1. WELCOME Welcome participants to a day and a half of MAPP training.
Housekeeping
Review the layout of the training area, pointing out bathrooms, water fountains, and phone availability.
Remind participants of requests regarding cell phones. (If there are any.)
Review lunch and dinner plans as appropriate. Ask if there are questions.
Your presenters today include: Leonadi Ward, a consultant with NACCHO for a number of years, working with LHDs and others on skills around Dialogue. As for NACCHO staff, I am the program manager for MAPP and have been with NACCHO for almost 7 years. I started out in Environmental Health. My education and training is in community development. Julia Joh Elligers is the Senior Analyst for MAPP and Performance Standards. She’s been with NACCHO for about 4 years. She has a public health back ground, and is currently working on a PhD in public policy, focusing on the more political aspects of public health. Maria Rishoi is our newest MAPP staff, only being with NACCHO for a few months, as a program assistant. However, she comes to us with a wealth of community and partnership development experience as a peace corps volunteer in Thailand. Later on we will have Liza Corso from CDC here. I will introduce her more then.
And probably most importantly, we have some mapp users here I would like to point out so during the break you can pick their brains….
Cle Moore is from Stanislaus County in CA.
Mike Smeltzer is from Columbus OH.
on our MAPP Work Group, which provides guidance to all of the work NACCHO staff does with the MAPP program.

2. 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:
Now let’s look at MAPP in more detail.
The MAPP acronym 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.

3. The National Vision for MAPP
The values of mobilizing broad-based community partnerships, taking strategic action, and performance improvement are institutionalized through the use of MAPP in local public health systems across the U.S. resulting in:
measurable improvement in the community’s health and quality of life;
increased visibility of public health within the community;
community advocates for public health and the local public health system.
ability to effectively anticipate and manage change; and
stronger public health infrastructure, partnerships and leadership.
The MAPP Work Group, which is composed of 12 MAPP users from LHDs across the nation, as well as partners from CDC, APHA, NNPHI, PHF, ASTHO, and NALBOH, recently updated our vision for the MAPP program. We asked ourselves what did we want to achieve through our efforts?
Basically, MAPP will help communities institutionalized the use of broad-based community partnerships, performance improvement, and strategic planning in their public health practice. We are convinced that this will lead to
measurable improvement in the community’s health and quality of life;
increased visibility of public health within the community;
community advocates for public health and the local public health system.
ability to effectively anticipate and manage change; and
stronger public health infrastructure, partnerships and leadership.
State
Because MAPP is flexible, can be adapted to different situations, and brings together so many concepts, it may sound abstract.
State:
One of the goals of this training is to help you start to get your arms around what MAPP is, to familiarize you with the tools it includes, and to encourage you to meet and network with others who are also trying to use MAPP.

4. MAPP’s Origins MAPP advances the thinking behind APEXPH.
The MAPP Tool was launched in 2001.
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.
Launched in 2001, MAPP differs from APEX in 5 fundamental ways:
APEX- Build LHD leadership. MAPP also Builds LHD leadership, but also promote community responsibility for the health of the public
APEX- Assess LHD capacity for delivering public health services, whereas MAPP Assesses capacity of entire local public health system
APEX- Operational planning, while MAPP provides a framework for Strategic planning
APEX- Focus on health status, and MAPP Focuses on health status, community perceptions, forces of change, and local public health system capacities
APEX- Develop plans to address needs, while MAPP Strategically match needs, resources, ideas, and actions.

5. 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”. The red arrow points to the Local Public Health System Assessment, which is the point at which the local NPHPS instrument is used. MAPP includes three other assessments in addition to the information collected in the local public health system assessment. This assures that community health improvement plans truly address the gamut of strengths, weaknesses, challenges and opportunities that exist in the community.
Whereas the NPHPSP looks at how the system is functioning, MAPP puts it in the context of how it can improve to better address the communities public health priorities.
Use of NPHPSP within MAPP ensures broad-based involvement in the performance assessment process. Through MAPP, a broad collection of system partners and community residents will come together. These are also the right people who need to be involved in completing the performance standards instrument. Consequently, for those communities that have already done the performance standards, you have a head start in conducting the MAPP process. Once you’ve completed this system assessment tool, you can then look at using MAPP as a means to address systems performance improvement against a backdrop of the systems public health priorities.

