1. Illinois Project for Local Assessment of Needs (IPLAN) Office of Epidemiology and Health Systems Development Division of Health Policy September 28, 2001

2. What is IPLAN? PPrimary goals <To establish a process for community involvement and participation in community health assessment and planning <To make local health departments accountable to their communities rather than to the state PEssential elements <Organizational capacity assessment <Community health needs assessment <Community health plan, focusing on a minimum of three priority health problems

3. What led to IPLAN? Over a decade of strategic planning in public health

4. What led to IPLAN? 1984 - The Roadmap Committee Report PFour principles for change <Service delivery should be improved. <Societal benefits should be effectively communicated. <Quality of services should be improved and standardized. <Funding should be increased.

5. What led to IPLAN? 1984 - The Roadmap Committee Report PUnderlying belief <Services are most efficiently and effectively provided at the local level.

6. What led to IPLAN? 1988 - Roadmap Implementation Task Force PExamined existing policies, statutes, regulations, funding and administration of public health PVisioned an optimal public health system and compared it with the current system PDeveloped 29 recommendations that were published in The Road to Better Health for All of Illinois

7. What led to IPLAN? 1990 - Project Health The Illinois Public Health Improvement Project PConducted by more than 200 public health professionals from state and local health departments, public health academia, and public health associations PAdopted 27 of the RITF recommendations PCatalyzed the development of progressive rules for certification of local health departments in Illinois

8. Requirements for Certification of Illinois Local Health Departments Before and After 1993 Before July 1993 To be recognized as a local health department in Illinois, LHDs MUST DO – 1.Potable Water 2.Food Sanitation 3.Maternal Health/Family Planning 4.Child Health 5.Communicable Disease Control 6.Private Sewage 7.Solid Waste 8.Nuisance Control 9.Chronic Disease 10.Administration After July 1993 To be certified as a local health department in Illinois, LHDs MUST– 1.Assess community health needs 2.Investigate hazards within the community 3.Analyze identified health needs for their determinants 4.Advocate and build constituencies for public health 5.Prioritize among identified community health needs 6.Develop policies and plans to respond to priority needs 7.Manage resources and organizational structures 8.Implement programs and services to respond to priority needs 9.Evaluate programs and services 10.Inform and educate the community

9. Illinois Administrative Code Title 77: Public Health Chapter 1: Department of Public Health Subchapter H: Local Health Departments Part 600: Certified Local Health Department Code

10. Illinois Administrative Code Section 600.400: Certified Health Department Code Public Health Practice Standards 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 600.410.

11. Illinois Administrative Code Section 600.400: Certified Health Department Code Public Health Practice Standards A community health needs assessment that systematically describes the prevailing health status and health needs of the population within the local health department=s jurisdiction shall be conducted once every five years.

12. Illinois Administrative Code Section 600.400: Certified Health Department Code Public Health Practice Standards Develop a community health plan that addresses at least three priority health needs, identified pursuant to Section 600.400, during each certification period.

13. The IPLAN Process Community Health Needs Assessment Community Health Plan Program Development Implementation Evaluation

14. What is the State’s role?  Established the framework for the assessment and plan (APEX-PH model)  Developed, enhances and maintains IPLAN data system  Conducts training and provides technical assistance  Reviews submitted assessments and plans for substantial compliance with the administrative rules (every 5 years) and provides follow-up technical assistance

15. A Community Health Needs Assessment should contain-- A description of the health status and health problems most meaningful for the community in the data groupings contained in the IPLAN Data System: $ Demographic & Socioeconomic Characteristics $ General Health & Access to Care $ Maternal & Child Health $ Chronic Disease $ Infectious Disease $ Environmental, Occupational, & Injury Control $ (Sentinel Events)

16. A Community Health Needs Assessment should contain-- $A description of the process and outcomes of setting priorities; $A statement of purpose of the community health needs assessment that includes a description of how the assessment will be used to improve health in the community; $ A description of the community participation process, a list of community groups involved in the process, and method for establishing priorities;

