Presentation on theme: "Lesson 1B Moving Toward the MAPP Model"— Presentation transcript:
1Lesson 1B Moving Toward the MAPP Model Community Health Analysis MPH607REVISED: 01/2010
2Lesson 1B ObjectivesUnderstand the development of the MAPP process by examining earlier models of health improvement.Identify the steps key concepts underlying each modelReview models:Precede/ProceedPATCHAPEXPHIOM CHIP ModelMAPP
3Models for Public Health Planning PROGRAMPRECEDE /PROCEEDPATCHAPEXPHCHIP (IOM)MAPP SYSTEMMAPP – Mobilizing for Action through Planning and Partnerships was preceded by a number of models of planning for use in public health.Evolution of the Models as one moves from Precede/Proceed to MAPP:Increasingly emphasize the cyclical nature of health improvementMove from program/intervention focus to system improvement.Greater emphasis on performance/quality improvementCommon elements to the approaches in all of the models:Engage the “participant” in processFocus on assessment/diagnosisInvolve prioritization of health issuesFocus on measurement and evaluationUse of objectives to measure process, impact and outcomes
4PRECEDE -PROCEED Developers: L. Green, M. Krueter Years of origin for PRECEDE, late 1980s for PROCEED.Principles:Success in achieving change is enhanced by the active participation of members of the target audience. The important role of the environmental factors as determinants of health and health behavior such as media, industry, politics, and social inequitiesThe Precede-Proceed model was developed for Health Promotion program planning.It emphasized the participation of the target audience in development of the program planning.It also looked beyond individual factors that played a role in behavior change and included a broader view of determinants in the change process.PRECEDE:Focus: Health EducationProcess for development and evaluation of health education programs.In theory it held thathealth education is dependent on voluntary cooperation and participation of the client in a process – behavior change is voluntaryhealth and health behaviors have multiple causations which must be evaluated in order to assure appropriate intervention.this theory applies to health education in various settings e.g. such as school, clinic/patient, community educationSource: THE PRECEDE/PROCEED MODEL.
5PRECEDE -PROCEEDPRECEDE is an acronym for Predisposing, Reinforcing, Enabling, Causes in, Educational Diagnosis and Evaluation.PROCEED is an acronym for Policy, Regulatory, Organizational Constructs in Educational and Environmental Development.(You do not need to memorize these! These are somewhat convoluted and contrived!)In health education and health promotion planning, this model’s first step was to “precede” (with assessment) and the “proceed” with policy and planning.
6PRECEDE - 5 “Diagnosis” Phases 1 Social: identify and evaluate the social problems which impact the quality of life 2 Epidemiological: identify specific health problems and non-health factors 3 Behavioral: analysis of behavioral links to the problems identified in the first phases Environmental: parallel analysis of factors in the social/physical environment 4 Education & Organizational: looks at the specifics that hinder or promote behaviors 5 Administrative & Policy: assessment of policy resources, circumstances that could impact implementation.PRECEDE consisted of 5 Diagnosis phases. The “Diagnosis” phases parallel ‘Assessment’ from a planning perspective.Each of the elements were assessed in developing the program plan. Note that the scope is broader than epidemiologic outcomes and measures alone.
7PROCEED PROCEED: added to the framework . Recognition of the need for health promotion interventions that goes beyond traditional educational approaches to changing health behaviors.Flows from the PRECEDE:to promote the plan or policy, regulate the environment, and organize the resources and services, as required by the plan or policy. Proceed was added later to the Precede. Following the “diagnosis”, policy and planning for community health promotion strategies which were broader than student/client education – targeting social norms (e.g. societal norms about smoking, seat belt use, etc), as means of behavior change.
8PROCEED – Action/Evaluation 6 IMPLEMENTATION7 PROCESS EVALUATION evaluates:the process by which the program is being implemented.8 IMPACT EVALUATION measureseffectiveness related to intermediate objectiveschanges in predisposing, enabling, and reinforcing factors. 9 OUTCOME EVALUATION measureschange in overall objectives andchanges in health and social benefits or the quality of life.The emphasis in proceed was on implementing the plan and evaluating the results at the process, impact and outcome levels.Aspects of this model are present in subsequent models of health improvement (e.g. APEXPH).
10Planned Approach to Community Health (PATCH) Developed 1983; by CDCProgram focus.Assist local health agencies to partner with local communitiesEvaluate health promotion/prevention programsImprove linkages within/between communities, health depts, universities, etcPATCH was developed to provide a model to assist state and local public health agencies, in their partnerships with local communities, to plan, conduct, and evaluate health promotion and disease prevention programs.PATCH was also intended to serve as a mechanism to improve links both within communities and between communities and state health departments, universities, and other agencies and organizations.