6. MAPP Overview
Basically, the performance standards partners will look out the outcomes of the assessment and see who else needs to be at the table. In the MAPP process, this would be the Organizing for Success and Partnership Development phase. Organize for Success and Partnership Development phase allows you to plan a MAPP process that builds commitment, engages participants, uses their time well, and results in a plan that can be implemented successfully. This phase will probably not take as long for you since you have most of the partners already at the table and committed to this concept because of their involvement in the local public health systems assessment. The challenge is to keep them engaged through out the MAPP process.
Then, all partners develop a shared vision and values for the community. The visioning process is a collaborative and creative approach that leads to a shared community vision and common values.
The next step is the real “meat” of the MAPP process – the four assessments. In these assessments, the community identifies:
1) community themes and strengths or “what is important to community members and what assets do we have?”;
2) forces of change or “what is occurring or might occur that will affect the community or public health system?”;
3) community health status or “what does our data tell us about our health?” and
4) Finally, The NPHPSP local instrument piece of MAPP.
After conducting the four assessments, the community uses the info from the assessments to identify strategic issues, formulate goals and strategies, and lastly, conduct the Action Cycle in which action plans are implemented and evaluated.
Identify Strategic Issues uses the information gathered from the four assessments to determine the strategic issues for the community.
In Formulate Goals and Strategies specific goals are devised for each of the strategic issues identified in the previous phase.
The Action Cycle includes planning, implementation, and evaluation.

7. MAPP, a non-linear process
Phase 1
Org. for Success
Phase 3 - LPHSA/NPHPS
But MAPP is not a linear process
Here’s a diagram of the reality. Ok, so most of you have been to the NPHPS training, so let’s assume that you do that first and then you implement MAPP. Here’s how it looks, Diagrammed…
First you determine your partners for NPHPS.
then you implement the NPHPS. In doing so, you determine that there are other people that need to be at the table.
You go back to organizing for success…where you also plan how to implement MAPP now that the NPHPS is complete.
After doing a more indepth Org for success, you bring your partners together for visioning.
You then move onto the MAPP assessments.
But wait! In Org for success and the NPHPS, you found out that a few of your partners have already conducted parts of the CHSA! And/or you have already done the CHSA.
So, you and the partners review the CHSA to see what’s missing, and you might collect addition data. And the info from your existing CSHA informs the CTSA and the FOC assessments. We’ll get into how later.
All of that completes your assessments. And you move into phase 4… identifying strategic issues.
WAIT! Your community already identified strategic issues from a Turning Point initiative. Which you learned in the org for success phase. So you look at the existing issues, see if the new data supports the existing issues or if changes need to be made.
You then formulate goals and strategies, and move into the action cycle.
But Wait…this process takes 18 months, and your going to make your partners wait all of that time before anything actually happens? The MAPP partnership, or individual partners may want to take the data once it’s been gathered and begin working on activities right away. There may be some low hanging fruit, or a grant opportunity that can be acted on right away.
So, that’s how you build from existing initiatives, and use this process as a framework to guide you.
Phase 2
Visioning
Phase 3
MAPP Assessments
Phase 3 – CHSA
Phase 3 - CTSA
Phase 3 - FoC
Phase 4
Identifying Strategic Issues
Phase 5
Formulate Goals & Strategies
Phase 6
Action Cycle
Plan – Implement - Evaluate

8. Paradigm Shift MAPP is a journey, not a destination.
MAPP is a shift in how we think about public health activities and planning with and through our communities.
MAPP is a complete, long-term, system-wide PARADIGM SHIFT.
State:
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.
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.

9. 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.’

10. 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.
Add:
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.
State:
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. Other organizations such as hospitals, businesses, faith organizations, and community-based organizations play a critical role in assuring the public’s health.
Summarize:
MAPP is a radical new approach to public health. In fact, MAPP has the potential to put the “public” back in public health.

