welcome! 2015 mch workforce academy leading in a transformative environment to improve population...

Welcome!2015 MCH Workforce Academy

Leading in a transformative environment to improve population health

Wifi In Meeting Space 1. Connect to Kimpton_conf

2. Bring up your internet browser3. See splash page with option to enter internet code

Code is “Karma”

• Thank you• Time as a gift• Additional resources and

slides on amchp.org-Transformation Station

• Share ideas and sign up to keep working

• Luggage & airport transportation

• Reimbursement form• Today’s events

Housekeeping

Population Health and the Chief Health Strategist – Ideas for

Change

Important Contact Information

Brian C. Castrucci, MAChief Program and Strategy Officer

de Beaumont Foundation [email protected]

@BrianCCastrucci

www.debeaumont.org@deBeaumontFndtn

About de Beaumont

• We believe in a strong governmental public health system

• We fund – Training– Building the public health

infrastructure– Improving information and

data management

Priorities and Principles

• The High Achieving Governmental Health Department in 2020 as the Community Chief Health Strategist– Promoting the reorientation of the

healthcare system toward prevention and wellness

– Interpreting and distributing data

Promoting the Reorientation of the Healthcare System Toward Prevention and Wellness

7

8

“We’ve gone from microbial, physiological, and biological origins of disease to social and

environmental.”

10

“There is no treatment, pill, or vaccine to address the challenge of having better access to an MRI in many communities than fresh fruits

and vegetables or physical activity.”

We’ve Been Discovered

• We’ve been doing population health– Safe sleep– Breastfeeding support– Injury and violence prevention– Many other examples

• We could do it better together

What de Beaumont is Doing

• www.PRACTICALPLAYBOOK.org• www.BUILDHealthChallenge.org• www.huffingtonpost.com/brian-castrucci• www.deBeaumont.org

What Can We Do?

• Leadership– Be a Voice– Convene

• Mayors/Governors/SHOs and hospital leaders• ED department heads

• Policy/Regulation– Maximizing opportunities– Texas Medicaid example– CPS regulation

What Can We Do?

• Funding– EPIC (Educating Physicians in their Communities)– Redirect community benefit– Leverage the Community Health Needs Assessment– Fund cities to create a multisectoral Master Health

Plan

What Skills Do We Need

• Systems thinkers• Communicate persuasively

– Convening and facilitating• Change management

Interpreting and Distributing Data

23

24

Geo

grap

hic

Spec

ifici

ty

X, Y Coordinate

Nation

Time Lag

Real

Tim

e

5 or

mor

e ye

ars

BRFSS

YRBSS

County

WIC

Medicaid claims

Laboratory reporting

RegistryEMR data

12 months

Reportable disease

NIS

PRAMS

NSCH

Hospital discharge

NVSS

What Can We Do?

• Get access to hospital/health system data– ER– Inpatient– Pick one issue; start small

• Add a question to the EMR?– Neutral convener/aggregator of data– Overcome HIPAA

• Public health exemption• Make it reportable• Get your lawyers on board

What Can We Do?

• Get access to other governmental data– Medicaid data– WIC data– CPS data– Police data (not state level)– Education data

• Contextualize outcome data– www.data.gov

What Skills Do We Need?

• The Right Epidemiologists– Comfortable using non-traditional data– Comfortable getting the data out ASAP– Comfortable with creating INFORMATION

• People who have communications expertise– Develop data driven sound bites– Make the data accessible

Final Thoughts

• You are the leaders we have• We have an opportunity – Seize it!!• Don’t be intimidated by the size of the issue/problem• Many small wins add up• Use your power and influence to speak for the

community

Important Contact Information

Brian C. Castrucci, MAChief Program and Strategy Officer

de Beaumont Foundation [email protected]

@BrianCCastrucciwww.huffingtonpost.com/brian-castrucci

www.debeaumont.org@deBeaumontFndtn

Health Equity with Population Health Initiatives

Diane Rowley, MD, MPHDepartment of Maternal and Child Health

UNC Gillings School of Global Public Health

Population health perspective:Considers a broad set of determinants in

improving the distribution of health and well-being outcomes.

