CHAPS phases

Eight phases of CHAPS

Use the eight phases of CHAPS to guide your local health agency's collaborative community health assessment and public health improvement plan process. By doing so, your agency will meet the requirements of the Colorado Public Health Act and create a way to address leading public and environmental health issues in your communities.
 
Each phase includes
  • CHAPS tools and templates to help get you started.
  • Recommended steps.
  • Locally developed resources for peer sharing.
Need a quick overview?
Click here for a CHAPS outline of the phases and steps.
 
Follow assessment and planning requirements

Community health assessment and public health improvement plan requirements are listed on the Requirements page. Updates are based on the 2019 Public Health Transformation project, newly updated Colorado Core Public Health Services, and keeping in alignment with PHAB standards and measures, which we recommend for more guidance. See the Background section for additional CHAPS context and history.


Take a health equity approach

Using a health equity approach in your assessment and planning is essential to carrying out an impactful and meaningful process. Consider health equity in all aspects of the process such as who you involve and how, how you build trust, how you collect data, how you communicate results to your community members, and how you determine your priorities. This will support your efforts to change how your communities understand, talk about, and address complex health issues. "Changing the narrative" around health issues opens up the discussion about root, systemic causes such as racism, oppression, and inequities that if left unaddressed will meet with further challenges in truly impacting your communities' health.

We recommend general health equity resources and encourage you to apply this approach to best meet the needs of your communities and seek out the resources that you need to advance this approach.

On this page

Phase 1 Plan the process
Phase 2  Equity and community engagement
Phase 3 Conduct a community health assessment
Phase 4 Assess capacity
Phase 5 Prioritize issues
Phase 6 Develop a plan
Phase 7 Implement, promote, and monitor
Phase 8 Participate in statewide public health improvement opportunities

Include environmental health

The Colorado Public Health Act includes the field of environmental health under the broad definition of public health; therefore, environmental health service capacity indicators and resulting environmental and health outcomes should be documented during local assessment processes. If determined to be a focus area for improvement, use the public health improvement plan (PHIP) to mobilize efforts to address it.

Broader issues of climate change and community resiliency are seen as key issues in Colorado within which public health is a leader and primary partner.


Optimize a regional partnership approach

Local public health agencies may consider taking a regional partnership approach to CHAPS. This approach can help build core public health service capacity in a region and throughout the state by better using scarce resources for assessment and planning activities. This is especially important for agencies that are currently not able to ensure all the foundational public health services and may want to determine how to share services across counties and throughout a region.

Any combination of the phases and steps can be conducted together or separately. At a minimum, it will be helpful to start this process during the same time frame to inform each other, particularly with the number of shared services and regional partners.

See the CHAPS status map to see how LPHAs are currently partnering.


Align with other assessment processes

The following are some examples of other assessment and plans to consider when planning and conducting CHAPS:

  • Non-profit hospital community health needs assessments (CHNAs) are required by the Patient Protection and Affordable Care Act every three years to maintain their preferred tax-exempt status. Many LPHAs partner with their local hospitals to share data collection processes and results as well as to partner on shared priority issues.
  • Other funders, including CDPHE programs, may also require an assessment to meet contractual requirements, such as the Communities That Care youth substance use prevention program.
  • Each agency receives CDPHE Maternal and Childhood Health grants, many of which leverage the CHAPS process to meet their Maternal and Childhood Health goals.
  • Environmental health assessment processes, such as PACE-EH.

This list is not all-inclusive. It is important to do a scan of other assessment and planning processes going on within your agency and community when beginning the CHAPS process.


Align with strategic partners

Local public health agency strategic plans, the PHIP, and even partner strategic plans should include goals, strategies, evaluation measures, and time frames. Remember, the PHIP involves the entire public health system, including organizations and individuals outside the public health agency, whereas the agency strategic plan is specific to agency staff and resources. It is important to seek alignment when partnership and synergy can help advance your goals.

Ideally, the CHA informs the PHIP and the PHIP informs your agency's strategic plan. To follow national standards and best practices, incorporate relevant parts of the local public health plan into the strategic plan. This helps hold the agency accountable for implementation and to measure progress. Additionally, the agency-level strategic plan, like the public health improvement plan, is one of the prerequisites for voluntary national PHAB accreditation.

Phase 1: Plan the process

Use this phase to help determine the project's scope; leadership, advisory roles, and relationships; develop partnerships; needed resources; timeline; and initial communications.

These planning steps are recommended and can be done simultaneously or in an order that makes the most sense for your agency and partners. Review all CHAPS phases before returning to Phase 1 to begin your planning. Timing, funding, and capacity assets can help drive how the assessment and planning process is initiated.

 

The local public health agency (LPHA) CHAPS point of contact and project management team are responsible for planning and management of the entire CHAPS process. The entire assessment and planning process is meant to be community-wide and include stakeholders, however, the main driver for the community health assessment (CHA) and public health improvement plan (PHIP) is a requirement of each local public health agency in Colorado. Therefore, the structure and makeup of the team will depend on how you are conducting the CHAPS process: as a single entity, regional LPHA partnership, or partnering with other local organizations.

Roles can include

  • Project manager: coordinates and manages the implementation of all CHAPS activities
  • Agency decision-maker(s): public health director, division director, director of planning, etc.
  • Health planner: gathers, interprets, and communicates data
  • Facilitator: plans, facilitates, and records meetings
  • Content experts: LPHA staff and community partners with knowledge across public health topics
  • Administrative support: coordinates logistics and communicates with stakeholders.
  • Partner organization(s): if the process is being co-led, hospital, agency, or community partner
  • Community representatives

Gaps in skills can also inform who else in your community or region needs to be part of the process to inform best practices and quality engagement. OPHP staff can also help connect you to these resources and potential partners.

 

Determine if your internal team needs any additional training on

  • CHAPS
  • Project management
  • Data collection (quantitative and qualitative)
  • Public Health Accreditation
  • Change management
  • Health equity and community engagement
  • Social determinants of health
  • Strategic planning
  • Facilitation

Why

The community health assessment and public health improvement plan are intended to be community-based processes and guiding documents that support the local public health agency, key stakeholders and community residents in addressing priority health issues. Once you have determined the internal roles of LPHA staff, create a group of key community or regional stakeholders. This group can:

  • Advise the assessment process (data collection and community engagement).
  • Engage community.
  • Participate in prioritization of public health and environmental health issues.
  • Develop the public health improvement plan.
  • Form work groups to craft action plans to address priority issues.
  • Be responsible for or advise implementation.
  • Contribute to the monitoring and revision of action plans.

 

Who

The make-up of this group will be dependent upon your local process. For example, it can be an already formed group of local partners, such as a health care coalition, public health alliance, or LPHA staff representing different counties in a regional partnership. Or it can be a newly formed group for the purpose of guiding the CHAPS process.

Convening this type of advisory group is a great example of Public Health 3.0 and illustrates the chief health strategist role that public health plays. From this vantage point, it is also an opportunity for public health to strategically seek stakeholders beyond public health. As the Colorado public health system works to address and support priority issues such as climate change and behavioral health in ways that focus on the root causes of the issues and associated inequities, this advisory group is one place to engage different sectors and community members. Engaging diverse perspectives in the data collection, prioritization, and decision-making activities will strengthen the validity, transparency, and potential impact of the assessment and planning process in your communities. Use a health equity framework, like the Bay Area Regional Health Inequities Initiative (BARHII) Framework as a guide for which sectors and parts of your community you can engage in this advisory group. See Phase: 2 Engage Stakeholders for further guidance on engaging stakeholders throughout the CHAPS process.

 

Advisory group engagement

This is group is composed of strategically selected stakeholders who meet regularly to advise the assessment process, participate in prioritization, then develop and implement the public health improvement plan.

The internal project management team should be a part of the advisory group, in addition to community organizations, civic leaders, elected officials, and consumers.

Recruit members who can influence systems, provide a voice to underserved communities and/or champion priorities. New members can be added at any time. This type of committee usually meets monthly, bimonthly, or quarterly, depending on the planned milestones and timelines.

The advisory group may range in size from a few people to 20 or more. If you have too many participants to reasonably manage, consider using topic-specific subcommittees, each with a representative to the larger steering committee.

A trained facilitator is useful to manage advisory group meetings, as this is where key decisions will be made.

  • Contribute to the communication and promotion of the process and plan.
  • Contribute to the evaluation of action plans and assessment and planning process to provide recommendations for improvements for the next cycle.

In addition to or in lieu of an advisory group, you may choose to do this work in partnership with another entity. Partnering with either neighboring local public health agencies in your region or community organizations within your jurisdiction, such as non-profit organizations, other government agencies or hospitals, may be a more efficient or effective way to carry out the CHAPS process in your jurisdiction(s). Colorado local public health partnerships have sprung up around conducting assessments on shared populations and implementing shared, county-wide and region-wide public health improvement plans. As LPHAs develop strategic partnerships to address pressing priority and emerging issues, variations of partnership models are needed to tackle issues that public health cannot tackle by itself.

If this is the route you take, consider developing a legal agreement such as a memorandum of understanding (MOU) to formally delineate roles, expectations, leadership, and funding. Check out the Center for Public Health Sharing for guidance on government cross-jurisdictional sharing.

A common time frame for the full CHAPS process is approximately 12 to 24 months. Use a timeline to outline how long you plan each phase to take. Use a work plan to outline more detailed activities, time frame, and person responsible for each phase.

Talk with the OPHP Public Health Planner about

  • Timing and work plan
  • Requirements
  • Partnerships

At any step in the process, connect with OPHP for guidance and support on

  • Potential funding
  • Data collection and sources
  • Training and capacity building needs

Familiarize yourself and your partners with the:

Requirements for local public health agency community health assessments and public health improvement plans. Start with the Requirements for Local Public Health Improvement crosswalk. Pay close attention to the Public Health Act, which can be found at Section 25-1-501, CRS et seq. (Title 25 - Public Health and Environment - Article I: Administration - Part 5 Public Health Act - Subparts 1 through 3). This statute requires local and statewide public health improvement plans to be conducted every 5 years.

Phases and steps of CHAPS so you can formulate your local process, determine where your process may deviate, and note any questions for the Office of Public Health Practice, Planning, and Local Partnerships (OPHP). This discussion will help inform the overall CHAPS process with local examples.

State and national level standards for community health assessments and public health improvement plans, such as:

Review existing assessments and plans to prevent duplication of effort, seek new stakeholders and partnerships, use data and priorities that have already been established, illuminate gaps, and help frame the scope of your process.

Here are recommended places to start:

Who

Determine which organizational leaders in the community will need to be involved in this process ahead of time so they can support it. Then, determine how you will continually engage them in the process. Those with approving authority, such as agency leadership and your local board of health, will be some of the first levels of leadership you will work with.

These leaders may include:

  • County administrator.
  • County commissioners.
  • Local board(s) of health.
  • Public health/environmental health agency staff.
  • Local hospital(s)
  • Non-profit entities, including those outside of public health
  • Other county governmental agencies, including those outside of public health
  • School district(s)
  • Service organizations

 

Consider additional key supporters. These are stakeholders who may or may not be formally involved in the process but who need to know about it early, so they can be supportive.

 

How

The community health assessment and public health improvement plans are valuable efforts to talk about health and environmental issues in new and different ways to impact the changes you seek. How the results of the assessment and the prioritized issues are communicated or framed can have a bearing on how they are interpreted, believed, acted upon, and supported. Phase 3 (Assess community), Phase 6 (Develop the plan), and Phase 7 (Implement the plan) all include recommendations to build a communications plan. Use those steps to take a closer look at communication methods and modes. Communicating the process and findings with leadership will be an initial test of your messaging, explanation, and context that you provide along with data results.

The resources needed to complete assessment and planning activities will depend on

  • Size of the community(ies).
  • Amount of in-kind resources (i.e. donated time, money, supplies, space, etc.)
  • How extensive the assessment and planning process needs to be, based on what is already available.

 

Operations

Develop a budget that includes the following:

Identify operational resource needs to carry out all phases of CHAPS. Note which are provided in-kind vs. those that need funding. Examples include:

  • Meeting space
  • Equipment (laptop, projector, conferencing capabilities)
  • Supplies for meetings (flip charts, markers)
  • Travel funding (mileage reimbursement to promote participation)
  • Funding for producing a printable and/or online version of the community health assessment and public health improvement plan
  • Funding for community engagement processes
  • Staff training and capacity building if they are new to their role

Consider resource needs for monitoring and evaluating the impact of your plans. Contact state agencies, other LPHAs, or other community organizations who might be needed to provide data or technical assistance for the evaluation early in the process.

Determine if there are community partners who might also benefit from a public health improvement process and may be willing to contribute resources, such as

  • Nonprofit hospitals: required to complete a community health assessment every 3 years.
  • Community partners: may contribute staff time, supplies, equipment, meeting space.
  • Public Health or Nursing Students: student project contributions.

 

Download a Sample CHAPS Budget

Review sample job descriptions

  • Project Manager Position Description
  • Health Planner Position Description
  • Facilitator Position Description

 

Personnel

Identify key positions and personnel needs in relationship to current staff resources and the scope of your process.

A single staff member may be used to fill more than one position and a consultant may also carry out the functions of a position (facilitation, data analysis, strategic planning).

