INDIANA PUBLIC HEALTH SYSTEM QUALITY IMPROVEMENT PROGRAM

Transcription

1 INDIANA PUBLIC HEALTH SYSTEM QUALITY IMPROVEMENT PROGRAM Howard County Local Public Health System Performance Reassessment Final Report September 2011 The concept, design, and implementation for this project is attributed to the Indiana State Department of Health. This project

2 Indiana Public Health System Quality Improvement Program HOWARD COUNTY Table of Contents Executive Summary...3 Assessment Participants...4 Final Assessment Report...5 Assessment Notes...35 Next Steps...37 Public Health System...38 Visioning...39 The concept, design, and implementation for this project is attributed to the Indiana State Department of Health. This project is funded by the CDC PHHS Block Grant award number 2010-B1-IN-PRVS. 2

3 Indiana Public Health System Quality Improvement Program HOWARD COUNTY LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT EXECUTIVE SUMMARY On July 28, 29, August 9 and 23, public health system partners of Howard County convened meetings to complete an assessment process to evaluate how well they are serving the public health and healthcare needs of the county s estimated 83,000 residents. The Howard County Health Department hosted the four partial day meetings, in partnership with other key local partners. The Indiana State Department of Health, in collaboration with Purdue University s Healthcare Technical Assistance Program Population Health Initiatives Program, worked together to create this opportunity for all local public health system partners to identify existing strengths, as well as opportunities to establish and formalize public health system infrastructure improvements in Indiana counties. Howard County partners met to complete the CDC National Public Health Performance Standards, Local Public Health System Assessment a nationally recognized public health system assessment tool. The assessment process and results enable a greater understanding of how the County s healthcare and public health organizations relate to one another and how they provide essential public health and healthcare services to the public they serve. The assessment specifically focused on areas such as communication, partnerships, linking people to needed services, and sharing of resources. Findings of the assessment revealed strengths of the system: identification and surveillance of health threats, and response to public health threats and emergencies informing, educating, and empowering people about health issues enforcement of laws and regulations that protect health and ensure safety The assessment also revealed important areas for performance improvement: mobilizing health partnership to identify and solve health problems assuring a competent public and personal health care workforce developing policies and plans that support individual and community health efforts The Assessment process can serve as the foundation to formalize processes that strengthen local public health system infrastructure with the capacity and resources to improve quality and effectiveness of healthcare services in Howard County. A primary component of such a process may include a focus on partnerships and collaboration to ensure sustainability. Goals include: forming a community health improvement committee developing a community health improvement plan conducting a formal community-wide assessment of the public health workforce Approximately 144 healthcare and social service agencies exist to support the residents of 1 city, 3 towns and 11 townships. Public health system partners across the county are committed to enhancing systemic performance by engaging partnerships, support, and input, so that together we can better serve the residents of Howard County. The concept, design, and implementation for this project is attributed to the Indiana State Department of Health. This project is funded by the CDC PHHS Block Grant award number 2010-B1-IN-PRVS. 3

4 Indiana Public Health System Quality Improvement Program HOWARD COUNTY LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT Assessment Attendees Joe Cross, Howard County Health Department Judy Dennis, Family Service Association of Howard County Shirley Dubois, Family Service Association of Howard County/ Howard County Tobacco Coalition Carrie Giannakos, Project Access Rebekah Grant, Healthy Children Healthy Teens & Family Planning Marian Henry, Ivy Tech Community College John Hughey, Indiana University Kokomo Elissa Hughes, Healthy Children Healthy Teens & Family Planning Pam Isaac, Family Service Association of Howard County Valerie Johnson, Healthy Children Healthy Teens & Family Planning Brent Kelley, Kinsey Youth Center Janet Kissinger, Howard County Health Department Shelly Leary, Advantage Health Solutions Steve Linerode, Howard Regional Health System Karen Long, Howard County Health Department Karen Lopke, Howard County Health Department Diana Lowery, St. Joseph Hospital Cheryl Maple, Ivy Tech Community College Susan Neher, Purdue Extension Kathy Oldaker, Howard County Health Department Maria Pantaleo, Howard Regional Health System Linda Sardin, Kinsey Youth Center T.R. Scherschel, Howard County Health Department Cathy Shaw, Howard County Health Department Shaina Shutt, American Red Cross Larry Smith, Howard County EMA Lori Tate, United Way Candy Thompson, Indiana University Kokomo James Vest, Howard County Health Department Linda Wallace, Indiana University Kokomo Kent Weaver, Howard County Health Department Janie Young, Kokomo Common Council Don Zent, Howard County Health Department The concept, design, and implementation for this project is attributed to the Indiana State Department of Health. This project is funded by the CDC PHHS Block Grant award number 2010-B1-IN-PRVS. 4

5 Indiana Public Health System Quality Improvement Program Final Report from Purdue University: Local Public Health System Instrument Version 2.0 Point of Contact: Deb Koester, Howard County September 2011 Participating Counties ISDH The concept, design, and implementation for this project is attributed to the Indiana State Department of Health. This project 5

