1. Sustaining Evidence-Based Health Promotion Programs Lora Connolly, California Department of Aging June Simmons, Partners in Care Foundation Terri Whirrett, South Carolina Lt. Governors Office on Aging Cora Plass, South Carolina Department of Health

2. Compelling Statistics 12 million older adults have chronic conditions like arthritis, diabetes and heart disease 12 million older adults have chronic conditions like arthritis, diabetes and heart disease More than 13,700 people over age 65 die each year from fall related injuries (30%-40% of which could have been prevented) More than 13,700 people over age 65 die each year from fall related injuries (30%-40% of which could have been prevented)

3. Compelling Statistics Older adults are disproportionately affected by chronic diseases Older adults are disproportionately affected by chronic diseases These conditions account for 7 out of 10 deaths These conditions account for 7 out of 10 deaths These conditions account for ¾ of all health care expenditures These conditions account for ¾ of all health care expenditures They negatively impact quality of life & older adults ability to live independently They negatively impact quality of life & older adults ability to live independently

4. Research to Develop Strategies National Center for Disease Control (CDC) investment in research aimed at identifying best practices in treating chronic health conditions National Center for Disease Control (CDC) investment in research aimed at identifying best practices in treating chronic health conditions Found that these conditions are not curable, but can be effectively dealt with through self management & behavioral changes Found that these conditions are not curable, but can be effectively dealt with through self management & behavioral changes Quantified the associated fiscal & quality of life costs Quantified the associated fiscal & quality of life costs

5. Evidence Based Model Evidence-Based Disease Prevention program refers to a program that closely replicates a specific intervention that has been tested through randomly controlled experiments with results published in peer-reviewed journals. Evidence-Based Disease Prevention program refers to a program that closely replicates a specific intervention that has been tested through randomly controlled experiments with results published in peer-reviewed journals. Sources of evidence include HHS sponsored research funded by the National Institutes of Health (including National Institute on Aging), the Centers for Disease Control and Prevention (including work in the Healthy Aging Research Network), Agency for Health Care Research and Quality (AHRQ), the Centers for Medicaid and Medicare Services (CMS) and the Substance Abuse Mental Health Services Administration (SAMHSA). Sources of evidence include HHS sponsored research funded by the National Institutes of Health (including National Institute on Aging), the Centers for Disease Control and Prevention (including work in the Healthy Aging Research Network), Agency for Health Care Research and Quality (AHRQ), the Centers for Medicaid and Medicare Services (CMS) and the Substance Abuse Mental Health Services Administration (SAMHSA). Promising Practice Best Practice Evidence Based Model

6. First Round of Community Evidence Based Grants National Council on Aging coordinated the development of 4 evidence based health promotion programs: National Council on Aging coordinated the development of 4 evidence based health promotion programs: –Healthy Moves (physical activity) –Healthy IDEAS (depression) –Healthy Changes (diabetes) –Healthy Eating (nutrition) Findings evaluated, further replication & second round of grants Findings evaluated, further replication & second round of grants

7. 2006 AoA Request for Proposal Funding opportunity for states to implement evidence based health promotion programs targeting older adults Funding opportunity for states to implement evidence based health promotion programs targeting older adults Required partnership between state departments of health and aging services Required partnership between state departments of health and aging services Required Chronic Disease Self-Management Program (CDSMP) & could include other evidence based programs Required Chronic Disease Self-Management Program (CDSMP) & could include other evidence based programs

8. 2006 AoA Request for Proposal (continued) Requires a community based partner that received OAA funding Requires a community based partner that received OAA funding Requires involvement of Area Agencies on Aging Requires involvement of Area Agencies on Aging Grants = $250,000/year for three years to 16 states (now 24 states have grants) Grants = $250,000/year for three years to 16 states (now 24 states have grants)

9. AoA Approved Evidence-based Programs Chronic Disease Self-Management Program Chronic Disease Self-Management Program Matter of Balance Matter of Balance Enhance Wellness Enhance Wellness Active Choices Active Choices Enhance Fitness Enhance Fitness Strong for Life Strong for Life Healthy IDEAS or PEARLS Healthy IDEAS or PEARLS Prevention & Management of Alcohol Problems in Older Adults Prevention & Management of Alcohol Problems in Older Adults Visit www.healthyagingprograms.org to view additional evidence-based programs www.healthyagingprograms.org that meet AoA criteria

