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1/7/2017 Public Health: What It Is and How It Works
https://bookshelf.vitalsource.com/#/books/9781284046342/cfi/1
2!/4/2/22/6/[email protected]:33.0 1/2
PRINTED BY: [email protected] Printing is for personal, privat
e use only. No part of this book
may be reproduced or transmitted without publisher's prior perm
ission. Violators will be prosecuted.
mobilization and constituency building. PATCH focuses on orie
nting and training community leaders and other
community participants in all aspects of the community needs as
sessment process and includes excellent
documentation and resource materials. Although originally deve
loped by the Centers for Disease Control and
Prevention (CDC) to focus on chronic health conditions and sti
mulate health promotion and disease prevention
interventions, PATCH is flexible enough to be used in a wide va
riety of community health needs assessment
applications.
Another important tool for addressing public health core functio
ns and their associated processes is Model
Standards, Healthy Communities.8 The steps outlined for imple
mentation of the Model Standards process in the
community link many of the various core function-related tools;
they represent, in effect, a pathway for
organizations to participate in community health improvement a
ctivities.
1. Assessment of organizational role. Communities are organize
d and structured differently. As a result, the
specific roles of local public health organizations will vary from
community to community. An essential
first step is to reexamine organizational purpose and mission an
d develop a long-range vision through
strategic planning involving its internal and external constituen
cies. The resulting mission statement and
long-range vision serve to guide the organization (leadership an
d board, as well as employees) and to define
it for its community partners. This critical step should be compl
eted before the remaining steps can be
successfully addressed. Part I of APEXPH and the expanded stra
tegic planning elements of MAPP are
useful in accomplishing this task.
2. Assessment of organizational capacity. After mission and rol
e have been defined, it is necessary to
examine an organization’s capacity to carry out its role in the co
mmunity. This calls for an assessment of
the major operational elements of the organization, including its
structure and performance for specific
tasks. This type of organizational and local public health system
self-assessment is best carried out through
broad participation from all levels. Both APEXPH and MAPP in
clude hundreds of indicators that can be
used in this capacity assessment. These indicators can be modifi
ed or eliminated if deemed inappropriate,
and additional indicators can also be used. This step serves to id
entify strengths and weaknesses relative to
mission and role.
3. Development of a capacity-building plan. The development of
a capacity-building plan incorporates the
organization’s strengths and prioritizes its weaknesses so that th
e most important are addressed first. As in
any plan, specific objectives for addressing these weaknesses ar
e developed, responsibilities are assigned,
and a process for tracking progress over time is established. Ag
ain, APEXPH and MAPP are valuable tools
for accomplishing this task.
4. Assessment of community organizational structure. Having lo
oked internally at its capacity and ability to
exercise its leadership role for identifying and addressing priori
ty health needs in the community, the public
health organization must assess the key stakeholders and necess
ary participants for a community-wide
needs assessment and intervention initiative. This is often a lon
g-term and continuous process in which the
relationship of all important community stakeholders and partne
rs (e.g., the health agency, community
providers of health-related services, community organizations, c
ommunity leaders, interest groups, the
media, and the general public) is assessed. This step determines
how and under whose auspices community
health planning will take place within the community. Both APE
XPH/MAPP and PATCH processes support
the successful completion of this step.
5. Organization of community. This step calls for organizing the
community so that it represents a strong
constituency for public health and will participate collaborativel
y in partnership with the health agency.
Specific strategies and activities will vary from community to c
ommunity but will generally include
hearings, dialogues, discussion forums, meetings, and collaborat
ive planning sessions. The specific roles
and authority of community participants should be clarified so t
hat the process is not perceived as one
driven largely by the health agency and so-called experts. Both
APEXPH/MAPP and PATCH are useful for
completing this step.
