Health and Wellness

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Literary Analysis and Composition II (Sem1) | Writing to a Prompt | Lesson 3

HW 425: Health and Wellness Programming: Design and Administration

Unit 2 Target Populations: Assessing Assets and Problems

Lesson 3: Administrative and Policy Assessment

Introduction

As Hodges and Videto discuss, once the target population is identified and the epidemiologic methods evaluated, health and wellness professionals need to review resources, challenges or obstacles to program implementation. At this stage of the assessment process resources, implementation and policies should be assessed to ensure program success. Support roles and tasks should be examined in order to determine the efficacy of each and how they fit into the overall program. (2005). Both program timelines and money aspects should be assessed in order to identify the factors that impact program success in reaching goals and objectives.

Social Science and Medicine (1985) points out some of the challenges with administrative and policy assessment including inadequate resources

There is a vast gap between methodology and practice in the analysis and assessment of health programs. This presents an acute problem in developing countries where resource allocation decisions at the tight budgetary margin have important practical consequences. The prospects for improving this primitive situation depend critically on placing priority emphasis on the simpler areas of analysis which are likely to yield the greatest returns in actually improving the assessment of health programs. The analysis of affordability--especially on the recurrent cost side--is a necessary condition which at least ensures that proposed health programs are not likely to be vulnerable to implementation delays or underfinancing [sic] of subsequent recurrent costs which may seriously compromise the returns expected from the investment. Improved analysis of effectiveness is also essential in order to help planners choose the best pattern of resource use from among the various combinations of programs that are affordable. The minimal requirements for this are the ability to identify relevant sectoral goals and to assess the likely effectiveness of various feasible health programs in achieving them. There is 1st a need to lift the veil of obscurity over health sector goals which induces the coexistence of rhetorical priority for reducing infant and child mortality with programs of health resources use that continue to be dominated by hospital services intended to serve the adult population. 2nd, there is a need to fill the void of organized empirical knowledge on the effectiveness of health interventions in achieving whichever goals are considered to be the most important. This will require a shift of analytical effort away from single interventions directed at communicable diseases in children to a broader concern with multipurpose interventions, including those directed at the emerging problems of communicable disease in adults. (Social Science and Medicine, 1985)

Resources

As Hodges and Videto point out, “Resources include time, money, and people.” Each of these need evaluated to determine whether…” (2005, page 49, ¶2) sufficiency of each exists to meet the “…stated goals and objectives….” (2005, page 49, ¶2).

Click here to view an actual resource assessment http://www.co.tillamook.or.us/gov/CCF/pages/RAWGSum.htm for Tillamook County, Oregon Commission on Children and Families.

Time

According to the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), develop a timeline”… that visually organizes how you put your communication activities, materials, and tasks into action” (CDC, 2008)

There are many kinds of timelines. Select the type of timeline that makes most sense for your program or your organization. Options include Gantt charts, PERT charts, and others.

Whatever option you choose, your timeline should address some important questions:

· What activities are needed? (for example: selecting methods, obtaining resources, hiring personnel, recruiting participants)

· When does each activity begin and end, or when is an activity repeated?

· What time frame (by week, by month…) is most suitable for your communication plan?

· When will selected activities identified in your timeline be accomplished?

· When will the outcomes and/or products you create that result from your program objectives be due?

· Is there an order to the activities listed in the budget? Are there certain things that must be done before another? (CDC, 2008)

Gantt and PERT Charts

Peltier Technical Services describes a “…useful tool in program management, which help to show graphically when tasks must start and finish, and which tasks are underway at any given time” (2008).

Gantt and PERT charts are visualization tools commonly used by project managers to control and administer the tasks required to complete a project. (Commonwealth of Virginia Education, n.d.)

The Gantt chart, developed by Charles Gantt in 1917, focuses on the sequence of tasks necessary for completion of the project at hand. Each task on a Gantt chart is represented as a single horizontal bar on an X-Y chart. The horizontal axis (X-axis) is the time scale over which the project will endure. Therefore, the length of each task bar corresponds to the duration of the task, or the time necessary for completion. Arrows connecting independent tasks reflect the relationships between the tasks it connects. The relationship usually shows dependency where one task cannot begin until another is completed. The resources necessary for completion are also identified next to the chart. The Gantt chart is an excellent tool for quickly assessing the status of a project. The following Gantt chart was developed using MS Project for developing a proposal. (Commonwealth of Virginia Education, n.d.)

