1. WELCOME
Welcome
Introduce yourself
Thank host

2. Mobilizing for Action through Planning and Partnerships: what is it and why should we care?
Or: what’s in it for me?
Welcome questions throughout presentation
National Association of County & City Health Officials

3. Overview What is MAPP Overview of the Process Stories from the Field
Importance to You
We will cover:
What is MAPP
Overview of the Process
Stories from the Field
Importance to You

4. History of MAPP
Created in 2001 by a workgroup of local public health practitioners & national partners
MAPP advances the thinking behind APEXPH.
9 Demonstration Sites
Since then, about 700 organizations have utilized the MAPP process
Several communities in their 2nd and even 3rd iteration of MAPP
650 implementing, referencing, or using it as a teaching tool
Almost 300 communities
From , NACCHO and CDC developed MAPP.
All phases of the development assured a practice-driven process, ongoing substantive input from the field, careful attention to research and literature, and intentional linkage with related efforts. This deliberate process laid the foundation for a tool that is well-grounded in research and concepts but also relevant for practical use in communities.
MAPP advanced the thinking behind APEXPH and shifted the focus from the health department to the community and local public health system.
APEXPH was developed to be used voluntarily by local health officials to assess the organization and management of the health department, provide a framework for working with community members and other organizations in assessing the health status of the community, and establish the leadership role of the health department in the community.
Until the development of MAPP, there was little guidance directly informed by public health practice on what to include in a public health strategic planning process, especially one focused on a local public health system. MAPP was developed to provide structured guidance that will result in an effective strategic planning process that is relevant to public health agencies and the communities that they serve. The success of MAPP as a planning tool is based on both building on the history of planning in public health and on introducing new approaches that connect public health agencies to the challenges of today and to the partners they will need to meet those challenges.
Launched in 2001, MAPP is a paradigm shift in the way LHDs do the business of Public Health

5. MAPP is:
A community-wide strategic planning tool for improving public health.
A method to help communities prioritize public health issues, identify resources for addressing them, and take action.
State:
The MAPP stands for Mobilizing for Action through Planning and Partnerships.
MAPP is a community-wide strategic planning tool for improving public health, as well as an action oriented process to help communities prioritize public health issues, identify resources for addressing them, and take action.
Emphasis is on community
Focus on strategic planning
Leads to an action-oriented process

6. MAPP Overview
This is one of 2 models showing how the MAPP process works – the phases of MAPP are shown along a road that leads to “A Healthier Community”. MAPP is a way to define your interim goals between where you are and “A Healthier Community.” It also helps prioritize, set realistic action plans to get there, and celebrate your successes along the way.
Before I get into the details of the process:
Question: how many of you have experience collecting health data? What about community input, knowledge, and concerns on health issues?
How many of you have experience working with partners outside of the LHD?
Raise your hand if you’d say that you do a lot of community outreach?
These are some of the key skills needed for this process.

7. MAPP Overview
There are six phases in the MAPP process. This model shows the six phases in a linear fashion down the middle of the graphic. The four arrows surround the linear process to illustrate that the information and outcomes from the four MAPP assessments are crucial to driving the entire MAPP process.

8. Organize for Success/Partnership Development
Plan a MAPP process that
Builds commitment
Engages participants
Uses participants’ time well
Results in a plan that can be successfully implemented
The goal of Organizing for Success is to plan a process that
Builds commitment--ownership
Engages participants—involves educating the community and system partners
Uses participants’ time well—requires planning and preparation
Ultimately, this first phase should result in a plan that can be implemented successfully
This phase requires time and energy.
It is the foundation for the rest of the process, and
Should be revisited to ensure the sustainability of the process
It’s important to become familiar with the MAPP process in its entirety up-front and really think through each of the different phases during the planning or organize for success phase.
How will you manage the process?
Where/How will the community be part of the process (subcommittees? Identifying indicators? Drafting survey questions?)?
It’s important to recognize that simply surveying community members doesn’t qualify as community engagement – community members need to be engaged throughout the process, in meaningful ways. It’s critical to think through these pieces up-front:
how will you engage the community and what you will do to make sure community members feel safe, heard, valued and really have a sense of ownership in the process? These are all elements that require strong facilitation and planning skills.
STOP: what will staff’s role be in this phase?

