CHAPS HomePhase VI: Local Public Health Plan
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CDPHE Office of Planning and Partnerships
4300 Cherry Creek Drive S.
Denver, CO 80246
Phone: 303-692-2350
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Local PHIP Frequently Asked Questions
 

Frequently Asked Questions

Q: When is our local public health improvement plan (PHIP) due?

A: Colorado’s Public Health Act specifies that county or district PHIPs be complete “as soon as practicable after the approval of each comprehensive, statewide public health improvement plan…” Colorado’s next statewide public health improvement plan is due in 2014. In order to inform the statewide plan, it is anticipated that local PHIPs will be completed in or before 2013.

Q: Our team is ready to determine the content and outline of our PHIP. Where can I locate examples of how other jurisdictions have organized their plans? Is there a sample outline?

Find a sample PHIP outline on the CHAPS website under the Phase 6 tab at: http://www.chd.dphe.state.co.us/CHAPS/phases.aspx?phaseID=phase6

Find recent PHIPs from Colorado jurisdictions under the Local Public Health Improvement Plan bar at: http://www.chd.dphe.state.co.us/CHAPS/phases.aspx?phaseID=phase6

Find links to PHIPs from jurisdictions throughout the nation at: http://www.chd.dphe.state.co.us/CHAPS/Documents/CHIPlinks.pdf

Q: Once our PHIP is complete, what submission requirements apply?

A: Completed plans should be submitted to your local board of health for review and then submitted to the Office of Planning and Partnerships for review and presentation to the state board of health. Please send electronic documentation of the date on which your plan was reviewed by the local board. The Office of Planning and Partnerships is also available to conduct a formal review of your draft plan against Act requirements.

Q: Colorado’s Public Health Act states that local PHIPs must examine data about health status and risk factors in the local community. Our county chose to publish a community health status report to share our health status and risk factor information. Does this information need to be restated in our PHIP?

A: The full contents of your health status report do not need to be restated in the local PHIP, but the information should be referenced and readily available to the public. Information necessary to justify and build support for the local PHIP should be included where necessary, such as through the inclusion of health and capacity assessment highlights or an executive summary.

Q: Does our PHIP need to detail all of the activities our local public health system will complete over the next 5 years?

A: Counties may choose to create work plans for all of their identified strategies, or focus on priority areas.

Q: Are we required to use the chart that is included in CHAPS Phase 6 as our official work plan template?

A: Documentation of the categories of information requested in the provided work plan template is required, although use of an alternate format is acceptable. Document goals and strategies for improving the health of the local community in a format that works for you, using SMART objectives.

Local Public Health Improvement Plan Requirements

Excerpted from Colorado SENATE BILL 08-194

25-1-505. County and district public health plans - approval.

(1) AS SOON AS PRACTICABLE AFTER THE APPROVAL OF EACH COMPREHENSIVE, STATEWIDE PUBLIC HEALTH IMPROVEMENT PLAN PURSUANT TO SECTION 25-1-504, EACH COUNTY OR DISTRICT PUBLIC HEALTH AGENCY SHALL PREPARE A COUNTY OR DISTRICT PUBLIC HEALTH PLAN, REFERRED TO IN THIS SECTION AS THE "LOCAL PLAN". EACH LOCAL PLAN SHALL NOT BE INCONSISTENT WITH THE COMPREHENSIVE, STATEWIDE PUBLIC HEALTH IMPROVEMENT PLAN REQUIRED UNDER SECTION 25-1-504.

(2) EACH LOCAL PLAN SHALL, AT A MINIMUM:

(a) EXAMINE DATA ABOUT HEALTH STATUS AND RISK FACTORS IN THE LOCAL COMMUNITY;

(b) ASSESS THE CAPACITY AND PERFORMANCE OF THE COUNTY OR DISTRICT PUBLIC HEALTH SYSTEM;

(c) IDENTIFY GOALS AND STRATEGIES FOR IMPROVING THE HEALTH OF THE LOCAL COMMUNITY;

(d) DESCRIBE HOW REPRESENTATIVES OF THE LOCAL COMMUNITY DEVELOP AND IMPLEMENT THE LOCAL PLAN;

(e) ADDRESS HOW COUNTY OR DISTRICT PUBLIC HEALTH AGENCIES COORDINATE WITH THE STATE DEPARTMENT AND OTHERS WITHIN THE PUBLIC HEALTH SYSTEM TO ACCOMPLISH GOALS AND PRIORITIES IDENTIFIED IN THE COMPREHENSIVE, STATEWIDE PUBLIC HEALTH IMPROVEMENT PLAN; AND

(f) IDENTIFY FINANCIAL RESOURCES AVAILABLE TO MEET IDENTIFIED PUBLIC HEALTH NEEDS AND TO MEET REQUIREMENTS FOR THE PROVISION OF CORE PUBLIC HEALTH SERVICES.

