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Better Focusing on Our Problems: Needs Assessment & the Planning Process

Better Focusing on Our Problems: Needs Assessment & the Planning Process. William M. Sappenfield, MD, MPH MCH EPI Program Consultant Division of Reproductive Health, CDC

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Better Focusing on Our Problems: Needs Assessment & the Planning Process

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  1. Better Focusing on Our Problems:Needs Assessment & the Planning Process William M. Sappenfield, MD, MPH MCH EPI Program Consultant Division of Reproductive Health, CDC Needs Assessment Training Course AMCHP Preconference Skills Building Workshop Atlanta, GA – December 8th & 9th

  2. Acknowledgements • Mary D. Peoples-Sheps, Anita Farel, & Mary Rogers • South Carolina Department of Health and Environment Control (DHEC) • CityMatCH Urban MCH Data Use Institute • Greg Alexander & Donna Peterson

  3. Act I Public Health Planning Cycle

  4. Evaluation Assessment Plan Monitor Capacity & Strategies Implement Plan Do Being Effective in Public Health

  5. Being Effective in Public Health? Capacity &

  6. Evaluation Assessment Plan Monitor Capacity & Strategies Implement Plan Do Being Effective in Public Health

  7. Health Problem:Late PNC EntrySouth Carolina

  8. Needs Assessment • Underreporting of prenatal visits • Physicians not starting to 2nd trimester • Late entry into the WIC program • Problem recognition by Community • Transportation & child care barriers • Unintended pregnancy

  9. Potential Strategies • Underreporting of prenatal visits • Vital registration manual • Clerk training • Health department record transfer • Physician record transfer • Standardized prenatal care record • Physician & hospital education • Monthly reporting system • Hospital standards • Incentive awards

  10. Chosen Strategies • Underreporting of prenatal visits • Vital registration manual • Clerk training • Health department record transfer • Physician record transfer • Standardized prenatal care record • Physician & hospital education • Monthly reporting system • Hospital standards • Incentive awards

  11. Evaluation Assessment Plan Monitor Capacity & Strategies Implement Plan Do Being Effective in Public Health

  12. Health Problem:Late PNC EntrySouth Carolina

  13. So Why Doesn’t It Happen? • Over-commited staff • Lack of political will • Committed to present activities • Previous planning failures • Limited expertise • Insufficient resources • Competing priorities/desires

  14. Evaluation Assessment Plan Who? What? Monitor Capacity & Strategies When? Where? How? Resources? Implement Plan Do Being Effective in Public Health

  15. Act II Needs Assessment

  16. Evaluation Assessment Plan Monitor Capacity & Strategies Implement Plan Do Being Effective in Public Health

  17. Definition of Needs Assessment Systematic collection and examination of information

  18. Definition of Needs Assessment Systematic collection and examination of information to make decisions

  19. Definition of Needs Assessment Systematic collection and examination of information to make decisions to formulate a plan

  20. Definition of Needs Assessment Systematic collection and examination of information to make decisions to formulate a plan for the next stepsleading to public health action.

  21. Definition of Needs Assessment Systematic collection and examination of information to make decisions to formulate a plan for the next steps leading to public health action.

  22. Needs Assessment Qualities • Conceptual • Visionary • Systematic • Resourceful • Pragmatic • Action-oriented • Cohesive

  23. Types of Needs Assessment... • Community--Healthy Communities • Population--Title V (MCH) • Health Systems--Emergency Response • Program--Title X (Family Planning) • Health Services--Prenatal Clinic Location • Health Problem--Infant Mortality

  24. Needs Assessment Phases Part 1 • Health problem identification and measurement • Prioritization of health problems • Analysis of a particular health problem • Assess potential strategies to address targeted aspects Part 2

  25. Needs Assessment Phases Part 1 • Health problem identification and measurement • Prioritization of health problems • Analysis of a particular health problem • Assess potential strategies to address targeted aspects. Part 2

  26. What is a health problem? • Community perception? • Health status measure? • Risk Factor? • Health Service Deficiency? • Measurement? • Comparison?