6. Assessment of community health needs. The actual process of
identifying health problems of importance
to the community is one that must carefully balance information
derived from data sets with information
https://jigsaw.vitalsource.com/books/9781284046342/content/id
/ch05bib1-008
1/7/2017 Public Health: What It Is and How It Works
https://bookshelf.vitalsource.com/#/books/9781284046342/cfi/1
2!/4/2/22/6/[email protected]:33.0 2/2
PRINTED BY: [email protected] Printing is for personal, privat
e use only. No part of this book
may be reproduced or transmitted without publisher's prior perm
ission. Violators will be prosecuted.
derived from the community’s perceptions of which problems ar
e most important. Often, community
readiness to mitigate specific problems greatly increases the cha
nces for success, as well as support for the
overall process within the community. In addition to generating
information on possible health problems,
this step gathers information on resources available within the c
ommunity. This step serves to provide the
information necessary for the community’s most important healt
h problems to be identified. The
community needs assessment tools provided in both APEXPH/M
APP and PATCH can be used to
accomplish this step.
7. Determination of local priorities and community health resou
rces. After important health problems are
identified, decisions must be made as to which are most importa
nt for community action. This step requires
broad participation from community participants in the process
so that priorities will be viewed as
community rather than agency-specific priorities. Debate and ne
gotiation are essential for this step, and
there are many approaches to coming to consensus around speci
fic priorities. Both APEXPH/MAPP and
PATCH support this step.
8. Selection of outcome objectives. After priorities are determin
ed, the process must establish a target level
to be achieved for each priority problem. For this step, the Mod
el Standards process is especially useful in
linking community priorities to national health objectives and e
stablishing targets that are appropriate for
the current status and improvement possible from a community i
ntervention. This step also calls for
negotiation within the community because deployment and reall
ocation of resources may be needed to
achieve the target outcomes that are agreed upon. In addition to
Model Standards, both APEXPH/MAPP
and PATCH can be useful in accomplishing this step.
9. Development of intervention strategies. This step is one of de
termining strategies and methods of
achieving the outcome objectives established for each priority h
ealth problem. This can be quite difficult
and, at times, contentious. For some problems, there may be few
or even no effective interventions. For
others, there may be widely divergent strategies available, some
of which may be deemed unacceptable or
not feasible. After agreement is reached as to strategies and met
hods, responsibilities for implementing and
evaluating interventions will be assigned. With community-wide
interventions, overall coordination of
efforts may also need to be addressed as part of the intervention
strategy.
10. Implementation of intervention strategies. After the establis
hment of goals, objectives, strategies, and
methods, specific plans of action for the intervention are develo
ped, and specific tasks and work plans are
developed. Clear delineation of responsibilities and time lines is
essential for this step.
11. Continuous monitoring and evaluation of effort. The evaluat
ion strategy for the intervention will track
performance related to outcome objectives, as well as process o
bjectives and activity measures over time. If
activity measures and process objectives are being accomplishe
d, there should be progress toward
achieving the desired outcome objectives. If this does not occur,
the selected intervention strategy needs to
be reconsidered and revised.
Since 1990, numerous communities have used PATCH, Model S
tandards, and other tools (such as Healthy Cities
and Healthy Communities, two similar community needs assess
ment processes) in community health-
improvement initiatives.