MCHB:

“Our vision of a Nation where all children and families are healthy and thriving,

where every child and family have a fair shot at reaching their fullest potential.”

Lu MC, Lauver CB, Dykton C, Kogan MD, Lawler MH, Raskin-Ramos L, Watters K, Wilson LA. Transformation of the title V maternal and child health services block grant. Matern Child Health J. 2015 May;19(5):927-31.

.

SOCIAL DETERMINANTS OF HEALTH INEQUITY

RACISM POVERTYGENDER ROLES

HOUSING

LIVING CONDITIO

NSETC.

SEEK HELP

LIVE WORK PLAY STUDYWORSHI

PSHOP

Culture

Capacity

Resources

Resilience

MCH FEDERAL

MCH STATE - WIC

MCH LOCAL

Inputs are the same, but

Outcomes are

unequal

With Equity, inputs may need to be different to achieve equal outcomes

This is EQUITY

How to Develop an Equity Plan

Hogan VH, Rowley DL

Outlines the five new domains of action you need to make it

an Equity Plan

R4P

Otherwise, it’s just “a plan”

Click icon to add picture




• PROVIDE• Culturally and economically feasible health education and medical care are required, along with the required resources and environmental supports, so that

it is the easiest option for people to choose and sustain health promoting actions

REPAIR RESTRUCTURE

REMOVE REMEDIATE

Repair the damage of the past. Historical risk is embedded in current physiologic, biologic, psychological, behavioral and socialstructures. Historical trauma sets a population group back in the present.

Societal structures (where we live, work, play…..) can function inequitably and continue to expose new populations and produce risk. Structural changes (changes in social, economic, educational equity, rules, regulations, etc…) are needed to stop new production of risk and permanently remove the stressors and toxic exposures.

Forces that are adverse to health, health maintenance and health seeking are embedded in most societal institutions. Such forces-- like Power imbalances, Racism, SES inequities-- must be directly acknowledged and removed.

While we wait for structural changes to be completed, the social context continues to be a source of adverse exposures. At-risk populations need to be buffered from these exposures to reduce their vulnerability until such time that the negative stressor is completely removed.

R4PR4P Copyright 2010, Hogan and Rowley


What past exposures produced damage that

impact on current ability (of population) to access health care,

maintain health, or practice healthy

behaviors?

REPAIR

REPAIR THE DAMAGE OF THE PAST

• Historical risk is embodied in current physiologic, psychologic, behavioral and social structures

• Actively recognize and discuss historical disadvantages of populations we serve

• Actively undo historical

disadvantages of populations we serve


• What processes/social forces continue to produce risk,

disadvantage and other adverse effects in vulnerable populations?

• How can I revamp the process or structure so that future generations

are no longer exposed?

Restructure

BET questions

Institutional policies and processes need to be restructured so that they stop producing more risks.

Assess the structures in organizations that maintain systematic exclusion of disparity populations while simultaneously providing advantage or privilege to others.

Interventions that include the restructure component will focus on changing institutions and organizations rather than attempting to change people.


How can we buffer people from the adverse effects

while we wait for structural change?

• While we wait for structural changes the social context continues to product risks.

• It is important to minimize effects until restructuring occurs.

Remediate

R4P Copyright 2010, Hogan and Rowley


Where do racism and other ‘isms’ operate

here?

The remove component may overlap with repair, restructure, and remediate, but this component requires explicit attention to racism, sexism, and classism that could be overlooked in previous steps.

Remove


Click icon to add pictureCulturally and

socioeconomically feasible interventions (or policies) and ensure that families have the tools and resources to carry

out recommended care PLANS

• Services should be planned and delivered in a way that the resources and environmental supports are easily attainable for disparity populations.

• Not only do we need to define the right EBP, but we also need to focus attention on the way that practice is implemented vis a vis the population factors with respect to race, class, gender, history.

Provide


• •

• When you include these- it becomesan equity plan!

Woo Hoo!

Whenever a need, a problem, or a gap is identified:

Always Do Something!

Practicing Equity requires this!!!

