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APPENDIX A: FRAMEWORK FOR COMPREHENSIVE CHRONIC DISEASE PROGRAMS

Introduction

A comprehensive approach to chronic disease prevention and control is described in some detail in “Promising Practices in Chronic

Disease Prevention and Control: A Public Health Framework for Action.”

(http://www.cdc.gov/nccdphp/publications/PromisingPractices/). It is based on prevention effectiveness research; program

evaluations; and the expert opinions of national, state, and local leaders and public health practitioners. It provides a framework to

help states build new chronic disease prevention and control programs and enhance existing programs.

A comprehensive approach to chronic disease prevention and control addresses the leading causes of death and disability (heart

disease and stroke, diabetes, cancer, and arthritis); addresses the major risk factors (physical inactivity, obesity, nutrition and tobacco

use); takes into account health disparities in populations; reaches the general population as well as targeted high-risk and priority

populations in all of the places in which member of the communities are found; and provides opportunities for programs to work

together, promotes collective thinking and problem-solving and supports working together in new ways so that the impact of all

programs is improved.

For the STAR, this document will serve as a guide for preparing the state briefing book prior to a site visit by the STAR Team. The

framework contains nine elements comprising a comprehensive chronic disease prevention and control program: Leadership,

Epidemiology and Surveillance, Informatics, Partnerships, State Plan, Interventions, Evaluation, Program Management, and Program

Integration. For each program element, there are one or more indicators that help determine whether the element is in place and is

adequate and sufficient.

The state should describe briefly how the chronic disease prevention and control program is addressing each of the 42 program

indicators: 8 for Leadership, 5 for Epidemiology and Surveillance, 3 for Informatics, 1 for Partnerships, 1 for State Plan, 10 for

Interventions, 2 for Evaluation, 4 for Program Management, and 8 for Program Integration.

Program Elements and Indicators:

LEADERSHIP: The state chronic disease prevention and control unit is the unifying voice for the prevention and control of

chronic diseases.

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1. There is a single designated unit responsible for all chronic disease prevention and control activities in the state health department.

a) There is a state mandate for a chronic disease prevention and control prevention.

b) The unit is a key contact for others who are interested in chronic disease prevention and control.

c) The unit informs decision-makers and partners about the program’s value and accomplishments. Decision-makers and

partners include media, governor, legislature, department directors in other agencies, community coalitions and consumer

and advocacy groups.

d) The unit collaborates with other state level agencies and organizations to develop knowledge and awareness of chronic disease prevention and control activities in place in the state.

e) The unit has demonstrated the capacity to articulate the health needs of state residents.

f) The unit has demonstrated the ability to argue convincingly that a comprehensive approach to chronic health problems will

help meet those needs.

g) The unit has demonstrated the capacity to be a catalyst for change at multiple levels and in multiple sectors of the

community.

2. The chronic disease prevention and control unit has access to policymakers to achieve chronic disease prevention and control goals.

a) The unit has established ways to work within approved structures to influence policy-makers.

b) Staff testifies at state and local hearings.

c) Staff contacts policy-makers and/or their staff.

d) Staff participates on boards and commissions at the national, state and local levels.

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3. The chronic disease prevention and control staff generates and disseminates information on the effectiveness of existing state and local policies related to chronic disease prevention and control. (Refer also to the section on the Evaluation

element.)

a) The unit assesses the need for new policies and regulations and disseminates findings.

b) The unit designs and conducts methodologically sound evaluations of existing policies and disseminates findings.

c) The unit conducts methodologically sound cost-benefit analyses of chronic disease prevention and control policies and

disseminates findings.

4. The chronic disease prevention and control unit reviews proposed legislation.

a) The unit monitors legislation in relation to sound chronic disease prevention and control principles.

b) The unit provides written analyses of legislation.

c) The unit recommends health department positions for relevant bills.

