized and employed to address health issues. These must include other sectors. For example, a local park or recreation center can encourage physical activity. Similarly, local farmers’ markets can be vehicles to promote healthful eating, and a school district can partner with the health department to provide health education.

2. Opportunity for the Tribal or local community at large to review and contribute to the assessment

2. The health department must document that the preliminary findings of the assessment were distributed to the community at large and that the community’s input was sought. Examples of methods to seek community input include: publication of a summary of the findings in the Tribal/local press with feedback or comment forms, publication on the health department’s website and website comment form, community/town forums, listening sessions, newsletters, presentations and discussions at other organizations’ local meetings, etc.

2 examples 5 years

MEASURE 1.1.2 T/L, continued

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28 PUBLIC HEALTH ACCREDITATION BOARD Standards & Measures VERSION 1.5 APPROVED DECEMBER 2013

DOMAIN 1 DOMAIN 2 DOMAIN 3 DOMAIN 4 DOMAIN 5 DOMAIN 6 DOMAIN 7 DOMAIN 8 DOMAIN 10 DOMAIN 11DOMAIN 9 DOMAIN 12

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

3. The ongoing monitoring, refreshing, and adding of data and data analysis

3. The health department must document the gathering of information, collection of data, conduct of community dialogues, and/or identification of community assets specific to populations and/or geographic areas in the community where health inequities and poorer health indicators were identified in the community health assessment. Additional data analysis is expected to be neighborhood/community specific in order to understand health inequities and the factors that create them. Geographic information analysis of socioeconomic conditions would be appropriate information to include in an annual update or supplement.

A complete revision or overhaul of the community health assessment, is not required, but for a continuous effort to better understand the health of the population through the collection of information and data.

Examples of community dialogue include organizing town meetings, conducting focus groups, participating in other local organizations’ community meetings (e.g., church community meetings, school public meetings, community association meetings or assemblies, etc.), conducting open forums, and conducting group discussions with specific populations (e.g., teenagers, young mothers, residents of a specific neighborhood, etc.).

Documentation could be, for example, reports of data and their analysis, findings from a focus group, meeting minutes where health issues or needs were discussed, reports of open forums, etc. Documentation of attendance at a meeting is not sufficient; documentation of the information gathered and analyzed is required.

2 examples from different years

If the CHA is two years or more old, then the examples must be from two different years.

14 months –

or, if the CHA is 2 years old or older, 1 example within the last 14 months and 1 example from another year since the CHA was adopted.

MEASURE 1.1.2 T/L, continued

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DOMAIN 1 DOMAIN 2 DOMAIN 3 DOMAIN 4 DOMAIN 5 DOMAIN 6 DOMAIN 7 DOMAIN 8 DOMAIN 10 DOMAIN 11DOMAIN 9 DOMAIN 12

MEASURE PURPOSE SIGNIFICANCE Measure 1.1.3 A

Accessibility of community health assessment to agencies, organizations, and the general public

The purpose of this measure is to assess the Tribal, state, or local health department’s efforts to share the community health assessment with other agencies and organizations and to make the assessment results available to the general public.

The community health assessment is a resource for all members of the public health system and the population at large. It is a basis for collaborations and for priority setting, planning, program development, funding applications, coordination of resources, and new ways to collaboratively use assets to improve the health of the population. Other governmental units and not-for-profits will use the community health assessment in their planning, program development, and development of funding applications.

STANDARD 1.1: Participate in or lead a collaborative process resulting in a comprehensive community health assessment.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. Information provided to partner organizations concerning the availability of the community health assessment

1. Health departments must document how it inform partners, stakeholders, other agencies, associations, and organizations of the availability of the community health assessment.

Documentation could be, for example, emails to partners and stakeholders providing information of how to access the assessment; announcements in department newsletters; articles in newspapers; digital media, health department tweet or Facebook; public service announcements, and local news announcement.

2 examples 5 years

2. The availability of the community health assessment findings to the public

2. Health departments must document how it communicates the community health assessment findings to the public.

Documentation could be, for example, evidence of distribution of the assessment to libraries or the publication of the community health assessment on the department’s website. Summaries of the findings could be, for example, published in newspapers, outlined in the department’s newsletter, linked to from the department’s Facebook page, or published on the department’s website.

2 examples 5 years

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Reliable data are key building blocks of public health. Health departments must gather timely and accurate data to identify health needs, understand factors that contribute to higher health risks or poorer health outcomes among populations, develop and evaluate programs and services, and determine resources. Health departments require reliable and valid data that can be compared between populations and across time. To best use the information available, health departments require a functional system for collecting data within their jurisdiction and for managing, analyzing, and using the data. Additionally, it is important that health departments share data with other organizations and access others’ data.

STANDARD 1.2: Collect and maintain reliable, comparable, and valid data that provide information on conditions of public health importance and on the health status of the population.

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STANDARD 1.2: Collect and maintain reliable, comparable, and valid data that provide information on conditions of public health importance and on the health status of the population.

MEASURE PURPOSE SIGNIFICANCE Measure 1.2.1 A 24/7 surveillance system or set of program surveillance systems

The purpose of this measure is to assess the health department’s process for collecting and managing health data for public health surveillance.

Public health surveillance is the continuous, systematic collection, analysis, and interpretation of health-related data needed for the planning, implementation, and evaluation of public health practice. Such surveillance can: serve as an early warning system for impending public health emergencies; document the impact of an intervention or track progress towards specified goals; and monitor and clarify the epidemiology of health problems, to allow priorities to be set and to inform public health policy and strategies. (World Health Organization)

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. Process(es) and/ or protocol(s) for the collection, review, and analysis of comprehensive surveillance data on multiple health conditions from multiple sources

1. The health department must provide written process(es) and/ or protocol(s) used to collect surveillance data from multiple sources and to review and analyze those data. Process(es) and protocol(s) must include how data are collected, (e.g., fax, emails, web reports, electronic data, phone calls to the health department or to another site, for example, emergency management or a 9-1-1 call center). The health department defines from whom reports are received.

A Tribal surveillance system may include a diverse set of partners, including, but not limited to, federal entities, Tribal epidemiology centers, local and state health departments, or other system partners. Since many Tribal surveillance systems include multiple partners outside of the Tribe, MOUs, MOAs, or other formal written agreements may be used as documentation to demonstrate processes, protocols, roles and responsibilities, confidentiality protection (2 below) and reporting.

1 department- wide process or protocol, or a set of processes or protocols

5 years

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REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

2. Processes and/or protocols to assure that confidential data are maintained in a secure and confidential manner

2. The health department must provide written processes and/ or protocols that (1) specify which surveillance data are, and which are not, considered to be confidential and (2) assure that confidential data are maintained and handled in a secure and confidential manner.

1 department- wide process or protocols, or a set of processes or protocols

5 years

3. 24/7 contact capacity 3. The health department must document a 24/7 contact system or protocol to collect data from those who report data to the health department. This may be, for example, a designated telephone line (voice or fax), email addresses, or ability to submit a report on the health department’s website. There may be a designated contact person for the health department or a list of contacts. The list may be a call-down list that is used if the primary call is received off-site or by another organization. Reports may be received by a contractor or by a call center (for example a poison control center), via regional or state agreements, or other arrangement. If there is a contract or other form of agreement to provide such services, the contract or agreement must be submitted as part of the documentation.

1 department- wide contact system or protocol or a set of contact systems

14 months

4. Testing 24/7 contact systems

4. The health department must provide reports of testing the 24/7 contact system. The health department determines how the system is tested and the frequency of such testing (which is expected to also be defined in the processes and/or protocols). The testing process can include receipt of a sample report by the various elements of the system. For example, if the system is set up to receive reports by internet, fax, email and a designated phone line, then all elements must be tested to ensure the ability to receive reports.

2 examples 5 years

MEASURE 1.2.1 A, continued

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33 PUBLIC HEALTH ACCREDITATION BOARD Standards & Measures VERSION 1.5 APPROVED DECEMBER 2013

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STANDARD 1.2: Collect and maintain reliable, comparable, and valid data that provide information on conditions of public health importance and on the health status of the population.

MEASURE PURPOSE SIGNIFICANCE Measure 1.2.2 A Communication with surveillance sites

The purpose of this measure is to assess the health department’s regular contact with sites who report surveillance data to the health department.

The department ensures that sites are providing timely, accurate, and comprehensive data by communicating with them about their surveillance responsibilities.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. The identification of providers and public health system partners who are surveillance sites reporting to the surveillance system

1. The health department must provide a list of the individuals or organizations that provide surveillance data to the health department. Examples of surveillance sites include, for example, health care providers, schools, laboratories, veterinarians, Tribal epidemiology centers, etc.

1 list 14 months

2. Trainings/meetings held with surveillance sites regarding reporting requirements including reportable diseases/ conditions, and reporting timeframes

2. The health department must document trainings or meetings held with surveillance site members regarding relevant reporting requirements, reportable diseases/ conditions, and timeframes.

Trainings may address general requirements or topic issue requirements.

Training need not be in-person but may be provided online, via webinars, etc.

Documentation must include when the training or meeting was held, who attended the training, and what topics were covered.

Documentation could be, for example, sign-in sheets and agendas, reports, or minutes of the meeting.

2 examples of trainings/ meetings

14 months

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3. Surveillance data received concerning two different topics

3. The health department must provide received surveillance data that address two different topics (for example, reports of flu cases, animals with confirmed rabies, a case of antibiotic resistant infection, or environmental public health monitoring data) itemized by reporting site.

2 examples of data received

2 different topics

2 different occasions

14 months

4. The distribution of surveillance data

4. The health department must document the distribution of surveillance data to others.

Documentation could be, for example, copies of emails, documented phone calls, newsletters, presentations, and meetings.

2 examples 14 months

MEASURE 1.2.2 A, continued

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STANDARD 1.2: Collect and maintain reliable, comparable, and valid data that provide information on conditions of public health importance and on the health status of the population.

MEASURE PURPOSE SIGNIFICANCE Measure 1.2.3 A Primary data

The purpose of this measure is to assess the health department’s capacity to collect primary data concerning health; health inequities; contributing factors or causes of health challenges; or potential policy, public health and/ or community solutions. This measure addresses data other than surveillance data.

Primary data are required to better understand specific situations, issues, and potential solutions. While secondary data can provide a wealth of information concerning the population’s health, it is not possible to understand how the reality of those data impact on the population, what the population’s perspectives and priorities are or what community resources or resilience can be mobilized to address situations that cause poor health.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. Collection of primary quantitative health data

1. The health department must provide the results of the collection of quantitative primary data from the population (in addition to its surveillance data). Primary data are data that did not exist before the health department gathered it.

The collection of primary quantitative data need not be complicated or costly. The data collection is intended to enhance the knowledge and understanding of the population the health department serves.

Data can be obtained from surveys of target groups (e.g., teenagers, the jobless, residents of a neighborhood with higher risks of poor health outcomes). Vital records are considered primary data for state health departments, if the state health department collects them.

Documentation could be reports, presentations made, minutes of briefings given, or other communications of the data results and conclusions.

2 examples 3 years

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2. Collection of primary qualitative health data

2. The health department must provide the results of the collection of qualitative primary data from the population. Data must be collected directly from groups or individuals who are at higher health risk.

The collection of primary qualitative data need not be complicated or costly. The data collection is intended to enhance the knowledge and understanding of the population the health department serves.

These data may address social conditions that have an impact on the health of the population served, for example, unemployment, poverty, lack of accessible facilities for physical activity, housing, transportation, and lack of access to fresh foods.

Examples of data collection methods include open ended survey questions, forums, listening sessions, focus groups, storytelling, group interviews, stakeholder interviews, key informant interviews, etc.

Documentation could be, for example, reports, presentations made, minutes of briefings given, or other communications of the data results and conclusions.

2 examples 2 years

3. The use of data collection instruments

3. The health department must provide standardized data collection instruments that they have used.

Standardized instruments include those that are recognized as national, state-wide, or local data collection tools. They may also be standardized from the standpoint that the same tool was used with all respondents, for example, a local survey developed and distributed to a representative sample of potential respondents. The tool may collect quantitative or qualitative data.

Tribes often use qualitative data collection methods, e.g., focus groups, interviews and other methodologies with elders, traditional healers, or ceremonial/cultural leaders. Documentation of qualitative data collection using indigenous methodologies of this type is acceptable. Cultural adaptations of nationally or state-wide recognized data collection tools and methods can be included as examples of data collection instruments. Tribal specific data collection tools that are nationally recognized may or may not exist, in which case, Tribal surveys adapted for their communities will be accepted.

2 examples

The health department can provide the tools used for the required documentation listed under the Required Docu- mentation 1 or 2 for this measure, or they can be examples from different data collection activi- ties, showcasing different data collection efforts.

2 years

MEASURE 1.2.3 A, continued

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STANDARD 1.2: Collect and maintain reliable, comparable, and valid data that provide information on conditions of public health importance and on the health status of the population.

MEASURE PURPOSE SIGNIFICANCE Measure 1.2.4 S Data provided to Tribal and local health departments located in the state

The purpose of this measure is to assess the state health department’s role in and process for sharing data with Tribal and local health departments located in the state.

Tribal and local health departments should have access to data that pertain to the health status of the population they serve. States should have a process in place to share data that they have collected or to which they have access.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. The provision of data to local health departments

1. The state health department must document the provision of primary and secondary data to local health departments located in the state.

Data can be aggregate for the local health department, or for a region of the state.

Data could be, for example, collected at the local level and submitted to the state. Some data may be available only at a regional or state level because some local populations are small, and the small data set could impact the statistical power and/or compromise confidentiality.

Data could be from registries, (e.g., cancer registries or immunization registries); vital records reports; environmental public health data; or data in web-based infectious disease reporting systems.

Data may address social conditions that affect the health of the population served, for example, unemployment, poverty, or lack of accessible facilities for physical activity, housing, transportation, or lack of access to fresh foods.

Data may be distributed in an electronic or hard copy format.

Documentation could be, for example, distribution lists, distribution protocols, email confirmation of receipt of reports, screen shots of web pages or portals, etc.

2 examples 14 months

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2. The provision of data to Tribal health departments in the state (if one or more is located in the state)

2. If one or more Tribal health departments is located in the state, the state health department must document the provision of primary and secondary data to the Tribal health department located in the state.

Data can be aggregate for the Tribal health department, or for a region of the state.

Data could be collected at the Tribal level and submitted to the state. Some data may be available only at a regional or state level because some local populations are small, and the small data set could impact the statistical power and/or compromise confidentiality.

Data could be, for example, from registries, (e.g., cancer registries or immunization registries); vital records reports; environmental public health data; or data in web-based infectious disease reporting systems.

Data may address social conditions that affect the health of the population served, for example, unemployment, poverty, or lack of accessible facilities for physical activity, housing, transportation, or lack of access to fresh foods.

Data may be distributed in an electronic or hard copy format.

Documentation could be, for example, distribution lists, distribution protocols, email confirmation of receipt of reports, screen shots of web pages or portals, etc.

2 examples 14 months

MEASURE 1.2.4 S, continued

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STANDARD 1.2: Collect and maintain reliable, comparable, and valid data that provide information on conditions of public health importance and on the health status of the population.

MEASURE PURPOSE SIGNIFICANCE Measure 1.2.4 L Data provided to the state health department and Tribal health departments in the jurisdiction the local health department is authorized to serve

The purpose of this measure is to assess the local health department’s role and process for sharing data with their state health department and Tribal health departments.

State health departments should have access to local data that pertain to health of the state’s population. Likewise, Tribal health departments should have access to local data that pertain to the health of the Tribe’s population. Local health departments should have a process in place to share local data to which they have access with the state and Tribes (if applicable).

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. The provision of data to the state health department and to a Tribal health department (if one or more is located in the jurisdiction the local health department is authorized to serve)

1. The local health department must document the provision of primary or secondary data to the state health departments and Tribal health departments.

Local health departments that do not have jurisdictions that overlap with the Tribal health departments do not have to demonstrate that they share local data with Tribes, but must provide documented evidence that there is no jurisdictional overlap.

Date could be, for example, data submitted for registries (e.g., cancer registries or immunization registries); vital records data; environmental public health data; or data in web-based infectious disease reporting systems.

Data may address social conditions that affect the health of the population served, for example, unemployment, poverty, lack of accessible facilities for physical activity, and lack of access to healthy foods.

Data may be distributed electronically or via hard copy format.

Documentation could be, for example, distribution lists, distribution protocols, email confirmation of receipt of reports, screen shots of web pages or portal, etc.

2 examples; if a Tribal health department is located within the health department’s jurisdiction, one example must be of data provided to a Tribal health department

14 months

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STANDARD 1.2: Collect and maintain reliable, comparable, and valid data that provide information on conditions of public health importance and on the health status of the population.

MEASURE PURPOSE SIGNIFICANCE Measure 1.2.4 T Data provided to the state health department and to local health departments

The purpose of this measure is to assess Tribal health department’s role and process for sharing data with the state health department and nearby local health departments.

State and local health departments should have access to Tribal data that pertain to the health of the state population and nearby communities. Tribal health departments should have a process in place to share relevant Tribal health data to which they have access with the state and local health departments.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. The provision of data to the state health department and to a local health department

1. The Tribal health department must document the provision of primary and secondary data to the state health department and to a local health department.

Data could be, for example, data submitted for registries (e.g., cancer registries or immunization registries); vital records data; environmental public health data; or data in web-based infectious disease reporting systems. The data may address social conditions that have an impact on the health of the population served, for example unemployment, poverty, lack of accessible facilities for physical activity and lack of access to healthy foods.

Data may be distributed electronically or via hard copy format.

Documentation could be, for example, distribution lists, entries in registries, faxed paper reports, distribution protocols, email confirmation of receipt of reports, screen shots of web page or portal, etc.

2 examples;

one example of data to the state and one example of data provided to a local health department

14 months

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Data analysis involves the examination and interpretation of data with the goal of drawing conclusions that inform planning, decision making, program development, evaluation, and quality improvement. The purpose of data analysis is to identify and understand current, emerging, or potential health problems, the contributing causes of health challenges, or environmental public health hazards. Data can identify trends in behaviors, disease incidence, opinions, socioeconomic status, the environment (natural and built), and other factors that aid in understanding health issues and their causes and in designing and evaluating programs and interventions.

STANDARD 1.3: Analyze public health data to identify trends in health problems, environmental public health hazards, and social and economic factors that affect the public’s health.

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STANDARD 1.3: Analyze public health data to identify trends in health problems, environmental public health hazards, and social and economic factors that affect the public’s health.

MEASURE PURPOSE SIGNIFICANCE Measure 1.3.1 A Data analyzed and public health conclusions drawn

The purpose of this measure is to assess the health department’s capacity to analyze and utilize data to identify trends over time, identify clusters, understand health problems, assess behavioral risk factors, detect environmental public health hazards, and recognize social and economic conditions that affect the public’s health.

Valid analysis of data is important for assessing the contributing factors, magnitude, geographic location(s), changing characteristics, and potential interventions of a health problem. Data analysis is critical for problem identification, program design, and evaluation of programs for continuous quality improvement.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. Analysis of data and conclusions drawn with the following characteristics:

1. The health department must document the analysis of data with conclusions drawn from the data. The provision of data used in the analysis is not required, but evidence of the health department’s analysis and conclusions is required.

Data to be analyzed can include qualitative and/or quantitative, primary and/or secondary data, or combinations of data.

Examples include: epidemiologic data, vital statistics, workplace fatality or disease investigation results, cluster identification or investigation results, outbreak investigation results, environmental and occupational public health hazard data, population health or key health indicator data, community survey/focus group results and conclusions, outbreak after action reports, analysis of hospital data, analysis of not-for-profit organizations’ data (for example, poison control center data or child health chart book), health disparities data, environmental data, socioeconomic data, stratified racial and ethnic health disparities data, and community health indicator data. Other examples include results of an investigation of a food borne disease outbreak, environmental hazard trends with arsenic in well water, or trends of reported infectious diseases over the past five years.

2 examples;

one example must be the analysis of qualitative data and one must be quantitative data

Analysis conduct- ed within 14 months (data may be older)

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a. The inclusion of defined timelines

b. A description of the analytic process used to analyze the data or a citation of another’s analysis

c. The inclusion of the comparison of data to other agencies and/ or the state or nation, and/or other Tribes, and/or similar data over time to provide trend analysis

The data may point out social conditions that have an impact on the health of particular or specific populations served, for example, unemployment, poor housing, lack of transportation, high crime residential areas, poor education, poverty, or lack of accessible facilities for physical activity.

a. Data used in the report must be distinct to a specific time period, for example, fiscal year 12-13, calendar year 2014, years 2012-2014.

b. The type of analytic process used must be stated and/or be evidence- based with the citation available. The intent is to have conclusions based on solid analysis, not just collection of data.

c. The analysis and conclusions must have the quality of comparability. That is, the data can be compared with (1) other similar socio- geographic areas, sub-state areas, the state, or nation, or (2) similar data for the same population gathered at an earlier time to establish trends.

Examples of trend analysis include conclusions based on rates of sexually transmitted diseases over the past five years, childhood immunization rates over the past eight quarters, unemployment rates over the past five years, or crime rate over the past two years, etc.

2. Review and discussion of data analysis

2. The health department must document the review of data analysis selected for Measure 1.3.1, Required Documentation 1, above.

The intent is to document the sharing of data and their analysis with others.

The discussions may be internal, with governing entities, with community groups, with other health or social service organizations, or provided to elected bodies.

Documentation could be, for example, minutes or documentation of meetings to show the presentation, review, and discussion of data analysis.

2 examples 14 months

MEASURE 1.3.1 A, continued

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3. Analysis of data that demonstrates the use of information and data from multiple databases or data sources

3. The health department must document the analysis of data that combines data from multiple databases of different data topics, (e.g., the housing department’s data and the prevalence of asthma) or data sources to support its conclusion. The analysis of data from multiple data sources demonstrates an understanding of how multiple factors affect health issues.

Other data sources include, for example, education, transportation, and housing.

1 example 5 years

4. Aggregated primary and secondary data and the sources of each

4. The health department must document the aggregation of primary and secondary data. Data must be compiled, analyzed, and conclusions drawn. The sources of the data used must also be provided.

Documentation could be reports, memos, GIS maps, or other written documents.

2 examples 14 months

MEASURE 1.3.1 A, continued

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STANDARD 1.3: Analyze public health data to identify trends in health problems, environmental public health hazards, and social and economic factors that affect the public’s health.

MEASURE PURPOSE SIGNIFICANCE Measure 1.3.2 S Statewide public health data and their analysis provided to various audiences on a variety of public health issues

The purpose of this measure is to assess the state health department’s provision of statewide public health data and analysis to various audiences in the state.

Governmental and other public data about the health of the state’s population should be shared with others in the state. Other organizations cannot effect change if they are not aware of the status of the health of the state. Sharing data can lead to partnerships to address public health issues.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. The distribution of data analysis and findings that address public health issues to specific audiences

1. The state health department must document the distribution of analytical public health findings to specific audiences in the state.

Examples must include data on one or more specific public health issue, for example, health behaviors; public health laboratory reports; environmental public health hazards reports; disease clusters or trends; vital records and health statistics; or health indicators (e.g., infant mortality rate).

Distribution of the data analysis and findings may be targeted to a variety of audiences, for example, public health and health care providers, employers, labor unions and other public health stakeholders, partners, and the public.

A range of methods of distribution could be used including: mailing lists, email lists, presentations, workshops, web postings, meeting minutes, published editorials, and press releases.

The data or written report of the analysis itself does not have to be distributed, but the contents and findings must be communicated. Thus, while distribution of a hard copy of a report would meet the requirement of the measure, so would a verbal presentation to an audience of the contents of the report.

The analysis does not have to be produced by the state health department. The state health department could use reports produced by CDC, or other federal government agencies, an academic institution, or other organization. However, data analysis developed by others must have a connection to the state and the state’s population and contain information of public health significance.

2 examples

Two examples must be from two different years; one from one year and the other from a different year.

1 example dated within 14 months; the other dated older than 14 months but within 5 years.

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STANDARD 1.3: Analyze public health data to identify trends in health problems, environmental public health hazards, and social and economic factors that affect the public’s health.

MEASURE PURPOSE SIGNIFICANCE Measure 1.3.2 L Public health data provided to various audiences on a variety of public health issues

The purpose of this measure is to assess the local health department’s provision of community public health data and analysis to the community it serves.

Governmental and other public data about the health of the community should be shared with the community. Community members cannot effect change if they are not aware of the status of the health of the community. Sharing data can lead to partnerships to address public health issues.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. The distribution of data analysis and findings to address community public health issues, to specific audiences

1. The local health department must document distribution of analytical public health findings to specific audiences in the community.

Examples must include data on one or more specific public health issues, for example, health behaviors; disease clusters or trends; public health laboratory reports; environmental public health hazards reports; or health indicators (e.g. infant mortality rate).

Distribution of the reports may be targeted to a variety of audiences, including: public health organizations, health care providers, employers, veterinarians, community service groups, local schools, labor unions, other public health stakeholders, partners, and the public.

A range of distribution methods could be used including, for example, mailing lists, email lists, presentations, workshops, web postings, meeting minutes, published editorials, and press releases.

The data or written report of the analysis itself does not have to be distributed, but the contents must be communicated. Thus, while distribution of a hard copy of the report meets the requirement of the measure, so could a verbal presentation to an audience of community members of the contents of the report.

2 examples

Two examples must be from two different years; one from one year and the other from a different year.

1 example dated within 14 months; the other dated older than 14 months but within 5 years.

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The report does not have to be produced by the local health department. The local health department could use reports produced by the state, an academic institution, or other organizations. However, data analysis developed by others must have a connection to the jurisdiction and the populations served by the health department and contain information of public health significance.

MEASURE 1.3.2 L, continued

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STANDARD 1.3: Analyze public health data to identify trends in health problems, environmental public health hazards, and social and economic factors that affect the public’s health.

MEASURE PURPOSE SIGNIFICANCE Measure 1.3.2 T Public health data provided to the Tribal community on a variety of public health issues

The purpose of this measure is to assess the Tribal health department’s provision of Tribal public health data and analysis to the Tribe it serves.

Governmental and other public data about the health of the Tribe should be shared with the Tribal community. Tribal members cannot effect change if they are not aware of the status of the health of the Tribe. Sharing data can lead to partnerships to address public health issues.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. The distribution of data analysis and findings that address community public health issues, to specific audiences

1. The Tribal health department must document distribution of analytical public health findings to specific audiences in the Tribe.

Examples must include data on one or more specific public health issues, for example, health behaviors; disease clusters or trends; public health laboratory reports; environmental public health hazards reports; or health indicators (e.g., infant mortality rate).

Distribution of the data analysis and findings may be targeted to a variety of audiences, including: public health organizations, health care providers, veterinarians, community service groups, local schools, other stakeholders and partners, and the public.

A range of distribution methods could be used, including, for example, mailing lists, email lists, presentations, workshops, web postings, meeting minutes, published editorials, and press releases.

The data or written report of the analysis itself does not have to be distributed, but the contents and findings must be communicated. Thus, while distribution of a hard copy of the report meets the requirement of the measure, so could a verbal presentation to an audience of community members of the data analysis and findings.

2 examples

Two examples must be from two different years; one from one year and the other from a different year.

1 example dated within 14 months; the other dated older than 14 months but within 5 years.

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The analysis does not have to be produced by the Tribal health department; the Tribal health department could use reports produced by the state, an academic institution, Tribal epidemiology center, or other organizations. However, data analysis developed by others must have a connection to the Tribal health department and to the populations served by the Tribal health department and contain information of public health significance.

MEASURE 1.3.2 T, continued

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The development of public health policies, processes, programs, and interventions should be informed by the use of public health data. Data should be shared with others so that they can use it for health improvement efforts.

STANDARD 1.4: Provide and use the results of health data analysis to develop recommendations regarding public health policies, processes, programs, or interventions.

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STANDARD 1.4: Provide and use the results of health data analysis to develop recommendations regarding public health policies, processes, programs, or interventions.

MEASURE PURPOSE SIGNIFICANCE Measure 1.4.1 A Data used to recommend and inform public health policy, processes, programs, and/or interventions

The purpose of this measure is to assess the health department’s use of data to impact policy, processes, programs, and interventions.

Public health policy, processes priorities, program design, and interventions should be based on the most current and relevant data available.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. The use of data to inform public health policy, processes, programs, and/or interventions

1. The health department must document that public health data have been used to impact the development of policies, processes, programs, or interventions or the revision or expansion of an existing policies, processes, programs, or interventions. The data used to inform the policy, process, program, or intervention must also be included. The data alone will not serve as evidence for this measure. The health department must demonstrate the use of the data.

Documentation could be, for example, documented program improvements, or a revised or new policy and procedure. Documentation could also be Tribal Council resolutions and Health Oversight Committee meeting minutes, which demonstrate that data was used to inform policy, processes, programs and/or interventions.

2 examples

One of the two examples must demonstrate the use of data across multiple data sets, databases, or data source.

14 months

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STANDARD 1.4: Provide and use the results of health data analysis to develop recommendations regarding public health policies, processes, programs, or interventions.

MEASURE PURPOSE SIGNIFICANCE Measure 1.4.2 S Statewide summaries or fact sheets of data to support health improvement planning processes at the state level

The purpose of this measure is to assess the state health department’s development and distribution of statewide health data to inform and support others’ health improvement efforts at the state level.

In addition to the state health assessment, the state health department should provide health-issue specific or program specific data summaries. These will be summaries of data that focus on a particular issue, for example, health behaviors, health equity factors, or the incidence of infectious diseases. It is important that others have access to health data to inform their program planning and activities at the state level. Health data summaries are used to inform stakeholders and partners about state health issues and to advocate for the health of the state and for the needs identified in the profile.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. State health data summaries or fact sheets

1. The state health department must provide summaries or fact sheets that condense the state’s public health data. Data summaries may address a combination of public health issues or may focus on a particular health issue regarding the population served.

Statewide health data summaries are not the same as a community health assessment. A data summary can take several forms. It can be an overview, summary, or synopsis of a particular health issue, such as cancer or obesity. Or it can address a set of issues, such as health equity or the health issues of the state’s adolescents. It may also focus on select key indicators of the health of the state, such as health behaviors like tobacco use or healthful eating.

Health data summaries produced by national or federal sources are insufficient documentation of the measure, unless the state health department demonstrates how the data summary was supplemented with additional data collected and analyzed by the state health department.

2 examples of data summaries

5 years

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Documentation could be, for example, a summary, fact sheet, brief, overview, a single document of comprehensive data, or a dynamic website with comprehensive state data that is updated as data are available (i.e., web-based dashboard).

2. Distribution of summaries of state data to public health system partners, community groups and key stakeholders

2. The state health department must document the distribution of summaries of health data to public health system partners, community groups, Tribal health departments, local health departments, elected officials, or key stakeholders, such as governing entities or community advisory groups. This may include partners, including community-based organizations, civic groups, and any others who receive services, help in the delivery of services, or support public health services.

Documentation could be, for example, a mailing list, email list-serve, posting on the website, press releases, meeting minutes documenting distribution of the profile, presentations, inserts or flyers, or a website of data that is updated as data are available.

2 examples of distribu- tion of issue specific data sum- maries or 1 example of provision of comprehen- sive data

5 years

MEASURE 1.4.2 S, continued

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STANDARD 1.4: Provide and use the results of health data analysis to develop recommendations regarding public health policies, processes, programs, or interventions.

MEASURE PURPOSE SIGNIFICANCE Measure 1.4.2 T/L Tribal/community summaries or fact sheets of data to support public health improvement planning processes at the Tribal or local level

The purpose of this measure is to assess the Tribal and local health department’s development and distribution of health data to inform and support others’ health improvement efforts at the Tribal and local level.

In addition to the Tribal/local health assessment, Tribal and local health departments should provide health-issue specific or program specific data summaries. These will be summaries of data that focus on a particular issue, for example, health behaviors, health equity factors, or the incidence of infectious diseases. It is important that others have access to health data to inform their program planning and activities at the local or Tribal community level. Health data summaries are used to inform stakeholders and partners about the health of the community health issue and to advocate for the health of the Tribe or locality and for the needs identified in the profile.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. Tribal or community health data summaries or fact sheets

1. The Tribal or local health department must provide summaries or fact sheets of Tribal/community health data that condense public health data. Data summaries may address a combination of public health issues or may focus on a particular health issue regarding the population served.

Tribal or local health data summaries are not the same as a community health assessment. A data summary can be an in several forms. It can be an overview, summary, or synopsis of a particular health issue, such as cancer or obesity. Or, it can address a set of issues, such as health equity or health issues of adolescents. It may also focus on select key indicators of the health of the community, such as health behaviors like tobacco use or healthful eating.

Documentation could be, for example, a summary, fact sheet, brief, overview, a single document of comprehensive data, or a dynamic website with comprehensive data that is updated as data are available (i.e., web-based dashboard).