6 Table of Contents Introduction 1 Section I: Report 2 Section II : Overall Comparisons 7 Bullet Graph Bubble Graph To compare overall composite score of your county to geographical group, population size group, and full survey group To compare essential service composite scores of your county to geographical group, population size group, and full survey group 7 8 Section III : Individual Results 9 Table of Composite Scores To compare composite scores of each essential service and underlying model standard of your county to your geographical, population size, and entire survey group 9 Section IV : Full Survey Responses 10 List of questions from the full survey and responses given by your county Section V : List of Questions with Response of 'No Activity' 25 6

7 Introduction Definition of County Groupings: For this report, counties have been divided into categories based on population size and geographic location. The groupings are as follows: Population Size: Small/Medium: Carroll, Clinton, Dubois, Fountain & Warren, Henry, Howard, Kosciusko, LaGrange, Marshall, Montgomery, Boone, Putnam, Scott, Wayne, Vermillion, Tipton, Knox, Wabash, Grant Gibson, Washington, Harrison, Parke, Floyd, Greene, Sullivan, White, Benton, Jay, Warrick, Blackford, Perry,Crawford, Martin, Ohio, Union, Jennings, Clay Large: Allen, Clark, Delaware, Monroe, Porter, Vanderburgh, Elkhart, Tippecanoe, Vigo, Madison Geographic Location: Region A (Districts 1, 2, and 3): Allen, Lagrange, Kosciusko, Marshall, Porter, Wabash, Elkhart, Region B (Districts 4, 5, 6, and 7): Carroll, Clinton, Delaware, Fountain & Warren, Henry, Howard, Montgomery, Boone, Putnam, Wayne, Vermillion, Tipton, Grant, Parke, Greene, Sullivan, White, Benton, Tippecanoe, Vigo, Madison, Blackford, Union, Clay, Jay Region C (Districts 8, 9, and 10): Clark, Dubois, Monroe, Vanderbugh, Scott, Knox, Gibson,Warrick Washington, Harrison, Floyd, Jackson Perry, Crawford, Martin, Ohio, Jennings Coding Key: Survey responses are coded according to the following scheme: Optimal Activity: 100% Significant Activity: 75% Moderate Activity: 50% Minimal Activity: 25% No Activity: 0% Note: The pages in Section I of this document are derived from the original CDC document, "Report of Results from the National Public Health Performance Standards Program: Revised Local Instrument." Modifications have been made to the pie charts (Figures 4-6) to reflect the survey response cutoffs defined above. Page 1 of 30 7

8 Section I : Report REPORT OF RESULTS FROM THE NATIONAL PUBLIC HEALTH PERFORMANCE STANDARDS PROGRAM REVISED LOCAL INSTRUMENT Howard County Responses to the Local Instrument are used to construct summary measures of performance, called composite scores, for each of the 10 Essential Public Health Services (EPHS). Each composite score can be interpreted as the overall degree to which the public health system meets the performance standards defined for each essential service. Composite scores range from a minimum value of 0% (absolutely no activity is performed pursuant to the standards) to a maximum possible value of 100% (all activities associated with the standards are performed at optimal levels). Figure 1 displays composite scores for each essential service along with an overall composite score that indicates the average performance level across all 10 essential services. Figure 2 ranks each composite score from low to high, allowing easy identification of service domains where performance is relatively strong or weak. The graphics in Figure 3 display composite scores for the performance model standards within each essential service. These graphics highlight the specific activities that contribute to performance levels within each essential service. FIGURE 1: COMPOSITE PERFORMANCE SCORES FOR EACH ESSENTIAL SERVICE AND OVERALL 1. Monitoring 45% 2. Surveillance 94% 3. Inform/educate 85% 4. Partnerships 29% 5. Planning/policy 68% 6. Enforcement 98% 7. Outreach/linkage 62% 8. Workforce 54% 9. Evaluation 38% 10. Research 51% Overall 62% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Note: error bars show the score range (minimum and maximum values) for model standards within each service FIGURE 2: RANK ORDERED PERFORMANCE SCORES FOR EACH ESSENTIAL SERVICE Minimal (1-25%) Moderate (26-50%) Significant(51-75%) Optimal (76-100%) 4. Partnerships 9. Evaluation 1. Monitoring 10. Research 8. Workforce 7. Outreach/linkage 5. Planning/policy 3. Inform/educate 2. Surveillance 6. Enforcement 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Note: error bars show the score range (minimum and maximum values) for model standards within each service Page 2 of 30 8

9 FIGURE 3: PERFORMANCE SCORES FOR EACH MODEL STANDARD, BY ESSENTIAL SERVICE 1-Monitoring 1.1 Community profile 1.2 Data technology 1.3 Registries Overall 11% 25% 45% 100% 2-Surveillance 86% 96% 100% 94% 0% 50% 100% 0% 20% 40% 60% 80% 100% 3-Inform/Educate 3.1 Health education 60% 3.2 Health commun. 3.3 Risk commun. Overall 95% 100% 85% 0% 50% 100% 4-Partnerships 4.1 Constituency 57% 4.2 Partnerships 0% Overall 29% 0% 50% 100% 5.1 Gov. presence 87% 6.1 Review laws 97% 5-Planning/Policy 5.2 Policy dev. 71% 5.3 Planning 13% 5.4 Emergency plan 100% Overall 68% 0% 50% 100% 6-Enforcement 6.2 Improve laws 6.3 Enforce laws Overall 100% 98% 98% 0% 50% 100% 7-Outreach/Linkage 7.1 Identify needs 75% 7.2 Assure linkage Overall 49% 62% 0% 20% 40% 60% 80% 100% 8-Workforce 8.1 Assessmt 8% 8.2 Standards 100% 8.3 Learning 8.4 Leadership Overall 59% 50% 54% 0% 20% 40% 60% 80% 100% 9.1 Population srv. 34% 10.1 Innovation 38% 9-Evaluation 9.2 Personal srv. 9.3 PH system Overall 25% 38% 55% 10-Research 10.2 Linkages 10.3 Capacity Overall 50% 51% 67% 0% 50% 100% 0% 50% 100% Page 3 of 30 9