PERT (Program Evaluation and Review Technique) charts were first developed in the 1950s by the Navy to help manage very large, complex projects with a high degree of intertask dependency. Classical PERT charting is used to support projects that are often completed using an assemply [sic] line approach. MS Project can create a PERT chart from a Gantt chart. The PERT below is another representation of the Proposal project shown above. (Commonwealth of Virginia Education, n.d.)

Again, the representation above is relatively self explanatory. The completed tasks have been crossed out while partially completed tasks have one slash through them. The tasks also show duration, beginning date and ending date. (Commonwealth of Virginia Education, n.d.)

The critical path (shown in red) is a series of tasks that must be completed on schedule for a project to finish on schedule. Each task on the critical path is a critical task. Most tasks in a typical project have some slack and can therefore be delayed a little without affecting the project finish date. Those tasks that cannot be delayed without affecting the project finish date are the critical tasks. As you modify tasks to resolve overallocations or other problems in your schedule, be aware of the critical tasks and that changes to them will affect your project finish date. (Commonwealth of Virginia Education, n.d.)

People

“People resources include availability and training of appropriate personnel” (Hodges and Videto, 2005, page 49, ¶3) and determining

1. Personnel available

2. Percentage of time required for program tasks and activities

3. Skill level of available personnel

4. Additional support staff needed

5. Funding for personnel needs (Hodges and Videto, 2005, page 49, ¶3)

Money

“The budget situation will also have to be assessed. The largest categories in a budget will be personnel (the largest), supplies, services, and travel (in some cases)” (Hodges and Videto, 2005, page 49, ¶4). According to the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), developing a budget to track the money used for program administration should be developed “…that reflects your organization's or funding organization's format. Often, budgets are created in columns with direct and indirect expenses outlined in separate sections” (CDC, 2008)

Budgets clearly explain costs in an organized fashion. You can develop a complete, workable budget by making sure that it fulfills some key objectives:

· Tells the same story as your program's narrative

· Includes detailed descriptions or reasons for use, if reasons are needed

· Projects costs to be needed during the program's duration

· Anticipates various or unforeseen expenses

· Includes all items required by the funding source

· Includes all items paid for by other sources

· Includes volunteer and in-kind services to be provided

· Details additional benefits separate from salaries, if these costs are required

· Includes all fees for consultants or contractors

· Lays out details of all non-personnel costs

· Includes indirect costs when appropriate (CDC, 2008)

Provide a budget narrative that includes the details and reasons for each of the expenses requested for your program.

The budget and budget narrative should relate the same story as your objectives, program activities, methods, and program evaluation. (CDC, 2008)

CDC Sample Budget (CDC, 2008)

I. Sample Budget with Descriptors

Budgets contain three primary sections:

· Direct costs (Personnel)

· Direct costs (Non-personnel)

· Indirect Costs

Budget tables designed similarly to spreadsheets are descriptive and can be useful.

Columns including information comparing fixed costs with variable costs and requested funds with donated and/or matched funds are particularly useful. (CDC, 2008)

A. Personnel

1. Salaries and Wages: The following format is useful for indicating all full-time and part-time staff for your proposed project:

Full-time and Part-time Staff
Number of persons per title	Title	Annual salary	Percentage of time commitment	Amount requested	Amount donated or in-kind aid	Total

B. Non-Personnel

1. Space Costs: The following format is useful for indicating costs of facilities (buildings and/or meeting rooms) that you will be using (rented, donated, or otherwise).

Additional costs to be calculated might include:

· utilities (heating or water)

· maintenance services

· repair work or changes to the space (if allowed)

· insurance on the facility

· other applicable costs

Space costs	Amount requested	Amount donated or in-kind aid	Total
Office space 900 sq. ft. $1125.00/mo x 12 mos.	$13,500	-0-	$13,500
Facility insurance @ $600/year	-0-	$600	$600

C. Indirect Costs

1. Expenses to your organization or institution that are not directly related to the project, but are required in order to put the project into action.

(for example:

· environmental management heating, cooling, etc.

· water

· protection and security

· cleaning services

· decrease of value due to wear and use

· equipment repairs and upkeep).

