Illinois Project for Local Assessment of Needs (IPLAN)

1. Illinois Project for Local Assessment of Needs (IPLAN) Office of Epidemiologyand Health Systems DevelopmentDivision of Health PolicySeptember 28, 2001

2. What is IPLAN? • Primary goals • To establish a process for community involvement and participation in community health assessment and planning • To make local health departments accountable to their communities rather than to the state • Essential elements • Organizational capacity assessment • Community health needs assessment • Community health plan, focusing on a minimum of three priority health problems

3. What led to IPLAN? Over a decade of strategic planning in public health

4. What led to IPLAN? 1984 - The Roadmap Committee Report • Four principles for change • Service delivery should be improved. • Societal benefits should be effectively communicated. • Quality of services should be improved and standardized. • Funding should be increased.

5. What led to IPLAN? 1984 - The Roadmap Committee Report • Underlying belief • Services are most efficiently and effectively provided at the local level.

6. What led to IPLAN? 1988 - Roadmap Implementation Task Force • Examined existing policies, statutes, regulations, funding and administration of public health • Visioned an optimal public health system and compared it with the current system • Developed 29 recommendations that were published in The Road to Better Health for All of Illinois

7. What led to IPLAN? 1990 - Project Health The Illinois Public Health Improvement Project • Conducted by more than 200 public health professionals from state and local health departments, public health academia, and public health associations • Adopted 27 of the RITF recommendations • Catalyzed the development of progressive rules for certification of local health departments in Illinois

8. Requirements for Certification of Illinois Local Health Departments Before and After 1993 After July 1993 To be certified as a local health department in Illinois, LHDs MUST– Before July 1993 To be recognized as a local health department in Illinois, LHDs MUST DO – • Assess community health needs • Investigate hazards within the community • Analyze identified health needs for their determinants • Advocate and build constituencies for public health • Prioritize among identified community health needs • Develop policies and plans to respond to priority needs • Manage resources and organizational structures • Implement programs and services to respond to priority needs • Evaluate programs and services • Inform and educate the community • Potable Water • Food Sanitation • Maternal Health/Family Planning • Child Health • Communicable Disease Control • Private Sewage • Solid Waste • Nuisance Control • Chronic Disease • Administration

9. Illinois Administrative CodeTitle 77: Public Health Chapter 1: Department of Public Health Subchapter H: Local Health Departments Part 600: Certified Local Health Department Code

10. Illinois Administrative Code Section 600.400: Certified Health Department CodePublic Health Practice Standards The local health department shall, at least once every five years, perform an organizational capacity self-assessment that meets the requirements set forth in Section 600.410.

11. Illinois Administrative Code Section 600.400: Certified Health Department CodePublic Health Practice Standards A community health needs assessment that systematically describes the prevailing health status and health needs of the population within the local health department=s jurisdiction shall be conducted once every five years.

12. Illinois Administrative Code Section 600.400: Certified Health Department CodePublic Health Practice Standards Develop a community health plan that addresses at least three priority health needs, identified pursuant to Section 600.400, during each certification period.

13. Community The IPLAN Process Health Needs Assessment Community Health Plan Evaluation Program Development Implementation

14. What is the State’s role? • Established the framework for the assessment and plan (APEX-PH model) • Developed, enhances and maintains IPLAN data system • Conducts training and provides technical assistance • Reviews submitted assessments and plans for substantial compliance with the administrative rules (every 5 years) and provides follow-up technical assistance

15. A Community Health Needs Assessment should contain-- A description of the health status and health problems most meaningful for the community in the data groupings contained in the IPLAN Data System:$ Demographic & Socioeconomic Characteristics$ General Health & Access to Care$ Maternal & Child Health$ Chronic Disease$ Infectious Disease$ Environmental, Occupational, & Injury Control$ (Sentinel Events)

16. A Community Health Needs Assessment should contain-- $A description of the process and outcomes of setting priorities; $A statement of purpose of the community health needs assessment that includes a description of how the assessment will be used to improve health in the community; $A description of the community participation process, a list of community groups involved in the process, and method for establishing priorities;

