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pdfTHE NATIONAL PUBLIC HEALTH PERFORMANCE STANDARDS PROGRAM
STATE PUBLIC HEALTH SYSTEM
PERFORMANCE ASSESSMENT INSTRUMENT
Version 2.0
1
OMB Control No.
0920--0557
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THE NATIONAL PUBLIC HEALTH PERFORMANCE STANDARDS PROGRAM
STATE PUBLIC HEALTH SYSTEM
PERFORMANCE ASSESSMENT INSTRUMENT
Version 2.0
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Table of Contents
Performance Assessment Instrument
Essential Service 1
Monitor Health Status to Identify Health Problems
3
Essential Service 2
Diagnose and Investigate Health Problems and Health Hazards
10
Essential Service 3
Inform, Educate, and Empower People about Health Issues
19
Essential Service 4
Mobilize Partnerships to Identify and Solve Health Problems
26
Essential Service 5
Develop Policies and Plans that Support Individual and Statewide Health Efforts
32
Essential Service 6
Enforce Laws and Regulations that Protect Health and Ensure Safety
42
Essential Service 7
Link People to Needed Personal Health Services and Assure
the Provision of Health Care when Otherwise Unavailable
50
Essential Service 8
Assure a Competent Public and Personal Health Care Workforce
57
Essential Service 9
Evaluate Effectiveness, Accessibility, and Quality of Personal
and Population-Based Health Services
66
Essential Service 10
Research for New Insights and Innovative Solutions to Health Problems
73
Respondent Information Form
80
Priority Questionnaire
84
Agency Contribution Questionnaire
88
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Essential Service # 1:
Monitor Health Status to Identify Health Problems
This service includes:
Assessment of statewide health status and its determinants, including the identification of health
threats and the determination of health service needs.
Analysis of the health of specific groups that are at higher risk for health threats than the general
population.
Identification of community assets and resources, which support the state public health system
(SPHS) in promoting health and improving quality of life.
Interpretation and communication of health information to diverse audiences in different sectors.
Collaboration in integrating and managing public health related information systems.
SPHS Model Standard 1.1: Planning and Implementation
The state public health system (SPHS) measures, analyzes and reports on the health status of the
state's population. The state’s health status is monitored through data describing critical indicators of
health, illness, and health resources. Monitoring health is a collaborative effort involving many state
public health partners and local public health systems. The effective communication of health data
and information is a primary goal of all systems partners that participate in this effort to generate new
knowledge about health in the state.
To accomplish this, the SPHS:
Develops and maintains population-based programs that collect health-related data to measure
the state’s health status.
Produces useful data and information products for a variety of data users.
Organizes health-related data into a state health profile that routinely reports on the prevailing
health of the people of the state.
Operates a data reporting system for receiving and transmitting information regarding
reportable diseases and other potential public health threats.
Protects personal health information by instituting security and confidentiality policies that
define protocols for health information access and data integrity.
Please answer the following questions related to Model Standard 1.1:
1.1.1
Does the SPHS use surveillance and monitoring programs designed to measure the health
status of the state’s population?
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Do these programs:
1.1.1.1
Identify data required for monitoring health status?
1.1.1.1 Discussion Toolbox
In considering question 1.1.1.1, do these data measure:
Vital statistics, including mortality and natality?
Personal health care services?
Environmental conditions?
Infectious disease?
Chronic disease?
Injury?
Behavioral risk factors?
Mental health?
Substance abuse?
1.1.1.2
1.1.1.3
1.1.1.4
1.1.2
Identify the methods for data collection and storage?
Identify the roles of state and local governmental agencies and relevant nongovernmental agencies in the collection of health data?
Facilitate access to health-related data for state and local partners, researchers
and other interested groups?
Does the SPHS regularly compile and provide health data in useable products to a variety of
health data users?
Do these state data products use:
1.1.2.1
National health objectives, such as Healthy People objectives?
1.1.2.2
Linked data from diverse sources, (e.g., universities, hospitals, managed care
organizations, and health departments)?
1.1.2.3
Geo-coded data for geographic analysis?
1.1.2.4
Population health registries (e.g., cancer incidence, birth defects)?
1.1.2.5
A uniform set of health indicators to describe the health of the state’s
population?
1.1.2.6
A web-based data query system?
1.1.2.7
Data reporting capability that allows electronic data exchange?
1.1.2.7 Discussion Toolbox
In considering question 1.1.2.7, is there electronic data exchange among:
Local health departments?
Hospitals?
Ambulatory care sites?
Laboratories?
Professional health organizations (e.g., state Medical and Nursing trade groups,
State Hospital Associations)?
EMS providers?
State public health agency?
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1.1.3
Does the SPHS publish or disseminate health-related data into one or more documents that
collectively describe the prevailing health of the state's population (i.e., a state health profile)?
1.1.3 Discussion Toolbox
In considering, question 1.1.3, does the profile use data to:
Identify emerging health problems?
Report trends in health status?
Report changes in the prevalence of health risk factors?
Report changes in health resource consumption?
1.1.4
Does the SPHS operate a data reporting system designed to identify potential threats to the
public’s health?
Does the SPHS:
1.1.4.1
Have written procedures for receiving information concerning reportable public
health threats from the state’s public and private laboratories?
1.1.4.2
Share information and data regarding reportable public health threats with local
and federal public health agencies, using National Electronic Disease
Surveillance System (NEDSS)-compatible electronic systems?
1.1.4.3
Receive information from organizations that may have first contact with public
health threats?
1.1.4.3 Discussion Toolbox
In considering question 1.1.4.3, do these organizations include:
Laboratories?
Hospitals and emergency departments?
Medical examiners?
Primary care providers?
Schools?
Day care centers?
Nursing homes?
Businesses?
EMS Providers?
Police and fire department?
Pharmacies?
1.1.4.4
1.1.5
Have the capability to rapidly communicate with potential disease reporters
with special alerts when needed?
Does the SPHS enforce established laws and the use of protocols to protect personal health
information and other data?
Do these protocols include procedures to:
1.1.5.1
Protect personal identifiers?
1.1.5.2
Specify access for confidential and non-confidential health information?
1.1.5.3
Provide data security from loss, corruption of files, and computer failure?
SPHS Model Standard 1.2: State-Local Relationships
6
The SPHS works with local public health systems to provide assistance, capacity building, and
resources for local efforts to monitor health status and identify health problems.
To accomplish this, the SPHS:
Offers technical assistance in the interpretation, use, and dissemination of local health data.
Provides a standard set of health-related data to local public health systems and assists them in
accessing, interpreting, and applying these data in policy and planning activities.
Assists in the development of information systems needed to monitor health status at the local
level.
Please answer the following questions related to Model Standard 1.2:
1.2.1
Does the SPHS offer technical assistance (e.g., training, consultations) to local public health
systems in the interpretation, use, and dissemination of health-related data?
Does the assistance focus on:
1.2.1.1
Issues in small area analysis?
1.2.1.2
Methods of accessing state data?
1.2.1.3
Methods of analysis and interpretation of data, including trends over time?
1.2.1.4
Applying state data to local planning and policy activities, including the
development of community health profiles?
1.2.1.5
Helping media and local constituents understand the meaning and implications
of community health data?
1.2.2
Does the SPHS regularly provide local public health systems a uniform set of local healthrelated data?
Do uniform data set(s):
1.2.2.1
Provide comparisons with national and/or state health objectives?
1.2.2.2
Provide geo-coded data enabling local public health systems to conduct
analysis by location?
1.2.2.3
Become available to local public health systems in a timely fashion?
1.2.3 Does the SPHS offer technical assistance in the development of information systems needed to
monitor health status at the local level?
Does the assistance provide methods for:
1.2.3.1
Maintaining local health monitoring systems?
1.2.3.2
Establishing criteria and processes for reporting health events?
1.2.3.3
Maintaining and/or contributing to population health registries?
SPHS Model Standard 1.3: Performance Management and Quality Improvement
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The SPHS reviews the effectiveness of its performance in monitoring health status. Members of the
SPHS actively use the information from these reviews to continuously improve the quality of
monitoring efforts.
To accomplish this, the SPHS:
Reviews the effectiveness of its efforts to monitor health status to determine the relevance of
existing health data and its effectiveness in meeting user needs.
Manages the overall performance of its health status monitoring activities for the purpose of
quality improvement.
Please answer the following questions related to Model Standard 1.3:
1.3.1
Does the SPHS review the effectiveness of its efforts to monitor health status?
Do these reviews examine:
1.3.1.1
The relevance of existing health-related data?
1.3.1.2
Effectiveness in meeting user needs?
1.3.1.3
Local public health system feedback on their health status monitoring efforts?
1.3.1.4
Changes needed to improve the usefulness of health data products?
1.3.2
Does the SPHS manage and improve the overall performance of its health status monitoring
activities?
1.3.2 Discussion Toolbox
In considering 1.3.2, do SPHS organizations:
Use relevant standards or benchmarks to establish system-wide expectations for
health status monitoring?
Measure performance?
Report on progress to system partners?
Conduct ongoing quality improvement activities using performance information?
