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Frequently Asked Questions about Assessment and the CDC Assessment
Initiative
- How does the Assessment Initiative differ from
other assessment-related projects and programs?
Different tools and approaches have been developed to assist
state and local health departments in working with communities
to assess health needs and develop plans to address them (e.g.,
Mobilizing for Action through Planning and Partnerships [MAPP],
Assessment Protocol for Excellence in Public Health [APEXPH]);
however, each state is unique with regard to organizational
structure, legislative requirements, degree of local health
department autonomy, and other factors that affect the way in
which assessment can be effectively implemented.
Rather than focusing on the specific tool that is used,
the Assessment Initiative centers on building
state capacity and infrastructure to do assessment, taking
into consideration the strengths and weaknesses that already
exist and relying on the state Assessment Initiative team
to develop and evaluate an assessment process that works
for them. In certain cases, that equates to a state developing
tools unique to its situation; in other cases, it might
involve modifying existing tools or implementing different
tools in different areas of the state depending on each
jurisdiction's unique needs and limitations. In this way,
the Assessment Initiative is able to draw on each
grantee's individual abilities and intimate knowledge of
its own organizational structure, politics, strengths, and weaknesses
to produce systems, methods, and resources that can be
shared with other states with similar needs.
- The Assessment Initiative provides a cross-cutting
rather than categorical funding source, enabling states to
work across organizational and programmatic lines to develop
a systematic approach to assessment, encompassing all relevant
issues and health conditions.
- Because of its flexibility and non-categorical nature, the
Assessment Initiative is able to support capacity development
on multiple levels, all of which need to be addressed if assessment
is to be comprehensive, systematic, and effective. Assessment
Initiative states employ multiple mechanisms to facilitate
this, including
- Conducting training programs to improve workforce skills
in epidemiology and statistics, so that staff in local
health jurisdictions (LHJs) understand how to accurately
interpret community health data and translate data into
action;
- Developing and adapting electronic systems to improve LHJ's
timely access to relevant data;
- Organizing and implementing peer mentoring programs to
support capacity development in weaker LHJs;
- Developing and implementing practical tools to assist LHJs
in completing the components of a community health
assessment; and
- Developing and pilot-testing new methodologies to link
disparate data sets and expand their utility.
- How does
community health assessment differ from public health surveillance
and planning?
Public health "surveillance" and "assessment" have similar
definitions.
- Public Health Surveillance: The ongoing, systematic collection,
analysis, and interpretation of outcome-specific data for
use in the planning, implementation, and evaluation of public
health practice.
(Thacker SB, Berkelman RL. Public health surveillance in the United States, Epidemiol Rev 1988;10:164-90.)
- Public Health Assessment: The systematic collection,
assembly, analysis, and dissemination of information about
the health of a community.
(Stoto MA, Abel C, and Dievler A, eds. Healthy Communities: New Partnerships for the Future of
Public Health. Institute of Medicine. National Academy Press, 1996.)
However, in real-life public health practice, the process
of community health assessment often goes beyond these basic
functions, encompassing the use of surveillance and statistical
data together together with information on health assets, resources,
needs, and health perceptions of a community. The process generally
culminates in a comprehensive report that provides the basis
for discussion with health professionals, policymakers, and
community leaders to identify priority health problems and concerns
and develop an action plan to address those priority concerns.
Therefore, a robust community health assessment process can often
include activities related to surveillance and planning. This
point is well illustrated in the following examples of approaches
to community health assessment used in New York and North Carolina.
North Carolina: Eight-Step Approach to Community Health Assessment
(CHA) (http://www.healthycarolinians.org/pdfs/02Guidebook.pdf )
- Establishing a CHA team
- Collecting community data
- Analyzing the county health data book
- Combining local health statistics with community data
- Reporting to the community
- Selecting health priorities
- Creating the CHA document
- Developing the community health action plan
New York: Ten-Step Approach to Community Health Assessment
(CHA) (http://www.health.state.ny.us/nysdoh/chac/10steps.htm)
- Establishing a CHA team
- Identifying and securing resources
- Identifying and engaging community partners
- Collecting, analyzing, and presenting data
- Setting health priorities
- Clarifying the issue
- Setting goals and measuring progress
- Choosing the strategy
- Developing the community health assessment document
- How does the Assessment Initiative
benefit other state and local health departments that are
not directly funded?