Phase 2: Equity and community engagement

Use this phase to think through how you will engage a range of stakeholders throughout the CHAPS process to support equity and create a better assessment, plan, and implementation process. Local public health agencies are the required entity to carry out this process but it is intended to be done in partnership with the community.

Engaging stakeholders is addressed through the CHAPS phases, which will take place over the course of a few years so be mindful of your engagement methods and adapt as necessary to respond to your community's needs and capacity for involvement. The community engagement strategies you use will be one way that you will be able to be transparent, build trust, and address equity through your assessment and planning process.

Community engagement is an essential function of public health and found across national and state requirements is a public health best practice. Colorado Core Public Health Services and Capabilities model cites community engagement as a way to operationalize core services and PHAB devotes Domain 4: Engage with the community to identify and address health problems to this work and requires it in both the community health assessment and community health improvement plan processes.

 

Phase 2 tools &, templates

 

Shared Definitions

There are many reputable and wonderful community engagement and health equity resources that can guide your assessment and planning process. To maintain focus in CHAPS, we will reference a shortlist of recommended resources and encourage you to explore and adapt others to inform your local process.

Engaging a variety of different individuals, organizations, and sectors that have a "stake" in the process is a consistent activity throughout the CHAPS process. Regardless of the term used to define individuals that ultimately form the groups involved, it all falls within the definition of community engagement. Terms will be used interchangeably within guidance and local application and the same principles will apply.

Community engagement

As defined by the Colorado Office of Health Equity in the Authentic Community Engagement to Advance Equity resource, is:

  • "a two-way exchange of information, ideas, and resources. Community engagement should offer opportunities to exercise power in decision-making. It should also consider the diversity of our communities - including culture and ethnicity - and seek to create an inclusive and accessible process."

PHAB guidance in Domain 4 expands on the definition to include:

  • "Community engagement is an ongoing process of dialogue and discussion, collective decisions, and shared ownership. Public health improvement requires social change, social change takes place when the population affected by the problem is involved in the solution. Collaborative partnerships to address public health issues and concerns provide various perspectives, additional expertise, and assets and resources. Partnerships provide the opportunity to leverage resources, coordinate activities, and employ community assets in new and effective ways. Collaborative partnerships include engagement with community members so that they are involved in the process and participate in the decisions made and actions taken. Community engagement also has benefits of strengthening social engagement, building social capital, establishing trust, ensuring accountability, and building community resilience."
Equity

As defined by the Colorado Office of Health Equity, is:

  • "when everyone, regardless of who they are or where they come from has the opportunity to thrive. This requires eliminating barriers like poverty and repairing injustices in systems such as education, health, criminal justice, and transportation." Colorado Office of Health Equity definition.

Equity and community engagement are then paired because you cannot do community engagement without addressing equity and you cannot address equity without doing community engagement. The Colorado Equity Action Guide challenges the CHA/PHIP process to empower communities and to "lift up community-identified needs and solutions." Conducting cyclical assessment, planning, and implementation processes can become a way to both "educate and mobilize" your communities. Seek out and build relationships with community champions and community organizers to inform community engagement efforts and data collection.

You and your partners are strongly encouraged to engage community members' lived experience along with traditional data sources to get the reasons for and solutions to equity-based health issues.

Furthermore, the Colorado Core Public Health Services and Capabilities operationalizes health equity and social determinants of health in the following capability definition:

  • "The governmental public health system in Colorado will intentionally focus on improving systems and institutions that create or perpetuate socio-economic disadvantage, social exclusion, racism, historical injustice, or other forms of oppression so that all people and communities in Colorado can achieve the highest level of health possible. Governmental Public Health will have the requisite skills, competencies, and capacities to play an essential role in creating comprehensive strategies needed to address health inequities and social determinants of health."

To do this work, you need quality engagement practices delivered in culturally and linguistically appropriate ways to listen, learn, and act. These practices will then provide a foundation to collect data, make decisions, provide leadership, and ultimately inform how you will tell the health story of your communities, county, and region.

By engaging in a variety of stakeholders throughout the CHAPS process in an intentional and thoughtful way, you can ensure that your assessment and plan reflects your community's voice and priorities. Without their involvement, you may miss aspects of their lived experience that shed light on potential root causes and local solutions that may not otherwise appear in your data collection processes or in the literature. With increasing efforts to address the root causes of your community's health issues in addition to addressing current conditions, their voice is ever more important.

 

Recommended resources

There are many resources on how to go about engaging stakeholders, conducting community engagement, and thoughtfully using the results of your engagement (new partnerships, data collection, etc.). Here are a few recommendations:

 

Use engagement to advance equity.

The Colorado Office of Health Equity's Authentic Community Engagement to Advance Equity recommendations can help facilitate a discussion on how assessment and planning work plays an invaluable role in providing data, engaging the community, and prioritizing issues in ways that communicate health inequities.

True to the Public Health 3.0 "chief health strategist" role, this ongoing effort will result in partnerships building opportunities that may not have been imagined otherwise. Including a variety of perspectives and efforts are necessary to tell the lived health story of your community, county, or region. It is also essential to addressing health inequities and addressing them with meaningful, locally developed solutions.

 

Link with other community initiatives

With a focus on equity, engagement and a diverse set of stakeholders comes alignment with other health initiatives that are likely occurring within your community. The public health agency's role as leader and convener of this stakeholder process will promote local alignment of priorities, strategies, and resources to improve community-driven focus areas.

An initial meeting with these entities can determine whether they are collecting data that can inform your assessments and whether the issue and work they are championing can be supported through the public health improvement process. For example, the local hospital may be mandated to also conduct a community health assessment under the Affordable Care Act. Also, there may be community coalitions that are organized around a particular health issue, determinant of health(e.g., housing, transportation), or population (e.g., seniors/adolescents) that can contribute to or join your process.

 

Apply what you have learned

Use a community engagement spectrum or continuum to understand what types of engagement you are employing or would like to employ, why, and how. A cornerstone resource has been a public participation spectrum developed by the International Association for Public Participation. Through CHAPS peer-networking event, CHAPS Community Engagement Spectrum version was created to apply the recommendations in the spectrum.

 

Use best practices

The Health Impact Project developed the Health Equity Guide for government entities with a specific focus on "Share[ing] power with communities" as a way to use community engagement effectively. Best practices to keep in mind include:

  • Remaining open to learning about community priorities
  • Allowing time and space to get to know one another
  • Identifying strategic opportunities for communities to contribute their expertise and knowledge
  • Sharing resources to develop skills and capacity to partner with the health department

The CDC Practitioner's Guide to Advancing Health Equity is another resource that provides guidance on how to go about meaningful community engagement, such as learning about the history of engagement in the communities you seek to support and work with. What has worked well or not in the past is important for your relationship building going into an engagement. Check out steps like these in the mini-version of the guide: Meaningful Community Engagement for Health and Equity. Tailor your engagement to be culturally and linguistically appropriate for the communities you are engaging with. Reference the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care blueprint.

Enter into community engagement with an open mind and respect that you may not know what you do not know. Because of this, it can be helpful to use an objective tool that facilitates the process of understanding what you and your partners know, what you need to learn, and where you can learn it from.

 

Here are two equity assessment tools that can get you started:

Community Engagement Assessment tool developed by the Nexus Community Partners organization is a self-assessment to ask why, how, and when you will engage. Racial Equity Toolkit developed by the Government Alliance on Race and Equity (GARE). See Step #3 for community engagement questions along with other GARE resources mentioned in the toolkit.

 

Questions to consider:

What training do stakeholders need to meaningfully engage stakeholders? What resources do we have internally to engage stakeholders through community engagement activities and events? What resources do we have in the community that can help us manage and execute engagement efforts? (e.g., existing coalitions, other efforts engaging the community for different purposes, grants available, CSPH community health assessment class)

The assessment tools will be useful again in the development of the community health assessment (Phase 3), capacity assessment (Phase 4), and public health improvement plan (Phase 5).

 

Workforce development

Based on the results of your community engagement discussions and assessments thus far, assess the need to develop community engagement and equity skills to carry out this work as well as what resources you will need to sustain ongoing engagement with stakeholders throughout the CHAPS process. Reference the Colorado Office of Health Equity's Measuring Performance to Advance Equity for indicators that you can use to design a process and support your stakeholders so that you can achieve equitable outcomes.

This type of engagement and with who will depend on the level and type of expertise you need to incorporate into the process. With your advisory group, identify the points at which it would be most helpful to engage stakeholders in your process and consider your community capacity for managing engagement efforts.

 

Stakeholders

Local customization of community engagement techniques is the key to making them work. While some of your stakeholders, such as advisory group members, will play a consistent role throughout your process, others may engage only at specific times. Also, consider any differences in power or communication skills among your stakeholders and explore ways to ensure that each participant has an equal voice in any given process. It is also very important that all stakeholders have a role that's purposeful, specific, and defined, and that their time and contributions are recognized and celebrated.

When to involve stakeholders depends on the role they will play and those associated activities. The scheduling of stakeholder activities will be driven by the timeline of your overall project and the related outputs and milestones.

Stakeholders whose support, approval, and/or funding that you need to make sure the process is successful from the start and able to move forward should be engaged first. In CHAPS, these are called "key supporters" and include the local board of health, LPHA staff, county commissioners, county administrator, and other community leaders. Stakeholders who will be involved in an ongoing advisory capacity, such as a steering committee.

  • Before selection, you may want to take an initial look at community health data to aid in identifying steering committee members based on known health issues.
  • Alternatively, you may already have a community group working broadly on health issues that can fulfill the role of the steering committee.

 

Coalitions or other organizations

Coalitions or other organizations working on a singular health issue should also be engaged as soon as the topic becomes relevant to the process.

  • These groups can be managed as subcommittees with a designated representative to the larger steering committee to ensure alignment among all the groups.

 

Subject matter experts, Focus groups, and Stakeholder meetings

Interviews of subject matter experts and the facilitation of focus groups and stakeholder meetings are likely to occur later, during the assessment and planning phases. Engaging stakeholders through these mechanisms can:

  • Elicit community perceptions of health issues
  • Determine why certain health indicators look the way they do, including likely root causes
  • Suggest strategies to address health issues, including programs or initiatives already planned or in progress
  • Identify community entities in the best position to take the lead on an issue

You will know who you need to involve in this process, however, as public health works to address ever more complex health issues and the social determinants that influence health, consider this recommended list of potential stakeholders.

Who can...

Impact the leading causes of disease, injury, disability, and death and/or the greatest health risk to our community?

Represent populations that should be assured a voice in the process?

Provide lived experience with the issue we are working to address?

• Community-based organizations

• Other non-health local governmental departments or agencies such as transportation, education, law enforcement, justice department, housing authority/agency, economic development, parks and recreation, planning and zoning

• Human services

• School board(s)

• Environmental health organizations

• Local hospital, other medical providers, health plans

• Business community

• Community members, especially those who will be impacted by the plan, such as youth, parents, seniors, LGBTQ, refugees and immigrants, and/or people with disabilities, etc.

• Populations that are at higher health risk or have poorer health outcomes

• Faith-based organizations

• Civic groups such as Rotary Club or Lions Club

• Media

What other entities are also providing foundational public health services or addressing a pressing health issue?

• Neighboring local public health agencies

• Other non-health governmental departments or agencies

• Community-based organizations

• Local hospital and other medical providers

• State or federal governments

Who is in a leadership position to change or influence policy, impact large systems, provide a new service or contribute resources?

• Elected officials

• Local board(s) of health

• Directors of community-based organizations

• Public health director from a neighboring county

• Community coalitions

• Municipal leadership

• Other non-health local governmental departments or agencies such as transportation, education, law enforcement, justice department, housing authority/agency, economic development, parks and recreation, planning and zoning

• Area Health Education Centers (AHECs)

• CEOs (or their designees) of local health-oriented businesses (e.g., hospital)

• Community champions who may advocate and fundraise

• Other agencies that would naturally take the lead on an issue that impacts public health (law enforcement, planning dept., school district, human services, etc.)

What subject matter experts are need to inform the process?

• Community members and trusted leaders in the community

• Representatives and members of disparately affected populations

• Community advocates/organizers that may provide a voice for hard-to-reach populations

• Issue-specific experts at local, state and/or national level

Whose support is needed to assure the process is successful?

• Public health agency director

• County administrator

• Local board of health

• Elected officials

• Everyone engaged in your process

Adapted from CHAPS 1.0 and PHAB reaccreditation requirements.

 

Engagement strategies

Stakeholders will be engaged throughout the process, so while they all do not need to be contacted immediately, it will be good to have a plan for who gets contacted when, in what manner, and by whom. Here are general recommendations:

 

Communications methods and techniques

LPHAs are more commonly including aspects of communities or partners engaged, how often, and in what ways in the action plans so that this effort is done in tandem with key activities to address the priority issue. Action plans are discussed in Phase 6.

Some stakeholders may "wear many hats" within the community and be involved in many volunteer and community efforts. Be mindful of this challenge and use it to inform how often they are engaged, in what methods or mode, and why. Hone your facilitation skills to be the most efficient with their time.

 

Build engagement and communication into your action plans

When engaging stakeholders for the first time, it will be particularly important to define expectations such as their role, time commitment, level of decision-making authority, how communication will occur, and intended outcome (e.g., a public health improvement plan). Many times, community members are overextended and may be reluctant or unable to participate in one more local effort. Providing them with a well-defined role, timeline, and a vision of the outcome communicates your resolve to get things done.