5. The chronic disease prevention and control unit collaborates with all appropriate partners, reflective of the state’s diverse populations, to promote policies, legislation, and regulations related to chronic disease prevention and control

issues. (Refer also to the section on the Partnerships element.)

a) The unit collaborates with partners to problem solve ways to advocate for policies.

b) The unit participates in task forces and other groups that are involved in policy change.

c) The unit provides partners with information on pertinent legislative contacts, the legislative process, and state chronic

disease prevention and control priorities.

d) The unit provides examples of model legislation to partners.

e) The unit provides topic-specific data and other information to partners about relevant policy and advocacy issues.

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f) The unit collaborates with partners to develop and expand a public constituency for the public health problem of injuries.

6. The chronic disease prevention and control unit participates in the process of policy development to support chronic disease prevention and control.

a) The unit has assured that state and local legislation is drafted and submitted to policy-makers to promote chronic disease

prevention and control activities.

b) The unit has assured the development of state regulations and other policies that create specific chronic disease prevention

and control measures (e.g., within the health department or other departments such as education, transportation, law

enforcement, social services, drug and alcohol, mental health, etc).

c) The unit has supported the development of local policies that enact specific chronic disease prevention and control

measures.

7. The chronic disease prevention and control unit provides practical training about chronic disease prevention and control at the basic and advanced levels to professionals (state and local), students, and the public.

a) The unit offers preceptors and practica for undergraduate and graduate students.

b) The unit conducts assessments of the training needs of grantees or other local public health providers and provides training

as needed.

c) The unit has established initiatives within the state to teach specific skills related to chronic disease prevention and control.

d) The unit has developed or adapted protocols and training manuals.

e) Staff makes presentations at professional conferences and meetings.

f) The unit participates in and/or presents at seminars offered by Prevention Research Centers or other university-based

programs.

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g) The unit responds to public requests for presentations.

h) The unit involves partners in developing and delivering training programs sponsored by the chronic disease prevention and

control unit.

8. The chronic disease prevention and control unit provides consultation and technical support to improve and enhance chronic disease prevention and control efforts in the state.

a) The unit provides technical support proactively and upon request to address the specific needs of various partners. Potential recipients of technical support: local health departments, other local coalitions, schools, community groups or

organizations, state level groups, agencies and organizations, state health departments and national organizations.

b) The unit publishes articles in peer-reviewed journals, newsletters and other publications.

EPIDEMIOLOGY AND SURVEILLANCE: The state chronic disease prevention and control unit establishes the burden

associated with chronic diseases and frames the problem to be addressed.

9. Consistent with Indicators for Chronic Disease Surveillance, the chronic disease prevention and control unit operates or utilizes an epidemiologic surveillance system that is used to identify chronic disease prevention and control priorities.

a) The chronic disease surveillance system includes the 92 indicators for the 13 recommended conditions, using 8 core data

sets, consistent with Indicators for Chronic Disease Surveillance.

b) The unit provides a chronic disease surveillance summary data report on a regular basis.

c) The surveillance summary report is written in terms that speak to a variety of audiences, including community residents,

state leaders and other decision-makers.

d) The unit has assessed the completeness and validity of all core data sets.

e) The unit links data sets when it is appropriate and useful to do so.

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f) Surveillance data are used to track chronic disease prevalence, risk factors, morbidity, and mortality; to identify groups at

highest risk; to identify underlying causes; and to recommend prevention priorities.

g) Surveillance data serve as the basis for developing comprehensive state plans.

h) The unit collaborates with other agencies for the sharing of data.

i) The unit promotes integration of chronic disease surveillance and information systems with general public health

surveillance.

j) As with other health conditions, a mechanism is in place to alert state and local health officials to chronic disease hazards

or disease clusters and risk factors that require timely investigations or field studies.