The following format is useful for indicating indirect costs:

Indirect Costs	Amount requested	Amount donated or in-kind aid	Total
43% of direct costs ($121,205)		$58,178	$58,178

TOTAL BUDGET (Sum of Direct and Indirect Costs)

Budget statements may be required to describe the necessity for spending any money that could be thought unusual or for purchases that cost more than a similar item found from another source. Be sure to base your justification on your goals, objectives, and methods stated earlier. (CDC, 2008)

Policy Assessment 101

The Centers for Disease Control and Prevention (CDC) publishes a defined policy description that provides “…basic information about policies and explains why they are important to workforce health promotion (WHP) planners. Workplaces that are not federal agencies can use this information to generate ideas about how policies impact health promotion in your organization” (CDC, 2008).

"Organizations are important components of social and physical environments, and they exert considerable influence over the choices people make, the resources they have to aid them in those choices, and the factors in the workplace that could influence healthy lifestyles status.”1 Formal policies are one aspect of influence. A workplace that supports health is likely to have policies that enable healthy behavior choices of employees by promoting employee health behavior, offering behavioral incentives to employees, and increasing employees’ access to health resources (CDC, 2008).

“Policies” discussed in the CDC Web site are formal laws, regulations, and rules that have been adopted on a collective basis to guide individual and collective behavior at the federal workplace. They may be voluntary or legally binding. (CDC, 2008)

· Policies can be voluntary or legally binding. These can include, but are not limited to

· Formal, written laws and policies, such as federal authorizing and appropriations law or a specific smoking ban

· Informal, such as “casual Fridays,” where such a rule doesn’t exist formally, but is collectively assumed that employees may wear jeans to work

· Policies can have substantial impact on workforce health promotion (WHP) because they set boundaries around which wellness practices can be implemented (CDC, 2008)

Click here http://www.cdc.gov/nccdphp/dnpa/hwi/policies/CDC%20Tobacco-Free%20Campus.pdf (CDC, 2008) for a “…example of a policy from the CDC for employees. Program planners can use this as a guideline when developing policies for their own workplace” (CDC, 2008)

Click here http://www.cdc.gov/nccdphp/dnpa/hwi/policies/HSE%20Policy.pdf to view the CDC Healthier Worksite Initiative Health, Safety and Environmental Policy. (CDC, 2008)

Implementation Assessment

The Centers for Disease Control and Prevention (CDC) also provides resources for implementation of health programs. Implementation resources are “…activities [that] involve setting priorities for the workforce health promotion (WHP) program based on the needs assessment, designing practices to address specific wellness issues, and developing an implementation plan. During these activities consider the following program influencers” (CDC, 2008)

· Company hierarchy may influence the organizational structure of the wellness program

· Company policies may dictate which practices can be implemented and how they are administered

· Company environment may promote or deter desired healthy behaviors

· Staff skills and knowledge, budget, and other company resources may present program limitations (CDC, 2008)

The CDC provides both federal and non-federal resources “…that can be used to help guide planning, design, and implementation activities. These examples are not meant to be comprehensive, but to provide WHP [Workplace Health Planners] planners with a place to start” (CDC, 2008)

Non-Federal Resources

Healthy Workforce 2010: An Essential Health Promotion Sourcebook for Employers, Large and Small Uses the objectives of Healthy Workforce 2010 to explain how and why a company should be involved in health promotion for its employees. (CDC, 2008)

A Purchaser's Guide to Clinical Preventive Services: Moving Science into Coverage A Purchaser's Guide to Clinical Preventive Services: Moving Science into Coverage is an important resource on preventive services. Developed in collaboration with the Centers for Disease Control and Prevention (CDC), the Agency for Healthcare Research and Quality (AHRQ) and the National Business Group on Health (NBGH), the Purchaser's Guide translates clinical guidelines and medical evidence, providing large employers with the information they need to select, define, and implement preventive medical benefits such as colorectal cancer screening and tobacco use treatment. (CDC, 2008) Wellness Councils of America: Key Resources Provides a list of manuals and books that can help guide the development of WHP programs. (CDC, 2008) Wellness Councils of America: Free Reports Provides a list of free reports, studies, and other publications that explain key WHP issues. (CDC, 2008)

Summary

Part of the needs assessment process is the examination of the factors that may influence or impact program goals and objectives. According to Hodges and Videto, a checklist “…can be used for each phase of the process related to administrative and policy assessment: (2005, page 54, Box 2.5). By assessing the resources, challenges or obstacles to program implementation the potential for program efficacy and success can be evaluated. Support roles and tasks should be examined in order to determine the efficacy of each and how they fit into the overall program (2005) as well as determining if additional resources may need to be acquired.