10. Chronic Disease Self-Management Designed to help people manage chronic illnesses Designed to help people manage chronic illnesses Consists of six 2½ hour sessions led by 2 leaders Consists of six 2½ hour sessions led by 2 leaders Groups are small (10-20 people) Groups are small (10-20 people) Topics include: Topics include: 1.How to deal with frustration, fatigue, pain and isolation 2.Exercise 3.Medication useage 4.Communicating with family, friends, and health professionals 5.Nutrition 6.Evaluating new treatments

11. Matter of Balance: Managing Concerns About Falls Based upon research conducted by the Roybal Center for Enhancement of Late-Life Function at Boston University Based upon research conducted by the Roybal Center for Enhancement of Late-Life Function at Boston University Consists of 8 two-hour courses Consists of 8 two-hour courses Designed to reduce the fear of falling and increase the activity levels of older adults with fall concerns Designed to reduce the fear of falling and increase the activity levels of older adults with fall concerns Participants learn: Participants learn: –To view falls and fear of falling as controllable –To set realistic goals for increasing activity –To change your environment to reduce fall risk factors –To promote exercise to increase strength and balance

12. Californias Evidence Based Health Promotion Grant Brief Overview

13. Californias Size Shapes Implementation Strategy and Potential Impact

14. Participating California Counties Original County New County

15. California Project CA Department of Aging is lead agency in partnership with CA Department of Public Health CA Department of Aging is lead agency in partnership with CA Department of Public Health 5 initial counties & respective Area Agencies on Aging participating (Fresno, Los Angeles, Madera, San Diego & Sonoma) 5 initial counties & respective Area Agencies on Aging participating (Fresno, Los Angeles, Madera, San Diego & Sonoma) Partners in Care Foundation, already implementing two AoA evidence based programs serving frail seniors, acting as project office Partners in Care Foundation, already implementing two AoA evidence based programs serving frail seniors, acting as project office Statewide steering committee comprised of two departments, Partners, participating counties, major local partners Statewide steering committee comprised of two departments, Partners, participating counties, major local partners

16. California Department of Aging Programs Older Americans Act & Older Californians Act –33 Area Agencies on Aging Older Americans Act & Older Californians Act –33 Area Agencies on Aging Multipurpose Senior Services Program – home & community based waiver for frail elderly Multipurpose Senior Services Program – home & community based waiver for frail elderly 300+ Adult Day Health Care Centers 300+ Adult Day Health Care Centers

17. California Project Participating counties were asked to mentor other interested counties in Years II & III. Participating counties were asked to mentor other interested counties in Years II & III. Programs are offered in English & Spanish Programs are offered in English & Spanish MSSP programs (HCBS wavier for seniors) will introduce two evidence based programs: MSSP programs (HCBS wavier for seniors) will introduce two evidence based programs: –Medication Management Improvement System –Healthy Moves for Aging Well

18. California Grant Overview

19. Coordinating for Successful Implementation Successful implementation requires: –Effective Outreach –Coordinated Training Strategies –Involvement of AAA I&A and health promotion activities (& many others!) –Coordination with California Dept. of Public Health network addressing chronic diseases –Sustainable infrastructure & long term committed partners

20. Being strategic means we have to be clear about the types of changes we want to advance over the next 10 years, and the role we want to play as a network in implementing those changes. Being strategic means we have to be clear about the types of changes we want to advance over the next 10 years, and the role we want to play as a network in implementing those changes. It means playing to our strengths, and capitalizing on our unique assets and capabilities. It means modernizing our business practices and honing our skills so we can remain competitive in the changing market place and able to keep pace with innovation and the changing needs and demands of our consumers. It means playing to our strengths, and capitalizing on our unique assets and capabilities. It means modernizing our business practices and honing our skills so we can remain competitive in the changing market place and able to keep pace with innovation and the changing needs and demands of our consumers. --AoA Assistant Secretary Josefina G. Carbonell --AoA Assistant Secretary Josefina G. Carbonell Choices for Independence: National Leadership Summit Choices for Independence: National Leadership Summit December 5, 2006 December 5, 2006

21. Sustaining Evidence-Based Health Promotion Programs The California Perspective Sustaining Evidence-Based Health Promotion Programs The California Perspective June Simmons, CEO

22. Changing American Culture We are in the service of a great vision We are in the service of a great vision –Mainstreaming access to tools for health –Building a platform for health and quality of life –This is a MISSION, not a PROJECT

23. Launching Lasting Change Current projects are seed money to launch a new movement Current projects are seed money to launch a new movement Need to identify and involve many investors in order to take this to scale Need to identify and involve many investors in order to take this to scale Scale = creating a new norm for healthy living Scale = creating a new norm for healthy living Scale = new norms for widespread ready access to proven programs and services Scale = new norms for widespread ready access to proven programs and services