10. The chronic disease prevention and control unit maintains specific data collection activities that support program development and reflect state and local priorities.

a) The unit conducts needs assessments to support effective program implementation, including original data collection and

use of existing data sets.

b) The unit maintains data or information systems for priority conditions.

c) The data collected or maintained by the unit meet rigorous quality standards.

11. The chronic disease prevention and control unit collaborates with other agencies and groups to ensure the quality of their data, improve their utility for prevention purposes, and provide assistance in the development of data.

a) The unit collaborates with offices responsible for vital records, hospital discharge data and behavior risk surveys to develop plans for optimal use of their data.

b) The unit collaborates with offices that have data on specific conditions to develop plans for optimal use of their data (e.g.,

Mental Health, Workers Compensation, Emergency Medical Services, Elder Services, and Department of Education).

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c) The unit provides technical assistance to other groups and agencies about surveillance systems and data use (either

suggesting new systems or improving existing systems).

12. The chronic disease prevention and control unit regularly monitors and reports disparities in chronic disease prevalence, risk and outcomes.

a) The unit collaborates with other agencies and community groups to establish and periodically reassess the variables and

assigned values relevant to data reports on chronic disease disparities.

b) The unit establishes clear operational definitions of variables such as “race,” “ethnicity,” and “socioeconomic status” and

provides those definitions in all reports that use the terms.

c) Published reports include relevant chronic disease data broken out by disparity group.

d) The unit distributes reports on chronic disease disparities and invites feedback from other agencies, organizations, and

community groups.

13. The chronic disease prevention and control unit disseminates data to relevant coalitions and partners, including other health department programs and all levels of government (state and local).

a) Unit reports (e.g., state publications, peer-reviewed articles, websites, and newsletters) are readily available.

b) Staff members participate in or make presentations to local, state and national groups about chronic disease data.

c) Data files or custom reports are provided to individuals or groups upon request and in a timely fashion, consistent with any

data protection regulations.

INFORMATICS: The state chronic disease prevention and control unit manages and uses health information systems to

support staff and program effectiveness.

14. The chronic disease prevention and control unit has direct access to adequate information resources and knowledge of their use.

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a) Staff has access to the Internet, printed scientific literature and media.

b) Staff has access and uses modern information technology tools and state-of-the-art software tools for the full range of

electronic communication, as well as health information acquisition, data entry, management, analysis, planning, and

reporting.

c) Staff has knowledge of the existence, structure, and uses of public health and health databases and networks.

d) Staff has an understanding of the basic functions and operations of information technologies that have significant

application to public health practice such as geographic information systems and the web-based information dissemination.

e) The unit manages the information produced and/or accessed as a key strategic resource and mission tool.

15. The chronic disease prevention and control unit uses various kinds of information technology to improve staff’s professional effectiveness.

a) Staff receives training on ways to extract useful chronic disease prevention and control information from available

resources.

b) Staff has access to modern distance-learning technologies to support life-long learning appropriate to programmatic needs.

16. The chronic disease prevention and control unit effectively develops and manages information systems to improve the effectiveness of the chronic disease prevention and control enterprise.

a) Staff utilizes modern information science and technology as a strategic tool to promote public health (e.g., through

community education, behavior modification, collaborative policy development, issue advocacy and community

mobilization).

b) Technology is integrated appropriately to describe the magnitude of chronic disease problems; analyze risk factors; identify

community strengths from which strategies may be defined and tools created to intervene, prevent problems, and promote

health and well-being; and continuously evaluate, refine, and implement what works.

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c) The unit combines data and information from multiple sources, to create new information to support public health decision-

making.

d) The unit actively engages and communicates with information technology specialists and participates in the development

of new and enhanced databases for chronic disease prevention and control.

PARTNERSHIPS: The state chronic disease prevention and control unit establishes strong working relationships with other

government agencies and with nongovernmental, lay and professional groups.

