Engaging Staff & Stakeholders in the Community Health Assessment Process

State: CT Type: Model Practice Year: 2009

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The Milford Health Department will increase the capacity of its staff and key stakeholders to conduct and contribute to a community health assessment. By October 31, 2008, the Milford Health Department (MHD) will conduct training on the importance of community health assessments and quality improvement for staff and community stakeholders to increase knowledge of assessment processes and brainstorm potential priority areas for assessment.

With funding through NACCHO’s Demonstration Sites program, MHD began a QI process to assist with accreditation preparation. Using the NACCHO LHD Self-Assessment Tool for Accreditation Preparation and Quality Improvement, MHD determined that the focus of its project would be to address Standard I-C—“Conduct or contribute expertise to periodic community health assessments (CHA).” MHD conducted training on the importance of community health assessments and quality improvement for staff and community stakeholders to increase knowledge of assessment processes and brainstorm potential priority areas for assessment. After the training was completed and data were collected, next steps were identified to encourage continued participation by the targeted groups. MHD successfully implemented a QI process using the Plan-Do-Check-Act model.

Through use of QI tools, MHD staff increased knowledge of how to apply tools to improve the quality of public health services for our residents. This process enabled MHD staff to market the importance of public health programs and services to key stakeholders in the community and has engaged them in future activities. MHD developed a Gantt chart, which provided a timeline for conducting a CHA in Milford. Through completion of this project along with implementation of next steps, MHD will be more prepared for accreditation in 2011. Particularly, MHD has and will continue to build its capacity to meet all requirements of Essential Services I, IX, and X through these completed and planned activities.