11PATCH STEPS 1) mobilizing the community, 2) collecting and organizing data,3) choosing health priorities,4) develop comprehensive intervention plan5) evaluation.The focus of PATCH was on gaining community participation in the development of the public health programming. It emphasized community engagement. It also required collection of data to support priorities and plans. Finally it included an evaluation component.PATCH required:Time to complete the process – up to a year or moreHaving adequate time and resources to gather and interpret dataRequires actively engaging community membersDeveloping cohesion among stakeholder organizations.PATCH is an example of a model that not only tested the application of theory, but has also facilitated the link between research and practice in community health education and health promotion.It still had an emphasis on public health program interventions – not focused on a true strategic, systems approach.
12PATCH Benefits Strengths: Tested the application of theory PATCH increases community(1) organizing and data use skills,(2) awareness and interest in health,(3) networking and ability of groups and organizations to work together, and(4) the number of health promotion interventions activities.Strengths:Tested the application of theoryFacilitated the link between research and practice in community health education and health promotion.Practical/user friendly approachHowever, PATCH planning sometimes leads to a priority problem for which resources are available. In some cases if the selected problem is not a priority of the government entity, the community may have to choose between shifting focus to a health issue for which there are available resources, or go without. Since the process focuses on an organizational approach rather than a systems approach, the ability to implement priorities not aligned with (public health) agency resources was limited.
13Assessment Protocol for Excellence in Public Health (APEXPH) A collaborative project ofThe American Public Health AssociationThe Association of Schools of Public HealthThe Association of State and Territorial Health OfficialsThe Centers for Disease ControlThe National Association of County Health OfficialsThe United States Conference of Local Health OfficersFunded through a Cooperative Agreement between the Centers for Disease Control and the National Association of County Health Officials (NACCHO)APEXPH was the result of a broad collaborative during the late ‘80s and early ’90s.APEXPH: Public Health LeadershipEmphasized the leadership role of governmental public healthLocal health departments have a responsibility to take a key role in local efforts to improve the conditions that affect health Health departments must lead their communities in assessing health problems, setting appropriate policies, and assuring that health problems are effectively addressed.It moved the focus beyond program planning to addressing community health priorities with a focus on broader strategy and community participation.
14APEXPH – 3 Part Process Part I, Organizational Capacity Assessment an internal review of a local health department.an assessment of department's basic administrative capacity and to undertake Part II.Part II, The Community Processinvolving key members of a community and department staffassessing the health of the community and identifying the role of the health department in relation to community strengths and health problems.use of objective health datause of community's perceptions of community health problems.Part III, Completing the Cycleintegrates the plans developed during Part 1 and Part IIinto the ongoing activities of a health department and the community it serves.discusses policy development, assurance, monitoring, and evaluation of plansThe APEXPH process was comprised of 3 parts:Part 1 was focused on the public health agency – the local health department’s capacity.Part 2 was the community based assessment and planning process.Part 3 was the implementation phase of the plan.
15STEPS: APEX PARTS I & IIINTERNAL1. Prepare for the organizational capacity assessment2. Score indicators for importance and current status3. Identify strengths and weaknesses4. Analyze and report strengths5. Analyze weaknesses6. Rank problems in order of priority7. Develop and implement action plans8. Institutionalize the assessment processEXTERNAL1. Prepare for the community process2. Collect and analyze health data3. Form a community health committee4. Identify community health problems5. Prioritize community health problems6. Analyze community health problems7. Inventory community health resources8. Develop a community health planThe APEXPH model was much more comprehensive process that previous models. It also shifted the process outside of the health department. The priorities that were to be determined were derive from a process involving community input and prioritization.APEXPH was used as the model that was (is) required for Illinios’ IPLAN and part of the Illinois public health certification rules:“The local health department shall, at least once every five years perform an organizational capacity self-assessment that meets the requirements set forth in Section The process shall involve community participation in the identification of community health problems, priority-setting, and completion of the community health needs assessment and community health plan.”The IPLAN version of this process is modified slightly. These essential steps are nearly identical but the IPLAN version calls for the formation of a community health committee as the first step of the process. Below are the steps in the IPLAN version of this process.Convening the Community Health CommitteeAnalysis of Health Problems and Health DataPrioritize Community Health ProblemsConduct Detailed Analysis of Community Health ProblemsInventory Community Health ResourcesDevelop a Community Plan
16APEXPH Strengths: Challenges: Strengthened health department’s role True organizational assessmentAdaptable to fit local situations and resources.Limit size/scope of effort.Focused on community as partners in health improvementChallenges:Commitment of time and resourcesPriorities may not align with program fundingLacked environmental health component
17IOM: Community Health Improvement Process (CHIP) Focuses on a broader definition of health:Health is a state of well-being and the capability to function in the face of changing circumstances” (IOM 1997).Underlying themes:The origins of good health are multiple and cross- sectorial.A focus on the origins of health:emphasizes the need for cross-sectorial assumptions of responsibilitiescreates multiple options for interventionThe Institute of Medicine model for Community Health Improvement (CHIP) emphasized a broader health view of health. APEXPH was focused on health problems defined by health status indicators of disease, death or disability.The IOM process expanded the view of health to include both the health outcomes and risk factors but also the systems that enable people to be healthy. It also placed more of the responsibility for health on entities other than the public health department alone or the health sectors alone. This enabled interventions to focus on more than medical interventions – opening opportunities for social and economic interventions as well.