11. Strategic Thinking Requires broad-scale information gathering
Encourages exploration of alternatives
Places emphasis on future implications of present decisions
Facilitates communication and participation
Accommodates divergent interests and values
State:
Let’s focus on strategic thinking by looking at strategic planning. MAPP is different from previous public health planning tools in that it introduces strategic thinking - via strategic planning - into public health planning efforts. (Bring in each bullet separately)
Strategic thinking requires broad-scale information gathering
An exploration of alternatives
And an emphasis on the future implications of present decisions. 
It can facilitate communication and participation,
And accommodate divergent interests and values, and foster orderly decision-making and successful implementation. - we will receive pieces of Dialogue training during this training which will introduce you to methods to accommodate divergent interests and values.
Add:
For example, in traditional public health planning you may have just taken into consideration community perceptions and data – and then used that information to determine priority public health issues. But 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. All of this is done with maximum input from individuals representing diverse organizations and perspectives. 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.
Ask:
Given what I’ve just said about strategic thinking, what types of issues or topics will MAPP help uncover that weren't addressed through traditional public health assessment processes?

12. Community Driven Process
Mobilizing and engaging the community
Action with and by the community
Planning driven by the community
Partnerships to strengthen the community
Introduce the second key to MAPP:
The second key to MAPP is that it is a community driven process. The community helps bring about collective thinking that results in effective, sustainable solutions to complex problems that are relevant to a given community.
Describe:
When people with different points of view come together they develop solutions to problems that may be better and more creative. MAPP serves as a tool for including diverse portions of the community and thereby maximizes the creative resources of the community. When ownership of the problems and solutions includes a broad base of the community, the effort is sustainable, actions build on collective wisdom, and resources from throughout the community contribute to health improvement.
Example:
For example, a hospital in a rural Georgia was going to close for financial reasons. The community pulled together, and assembled a broad base of citizens, businesses, and local government. They were able to keep the hospital open. By collecting and assessing data, the community worked together to identify additional problems in the community. Through the efforts of the bank, businesses, citizens, and local government the county was successful in not only preserving the hospital, but recruiting new physicians to the community and creating a hospital oversight committee. MAPP provides this kind of strategic thinking and creative planning.
FACILIATOR NOTE: Review the Miller County story on the MAPP website for more details.

13. Local Public Health System
MCOs
Home Health
Parks
Economic Development
Mass Transit
Employers
Nursing Homes
Mental Health
Drug Treatment
Civic Groups
Laboratory Facilities
Hospitals
EMS
Community Centers
Doctors
LHD
Churches
Philanthropist
Elected Officials
Tribal Health
Schools
Police
Fire
Corrections
Environmental Health
When I talk about the LPHS, it is all the entities that, collectively, address local public health…these include government, private and non-profit organizations and agencies. It also includes the state and CDC.
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.
Summarize:
MAPP is a radical new approach to public health. In fact, MAPP has the potential to put the “public” back in public health.
Urban Planners

14. Bringing Local Initiatives Together
State:
By bringing together the collective wisdom of the community, MAPP can serve as the boat for a community. In any community there are many oars in the water, just as there are new and ongoing initiatives. MAPP is the process that gives unified direction to the various initiatives in a local community.
MAPP includes other community initiatives that have been undertaken or are currently occurring in the community.
For example, the United Way may be conducting a community survey, the local hospital may be undertaking a community health assessment, or a community may have conducted a visioning process in the past year. All of these efforts fit together. The United Way’s survey and the hospital’s data may tell a similar story, but there is no way to find out if coordination doesn’t exist. MAPP can help bring the participants and results of these efforts together into one comprehensive process.

15. Benefits of MAPP
Creates a healthy community and better quality of life.
Increases visibility of public health.
Anticipates and manages change.
Creates a stronger public health infrastructure.
Builds stronger partnerships.
Builds public health leadership.
Creates advocates for public health.
The benefits of MAPP include
- Increases visibility of public health within the community.
- Creates advocates for public health which helps to put public health issues as a priority in local government decision making.
- There are so many new emergent threats, its difficult to be proactive. However, since 9/11 there has been a huge push for to be prepared. The MAPP process helps communities design plans that Anticipates and manages the change and new threats we face.
- And through the use of the Performance Standards, it creates a stronger public health infrastructure.
- Because it is not a tool for the LHD, but for all partners within the public health system to work on collaboratively, it Builds stronger partnerships.
- As partners begin to have a better understanding of their role within the LPHS (as not all of them will initially understand that what they do necessarily impacts public health) the local public health department’s leadership strengthens among is partners.

16. MAPP Contacts Julia Joh Elligers, MPH Senior Analyst, NACCHO
(202) , Ext. 245