Chronic Disease and Health Promotion Program Integration

1. Chronic Disease and Health Promotion Program Integration Rosemarie Henson, MSSW, MPH Deputy Director Kaetz Beartusk, MPH Team Lead, Public Health Practice National Center for Chronic Disease Prevention and Health Promotion

2. Vision and Mission of NCCDPHP Our VisionAll people living healthy lives free from the devastation of chronic diseases Our MissionLeading efforts to promote health and well-being through prevention and control of chronic diseases

3. NCCDPHP Goals • Prevent, delay, detect, and control chronic diseases • Contribute to chronic disease research and apply that research to put practical and effective intervention strategies into practice • Achieve equity in health by eliminating racial and ethnic disparities and achieving optimal health for all Americans

4. Office of Public Health Genomics Division for Heart Disease and Stroke Prevention Muin J. Khoury, M.D. Darwin Labarthe, M.D., M.P.H., Ph.D. Director Director Division of Nutrition, Physical Activity, and Obesity William H. Dietz, M.D., Ph.D. Director Division of Adolescent and School Health Division of Oral Health Howell Wechsler, Ed.D, M.P.H. Kathleen Ethier, Ph.D. Director Acting Director Division of Diabetes Translation Office on Smoking and Health Ann Albright, Ph.D. Matthew T. McKenna, M.D., M.P.H. Director Director National Center for Chronic Disease Prevention and Health Promotion Disease-Focused Divisions Risk Factor Divisions Population/Setting Divisions Division of Cancer Prevention and Control Barbara Bowman, Ph.D. Acting Director Division of Adult and Community Health Wayne H. Giles, M.D., M.S. Director Division of Reproductive Health John Lehnherr Acting Director

5. Framework for Preventing Chronic Disease and Promoting Health Life Span and Settings • Worksites • - Schools • - Communities • Health Systems • Infants • Children and Adolescents • Adults and Older Adults Priority Conditions Underlying Risk Factors • Heart Disease • Stroke • - Cancer • Diabetes • Obesity • Arthritis • Oral Health • Tobacco • Nutrition • Physical Activity • Alcohol • Family History

6. Prevent, Delay, Detect & Control Chronic Disease Division for Heart Disease and Stroke Prevention Office on Smoking and Heath Division of Nutrition, Physical Activity and Obesity Division of Adolescent and School Health Division of Adult and Community Health Office of Public Health Genomics Heart Disease

7. Early Efforts • WISEWOMAN • Comprehensive Cancer Control • REACH (Racial and Ethnic Approaches to Community Health) • Steps to a HealthierUS • Chronic Disease Program Linkages with Quitlines

8. Integration Initiative Background FY '05 • Began working with states to understand the program integration efforts implemented by states • Siloed programs FY '06 • Integration workshop sponsored by CDC and NACDD FY '07 • Offers to Participate (Negotiated Agreements) FY '08 • Activities - Simplified FOAs - Negotiated Agreements - Collaborative FOAs

9. NCCDPHP Vision for Program Integration To nurture and sustain a culture for program integration across chronic disease and health promotion, and other related programs

10. Improve program reach and impact by enhancing synergies among approaches to different diseases, risk factors, populations, and settings Promote opportunities for greater flexibility, creativity and responsiveness by our partners Increase efficiencies across categorical disease programs Provide consistency of CDC processes, reporting and interpretation of policy across programs for states and other partners Maximize and leverage limited federal resources Goals for Integration

11. Evaluation What integration efforts seem to create the favorable environment that is necessary for implemented programs to achieve their intended chronic disease outcomes. • Do/did integration efforts produce improvements in intra-organization collaboration, efficiencies etc • Do/did integration efforts produce the intended external improvement such as increased outreach/access to populations, leveraged funding etc • Do/did the increased leverage, efficiencies, collaboration lead to enhanced reach and /or significant policy or environmental changes

12. NCCDPHP’s Integration Approaches • 2008 Streamlined FOAs for all Center programs • 2009 Collaborative Performance Agreements for Pacific Basin Programs (BRFSS, Diabetes, Tobacco) • 2009 Collaborative FOA for National Programs (BRFSS, Tobacco, Diabetes + DACH Healthy Communities) • 2009-2011 Negotiated Agreement Pilots

13. Integration Challenges • Organization norm change • Technical Assistance/Consultation • Business Processes • MIS (Management Information Systems) • Reporting Requirements • Evaluation • Sharing lessons learned, challenges, successes

14. Early Successes • Integrated work plan (process & the document) • Increased communication and engagement among staff • Recognizing need for consistency in our terminologies, processes, and messages • Engagement with PGO in new ways of doing business

15. Early Observations • Organizational change is difficult, it takes time • Good relationships between categorical Project Officers and Program Managers need to be preserved • Staff at all levels must be engaged • Processes must be transparent • Need to create a learning organization where people share information freely and create new systems for open communication

16. Chronic Disease Program Integration Learning Community Vision: An opportunity for continuous learning across chronic disease programs to exchange relevant tools and approaches for building collaborative knowledge and to propel program integration and integrative thinking • Program Integration – On Demand • Program Integration Networking Calls • Program Integration Webinar Series