2 examples of data summaries

5 years

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Community health data summaries produced by national, federal including Tribal Epidemiologic Centers), or state health department sources for the local health departments are insufficient documentation of the measure, unless the local health department demonstrates how the data summary was supplemented with additional data collected and analyzed by the local health department.

2. Distribution of health data summaries to public health system partners, community groups, and key stakeholders

2. The Tribal or local health department must document the distribution of summaries of health data to public health system partners, community groups, other Tribal and local health departments, elected officials, or key stakeholders, such as governing entities or community advisory groups. This may include partners, including elected/appointed officials, community based organizations, civic groups and any others who receive services, help in the delivery of service, or support public health services.

Documentation could be, for example, a mailing list, email list-serve, posting on the website, press releases, meeting minutes documenting distribution of the profile, presentations, and inserts or flyers, or a dynamic website of data that is updated as data are available.

2 examples of distribu- tion of issue specific data sum- maries or 1 example of provision of comprehen- sive data

5 years

MEASURE 1.4.2 T/L, continued

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STANDARD 1.4: Provide and use the results of health data analysis to develop recommendations regarding public health policies, processes, programs, or interventions.

MEASURE PURPOSE SIGNIFICANCE Measure 1.4.3 S Support provided to Tribal and local health departments in the state concerning the development and use of summaries of community data

The purpose of this measure is to assess the state health department’s support to Tribal and local health departments within the state concerning the development and use of community or Tribal summaries of data.

State health departments have access to and compile data that are not available to Tribal and local health departments. State health departments should share these data with Tribal and local health departments. State health departments also should provide assistance to the Tribal and local health departments on how to use community health data or summaries of data.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. Tools and guidance 1. The state health department must document that data analysis and/or data presentation tools were provided to Tribal and local health departments in the state. The state may also offer guidance – by phone, electronically, or in person – to help with Tribal and local profile development.

2 examples 5 years

2. Summaries of community data

2. The state health department must provide summaries of data of the Tribal and local community.

These must be summaries of data specific to the Tribe or local area and may include data collected by other state agencies, for example, educational attainment, unemployment, types of employment, or crime statistics.

2 examples 5 years

3. Determination of support or assistance in the analysis and understanding of data appropriate for Tribal and local health departments decision making

3. The state health department must document that it has asked Tribal and local health departments about what support or technical assistance is needed or requested.

Documentation could be, for example, phone call minutes, faxes, newsletters, memos, meeting minutes.

2 examples;

1 example is a Tribal health department if one exists in the state.

5 years

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4. Technical assistance provided to Tribal and local health departments in the analysis and understanding of data appropriate for public health decision making

4. The state health department must document the assistance that it provided to Tribal and local health departments concerning the use of summaries of data.

Documentation could be, for example, faxes, newsletters, memos, meeting minutes, phone call minutes.

2 examples;

1 example is a Tribal health department if one exists in the state.

5 years

MEASURE 1.4.3 S, continued

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Domain 2 focuses on the investigation of suspected or identified health problems or environmental public health hazards. Included are epidemiologic identification of emerging health problems, monitoring of disease, availability of public health laboratories, containment and mitigation of outbreaks, coordinated response to emergency situations, and communication.

DOMAIN 2 INCLUDES FOUR STANDARDS:

Standard 2.1: Conduct Timely Investigations of Health Problems and Environmental Public Health Hazards

Standard 2.2: Contain/Mitigate Health Problems and Environmental Public Health Hazards

Standard 2.3: Ensure Access to Laboratory and Epidemiologic/Environmental Public Health Expertise and Capacity to Investigate and Contain/Mitigate Public Health Problems and Environmental Public Health Hazards

Standard 2.4: Maintain a Plan with Policies and Procedures for Urgent and Non-Urgent Communications

Domain 2: Investigate Health Problems and Environmental Public Health Hazards to Protect the Community

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The ability to conduct timely investigations of suspected or identified health problems is necessary for the detection of the source of the problem, the description of those affected, and the prevention of the further spread of the problem. When public health or environmental public health hazards are investigated, problems can be recognized and rectified, thus preventing further spread of disease or illness.

STANDARD 2.1: Conduct timely investigations of health problems and environmental public health hazards.

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STANDARD 2.1: Conduct timely investigations of health problems and environmental public health hazards.

MEASURE PURPOSE SIGNIFICANCE Measure 2.1.1 A Protocols for investigation process

The purpose of this measure is to assess the health department’s ability to conduct standardized investigations with consistent procedures and a set of rules to follow.

Health departments require standard operations, assigned roles and responsibilities, and well thought out coordination to study patterns of health and illness and their associated factors. A standardized approach ensures thorough investigation into the cause of a public health problem or environmental public health hazard and timely response so that further disease and illness can be prevented.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. Protocols that include:

a. Assignment of responsibilities for investigations of health problems, environmental, and/ or occupational public health hazards

1. The health department must provide written protocols that include a procedure for conducting investigations of suspected or identified health problems and environmental and occupational public health hazards.

Examples of health problems that require investigation include infectious disease, sexually transmitted disease/infection, injury, chronic disease, chemical emissions, and drinking water contamination, etc.

a. The protocol must delineate the assignment of responsibilities for investigations of health problems and environmental public health hazards. The assignment may be to a specified position or positions (for example, all environmental public health sanitarians, epi-diagnostic teams, and/or community health outreach staff in the health department) or may be assigned to a named individual. Documentation must include specific responsibilities shown in a procedure, protocol, or flow chart.

If this function is carried out in full or in part by a federal agency, other health department, or other entity, then an MOU/MOA or other agreement, must be provided to demonstrate the formal assignment of responsibilities for investigation of health problems and environmental and occupational public health hazards.

1 compre- hensive protocol or a set of protocols that covers diseases and environmen- tal health issues

24 months

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b. Health problem or hazard specific protocol steps including case investigation steps and timelines, and reporting requirements

b. The protocol must contain protocol steps or procedures for the health problems or hazards that will be investigated, case investigation steps, and timelines related to those problems or hazards, and reporting requirements.

The protocols may be in separate documents, may be contained in a manual format, or may be in a single compiled document.

MEASURE 2.1.1 A, continued

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STANDARD 2.1: Conduct timely investigations of health problems and environmental public health hazards.

MEASURE PURPOSE SIGNIFICANCE Measure 2.1.2 S Capacity to conduct and/ or support investigations of infectious diseases simultaneously

The purpose of this measure is to assess the state health department’s capacity to engage in more than one investigation of infectious disease health problems at the same time.

More than one health problem that requires an investigation may occur simultaneously. Health problems may occur simultaneously in more than one location in the state or may be contained in the jurisdiction of a single or multiple Tribal or local health departments. It is important that the state health department has the capacity to investigate or help support multiple investigations of infectious disease at the same time. The focus of this measure is on investigation of infectious diseases such as influenza, measles, food borne illnesses, or Lyme disease.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. Procedures for the conduct of simultaneous investigations

1. The state health department must provide written procedures that describe how it conducts multiple, simultaneous investigations of infectious diseases.

State health departments often work together with Tribal health departments and local health departments to conduct investigations; the state health department can include contractors and/or relationships with Tribal health departments, local health departments, or other state governmental departments to show the capacity to conduct simultaneous investigations.

The state health department does not have to perform all functions of an investigation, but must have the capacity to respond when needed.

Documentation could be, for example, response plans, internal plans, staff capacity and expertise, and resources available to the health department from other state governmental departments (for example, the Department of Agriculture or the Department of Environmental Resources).

1 compre- hensive procedure or 2 examples of procedures

5 years

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2. Reviews of investigation reports against procedures

2. The state health department must provide program audits (internal or external), programmatic evaluations, case reviews, or peer reviews of investigation reports (as compared to written procedures) developed as a result of an investigation of infectious diseases. The documentation must reference the state health department’s capacity to respond to outbreaks of infectious or communicable disease. The documentation could be a completed After Action Report (AAR).

2 examples of simultaneous investigations

5 years

MEASURE 2.1.2 S, continued

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STANDARD 2.1: Conduct timely investigations of health problems and environmental public health hazards.

MEASURE PURPOSE SIGNIFICANCE Measure 2.1.2 T/L Capacity to conduct an investigation of an infectious disease

The purpose of this measure is to assess the Tribal/local health department’s capacity to implement its protocols for an investigation of infectious disease.

Investigations of infectious disease provide information that allows the health department to understand the best way to control a current outbreak of a disease and to prevent further spread of an outbreak. Sometimes a health problem or hazard requiring investigation occurs where local and state and/or local and Tribal jurisdictions overlap or are adjacent to one another requiring response and coordination between health departments. The focus of this measure is on investigation of infectious diseases, such as influenza, measles, food borne illnesses, or Lyme disease.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. Reviews of investigation reports against procedures

1. The Tribal/local health department must provide audits (internal or external), programmatic evaluations, case reviews, or peer reviews of investigation reports (as compared to written procedures). The documentation must reference the health department’s capacity to respond to outbreaks of infectious disease.

The Tribal/local health department can include contractors and/or relationships with the state health department, Tribal health departments in the state, local health departments, or other local government departments to demonstrate the capacity to conduct an investigation. The health department does not have to perform all functions of an investigation of an infectious disease, but must have formal arrangements with others who will participate and support the Tribal/local health department in its investigations.

The documentation could be a completed After Action Report (AAR).

2 examples 5 years

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STANDARD 2.1: Conduct timely investigations of health problems and environmental public health hazards.

MEASURE PURPOSE SIGNIFICANCE Measure 2.1.3 A Capacity to conduct investigations of non-infectious health problems, environmental, and/or occupational public health hazards

The purpose of this measure is to assess the health department’s capacity to implement protocols for an investigation of non-infectious diseases and illnesses and of environmental public health hazards.

Investigations of non-infectious diseases and illnesses and of environmental public health hazards allow the health department to learn how to prevent or mitigate health problems caused by non-infectious health problems and environmental public health hazards.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. Completed investigation of a non-infectious health problem or hazard

1. The health department must provide written reports of a completed investigation of a non-infectious health problem or hazard. There is no specified format.

Non-infectious health problems include: morbidity and mortality associated with emergent and non-emergent health problems that are not infectious, for example, chronic disease, injuries, and environmental public health hazards, as well as their risk factors, including socioeconomic issues. An example of a non-infectious health problem would be an increase in diagnosed diabetes cases or a geographic area with a higher than normal rate of a cancer type. An example of an environmental public health hazard could be arsenic or lead in drinking water, as opposed to an infectious public health hazard, such as a restaurant food-borne outbreak.

If this activity is provided through a contract/MOA/MOU, then written assurance that the investigation was completed must be provided.

Documentation could be, for example, reports of the investigation, executive summary, presentation or investigation records, including logs and notes.

2 examples 5 years

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STANDARD 2.1: Conduct timely investigations of health problems and environmental public health hazards.

MEASURE PURPOSE SIGNIFICANCE Measure 2.1.4 A Collaborative work through established governmental and community partnerships on investigations of reportable diseases, disease outbreaks, and environmental public health issues

The purpose of this measure is to assess the health department’s working relationships that are needed to investigate reports of reportable diseases and environmental public health problems.

As a part of conducting investigations, the health department must partner with other governmental agencies and community partners to investigate reports on reportable diseases and environmental public health investigation.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. Partnerships with other governmental agencies/ departments and/or key community stakeholders that play a role in investigations or have direct jurisdiction over investigations

1. The department must provide contracts/MOAs/MOUs/ agreements/funding agreements that document established partnerships for the investigation of outbreaks of disease, health care associated infections, or environmental public health hazards. These partnerships are with other governmental agencies/ departments and key community stakeholders, and the agreement must state or show that the partner plays a role in investigation. The agreement may state that the partner may have a direct jurisdiction over a specified type of investigation.

2 examples 5 years

2. Working with partners to conduct investigations

2. The department must document work with partners to conduct investigations.

Documentation could be investigation reports and records, AARs, meeting minutes, presentations, and news articles

2 examples

The examples must be from two different investigations of reportable diseases or environmental public health investigations

5 years

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3. Laboratory testing for notifiable/reportable diseases

3. The department must provide a list of public health laboratory services presently provided that includes testing for notifiable/ reportable diseases.

1 list of public health laboratory services

5 years

MEASURE 2.1.4 A, continued

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STANDARD 2.1: Conduct timely investigations of health problems and environmental public health hazards.

MEASURE PURPOSE SIGNIFICANCE Measure 2.1.5 A Monitored timely reporting of notifiable/reportable diseases, lab test results, and investigation results

The purpose of this measure is to assess the health department’s assurance of timely investigations including reporting of notifiable/ reportable diseases, laboratory test results, and reporting investigation results.

A component of assuring timely investigations is the monitoring of reporting notifiable/reportable diseases, laboratory testing, and investigation of results as appropriate and required by law. When all steps are timely, partners can work together to stop the spread of disease.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. Tracking log or audit of reports of disease reporting, laboratory tests reports, and/or investigations with actual timelines noted

1. The health department must provide a tracking log or audit on investigations that includes reporting lab test results and investigation results. The log is used to track various elements of investigations.

Documentation could be a log or a report. The log or report must include timelines.

1 tracking log or audit of investiga- tions conducted

5 years

2. Applicable laws 2. The department must provide a copy of laws relating to the reporting of notifiable/reportable diseases.

State health departments must include laws for local health departments to report to the state, as well as for states reporting to CDC.

Documentation could be, for example, a screen shot of a posting on a website or a department intranet or a pdf copy.

1 set of laws The law may be older than 5 years, but the health department should document that the law has been reviewed within 5 years

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STANDARD 2.1: Conduct timely investigations of health problems and environmental public health hazards.

MEASURE PURPOSE SIGNIFICANCE Measure 2.1.6 S Consultation, technical assistance, and/or information provided to Tribal and local health departments in the state regarding the management of disease outbreaks and environmental public health hazards

The purpose of this measure is to assess the consultation, technical assistance, and information that a state health department provides to Tribal and local health departments in the state concerning the management of disease outbreaks and public health hazards.

The state health department’s provision of technical assistance, information, and consultation to Tribal and local health departments on epidemiological, laboratory, and environmental public health assistance improves the effectiveness of the public health response locally and state-wide. The measure includes assistance concerning identifying, analyzing, and responding to infectious disease outbreaks, as well as to environmental and occupational public health hazards.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. The provision of consultation, technical assistance, and/or information

1. The state health department must document how it provides assistance to Tribal or local departments. This may be at the request of locals or can be initiated by the state. This can include communications that have gone to one or more Tribal or local health departments; meetings at the Tribal, state, or local level; and training sessions and presentations. It can also include email communication – both to individuals and to list-serves.

State health department assistance can be for example, onsite, phone consultation, conference calls, webinars, presentations, training sessions, written guidelines, and investigation protocols and manuals.

2 examples 5 years

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Health departments must be able to act on information concerning health problems and environmental public health hazards that was obtained through public health investigations. Health departments must have the ability to contain or mitigate health problems and hazards. The containment or mitigation of health problems and environmental public health hazards must be coordinated with other levels of government, other government departments, and other stakeholders.

STANDARD 2.2: Contain/mitigate health problems and environmental public health hazards

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STANDARD 2.2: Contain/mitigate health problems and environmental public health hazards.

MEASURE PURPOSE SIGNIFICANCE Measure 2.2.1 A Protocols for containment/ mitigation of public health problems and environmental public health hazards

The purpose of this measure is to assess the health department’s ability to contain or mitigate health problems or environmental public health hazards. This includes disease outbreaks. This measure assesses the existence of protocols for the containment or mitigation of public health problems or public health environmental hazards.

Health departments are responsible for acting on information concerning health problems and environmental public health hazards in order to contain or lessen the negative effect on the health of the population.

Health departments require standard operations, assigned roles and responsibilities, and well thought out coordination in order to effectively address disease outbreaks. A standardized approach ensures timely response.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. Protocol(s) that address containment/mitigation of public health problems and environmental public health hazards

1. The health department must provide written protocols or a set of protocols for the containment/mitigation of health problems and hazards. This includes disease-specific procedures (for example, pertussis, TB) for follow-up and reporting during outbreaks.

The protocols must address mitigation, contact management, clinical management, use of prophylaxis and emergency biologics, communication with the public health laboratory, and the process for exercising legal authority for disease control.

These protocols may be in a single document or be comprised of many separate documents.

1 compre- hensive protocol or a set of protocols

2 years

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STANDARD 2.2: Contain/mitigate health problems and environmental public health hazards.

MEASURE PURPOSE SIGNIFICANCE Measure 2.2.2 A A process for determining when the All Hazards Emergency Operations Plan (EOP) will be implemented

The purpose of this measure is to assess the health department’s ability to know when their All Hazards Emergency Operations Plan (EOP) needs to be put into operation in order to address a natural disaster, terrorist event, disease outbreak or cluster, environmental public health hazard, or other emergency that threatens the population’s health.

Protocols for a health department to determine that they need to implement their All Hazards Emergency Operations Plan are necessary to ensure that the plan is put into action when needed and that it is not put into action when it is not needed.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. Protocols that address infectious disease outbreaks describing processes for the review of specific situations and for determining the activation of the All Hazards Emergency Operations Plan

1. The health department must provide all infectious disease outbreak protocols. Though these may be the same protocols from 2.2.1 A, the department must highlight the description of the process for determining when the All Hazards or Emergency Operations Plan will be implemented.

1 compre- hensive protocol or a set of protocols

5 years

2. Protocols that address environmental public health issues describing processes for the review of specific situations and for determining the initiation of the All Hazards Emergency Operations Plan

2. The health department must provide protocols that specifically address environmental public health hazards and that describe the process for determining when the All Hazards Emergency Operations Plan will be implemented.

1 compre- hensive protocol or a set of protocols

5 years

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3. Cluster evaluation protocols that describe the processes for the review of specific situations that involve a closely grouped series of events or cases of disease or other health-related phenomenon with well- defined distribution patterns in relation to time or place or both, and for determining initiation of the All Hazards Emergency Operations Plan

3. The health department must provide protocols that include cluster evaluation protocols describing the process for determining when the All Hazards Emergency Operations Plan will be implemented. Cluster evaluations will provide evidence of an unusual number of health events, for example, SARS, influenza, food poisoning, health care associated infections (e.g., MRSA), or unusual symptoms in a group, together in time and location.

A cluster evaluation is differentiated from an outbreak in that a single case of some infectious diseases may trigger the use of an outbreak protocol (e.g., small pox or polio).

1 comprehen- sive protocol or a set of protocols

5 years

MEASURE 2.2.2 A, continued

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STANDARD 2.2: Contain/mitigate health problems and environmental public health hazards.

MEASURE PURPOSE SIGNIFICANCE Measure 2.2.3 A Complete After Action Reports (AAR)

The purpose of this measure is to assess the department’s development of descriptions and analysis of performance after an emergency operation or exercise. This measure assesses the existence of After Action Reports.

A process for After Action Reports provides a way for the health department to assess its performance during an emergency operation for quality improvement. It identifies issues that need to be addressed and includes recommendations for corrective actions for future emergencies and disasters.

An AAR is to be completed when an infectious disease outbreak occurs, an environmental public health risk has been identified, a natural disaster occurs, and any other event occurs that threatens the public’s health. While AARs have been used for drills and exercises as part of All Hazards Plans (see 5.4.3 A), the focus of this measure is concerning the determination of when AAR methodology is applied to actual events that threaten the health of the people living in the jurisdiction of the health department.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. Protocol describing the processes used to determine when events rise to significance for the development and review of an AAR

1. The health department must provide a written description of how it determines if an event has risen to the level of significance requiring an AAR. Not every event will require an AAR. For example, a food borne outbreak may have 10 positive cases before being designated as significant enough to require an AAR. The process must address infectious disease outbreaks, environmental public health hazards, natural disasters, and other threats.

1 protocol 5 years

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2. A list of all events that occurred, including outbreaks and environmental public health risks

2. The health department must provide a list of significant events that have occurred within the last five years. The list must include all events that met and did not meet the level of significance to require an AAR. The list must include, at minimum, the event name, dates of the event, and type of event (e.g., natural disasters, such as floods or hurricanes; manmade disasters, such as a toxic chemical release or pollution; and terrorism, such as anthrax or explosions). The list must include all outbreaks, environmental public health risks, natural disasters, or other events that threaten the public’s health.

1 list 5 years

3. Completed AAR for two events

3. The health department must provide completed AARs.

An AAR documents successes, issues, and recommended changes in investigation and response procedures or other process improvements. The AARs must report what worked well, what issues arose, what improvement in protocols are indicated, and recommended improvements.

2 examples of separate events

5 years

MEASURE 2.2.3 A, continued

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Successful investigation and mitigation of public health problems and environmental hazards will often depend on laboratory testing, epidemiologist involvement, and environmental public health expertise. These areas of expertise provide vital support to an investigation and are a part of the capacity that a department should have to respond to health problems and environmental public health hazards.

STANDARD 2.3: Ensure access to laboratory and epidemiological/environmental public health expertise and capacity to investigate and contain/ mitigate public health problems and environmental public health hazards.

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STANDARD 2.3: Ensure access to laboratory and epidemiological/environmental public health expertise and capacity to investigate and contain/mitigate public health problems and environmental public health hazards.

MEASURE PURPOSE SIGNIFICANCE Measure 2.3.1 A Provisions for the health department’s 24/7 emergency access to epidemiological and environmental public health resources capable of providing rapid detection, investigation, and containment/mitigation of public health problems and environmental public health hazards

The purpose of this measure is to assess the department’s capacity for rapid detection, investigation, and containment/mitigation of public health problems and environmental public health hazards.

Health departments need the capacity to respond to public health emergencies. The department needs to have access to epidemiological and environmental public health resources that can support the rapid detection, investigation, and mitigation of problems and hazards. This access must be available to the department 24/7.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. Policies and procedures ensuring 24/7 coverage

1. The health department must provide policies and procedures outlining how the health department maintains 24/7 access to support services in emergencies. These policies and procedures may be contained in the All Hazards Emergency Operations Plan or may be separate policies and procedures. These resources may be within the department, or the department can have agreements with other agencies, individual contractors, or a combination in order to be responsive 24/7.

1 compre- hensive policies and procedures document or a set of policies and procedures

5 years

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2. Process to contact epidemiological and environmental public health resources

2. The health department must provide the call down list that is used to contact epidemiological and environmental public health resources.

1 call down list

5 years

3. Contracts/MOAs/MOUs/ mutual assistance agreements detailing relevant staff

3. The health department must provide a list and description of contracts, MOA/MOUs, or mutual assistance agreements that define access to resources to assist in 24/7 capacity for emergency response.

1 list 5 years

MEASURE 2.3.1 A, continued

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STANDARD 2.3: Ensure access to laboratory and epidemiological/environmental public health expertise and capacity to investigate and contain/mitigate public health problems and environmental public health hazards.

MEASURE PURPOSE SIGNIFICANCE Measure 2.3.2 A 24/7 access to laboratory resources capable of providing rapid detection, investigation and containment of health problems and environmental public health hazards

The purpose of this measure is to assess the department’s access to needed laboratory services to provide rapid detection, investigation, and containment/mitigation of public health problems and environmental public health hazards.

Emergency laboratory services are critical to recognize agents for the development of an appropriate public health rapid response. The department must have access to public health laboratory resources that can support the rapid detection, investigation, and containment of problems and hazards. This access should be available to the department 24/7.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. Laboratory certification 1. The health department must provide documentation of laboratory capacity. Laboratory capacity may be within the health department, may be provided by reference laboratories, or a combination of both internal and external support.

The health department must provide documentation that the laboratory has accreditation, certification, and licensure appropriate for all the testing that it performs (i.e., CLIA License, EPA Drinking Water Certification, FDA Certification for Milk Testing, etc.)

Accreditation documenta- tion, certification, and/or licensure appropriate for all the testing that is performed

5 years

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2. Policies and procedures ensuring 24/7 coverage

2. The health department must provide policies and procedures that assure 24/7 laboratory coverage. These resources may be within the department, or the department can have agreements with other agencies, individual contractors, or a combination in order to be responsive 24/7. These policies and procedures may be contained in the All Hazards Emergency Operations Plan or may be separate policies and procedures.

Documentation could be contracts, MOAs/MOUs, or mutual assistance agreements that the department has with other public and private laboratories to provide support services.

1 set of policies and procedures or policies and procedures, MOUs, or agreements

5 years

3. Protocols for the health department’s handling and submitting of specimens

3. The department must provide protocols for the health department’s handling and submitting of specimens.

1 comprehen- sive protocol or a set of protocols

5 years

MEASURE 2.3.2 A, continued

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STANDARD 2.3: Ensure access to laboratory and epidemiological/environmental public health expertise and capacity to investigate and contain/mitigate public health problems and environmental public health hazards.

MEASURE PURPOSE SIGNIFICANCE Measure 2.3.3 A Access to laboratory and other support personnel and infrastructure capable of providing surge capacity

The purpose of this measure is to assess the department’s support personnel and infrastructure capacity for providing surge capacity for rapid detection, investigation, and containment/mitigation of public health problems and environmental public health hazards.

Access to additional support personnel is important in the case of an emergency, such as a bio-terrorism event or disease outbreak, when response needs of the health department exceed normal capacity of health department staff.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. Surge capacity protocol that pre-identifies support personnel to provide surge capacity

1. The health department must provide the protocol, procedure, or policy that identifies support personnel who will be called on to provide surge capacity. This could refer to support staff within the health department who can assist during times of response and who would be performing duties outside their routine assignments; or it could be a listing of support personnel from outside the health department who would be available to assist the department. The protocol must include access to public health laboratory services.

1 protocol 5 years

2. Access to surge capacity staffing list

2. The health department must provide the staffing list(s) for surge capacity that refers to both the staffing needed for a surge response and how department staff will fill those needs.

Included with this documentation must be a description of how staff will access this information. Access could be through various methods, including: web or intranet, central location in the facility, or distributed to those positions that have surge capacity assignments.

The HD must also demonstrate that staff on the list have access to the list.

Positions on the list may include, for example, nursing, health education specialist, communications, IT, logistics, veterinarian and animal caretaker, environmental health specialist, laboratory, and administrative personnel.

This could be a part of an All Hazards/ERP or a separate protocol.

1 list or lists 5 years

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3. Availability of equipment 3. The health department must provide a document detailing the availability of equipment to support a surge in order to demonstrate the availability of additional infrastructure for a response. For example, equipment may be used for transportation, field communications, Personal Protective Equipment (PPE), etc.

1 document 5 years

4. Training/exercise schedule for surge personnel

4. The health department must provide a schedule for training or exercises to prepare personnel who will serve in a surge capacity (for example, ICS or PPE training). This does not have to be the sole focus of the training or exercise, but must be a component of the training.

1 schedule 2 years

5. Contracts/MOAs/MOUs/ mutual assistance agreements for additional staff capacity for surge situations

5. The health department must provide a list and description of contracts, MOAs/MOUs, and/or mutual assistance agreements providing additional staff and services, including laboratory services, for surge capacity. Any of the contracts or agreements for this measure can consist of separate documents or a single agreement covering several aspects of support.

1 list 5 years

MEASURE 2.3.3 A, continued

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STANDARD 2.3: Ensure access to laboratory and epidemiological/environmental public health expertise and capacity to investigate and contain/mitigate public health problems and environmental public health hazards.

MEASURE PURPOSE SIGNIFICANCE Measure 2.3.4 A Collaboration among Tribal, state, and local health departments to build capacity and share resources to address Tribal, state, and local efforts to provide for rapid detection, investigation, and containment/ mitigation of public health problems and environmental public health hazards

The purpose of this measure is to assess coordination and collaboration between Tribal health departments, state health departments, and local health departments in order to share resources for rapid detection, investigation, and containment/ mitigation of public health problems and environmental public health hazards.

Public health problems and environmental public health hazards are not always contained in the jurisdiction of the health department. Tribal, state, and local health departments have the responsibility to work together to provide rapid detection, investigation and containment/mitigation. In most public health situations requiring investigation and mitigation, the state health department and local health department must be partners in the response. Likewise, Tribal health departments network with local and state entities for mitigation, detection, and containment with contracts, memorandums of understanding or agreement, as approved by the Tribal government. Seamless coordination and communication are necessary for the most effective use of resources.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. Shared resources and/or additional capacity

1. The health department must document Tribal, state, and local health departments working together to build capacity and share resources.

Documentation could be policies and procedures, MOUs, or other written agreement that demonstrate plans to communicate and collaborate in addressing public health problems and environmental public health hazards. Other forms of documentation could include meeting minutes that evidence discussion and decisions to work together, as well as After Action Reports that describe coordination.

2 examples 5 years

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2. Joint exercises for rapid detection, investigation, and containment/ mitigation of public health problems and environmental public health hazards

2. The health department must document joint exercises that show the Tribal, state, and local levels work together to test or implement shared resources and build capacity during the exercise.

Documentation could be AARs or other records.

2 examples; one example must include a Tribe, if one exists in the health department’s jurisdiction.

5 years

MEASURE 2.3.4 A, continued

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Reliable and timely communication with partners and the public is important to ensure informed and appropriate responses to public health problems and environmental public health hazards.

STANDARD 2.4: Maintain a plan with policies and procedures for urgent and non-urgent communications.

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STANDARD 2.4: Maintain a plan with policies and procedures for urgent and non-urgent communications.

MEASURE PURPOSE SIGNIFICANCE Measure 2.4.1 A Written protocols for urgent 24/7 communications

The purpose of this measure is to assess the department’s written protocols for communications during detection, investigation, and mitigation of urgent public health problems and environmental public health hazards that may occur at any time.

Urgent public health problems and environmental public health hazards require a community-wide response. Accurate and timely information is necessary to ensure an appropriate and effective community response. Partners and the public need to know how to contact the health department to both report and receive information about a public health emergency or environmental public health risk.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. Protocol for urgent 24/7 communications

1. The health department must provide a communication protocol that provides a means for the department to contact health care providers, response partners, the media, and others, 24/7. The protocol must include the contact information (for example, phone numbers, email addresses, and website addresses for relevant partners). The health department must have duplicative means to get in touch with partners.

1 protocol 14 months

2. Availability of information to partners (and/or the public) on how to contact the health department to report a public health emergency or environmental/ occupational public health risk 24/7

2. The health department must document the provision of information to partners and the public about how to contact the health department to report a public health emergency, risk, problem, or environmental or occupational public health hazard. Partners may include: law enforcement, schools, hospitals, veterinarians, and government agencies.

Documentation could be a screen shot of a web page with contact information.

1 example 5 years

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3. The method for partners and the public to contact the health department 24/7

3. The health department must document how partners and the public contact the health department 24/7. An after-hour answering service or pager service could provide this capacity.

Documentation could be, for example, a script or transcript of an answering service.

1 example 5 years

MEASURE 2.4.1 A, continued

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STANDARD 2.4: Maintain a plan with policies and procedures for urgent and non-urgent communications.

MEASURE PURPOSE SIGNIFICANCE Measure 2.4.2 A A system to receive and provide urgent and non- urgent health alerts and to coordinate an appropriate public health response

The purpose of this measure is to assess the health department’s ability to receive and issue health alerts and to communicate and coordinate the appropriate public health response with health care providers, emergency responders, and communities on a 24/7 basis.

Speedy and accurate communications with health care providers, emergency responders, and other partners concerning health alerts facilitates their understanding of the scope of the emergency, the steps necessary to respond to it, and the protection of the community and responders. Communication allows the development of effective and coordinated responses to urgent public health problems and environmental public health hazards.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. A tracking system for the receipt and issuance of urgent and non-urgent health alerts

1. The health department must document that it has established or participates in a Health Alert Network (HAN) or similar system that receives and issues alerts 24/7. A HAN usually has the capacity to issue response measures or information related to the risk, hazard or problem.

The tracking system or Health Alert Network may be a state system in which Tribal or local health departments participate. The Tribal or local system may establish a smaller system for providers and responders within the jurisdiction of the health department. Some jurisdictions have established a Joint Information Center (JIC) with a public information officer for the health department; health departments may provide evidence of this as documentation.

1 tracking system or health alert network

5 years

2. Reports of testing 24/7 contact and phone line(s)

2. The health department must provide reports of testing the 24/7 contact procedure. This testing must include normal work hours and after hours. Email contact, phone lines, pager, website and other contact points with the department must be tested where applicable.

2 examples 5 years

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STANDARD 2.4: Maintain a plan with policies and procedures for urgent and non-urgent communications.

MEASURE PURPOSE SIGNIFICANCE Measure 2.4.3 A Timely communication provided to the general public during public health emergencies

The purpose of this measure is to assess the health department’s ability to provide information to the public during a public health emergency.