• I’m tough enough

• Acknowledge the risk of

failure… and be at peace

with the consequence

s

Effectively Advancing Population Health Priorities:

What, How and Who

AgendaContext setting The WhatThe HowThe WhoGetting started Getting Better

49

Facilitators

Sharron Corle, Amy Mullenix, Sarah Beth McClellan, Steve Orton, Oscar Fleming

Objectives

• Demonstrate the use of active implementation concepts to inform the design, preparation, delivery and sustainability of population health strategies

• Apply population health planning tool to move participants from theory to appropriate action

Methodology

• Form Small Groups – All state representatives together– Pairs and Individuals will be joined

with others

• Activity Blocks– Content Review, Applied Example,

Group dialogue & action planning

• Reflect, Discuss, Capture

PopHealth Connections

Evidence base Implementation Effectiveness

System Performance Population Health Outcomes

• NPMs represent population health outcomes

• The Title V program creates the collective action platform & plans

ESMs NPMs NOMs

SPMs

Evidence-based

strategies / practices

Improved performance

leads to improved outcomes

Title V Measurement Framework

STATE PRIORITIES

Block Grant Guidance

NPMs and SPMs drive improved MCH population outcomes (i.e. NOMs).

ESMs:• Measure evidenced-based/informed

practices that will impact population-based NPMs.

• State-specific and actionable, • Track Title V program’s strategies and

activities • Provide accountability for improving

quality and performance

Evidence-based Practices -Selected Sources

• AMCHP Innovation Station: Best, promising, and emerging practices from MCH programs

• NACCHO Model Practices Database: programs, resources and tools from local health departments

• The Community Guide: effective program and policy interventions

• National Center for Education in MCH: Evidence Briefs by domain and national performance measure

• Child Trends’ What Works/LINKS database: over 650 programs with at least 1 randomized, intent-to-treat evaluation to assess child or youth

• Strengthen The Evidence Base For MCH Programs: Resources from Johns Hopkins University, HRSA, Welch Medical Library at JHU, and AMCHP

• What Works in Health: information to help select and implement evidence-informed policies, programs, and system changes

System: Policy and Infrastructure

Constituents

External SupportsSystems Complexity

Funding Policy

Culture

HistoryEconomy

Definition

• Implementation: A specified set of activities designed to put into practice an activity or program of known dimensions1

1 National Implementation Research Network (NIRN). Implementation defined. NIRN Web site. http://nirn.fpg.unc.edu/learn-implementation/implementation-defined. Accessed November 13, 2014.

Why it Matters

Women, children and families do not benefit from interventions they do not

receive.

• Developing and identifying evidence-based/informed programs and practices has improved significantly…

• The science and practice of Implementing these programs with fidelity, in real-world settings, has lagged behind…

…but the science is emerging rapidly

ACTIVE Implementation

Moving from Letting it happen (Diffusion ) & Helping it happen (dissemination) to…

Making it happen

All too often…

EffectiveInterventions

EffectiveImplementation

EnablingContexts

Significant Outcomes

Implementation Equation

Active Implementation Frameworks

Frameworks

The “What”• Neither “Rigorous evidence” for

evidence-based/informed interventions nor promising results from emerging practice is enough…

• Well-defined interventions must be teachable, learnable, doable, assessable, and repeatable in practice

Effective Interventions

The “What”

3. Operational Definitions

1. ClearDescription

4. PerformanceAssessment

2. EssentialFunctions

1. Clear Description of the program Philosophy, values, principles Inclusion – exclusion criteria

2. Identified Core Components (aka, active ingredients, essential functions)

3. Operational Definitions of core intervention components (what practitioners do, say)

4. Practical Performance/Fidelity Assessment


Title V & Interventions

• NPM: “Medical home”

• Selected Strategy: Care Coordination for CYSHCN

• Potential Interventions:

Care Coordination

Services Family

Engagement

Medicaid Partnerships

Applied Example: Usable Interventions


Pulse Check

For each state or territory, select ONE intervention linked to a population health strategy

• Reflect on the Usable intervention criteria

• Discuss– How well defined is the population health

intervention you selected?– What is needed to further define the

intervention?