(Examples of QI activities are setting priorities, updating policies to improve
effectiveness , and the continuous application of new knowledge and evidence to
practice)
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SPHS Model Standard 1.4: Public Health Capacity and Resources
The SPHS effectively invests in and utilizes its human, information, technology, organizational and
financial resources to monitor health status and to identify health problems in the state.
To accomplish this, the SPHS:
Commits adequate financial resources to monitoring health status.
Aligns organizational relationships to focus statewide assets on monitoring health status.
Uses a workforce skilled in collecting, analyzing, disseminating, and communicating health
status data and maintaining data management systems.
Please answer the following questions related to Model Standard 1.4:
1.4.1
Does the SPHS commit financial resources to health status monitoring efforts?
1.4.1 Discussion Toolbox
In considering 1.4.1., do SPHS organizations:
Allocate existing resources to a broad scope of health status monitoring activities?
Share financial resources to invest in health status monitoring activities?
Seek new resources to support health status monitoring?
Fund mechanisms for communicating health data and information within the
SPHS and to elected officials and the public?
1.4.2
Do SPHS organizations align and coordinate their efforts to monitor health status?
Do SPHS organizations:
1.4.2.1
Align their organizational strategic plans to improve system performance in
monitoring health status?
1.4.2.2
Coordinate technology resources to more effectively report, analyze and
disseminate health status data?
1.4.2.3
Utilize the leadership of the state public health agency in monitoring health
status?
1.4.2.3 Discussion Toolbox
In considering question 1.4.2.3, does the state public health agency:
Work collaboratively with system partners to coordinate a systems approach to
improve health status monitoring?
Provide leadership in establishing state policy that promotes more effective health
status monitoring?
Invest in professional expertise needed to carry out health status monitoring
activities?
Promote evidence-based solutions for resolving issues in health status
monitoring?
Provide assistance to local public health agencies in the collection, analysis and
use of local health data?
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1.4.3
Does the SPHS have the professional expertise to carry out health status monitoring activities?
Is the SPHS workforce:
1.4.3.1
Skilled in statistics, epidemiology and information systems management?
1.4.3.1 Discussion Toolbox
In considering question 1.4.3.1, is the SPHS workforce skilled in:
Analyzing data into clear and useful information?
Designing sampling frameworks and survey designs for collecting data?
Integrating data from a variety of sources?
Designing and implementing population health registries?
Managing data systems and supporting data users?
Promoting effective use of data and information?
1.4.3.2
Sufficiently staffed to carry out health status monitoring activities?
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Essential Service # 2:
Diagnose and Investigate Health Problems and Health Hazards
This service includes:
Epidemiologic investigation of disease outbreaks and patterns of infectious and chronic diseases,
injuries, and other adverse health conditions.
Population-based screening, case finding, investigation, and the scientific analysis of health
problems.
Rapid screening, high volume testing, and active infectious disease epidemiologic investigations.
SPHS Model Standard 2.1: Planning and Implementation
The state public health system (SPHS) works collaboratively to identify and respond to public health
threats, including infectious disease outbreaks, chronic disease prevalence, the incidence of serious
injuries, environmental contaminations, the occurrence of natural disasters, the risk of exposure to
chemical and biological hazards, and other threats.
To accomplish this, the SPHS:
Operates a broad scope of surveillance and epidemiology to identify and analyze health
problems and threats to the health of the state’s population.
Establishes and maintains the capability to initiate enhanced surveillance in the event of an
emergency.
Organizes its public and private laboratories into an effectively functioning laboratory system.
Uses public and private laboratories, within and possibly outside of the state, that have the
capacity to analyze clinical and environmental specimens in the event of suspected exposures
and disease outbreaks.
Investigates and responds to public health problems and hazards.
Note: The SPHS may operate more than one surveillance system. In the Model Standard and
measures for Model Standard 2.1, the word “system” should therefore be read broadly, to include the
complete collection of surveillance systems operated by the SPHS.
Please answer the following questions related to Model Standard 2.1:
2.1.1
Does the SPHS operate surveillance system(s) and epidemiology activities that identify and
analyze health problems and threats to the health of the state’s population?
Does the SPHS operate:
2.1.1.1
Infectious disease surveillance programs?
2.1.1.2
Chronic disease surveillance programs?
2.1.1.3
Injury (intentional and unintentional) surveillance programs?
2.1.1.4
Environmental hazard surveillance programs?
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2.1.1.5
2.1.1.6
Maternal and child health surveillance programs?
Surveillance programs focused on all-hazards and threats?
2.1.1.1. – 2.1.1.6 Discussion Toolbox
In considering questions 2.1.1.1 – 2.1.1.6, do SPHS organizations:
Analyze the type and magnitude of disease threats?
When appropriate, examine trends over time and forecast future problems or
threats (i.e., environmental hazards)?
Integrate state surveillance of diseases with national and local surveillance
systems (i.e. in infectious disease, the use of the National Electronic Disease
Surveillance System (NEDSS)?
Conduct epidemiologic studies of disease patterns, population risk factors, and
evidence-based programs?
Expand their capacity to conduct active surveillance of conditions identified as of
special importance?
2.1.2 Does the SPHS have the capability to rapidly initiate enhanced surveillance when needed for a
statewide/regional health threat?
Do SPHS organizations:
2.1.2.1
Utilize a prompt communication process and protocols to initiate enhanced
surveillance?
2.1.2.2
Use written protocols to assure deployment and coordination of local
epidemiologic and laboratory expertise and facilities?
2.1.2.3
Use written protocols to assure coordination with hospital, physician offices,
clinic and other settings to identify potential threats to population health?
2.1.2.4
Use plans to deploy state government resources to enhanced surveillance?
2.1.2.5
Coordinate public health action according to state and local emergency
management plans?
2.1.3
Does the SPHS organize its private and public laboratories (within the state and outside of the
state) into a well-functioning laboratory system?
Does the SPHS:
2.1.3.1
Have written protocols for the handling, storage, and transportation of
specimens associated with public health threats?
2.1.3.2
Identify and use laboratories that collectively can identify all diseases and
conditions for which notification is required by state law?
2.1.3.3
Assure that the laboratories that collaborate with the SPHS are appropriately
licensed for the testing they provide?
2.1.3.4
Use the state public health laboratory to develop a network of clinical labs in
the state?
2.1.3.5
Maintain a list of all clinical laboratories, categorized by their capacity to
analyze human specimens and environmental specimens in the event of
suspected disease outbreaks or hazardous exposures? (Note: consider whether
the scope of the list includes: state and local public health laboratories; clinical
laboratories (hospital, clinics, physician office labs); commercial laboratories)
2.1.3.6
Maintain its list of all clinical labs in a portable database and backed up offsite?
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2.1.3.7
2.1.3.8
2.1.3.9
2.1.4
Have tested capability to communicate electronically with all clinical labs in
the state within one hour in the event of an emergency?
Maintain linkages with environmental, food, blood, veterinary, and
forensic laboratories?
Participate fully in the national Laboratory Response Network?
Does the SPHS have laboratories that have the capacity to analyze clinical and environmental
specimens in the event of suspected exposure or disease outbreak?
Do SPHS laboratories:
2.1.4.1
Have the capacity to identify diseases and conditions for which notification is
required by state law as well as the diseases and conditions included in the
National Notifiable Diseases Surveillance System (NNDSS)?
2.1.4.2
Have in-state laboratory capacity to conduct clinical and environmental testing?
2.1.4.2 Discussion Toolbox
In considering question 2.1.4.2, do clinical testing capabilities include:
Identifying pathogenic microorganisms (e.g., mycrobacteria, parasites, STDs,
HIV, and other viruses)?
Analyzing and identifying anti-microbial resistant infections?
Newborn testing?
Agreements assuring access to laboratories capable of testing for infectious agents
that are rarely encountered?
In considering question 2.1.4.2, do environmental testing capabilities include:
Environmental testing on water, air, and soil?
Agreements assuring access to laboratories capable of testing for environmental
agents that are rarely encountered?
2.1.5
Does the SPHS investigate and respond to identified public health threats?
Do SPHS organizations:
2.1.5.1
Use defined roles and responsibilities in responding to public health threats for
SPHS organizations, including local public health systems?
2.1.5.1 Discussion Toolbox
In considering question 2.1.5.1, are roles and responsibilities established for
responding to:
Infectious disease threats?
Chronic disease problems?
Injury-associated problems?
Environmental hazards?
Maternal and child health problems?
All-hazards, including bioterror threats?
2.1.5.2
2.1.5.3
2.1.5.4
Inform policymakers of possible threats to the health of the public?
Use communications systems designed to alert appropriate health officials in
the case of adverse public health events that require a rapid response?
Utilize rapid response teams with expertise from multiple disciplines?
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2.1.5.4 Discussion Toolbox
In considering question 2.1.5.4, does that expertise include:
Medical examiner services?
Laboratory services?
Environmental expertise, including toxicology?
Emergency management and response expertise?
Occupational health and safety expertise?
Infectious disease investigation and analysis?
Chronic disease investigation and analysis?
Injury investigation and analysis?
Investigation and analysis of adverse health behaviors and other determinants of
health (e.g., poverty, lack of health insurance)?
Geographic analysis expertise?
2.1.5.5
Provide screening tests in response to exposures to health hazards?