� Hodges, B. C., Videto, D. M. (2005). Assessment and planning in health programs. Boston: Jones and Bartlett Publishers.

� Prescott, N., De Ferranti, D. (1985). The analysis and assessment of health programs. Social Science and Medicine, 1985; 20(12):1235-40. Retrieved January 06, 2008 from �HYPERLINK "http://www.popline.org/docs/0705/268292.html"�http://www.popline.org/docs/0705/268292.html�

� Hodges, B. C., Videto, D. M. (2005). Assessment and planning in health programs. Boston: Jones and Bartlett Publishers.

� U.S. Department of Health and Human Services Centers for Disease Control and Prevention (CDC). (2008). Budgets: Step 4.1 Work with partners to draft a timetable, budget, and plan for developing and testing concepts, messages, settings, activities, and materials. Retrieved January 05, 2009 from �HYPERLINK "http://www.cdc.gov/dhdsp/CDCynergy_training/Content/phase4/phase4step1content.htm"�http://www.cdc.gov/dhdsp/CDCynergy_training/Content/phase4/phase4step1content.htm�

� Peltier Technical Services. (2008). Advanced Gantt charts in MS Excel. Retrieved January 06, 2008 from �HYPERLINK "http://peltiertech.com/Excel/Charts/GanttChart.html"�http://peltiertech.com/Excel/Charts/GanttChart.html�

� Commonwealth of Virginia Education. (n.d.). Gantt and PERT charts. Retrieved January 06, 2008 from http://gates.comm.virginia.edu/rrn2n/teaching/gantt.htm

� U.S. Department of Health and Human Services Centers for Disease Control and Prevention (CDC). (2008). Policy assessment: Policy 101. Retrieved January 05, 2009 from � HYPERLINK "http://www.cdc.gov/nccdphp/dnpa/hwi/policies/policy_101.htm" ��http://www.cdc.gov/nccdphp/dnpa/hwi/policies/policy_101.htm� �HYPERLINK "http://www.cdc.gov/dhdsp/CDCynergy_training/Content/phase4/phase4step1content.htm"��

� U.S. Department of Health and Human Services Centers for Disease Control and Prevention (CDC). (2008). Policy assessment. Retrieved January 05, 2009 from �HYPERLINK "http://www.cdc.gov/dhdsp/CDCynergy_training/Content/phase4/phase4step1content.htm"�� HYPERLINK "http://www.cdc.gov/nccdphp/dnpa/hwi/policies/index.htm#CDC" ��http://www.cdc.gov/nccdphp/dnpa/hwi/policies/index.htm#CDC�

� U.S. Department of Health and Human Services Centers for Disease Control and Prevention (CDC). (2008). Healthier worksite initiative: Health, safety and environmental policy. Retrieved January 05, 2009 from � HYPERLINK "http://www.cdc.gov/nccdphp/dnpa/hwi/policies/HSE%20Policy.pdf" ��http://www.cdc.gov/nccdphp/dnpa/hwi/policies/HSE%20Policy.pdf� �HYPERLINK "http://www.cdc.gov/dhdsp/CDCynergy_training/Content/phase4/phase4step1content.htm"�� HYPERLINK "http://www.cdc.gov/nccdphp/dnpa/hwi/policies/CDC%20Tobacco-Free%20Campus.pdf" ��

� U.S. Department of Health and Human Services Centers for Disease Control and Prevention (CDC). (2008). Implementation resources. Retrieved January 05, 2009 from � HYPERLINK "http://www.cdc.gov/nccdphp/dnpa/hwi/program_design/implementation.htm" ��http://www.cdc.gov/nccdphp/dnpa/hwi/program_design/implementation.htm�

� Hodges, B. C., Videto, D. M. (2005). Assessment and planning in health programs. Boston: Jones and Bartlett Publishers.

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