9. Visioning Vision and values statements provide focus purpose direction
Phase 2 of MAPP is visioning.
Visioning is a collaborative and creative process. This phase provides focus, purpose, and common direction for the MAPP process.
A shared community vision provides an overarching goal for the community — a statement of what the future should look like.
And values are the fundamental principles and beliefs that guide a community-driven planning process. Example of values include mutual respect, commitment, and teamwork.
The vision represents the ideal picture of what your community will look like at its best.
A vision is like the picture on a jigsaw puzzle box. It's easier to put the puzzle together if you can see the whole picture on the box cover.
In this way the vision serves to guide participants through the MAPP process. In this depiction of MAPP there’s a sun that says, “a healthier community.” That is in fact where the vision is. It is developed early on, and then represents everything you’re working towards through the process.
STOP: what will staff’s role be in this phase?
focus
purpose
direction

11. The Four Assessments Forces of Change Local Public Health System
Community Themes & Strengths
Community Health Status
As I mentioned earlier, the four Assessments are really the meat of the MAPP process:
Forces of Change
Local Public Health System
Community Themes and Strengths
Community Health Status
The four assessments do not need to be implemented in any specific order—some communities use subcommittees to complete the assessments simultaneously.
STOP: what will staff’s role be in this phase?

12. Needed Knowledge and Skills
CHSA
CTSA
LPHSA
FOC
Members
Epidemiologists, Data Enthusiasts & Data Collectors
LPHS Partners, Community Residents,
Health Educators, Public Health Nurses
LPHS Partners
Leaders in the Community "Movers & Shakers"
Knowledge
Data management, analysis, reporting, technology, validation
Community assets, resident issues, quality of life, Qualitative methods
Distribution and use of local public health services, Facilitation skills
Major local, state & national policy issues, demographic trends, future events

13. Identify Strategic Issues, Formulate Goals & Strategies
Strategic issues are those fundamental policy choices or critical challenges that must be addressed in order for a community to achieve its vision.
Strategic issues usually center around a tension or conflict to be resolved and have no obvious solution. If there is an apparent solution, the question becomes why hasn’t this been implemented. Strategic issues reflects policy-level, not day-to-day or operational problems.
This must be something the local public health system can address. For example, universal health coverage and eradicating poverty are admirable aspirations and would improve the public’s health, but are not likely to be taken on successfully at the local level. (EXAMPLE STRATEGIC ISSUE: How can the public health community ensure access to population-based and personal health care services?)
Strategic issues represent predominant and cross-cutting issues that emerge when you look at the assessments collectively.
The next phase is to formulate goals and strategies.
Goals answer the question, “What do we want to achieve by addressing this strategic issue?”
Strategies answer the question, “How do we want to achieve it? What action is needed?”
Goals and strategies provide a connection between the current reality and the vision of what the local public health system and community will look like in the future.
Example for reference: For example a strategic issue might be: How can the public health community ensure access to population-based and personal health care services?
A goal related to this strategic issue might be: All persons living in our community will have access to affordable quality health care.
And a strategy related to this goal/strategic issue might be to provide free or reduced cost transportation services to community residents for whom transportation is a major barrier.
STOP: what will staff’s role be in this phase?

14. Action Cycle Evaluate Plan Implement
The next phase is the Action Cycle:
You may consider this the final stage of MAPP. But remember, MAPP is not something that is ever completed. It is a process, a whole new way of doing business, and the action cycle is something that is continuous and ongoing. It is during the Action Cycle that a community begins to see results. The Action Cycle involves three activities: Planning, Implementation, and Evaluation. This is one of the most challenging phases, as it may be difficult to sustain the process and continue implementation over time.
Each of these activities builds upon the others in a continuous and iterative manner.
It’s essential that the broader community be involved in the phases following the assessments. Community members’ should be a part of the assessment data review and should provide input as to what issues they see emerging from the data/process. If community members are an integral part of the beginning phases of MAPP and then their input isn’t solicited/valued in the more action oriented phase of the process, distrust and resentment may ensue – additionally, if the strategic issues, goals and strategies and action plan aren’t reflective of the community’s needs, they won’t be successful. Again, our interventions have to be aligned with community values – the only way to assure this is to include the community during every phase in t he process.
STOP: what will staff’s role be in this phase?
Implement