2.1.5.5 Discussion Toolbox
In considering question 2.1.5.5, does the lab screening capacity include:
Screening for populations exposed to health hazards?
Environmental tests in response to suspected environmental hazards?
Agreements to perform testing if the state’s capacity becomes overloaded (surge
capacity)?
14
SPHS Model Standard 2.2: State-Local Relationships
The SPHS works with local public health systems to provide assistance, capacity building, and
resources for local efforts to identify, analyze, and respond to public health problems and threats.
To accomplish this, the SPHS provides:
Assistance in epidemiologic analysis to local public health systems.
Assistance to local public health systems in using public health laboratory services.
Information about possible public health threats and appropriate responses to these threats by
local public health systems.
Trained personnel to local communities on-site to assist in the investigation of disease
outbreaks and other emergent health threats, as needed.
Please answer the following questions related to Model Standard 2.2:
2.2.1
Does the SPHS provide assistance (through consultations and/or training) to local public
health systems in the interpretation of epidemiologic findings?
Does this assistance address:
2.2.1.1
Information on how to access epidemiology services?
2.2.1.2.
Procedures for reporting local data to state surveillance systems?
2.2.1.3
Interpretation of epidemiologic findings?
2.2.1.4
Methods for conducting investigations of outbreaks?
2.2.2
Does the SPHS provide laboratory assistance to local public health systems?
Does this assistance address:
2.2.2.1
Information on how to access and utilize SPHS laboratory services (including
the Laboratory Response Network)?
2.2.2.2
Interpretation of laboratory findings?
2.2.3
Does the SPHS provide local public health systems with information and guidance about
public health problems and potential public health threats (e.g., health alerts, consultations)?
15
Does the SPHS provide:
2.2.3.1
Current analyses of the incidence and prevalence of diseases and other adverse
health conditions?
2.2.3.2
Current guidance relating to the most effective population-based methods of
disease prevention and control?
2.2.3.1 and 2.2.3.2 Discussion Toolbox
In considering question 2.2.3.1 and 2.2.3.2, do the current analyses and guidance focus
on:
Infectious diseases?
Chronic disease?
Injuries?
Environmental health risks?
Adverse maternal and child health outcomes?
Bioterror, chemical and radiological threats?
2.2.3.3
Guidance for response to emergencies?
2.2.3.3 Discussion Toolbox
In considering 2.2.3.3, does this guidance address:
Collecting and handling specimens?
Investigating problems and threats?
Interacting with state and national surveillance systems as part of the development
of local All-Hazards Preparedness Plans?
Participating in the Health Alert Network?
2.2.4
Does the SPHS provide trained personnel, as needed, to assist local communities in the
investigations of public health problems and threats?
16
SPHS Model Standard 2.3: Performance Management and Quality Improvement
The SPHS reviews the effectiveness of its performance in diagnosing and investigating health
problems. Members of the SPHS actively use the information from these reviews to continuously
improve the quality and responsiveness of their efforts.
To accomplish this, the SPHS:
Reviews the effectiveness of its state surveillance and investigation procedures, using
published guidelines, including CDC’s Updated Guidelines for Evaluating Public Health
Surveillance Systems and CDC’s measures and benchmarks for emergency preparedness.
Manages the overall performance of its diagnosis and investigation activities for the purpose
of quality improvement.
Please answer the following questions related to Model Standard 2.3:
2.3.1
Does the SPHS periodically review the effectiveness of the state surveillance and investigation
system?
Do the reviews examine:
2.3.1.1
Whether the surveillance of possible public health threats is based on current
public health science?
2.3.1.2
The timeliness of reporting results of epidemiologic investigations and
laboratory tests of notifiable diseases?
2.3.1.3
Whether the state’s investigation and response plans meets program standards?
2.3.1.4
Results of emergency response tabletop exercises and drills?
2.3.1.5
Whether surge capacity in epidemiology programs and public health
laboratories is sufficient in the event of an emergency?
2.3.2
Does the SPHS actively manage and improve the overall performance of its activities to
diagnose and investigate health problems and health hazards?
2.3.2 Discussion Toolbox
In considering question 2.3.2, do SPHS organizations:
Use relevant standards or benchmarks to establish system-wide expectations for
its activities to diagnose and investigate health problems?
Measure performance?
Report on progress to systems partners?
Conduct ongoing quality improvement activities using performance information?
Examples of QI activities are setting priorities, updating policies to improve
effectiveness, and the continuous application of new knowledge and evidence to
practice)
SPHS Model Standard 2.4: Public Health Capacity and Resources
17
The SPHS effectively invests in and utilizes its human, information, organizational, and financial
resources to diagnose and investigate health problems and hazards that affect the state’s population.
To accomplish this, the SPHS:
Commits adequate financial resources for diagnosing and investigating health problems and
hazards.
Aligns organizational relationships to focus statewide assets on diagnosis and investigation of
health problems.
Uses a workforce skilled in epidemiology and laboratory science to identify and analyze
public health problems and hazards and to conduct investigations of adverse public health
events.
Please answer the following questions related to Model Standard 2.4:
2.4.1
Does the SPHS commit financial resources to support the diagnosis and investigation of health
problems and hazards?
2.4.1 Discussion Toolbox
In considering 2.4.1, do SPHS organizations:
Allocate existing resources to a broad scope of epidemiology work?
Share financial resources to invest in the diagnosis and investigation function?
Seek new resources to diagnose and investigate health problems?
2.4.2
Do SPHS organizations align and coordinate their efforts to diagnose and investigate health
hazards and health problems?
Do SPHS organizations:
2.4.2.1
Align their organizational strategic plans to improve system performance in
diagnosing and investigating health problems?
2.4.2.2
Coordinate technology resources to more effectively report, analyze and
communicate health data needed to implement the diagnosis and investigation
activities?
2.4.2.3
Utilize the active role of the state public health agency to carry out the
diagnosis and investigation function?
2.4.2.3 Discussion Toolbox
18
In considering question 2.4.2.3, does the state public health agency:
Work collaboratively with systems partners to improve diagnosis and
investigation efforts?
Provide leadership in establishing state policy that promotes the diagnosis and
investigation of health problems?
Invest in professional expertise needed to carry out the diagnosing and
investigating of health problems?
Promote evidence-based solutions for resolving issues that arise in diagnosing and
investigating efforts?
2.4.3
Does the SPHS have the professional expertise to identify and analyze public health threats
and hazards?
Is the SPHS workforce:
2.4.3.1
Skilled in detecting and investigating health problems?
2.4.3.1 Discussion Toolbox
In considering question 2.4.3.1, is the workforce skilled in:
Infectious disease epidemiology?
Chronic disease epidemiology?
Injury epidemiology?
Environmental epidemiology?
Maternal and child health epidemiology?
Emergency preparedness-associated epidemiology?
Laboratory science?
2.4.3.2
Sufficiently staffed to carry out diagnosis and investigation activities?
19
Essential Service # 3:
Inform, Educate, and Empower People about Health Issues
This service includes:
Health information, health education, and health promotion activities designed to reduce health
risk and promote better health.
Health communication plans and activities such as media advocacy and social marketing.
Accessible health information and educational resources.
Health education and promotion program partnerships with schools, faith communities, work
sites, personal care providers, and others to implement and reinforce health promotion programs
and messages.
SPHS Model Standard 3.1: Planning and Implementation
The state public health system (SPHS) actively creates, communicates, and delivers health
information and health interventions using customer-centered and science-based strategies to protect
and promote the health of diverse populations. The state’s population understands and uses timely
health information and interventions to protect and promote their health and the health of their
families and communities.
The SPHS supports its health improvement objectives and responds to public health issues with health
communication and health education and promotion interventions that are based on the best available
scientific evidence of effectiveness in helping people make healthy choices throughout their lives.
Health communications are culturally and linguistically appropriate and are delivered through
multiple media channels to enhance their effectiveness and reach into high risk populations.
To accomplish this, the SPHS:
Designs and implements health education and health promotion interventions to help meet the
state’s health improvement objectives, reduce risks, and promote better health.
Designs and implements health communications to reach wide and diverse audiences with
information that enables people to make healthy choices.
Maintains an effective emergency communications capacity to ensure rapid communications
response in the event of a crisis.
Please answer the following questions related to Model Standard 3.1:
3.1.1
Does the SPHS design and implement health education and health promotion interventions?
Do these interventions:
20
3.1.1.1
Provide effective health education services?
3.1.1.1 Discussion Toolbox
In considering 3.1.1.1, are these health education interventions:
Based on sound theory, evidence of effectiveness, and/or best practice?
Designed to reach diverse target populations that have higher risk of illness?
Designed to emphasize healthy behaviors, including positive environmental
changes and social practices?
Carried out collaboratively by SPHS organizations? For example, do these
collaborations include: the target population; local public health systems; and or
multi-disciplinary teams to provide guidance in development of health education
materials and activities to ensure their scientific appropriateness?
3.1.1.2
Provide effective health promotion programs?
3.1.1.2 Discussion Toolbox
In considering 3.1.1.2, are these health promotion interventions:
Based on sound theory, evidence of effectiveness, and/or best practice?
Designed with an active focus on understanding the target population, i.e., how
that population might respond to new information and interventions about health
behaviors?