During a public health emergency, the health department functions as the expert. Speedy and accurate communications with the public during public health emergencies facilitates their understanding of the seriousness of the emergency and informs them of the actions they should and should not take in response to the public health emergency. In the absence of accurate information, false information will be created and spread. Public information also lets the public know that the public health department is working to protect the community. A key mechanism to reach the public is the media.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. Communications plan, procedure, or process to provide emergency information to the public

1. The department must demonstrate how it communicates with and provides information to the public.

Documentation must provide evidence of outreach and communication methods designed specifically to communicate with the disabled, linguistically challenged, and other members of the public that require particular communication considerations.

The measure deals with public health emergencies (for example, an outbreak of an infectious disease, a release of toxic chemicals, or the need to boil water during a flood or water main break); documentation must demonstrate processes to ensure timely communication with the public during an emergency.

General public health educational materials are not relevant for this measure.

The process must include a variety of means to communicate information to the public, including, for example, posting on a website, distribution of printed materials (brochures, flyers, factsheets, inserts), fax broadcast to all providers and other responders, automated call systems, digital media (e.g., Twitter) and email list-serves.

2 examples 5 years

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2. Communications through the media to provide information during a public health emergency

2. The department must demonstrate the use of the media to communicate information to the public during a public health emergency.

Documentation must provide evidence of relationships with media, organizations, and outlets for reaching the disabled, the non-English speaking public, and other members of the public that require particular communication considerations.

The measure deals with public health emergencies and the documentation must demonstrate timely communication with the media during an emergency.

General public health educational information is not relevant for this measure.

Documentation could be, for example, a press conference, media packets, press release, public service announcement, or video of a televised interview.

2 examples 5 years

MEASURE 2.4.3 A, continued

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STANDARD 2.4: Maintain a plan with policies and procedures for urgent and non-urgent communications.

MEASURE PURPOSE SIGNIFICANCE Measure 2.4.4 S Consultation and technical assistance provided to Tribal and local health departments on the accuracy and clarity of public health information associated with a public health emergency

The purpose of the measure is to assess the state health department’s support to Tribal and local health departments’ efforts to inform the public concerning an outbreak or an environmental or other public health emergency.

The state health department has a role in serving as a resource to Tribal and local health departments for communication associated with outbreaks and emergencies. An important element in communication is consistent messaging from partners.

The state has a role in crafting messages that are shared to ensure that public health information is accurate and clear. The measure specifies the assistance on information that is associated with an outbreak, an environmental event, or other emergency.

REQUIRED DOCUMENTATION GUIDANCE NUMBER OF EXAMPLES

DATED WITHIN

1. Consultation, technical assistance, or guidance provided to Tribal and local health departments

1. The state health department must document the provision of consultation, technical assistance, or guidance provided to Tribal and local health departments. The state health department does not have to demonstrate that the Tribal and local health departments use the services from the state, but consultation and technical assistance must be available if requested.

Documentation could be, for example, minutes of meetings or conference calls. Meeting or training agenda or presentations can be provided and must include a list of Tribal or local health attendees. Assistance could also be documented by emails or list-serves sent to Tribal and local health departments.

2 examples; one example must include a Tribe, if one exists in the health department’s jurisdiction.

5 years

2. Guidelines for accurate and clear communication to the public

2. The state health department must provide communication guidelines, protocols, or written assistance for Tribal and local departments. Guidelines must include information about developing clear and accurate public health information during an outbreak, crisis, or emergency to prepare Tribes and local health departments for such an occurrence.

1 set of guidelines

5 years

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Domain 3 focuses on informing and educating the public. This domain assesses the health department’s processes for continuing two-way communication with the public as standard operating procedure.

A role of the health department is to provide accurate and reliable information about how to protect and promote individual and family health. Health departments provide information about healthy behaviors, such as good nutrition, hand washing, and seat belt use. The public needs access to accurate and timely information in the case of particular health risks like H1N1, a food borne disease outbreak, or an anthrax attack. For information to be actionable, it must be communicated in a language and format that the population can access and understand. Messages need to be culturally appropriate and trusted. Public health departments also have a responsibility to educate the public about the mission, value, roles, and responsibilities of the health department and the meaning and importance of public health. Building and maintaining a positive, trustworthy reputation in all of its diverse communities is essential.

These educational responsibilities require a continuing flow of information. To be effective, information cannot be one-way. For the health department to communicate with the public accurately, reliably, and in a timely manner, it must gather and use information that it receives from federal, Tribal, state, and local health departments. To facilitate communication, it needs to have a relationship with community partners and the population and sub- groups of the population that it serves. Communication requires dialogue with the target population to assure that the message is relevant, culturally sensitive, and linguistically appropriate. Communication methods are changing rapidly through digital media such as Twitter and Facebook. Selected communication methods must be appropriate for the target audience, the urgency of the communication, and the type of information. In addition, the science of public health branding is developing rapidly. Branding is important for the department’s image, reputation, and perceived value.

DOMAIN 3 INCLUDES TWO STANDARDS:

Standard 3.1: Provide Health Education and Health Promotion Policies, Programs, Processes, and Interventions to Support Prevention and Wellness

Standard 3.2: Provide Information on Public Health Issues and Public Health Functions Through Multiple Methods to a Variety of Audiences

Domain 3: Inform and Educate about Public Health Issues and Functions

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Health promotion involves a wide range of social and environmental changes that allow and encourage the population to be healthy. Health promotion policies, programs, processes, and interventions are the mainstay of public health improvement efforts. Health promotion can involve health education, communication, working with the media and other stakeholders, social marketing, health equity, behavior change, environmental changes, community mobilization, community development, and policy changes.

Health education is an important component of encouraging the adoption of healthy behaviors. Health education provides the information needed to improve and protect their health. Health education involves gathering knowledge about the health issue and the target population and sharing that information in a manner and format that can be used effectively by the population.

STANDARD 3.1: Provide health education and health promotion policies, programs, processes, and interventions to support prevention and wellness.

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STANDARD 3.1: Provide health education and health promotion policies, programs, processes, and interventions to support prevention and wellness.

MEASURE PURPOSE SIGNIFICANCE Measure 3.1.1 A Information provided to the public on protecting their health

The purpose of this measure is to assess the health department’s dissemination of accurate information to the populations that it serves concerning health risks, health behaviors, disease prevention, and wellness approaches.

A key activity in promoting population health is providing public health information that encourages the adoption of healthful behaviors and activities. To be effective, information should be appropriate for the target audience. It must be accurate, timely, and provided in a manner that can be understood and used effectively by the target population.

Public health information can address a broad range of public health promotion messages:

• Health risks, for example, high blood pressure or high cholesterol.

• Health risk behaviors, for example, tobacco use or unprotected sexual activity.

• Disease, illness, or injury prevention, for example, seat belt use or immunizations.

• Wellness, for example, health nutrition or physical activity.

Health information could address a combination of these targets and messages. For example, unprotected sex, needle sharing, and HIV transmission could combine aspects of health risks, health behaviors, and prevention.

For the information to be trusted and understood, health education messaging must not be contradictory or confusing. Ideally, messaging needs to be coordinated with others who are providing public health information to the public.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. The provision of information to the public on health risks, health behaviors, disease prevention, or wellness

1. The health department must document the provision of information to the public to address health risks, health behaviors, disease prevention, and/or wellness. Information must be accurate, accessible, and actionable. The need for cultural competence and consideration of health literacy must be taken into account. Information is expected to be provided in plain language with everyday examples.

2 examples

(See details on following page.)

5 years

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Documentation must note the target group or audience, the program area, the date the information was shared or distributed, and the purpose for the information.

Documentation could be, for example, a public presentation, distribution of a press release, media communications, brochures, flyer, or public service announcement.

The two examples can relate to the same message area, such as two items addressing disease prevention issues. The two examples must, however, be from different program areas, one of which must address a chronic disease program, for example, diabetes, obesity, heart disease, HIV, or cancer.

2. Consultation with the community and target group during the development of the educational material/ messages

2. The health department must document steps taken to solicit input from the target audience during the development of messages and materials. Input is intended to help shape the final content, cultural competence, language, and real life situations of the target audience. The role of social and environmental factors must be addressed (rather than focusing primarily on the individual).

Documentation could be, for example, a report of findings from a focus group, key informant interviews, or pull-aside testing. Documentation could also be minutes from a town meeting with the target population or a meeting of an advisory group representing the target population.

2 examples

One example must come from one of the two program areas from which documen- tation was provided in 1, above

5 years

3. Health education messages that are coordinated with Tribal, state, and/ or local health departments; and/ or community partners

3. The health department must document communication with other health departments (Tribal, state, or local) or community partners to promote unified messaging.

Documentation could be, for example, a fact sheet, an email or memorandum, meeting minutes where messaging was discussed, or documented phone conversation discussing the message.

2 examples 5 years

MEASURE 3.1.1 A, continued

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STANDARD 3.1: Provide health education and health promotion policies, programs, processes, and interventions to support prevention and wellness.

MEASURE PURPOSE SIGNIFICANCE Measure 3.1.2 A Health promotion strategies to mitigate preventable health conditions

The purpose of this measure is to assess the health department’s strategies to promote health and address preventable health conditions.

Health promotion aims to enable individuals and communities to protect and improve their own health. Health promotion encourages positive health behaviors. Health promotion is a combination of health education, community change, environmental change (including the built environment) and organizational and social supports that provide conditions conducive to the good health of individuals, groups, and communities. Health promotion combines educational, political, regulatory, social, and organizational efforts.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. A planned approach for developing and implementing health promotion programs

1. The health department must document a planned approach for developing and implementing health promotion materials and activities.

A planned approach could be documented through, for example, policies and procedures, a health promotion communications plan, the use of a communications model or methodology (for example, CDCynergy), or other documentation that describes how health promotion programs are developed (including the use of data and community input).

1 example 5 years

2. Development and implementation of health promotion strategies

2. The health department must document the development and implementation of health promotion strategies. The documentation must show how the strategies:

• Are evidence-based, rooted in sound theory, practice-based evidence, and/ or promising practice.

• Were developed with engagement of the community, including input, review, and feedback from the target audience.

2 examples

The examples must come from two different program areas, one of which must address the prevention of a chronic disease.

5 years

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• Focus on social and environmental factors (such as air quality or the built environment) that create poor health, discourage good health, or encourage individual behavioral factors that impact negatively on health.

• Use various marketing or change methods including, for example, digital media and social marketing, as appropriate.

• Were implemented in collaboration with stakeholders, partners, and the community.

Examples of health promotion efforts include biking pathways, farmers markets, public meeting places (to encourage social interaction), distribution of child safety devices, walking clubs, and smoke free zones.

Documentation could be, for example, a portion of a program plan, a portion of a program strategic plan, minutes of a program planning meeting, part of a report developed for submission to a funding agency, evaluation report of the program, or other official description of the strategy.

Due to the limited availability of evidence-based practices or promising practices in Tribal communities, Tribes may provide examples of practice-based evidence used to adapt models or create models based on a cultural framework.

3. Engagement of the community during the development of a health promotion strategy

3. The health department must document that it solicited review, input, and/or feedback from the target audience during the development of the health promotion strategy.

Documentation must include a description of the process and the results.

Documentation could be, for example, findings from a focus group, key informant interviews or pull-aside testing. It could also include minutes from a town meeting or planning meeting with the target population or a meeting of an advisory group representing the target population.

2 examples

One of the examples must be from one of the two program areas from which documentation was provided in Required Documentation 2, above.

5 years

MEASURE 3.1.2 A, continued

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4. Implementation of strategies in collaboration with stakeholders, partners, and/or the community

4. The health department must document that implementation of the strategies was in collaboration with stakeholders, partners, and/or the community. The stakeholders and partners associated with the strategy must be listed or community described. The documentation must define the stakeholders’, partners’, and/or community’s relationship to and role in the strategy.

Documentation could be minutes of a program review meeting, a portion of a report developed for submission to a funding agency, an annual report, or other official description of the implementation of the strategy.

2 examples

One of the examples must be from one of the two program areas from which documentation was provided in 2, above.

5 years

MEASURE 3.1.2 A, continued

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STANDARD 3.1: Provide health education and health promotion policies, programs, processes, and interventions to support prevention and wellness.

MEASURE PURPOSE SIGNIFICANCE Measure 3.1.3 A Efforts to specifically address factors that contribute to specific populations’ higher health risks and poorer health outcomes

The purpose of this measure is to assess the health department’s assessment, identification, and efforts to address factors that contribute to specific populations’ higher health risks and poorer health outcomes, or health inequities.

Differences in populations’ health outcomes are well documented. Factors that contribute to these differences are many and varied and include the lack of opportunities and resources, economic and political policies, discrimination, and other aspects of a community that impact on individuals’ and population’s resilience. These differences in health outcomes cannot be effectively addressed with programs and interventions; they require engagement of the community in strategies that develop community resources, capacity, and strength.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Identification and implementation of strategies to address factors that contribute to specific populations’ higher health risks and poorer health outcomes, or health inequity, including:

a. Analysis of factors that contribute to higher health risks and poorer health outcomes of specific populations and the development of health equity indicators

1. The health department must document efforts to address health equity among the populations in the health department’s jurisdiction. The health department must provide:

a. The analysis of health inequity, factors that cause or contribute to it, and health equity indicators across communities or neighborhoods. Health equity indicators must be specific to the factors analyzed.

Factors could be, for example, tax policies, community zoning, public education, transportation policy, and resource allocation.

2 examples 5 years

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MEASURE 3.1.3 A, continued

b. Public health efforts to address identified community factors that contribute to specific populations’ higher health risks and poorer health outcomes and to impact health equity indicators

c. Internal policies and procedures to ensure programs address specific populations at higher risk for poor health outcomes

Indicators identified could be, for example, living standards, foreclosure rates, housing stock, transportation, safety, air quality, infrastructure (sewage, sidewalks, street design, etc.), employment and income levels, parks, and food access. Documentation of indicators would be the list of indicators identified.

Documentation could be, for example, the results of an analysis in a report, white paper, briefing paper, or a memo.

b. Plans and/or of efforts to address social change, social customs, community policy, level of community resilience, or the community environment to impact on health inequities.

For example, the question “How do we motivate people to stop smoking?” can be rephrased as “What are the community conditions (e.g., stress, convenience stores, social norms) that encourage smoking?” Plans address the issue as defined as a community issue that impacts on higher health risks and poorer health outcomes of specific populations. Plans and/or reports will address efforts to work with those who set policy and make other decisions that impact the community’s health inequities.

Documentation could be, for example, program plans, program goals and objectives, reports, or other written commitment to address the factors in 1a, above. Reports could be, for example, press releases, formal reports to governance and/or the community, or other written document that outlines efforts to be made or achievements.

c. Internal policies and procedures for the inclusion of health equity considerations of specific populations (for example, racial/ethnic minorities, those who live in poverty, and people with disabilities), in program development (e.g., RFPs or program proposals or plans).

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Health departments must have processes and procedures for communicating with external audiences. Processes and procedures should address both accessing information from outside sources and communicating to people outside of the department. Effective public health communication requires a variety of methods and formats. Health departments should communicate with the public about their products and services, regulatory and policy activities, role in the community, and the value the departments deliver to the community. Also included are plans to communicate information to the public in times of calm and crisis, disasters, outbreaks, or other threats to the public’s health.

STANDARD 3.2: Provide information on public health issues and public health functions through multiple methods to a variety of audiences.

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STANDARD 3.2: Provide information on public health issues and public health functions through multiple methods to a variety of audiences.

MEASURE PURPOSE SIGNIFICANCE Measure 3.2.1 A Information on public health mission, roles, processes, programs, and interventions to improve the public’s health provided to the public

The purpose of this measure is to assess the health department’s efforts to inform the public and stakeholders about the role and value of public health and the range of services and programs that the health department provides.

Public health means different things to different people at various times. Conveying the value, mission, roles, processes, programs, and interventions of the health department is a necessary step in building effective public health programs and ensuring sustained funding levels.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. The provision of information provided to the public about what public health is, its value, and/ or on the health department’s roles, processes, programs, and interventions

1. The health department must document the distribution of information to the public about the role and value of public health and/or the health department’s role, mission, and scope of processes, programs and interventions. The documentation must describe how the information was distributed, dates of distribution (or range of dates), and the purpose of the information.

Documentation could be, for example, a copy of a presentation, advertisements or newspaper inserts, web posting, email or fax list-serve, fax cover sheet, brochure, services directory, or program flyers.

The Tribal attorney may need to be included when crafting messages for the public and public health partners, especially for situations involving Tribal sovereignty, land and mineral disputes, or interactions with other local and federal government entities. Evidence of Tribal attorney use is acceptable documentation for items listed above, as appropriate.

2 examples 5 years

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2. Relationship with the media to ensure their understanding of public health and to ensure that they cover important public health issues

2. The health department must document communication with the media.

The media include print media, radio, television, bloggers, web reporters, and diverse media outlets (for example, urban radio stations; free community newspapers; migrant worker newspapers; immigrant, ethnically targeted, and non-English language newspapers or radio stations, etc.)

Documentation could be, for example, a log of media contacts, a published editorial concerning a public health issue (written by a department staff person or member of the governing entity), an appearance on a television show (of a department staff person or member of the governing entity), or a radio interview (of a department staff person or member of the governing entity), minutes or other documentation of a meeting or phone call with editorial staff, and emails or other communications with bloggers.

2 examples 2 years

MEASURE 3.2.1 A, continued

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STANDARD 3.2: Provide information on public health issues and public health functions through multiple methods to a variety of audiences.

MEASURE PURPOSE SIGNIFICANCE Measure 3.2.2 A Organizational branding strategy

The purpose of this measure is to assess the health department’s strategy to communicate the value of its products, services, and practices to external audiences.

Branding is a standard business practice to raise the visibility, perceived value, and reputation of an organization. Branding communicates what the health department stands for and what it provides that is unique and differentiated from other agencies and organizations. Branding can help to position the health department as a valued, effective, trusted leader in the community.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. A department brand strategy

1. The health department must provide a brand strategy that includes provisions or steps to:

a. ensure that department staff have a clear understanding and commitment to the brand of the health department,

b. communicate the health department’s brand in a targeted manner (customized to different stakeholders) to convey the presence of the health department and the essential products and services that it delivers to its community,

c. integrate brand messaging into organizational communication strategies and external communications (e.g., website, media releases, public service announcements, social media activities, speeches, grant applications, and promotional materials),

d. use a common visual identity (logo) to communicate the health department’s brand,

e. display appropriate signage inside and outside the health department facility, and

f. link the branding strategy to the department’s strategic plan.

Documentation could be, for example, written health department policies, plan, or strategies or could be a separate branding strategic document.

1 policy, plan, or set of policies or strategies

5 years

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2. Implementation of the department’s branding strategy

2. The health department must document its implementation of elements of its branding strategy.

Examples must implement plans, policies, or strategies as presented above.

2 examples 5 years

MEASURE 3.2.2 A, continued

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STANDARD 3.2: Provide information on public health issues and public health functions through multiple methods to a variety of audiences.

MEASURE PURPOSE SIGNIFICANCE Measure 3.2.3 A Communication procedures to provide information outside the health department

The purpose of this measure is to assess the health department’s written procedures for communication to the public, partners, and stakeholders.

Written procedures and protocols that are put into practice ensure consistency in the management of communications on public health issues. Such measures also ensure that the information is in an appropriate format to reach target sectors or audiences. This includes responding to requests for information or materials that the health department distributes in its jurisdiction. Departments should answer information requests in a timely and appropriate fashion and should obtain appropriate reviews and approvals of information they disseminate.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Procedures for communications that include:

a. Dissemination of accurate, timely, and appropriate information for different audiences

b. Coordination with community partners for the communication of targeted and unified public health messages

1. The health department must provide a copy of communication procedures. There is no required format for the procedures. The procedures must:

a. Describe the process for disseminating information accurately, timely, and appropriately. The procedures must define the process for different audiences who may request or receive information from the health department.

b. Describe the process for informing and/or coordinating with community partners to promote the dissemination of consistent and unified public health messages that are accurate and appropriate for the audience.

1 procedure or one set of procedures

2 years

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c. A contact list of media and key stakeholders

d. A designated staff position as the public information officer

e. Responsibilities and expectations for positions interacting with the news media and the public, including, as appropriate, any governing entity members and any department staff member

c. Include a contact list of media and key stakeholders related to the protocol; set forth when the contact list is to be used; and include the process for maintaining the contact list.

d. Identify which department staff position is designated as the public information officer. The protocol must define this position’s responsibilities, which must include: maintaining media relationships; creating appropriate, effective public health messages; and managing other communications activities.

Documentation could be, for example, a job description or other description of responsibilities.

e. Describe the responsibilities for all staff positions that may interact with the news media and the public. This may include guidance for specific staff positions, such as the director, public information officer, and representatives of the governing entity.

1 policy, plan, or set of policies or strategies

5 years

2. Implementation of communications procedures

2. The health department must document the department’s implementation of the communications procedures listed in 1, above. The health department must provide public health messages disseminated outside the health department.

Documentation could be a press release, email between the public information officer and the media, or other written communication to the media.

2 examples

Examples must come from two different program areas, one of which is a chronic disease program.

2 years

MEASURE 3.2.3 A, continued

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STANDARD 3.2: Provide information on public health issues and public health functions through multiple methods to a variety of audiences.

MEASURE PURPOSE SIGNIFICANCE Measure 3.2.4 A Risk communication plan

The purpose of this measure is to assess the health department’s plans for risk communication during a crisis, disaster, outbreak, or other threat. The goal is to ensure an accurate understanding of the actual and perceived public health risks, the possible solutions, and related issues and concerns voiced by experts and non- experts.

The purpose of the risk communication plan is to detail the communications and media protocols the health department will follow during a public health crisis or emergency. The risk communication plan outlines the decisions and activities that will be taken for a timely, effective response. The plan will detail public relations processes and give guidance on anticipating a crisis and responding effectively. It should also address how to prevent public alarm by dealing appropriately with misconceptions or misinformation.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Risk communication plan

1. The health department must provide a copy of the risk communication plan, protocol, or procedures.

The plan must provide protocols that address how information is provided for a given situation; address how information is provided 24/7; delineate roles, responsibilities and chain of command; describe how information will be disseminated in the case of communication technology disruption; address how message clearance will be expedited; and describe how the health department will work with the media. The plan must also address preventing public alarm by dealing with misconceptions or misinformation.

There is no required format for the plan; that is, it may be a part of a larger communications plan or part of an overall department emergency operations plan.

A risk communication plan may be identified, for example, as an emergency communication plan, crisis communication policies, risk communication plan, or media communication plan..

1 plan 5 years

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MEASURE 3.2.4 A, continued For Tribal health departments, documentation may include referencing an existing, approved Tribal policy that identifies another Tribal employee or program (such as the Tribal emergency management planner) as being responsible for the risk communication plan and its implementation. For smaller Tribal health departments and programs, this measure could also be met with a written MOU or MOA with an external agency, such as a local health department, with clearly delineated roles for Tribal and non-Tribal staff and elected officials involved in the plan.

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STANDARD 3.2: Provide information on public health issues and public health functions through multiple methods to a variety of audiences.

MEASURE PURPOSE SIGNIFICANCE Measure 3.2.5 A Information available to the public through a variety of methods

The purpose of this measure is to assess the health department’s use of a variety of methods and formats to keep the public informed about public health and environmental public health issues, health status, public health laws, health programs, and other public health information.

Health departments need the ability to present information to different audiences through a variety of methods, including information technology.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. A website or web page that contains information on:

a. 24/7 contact number for reporting health emergencies

b. Notifiable/reportable conditions link or contact number

c. Health data

d. Links to public health-related laws

e. Information and materials from program activities

1. The health department must document that its website provides:

a. A 24/7 contact number for reporting health emergencies;

b. Notifiable/reportable conditions line or contact number;

c. Health data, for example, morbidity and mortality data;

d. Links to public health related laws or public health code;

e. Information and materials from program activities, for example, infectious disease, chronic diseases, environmental public health, prevention, and health promotion;

1 website 2 years

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f. Links to CDC and other public health-related federal, state, or local agencies, as appropriate

g. The names of the health department’s leadership

f. Links to CDC and other public health-related federal, state, or local agencies, as appropriate; and

g. The names of the health department director and the leadership team.

The health department may have its own website or be part of another governmental website or internet domain.

Documentation could be screen shots of the pages that contain the information required in each of the elements listed.

2. Other communication strategies for informing the public about public health issues or functions

1. The health department must document the use of other methods used to make information available to the general public about public health issues and/or functions.

Methods could include, for example, radio or television programs or interviews, brochures, flyers, newsletters, or digital media, Facebook or Twitter.

2 examples 5 years

MEASURE 3.2.5 A, continued

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STANDARD 3.2: Provide information on public health issues and public health functions through multiple methods to a variety of audiences.

MEASURE PURPOSE SIGNIFICANCE Measure 3.2.6 A Accessible, accurate, actionable, and current information provided in culturally sensitive and linguistically appropriate formats for target populations served by the health department

The purpose of this measure is to assess the health department’s ability to convey public health information to the population it serves, including those who are hard to reach or who present language or cultural challenges.

Public health information must be understandable and usable by the target audience. Information should be accessible to all audiences in the jurisdiction served, whether they are non-English speaking, are hearing impaired, or have low literacy.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Demographic data regarding ethnicity and languages spoken in the community

1. The health department must provide demographic data defining the ethnic distribution and languages spoken in the jurisdiction served.

1 data report or multiple data sets

2 years

2. Interpretation, translation, or other specific communication services

2. The health department must provide a list of staff or contractors who provide interpretation, translation, or specific communication services. Specific communication services may mean non-English speaking or low literacy or hearing impaired communications. These services are provided as needed, based on demographic data. The services do not have to be provided directly by the health department, but must be available when needed.

Tribal health departments may have “Indian preference” policies that demonstrate the promotion of culturally appropriate interactions between staff and community members. CHRs or “Cultural Interpreters” may also be available to provide both translation and feedback from community members on program materials or services provided.

1 list 5 years

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3. Assistive staff or technology devices

3. The health department must document assistance for the hearing and the visually impaired, or other assistive staff or technology devices.

1 example of assistive staff or devices

5 years

4. Public health materials that are culturally appropriate, in other languages, at low reading level, and/ or address a specific population that may have difficulty with the receipt or understanding of public health communications

4. The health department must provide materials that are appropriate for a population who may have difficulty with the receipt or understanding of public health communications.

Methods that target low-literacy individuals could include, for example, audio- visual formats and/or written materials that include images to support text.

Documentation could be, for example, materials that are culturally or linguistically appropriate, or communicated for the hearing impaired.

National Standards for Culturally and Linguistically Appropriate Services in Health and Healthcare is a resource for these efforts (http://thinkculturalhealth.hhs.gov/content/CLAS.asp)

2 examples are required; two examples must be from different program areas.

2 years

MEASURE 3.2.6 A, continued

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Domain 4 focuses on community engagement. Members of the community possess unique perspectives on how issues are manifested in the community, what and how community assets can be mobilized, and what interventions will be effective. Community members are important partners in identifying and defining public health issues, developing solutions or improvements, advocating for policy changes, communicating important information, and implementing public health initiatives. Public health can broaden its leverage and impact by doing things with the community rather than doing things to the community. Aligning and coordinating efforts towards health promotion, disease prevention, and health equity across a wide range of partners is essential to the success of health improvement. This domain addresses health departments’ establishment and maintenance of community partnerships and collaborations that will facilitate public health goals being accomplished, promote community resilience, and advance the improvement of the public’s health.

DOMAIN 4 INCLUDES TWO STANDARDS:

Standard 4.1: Engage with the Public Health System and the Community in Identifying and Addressing Health Problems through Collaborative Processes

Standard 4.2: Promote the Community’s Understanding of and Support for Policies and Strategies that will Improve the Public’s Health

Domain 4: Engage with the Community to Identify and Address Health Problems

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Health improvement efforts will be most effective when the health department works with the community that it serves. Ongoing dialogue about community issues, discussions about options and alternatives, and community ownership increase the effectiveness of health improvement efforts. Collaboration with other members of the public health system and with members of the community develops shared responsibility and leads to better coordination of the use of resources. Collaboration provides the health department with various perspectives and additional expertise. Collaboration allows the community’s assets to be mobilized, coordinated, and used in creative ways for increased community efficacy in addressing public health issues and concerns.

STANDARD 4.1: Engage with the public health system and the community in identifying and addressing health problems through collaborative processes.

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STANDARD 4.1: Engage with the public health system and the community in identifying and addressing health problems through collaborative processes.

MEASURE PURPOSE SIGNIFICANCE Measure 4.1.1 A Establishment and/ or engagement and active participation in a comprehensive community health partnership and/ or coalition; or active participation in several partnerships or coalitions to address specific public health issues or populations

The purpose of this measure is to assess the health department’s engagement with partners in the public health system, representatives of various sectors of the community, and community members to address public health issues and concerns.

Community engagement is an ongoing process of dialogue and discussion, collective decisions, and shared ownership. Public health improvement requires social change; social change takes place when the population affected by the problem is involved in the solution. Collaborative partnerships to address public health issues and concerns provide various perspectives, additional expertise, and assets and resources. Partnerships provide the opportunity to leverage resources, coordinate activities, and employ community assets in new and effective ways. Collaborative partnerships include engagement with community members so that they are involved in the process and participate in the decisions made and actions taken. Community engagement also has benefits of strengthening social engagement, building social capital, establishing trust, ensuring accountability, and building community resilience.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Collaborative partnerships with others to address public health issues

1. The health department must document a current, ongoing comprehensive community partnership or coalition in which it is an active member. The purpose of the partnership or coalition must be to improve the health of the community and, therefore, must be engaged in various issues and initiatives.

A comprehensive community partnership, in this context, is a partnership that is not topic or issue specific. It is a community partnership that addresses a wide range of community health issues.

The comprehensive partnership or coalition may be organized into several committees or task forces to address specific issues, for example, teenage pregnancy, social determinants of health, health equity, or increased opportunities for physical activities. This partnership or coalition may be the same group that developed the community health assessment and community health improvement plan.

1 broad community partnership or coalition addressing at least 4 health issues; or 4 examples of issue specific partnership or coalitions; or a mix of a partnership addressing 1 to 4 issues and single issue partnerships addressing the remaining number, for a total of four issues.

2 years

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This partnership or coalition may work on various issues addressed in the Standards and Measure, such as access to care (Domain 7).

Alternatively, the health departments must document their involvement in several current ongoing partnerships or coalitions that address specific public health issues. In this case, each collaboration must address a particular public health issue or population. Examples of collaborative partnerships include: an anti-tobacco coalition, a maternal and child health coalition, an HIV/AIDS coalition, a childhood injury prevention partnership, child labor coalition, immigrant worker/community coalition, newborn screening advisory group, integrated chronic disease prevention coalition, and a partnership to decrease childhood obesity. Partnerships addressing issues that impact on health, for example, housing, transportation, or parks and recreation are acceptable.

Tribal public health departments may partner with other Tribal or local partners, for example, Head Start, emergency management, and social services to address specific Tribal health issues.

These partnerships and coalitions, whether a broad multi-issue partnership or a group of single issue partnerships or coalitions, may address an already established program area; newly identified issues; issues identified by the health assessment; strategies or actions included in a health improvement plan; a potential public health threat or hazard; populations with particular health needs; and/or goals of the community, health department, community, region, or state. They may address broad public health issues, for example, health equity or access to community resources. The partnerships or coalitions may also address issues that impact health, for example, smart growth and the built environment, education and training, employment rates, or transportation.

These partnerships or coalitions may be convened by the health department, by another organization, or by community members. The health department must actively participate. Examples must be from current, active partnerships and not partnerships that have completed their tasks and disbanded. Partnerships must include representation of the community impacted.

Documentation could be a summary or report of the partnership(s) or coalition(s), indicating on-going activities; meeting minutes and agendas: progress reports; evaluations, etc.

MEASURE 4.1.1 A, continued

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2. Partner organizations or representation

2. The health department must provide a list of the participating partner organizations for the partnerships(s) or coalitions referenced above. Organizational and representational membership must be listed; individuals’ names are not required. For example, names of: the hospitals; school systems; and specific businesses, social service organizations, not-for-profit organizations, faith institutions, private citizen groups, or particular population groups. The membership must be broad and include various sectors of the community. Community members must be included.

1 membership list of the broad community partnership or coalition; or lists of members of the 4 examples provided above in 4.1.1 RD 1

2 years

3. Community, policy, or program change implemented through the partnership(s) or coalition(s)

3. The health department must document a change in the community, a change in policy, or a new or revised program that was implemented through the work of the partnership(s) or coalition(s) identified in Required Documentation 1, above.

Examples could be an increase in the number and types of locations where tobacco use is not permitted, an increase in the number of miles of bike paths, a local zoning change, the removal of soda vending machines from public schools, an increase in the frequency of restaurant inspections, an increase in the number of community police stations, policies that address social determinants of health, etc.