• Capture your action ideas

Interlude

The “How”

• Implementation Stages: Describe and guide how the work unfolds over time.

• Implementation Drivers: Identify the capacity and infrastructure linked to effective intervention delivery across the stages.

Effective Implementation

Exploration Installation Initial Implementation

Full Implementation

2-4 Years

Implementation Stages


Performance Assessment (Fidelity)

Coaching

Training

Selection

Systems Intervention

Facilitative Administration

Decision Support Data System

AdaptiveTechnical

Competency Drivers Organization Drivers

Leadership Drivers

Consistent Uses of Innovations

Reliable Benefits

Integrated & Compensatory

Implementation

Drivers


Competency: Build provider confidence and competence to deliver intervention with fidelity

Organizational: Align organizational and system resources to support high fidelity delivery

Leadership: Provide sustained vision, motivation & support for the change process; Responds appropriately to adaptive and technical challenges

Integrated & Compensatory: The divers reinforce each other and gaps in one driver can be compensated by another


Implementation Drivers

Exploration Installation Initial Implementation

Full Implementation

• Assess needs• Examine

intervention components

• Consider Implementation Drivers

• Assess fit

• Acquire Resources• Prepare

Organization• Prepare


• Prepare staff

• Activate Data Systems

• Manage change• Strengthen


• Initiate Improvement Cycles

• Achieve and improve Fidelity and Outcomes

• Monitor & manage Implementation Drivers

Drivers and Stages Together


2-4 Years

Applied Exploration

Accessed on 8/21/2105 at http://implementation.fpg.unc.edu/sites/implementation.fpg.unc.edu/files/resources/NIRN-TheHexagonTool_0.pdf

Applied Example: Implementation

Drivers & Stages


Pulse Check

In your groups Reflect, Discuss and Capture

• Which Implementation Stage are you in with the selected intervention? Briefly justify your response.

• How are the Implementation Drivers being addressed? Which need more attention?

Interlude

The “Who”

Implementation Teams: Integrate the use of implementation stages, drivers and improvement cycles to support the implementation, sustainability, and scale-up of usable interventions

Teams “MAKE IT HAPPEN”


Site Implementation

Team

Site Implementation

Team

RegionalImplementation

Team

StateImplementation

Team

StateImplementation

Team

Implementation Teams have…

- Competencies• Know the Intervention

• Know and apply Implementation Science (e.g. Active Implementation Frameworks)

• Know and facilitate Organization and Systems Change

– Minimum of three people • four or more preferred


Exploration: - Evaluate and recommend

potential interventions to address your priorities

Installation: - Develop communication

protocols for program stakeholders (e.g. parents and leaders)


What Implementation Teams do:

Implementation Teams are involved in all stages.

Initial Implementation: - Regularly review performance

data related to strategies

Full Implementation: - Formalize technical assistance

plans for ongoing program support and resources;

Applied Example: Implementation Teams


Pulse Check

In your groups…

• Who can be engaged in an Implementation Team to support the effective delivery of the intervention?

• What’s your role?

Interlude

• Sustained Attention – Keeping the goals in focus, energizing the effort

• Stable Resources – Ensuring human, financial and material supports aligned with goals

• Support for Learning - Getting Started, Getting Better; Fail forward

Enabling Contexts

Leadership

Quality Improvement

“Getting Started, Getting Better”

• Rapid Cycle Improvement

• Usability Testing

• Practice Policy Feedback Loops

Enabling Contexts

Form Supports Function

Policy

Practice

DoExte

rnal

Impl

emen

tatio

n Su

ppor

t

Policy

Practice

Structure

ProcedureStudy

ActPr

actic

e In

form

s Po

licy

Policy Enables Practice

Plan

Practice Policy Feedback Loops

Enabling Contexts

All organizations are designed, intentionally or unwittingly, to achieve precisely the results they get.

R. Spencer Darling, Leadership Institute, Inc.

The reality is that any social system is the way it is because the people in that system want it that way.