Designed to accomplish state health improvement objectives and priorities?
Designed to allow modifications by local public health systems to meet objectives
in community health improvement?
Advocating for social, economic and/or environmental changes in living
conditions that will likely result in improvements in health (e.g., built
environment changes to expand biking/hiking trails, developing safe routes to
school)?
Carried out collaboratively by SPHS organizations? For example, do these
collaborations include: the target population; local public health systems; and /or
multi-disciplinary teams to provide guidance in development of health promotion
activities to ensure their scientific appropriateness (do the teams include expertise
in health communications, health education and promotion clinical care,
epidemiology, multi-cultural systems and social marketing)?
3.1.2
Does the SPHS design and implement health communications?
Are these health communications:
3.1.2.1
Based on established health communication theories and best practices?
3.1.2.2
Designed with an active focus on understanding the target population, i.e., how
that population might respond to new information and interventions about
health behaviors and health issues?
3.1.2.3
Based on a communication plan developed collaboratively among SPHS
organizations?
3.1.2.3 Discussion Toolbox
21
In considering question 3.1.2.3, does the communication plan include:
Policies for creating, sharing and disseminating information to the public?
Use of multiple channels (television, radio, print, Internet, etc.) for dissemination
of information?
Guidance for creating effective public health messages?
3.1.2.4
3.1.2.5
3.1.2.6
Producing public health messages with content and materials appropriate to the
target population?
Delivering targeted public health messages to at-risk populations with content
and materials that are culturally and linguistically appropriate?
Using a coordinated media strategy?
3.1.2.6 Discussion Toolbox
In considering question 3.1.2.6, does the media strategy include:
A designated spokesperson trained in providing accurate, timely, and appropriate
information on public health issues for different audiences?
Active coordination with local news media to develop information or features on
health issues?
3.1.3
Does the SPHS have a crisis and emergency communications plan?
Does this emergency communications plan include:
3.1.3.1
Protocols for the creation and dissemination of information at each stage
of a crisis according to recognized theories and methods?
3.1.3.2
Content and materials targeted to specific audience characteristics?
3.1.3.3
Adaptations of content to different types of emergencies (i.e., natural
disasters, bioterrorism, etc.)?
3.1.3.4
Responsibilities for emergency communications teams established in
accordance with National Incident Management System (NIMS)?
3.1.3.5
Policies and procedures to coordinate communications with state and local
emergency management agencies?
3.1.3.6
Policies and procedures to disseminate information among SPHS
organizations and members of the public in a timely fashion?
3.1.3.7
Adequate resources to ensure rapid communications response, such as
redundant communication devices and trained staff (e.g., Health Alert
Network)?
22
SPHS Model Standard 3.2: State-Local Relationships
The SPHS works with local public health systems to provide assistance, capacity building, and
resources for local efforts to inform, educate and empower people about health issues.
To accomplish this, the SPHS:
Provides technical assistance to develop skills and strategies for effective local health
communication, health education, and health promotion interventions.
Supports and assists local public health systems in developing effective emergency
communication capabilities.
Please answer the following questions related to Model Standard 3.2:
3.2.1
Does the SPHS provide technical assistance to local public health systems (through
consultations, training, and/or policy changes) to develop skills and strategies to conduct
health communication, health education, and health promotion interventions?
Does this include assistance in:
3.2.1.1
Using evidence of effectiveness to select health communication resources?
3.2.1.2
Selecting or developing health education and health promotion resources?
3.2.1.3
Evaluating health communication, health education and promotion resources?
3.2.1.4
Using social marketing techniques to develop health promotion initiatives?
3.2.1.5
Targeting populations at high risk of poor health?
3.2.1.5 Discussion Toolbox
In considering 3.2.1.5, does the assistance on effective targeting of risk groups
include:
Understanding the impact of culture (e.g., attitudes, language) on health behaviors
and behavior change?
Using culturally and linguistically appropriate communication and education
resources?
Reaching targeted populations in specific settings? Note: do these settings include
personal health care delivery locations, work sites, schools, recreational facilities,
places of worship?
3.2.2
Does the SPHS support and assist local public health systems in developing effective
emergency communications capabilities?
Does this support and assistance address:
3.2.2.1
Development of emergency communications plans that can be used in different
types of emergencies (i.e., outbreaks, natural disasters, bioterrorism)?
3.2.2.2
Policies and procedures for linking with state emergency communications
plans?
3.2.2.3
Rapid communications response, including the use of a Health Alert Network,
redundant communications, and communications surge capacity?
3.2.2.4
Training new and current staff in crisis/ emergency communications?
3.2.2.5
Applying risk communication principles in developing health communication
messages?
23
SPHS Model Standard 3.3: Performance Management and Quality Improvement
The SPHS reviews the effectiveness of its performance in informing, educating, and empowering
people about health issues. Members of the SPHS actively use the information from these reviews to
continuously improve the quality of their efforts in these areas.
To accomplish this, the SPHS:
Reviews the effectiveness and appropriateness of its health communication, health education
and promotion interventions.
Manages the overall performance of its activities to inform, educate and empower people
about health issues for the purpose of quality improvement.
Please answer the following questions related to Model Standard 3.3:
3.3.1
Does the SPHS periodically review the effectiveness of health communication, including
emergency communication, health education and promotion interventions?
Do these reviews:
3.3.1.1
Assure content is accurate and current?
3.3.1.2
Assess the effectiveness and appropriateness of the programs and
interventions?
3.3.1.3
Include the participation of the populations served by the intervention efforts?
3.3.1.4
Assess the effectiveness of efforts to target special populations with culturally
and linguistically appropriate resource materials?
3.3.1.5
Assess the effectiveness of media strategy(s)?
3.3.2
Does the SPHS actively manage and improve the overall performance of its activities to
inform, educate and empower people about health issues?
3.3.2 Discussion Toolbox
In considering 3.3.2, do SPHS organizations:
Use relevant standards or benchmarks to establish system-wide expectations for
informing, educating and empowering people about health issues?
Measure performance?
Report on progress to systems partners?
Conduct ongoing quality improvement activities using performance information?
(Examples of QI activities are setting priorities, updating policies to improve
effectiveness, and continuous application of new knowledge and evidence to
practice)
24
SPHS Model Standard 3.4: Public Health Capacity and Resources
The SPHS effectively invests, manages, and utilizes its human, information, organizational, and
financial resources to inform, educate, and empower people about health issues.
To accomplish this, the SPHS:
Commits adequate financial resources to informing, educating, and empowering people about
health issues.
Aligns organizational relationships to focus statewide assets on health communication and
health education and promotion services.
Uses a culturally competent workforce skilled in developing and implementing health
communication and health education and promotion interventions.
Please answer the following questions related to Model Standard 3.4:
3.4.1
Does the SPHS commit financial resources to support health communication and health
education and health promotion efforts?
3.4.1 Discussion Toolbox
In considering 3.4.1, do SPHS organizations:
Allocate existing resources to high priority problems in health education and
promotion?
Share financial resources to invest in health communication, including emergency
communication, and health education and health promotion activities?
Seek new resources to support health communication, including emergency
communication, and health education and health promotion activities?
3.4.2
Do SPHS organizations align and coordinate their efforts to implement health communication,
health education, and health promotion services?
Do SPHS organizations:
3.4.2.1
Align their organizational strategic plans to improve system performance in
informing, educating and empowering people about health issues?
3.4.2.2
Coordinate technology resources to more effectively develop and disseminate
health information messages?
3.4.2.3
Utilize the leadership of the state public health agency to inform, educate and
empower people about health issues?
25
3.4.2.3 Discussion Toolbox
In considering question 3.4.2.3, does the state public health agency:
Work collaboratively with systems partners to coordinate its efforts to inform,
educate and empower people about health issues?
Provide leadership in establishing state policy that sets priorities and promotes
effective and timely health communication and health education and promotion
programs?
Invest in professional expertise needed to carry out the planning, implementation
and evaluation of health communication, health education, and health promotion
programs?
Promote evidence-based solutions for resolving issues that arise in efforts to
inform, educate and empower people about health issues?
3.4.3
Does the SPHS have the professional expertise to carry out effective health communications,
health education, and health promotion services?
Is the SPHS workforce:
3.4.3.1
Skilled in informing, educating and empowering people about health issues?
3.4.3.1 Discussion Toolbox
In considering question 3.4.3.1, is the workforce skilled in:
Planning and implementing health education and promotion programs?
Cultural competency, including developing culturally and linguistically
appropriate interventions?
Social marketing?
Planning and implementing health communications programs?
Risk communication?
Media relations and media advocacy?
Program evaluation?
3.4.3.2
Sufficiently staffed to carry out efforts to inform, educate, and empower the
public about health issues?
26
Essential Service # 4:
Mobilize Partnerships to Identify and Solve Health Problems
This service includes:
The organization and leadership to convene, facilitate, and collaborate with statewide partners
(including those not typically considered to be health-related) to identify public health priorities
and create effective solutions to solve state and local health problems.
The building of a statewide partnership to collaborate in the performance of public health
functions and essential services in an effort to utilize the full range of available human and
material resources to improve the state’s health status.