 

Minimize burnout

This approach can also help you negotiate the type of participation by specific stakeholders. For example, if an organization's leader cannot commit to regular meetings, ask her or him to delegate a representative and see if she or he would agree to serve as a subject matter expert. This will keep her or him engaged, even if she or he cannot participate in an ongoing manner.

 

Initial engagement

The health of a community is influenced by a number of factors, not all of which are under the public health agency's control. For some issues, other community entities may be in a better position to carry out strategies that improve public health. Learn more about addressing social determinants of health and how to create effective messaging from resources like the Colorado Office of Health Equity.

 

Face-to-face meetings

Your recruitment will be more successful if you determine the best method of making contact, instead of a one-size-fits-all approach. So, while some of the "usual suspects" may agree to participate after simply receiving a letter or email, you may get better results from other stakeholders, especially those who are new or deemed absolutely essential, through a face-to-face meeting.

 

Partners outside of public health

Potential stakeholders will need to understand the"why" behind your work in order to find shared beliefs and values that would motivate engagement. Learn more about messaging and communication, especially around complex issues such as housing and mental health at the FrameWorks Institute. The County Health Rankings and Roadmaps Action Center also provides concrete tools and resources to develop sound communication plans.

Determine if additional stakeholders would benefit the process. This may occur through mechanisms such as:

  • Asking the steering committee who's missing
  • Asking subject matter experts to recommend additional experts
  • The emergence of new environmental and public health issues during the assessment phases.
  • Realization of the need for further community input for prioritization and planning

New stakeholders may be added at any time. If new members are added to the advisory group, consider providing them with an orientation before their first meeting. Likewise, stakeholder positions may change individuals, such as county commissioners and leadership positions. Do your due diligence to get them up to speed so that you can maintain institutional knowledge in the process and incorporate the expertise and insights that a new individual will bring to the process.

Throughout the process, use a positive engagement strategy to acknowledge the contributions of all your partners and invite them to celebrate the achievement of milestones. A key part of the celebration is to acknowledge progress. When any milestone is reached, establish or maintain an ongoing communication mechanism to keep them informed and engaged to the degree that is appropriate for their role and level of interest.

The CDC cites common and instructive guiding principles of a community health assessment process. As you prepare for the process or reflect back on engagement, look at how many are tied to meaningful community engagement of diverse stakeholders.

Multi-sector collaborations that support shared ownership of all phases of community health improvement, including assessment, planning, investment, implementation, evaluation. Proactive, broad, and diverse community engagement to improve results.
- From Principles to Consider for the Implementation of a Community Health Needs Assessment Process (June 2013), Sara Rosenbaum, JD, The George Washington University School of Public Health and Health Services, Department of Health Policy.

  • A definition of community that encompasses both a significant enough area to allow for population-wide interventions and measurable results, and includes a targeted focus to address disparities among subpopulations.
  • Maximum transparency to improve community engagement and accountability
  • Use of evidence-based interventions and encouragement of innovative practices with a thorough evaluation
  • Evaluation to inform a continuous improvement process
  • Use of the highest quality data pooled from and shared among, diverse public and private sources

Phase 3: Conduct a community health assessment

Use this phase to design and conduct a community health assessment (CHA). Recommended steps will guide you and your partners through reviewing requirements and background materials, gathering, collecting and interpreting data, engaging the community, and communicating results. Steps can be carried out in an order that makes the most sense for your process. The results will inform prioritization and the local public health improvement plan, driving the work on top of health concerns over the next five years.

Considered a necessary foundation for quality public health work, conducting a comprehensive assessment of the community's health and environmental status is a Colorado Public Health Act requirement and a Colorado Core Public Health Capability for local public health agencies, as well as a prerequisite for agencies choosing to become accredited under the national voluntary Public Health Accreditation Board standards (PHAB). CHAPS Phase 3 aligns with PHAB Version 1.5 standards for conducting a comprehensive community health assessment.
 
 
Important elements of a community health assessment
A story approach
Phase 3 guidance will help you tell the "story" of the health of your communities and the broad list of factors that are involved, reflecting the lived experiences of health. This concept helps us visualize the many different data inputs woven together to provide evidence and context to health issues and assets so that we can understand root causes and make the best decision about solutions and strategies, especially when communicating with a broad set of partners and stakeholders.
 
Shared definition
It is important to be grounded in a base definition of a community health assessment (CHA), such as this one adapted by the Public Health Accreditation Board:
 
Community health assessment is a systematic examination of the health status indicators for a given population that is used to identify key problems and assets in a community. The ultimate goal of a community health assessment is to develop strategies to address the community's health needs and identified issues. A variety of tools and processes may be used to conduct a community health assessment, the essential ingredients are community engagement and collaborative participation.
 
 
The CDC cites common and instructive guiding principles of a community health assessment process:
  • Multi-sector collaborations that support shared ownership of all phases of community health improvement, including assessment, planning, investment, implementation, and evaluation
  • Proactive, broad, and diverse community engagement to improve results
  • A definition of community that encompasses both a significant enough area to allow for population-wide interventions and measurable results, and includes targeted focus to address disparities among subpopulations
  • Maximum transparency to improve community and accountability
  • Use of evidence-based interventions and encouragement of innovative practices with a thorough evaluation
  • Evaluation to inform a continuous improvement process
  • Use of the highest quality data pooled from and shared among, diverse public and private sources
    -From Principles to Consider For Implementation of a Community Health Needs Assessment Process (June 2013), Sara Rosenbaum, JD, The George Washington University School of Public Health and Health Services, Department of Health Policy.

 

A community health assessment is a valuable public health role and responsibility. Enjoy piecing together data and telling your community's story!

 
Public Health Act requirements and timeline
The Colorado Public Health Act of 2008 (Section 25-1-501, CRS et. seq.), and the Core Public Health Capability: Assessment and Planning, require a public health improvement planning process to include the following six components of which the first three are specific to the community health assessment:
  • Examine data about health status and risk factors in the local community
  • Assess the capacity and performance of the county or district public health system
  • Identify goals and strategies for improving the health of the local community
  • Describe how representatives of the local community develop and implement the local plan
  • Address how county or district public health agencies coordinate with the state department and others within the public health system to accomplish goals and priorities identified in the comprehensive, statewide public health improvement plan
  • Identify financial resources available to meet identified public health needs and to meet requirements for the provision of core public health services
  • Not to be inconsistent with the statewide public health improvement plan

 

CHAPS provides guidance on meeting these requirements along with an emphasis on health equity and community engagement. Steps are in alignment with Public Health Accreditation Board (PHAB) Standards and Measures Version 1.5 and are continually updated to reflect best practices. Agencies seeking accreditation should visit the PHAB website to review the latest guidance and documentation requirements. Reviewing the full set of PHAB standards and measures will provide useful information throughout the development and implementation of your public health improvement plan.

For additional information and context, got to the Requirements page.

 

Timeline
Local and state public health agencies are also required to carry out this process on a five-year cycle. The most recent local public health improvement assessments and plans will have been completed in 2016-2019. The most recent state health assessment was completed at the end of 2018.

It's recommended that local assessments, prioritization, and, if possible, completed plans be submitted prior to each statewide plan to inform the development and implementation of the state plan; therefore, the next local public health assessments and improvement plans are due in 2024 and the state plan is due in 2025.

 

Begin this phase by collecting and reviewing requirements, background materials and inquiring with agency staff who have been involved in the process before.

Useful questions to consider:

  • What are the requirements for a local community public health assessment?
  • What are the priorities identified in your last PHIP?
  • Have you reached out to current and potential partners to learn about their recent assessments or priorities in your community, county or region?
  • Are there specific efforts to address health inequities happening in your community, county or region?
  • What are other current local and/or regional priorities?
  • What are the current state public health and environmental health priorities?
  • How does this information inform your assessment process?

 

Document

Purpose

Requirements

Colorado Public Health Act (found at section 25-1-505, CRS et seq. Title 25 - Public Health and Environment - Article I: Administration - Part 5 Public Health Act - Subpart 2 Public Health Plans)

Community health assessment and public health improvement plan requirements for local public health agencies, public health directors and local boards of health. Use to guide entire process as well as determine capacity.

 

Public Health Act and PHAB requirements

Outline responsible party, process requirements, approvals, timeline and link between local and state processes.

 

Colorado Core Public Health Capability: Assessment and Planning

Note: Most applicable resources will be linked when available.

Required assessment and planning knowledge and skill capacity.

Background Materials

Past health assessments conducted by your agency

Note significant findings and investigate changes or trends. Review data collection methods and communication plan.

 

Needs assessments conducted by other entities in your community, county or region

Supplement your assessment, prevent duplication of effort, determine additional community-specific data needed.

 

Community health assessments from other jurisdictions

Awareness of how similar counties/local public health agencies have carried out their assessment process.

 

Colorado health and environmental assessments:

Colorado\'s Story: 2018 Public Health and Environmental Assessment | Assessment dashboard

2013 Colorado Health and Environmental Assessment

Align priorities, goals, strategies and partners where appropriate.

 

Colorado public health improvement plans:

2020-2024 Coming in 2019! Progress Upates

2015-2019 Healthy Colorado: Shaping a state of health | PDF

Align priorities, goals, strategies and partnes where appropriate.

Meaningful process
It is important to design and carry out a process that meets local needs and is meaningful to your agency, partners and communities. Research other assessment and planning resources to learn more about the process, access different tools and methods, or find more specific guidance on assessment and planning activities. The following resources are recommended and commonly used:

Use a data gathering outline to guide the assessment. It will include data gathering, collection and analysis, and community engagement. The scope will depend on available data, data needs and capacity. The results will support the design of a comprehensive community health assessment that tells the "story" of the health of your community/ies and environment.

Elements of an outline

Think through the data that you would like to use to describe the story of your community. Here are a few elements to consider:

Definitions

  • Define what is meant by "community" with explicit attention paid to populations experiencing health inequities. Develop or use already existing definitions for health, health equity and social determinants of health to guide the data you gather, collect and use in the assessment and planning process. Note that some of these can be informed by community member perspectives in the data collection process.

‚ÄãHere are two recommended examples:

  • Equity is when everyone, regardlessof who they are or where they come from has the opportunity to thrive. This requires eliminating barriers like poverty and repairing injustices in systems such as education, health, criminal justice and transportation."‚ÄãColorado Office of Health Equity
  • "Social determinants of health are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems." World Health Organization

‚ÄãFramework or model

  • Using a framework or model will help you think through the different components or "buckets" that describe the population so that you take a comprehensive look at all the factors influencing the health of the community. It also gives you a way to organize the data that you are collecting and help identify data gaps where you might need to gather more information. Look for frameworks or models that include upstream determinants of health to ensure a comprehensive process. Lastly, the model you select to outline your data gathering activity does not have to be the way you choose to display or report your data results. here are three recommended examples:

‚ÄãHealth Equity Approach

  • In addition to using a health equity focused framework, actively embed health equity into the assessment process. The local CHAPS process is a valuable effort that can be used to highlight health inequities while also building inclusive and trusting partnerships. Through your community\'s lived experiences or use of health equity and social determinants of health indicators and data sources, root causes can be identified.
  • It can also be a force for broader, multi-sector partnership building and for new ways of meaningfully engaging community members. Make sure your staff and partners know what health equity is and why it is important in the assessment process. Reach out if you have questions and tap into the plethora of health equity capacity building resources available to apply this approach

‚ÄãData sources and methods

  • A CHA is a method to tell the story of the health of your community/ies, integrating a variety of different data sources together to do so. Use this outline to identify and document an initial list of data sources and methods you intend on using in assessment.
  • Include both quantitative and qualitative data sources. Differentiate between already collected sources of secondary data and potential new primary data sources and/or collection methods. Carefully document the sources and methods to support a plan to monitor and refresh the data. Plan on updating or refining this list as you progress in your data gathering and collection efforts.

‚ÄãExisting assessments and priority issues

‚ÄãAssets and resources

  • When telling the health story of a community, we recommend using a strengths-based approach so that you look for assets and resources throughout the data collection process. This approach may bring more partners to the process, help identify areas of a community that support the health of the population, and even potential solutions to consider when developing the public health improvement plan.

‚ÄãPHAB Community health assessment requirements (1.1.2 T/L 1.a-e)

  • A local or Tribal community health assessment includes:
  1. ‚ÄãData and information from various sources contributed to the community health assessment and how the data were obtained.
  2. Demographics of the population
  3. Description of the health issues and specific descriptions of population groups with particular health issues and inequities.
  4. Description of factors that contribute to specific populations\' health challenges.
  5. Description of existing Tribal or community assets or resources to address health issues.

‚ÄãYour outline will depend on how you design your community health assessment. Contact the Office of Planning, Partnerships and Improvementto discuss any questions, data collection needs or ideas that you may have.

Determine the resources needed to carry out a community health assessment based on collection and review of background materials, requirements and your data gathering outline.