Heifetz, Grashow, & Linsky (2009, p.17)

Systems trump programs.Patrick McCarthy, Annie E. Casey Foundation

System Wisdom

Enabling Contexts

Discussion

Oscar Fleming [email protected]

http://nirn.fpg.unc.edu/ www.globalimplementation.org

http://implementation.fpg.unc.edu/

Additional Resources

Website: http://mchwdc.unc.edu/

Website: http://www.amchp.org

Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M. & Wallace, F. (2005). Implementation Research: A Synthesis of the Literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231).

Implementation Research: A Synthesis of the Literature

mailto:[email protected]

http://nirn.fpg.unc.edu/

http://www.implementationconference.org/

• Health Resources and Services Administration (Maternal and Child Health Workforce Development Center)

• Annie E. Casey Foundation (EBPs and Cultural Competence)

• William T. Grant Foundation (Implementation Literature Review)

• Substance Abuse and Mental Health Services Administration (Implementation Strategies Grants; National Implementation Awards)

• Centers for Disease Control & Prevention (Implementation Research)

• National Institute of Mental Health (Research And Training Grants)

• Juvenile Justice and Delinquency Prevention (Program Development And Evaluation Grants)

• Office of Special Education Programs (Scaling up and Capacity Development Center)

• Administration for Children and Families (Child Welfare Leadership; Capacity Development Center)

• The Duke Endowment (Child Welfare Reform)

Recognition

©Copyright Oscar Fleming,Dean Fixsen and Karen Blase

This content is licensed under Creative Commons license CC BY-NC-ND, Attribution-NonCommercial-NoDerivs. You are free to share, copy, distribute and transmit the work under the following conditions: Attribution — You must attribute the work in the manner specified by the author or licensor (but not in any way that suggests that they endorse you or your use of the work); Noncommercial — You may not use this work for commercial purposes; No Derivative Works — You may not alter or transform this work. Any of the above conditions can be waived if you get permission from the copyright holder.

http://creativecommons.org/licenses/by-nc-nd/3.0

http://creativecommons.org/licenses/by-nc-nd/3.0

Lunch Panel with:Mallory Cry

Owen ErquiagaEileen Forlenza

Moderated by: Anita Farel

Establishing Effective Partnerships for MCH

Population HealthMCH Population Health Academy

August 28, 2015Dorothy Cilenti, DrPH, MPH, MSW

Gillings School of Global Public Health UNC at Chapel Hill

Objectives

• Describe context for population health improvement as it relates to MCH populations

• Identify opportunities for Title V leaders to engage external partners in MCH population health improvement

“With rare exceptions, all of your most important achievements on

this planet will come from working with others-or in a word,

partnership.”Dr. Paul Farmer

Partners in Health

Overview

• This is one of the most exciting times in public health– On the cusp of major changes in health system

• At the end of the decade, public health and health care will be radically different

– Balance of challenges and opportunities– We are beginning to recognize and address the

social and environmental determinants of health; we just need to bring to scale

Background

• Affordable Care Act• National Quality Strategy• National Prevention Strategy • Population Health• Social and Environmental Determinants of

Health

ACA Opportunities

• Expanded Insurance Coverage• Clinical Preventive Services• Patient-Centered Medical Homes• Accountable Care Organization/Accountable

Care Communities• Expansion of Community Health Centers• Prevention and Public Health Fund

Other Opportunities

• Life course health development approach highlights the importance of investing in maternal and child health to improve population health

• Positions MCH at the forefront of health reform efforts

102

National Quality Strategy is to concurrently pursue three aims:

Better Care

HealthyPeople/Healthy Communities Affordable Care

National Prevention Strategy

Population Health

• Population health concept is driving all to think about outcomes, not process

• Covers everything from a patient panel to an entire geographic community

• Achieving health outcomes for any definition of “population” requires partnering with others with a different definition

Social and Environmental Determinants of Health• Protecting vulnerable populations is core to MCH field• Collecting, assessing, evaluating and disseminating data on

the impact of health care transformation on MCH populations highlights the importance of health equity

• Responding quickly and effectively to changes in public health, financing, policy, and health care delivery systems maximizes opportunities for alignment to address upstream causes of poor health

• Addressing social and environmental determinants of health requires new partnerships– Moving beyond health in all policies– Examples abound of new partners across housing, education,

community development

Partnerships

• “A partnership is an agreement to do something together that will benefit all involved.”