Assistance to partners and communities to organize and undertake actions to improve the health of
the state’s communities.
SPHS Model Standard 4.1: Planning and Implementation
The state public health system (SPHS) conducts a variety of statewide community-building practices
to identify and to solve health problems. These practices include community engagement,
constituency development, and partnership mobilization, which is the most formal and potentially farreaching of these practices.
To accomplish this, the SPHS:
Engages and builds statewide support for a variety of public health issues by identifying,
convening, and communicating with organizations that contribute to or benefit from the
delivery of the Essential Public Health Services.
Organizes partnerships for public health to foster the sharing of resources, responsibilities,
collaborative decision-making, and accountability for delivering Essential Public Health
Services at the state and local levels.
Please answer the following questions related to Model Standard 4.1:
4.1.1
Does the SPHS build statewide support for public health issues?
Do members of the SPHS:
4.1.1.1
Identify new and existing partners for specific health concerns (e.g., disease,
risk factor, life stage need, and health policy topics)?
4.1.1.2
Maintain linkages with stakeholders to facilitate communication and optimize
resource sharing?
4.1.1.3
Regularly communicate with stakeholders about priority health issues?
4.1.1.4
Implement joint efforts to strengthen public health resources at the state and
local levels?
4.1.1.5
Use established processes to brief state and local elected officials on priority
health issues?
4.1.2
Does the SPHS organize partnerships to identify and to solve health problems?
27
Do these partnerships:
4.1.2.1
Conduct collaborative decision-making and action?
4.1.2.2
Maximize the use of available resources to deliver the Essential Public Health
Services?
4.1.2.3
Share responsibilities to deliver the Essential Public Health Services?
4.1.2.4
Collaborate with a broad representation of partners?
4.1.2.4 Discussion Toolbox
In considering question 4.1.2.4, does this representation include:
Government agencies that contribute to the public's health?
Local health departments?
Hospitals and other health care facilities?
Foundations or philanthropic organizations?
Managed care organizations?
Physicians and other health care workers?
Social service providers?
Civic organizations?
Professional public health and health care associations?
Business and industry?
Labor organizations/unions?
Faith-based organizations?
Transportation providers?
Schools?
Institutions of higher education?
Public safety and emergency response organizations?
Environmental or environmental-health organizations?
Occupational health organizations?
Community members or consumers (including those at increased risk of negative
health outcomes)?
Legislators and other state and local policymakers?
28
SPHS Model Standard 4.2: State-Local Relationships
The SPHS engages in a robust partnership with local public health systems to provide technical
assistance, capacity building and resources for local community partnership development.
To accomplish this, the SPHS:
Assists local public health systems to build competencies in community development,
advocacy, collaborative leadership and partnership management.
Provides incentives for local partnership development .
Please answer the following questions related to Model Standard 4.2:
4.2.1
Does the SPHS provide assistance (through consultations and/or trainings) to local public
health systems to build partnerships for community health improvement?
4.2.1 Discussion Toolbox
In considering 4.2.1, is assistance provided in:
Effective community (economic and infrastructure) development models?
Constituency development?
Coalition building and maintenance?
Advocacy development?
Media relations?
Effective team management?
Negotiation and conflict resolution?
Group facilitation methods?
Collaborative leadership?
4.2.2
Does the SPHS provide incentives to local partnerships through grant requirements, financial
incentives and/or resource sharing?
29
SPHS Model Standard 4.3: Performance Management and Quality Improvement
The SPHS reviews the effectiveness of its performance in mobilizing partnerships. Members of the
SPHS actively use the information from these reviews to continuously improve the quality of their
partnership efforts.
To accomplish this, the SPHS:
Reviews the effectiveness of its partnership efforts, including the commitment of SPHS
partner organizations.
Manages the overall performance of its partnership activities for the purpose of quality
improvement.
Please answer the following questions related to Model Standard 4.3:
4.3.1
Does the SPHS review its partnership development activities?
Do these reviews examine:
4.3.1.1
The effectiveness of partnership participation in solving health problems?
4.3.1.2.
The satisfaction of constituents with SPHS efforts?
4.3.2.3
The participation and commitment of its policy leaders and systems partners?
(see 4.1.2.4 discussion toolbox for examples)
4.3.2
Does the SPHS actively manage and improve the overall performance of its partnership
activities?
4.3.2 Discussion Toolbox
In considering 4.3.2, do SPHS organizations:
Use relevant standards or benchmarks to establish system-wide expectations for
partnership efforts?
Measure performance?
Report on progress to systems partners?
Conduct ongoing quality improvement activities using performance information?
(Examples of QI activities are setting priorities, updating policies to improve
effectiveness, and the continuous application of new knowledge and evidence to
practice)
30
SPHS Model Standard 4.4: Public Health Capacity and Resources
The SPHS effectively invests in and utilizes its human, information, organizational and financial
resources to assure that its partnership mobilization efforts meet the needs of the state’s population.
To accomplish this, the SPHS:
Commits adequate financial resources to sustain partnerships and support their actions.
Aligns organizational relationships to focus statewide assets on partnerships.
Uses a workforce skilled in assisting partners to organize and act on behalf of the health of the
public.
Please answer the following questions related to Model Standard 4.4:
4.4.1
Does the SPHS commit financial resources to sustain partnerships?
4.4.1 Discussion Toolbox
In considering 4.4.1, do SPHS organizations:
Allocate existing resources to partnership development statewide?
Support the development of local partnerships?
Share financial resources to invest in partnership efforts?
Seek new resources to support partnership activities?
4.4.2
Do SPHS organizations align and coordinate their efforts to mobilize partnerships?
Do SPHS organizations:
4.4.2.1
Align their organizational strategic plans to improve system performance in
partnerships?
4.4.2.2
Coordinate technology resources to more effectively collaborate within
partnerships (e.g. communication technology to support listservs, newsletter
publication, etc)?
4.4.2.3
Work toward partnership growth, by nurturing and incorporating new partners?
4.4.2.4
Utilize the active role of the state public health agency in mobilizing
partnerships?
4.4.2.4 Discussion Toolbox
In considering question 4.4.2.4, does the state public health agency:
Work collaboratively with system partners to improve partnerships?
Provide leadership in establishing policy that promotes partnership development?
Invest in professional expertise needed to carry out partnership activities?
Promote evidence-based solutions for resolving public health issues?
Provide leadership in convening a wide range of multi-sectoral collaborative
efforts in the state?
4.4.3
Does the SPHS have the professional expertise to carry out partnership development
activities?
31
Is the SPHS workforce:
4.4.3.1
Skilled in collaborative group processes?
4.4.3.1 Discussion Toolbox
In considering question 4.4.3.1, is the SPHS workforce skilled in:
Using the multiple determinants of health to facilitate cross-sectoral
understanding of public health systems?
Principles of community engagement?
Building and maintaining coalitions?
Facilitating dialogue and action?
Negotiation and conflict management?
Planning and coordinating events?
Collaborative leadership?
4.4.3.2
Sufficiently staffed to carry out partnership development activities?
32
Essential Service # 5:
Develop Policies and Plans that Support Individual and Statewide
Health Efforts
This service includes:
Systematic health planning that relies on appropriate data, develops and tracks measurable health
objectives, and establishes strategies and actions to guide community health improvement at the
state and local levels.
Development of legislation, codes, rules, regulations, ordinances, and other policies to enable
performance of the Essential Public Health Services, supporting individual, community, and state
health efforts.
The process of dialogue, advocacy and debate among groups affected by the proposed health
plans and policies prior to adoption of such plans or policies.
SPHS Model Standard 5.1: Planning and Implementation
The state public health system (SPHS) conducts comprehensive and strategic health improvement
planning and policy development that integrates health status information, public input and
communication, analysis of policy options, and recommendations for action based on the best
evidence. Planning and policy development are conducted for public health programs, for
organizations and for the public health system, each with the purpose of improving public health
performance and effectiveness.
To accomplish this, the SPHS:
Develops statewide health improvement processes that include convening partners, facilitating
collaborations, and gaining statewide participation in planning and implementation of needed
improvements in the public health system.
Produces a state health improvement plan(s) that outlines strategic directions for statewide
improvements in health promotion, disease prevention and response to emerging public health
problems.
Establishes and maintains public health emergency response capacity, plans and protocols for
all-hazards, addressing 24/7 readiness, multi-agency coordination, emergency operations, and
the special needs of vulnerable populations in an emergency.
Engages in health policy development activities and takes necessary actions (including
communication with advocacy groups and advocating to policy makers) to raise awareness of
policies that affect the public’s health.
Please answer the following questions related to Model Standard 5.1:
5.1.1
Does the SPHS implement statewide health improvement processes that convene partners and
facilitate collaboration among organizations contributing to the public’s health?
33
Do participants in planning processes:
5.1.1.1
Include state and community-level leaders?
5.1.1.2
Include populations affected by health improvement efforts?
5.1.1.3
Identify statewide health improvement priorities (within topical areas such as
tobacco planning, cancer prevention planning, diabetes planning, etc.)?
5.1.1.4
Recommend measurable health improvements in the form of objectives?
5.1.1.5
Propose collaborative approaches for accomplishing objectives?