18Determinants of Health It expanded the view of determinants of health beyond the biologic environment and individual behavior, to include social and physical environment factors that play a role in health – the social determinants of health. These were indirect factors -- outside of the direct cause-effect pathway. However they exert an impact on the ability of individuals to respond to health hazards and potential detrimental behavioral choices.A model of the determinants of health. Source: Reprinted from R.G. Evans and G.L. Stoddart, 1990, Producing Health, Consuming Health Care, Social Science and Medicine 31:1347–1363
19IOM: Community Health Improvement Process (CHIP) Two Cycles:Problem Identification and PrioritizationAnalysis and ImplementationEmphasizes ongoing nature of community improvement processThe CHIP process involves an initial problem identification and prioritization cycle . This phase focuses on bringing community stakeholders together in a coalition, assessing community-level health indicators, and identifying specific health issues as community priorities.The priorities are addressed in the second kind of CHIP cycle—an analysis and implementation cycle. This cycle’s components are analyzing a health issue, assessing resources, determining how to respond and who should respond, and selecting and using stakeholder-level performance measures together with community-level indicators to assess whether desired outcomes are being achieved.More than one analysis and implementation cycle may be ongoing at once if a community is responding to multiple issues.
20CHIP: Problem Identification Cycle Focuses on bringing community stakeholders together in a coalition Monitoring community-level health indicators Identifying specific health issues as community priorities.
21CHIP: Analysis & Implementation Cycle Analyzing a health issue (for determinants )Assessing resourcesDetermining:How to respondWho should respondAssess outcomesPerformance monitoringCommunity indicators
22What is meant by Performance Monitoring in Health Improvement? Continuing and evolving process – measure along the wayShared responsibility and accountabilityNot outcomes (disease) alone:using a limited number of indicators that can track critical processes AND outcomes over time and among accountable stakeholders;collecting and analyzing data on those indicators;making the results available to inform assessments of the effectiveness of an intervention AND the contributions of accountable entities.Move toward “systems” approach.Performance monitoring is a key component of the CHIP process and later models (i.e. MAPP).Each stakeholder establishes performance measures as part of implementation. These are monitored and tracked. Stakeholders are held accountable for measures.Increasing movement away from accountability by one agency/entity to a systems approach.
23Mobilizing for Action through Planning and Partnerships (MAPP) Developed by the National Organization of City and County Health Officials (NACCHO) and CDCa community-wide strategic planning tool for improving public health,an action oriented process to help communities prioritize public health issues, identify resources, take action
24Three Keys to MAPP Strategic Thinking Community Driven Process Focus on the Local Public Health SystemMAPP is based on strategic planning concepts, requires creative, long-term strategic thinking.It is a community driven process that relies on participation from a wide range of individuals, groups, and constituencies in the community. Since the community drives the process, the process has credibility, ensures buy-in and creates sustainability over time. It can also create greater advocacy for public health.The third key to making MAPP successful is the use of a broad definition of the Local Public Health System. Recognizing that public health is provided by more than just the local health department promotes a shift from silos to systems.
25Strategic Thinking Requires broad-scale information gathering Encourages exploration of alternativesPlaces emphasis on future implications of present decisionsFacilitates communication and participationAccommodates divergent interests and valuesMAPP is different from previous public health planning tools in that it introduces strategic thinking into public health planning efforts. Strategic thinking requires broad-scale information gatheringAn exploration of alternativesAnd an emphasis on the future implications of present decisions. It can facilitate communication and participation,And accommodate divergent interests and values, and foster orderly decision-making and successful implementation.For example, in traditional public health planning you may have just taken into consideration community perceptions and data – and then used that information to determine priority public health issues. But thinking strategically means looking at multiple sources of information - such aslocal perceptions about health and the community,public health data and trends,information about how the public health system is operating and gaps in services, andforces of change, such as the fact that new legislation is being implemented or state funding for public health has been decreasing or the kinds of things that may happen if certain solutions are implemented.It also maxmizes input from individuals representing diverse organizations and perspectives.This approach - looking at multiple sources of information, incorporating future implications of decisions, and using broad input, a stronger community health improvement plan emerges that has a better likelihood for success and sustainability.