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Milford Health Department
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Engaging Staff & Stakeholders in the Community Health Assessment Process
The Milford Health Department will increase the capacity of its staff and key stakeholders to conduct and contribute to a community health assessment. By October 31, 2008, the Milford Health Department (MHD) will conduct training on the importance of community health assessments and quality improvement for staff and community stakeholders to increase knowledge of assessment processes and brainstorm potential priority areas for assessment. With funding through NACCHO’s Demonstration Sites program, MHD began a QI process to assist with accreditation preparation. Using the NACCHO LHD Self-Assessment Tool for Accreditation Preparation and Quality Improvement, MHD determined that the focus of its project would be to address Standard I-C—“Conduct or contribute expertise to periodic community health assessments (CHA).” MHD conducted training on the importance of community health assessments and quality improvement for staff and community stakeholders to increase knowledge of assessment processes and brainstorm potential priority areas for assessment. After the training was completed and data were collected, next steps were identified to encourage continued participation by the targeted groups. MHD successfully implemented a QI process using the Plan-Do-Check-Act model. Through use of QI tools, MHD staff increased knowledge of how to apply tools to improve the quality of public health services for our residents. This process enabled MHD staff to market the importance of public health programs and services to key stakeholders in the community and has engaged them in future activities. MHD developed a Gantt chart, which provided a timeline for conducting a CHA in Milford. Through completion of this project along with implementation of next steps, MHD will be more prepared for accreditation in 2011. Particularly, MHD has and will continue to build its capacity to meet all requirements of Essential Services I, IX, and X through these completed and planned activities.
Based on results of a self-assessment using NACCHO’s self-assessment tool, MHD identified Standard I.C as an area requiring improvement. Specifically, a community health assessment (CHA) had not been conducted by MHD during the tenure of most current staff (more than 10 years at least). However, to conduct a CHA, MHD identified two significant barriers that needed to be addressed—current staff had limited knowledge of community health assessments and the importance of quality improvement activities, and key community stakeholders (policymakers and local elected/appointed officials) had never been involved in a community health assessment in Milford. By conducting the training program described in this application, MHD successfully addressed the identified challenges and has engaged participants in the process moving forward. Particularly, MHD has and will continue to build its capacity to meet all requirements of Essential Services I, IX, and X through these completed and planned activities. By increasing our capacity to perform three of the 10 essential services of public health, the Milford community will undoubtedly benefit from higher quality programs and services being provided to more specifically meet the needs identified by the community itself. T his process enabled MHD staff to market the importance of public health programs and services to key stakeholders in the community and has engaged them in future activities. Consequently, this project not only served to benefit MHD staff, but also key community officials and the city of Milford at large. Using a one-day training session to increase capacity of staff and key stakeholders to assist with planning and implementation of a CHA process is not inventive in itself. However, the structure and content of the day and planned long-term activities to foster continued partnerships is unique in the field and our target population. After reviewing NACCHO’s model practice database, along with samples of how some communities have worked to address Standard I.C. (Minnesota and Michigan), it appears that most often departments tend to address each of the target groups—LHD staff and local policymakers and elected/appointed officials (key stakeholders)—separately. This practice is innovative because it provided a platform to present information specifically designed for each group, while still allowing for interaction across both groups. In particular, the training was structured to encourage open discussion among all LHD staff regarding CHA and QI in the morning. This morning session was followed by a lunch session designed for local policymakers and elected/appointed officials to learn about the importance of CHAs and the effect of public health in their day-to-day work. Supervisors from each division of MHD also attended the lunch session, allowing for interaction between the two groups. Officials were able to openly ask questions and request more detailed information from division supervisors. This process was unique for our population as this session was the first time that several state representatives and senators (representative of three Milford districts) met some LHD staff and were able to gain insight into the work performed by each division. The session was also novel because not only were local policymakers and elected/appointed officials requested to attend the one-hour session, but they were assigned a task to be submitted at a later date. Stakeholders were requested to complete a brainstorming worksheet to provide input as to public health areas of concern that they had an interest in seeing addressed through the CHA process in the month following the training. This task was assigned to ensure that stakeholders understood that the LHD was interested in obtaining their views on the issue, but also as a tool for engaging stakeholders even after the training was over. Moreover, as a result of this training, a project timeline (Gantt chart) was developed for the CHA p
Agency Community RolesThe implementation of this project involved participation of external community partners and internal staff. MHD has taken and will continue to take various roles through this project. MHD coordinated the training session for staff, policymakers, and elected/appointed officials. In addition to coordinating the logistics of the training, MHD staff worked with the QI consultant to develop the agenda for training, pre- and post-test questions, and content for the day. Additionally, MHD is responsible for providing continuous opportunities for participation by stakeholders in the future. Stakeholders, specifically local policymakers and elected/appointed officials, were invited to participate in the training session. Those invited included local and state representatives and senator, the mayor, local board of health members, board of Alderman members, and board of education members. To further foster collaboration with these stakeholders, participants at the training were asked to submit input regarding priority areas of concern to be included in the CHA within the 30 days following the training. Feedback was received by 40 percent of stakeholders, with an additional 20 percent stating that feedback is forthcoming. To encourage continued participation, the Gantt chart (project timeline) that was developed will be shared with stakeholders. Tasks that require their participation will be highlighted and their input will be solicited throughout the process. Also, progress on the project will be discussed during board of health meetings where community members and policymakers are welcome to attend. Finally, additional meetings of the original stakeholders who participated in the training will be convened to provide updates to this key groupand to provide an opportunity for these individuals to pose questions or concerns. Community collaboration lies at the heart of the work that MHD does within Milford. The department’s strong relationship with other local governmental agencies and community-based agencies is clearly evident. Specifically, various members of MHD staff serve on several committees where social service and city agencies come together to find solutions to community issues. Continued participation in such events will also serve to encourage even more collaboration with community stakeholders, particularly as it pertains to conducting a CHA within the next year.ImplementationDuring the first two months of the contract, MHD formed an internal accreditation workgroup composed of the health director and division supervisors including the School nursing administrator, chief of environmental health, and community health coordinator. The workgroup used the NACCHO Operational Definition Prototype Metrics tool for the self-assessment. The community health coordinator met with each individual on the workgroup to review metrics relevant to their areas. Upon completion of these sessions, the community health coordinator calculated the self-assessment scores and facilitated a discussion regarding the results. Based on the discussion, a consensus was reached regarding priority area(s) to address through a quality improvement (QI) process. Specifically, the group decided to address Standard I-C with the focus of conducting or contributing expertise to periodic community health assessments. These results were shared with the City of Milford board of health during a monthly board meeting for comments and discussion. Based on feedback received from the board, final goal statements were developed and area(s) to address during the QI process were finalized. During the remaining four months of the contract, Milford health department used a NACCHO-identified QI consultant from the Public Health Foundation (PHF) to facilitate the QI process once priority QI areas were selected. The consultant and key members of the workgroup identified two significant challenges related to the standard—most Milford Health Department staff had limited knowledge of community health assessments and key community stakeholders (policymakers and local elected/appointed officials) had never been involved in a community health assessment in Milford. The group determined that a one-day onsite training would be designed to relay the importance of CHAs and QI activities to three groups—in-house MHD staff, key stakeholders including local policymakers and elected/appointed officials, and school nurses (MHD staff physically housed in 19 different schools within Milford). Pre- and post-tests could be used to measure increased knowledge of MHD staff (in-house and school nurses) regarding QI and CHAs. Additionally, program participants would be notified of the plan to conduct a CHA within the following year. Training participants, particularly local policymakers and elected/appoint officials, were asked to submit brainstorms of priority areas to be included in the CHA to the community health coordinator within 30 days of the training.
Invitations for future training should be mailed two months prior and should not be scheduled during election season. In the future, additional six month follow-up evaluations should be administered to measure knowledge retained.
One of the intended objectives of this project was to engage key community stakeholders in the community health assessment and quality improvement process. The project was somewhat successful in that 71 percent of those invited to the training attended and of those invited 60 percent either submitted feedback and/or indicated that feedback is forthcoming. All (100 percent) stakeholders who were present indicated their interest in remaining involved in the process in the future and indicated their support of a CHA to be conducted within the next year. Through this project, the MHD developed a Gantt chart, which provided a timeline for conducting a CHA in Milford. This timeline will be shared with training participants, who will be engaged at specific points throughout the timeline.To accomplish the tasks identified, MHD staff will work internally to continue to identify priority assessment areas and to develop a community profile based on existing data. Initial funding through NACCHO was extremely beneficial because it assisted with start-up costs involved with orienting staff to QI processes and tools. To sustain the process going forward as it pertains to conducting the CHA, the community health coordinator has submitted a proposal to work with graduate students from the Yale School of Public Health to develop a CHA tool to be administered within the community. MHD will partner with local academic institutions and community-based agencies to assist with data analysis of the CHA, and to identify priority health concerns to be addressed based on CHA results. Additionally, stakeholders have indicated their support for this project and will be looked to for additional resources that may be identified throughout the project. Including stakeholders throughout the process will assist with obtaining continued buy-in specific to identified needs for resources within the community.
 
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