15. Organizing for Success MAPP Steering Committee
Visioning
LPHS Partners & Greater Community
LPHSA Sub-committee
CHSA Sub-committee
CTSA Sub-committee
FOCA Sub-committee
Assessments
Identify Strategic Issues
Steering Committee, LPHS Partners, Greater Community
Formulate Goals and Strategies
Action Cycle
Goal 1 Sub-committee
Goal 2 Sub-committee
Goal 3 Sub-committee
Goal 4 Sub-committee
Goal 5 Sub-committee

16. 3 Common Challenges Resource limitations Staff Time Financial
Loss of momentum
System partners leave implementation to LHD

17. Ensuring Success Leadership support Focus on system throughout process
Leveraging partner resources (e.g. business community)
Neutral facilitators
Clear goals, objectives, action plans, and accountability
Money follows good planning

18. MAPP as a Framework Organizational or Community Visions
We describe MAPP as a framework because MAPP is not unique. You will recognize much of MAPP’s phases reflect existing efforts you, or your community partners, are already doing. MAPP provides a process to coordinate and organize these existing efforts to help you use those efforts strategically. It will also help you build off of the efforts your partners are doing your community as well.
You will want to build from existing initiatives, and use this process as a framework to guide you. Here are some common examples:
Your community may already have a vision, or several of your partners may have visions that can form a draft of a collective vision to build from…rather than starting from scratch.
Your LHD may already conduct CHAs in your community. Or, and we find this in may communities, the local hospital may be undertaking a community health assessment
When I talk with public health educators and nurses, I find that they are already doing a lot of community engagement efforts that discuss key health concerns, but also get at some of the healthy opportunities communities enjoy. The United Way may be conducting a community survey. This information can either feed into, or depending on the content, can serve as your Community Themes and Strengths assessment.
Your community could have identified strategic issues from a Turning Point initiative, or previous planning effort. You’ll want to review these issues and see if the new data supports the existing issues or if changes need to be made.
You can review the existing strategies you are using to see if they can be modified or enhances to more directly support the goals developed through your MAPP process, but you don’t want to necessarily completely abandon your existing strategies unless they are addressing the wrong (or not important) issue, or they are approaching an issue in an effective way.
And, of course, you are already implementing activities. This process helps focus those activities towards priority areas.
NPHPSP Assessment
Qualitative data on Community Perceptions
Community Health Assessment
Priority Areas
Strategies
Pubic Health Activities 18

19. MAPP is Unique Not just an assessment process
Not just a planning process
Not just an agency process

20. Paradigm Shift MAPP is a journey, not a destination.
MAPP is a shift in how we think about public health activities and planning with our communities.
MAPP is a complete, long-term, system-wide PARADIGM SHIFT.
However, saying that MAPP isn’t unique doesn’t tell the whole story either.
MAPP isn’t just a short-term project that has a beginning and an end. MAPP changes the way public health is practiced in your community. Therefore, once you’re finished a cycle of MAPP, the effects of the process should continue to positively impact the community. MAPP is not a planning process for the LHD, it results in a plan for the entire public health system.
Another way of saying this is: MAPP is really a journey, not a destination.
MAPP is a complete, long-term, system-wide paradigm shift.
MAPP is a shift in how we think about public health activities and planning with and through our communities.

21. The MAPP Paradigm Shift
Ask: Why is MAPP such a paradigm shift?
MAPP is a paradigm shift in how we think about public health planning. It is a shift from operational to strategic planning; from a focus on the agency to a focus on the community and the entire public health system; from needs assessment to an emphasis on assets and resources; from a medically or service oriented model to a model that encompasses a broad definition of health; and from an “agency knows all” perspective to the belief that “everyone knows something.”
MAPP is a way of bringing everyone’s collective wisdom together. By gathering all of the assets and resources within the community, the community is able to determine how best to use all of the wisdom to create a healthier community.
Such a paradigm shift means that MAPP is a ‘new way of doing business.’