2 examples 5 years

MEASURE 4.1.1 A, continued

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STANDARD 4.1: Engage with the public health system and the community in identifying and addressing health problems through collaborative processes.

MEASURE PURPOSE SIGNIFICANCE Measure 4.1.2 S Technical assistance provided to Tribal and local health departments and/or public health system partners regarding methods for engaging with the community

The purpose of this measure is to assess the state health department’s provision of technical assistance to Tribal and local health departments and/or to public health system partners concerning methods of community engagement.

State health departments are a resource to Tribal and local health departments in the state and to public health system partners for information about engaging with the community.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. The provisions of consultation, technical assistance, and/ or information concerning the use of models of community organizing or methods of community engagement provided to Tribal and local health departments and/or public health system partners

1. The state health department must document the provision of consultation, technical assistance, and/or information to Tribal and local health departments or to public health system partners on use of methods for collaborative community engagement. The state health department can provide this technical assistance directly, or through an established partner or contractor, such as a consultant or academic institution.

Established methods of community engagement include but are not limited to: Healthy Cities/Communities methods; Asset Based Community Development; and deliberative processes, for example, regular town forums, community advisory groups, and participatory decision processes. Tools include the National Public Health Performance Standards Program (NPHPSP), asset mapping, community indicator projects, and Mobilizing for Action Through Planning and Partnership (MAPP). Other community organizing models and methods are acceptable.

Documentation could be, for example, emails, newsletters, meeting minutes, web based assistance, agenda of meetings, documented phone calls, presentations, and training sessions.

2 examples

If the state has a Tribal health department located in its jurisdiction, one of the examples must be related to a Tribal health department.

5 years

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STANDARD 4.1: Engage with the public health system and the community in identifying and addressing health problems through collaborative processes.

MEASURE PURPOSE SIGNIFICANCE Measure 4.1.2 T/L Stakeholders and partners linked to technical assistance regarding methods of engaging with the community

The purpose of this measure is to assess the Tribal or local health department’s provision of sources of information about principles, processes, and methods of community engagement.

Tribal and local health departments are a community resource for partners and stakeholders who are seeking information about engaging with the community. Local health departments should be able to assist and link partners and stakeholders to resources for information on the principles, processes, and methods for engaging with the community.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. The provision of consultation, technical assistance, or information concerning methods of community engagement

1. Tribal health departments and local health departments must document that consultation, technical assistance, or information is provided to community partners or stakeholders concerning methods for collaborative community engagement.

Tribal health departments may provide supporting documentation that they forward technical assistance requests to the state or a federal agency, for example, IHS, BIA, CDC or EPA, or that they work in partnership with state or local health departments, or other organizations/entities, such as an academic institution or consultant.

Established methods of community engagement include but are not limited to: Healthy Cities/Communities methods; Asset Based Community Development; Mobilizing Action Toward Community Health (MATCH), and deliberative processes for example, regular town forums, community advisory groups, and participatory decision processes. Tools include asset mapping, community indicator projects, and Mobilizing for Action Through Planning and Partnership (MAPP).

Documentation could be, for example, emails, newsletters, meeting minutes, web based assistance, agenda of meetings, documented phone calls, presentations, or training sessions that provide information about community engagement principles, processes, and/or models.

2 examples 5 years

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Community understanding and support is critical to the implementation of public health policies and strategies. Community input and support is an important public health tool in developing and implementing policies and strategies. It is important to gain community input to ensure that a policy or strategy is appropriate, feasible, and effective.

STANDARD 4.2: Promote the community’s understanding of and support for policies and strategies that will improve the public’s health.

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STANDARD 4.2: Promote the community’s understanding of and support for policies and strategies that will improve the public’s health.

MEASURE PURPOSE SIGNIFICANCE Measure 4.2.1 A Engagement with the community about policies and/or strategies that will promote the public’s health

The purpose of this measure is to assess the health department’s engagement with the community on public health policies and strategies to promote the health of the population.

A health policy or strategy will more likely be strongly supported by the community if the community has engaged in a dialogue, discussed the options and alternatives, and taken ownership of the issue and the policy or strategy. Community engagement will encourage a sense of shared responsibility for the support and implementation of the policy or strategy.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Engagement of members of the specific community or group that will be affected by a policy and/or strategy to promote the public’s health

1. The health department must document engagement with the specific population in the community that will be affected by a policy or strategy. The efforts can target the community as a whole (if the policy or strategy is community-wide) or it can target a specific group that will be most affected by a policy or strategy. Listening sessions, open forums, and other methods of dialogue can be used to develop engagement and community ownership.

Documentation could be, for example, an announcement or minutes of a town meeting or public hearing, or a call for review and input posted through groups’ customary communication channels such as newspapers and newsletters. Other examples include meetings with a particular geographic community served by the health department or a particular group of people, for example, adolescents, single mothers, or seniors.

2 examples from different policy areas

2 years

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STANDARD 4.2: Promote the community’s understanding of and support for policies and strategies that will improve the public’s health.

MEASURE PURPOSE SIGNIFICANCE Measure 4.2.2 A Engagement with governing entities, advisory boards, and elected officials about policies and/or strategies that will promote the public’s health

The purpose of this measure is to assess the health department’s efforts to engage with governing entities, advisory boards, and elected officials whose policy decisions, advice, or strategies affect public health actions.

Health department policies and strategies will more likely be endorsed and supported by governing entities, advisory boards, and elected officials if they have been informed, engaged, and consulted during the decision-making process.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Engagement with the governing entity, advisory boards, and/or elected officials about policies and/ or strategies that will promote the public’s health

1. The health department must document that it communicates and collaborates with the governing entity, an advisory board, and/or elected officials concerning public health policy or strategy.

Documentation could be, for example, a copy of a presentation, meeting packet, meeting agenda, meeting minutes, press story, event summary, briefing paper, or written public comments.

Tribal documentation could be, for example, reports and/or meeting minutes from Health Oversight Committees and Tribal Council meetings, and Tribal and non-Tribal media coverage, including Tribal radio, newspapers, or newsletters.

2 examples; examples must address two separate public health issues

2 years

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124 PUBLIC HEALTH ACCREDITATION BOARD Standards & Measures VERSION 1.5 APPROVED DECEMBER 2013

DOMAIN 5 DOMAIN 6

Domain 5 focuses on the development of public health policies and plans. Written policies and plans serve as tools to guide the health department’s work and bring structure and organization to the department. Written policies and plans provide a resource to health department staff as well as to the public. Policies and plans help to orient and train staff, inform the public and partners, and serve as a key component of developing consistency in operations and noting areas for improvement. The development of policies and plans can be a vehicle for community engagement and shared responsibility for addressing population health improvement.

Policies and plans that are not public health specific may also impact the public’s health, for example, zoning, transportation, and education. Policy makers should be informed of the potential public health impact of policies that they are considering or that are already in place. Policy makers and the public should have access to sound, science-based, current public health information when policies are being considered or adopted.

DOMAIN 5 INCLUDES FOUR STANDARDS:

Standard 5.1: Serve as a Primary and Expert Resource for Establishing and Maintaining Public Health Policies, Practices, and Capacity

Standard 5.2: Conduct a Comprehensive Planning Process Resulting in a Tribal/State/Community Health Improvement Plan

Standard 5.3: Develop and Implement a Health Department Organizational Strategic Plan

Standard 5.4: Maintain an All Hazards Emergency Operations Plan

Domain 5: Develop Public Health Policies and Plans

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Health departments possess knowledge and expertise on current public health science, evidence- based interventions, and promising practices that are required to develop sound public health policies, practices, and capacities. Health departments also have access to community and population data and information that provide knowledge concerning the potential or current impact of policies, practices, and capacities. For these reasons, health departments should play a central and active role in the establishment of policies and practices, whenever governing entities, elected officials, governmental departments, and others set policies and practices that have public health implications.

STANDARD 5.1: Serve as a primary and expert resource for establishing and maintaining public health policies, practices, and capacity.

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Standard 5.1: Serve as a primary and expert resource for establishing and maintaining public health policies, practices, and capacity.

MEASURE PURPOSE SIGNIFICANCE Measure 5.1.1 A The monitoring and tracking of public health issues that are being discussed by individuals and entities that set policies and practices that impact on public health

The purpose of this measure is to assess the health department’s ability to maintain knowledge about what policies are being considered in order to ensure that the health department is in a position to influence the development of those policies and their impact on public health.

An important role for health departments is influencing the adoption of effective public health policies and practices by being a resource for science-based public health information. Health departments need to be constantly aware of what issues are being discussed by those who set policies and practices so that they can exert influence.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Monitoring/tracking of policies under consideration by the governing entity, elected officials, government officials, and/ or other entities that set policies and practices that impact public health

1. The health department must document that the department stays informed of the public issues that are being discussed by the health department’s governing entity, and by elected officials, individuals, and/or other entities that set policies and practices that impact on the health department or public health.

Local elected officials include county (for example, county manager, board of commissioners, or supervisors) or city officials (for example, mayor, city council, board of commissioners, or supervisors). State elected officials include the governor, council of state, or state legislators. Tribal elected or appointed officials vary depending on the Tribal Nation’s governance. Some examples include: Principal Chief, Chief, President, Chairman/woman/person, Governor, Tribal Council Member, or Health Oversight Committees.

Government officials include elected or appointed positions or other staff of government departments (e.g., education, labor, insurance, etc.).

Policies being discussed could be Tribal. State, or local policies.

Documentation could be, for example, meeting minutes and agendas; a log of legislation impacting on health and environmental public health; health department membership on a list-serve that discusses public health issues; or newsletters, reports, or summaries showing health department review and tracking of issues discussed by elected officials or governing entities.

2 examples 2 years

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Standard 5.1: Serve as a primary and expert resource for establishing and maintaining public health policies, practices, and capacity.

MEASURE PURPOSE SIGNIFICANCE Measure 5.1.2 A Engagement in activities that contribute to the development and/or modification of policy that impacts public health

The purpose of this measure is to assess the Tribal, state, or local health department’s efforts to contribute to and influence the development and/or modification of Tribal, state, or local policies that impact public health.

To ensure that public health policies and practices are effective, health departments must be actively engaged in the development and/or modification of policies. The health department can provide policy makers with sound, science- based, current public health information that should be considered in setting policies and practice.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Contribution to deliberations concerning public policy

1. The health department must document that it has contributed to deliberations concerning public policy and practice and its impact on public health. The health department must engage with those who set policies, as well as with other stakeholders who can influence those who set policies. The health department can also contribute to and encourage stakeholder or community involvement in development and/or modification of public health related policy.

The two examples must address two different items of the items listed below:

• Informational materials, for example, issue briefs, media statements, talking points, fact sheets, white papers, and other official written documents.

• Health department staff providing official department public testimony.

• Health department staff participation in an advisory or work group appointed by the governing entity, elected officials, or the health department director. The group must have a stated purpose or intent of providing advice or influencing health policy. This does not have to be the only role of the group, but may be one among many responsibilities assigned.

2 examples

Each example must address one item listed in the guidance. The two examples must address different items.

2 years

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Standard 5.1: Serve as a primary and expert resource for establishing and maintaining public health policies, practices, and capacity.

MEASURE PURPOSE SIGNIFICANCE Measure 5.1.3 A Informed governing entities, elected officials, and/or the public of potential intended or unintended public health impacts from current and/ or proposed policies

The purpose of this measure is to assess the health department’s provision of information about the intended or unintended public health impacts of proposed or current public policies.

The health department is responsible for informing others of the potential public health impact of policies that they are considering or that are in place. Policies that are not health specific may impact the public’s health. Health departments should provide policy makers and the public with sound, science-based, current public health information that should be considered in setting or supporting policies.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Information provided to policy makers and/or the public about potential public health impacts of policies that are being considered or are in place

1. The health department must document that it has informed policy makers and/or the public about potential public health impacts of policies that are being considered or are in place. Included may be policies that impact public health but are developed by other sectors, for example, land use, housing, employment, transportation, and education. The health department may address both intended and unintended impact. Documentation can address policies either in effect or proposed.

Each example must address one of the items listed below must be addressed:

• Impact statement or fact sheet that addresses current or proposed policies. The impact statements must be science-based. The health department must show to whom the statement or fact sheet was distributed.

• The distribution of correspondence, emails, briefing statements, or reports on policy impacts. If there is a discussion of policy issues and impacts, the documentation must include who in the health department participated, who was invited to participate, participant listing, what was discussed, meeting materials or agenda, and any follow- up to be completed.

• A presentation of evaluations or assessments of current and/or proposed policies. The presentation or the evaluation/assessment report and an agenda for the presentation.

2 examples

Examples must address different items listed in the Guidance.

2 years

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DOMAIN 5 DOMAIN 6

The Tribal, state, or community health improvement plan is a long-term, systematic plan to address issues identified in the Tribal, state, or community health assessment. The purpose of the community health improvement plan is to describe how the health department and the community it serves will work together to improve the health of the population of the jurisdiction that the health department serves. The community, stakeholders, and partners can use a solid community health improvement plan to set priorities, direct the use of resources, and develop and implement projects, programs, and policies.

The plan is more comprehensive than the roles and responsibilities of the health department alone, and the plan’s development must include participation of a broad set of community stakeholders and partners. The planning and implementation process is community-driven. The plan reflects the results of a collaborative planning process that includes significant involvement by a variety of community sectors.

The state health department’s state health improvement plan addresses the needs of all citizens in the state. The local health department’s community health improvement plan addresses the needs of the citizens within the jurisdiction it serves. The Tribal health department’s Tribal health improvement plan addresses the needs of the Tribal population residing within the Tribe’s jurisdictional area.

STANDARD 5.2: Conduct a comprehensive planning process resulting in a Tribal/state/community health improvement plan.

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

MEASURE PURPOSE SIGNIFICANCE Measure 5.2.1 S A process to develop a state health improvement plan

The purpose of this measure is to assess the state health department’s collaborative community health improvement planning process and the participation of stakeholders.

While the state health department is responsible for protecting and promoting the health of the population, it cannot be effective acting unilaterally. The health department must partner with other agencies and organizations to plan and share responsibility for health improvement. Other sectors of the state and stakeholders have access to additional data and bring different perspectives that will enhance planning. A collaborative planning process fosters shared ownership and responsibility for the plan’s implementation. The state health improvement process is a vehicle for developing partnerships and for understanding roles and responsibilities.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. State health improvement planning process that included:

1. The state health department must document the collaborative state health improvement planning process. The process may be a national model; state-based model; a model from the public, private, or business sector; or other participatory process model. When a specific model is not used, the key steps undertaken that outline the process used should be described.

National models include, for example, State Health Improvement Plan (SHIP) Guidance and Resources (http://www.astho.org/accreditation/SHIP/), Mobilizing for Action through Planning and Partnerships (MAPP) (developed for local health departments but can be used in state health departments), Association for Community Health Improvement (ACHI) Assessment Toolkit, Assessing and Addressing Community Health Needs (Catholic Hospital Association of the US) (http://www.chausa.org/docs/default-source/general- files/cb_assessingaddressing-pdf.pdf?sfvrsn=4), and the University of Kansas Community Toolbox (http://ctb.ku.edu/en/node/9).

Examples of tools or resources that can be adapted or used include Community Indicators process project, Asset Based Community Development model, National Public Health Performance Standards Program (NPHPSP), Assessment Protocol for Excellence in Public Health (APEX/PH), Guide to Community Preventive Services, and Healthy People 2020.

1 process 5 years

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DOMAIN 5 DOMAIN 6

a. Broad participation of community partners

b. Information from community health assessments

c. Issues and themes identified by stakeholders in the community

d. Identification of assets and resource

e. A process to set health priorities

The state health department must document that the state health improvement planning process included all of the following:

a. Participation by a wide range of community partners representing various sectors of the community. Partners are organizations that work with the state health department on health issues and could include other governmental agencies, statewide not-for-profit groups, statewide associations, veterinarian organizations, and others, including organizations that are not health-specific, for example, education advocates, businesses, recreation organizations, faith-based organizations, etc. Members of this group may or may not be the same as members of the community health assessment partnership.

Documentation could be, for example, participant lists, attendance rosters, minutes, or membership lists of work groups or subcommittees.

b. Data and information from the community health assessment provided to participants in the state health improvement planning process to use in their deliberations. This may include a list of data sets or evidence that participants used for the community health assessment.

c. Evidence that stakeholder discussions were held and that they identified issues and themes. The list of issues must be provided as documentation.

d. Assets and resources identified and considered in the state health improvement planning process. Community assets and resources could be anything that the state could utilize to improve the health of the community. Community assets and resources could include, for example, skills of residents, the power of state associations (e.g., service associations, professional associations) and institutions (e.g., faith based organizations, foundations, institutions of higher learning), as well as other state factors for example, state recreational facilities, social capital, community resilience, a strong business community, etc. Assets and resources can be documented in a list, chart, narrative description, etc.

e. A description of the process used by participants to develop a set of priority state health issues

MEASURE 5.2.1 S, continued

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

MEASURE PURPOSE SIGNIFICANCE Measure 5.2.1 L A process to develop a community health improvement plan

The purpose of this measure is to assess the local health department’s collaborative community health improvement process and the participation of stakeholders.

While the local health department is responsible for protecting and promoting the health of the population, it cannot be effective acting unilaterally. The health department must partner with other sectors and organizations to plan and share responsibility for community health improvement. Other sectors of the community and stakeholders have access to additional data and bring different perspectives that will enhance planning. A collaborative planning process fosters shared ownership and responsibility for the plan’s implementation. The community health improvement process is a vehicle for developing partnerships and for understanding roles and responsibilities.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Community health improvement planning process that included:

1. The local health department must document the collaborative community health improvement planning process. The process used may be an accepted national model; state-based model; a model from the public, private, or business sector; or other participatory process model. When a specific model is not used, the key steps undertaken that outline the process used should be described.

National models include, for example, Mobilizing for Action through Planning and Partnerships (MAPP), Association for Community Health Improvement (ACHI) Assessment Toolkit, Assessing and Addressing Community Health Needs (Catholic Hospital Association of the US) (http://www.chausa.org/docs/ default-source/general-files/cb_assessingaddressing-pdf.pdf?sfvrsn=4), and the University of Kansas Community Toolbox (http://ctb.ku.edu/en/node/9).

Examples of tools or resources that can be adapted or used include NACCHO’s Resource Center for Community Health Assessments and Community Health Improvement Plans, Community Indicators process project, Asset Based Community Development model, National Public Health Performance Standards Program (NPHPSP), Assessment Protocol for Excellence in Public Health (APEX/PH), Guide to Community Preventive Services, and Healthy People 2020.

1 process 5 years

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a. Broad participation of community partners

b. Information from community health assessments

c. Issues and themes identified by stakeholders in the community

d. Identification of community assets and resources

e. A process to set health priorities

The local health department must document that the community health improvement planning process included all of the following:

a. Participation by a wide range of community partners representing various sectors of the community. Community partners could include, as appropriate for the specific community: hospitals and healthcare providers, the faith community, veterinarians, military installations, academic institutions, local schools, other departments of government (e.g., parks and recreation, planning and zoning, housing and community development, etc.), economic development, community not-for-profits, civic groups, elected officials, the chamber of commerce and local businesses, police, housing, foundations and philanthropists, planning organizations, and the state health department. Members of this group may or may not be the same as members of the community health assessment partnership.

Documentation could be, for example, participant lists, attendance rosters, minutes, or membership lists for work groups or subcommittees.

b. Data and information from the community health assessment provided to participants in the community health improvement planning process for use in their deliberations. This may include a list of data sets or evidence that participants used the community health assessment.

c. Evidence that community and stakeholder discussions were held and that they identified issues and themes. Community members’ definition of health and of a healthy community must be included. The list of issues identified by the community and stakeholders must be provided as documentation.

d. Community assets and resources identified and considered in the community health improvement process. Community assets and resources could be anything in the community that could be utilized to improve the health of the community. Community assets and resources could include, for example, skills of residents, the power of local associations (e.g., service associations, professional associations) and local institutions (e.g., faith based organizations, local foundations, institutions of higher learning), as well as other community factors for example, parks, social capital, community resilience, a strong business community, etc.

Community assets and resources can be documented in a list, chart, narrative description, etc.

e. A description of the process used by participants to develop a set of priority state health issues.

MEASURE 5.2.1 L, continued

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

MEASURE PURPOSE SIGNIFICANCE Measure 5.2.1 T A process to develop a Tribal community health improvement plan

The purpose of this measure is to assess the Tribal health department’s collaborative community health improvement planning process and the participation of stakeholders.

While the Tribal health department is responsible for protecting and promoting the health of the population, it cannot be effective acting unilaterally. The health department must partner with other sectors and organizations to plan and share the responsibility for health improvement. Other sectors of the community and stakeholders have access to additional data and bring different perspectives that will enhance planning. A collaborative planning process fosters shared ownership and responsibility for the plan’s implementation. The community health improvement process is a vehicle for developing partnerships and for understanding roles and responsibilities.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Tribal community health improvement planning process that included:

1. The Tribal health department must document the collaborative community health improvement process. The process used may be an accepted national model; state-based model; a model from the public, private, or business sector; or other participatory process model. When a specific model is not used, the key steps undertaken that outline the process used should be described.

National models include, for example, Mobilizing for Action through Planning and Partnerships (MAPP) (developed for local health departments but can be used in Tribal health departments), Association for Community Health Improvement (ACHI) Assessment Toolkit, Assessing and Addressing Community Health Needs (Catholic Hospital Association of the US) (http://www.chausa.org/docs/default-source/general- files/cb_assessingaddressing-pdf.pdf?sfvrsn=4), and the University of Kansas Community Toolbox (http://ctb.ku.edu/en/node/9).

Examples of tools or resources that can be adapted or used as part of the community health improvement planning process include NACCHO’s Resource Center for Community Health Assessments and Community Health Improvement Plans, Community Indicators process project, Asset Based Community Development model, Tribal Accreditation Readiness Guidebook and Roadmap, Inter Tribal Council of Arizona’s Tribal CHA Toolkit, National Public Health Performance Standards Program (NPHPSP), Assessment Protocol for Excellence in Public Health (APEX/ PH), Guide to Community Preventive Services, and Healthy People 2020.

1 process 5 years

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a. Broad participation of public health system partners

b. Information from Tribal health assessments

c. Issues and themes identified by the stakeholders

d. Identification of Tribal assets and resources

e. A process to set Tribal health priorities

The Tribal health department must document that the Tribal health improvement planning process included all of the following:

a. Participation by a wide range of community partners. Community partners could include, for example, organizations that work with the Tribal health department to address health issues and may include other governmental agencies, not-for- profit groups, associations, and others, including organizations that are not health- specific, for example, education advocates, businesses, recreation organizations, faith-based organizations, veterinarians, military installations, etc. Members of this group may or may not be the same as members of the community health assessment partnership.

Documentation could be, for example, participant lists, attendance rosters, minutes, or membership lists of work groups or subcommittees.

b. Data and information from the Tribal community health assessment that were provided to participants in the Tribal health improvement planning process to use in their deliberations. National data sources on American Indian/Alaska Native populations include Indian Health Service data and other sources.

Documentation may include a list of data sets or evidence that participants used the community health assessment.

c. Evidence that stakeholder discussions were held and that they identified issues and themes. Community members’ definition of health and healthy community must be included. The list of issues must be provided as documentation.

d. Assets and resources identified and considered in Tribal community health improvement planning process. Tribal community assets and resources could be anything in the community that could be utilized to improve the health of the community. Community assets and resources could include skills of residents, the power of community groups (e.g., council of elders, youth councils, health promotion coalitions of Tribal program) and local community partners (e.g., faith based organizations, schools, institutions of higher learning), as well as recreation centers, cultural celebrations and activities, other community factors for example, parks, social capital, community resilience, etc.

Community assets and resources can be documented in a list, chart, narrative description, etc.

e. A description of the process used by participants to develop a set of priority Tribal health issues.

MEASURE 5.2.1 T, continued

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

MEASURE PURPOSE SIGNIFICANCE Measure 5.2.2 S State health improvement plan adopted as a result of the health improvement planning process

The purpose of this measure is to assess the state health department’s state health improvement plan. While some or many programs in the state health department may have program specific plans, they do not fulfill the purpose of the state health improvement plan, which looks at population health across programs and across the state.

The state health improvement plan provides guidance to the health department, its partners, and stakeholders for improving the health of the population within the health department’s jurisdiction. The plan reflects the results of a collaborative planning process that includes significant involvement by key sectors. Partners can use a state health improvement plan to prioritize existing activities and set new priorities. The plan can serve as the basis for taking collective action and can facilitate collaborations.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. State health improvement plan that includes:

a. Desired measurable outcomes or indicators of health improvement and priorities for action

1. The state health department must provide a state health improvement plan that includes all of the following:

a. The desired measurable outcomes or indicators of the health improvement effort and the priorities for action, from the perspective of the population of the state. The plan must include statewide health priorities, measurable objectives, improvement strategies, and activities with time-framed targets that were determined in the planning process. In establishing priorities, the plan must include consideration of addressing social determinants of health, causes of higher health risks and poorer health outcomes of specific populations, and health inequities.

Measurable and time-framed targets may be contained in another document, such as an annual work plan. If this is the case, the companion document must be provided with the state health improvement plan for this measure.

Strategies may be evidence-based, practice-based, or promising practices or may be innovative to meet the needs of the population. National state-of-the-art guidance (for example, the National Prevention Strategy, Guide to Community Preventive Services, and Healthy People 2020) should be referenced, as appropriate.

1 completed plan

5 years

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b. Policy changes needed to accomplish health objectives

c. Individuals and organizations that have accepted responsibility for implementing strategies

d. Consideration of Tribal, local, and national priorities

b. Policy changes needed to accomplish the identified health objectives must be included in the plan. Policy changes must include those that are adopted to alleviate the identified causes of health inequity. Policy changes may address the social and economic conditions that influence health equity including housing, transportation, education, job availability, neighborhood safety, and zoning, for example.

c. Designation of individuals and organizations that have accepted responsibility for implementing strategies outlined in the state health improvement plan. This may include assignments to staff or agreements between planning participants, stakeholders, other state governmental agencies, or other statewide organizations. For this measure, agreements do not need to be formal, such as an MOA/MOU.

d. States must demonstrate that they considered both Tribal and local health department health improvement priorities. Consideration of national priority alignment could include using the National Prevention Strategy and Healthy People 2020.

MEASURE 5.2.2 S, continued

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

MEASURE PURPOSE SIGNIFICANCE Measure 5.2.2 L Community health improvement plan adopted as a result of the community health improvement planning process

The purpose of this measure is to assess the local health department’s community health improvement plan. While some or many programs in the local health department may have program specific plans, they do not fulfill the purpose of the community health improvement plan, which looks at population health across programs and across the community.

The community health improvement plan provides guidance to the health department, its partners, and stakeholders for improving the health of the population within the health department’s jurisdiction. The plan reflects the results of a collaborative planning process that includes significant involvement by key sectors. Partners can use a community health improvement plan to prioritize existing activities and set new priorities. The plan can serve as the basis for taking collective action and can facilitate collaboration.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Community health improvement plan that includes:

a. Desired measurable outcomes or indicators of health improvement and priorities for action

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

a. The desired measurable outcomes or indicators of the health improvement effort and priorities for action, from the perspective of community members. The plan must include community health priorities, measurable objectives, improvement strategies and activities with time-framed targets that were determined in the community planning process. In establishing priorities, the plan must include consideration of addressing social determinants of health, causes of higher health risks and poorer health outcomes of specific populations, and health inequities.

Measurable and time-framed targets may be contained in another document, such as an annual work plan. If this is the case, the companion document must be provided with the health improvement plan for this measure.

Strategies may be evidence-based, practice-based, or promising practices or may be innovative to meet the needs of the community. National state-of-the-art guidance (for example, the National Prevention Strategy, Guide to Community Preventive Services, and Healthy People 2020) should be referenced, as appropriate.

1 plan 5 years

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b. Policy changes needed to accomplish health objectives

c. Individuals and organizations that have accepted responsibility for implementing strategies

d. Consideration of state and national priorities

b. Policy changes needed to accomplish the identified health objectives must be included in the plan. Policy changes must include those that are adopted to alleviate the identified causes of health inequity. Policy changes may address social and economic conditions that influence health equity including housing, transportation, education, job availability, neighborhood safety, access to recreational opportunities, and zoning, for example.

c. Designation of individuals and organizations that have accepted responsibility for implementing strategies outlined in the community health improvement plan. This may include assignments to staff or agreements between planning participants, stakeholders, health care providers (community benefit), other local governmental agencies, or other community organizations. For this measure, agreements do not need to be formal, such as an MOA/MOU.

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

MEASURE 5.2.2 L, continued

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

MEASURE PURPOSE SIGNIFICANCE Measure 5.2.2 T Tribal community health improvement plan adopted as a result of the health improvement planning process

The purpose of this measure is to assess the Tribal health department’s Tribal community health improvement plan. While some or many programs in the Tribal health department may have program specific plans, they do not fulfill the purpose of the Tribal community health improvement plan, which looks at population health across programs and throughout the Tribal jurisdiction or service area.

The Tribal community health improvement plan provides guidance to the health department, its partners, and stakeholders for improving the health of the population within the health department’s jurisdiction. The plan reflects the results of a collaborative planning process that includes significant involvement by key sectors. Partners can use a health improvement plan to prioritize existing activities and set new priorities. The plan can serve as the basis for taking collective action and can facilitate collaboration.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Tribal health community improvement plan that includes:

a. Desired outcomes of health improvement and priorities for action

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

a. The desired measurable outcomes or indicators of the community health improvement effort and priorities for action, from the perspective of the population of the Tribe. The plan must include Tribal health priorities, measurable objectives, improvement strategies, and activities with time-framed targets that were determined in the planning process. In establishing priorities, the plan must include consideration of addressing social determinants of health, causes of higher health risks and poorer health outcomes of specific populations, and health inequities.

Measurable and time-framed targets may be contained in another document, such as an annual work plan. If this is the case, the companion document must be provided with the health improvement plan for this measure.

Strategies may be evidence-based, practice-based, promising practices, or may be innovative to meet the needs of the Tribe’s population. Guidance (for example, National Prevention Strategy, Guide to Community Preventive Services, and Healthy People 2020) should be referenced, as appropriate.

1 plan 5 years

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b. Policy changes needed to accomplish health objectives

c. Individuals and organizations that have accepted responsibility for implementing strategies

d. Consideration of local, state, and national priorities

b. Policy changes needed to accomplish the identified health objectives must be included in the plan. Policy changes must include those that are adopted to alleviate the identified causes of health inequity. Policy changes may address the social and economic conditions that influence health equity including housing, transportation, education, job availability, neighborhood safety, access to recreational activities, and zoning, for example.

c. Designation of individuals and organizations that have accepted responsibility for implementing strategies outlined in the Tribal health improvement plan. This may include assignments to staff or agreements between planning participants, stakeholders, other governmental agencies, or other Tribal organizations. For this measure, agreements do not need to be formal and do not require compacts, contracts or an MOA/MOU.

d. Tribes must demonstrate that they considered state, local and national health improvement priorities. This could include the National Prevention Strategy and Healthy People 2020.

MEASURE 5.2.2 T, continued

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

MEASURE PURPOSE SIGNIFICANCE Measure 5.2.3 A Elements and strategies of the health improvement plan implemented in partnership with others

The purpose of this measure is to assess the Tribal, state, or local health department’s implementation of its community health improvement plan in partnership with others.

Any plan is useful only when it is implemented and provides guidance for activities and resource allocation.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. A process to track actions taken to implement strategies in the community health improvement plan

1. The health department must provide a tracking process of actions taken toward the implementation of the community health improvement plan.

The tracking process must specify the strategies being used, the responsible partners involved, and the status of the effort or results of the actions taken.

Documentation could be, for example, a narrative, table, spread sheet, or a combination. This may look like a work plan that includes the status of the implementation of the work plan.

1 report or a group of reports

5 years

2. Implementation of the plan

2. The health department must document areas of the plan that were implemented by the health department and/or its partners. Examples must identify a specific achievement and describe how it was accomplished.

2 examples 5 years

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

MEASURE PURPOSE SIGNIFICANCE Measure 5.2.4 A Monitor and revise as needed, the strategies in the community health improvement plan in collaboration with broad participation from stakeholders and partners

The purpose of this measure is to assess the health department’s efforts to ensure that the strategies of the community health improvement plan are assessed for feasibility and effectiveness and that they are revised as indicated by those assessments.

Effective, community health improvement plans are dynamic. While goals, objectives, and priorities are meant to be long range, strategies may need to be adjusted. Strategies may need revision based on a completed objective, an emerging health issue, a change in responsibilities, or a change in resources and assets. All identified tasks and timelines, should be monitored and assessed for progress, and adjustments should be made when indicated to ensure that the plan remains relevant. Changes should be developed in collaboration with partners and stakeholders involved in the planning process.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Report on progress made in implementing strategies in the community health improvement plan

1. The health department must provide an annual report on the progress made in implementing strategies in the community health improvement plan.