10 Figures 4-5 display the proportion of performance measures that exceeded specified thresholds of achievement in meeting performance standards. The five threshold levels of achievement used in scoring these measures are shown in the legend at the middle of the page. For example, measures receiving a composite score of % were classified as meeting performance standards at the optimal level. Figure 4 summarizes the composite performance measures for each essential service, and Figure 5 summarizes the composite measures for each model standard and for all questions on the instrument. FIGURE 4: PERCENTAGE OF ESSENTIAL SERVICES SCORED AS MEETING PERFORMANCE STANDARDS, BY LEVEL OF ACHIEVEMENT 40% 30% 30% 0% 0% Response Scale Optimal: % met Significant : 51-75% met Moderate: 26-50% met Minimal: 1-25% met No activity: 0% FIGURE 5: PERCENTAGE OF MODEL STANDARDS AND QUESTIONS SCORED AS MEETING PERFORMANCE STANDARDS, BY LEVEL OF ACHIEVEMENT 23% 9% 11% 17% 13% 17% 26% 40% 41% 3% Note: instrument contains 30 model standards and 322 total scored questions Page 4 of 30 10

11 Figures 6-7 display performance scores for each service and model standard, arrayed by the priory ranking assigned to each. The upper left quandrant (I) contains activities that were considered relatively high-priority but were performed at relatively low levels. Priority should be given to improving performance for these activities. Activities appearing in the top right quadrant (II) were considered relatively high-priority activities and were performed at relatively high levels. Priority should be given to maintaining high performance levels for these activities The lower right quadrant (III) contains activities that were considered lower-priority activities and were performed at relatively high levels. Systems may choose to give activities in this quadrant less attention while focusing improvement efforts elsewhere. Finally, the lower left quadrant (IV) contains activities that were considered lower-priority activities and were performed at relatively low levels. Activities in this quadrant may be considered for future improvement efforts once priority activities have been addressed. FIGURE 6: BOX PLOT OF ESSENTIAL SERVICE SCORES AND PRIORITY RANKINGS FOR THE LOCAL PUBLIC HEALTH SYSTEM Priority 2 Highest Lowest I IV % 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% FIGURE 7: BOX PLOT OF MODEL STANDARD SCORES AND PRIORITY RANKINGS FOR THE LOCAL PUBLIC HEALTH SYSTEM 10 Composite Performance Score II III 6 2 Highest 1.5 I II Priority Lowest IV III -2 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Composite Performance Score Page 5 of 30 11

12 Figures 8-9 display performance scores for each service and model standard, arrayed by the level of contribution made by the local public health agency (agency). The upper left quandrant (I) contains activities that were rated relatively high on agency contribution but were performed at relatively low levels. Activities appearing in the top right quadrant (II) had high agency contribution scores and were performed at relatively high levels. The lower right quadrant (III) contains activities that were rated relatively low on agency contribution and were performed at relatively high levels. Finally, the lower left quadrant (IV) contains indicators that were rated relatively low on agency contribution and were performed at relatively low levels. Agency Contribution 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% I FIGURE 8: BOX PLOT OF ESSENTIAL SERVICE SCORES AND LHD AGENCY SCORES IV III 0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Composite Performance Score II FIGURE 9: BOX PLOT OF MODEL STANDARD SCORES AND LHD AGENCY SCORES Agency Contribution 100% 90% 80% 70% 60% 50% 40% 30% % 10% I IV III 0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Composite Performance Score II Page 6 of 30 12

13 Section II : Overall Comparisons Responses to the Local Instrument are used to construct summary measures of performance, called composite scores, for each of the 10 Essential Public Health Services (EPHS). Each composite score can be interpreted as the overall degree to which the public health system meets the performance standards defined for each essential service. Composite scores range from a minimum value of 0% (absolutely no activity is performed pursuant to the standards) to a maximum possible value of 100% (all activities associated with the standards are performed at optimal levels). Figure 10 displays a bullet graph giving a comparison of the overall composite score for your county to the overall composite score for your county's geographical group, population size group, and to the entire group of counties as a whole. The horizontal blue bars represent the overall composite score for each of these three groups, and the vertical black bar represents the overall composite score for your county. As an example, Howard County had an overall composite score of 62.44% (represented by the vertical black bar), and the average overall composite score for your geographical group was 62.77% (represented by the first horizontal blue bar). FIGURE 10: BULLET GRAPH OF OVERALL SCORES Geographical Group 63% Population Size Group 64% Entire Group 60% 0% 25% 50% 75% 100% Page 7 of 30 13