23. Three Keys to MAPP Strategic Thinking Community Driven Process
Focus on the Local Public Health System
State: There are three keys to MAPP.
The first key is strategic thinking. MAPP is unique because it is based on strategic planning concepts, and - in order to be successful - requires creative, long-term strategic thinking.
Thinking strategically means looking at multiple sources of information - such as local perceptions about health and the community, public health data and trends, information about how the public health system is operating and gaps in services, and forces of change such as the fact that new legislation is being implemented or state funding for public health has been decreasing. You’ll also take into consideration the kinds of things that MIGHT happen if you implement certain solutions. By looking at multiple sources of information, thinking about future implications of decisions, and using broad input, you’ll develop a stronger community health improvement plan that has a better likelihood for success and sustainability.
The second key to MAPP is that MAPP is a community driven process. MAPP 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. This is a community driven process.
The third key to making MAPP successful is the use of a broad definition of the Local Public Health System. This recognizes that public health is provided by more than just the local health department, yet recognizes that the LHD, and PH Nurses are the backbone of the system. Nevertheless, other organizations play a critical role in assuring the public’s 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.
For example:
Personal safety, policing and fire department
Traffic safety, the police as well and transportation planners have a hand in that.
Mental health, social services, services for older adults, school councilors, courts.
A huge issue in the press right now is obesity, which is linked to a lack of physical activity. Providing walkable communities to prove a environment more conducive to physical activity involve city/county planners.
In addition, life expectancy is tied to economic policy. So businesses have not only an impact on a communities quality of life, but also a stake in a healthy community (otherwise, they don’t have employees able to do their jobs).

24. What Does a Community-Driven Process Look Like?
“There is a critical difference between going through the empty ritual of participation and having the real power needed to affect the outcome of the process.”
(Sherry Arnstein, 1969: “A Ladder of Citizen Participation,” pg. 1)
“There is a critical difference between going through the empty ritual of participation and having the real power needed to affect the outcome of the process.”

25. A Ladder of Citizen Participation
Citizen Control
Degrees of Citizen Power
Degrees of Tokenism
Degrees of Non-Participation
Delegated Power
Partnership
Placation
Sherry Arnstein constructed this ladder of citizen participation that we’re going to use to briefly examine what community-ownership looks like in the context of MAPP.
It’s important to note that this is a superficially simplistic way of describing the spectrum of community participation. In the “real world” there might be as many as 150 rungs with less sharp or “pure” distinctions between them; however, for the ease of our conversation we’ll take a look at these 8 rungs.
Earlier, we talked about the MAPP Paradigm Shift. Two important components of the paradigm shift play into the 2nd key of MAPP – a community-owned process. In order for MAPP to manifest as a community-owned process, two important shifts must take place: facilitators must move from a focus on the agency to a focus on the community and entire LPHS, and facilitators must shift from an “Agency knows all” perspective to believing that every member of the community has valuable knowledge to contribute to improving the public’s health.
When these shifts in thinking occur, the MAPP process sits somewhere on the seventh rung: Delegated Power. A MAPP process that sits on the Partnership rung would look something like this:
The MAPP Coalition includes representation from the LHD and a spectrum of LPHS partners. LPHS partners and community members play an active role in every phase of the process from planning to implementation. During the Assessment Phase, for example, LPHS partners and community members are engaged in selecting the methods for each of the assessments, selecting indicators for data collection, collecting data, analyzing data, and disseminating results.
Activities implemented during the Action Cycle may later spin off into citizen-controlled projects no longer affiliated with MAPP or the LHD or LPHS; however, the phases of the process should be implemented as a “working partnership” between the LHD, its LPHS partners, and the broader community.
Background Information:
Sherry is the former Director of Community Development Studies for The Commons, a non-profit research institute in DC and Chicago. She created this ladder in 1969.
Limitations: The ladder juxtaposes powerless citizens with the powerful in order to highlight the fundamental divisions between them. In actuality, neither the have-nots nor the power-holders are homogenous blocks. Each group encompasses a host of divergent points of view, competed vested interests and splintered subgroups. The justification for using such simplistic abstractions is that in most cases the have-nots really do perceive the powerful as a monolithic “system” and power-holders actually do view the have-nots as a sea of “those people” with little comprehension of the class and caste differences among them (Arnstein, 2).
Consultation
Informing
Therapy
Manipulation

