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Sustaining Evidence-Based Health Promotion Programs


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Title: Sustaining Evidence-Based Health Promotion Programs

Sustaining Evidence-Based Health Promotion
  • Lora Connolly, California Department of Aging
  • June Simmons, Partners in Care Foundation
  • Terri Whirrett, South Carolina Lt. Governors
    Office on Aging
  • Cora Plass, South Carolina Department of Health

Compelling Statistics
  • 12 million older adults have chronic conditions
    like arthritis, diabetes and heart disease
  • More than 13,700 people over age 65 die each year
    from fall related injuries (30-40 of which
    could have been prevented)

Compelling Statistics
  • Older adults are disproportionately affected by
    chronic diseases
  • These conditions account for 7 out of 10 deaths
  • These conditions account for ¾ of all health care
  • They negatively impact quality of life older
    adults ability to live independently

Research to Develop Strategies
  • National Center for Disease Control (CDC)
    investment in research aimed at identifying best
    practices in treating chronic health conditions
  • Found that these conditions are not curable,
    but can be effectively dealt with through self
    management behavioral changes
  • Quantified the associated fiscal quality of
    life costs

Evidence Based Model
Evidence Based Model
Promising Practice
Best Practice
  • Evidence-Based Disease Prevention program
    refers to a program that closely replicates a
    specific intervention that has been tested
    through randomly controlled experiments with
    results published in peer-reviewed journals.
  • Sources of evidence include HHS sponsored
    research funded by the National Institutes of
    Health (including National Institute on Aging),
    the Centers for Disease Control and Prevention
    (including work in the Healthy Aging Research
    Network), Agency for Health Care Research and
    Quality (AHRQ), the Centers for Medicaid and
    Medicare Services (CMS) and the Substance Abuse
    Mental Health Services Administration (SAMHSA).

First Round of Community Evidence Based Grants
  • National Council on Aging coordinated the
    development of 4 evidence based health promotion
  • Healthy Moves (physical activity)
  • Healthy IDEAS (depression)
  • Healthy Changes (diabetes)
  • Healthy Eating (nutrition)
  • Findings evaluated, further replication second
    round of grants

2006 AoA Request for Proposal
  • Funding opportunity for states to implement
    evidence based health promotion programs
    targeting older adults
  • Required partnership between state departments of
    health and aging services
  • Required Chronic Disease Self-Management Program
    (CDSMP) could include other evidence based

2006 AoA Request for Proposal (continued)
  • Requires a community based partner that received
    OAA funding
  • Requires involvement of Area Agencies on Aging
  • Grants 250,000/year for three years to 16
    states (now 24 states have grants)

AoA Approved Evidence-based Programs
  • Chronic Disease Self-Management Program
  • Matter of Balance
  • Enhance Wellness
  • Active Choices
  • Enhance Fitness
  • Strong for Life
  • Healthy IDEAS or PEARLS
  • Prevention Management of Alcohol Problems in
    Older Adults
  • Visit to view
    additional evidence-based programs
  • that meet AoA criteria

Chronic Disease Self-Management
  • Designed to help people manage chronic illnesses
  • Consists of six 2½ hour sessions led by 2 leaders
  • Groups are small (10-20 people)
  • Topics include
  • How to deal with frustration, fatigue, pain and
  • Exercise
  • Medication useage
  • Communicating with family, friends, and health
  • Nutrition
  • Evaluating new treatments

Matter of Balance Managing Concerns About Falls
  • Based upon research conducted by the Roybal
    Center for Enhancement of Late-Life Function at
    Boston University
  • Consists of 8 two-hour courses
  • Designed to reduce the fear of falling and
    increase the activity levels of older adults with
    fall concerns
  • Participants learn
  • To view falls and fear of falling as controllable
  • To set realistic goals for increasing activity
  • To change your environment to reduce fall risk
  • To promote exercise to increase strength and

