Chronic Disease Program Integration

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Chronic Disease Program Integration
NACDD General Member Call May 25, 2006
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• Report on Workshop on Program Integration
• March 29-30, 2006 Atlanta, GA
• Presenters
• Amy Slonim, Chair
• Professional Development Committee
• Carol Callaghan and Barbara Leonard Workshop
  Co-Chairs

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Workshop Planning Committee

• Carol Callaghan
• Chuck Gollmar
• Ellen Jones
• Barbara Leonard
• Staff Lisa Daily

• Paula Marmet
• Amy Slonim
• Rob Smariga
• Fran Wheeler

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Workshop Participants

• 55 State Chronic Disease Staff
• 12 State Chronic Disease Teams
• 10 State Chronic Disease Directors
• 25 CDC-NCCDPHP Staff
• NACDD Staff

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Workshop Objectives

• Understand challenges and benefits of program
  integration, as well as factors that promote or
  hinder program integration.
• Learn how selected states are developing
  integrated chronic disease programs and how they
  are meeting challenges and opportunities along
  the way.
• Identify tools and resources available to assist
  states in developing integrated comprehensive
  chronic disease programs.

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Workshop Objectives, cont.

• Understand the general attributes and skills that
  foster organizational change.
• Work to develop guiding principles
• Recommend specific actions needed to move forward
  with chronic disease program integration.

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Meeting Organization

• Day 1
• Welcomes NACDD and CDC
• Keynote Address Creating Change from the Middle
• Plenary Session State and National Perspectives
• Roundtables Elements of Integrated Chronic
  Disease Programs

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Meeting Organization, cont.

• Day 2
• Panel Presentation Current State of Integrated
  Chronic Disease Programs
• Breakout Sessions Development of Principles for
  Integrated Chronic Disease Programs
• Breakout Sessions Development of
  Recommendations for States, CDC and NACDD
• Plenary Session Reports and Reactions

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Major Elements of Workshop

• Organizational Change
• Factors that Support Integrated Programs
• Elements of an Integrated Program
• Recommendations for CDC, States and NACDD

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Elements of an Integrated Program

• Leadership
• Epidemiology and Surveillance
• Partnerships
• Integrated Plan
• Interventions
• Evaluation
• Information Technology
• Program Management and Administration

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Guiding Principles for Program Integration

• Program Integrity
• Integration should do no harm to categorical
  programs
• Definition and Purpose
• Integration should be defined and have
  purposeful,
• intended outcomes
• Benefits
• Benefits to programs and partners should be
  clearly
• delineated.

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Guiding Principles, cont.

• Maximize Resources
• Program effectiveness and efficiency should be
• at the heart of integration efforts.
• Evaluation
• Integration outputs and outcomes should be
  tracked
• and evaluated and adjustments made accordingly.

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Guiding Principles, cont.

• Stakeholders
• Integration efforts should engage key
• stakeholders meaningfully and respectfully.
• Leadership
• Integration requires organizational leadership
• and support.

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Recommendations for States

• Leadership
• Program integration needs leadership to drive
  definition and purpose, vision, goals and
  objectives and impacts/outcomes of success, to
  engage champions internally and among partners
  and to secure broad-based buy-in.
• Leadership provides direction and a unifying
  voice for diverse interests to come together.

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State Recommendations, cont.

• Epidemiology and Surveillance
• Program integration needs a solid foundation on
  which to build the case for action and to frame
  the problems to be addressed.
• These efforts are pivotal to effective and
  efficient program integration.
• Key elements may include a master plan for data
  collection and analyses and timeline integrated
  mapping of burden and risk factors sharing
  resources and packaging of result.

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State Recommendations, cont.

• Partnerships
• Program integration requires strong working
  relationships among chronic disease programs,
  with other health department programs, and with
  other governmental and non-governmental lay and
  professional groups.
• Partnerships can be optimized with a focus on
  mutual benefits, coordinated/unified approaches
  to planning, implementation and evaluation,
  effective communication, and thinking broadly
  about potential stakeholders and collaborators.