17. Community Health Committee • ethnic & racial groups • medical & hospital community • mental health & social service organizations • cooperative extension service • schools • law enforcement organizations • voluntary organizations • faith community • businesses and economic development • unions • youth, senior citizens, other target populations

18. Prioritize Community Health Problems • Hanlon Method • Nominal Group • Delphi Technique • PEARL (Propriety, Economics, Acceptability, Resources, and Legality)

19. Detailed Analysis of Community Health Problems

20. Health Problem AnalysisWorksheet Indirect Contributing Factors Direct Contributing Factors Risk Factors Health Priority aka - NCAA Chart

21. Health Priority A situation or condition of people which is considered undesirable, is likely to exist in the future, and is measured as death, disease, or disability. Indirect Contributing Factors Direct Contributing Factors Risk Factors Health Priority

22. Risk Factor A scientifically established factor (determinant) that relates directly to the level of a health problem. Indirect Contributing Factors Direct Contributing Factors Risk Factors Health Priority

23. Direct Contributing Factor A scientifically established factor that directly affects the level of a risk factor. Indirect Contributing Factors Direct Contributing Factors Risk Factors Health Priority

24. Indirect Contributing Factors A community specific factor that directly affects the level of the direct contributing factor. Indirect Contributing Factors Direct Contributing Factors Risk Factors Health Priority

25. Outcome Objective The level to which a health problem (priority) should be reduced. Indirect Contributing Factors Direct Contributing Factors Risk Factors Health Priority

26. Indirect Contributing Factors Direct Contributing Factors Risk Factors Health Priority Impact Objective The level to which a risk factor should be reduced.

27. Indirect Contributing Factors Direct Contributing Factors Risk Factors Health Priority Intervention Strategy Demonstrated to be effective or used as national model and should address an impact objective. Impact Objective The level to which a risk factor should be reduced.

28. Community Health Plan: Worksheet Outcome Objective Health Problem Risk Factor Impact Objective Contributing Factors Proven Intervention Strategies Barriers Resources Available

29. Community Health Plan: Worksheet Health Problem Outcome Objective By 2004, reduce stroke deaths to no more than 70 per 100,000 (Baseline: 1997 crude rate 76.5 per 100,000). Cerebrovascular Disease (Stroke) Risk Factor Impact Objective By 2002, reduce cigarette smoking to a prevalence of no more than 24 percent among people aged 18 and older. (Baseline: 1996 BRFS percentage 27.3). Tobacco Use Contributing Factors Proven Intervention Strategies Addiction Sedentary Lifestyle Hypertension Advertising (Indirect) Coalition will implement CDC=s community-based tobacco control program, focusing on delaying initiation, cessation programs, and advertising control. Barriers Resources Available Limited number smokers seeking counseling. Media messages promote smoking. Peer pressure. Coalition will provide support to LHD with in-kind donations, staff, and clinical counseling space.

30. Community Health Plan Description of the Health Problem, Risk Factors and Contributing Factors Corrective Actions Proposed Community Organizations Evaluation Plan

31. Community Health Plan Description of the Health Problem, Risk Factors and Contributing Factors The problem is the high death rate associated with cerebrovascular disease (county CR = 76.5, state CR =61.7 p/100,000 or 23% above state rate). The major risk factor is cigarette smoking and county has higher percentage of smokers (27.6%) , especially males (31%) than state (24%, 28%, respectively). Addiction appears to be the chief contributing factor. Corrective Actions In order to effectively address this health problem a multi-sited and multi- targeted campaign is required to delay initiation of smoking behavior, assist persons attempting to quit, and provide counter advertising to tobacco promotions. Proposed Community Organizations A coalition of community groups, including the LHD, Cancer Society, Lung Association, General Hospital, Teens Against Butts will collaborate with in- kind donations, staff, and clinical counseling space to assist in meeting objectives. Evaluation Plan Coalition will meet quarterly to assess progress in achieving goals. Coalition will use the evaluation tool developed by the CDC to determine effectiveness of programming efforts. Surveys will be conducted amongst coalition members to ascertain stakeholder satisfaction with program.