Useful questions to consider:

  • What is the timeline of our process?
  • Are there any deadlines driving it and if so what can be accomplished in the allotted time frame?
  • What internal human resources are available or obtainable to dedicate to this assessment?
  • Is your advisory group prepared to help provide guidance, input and investment of time and resources?
  • How will you engage your advisory group who will help guide the assessment? (Think meeting location, structure and access as well as what they will commit to helping with.)
  • What other partners do you need to engage to help fill data gaps or gain additional community perspectives?
  • Will you need to engage subject matter experts to inform data sources and collection methods?
  • Will you use a consultant or partner with the Colorado School of Public Health?
  • Will a variety of sectors be involved in data gathering, collection and interpretation?

‚ÄãUltimately, you need to ensure that you, your advisory group and partners have the knowledge, skills, relationships and resources on hand to carry out a comprehensive community health assessment to the best of your abilities.

Community engagement is an "essential ingredient" in a community health assessment and throughout the CHAPS process. Refer back to the equity and engagement assessment tools recommended in Phase 2 for additional information. It is worth learning more about it, building the necessary relationships to do it well, and allotting time and resources to make it happen. Engagement of your community members should span the geography covered in the assessment, capture community strengths and assets and include communities experiencing health inequities.

Use tools like the CHAPS Community Engagement Spectrum to decide why, when and how you will meaningfully engage along with results of any equity and engagement tools you may have completed thus far.

As expressed in Phase 2, there are many resources to guide community engagement work. Below are recommended resources for this step but continue to look for the right tools that wok well for your local process.

Use the data gathering outline you\'ve developed in Step 2 to guide you through this step. First, you will gather quantitative and qualitative data that has been previously collected. Then ask, "What else do we need to know to tell the story of health of our communities?" Next you will collect additional secondary or primary data to complete the "story".

Data support

Engage internal agency staff and/or partners who have expertise in data collection, analysis and interpretation. These initial activities can be challenging so make sure you are involving the right people with the skill sets needed to help. This can include epidemiologists, planners with past assessment experiences and even state or national program staff who can offer insights into the types of indicators and measures youcan use. Having this support system set up will help prepare you for handling gaps in data or suppressed data, especially if you are in a rural or frontier area. Also, you can reach out to the Office of Planning, Partnerships and Improvement throughout this process for guidance on all aspects of data collection, analysis, interpretation and communication.

Gather quantitative data

Here are some suggestions of places to start looking for data, and some sites to explore for additional data. The sites to start with compile data points from different primary data sources and help you compare your community to other counties, the state or nation.

 

 

Name

Description

Where to start

Colorado Health Indicators

This dataset was created to be used for community health assessment work in Colorado

 

County Health Rankings &, Roadmaps

The website provides a comprehensive data view at the county level.

How to dig deeper

CDPHE Center for Health and Environmental Data

Under the "Explore Data" section you can find several websites providing a variety of Colorado-specific data.

 

VISION

Chronic disease and behavioral health measures.

 

Community Level Estimates

Census tract level data for 18 important health conditions and risk behaviors.

 

CO Suicide Data Dashboard

Suicide specific data.

 

Health Kids Colorado Survey (HKCS) Dashboard

Visualize data for adolescent population.

 

Community Commons

Create data visualization maps with environmental and health indicator data.

 

American FactFinder website

Demographic and equity data.

 

American Community Survey (ACS)

Demographic and equity data available at small geographic levels.

 

Colorado State Demography

Birth, death, age, and population change data.

 

Additional Colorado-specific data sources listed on County Health Rankings &, Roadmaps Colorado Data Source

Education, mental health, criminal justice, Medicaid, immunization, cancer, prescription drug data and more.

There are lots of places to find quantitative data and it\'s easy to get sucked into the vortex of information. Refer back to your data gathering outline to help focus your data gathering efforts. you can also reach out to the Office of Planning, Partnerships and Improvement to ask for technical assistance in finding certain data.

Gather qualitative data

Incorporating qualitative data into your community health assessment broadens your overall findings and enriches the story you are able to tell. This type of information can include lived experience and why a health issue may exist from the perspective of someone who experiences it. This context may uncover health issues that the quantitative data don\'t illustrate, or provide a context for the quantitative data, enabling you to delve into a specific issue more thoroughly.

Start by reviewing the community health assessments you collected in Step 1 for qualitative data or stories. Reach out to partners to see if they have gathered any qualitative data recently that they are willing to share so that you do not overburden any one community. Plug the available qualitative data into your data gathering outline.

Collect quantitative data

Now that your data gathering outline has been populated with existing quantitative and qualitative data, it is time to ask the question, "What else do we need to know to tell the story of the community?"

Are there areas you weren\'t able to populate in your data gathering outline with already suggested sources? Think about other local partners who might already be gathering data locally on the topic you\'re interested in. Think about non-profit, other government agencies and hospitals that might be willing to share data with you. If you still can\'t find the quantitative data you want to help tell the story of the community, consider gathering qualitative data or reach out to discuss whether it makes sense to collect primary data for your assessment with the Office of Planning, Partnerships and Improvement.

Collect qualitative data

After you have reviewed the recent qualitative data specific to your community that already exists, it is time to reference your data gathering outline and determine what additional qualitative data you will collect in order to help tell the story of your community.

Qualitative data can help describe factors unique to your community, capture the perceptions of residents, provide a context for the quantitative data and enable you to delve into a specific issue more thoroughly. You can choose from a variety of qualitative data gather techniques, such as:

  • Community meetings.
  • Focus groups/listening sessions.
  • Key informant interviews.
  • Asset mapping.
  • Photovoice.
  • Nominal group technique.

For more on how to conduct these techniques, check out this list of recommendedresources or see the Rotary International Community Assessment Tools document for helpful guidance.

Analyze
Analyze the quantitative data you have gathered and collected to identify key findings and correlations that tell the story of your community.
 
Interpret
When interpreting the data, consider the following questions:
  • What are the top health issues in the community?
  • Do you know why these are the top issues?
  • What health behaviors and determinants of health are influencing these?
  • Do these differ by age, race/ethnicity, gender, and neighborhood?
  • Who is impacted the most?
  • Have these issues changed over time?
  • How do these health concerns compare to the state?
  • What concerns do community members have?
  • Were emerging issues uncovered that we did not necessarily expect to find?

Data points won\'t stand on their own, they need context and understanding of an issue. Remember that how you frame the data can influence the story you tell. The frame can either highlight or mask disparities in outcomes and it can either make connections to determinants of health or let the reader draw their own connections. Refer to the Office of Health Equity\'s Framing Data to Advance Health Equity tool for additional guidance to consider in these initial activities to summarize the assessment. This will be addressed further in Step 8.

Topics to consider for prioritization
While the assessment work is fresh, include a list of main topic areas to consider for prioritization. This will help you prepare for the next phase of the assessment and planning process. Work with your advisory group and interested partners to select 5-10 issues that have "risen to the top" due to their importance to community health, level of community need or window of opportunity to address.

Share the findings of your community health assessment with your local board of health (BOH). Engaging your BOH throughout the CHAPS process allows them to provide feedback and direction and to be advocates for potential priority areas that will be identified in your public health improvement plan.

Upon review and approval from the BOH:

  1. Post on your agency and/or partnership website.
  2. Submit your completed community health assessment and website link to OPHP by emailing the public health planner. Please include documentation of BOH discussion/approval or a copy of meeting minutes/agenda.

The Office of Public Health Practice, Planning, and Local Partnerships public health planner will post a link to your assessment on the CHAPS website.

How do you choose to communicate the health assessment results is based on both the purpose and the target audience(s). The results will be used to educated and mobilize stakeholders and community members, identify priorities, create a local public health improvement plan and garner resources to support plan implementation.

Change the narrative

As Colorado\'s public health system moves to address issues that are considered upstream or root causes to your communities\' health and environment issues, this is the opportunity to choose how you describe issues in ways that connect social, environmental, political and economic inequities to prioritize health and environmental issues.

Recommended resources:

Communication plan
You can create a communication plan to strategically think through how, when and to whom you will communicate the findings and next steps. We strongly encourage referencing Phase 2 to follow community engagement best practices in your communication. This will help you address equity issues in your community while being inclusive, culturally and linguistically appropriate in your communications style, transparent with your process and able to build trust while communicating issues that may be difficult to understand and act upon.

A communication plan may include:

  • Target audience(s) for the findings of your community health assessment, such as:
    • ‚ÄãCommunity members.
    • Partner agencies.
    • Local Board of Health.
    • Local leadership.
    • Stakeholders identifying priorities for an improvement plan.
  • ‚ÄãHow much, what kind, and what level of data is most useful for your audience(s).
  • Culturally and linguistically appropriate messaging, methods and channels.
  • Data collection framework you chose to use when collecting data and a discussion about the best way to present the data to your stakeholders.
  • Next steps in the process and potential opportunities for engagement.

Your communication process should include the following practices and activities:

  • Use plain language by incorporating health literacy principles and plain language communication tools.
  • Craft culturally and linguistically appropriate messaging, methods and channels.
  • Use emerging communication recommendations from resources like FrameWorks Institute to articulate complex health issues in ways that resonate with your audiences and can lead to action.
  • Test your communication messages and materials with a variety of audiences to ensure your community\'s health story is understood and is relatable.
  • Use principles of community engagement to inform how you craft your communications and when to employ them.
  • Use this step as a tool to model the changes you are aiming to make in the ways that you need. How public health describes the connections between health issues and the underlying racial, social and historical inequities can be a powerful strategy in and of itself.
  • Discuss the merits and limitations of various communication formats and methods and decide what works best for your community.

Format examples include:

  • Data dashboard
  • Agency and/or partnership website
  • Video
  • Fact sheets
  • Report
  • Executive summary of key findings

Examples of sharing out the CHA that communities across Colorado have used include:

  • Community open house
  • Presentations to local leadership and partners
  • Email to community partners
  • Posting on website
  • Press release
  • Paid/earned media
  • Announcements via social media (Facebook, Twitter, etc.)

Regardless of the format(s) you choose, be consistent and systematic with documenting the methods and data sources of the community health assessments so that the effort can be monitored, refreshed and replicated.

"Locally developed resources"]

Coming in 2019.

"Examples of local CHAs"]

Phase 4: Assess capacity

Use this phase to assess capacity to achieve community health goals. A public health capacity assessment is a set of questions or a process to measure the ability of an agency, partners, and/or systems to deliver or ensure public health and environmental health services, programs and activities, or to address local priority issues.

Make note that you will use the results of your capacity assessment from Phase 4 throughout the prioritization process in Phase 5. It is important to consider how Phase 4 and 5 are related and how one influences the other before choosing and designing a capacity assessment.

The Colorado Public Health Act requires every local health plan to "assess capacity and performance of the county or district public health system" (Section 25-1-205 Subpart 2b). The act does not require a specific process, content, or reporting format; therefore, each community will decide the best method for collecting, sharing, and using this information based on local needs.

Begin the phase by determining the area of capacity to assess and to what extent you will determine capacity. Choose the area that will best support the overall assessment and planning process. This will look different for each agency and depend on various factors, including:

  • Findings from the community health assessment conducted in CHAPS Phase 3
  • Current delivery of foundational public and environmental health services and capabilities within the jurisdiction
  • Whether incorporating quality improvement methods and/or sustainability planning into the process is an identified agency goal
  • Whether the agency is preparing to seek national public health accreditation and/or is interested in measuring performance against state and nationally recognized public health performance standards

As local public health agencies move toward addressing root causes of health inequities in their communities, having an understanding of any aspect of capacity in conjunction with the community health assessment and prioritization process can greatly influence the building of the public health improvement plans and successful implementation.

Below are three examples of capacity areas to consider. The first one is required to gather enough information to prioritize issue areas coming out of your CHA; however, you can choose to assess additional areas to better understand both internal and external capacity to deliver foundational public health services to serve your communities. If additional capacity issues arise, know they can also be considered in the Phase 5 prioritization process.

Capacity area

When to assess benefits

Partners involved

Examples of questions to consider

Capacity to address prioritized public health issues.
This type of assessment examines the ability of your agency and partner(s) to address public health issues in your community(ies), county, or region.

Assess as part of the community health assessment (Phase 3), as a parallel phase, or as part of the prioritization process (Phase 5)

Provides rich information about the ability, potential capacity, and feasibility of the agency and local partners to come together to address priority issues.
Stakeholders will need to have an understanding of your capacity assessment findings to make informed decisions during this process. This information is necessary for completing Phase 5.

• Agency leadership and governing authority, such as local board of health

• CHAPS oversight committee

• Community stakeholders (ranging from community members and representatives to organizations and community leaders)

• Type of support an organization can provide

• Interest level in addressing priority issues with partners

• Equity-specific questions regarding populations served and impacted

• Workforce expertise to address priority issues

Colorado Core Public Health Services and Capabilities.

It is the responsibility of each local public health agency to regularly assess its ability to provide or assure Core Public Health Services and Capabilities. A core services capacity assessment examines the range to which these services are fulfilled. Services and capabilities were identified and drafted by Colorado's public health community and established into rule by the Colorado State Board of Health in 2011 and amended in 2019.

Assess as part of the community health assessment (Phase 3) or as a parallel phase, or an ongoing agency process.

Results will determine an agency's capacity to deliver core public health services and meet the requirements of the Colorado Public Health Act.

Colorado Core Public Health Services and Capabilities provide a clear guide for the delivery of quality public health services. It will be important for agencies to know how their agency aligns in order to address any gaps that may present barriers to the overall delivery of quality services.