The report will consider the feasibility and the effectiveness of the strategies and/ or changing priorities, resources, or community assets.

If the plan was adopted within the year, a report of a previous plan may be provided or detailed plans for assessment and reporting may be submitted.

1 example 14 months

2. Review and revision, as necessary, of the health improvement plan strategies based on results of the assessment

2. The health department must document that the health improvement plan has been reviewed and revised as necessary based on the report required in 1 above.

The revisions may be in the improvement strategies, planned activities, time-frames, targets, or assigned responsibilities listed in the plan. Revisions may be based on, for example, achieved activities, implemented strategies, changing health status indicators, newly developing or identified health issues, and changing level of resources.

If the plan was adopted less than a year before it was uploaded to PHAB, the health department may provide (1) revisions of an earlier plan or (2) detailed plans for a revision process.

1 example 14 months

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Strategic planning is a process for defining and determining an organization’s roles, priorities, and direction over three to five years. A strategic plan sets forth what an organization plans to achieve, how it will achieve it, and how it will know if it has achieved it. The strategic plan provides a guide for making decisions on allocating resources and on taking action to pursue strategies and priorities. A health department’s strategic plan focuses on the entire health department. Health department programs may have program-specific strategic plans that complement and support the health department’s organizational strategic plan; this standard addresses the health department’s organizational strategic plan.

STANDARD 5.3: Develop and implement a health department organizational strategic plan.

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Standard 5.3: Develop and implement a health department organizational strategic plan.

MEASURE PURPOSE SIGNIFICANCE Measure 5.3.1 A Department strategic planning process

The purpose of this measure is to assess the health department’s strategic planning process.

A functional and useful organizational strategic plan requires that it be understood by staff and implemented by the health department. The development of such a plan requires a planning process that considers opinions and knowledge from across the health department, assesses the larger environment in which the health department operates, uses its organizational strengths and addresses its weaknesses, links to the health improvement plan that has been adopted by the community, and links to the health department’s quality improvement plan.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Use a planning process to develop the organization’s strategic plan:

a. Membership of the strategic planning group

b. Strategic planning process steps

1. The health department must document the process that it used to develop its organizational strategic plan. The planning process may have been facilitated by staff of the health department or by an outside consultant.

If the health department is part of a super health agency or umbrella agency (see PHAB Acronyms and Glossary of Terms), the health department’s process may have been part of a larger organizational planning process. If that is the case, the health department must have been actively engaged in the process and must provide evidence that public health was an integral component in the process.

a. A list of the individuals who participated in the strategic planning process and their titles must be provided. Participants must include various levels of staff as well as representatives of the health department’s governing entity.

Documentation could be, for example, meeting minutes, a report that presents the members of a strategic planning committee, or other formal listing of participants.

b. Documentation must include a summary or overview of the strategic planning process, including the number of meetings, duration of the planning process, and the methods used for the review of major elements by stakeholders. Steps in the planning process must be described, for example, opportunities and threats analysis or environmental scanning process, stakeholder analysis, story-boarding, strengths and weaknesses analysis, and scenario development.

1 strategic planning process

5 years

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Standard 5.3: Develop and implement a health department organizational strategic plan.

MEASURE PURPOSE SIGNIFICANCE Measure 5.3.2 A Adopted department strategic plan

The purpose of this measure is to assess the health department’s completion and adoption of a department strategic plan.

A strategic plan defines and determines the health department’s roles, priorities, and direction over three to five years. A strategic plan sets forth what the department plans to achieve as an organization, how it will achieve it, and how it will know if it has achieved it. The strategic plan provides a guide for making decisions and allocating resources to pursue its strategies and priorities.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Health department strategic plan that includes:

1. The health department must provide a strategic plan.

If the health department is part of a super health agency or umbrella agency (see PHAB Acronyms and Glossary of Terms), the health department’s strategic plan may be part of a larger organizational plan. If that is the case, the plan must include a section that addresses the health department and includes the required elements of the plan specific to the health department. Submitted documentation should include only the section(s) of the larger plan that addresses the health department and not the entire plan. If the plan of the super health agency or umbrella agency does not include the required elements for the health department, then the health department must document that it has conducted an internal health department planning process and adopted a health department specific strategic plan.

Some health departments may have shorter planning timeframes and, for example, may produce a strategic plan every three years. Some of the goals in the plan may be for a longer time period than five years, but the plan must have been produced or revised within the last five years.

There is no required or suggested format for the strategic plan. There is no required or suggested length of the strategic plan.

The health department may call the plan something other than a “strategic plan,” but it must include the items listed in a through g.

1 strategic plan

5 years

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a. Mission, vision, guiding principles/ values

b. Strategic priorities

c. Goals and objectives with measurable and time-framed targets

d. Consideration of key support functions required for efficiency and effectiveness

e. Identification of external trends, events, or factors that may impact community health or the health department

f. Assessment of health department strengths and weaknesses

g. Link to the health improvement plan and quality improvement plan

The strategic plan must include all of the following:

a. The health department’s mission, vision, and guiding principles/values for the health department.

b. The health department’s strategic priorities.

c. The health department’s goals and objectives with measurable and time-framed targets (expected products or results). Measurable and time-framed targets may be contained in another document, such as an annual work plan. If this is the case, the companion document must be provided with the strategic plan for this measure.

d. The strategic plan must consider capacity for and enhancement of information management, workforce development, communication (including branding), and financial sustainability.

e. The identification of external trends, events, or other factors that may impact community health or the health department.

f. The analysis of the department’s strengths and challenges.

g. Linkages with the health improvement plan and the health department’s quality improvement plan. The strategic plan need not link to all elements of the health improvement plan or quality improvement plan, but it must show where linkages are appropriate for effective planning and implementation.

MEASURE 5.3.2 A, continued

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Standard 5.3: Develop and implement a health department organizational strategic plan.

MEASURE PURPOSE SIGNIFICANCE Measure 5.3.3 A Implemented department strategic plan

The purpose of this measure is to assess the health department’s implementation of its strategic plan.

A plan is useful only when it is implemented and provides guidance for priorities, activities, and resource allocation. A strategic plan sets forth what the department plans to achieve as an organization, how it will achieve it, and how it will know if it has achieved it. It is important to regularly review the implementation of the plan to ensure that the department is on track to meet its targets.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Progress towards achievement of the goals and objectives contained in the plan

1. The health department must provide reports developed since the plan’s adoption showing that it has reviewed the strategic plan and has monitored and assessed progress towards reaching the goals and objectives.

The reports must include how the targets are monitored. Progress is evidenced by completing defined steps to reach a target, by completing objectives, or by addressing priorities and implementing activities. Reports must be completed no less frequently than annually. The plan may be revised based on work completed, adjustments to timelines, or changes in available resources.

If the plan has been adopted within the year, progress reports of a previous plan may be provided or detailed evaluation plans may be submitted.

2 reports 1 report dated within 14 months; second report may be older

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Health departments play important roles in preparing for and responding to disasters, including preventing the spread of disease, protecting against environmental public health hazards, preventing injuries, assisting communities in recovery, and assuring the quality and accessibility of health and health care services following a disaster. Disasters include: natural disasters (such as floods, earthquakes, and tornadoes), manmade or technological disasters (such as bridge or building collapses, nuclear accidents, and chemical releases), and terrorism (such as anthrax or other biological terrorism, chemical terrorism, radiological/nuclear terrorism, or bombings). Plans for responding to emergencies are critical to being prepared for effective public health action during disasters and similar emergency events and for building community resilience over time.

STANDARD 5.4: Maintain an all hazards emergency operations plan.

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Standard 5.4: Maintain an all hazards emergency operations plan.

MEASURE PURPOSE SIGNIFICANCE Measure 5.4.1 A Process for the development and maintenance of an All Hazards Emergency Operations Plan (EOP)

The purpose of this measure is to assess the health department’s collaborative activities to organize coordinated responses to emergencies.

Health departments play a central but not exclusive role in response to emergencies. It is critical to ensure effective coordination of many agencies and organizations involved in responding to emergencies, managing the many response and recovery activities, and building community resilience.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Collaborative planning with other government agencies

1. The health department must document that it participates in preparedness meetings with other government agencies and other levels of health departments (Tribal, state, and local).

Documentation could be, for example, meeting agenda and minutes, meeting rosters, calendar of meetings, email exchanges, and phone calls, as shown on a log or other record.

2 examples 5 years

2. Collaborative testing of the All Hazards EOP:

a. Description of a real emergency or exercise

b. Debriefing or After- Action Report (AAR)

2. The health department must document that it participates in drills, exercises, or actual implementation of the All Hazards Emergency Operations Plan in order to test its implementation.

a. The documentation may be of either an actual or a simulated emergency (drill or exercise). This description must include documentation of how the health department coordinated with emergency response partners during the emergency or drill/exercise. Emergency response partners may be Tribal, state, or local emergency services agencies, including law enforcement, or community partners, such as a hospital. Partners may also come from the Tribal, state or local planning committee.

b. Documentation must include debriefing or evaluation reports from the emergency or drill/exercise.

Examples could be an evaluation report, minutes from a debriefing session, or the AAR produced by the health department or a partner health department.

2 examples 5 years

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3. Collaborative revision of the All Hazards EOP that includes:

a. A collaborative review meeting

b. Updated contact information

c. Coordination with emergency response partners

d. Revised All Hazards/EOP

3. The health department must document collaboration in revising emergency plans including:

a. A collaborative review of the All Hazards Emergency Operations Plan by those responsible for its implementation.

Documentation could be, for example, meeting agendas and minutes or attendance rosters or other written report or record.

b. A contact list of responders.

Documentation could be the most current contact list or previous listings that have been updated.

c. The delineation of roles and responsibilities in the Emergency EOP and the various roles that partners play in responding to a public health emergency or hazard.

d. A copy of the revised emergency operations plan to document the result of the work to maintain the plan and ensure that it is up-to-date and reflects current practice and information. Updates must be indicated in some way (e.g., underlined) and the date of the change must be noted.

1 example 5 years

MEASURE 5.4.1 A, continued

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Standard 5.4: Maintain an all hazards emergency operations plan.

MEASURE PURPOSE SIGNIFICANCE Measure 5.4.2 A Public health emergency operations plan (EOP)

The purpose of this measure is to assess the health department’s development and maintenance of the emergency operations plan.

An emergency operations plan outlines core roles and responsibilities for all-hazard responses, as well as plans for scenario- specific events, such as hurricanes. Health departments must engage in basic activities to prepare for respond to emergencies. In addition to coordination and communication with other agencies and organizations, the health department should have a public health specific emergency operations plan to work with the community in an emergency for the community’s sustained ability to withstand and recover from an emergency event.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. EOP, as defined by Tribal, state, or national guidelines that includes:

1. The health department must provide its public health emergency operations plan. The plan must be written as defined by national, Tribal, or state guidelines. The guidelines may be defined for local health departments by the state health department or may be defined for both state and locals by a Federal or another state agency, such as an office of emergency management. Project Public Health Ready (PPHR) is a national model that could be used. Tribes may use guidelines that are most appropriate for their unique emergency management needs.

The plan may be a standalone document that delineates the health department’s roles and responsibilities, or it may be a section within a larger plan.

The plan must address emergency operations for the entire population (including special needs and vulnerable populations, e.g., those with disabilities and non-English speaking people).

The public health EOP must include all of the following:

1 EOP 5 years

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a. Designation of the health department staff position that is assigned the emergency operations coordinator responsibilities

b. Roles and responsibilities of the health department and its partners

c. Communication networks or communication plan

d. Continuity of operations

a. The health department staff position responsible for coordinating a response within the department in an emergency. This position may have various job titles.

b. The roles and responsibilities of the health department and its partners.

c. A health department communication network that addresses communication with other members of emergency networks or organizations that are also responders; or an emergency communication plan.

The plan may be a separate plan, a defined section within the emergency operations plan, or it may be incorporated within the emergency operations plan.

d. Description of how the health department will manage continuity of operations during an emergency.

2. Testing of the public health EOP, through the use of drills and exercises

a. Process for exercising and evaluating the public health EOP

b. After-Action Report (AAR)

2. The health department must document that the plan has been reviewed or tested through the use of exercises and drills, and revised as needed and must include:

a. A description of the process for testing and evaluating the Emergency Operations Plan.

Documentation could be, for example, a written procedure, a memo stating the process, meeting minutes that document the procedure, or other written report or record.

b. An After-Action Report (AAR) developed after an emergency or exercise/drill.

2 examples 5 years

MEASURE 5.4.2 A, continued

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3. Revision of the public health EOP including:

a. A review meeting

b. Revised public health EOP, as needed

3. The health department must document that the public health emergency operations plan has been revised as indicated by review of the AAR.

a. Documentation of a review meeting.

Documentation could be, for example, meeting minutes, a list of items discussed, a memo documenting review and decisions, or other written report or record.

b. A public health EOP that has been revised as indicated through review, evaluation, and/or drills.

1 example 2 years

MEASURE 5.4.2 A, continued

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Standard 5.4: Maintain an all hazards emergency operations plan.

MEASURE PURPOSE SIGNIFICANCE Measure 5.4.3 S Consultation and/or technical assistance provided to Tribal and local health departments in the state regarding evidence- based and/or promising practices/templates in EOP development and testing

The purpose of this measure is to assess the state health department’s support of Tribal and local health departments in the state in preparing for response to emergency situations and the development of an EOP.

State health departments are ultimately responsible for ensuring adequate response to public health emergencies. Tribal and local health departments are partners in providing a public health response to an emergency. State health departments are in a position to share communications and information received from the federal level and to share information concerning the state’s EOP to ensure optimal coordination.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. The provision of consultation and/or technical assistance

1. The state health department must document the provision of expert consultation, advice, and /or information provided to Tribal or local health departments concerning the development and testing of emergency operations plans.

Documentation could be, for example, blast faxes, webinars, emails, briefing papers, meeting minutes, distributed sample protocols, newsletters, trainings, conference calls, and documented phone calls.

2 examples 5 years

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Domain 6 focuses on the role of public health departments in the enforcement of public health related regulations, executive orders, statutes, and other types of public health laws. Public health laws are key tools for health departments as they work to promote and protect the health of the population. Health department responsibilities related to public health laws do not start or stop with enforcement. Health departments also have a role in promoting new laws or revising existing laws. Public health related laws should be science-based and protect the rights of the individual, as they also protect and promote the health of the population. Health departments have a role in educating regulated entities about the meaning, purpose, compliance requirements, and benefit of public health laws. Health departments also have a role in educating the public about laws and the importance of complying with them.

The term “laws” as used in these standards and measures refers to ALL types of statutes, regulations, rules, executive orders, ordinances, case law, and codes that are applicable to the jurisdiction of the health department. For state health departments, not all ordinances are applicable, and therefore ordinances may not need to be addressed by state health departments. Similarly, some statutes are not applicable to local health departments, and therefore some statutes may not need to be addressed by local health departments. For Tribal health departments, applicable “laws” will depend on several factors, including governance framework and interaction with external governmental entities (federal, state, and local).

Public health laws include such areas as environmental public health (food sanitation, lead inspection, drinking water treatment, clean air, waste- water disposal, and animal and vector control), infectious disease (outbreak investigation, required newborn screenings, immunizations, infectious disease reporting requirements, quarantine, tuberculosis enforcement, and STD contact tracing), chronic disease (sales of tobacco products to youth, smoke-free ordinances, and adoption of bike lanes), and injury prevention (seat belt laws, helmet laws, and speeding limits). Clearly, health departments are not responsible for the enforcement of many or most of these laws. The adoption and implementation of such laws, however, have enormous public health implications. It is important for the health department to be involved in their adoption, monitoring their enforcement, providing follow-up services and/or education, and educating the policy makers and the public about their importance and impact.

Domain 6: Enforce Public Health Laws

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DOMAIN 6 INCLUDES THREE STANDARDS:

Standard 6.1: Review Existing Laws and Work with Governing Entities and Elected/Appointed Officials to Update as Needed

Standard 6.2: Educate Individuals and Organizations on the Meaning, Purpose, and Benefit of Public Health Laws and How to Comply

Standard 6.3: Conduct and Monitor Public Health Enforcement Activities and Coordinate Notification of Violations among Appropriate Agencies

Domain 6: Enforce Public Health Laws

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Public health laws should be current with public health knowledge, practices, and emerging issues in public health. Laws may need to be revised to also be current with societal actions and behaviors that place individuals or groups at health risk. Health departments must have the legal capacity to review laws, as well as the ability to assess them for recommended changes. Health departments should collaborate and work with the appropriate entities to effect changes to a law, when needed.

STANDARD 6.1: Review existing laws and work with governing entities and elected/appointed officials to update as needed.

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Standard 6.1: Review existing laws and work with governing entities and elected/appointed officials to update as needed.

MEASURE PURPOSE SIGNIFICANCE Measure 6.1.1 A Laws reviewed in order to determine the need for revisions

The purpose of this measure is to assess the health department’s analysis of public health laws and other laws that have public health implications to ensure that they are consistent with evidence-based public health and newly emerging public health issues and information. The assessment of laws should consider individual or community cost, inconvenience, impact on systemic health inequities, and regulatory alternatives and sanctions, in addition to the public health program benefits of the law.

Health departments need to be aware of current public health laws and of laws that are not specific to public health but have public health implications, for example, zoning, recreation related, animal related, or transportation laws. These types of laws can have significant impact on health equity. The laws that the health department reviews need not be only laws that the health department enforces. They may also be laws that others enforce but that impact public health, for example, helmet use laws, school nutrition requirements, sale of tobacco products to minors, animal rabies vaccination laws, or school requirements for proof of childhood vaccinations. Program staff of the health department reviews these laws to ensure that they are consistent with evidence- based public health practices and emerging public health issues.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Reviews of public health laws or laws with public health implications that include the following:

1. The health department must document its evaluation of laws for their public health implications.

Reviews may be of a law that the health department enforces or of a law that the health department has no legal authority to enforce, but that has implications for the health of the public in the jurisdiction of the health department. The documentation may address the review of enforcement protocols and/or adherence to protocols and not of a law itself. This is a program review and does not require the review by a lawyer.

Documentation could be, for example, meeting minutes, reports, presentations, memos, or some other record of the discussion of the review and findings. They could also be in the form of policy agendas, position papers, white papers, and legislative briefs, including recommendations for amendments.

Health departments must document that the review of the law included:

2 examples that are from different programs

1 example must demonstrate collaboration with other levels of health departments (Tribal, state, and/or local)

Reviews completed within 3 years

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a. Evaluations of laws for consistency with public health evidence-based and/or promising practices; and consideration of the impact on health equity

b. Use of model public health laws, checklists, templates, and/ or exercises in reviewing law

c. Input solicited from key stakeholders on proposed and/or reviewed laws

d. Collaboration with other levels of health departments when the laws impact on them

a. Consideration of evidence-based practices, promising practices, or practice- based evidence. The impact of the law on health equity in the health department’s jurisdiction, if any, must also be considered.

b. The use of model public laws, check lists, templates, or some other standard outline or guide. The standard outline or guide could be developed by the health department or by others.

Due to the limited availability of evidenced-based practices or promising practices in Tribal communities, Tribes may provide examples of practice- based evidence used to adapt models or create models based on a cultural framework or traditional forms of governance.

c. Input from key partners and stakeholders. Input may be sought through, for example, public notice, town forums, meetings, hearings, or request for input on the health department’s web page.

d. Collaboration with other levels of government health departments.

State health departments must document that it has collaborated with Tribal or local health departments in reviewing laws that may impact those Tribal or local health departments. This collaboration may involve state health departments providing assistance to Tribal or local health departments as they review and revise laws or it may involve obtaining Tribal or local input on new state laws or revisions of state laws. Specifically, states must consult with Tribal governments on laws that may impact them or for which they are requesting assistance for implementing within Tribal jurisdictions.

Documentation of state collaboration could be minutes or summaries of meetings held by the state with Tribal and/or local public health officials; agenda, minutes, and any resulting documents from meetings with stakeholders; summaries of comments from town meetings, hearings, or comments received through a website.

MEASURE 6.1.1 A, continued

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Local health departments must document how they consult with Tribes when reviewing laws that impact multiple jurisdictions, for example, disease reporting, isolation and quarantine, and immunizations.

Tribal health departments must document work with its local Tribal units (i.e. Chapter Houses, Pueblos, or Districts), in addition to other partners, when reviewing existing laws and revising or creating new laws.

Documentation could be, for example, reports of working with local Tribal community stakeholders, for example, elected Tribal District Chairpersons, elected Tribal council committees, Tribal Community Colleges, school districts, and boards. Tribal health documentation may also include work completed with Tribal Legislative Counsel or Tribal Elected/Appointed officials, for example, District Chairpersons, Tribal Oversight Committees, and governing entities.

2. Access to legal counsel

2. The health department must document that it has access to legal counsel review and advice for use, as needed.

Documentation could be, for example, an MOU, a contract, a letter of agreement, or statement that a governmental attorney’s office has the responsibility to provide legal counsel to the health department.

1 example 3 years

MEASURE 6.1.1 A, continued

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Standard 6.1: Review existing laws and work with governing entities and elected/appointed officials to update as needed.

MEASURE PURPOSE SIGNIFICANCE Measure 6.1.2 A Information provided to the governing entity and/ or elected/appointed officials concerning needed updates/ amendments to current laws and/or proposed new laws

The purpose of this measure is to assess the health department’s efforts to provide advice to governing entities and/or elected/ appointed officials on the public health impact of the content of new laws and changes to current laws.

The health department can be an expert on the impact of new laws or changes to laws that impact the public’s health. As the public health expert for the jurisdiction, the health department should share its findings and make recommendations for amendments – revision, creation, deletion – to the body of public health law. The laws need not be laws that the health department enforces but may be laws that others enforce that impact public health, for example, helmet use laws, school nutrition requirements, sale of tobacco products to minors, texting while driving law, animal rabies vaccination laws, or public school requirements for proof of childhood vaccinations. Not all legal reviews or policy recommendations will result in a change, but health departments have a responsibility to provide the information for consideration by elected/appointed officials.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. The provision of written recommendations to governing entity and/or elected/ appointed officials concerning amendments or updates to current laws and/or proposed new laws

1. The health department must document that it has submitted written reviews of current laws or proposals for new laws to the governing entity and/or elected/appointed officials.

Documentation could be, for example, a governing entity meeting agenda, email, or mailed cover memo to governing entity members and elected/ appointed officials. For this measure, a public posting, such as a notice on the health department website, would not be sufficient. The documentation must show distribution to the targeted audiences of governing entities and/or elected/ appointed officials.

Documentation for Tribal health departments could be, for example, work completed with Tribal Legislative Council or Tribal Elected/Appointed officials, for example, District Chairpersons, Tribal Oversight Committees, and other governing entities.

2 examples

The examples can be, but do not have to be, related to the two examples provided for measure 6.1.1.

5 years

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Public health laws impact all members of the community. Health departments have the responsibility to educate the public about public health laws and to inform members of the community about the meaning behind the law, the purpose for the law, the benefits of the law, and compliance requirements. Educational efforts should be aimed at individuals and organizations that are a part of the jurisdiction served, including schools, civic organizations, human service organizations, other government units and agencies, and the medical community. Education efforts need to be culturally and linguistically appropriate to the audience.

STANDARD 6.2: Educate individuals and organizations on the meaning, purpose, and benefit of public health laws and how to comply.

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Standard 6.2: Educate individuals and organizations on the meaning, purpose, and benefit of public health laws and how to comply.

MEASURE PURPOSE SIGNIFICANCE Measure 6.2.1 A Department knowledge maintained and public health laws applied in a consistent manner

The purpose of this measure is to assess the health department’s knowledge of how laws support public health practice and their efforts to ensure that these measures are applied consistently.

Health departments with the responsibility to enforce laws must maintain assurance that the laws are clearly understood by health department staff and that the laws are being applied in a consistent manner.

Health departments that do not have regulatory enforcement responsibility still have a responsibility to maintain knowledge of laws that impact public health and to ensure that the laws are applied consistently. For example, the school system may have the responsibility to ensure that all children entering kindergarten have had age appropriate vaccinations. The health department should work with the schools to ensure that those laws are consistently enforced. Another example is the assurance that the prohibition against the sale of tobacco products to minors is enforced consistently.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

NOTE: Public health law enforcement, for example, environmental public health, animal control, solid waste and food codes, may be handled by multiple departments within the Tribal, state, or local government. For this measure, the health department must provide documentation of how it maintains knowledge of the laws and their consistent application.

1. Provisions of training for staff in laws to support public health interventions and practice

1. The health department must document that the staff are trained in laws that support public health interventions and practice. The training agenda is not specified and can include both general and specific aspects of public health law. Staff must be trained on the specific aspects of the law for which they are programmatically responsible. For example, an infectious disease nurse should be trained on the law that addresses infectious disease reporting; he or she would not be required to know specific elements on public water laws.

Documentation could be, for example, training agendas, minutes of training meetings, HR lists of personnel trained and the date of the training, or screenshots of links to online training required for staff completion and documentation that it was completed. Orientation for new staff is not sufficient.

2 examples 2 years

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2. Efforts to ensure the consistent application of public health laws

2. The health department must document efforts to ensure the consistent application of public health laws. Documentation may be a review of either health department staff’s application of laws or other organizations’ application of public health laws for which the health department is not responsible for enforcement. Coordination with other organizations that apply laws must be evidenced. Examples include enforcement of seat belt use, environmental public health laws, sale of tobacco products to minors, clean indoor air laws, quarantine laws, food safety, etc.

Documentation could be, for example, internal audits, enforcement documents or logs, written review of case reports, reports or minutes of meetings with other agencies or entities that enforce laws, communications with other agencies or entities on the importance of consistent application of laws.

2 examples 5 years

MEASURE 6.2.1 A, continued

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Standard 6.2: Educate individuals and organizations on the meaning, purpose, and benefit of public health laws and how to comply.

MEASURE PURPOSE SIGNIFICANCE Measure 6.2.2 A Laws and permit/ license application requirements are accessible to the public

The purpose of this measure is to assess the health department’s provision of information to the public concerning public health related permits and license applications.

Members of the public will seek information from the health department about laws, permits and license requirements and applications. In some cases, the health department may not be responsible for the administration of the requirements of the laws, but it should be sufficiently informed to correctly advise the public and direct them to the responsible agency.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Public access to information about laws and permit/ license application processes

1. The health department must document how it makes information concerning public health related laws and permits/license applications available to members of the public who request it. This information can be made available through the health department’s website or provided to the public in a paper document (e.g., flyer, brochure, etc.). The website can post laws, or provide a link to the laws, along with forms, protocols or other components of the permit or licensing process. Information will direct the public to the appropriate agency, if the responsibility does not legally reside with the health department.

1 example 5 years

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Standard 6.2: Educate individuals and organizations on the meaning, purpose, and benefit of public health laws and how to comply.

MEASURE PURPOSE SIGNIFICANCE Measure 6.2.3 A Information or education provided to regulated entities regarding their responsibilities and methods to achieve full compliance with public health related laws

The purpose of this measure is to assess the health department’s education of entities that are responsible for complying with laws that have public health impact. Enforcement of compliance with these laws may or may not be the responsibility of the health department.

A primary role of health departments is to educate the population and regulated entities and organizations about the meaning, purpose, benefits, and compliance requirements of public health related laws.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Provision of information or education to regulated entities concerning their responsibilities for compliance with public health laws

1. The health department must provide a written record of the provision of information to regulated individuals or entities about their responsibilities related to public health laws. Documentation must include both the information provided and evidence of its distribution.

The information could be provided to a targeted group, such as public schools that are responsible for, for example, enforcing immunization requirements of their students, tracking immunization records, and reporting the vaccination records or lack of records; or, it may be the entire population, who are a regulated entity in regard to the immunization law and their responsibility for having their children vaccinated.

Documentation could be, for example, a set of FAQs on the health department’s website, newsletters (with distribution list), training sessions (with attendance list and materials), public meetings (with minutes or agendas and attendance list), documentation of technical assistance and information (provided through email, phone logs, etc.), pamphlets, posters, or press releases.

1 written record

5 years

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Health departments have a role in ensuring that public health laws are enforced. In some cases, the health department has the enforcement authority. In other cases, the health department works with those who have the legal authority to enforce the laws. When other state agencies, local departments, or levels of government have enforcement authority, the role of the health department is to collaborate, assist, and share information. In either case, the health department needs to know about enforcement activities and violations in their jurisdiction, since violations and enforcement can impact the public’s health. The department should be coordinating and sharing information with agencies that have public health related enforcement authority. The health department is responsible for follow-up communication and education on public health impacts and protection.

As with all of the standards and measures, accountability for meeting the measures rests with the health department being reviewed for accreditation. Documentation that provides evidence of meeting the measure must be provided, even if the documentation is produced by a partner organization, another governmental agency, or another level of government, and not by the health department seeking accreditation. The health department must partner with enforcement agencies to ensure that the laws and their enforcement protect and promote the public’s health.

STANDARD 6.3: Conduct and monitor public health enforcement activities and coordinate notification of violations among appropriate agencies.

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Standard 6.3: Conduct and monitor public health enforcement activities and coordinate notification of violations among appropriate agencies.

MEASURE PURPOSE SIGNIFICANCE Measure 6.3.1 A Written procedures and protocols for conducting enforcement actions

The purpose of this measure is to assess the health department’s standard and consistent enforcement actions.

Enforcement actions require standard steps, criteria, and actions. When public health enforcement is conducted by other agencies or entities, the health department should have working relationships with those entities to share information. The health department may be able to provide advice concerning enforcement. Additionally, the health department should be informed of noncompliance. For example, if a toxic substance is being emitted by a plant or a restaurant inspection identifies a risk of a food borne illness, the health department should be involved to provide public health follow-up on any related illnesses or to deliver community information and education.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Authority to conduct enforcement activities

1. The health department must document its authority to conduct enforcement activities. This authority may be located in a state or local code, MOU, letter of agreement, contract, legislative action, executive order, ordinance, or rules/regulations. In some cases, the health department may have little or no authority to conduct enforcement actions. In those cases, the department must be coordinating and sharing information with agencies that do have public health related enforcement authority. In those cases, the health department must provide documentation of the authority of the other entity that conducts enforcement.

2 examples no date restriction

2. Procedures and protocols for achieving compliance with laws or enforcement actions

2. The health department must provide copies of procedures, protocols or processes (for example, decision trees) for enforcement program areas.

Where the health department does not conduct public health enforcement actions, the protocols used by the enforcement agency must be provided and must demonstrate cooperation between the enforcement agency and the health department.

2 examples; one of the examples must address infectious disease.

2 years

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Standard 6.3: Conduct and monitor public health enforcement activities and coordinate notification of violations among appropriate agencies.

MEASURE PURPOSE SIGNIFICANCE Measure 6.3.2 A Inspection activities of regulated entities conducted and monitored according to mandated frequency and/or a risk analysis method that guides the frequency and scheduling of inspections of regulated entities

The purpose of this measure is to assess the health department’s adherence to guidelines on the frequency of inspection activities.

Where the inspections are conducted by other agencies, the health department should be notified of inspections, protocols, and status. This enables the health department to provide follow-up education and communication, where appropriate, to safeguard the public’s health.

.

When the law specifies inspection frequency, the health department should be following the defined schedule. When there is no mandated schedule, the health department should have a method to define an appropriate schedule and should adhere to the schedule.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Protocol/algorithm for scheduling inspections of regulated entities

1. The health department must provide schedules for inspections. The health department may select the areas or programs. The selected schedules must be in programs where the health department has authority to conduct an inspection of the regulated entity, unless the health department has no such authority.

In some cases, schedules for inspections are mandated. In other cases, the department may provide a protocol or an algorithm for scheduling inspections. For example, rules requiring restaurant inspections on a specified schedule or a schedule for return inspections after a violation may be submitted. These may be documents provided by another agency that has enforcement responsibilities.

2 examples from 2 different programs

5 years

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2. Inspections that meet defined frequencies with reports of actions, status, follow-up, re-inspections, and final disposition

2. The health department must document a database or provide a log of inspection reports with actions taken, current status, follow-up, return inspections and final disposition.

Documentation could be screen shots, if the data are kept electronically.

In some cases, the health department may have little or no authority to conduct enforcement actions. In those cases, the department must coordinate and share information with agencies that do have public health related enforcement authority. In those cases the health department must provide documentation of the authority of the other entity that conducts enforcement. The health department must provide documentation that it is informed of inspection protocols and reports showing the results of inspection.

2 examples

This documentation of inspections must relate to the same programs for which schedules were provided in 1 above.

5 years

MEASURE 6.3.2 A, continued

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Standard 6.3: Conduct and monitor public health enforcement activities and coordinate notification of violations among appropriate agencies.