14 Figure 11 displays a bubble graph giving a comparison of the average composite scores by essential service for your county to the geographical group, population size group, and entire group averages. Essential services are labeled 1 to 10. The size of the bubbles in this diagram is proportional to the score for a particular essential service. That is, the larger the bubble, the higher the average score for a particular essential service. As an example, for Essential Service 1 (Monitoring), your county had a composite score of 45.49% and the average composite score for your geographical group was 46.1%. As a result, the bubble representing Essential Service 1 for your county is smaller than that representing Essential Service 1 for your geographical group. This graph gives a visual comparison of the relative scores of essential services by comparison group. See Table 1 for a numerical summary of this graph. FIGURE 11: COMPOSITE PERFORMANCE SCORES FOR EACH ESSENTIAL SERVICE Scale Your 100% County Geographical 75% Group Population 50% Size Group Entire 25% Group Essential Service Your County Comparison Groups 0% Page 8 of 30 14

15 Section III : Individual Results Table 1 gives a numerical summary of the bar graphs shown in Figures 1-3. The composite score of each essential service, as well as the composite score for each underlying model standard, is included as a percentage. The average composite scores for your geographical group and population size group are also included, as well as the average composite score for the entire group. Category County Geo. Pop. Size Entire ES 1 - Monitoring 45.5% 46.1% 45.7% 44.5% 1.1: Population-Based Community Health Profile (CHP) 11.5% 24.5% 19.6% 20.0% 1.2: Current Technology to Manage and Communicate Health Data 25.0% 35.0% 32.9% 33.4% 1.3: Maintenance of Population Health Registries 100.0% 78.8% 84.7% 80.1% ES 2 - Surveillance 94.1% 84.0% 86.7% 82.4% 2.1: Identification and Surveillance of Health Threats 86.1% 70.4% 75.1% 71.3% 2.2: Investigation and Response to Public Health Threats 96.3% 88.6% 90.7% 86.1% 2.3: Laboratory Support for Investigation of Health Threats 100.0% 93.0% 94.4% 89.7% ES 3 - Inform/educate 84.9% 67.2% 71.6% 68.3% 3.1: Health Education and Promotion 59.7% 64.6% 64.0% 62.8% 3.2: Health Communication 95.0% 63.6% 70.5% 66.9% 3.3: Risk Communication 100.0% 73.4% 80.3% 75.2% ES 4 - Partnerships 28.5% 48.2% 48.8% 45.1% 4.1: Constituency Development 57.0% 56.7% 62.5% 57.7% 4.2: Community Partnerships 0.0% 39.6% 35.2% 32.5% ES 5 - Planning/policy 67.6% 68.3% 65.8% 63.6% 5.1: Governmental Presence at the Local Level 86.9% 82.4% 82.6% 79.4% 5.2: Public Health Policy Development 70.8% 63.5% 59.4% 57.2% 5.3: Community Health Improvement Process and Strategic Planning 12.5% 35.4% 29.1% 28.9% 5.4: Plan for Public Health Emergencies 100.0% 91.7% 92.1% 88.8% ES 6 - Enforcement 98.1% 86.7% 88.6% 83.4% 6.1: Review and Evaluation of Laws, Regulations, and Ordinances 96.9% 90.5% 91.2% 86.1% 6.2: Involvement in the Improvement of Laws, Regulations, and 100.0% 76.4% 81.3% 76.4% 6.3: Enforcement of Laws, Regulations, and Ordinances 97.5% 93.1% 93.3% 87.5% ES 7 - Outreach/linkage 62.0% 59.0% 63.6% 58.9% 7.1: Identification of Personal Health Service Needs of Populations 75.0% 62.5% 67.0% 62.9% 7.2: Assuring the Linkage of People to Personal Health Services 49.0% 55.5% 60.2% 55.0% ES 8 - Workforce 54.4% 59.1% 56.0% 54.1% 8.1: Workforce Assessment, Planning, and Development 8.3% 36.5% 32.1% 31.1% 8.2: Public Health Workforce Standards 100.0% 79.2% 77.3% 76.0% 8.3: Life-Long Learning Through Continuing Education, Training 59.4% 66.7% 67.1% 63.2% 8.4: Public Health Leadership Development 50.0% 53.9% 47.5% 46.1% ES 9 - Evaluation 37.9% 50.7% 52.2% 47.8% 9.1: Evaluation of Population-Based Health Services 33.6% 54.0% 57.4% 51.9% 9.2: Evaluation of Personal Health Services 55.0% 61.2% 65.2% 61.1% 9.3: Evaluation of the Local Public Health System 25.0% 36.8% 34.0% 30.3% ES 10 - Research 51.4% 58.5% 59.0% 56.1% 10.1: Fostering Innovation 37.5% 53.3% 52.5% 49.4% 10.2: Linkage with Institutions of Higher Learning and/or Research 66.7% 67.4% 69.3% 66.8% 10.3: Capacity to Initiate or Participate in Research 50.0% 54.8% 55.1% 52.1% Average Total Score 62.4% 62.8% 63.8% 60.4% Page 9 of 30 15