Health equity and social determinants of health is a foundational capability. This assessment area also provides an opportunity to understand an agency\'s capacity to address root causes of health inequities, educate staff, and address social issues that influence and determine health.

• Internal agency staff

• External partners and customers can provide input

• Agency leadership and governing authority, such as local board of health

• Likert-scale questions regarding alignment with service and capability operational definition

Agency or system performance.

Besides looking at programming, staffing, and resources to meet core services and/or priority areas, you may also elect to assess agency performance. PHAB standards require agencies to address quality improvement and performance management

Assess as part of the community health assessment (Phase 3), as a parallel phase, or an ongoing agency process.

Performance management and quality improvement are ways to understand how an agency or system is functioning, which is a useful input to the development of an agency strategic plan.

• Internal agency staff

• Customers

• Customer satisfaction

• Professional and workforce development

• Progress made on program, policies or process goals

• Infrastructure capacity

Based on the scope of assessing capacity, here are some recommended resources to review for your process:

  • Previous agency capacity assessments. Some local public health agencies have a history of assessing the public and environmental health needs in their community in relation to existing services and required resources.
    • Each Colorado local public health agency completes and submits a self-assessment as part of an annual report to the Office of Public Health Practice, Planning, and Local Partnerships (OPHP) to document the degree to which the agency provides or ensures core public health services. For information on your agency's responses and for support in interpreting the data, contact OPHP.
    • In 2019, all local public health agencies will have completed a public health and environmental health core service cost assessment. Your individual county results as well as results from your region may provide insights into strengths and weaknesses in agency capacity.
  • Workforce development. Insufficient staff and expertise are cited barriers in Colorado's public health system. Identify whether data on staffing, resources, and activities have been collected recently for other purposes. This may include documents such as annual reports, grant activities/deliverables, and applications prepared by your agency or partners. For the national context, de Beaumont Public Health Workforce Interests and Needs Survey (PH WINS) provides insights into the public health workforce that may be beneficial to compare to your local context. Gaps and assets may reveal valuable information that have bearing on your agency's capacity to provide quality public health services or implement a public health improvement plan. Check out the Building Skills for a More Strategic Public Health Workforce: A Call to Action, also led by the de Beaumont Foundation, for ways to act on results from the capacity assessment.
  • Capacity assessments conducted by other organizations providing public health or environmental health services for your jurisdiction, if available. Discuss with partners to learn more and to gain additional local perspectives.

Collect new data if your agency and partner(s) need to know more. Use a method or approach deemed most important to the community health assessment and planning process. Aim to gain a wide variety of perspectives of the agency/system's ability to address priority issues and/or provide public health services. Reference Phase 2 when considering the best way to engage stakeholders in collecting data.

Consider these data collection techniques:

  • Community asset inventory (may already be part of the community health assessment process)
  • Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis
  • Core services baseline review analysis or core service cost assessment result analysis
  • Facilitated input discussions with stakeholders
  • Key informant interviews
  • Online partner survey

See CHAPS Qualitative data collection techniques for more guidance.

Once data collection is complete, analyze and interpret the story it tells. Highlight areas of strength and strategic opportunities for moving toward increased capacity in whichever capacity area(s) you have chosen. These strategic capacity-building opportunities and assets may ultimately become key goals or strategies in your public health improvement plan over the next five years or the agency's next strategic plan.

Now that you have analyzed capacity data, it is time to summarize and share the information based on how the results will be used. Here are a few examples of how the results can be used.

 

Capacity area

Use of results

Capacity to address prioritized public health issues

• Phase 5 - Prioritization process: Results can help make decisions about the potential priority areas identified in the CHA to drive the public health improvement plan (PHIP).

• Phase 6 - PHIP: Results can inform action steps to address important capacity shortfalls, including the implementation of capacity-building and performance-improvement activities and ongoing evaluation of capacity-building progress over time.

• Collective impact: Results can provide opportunity(ies) with system partners who are identified to take the lead on individual components of the larger plan (PHIP).

• Results may provide insight into root causes of health inequities and influence action plans in the public health transportation plan.

Colorado Core Public Health Services and Capabilities

• Phase 5 - Prioritization process: Results can help make decisions about the potential priority areas identified in the CHA to drive the public health improvement plan.

• Phase 6 - PHIP: Results can inform action steps to address important capacity shortfalls, including the implementation of capacity-building and performance-improvement activities and ongoing evaluation of capacity-building over time.

• Determine an agency's capacity to meet the requirements of the Colorado Public Health Act and align with Core Public Health Services and Capabilities

• Agency annual report, strategic plan, performance management plan and/or quality improvement plans.

• Determine health equity/social determinants of health capacity gaps and strengths.

• Communicate and advocate for public health and environmental health services to a variety of different audiences (e.g. county commissioners, funders, local partners).

• Support PHAB accreditation process.

Agency or system performance

• Phase 5 - Prioritization process: Results can help make decisions about the potential priority areas identified in the CHA to drive the public health improvement plan.

• Phase 6 - PHIP: Results can inform action steps to address important capacity shortfalls, including the implementation of capacity-building and performance-improvement activities and ongoing evaluation of capacity-building over time.

• Agency annual report, strategic plan, performance management plan and/or quality improvement plans.

• Support PHAB accreditation process.

Phase 5: Prioritize issues

Use this phase to prioritize issues that arose during the assessment to determine a few focus areas for the five-year public/community/regional health improvement plan. A well-defined priority-setting process will help you and your stakeholders determine how to strategically direct resources toward issues where they will have the greatest impact. These are recommended steps and can be done in the order that makes the most sense for your local planning and action needs.

Make note that you will use the results of your capacity assessment from Phase 4 throughout the prioritization process in Phase 5. It is important to consider how Phase 4 and 5 are related and how one influences the other before choosing and designing a prioritization process.

Prioritizing issues is a cross-cutting public health activity required in the Colorado Public Health Act, updated Core Public Health Services and Capabilities, and the Public Health Accreditation Board accreditation process (PHAB).

Phase 5 Tools & Templates

Aim to identify 5-10 potential priority areas to consider.

Review the results of the community health assessment and the list of main topic areas to consider for prioritization that were included in the assessment. Also, review the results of any capacity assessments completed in Phase 4 for potential topic areas to consider for prioritization. Focus areas may include public health issues, environmental health issues, capacity/infrastructure needs, or issues that address the social determinants of health or health equity.

Selecting focus areas for public health improvement helps ensure that limited resources can be targeted and important issues can be spotlighted. Focus areas are high-priority, high-visibility issues that organizations serving the community will come together to champion. Efforts to support the focus areas will occur alongside the maintenance of regular public health activities.

Select a prioritization method and determine how, by who, and when you will execute the process. The design of your prioritization process should take into account your capacity assessment needs and the amount of additional information you will need to gather on potential priority areas. This may happen at the same time, before, or after you complete your capacity assessment, depending on your unique needs.

 

Choose a prioritization method

A prioritization method is used to determine a few local public health improvement focus areas by further examining and ranking important issues that have been identified through the community health assessment and capacity assessment processes. When determining a method, ensure that you outline a structured process that you will follow that incorporates guided discussion among all participants.

Recommended resources include:

 

Choose criteria

The following criteria should be used to discuss, evaluate, and score each potential priority area:

  1. Significance to the community's health
  2. Existence of associated strategies that can be implemented successfully and are likely to have a sustainable impact
  3. Presence of community support, leadership, and capacity to move the issue forward
  4. Impact on health equity

Questions to consider for the facilitated discussion are detailed in Step 4.

 

Determine who to involve

The prioritization process is an important way to gain buy-in from those in the best position to influence outcomes of the public health improvement plan and ensure that under-represented communities and participants have a voice. Being strategic in your selection of participants means you have identified a role for everyone involved in the process, for example:

  • Advisory group
  • Decision-makers who can impact policy adoption, implementation or enforcement
  • Potential funders that may contribute toward addressing an issue (e.g., a municipality or hospital)
  • Community organizations or neighboring local public health agencies (LPHAs) that may offer to enhance or provide a new program
  • Community advocates that can give voice to the underserved
  • Potential champions who can generate support, advocate and fundraise
  • Public health agency staff who may be responsible for implementation
  • Other government directors who would naturally take the lead on an issue (law enforcement, planning department, transportation, school district, human services, etc.)

Be sure to clearly communicate the participants' roles and level of decision-making authority to the group ahead of time. Determine whether it is the role of the participants in the prioritization meeting to make the final decision on priorities for public health improvement or whether they are to make a recommendation to the Board of Health or other entity. Note that the public health agency need not be the lead organization on every community health priority. The more engaged stakeholders are in terms of being able to make decisions, the more likely that advocates and lead organizations will step forward.

There are probably many groups already focusing locally on priority health issues. Some may be addressing an issue with great success while others may be struggling because they lack funding, staff, or other resources, or they may be using an ineffective strategy. A prioritization process can help stakeholders align by focusing energy, funding, and other resources on the same areas and respective strategies that result from this process.

 

Facilitation

Determine who will facilitate the meeting or meetings. The prioritization process will involve a considerable amount of discussion, both before issues are scored and ranked and afterward, to validate or change the rankings and to determine the number of priorities given levels of capacity. If you feel like you do not have the capacity to provide skilled, neutral facilitation of the prioritization process within your agency or community, contact OPHP to assist with identifying a facilitator who can help guide the group toward consensus and moving forward.

 

Documentation

Documenting the process, method(s), who is involved, how the prioritization process was created demonstrates the integrity of your process. It is a PHAB requirement as well as a best practice in being transparent about a critical part of the CHAPS process.

 

Design a process

Combine previous decisions about the method, who to involve, and how to create your prioritization process. This will provide direction for a facilitated discussion with key stakeholders to systematically determine which issues should have a more targeted and planned focus over the next five years. The five-year goals are to "move the needle" on the issue, by either improving capacity or positively impacting a health outcome in a measurable way.

Gather additional information with the goal of creating a more complete profile of each potential priority issue for the purpose of decision making. For each potential priority issue be sure to provide information about each of the following criteria areas.

 

Criteria

Description

Examples of where to find information

Significance to the community's health.

• The prevalence of individuals affected or at risk (e.g., mortality, morbidity, and injury rates).

• The degree of health disparities or impact to subpopulations.

• Phase 3 Community health assessment

• Reference primary data sources in Phase 3

• Phase 4 Capacity assessment

• Engage a subject matter expert

Existence of associated strategies that can be implemented successfully and are likely to have a sustainable impact.

• Existence of strategies/best practices likely to have an impact.

• Level of community readiness and support for change (including political will).

County Health Rankings Roadmap - What Works for Health

CDC Guide to Community Prevention Services

CDPHE Communities That Care communities and facilitators

• Engage a subject matter expert

Presence of community support, leadership, and capacity to move the issue forward.

• Local organizations that are prepared to take the lead.

• Sufficient resources, including staffing and funding, are available or obtainable.

• Phase 4 Capacity assessment

• Engage a subject matter and community expert(s) and representative(s)

Impact on health equity.

• Incorporates a broader understanding of the priority issue inequities and disparities.

• Are there population-based, primary prevention policies that improve physical, environmental, social, and economic conditions that affect the issue?

• Phase 3 Community health assessment

CDC Guide to Community Preventative Services

ColoradoOffice of Health Equity Suite of Tools

 

Presentation format

Determine the best format(s) to present this information to stakeholders participating in the prioritization process to ensure they have a common understanding of the issues and all of the information needed to select priorities. Methods of delivery include:

  • PowerPoint presentation
  • One-page issue summary profiles
  • Infographics
  • Gallery of posters
  • Report

Depending on your group, provide adequate information either before the prioritization process or during to ensure everyone has had an adequate amount of time to take in the information and to be prepared to make a decision.

Convene your stakeholders and facilitate the prioritization process you have designed. A thorough prioritization process will probably take three to four hours or longer, depending on the number of stakeholders and the number of issues. It may be structured as one or more meetings.

Sample agenda: (Could take place over one to three meetings)

  • Purpose of the meeting/background
  • Set meeting norms (also known as ground rules)
  • Overview of decision-making roles and process
  • Criteria for scoring/ranking
  • Presentation of issue profiles with facilitated discussion
  • Scoring/ranking of each issue
  • Facilitated discussion on rankings
  • Select final priorities
  • Identify the next phase and steps in the planning process

The initial part of the meeting should provide background in terms of purpose, the role of the group, the decision-making process, and method of scoring. Consider setting ground rules or meeting norms as well. Choosing priorities can be challenging, as decisions will be difficult and not everyone's preferred issue will be selected. Ask the group to brainstorm norms for working together (e.g., confidentiality, respecting one another's opinions, etc.) and record them on a flip chart that all participants can see during the meeting. Ask participants if they can agree to all the norms. When a norm is broken, the facilitator can remind the group by referencing the flip chart.

The next part of the meeting will be the presentation of the issue. These are the five to ten issues up for consideration to be focus areas for the public health improvement plan. The objective of this activity is to educate the participants about the issues, provide enough background so they can score them, and have a discussion so that participants can exchange thoughts and ask questions. This part of the meeting will take the longest, you may want to allow a half-hour to present and discuss each issue.

Following the presentation and discussion of the issues comes the prioritization method that you have designed. Depending on the size of the group that you are working with and the method that you have chosen, this may occur in-person or through the use of technology.