 
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Objective
 
The objective of this phase is to conduct a collaborative planning process, based on the results of assessment activities and the selection of priority focus areas for improvement, and then to develop a five-year local public health improvement plan (PHIP), also referred to as a community health improvement plan (CHIP). The PHIP will become the “roadmap” for community and regional partners to make improvements to the public health system and ultimately the population’s health.

A public health improvement plan provides guidance to the public health agency, its partners, and its stakeholders, on improving the health of the population within the public health agency’s jurisdiction. The plan is critical for developing policies and defining actions to target efforts that promote health. Government agencies, including those related to health and the environment, human services, and education, will use the public health improvement plan in collaboration with community partners to set priorities and coordinate and target resources.
 

Why is this phase important?
 
By now, your public health agency has convened a community-wide process that has examined health and environmental data, service capacity, and has selected top focus areas or priorities for improvement, and may have selected strategies for addressing those priority areas. The next step is to develop specific action plans for implementation and evaluation. A Public Health Improvement Plan (PHIP) provides a road map that illustrates the county or regional public health needs, describes priorities for health improvement, names the partners to be involved, documents the steps to get there, and provides a method for evaluating progress.

The PHIP has become a standard practice within the field of public health, recommended by the National Association of City and County Health Officials (NACCHO), mandated by the 2008 Colorado Public Health Act for all local public health agencies, and required for voluntary accreditation by the national Public Health Accreditation Board (PHAB). In Colorado, the local PHIPs will be used to inform the next State Public Health Improvement Plan.

A brief description of how a public health improvement plan makes a difference to a community’s health is available here:
"How Does a Public Health Improvement Plan Make a Difference?”

In Summary: A PHIP serves as a measurable, outcomes-focused plan for your community
  • to inform and mobilize the community
  • to align policy and community efforts
  • to outline action steps for community partners (e.g., hospitals, schools, transportation, environmental groups, among others)
  • to support grant applications with data and information
  • to inform the state public health improvement plan
 

Who should be involved?
 
Stakeholders most integral to developing the Public Health Improvement Plan are those who will have a role in implementing, supporting, evaluating and/or funding the activities outlined in the plan. These are likely stakeholders who have been involved throughout the process, for example, your steering committee, agency staff, and community leaders. However, new stakeholders can be brought in at any time. For example, the selection of priority areas in the previous phase may have identified necessary partners who have expertise in one of the priority areas, but who thus far, have not been participants. Consider also involving community advocates that can give a voice to under-represented populations or those who can help address relevant health disparities. They can help engage communities who otherwise might not participate in public health activities, and may help tailor your strategies to appropriately fit the population.
 

How do the local and state Public Health Improvement Plans align?
 
It is intended that local public health improvement plans will inform the next statewide planning process for the purposes of:
  • Increasing the efficiency and effectiveness of the public health system statewide;
  • Identifying gaps and the need for greater resource allocation to support core public health service provision;
  • Informing statewide goals and priorities for improvement; and
  • Informing the state health agency in order to support and promote local public health
 

What are the requirements of the Local Public Health Improvement Plan?
 
Per the 2008 Colorado Public Health Act, the PHIP should address both population health and capacity issues identified as priorities through assessment activities. A standardized format is not required, however, a sample outline is provided. The outline identifies components of the plan that are required either by the Act or by the Public Health Accreditation Board.

Figure 1: 2008 Colorado Public Health Act, Local PHIP Requirements
Each local plan shall at minimum:
  • Examine data about health status and risk factors in the local community;
  • Assess the capacity and performance of the county or district public health system;
  • Identify goals and strategies for improving the health of the local community;
  • Describe how representatives of the local community develop and implement the local plan;
  • Address how county or district public health agencies coordinate with the state health agency and others within the public health system to accomplish goals and priorities identified in the comprehensive, statewide public health improvement plan;
  • Identify financial resources available to meet identified public health needs and requirements for the provision of core public health services; and
  • Not be inconsistent with the Statewide Public Health Improvement Plan.