16 Section IV : Full Survey Responses ES 1 - Monitor health status to identify health problems 1.1: Population-Based Community Health Profile (CHP) Has the LPHS conducted a community health assessment? 50% Is the community health assessment updated at least every 3 years? 0% Are data from the assessment compared to data from other representative areas or populations? 25% Are data used to track trends over time? 25% Does the LPHS use data from community health assessments to monitor progress toward healthrelated 25% objectives? Does the LPHS compile data from the community health assessment(s) into a community 0% health profile (CHP)? Community demographic characteristics? 0% Community socioeconomic characteristics? 0% Health resource availability data? 0% Quality of life data for the community? 0% Behavioral risk factors for the community? 0% Community environmental health indicators? 0% Social and mental health data? 0% Maternal and child health data? 0% Death, illness, and/or injury data? 0% Communicable disease data? 0% Sentinel events data for the community? 0% Has the LPHS identified the individuals or organizations responsible for contributing data and /or 0% resources to produce the CHP? Does each contributor of data have access to the completed CHP? 0% Is community-wide use of community health assessment or CHP data promoted? 0% Is a media strategy in place to promote community-wide use of the CHP? 0% Is the information easily accessible by the general public? 0% Do organizations in the LPHS use the CHP to inform health policy and planning decisions? 0% 1.2: Current Technology to Manage and Communicate Population Health Data Does the LPHS use state-of-the-art technology to support health profile databases? 25% Is technology utilized to make community health data available electronically? 25% Does the LPHS have access to geocoded health data? 25% Does the LPHS use geographic information systems (GIS)? 25% Does the LPHS use computer-generated graphics to identify trends and/or compare data by 25% relevant categories (i.e., race, gender, age group)? 1.3: Maintenance of Population Health Registries Does the LPHS maintain and/or contribute to one or more population health registries? 100% Are there standards for data collection? 100% Are there established processes for reporting health events to the registry or registries? 100% In the past year, has the LPHS used information from one or more population health 100% registries? Page 10 of 30 16

17 ES 2 - Diagnose and investigate health problems and health hazards 2.1: Identification and Surveillance of Health Threats Does the LPHS operate or participate in surveillance system(s) designed to monitor health 50% problems and identify health threats? Integrated with national and/or state surveillance systems? 50% Compliant with national and/or state health information exchange guidelines? 100% Does the LPHS use the surveillance system(s) to monitor changes in the occurrence of health 50% problems and hazards? Do community health professionals submit reportable disease information in a timely manner 100% to the state or LPHS? Does the LPHS have necessary resources to support health problem and health hazard 100% surveillance and investigation activities? Does the LPHS use information technology for surveillance activities (e.g., geographic information 100% systems, word processing, spreadsheets, database analysis, and graphics presentation software)? Does the LPHS have (or have access to) Masters or Doctoral level epidemiologists and/or 100% statisticians to assess, investigate and analyze public health threats and health hazards? 2.2: Investigation and Response to Public Health Threats and Emergencies Does the LPHS maintain written protocols for implementing a program of case finding, 75% contact tracing, source identification, and containment for communicable diseases or toxic exposures? Animal control? 100% Vector control? 100% Exposure to food-borne illness? 100% Exposure to water-borne illness? 100% Excessive lead levels? 100% Exposure to asbestos? 0% Exposure to other toxic chemicals? 100% Communicable diseases? 100% Does the LPHS have current epidemiological case investigation protocols to guide immediate 100% investigations of public health emergencies? Infectious disease outbreaks? 100% Environmental health hazards and emergencies? 100% Chemical threats and incidents? 100% Biological agent threats? 100% Radiological threats? 100% Large-scale natural disasters? 100% Intentional incidents? 100% Has the LPHS designated an individual to serve as an Emergency Response Coordinator 100% within the jurisdiction? Coordinate with the local health department s emergency response personnel? 100% Coordinate with local community leaders? 100% Can LPHS personnel rapidly respond to natural and intentional disasters? 100% Page 11 of 30 17

18 Does the LPHS maintain a current roster of personnel with the technical expertise to respond to 100% natural and intentional emergencies and disasters? Does the LPHS have access to response personnel within one hour? 100% Does the LPHS have capacity to mobilize sufficient numbers of trained professionals in an 100% emergency (i.e., surge capacity)? Does the LPHS have capacity to mobilize volunteers during a disaster? 100% Does the LPHS evaluate public health emergency response incidents for effectiveness and 100% opportunities for improvement (e.g., After Action Reports)? Are findings incorporated into emergency plans? 100% 2.3: Laboratory Support for Investigation of Health Threats Does the LPHS maintain ready access to laboratories capable of meeting routine diagnostic 100% and surveillance needs? Does the LPHS have ready access to laboratory services to support investigations of public 100% health threats, hazards, and emergencies? Does the LPHS have access to laboratory services to support these investigations within four hours 100% of notification? Does the LPHS have access to at least one microbiology laboratory within four hours of notification? 100% Does the LPHS utilize only laboratories that are licensed and/or credentialed? 100% Does the LPHS maintain current guidelines or protocols for handling laboratory samples? 100% ES 3 - Inform, educate and empower people about health issues 3.1: Health Education and Promotion Does the LPHS provide the general public, policymakers, and public and private stakeholders 50% with information on community health? Community health status (e.g., heart disease rates, cancer rates, environmental risks)? 50% Community health needs, such as those identified by members of the community or through a needs 50% assessment tool such as APEXPH or MAPP, including prevention and risk (e.g., obesity, smoking, etc.)? Does the LPHS plan and conduct health education and/or health promotion campaigns? 50% Are these campaigns based on sound theory, evidence of effectiveness, and/or best practice? 75% Are these campaigns designed to support healthy behavior among individuals and their 75% communities? Are campaigns tailored for populations with higher risk of negative health outcomes? 50% Are campaigns designed to reach populations in specific settings? 50% Does the LPHS evaluate its public health education and health promotion activities on an ongoing 50% basis? Are evaluation results used to revise and strengthen the programs? 50% Do LPHS organizations work together to plan, conduct, and implement health education and 75% promotion activities? Do organizations work together on specific health promotion activities (e.g., supermarkets and 75% nutrition interventions)? Page 12 of 30 18