17. Community Health Committee Pethnic & racial groups Pmedical & hospital community Pmental health & social service organizations Pcooperative extension service Pschools Plaw enforcement organizations Pvoluntary organizations Pfaith community Pbusinesses and economic development Punions Pyouth, senior citizens, other target populations

18. Prioritize Community Health Problems P Hanlon Method P Nominal Group P Delphi Technique P PEARL (Propriety, Economics, Acceptability, Resources, and Legality)

19. Detailed Analysis of Community Health Problems

20. aka - NCAA Chart Health Problem Analysis Worksheet Risk Factors Health Priority Indirect Contributing Factors Direct Contributing Factors

21. Risk Factors Health Priority Indirect Contributing Factors Direct Contributing Factors Health Priority A situation or condition of people which is considered undesirable, is likely to exist in the future, and is measured as death, disease, or disability.

22. Risk Factors Health Priority Indirect Contributing Factors Direct Contributing Factors Risk Factor A scientifically established factor (determinant) that relates directly to the level of a health problem.

23. Risk Factors Health Priority Indirect Contributing Factors Direct Contributing Factors Direct Contributing Factor A scientifically established factor that directly affects the level of a risk factor.

24. Indirect Contributing Factors A community specific factor that directly affects the level of the direct contributing factor. Risk Factors Health Priority Indirect Contributing Factors Direct Contributing Factors

25. Outcome Objective The level to which a health problem (priority) should be reduced. Risk Factors Health Priority Indirect Contributing Factors Direct Contributing Factors

26. Risk Factors Health Priority Indirect Contributing Factors Direct Contributing Factors Impact Objective The level to which a risk factor should be reduced.

27. Intervention Strategy Demonstrated to be effective or used as national model and should address an impact objective. Risk Factors Health Priority Indirect Contributing Factors Direct Contributing Factors Impact Objective The level to which a risk factor should be reduced.

28. Health Problem Outcome Objective Risk FactorImpact Objective Contributing Factors Community Health Plan: Worksheet Proven Intervention Strategies Resources Available Barriers

29. Tobacco Use By 2002, reduce cigarette smoking to a prevalence of no more than 24 percent among people aged 18 and older. (Baseline: 1996 BRFS percentage 27.3). Addiction Sedentary Lifestyle Hypertension Advertising (Indirect) Coalition will implement CDC=s community-based tobacco control program, focusing on delaying initiation, cessation programs, and advertising control. Coalition will provide support to LHD with in-kind donations, staff, and clinical counseling space. Cerebrovascular Disease (Stroke) By 2004, reduce stroke deaths to no more than 70 per 100,000 (Baseline: 1997 crude rate 76.5 per 100,000). Limited number smokers seeking counseling. Media messages promote smoking. Peer pressure. Health ProblemOutcome Objective Risk Factor Impact Objective Contributing Factors Community Health Plan: Worksheet Proven Intervention Strategies Resources Available Barriers

30. Description of the Health Problem, Risk Factors and Contributing Factors Corrective Actions Proposed Community Organizations Evaluation Plan Community Health Plan

31. Description of the Health Problem, Risk Factors and Contributing Factors Corrective Actions Proposed Community Organizations Evaluation Plan The problem is the high death rate associated with cerebrovascular disease (county CR = 76.5, state CR =61.7 p/100,000 or 23% above state rate). The major risk factor is cigarette smoking and county has higher percentage of smokers (27.6%), especially males (31%) than state (24%, 28%, respectively). Addiction appears to be the chief contributing factor. In order to effectively address this health problem a multi-sited and multi- targeted campaign is required to delay initiation of smoking behavior, assist persons attempting to quit, and provide counter advertising to tobacco promotions. A coalition of community groups, including the LHD, Cancer Society, Lung Association, General Hospital, Teens Against Butts will collaborate with in- kind donations, staff, and clinical counseling space to assist in meeting objectives. Coalition will meet quarterly to assess progress in achieving goals. Coalition will use the evaluation tool developed by the CDC to determine effectiveness of programming efforts. Surveys will be conducted amongst coalition members to ascertain stakeholder satisfaction with program. Community Health Plan