In 1996, and again in 2002, the IOM revisited issues addressed i
n The Future of Public Health report, concluding
that different organizations, leadership, and political and econo
mic realities were transforming how public health
carried out its core functions and essential services.16,17 On on
e hand, market-driven health care was forcing
public health to clarify and strengthen its public role in a predo
minately private system. On the other, public
health was increasingly identifying and working with a variety o
f entities within the community that shape
community health and well-being. Another important IOM repor
t18 in 1997 advanced an expanded CHIP model
that extends the tools developed earlier in the decade and the ste
ps described previously here. Its main features are
its expanded perspective on the wide variety of factors that infl
uence health, its support for broad participation by
community stakeholders, and its emphasis
https://jigsaw.vitalsource.com/books/9781284046342/content/id
/ch05bib1-016
https://jigsaw.vitalsource.com/books/9781284046342/content/id
/ch05bib1-017
https://jigsaw.vitalsource.com/books/9781284046342/content/id
/ch05bib1-018

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172017 Public Health What It Is and How It Workshttps.docx

  • 1. 1/7/2017 Public Health: What It Is and How It Works https://bookshelf.vitalsource.com/#/books/9781284046342/cfi/1 2!/4/2/22/6/[email protected]:33.0 1/2 PRINTED BY: [email protected] Printing is for personal, privat e use only. No part of this book may be reproduced or transmitted without publisher's prior perm ission. Violators will be prosecuted. mobilization and constituency building. PATCH focuses on orie nting and training community leaders and other community participants in all aspects of the community needs as sessment process and includes excellent documentation and resource materials. Although originally deve loped by the Centers for Disease Control and Prevention (CDC) to focus on chronic health conditions and sti mulate health promotion and disease prevention interventions, PATCH is flexible enough to be used in a wide va riety of community health needs assessment applications. Another important tool for addressing public health core functio ns and their associated processes is Model Standards, Healthy Communities.8 The steps outlined for imple mentation of the Model Standards process in the community link many of the various core function-related tools; they represent, in effect, a pathway for organizations to participate in community health improvement a ctivities. 1. Assessment of organizational role. Communities are organize
  • 2. d and structured differently. As a result, the specific roles of local public health organizations will vary from community to community. An essential first step is to reexamine organizational purpose and mission an d develop a long-range vision through strategic planning involving its internal and external constituen cies. The resulting mission statement and long-range vision serve to guide the organization (leadership an d board, as well as employees) and to define it for its community partners. This critical step should be compl eted before the remaining steps can be successfully addressed. Part I of APEXPH and the expanded stra tegic planning elements of MAPP are useful in accomplishing this task. 2. Assessment of organizational capacity. After mission and rol e have been defined, it is necessary to examine an organization’s capacity to carry out its role in the co mmunity. This calls for an assessment of the major operational elements of the organization, including its structure and performance for specific tasks. This type of organizational and local public health system self-assessment is best carried out through broad participation from all levels. Both APEXPH and MAPP in clude hundreds of indicators that can be used in this capacity assessment. These indicators can be modifi ed or eliminated if deemed inappropriate, and additional indicators can also be used. This step serves to id entify strengths and weaknesses relative to mission and role. 3. Development of a capacity-building plan. The development of a capacity-building plan incorporates the organization’s strengths and prioritizes its weaknesses so that th e most important are addressed first. As in any plan, specific objectives for addressing these weaknesses ar e developed, responsibilities are assigned, and a process for tracking progress over time is established. Ag
  • 3. ain, APEXPH and MAPP are valuable tools for accomplishing this task. 4. Assessment of community organizational structure. Having lo oked internally at its capacity and ability to exercise its leadership role for identifying and addressing priori ty health needs in the community, the public health organization must assess the key stakeholders and necess ary participants for a community-wide needs assessment and intervention initiative. This is often a lon g-term and continuous process in which the relationship of all important community stakeholders and partne rs (e.g., the health agency, community providers of health-related services, community organizations, c ommunity leaders, interest groups, the media, and the general public) is assessed. This step determines how and under whose auspices community health planning will take place within the community. Both APE XPH/MAPP and PATCH processes support the successful completion of this step. 5. Organization of community. This step calls for organizing the community so that it represents a strong constituency for public health and will participate collaborativel y in partnership with the health agency. Specific strategies and activities will vary from community to c ommunity but will generally include hearings, dialogues, discussion forums, meetings, and collaborat ive planning sessions. The specific roles and authority of community participants should be clarified so t hat the process is not perceived as one driven largely by the health agency and so-called experts. Both APEXPH/MAPP and PATCH are useful for completing this step. 6. Assessment of community health needs. The actual process of identifying health problems of importance to the community is one that must carefully balance information derived from data sets with information