The final part of the meeting is selecting priorities based on the discussion of the rankings. Scoring and ranking are not perfect processes. As such, the group should discuss how the rankings come out. The facilitator can use questions such as the following to prompt discussion:

  • Is there a natural cutoff point for the highest-ranking issue?
  • Do these issues seem like they are ranked in the correct order?
  • Are there any criteria (like a political will or lack of a lead agency) that may make a particular issue difficult to implement regardless of its score?
  • Of the highest-ranked issues, are there any that you think are not doable, and if so, why?
  • Of the lowest-ranked issues, are there any that you think are doable that should be considered?
  • Of the top issues, how many should be public health improvement priorities?
  • Who is identified as the lead agency for the top issues, and how does this affect the overall number of priorities that can be selected?

At this point in the process, the group should be close to consensus on all or most of the issues. A show of thumbs or use of the clicker can indicate consensus or disagreement. If there is disagreement among several members, either a discussion should continue or the group may decide they need more information before coming to a consensus or compromise. As decisions are made on focus are priorities, record them. Reflect any notes having to do with voting, dissenting opinion, or any further actions needed before a consensus or compromise can occur.

End your meeting by discussing the next steps of the process. The priorities will need to be developed into action plans by workgroups (explained in Phase 6 - Develop the plan). Consider what communication might need to occur with stakeholders who were not able to attend. Help the participants understand and/or determine their potential roles in future steps. Lastly, celebrate the completion of this pivotal milestone in the public health improvement process.

Phase 6: Develop a plan

Use this phase to develop a five-year local public health improvement plan (PHIP), also referred to as a community health improvement plan (CHIP) or regional health improvement plan, based on the results of assessment activities and the selection of priority focus areas. The PHIP will become the road map for community and regional partners to make improvements to the public health system and ultimately the population's health. It will illustrate your county or regional public health needs, describe priorities for health improvement, include partners to be involved, document the steps to get there, and provide a method for evaluating progress.

There are a variety of proven processes to create a meaningful process and plan. These are recommended steps and can be arranged to best fit your local needs.

Considered a necessary foundation for quality public health work, developing and implementing a public health improvement plan is a requirement and a Colorado Core Public Health Capability for local public health agencies in Colorado, as well as a prerequisite for agencies choosing to become accredited under the national voluntary Public Health Accreditation Board standards (PHAB). CHAPS Phase 6 aligns with PHAB Version 1.5 standards for developing and implementing a public health improvement plan.

Phase 6 tools and templates

 

Important elements of a public health improvement plan

By now, your public health agency and advisory group has convened a community-based process that has examined health and environmental data, service capacity, and has selected top focus areas or priorities for improvement; essentially, telling the health story of your communities. The next step is to act on what you have learned by developing priority action plans for implementation and evaluation.

 

Shared definition

The public health improvement plan has become a standard practice within the public health field, recommended by the National Association of City and County Health Officials, mandated by the 2008 Colorado Public Health Act for all local public health agencies, and required for voluntary accreditation by the national Public Health Accreditation Board (PHAB), which defines a plan as:

  • "... a long-term, systematic effort to address public health problems on the basis of the results of community health assessment activities and the community health improvement process. This plan is used by health and other governmental education and human service agencies, in collaboration with community partners, to set priorities and coordinate and target resources. A community health improvement plan is critical for developing policies and defining actions to target efforts that promote health. It should define the vision for the health of the community through a collaborative process and should address the gamut of strengths, weaknesses, challenges, and opportunities that exist in the community to improve the health status of that community."
     -Public Health Accreditation Board Acronyms and Glossary of Terms Version 1.0 CDC-pdf, July 2011, as adapted from Healthy People 2010 and CDC‚ National Public Health Performance Standards Program.

 

To the extent that this plan can impact your communities, always keep in mind that it is more than just a public health agency plan (research strategic plans for more information on how to do that). PHAB further defines a plan to be community-driven:

  • "The plan is more comprehensive than the roles and responsibilities of the health department alone, and the plan's development must include the participation of a broad set of community stakeholders and partners. The planning and implementation process is community-driven. The plan reflects the results of a collaborative planning process that includes significant involvement by a variety of community sectors." 
    -Public Health Accreditation Board Standards and Measures Version 1.5, Domain 5, Standard 5.2 p. 129.

 

In summary, the PHIP serves as a measurable, outcomes-focused plan for your community to:

  • Inform, engage and mobilize your community(ies)
  • Align policy and community efforts
  • Investigate and address social determinants of health and health inequities
  • Outline shared action plans for your public health agency and community partners (e.g., hospitals, schools, transportation, environmental groups)
  • Support grant applications with data and information
  • Inform and engage with the state public health improvement plan to strengthen partnerships and maximize efforts

The plan is not limited to these benefits. Find the best ways to leverage this process in your community to use assets, engage your community and meet their unique needs.

 

Public Health Act requirements and timeline
Requirements

The Colorado Public Health Act of 2008 (Section 25-1-501, CRS et. seq.) requires a public health improvement plan to include the following six components:

  • examine data about health status and risk factors in the local community
  • assess the capacity and performance of the county or district public health system
  • identify goals and strategies for improving the health of the local community
  • describe how representatives of the local community develop and implement the local plan
  • address how county or district public health agencies coordinate with the state department and others within the public health system to accomplish goals and priorities identified in the comprehensive, statewide public health improvement plan
  • identify financial resources available to meet identified public health needs and to meet requirements for the provision of core public health services
  • not be inconsistent with the statewide public health improvement plan

CHAPS provides guidance on meeting these requirements along with an emphasis on health equity and community engagement. Steps are in alignment with Public Health Accreditation Board (PHAB) Standards and Measures Version 1.5 and are continually updated to reflect best practice. Agencies seeking accreditation should visit the PHAB website to review the latest guidance and documentation requirements. Reviewing the full set of PHAB standards and measures will provide useful information throughout the development and implementation of your public health improvement plan.

For additional information and context, go to the Requirements page.

 

Timeline

Local and state public health agencies are also required to carry out this process on a five-year cycle. The most recent local public health improvement plans will have been completed in 2016-2019. The most recent state public health improvement plan will be completed at the end of 2019.

It is recommended that local assessments, prioritization, and if possible, completed plans be submitted prior to each statewide plan to inform the development and implementation of the state plan. Therefore, the next local public health assessments and improvement plans are due in 2024 and the state plan is due in 2025.

A well-thought-out process will ensure that the plan's development and execution is successful.

 

Scope

The scope of the plan will depend upon factors such as the end goal(s), regional public health and community partners involved, capacity, and whether or not your agency is using the plan to apply for accreditation or re-accreditation. Discuss and define the "right scope" of the plan with your advisory committee so that it is usable by all involved, measurable, meets requirements, and has the potential for impact.

You will also want to discuss the potential uses of the plan. For example, local leaders, such as the board of health could use it to advocate for funding, partner organizations may need it for grant applications, or it may be used to engage other sectors and define public health in a community, county, or region. The scope and potential uses of the plan will help inform the following steps, guide implementation, engagement, communication, and evaluation.

This conversation will also be a valuable time for those involved to connect work done in the assessment phases with future ability to act on priority issues. The plan needs to be a solid connection between the two.

 

Planning process

Determine meeting schedule and logistics, such as location, frequency, length, agendas, communication method, etc. to complete the planning process. The number of meetings will depend on the size of your community and stakeholder group, and the number of priorities chosen.

Check on communication methods between those involved to ensure all are providing and receiving materials in a timely manner to review and take action. Also, check that everyone is doing an expected amount of work based on their original commitment to the process. Revise and update the process if need be. It is likely many involved will be volunteering their time. Take the time to thank them.

Prepare to delegate components of the plan and the following recommended steps to those involved. Allot adequate time for communication, discussion, and inclusion of stakeholders to participate. Determining strategies for an action plan or designing an evaluation plan will require specific skill sets and/or knowledge to accomplish. Consider these needs early on so that you have the capacity to engage additional subject matter or process experts. This may lengthen the process time but the engagement is worth it.

 

Engage advisory group

Re-engage your advisory group for the second part of this community process. An advisory group, a best practice for this work, can help foster the momentum of implementing the plan after it is developed by acting as a resource when barriers arise, as well as assisting in monitoring and evaluating progress. Provide adequate communication to the group about the assessment results, uses, and dissemination, as well as requirements and future needs of the plan to keep your decision-makers up to date. New stakeholders can be added at any time but now in particular is when additional stakeholders with different types of needed expertise within the priority areas can be included in the process. Be prepared to provide information based on their familiarity with the process thus far.

 

Determine needed resources

Just as you determined resources for the assessment, determine the resources needed to develop and implement the public health improvement plan.

Useful questions to consider:

  • What is the timeline of our process?
  • Are there any deadlines driving it and if so, what can be accomplished in the allotted time frame?
  • Is your oversight group prepared to help provide guidance, input, and investment of time and resources?
  • How will you engage your oversight committee group who will help guide the plan? (Think meeting location, structure and access as well as what they will commit to helping with.)
  • What other partners do you need to engage to help fill information gaps or gain additional community perspectives?
  • Will you need to engage subject matter experts to inform strategy development for priority areas?
  • Do you have evaluation skills on staff or within the advisory committee?
  • Will you use a consultant or partner with the Colorado School of Public Health?
  • Will a variety of sectors be involved in the creation and implementation of the action plans?
  • Do you or your stakeholders have grant writing experience to apply for grants to implement priority area action plans?

Ultimately, you need to ensure that you, your oversight committee, and partners have the knowledge, skills, partnerships, and resources on hand to develop and implement a public health assessment to the best of your abilities.

This step will depend on your local process. Discuss with your internal team and advisory council to determine your needs and capacity for engaging more stakeholders. Engagement is discussed in more detail in Phase 2, however, the following points are recommendations to keep in mind.

 

Involve different sectors

  • When discussing the root causes and potential capacity for addressing your priority health issue(s), identify the different stakeholders that are already involved and working in this/these area(s). If an issue includes transportation barriers, engage transportation entities. If an issue overlaps with human services, engage both governmental and non-profit organizations. If an issue includes the built environment, engage those who are responsible for land use and planning. Engaging groups who may not be the typical players as early as possible (preferably in the assessment phase) so that you can collaborate moving forward to reduce duplicative efforts or fill gaps in services. Having sound subject matter expertise can also provide insight into aiming for policy-level solutions that have a broad base of support.

 

Address health inequities and social determinants of health

  • If you have done the work to include diverse stakeholders, key subject matter experts, and community voices throughout your process, you will be more prepared to understand the context of the issues and historical inequities that you seek to address. This will unearth the root, systems-level causes contributing to an issue. By having the "right people at the table" especially in the workgroups, you will all be more prepared to incorporate the strategies that address social, cultural, economic, and educational causes of priority health issues.

 

Assessment and plan accessibility

  • Develop final products that are accessible and trackable by your partners. This will ensure transparency in your process and make it easier for your advisory group and any additional stakeholders to contribute to monitoring and evaluating the plan. PHAB measure 5.4.4 A states, "Monitor progress on implementation of strategies in the community health improvement plan in collaboration with broad participation from stakeholders and partners. Changes should be developed in collaboration with partners and stakeholders involved in the planning process."

 

Communication

  • Develop effective communication that resonates with your communities. If you have engaged a broader set of stakeholders and have involved them in different parts of your process, you can craft and test these messages together. Challenge your stakeholders to identify jargon or terms that may be misunderstood, diluting the effectiveness of your communication, and come up with locally defined ways to communicate.

Begin developing the plan by gathering available resources and insights. This work will be done by a core group of stakeholders, which may include all of the advisory or steering committee or a mix of committee and agency staff members.

Useful questions to consider:

  • What are the requirements for a local public health improvement plan (PHIP)?
  • What are the priorities identified in your last PHIP?
  • Have you reached out to current and potential partners to learn about their priorities in your community, county or region?
  • Are there specific efforts to address health inequities happening in your community, county or region?
  • What are other current local and/or regional priorities?
  • What are the current state public health and environmental health priorities?
  • How does this information inform your plan process?

Collect and review requirements and additional relevant materials. The following are recommendations and only a start to your process. Continue by inquiring with agency staff and stakeholders who have been involved in the process before for their insights into the process and what has worked well in the past and currently.

 

 

Document

Purpose

Requirements

Colorado Public Health Act (found at Section 25-1-505, CRS et seq. Title 25 - Public Health and Environment - Article I: Administration - Part 5 Public Health Act - Subpart 2 Public Health Plans)

Community health assessment and public health improvement plan requirements for local public health agencies, public health directors and local boards of health. Use to guide entire process as well as determine capacity.

 

Public Health Act and PHAB requirements

Outlines responsible party, process requirements, approvals, timeline and link between local and state processes.

 

Colorado Core Public Health Capability: Assessment and Planning

Note: Most applicable resources will be linked when available.

Required assessment and planning knowledge and skill capacity.

Relevant materials

Past improvement plans developed by your agency

Note significant findings and investigate changes or trends.

Review actions plans and communication plan.

 

Health improvement or action plans conducted by other entities in your community, county, or region

Supplement your plan.

Prevent duplication of effort.

Determine gaps in who is addressing community needs/priorities.

 

Public health improvement plans from other jurisdictions

Awareness of how similar counties/local public health agencies have carried out their planning process.

