Colorado Department of Public Health and Environment

1. Phase V:Prioritize Issues with Stakeholders Colorado Department of Public Health and Environment

2. Agenda Today’s focus • Identifying issues for prioritization • Identifying viable strategies • Identifying prioritization process participants • Organizing the prioritization process • Facilitating prioritization meetings • Next steps

3. Why Choose priorities? • Many health areas are important, but with limited resources it is necessary to focus on a few areasin order to make a difference. • Public health can not do it alone and needs resources and energy from other sectors. Choosing priorities is a good way to engage and align partners. • Identifying a few key areas to collectively focus on results in improvement plans that are realistic and impactful.

4. What is a CHAPS Prioritization Process? The CHAPS Prioritization process takes a manageable number of health and capacity issues (5-10) identified during the assessments and puts them through a scoring, ranking and discussion process with partners to determine the 1-5 focus areas of the public health improvement plan.

5. When in CHAPS does a Prioritization Process Occur? After Assessment Phases 3 & 4 Before the PHIP Planning Phase 6

6. Common structure for this phase

7. Public Health Accreditation Board (PHAB)Standards Standard 5.2: Conduct a comprehensive planning process resulting in a state/community health improvement plan 5.2.1 L Conduct a process to develop community health improvement plan that includes: • a. Broad participation of community partners • b. Information from community health assessments • c. Issues and themes identified by stakeholders in the community • d. Identification of community assets and resources • e. A process to set community health priorities

8. Prioritization Process steps

9. Step 1: Use assessment results to identify 5-10 issues for consideration Hint: “Cast a Wide Net” in this first round of issue identification Option 1: Ask the Project Management Team which 5-10 (or so) issues “rose to the top” during the assessments. For example: • What core service gaps were identified? • What issues are important to improving community health given the level of need, number of residents impacted or window of opportunity to address?

10. Step 1Use assessment results to identify issues for consideration Option 2: Prior to the prioritization process meeting, present assessment findings to your steering committee. Brainstorm issues based on your findings. If more than 10 arise, consider using a process (dot stickers, ranking, clicker votes) to reduce them to a manageable number for prioritization. Option 3: Combine options 1 and 2 or use a different process entirely. These are only suggestions for identifying a manageable number of issues for the prioritization process.

11. Step 2: Identify Strategies to Address the Issues A strategy is a new or enhanced: • Policy (seatbelt law, tobacco control ordinance, land use regulation) • System-level change(after-hours health services, shared core public health services) • Service(restaurant inspections, family planning clinic, fluoride varnish clinics) • Infrastructure/Capacity(e.g. federally qualified health center, water system fluoridation, environmental health specialist position) • Program (emergency preparedness program, food handler training) Strategy: How an Issue gets Addressed

12. Step 2: Identify Strategies to Address the Issues • It is worth spending a lot of time on this step. • Strategies will “make or break” a plan. Strategies that are hard to operationalize will result in the plan “sitting on a shelf.” Strategies that are ineffective will result in a waste of resources and burn out of partners. • Strategies are so important, they are one criteria in the prioritization process. If there is a great need but no good way to address it, that discussion should happen during a prioritization process. • CHAPS Phase V provides suggestions for researching strategies. OPP can also provide technical assistance. Strategies are sometimes called Best Practices or Interventions.

13. Good Strategy Model: Health Impact Pyramid “Interventions (strategies)focusing on the lower levels of the pyramid tend to be more effective because they reach broader segments of society and require less individual effort.” - Dr. Thomas Frieden, CDC Director American Journal of Public Health, April 2010, Vol. 100 No. 4

14. Step 3: Develop a Presentation Summarizing Each Issue for the Prioritization Meeting(s) • During the prioritization process, you will want to give participants enough information so they are able to score and rank each issue. • Use the data from your assessments. • Make sure to cover each scoring criteria . . . This can be done using Power Point with 3-7 slides per issue and having a discussion around strategies and capacity.

15. CHAPS Prioritization Scoring Criteria

16. Step 4: Determine Prioritization Process participants Ideally, participants . . . • Have been involved from the beginning and understand the issues. • Can play a role in implementing the PHIP because they are: Champions, gatekeepers, policy makers, funders, and/or a lead agency • Represent all issues being considered. Hint: It is okay to add new participants to the process, just make sure they are oriented before the first prioritization meeting, so they have the background necessary to score and rank issues.

17. Step 5: Plan the prioritization Process 1. Determine who will facilitate. 2. Determine the role of prioritization participants in decision making—will they choose the PHIP focus areas or make a recommendation? 3. Determine your decision making process (show of thumbs, clickers, etc.). 4. Determine your process for scoring the issues. (A scoring tool is provided which works with a clicker process or paper scoring). Hint: Using “Thumbs Up,” “Thumbs Down” & “Thumbs Sideways” to vote is an easy to way move forward by allowing someone to say they can live with a decision, even though they may not fully agree with it.

18. Step 5: Plan the prioritization Process 6. Develop the Agenda • Purpose of the meeting • Meeting norms (a.k.a. ground rules) • Overview of decision-making roles and process • Criteria for scoring • Presentation/discussion on each issue (you may not get through all the issues in one meeting) • Scoring of each issue • Facilitated discussion on rankings • Choose focus areas • Identify the next steps in the planning process Hint: It may work best to score each issue immediately after it has been presented and discussed, while it is still fresh in participants’ minds.

19. Step 6: Facilitate Prioritization Meetings to Determine PHIP Focus Areas You may need 1-3 meetings depending on the number of issues and participants. The meeting has four main parts: • Background information • Presentation of Issues • Scoring/Ranking • Discussion to choose Focus Areas Note: Scoring and ranking issues is not an exact science. CHAPS Phase V has sample questions to ask the group to help determine whether the ranking should stand or if some issues should be moved up or down.

20. Tools and Templates: Phase V Work Plan Phase 5 Prioritization Results

21. Tools and Templates: Scoring Tool To Access Full Tool Visit “Tools and Templates” On the CHAPS Website Scoring on a Scale of 1 – 5: No Somewhat Yes 1 2 3 4 5

22. Technical Assistance The Office of Planning and Partnerships is available to assist with: • Strategically identifying and engaging stakeholders • Identifying evidence-based strategies to address public health issues • Designing a prioritization process using either an electronic response system (a.k.a. “clickers”) or other facilitation tool • Identifying a facilitator