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OUTLINE
• Overview of CPHA Pilot Project• The Planning & Assessment Tool• Key Findings and Next Steps• The Cumberland Story
CAPACITY-BUILDING
•Organizational development•Workforce development•Resource allocation•Leadership•Partnership development
• Reference: A Framework for Building Capacity to Improve Health, NSW Health, 2001.
AIMS TO:
• Engage stakeholders in dialogue • Promote information exchange• Assess current policy, planning and
practice• Identify actions, roles and shared
responsibilities for strengthening prevention and management of chronic disease
CRITICAL SUCCESS FACTORS
1. Common Values and Shared Goals2. Focus on Determinants of Health3. Leadership, Partnership and Investment4. Public Health Capacity and Infrastructure5. Primary Care Capacity and Infrastructure6. Community Capacity and Infrastructure7. Integration of Chronic Disease Prevention and
Management8. Monitoring, Evaluation and Learning
METHOD/APPROACHEvidence-Informed
The Tool was developed through:Working with an expert advisory
committeeReview and synthesis of peer-reviewed,
indexed journal articles and grey literature
Key Informant InterviewsFocus GroupsPiloting in Four Health Regions
WORKSHEETS AND RATING SCALES
• Cues to help assess current capacity• Where are we now in our practice?• What opportunities are there to build
capacity/improve practice?
• Question with explanation/example• Rating scale with qualitative indicators
(0=nothing in place; 4=best/promising practice)
• Space for local indicators, notes
Chronic Disease Prevention and Management Continuum
Well Population
Primary Prevention
At Risk Population
Secondary Prevention
Established Disease Controlled Chronic Disease
•Surveillance of diseases & risk factors
•Promotion of healthy behaviours
•Creation of supportive environments
•Universal & targeted approaches
•Screening
•Case finding
•Periodic health examinations
•Early intervention
•Medication to control
•Universal & targeted approaches
•Treatment and acute care
•Complications management
•Self-management
•Continuing Care
•Maintenance
•Rehabilitation
•Self-Management
Health Promotion Health Promotion Health Promotion Health Promotion
Prevent movement to at-risk group
Prevent progressionTo established disease
Prevent progression to complications and/orhospitalizations
Tertiary Prevention
REGIONAL PILOT PROJECT
REGIONAL PARTNER SITES
Health Region Contact Position Location GeographicalRegion
Champlain Local Health Integration Network
Karen Patzer SeniorPlanner
Ottawa, ON Central
Cumberland District Health Authority
Camille Dumond Health Promotion Coordinator
Amherst, NS Eastern
Capital District Health Authority
Dr. Gaynor Watson-CreedWith Michelle Le Drew & Shannon Ryan
Medical Officer of Health
Halifax, NS Eastern
Five Hills Health Region
Dr. Mark VooghtWith Audrey O’Reilly &Karen Lehman
Medical Officer of Health
Moose Jaw, SK
Western
PROJECT OVERVIEW
• Engage Stakeholders, Pilot Tool, Track Learnings and Evaluate
• Identify four pilot sites• Provided process support• Partner to engage regional
stakeholders• Held workshops – orientation to the
Tool• Tracked site experiences using the
Tool• Facilitated learning exchange across
jurisdictions
SELECT FINDINGS
• Use of tool varied with each site and depended on context
• Flexible, multiple approaches• Complex, takes time• Process was as important as the Tool
itself• Learnings came from engagement at
project level and at the regional level• Participatory approach was key• Nature of engagement and support
provided helped to build capacity in different ways
Our CDPM JourneyOur CDPM Journey
Small CDPM Planning TeamSmall CDPM Planning Team Environmental ScanEnvironmental Scan Steering committee / Stakeholders – Steering committee / Stakeholders –
CPHA Orientation to ToolCPHA Orientation to Tool 2 Stakeholder Forums2 Stakeholder Forums Criteria and Priority SettingCriteria and Priority Setting Identified actions to move forwardIdentified actions to move forward
The CPHA ToolThe CPHA Tool
Common Values/ Health Goals Common Values/ Health Goals / Integration // Integration /
Determinants of HealthDeterminants of Health
Stakeholder ForumsStakeholder ForumsPovertyPoverty workshop workshop
(Multi-sectoral partners)(Multi-sectoral partners)
Indirect
Staff Groups, Staff Groups, Steering CommitteeSteering CommitteeHP Working Group HP Working Group
DirectDirect
Dialogue PotentialUnderstanding Validation Capacity Building
Poverty Reduction Poverty Reduction ForumForum
1.1. How aware are people of the link between How aware are people of the link between the social determinants of health and the social determinants of health and chronic disease? How do people see the chronic disease? How do people see the social determinants as informing social determinants as informing approaches to this work?approaches to this work?
2.2. What are some supports for taking a What are some supports for taking a social determinants of health approach to social determinants of health approach to addressing chronic disease in this region?addressing chronic disease in this region?
3.3. What are some of the barriers to taking a What are some of the barriers to taking a social determinants of health approach to social determinants of health approach to addressing chronic disease prevention and addressing chronic disease prevention and management?management?