 

Colorado public health improvement plans:

2020-2024 Coming in 2019!

2015-2019 Healthy Colorado: Shaping a state of health | PDF

Align priorities, goals, strategies, and partners where and when appropriate.

Opportunity for engagement and relationship building between local and state entities around shared priority issues.

 

 

 

 

 

Delegate components of the public health improvement plan to focus specifically on priority areas. This will depend on the number of people involved and the expertise they bring to the process.

 

Who should be involved

  • Breaking this process down into workgroups will provide an opportunity to bring in additional content experts or individuals who can represent subject matter expertise which also includes the lived experience of those who will be impacted by the plan. This may include those who have not been participants thus far. They may also have a stronger working knowledge of what it will take to implement strategies, make an impact in your communities as well as have evaluation, funding, and implementation capacity. Consider capacity gaps and seek stakeholders who can bring process expertise, such as evaluation. Look into the priority areas to see if any new stakeholders have been identified thus far.
  • If you have not already, consider involving community advocates or organizers that can give a voice to underrepresented populations or those who can help address relevant health disparities. They can help engage communities that otherwise might not participate in public health activities, and may help tailor your strategies to appropriately fit the population. See Phase 2: Engage stakeholders for more ideas.

 

Responsibility

  • The priority area workgroup(s) will be responsible for collecting any additional data and research necessary to make decisions about goals and strategies, developing an action plan (Step 5), contributing to an evaluation plan, providing local knowledge about how to communicate and promote the action plans, and potentially serve as partners in implementation (Phase 7). The meeting logistics and frequency will have been determined in the initial planning process (Step 1) of this phase.

Use this step to design action plans, logic model, and to identify strategies. The main part of the public health improvement plan will be the priority area action plan(s). An action plan is where priority area workgroups document how the agency and partners are going to address the priority issue, when, how, by how much, and by whom.

From the beginning, see action plans as multi-purpose tools that will be used to guide implementation, support accountability, enable you and your partners to review and revise the plan, monitor the integrity of the process, be a communication tool, and aid in evaluation. Throughout this phase, look for ways that you can adapt these recommendations to support your planning process and to develop efficient and effective plans that are feasible to implement.

To that end, review this entire step to inform what additional information and activities are needed for priority area workgroups to complete.

 

Required components

The following PHAB requirements provide a comprehensive list of components to include:

Accreditation:

PHAB Domain 5

Measure 5.2.2 and 5.2.3

Community health improvement plan that includes:

Re-accreditation:

PHAB Domain 5

Measure 5.2

Consider re-accreditation requirements because they reflect knowledge growth in this area

• Desired measurable outcomes or indicators of health improvement and priorities for action

• Policy changes needed to accomplish health objectives

• Individuals and organizations that have accepted responsibility for implementing strategies

• Consideration of state and national priorities

• A process to track actions taken to implement strategies in the community health improvement plan

• Community priorities for action

• Desired measurable outcomes or indicators of health improvement and priorities for action

• Considerations of social determinants of health, causes of higher health risks and poorer health outcomes, and health inequities

• Plans for policy and system-level changes for the alleviation of identified causes of health inequity

• Policy changes may address social and economic conditions that influence health and health equity including, for example, housing, transportation, education, job availability, neighborhood safety, and zoning

• Designation of the individuals and organizations that have accepted responsibility for implementing strategies. (2016)

 

CHAPS action plan

CHAPS guidance builds on these requirements through the development of an action plan. See the CHAPS Action Plan template for guidance on including the following components:

  • Priority area with a description of the issue that includes relevant indicators and contributing factors/root causes of the issue
  • Goal
  • Strategy (read below for more in-depth guidance on strategy identification)
  • SMART objectives
  • Indicator(s) for monitoring and evaluation
  • Reach/target population/community engagement
  • Evidence-based, locally actionable strategies
  • Major activities or action steps
  • Timeline
  • Entity or entities responsible for implementing
  • Date completed/Status

Include additional fields as necessary to support the viability of the action plan and to clearly communicate how you will address the priority issue. There are many different types of guidance around action planning. This is an important process, so build plans that work well for you and your partners. County Health Rankings and Roadmaps also offers helpful guidance on the action planning process and product(s) along with curated tools and resources. Remember, there are a variety of ways to do this work, choose processes that will use the data you have collected to make decisions and lead to action.

 

Logic model

If you would like to take your planning process further to connect and communicate higher-level goals, consider using the CHAPS Logic Model template. You can find guidance on how to link your action plans and logic model in the OPHP CHAPS Action Planning presentation from Public Health in the Rockies. County Health Rankings and Roadmaps Action Center also recommends a Tearless logic model resource for additional insight into the process.

A logic model will also be a valuable activity and product to use to communicate progress and evaluate impact (Step 6 of Phase 6 and Phase 7).

 

Strategy identification

Take an adequate amount of time to research, identify and discuss strategies. Keep the overall plan goal, scope, and capacity in mind, while also looking for creative, innovative solutions that address the root causes of public health and environmental health issues.

Within the workgroup meetings, begin with understanding the factors contributing to the priority issue and information learned during the prioritization process, such as evidence-based strategies, locally informed strategies and solutions, partners, and existing efforts.

Depending on your process, you can choose a formal identification method such as a prioritization matrix or decide through group discussion. Here are criteria to discuss in selecting strategies:

  • Likelihood of population impact
  • Capacity to implement
  • Impact on health disparities and inequities
  • Community assets and resources
  • Ability to measure change
  • Ability to evaluate for process improvement and/or impact
  • Political/community support
  • Policy level strategies exist

This is the time to address upstream, social influencers of health. Invest time and resources into identifying equity-specific strategies for the plan. For example, seek out and identify upstream policy level strategies that have the potential to influence societal and cultural norms around priority health issue areas.

Refer back to the equity and engagement assessment tools recommended in Phase 2. Act on the results of these assessments by incorporating equity-based strategies. Ask important questions such as the following set included in the 2019 State Assessment and Planning process from the Office of Health Equity:

  • Could the efforts burden traditionally underserved communities?
  • How will this proposed strategy benefit traditionally underserved communities?
  • Will affected communities have decision-making power in the decision-making process?
  • How are affected communities involved in defining success?
  • Are there mechanisms in place for affected communities to hold decision-makers accountable?

The following recommended resources will help you dig deeper:

Here are additional recommended national resources for strategy identification:

Here are additional recommended national resources for strategy identification:

To further illustrate how chosen strategies are addressing root causes, social determinants, and influences on population health and environmental health, consider using a tool such as the NACCHO Community Health Improvement Matrix. It overlaps a strategy identification process with the socio-ecological model to visualize different levels of strategy intervention. By visualizing "where" all of the strategies are being implemented in a population, you can see if you are choosing a comprehensive set of strategies. Importantly, strive to include policy and culture influencing strategies for greater impact on population health and for addressing root social causes. Strategy identification is an iterative process. After using this guide, go back to revise strategies, if necessary.

Check out other Colorado public health improvement plans to learn more about local strategies chosen across the state. Agencies and partnerships choose a wide variety of strategies to meet their local needs and are influenced by their local context.

Report final action plans back to the advisory group for final discussion and inclusion in the plan.

Create a process to keep your action plans accountable, current, and responsive to internal and external factors. Use this process to monitor action plans on an ongoing basis to improve and revise them as progress is made and changes occur.

A process should include how changes will be tracked, when and how often, who will be responsible, and when and how revisions will be made. Ultimately, this activity will begin to answer the question, "Did we do what we said we were going to do?" and contribute to the evaluability of the overall plan. PHAB Measure 5.2.4 A states:

"Effective, implemented plans are dynamic. The plan may need revision based on a completed objective, a newly identified priority, a change in responsibilities, or a change in resources and assets. All aspects of the plan, and the identified tasks and timelines, should be monitored for progress, and adjustments should be made when indicated to ensure that the plan remains relevant. Changes should be developed in collaboration with partners and stakeholders involved in the planning process."

To keep your plans "dynamic" and "living" consider the following questions:

When developing a process

  • Has a data tracking system been identified to generate information on indicators?
  • Will a monitoring system be used, such as software, databases, Web-based dashboards, and/or community-balanced scorecards?
  • What indicators do you look at and how often?
  • Are there adequate resources to complete data collection and analysis?
  • Will the monitoring plan answer useful evaluation questions that can inform process or strategy improvement?
  • How will stakeholders access action plan status?
  • Do you have the information that you need in your action plan template?

 

If a monitoring system is chosen...

  • Who will populate the system?
  • How often is data updated and from what sources?
  • What are the potential negative impacts? How will these be mitigated?
  • What is the initial development cost, if any? Who might want to share the costs? What is the cost to update and maintain? At what frequency? Financial sustainability?

 

If revisions need to be made...

  • What are the criteria for action plan revision?
    • Will it be based on quantitative or qualitative data sources?
    • Will it be influenced by state or national scale changes (e.g., CDPHE state health improvement plan, Healthy People 2030)
    • What is the time frame?
    • Who will need to approve?
  • What will you change?
    • Objectives: Actual aim, or just the number you were trying to reach?
    • Strategies: If what you are doing is not working, how will you change it?
    • Indicators: Will you change the indicator if you realize that it is not measuring your objective or the indicator is not suitable?

This step will provide the base set of information needed to evaluate action plans and the assessment and planning process.

Why?

CHAPS is a cyclical public health improvement planning process that provides the opportunity for an agency and your partners to increase impact and improve the process over time. By monitoring the action plans, all involved will have a sense of progress or change due to the process. When you wrap up one cycle and prepare for the next, however, plan to evaluate the overall process to include both outcomes of the action plans and the assessment and planning process in general.

 

What can you evaluate?

Amongst the advisory group, determine what you would like to evaluate in 2-3 years' time. Consider these specific areas to include:

  • goals and objectives determined in the action plan(s)
  • process or outcome measures/indicators identified in the action plan(s)
  • implementation of strategies (intended and unintended outcomes)
  • community engagement throughout the process from data collection through implementation (satisfaction, inclusivity, quality, reach, etc.)
  • partnership engagement throughout the process (satisfaction, inclusivity, geography, sectors, quality, reach, etc.)
  • public health improvement planning process
  • capacity to address health inequities
  • communication methods and reach

This can be a general outline and at this point is most helpful in informing the information you collect so that you have it available to evaluate. Keep in mind that you do not need to evaluate everything. Choose the most meaningful activities, inputs, outputs, and products of your process and invest in collecting the data you need to monitor and evaluate them. Circle back to your action plans to make sure you are optimizing that process to collect information that can be evaluated.

 

Evaluation design and resources

At the time you intend to evaluate, determine the optimal type of evaluation, such as a process or outcome evaluation. At the minimum, your evaluation should help you answer the following questions within each area you have chosen to evaluate:

  • Did we achieve the goals we set out to?
  • What were the impacts of the plan?
  • Was there an equity impact?
  • What do stakeholders want to know?
  • What went well?
  • What were the challenges?
  • What improvements should we make and how?

Seek out specific evaluation resources, engage your partners that have evaluation expertise and community impacted by the plan to guide your process. Here are some recommended resources to take a deeper dive into this specific process:

 

"Evaluation allows you to be sure the strategies you are implementing are working in the way you intended and that your efforts are as effective and efficient as possible."
NACCHO Developing a Local Health Department Strategic Plan: A How-To Guide

 

Striving for continuous improvement is a public health best practice, and evaluation of an assessment and planning process is a powerful method to apply it. Including evaluation into your CHAPS process will open up opportunities for further investment in quality improvement, performance management, and strategic planning. Although these are not requirements of CHAPS, they are key requirements of the PHAB accreditation process and are meant to improve public health programs, policies, processes, and interventions.

The final plan products will be based on both internal and external stakeholder needs. Traditionally, a single PHIP was produced but to keep these plans dynamic, effective, and working documents, they need to be accessible in a variety of different forms to meet the uses and needs of different stakeholders.

 

Components

A plan format is not required, however, here are important components you will want to consider including:

  • Intro and orientation to purpose, content
  • Description of jurisdiction: community profile, community vision, and values (this may also be part of the community health assessment or community health status report)
  • Description of how all stakeholders involved developed the plan (community health assessment process, community engagement, prioritization process, development of goals, strategies, etc.)
  • Capacity and performance assessment results
  • Description of how stakeholders identified issues and needs
  • Document process used to determine priorities
  • Summary of priority areas, including why these were chosen and how your plan aligns with the state priorities:
    • Data indicators and trends
    • Goals
    • Measurable objectives
    • Improvement strategies
    • Action steps with identification of lead agency or agencies and partners
    • Evaluation and equity measures
  • Financial resources available/required
  • Plan for monitoring
  • Plan for evaluation
  • Acknowledgments
  • Local board of health approval
  • Where stakeholders can access plan and more information

LPHAs or partnerships that have not developed separate community health assessment reports are encouraged to include health assessment data in the PHIP. At a minimum, assessment data should be included in the summary of priority areas.