19 Do LPHS entities work with community advocates and local media outlets to publicize health 75% promotion activities? 3.2: Health Communication Have LPHS organizations developed health communication plans? 75% Do LPHS organizations work collaboratively to link the communication plans? 75% Include policies and procedures for creating, sharing, and disseminating information with partners 100% and key stakeholders? Identify different sectors of the population in order to create targeted public health messages for 100% various audiences? Provide guidance for developing content and materials appropriate to the type of dissemination 100% channel? Provide guidance for creating targeted public health messages using various channels? 100% Does the LPHS establish and utilize relationships with the media? 100% Does the LPHS have policies and procedures in place to route all media inquiries appropriately? 100% Does the LPHS have a mechanism in place to document and respond to public inquiries? 100% Does the LPHS coordinate with local media to develop information or features on health issues? 100% Has the LPHS identified and designated individuals such as public information officers to 100% provide important health information and answers to public and media inquiries? Are designated spokespersons adequately trained in providing accurate, timely, and appropriate 100% information on public health issues for different audiences? Does the LPHS have policies and procedures in place to coordinate responses and public 100% announcements related to public health issues? 3.3: Risk Communication Has the LPHS developed emergency communications plan(s) that can be adapted to different 100% types of emergencies (i.e., disease outbreaks, natural disasters, bioterrorism)? Procedures for inter-agency coordination of plans dependent upon the type of emergency (i.e., use of 100% the plans to create a unified emergency communications plan)? Established lines of authority, reporting, and responsibilities for emergency communications teams 100% in accordance with the National Incident Management System (NIMS)? Procedures for alerting communities, including special populations, about possible health threats or 100% disease outbreaks? Guidelines for providing necessary, appropriate information from emergency operation center 100% situation reports, health alerts, and meeting notes to stakeholders, partners, and the community? Does the LPHS have resources to ensure rapid communications response? 100% Have the technological capacity (e.g., telephone, electronic, and print) to respond to communication 100% needs? Have staff to develop or adapt emergency communications materials and to provide communications 100% for all stakeholders and partners in the event of an emergency? Does the LPHS provide crisis and emergency communications training for new and current 100% staff? Does the LPHS have policies and procedures in place to ensure rapid, mobile response by 100% public information officers? Page 13 of 30 19

20 Does the LPHS maintain a directory of emergency contact information for media liaisons, partners, 100% stakeholders, and public information officers? Does the LPHS provide communication Go-Kits to assist in public information officer response? 100% ES 4 - Mobilize community partnerships to identify and solve health problems 4.1: Constituency Development Does the LPHS have a process for identifying key constituents or stakeholders? 75% Does the LPHS maintain a current list of the names and contact information for individuals and key 75% constituent groups? Are new individuals/groups identified for constituency building? 75% Are key constituents identified for general health issues (i.e., improved health and quality of life at 75% the community level)? Are key constituents identified for specific health concerns (i.e., a particular health theme, disease, 50% risk factor, life stage need)? Does the LPHS encourage the participation of constituents in improving community health? 75% Does the LPHS encourage constituents from the community-at-large to identify community issues 50% and themes through a variety of means? Does the LPHS support, through recruitment, promotion, and retention, opportunities for volunteers 75% to help in community health improvement projects or activities? Does the LPHS maintain a current directory of organizations that comprise the LPHS? 50% Is the directory easily accessible? 25% Does the LPHS use communications strategies to build awareness of the importance of public 50% health? Do communications strategies exist for building awareness with the community-at-large? 50% Do communications strategies exist for facilitating communication among organizations? 50% 4.2: Community Partnerships Do partnerships exist in the community to maximize public health improvement activities? 0% Exchange information? 0% Alter or align activities related to the Essential Public Health Services? 0% Conduct collaborative decision-making and action? 0% Optimize resources to deliver Essential Public Health Services? 0% Share responsibilities to deliver Essential Public Health Services? 0% Include a broad representation of the community (including representatives such as those listed in 0% Discussion Toolbox)? Does the LPHS have a broad-based community health improvement committee? 0% Participate in the community health assessment process? 0% Participate in the implementation of a community health improvement process? 0% Monitor and evaluate progress toward prioritized goals? 0% Leverage community resources? 0% Meet on a regular basis? 0% Does the LPHS review the effectiveness of community partnerships and strategic alliances 0% developed to improve community health? Page 14 of 30 20