MEASURE PURPOSE SIGNIFICANCE Measure 6.3.3 A Procedures and protocols followed for both routine and emergency situations requiring enforcement activities and complaint follow-up

The purpose of this measure is to assess the health department’s implementation of procedures and protocols for routine and emergency enforcement activities and for follow up of complaints.

Scheduled investigations, emergency situations, and complaint follow-up should be conducted according to standard procedures and protocols to ensure that they are conducted appropriately.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Actions taken in response to complaints

1. The health department must document actions taken as a result of investigations or follow-up of complaints, as well as analysis of the situation and standards for follow-up.

Documentation could be, for example, a database or log with analysis and standards for follow-up at each level. The standards for follow-up may be within the procedure and protocols. If separate, the standards must be included with the database or log for the documentation.

2 examples from 2 different programs

5 years

2. Communications with regulated entities regarding a complaint or compliance plan

2. The health department must document hearings, meetings, or other official communications with regulated entities regarding a complaint and any resulting compliance plans. The compliance plan has no specific format and will be determined by law or department protocol. The regulated entity, based on the law, could be an organization, business, or individual.

In some cases, the health department may have little or no authority to conduct enforcement actions. In those cases, the department must coordinate and share information with agencies that do have public health related enforcement authority. In those cases, the health department must provide documentation of the authority of the other entity to conduct enforcement. The health department must provide documentation that it is informed of inspection protocols and reports showing the results of inspection.

2 examples 5 years

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Standard 6.3: Conduct and monitor public health enforcement activities and coordinate notification of violations among appropriate agencies.

MEASURE PURPOSE SIGNIFICANCE Measure 6.3.4 A Patterns or trends identified in compliance from enforcement activities and complaints

The purpose of this measure is to assess the health department’s analysis of patterns, trends, and compliance from enforcement activities and complaint investigations.

It is important for the health department to determine patterns or trends in non- compliance, complaints, or enforcement activities. This will help in understanding the prevalence of issues, in employing preventive measures, in pursuing opportunities for improvement in enforcement activities, and in providing follow-up education.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Enforcement programs’ annual reports summarizing complaints, enforcement activities, or compliance

1. The health department must provide annual reports that summarize complaints, enforcement activities, or compliance. Reports must include patterns, trends, and compliance.

Documentation from an enforcement program that is out of compliance with state law or is under sanctions or a performance improvement plan must be labeled as being out of compliance with state law or under sanctions or a performance improvement plan.

2 examples from different enforcement programs. If the department operates an enforcement program that is out of compliance with state law or is under sanctions or a performance improvement plan, then one of the examples must be from that program.

14 months

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2. Debriefings or other evaluations on enforcement for process improvements

2. The health department must document debriefings or other methods to evaluate what worked well, problems that arose, issues and recommended changes in investigation/response procedures, and other process improvements to enforcement protocols or procedures. All other process improvements discussed must be noted in the documentation.

In some cases, the health department may have little or no authority to conduct enforcement actions. In those cases, the department must coordinate and share information with agencies that do have public health related enforcement authority. In those cases, the health department must provide documentation of the authority of the other entity to conduct enforcement. The health department must document that it is informed of patterns, trends, and compliance.

2 examples 5 years

MEASURE 6.3.4 A, continued

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Standard 6.3: Conduct and monitor public health enforcement activities and coordinate notification of violations among appropriate agencies.

MEASURE PURPOSE SIGNIFICANCE Measure 6.3.5 A Coordinated notification of violations to the public, when required, and coordinated sharing of information among appropriate agencies about enforcement activities, follow-up activities, and trends or patterns

The purpose of this measure is to assess the health department’s communication with the public concerning enforcement violations and with appropriate agencies concerning enforcement activities, follow-up activities, and trends or patterns.

In some cases, the health department may have little or no authority to conduct enforcement actions. In those cases, the department should be coordinating and sharing information with agencies that do have public health related enforcement authority.

It is important that the health department share enforcement information with the public so that the public may make decisions or alter their behavior, based on the information. For example, many members of the public want to know what local restaurants have failed inspection and why.

It is important that the health department shares information concerning enforcement actions and/or any resulting follow- up with other agencies that have a role in educating or providing follow-up with the enforced entity or educating the public. Appropriate agencies include health departments at other levels of government: Tribal, state, or local health departments.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Communication protocol for interagency notifications

1. The health department must provide a communication protocol for interagency notifications.

The protocol may be in parts to address multiple communication protocols or it may be a single comprehensive protocol for notifying other agencies concerning enforcement actions.

1 protocol 5 years

2. Protocol for notification of the public of enforcement activities

2. The health department must provide a protocol for notifying the public of enforcement activities. If there are laws that require public notification, the reference must be submitted. The health department may also allow for public notification without a legal requirement. In that case, provide a copy of the relevant protocol. Examples include notifications of the public of restaurant inspection violations, emission violations, and inspections of public facilities (for example, public swimming pools).

1 department- wide protocol or 2 examples

5 years

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3. Notifications of enforcement actions and other sharing of information concerning enforcement activities

3. The health department must document the notification of enforcement actions.

Required Documentation 1 and 2 requires written protocols. Required Documentation 3 requires documentation of the implementation of a protocol. Documentation must demonstrate that protocols were followed.

Notification can be through a variety of methods, including: posting on a website, minutes from public meetings, conference calls, emails, correspondence, press release, public presentation, reports, and MOUs and MOAs with other agencies that demonstrate sharing information on enforcement activities.

When other agencies have enforcement authority, the health department must provide documentation that it is informed of patterns, trends, and compliance.

2 examples are required.

The two examples must be from two different enforcement programs.

5 years

MEASURE 6.3.5 A, continued

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Domain 7 focuses on the population’s access to needed health care services. An important role of public health is the assessment of the population’s access to health care services and the capacity of the health care system to meet the health care needs of the population. Public health also has a role in efforts to increase access to needed health care services, particularly primary care. The focus of this Domain is not on health care or clinical services that the health department may provide directly, though those services are part of the analysis of access to health care.

DOMAIN 7 INCLUDES TWO STANDARDS:

Standard 7.1: Assess Health Care Service Capacity and Access to Health Care Services

Standard 7.2: Identify and Implement Strategies to Improve Access to Health Care Services

Domain 7: Promote Strategies to Improve Access to Health Care

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Health departments should work with the health care system to (1) understand the availability of health care services to the population, (2) identify populations who experience barriers to health care services, and (3) identify gaps in access to health care and barriers to the receipt of care.

STANDARD 7.1: Assess health care service capacity and access to health care services.

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Standard 7.1: Assess health care service capacity and access to health care services.

MEASURE PURPOSE SIGNIFICANCE Measure 7.1.1 A Process to assess the availability of health care services

The purpose of this measure is to assess the health department’s participation in a collaborative process to develop an understanding of the population’s access to needed health care services.

Collaborative efforts are required to assess the health care needs of the population of the Tribe, state, or community. The focus is on the need for primary care, particularly preventive primary care and chronic disease management.

Health care services, for access planning purposes, include: clinical preventive services, emergency services, urgent care, occupational medicine, ambulatory care (primary and specialty), and dental treatment.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. A collaborative process to assess availability of health care services

1. The health department must document its participation in a collaborative process to assess the availability of health care services to the population.

The collaborative process must include the involvement of the health care system. Other partners may include, for example, representatives of social service organizations, employers, health insurance companies, communities of color, Tribes, low income workers, military installations, correctional agencies, specific populations who may lack health care and/ or experience barriers to service (e.g., disabled, non-English speaking, or otherwise disenfranchised residents), and other stakeholders.

For Tribal health departments it may include clinic and hospital representatives, Indian Health Service, other Tribal programs and departments, and individuals representing communities that experience barriers to services (e.g., distance from service, transportation barriers).

Information on the partnerships developed to assess health care must include rosters of coalition/network/council members.

Documentation could be, for example, charters or meeting agendas, or meeting minutes.

1 collaborative process

5 years

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2. The sharing of comprehensive data for the purposes of assessing the availability of health care services and for planning

2. The health department must document the sharing of public health Tribal, state, and/or local data for assessment and planning purposes.

Sharing mechanisms can include regional health information organizations (RHIOs) and health information exchanges (HIEs), or less formal data sharing efforts, for example, MOUs or contracts.

Documentation could be examples of data sharing through reports, emails, etc.

2 examples 5 years

3. Consideration of emerging issues in public health, the health care system, and health care reimbursement

3. The health department must document consideration of emerging issues that may impact access to care. These might include changes in the structure of the health care system; types and numbers of health care professionals being trained; changes in reimbursement structure, rates, or payment mechanisms such as accountable care organizations; developing care models, for example, coordinated care organizations or convenient care clinics; and electronic medical records.

Documentation could be, for example, meeting minutes, reports, or white papers.

2 examples 5 years

MEASURE 7.1.1 A, continued

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Standard 7.1: Assess health care service capacity and access to health care services.

MEASURE PURPOSE SIGNIFICANCE Measure 7.1.2 A Identification of populations who experience barriers to health care services identified

The purpose of this measure is to assess the department’s knowledge of barriers to health care and of the specific populations who experience those barriers.

It is important for the health department to identify populations in its jurisdiction that experience perceived or real barriers to health care. Assessing capacity and access to health care includes the identification of those who are not receiving services and understanding the reasons that they are not receiving needed care or experiencing barriers to care. Barriers may be experienced, for example by populations who are uninsured or under-insured, have no transportation to health care, are non-English speaking, are immuno-compromised, or live where there is a shortage of primary care practitioners. Barriers may also be perceived by populations who do not trust the health care system or do not understand why certain routine medical services or screenings are necessary for their health. The importance of access to health care services includes, for example: pregnant women who use tobacco (who are at risk of giving birth to a low birth weight baby); obese populations (who are at risk for diabetes); or individuals who use tobacco products (who are at risk for cancer).

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. A process for the identification of un-served or under- served populations

1. The health department must document the process and information used to identify populations who lack access to health care. Information could be obtained from an assessment survey and/or surveys of particular population groups. Other information sources include: analysis of secondary data and/or health care data, such as emergency department admissions or population insurance status data.

1 process 5 years

2. A report that identifies populations who are un-served or under-served

2. The health department must provide a report that identifies populations who experience barriers to health care services. Populations may be identified by a variety of characteristics, for example, age (e.g., teenagers, elderly, etc.), ethnicity, geographic location, health insurance status, educational level obtained, mental or physical disabilities, discrimination (e.g., marriage inequality), or special health service needs (women who are pregnant, individuals with diabetes, etc.).

This report could be a section of a larger report that includes other topic, a separate report, or part of the community health improvement plan.

1 report 5 years

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Standard 7.1: Assess health care service capacity and access to health care services.

MEASURE PURPOSE SIGNIFICANCE Measure 7.1.3 A Identification of gaps in access to health care services and barriers to the receipt of health care services identified

The purpose of this measure is to assess the health department’s knowledge of gaps in access and barriers to health care services among the population it serves.

It is important for health departments to understand the gaps in access to health care and the barriers to care so that effective strategies can be put in place to address the lack of access to health care. Barriers to health care services can range from financial (e.g., lack of affordable services), health care system capacity (e.g., lack of dental providers), cultural (e.g., lack of interpreters), geographic (e.g., lack of transportation), and lack of health insurance, among others. Shared data among the members of the partnership can evidence an effort to capture and understand all possible gaps that exist.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. The process or set of processes used for the identification of service gaps and barriers to accessing health care services

1. The health department must document the process used to identify gaps in health care services and barriers to care. The documentation must identify who was involved in the identification process. Processes may include sector maps, analysis of hospital admissions or emergency department data, analysis of health insurance data, or other tools.

1 process or set processes

5 years

2. Reporting the analysis of data from across the partnership (see 7.1.1) that identify the gaps in access to health care services and the causes of gaps in access, or barriers to care.

Reports must include:

2. The health department must provide reports of analysis of data from various partnership sources that identify and describe gaps in access and barriers to health care services. Reports must include analysis of data and conclusions that can help develop effective strategies to address gaps in access. At a minimum, data sources must include the partners that participated in the collaborative process described in measure 7.1.1. Data may be contributed by all partners or may be discussed or evaluated by partners. The reports must include:

2 examples 5 years

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MEASURE 7.1.3 A, continued a. Assessment of

capacity and distribution of health care providers

b. Availability of health care services

c. Identification of causes of gaps in services and barriers to receipt of care

d. Results of data gathered periodically concerning access

a. Assessment of capacity and distribution of health care providers. These data will show geographic gaps in the availability of health care providers.

b. Assessment of the availability of health care services, for example, clinical preventive services, EMS, emergency departments, urgent care, occupational medicine, ambulatory care (primary and specialty), inpatient care, chronic disease care (e.g., diabetic care, HIV health services), dental, and other health care services. These data can be useful in seeking support for a particular service.

c. Assessment of cause(s) for lack of access to services and barriers to access to care. Causes may include: a population that is uninsured/under- insured, lacks transportation to health care, does not speak or understand English, is immuno-compromised, or lives where there is a shortage of primary care and dental practitioners. Barriers may also be the result of populations who do not trust health care providers or do not understand why certain routine medical services or screenings are necessary to protect their health. Barriers may include, but not be limited to, travel distance in rural areas, inability to obtain timely appointments, lack of ability to pay for services, or limited service hours of health care.

d. Results of data or information gathered concerning access, for example, focus groups, studies of eligible groups receiving services, and other assessment information, can provide perspectives from the population that lacks access. These data collection efforts do not have to be administered by the health department, but the results must be considered in the assessment of gaps in access and barriers to care.

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There are many factors that can contribute to lack of access to health care, including insurance status, transportation, travel distance, availability of a regular source of care, wait time for appointments, and office wait times. Social conditions also influence access to health care, including education and literacy level, language barriers, knowledge of the importance of symptoms, trust in the health care system, and employment leave flexibility. Once the barriers and gaps in service are identified, strategies may be developed and implemented to address them and improve access to health care services.

STANDARD 7.2: Identify and implement strategies to improve access to health care services.

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Standard 7.2: Identify and implement strategies to improve access to health care services.

MEASURE PURPOSE SIGNIFICANCE Measure 7.2.1 A Process to develop strategies to improve access to health care services

The purpose of this measure is to assess the health department’s collaborative efforts to develop strategies to increase access to health care for those who experience barriers to services.

Factors that contribute to poor access to care are varied. A partnership with other organizations and agencies provides the opportunity to address multiple factors and coordinate strategies. The health department need not have convened or have led the collaborative process, but it must have participated in the process.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. A coalition/ network/ council working collaboratively to reduce barriers to health care access or gaps in access

1. The health department must document its involvement in a collaborative process for developing strategies to improve access to health care. The example must demonstrate involvement of representatives of providers of health care services, for example, hospitals, clinics, primary care physicians, etc. Other partners may include, for example: community service providers, schools, correctional agencies, migrant health, social service organizations, transportation providers, military installations, and employers.

The documentation must demonstrate that the group is actively working to identify strategies.

The collaborative process and development of strategies in this measure can be done in conjunction with 7.1.1, and the same collaborative process/partnership can be used.

Documentation could be, for example, a charter for the group; membership rosters or participant/attendance lists; meeting agendas and minutes; or workgroup reports, work plans, and white papers.

1 collaborative process

5 years

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2. Strategies developed by the coalition/ network/council working through a collaborative process to improve access to health care services

2. The health department must provide strategies that the coalition/ network/council developed to improve access to health care services and reduce barriers to care. Examples include: linking individuals with needed and convenient services; establishing systems of care in partnership with other members of the community; addressing transportation barriers; addressing cuts in budgets and clinic hours; expanding roles of care givers (e.g., mid-level providers) to provide screenings and referrals; working with employers to increase the number of insured workers; or other strategies to address particular barriers.

Documentation could be, for example, reports, meeting minutes, or MOUs.

2 examples 5 years

MEASURE 7.2.1 A, continued

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Standard 7.2: Identify and implement strategies to improve access to health care services.

MEASURE PURPOSE SIGNIFICANCE Measure 7.2.2 A Implemented strategies to increase access to health care services

The purpose of this measure is to assess the health department’s involvement in the implementation of strategies to increase access to health care services.

Improved access to care will provide continuity of health promotion and disease prevention to members of the population and ensure access to needed preventive services.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Collaborative implementation of mechanisms or strategies to assist the population in obtaining health care services

1. The health department must document collaborative implementation of strategies to improve access to services for those who experience barriers. Documentation could be, for example:

• A signed Memoranda of Understanding (MOU) between partners to list activities, responsibilities, scope of work, and timelines.

• A documented cooperative system of referral between partners that shows the methods used to link individuals with needed health care services.

• Documentation of outreach activities, case findings, case management, and activities to ensure that people can obtain the services they need.

• Documentation of assistance to eligible beneficiaries with application and enrollment in Medicaid, workers’ compensation, or other medical assistance programs.

• Documentation of coordination of service programs (e.g., common intake form) and/or co-location (e.g., WIC, immunizations, and lead testing) to optimize access.

• Grant applications submitted by community partnerships that address increased access to health care services.

• Subcontracts in the community to deliver health care services in convenient and accessible locations.

• Program/work plans documenting that strategies developed collaboratively have been implemented.

• Documentation of transportation programs.

2 examples 5 years

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Standard 7.2: Identify and implement strategies to improve access to health care services.

MEASURE PURPOSE SIGNIFICANCE Measure 7.2.3 A Implemented culturally competent initiatives to increase access to health care services for those who may experience barriers to care due to cultural, language, or literacy differences

The purpose of this measure is to assess the health department’s involvement in the incorporation of cultural competence, language, or literacy in efforts to address the health care service needs of populations who experience barriers to access to health care.

Cultural differences can present serious barriers to receipt of health care services. Cultural differences must be addressed in strategies to improve access to health care services, if those strategies are to be successful. For example, some cultures discourage women from talking about personal issues with people outside of their families, discourage men from seeking care, may not trust health care providers, or may rely on community providers who are not trained in medical care. Language and low literacy can also limit access to care.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Initiatives to ensure that access and barriers are addressed in a culturally competent manner

1. The health department must document that initiatives to ensure access and address barriers are culturally competent, and take into account cultural, language, or low literacy barriers. The initiatives may be developed by the health department or in collaboration with others.

Examples of initiatives include the use of lay health advocates indigenous to the target population; parish nursing; informational materials developed for low literacy individuals; culturally competent initiatives developed with members of the target population; language/interpretive services; family-based care for some populations; or provision of health care that combines cultural health care and the health care system.

2 examples 5 years

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DOMAIN 8 DOMAIN 9

Domain 8 focuses on the need for health departments to strategically approach the development of a competent workforce to perform public health duties. Effective public health practice requires a well prepared workforce. A multi-disciplinary workforce that is matched to the specific community being served facilitates the interdisciplinary approaches required to address health equity and the population’s public health issues. The manner in which services are provided to the public determines the effectiveness of those services and influences the population’s understanding of, and appreciation for, public health. A strategic workforce includes the alignment of workforce development with the health department’s overall mission and goals and the development of strategies for acquiring, developing, and retaining staff.

DOMAIN 8 INCLUDES TWO STANDARDS:

Standard 8.1: Encourage the Development of a Sufficient Number of Qualified Public Health Workers

Standard 8.2: Ensure a Competent Workforce through Assessment of Staff Competencies, the Provision of Individual Training and Professional Development, and the Provision of a Supportive Work Environment

Domain 8: Maintain a Competent Public Health Workforce

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Maintaining a competent public health workforce requires a supply of qualified public health workers sufficient to meet public health needs. As public health workers retire or seek other employment opportunities, newly trained public health workers must enter the field. Trained and competent workers are needed in such diverse areas as epidemiology, health education, community health, public health laboratory science, public health nursing, environmental public health, and public health administration and management. Every health department has a responsibility to collaborate with others to encourage the development of a sufficient number of public health students and to encourage qualified individuals to enter the field of public health to meet the staffing needs of public health departments and other public health related organizations.

STANDARD 8.1: Encourage the development of a sufficient number of qualified public health workers.

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Standard 8.1: Encourage the development of a sufficient number of qualified public health workers.

MEASURE PURPOSE SIGNIFICANCE Measure 8.1.1 S Relationship and collaboration with educational programs that promote the development of future public health workers

The purpose of this measure is to assess the state health department’s contributions to the development of qualified public health workers.

Working with schools of public health and other related academic and educational programs (for example, public health nursing, public health laboratory services, health promotion, environmental public health, public policy, colleges of veterinary medicine) is a means to promote public health as an attractive career choice. Collaborative efforts promote the health department as an employer of choice and open new pathways for recruitment. Collaboration with academic programs can create opportunities for internships, guest lecturers, and other ways to expose students or new graduates to public health practice.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Partnership or ongoing collaboration with educational programs to promote public health as a career or to provide training in public health fields

1. The state health department must document a partnership or collaboration with a school of public health and/or other related academic programs that prepare public health workers. The documentation must show strategies for promoting public health careers or enhancing training in public health.

Examples of partnership or collaboration include: a practicum; student placements/academic service learning; internship opportunities; faculty positions or guest lectures by health department staff; participation in high school, university, college, or Tribal college programs; and/or job/career fairs.

1 partnership or ongoing collaboration

5 years

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Standard 8.1: Encourage the development of a sufficient number of qualified public health workers.

MEASURE PURPOSE SIGNIFICANCE Measure 8.1.1 T/L Relationships and/ or collaborations that promote the development of future public health workers

The purpose of this measure is to assess the health department’s activities to encourage public health as a career choice.

Working with schools, academic programs, or other organizations is a means to promote public health as an attractive career choice. Collaborations can create paths for exposing students or new graduates to public health practice.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Relationship or collaboration that promotes public health as a career

1. The health department must document a partnership or collaboration that promotes public health as a career choice.

Examples of partnerships or collaborations include collaboration with a school or college of public health, working with organizations such as AmeriCorps, coordinating with a high school to make presentations to students about public health and public careers, working with a vocational training school to promote public health, partnering with a 4H club to provide information about public health to members, guest lecturing at a community college, or providing after school experiences for high school students.

1 example 5 years

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A health department workforce development plan ensures that staff development is addressed, coordinated, and appropriate for the health department’s needs. Staff job duties and performance should be regularly reviewed to note accomplishments and areas that need improvement. This should not be a punitive process but one that identifies needs for employee training or education. This approach can point out gaps in competencies and skills for the health department and provide workforce development guidance for individual staff members.

STANDARD 8.2: Ensure a competent workforce through the assessment of staff competencies, the provision of individual training and professional development, and the provision of a supportive work environment.

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Standard 8.2: Ensure a competent workforce through the assessment of staff competencies, the provision of individual training and professional development, and the provision of a supportive work environment.

MEASURE PURPOSE SIGNIFICANCE Measure 8.2.1 A Workforce development strategies

The purpose of this measure is to assess the health department’s planning for employee training, implementation of those plans, and the development of core competencies.

Health departments must have a competent workforce with the skills and experience needed to perform their duties and carry out the health department’s mission. Workforce development strategies support the health department, individual staff members, staff development, and the overall workplace environment. Employee training and core staff competencies assure a competent workforce.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Workforce development plan

1. The health department must provide a health department-specific workforce development plan. The workforce development plan must:

• Address the collective capacity and capability of the department workforce and its units.

• Address gaps in capacity and capabilities and include strategies to address them.

• Be responsive to the changing environment and include consideration of areas where the technology advances quickly such as information management and (digital) communication science.

• Be responsive to the changing environment and include considerations of areas where the field is advancing, for example, emergency preparedness training, health equity, and cultural competence.

The plan must include:

• An assessment of current staff competencies against the adopted core competencies. An example of nationally adopted core competencies is the “Core Competencies for Public Health Professionals” from the Council on Linkages Between Academia and Public Health Practice. The plan may also use state developed or specialty focused sets of competencies, for example, nursing, public health preparedness, informatics, and health equity competencies.

1 plan 2 years

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• Training schedules and a description of the material or topics to be addressed in the training curricula to address gaps in staff competencies.

• A description of barriers/inhibitors to the achievement of closing gaps or addressing future needs in capacity and capabilities and strategies to address those barriers/inhibitors.

2. Implemented workforce development strategies

2. The health department must document implementation of its workforce development strategies. Examples must demonstrate how the health department addresses gaps in capacity and capabilities.

2 examples 2 years

MEASURE 8.2.1 A, continued

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Standard 8.2: Ensure a competent workforce through the assessment of staff competencies, the provision of individual training and professional development, and the provision of a supportive work environment.

MEASURE PURPOSE SIGNIFICANCE Measure 8.2.2 A A competent health department workforce

The purpose of this measure is to assess the health department’s execution of its workforce development plan related to recruitment, retention, and staff qualifications.

Health departments’ success, as in all organizations, depends on the capabilities and performance of its staff. Actions that maximize staff capabilities and performance are necessary for a health department to function at a high level.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Recruitment of qualified individuals for specific positions

1. The health department must document the recruitment of individuals who are qualified for their public health specific specialty position.

Examples of the evidence of the efforts of the health department to achieve the desired applicant pool are required.

Documentation could be, for example, a competency-based job description and requirement for specific certification posting that specifies the level of skills, training, experience, and education that the applicant needs to possess to qualify for the position.

2 examples 5 years

2. Recruitment of individuals who reflect the population served

2. The health department must document the recruitment of individuals who reflect the demographics (e.g., race, ethnicity, language, etc.) of the population that the health department serves.

Examples of the evidence of the efforts of the health department are required, not the success or failure to achieve the desired applicant pool.

Tribal health departments may use Indian Preference hiring policies.

2 examples 5 years

3. Retention activities

3. The health department must document activities to retain staff. Examples include: employee satisfaction survey results, needs assessments of work environment, reward and recognition programs, career ladders, promotion opportunities, and supervisor mentoring programs.

2 examples 5 years

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4. Position descriptions, available to staff

4. The health department must provide position descriptions or job descriptions. Position or job descriptions must include the competencies that are required for the position and must address both public health specialty needs (e.g., epidemiologist, public health laboratory technician, etc.) and generalist needs.

The health department must also document how the descriptions are made available to staff. They may be made available for example, through the internet/ intranet, a policy procedures manual, or through the human resources department.

2 examples 3 years

5. A process to verify staff qualifications

5. The health department must document the process used to verify staff qualifications. This process may be defined in policy or it may be found in personnel guidelines that are part of the human resources system or a central administrative unit, such as a civil service system. Other examples include: guidelines used by all Tribal/county/state agencies or a separate process defined and used by the health department. The process may include: reference checks; confirmation of transcripts with the issuing academic institution; confirmation of any registration, certification, or license with the issuing institution; or other check of credentials provided by the staff member. Tribal health departments may include using the Indian Preference hiring policies and/or proof of enrollment.

1 process 2 years

6. Verified qualifications for all staff hired

6. The health department must document that qualifications have been verified for all staff hired in the past two years. Reviews include tracking required recertification.

Documentation could be, for example, personnel files, a log or spreadsheet, or a template or form used by the health department; civil service commission certification; or evidence from a county or state personnel office demonstrating that the person is qualified for the position.

Tribes often operate a human resources department to support its administration, including the Tribal health department. If this is the case, the health department must demonstrate how it works with human resources to ensure that it follows the appropriate policies and procedures.

2 examples 2 years

MEASURE 8.2.2 A, continued

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Standard 8.2: Ensure a competent workforce through the assessment of staff competencies, the provision of individual training and professional development, and the provision of a supportive work environment.

MEASURE PURPOSE SIGNIFICANCE Measure 8.2.3 A Professional and career development for all staff

The purpose of this measure is to assess the health department’s comprehensive approach to the provision of opportunities for professional career development for all staff and the department’s implementation of staff development activities.

All staff should have opportunities for professional development. All employees need to have a basic understanding of public health in order to coordinate program efforts, especially in the case of working with the public and in the case of emergency situations. All staff should have opportunities to learn and to grow in their positions both to improve their own skills and also to address the changing needs of the health department.

In addition to their specific public health activities, leaders and managers must oversee the health department, interact with stakeholders and constituencies, seek resources, interact with governance, and inspire employees and the community to engage in healthful public health activities. Development activities can assist leadership and management to employ state-of-the-art theory, management processes, public health knowledge, and management techniques.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Participation in personal professional development activities by staff of the department (other than management and leadership staff, who are addressed below)

1. The health department must document staff’s completion of their annual personal professional development plan.

Professional development activities could include: education assistance (e.g., time off for classes, tuition reimbursement, bringing classes to the health department), continuing education, training opportunities, mentoring, job shadowing, certification in public health, etc.

Topics could be, for example, HIPAA, emergency response, methods for the presentation of data, health equity, communications, and courses required for Certified Public Health continuing education.

Documentation could be, for example, a training completion certificate, an attendance record for a class, or a report written by the staff person documenting the activities and learnings.

2 examples 2 years

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2. Development activities for leadership and management staff

2. The health department must document the provision of department training and development programs for department leaders and managers.

Activities could include, for example, education assistance, continuing education, support for membership in professional organizations, and training opportunities.

2 examples 2 years

3. Participation of department leaders and managers in training provided by others, outside of the health department

3. The health department must document leaders’ and/or managers’ attendance at a leadership and/or management development training. Online courses are acceptable.

Examples of providers include National Public Health Leadership Institutes; Public Health Training Centers Network, Environmental Public Health Leadership Institute; executive management seminars or programs; graduate programs in leadership/management; and related meetings and conferences.

Examples of course topics include negotiation skills, CQI, systems thinking, change management, intercultural or intergenerational management, collaborative intelligence, handling conflict, coaching and mentoring skills, communications skills for managers, leadership styles, effective networks, concepts of public health informatics, leading teams and collaborations, health equity, community resilience, relationship building, marketing/branding, business process improvement, digital media, and crisis/risk communication.

2 examples 2 years

MEASURE 8.2.3 A, continued

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Standard 8.2: Ensure a competent workforce through the assessment of staff competencies, the provision of individual training and professional development, and the provision of a supportive work environment.

MEASURE PURPOSE SIGNIFICANCE Measure 8.2.4 A Work environment that is supportive to the workforce

The purpose of this measure is to assess the health department’s efforts to create an organizational culture and work environment that is supportive of the staff and their maximum productivity.

A positive work environment is vital to the success of any organization. The work environment impacts job satisfaction, employee retention, and employee creativity and productivity. The work environment should support and foster each employee’s ability to contribute to the achievement of the department’s mission, goals, and objectives.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Policies that provide an environment in which employees are supported in their jobs

1. The health department must provide policies that provide a supportive work environment. Policies could include, for example:

• A work/life balance, for example, telecommuting, flex time, and breastfeeding/ lactation support;

• Diversity (especially for staffing to match the diversity of the population);

• Leadership attributes, for example, setting a professional tone; fair and equitable management decisions; focus on the department’s vision and mission;

• Regular assessments of the organizational climate, for example, regular staff surveys and 360 reviews of the management team;

• The provision of the tools, information, and freedom to allow staff to perform their responsibilities;

• The maintenance of institutional memory, the transfer of knowledge, and the celebration of past and current accomplishments, for example, partnerships with retirees, sharing of stories, celebration events, etc.

• Supervisors’ encouragement of systems thinking, change management, data use for decisions, and a culture of quality improvement; and

• Collaborative learning, for example participation of staff on boards, committees, and task forces in community, collaborative planning sessions, shared reviews of program evaluations, etc.

1 policy or set of policies, plans, or program descriptions

5 years

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2. A process for employee recognition

2. The health department must provide employee recognition policies. Examples can address both team and individual recognition and recognition for employee improvement.

Examples of employee recognition include a call out in a newsletter, employee of the month program, posting an employee honor roll, recognition letters, regularly organized recognition lunch, etc.

1 set of policies, plans, or program descriptions

5 years

3. Employee wellness activities

3. The health department must provide a policy, plan, or description of opportunities provided to staff to promote health and wellness and prevent disease.

Activities may include, for example, health screenings and risk assessments, flu shots, exercise programs, nutrition information, stress reduction methods, breastfeeding and lactation support, and tobacco use cessation. Examples may also include healthy food policies and efforts to create a culture of health and wellness.

1 policy, plan, or program description

5 years

MEASURE 8.2.4 A, continued

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Standard 8.2: Ensure a competent workforce through the assessment of staff competencies, the provision of individual training and professional development, and the provision of a supportive work environment.

MEASURE PURPOSE SIGNIFICANCE Measure 8.2.5 S Consultation and/or technical assistance provided to Tribal and local health departments regarding evidence-based and/or promising practices in the development of workforce capacity, training, and continuing education

The purpose of this measure is to assess the state health department’s provision of consultation and/or technical assistance to Tribal and local health departments on evidence-based and/or promising practices in the development of workforce capacity, workforce training, and/or continuing education.