The Assessment Initiative serves as a "test-bed" for developing new methodologies,
tools, and promising practices. Part of CDC's role is to
disseminate the outcomes of this work to the larger public
health community.
-
If assessment is a
basic public health function,
why do state health departments
need additional support through
the Assessment Initiative?
Assessment is one of three core functions of public
health and is, therefore, a key capacity associated with
public health infrastructure development. The 2002 Institute
of Medicine Report The Future of the Public's Health
in the 21st Century identified six areas of action
needed to address present and future challenges faced
by the nation's public health system, one of which is
the ongoing need to strengthen the public health infrastructure.
In spite of funding increases in targeted areas (e.g.,
terrorism preparedness), many states continue to face
budget restrictions and staffing shortages, coupled with
multiple competing priorities demanding immediate attention.
Without dedicated staff, leadership support, and adequate
resources to support and customize assessment-related
training and development, addressing
this key public health function in a comprehensive and
systematic way is difficult.
- What are examples of factors that
contribute to an effective community health assessment?
New York State recently embarked on work
in this area that will occur during the next three years; however,
preliminary work conducted in the state of Washington identified
the following characteristics that are critical in making community health assessment
practice an effective ingredient in achieving the goal of the local health jurisdiction:
- Leadership and vision are essential.
- LHJ directors should have an expansive vision of
public health and the role of the community in achieving
it.
- Directors need to view assessment as a core function.
- The health officer must be engaged in the assessment
function.
- The board of health makes a key contribution.
- The community is a powerful partner in achieving
health goals.
- A community-based stakeholder group should be present
and active. These groups are invested in public health
concerns and bring an additional and separate voice
to local public health problems. The size, structure,
and composition of these groups vary - the key is
that the LHJ has an active voice in addition to its
own.
- Dedicated staffing makes a big difference.
- Assessment is a dedicated staff function.
- Assessment staff should have direct access to the LHJ
director.
- Staff conducting assessment should have a passion for doing it.
- Staff development and training must be available.
- LHJs committed to assessment find a way to make
it happen.
- Paying for assessment takes creativity and commitment.
- Directors who value assessment will find a way to pay
for it.
- LHJs must move beyond traditional funding streams
to pay for assessment.
- Assessment must be able to weather budget reductions.
- Access to key supports is critical, including
- Access to useful, timely data;
- Ability to take advantage of peer learning
opportunities; and
- Access to technological expertise (
in statistical analysis and epidemiology) and
enhancements (e.g., GIS capability and web design and posting).
- How does assessment result
in public health impact?
Several Assessment Initiative states
have documented ways in which local community health
assessments, or data disseminated through state health
department systems, have generated positive changes (e.g., an increase in legislative advocacy, additional funding,
development of a new program, or a necessary reallocation
of services to target the identified health conditions). The following examples are from Missouri.
- The Missouri Department of Health
and Senior Services developed an integrated data
warehouse and an Internet-based, interactive query
system (Missouri Information for Community Assessment [MICA])
for disseminating health data to users in local health
jurisdictions. In the fall of 2001, data generated
from this system was presented to the Missouri Health
Foundation, a group created from the conversion of
Blue Cross/Blue Shield of Missouri from nonprofit
to for-profit status. The foundation's board of directors
was tasked with identifying health priorities to
form the basis for a state-wide grant program. On the basis of compelling county-level data presented by
state staff to the Board of Directors on life expectancy,
poverty, and 52 health conditions, three priority
health conditions were established. The following year,
approximately $20 million was awarded to non profit
health organizations across Missouri through a grant
program focused specifically on these priority concerns.
- Through a community health assessment
supported by data from the MICA system, Douglas County,
Missouri, identified diabetes as its fourth leading
cause of death. By using this data, the Douglas
County Health Department successfully competed for
funding through the Missouri Hospital Association
Community Interventions Initiative to reduce the
prevalence and severity of diabetes in the county.
Funds are being used to support diabetes
education, case management, and enhanced early detection
programs. Preliminary data indicate success in improving
the health care of clients and in identifying new
cases throughout the county. The intervention has
also led to the formation of new partnerships among
health-care providers in the region.
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