ALIGNMENT OF NJ’S COUNTY CHAS & CHIPS WITH NATIONAL STANDARDS New Jersey Association of County and City Health Officials 4/16/2015
Who is Kevin McNally? • 31 years at NJ Department of Health (1982-2013) • Including four years (2004-08) in Office of Local Health • Coordinated State Public Health System Performance Assessment (2009) • NJDOH Accreditation Coordinator (2012-13) • Community Volunteer, Monmouth County Health Improvement Coalition • Completed PHAB training for document reviewer and site visitor
Presentation Contents • Results of an assessment of existing county and city CHAs and CHIPS in New Jersey with national public health accreditation standards • Principles for preparing CHAs and CHIPs that conform with accreditation standards
THE BASICS
Lingo Community Health Assessment (CHA) Community Health Needs Assessment (CHNA) Community Health Improvement Plan (CHIP)
Why Do a CHA/CHIP? • Required by NJ’s Practice Standards • Pre-requisite for obtaining national accreditation • It’s a good idea!
Why Do a CHA/CHIP? • Aligns local health department activities with the needs of the community served • Promotes understanding, support and participation from the community in local health department initiatives
PUBLIC HEALTH PRACTICE STANDARDS OF PERFORMANCE FOR LOCAL BOARDS OF HEALTH IN NEW JERSEY (NJAC 8:52)
NJ Practice Standards Requirements NJAC 8:52-9.2 Development and participation in community public health partnerships Each countywide or multi-countywide area shall establish a community (a) public health partnership representing key corporate, private, and non-profit entities. Each partnership shall perform a countywide or multi-countywide community health assessment in accordance with N.J.A.C. 8:52-10 and develop a Community Health Improvement Plan in accordance with N.J.A.C. 8:52-11. Each community public health partnership shall foster relationships that impact the community's health consistent with the needs identified in the Community Health Improvement Plan. Each local health agency shall: (b) 1. Actively participate in a new or existing community health partnership
PUBLIC HEALTH ACCREDITATION BOARD (PHAB) Administers a national accreditation process for State, local and tribal public health agencies
PHAB Pre-requisites for applying for national accreditation • Community Health Assessment • Community Health Improvement Plan • Agency Strategic Plan
PHAB Standards Standard 1.1: Participate in or conduct a collaborative process resulting in a comprehensive community health assessment.
PHAB Standards Standard 5.2: Conduct a comprehensive planning process resulting in a community health improvement plan.
NJ vs PHAB • NJ Practice Standards are compatible with, but not identical to, PHAB Standards. • PHAB Standards much more detailed • Therefore: CHAs and CHIPs that meet NJ Practice Standards may not comply with PHAB Standards for national accreditation
Practice Standards Requirement for CHIP (c) Each Community Health Improvement Plan shall consist of: 1. A countywide or multi-countywide Community Health Assessment as described at N.J.A.C. 8:52-10.2; 2. A Community Health Profile as described at N.J.A.C. 8:52-10.2(d)5; 3. A mechanism which monitors external environment for forces and trends that might impact the ability of a local public health system to protect the health of the public; 4. An analysis and a prioritization of current and potential health problems based upon planning methodologies such as those described at N.J.A.C. 8:52-10.2(d); 5. A plan which specifies the roles and responsibilities agreed upon by each local health agency and each public, private, non-profit, and voluntary agency; 6. Specific strategies to address health problems and to sustain effective interventions; 7. A plan to evaluate the intervention strategies and health outcomes; and 8. A method that allows for changes to the plan.
PHAB Requirements for CHIP 1. Community health improvement plan The local health department must provide a community health improvement plan that includes all of the following: a. The desired measurable outcomes or indicators of the health improvement effort and priorities for action, from the perspective of community members. The plan must include community health priorities, measurable objectives, improvement strategies and activities with time-framed targets that were determined in the community planning process. In establishing priorities, the plan must include consideration of addressing social determinants of health, causes of higher health risks and poorer health outcomes of specific populations, and health inequities. Measurable and time-framed targets may be contained in another document, such as an annual work plan. If this is the case, the companion document • must be provided with the health improvement plan for this measure. Strategies may be evidence-based, practice-based, or promising practices or may be innovative to meet the needs of the community. National state-of- • the-art guidance (for example, the National Prevention Strategy, Guide to Community Preventive Services, and Healthy People 2020) should be referenced, as appropriate. b. Policy changes needed to accomplish the identified health objectives must be included in the plan. Policy changes may include those that are adopted to alleviate the identified causes of health inequity. Policy changes may address social and economic conditions that influence health equity including housing, transportation, education, job availability, neighborhood safety, access to recreational opportunities, and zoning, for example. c. Designation of individuals and organizations that have accepted responsibility for implementing strategies outlined in the community health improvement plan. This may include assignments to staff or agreements between planning participants, stakeholders, health care providers (community benefit), other local governmental agencies, or other community organizations. For this measure, agreements do not need to be formal, such as an MOA/MOU. d. Local health departments must demonstrate that they considered both national and state health improvement priorities where they have been established. National priority alignment could include the National Prevention Strategy and Healthy People 2020.
NJACCHO CHA/CHIP Assessment Project • Assignment: Review the most recent CHA and CHIP for each county (and any city that had done their own) to determine if they were in compliance with the current PHAB standards. • Reviewed 22 CHA/CHIP pairs: 19 Counties 1 Covering 2 counties 2 Cities • Review based on PHAB Standards and Measures Version 1.5 (effective June 2014) • Assessment based on standards both for process and the completed document
NJACCHO CHA/CHIP Assessment Project • Assessments completed between June and September 2014 • Report sent to: • GPHP Chair or County/City Health Officer • Partnership Coordinator • NJACCHO project manager
First Step • Contacted PHAB to obtain guidance as to whether New Jersey’s requirement that local health agencies participate in a county- wide process to develop CHAs and CHIPs is acceptable under the PHAB standards. • Obtained a written statement from PHAB’s Chief Program Officer that a New Jersey health department could use its county CHA and CHIP to meet the pre-requisites for its accreditation application, so long as it could document that it had participated in the development and implementation of these documents.
PHAB Review Scores • Fully demonstrated • Largely demonstrated • Slightly demonstrated • Not demonstrated
CHA Process
COMMUNITY PARTICIPATION 0% Not included 23% Full Partners 50% Consulted 27%
Hospital CHNAs • For those counties that did not have a CHA completed within the PHAB time frame (5 years), reviewed recent community health needs assessments completed by hospitals (where available). • Reviewed 10 hospital CHNAs • None met all of the PHAB requirements • Reasons: • Used countywide data, but otherwise focused on hospital’s service area • Did not meet community participation standard • Limited or no participation by local health departments
General Observations • CHAs/CHIPs developed by Community Public Health Partnerships (CPHPs) that compiled with the CPHP model described in the Practice Standards tended to meet more of the PHAB requirements than those where the county GPHP or Health Department lead the process. • CHAs/CHIPs developed through collaborations between the local health department(s) and hospitals / healthcare systems tended to meet more of the PHAB requirements than those where the hospitals were not full partners the process.
What Next? Implementation Plan PHAB Action Plan Local CHA/CHIP
GUIDELINES FOR DEVELOPING A PHAB- COMPLIANT CHA/CHIP
PHAB’s Fundamental Principles Process Participation Performance Improvement
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