17. The chronic disease prevention and control unit collaborates with internal and external stakeholders, reflective of the state’s diverse populations, to promote the development, implementation and evaluation of chronic disease prevention

and control interventions.

a) The unit has a process to identify and include stakeholders from relevant internal and external constituencies.

b) The unit collaborates with other offices within the state health department to learn about, coordinate and enhance each

other’s chronic disease prevention and control efforts. Potential partners include (but are not limited to): MCH, health

promotion, epidemiology, EMS, environmental health, school health, substance abuse, aging, injury, and occupational

health.

c) The unit collaborates with other state agencies to learn about, coordinate and enhance chronic disease prevention and control programming by state government. Potential partners include (but are not limited to): Medicare, Medicaid, Office

on Aging, Department of Education, and Department of Mental Health.

d) The unit assists partners with strategic planning and priority setting activities that support chronic disease prevention and control.

e) The unit collaborates with non-governmental organizations in the state to learn about, coordinate and enhance chronic

disease prevention and control efforts. Potential partners include (but are not limited to): American Cancer Society,

American Diabetes Association, American Heart Association, American Lung Association, Arthritis Foundation, health

care associations, chronic disease and/or risk factor community-based organizations, business and industry, consumer

groups, youth-serving organizations, universities, religious organizations, and PTA’s.

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f) The unit collaborates with federal agencies, national organizations and colleagues from other states to inform the state

program and have an impact at the national level. Potential partners include (but are not limited to): CDC, NACDD,

Prevention Research Centers, American Cancer Society, American Diabetes Association, American Heart Association,

American Lung Association and Arthritis Foundation.

STATE PLANS: The state chronic disease prevention and control unit uses data and works with partners to develop

comprehensive state plans to guide program efforts.

18. The chronic disease prevention and control unit, in cooperation with its partners, develops a state plan that describes what health problems will be addressed, how they will be address, and how program activities will be funded and

evaluated.

a) The unit develops and implements a state health department plan to prevent and control chronic disease in the state that

includes specific goals, objectives and activities, and timelines.

b) Chronic disease prevention and control is included in all relevant state health plans.

c) The unit coordinates and collaborates with other state agencies and stakeholders to develop a comprehensive statewide

chronic disease prevention and control plan, which includes disease burden, rationale for proposed activities, core capacities

and functions, existing capacity, objectives and activities, responsible parties, and a time line.

INTERVENTIONS: The state chronic disease prevention and control unit identifies specific targets for change (population

segments, organizations, or environments), chooses the best channels through which to effect such changes, and selects

appropriate strategies for doing so.

19. The chronic disease prevention and control unit’s interventions encompass a comprehensive strategy that includes multiple targets for change: individual behaviors, organizational practices, policies and environment.

a) The unit includes interventions targeted to individuals or population groups with relatively high prevalence of disease or secondary risk factors, limited access to information or services, or a higher risk of developing disease.

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b) The unit includes interventions targeted to organizations or systems capable of affecting the health of the targeted

population segments.

c) The unit includes interventions targeted to changing the physical or policy environment in which people live, work, learn

and play.

d) The unit includes interventions that simultaneously address multiple levels for change – individual, organization or system,

and policy or environment.

20. The chronic disease prevention and control unit’s interventions utilize multiple channels for reaching targeted individuals and populations.

a) The unit uses communities and community organizations (such as religious groups, unions, clubs, professional

associations, community action groups, sports groups, voluntary health agencies, and social services groups) as a channel

for chronic disease prevention and control interventions.

b) The unit utilizes health care settings as a channel for chronic disease prevention and control interventions.

c) The unit utilizes workplaces as a channel for chronic disease prevention and control interventions.

d) The unit uses schools as a channel for chronic disease prevention and control interventions.

The unit uses media (such as television, radio, newspapers, magazines, billboards, computer networks) as a channel for chronic

disease prevention and control interventions.

e) The unit conducts interventions that simultaneously utilize multiple channels for reaching target populations.