5.1.2
Does the SPHS develop one or more state health improvement plan(s) to guide its collective
efforts to improve health and the public health system?
Do the state health improvement plan(s):
5.1.2.1
Use the data and information from the state health profile about the prevailing
health of the state’s population?
5.1.2.2
Include strategic health objectives and improvement strategies for the state?
5.1.2.2 Discussion Toolbox
In considering question 5.1.2.2 are the following addressed:
Preventive interventions for individuals?
Preventive interventions for community populations?
Changes in SPHS performance and capacity needed to improve the delivery of the
Essential Public Health Services?
5.1.2.3
5.1.2.4
5.1.2.5
5.1.2.6
5.1.3
Identify policy changes that are needed to accomplish health objectives?
Identify individuals and organizations that have accepted responsibility for
implementing specific statewide strategies?
Specify measurable indicators used to monitor progress toward achievement of
health objectives?
Combine into a single comprehensive state health improvement plan?
Does the SPHS have in place an All-Hazards Preparedness Plan guiding systems partners to
protect the state’s population in the event of an emergency?
Does the preparedness plan:
5.1.3.1
Align system-wide interdisciplinary planning and implementation of a public
health response?
5.1.3.1 Discussion Toolbox
In considering question 5.1.3.1, does the all-hazards planning process align together:
State/local emergency management plans?
Hospital disaster plans?
Pre-hospital triage protocols?
Surge capacity plans?
National Incident Management System?
Risk communications plans and protocols?
Mental health plans?
Vulnerability assessments and plans?
5.1.3.2
Identify objectives and strategies and address systems changes to improve the
34
readiness of public health in responding to emergency and disaster situations?
5.1.3.2 Discussion Toolbox
In considering question 5.1.3.2, does the scope of these objectives and strategies
address public health responses for:
Events of bioterrorism?
Natural disasters?
Public exposures to hazardous materials, including toxic chemical spills?
Continuity of operations?
Receipt and deployment of the Strategic National Stockpile?
Enhanced surveillance?
Enhanced communications?
Enhanced situational awareness?
Worker health and safety?
Mass casualty care?
5.1.3.3
Specify operational responsibilities for state, local, public and private
organizations in the event of an emergency?
5.1.3.3. Discussion Toolbox
In considering question 5.1.3.3, do the operations protocols specify:
Deployment of state and local assets?
Deployment of volunteers?
Information sharing and communication processes?
Decision-making process?
Public communication responsibilities?
A schedule for exercising and testing the plan?
Mechanisms for addressing the needs of special population groups in an
emergency (e.g., elderly, disabled, poor residents)?
Activities of the Emergency Operations Center?
5.1.4
Does the SPHS conduct policy development activities?
Do members of the SPHS:
5.1.4.1
Convene interested stakeholders to address policy issues of mutual interest?
5.1.4.1 Discussion Toolbox
In considering question 5.1.4.1, are issues of current interest and importance
addressed, such as:
Medicaid policy?
Health care quality monitoring?
Improvements in access to health care?
Racial and ethnic health disparities?
Health promotion and the built environment ?
In considering question 5.1.4.1, do stakeholders participating in the process include:
A broad representation of the SPHS, including local leaders?
The Governor or Governor’s staff?
Legislative oversight committees?
5.1.4.2
5.1.4.3
Prepare reports outlining policy options?
Convene forums to hear public feedback, formal public testimony, and
recommendations?
35
5.1.4.4
5.1.4.5
5.1.4.6
Communicate with state boards or advisory panels responsible for health policy
development?
Inform federal boards or advisory panels responsible for health policy
development of relevant state issues?
Identify policy changes needed to improve the public’s health?
5.1.4.6 Discussion Toolbox
In considering question 5.1.4.6, do these policy changes include:
Legislative actions needed to improve the delivery of the Essential Public Health
Services?
Legislative actions needed to improve the health of populations bearing
disproportionate burdens of mortality and morbidity?
Strategies to communicate to state and local partners?
The enlistment of advocacy groups to promote the necessary policy changes?
5.1.4.7
5.1.4.8
Draft legislation or public health regulations?
Assure that policy changes are identified to achieve the objectives in the state
health improvement plan?
36
SPHS Model Standard 5.2: State-Local Relationships
The SPHS works with local public health systems to provide assistance, capacity building, and
resources for their efforts to develop local policies and plans that support individual and statewide
health efforts.
To accomplish this, the SPHS:
Provides technical assistance and training to local public health systems developing
community health improvement plans.
Supports development of community health improvement plans and provides assistance in
adapting and integrating statewide improvement strategies to the local level.
Provides assistance to local public health systems in the development of local All-Hazards
Preparedness Plans.
Provides technical assistance and support for conducting local health policy development.
Please answer the following questions related to Model Standard 5.2:
5.2.1
Does the SPHS provide technical assistance and training to local public health systems for
developing local plans?
Does this technical assistance address:
5.2.1.1
Training in the use of health planning models such as APEXPH and MAPP
(Mobilizing for Action through Planning and Partnerships)?
5.2.1.2
Use of local health data to determine health priorities and objectives?
5.2.1.3
Selecting and using effective intervention strategies for addressing local health
priorities and objectives?
5.2.1.4
Mobilizing communities to implement improvements outlined in the plans?
5.2.1.5
Approaches for integrating health issues and improvement strategies into other
local community development or planning initiatives (e.g., Chamber of
Commerce, United Way needs assessment, Emergency Management, Healthy
Cities initiatives, etc.)?
5.2.2
Does the SPHS provide support and assistance for the development of community health
improvement plans that are integrated with statewide health improvement strategies?
Does the SPHS provide technical assistance for:
5.2.2.1
Local program planning for public health infrastructure improvements outlined
in the state health improvement plans?
5.2.2.2
Local system changes needed to improve statewide initiatives (e.g., statewide
strategies to combat emerging infections, coordinated statewide strategies to
reduce obesity)?
5.2.3 Does the SPHS provide technical assistance in the development of local public health allhazards preparedness plans for responding to emergency situations?
Do SPHS members assist in the development of local operational plans that address:
37
5.2.3.1
5.2.3.2
5.2.3.3
5.2.3.4
5.2.3.5
5.2.3.6
5.2.4
Continuity of operations?
Written agreements to assure joint planning, mutual aid and coordinated
response?
Clear definition of state and local roles and responsibilities?
Managing across organizational structures during an event?
Methods for deploying local assets during an emergency event?
Training in the National Incident Management System (NIMS)?
Does the SPHS provide technical assistance in local health policy development?
Do members of the SPHS provide assistance to:
5.2.4.1
Use health data in policy development?
5.2.4.2
Obtain public input on policy options?
5.2.4.3
Analyze policy options?
5.2.4.4
Develop policies based on proven interventions?
5.2.4.5
Inform policymakers of policy issues?
5.2.4.6
Draft rules, regulations, or ordinances needed to protect and promote the health
of the public?
5.2.4.7
Develop systems linkages between public health and the health care system?
38
SPHS Model Standard 5.3: Performance Management and Quality Improvement
The SPHS reviews the effectiveness of its performance in policy and planning. Members of the
SPHS actively use the information from these reviews to continuously improve the quality of policy
and planning activities in supporting individual and statewide health efforts.
To accomplish this, the SPHS:
Regularly monitors the state’s progress towards accomplishing its health improvement
objectives.
Reviews new and existing policies to determine their public health impact.
Conducts exercises and drills to test preparedness response capacity outlined in the state’s allhazard preparedness plan.
Manages the overall performance of its policy and planning activities for the purpose of
quality improvement.
Please answer the following questions related to Model Standard 5.3:
5.3.1
Does the SPHS review progress towards accomplishing health improvement across the state?
5.3.1 Discussion Toolbox
In considering 5.3.1, do members of the SPHS:
Report annually on actions taken to implement the state health improvement
plan(s)?
Report progress on meeting the state’s health improvement objectives every three
to five years?
Inform policymakers and the public of the impact arising from implementation of
those objectives?
5.3.2
Does the SPHS review new and existing policies to determine their public health impacts?
5.3.3
Does the SPHS conduct formal exercises and drills of the procedures and protocols linked to
its All-Hazards Preparedness Plan?
Does the SPHS:
5.3.3.1
Make adjustments in procedures based on the results of exercises and drills to
improve the effectiveness of the state’s response to an emergency?
5.3.3.2
Conduct such exercises and drills at least annually?
5.3.4
Does the SPHS actively manage and improve the overall performance of its planning and
policy development activities?
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5.3.4 Discussion Toolbox
In considering 5.3.4, do SPHS organizations:
Use relevant standards or benchmarks to establish system-wide expectations for
planning and policy development?
Measure performance?
Report on progress to systems partners?
Conduct ongoing quality improvement activities using performance information?
(Examples of QI activities are setting priorities, updating plans and policies to
improve their effectiveness, and the continuous application of new knowledge and
evidence to practice)
40
SPHS Model Standard 5.4: Public Health Capacity and Resources
The SPHS effectively invests in and utilizes its human, information, organizational and financial
resources to assure that its health planning and policy practices meet the needs of the state’s
population.
To accomplish this, the SPHS:
Commits adequate financial resources to develop and implement health policies and plans.
Aligns organizational relationships to focus statewide assets on health planning and policy
development.
