1. Healthy North Carolina 2020 and EBS/EBI 101 Joanne Rinker MS, RD, CDE, LDN Center for Healthy North Carolina Director of Training and Technical Assistance 1

2. Outline  HNC2020  EBS/EBI  Background  Review current EBS project at DPH 2

3. EBS vs. EBI  An Evidence Based Strategy (EBS) is a recommendation or suggestion of how to improve a problem.  An evidence-based intervention (EBI) is a specific program, policy, or practice that has been proven to positively change the problem being targeted.  Determining whether or not an intervention is evidence-based is done by collecting data through an evaluation process when a specific intervention is implemented. 3

4. Background: Defining Evidence Based Best (B), Proven, or EBP: supported by intervention evaluations or studies with rigorous systematic review that have evidence of effectiveness, reach, feasibility, sustainability, and transferability Leading (L): supported by intervention evaluations or studies with peer review of practice that have evidence of effectiveness, reach, feasibility, sustainability, and transferability Promising (P): supported by intervention evaluations without peer review of practice or publication that have evidence of effectiveness, reach, feasibility, sustainability, and transferability Emerging (E): supported by field-based summaries or evaluations in progress that have plausible effectiveness, reach, feasibility, sustainability, and transferability 4 Source: Adopted from the Centers for Disease Control and Prevention Best Practices Workgroup

5. Background: Role of DPH and LHDs  DPH and the local health departments (LHDs) are charged with working in partnership to “promote and contribute to the highest level of health possible for the people of North Carolina”  DPH and LHD must find ways to optimize the impact of their work with limited resources available  Evidence-based strategies (EBS) offer a way to do this 5

6. NCIOM Task Force Vision  Selecting, implementing, and evaluating EBSs often requires skills, knowledge, and resources that LHDs may not currently have.  Improving North Carolina’s Health: Applying Evidence for Success provides the vision of the Task Force for how to improve the health of North Carolinians through a strong partnership between DPH and LHDs, as well as other state partners, working collaboratively to effectively select, implement, and evaluate EBSs 6

7. Working Collaboratively  Collaborative leadership, built on a foundation of reciprocal accountability that recognizes and builds on the responsibilities, assets, and strengths of DPH and LHDs, is critical 7

8. Recommendation: Education  DPH and LHD staff need a basic understanding of what EBSs are, why it is important to implement EBSs, and the need to implement these strategies with fidelity to their tested design  Recommendation 5.1: Educate LHDs about Evidence-based Strategies and Implementation Science : State public health staff, in partnership with other state agencies and other partners, should offer trainings on EBS to appropriate state, regional, and local staff 8

9. Recommendation: Education  LHDs need more information about the different EBSs including  Level of evidence  Staffing needs  The costs  technical assistance and/or coaching that is availableto implement the program with fidelity  Evaluation  Sustainability  EBS Trainings: http://www.eahec.ecu.edu/calendar/allied1. cfm?category=allied_health http://www.eahec.ecu.edu/calendar/allied1. cfm?category=allied_health 9

10. Recommendation: Selection  Recommendation 5.2: Select Appropriate Evidence-Based Strategies: The Division of Public Health should provide guidance to LHDs around selecting appropriate evidence- based strategies. As part of this effort, DPH should work with local health directors, academic institutions, and partnering organizations to identify 2 state-supported EBSs for 10 of the priority HNC 2020 objectives identified by LHD action plans, and at least one expert contact for each selected EBS 10

11. Recommendation: Selection  HNC2020 Implementation Team identified 5 focus areas from the 13 listed in the HNC 2020 Action Plan, where CHNC and DPH staff can best support LHDs and community agencies determine their capacity and ability to implement EBS.  Gaps analysis completed and posted in Dec 2013.  Information and resources to implement EBS currently in process around the state, collected and available on DPH website: http://www.publichealth.nc.gov/hnc2020/docs/Ga psAnalysisWithRecommendations-022613.pdf  IMAPP,  Providing technical assistance throughout the selection and implementation processes.

12. Recommendation: Implementation  Need to ensure LHDs have training and expertise needed to implement chosen EBSs with fidelity  Recommendation 5.3: Implement Evidence- Based Strategies: DPH should create a system that supports and encourages LHDs to implement EBSs with fidelity through utilizing a quality improvement approach; pursuing and publicizing funding opportunities; promoting learning collaboratives; and providing training, technical assistance, and coaching to the extent possible 12

13. Recommendation: Evaluation  Collecting process and outcome measures is critical for evaluating the effectiveness of the EBS  Recommendation 5.4: Monitor and Evaluate Process and Outcomes: DPH should identify or develop evaluation and data collection tools for each state-selected EBS and provide training and coaching to local staff to enable them to collect the appropriate data. LHDs should ensure staff receive necessary training to collect requisite process and outcome data 13

14. Recommendation: Reciprocal Obligation  Recommendation 5.5: Revise the Consolidated Agreement: If DPH fulfills the obligations outlined in recommendations 5.1-5.4. DPH revised the 2013 Consolidated Agreement to require LHDs to:  identify and implement two new EBSs to address HNC 2020 priority objectives from different HNC 2020 focus areas as identified through the community health assessment.  The LHD action plans should articulate the selected EBSs.  As of July 1, 2014, LHD action plans must also include information about staffing, training, implementation and evaluation of the chosen EBS. 14

15. DPH EBS Project  Diabetes: DERP  Cardiovascular: CDSMP  Obesity: Implement comprehensive early care and education standards and policies for nutrition and physical activity  http://publichealth.nc.gov/lhd/cha/docs/ HistoryofLocalHealthDirectorsAdopting- EBS-June2014.pdf http://publichealth.nc.gov/lhd/cha/docs/ HistoryofLocalHealthDirectorsAdopting- EBS-June2014.pdf 15

16. Recommendation: Evaluation  Expand reach of DPH by partnering with state and national partners  Recommendation 5.6: Collaborate with Partner Organizations: The Center for Training and Research Translation (TRT) within UNC-CH, should convene academic and other organizations to work with DPH and LHDs in implementing EBS to address the HNC2020 objectives, provide implementation support; assist with the collection and analysis of data  Center TRT: http://centertrt.org/?p=interventions_overview http://centertrt.org/?p=interventions_overview 16

17. Implementing Recommendations  The Division of Public Health has tasked the Center for Healthy North Carolina with oversight of the recommendations from the NCIOM Task Force on Implementing Evidence Based Strategies in Public Health  The Center for Healthy North Carolina will work with partners to:  Identify a curriculum and coordinate training on EBS  Facilitate a learning collaborative  Develop a web based resource for EBS specific to HNC2020: IMAPP (collaborative effort between CHNC and CPHQ) 17

18. What can you do? Initial steps after CHA is complete - Engage partners - Present assessment data - Collaboratively prioritize health goals and intended populations - Collaboratively identify behavioral/environmental objectives and potential implementation venues

19. Questions

20. How Can You Find Out More? Center for Healthy North Carolina http://publichealth.nc.gov/hnc2020 Contact: Joanne Rinker Joanne.rinker@centerforhealthync.org 919-699-5886 20