21. The chronic disease prevention and control unit’s intervention strategies should be comprehensive, multifaceted, and reinforcing.

a) Policy interventions address multiple levels (state, regional, local) and multiple types of policy (voluntary, regulation,

legislation, standards).

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b) The unit includes efforts to change the health-related policies of private organizations and/or governmental entities.

c) Skill-building interventions address multiple factors, including knowledge and beliefs about a health issue, motivation to

change behaviors, skills needed to change behaviors, and the specific actions to be taken to adopt and maintain a healthier

lifestyle.

d) The unit includes screening and other preventive health services designed to detect and treat risk factors or disease at the earliest possible stage.

e) Preventive health services are offered in conjunction with educational efforts, include appropriate provider training and quality assurance monitoring, and have clearly defined follow-up procedures.

e) The unit conducts interventions that simultaneously utilize multiple strategies for change – skills-building, preventive

health services, and policy.

22. The selection and design of interventions is informed by assessment of needs and assets, as well as data on disparities in morbidity, mortality, and risk factors.

a) Community needs and assets inform the selection and design of interventions.

b) Data about chronic diseases – such as mortality, morbidity, prevalence and risk factors – impact the focus and design of

interventions.

23. The chronic disease prevention and control staff adopts effective or promising approaches and considers feasibility and acceptability when developing intervention plans.

a) Reviews of the best current scientific literature inform intervention plans to ensure use of evidence-based interventions.

b) Research and program evaluation conducted by the state health agency, academic partners, and professional colleagues

inform intervention plans.

c) Program interventions are evidence-based, with clear connection to published literature, national evidence-based

guidelines, ongoing research and/or program evaluation.

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24. Attention is given to fitting chronic disease prevention and control interventions into a culturally appropriate framework of norms, values, roles, and practices.

a) Chronic disease prevention and control interventions demonstrate sensitivity to and understand of the unique cultural

differences within, among, and between different populations in the state.

b) Chronic disease prevention and control interventions reflect the knowledge, attitudes, and beliefs of the target population.

25. All chronic disease prevention and control interventions are designed to include multi-faceted evaluation and dissemination of evaluation findings. (Refer also to the section on the Evaluation element.)

a) An evaluation plan is outlined for each program, project or initiative prior to implementation.

b) Both qualitative and quantitative assessments are used.

c) Formative, process, impact and outcome evaluation techniques are utilized.

d) A designated internal or external evaluator is assigned to each intervention.

e) Evaluation findings are disseminated to stakeholders (e.g. staff members responsible for intervention development,

professionals and academics at the national level, and agency leadership).

26. Each chronic disease prevention and control intervention utilizes a comprehensive, multi-level approach.

a) Interventions employ multiple strategies for prevention including educational campaigns, environmental changes, and

enforcement of new and existing regulations/legislation.

b) Interventions demonstrate a multi-level approach to prevention. Potential levels of intervention include (but are not limited

to) knowledge and skills of individuals, community norms, and institutional practice.

27. The state chronic disease prevention and control unit supports and monitors chronic disease prevention and control activities at the local level.

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a) Local program roles are explicit in state chronic disease prevention and control plans.

b) There is a procedure for how the chronic disease prevention and control unit interacts with local programs and

interventions.

c) There is a mechanism for monitoring the progress of local interventions, including required and routine progress reports.

d) The unit promotes the development of local interventions.

e) The unit provides support materials to local programs and interventions.

28. The chronic disease prevention and control unit establishes collaborative agreements or contractual arrangements with agencies and individuals to implement chronic disease prevention and control interventions.

a) The unit collaborative agreements with agencies and individuals as evidenced by memoranda of agreement and contracts.

b) The selection process for collaborative agreements or contractual arrangements includes consideration of need, size of

target population, resources, skill level.

c) The selection process for contracts and collaborative agreements includes an objective review.