  27. Problem Identification & Verification • Stakeholders • Partners • Reports • Available Data Purpose: Search & compile

  28. Problem Definition • Extent • Duration • Expected future course • Variation Purpose: Define, describe & validate

  29. Types of Prioritization • Group consensus • Voting • Criteria-based rating • Q sort Purpose: Build consensus/support

  30. Q-Sort Procedure: Priority Log Sheet for 25 MCH Needs

  31. Part 1:Identification & PrioritizationSelection Criteria • Magnitude of the problem • Trend • Severity/consequences • Perceived preventability • National/state goals • Agency capacity • Political/community acceptability

  32. Part 1:Identification & PrioritizationReal Selection Criteria • State or agency political will • Current program priority • Currently funded activity • Fits current staffing/resource patterns • People available to work on the issue • Important issue to the heart

  33. Matrix of MCH Problems

  34. Clear Scoring Criteria Magnitude • Low incidence/prevalence • Moderate in some subgroups • Moderate in all groups • High in some subgroups • High in all groups

  35. Matrix of MCH Problems

  36. Act III Problem-Oriented Needs Assessment

  37. Needs Assessment Phases Part 1 • Health problem identification and measurement • Prioritization of health problems • Analysis of a particular health problem • Assess potential strategies to address targeted aspects. Part 2

  38. Problem Map:Basic Components Precursors Before Problem Consequences After

  39. Precursors Tertiary: Secondary: Continuation Initiation Use of of Sexual Direct: of Sexual Contraception Activity Activity Problem Teen Pregnancy

  40. Precursors Tertiary: Secondary: Partner Age Access to Unsupervised Disparity Confidential Activities Services Continuation Initiation Use of of Sexual Direct: of Sexual Contraception Activity Activity Problem Teen Pregnancy

  41. Precursors Social Norms After Tertiary: School Programs Health Policy Secondary: Partner Age Access to Unsupervised Disparity Confidential Activities Services Continuation Initiation Use of of Sexual Direct: of Sexual Contraception Activity Activity Problem Teen Pregnancy

  42. Precursors Social Youth Sex/Contraceptive Role Norms Unemployment Education Models TV/Movies Parenting At Risk After Knowledge Tertiary: & Music Educational School Programs Programs Health Policy Racism Poor School Sex/Contraceptive Poor Family Connectedness Connectedness Knowledge Secondary: Partner Age Peer Access to Unsupervised Disparity Group Confidential Activities Services Life Goals Parental Risk Family Beliefs & Behaviors Income Acceptable Abuse Behaviors Method Continuation Initiation Use of of Sexual Direct: of Sexual Contraception Activity Activity Problem Teen Pregnancy

  43. Consequences Problem Teen Pregnancy Live Birth Fetal Death Direct: Abortion Secondary: Tertiary:

  44. Consequences Problem Teen Pregnancy Live Birth Fetal Death Direct: Abortion LBW/Prematurity Secondary: School Delay or Drop Out Abortion Consequences Tertiary:

  45. Consequences Problem Teen Pregnancy Live Birth Fetal Death Direct: Abortion LBW/Prematurity Secondary: School Delay or Drop Out Abortion Consequences Tertiary: Impaired Economic Productivity

  46. Consequences Problem Teen Pregnancy Live Birth Fetal Death Direct: Abortion Medical LBW/Prematurity Complications Secondary: Poor Growth School Delay Economic Environment or Drop Out Abortion Difficulties Consequences Limited Limited Limited Family Maternal Father Tertiary: Support Skills Involvement Poverty Repeat Cycle Pregnancy Day Care Slowed Subsidy Development Impaired Social Child Medicaid Economic Support Neglect Support Productivity

  47. Need for Services • Standards--Professional or Consensus • Demand--Waiting Lists • Population at Risk--At Risk Not Using • Relative--Population Comparisons • Perceptions--Reported Needs

  48. Precursors Social Norms After Tertiary: School Programs Health Policy Secondary: Partner Age Access to Unsupervised Disparity Confidential Activities Services Continuation Initiation Use of of Sexual Direct: of Sexual Contraception Activity Activity Problem Teen Pregnancy

  49. Why Do You Need A Problem Map? • Many causes & risk factors • Many levels of influence • Different opinions--causes & solutions • Vast scientific knowledge • Stacks of local data

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