• Partnerships are:– A way to pool resources– A means of sharing risk– Built on current efforts– Formed for different reasons

Scale

• Creating change and building partnerships happen at multiple levels and over time– Internal – within an agency– One new partnership– Multiple partnerships– Workgroups / Task Force /

Action Committee– Coordinating Council– Coalitions

Engaging Community

• Defined as…“the process of working collaboratively with and through groups of people affiliated by geographic proximity, special interest or similar situations to address issues affecting the well-being of those people.”

109

The Principles of Community Engagement, 2nd edition, by the Clinical and Translational Science Awards Consortium Community Engagement Key Function Committee Task Force on the Principles of Community Engagement, DHHS NIH Publication No. 11-7782, June 2011.

Community Engagement Continuum

Role of Title V & CommunityEngagement

• Fundamental shift to engage communities around the shared goal of population health improvement

• Requires significant expansion of public health efforts outside of governmental public health organizations

• Must partner with other sectors eg. schools to deliver preventive services and address social determinants of health

• Title V practitioners, as trusted and credible health experts, may serve as catalysts for change in their communities

Title V Value Proposition

• Implement life course health development strategies to synergize policies across different sectors

• Align previously siloed sectors to integrate services

• Create networks to optimize health development capacity

• Use data and evidence-informed approaches to achieve measurable improvements

Integrator Role & Functions

• Integrators – Facilitate agreement on shared goals and metrics– Assess resources, such as workforce capabilities, available

to reach goals– Implement policy and practice changes that impact

populations– Serve as source of spreading to reach sufficient scale– Pursue financial sustainability– Provide enabling infrastructure, such as health IT support,

payment reforms and training to share best practices and build process improvement

Hospitals and Health Systems Revised 990, Schedule H CHNA

1. Describe how healthcare needs of community are assessed

2. Provide justification for unaddressed unmet needs

3. Establish community need for activity

Requirements:4. Input from broad community interests, including

public health

5. Broad disseminationImplementation strategy

6. May be completed in collaboration with public health, other partners

Challenges• Ability to articulate added value of Title V• Need to significantly change financing,

delivery, and organization of MCH services in collaboration with Medicaid, CHIP, HIEs

• Coordination of state-level policies across health, social services, education and other sectors

• Assume new leadership roles based on rapidly-evolving evidence base and development of new partnerships

Summary

• Health care transformation is requiring a more collaborative, community-engaged approach to population health improvement.

• Title V may catalyze partners, such as medical providers, hospitals, and health systems to invest and align resources to achieve shared goals.

• Opportunities abound to improve health of MCH populations and future generations

What future do you envision and how will you lead into it?

116

Center’s Mission• Advance workforce development for state and

territory Title V programs and partners in the context of health transformation

• Build capacity in four core areas of health transformation– Access to Care– Change Management (Population Health Management)– Quality Improvement– Systems Integration

• Prepare future workforce for success

118

Intensive Training

Training Webinars

9 webinars:

Quality Improvement

Systems Integration

Adaptive Leadership

Project Updates

In-person Training

2-day in-person trainingQuality ImprovementSystems MappingAccess to CareLeadership

State Site Visits

2-3 day visits tailored to state needs in key areas of health transformation

Center coach brokering resources

Title V Partnerships

Title V

119

Upcoming Opportunities

• Cohort 4 RFP released in April 2015, due September 30– Cohort 4: December-June, training in DC area

• Targeted Assistance is available at anytime:www.amchp.org/Transformation-Station/Pages/Home.aspx

• For more information about engaging with the Center, please contact Amy Mullenix, Senior Collaboration Manager, at [email protected]

http://www.amchp.org/Transformation-Station/Pages/Home.aspx

welcome! 2015 mch workforce academy leading in a transformative environment to improve population...

Documents

population health wifi

governmental health

internet code code

chief health strategist

healthcare system

internet browser3

transformative environment

data management