EVALUATION: The state chronic disease prevention and control unit establishes systematic approaches for determining

whether its comprehensive chronic disease control program is being implemented successfully and whether its objectives are

being achieved. (Refer also to the section on the Interventions element.)

29. Progress in achieving the objectives of the chronic disease prevention and control plan or agenda is monitored by state chronic disease prevention and control staff.

a) A designated staff member leads a state progress review at least annually.

b) The results of state and local interventions are reviewed in order to consider and implement adjustments.

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c) The unit seeks input and uses feedback from its constituency and the general public to improve its performance and

programming.

30. Evaluation of the state chronic disease plan uses multiple methods and includes dissemination of evaluation findings.

a) An evaluation plan is outlined for prior to implementation.

b) Both qualitative and quantitative assessments are used.

c) Formative, process, impact and outcome evaluation techniques are utilized.

d) Evaluation findings are disseminated to stakeholders (e.g. staff members responsible for intervention development,

professionals and academics at the national level, and agency leadership.

PROGRAM MANAGEMENT AND ADMINISTRATION: The state chronic disease prevention and control unit provides the

consistent administrative, financial, and staff support necessary to maintain successful programs.

31. The chronic disease prevention and control unit has a strong management structure and effective, efficient

administrative systems that are both agile and auditable.

a) Program components are coordinated, avoiding duplication of efforts and ensuring consistency for the comprehensive

approach to chronic disease prevention and control.

b) The unit’s management structure provides adequate fiscal and program oversight.

c) The unit’s management structure facilitates effective communication among program participants and partners.

d) The unit has clearly defined lines of authority.

e) The unit is held accountable for results.

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f) The unit’s organizational structure allows related programs to interface and interact easily.

g) The unit’s administrative structure and procedures allow for timely and efficient action.

32. ) Staffing is adequate to conduct a statewide chronic disease prevention and control program. (NACDD has developed Competencies for Chronic Disease Practice that define the skills and knowledge specific to leading and managing chronic disease

programs. A tool to assess competencies of teams working in chronic disease programs is available on the NACDD website at http://www.chronicdisease.org/files/public/CompetenciesTeamAssessmentTool.pdf

a) The state unit for chronic disease prevention and control has an identified director.

b) Core staff members have permanent positions in the state health department.

c) Key staff members have training related to public health.

d) Key staff members have training related to chronic disease prevention and control or program design, implementation, and

evaluation.

h) Staff members possess knowledge and skills relevant to culturally competent and targeted chronic disease prevention and

control interventions, serving the state’s diverse populations.

i) In the hiring process, a priority is placed on achieving or maintaining a staff composition that reflects the diversity of the

populations in the state.

j) Staffing includes support staff adequate to program needs (e.g., clerical or grants management staff).

33. The chronic disease prevention and control staff receives orientation, basic chronic disease prevention and control training, on-the-job training, and continuing education.

a) New staff members are mentored by experienced staff members.

b) Staff members have received basic training in chronic disease prevention and control.

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c) Key staff members have received advanced training to include evaluation, strategic planning, the use of surveillance data,

and grant writing.

d) Staff members have received topic-specific training as appropriate.

34. The chronic disease prevention and control unit takes action to obtain funding that is both adequate to support its core functions and commensurate with the nature and scope of the chronic disease problem in the state.

a) The unit has worked to achieve chronic disease line items in the state budget through collaborations with partners and

proposals submitted through the administration.

b) Dedicated funding in the state budget for chronic disease prevention and control has been obtained.

c) The unit has participated in the priority-setting processes of the Preventive Health and Health Services (PHHS) Block Grant, the Title V (MCH) Block Grant, and other relevant state and local level budget and grant processes.

d) PHHS and MCH block grant funding for the chronic disease prevention and control program has been obtained.

e) The unit seeks and maintains funding from diverse sources (i.e., state, federal and private sources).

f) In-kind support is provided by partner organizations.

g) Funding is available for implementation of chronic disease prevention and control programs at the local level.

h) The unit identifies and tracks potential sources for chronic disease prevention and control funding.