24. Major Assumptions Lasting Change Lasting Change Converting Aging Network to a Platform for Health Converting Aging Network to a Platform for Health Aging Network Leading Conversion of Other Systems to Platforms for Health Aging Network Leading Conversion of Other Systems to Platforms for Health Moving From Projects to Tipping Points Moving From Projects to Tipping Points Cannot Work Alone!!! – Partners Essential Cannot Work Alone!!! – Partners Essential 80/20 Rule 80/20 Rule

25. Building a Franchise For Health Essential Forms of Capital to Invest Essential Forms of Capital to Invest –Mission/Vision –Leadership – Organizational Commitment –A Community of Peers – a Movement –Mandates, competitive forces, glory, accountability –Capital – Money & Other Resources

26. Sources of Shared Leadership: Bringing Vision & Expectations AoA and NCOA AoA and NCOA State Departments of Aging and Public Health State Departments of Aging and Public Health 4 As and AAAs 4 As and AAAs Aging Network Aging Network Funders Funders Associations Associations Other Partners with Aligned Incentives Other Partners with Aligned Incentives –80/20 Rule

27. Evidence- Based Project Office Public Health Sector Senior Housing Sites Hospitals Health Plans Physician Groups Community Colleges Faith- Based Orgs Mental Health Sector Senior Centers Parks and Rec. Target Sectors For ADOPTION/ENGAGEMENT

28. Selection Criteria Organizations with Aligned Mission Who: Organizations with Aligned Mission Who: –Have a heart for it –Care about this movement –Will Benefit From Engagement Over Time Obligations Obligations Needs Needs Outcomes Outcomes

29. Selection Criteria Potential for Scale/Impact Potential for Scale/Impact –Directly/Indirectly Mutual Benefit/Alignable Incentives Mutual Benefit/Alignable Incentives Aligned Mission/Vision Aligned Mission/Vision Product Champion Product Champion Has Relevant Resources Has Relevant Resources

30. Relevant Resources Vary Funding for Training, Materials, Staff Funding for Training, Materials, Staff Staff Motivated to Lead Staff Motivated to Lead Space for Programs Space for Programs Access to Target Populations Access to Target Populations Ability to Outreach/Market Ability to Outreach/Market Opinion Leader/Standard Setting Agency Opinion Leader/Standard Setting Agency

31. California Examples Statewide Steering Committee Statewide Steering Committee Expansion & Sustainability Think Tank Expansion & Sustainability Think Tank –Identify Strategic Sectors for Partnership –Identify Funding to go to Scale and Extend Timeframe for Funded Leadership –Identify Lasting Infrastructure to Sustain

32. Expansion & Sustainability Workgroup Purpose: Guidance to the CA Depts. of Aging and Public Health to craft a comprehensive expansion and sustainability plan Members: –Health Plans: Catholic Health Care West; Kaiser Permanente; St. Joseph Health System; Daughters of Charity –Foundations: Archstone Foundation; UniHealth Foundation; The CA Endowment; CA HealthCare Foundation; Kaiser Permanente Community Benefit –Education: Older Adult Community College Educators –Non-Profit: Partners in Care Foundation –Government: Los Angeles County Public Health Dept. –Business: Pacific Business Group on Health

33. Sustainability Work Group Members Eileen L. Barsi Eileen L. Barsi Catholic Healthcare West Diana Bonta Diana Bonta Kaiser Permanente Lora Connolly Lora Connolly CA Department of Aging Lynn Daucher Lynn Daucher CA Department of Aging Ronald DiLuigi Ronald DiLuigi St. Joseph Health System Pam Ford-Keach CA Department of Health Services Pam Ford-Keach CA Department of Health Services Jerry Kozai Jerry Kozai St. Francis Medical Center Mary Ellen Kullman Mary Ellen Kullman Archstone Foundation Mary Odell Mary Odell UniHealth Foundation Kate OMalley Kate OMalley CA HealthCare Foundation James Philipp James Philipp Pacific Business Group on Health Barry Ross St. Jude Medical Center June Simmons June Simmons Partners in Care Foundation Rita Speck Rita Speck Kaiser Permanente Janet Tedesco Janet Tedesco CA Department of Aging Lorraine Wicks Lorraine Wicks CA Community College Educators of Older Adults Dianne Yamashiro-Omi Dianne Yamashiro-Omi The CA Endowment M. Lynn Yonekura M. Lynn Yonekura CA Hospital Medical Center