Agencies seeking accreditation should visit the PHAB website to ensure receipt of the latest guidance and documentation requirements, which are unique to PHAB. Reviewing the full set of PHAB standards and measures will provide useful information throughout the development and implementation of your public health improvement plan
 

How will successful implementation be measured?
 
The Public Health Improvement Plan should include an “action plan” for each priority issue, to identify broad goals, evidence-based strategies, measurable objectives, major activities and a time frame. The action plan can serve as a tool to monitor, document and report progress. Sample Action Plan templates are provided as Appendix 6.3. It is helpful to begin thinking about how you will measure and evaluate your progress while you are developing your plan. CHAPS Phase VII provides additional guidance for monitoring and evaluating your plan. For agencies seeking voluntary national accreditation, PHAB requires “agencies to monitor progress on implementation of strategies in the community health improvement plan in collaboration with broad participation from stakeholders and partners.” Please visit the PHAB website for details.
 

What technical assistance is available for this phase?
 
Technical assistance will be available to support the process of local public health improvement planning. Requests can be made to the Office of Planning and Partnerships, who will either provide technical assistance directly, or triage the request within CDPHE or to other groups as needed. Technical assistance for public health improvement activities could include:
  • Quality improvement and planning tools (e.g., root cause analysis, logic models)
  • Effective strategies, best practices, model policies, data sources
  • Evaluation, performance measurement, developing measurable objectives
  • Resource identification (e.g., funding, leaders, advocates)
  • Communications and community engagement (e.g., making the case for change, media, educational material)
  • Networking, learning and sharing with other local public health agencies
 

What are the steps to conducting a public health improvement plan process?
 
There are eight CHAPS steps to conducting a public health improvement planning process that involve: reviewing background materials, developing and conducting the planning process with stakeholders, and drafting and submitting the plan. A work plan template is provided for your use to assist in identifying tasks, individuals responsible, and a timeline associated with the activities for each step.

Step 1: Review your community health assessment, current priorities, past PHIPs and the state public health improvement plan and priorities

Begin by revisiting your community health assessment results, current priorities and any past public health improvement plans, including any related work plans for your county or region. In addition, become familiar with the statewide priorities in order to align recommendations and activities as much as possible. Resources describing a collective impact approach may be helpful to review now also.

Step 2: Determine the purpose(s) and audiences of your PHIP

Consider in advance if your agency might be applying for accreditation from the national Public Health Accreditation Board, as a community public health improvement plan is required as part of the application. In addition, you may have existing work plans and measures that can be incorporated into this plan. In the future, the PHIP can help define program/priority specific work plans for grant applications, etc.

Who are your primary audiences? There are multiple possible audiences with potentially different expectations of your PHIP. They may include community members and leaders, policy makers, partner organizations and businesses, local and state boards of health, agency staff, funders, and hospitals and clinics.

Step 3: Develop a planning process that includes key stakeholders

A well-thought out process will ensure that the execution of the plan is successful. This includes planning meetings with the people needed to create and support measurable action plans for each of the top focus areas identified for your community during the prioritization process.

    Form planning groups
  1. Identify internal and external stakeholders that should participate in the planning process, such as your steering committee, agency staff, and community leaders. You may also want to add those who have expertise in one of the priority issue areas, or those who can advocate for and represent the communities and populations that you wish to reach, such as known leaders in the community, staff that work for community-based organizations, or community health workers/promoters.

    Many communities have identified a PHIP implementation oversight committee, as recommended as a best practice by the MAPP process. An oversight committee can help foster the momentum of implementing the plan after it is developed by acting as a resource when barriers arise, as well as assisting in monitoring and evaluating progress. The specific role and composition of the oversight committee, plus the frequency with which they meet and the type of activities to be performed, should be determined ahead of time, and introduced during the planning process.
  2. Design planning meetings

  3. Determine meeting logistics such as location, number, length, agendas etc. The number of meetings will depend on the size of your community and stakeholder group, and the number of priorities chosen. Identifying who will provide facilitation early on will assist with determining the methods used, number of facilitators, and space needs. For example, some communities choose to break out into small, focused teams with individuals who have expertise and interest in the particular priority areas.
  4. Depending on your group members, you will have to define the amount of information to present, and when to provide drafts for comment versus starting from scratch.