21 An assessment of the effectiveness of partnership participation in solving health problems? 0% Information on the satisfaction of constituents with partnership efforts? 0% An assessment of the expertise and system capacity needed to conduct partnership building 0% activities? Identification of actions to improve the partnership process and capacity? 0% Implementation of actions recommended to improve the partnership process and capacity? 0% ES 5 - Develop policies and plans that support individual and community health efforts 5.1: Governmental Presence at the Local Level Does the LPHS include a governmental local public health presence (i.e., local health 100% department) to assure the provision of Essential Public Health Services to the community? Maintain current documentation describing its mission? 100% Maintain current documentation describing its statutory, chartered, and/or legal responsibilities? 100% Assess its functions against the operational definition of a functional local health department? 0% Does the LPHS assure the availability of resources for the local health department s 75% contributions to the Essential Public Health Services? Availability of legal counsel on issues related to the provision of Essential Public Health Services? 100% Funding for mandated public health programs? 100% Funding for needed public health programs, as identified by the community? 0% The personnel required to deliver Essential Public Health Services, including a designated local 100% health official? The facilities, equipment, and supplies required to deliver Essential Public Health Services? 100% Does a local board of health or other governing entity conduct oversight for the local health 100% department? (This question not scored.) Has this local board of health or other governing entity completed the National Public Health 0% Performance Standards Program Local Public Health Governance Performance Assessment Instrument? (This question not scored.) Does the LHD work with the state public health agency and other state partners to assure the 100% provision of public health services? Have state partners completed the National Public Health Performance Standards Program State 100% Public Health System Performance Assessment Instrument with input from the local level? (This question not scored.) 5.2: Public Health Policy Development Does the LPHS contribute to the development of public health policies? 75% Does the LPHS engage constituents in identifying and analyzing issues? 50% Does the LPHS advocate for prevention and protection policies for those in the community who bear 75% a disproportionate risk for mortality or morbidity? Within the past year, has the LPHS been involved in activities that influenced or informed the public 100% health policy process? Does the LPHS alert policymakers and the public of public health impacts from current and/or 75% proposed policies? Does the LPHS review public health policies at least every three to five years? 100% Assessment of outcomes and/or consequences? 25% Page 15 of 30 21

22 Examination of potential community health impact of other policy areas (e.g., fiscal, social, 25% environmental)? Community constituents, including those affected by the policy? 25% 5.3: Community Health Improvement Process and Strategic Planning Has the LPHS established a community health improvement process (e.g., MAPP, PACE EH)? 0% Did the community health improvement process use an established tool such as MAPP or PACE- 0% EH? Is there broad participation in the community health improvement process? 0% Information from community health assessments? 0% Issues and themes identified by the community? 0% Identification of community assets and resources? 0% Prioritization of community health issues? 0% Development of measurable health objectives? 0% Does the process result in the development of a community health improvement plan? 0% Is the community health improvement plan linked to a state health improvement plan? (This 0% question not scored.) Has the LPHS developed strategies to address community health objectives? 25% Have the individuals or organizations accountable for the implementation of these strategies been 25% identified? Does the local health department (LHD) conduct a strategic planning process? 25% Does the LHD review its organizational strategic plan to determine how it can best be aligned with 0% community health improvement process? 5.4: Plan for Public Health Emergencies Do LPHS organizations participate in a task force or coalition of community partners to 100% develop and maintain local and/or regional emergency preparedness and response plans? Does task force participation include broad representation from the LPHS? 100% Does the LPHS have an all-hazards emergency preparedness and response plan? 100% Identify public health disasters and emergencies that might trigger its implementation? 100% Align with existing plans, protocols and procedures for emergency response within the community? 100% Clearly outline protocols and standard operating procedures for emergency response? 100% Has the All-Hazards plan been reviewed and, if appropriate, revised within the past two years? 100% Has any part of the plan been tested through simulations of one or more mock events within the 100% past two years? Did the mock event include a written After Action Report identifying opportunities for 100% improvement? Was the plan modified based on these findings? 100% Page 16 of 30 22

23 ES 6 - Enforce laws and regulations that protect health and ensure safety 6.1: Review and Evaluation of Laws, Regulations, and Ordinances Does the LPHS identify local public health issues that can only be addressed through laws, 100% regulations, and ordinances? Is the LPHS knowledgeable about federal, state, and local laws, regulations, and ordinances 100% that protect the public s health? Does the LPHS review the laws, regulations, and ordinances that protect public health at least 100% once every five years? Determine whether laws, regulations, and ordinances provide the authority to carry out the Essential 100% Public Health Services? Assess compliance with public health laws, regulations, and ordinances? 100% Determine the impact of existing laws, regulations, and ordinances on the health of the community? 0% Determine whether public health laws, regulations, and ordinances require updating? 100% Do governmental entities within the LPHS have access to legal counsel to assist with the review 100% of laws, regulations, and ordinances related to the public s health? 6.2: Involvement in the Improvement of Laws, Regulations, and Ordinances Does the LPHS identify local public health issues that are not adequately addressed through 100% existing laws, regulations, and ordinances? Within the past five years, have LPHS organizations participated in the development or 100% modification of laws, regulations, or ordinances for public health issues that are not adequately addressed through existing laws, regulations, and ordinances? Do LPHS organizations provide technical assistance to legislative, regulatory or advocacy 100% groups for drafting proposed legislation, regulations, or ordinances? 6.3: Enforcement of Laws, Regulations, and Ordinances Do governmental public health entities within your LPHS have the authority to enforce laws, 100% regulations, or ordinances related to the public s health? Does a document (paper or electronic) exist that identifies the roles and responsibilities of each 100% governmental entity with enforcement authority? Do governmental entities with enforcement authority provide their staff who engage in or support 50% enforcement activities, with formal training on compliance and enforcement? Is the local health department or governmental public health entity empowered through laws 100% and regulations to implement necessary community interventions in the event of a public health emergency? Implement quarantine and isolation? 100% Implement mass immunization and dispensing clinics? 100% Does the LPHS assure that all enforcement activities are conducted in accordance with 100% applicable laws, regulations, and ordinances? Have the appropriate power and ability to prevent, detect, manage, and contain emergency health 100% threats? Conduct enforcement activities within the time frame stipulated in laws, regulations, or ordinances? 100% Page 17 of 30 23