34. California Sustainability Example for CDSMP Merge CDSMP expansion efforts into the following 3 networks to produce the greatest impact and reach major populated areas: 1.Leading Physician Groups 2.Community College Older Adult Programs 3.County Public Health Departments

36. Physician Group Partnering Strategy Surround physician groups with CDSMP workshops hosted by Community Colleges, Public Health and other community agencies Surround physician groups with CDSMP workshops hosted by Community Colleges, Public Health and other community agencies Local community colleges are partnered with each practice to assure close collaboration and effective referral process Local community colleges are partnered with each practice to assure close collaboration and effective referral process

37. California Association of Physician Groups (CAPG) Nations largest state physician association - 150 leading physician groups Nations largest state physician association - 150 leading physician groups Physicians under CAPG provide care to over 15 million Californians – more than 50% of Californias health care Physicians under CAPG provide care to over 15 million Californians – more than 50% of Californias health care

38. Physician Group Sustainability Factors Have significant numbers of patients under capitation = Financial motivation to promote CDSMP Have significant numbers of patients under capitation = Financial motivation to promote CDSMP Once managed care patients routinely referred to CDSMP, will become the standard of practice to benefit fee-for-service Medicare patients as well Once managed care patients routinely referred to CDSMP, will become the standard of practice to benefit fee-for-service Medicare patients as well

39. California has 109 Community Colleges (62 have older adult programs) The 62 colleges serve 125,000 Californians ages 50+ per week

40. Community College Sustainability Factors Instructors are paid as faculty for leading CDSMP Instructors are paid as faculty for leading CDSMP Have relationships with community organizations serving older adults Have relationships with community organizations serving older adults Have strong marketing capacity Have strong marketing capacity Familiar resource for aging Boomers Familiar resource for aging Boomers Eager for new, evidence-based curricula and have protocols in place to approve it Eager for new, evidence-based curricula and have protocols in place to approve it

41. Long-Term Sustainability State leadership committed to sustaining this initiative over the long term. State leadership committed to sustaining this initiative over the long term. Once outreach and medical referrals are made through county networks of developed CDSMP providers and sponsors, will be largely self-sustaining Once outreach and medical referrals are made through county networks of developed CDSMP providers and sponsors, will be largely self-sustaining

42. Sustaining Evidence-Based Health Promotion Programs South Carolina Perspective Terri Whirrett, Deputy Director Lt. Governors Office on Aging Cora Plass, Director of Healthy Aging South Carolina Department of Health South Carolina Department of Health and Environmental Control

43. National Climate Ripe for Evidence-Based Prevention AoAs reauthorization of Older Americans Act places new emphasis on prevention by promoting EBPPs through aging service organizations AoAs reauthorization of Older Americans Act places new emphasis on prevention by promoting EBPPs through aging service organizations Healthy People 2010 Goals Healthy People 2010 Goals Increased coverage of prevention and disease management by Medicare Increased coverage of prevention and disease management by Medicare CDC, NACDD, NCOA, and AHRQ focus on evidence-based prevention CDC, NACDD, NCOA, and AHRQ focus on evidence-based prevention

44. Building the Foundation Working relationship between State Unit on Aging and State Health Department stems back to 1980s Working relationship between State Unit on Aging and State Health Department stems back to 1980s 2005 - present, relationship strengthened through collaboration on EBPPs and formation of statewide Healthy Aging Partnership 2005 - present, relationship strengthened through collaboration on EBPPs and formation of statewide Healthy Aging Partnership Common focus on prevention Common focus on prevention Common goal - increase the years and quality of life for older adults in SC (Healthy People 2010) Common goal - increase the years and quality of life for older adults in SC (Healthy People 2010)

45. EBP History in South Carolina Lowcountry Senior Center - CDSMP and Enhance Fitness prior to grant Lowcountry Senior Center - CDSMP and Enhance Fitness prior to grant 3 Master Trainers for CDSMP prior to AoA grant 3 Master Trainers for CDSMP prior to AoA grant SENIOR grant through NACDD for implementation of A Matter of Balance in Lee County SENIOR grant through NACDD for implementation of A Matter of Balance in Lee County Arthritis Foundation EBPs through State Health Dept, funded by CDC Arthritis Foundation EBPs through State Health Dept, funded by CDC

46. Strategies for Sustainability Partnerships Partnerships Financial Resources Financial Resources Policy Changes Policy Changes A Quality Product A Quality Product Change in Priorities/Culture Change Change in Priorities/Culture Change

