CHA: Setting Priorities, Assigning Roles, and Developing Action Plans

Community and State Health
Assessment :
Assigning Tasks and Developing
an Action Plan
Kansas MLC-3 Collaborative
Gianfranco Pezzino, M.D., M.P.H.
Senior Fellow
Kansas Health Institute

Community Health Assessment
L.S. 1 and A.P. 1 L.S. 2 and A.P. 2
• Community public health issues
• Test of gathering community input
• Priority settings
MLC-3 collaborative

The Logical Sequence of Steps
1. Setting priorities
2. Formulate goals and strategies
3. Assign roles
4. Develop action plan
• Steps 1 through 3 require
considerable community involvement
• Step 4 is agency-specific, but make
sure that action plans are coordinated

Disclaimer
• We will discuss how to perform tasks
during a community or state health
assessment
• These task will not all be practiced
during the MLC-e project

1. Setting priorities
Product: A list of community health issues
that are considered priorities

Recap - Priority Setting Tools
• There are a number of different tools which assist
in priority setting
• A tool as simple as a questionnaire or survey completed
by partners and/or public to help clarify health priorities
and potential strategies. Focus groups & key informant
interviews may be used
• Asset mapping
• Prioritization matrices , some of which are covered in the
memory jogger, or priority setting worksheets

Recap – Example: Priority Setting
Worksheets
• Priority setting worksheets can include multiple criteria
Example Criteria:
3. Priority Setting Worksheets
• Prevalence
• Mortality rate
• Community/Public concern
• Lost productivity (bed-disability days)
• Premature mortality (years of potential life lost)
• Medical costs to treat or community economic costs)
• Feasibility to prevent
• Ability to Evaluate
• Size of problem (how many people with health problem)
• Seriousness of health problem
• Community characteristics that support or inhibit health and healthy living
• Existing state, community and/or health department priorities

Priority Setting: Possible
Criteria
• How widespread is the issue
• How severe is it
• How preventable
• Are there “best practices” available
• What is the degree of control of P.H.
system over the issue
• What is the level of public concern

Priority Setting: Additional
Criteria
• What happens if issue is not
addressed
• How related is the issue to the
success of the P.H. agency/system
and its vision and mission
• Which issues related to the community
health assessment must be addressed
to achieve the vision and mission
• Link back to strategic plan

Example
• Vision: Health People in Healthy
Communities. As a community of
professionals who, through a
commitment to education, innovation,
leadership in crises, respect for our
citizens and research solutions for
health problems, we strive to make
XXX County residents the healthiest
people in the nation.

Example
• Vision: Health People in Healthy
Communities.
• Mission: Promote Physical and
Mental Health and Prevent Disease,
Injury, and Disability. Working
together and committed to excellence,
we protect and promote the health of
our citizens through prevention,
science, and the assurance of quality
health care delivery.

Example
• Vision: Health People in Healthy
Communities.
• Mission: Promote Physical and Mental
Health and Prevent Disease, Injury, and
Disability.
• Public Health issues:
*Children in poverty
*High school drop out rate
*High teen pregnancy rates
*Poor housing structures
*High STDs rates

Example
• Vision: Health People in Healthy
Communities.
• Mission: Promote Physical and Mental
Health and Prevent Disease, Injury, and
Disability.
• Public Health issues:
*Children poverty
*High school drop out rate
*High teen pregnancy rates
*Poor housing structures
*High STDs rates

2. Formulate goals and
strategies
Product: A list of goals and strategies for
each priority health issue

Definitions
• Goal = a common direction and
understanding of the anticipated end
result
• Strategies = how the community will
move towards the goals

Developing Goals and
Strategies
• Develop goals related to vision -
mission - priority health issues
• Examine each health issue separately
• Develop goal
• Develop possible strategies for
achieving the goal
• Select strategy (or strategies) to
implement

Selection of Strategies
• Can select multiple strategies for same issue
• Consider barriers to implementation and
implementation details
• Full plan of action is developed later
• How long before strategy can achieve results
• Try to include at least some strategies with short term
outcomes
• Build upon strategies that have worked (“best
practices”, successful projects, etc.)
• Look for strategies that can support multiple goals

Selection of Strategies – The
PEARL Criteria
• Propriety — Is a strategy consistent with the Essential Services
and public health principles
• Economics — Is the strategy financially feasible Does it make
economic sense to apply this strategy
• Acceptability — Will the stakeholders and the community accept
the strategy
• Resources — Is funding likely to be available to apply this
strategy Are organizations able to offer personnel time and
expertise or space needed to implement this strategy
• Legality — Do current laws allow the strategy to be
implemented
Source: Achieving Healthier Communities through MAPP:A Users Handbook