The state health department has knowledge and experience to share about workforce capacity, workforce training, and continuing education to address organizational gaps in the public health workforce. A trained and competent Tribal or local health department workforce enhances the capacity of the state health department.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. The provision of consultation and/or technical assistance to Tribal or local health departments

1. The state health department must document consultation or technical assistance provided to Tribal or local health departments.

Documentation could include, for example, emails, phone calls, webinars, documents/materials, site-visits, meetings, training sessions, and web postings.

2 examples

The state health department must include one example of assistance provided to a Tribal health department, and one example of assistance provided to a local health department. If the state does not contain any Tribal health departments, then the two examples must be from local health departments.

5 years

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DOMAIN 10DOMAIN 9

Domain 9 focuses on the use and integration of performance management and quality improvement practices and processes for the continuous improvement of the public health department’s practices, programs, and interventions.

Performance management identifies actual results against planned or intended results. Performance management systems ensure that progress is being made toward department goals by systematically collecting and analyzing data to track results to identify opportunities and targets for improvement.

Quality improvement is an element of performance management that uses processes to address specific targets for effectiveness and efficiency. “Quality improvement in public health is the use of a deliberate and defined improvement process that is focused on activities that are responsive to community needs and improving population health. It refers to a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality in services or processes which achieve equity and improve the health of the community.” (Riley, Moran, Corso, Beitsch, Bialek, and Cofsky. Defining Quality Improvement in Public Health. Journal of Public Health Management and Practice. January/February 2010).

DOMAIN 9 INCLUDES TWO STANDARDS:

Standard 9.1: Use a Performance Management System to Monitor Achievement of Organizational Objectives

Standard 9.2: Develop and Implement Quality Improvement Processes Integrated Into Organizational Practice, Programs, Processes, and Interventions

Domain 9: Evaluate and Continuously Improve Processes, Programs, and Interventions

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For the health department to most effectively and efficiently improve the health of the population, it is important to monitor the performance of public health processes, programs, interventions, and other activities. A fully functioning performance management system that is completely integrated into health department daily practice at all levels includes: 1) setting organizational objectives across all levels of the department, 2) identifying indicators to measure progress toward achieving objectives on a regular basis,3) identifying responsibility for monitoring progress and reporting, 4) identifying areas where achieving objectives requires focused quality improvement processes, and 5) visible leadership for ongoing performance management. Department information systems and public health data support performance management.

STANDARD 9.1: Use a performance management system to monitor achievement of organizational objectives.

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Standard 9.1: Use a performance management system to monitor achievement of organizational objectives.

MEASURE PURPOSE SIGNIFICANCE Measure 9.1.1 A Staff at all organizational levels engaged in establishing and/or updating a performance management system

The purpose of this measure is to assess the health department’s engagement of leadership and staff in developing, establishing, using, and updating a performance management system for the organization.

To continuously improve public health practice, the health department leadership and staff need to commit to establishing and using a performance management system. The performance management process must intentionally engage all levels of the organization in reaching decisions about the functionality and integration of various components of the performance management system. Staff ownership is required because implementation of a performance management system is successful only when staff is involved early and continuously in decision making. When department leadership and staff work together to promote the use of performance management practices, it is easier to achieve an integrated performance management system. Keeping top-down and bottom-up dialogue alive reinforces the importance of organizational excellence inherent in a fully functioning and completely integrated performance management system.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Health department leadership and management supportive and engaged in establishing and/ or updating a performance management system

1. The health department must document the health department leadership’s engagement in setting a policy for and/or establishing a performance management system for the department.

Documentation could be, for example, strategic and operational plans; training agendas, training programs, meeting agendas, packets, materials and minutes; draft policies or items discussed with the governing entity, and/or presentations to the governing entity.

Documentation may include minutes of team meetings, quality council monthly reports, and final reports from teams showing results achieved.

2 examples 5 years

2. Health department staff at all other levels engaged in establishing and/or updating a performance management system

2. The health department must document engagement of staff at all levels of the department in determining the nature of a performance management system for the department and implementing the system.

Documentation could be, for example, meeting agendas, packets, materials, and minutes; orientation presentations/programs for new personnel; health department meeting materials and operational plans.

2 examples 5 years

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Standard 9.1: Use a performance management system to monitor achievement of organizational objectives.

MEASURE PURPOSE SIGNIFICANCE Measure 9.1.2 A Performance management policy/ system

The purpose of this measure is to assess the health department’s adoption of a department- wide performance management system.

A performance management system encompasses all aspects of using objectives and measurement to evaluate performance of programs, policies, and processes, and achievement of outcome targets. An adopted performance management system communicates across the department how the department will (1) ensure that goals are being met consistently in an effective and efficient manner and (2) identify the need to improve organizational results.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. An adopted performance management system

1. The health department must provide a written description of the department’s adopted performance management system that includes:

a. Performance standards, including goals, targets and indicators, and the communication of expectations;

b. Performance measurement including data systems and collection;

c. Progress reporting including analysis of data, communication of analysis results, and a regular reporting cycle; and

d. A process to use data analysis and manage change for quality improvement and towards creating a learning organization.

1 performance management system

5 years

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Standard 9.1: Use a performance management system to monitor achievement of organizational objectives.

MEASURE PURPOSE SIGNIFICANCE Measure 9.1.3 A Implemented performance management system

The purpose of this measure is to assess the health department’s management practices for assessing performance and identifying and managing opportunities for improvement.

A performance management system ensures that progress is being made toward department goals and allows the department to identify areas for quality improvement.

Assessing current capability helps identify objectives in a structured way. There are a variety of performance management system models to assess and manage performance and identify opportunities for improvement.

Formal, fully functioning, integrated performance management systems are feasible in every health department, yet health departments may be using only some components of a performance management system. Identifying the performance management practices being used will help determine the extent to which components of a performance management system exist and which components need to be developed.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. A functioning performance management committee or team

1. The health department must provide documentation of a department committee, team, council, executive team, or some other entity that is responsible for implementing the performance management system. This does not have to be a separate group that deals only with performance management but may be a function of a standing department committee.

Documentation could be, for example, a charter, agendas, minutes, reports, or protocols of the subsidiary body responsible.

1 example 5 years

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2. Goals and objectives

2. The health department must document setting of goals and objectives with the identified time frames for measurement.

Examples of administrative areas where performance management might be appropriate include contract management (e.g., looking at the contract approval process or how contracts are tracked for compliance), vital records (e.g., processing birth and death certificates or evaluating their accuracy), human resources functions (e.g., the performance appraisal system), staff professional development (e.g., effectiveness of the professional development process), workforce development (e.g., appropriateness of employee wellness program), or financial management system (e.g., the financial data development, analysis, and communication process).

Documentation could be provided in narrative, table, or graphic form, depending on the chosen reporting method.

2 examples; one example must be from a programmatic area and the other from an administrative area.

5 years

3. Implementation of the process for monitoring the performance of goals and objectives

3. The health department must document the monitoring of performance towards the two objectives cited above.

Documentation could be, for example, from run charts, dashboards, histograms, data reports, monitoring logs, or other statistical tracking forms demonstrating analysis or progress in achieving measures; or meeting minutes from a quality team.

2 examples 5 years

4. Analysis of progress toward achieving goals and objectives and identification of areas in need of focused improvement processes

4. The health department must document that performance of the two objectives identified in 2) above was analyzed according to the time frames. Evidence for determining opportunities for improvement can be shown through the use of tools and techniques, for example, root cause analysis, cause and effect/Fishbone; or interrelationship digraphs or other analytical tools.

2 examples 5 years

5. Identification of results and next steps

5. The health department must document that performance results, opportunities for improvement, and next steps for the identified goals and corresponding objectives were documented and reported.

2 examples 5 years

MEASURE 9.1.3 A, continued

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6. A completed performance management self- assessment

6. The health department must provide a completed performance management self-assessment that reflects the extent to which performance management practices are being used.

The health department may develop its own performance management assessment or use existing models, such as The Public Health Performance Management Self-Assessment Tool (http://www.phf.org) or the Self-assessment tools available through the Baldrige Performance Excellence Program (http://www.nist.gov/baldrige/enter/self.cfm).

1 self- assessment

5 years

MEASURE 9.1.3 A, continued

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Standard 9.1: Use a performance management system to monitor achievement of organizational objectives.

MEASURE PURPOSE SIGNIFICANCE Measure 9.1.4 A Implemented systematic process for assessing customer satisfaction with health department services

The purpose of this measure is to assess the health department’s process for measuring the quality of customer relationships and service.

Customer focus is a key part of an organization’s performance management system. To evaluate the effectiveness and efficiency of the health department’s work, it is essential to identify customers and stakeholders, both internal and external. A health department also needs a process to capture and analyze customer feedback in order to address the expectations of various public health customers.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Collection, analysis, and conclusions of feedback from two different customer groups

1. Using a broad, customer/stakeholder identification list developed as part of a strategic planning or health improvement planning process, the health department must document how customer/stakeholder feedback was collected, analyzed, and conclusions drawn from two different types of customers (e.g., vital statistics customers; food establishment operators; individuals receiving population immunizations, population screenings, or other services; partners and contractors; elected officials, etc.). Special effort to address those who have a language barrier, are disabled, or are otherwise disenfranchised must be included.

Examples of instruments to collect customer/stakeholder satisfaction include forms, surveys, focus groups, or other methods.

Documentation could be a report, memo, or other written document that describes the process and the results and conclusions of the analysis of the feedback.

2 examples

Customers must be from two different programs

5 years

2. Results and actions taken based on customer feedback

2. The health department must document results and action taken based on the collection, analysis, and conclusions drawn from feedback from customer groups.

Documentation must relate to the examples in Required Documentation above.

2 examples 5 years

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DOMAIN 10DOMAIN 9

Standard 9.1: Use a performance management system to monitor achievement of organizational objectives.

MEASURE PURPOSE SIGNIFICANCE Measure 9.1.5 A Opportunities provided to staff for involvement in the department’s performance management

The purpose of this measure is to assess the health department’s support to expand and enhance performance management capacity in the department.

For a health department to be effective in establishing and implementing a performance management system, the staff must understand what a performance management system is and how evaluation integrates with performance management. The department needs to ensure staff competence in the appropriate use of tools and techniques for monitoring and analyzing objectives and indicators.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Staff development in performance management

1. The health department must document its staff professional development in the area of performance management. At a minimum, targeted staff includes those who will be directly working on performance measure monitoring and analysis, and/or serving on a quality team that assesses the department’s implementation of performance management practices and/or system.

Documentation could be, for example, training attendance rosters, training curricula and objectives, presentations, participation in webinars, and other training materials, or specific work with consultants or technical assistants in performance management.

2 examples 5 years

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Standard 9.1: Use a performance management system to monitor achievement of organizational objectives.

MEASURE PURPOSE SIGNIFICANCE Measure 9.1.6 S Technical assistance and/ or training provided on performance management to Tribal and local health departments

The purpose of this measure is to assess the state health department’s capacity to provide performance management orientation/training, evaluation training, and/or technical assistance to Tribal and local health departments.

State health departments have internal capacity or access to performance management and evaluation expertise to assist Tribal and local health departments in building or enhancing their performance management and evaluation capacity. States have an opportunity to share their expertise and best practice experiences with Tribal and local partners and create conditions in which the state’s population benefits from locally improved processes, programs, and interventions.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Provision of technical assistance about performance management systems

1. The state health department must document that it has offered technical assistance and/or training in performance management practices, methods, and/or tools to Tribal and local health departments. The technical assistance can be provided “as requested,” or can be scheduled, or provided as needed. It can be delivered by in-person sessions, webinars, individual studies, hard copy, or on-line. The technical assistance does not have to be used by Tribal or local health departments, but must be made available.

Documentation could be, for example, attendance rosters, curricula, presentations, exercises to apply tools and techniques, newsletters, briefing papers, e-newsletters, email notification, or flyer or brochure distribution.

2 examples 5 years

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DOMAIN 10DOMAIN 9

Performance management system concepts and practices serve as the framework to set targets, measure progress, report on progress, and make quality improvements. An important component of the performance management system is the implementation of a quality improvement program. This effort involves integration of a quality improvement component into staff training, organizational structures, processes, services, and activities. It requires application of an improvement model and the ongoing use of quality improvement tools and techniques to improve the public’s health. Performance management leads to the application of quality improvement processes.

Quality improvement is the result of leadership support. It requires staff commitment at all levels within an organization to infuse quality improvement into public health practice and operations. It also involves regular use of quality improvement approaches, methods, tools, and techniques, as well as application of lessons learned from evaluation.

STANDARD 9.2: Develop and implement quality improvement processes integrated into organizational practice, programs, processes, and interventions.

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Standard 9.2: Develop and implement quality improvement processes integrated into organizational practice, programs, processes, and interventions.

MEASURE PURPOSE SIGNIFICANCE Measure 9.2.1 A Established quality improvement program based on organizational policies and direction

The purpose of this measure is to assess the health department’s efforts to develop a quality improvement program that is integrated into all programmatic and operational aspects of the organization.

To make and sustain quality improvement gains, a sound quality improvement infrastructure is needed. Part of creating this infrastructure involves writing, updating, and implementing a health department quality improvement plan. This plan is guided by the health department’s policies and strategic direction found in its mission and vision statements, in its strategic plan, and in its health improvement plan.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. A written quality improvement plan

1. The health department must provide a quality improvement plan. The plan must address:

• Key quality terms to create a common vocabulary and a clear, consistent message.

• Culture of quality and the desired future state of quality in the organization.

• Key elements of the quality improvement effort’s structure, for example:

-- Organization structure

-- Membership and rotation

-- Roles and responsibilities

-- Staffing and administrative support

-- Budget and resource allocation

• Types of quality improvement training available and conducted within the organization for example:

-- New employee orientation presentation materials

-- Introductory online course for all staff

1 plan 5 years

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-- Advanced training for lead QI staff

-- Continuing staff training on QI

-- Other training as needed – position-specific QI training (MCH, Epidemiology, infection control, etc.)

• Project identification, alignment with strategic plan and initiation process:

-- Describe and demonstrate how improvement areas are identified and how they are prioritized for project activity

-- Describe and demonstrate how the improvement projects align with the health department’s strategic vision/mission

• Quality improvement goals, objectives, and measures with time-framed targets:

-- Define the performance measures to be achieved.

-- For each objective in the plan, list the person(s) responsible (an individual or team) and time frames associated with targets

-- Identify the activities or projects associated with each objective.

• The health department’s approach to how the quality improvement plan is monitored: data are collected and analyzed, progress reported toward achieving stated goals and objectives, and actions taken to make improvements based on progress reports and ongoing data monitoring and analysis.

• Regular communication of quality improvement activities conducted in the health department through such mechanisms as:

-- Quality electronic newsletter

-- Story board displayed publicly

-- Board of Health meeting minutes

-- Quality Council meeting minutes

-- Staff meeting updates

MEASURE 9.2.1 A, continued

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• Process to assess the effectiveness of the quality improvement plan and activities, which may include:

-- Review of the process and the progress toward achieving goals and objectives

-- Efficiencies and effectiveness obtained and lessons learned

-- Customer/stakeholder satisfaction with services and programs

-- Description of how reports on progress were used to revise and update the quality improvement plan.

MEASURE 9.2.1 A, continued

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Standard 9.2: Develop and implement quality improvement processes integrated into organizational practice, programs, processes, and interventions.

MEASURE PURPOSE SIGNIFICANCE Measure 9.2.2 A Implemented quality improvement activities

The purpose of this measure is to assess the health department’s use of quality improvement to improve processes, programs, and interventions.

It takes practice to effectively use the quality improvement plan to improve processes, programs, and interventions. Staff benefit from seeing the plan put into action and receiving regular feedback on progress toward achieving stated objectives, as well as on how well they have executed their respective roles and responsibilities.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Quality improvement activities based on the QI plan

1. The health department must document implementation of quality improvement activities and the health department’s application of its process improvement model. Examples must demonstrate:

• how staff problem-solved and planned the improvement,

• how staff selected the problem/process to address and described the improvement opportunity,

• how they described the current process surrounding the identified improvement opportunity,

• how they determined all possible causes of the problem and agreed on contributing factors and root cause(s),

• how they developed a solution and action plan, including time-framed targets for improvement,

• what the staff did to implement the solution or process change, and

• how staff reviewed and evaluated the result of the change, and how they reflected and acted on what they learned.

2 examples; one example must be from a program area and the other from an administrative area.

5 years

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Documentation must demonstrate ongoing use of an improvement model, including showing the tools and techniques used during application of the process improvement model. Documentation must also describe: actions taken, improvement practices and interventions, data collection tools and analysis, progress reports, evaluation methods, and other activities and products that resulted from implementation of the plan.

Documentation could be, for example, quality improvement project work plans or storyboards that identify achievement of objectives and include evidence of action and follow-up.

2. Staff participation in quality improvement activities based on the QI plan

2. The health department must document how staff were involved in the implementation of the plan, worked on improvement interventions or projects, and/or served on a quality team that oversees the health department’s improvement efforts.

Documentation could be, for example minutes, memos, reports, or committee or project responsibilities listings.

2 examples 5 years

MEASURE 9.2.2 A, continued

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Domain 10 focuses on the role that health departments play in building and advancing the science of public health. Public health is strengthened when its practitioners continually add to the body of evidence for promising practices -- those practices that have the potential to become evidence-based over time. Health departments should employ evidence-based practices for increased effectiveness and credibility. Health departments also have important roles in developing new evidence. Health departments should apply innovation and creativity in providing public health services appropriate for the populations they serve.

DOMAIN 10 INCLUDES TWO STANDARDS:

Standard 10.1: Identify and Use the Best Available Evidence for Making Informed Public Health Practice Decisions

Standard 10.2: Promote Understanding and Use of the Current Body of Research Results, Evaluations, and Evidence-based Practices with Appropriate Audiences

Domain 10: Contribute to and Apply the Evidence Base of Public Health

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Public health evidence-based practice requires that a health department use the best available evidence in making decisions and in ensuring the effectiveness of processes, programs, and interventions. Evidence-based practice assures that a health department’s resources are being used in the most effective manner. Health departments should access information about evidence-based practices and apply that information to their processes, programs, and interventions.

STANDARD 10.1: Identify and use the best available evidence for making informed public health practice decisions.

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Standard 10.1: Identify and use the best available evidence for making informed public health practice decisions.

MEASURE PURPOSE SIGNIFICANCE Measure 10.1.1 A Applicable evidence- based and/or promising practices identified and used when implementing new or revised processes, programs, and/or interventions

The purpose of this measure is to assess the health department’s use of evidence-based and/or promising practices in its design of new process, programs, or interventions or in revisions of programs.

It is important that public health efforts have the maximum positive impact possible. Evidence-based practices have been evaluated or researched and have been found to be effective.

Health departments should be aware of practices that are evidence-based and incorporate them into their processes, programs, and interventions, as appropriate. Evidence-based practice ensures that health department resources are being applied effectively. Promising public health practices also have the potential for evaluation and designation as evidence-based.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. The use of evidence-based or promising practices, including:

a. Documentation of the source of the evidence-based or promising practice

1. The health department must document the incorporation of an evidence- based or promising practice in a public health process, program, or intervention.

a. The health department must document the source of the information concerning the evidence-based or promising practice. The source of the practice could be (1) The Guide to Community Preventive Services, (2) an Initiative listed in the NACCHO Model Practices Database, (3) the result of an information search (web, library, literary review), or (4) result of interaction with consultants, academic faculty, researchers, other health departments, or other experts.

2 examples; examples must come from two different program areas, one of which is a chronic disease program or program that seeks to prevent chronic disease.

3 years

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b. Documentation of how the evidence-based or promising practice was incorporated into the design of a new or revised process, program, or intervention

b. The health department must provide a description of how the evidence-based or promising practice identified in (a) above was incorporated into the design of a new or revised process, program, or intervention. Incorporation of the evidence- based or promising practice must be appropriate to the particular group or community or it must be modified to be appropriate.

Documentation could be, for example, internal memos, annual reports, program descriptions in public information (reports, newsletters), or other program descriptions written by the department.

Due to the limited availability of evidenced-based practices or promising practices in Tribal communities, Tribal health departments may provide documentation of how evidence-based practices or promising practices have been adapted to integrate cultural values, beliefs, and traditional healing practices of the Tribe.

MEASURE 10.1.1 A, continued

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Standard 10.1: Identify and use the best available evidence for making informed public health practice decisions.

MEASURE PURPOSE SIGNIFICANCE Measure 10.1.2 T/S Fostered innovation in practice and research

The purpose of this measure is to assess the Tribal or state health department’s efforts to promote and support innovations in public health practice and research.

Public health addresses complex, multi- sectorial problems that are changing as rapidly as our social, cultural, and technological environment is changing. The need for innovation in public health practice and research is more urgent, given the increasingly rapid pace of change in the environment that affects the public’s health.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Relationships with academic institutions, research centers/ institutes

1. The Tribal or state health department must document that it has a working relationship with academic institutions, research centers/institutes, and/or Tribal organizations and Tribal Epidemiology Centers.

In some cases, the relationship may be a formal relationship that can be documented by a contract or a MOA/MOU. In other cases, the working relationship may be less formal. In those cases, documentation can be, for example, meeting minutes, emails, or a meeting agenda that demonstrates collaboration with academic institutions and/ or research centers/institutes. Additionally, jointly written reports, white papers, and research studies could demonstrate collaboration with academic institutions and/or research centers/institutes.

2 examples 5 years

2. Participation in research agenda-setting, practice- based research networks, or other research efforts

2. The Tribal or state health department must document that it is engaged with the work of the research community. The Tribal or state health department must demonstrate involvement of the community in the development of the research agenda.

Documentation could be, for example, membership in a practice-based research network, either with other states, institutions, or within the state. Community Based Participatory Research is a model that could be used.

For Tribal health departments, this may include the incorporation of practice-based evidence grounded in cultural values, beliefs, and traditional practices.

Documentation could be, for example, a membership list or meeting attendance roster. Documentation could also be meeting minutes or submission of IRB documentation showing participation in research (minutes, submission documentation).

2 examples 5 years

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Lack of communication or understanding between public health researchers and public health practitioners often exists. Gaps in understanding may also occur between the public health department and the general public. Communication can help bridge the areas where understanding is lacking and can strengthen the relationship and trust among researchers, public health practitioners, and the public. Communication between public health practitioners and the public, governing entities, and other audiences could encourage others to become advocates for research and to contribute to the science of public health. Health departments should encourage the use of research results, evaluations, and evidence-based practices.

STANDARD 10.2: Promote understanding and use of the current body of research results, evaluations, and evidence-based practices with appropriate audiences.

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Standard 10.2: Promote understanding and use of the current body of research results, evaluations, and evidence-based practices with appropriate audiences.

MEASURE PURPOSE SIGNIFICANCE Measure 10.2.1 A Protection of human subjects when the health department is involved in or supports research activities

The purpose of this measure is to assess the health department’s policies and practices for the protection of human subjects in research in which it is involved.

Many public health studies involve recipients of public health services or public health staff. Institutions that receive government funds for research are required to have the research that involves human subjects approved by a registered institutional review board (IRB) to ensure the ethical treatment of human subjects. Ethical treatment of human subjects is a basic value of public health research and programs. Appropriate efforts must be made to protect the rights, welfare, and well-being of subjects involved in research.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. An adopted human subjects research protection policy

1. The health department must provide a copy of a policy regarding research, such as an IRB review policy. If the health department does not have its own internal IRB process, the health department must have a copy of the IRB approval from the institution where the IRB review was done. If the health department does not currently engage in research that involves human subjects, a statement to that effect could be accepted as documentation.

Documentation for a Tribal health department could be a Tribal policy or protocol that describes the process for research review and approval by the Tribal Council, Health Oversight Committee, or other body or authority.

1 policy 5 years

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Standard 10.2: Promote understanding and use of the current body of research results, evaluations, and evidence-based practices with appropriate audiences.

MEASURE PURPOSE SIGNIFICANCE Measure 10.2.2 A Access to expertise to analyze current research and its public health implications

The purpose of this measure is to assess the health department’s ability to review and interpret research findings.

Health departments must have the internal capacity for, or ability to access, expert review and interpretation of research findings. Interpreting research findings is important when communicating the public health implications of those findings to stakeholders, partners, and the public. It is also important when incorporating research findings into department processes, programs, or interventions.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. The availability of expertise (internal or external) for analysis of research

1. The health department must document that it has expert staff or access to outside experts who can analyze research and its public health implications.

This measure includes analysis of the current body of research relevant to public health practice, irrespective of whether or not the research was conducted in the Tribe, state, or community.

Documentation could be, for example, a list of experts and a description of their training or expertise. The expertise may be within the department or may reside outside the health department, for example, an academic institution, research center, Tribal epidemiology center, public health institute, or consultant. If the expertise is outside of the health department, the health department must show a written agreement (contract, MOA/MOU, etc.) that demonstrates access to such expertise.

2 examples or one list

5 years

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Standard 10.2: Promote understanding and use of the current body of research results, evaluations, and evidence-based practices with appropriate audiences.

MEASURE PURPOSE SIGNIFICANCE Measure 10.2.3 A Communicated research findings, including public health implications

The purpose of this measure is to assess the health department’s efforts to keep others, both within and outside the public health profession, informed about the findings of public health research and the public health implications of those findings.

Public health research provides the knowledge and tools that people and communities need to protect their health. However, research findings can be confusing and difficult to translate into knowledge that steers action toward improved public health. Health departments can communicate the facts and implications of research so that individuals and organizations are informed and knowledgeable, and can act accordingly.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. The communication of research findings and their public health implications to stakeholders, public health system partners, and/or the public

1. The health department must document the provision of communication through which the department conveyed research findings and their public health implications to stakeholders, other health departments, members of the public health system and non-public health system partners, and/or the public.

Appropriate audiences could include: the health department’s governing entity; elected/appointed officials; agencies, departments, or organizations that collaborate with the health department in the delivery of services; community and healthcare partners; and the general public. Audiences would be especially appropriate if involved in or affected by the research. Community Based Participatory Research is an example of an approach that could be used.

Research referred to is research conducted and published by others, outside of the health department. The research must have been evaluated by experts to provide valid implications, for example, peer-review for publication in journals.

The state health department distribution list of research findings must include the Tribal and local health departments in the state.

The local health department distribution list of research findings must include the state health department and Tribal health department(s) in the state with which the local health department coordinates.

2 examples 5 years

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The Tribal health department distribution list of research findings must include the state and local health department(s) in the state with which the Tribal health departments coordinates.

Documentation could be, for example, a presentation, prepared report, discussion at a meeting recorded in the minutes, web posting, email list-serve, newspaper article, webinar, or press release.

MEASURE 10.2.3 A, continued

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Standard 10.2: Promote understanding and use of the current body of research results, evaluations, and evidence-based practices with appropriate audiences.

MEASURE PURPOSE SIGNIFICANCE Measure 10.2.4 S Consultation or technical assistance provided to Tribal and local health departments and other public health system partners in applying relevant research results, evidence-based and/or promising practices

The purpose of this measure to assess the state health department’s provision of assistance to Tribal and local health departments on the application of relevant research results and evidence-based/ promising practices.

Scientifically sound public health practices are essential for public health interventions to be effective. Public health practices are continually being researched and tested, and new findings are being made available to the field. State health departments should share their knowledge and expertise concerning research findings and evidence-based or promising practices with Tribal and local health departments in their state. State health departments can provide consultation or technical assistance on employing research and modifying practices to best suit the population served by the Tribal or local health department.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Provision of consultation or technical assistance to Tribal and/or local health departments, and/or other public health system organizations in applying relevant research, evidence- based, and/or promising practices

1. The state health department must document how it has provided consultation, technical assistance, advice, direction, or guidance to Tribal and/or local health departments and/or members of the public health system in the application of relevant research, evidence-based, and/or promising practices. This assistance must be specific to the application of relevant research results or the employment of evidence-based and/or promising practices. This assistance can be provided to local health departments, Tribal health departments in the state, or other partners or stakeholders.

The state health department cannot use examples of providing assistance to program divisions within the state health department.

2 examples 5 years

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Standard 10.2: Promote understanding and use of the current body of research results, evaluations, and evidence-based practices with appropriate audiences.

MEASURE PURPOSE SIGNIFICANCE Measure 10.2.4 T Technical assistance provided to the state health department, local health departments, and other public health system partners in applying relevant research results, evidence-based and/ or promising practices

The purpose of this measure to assess the Tribal health department’s provision of assistance to the state and local health departments and other Tribal health departments on the application of relevant research results and evidence-based/ promising practices.

Scientifically sound public health practices are essential for public health interventions to be effective. Public health practices are continually being researched and tested, and new findings are being made available to the field. Tribal health departments should share their knowledge and expertise on research findings and evidence-based or promising practices with state and local health departments, other Tribal health departments, and/or Tribal organizations. Tribal health departments can provide consultation or technical assistance on employing research and modifying practices to best suit the population being served. Tribal health departments should share with state and local health departments their knowledge and expertise on research methods that are culturally relevant or appropriate approaches to applying research in Tribal communities.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Provision of consultation or technical assistance to state and/or local health departments, other Tribal health departments, and/or Tribal organizations in applying relevant research, evidence- based, promising practices, and/ or practice-based evidence

1. The Tribal health department must document the provision of consultation, technical assistance, advice, direction, or guidance to others in the application of relevant research or evidence- based, promising practices, and/or practice-based evidence. This assistance must be specific to the application of relevant research results or the employment of evidence-based and/or promising practices. This assistance can be provided to the state health department, local health departments, other Tribal health departments or Tribal organizations in the state, or other partners or stakeholders.

Examples of technical assistance provided by the Tribe may be done together with a federal partner, such as IHS, a Tribal Epidemiology Center, or other Tribal department. The Tribal health department cannot use examples of providing assistance to itself, such as to program divisions within the Tribal health department.

2 examples 5 years

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Domain 11 focuses on health department management and administration capacity. Organizational administration and management is the process of organizing, leading, and controlling the efforts of organizational human and other resources to make decisions and achieve organizational goals. Health departments must have a well-managed human resources system, be competent in general financial management, have data management capacity and capability, and be knowledgeable about public health authorities and mandates. And, because of the nature of public health – the focus on the collective good, the employment of government action, and the objective of population-based outcomes – public health leaders need an infrastructure to ensure that decisions, policies, plans, and programs are ethical and address health equity. Health department leaders and staff must be knowledgeable about the structure, organization, and financing of their public health department and other agencies and organizations that provide public health services.

DOMAIN 11 INCLUDES TWO STANDARDS:

Standard 11.1: Develop and Maintain an Operational Infrastructure to Support the Performance of Public Health Functions

Standard 11.2: Establish Effective Financial Management Systems

Domain 11: Maintain Administrative and Management Capacity

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A strong operational infrastructure is necessary in order to administer public health services efficiently and effectively to meet the needs of the population. By maintaining a strong organizational infrastructure, the health department can assess and improve its operations, staffing, and program support systems.

STANDARD 11.1: Develop and maintain an operational infrastructure to support the performance of public health functions.

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Standard 11.1: Develop and maintain an operational infrastructure to support the performance of public health functions.

MEASURE PURPOSE SIGNIFICANCE Measure 11.1.1 A Policies and procedures regarding health department operations, reviewed regularly, and accessible to staff

The purpose of this measure is to assess the health department’s processes for maintaining policies and procedures, which includes developing, writing, reviewing, revising, training, and sharing health department policy and procedures with staff. This measure focuses on health department policies that direct organizational operations, not programs and program guidelines.

Standardized written policies and procedures are needed to operate an organization efficiently and effectively. Regular review and revision of those policies and procedures is important for continuous quality improvement. Staff needs to have ready access to policies and procedures to be informed of organizational and operations expectations.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Policy and procedure manual or individual policies

1. The health department must provide written operations policies/ procedures. This could be one manual or a group of policies.

These are operations policies, not human resource policies, which are addressed in Measure 11.1.5. Policies could address these topics, for example, records retention and back-up procedures, reimbursement, invoicing, emergency/ evacuation, events planning, procurement of office supplies, facilities operations, use of department equipment (including phones and internet), use of department vehicles, tobacco use, recycling, scheduling the use of meeting rooms, the development of policies that includes who needs to sign what types of policies and how often they are reviewed, and any policies and procedures that concern the operations of the department.

The policies can be provided to staff in paper form, on a central computer file, or a link to an electronic format. If electronic, the policies can be files on a server or postings on the web. If the policies are voluminous, the health department may provide a Table of Contents or list of policies.

1 Manual or, if a Table of Contents or list is provided, 2 example policies are also required.

5 years

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Only the most recent version of policies must be provided. Some health departments may use policies and procedures that are not specific to the health department, but are government-wide (i.e., state, city or county) or relate to a larger super-health agency or umbrella agency. These policies and procedures could demonstrate compliance with the measure if they apply to the health department as well as other government agencies.