Priority AreasPriority AreasReorienting Reorienting
Health Health ServicesServicesKey Strategy Key Strategy
Areas Areas
-Increasing -Increasing AwarenessAwareness
Knowledge Knowledge translationtranslation
Self Self ManagementManagement
Chronic Disease Chronic Disease Self ManagementSelf ManagementProvincial Provincial
Initiative SSMInitiative SSMPatient data – Patient data –
health passportshealth passportsHealth Care Health Care
providersproviders
Priority AreasPriority AreasCommunity Community
ActionAction
Workplace Workplace SettingSetting
Inter-sectoral Inter-sectoral Approach to Approach to SDOH / Health SDOH / Health Inequity Inequity reductionreduction
Information Information SystemsSystems
IT / IM Strategic IT / IM Strategic PlanningPlanning
Systems and Systems and Decision support Decision support ToolsTools
RedesignRedesign Linking systems for Linking systems for
information sharing information sharing across the systemacross the system
Moving Forward with Moving Forward with IntegrationIntegration
What is moving us forward?What is moving us forward? Increased awareness - concept of IntegrationIncreased awareness - concept of Integration
Connection with CD Accreditation standardsConnection with CD Accreditation standards
Overlapping Collaborating committees for Overlapping Collaborating committees for Self Management / Health Promotion Self Management / Health Promotion work/CCCPwork/CCCP
Opportunities - Self Management training in Opportunities - Self Management training in MarchMarch / / Promising Health Promotion Promising Health Promotion PracticesPractices
Moving Forward With Moving Forward With IntegrationIntegration
Transformation within Transformation within existing structures – CCCP existing structures – CCCP shift / IM srategic planningshift / IM srategic planning
Provincial / National supports Provincial / National supports – resources, strategies, – resources, strategies, training opportunitiestraining opportunities
Moving Forward With Moving Forward With IntegrationIntegration
Leadership Development and Leadership Development and SupportSupport
Building capacity - Strong / varied Building capacity - Strong / varied partnerships and commitment – partnerships and commitment – Community centre - SpringhillCommunity centre - Springhill
Health Promotion WG meeting Health Promotion WG meeting regularly (Multi layerd approach)regularly (Multi layerd approach)
Cumberland Health Authority Cumberland Health Authority Draft CDPMDraft CDPM
Support FrameworkSupport FrameworkNova Scotia Chronic Disease Prevention Strategy
Health Promotion Steering Committee (CDPM)Key Systems Level Stakeholders
Health Promotion Working GroupCollaborating Committee of Key (Intersectoral) Stakeholders
Cumb Collective Partnerships
Self Management Collaborating committee
Organizational Health / Workplace Coalition
Communications
Families Schools Workplaces CommunitiesHealthcare Settings
Social inclusion and Cultural Diversity
Holding us BackHolding us Back
• A solid strategy for introducing A solid strategy for introducing the tool and piloting – workplan the tool and piloting – workplan
• No provincial framework yetNo provincial framework yet• Lack of a Communication PlanLack of a Communication Plan• Understanding the Lay of the Understanding the Lay of the
Land – Integration pointsLand – Integration points• Awareness Building is Huge – Awareness Building is Huge –
needs to come firstneeds to come first
• Overlapping responsibilities - Time Overlapping responsibilities - Time Crunch – ie: Steering Committee – Crunch – ie: Steering Committee – More streamlined support structure More streamlined support structure Structure requiredStructure required
• Need to Build more capacity – tool Need to Build more capacity – tool should be usefulshould be useful
• Competing priorities – AccreditationCompeting priorities – Accreditation• Ruralness of the district – travel, Ruralness of the district – travel,
timetime
Learning re: Using Learning re: Using TOOLTOOL
CDPM Steering Committee – Values and RoleCDPM Steering Committee – Values and Role Communications is High PriorityCommunications is High Priority Need an Inventory of CDPM workNeed an Inventory of CDPM work Develop a working group and plan for using Develop a working group and plan for using
ToolTool Tool is an extremely useful catalyst Tool is an extremely useful catalyst Potential to adapt / use tool with for Potential to adapt / use tool with for
integration of other priority areas - Cultural integration of other priority areas - Cultural Diversity and SI discussions – ie: Common Diversity and SI discussions – ie: Common ValuesValues
CDPM work needs bilateral movement of ideasCDPM work needs bilateral movement of ideas
Taking a step backTaking a step back Developing the bigger frameworkDeveloping the bigger framework
Strategic plan / evidence / standardsStrategic plan / evidence / standards Integrating priority goals and Integrating priority goals and
objectivesobjectives Healthy Discussions – knowledge Healthy Discussions – knowledge
exchangeexchange Increasing awareness of what Increasing awareness of what
“integration” might look like“integration” might look like Looking at the Lay of the land – Looking at the Lay of the land –
integration points and alignmentintegration points and alignment
What will be KeyWhat will be Key Maintain Balance - Prevention with Maintain Balance - Prevention with
ManagementManagement Restructuring – system support and Restructuring – system support and
relationship buildingrelationship building Maintain focus on Stakeholder Priorities – in Maintain focus on Stakeholder Priorities – in
work-planswork-plans Continued Communication and EngagementContinued Communication and Engagement Use evidence to support Decisions and Use evidence to support Decisions and
RedesignRedesign Continue to Focus on theContinue to Focus on the Critical Success Critical Success
FactorsFactors