 

Format

Consider what formats are most likely to be used by the intended audience. For internal stakeholders, this includes what formats can allow you to easily revise and update the action steps in years two to five, as needed. Potential options include:

  • Data dashboard
  • Agency/partnership/partner website(s)
  • Video
  • Infographic
  • Fact sheets
  • Report
  • Executive summary of key findings
  • PDF for print as needed and electronic dissemination
  • PowerPoint slides
  • Hard copy, bound publication
  • Hybrid, a mixture of some or all of the above

Discuss the merits and limitations of various formats and methods and decide what works best for your community. Regardless of the format(s) you choose, be consistent and systematic with documenting the processes, methods, and data sources of the community health assessment and public health improvement plan so that the effort can be monitored, refreshed, evaluated, and replicated.

The Colorado Public Health Act requires that the local PHIP be submitted to both the local board of health and the state Board of Health. Ideally, you will have engaged your board of health (BOH) throughout the CHAPS process, allowing them to provide feedback and direction and to be advocates for potential priority areas that have been identified in your public health improvement plan.

Upon review and approval from the BOH:

  • Post on your agency and/or partnership website
  • Submit your completed public health improvement plan and website link to OPHP by emailing the public health planner. Include documentation of BOH discussion/approval or a copy of meeting minutes/agenda.

The Office of Public Health Practice, Planning, and Local Partnerships (OPHP) public health planner will submit your plan to the Colorado Board of Health on your agency's behalf and post a link to your plan on the CHAPS website.

How you communicate about the plan will impact how it is implemented and how impactful you can be.

 

Change the narrative

As Colorado's public health system moves to address issues that are considered upstream or root causes to your communities' health and environmental issues, this is the opportunity to choose how you describe issues in ways that connect social, environmental, political, and economic inequities to priority health and environmental issues.

Recommended communication resources:

 

A communication plan may include:

  • Update of your CHA communications plan
  • Target audience(s) for the findings of your community health assessment, such as:
    • Community members
    • Partner agencies
    • Local Board of Health
    • Local Leadership
    • Stakeholders identifying priorities for improvement plan
  • How much, what kind, and what level of data is most useful for your audience(s)
  • Data collection framework you chose to use when collecting data and a discussion about the best way to present the data to your stakeholders
  • Next steps in the process and potential opportunities for engagement

 

Your communication process should include the following practices and activities:

  • Use plain language by incorporating health literacy principles and plain language communication tools.
  • Craft culturally and linguistically appropriate messaging, methods, and channels.
  • Use emerging communication recommendations from resources like the FrameWorks Institute to articulate complex health issues in ways that resonate with your audiences and can lead to action.
  • Test your communication messages and materials with a variety of audiences to ensure your community's health story is understood and is relatable.
  • Use principles of community engagement to inform how you craft your communications and when to employ them.
  • Use this step as a tool to model the changes you are aiming to make in the ways that you. How public health describes the connections between health issues and the underlying racial, social, and historical inequities can be a powerful strategy in and of itself.
  • Discuss the merits and limitations of various communication formats and methods and decide what works best for your community.

 

Potential audiences may include:

  • Those engaged during the assessment
  • Leaders in positions of authority, such as the local board of health and/or county commissioners
  • Potential local funders
  • Key decision-makers in a position to make policy or systems changes
  • Community partners that will help implement the plan
  • Community members who will be impacted by the plan, if they have not already been involved

 

Examples for sharing out the PHIP that communities across Colorado have used include:

  • Community open house
  • Summit or conferences
  • Presentations to local leadership or partners
  • Email to community partners
  • Posting on agency/partnership/partners website(s)
  • Local artwork
  • Press release(s)
  • Paid/earned media
  • Announcements via social media (Facebook, Twitter, etc.)

Regardless of the communication method(s) you choose, be consistent and systematic with documenting so that the effort can be monitored, refreshed, and replicated.

Phase 7: Implement, promote, and monitor

Use this phase to implement the Public Health Improvement Plan (PHIP) you developed in Phase 6. A working PHIP that is monitored, evaluated, updated, and communicated to stakeholders on a regular basis will have the greatest impact on improving the selected priority areas in your community.

This critical phase puts into action the PHIP action plans. Foundational Public Health Capability Assessment and Planning requires local public health agencies to develop, implement, and evaluate a public or community health improvement plan (PHIP/CHIP) that is informed by a comprehensive community health assessment (CHA) and priorities identified by communities, at a minimum every five years.

Responsibility

Determine the entity(ies) responsible for ensuring that the CHAPS process stays on track. This includes implementing the action plan(s) as well as continuing to coordinate the overall process, including monitoring, evaluation, and communication. Options to accomplish this includes re-directing the role and responsibilities of the advisory committee, designating priority area leads, or empower the internal agency staff to lead and coordinate accordingly with partners. Regardless of who is responsible, changes should be made in partnership with stakeholders through an agreed-upon process.

Questions to consider:

  • Is there anyone missing from the advisory group with either content area knowledge or expertise in evaluation?
  • What are your expectations from the leaders of the committees in terms of commitment and coordination?
  • What kind of agreement would be most helpful in solidifying participation or financial commitment from partners? (e.g. MOU, IGA, contract, informal agreement)
  • Are agency, community, and partnership members represented equitably?
  • What are the expected outputs from implementation, evaluation, and monitoring activities? (e.g., evaluation plan, reports, etc.)
  • What measures or processes will you put in place to ensure accountability and monitor the progress of the plan?

 

Stakeholder engagement

It can be challenging to keep stakeholders and partners engaged in the implementation of the plan. Involving a broad array of partners in specific monitoring and communication activities helps sustain their participation and the overall momentum of the process. Monitoring and evaluation efforts also can be used to:

  • Improve program effectiveness
  • Strengthen funding applications
  • Increase political support
  • Engage community residents
  • Improve future assessment and planning processes
  • Celebrate your successes

As you delve into the work outlined in your action plans, you will need to monitor and revise the content of your action plans at regular intervals. Use the process you developed in Phase 6, Step 6 to keep your action plans accountable, current and responsive to internal and external factors.

Updates will need to be made when an objective is completed, a new priority is identified, or a change in circumstances affects previous planning. Changes should be made in partnership with stakeholders through an agreed-upon process.

Review and make any necessary enhancements to your action plan(s) to ensure:

  • Strategies and action plans mirror the actual work being done
  • Adaptations are made based on action plan revisions and evaluation results
  • Realistic and measurable objectives are related to each strategy
  • Responsible individuals/organizations are identified as leads
  • Appropriate people and organizations are included for each strategy. If they are not already participating, make plans to recruit them.
  • Realistic timelines are set for each strategy
  • Necessary and available resources have been identified

An ideal time to evaluate CHAPS is when you wrap up one cycle and prepare for the next.

Question(s):

During the development of the public health improvement plan (Phase 6), you and the advisory group will have outlined potential areas to evaluate, such as:

  • goals and objectives determined in the action plan(s)
  • process or outcome measures/indicators identified in the action plan(s)
  • implementation of strategies (intended and unintended outcomes)
  • community engagement throughout the process from data collection through implementation (satisfaction, inclusivity, quality, reach, etc.)
  • partnership engagement throughout the process (satisfaction, inclusivity, geography, sectors, quality, reach, etc.)
  • public health improvement planning process
  • capacity to address health inequities
  • communication methods and reach

 

Evaluation design and resources

Based on what questions you need to answer, determine the optimal type of evaluation, such as a process or outcome evaluation. Check out the following recommendations along with tapping into stakeholder expertise to carry out this important step.

 

Many communities choose to establish a subcommittee to oversee the evaluation activities; including the people who manage or work on the activities and those affected by its implementation will increase the usefulness and credibility of the evaluation. The PHAB measure 5.4.4 A also applies for this step:

  • Monitor progress on implementation of strategies in the community health improvement plan in collaboration with broad participation from stakeholders and partners. Changes should be developed in collaboration with partners and stakeholders involved in the planning process.

Whichever type of evaluation your choose, the process should help you answer the following questions within each area you have chosen to evaluate:

  • Did we achieve the goals we set out to?
  • What were the impacts of the plan?
  • Was there an equity impact?
  • What do stakeholders want to know?
  • What went well?
  • What were the challenges?
  • What improvements should we make and how?

 

Use the results

Results from your evaluation of the overall CHAPS process can add value the next time you start the cycle. Evaluation results that demonstrate the impact of your improvement plan can be useful in revising action plans and communicating progress. This process can also support documenting what went well and what could be improved the next go-around.

By this point in your process, your communication plan can be a tool to report on your progress and/or process to the community. Build off of your work in Phase 3 (Step 8 - Communicate findings and next steps) and Phase 6 (Step 10: Communicate results and next steps).

 

Change the narrative

As Colorado's public health system moves to address issues that are considered upstream or root causes to your communities' health and environmental issues, this is the opportunity to choose how you describe issues in ways that connect social, environmental, political, and economic inequities to priority health and environmental issues. Think critically and creatively about the story that your assessment and plan is telling and continue to use the implementation phase to build on efforts to change the narrative around complex health issues, advance equity, and address social determinants of health.

Recommended communication resources:

 

Communicate progress and evaluation results

Among your key messages to share should be findings and lessons learned from your monitoring and evaluation activities. These can be interim findings and preliminary interpretations regarding improvements, since outcomes may take time to occur. These talking points will be valuable when communicating to those who have funded or contributed resources to the process. Likewise, these messages will be important to share with your stakeholders to demonstrate how their contributions - time, perspective, connections, resources - have made a difference.

 

Communicating change

Depending on your priorities, strategies, and stakeholders involved, you may have a degree of change that you need to communicate. These plans may represent doing things differently, addressing chronic issues in new ways, and involve new and different partners. Lean on change management principles and tools to further hone your communication efforts to ensure that you are meeting your audiences where they are.

 

Communication as community engagement

When and how you choose to do this can create two-way conversations. To do this, tailor your message and method depending on your audience and purpose. Use the Office of Health Equity's Sweet Tools to Advance Equity to think through how you can communicate and receive feedback from all involved partners. Differentiate between internal and external communication, and develop products that are appropriate and useful for each audience and communication platform (email, website, social media, presentation, etc.) including:

  • Data dashboard
  • Agency/partnership/partner website(s)
  • Video
  • Infographic
  • Fact sheets
  • Report
  • Executive summary of key findings
  • PDF for print as needed and electronic dissemination
  • PowerPoint slides
  • Hard copy, bound publication
  • Hybrid, a mixture of some or all of the above

Use frequent, ongoing, and creative communication approaches to celebrate successes and recognize the hard work of participants and the efforts of the community. This is a multi-year project that you and your stakeholders will have endured together.

Phase 8: Participate in statewide public health improvement opportunities

Use this phase to connect local and statewide public health improvement efforts. Both local and state level public health entities are required to carry out public health improvement processes and follow the CHAPS process. This coordination enables local participation in the statewide planning process to inform data collection, issue prioritization, strategy identification and plan implementation and evaluation.

Submit to and share with OPHP

  • If you have not already, please submit your local and/or regional community health assessment (CHA) and public health improvement plan (PHIP) to the Office of Public Health Practice, Planning, and Local Partnerships (OPHP). Following local board of health review and approval, local public health agencies are required to submit their public health improvement plan. The plan should be submitted with documentation demonstrating local approval (i.e., meeting minutes). This activity is covered in both Phase 3 and 6 at the completion of your CHA and PHIP.

  • OPHP will review each plan to ensure that it meets act requirements and presents it to the state Board of Health for review. The Office also analyzes and summarizes each plan to inform the statewide public health improvement plan and to share with other local public health agencies, CDPHE programs, and other stakeholders.

Use OPHP networking calls and peer-learning opportunities to share out your local public health improvement process, progress, and impact. CHAPS is co-developed and sustained by local and state public health practitioners.

Share with CHAPS users

  • Report out on progress to OPHP. Phase 7 of CHAPS describes the process for regularly updating local public health improvement plans. OPHP is interested in receiving updated plans, including action plans, evaluation plans, communication plans and other related materials, to continuously improve Colorado's assessment and planning efforts and to share models with other agencies.

Share with the public health system

  • Collaborate and network with other counties and partners on implementation efforts by sharing promising practices, collaborating on joint efforts, providing peer support, and networking. OPHP sponsors networking opportunities such as conference calls, webinars, and in-person meetings on a variety of topics.

The Public Health Act of 2008 calls upon the Colorado Department of Public Health and Environment to develop a statewide public health improvement plan based on a comprehensive health assessment every five years, which sets priorities for the public health system.

The act identifies the need to incorporate, to the extent possible, goals and priorities of public health improvement plans developed by county or district public health agencies. It also requires local plans to address how county or district public health agencies coordinate with the state health department and others within the public health system to accomplish goals and priorities identified in the statewide public health improvement plan. The Public Health Accreditation Board also requires alignment between the state health improvement plan and tribal, local, and national priorities as does Healthy People 2030.

Through CHAPS, local and state public health assessments and improvement plans and implementation can be coordinated to

  • share data collection (qualitative and quantitative) results

  • reduce burden of data collection on targeted communities

  • inform each other's prioritization processes

  • identify and elevate shared priority areas

  • share and scale strategies to greater impact

  • partner in the implementation of local and state plans, especially when strategies involve a variety of stakeholder levels

  • inform monitoring and evaluation efforts to assess the effectiveness and impact of local and state processes

The priorities and objectives outlined in the state plan are intended to provide support, guidance, and focus for public health activities throughout the state. This coordinated state and local process enables enhanced management of resources, increased readiness for public health agency accreditation, and a more efficient approach to improving health outcomes.

Stay connected with OPHP to learn about opportunities to participate.