Californias Evidence BasedHealth Promotion
  • Brief Overview

Californias Size Shapes Implementation Strategy
and Potential Impact
Participating California Counties
Original County
New County
California Project
  • CA Department of Aging is lead agency in
    partnership with CA Department of Public Health
  • 5 initial counties respective Area Agencies on
    Aging participating (Fresno, Los Angeles, Madera,
    San Diego Sonoma)
  • Partners in Care Foundation, already implementing
    two AoA evidence based programs serving frail
    seniors, acting as project office
  • Statewide steering committee comprised of two
    departments, Partners, participating counties,
    major local partners

California Department of Aging Programs
  • Older Americans Act Older Californians Act 33
    Area Agencies on Aging
  • Multipurpose Senior Services Program home
    community based waiver for frail elderly
  • 300 Adult Day Health Care Centers

California Project
  • Participating counties were asked to mentor other
    interested counties in Years II III.
  • Programs are offered in English Spanish
  • MSSP programs (HCBS wavier for seniors) will
    introduce two evidence based programs
  • Medication Management Improvement System
  • Healthy Moves for Aging Well

California Grant Overview

Coordinating for Successful Implementation
  • Successful implementation requires
  • Effective Outreach
  • Coordinated Training Strategies
  • Involvement of AAA IA and health promotion
    activities ( many others!)
  • Coordination with California Dept. of Public
    Health network addressing chronic diseases
  • Sustainable infrastructure long term committed

  • Being strategic means we have to be clear
    about the types of changes we want to advance
    over the next 10 years, and the role we want to
    play as a network in implementing those changes.
  • It means playing to our strengths, and
    capitalizing on our unique assets and
    capabilities. It means modernizing our business
    practices and honing our skills so we can remain
    competitive in the changing market place and able
    to keep pace with innovation and the changing
    needs and demands of our consumers.
  • --AoA Assistant Secretary Josefina G. Carbonell
  • Choices for Independence National Leadership
  • December 5, 2006  

Sustaining Evidence-Based Health Promotion
ProgramsThe California Perspective
  • June Simmons, CEO

Changing American Culture
  • We are in the service of a great vision
  • Mainstreaming access to tools for health
  • Building a platform for health and quality of
  • This is a MISSION, not a PROJECT

Launching Lasting Change
  • Current projects are seed money to launch a new
  • Need to identify and involve many investors in
    order to take this to scale
  • Scale creating a new norm for healthy living
  • Scale new norms for widespread ready access to
    proven programs and services

Major Assumptions
  • Lasting Change
  • Converting Aging Network to a Platform for Health
  • Aging Network Leading Conversion of Other Systems
    to Platforms for Health
  • Moving From Projects to Tipping Points
  • Cannot Work Alone!!! Partners Essential
  • 80/20 Rule

Building a Franchise For Health
  • Essential Forms of Capital to Invest
  • Mission/Vision
  • Leadership
  • Organizational Commitment
  • A Community of Peers a Movement
  • Mandates, competitive forces, glory,
  • Capital Money Other Resources

Sources of Shared LeadershipBringing Vision
  • AoA and NCOA
  • State Departments of Aging and Public Health
  • 4 As and AAAs
  • Aging Network
  • Funders
  • Associations
  • Other Partners with Aligned Incentives
  • 80/20 Rule

Selection Criteria
  • Organizations with Aligned Mission Who
  • Have a heart for it
  • Care about this movement
  • Will Benefit From Engagement Over Time
  • Obligations
  • Needs
  • Outcomes

Selection Criteria
  • Potential for Scale/Impact
  • Directly/Indirectly
  • Mutual Benefit/Alignable Incentives
  • Aligned Mission/Vision
  • Product Champion
  • Has Relevant Resources

Relevant Resources Vary
  • Funding for Training, Materials, Staff
  • Staff Motivated to Lead
  • Space for Programs
  • Access to Target Populations
  • Ability to Outreach/Market
  • Opinion Leader/Standard Setting Agency

California Examples
  • Statewide Steering Committee
  • Expansion Sustainability Think Tank
  • Identify Strategic Sectors for Partnership
  • Identify Funding to go to Scale and Extend
    Timeframe for Funded Leadership
  • Identify Lasting Infrastructure to Sustain

