State and Local Collaboration for Coordinated Chronic Disease Prevention: A Qualitative Analysis Alecia Kennedy, MPH, Richard W. Wilson, DHSC, MPH Sue Thomas-Cox, RN APHA November 3, 2015

Presenter Disclosures (1)The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Alecia Kennedy, MPH “No relationships to disclose”

Background Coordinated Chronic Disease Prevention and Health Promotion Program (CCDP)

Kentucky’s State Categorical Programs Bone and Joint Breast and Cervical Cancer Tobacco Control and Prevention KBRFSS Respiratory Disease Coordinated School Health Nutrition and Obesity Healthy Communities Diabetes Heart Disease and Stroke Colon Cancer Screening

Methodology Planning Focus on current collaborative efforts Determine interview questions IRB approval Execution Private interviews Recorded, transcribed, analyzed Accuracy Check Dissemination of results to stakeholders Feedback used for revisions

Interview Focus Local Health Departments (LHDs) Community Partners State Categorical Program Partners Differences in Partnerships Collaboration: Benefits and Barriers

Relationships Local Health Departments Community Partners State Categorical Programs

Local Health Departments

Work Insights Majority of state programs worked with LHDs on a weekly basis Technical assistance and training were primary services Requirements for operation Benefits for state programs and LHDs

Funding Block grant funding for programs Grant-specific projects Non-financial assistance

Relationships Local Health Departments Community Partners State Categorical Programs

Community Partners University of Kentucky and the University of Louisville are the most common community partners Thirty-four different community partners identified Most community partners were engaged on a monthly basis

Work Insights Work on a common grant Provide professional development to partners Community partner provides advocacy assistance Community partner provides service Community partner provides network introductions

Funding Budget allocation to community coalitions Exchange training and materials for assistance in leading classes Grant-specific collaboration was common Federal money was a more common funding source than state money

Relationships Local Health Departments Community Partners State Categorical Programs

Tobacco Control and Prevention =Most common partner Grant dependent Physical proximity Uneven staffing

Work Insights Employee or data sharing Formal work on common grants or coalition work Informal work in the form of knowledge sharing Sharing information about other programs with contacts

Funding Unfunded collaboration Block Grant Uncertainty

Comparison of Partnerships State Categorical Programs Community Partners FocusReceptivityFreedom Comfort Level Convenience

Themes Primary Benefits Expand limited staff Stretch financial resources Learn about other programs Access additional funding Most Common Barriers Grant requirements and government restrictions Conflicting priorities Time constraints

In their words “They might do strategic planning with us. They might do other kinds of work. They do things that are bigger picture activities than their local area…Like I said, they’re almost extensions of our staff that way.” Referencing work with LHDs “It’s just one of me and I can’t do it all…They are my staff, so to speak, because I don’t have staff to do those things with me.” Referencing community partnerships “ I don’t know who half the people, the directors of these programs, are. I’d love to meet them.” New Program Coordinator “If it hadn’t been for my partners being there to help me, I don’t know what I would have done.” Program Coordinator with no staff

Primary Findings State programs already collaborate extensively with local health departments, other state programs and community partners There is great disparity between state programs in terms of staffing and intensity of collaboration Organizational structure for enhancing a more even approach to collaboration and staffing is lacking or perceived to be lacking by program coordinators Attitude toward increased collaboration is overwhelmingly positive if it is well-planned and managed

Recommendations Establish cross-agency collaboration as a standard measure of sustainability for state government health programs New coordinator orientation should include stakeholder collaboration training New coordinator orientation should include an introduction to local health department organization and operation Where state programs provide funding to local and regional partners, make collaboration a stipulation Develop and incorporate evaluation and accountability measures of collaboration into periodic performance reports required by funders