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State Recommendations, cont.

• State Plans
• Program integration requires using data and
  working with partners.
• Chronic disease state plans should support
  program integration efforts.
• State plans are a tool to set integration as a
  priority among stakeholders, assure performance
  measures are collected and feed realignment and
  readjustment and convene partners regularly.

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State Recommendations, cont.

• Management and Administration
• Program integration requires oversight to
  determine efficient and effective mechanisms to
  guide processes assure application of tools to
  implement and track, evaluate and adjust in real
  time negotiate changes in financial management
  practices and ensure strategic engagement of
  partners and stakeholders.
• Successful program integration needs consistent
  administrative, financial and staff support.

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State Recommendations, cont.

• Information Technology
• Program integration requires effective use of all
  available tools for communication and data
  management.
• Application of information technology in program
  integration should insure compatibility of
  systems within and outside of the State, jointly
  developed or shared software tools, and web-based
  repositories for sharing resources and data.

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State Recommendations, cont.

• Interventions
• Program integration requires interventions that
  identify specific targets for change, choose the
  best channels through which to effect changes,
  and select appropriate strategies for doing so.
• Program intervention needs interventions that are
  evidence-based focused on benefits, results and
  activities and regularly reviewed and adjusted
  in real time.

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State Recommendations, cont.

• Evaluation
• Program integration needs systematic approaches
  for determining the success of implementation,
  optimal efficiency, and achievement of stated
  purpose.
• It is important that state evaluation efforts
  include cross-cutting performance measures and
  impacts (outputs/outcomes), identifying ways to
  share effort and resources, and making sure
  adjustments are made based on findings and
  lessons learned.

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Recommendations for CDC

• Definitions
• Working with its partners, CDC will provide
  leadership for defining program integration and
  will develop and use common terms across
  categorical programs.
• RFA Guidelines
• All RFAs will support program integration and
  provide flexibility so that states can integrate
  programs in ways that increase program
  efficiency, effectiveness and/or quality.

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CDC Recommendations, cont.

• Performance Standards and Evaluation Tools
• CDC will develop a vision, goals and objectives
  for program integration, as well as performance
  standards that measure the impact of integration.
• Staff Guidance
• CDC will guide its staff to embrace integration
  by setting expectations, providing training,
  identifying incentives, and institutionalising
  collaboration.

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CDC Recommendations, cont.

• Integration Tools
• CDC will take the lead in developing tools that
  support program integration.
• Resources
• CDC will identify resources to support program
  integration needs.

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Recommendations for NACDD

• Tools
• Disseminate tools such as template for
  integrated plans, integrated surveillance, and
  partner database.
• Annual Conference
• Offer an integrated program track at annual
  conference.
• Partners
• Pull in other partners representing other public
  health organizations.

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NACDD Recommendations, cont.

• Reach beyond Chronic Disease
• Advocate with CDC for integration across Center
  lines
• asthma, environmental health, injury prevention
  
• and with other agencies such as HRSA (MCH and
• Community Health Centers).
• Professional Development
• Conduct workshops on specific topics relevant to
  program integration.

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NACDD Recommendations, cont.

• ASTHO and NACCHO
• Conduct presentations at ASTHO/NACCHO and Senior
  Deputies meetings to increase awareness of
  program integration.
• SMOs
• Advocate with CDC to expand use of State
  Management Officials to other states.
• Continuity
• Continue to convene CDC and States for
  implementation

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Next Steps

• Maintain momentum and enthusiasm engendered at
  workshop.
• Put Workshop Proceedings on NACDD website.
• Develop manuscript of proceedings for publication
  in CDC e-journal.
• Follow-up with states to monitor progress in
  implementing state recommendations.
• Continue to work closely with CDC to monitor
  implementation of CDC recommendations

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• Workshop Participants Reactions
• and
• Questions