26. Local Public Health System
Police
Community Centers
Home Health
Faith Organizations
MCOs
Health Department
EMS
Corrections
Parks
Hospitals
Schools
Doctors
Nursing Homes
Elected Officials
Philanthropist
Mass Transit
State: A Public Health System is complex. Here is a depiction of the complexity of a public health system and examples of organizations and groups that comprise the network.
You can see many of the system partners represented who contribute to health and delivery of the Essential Public Health Services.
Environmental Health
Civic Groups
CHCs
Fire
Economic Development
Tribal Health
Employers
Mental Health
Laboratories
Drug Treatment

27. Bringing Local Initiatives Together
Is the coxswain doing her job?
Are we all rowing together?
Are we moving toward our agreed upon destination?
Do we have the information we need to get to our destination?
MAPP is a way to row together towards reaching a common vision. The process ensures that all of the system partners are rowing in unison in order to be more effective.
1. Are we moving toward our agreed upon destination, i.e. our vision?
2. Do we have the information we need to get to our destination, i.e. do we have all the data we need to plan and implement change?
3.. is the lead organization effectively facilitating and guiding the process?
4. Are we all rowing together, i.e. is the system and community working together? 27

28. Benefits: A.K.A. What’s in it for You?
MAPP can incorporate planning and assessment needs of a variety of program areas.
MAPP assessments provide useful data for your program.
MAPP provides strategic direction to ensure that programs and partners are aiming for shared goals.
MAPP helps create better community oriented programs.
MAPP enables programs to develop stronger project proposals.
The benefits of MAPP include
MAPP is a flexible tool that can incorporate the planning and assessment needs of a variety of program areas.
And since funders like data, the MAPP assessments can provide useful qualitative and quantitative data for LPHA programs to use in developing data supported programs and proposals.
MAPP provides strategic direction to the public health community to ensure that all LPHA programs and program partners are aiming for shared goals.
And because the community is involved in the process, MAPP helps create better community oriented programs, and
enables programs to develop stronger, community supported project proposals.

29. “A reputation for capability was created and reputation is priceless.”
More benefits…
“The process served to build networks and reinforce partnerships in the community.”
it served to eliminate competition, definitely made for more collaboration – much of this due to MAPP.”
“A reputation for capability was created and reputation is priceless.”
“I would recommend it; it helps to define critical issues and strategies.”
And the benefit is not just for the health department. This slide has a few quotes about the MAPP experience from partners in a rural community in NE.
Just a few of the benefits partners have received from the process in other communities have been:
Increased recognition within the community, and among peers
Access to more appropriate and current data for their needs – the data that comes out of this process has been the #1 benefit that we have heard from partners.
Improved focus on their priorities, knowing that other areas would be address by their partners. You can get stretched too thin if you try to do everything. Having a better sense of who else is doing different things will help you be more efficient and effective in your work. You don’t have to spin your wheels.
Increase in financial resources. The data can help get you grants and funding. It can help you with advocating for more dollars for your efforts.

30. So, what do you want from me…
Identifying and Leveraging Partners
Supporting the Assessments
Helping to Identify Strategic Issues
Thinking how the information (assessments, strategic issues) might change the way you approach your programs
What else?
Let’s just get down to it…you’ve patiently waited through the slides, but what you really what to know is what is going to be asked of you.
You will not necessarily be ask to take a substantial role throughout the process, so don’t worry. However, you’re insight and expertise may be tapped periodically in these areas:
Participating in the Local Public health System Assessment – this would mean that you’d actually be apart of the assessment, as a system partner
Identifying and Leveraging Partners – because you have your own network of partners, it would be good to ensure that they are brought into this process as well.
Supporting the Community Themes and Strengths Assessment – this may entail assisting in the administration of the assessment, or gaining your insight on how to develop and administer the assessment given your knowledge of the community.

31. Discussion
What words that describe the MAPP process particularly stand out in your mind?
What do you like about the process? Why do you like those aspects?
What concerns you about the process? Why are you concerned about those aspects of the process?
What else do you need to better understand the process?

32. NACCHO Staff Contacts Heidi Deutsch, MA, MSDM Julia Joh Elligers, MPH
Program Manager, NACCHO
(202)
Julia Joh Elligers, MPH
Senior Analyst, NACCHO
(202)
Lisa Jacobs
Program Associate, NACCHO
(202)