26Community Driven Process Mobilizing and engaging the communityAction with and by the communityPlanning driven by the communityPartnerships to strengthen the communityMAPP is a community driven process. MAPP serves as a tool for including diverse portions of the community and thereby maximizes the creative resources of the community. It expands ownership of the problems and solutions to a broad base of the community. Ths assists in making efforts sustainable, actions that are built on collective wisdom, and incorporates resources from throughout the community to contribute to health improvement.
27Local Public Health System The third component that makes MAPP unique. It is MAPP’s emphasis on system-wide involvement, and a broader definition of public health.The local public health system includes all public, private and voluntary entities, as well as individuals and informal associations that contribute to public health services.No single organization provides public health services in a community. MAPP recognizes the important contributions of all entities involved in the local public health system and provides a process for coming together and planning how to provide better public health.
28MAPP Overview Phases Organize for Success and Partnership Development Who should we includeWho is part of the public health system in our community?VisioningWhat will the public health system look like if it is substantially providing the Ten Essential Public Health ServicesWhat will our community look like?What will our community’s health look like?What would we like to see?What mission and values drive this process?There are six phases in the MAPP process.The first phase involved organizing and preparing to implement MAPP (Organize for Success and Partnership Development). This phase allows for planning it assure that there will be a process that builds commitment, engages participants, uses their time well, and results in a plan that can be implemented successfully.The second phase is Visioning. This phase seeks to establish a shared vision and common values provide a framework for pursuing long-range community goals. During this phase, the community answers questions such as “What would we like our community to look like in 10 years?”
29MAPP Overview (cont.) Four MAPP Assessments Community Themes and Strengths“What is important to our community?”Local Public Health System“How are the Essential Services being provided?”Community Health Status“How healthy is are our residents?”Forces of ChangeWhat is occurring or might occur that affects the health of our community or LPHS?”Next, the four MAPP Assessments are conducted, providing critical insights into challenges and opportunities throughout the communityThe Community Themes and Strengths Assessment provides a deep understanding of the issues residents feel are important by answering the questions, “What is important to our community” and “How is quality of life perceived in our community?” and “What assets do we have that can be used to improve community health?”The Local Public Health System Assessment is a comprehensive assessment of all of the organizations and entities that contribute to the public’s health. This assessment answers the questions, “What are the activities, competencies, and capacities of our local public health system?” and “How are the Essential Services being Provided to our community?”The Community Health Status Assessment identifies priority issues related to community health and quality of life. Questions answered during the phase include, “How healthy are our residents?” and “What does the health status of our community look like?”The Forces of Change Assessment focuses on the identification of forces such as legislation, technology, and other issues that affect the context in which the community and its public health system operates. This answers the questions, “What is occurring or might occur that affects the health of our community or the local public health system?” and “What specific threats or opportunities are generated by these occurrences?”
30MAPP Overview (cont.) Identify Strategic Issues Focus on issues, not programs and servicesNot limited to health outcomesFormulate Goals and StrategiesGoals and objectivesResponsibilities and accountabilityAction CyclePlanImplementEvaluateOnce a list of challenges and opportunities has been generated from each of the four assessments, the next step is toIdentify Strategic Issues. During this phase, participants identify linkages between the MAPP assessments to determine the most critical issues that must be addressed for the community to achieve its vision.After issues have been identified, participants Formulate Goals and Strategies for addressing each issue.The final phase is the Action Cycle during which participants plan, implement, and evaluate. These activities build upon one another in a continuous and interactive manner and ensure continued success.
31MAPP Connects with National Frameworks and Initiatives National Public Health Performance Standards (NPHPSP) – (“model standards”) is used within MAPP to assess the local public health systemhtm10 Essential Services framework ensures a comprehensive picture of public healthMAPP can help address Healthy People 2020 objectivesMAPP incorporates national models and standards of public health practice and community health improvement.It incorporates the local instrument of the NPHPSP (National Public Health Performance Standards Program). This instrument examines the provision of the 10 Essential Public Health Services by the local public health system, by assessing the system’s performance of model practice standards.Healthy People objectives aligns community improvement plans and actions with national health improvement targets. Using Healthy People objectives also assists with interpreting health status and prioritizing health problems.
32SummaryPublic Health community health improvement planning has evolved from program oriented process to system level processes.Incorporates strategic planning principlesBroadened definition of health and determinantsIncreasing emphasis on community input and shared responsibility for public healthFocus on evidence based planning – link to standards and measures
33REFERENCESTHE PRECEDE/PROCEED MODEL. Retrieved 1/15/2010, 2010, fromPATCH: Its origin, basic Concepts/Links to health policy. Retrieved 1/15/2010, 2010, fromAPEXPH:Assesment protocol for excellence in public health. Retrieved 1/18/2010, 2010, fromMobilizing for action through planning and partnerships (MAPP) | NACCHO. Retrieved 1/18/2010, 2010, from