  • 4. https://jigsaw.vitalsource.com/books/9781284046342/content/id /ch05bib1-008 1/7/2017 Public Health: What It Is and How It Works https://bookshelf.vitalsource.com/#/books/9781284046342/cfi/1 2!/4/2/22/6/[email protected]:33.0 2/2 PRINTED BY: [email protected] Printing is for personal, privat e use only. No part of this book may be reproduced or transmitted without publisher's prior perm ission. Violators will be prosecuted. derived from the community’s perceptions of which problems ar e most important. Often, community readiness to mitigate specific problems greatly increases the cha nces for success, as well as support for the overall process within the community. In addition to generating information on possible health problems, this step gathers information on resources available within the c ommunity. This step serves to provide the information necessary for the community’s most important healt h problems to be identified. The community needs assessment tools provided in both APEXPH/M APP and PATCH can be used to accomplish this step. 7. Determination of local priorities and community health resou rces. After important health problems are identified, decisions must be made as to which are most importa nt for community action. This step requires broad participation from community participants in the process so that priorities will be viewed as community rather than agency-specific priorities. Debate and ne gotiation are essential for this step, and
  • 5. there are many approaches to coming to consensus around speci fic priorities. Both APEXPH/MAPP and PATCH support this step. 8. Selection of outcome objectives. After priorities are determin ed, the process must establish a target level to be achieved for each priority problem. For this step, the Mod el Standards process is especially useful in linking community priorities to national health objectives and e stablishing targets that are appropriate for the current status and improvement possible from a community i ntervention. This step also calls for negotiation within the community because deployment and reall ocation of resources may be needed to achieve the target outcomes that are agreed upon. In addition to Model Standards, both APEXPH/MAPP and PATCH can be useful in accomplishing this step. 9. Development of intervention strategies. This step is one of de termining strategies and methods of achieving the outcome objectives established for each priority h ealth problem. This can be quite difficult and, at times, contentious. For some problems, there may be few or even no effective interventions. For others, there may be widely divergent strategies available, some of which may be deemed unacceptable or not feasible. After agreement is reached as to strategies and met hods, responsibilities for implementing and evaluating interventions will be assigned. With community-wide interventions, overall coordination of efforts may also need to be addressed as part of the intervention strategy. 10. Implementation of intervention strategies. After the establis hment of goals, objectives, strategies, and methods, specific plans of action for the intervention are develo ped, and specific tasks and work plans are developed. Clear delineation of responsibilities and time lines is essential for this step.
  • 6. 11. Continuous monitoring and evaluation of effort. The evaluat ion strategy for the intervention will track performance related to outcome objectives, as well as process o bjectives and activity measures over time. If activity measures and process objectives are being accomplishe d, there should be progress toward achieving the desired outcome objectives. If this does not occur, the selected intervention strategy needs to be reconsidered and revised. Since 1990, numerous communities have used PATCH, Model S tandards, and other tools (such as Healthy Cities and Healthy Communities, two similar community needs assess ment processes) in community health- improvement initiatives. In 1996, and again in 2002, the IOM revisited issues addressed i n The Future of Public Health report, concluding that different organizations, leadership, and political and econo mic realities were transforming how public health carried out its core functions and essential services.16,17 On on e hand, market-driven health care was forcing public health to clarify and strengthen its public role in a predo minately private system. On the other, public health was increasingly identifying and working with a variety o f entities within the community that shape community health and well-being. Another important IOM repor t18 in 1997 advanced an expanded CHIP model that extends the tools developed earlier in the decade and the ste ps described previously here. Its main features are its expanded perspective on the wide variety of factors that infl uence health, its support for broad participation by community stakeholders, and its emphasis https://jigsaw.vitalsource.com/books/9781284046342/content/id /ch05bib1-016