47. Partnerships State - statewide coalition, delivery system partners, support partners State - statewide coalition, delivery system partners, support partners Regional/Local - advisory councils; Regional/Local - advisory councils; local health, community and faith-based organizations; volunteers local health, community and faith-based organizations; volunteers

48. SC Partnership for Healthy Aging Convened April 2007 Co-Led by SUA and SHD Serves as Advisory Council for grant initiative Provides infrastructure to support and sustain EBPs

49. SC Partnership for Healthy Aging 2007, Wide net cast to form SC Partnership for Healthy Aging with more than 40 organizations: Universities SC Hospital Association SC Primary Care Association SC Budget and Control Board Faith-based Organizations Coalitions Silver-Haired Legislature SC Rural Health Association State Medicaid Agency SC Academy of Family Physicians SC Nurses Assoc. State Health Dept Chronic Disease Programs And more…

50. Partnerships SC Hospital Association SC Hospital Association Health Care Plans - Special Needs Medicare Plan, BC/BS Health Care Plans - Special Needs Medicare Plan, BC/BS Osher Lifelong Learning adult education program Osher Lifelong Learning adult education program Institute for Engaged Aging - training center for community health workers Institute for Engaged Aging - training center for community health workers SC Dept of Vocational Rehabilitation SC Dept of Vocational Rehabilitation

51. Partnerships - Contd. Conferences/Districts of AME and AME Zion Churches, Progressive Church Conferences/Districts of AME and AME Zion Churches, Progressive Church SC Primary Care Association and federally funded health care centers SC Primary Care Association and federally funded health care centers State Diabetes Program and Coalitions State Diabetes Program and Coalitions State Employees Association State Employees Association

52. Financial Resources Insurance Reimbursement Insurance Reimbursement Grants - CDC Arthritis Grant, state prevention grant, Grants - CDC Arthritis Grant, state prevention grant, Healthcare organizations - Special Needs Plan (CIP), Health Centers, VA Healthcare organizations - Special Needs Plan (CIP), Health Centers, VA

53. Financial Resources Senior Housing - HUD Senior Housing - HUD Employers - EAPs, retired federal and state employees Employers - EAPs, retired federal and state employees Charging for Programs Charging for Programs

54. Shared Ownership of Financial Sustainability Provide mini-grants to Aging Network Provide mini-grants to Aging Network Promote programs Promote programs and provide training and provide training Promote and deliver Arthritis Foundation and other EBPs Promote and deliver Arthritis Foundation and other EBPs Pay for state license Pay for state license DHEC LGOA Joint Support of CDSMP Master Training

55. Reallocating State Funding Incentive Package Reallocating State Funding Incentive Package 4 pilot programs in 4 new regions 4 pilot programs in 4 new regions LGOA pay for training costs/Master Trainers LGOA pay for training costs/Master Trainers LGOA purchase state level license LGOA purchase state level license LGOA reimburse 4 pilot sites, $70 per completer (4 classes minimum) using state appropriated funds for home and community-based services LGOA reimburse 4 pilot sites, $70 per completer (4 classes minimum) using state appropriated funds for home and community-based services

56. Use of OAA IIID Funds As of July 1, 2008... Must use IIID funds only for EB programs Must use IIID funds only for EB programs Must use new Scope of Work for IIID programs Must use new Scope of Work for IIID programs Strict waiver requirements Strict waiver requirements

57. IIID Scope of Work Measurable Outcomes Measurable Outcomes Specialized qualifications of leaders Specialized qualifications of leaders Maintenance the fidelity of the evidence- based programs Maintenance the fidelity of the evidence- based programs

58. IIID Scope of Work Evaluation required: Self report of change; pre and post test; other Evaluation required: Self report of change; pre and post test; other Can charge a fee if funds used to expand the program vs. voluntary contributions Can charge a fee if funds used to expand the program vs. voluntary contributions Documentation required Documentation required Monitoring conducted by LGOA Monitoring conducted by LGOA

59. Ensuring A Quality Product Partners will not buy in if the program is not a high quality product Partners will not buy in if the program is not a high quality product Must assure the lay leaders and Master Trainers are of high quality Must assure the lay leaders and Master Trainers are of high quality Must monitor fidelity to the program – who will do this? Must monitor fidelity to the program – who will do this?

60. Culture Change Change is a process Change is a process Getting buy-in takes time, planning, patience, and hard work Getting buy-in takes time, planning, patience, and hard work Find your champions to help you Find your champions to help you Build upon small successes Build upon small successes Educate, support, and provide technical assistance Educate, support, and provide technical assistance Use motivational strategies to boost morale and maintain momentum Use motivational strategies to boost morale and maintain momentum

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