Step 4: Hold facilitated planning meetings

  1. Describe the process and intended outcomes
  2. Introduce or select a PHIP oversight committee; describe their role
  3. Present an overview of each priority issue area to the group, including relevant indicators, and potential strategies for addressing them
  4. For each priority area, conduct the following process (this may be done in one large group or in smaller groups reporting out, depending on the number of participants and issues to be addressed):

Step 5: Develop action plans/ work plans for each priority issue (this may be done in small groups or subcommittee)
    Each action plan should include:
  • A description of the issue that includes relevant indicators, and contributing factors/root causes of the issue
  • Evidence-based, locally actionable strategies
  • Measurable objectives
  • Major activities or action steps
  • Timeline
  • Entity(ies) responsible
  • Resources required and available
  • Potential barriers
Resources that may be helpful related to this step include: Example action plans are available for your use, along with a logic model template to guide planning.

Step 6: Draft the local Public Health Improvement Plan
The writing of the PHIP will most likely be carried out by either the Project Manager and/or Health Planner, with oversight and review from the Steering Committee. Consider asking for stakeholder volunteers to review sections of the plan; this can ensure continued engagement and support as the plan is being written. A sample local PHIP outline is provided.

The following items should be included:

  • Intro and orientation to purpose, content
  • Executive summary
  • Description of jurisdiction: community profile, community vision and values (this may also be part of the Community Health Assessment or Community Health Status Report)
  • Description of how the local community developed the plan (community health assessment process, prioritization process, development of goals, strategies, etc.)
  • Capacity and performance assessment results
  • Summary of priority areas including why these were chosen and how your plan aligns with the state priorities:
    • data indicators and trends
    • goals
    • measurable objectives
    • improvement strategies
    • action steps with identification of lead agency(ies) and partners
    • Counties who have not developed separate Community Health Assessment Reports are encouraged to include health assessment data in the PHIP. At a minimum, assessment data should be included in the summary of priority areas.
  • Financial resources available/required
  • Plan for monitoring and evaluation
  • Acknowledgements
Consider what format(s) are most likely to be used by the intended audiences, the ease of dissemination, and what format(s) can allow you to easily revise and update the action steps in years 2-5, as needed. Potential options include:
  • Hard copy, bound publication
  • Web version
  • PDF for print as needed and electronic dissemination
  • PowerPoint slides
  • Hybrid - a mixture of some or all of the above

Step 7: Submit the Public Health Improvement Plan

The Act requires that the local PHIP be submitted to both the local board of health and State Board of Health. After the local board reviews your plan, submit documentation of their review (i.e., meeting agenda and/or minutes) along with your plan to the Office of Planning and Partnerships (OPP) who will then submit your plan to the Colorado State Board of Health on your agency’s behalf. OPP will also post your plan on its website, with your permission.

Step 8: Disseminate the Public Health Improvement Plan

Determine strategically who needs to know about the results of the plan, then tailor messages and communication tools to desired audiences, which may include:
  • Leaders in positions of authority such as the Local Board of Health and/or County Commissioners
  • Potential local funders
  • Key decision makers in a position to make policy or systems changes
  • Community partners that will help implement the plan
For general distribution to the larger community, consider creating a publicity committee to lead dissemination efforts and keep the community informed about progress. The committee should be mindful of literacy levels, languages spoken, and that some residents will lack access to a computer. Keep contact lists of everyone who received the PHIP and the outreach methods used (people, media, partner organizations, distribution points, etc). Examples for disseminating the PHIP to the community include:
  • A PowerPoint of local data and PHIP results uploaded to the internet and provided in presentations to the community
  • Printed versions of the PHIP report and/or Executive Summary
  • An electronic version (e.g., PDF) of the PHIP available on the internet
  • CDs or thumb drives of the PHIP made available
  • Press releases with findings, recommendations, and information on how to obtain a copy of the PHIP, sent to newspapers and other local media
  • Summary document developed similar to a brochure that can be shared widely
  • Announcements via social media (Facebook, Twitter, etc.)
Once your PHIP with action plan(s) is/are complete, your community will move into implementation where this document can be used as a foundation for monitoring, evaluating, and communicating progress to community leaders and members. The action plan should be a dynamic tool that will be updated and revised as unforeseen challenges arise and are addressed.

 

Locally Developed Tools

Colorado Community Health Improvement Plans
 
 

Public Health Improvement Plans Examples
 
See what other counties and states are publishing
 

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Colorado Department of Public Health and Environment
Office of Planning and Partnerships
4300 Cherry Creek Dr. S
Denver,CO 80246
303-692-2350
Email Us : cdphe.edplanningandpartnerships@state.co.us
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