PROGRAM INTEGRATION: The state chronic disease unit has strategically aligned chronic disease categorical program

resources to increase the effectiveness and efficiency of each program in a partnership without compromising the integrity of

categorical program objectives.

35.The chronic disease prevention and control unit engages state health agency leadership to secure organizational

endorsement and broad-based buy-in of program integration efforts.

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a) The unit works with leadership in creating a vision, definition, purpose, and outcomes of program integration.

b) The unit convenes organizational and ongoing cross-program meetings.

c) The unit assures leaders are kept informed about integration progress.

36. The chronic disease prevention and control unit has developed crosscutting epidemiology and surveillance programs as a

foundation on which to build the case for action and to frame problems to be addressed.

a) The unit has developed a master plan and schedule for surveillance integration efforts that includes, when feasible, sharing

of resources.

b) The unit supports a trained and skilled multi-program epidemiology workforce.

c) Steps have been taken to integrate mapping of disease burden and risk factors.

d) Data reports are packaged to include multiple program areas and are meaningful and understandable by diverse audiences.

37. The chronic disease prevention and control unit leverages use of information technology for effective communication and data management.

a) The unit helps assure that administrative and management systems across programs and organizations are compatible.

b) The unit helps to jointly create or shares software tools

c) Systems to collect integrated data are developed.

d) Information is shared across program lines.

e) Repositories of collaborative workplans and population-based data are established.

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38. The chronic disease prevention and control unit builds state and local partnerships that focus on mutual benefits and coordinated approaches to planning, implementation, and evaluation of integration efforts.

a) The unit works to strengthen relationships across chronic disease programs, government, non-governmental organizations,

and lay and professional groups.

b) The unit helps assure communication networks and tools are in place for sharing of information among staff, partners, and

community collaborators.

39. The chronic disease prevention and control unit facilitates the development of integrated state plans.

a) Program integration is identified as a priority in the state plan.

b) The unit convenes a chronic disease partnership forum that meets on a regular basis.

c) The unit helps guide integration efforts.

d) The unit facilitates the mutual use of common and specialized data sources.

e) The unit helps assure that common performance measures are identified and data are collected.

f) Activities are aligned for integrated programming.

g) Internal and external partners convene regularly to monitor integration progress.

40. The chronic disease prevention and control unit has engaged management and administration in the support of program

integration.

a) The unit has assessed readiness and organizational support for a program integration initiative.

b) Regular, joint managements meetings are held.

c) Changes in financial management practices are negotiated, tracked, and evaluated.

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d) As necessary, reorganization to realign or add staff, budget, or program activities has occurred.

41. The chronic disease prevention and control unit facilitates the implementation of integrated interventions that focus on

integration benefits and results.

a) Resources and staff for implementing interventions have been identified.

b) The program has conducted assessments to determine common linkages and program gaps.

c) Interventions are developed that identify specific targets for change and the best channels through which to effect changes.

d) Evidence-based strategies are planned and implemented to jointly engage partners, stakeholders, and program staff.

e) Ways to share workload and resources have been identified.

f) Integrated activities are regularly reviewed for efficiency and effectiveness.

g) A communication mechanism is in place to provide updates to all staff involved in implementing and evaluating

interventions.

h) Partners and stakeholders have been brought together in joint problem solving efforts.

42. The chronic disease prevention and control unit evaluates chronic disease program integration initiatives.

a) Resources and staff needed to conduct evaluation activities have been identified.

b) An evaluation plan has been developed that includes both qualitative and quantitative monitoring.

c) Cross-cutting performance measures, short-term benchmarks, and integration outcome indicators have been determined.

d) A method to collect, process, and analyze data has been developed.

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e) Evaluation findings are used to make programmatic adjustments and modifications.

f) Outcomes, including lessons learned, are shared with partners and stakeholders.