Expansion Sustainability Workgroup
  • Purpose Guidance to the CA Depts. of Aging and
    Public Health to craft a comprehensive expansion
    and sustainability plan
  • Members
  • Health Plans Catholic Health Care West Kaiser
    Permanente St. Joseph Health System Daughters
    of Charity
  • Foundations Archstone Foundation UniHealth
    Foundation The CA Endowment CA HealthCare
    Foundation Kaiser Permanente Community Benefit
  • Education Older Adult Community College
  • Non-Profit Partners in Care Foundation
  • Government Los Angeles County Public Health
  • Business Pacific Business Group on Health

Sustainability Work Group Members
  • Eileen L. Barsi
  • Catholic Healthcare West
  • Diana Bonta
  • Kaiser Permanente
  • Lora Connolly
  • CA Department of Aging
  • Lynn Daucher
  • CA Department of Aging
  • Ronald DiLuigi
  • St. Joseph Health System
  • Pam Ford-KeachCA Department of Health Services
  • Jerry Kozai
  • St. Francis Medical Center
  • Mary Ellen Kullman
  • Archstone Foundation
  • Mary Odell
  • UniHealth Foundation
  • Kate OMalley
  • CA HealthCare Foundation
  • James Philipp
  • Pacific Business Group on HealthBarry Ross
  • St. Jude Medical Center
  • June Simmons
  • Partners in Care Foundation
  • Rita Speck
  • Kaiser Permanente
  • Janet Tedesco
  • CA Department of Aging
  • Lorraine Wicks
  • CA Community College Educators of Older Adults
  • Dianne Yamashiro-Omi
  • The CA Endowment
  • M. Lynn Yonekura
  • CA Hospital Medical Center

California Sustainability Example for CDSMP
  • Merge CDSMP expansion efforts into the following
    3 networks to produce the greatest impact and
    reach major populated areas
  • Leading Physician Groups
  • Community College Older Adult Programs
  • County Public Health Departments

(No Transcript)
Physician GroupPartnering Strategy
  • Surround physician groups with CDSMP workshops
    hosted by Community Colleges, Public Health and
    other community agencies
  • Local community colleges are partnered with each
    practice to assure close collaboration and
    effective referral process

California Association of Physician Groups (CAPG)
  • Nations largest state physician association -
    150 leading physician groups
  • Physicians under CAPG provide care to over 15
    million Californians more than 50 of
    Californias health care

Physician GroupSustainability Factors
  • Have significant numbers of patients under
    capitation Financial motivation to promote
  • Once managed care patients routinely referred to
    CDSMP, will become the standard of practice to
    benefit fee-for-service Medicare patients as well

California has 109 Community Colleges(62 have
older adult programs) The 62 colleges serve
125,000 Californians ages 50 per week
Community CollegeSustainability Factors
  • Instructors are paid as faculty for leading CDSMP
  • Have relationships with community organizations
    serving older adults
  • Have strong marketing capacity
  • Familiar resource for aging Boomers
  • Eager for new, evidence-based curricula and have
    protocols in place to approve it

Long-Term Sustainability
  • State leadership committed to sustaining this
    initiative over the long term.
  • Once outreach and medical referrals are made
    through county networks of developed CDSMP
    providers and sponsors, will be largely

Sustaining Evidence-Based Health Promotion
  • South Carolina Perspective
  • Terri Whirrett, Deputy Director
  • Lt. Governors Office on Aging
  • Cora Plass, Director of Healthy Aging
  • South Carolina Department of Health
  • and Environmental Control

National Climate Ripe for Evidence-Based
  • AoAs reauthorization of Older Americans Act
    places new emphasis on prevention by promoting
    EBPPs through aging service organizations
  • Healthy People 2010 Goals
  • Increased coverage of prevention and disease
    management by Medicare
  • CDC, NACDD, NCOA, and AHRQ focus on
    evidence-based prevention