Uses the skills of the SPHS workforce in long-range, operational and strategic planning
techniques.
Uses the skills of the SPHS workforce in health policy development, including skills in policy
analysis and in obtaining public participation in the policy-making process.
Please answer the following questions related to Model Standard 5.4:
5.4.1
Does the SPHS commit financial resources to health planning and policy development efforts?
5.4.1 Discussion Toolbox
In considering 5.4.1, do SPHS organizations:
Allocate existing resources to statewide health planning and policy development
activities?
Share financial resources to invest in planning and policy development?
Seek new resources to support planning and policy development activities?
5.4.2
Do SPHS organizations align and coordinate their efforts to implement health planning and
policy development?
Do SPHS organizations:
5.4.2.1
Align their organizational strategic plans to improve system performance in
planning and policy development?
5.4.2.2
Share information systems that provide data useful to health planning and
policy development activities?
5.4.2.3
Utilize the leadership of the state public health agency in planning and policy
development?
5.4.2.3 Discussion Toolbox
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In considering question 5.4.2.3, does the state public health agency:
Work collaboratively with systems partners to improve planning and policy
development efforts?
Provide leadership in establishing state policy that promotes planning and policy
development?
Invest in professional expertise needed to carry out planning and policy
development?
Promote evidence-based solutions for resolving issues that arise in planning and
policy development efforts?
5.4.3
Does the SPHS have the professional expertise to carry out planning activities?
5.4.3.1
Is the SPHS workforce skilled in health planning?
5.4.3.1 Discussion Toolbox
In considering question 5.4.3.1, does this expertise include:
Developing vision and mission statements?
Analyzing system strengths and weaknesses?
Analyzing risk factors and contributing factors to health problems?
Identifying external opportunities and threats to public health?
Facilitating a priority-setting process?
Developing goals and objectives?
Selecting effective intervention strategies?
Selecting performance indicators?
Monitoring performance in accomplishing plans and meeting objectives?
Facilitating public participation in all planning activities?
5.4.3.2
5.4.4
Is the SPHS workforce sufficiently staffed to carry out planning activities?
Does the SPHS have the professional expertise to carry out health policy development ?
5.4.4.1
Is the SPHS workforce skilled in health policy development?
5.4.4.1 Discussion Toolbox
In considering question 5.4.4.1, is there expertise in:
Obtaining input from state and local constituents on policy issues?
Prioritizing policy issues based upon their merit?
Developing policy options?
Analyzing policy options?
Drafting legislation?
Developing rules and regulations?
Establishing procedures that guide operations for normal situations?
Establishing procedures that guide operations for emergency situations?
Conducting policy evaluations?
5.4.4.2
Is the SPHS workforce sufficiently staffed to carry out policy development
activities?
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Essential Service #6:
Enforce Laws and Regulations that Protect Health and Ensure
Safety
This service includes:
The review, evaluation, and revision of laws (laws refers to all laws, regulations, statutes,
ordinances, and codes) designed to protect health and ensure safety to assure that they reflect
current scientific knowledge and best practices for achieving compliance.
Education of persons and entities in the regulated environment and persons and entities that
enforce laws designed to protect health and ensure safety.
Enforcement activities of public health concern, including, but not limited to, enforcement of
clean air and potable water standards; regulation of health care facilities; safety inspections of
workplaces; review of new drug, biological, and medical device applications; enforcement
activities occurring during emergency situations; and enforcement of laws governing the sale of
alcohol and tobacco to minors, seat belt and child safety seat usage, and childhood immunizations.
SPHS Model Standard 6.1: Planning and Implementation
The state public health system (SPHS) assures that laws and enforcement activities are based on
current public health science and best practices for achieving compliance. The SPHS emphasizes
collaboration between those who enforce laws and those in the regulated environment and provides
education to all those affected by public health laws to encourage compliance.
To accomplish this, the SPHS:
Reviews existing and proposed laws to assure these reflect current scientific knowledge and
best practices for achieving compliance and solicits input on reviewed laws from stakeholders
including legislators, legal advisors, and the general public, especially persons and entities in
the relevant regulated environment.
Reviews and updates laws to assure appropriate emergency powers are in place.
Fosters cooperation among persons and entities in the regulated environment and persons and
entities that enforce laws to support compliance and to assure that laws and regulations
accomplish their health and safety purposes.
Ensures that administrative processes, such as those for permits and licenses are customercentered for convenience, cost, and quality of service, and are administered according to
written guidelines.
Please answer the following questions related to Model Standard 6.1:
6.1.1 Does the SPHS assure existing and proposed state laws are designed to protect the public’s
health and ensure safety?
Do SPHS legal reviews:
6.1.1.1
Address whether laws have a sound basis in current public health science and
43
best practices for achieving compliance?
6.1.1.1 Discussion Toolbox
In considering question 6.1.1.1, does the review of state laws, at a minimum, use the
following criteria for effective public health law:
Periodically assesses and continuously improves the state’s public health
infrastructure?
Identifies roles and responsibilities of state and local public health agencies to
provide Essential Public Health Services through various governmental powers
while also respecting individual rights?
Promotes and builds strong relationships within the SPHS?
Creates scientifically- and legally-sound and effective powers of state and local
public health agencies for the prevention and control of conditions of public
health importance at the individual and community levels that are consistent with
guiding principles authorizing the responsible use of power and respect for
individual rights?
Responds to potential public health emergencies through formal declarations and
triggering of special public health powers during an emergency?
Addresses privacy and security issues arising from the acquisition, use,
disclosure, and storage of identifiable health information by state and local public
health agencies?
Implements administrative rule-making authority by the state or local public
health agency and sets affirmative procedures for protecting due process?
Provides fair and appropriate criminal and civil penalties for violations of the state
and local provisions, as well as declares immunities of specific actors where
justified?
Requires regular reporting and accountability by state and local public health
agencies?
6.1.1.2
6.1.1.3
Evaluate the intended and unintended impacts of enforcing laws?
Use input solicited from key stakeholders on laws reviewed?
6.1.1.3 Discussion Toolbox
In considering question 6.1.1.3, is input solicited from:
Legislators?
Legal advisors?
Members of the general public?
Persons or entities in the relevant regulated environment?
6.1.1.4
6.1.2
Result in advocacy by SPHS members to the appropriate legal body, such as
state legislatures or regulatory boards, for modifications that are identified
through their reviews of laws?
Does the SPHS assure that laws give state and local authorities the power and ability to
prevent, detect, manage, and contain emergency health threats?
6.1.2 Discussion Toolbox
In considering 6.1.2, do laws related to emergency powers:
44
Set a definition of what constitutes a public health emergency?
Require the development of a comprehensive public health emergency response
plan?
Authorize the collection of data and records and access to communications to
facilitate the early detection of a health emergency?
Grant state and local public health officials the authority to use and appropriate
property to care for patients, destroy dangerous or contaminated materials, and
implement safe handling procedures for the disposal of human remains or
infectious wastes?
Authorize officials to care and treat ill or exposed persons, to separate affected
individuals from the population at large to prevent further transmission, collect
specimens, and seek the assistance of in-state and out-of-state private sector
health care workers during an emergency?
Require public health authorities to inform the population of public health threats
through mediums and language that are accessible and understandable to all
segments of the population?
Authorize state authorities to allocate state finances as needed during an
emergency?
Create limited immunities for some state and private actors from future legal
causes of action?
Vest the power to declare a public health emergency in state authorities?
Balance due process with emergency powers?
Provide liability protection for health professionals (e.g., physicians, nurses,
EMTs) with out-of state licenses who enter the state to provide services during an
emergency?
6.1.3
Are there cooperative relationships between SPHS and persons and entities in the
regulated environment to encourage compliance and assure that laws accomplish their
health and safety purposes (e.g. hospitals and the state public health agency)?
6.1.3.1
Do these relationships support and encourage training to support compliance
with laws?
6.1.3.1 Discussion Toolbox
In considering 6.1.3.1, does training improve the understanding of:
Benefits that will result from complying with the law?
Rights and responsibilities of the general public with regard to the law ?
Persons affected by the laws and regulations? (i.e., regulated persons and entities,
workforce that enforces laws, and the general public)
6.1.3.2
Dialogue about promising new practices in accomplishing the health and safety
purposes of public health laws?
6.1.3.2 Discussion Toolbox
In considering 6.1.3.2, do the new practices include:
Incentive programs that improve health and safety practices in support of
45
compliance?
Accountability through self-regulation?
Methods for handling difficult situations, where there is a pattern of violations
over time?
6.1.4
Does the SPHS ensure that administrative processes are customer-centered (e.g., obtaining
permits and licenses)?
Are administrative processes:
6.1.4.1
Offered at convenient times and locations?
6.1.4.2
Offered with the convenience of electronic processing?
6.1.4.3
Accompanied by user fees that balance affordability and program
sustainability?
6.1.4.4
Offered with directions for achieving compliance and obtaining information?
6.1.4.5
Administered according to written guidelines?
46
SPHS Model Standard 6.2: State-Local Relationships
The SPHS works with local public health systems to provide assistance, capacity building, and
resources for local efforts to enforce laws that protect health and safety.