2. Health department organizational chart

2. The health department must provide its health department organizational chart. If the health department is part of a super-agency or umbrella agency, and some of the documentation provided is from other divisions within the umbrella agency, then an organizational chart showing the health department’s relationship with the other divisions is also required.

The health department’s organizational chart must show leadership, upper management positions, and the organization of programs. It need not detail every staff person. Position titles or program names are required; individuals’ names are not required.

If changes are made to the organizational chart between the submission of documentation to PHAB and the site visit, the health department must submit a copy of the revised chart to the site visit team. NOTE: This and the budget are the only two instance where information may be changed or updated between the submission of the health department’s documents to PHAB and the time of the site visit.

1 organiza- tional chart

2 years

3. Review of policies and procedures

3. The health department must document the review of policies and procedures. The original policies and procedures may have been in place for many years; official dates of policy revisions demonstrate that a review has been conducted within the last five years.

Documentation could be policies that were adopted longer than 5 years ago but that have been reviewed, revised, and signed off on by the health department within the last five years.

2 examples 5 years

4. Methods for staff access to policies

4. The health department must document how staff access policies. Access methods can include for example, the website; health department intranet; server access; or paper copy distributed to staff, available from supervisors, or located in central locations.

1 example 5 years

MEASURE 11.1.1 A, continued

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Standard 11.1: Develop and maintain an operational infrastructure to support the performance of public health functions.

MEASURE PURPOSE SIGNIFICANCE Measure 11.1.2 A Ethical issues identified and ethical decisions made

The purpose of this measure is to assess the health department’s policies and process for the identification and resolution of ethical issues that arise from the department’s program, policies, interventions, or employee/ employer relations.

Efforts to achieve the goal of protecting and promoting the public’s health have inherent ethical challenges. Employer/employees relations may also raise ethical issues. Understanding the ethical dimensions of policies and decisions is important for the provision of effective public health and public health management. Defining and addressing ethical issues should be handled through an explicit, rigorous, and standard manner that uses critical reasoning.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Strategies for decision making relative to ethical issues

1. The health department must document the identification of issues with ethical considerations and a strategic deliberative process for consideration and resolution of ethical issues. The policies and procedures must set forth a transparent process that provides an opportunity for input from affected stakeholders and considers their interests. The policies and procedures must provide for the consideration of the best evidence available. There must be opportunities to evaluate decisions as new information becomes available and there must be a provision for accountability of the decision makers.

Examples of a process include the adoption of the Public Health Code of Ethics, the establishment of an ethics board, the designation of a committee or process of the governing entity, or other process.

1 process or set of policies and procedures

5 years

2. Ethical issues reviewed and resolved

2. The health department must document the consideration, deliberation, and resolution of ethical issues.

Examples of ethical issues include, for example, privately constructed sewers, distribution of vaccine in a shortage situation, staff mandatory immunizations, an employee’s use of social media, an employee’s acceptance of gifts.

1 example 5 years

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Standard 11.1: Develop and maintain an operational infrastructure to support the performance of public health functions.

MEASURE PURPOSE SIGNIFICANCE Measure 11.1.3 A Policies regarding confidentiality, including applicable HIPAA requirements

The purpose of this measure is to assess how the health department protects customer confidentiality.

It is critical that health departments and the individuals who work in them maintain customer confidentiality and protect client health information. Lack of attention to confidentiality policies and their implementation can lead to violations of confidentiality. This creates liability to the health department and lessens credibility.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Confidentiality policies

1. The health department must provide written confidentiality policies and procedures. Policies must define the health department’s processes for protecting customer confidentiality, both personal (directed toward the individual) and informational (directed at their health data and records). This may include policies concerning such processes as clinical protocols, staff access to records, computer use, business associate agreements, and electronic transfer of data.

Policies may be maintained as either a paper copy or in an electronic format. If electronic, the policies can be files on a server or posted on the web. Some health departments may use confidentiality policies and procedures that are not specific to the health department, but are government-wide (i.e., state, city or county) or relate to a larger super-health agency or umbrella agency.

1 policy or a set of policies

5 years

2. Training staff on the implementation of confidentiality policies

2. The health department must document that staff has been trained on confidentiality policies, including training content and names of those who received the training.

Documentation could be, for example, a copy of training materials and an agenda for the training session – whether group or individual.

The health department must have a record of who attended the training. Documentation could also be a log, a sign-in sheet or a record/statement from web-based training.

2 examples of training

5 years

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3. Signed employee confidentiality form, as required by policies

3. The health department must provide a confidentiality form or agreement that is signed by employees. Through this form, staff will acknowledge their responsibilities for protecting confidentiality. The health department can submit a copy of the form. Do not submit copies of every employee-signed form; a log or other tracking mechanism showing that employees have signed the form is sufficient.

1 form and 1 example of a tracking form or log

5 years

MEASURE 11.1.3 A, continued

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Standard 11.1: Develop and maintain an operational infrastructure to support the performance of public health functions.

MEASURE PURPOSE SIGNIFICANCE Measure 11.1.4 A Policies, processes, programs, and interventions provided that are socially, culturally, and linguistically appropriate to specific populations with higher health risks and poorer health outcomes.

The purpose of this measure is to assess the health department’s social, cultural, and linguistic competence in providing public health programs to specific populations with higher health risks and poorer health outcomes.

Public health departments are responsible for all residents in the health department’s jurisdiction, and that usually includes people of various backgrounds, languages, and cultures. It is important for health departments to understand how values, norms, and traditions of the populations served affect how individuals perceive, think about, and make judgments about health, health behaviors, and public health services. Those values, norms, and traditions affect how populations interact with public health workers, how open they are to health information and health education, and how they can change health behaviors.

Ensuring that the health department’s policies, programs, services, materials, and processes address these social, cultural, and language differences (including low literacy, non-English speaking populations, and the visually or hearing impaired) will enhance the health department’s ability to provide the most effective programs and services to meet the needs of the population.

Ensuring that the health department’s policies, programs, services, materials, and processes intentionally address health disparities and health inequities will enhance the health department’s ability to impact the health of the population.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Policy or procedure for the development of interventions and materials that address areas of health inequity among the specific populations and are culturally and linguistically appropriate for the population the health department serves in its jurisdiction

1. The health department must provide a policy or procedure that demonstrates how health equity is incorporated as a goal into the development of policies, processes, and programs. A policy or procedure must ensure that social, cultural, and linguistic characteristics of the various populations groups of the population it serves are incorporated into processes, programs, and interventions. Characteristics of populations addressed in the policy or procedure may include social, racial, ethnic, cultural, sexual orientation and gender identity, linguistic characteristics, including non-English speaking populations, and the disabled.

1 policy or procedure

5 years

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2. Processes, programs, or interventions provided in a culturally or linguistically competent manner

2. The health department must document the provisions of processes, programs, or interventions that are culturally or linguistically appropriate, as defined above.

Oral communication is integral to many Tribal cultures. If oral communication is used to ensure that programs, processes, and interventions are culturally competent, the health department must provide documentation of its use, for example, plans, protocols, or objectives for focus groups, community gatherings, roundtables, talking circles, digital storytelling, or other activities. Tribal health departments may serve Tribal members from more than one Tribe or non-Tribal individuals. If this is the case, examples of culturally and linguistically competent services provided to these groups. (e.g., interpretation, materials in other languages) are acceptable documentation.

2 examples; The two examples must come from two different program areas of the health department

5 years

3. Assessment of the health department’s cultural competence and knowledge of health equity

3. The health department must provide an assessment of cultural and linguistic competence. This could be, for example, the Cultural and Linguistic Competency Policy (CLCPA) self-assessment from the National Center for Cultural Competence, assessment against Culturally and Linguistically Appropriate Services (CLAS) standards, Health Equity at Work: Skills Assessment of Public Health, or another assessment tool.

1 example 5 years

4. Health equity and cultural competency training provided to health department staff

4. The health department must document staff training on health equity and cultural competence, including social, cultural, and/or linguistic aspects of policies, processes and programs. Training may include: examining biases and prejudices; developing cross-cultural skills; learning about specific populations’ values, norms, and traditions; and/or learning about how to develop programs and materials for low literacy individuals or the visually or hearing impaired. Documentation must show the content of the training.

The health department must provide a record of who attended the training. This may be a log, a sign-in sheet, or a record/statement from web-based training. An example of training includes the Prevention Institute’s Health Equity Training Series.

Documentation could be, for example, a copy of the training materials or an agenda for the training session as well as a sign-in sheet or attendance list.

1 example 5 years

MEASURE 11.1.4 A, continued

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Standard 11.1: Develop and maintain an operational infrastructure to support the performance of public health functions.

MEASURE PURPOSE SIGNIFICANCE Measure 11.1.5 A A human resources function

The purpose of this measure is to assess the health department’s management of its human resources. A comprehensive human resource function may be fully contained within the health department or it may be located in its own governmental agency (for example, an office of management), in an office outside the health department, or may be implemented in a combination of ways. If the larger human resources system is outside of the health department, the health department still must perform human resources management functions, for example, ensuring that human resource policies are available to staff, keeping time sheets, managing leave, and conducting employees’ performance evaluations. A health department may also contract for certain human resource actions to an outside organization that specializes in human resource management functions.

A well-defined and structured human resources function is important for any organization. It provides the health department with the management processes to hire, manage, evaluate personnel, and improve personnel performance. A human resource function supports the health department, individual staff members, staff development, and the overall workplace environment.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Human resource (HR) policies and procedures

1. The health department must provide a human resource manual or set of policies and procedures. The policies and procedures must address all of the following:

• Employment and human resources legal requirements that pertain to the jurisdiction served by the health department (Tribal, state, and/or local);

• Personnel recruitment, selection, and appointment; • Employee confidentiality; • Equal opportunity employment; • Salary structure; • Hours of work; • Benefits package; • Performance evaluation process based on job/position descriptions and

individualized development plans; and • Problem solving and complaint handling, including sexual harassment.

Some health departments may use a human resource system that is not specific to the health department, but is government-wide (i.e., Tribe, state, city, or county).

1 set of HR policies and procedures

5 years

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The policies and procedures may not, therefore, be specific to only the health department but to all of city, county, state, or Tribal government. These policies and procedures could demonstrate compliance with the measure if they apply to the health department, as well as other government agencies.

Indian Preference Policies may be submitted in place of personnel selection and appointment and/or Equal Opportunity Employment policies. It may also be applicable that Tribal health departments provide MOAs for assignment of personnel [e.g., U.S. Public Health Service/Indian Health Service or other personal service contracts or agreement (PSA)].

2. Staff access to human resource policies and procedures

2. The health department must document how department staff access human resource policies and procedures.

Methods may include, for example, web-based, health department intranet, server access, or distribution of a hard copy that is available from supervisors or located in central locations.

1 example 5 years

3. Employment working relationship agreements

3. The health department must provide documents in use to establish working relationships.

Examples of documents used to establish working relationships include, for example, employment agreements, contract template, letter of employment template, contracts, or labor agreements (if appropriate).This does not include contracts for service.

1 example 5 years

4. A human resource function that supports management, the workforce, and workforce development by being a responsive partner to programs

4. The health department must document that the human resource function demonstrates a responsive partnership with management, programs, services, and staff to enable staff that provide public health programs, services, and products.

Documentation could be, for example, the human resource function and a program collaboratively resolving a human resource issue, human resource staff that are educated/experienced in public health (for the purpose of assessing workforce needs, enabling workforce development, and recruiting candidates for public health positions), human resource policies that support the public health program functions, and programs and the human resource function working together to develop policies and provide training and development.

2 examples 5 years

MEASURE 11.1.5 A, continued

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Standard 11.1: Develop and maintain an operational infrastructure to support the performance of public health functions.

MEASURE PURPOSE SIGNIFICANCE Measure 11.1.6 A Information management function that supports the health department’s mission and workforce by providing infrastructure for data storage, protection, and management; and data analysis and reporting

The purpose of this measure is to assess the health department’s capacity and capability to store, manage, protect, and utilize electronic information and data in order to provide relevant information for operational efficiency and informed decision making.

Effective public health decisions require accurate information and data. Health departments have access to a wealth of data, either created by the department or collected by others. To use data effectively, the health department must organize and process data in a manner to appropriately protect data and also make it available for decision making. The health department must maintain an information management system that provides the ability to store, protect, process, manage, analyze, utilize, and communicate information and data available from multiple sources.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Information technology infrastructure that supports public health functions

1. The health department must document that information technology supports public health and administrative functions of the department.

Documentation could be, for example, a scanning system to preserve records, a grant management system, vital records systems, program (such as WIC or immunization) information systems, licensing information systems, inspections and violations records, and on-line data services.

2 examples; The two examples must be from different areas. The health department may select the areas. They may be program and/or administrative areas.

5 years

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2. Secure information systems

2. The health department must document information vulnerability audits, security policies, and/or internal controls to ensure the privacy and security of information.

1 example 3 years

3. Maintenance of confidentiality of data

3. The health department must provide a policy that the department adheres to federal, state, and local privacy protection regulations for handling data.

1 policy 5 years

4. Maintenance of information management system

4. The health department must provide a written process for reviewing and developing information management business system requirements to guide systems changes and development.

1 example 5 years

5. Management of information assets

5. The health department must provide an inventory of data or data systems (either collected by the health department or by others) available to the health departments.

1 example 3 years

MEASURE 11.1.6 A, continued

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Standard 11.1: Develop and maintain an operational infrastructure to support the performance of public health functions.

MEASURE PURPOSE SIGNIFICANCE Measure 11.1.7 A Facilities that are clean, safe, accessible, and secure

The purpose of this measure is to assess the health department’s facilities for use by both staff and the public.

In order for the health department to implement processes, programs, and interventions, the facilities must be adequate. All facilities that are operated by the health department must be clean, safe, accessible, and secure for both staff and the public.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Licenses for laboratory

1. The health department must provide copies of licenses to meet national or state requirements appropriate for the laboratory services provided. Access to a laboratory that has Select Agent certification is required.

As needed 5 years

2. Inspection reports 2. The health department must provide examples of inspection reports, for example, OSHA, internal (department conducted), or external (an independent organization) inspection reports, cleaning and maintenance policies, logs, records, certificate of occupancy, contracts or orders. Other examples of documentation include environmental public health and safety committee meeting minutes and federal or Tribal environmental audits.

2 examples 5 years

3. Assurance of accessibility to the health department’s facilities

3. The health department must provide documentation that it is in compliance with Federal/state/local laws concerning accessibility.

PHAB will accept a copy of the ADA compliance report or the health department’s self-evaluation, as described by federal regulations. PHAB will accept documentation of compliance with ADA related Tribal, state, and/or local laws and regulations that pertain to the jurisdiction which the health department is authorized to serve. For health departments that may operate in buildings that are either exempt from the federal regulations or have waivers (such as buildings on the national register of historic buildings), PHAB requires documentation of the health department’s procedures to serve members of the public and health department staff who have physical disabilities, are sight impaired, or are hearing impaired.

1 example 5 years

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Sound financial practices are basic to any organization. They are required to manage resources wisely, to analyze present and future needs, to sustain operations, and demonstrate accountability. This standard measures the capacity of the health department to manage the organization’s finances.

STANDARD 11.2: Establish effective financial management system.

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Standard 11.2: Establish effective financial management system.

MEASURE PURPOSE SIGNIFICANCE Measure 11.2.1 A Financial and programmatic oversight of grants and contracts

The purpose of this measure is to assess the health department’s ability to manage grants and contracts and comply with external governmental funding requirements.

Health departments receive funding from a variety of sources. Each funding source has specific requirements for the use of the funds and for reporting to the funding agency. It is important that funds are used appropriately and legitimately and that the health department has systems for accountability.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Audited financial statements

1. The health department must provide regular (as defined by the health department) department-wide financial audit reports. Audits are formal examinations of the health department’s financial accounts. Audits are performed by external auditors.

The health department’s audit may be part of a large audit of the governmental unit (for example, umbrella agency, super agency, county government, or state government) of which the health department is a part.

2 examples Previous two fiscal years

2. Program reports 2. The health department must provide program reports that it has submitted to funding organizations.

Documentation could be, for example, compliance reports to federal funders, reports to legislatures or local city/county/Tribal councils, and reports to foundations. Monitoring reports or corrective action plans that show compliance with funding requirements are also acceptable. Contracts or agreements between state, local, and/or Tribal health departments to provide services may show the expectations for funding but might not show the compliance with funding agency requirements. If such contracts are used, they must be combined with follow-up reports that validate compliance.

2 examples 5 years

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3. Communications from federal or state funding agencies or organizations

3. The health department must provide any formal communications from state or federal funders that indicate the health department is a “high- risk grantee.”

Disclosure and documentation must be provided in the following types of instances: the department being put on manual draw-down; the department being put on a corrective action plan; placement on a ‘do not fund’ list; receivership status; and instances of malfeasance or misappropriations of funds.

Documentation could be letters or emails that officially and formally describe concerns from funding agencies (e.g., federal agencies, state health department funding to local health departments).

Documentation must also include a description of follow-up actions and internal controls that have occurred to remedy the situation.

If there have been no communications regarding “high-risk grantee” status, the health department director must provide a signed statement attesting to that fact.

All, as appropriate

5 years

MEASURE 11.2.1 A, continued

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Standard 11.2: Establish effective financial management system.

MEASURE PURPOSE SIGNIFICANCE Measure 11.2.2 A Written agreements with entities from which the health department purchases, or to which the health department delegates, services, processes, programs, and/or interventions

The purpose of this measure is to assess the health department’s management of agreements with other organizations to provide services, processes, programs, or interventions on behalf of the health department.

The health department may not directly deliver or provide all services and administrative activities. They may depend on other entities to act on its behalf. These services could be related to organizational, management, and administrative functions, or to program services or interventions delivered to the public.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Contracts/MOUs/ MOAs or other written agreements for the provision of services, processes, programs, and/or interventions

1. The health department must provide contracts or MOU/MOAs or other written agreements that have been executed with other organizations or departments.

State health department documentation could be, for example, a written agreement with a local or district health department for one of the examples. The other example must be with another agency or organization.

Local health department documentation could be a written agreement with the state health department for one of the examples. The other example must be with another agency or organization.

Tribal health department documentation could be a written agreement with a local, district, or state health department for one of the examples. The other example must be with another agency or organization. Tribal health departments may use the compact or funding agreement with the U.S. DHHS to carry out programs of the Indian Health Service. Also acceptable for documentation: agreements with non-Tribal entities to provide Contract Health Services (CHS) to beneficiaries of the Tribal health department, as well as MOA/MOUs or other agreements with other entities, such as epidemiological services provided to Tribes from Regional Epidemiologic Centers funded by IHS.

2 examples; the examples must be from two different program/ administrative areas featuring written agreements with different entities

2 years

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Standard 11.2: Establish effective financial management system.

MEASURE PURPOSE SIGNIFICANCE Measure 11.2.3 A Financial management systems

The purpose of this measure is to assess the health department’s ability to manage finances.

Sound management of financial resources is a basic function of a public health department. Health departments are accountable to their governing entity, elected officials, and the public they serve for the responsible use and oversight of public funds.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Approved health department budget

1. The health department must provide the approved budget that is in effect when the documentation for accreditation is submitted to PHAB. The budget may be approved by the governing entity or other body with approval authority, such as a governor’s budget office.

If a new budget is approved between the submission of documentation to PHAB and the site visit, the health department must provide a copy of the new budget to the Site Visit Team. NOTE: The budget and the organizational chart are the only two instances where information may be changed or updated between the submission of the health department’s documents to PHAB and the time of the Site Visit.

1 budget 2 years

2. Financial reports 2. The health department must provide quarterly financial reports. The examples provided may demonstrate two different types of reporting or may be two successive reports of the same type.

Documentation could be, for example, expense reports, reimbursement reports, reports to governing entities, and/or monthly budget reports – summarized or itemized.

2 examples 5 years

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Standard 11.2: Establish effective financial management system.

MEASURE PURPOSE SIGNIFICANCE Measure 11.2.4 A Resources sought to support agency infrastructure and processes, programs, and interventions

The purpose of this measure is to assess the health department’s activities to increase financial resources to support its infrastructure and to enhance or develop processes, programs, and interventions.

Additional funding to support public health processes, programs, and interventions should be sought through a variety of means, including budget increase requests, budget revision requests, and grants. Financial resources should be maximized by leveraging current funds to increase resources available for public health.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Formal efforts to seek additional financial resources

1. The health department must provide grant applications (funded or unfunded) or must document the leveraging funds to obtain additional resources (for example, providing matching funds).

2 examples 5 years

2. Communications concerning the need for financial support to maintain and improve public health infrastructure and services

2. The health department must document its communication concerning the need for additional investment in public health. Communication could address a specific issue or address public health in general.

Documentation could be, for example, articles or letters to the editor of a newspaper, presentations to the community, or testimony to elected officials.

Tribal health department documentation could be, for example, Tribal letters or resolutions of support, Tribal public health assessments for the purpose of demonstrating resources needed, or executive order adding resources.

2 examples 5 years

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DOMAIN 12

Domain 12 focuses on the health department’s support and engagement of its governing entity in maintaining and strengthening the public health infrastructure for the jurisdiction served. Governing entities both directly and indirectly influence the direction of a health department and should play a key role in accreditation efforts. However, much variation exists regarding the structure, definition, roles, and responsibilities of governing entities.

A governing entity, as it relates to the accreditation process, should meet the following criteria:

1. It is an official part of Tribal, state, or local government.

2. It has primary responsibility for policy-making and/or governing a Tribal, state, or local health department.

3. It advises, advocates, or consults with the health department on matters related to resources, policy making, legal authority, collaboration, and/or improvement activities.

4. It is the point of accountability for the health department.

5. In the case of shared governance (more than one entity provides governance functions to the health department), the governing entity, for accreditation purposes, is the Tribal, state, regional, or local entity that, in the judgment of the health department applying for accreditation, has the primary responsibility for supporting the applicant health department in achieving accreditation.

DOMAIN 12 INCLUDES THREE STANDARDS:

Standard 12.1: Maintain Current Operational Definitions and Statements of the Public Health Roles, Responsibilities, and Authorities

Standard 12.2: Provide Information to the Governing Entity Regarding Public Health and the Official Responsibilities of the Health Department and of the Governing Entity

Standard 12.3: Encourage the Governing Entity’s Engagement In the Public Health Department’s Overall Obligations and Responsibilities

Domain 12: Maintain Capacity to Engage the Public Health Governing Entity

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A health department operates with specific authorities to protect and preserve the health of the population within its jurisdiction. These authorities may be set forth in state statute, rules and regulation, local ordinances, administrative code, charters, or resolutions. Authorities may be regulatory and/or programmatic. This standard assures that the health department understands its authority, roles, and responsibilities and that of its governing entity, that such authority is put into practice, and that the governing entity is informed and engaged.

STANDARD 12.1: Maintain current operational definitions and statements of public health roles, responsibilities, and authorities

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Standard 12.1: Maintain current operational definitions and statements of public health roles, responsibilities, and authorities.

MEASURE PURPOSE SIGNIFICANCE Measure 12.1.1 A Mandated public health operations, programs, and services provided

The purpose of this measure is to assess the health department’s knowledge of and provision of the operations, programs, and services that it is mandated to provide.

Each health department has a set of mandated operations, programs, and services that it provides to protect and preserve the health of the population within the jurisdiction it serves. It is important that the health department is knowledgeable of these mandates and performs them as required.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Authority to conduct public health activities

1. The health department must provide a copy of the body of law (statutes, rules, regulations, ordinances) that sets forth its mandated public health operations, programs, and services or a listing of mandated public health services and the reference to the legal citation. The health department must make copies or access to the laws and regulations available to the Site Visit Team.

For example, the health department could provide the disease reporting rules or regulations reflected by the Council of State and Territorial Epidemiologist’s list of Nationally Notifiable Conditions; mandates for vaccinations; mandated oversight of environmental public health conditions, for example, solid waste, small public water systems, underground storage tanks, and hazardous materials; and various inspection programs, such as restaurant inspections.

Tribal health departments could provide a Tribal resolution, ordinance, or executive order.

1 example 5 years

2. Operations that reflect authorities

2. The health department must document how it implements its mandated processes, programs, or interventions.

Documentation could be, for example, service descriptions, annual reports, reports to the governing entity, meeting minutes, reports to governance, functional descriptions, organizational descriptions, or other written material.

1 example 5 years

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DOMAIN 12

Standard 12.1: Maintain current operational definitions and statements of public health roles, responsibilities, and authorities.

MEASURE PURPOSE SIGNIFICANCE Measure 12.1.2 A Operational definitions and/ or statements of the public health governing entity’s roles and responsibilities

The purpose of this measure is to assess the health department’s knowledge of the governing entity’s operational definition and/or governing entity’s roles and responsibilities.

The governing entity is the point of accountability for the health department. The health department should have a clear understanding of the governing entity’s structure, responsibilities, and expectations.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. The governing entity’s authority

1. The health department must provide a description of the governing entity and formal written statement of the governing entity’s authority.

The governing entity could be, for example, a board of health, a governor’s office, county commissioners, or other point of accountability.

Documentation could be a copy of the body of law (for example, statutes, rules, regulations, ordinances, charter) that sets forth the mandated authority or a description of the authority and the reference to the legal citation.

Tribal health department documentation could be aTribal resolution, ordinance, or executive order.

1 or more documents, as required

No date restriction

2. The governing entity’s structure and composition

2. The health department must provide a written description of the governing entity. The governing entity could be, for example, a board of health, a governor’s office, county commissioners, or other point of accountability.

Documentation could be, for example, a statute, rules, regulations, a charter, an official charge statement, or other formal written document.

1 example No time restriction

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DOMAIN 12

The governing entity is the point of accountability for the health department. The governing entity is accountable for the health department achieving its mission, goals, and objectives to protect and preserve the health of the population within its jurisdiction. This standard addresses the health department’s capacity for keeping the governing entity knowledgeable of the department’s overall legal authority, obligations, and responsibilities, and on the governing entity’s supporting role.

STANDARD 12.2: Provide information to the governing entity regarding public health and the official responsibilities of the health department and of the governing entity.

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Standard 12.2: Provide information to the governing entity regarding public health and the official responsibilities of the health department and of the governing entity.

MEASURE PURPOSE SIGNIFICANCE Measure 12.2.1 A Communication with the governing entity regarding the responsibilities of the public health department and of the responsibilities of the governing entity

The purpose of this measure is to assess the health department’s education of and communications with its governing entity regarding the health department’s responsibilities and the roles and responsibilities of the governing entity.

Governing entities significantly influence the direction of health departments through policy making and other similar activities. Many governing entities have key roles in resource allocation, policy making, legal authority, collaboration, and/or quality improvement activities. As a result, they may heavily influence whether health departments are fulfilling their responsibilities. The governing entity, to be an effective advocate for public health and for the agency, must be aware of its responsibilities and duties and of the health department’s roles and responsibilities.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Communication with the governing entity regarding the responsibilities of the public health department

a. Communication with the governing entity about its operational definitions and/ or statements of the public health governing entity’s roles and responsibilities

1. The health department must document communications provided to the governing entity concerning the health department’s responsibilities, as set forth in the health department’s authorizing document(s). Documentation must demonstrate the process of informing the governing entity about the responsibilities of the health department.

The health department will select its documentation for this measure based on the model of governance in place for the health department.

Documentation could be, for example, reports, testimonies, speeches, presentations, or emails.

a. The health department must document its sharing with the governing entity operational definitions and/or statements of the public health governing entity’s public health related roles and responsibilities. The health department will select its documentation based on and appropriate to the health department’s model of governance.

Documentation could be, for example, meeting minutes, memos, emails, briefing papers, or other correspondence.

2 examples for a; 1 process for b

5 years

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b. The orientation process for new members of the governing entity

b. The health department must document its process for orientation of new members of the governing entity. New member orientation must include both the responsibilities of the health department and of the governing entity.

Documentation could be, for example, orientation agenda, meeting minutes, orientation materials.

MEASURE 12.2.1 A, continued

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Public health governing entities exercise a wide range of responsibilities, including policy development, resource stewardship, legal authority, partner engagement, continuous improvement, and oversight. Specific areas of responsibilities may include, strategic planning, adopting and ensuring enforcement of public health regulations, ensuring that the governing body and health department act ethically, serving as a strong link between the health department and the community and other community organizations, supporting a culture of quality improvement, hiring and evaluating the health department director, taxing authority, and budget adoption. These responsibilities demand that the governing entity is well-versed in public health and in the work of the health department and the health challenges of the community. The governing entity and the health department should communicate regularly on the health of the community, strategic plan implementation, program activities, health department policy issues, public health ethical issues, and quality improvement activities.

STANDARD 12.3: Encourage the governing entity’s engagement in the public health department’s overall obligations and responsibilities.

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Standard 12.3: Encourage the governing entity’s engagement in the public health department’s overall obligations and responsibilities.

MEASURE PURPOSE SIGNIFICANCE Measure 12.3.1 A Information provided to the governing entity about important public health issues facing the community, the health department, and/or the recent actions of the health department

The purpose of this measure is to assess health department efforts to keep the governing entity informed of public health issues and health department activities.

The health department has a responsibility to communicate with its governing entity to ensure that the governing entity’s policies and decisions are informed. A regular flow of information helps to ensure that the governing entity acts in the best interests of the public’s health. Information also needs to flow from the governing entity to the health department to ensure mutual understanding of policy options and implications.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Communication with the governing entity regarding important public health issues and/or recent actions of the health department

1. The health department must document communications with the governing entity regarding important public health issues and/or recent actions of the health department. Important public health issues include a population’s health status, health indicators, health equity and disparities, disease outbreaks, environmental health hazards, etc.

Documentation could be reports, testimonies, formal meeting minutes, meeting summaries, program updates, reports on identified public health hazards, community health assessment findings, community dashboards, outbreak and response efforts, annual statistical reports, or other written correspondence (memos, emails).

2 examples 2 years

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Standard 12.3: Encourage the governing entity’s engagement in the public health department’s overall obligations and responsibilities.

MEASURE PURPOSE SIGNIFICANCE Measure 12.3.2 A Actions taken by the governing entity tracked and reviewed

The purpose of this measure is to assess the health department’s familiarity and awareness of the governing entity’s actions in order for the health department to identify patterns of issues discussed and topics or areas that call for increased communication and information.

It is important that the health department understand the priorities, policy positions, opinions, and actions of the governing entity in order to continually improve communication and effectiveness, leading to a quality governing entity-health department relationship.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Consistently review issues discussed, actions taken, and policies set by the governing entity

1. The health department must document that it has consistently reviewed the governing entity’s1) patterns of issues discussed; 2) opinions of the governing entity members; and/or 3) positions taken. This will highlight topics or issue areas where increased communication is desirable. Review must be done at least annually.

Documentation could be, for example, health department meeting minutes, reports, dashboards, presentations, memos, or other record of health department leadership’s discussion of governing entity actions.

2 examples 14 months

Examples do not need to be from different years.

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Standard 12.3: Encourage the governing entity’s engagement in the public health department’s overall obligations and responsibilities.

MEASURE PURPOSE SIGNIFICANCE Measure 12.3.3 A Communication with the governing entity about health department performance assessment and improvement

The purpose of this measure is to assess the health department’s communication with the governing entity on the overall assessment and improvement of the performance of the health department.

The governing entity should be knowledgeable about the health department’s overall assessment and quality improvement initiatives. The governing entity will be in a better position to guide, advocate for, and engage with the health department if it is aware of improvements being undertaken.

REQUIRED DOCUMENTATION GUIDANCE

NUMBER OF EXAMPLES

DATED WITHIN

1. Communication with the governing entity concerning assessment of the health department’s performance

1. The health department must document communications with the governing entity on plans and processes for improving health department performance.

The health department will select its documentation for this measure based on the model of governance in place for the health department.

Communication efforts could include, for example, program reviews, accreditation efforts, quality improvement projects, and other performance improvement activities.

Documentation could be, for example, meeting minutes, reports, presentations, memos, or other discussion records.

2 examples 5 years

2. Communication with the governing entity concerning the improvement of the health department’s performance

2. The health department must document communication with the governing entity on its performance improvement efforts as a result of performance improvement processes and/or activities.

The health department will select its documentation for this measure based on the model of governance in place for the health department.

Documentation could be, for example, annual reports, department dashboards, program reviews, meeting minutes, reports, presentations, memos, or other record of discussion.

2 examples 5 years

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This publication was supported through grant funding from the Robert Wood Johnson Foundation (RWJF) and Cooperative Agreement #1U900T000228-01 from the Centers for Disease Control and Prevention (CDC). Its contents are solely the

responsibility of the authors and do not necessarily represent the official views of the CDC or RWJF.

Copyright © 2014 Public Health Accreditation Board. All rights reserved.

PUBLIC HEALTH ACCREDITATION BOARD 1600 Duke Street, Suite 200

Alexandria, VA 22314

T: 703.778.4549

F: 703.778.4556

www.phaboard.org

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