Building the Foundation
  • Working relationship between State Unit on Aging
    and State Health Department stems back to 1980s
  • 2005 - present, relationship strengthened through
    collaboration on EBPPs and formation of
    statewide Healthy Aging Partnership
  • Common focus on prevention
  • Common goal - increase the years and quality of
    life for older adults in SC (Healthy People 2010)

EBP History in South Carolina
  • Lowcountry Senior Center - CDSMP and Enhance
    Fitness prior to grant
  • 3 Master Trainers for CDSMP prior to AoA grant
  • SENIOR grant through NACDD for implementation of
    A Matter of Balance in Lee County
  • Arthritis Foundation EBPs through State Health
    Dept, funded by CDC

Strategies for Sustainability
  • Partnerships
  • Financial Resources
  • Policy Changes
  • A Quality Product
  • Change in Priorities/Culture Change

  • State - statewide coalition, delivery system
    partners, support partners
  • Regional/Local - advisory councils
  • local health, community and faith-based
    organizations volunteers

SC Partnership for Healthy Aging
Convened April 2007 Co-Led by SUA and SHD
Serves as Advisory Council for grant initiative
Provides infrastructure to support and
sustain EBPs
SC Partnership for Healthy Aging
2007, Wide net cast to form SC Partnership for
Healthy Aging with more than 40 organizations
  • Universities
  • SC Hospital Association
  • SC Primary Care Association
  • SC Budget and Control Board
  • Faith-based Organizations
  • Coalitions
  • Silver-Haired Legislature
  • SC Rural Health Association
  • State Medicaid Agency
  • SC Academy of Family Physicians
  • SC Nurses Assoc.
  • State Health Dept Chronic Disease Programs
  • And more

  • SC Hospital Association
  • Health Care Plans - Special Needs Medicare Plan,
  • Osher Lifelong Learning adult education program
  • Institute for Engaged Aging - training center for
    community health workers
  • SC Dept of Vocational Rehabilitation

Partnerships - Contd.
  • Conferences/Districts of AME and AME Zion
    Churches, Progressive Church
  • SC Primary Care Association and federally funded
    health care centers
  • State Diabetes Program and Coalitions
  • State Employees Association

Financial Resources
  • Insurance Reimbursement
  • Grants - CDC Arthritis Grant, state prevention
  • Healthcare organizations - Special Needs Plan
    (CIP), Health Centers, VA

Financial Resources
  • Senior Housing - HUD
  • Employers - EAPs, retired federal and state
  • Charging for Programs

Shared Ownership of Financial Sustainability
  • Provide mini-grants to Aging Network
  • Promote programs
  • and provide training
  • Promote and deliver Arthritis Foundation and
    other EBPs
  • Pay for state license

Joint Support of CDSMP Master Training
Reallocating State Funding Incentive Package
  • 4 pilot programs in 4 new regions
  • LGOA pay for training costs/Master Trainers
  • LGOA purchase state level license
  • LGOA reimburse 4 pilot sites, 70 per completer
    (4 classes minimum) using state appropriated
    funds for home and community-based services

Use of OAA IIID Funds
  • As of July 1, 2008...
  • Must use IIID funds only for EB programs
  • Must use new Scope of Work for IIID programs
  • Strict waiver requirements

IIID Scope of Work
  • Measurable Outcomes
  • Specialized qualifications of leaders
  • Maintenance the fidelity of the evidence-based

IIID Scope of Work
  • Evaluation required Self report of change pre
    and post test other
  • Can charge a fee if funds used to expand the
    program vs. voluntary contributions
  • Documentation required
  • Monitoring conducted by LGOA

Ensuring A Quality Product
  • Partners will not buy in if the program is not a
    high quality product
  • Must assure the lay leaders and Master Trainers
    are of high quality
  • Must monitor fidelity to the program who will
    do this?

Culture Change
  • Change is a process
  • Getting buy-in takes time, planning, patience,
    and hard work
  • Find your champions to help you
  • Build upon small successes
  • Educate, support, and provide technical
  • Use motivational strategies to boost morale and
    maintain momentum

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