24 Conduct enforcement activities in compliance with due process and civil rights protections? 100% Does the LPHS provide information about public health laws, regulations, and ordinances to 100% the individuals and organizations who are required to comply with them? Is dissemination of this information integrated with other public health activities (e.g., health 100% education, communicable disease control, health assessment, planning)? In the past five years, has the LPHS assessed the compliance of institutions and businesses in 100% the community (e.g., schools, food establishments, day care facilities) with laws, regulations, and ordinances designed to ensure the public s health? Include input from the regulated institutions and businesses regarding their perceived difficulties 100% with compliance? Examine the extent of resistance to, or support for, enforcement activities by regulated institutions 100% and businesses? Include input from key stakeholders (other than the regulated institutions and businesses) of those 100% laws, regulations, and ordinances regarding the extent of their support for enforcement activities? ES 7 - Link people to needed personal health services and assure the provision of health care when otherwise unavailable 7.1: Identification of Personal Health Service Needs of Populations Does the LPHS identify any populations who may experience barriers to personal health 75% services? Has the LPHS identified the personal health service needs of populations in its jurisdiction? 75% Have personal health service needs been identified for populations who may experience barriers to 75% care? Has the LPHS assessed the extent to which personal health services in its jurisdiction are 75% available to populations who may experience barriers to care? Has the LPHS assessed the extent to which personal health services are utilized by populations who 75% may experience barriers to care? 7.2: Assuring the Linkage of People to Personal Health Services Does the LPHS link populations to needed personal health services? 75% Does the LPHS provide assistance to vulnerable populations in accessing needed health 50% services? Culturally and linguistically appropriate staff to assist population groups in obtaining personal health 25% services? Culturally and linguistically appropriate materials? 50% Transportation services for those with special needs? 50% Does the LPHS have initiatives to enroll eligible individuals in public benefit programs such as 50% Medicaid, and/or other medical or prescription assistance programs? Does the LPHS coordinate the delivery of personal health and social services to optimize access 25% to services for populations who may encounter barriers to care? Are services targeting the same populations co-located to optimize access? 25% Are services targeting the same populations coordinated among providers to optimize access? 25% Page 18 of 30 24

25 ES 8 - Assure a competent public health and personal health care workforce 8.1: Workforce Assessment, Planning, and Development Within the past three years, has an assessment of the LPHS workforce been conducted? 0% Whether or not a formal assessment has been conducted, have shortfalls and/or gaps within the 25% LPHS workforce been identified? Were gaps related to workforce composition identified? 25% Were gaps related to workforce size identified? 25% Were gaps related to workforce skills and/or experience identified? 25% Were recruitment and retention shortfalls identified? 25% Is this knowledge used to develop plans to address workforce gaps? 25% Have the organizations within the LPHS implemented plans for correction? 25% Is there a formal process to evaluate the effectiveness of plans to address workforce gaps? 25% Were the results of the workforce assessment and/or gap analysis disseminated for use in 0% LPHS organizations strategic or operational plans? Community leaders? 0% Governing bodies? 0% Public agencies? 0% Elected officials? 0% 8.2: Public Health Workforce Standards Are organizations within the LPHS aware of guidelines and/or licensure/certification 100% requirements for personnel contributing to the Essential Public Health Services? Are organizations within the LPHS in compliance with guidelines and/or licensure/certification 100% requirements for personnel contributing to the Essential Public Health Services? Have organizations within the LPHS developed written job standards and/or position 100% descriptions for all personnel contributing to the Essential Public Health Services? Do organizations within the LPHS conduct annual performance evaluations? 100% Does the LHD develop written job standards and/or position descriptions for all personnel? 100% Are job standards and/or position descriptions reviewed periodically? 100% Does the LHD conduct performance evaluations? 100% 8.3: Life-Long Learning Through Continuing Education, Training, and Mentoring Does the LPHS identify education and training needs so as to encourage opportunities for 100% workforce development? Distance learning technology? 100% National, state, local and regional conferences? 100% Staff cross-training? 100% Coaching, mentoring and modeling? 100% Does the LPHS provide refresher courses for key public health issues (e.g., HIPAA, nondiscrimination, 100% and emergency preparedness)? Does the LPHS provide opportunities for all personnel to develop core public health 50% competencies? An understanding of the Essential Public Health Services? 0% Page 19 of 30 25