Example
• Vision: Health People in Healthy Communities.
• Mission: Promote Physical and Mental Health and Prevent
Disease, Injury, and Disability.
• Public Health priority issue:
• High teen pregnancy rates have increased in the past five years due to
early onset of teen sexual behaviors and unsafe sexual practices
• Goal: Decrease high teen pregnancy
• Possible strategies:
• Health education in schools
• Enhanced family planning clinics
• Parental education: how to “talk” to your teen
• Integration of family planning and STD services
• Increase in bilingual staff

3. Assign roles
Products: 1. A list of who will address each
community priority health issue 2. A list of
priorities for the public health department

Assigning Roles - Options
• LHD will provide ongoing
services/activities
• LHD will provide new services/activities
• LHD cannot address at this time
• Another organization is/will address
• Consider option to address at regional
level
• Consider capacity
• Importance of capacity assessments

Assigning Roles - Example
Strategy LHD role OTHERS - Role
Health education in
schools
Will support
School district will lead
Enhanced family
planning clinics
Will start service
Community Health Clinic
will expand service
Parental education: how
to “talk” to your teen
Will support
Public library will conduct
sessions
Integration of family
planning and STD
services
Will do
Community Health Clinic
will do
Increase in bilingual
staff
Will expand
Community Health Clinic
and Hospital will expand

4. Develop action plan
Product: A plan of action for each of the health
issues being addressed

Introduction to Action Plan
• Action (or improvement) plan is
ultimate reason for doing a
community health assessment

Characteristics of Action Plan
• Agency- and issue- specific
• One action plan for each issue in each agency
• Assure coordination with other agencies
• Detailed:
• Consider appointing oversight committee with
community representation
• Who, what, when, how
• Include measurable objectives, evaluation
plan
• Review results periodically, adjust plan
• PDSA

Community health issue:
Rising STD rates and consistently high teen pregnancy/unintended pregnancy rates due to early and
unsafe sexual practices.
What about this community health issue
needs improvement
County Public Health does not have an in-house family planning program. There is a local Planned
Parenthood that is contracted with to provide a small amount of family planning services every year.
Because this is not a specific program within the department it has not been high priority to seek out and
send staff to training related to STDs and family planning. Years ago it seemed there was more statewide
training available on these topics and some staff were always sent. Public Health staff has lost knowledge
and capacity over the years as we have been aware of fewer opportunities.
What does the LPHD plan to invest to improve
this community health issue
What action steps does the LPHD plan to take
Which target populations or audiences does
the LPHD plan to reach with these activities,
strategies, or interventions
How was or will the affected community be
involved in making decisions about what
needs to be done
How will the activities, strategies, and/or
interventions be measured (process
measures/indicators)
What are the anticipated short-term outcomes
of these activities
What are the anticipated intermediate
outcomes of these activities
What are the anticipated long-term outcomes
of these activities
What measures or indicators of outcomes will
be used
Technical assistance needs identified
County Public Health intends to specifically seek out training for our MCH, school and possibly WIC staff.
Ideally this training would be local or possibly regional and designed to increase awareness for family
education opportunities, not for clinical practice (such as in a clinic setting). This training will be repeated
every 2-3 years depending on staff turnover and changes in the field to keep staff current on methods,
trends and other relative information.
County Public Health intends to assess what STD and Family Planning training is currently available and
who provides it. It will then be determined if staff are sent to an organized training or if County Public
Health alone or with others in the region organizes their own training to meet the needs of public health
nurses and family home visiting.
Target populations to be served with staff with increased knowledge in this area is families receiving home
visiting services, and potentially WIC participants. Condoms are available free in the public health office
with an educational brochure, but that is the extent of family planning services provided by public health
staff.
Individual clients will be impacted with education from more qualified staff in the topic. The agency serves
many teen parents and families of all types through our family home visiting programs and WIC program.
Decisions about family planning, preventing pregnancy and STDs and/or seeking treatment for STDs will
be a choice that the client will ultimately make armed with up to date accurate information.
The Assistant PHN Supervisor will play a significant role in measuring the outcomes of this intervention.
Documentation from family home visits will be reviewed and data will be monitored over time for changes
in STD and unintended pregnancy rates.
Family Health staff are trained in up to date information related to family planning methods and STDs.
Family Health Staff use the information gained through the training with families that they interact with on
their caseload.
Staff are confident in educating families on these topics and over time we see fewer STDs with clients, a
reduction in unintended pregancies and adequate spacing of pregnancies.
STD and pregancy and birth data from the MDH will be utilized as well as population reports from our PH
Doc nursing documentation system to track results.
County Public Health will ask for assistance in locating trainers if needed.

Kansas Health Institute
Healthier Kansans through
informed decisions