To accomplish this, the SPHS:
Offers technical assistance to local public health systems based on current scientific
knowledge and best practices for achieving compliance in both routine and complex
enforcement operations.
Partners with local governing bodies to provide assistance in developing local laws that
incorporate current scientific knowledge and best practices for achieving compliance.
Please answer the following questions related to Model Standard 6.2:
6.2.1
Does the SPHS provide technical assistance to local public health systems on best practices in
compliance and enforcement of laws that protect health and ensure safety?
Does this technical assistance focus on:
6.2.1.1
Enforcement protocols that incorporate current scientific knowledge and best
practices for achieving compliance?
6.2.1.2
Consultations in routine enforcement situations?
6.2.1.3
Direct assistance in complex enforcement operations?
6.2.1.4
Training to keep enforcement skills up-to-date?
6.2.1.4 Discussion Toolbox
In considering 6.2.1.4, is training offered to:
Newly hired enforcement personnel as part of their orientation?
Seasoned enforcement personnel?
In considering 6.2.1.4, is training designed to improve:
Counseling skills?
Communication skills?
Conflict management and negotiation skills?
6.2.2
Does the SPHS partner with local governing bodies in reviewing, improving and developing
local laws?
Does the partnership focus on:
6.2.2.1
Reviewing local laws?
6.2.2.2
Improving and modernizing local laws?
6.2.2.3
Developing new local laws that incorporate current scientific knowledge and
best practices for achieving compliance?
6.2.2.4
Assuring that local officials have the appropriate power and ability to prevent,
detect, manage, and contain emergency health threats?
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SPHS Model Standard 6.3: Performance Management and Quality Improvement
The SPHS reviews the effectiveness of its performance in enforcing laws that protect health and
safety. Members of the SPHS actively use the information from these reviews to continuously
improve the quality of enforcement efforts.
To accomplish this, the SPHS:
Reviews the effectiveness of its laws and enforcement activities, using resources such as the
Model State Public Health Act and Model State Emergency Powers Act.
Manages the overall performance of its enforcement activities for the purpose of quality
improvement.
Please answer the following questions related to Model Standard 6.3:
6.3.1
Does the SPHS review the effectiveness of its regulatory, compliance and enforcement
activities?
Do these reviews examine whether:
6.3.1.1
Gaps in regulatory activities are addressed through new laws or administrative
rules?
6.3.1.2
Cooperative relationships with persons and entities in the regulated
environment have resulted in improvement in compliance with laws?
6.3.1.3
State enforcement activities are appropriately coordinated with the enforcement
efforts at the local level?
6.3.1.4
Enforcement activities are performed professionally and any abuse of authority
is corrected quickly?
6.3.2
Does the SPHS actively manage and improve the overall performance of its regulatory
programs and activities?
6.3.2 Discussion Toolbox
In considering 6.3.2, do SPHS organizations:
Use relevant standards or benchmarks to establish system-wide expectations for
enforcement of laws?
Measure performance milestones?
Report on progress to systems partners?
Conduct ongoing quality improvement activities using performance information?
(Examples of QI activities are setting priorities, updating policies to improve
effectiveness, and the continuous application of new knowledge and evidence to
practice)
48
SPHS Model Standard 6.4: Public Health Capacity and Resources
The SPHS effectively invests in and utilizes its human, information, technology, organizational and
financial resources to enforce laws that protect health and safety in the state.
To accomplish this, the SPHS:
Commits adequate financial resources for the enforcement of laws that protect health and
ensure safety.
Aligns organizational relationships to focus statewide assets on enforcement activities.
Uses workforce expertise to effectively carry out the review, development, and enforcement of
public health laws.
Please answer the following questions related to Model Standard 6.4:
6.4.1
Does the SPHS commit financial resources to the enforcement of laws that protect health and
ensure safety?
6.4.1 Discussion Toolbox
In considering 6.4.1, do SPHS organizations:
Allocate existing resources to enforcement activities?
Share financial resources to invest in enforcement activities?
Seek new resources for enforcement of laws that protect health and ensure safety?
6.4.2
Do SPHS organizations align and coordinate their efforts to comply with laws and
regulations?
Do SPHS organizations:
6.4.2.1
Align their organizational strategic plans to improve system performance in
compliance and enforcement?
6.4.2.2
Coordinate technology resources to more effectively report, track, analyze and
communicate data relevant to enforcement?
6.4.2.3
Utilize the leadership of the state public health agency in enforcing laws that
protect health and ensure safety?
6.4.2.3 Discussion Toolbox
In considering question 6.4.2.3, does the state public health agency:
Work collaboratively with SPHS partners to coordinate a systems approach to
improve enforcement activities?
Provide leadership in establishing state policy that promotes more effective
enforcement?
Invest in professional expertise needed to carry out enforcement activities?
Promote evidence-based solutions for resolving issues in enforcement?
Provide assistance to local public health agencies in enforcement activities?
49
6.4.3
Does the SPHS have the professional expertise to carry out enforcement activities?
Is the SPHS workforce:
6.4.3.1
Skilled in the administration of legal and regulatory programs?
6.4.3.1 Discussion Toolbox
In considering question 6.4.3.1, do these personnel have expertise in:
Public health law?
Legal and administrative processes to adopt, amend, and implement laws?
Best practices and current scientific knowledge in achieving compliance?
Training and education about compliance with laws?
Development of customer-centered administrative processes?
Evaluation of enforcement activities?
6.4.3.2
Sufficiently staffed to carry out enforcement activities?
50
Essential Service #7:
Link People to Needed Personal Health Services and Assure the
Provision of Health Care When Otherwise Unavailable
This service includes:
Assessment of access to and availability of quality personal health services for the state’s
population.
Assurances that access is available in a coordinated system of quality care which includes
outreach services to link populations to preventive and curative care, medical services, case
management, enabling social and mental health services, culturally and linguistically appropriate
services, and health care quality review programs.
Partnership with public, private, and voluntary sectors to provide populations with a coordinated
system of health care.
Development of a continuous improvement process to assure the equitable distribution of
resources for those in greatest need.
SPHS Model Standard 7.1: Planning and Implementation
The state public health system (SPHS) assesses the availability of personal health services for the
state’s population and works collaboratively with state and local partners to assure that the entire state
population has access to high quality personal health care.
To accomplish this, the SPHS:
Assesses the availability and utilization of personal health services for all persons living in the
state, including underserved populations.
Works collaboratively with local public health systems and with health care providers to deliver
personal health services and to take policy and programmatic action to assure access, utilization,
and quality of health care for persons living in the state.
Uses a SPHS organization to provide statewide leadership and coordinate system efforts to
monitor, evaluate, and improve the availability, utilization, and effectiveness of personal health
care delivery within the state.
Mobilizes to reduce health disparities in the state (using guides such as Healthy People 2010) and
to meet the needs of vulnerable populations in the event of an emergency.
Please answer the following questions related to Model Standard 7.1:
7.1.1
Does the SPHS assess the availability of personal health services to the state’s population?
Does the assessment identify:
7.1.1.1
Health professional shortage areas within the state?
7.1.1.2
Gaps in the safety-net provider network?
51
7.1.1.3
7.1.1.4
Utilization of personal health care services?
Barriers to access among populations with special needs?
7.1.1.4 Discussion Toolbox
In considering question 7.1.1.4, are barriers to access considered with respect to:
Age?
Gender?
Sexual orientation?
Literacy level?
Financial status?
Culture, race, or ethnicity?
Geographic location?
Language?
Religion?
National origin (including immigration status)?
Insurance status?
Physical or mental disabilities?
7.1.2
Through collaborations with local public health systems and health care providers, does the
SPHS take action to eliminate barriers to access to personal health care?
Do SPHS collaborative partnerships take action to:
7.1.2.1
Assess the availability of personal health services throughout the state?
7.1.2.1 Discussion Toolbox
In considering question 7.1.2.1, do these services include:
Outreach services to link people to needed care?
Primary medical care (including clinical preventive services)?
Care (case) management?
Hospital care?
Tertiary medical care?
Restorative or rehabilitative care?
Social services?
Mental health services?
Substance abuse treatment services?
Oral health services?
7.1.2.2
Improve personal health service delivery?
7.1.2.2 Discussion Toolbox
In considering question 7.1.2.2, do access programs and initiatives:
Identify persons who are eligible for Medicaid or other state medical assistance
programs prior to their presentation to a medical facility for care?
Facilitate the placement of providers in health professional shortage areas?
Address cultural and linguistic needs of populations served?
7.1.2.3
Inform policymakers of the barriers to personal health care access experienced
by the state’s population?
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7.1.2.4
7.1.2.5
Recommend needed changes in state policy to increase access to personal
health care for populations in need?
Improve the working relationships of members of state and local public health
systems and health care providers?
7.1.2.5 Discussion Toolbox
In considering question 7.1.2.5, do these providers include:
Physicians?
Hospitals?
Nurses?
Dentists?
Social workers?
Public health departments?
7.1.2.6
7.1.3
Prepare for hospital and health professional surge capacity that will be needed
in the event of an emergency?
Does the SPHS have an entity responsible for monitoring and coordinating personal health
care delivery within the state?
Does this coordinating entity have the capability to:
7.1.3.1
Manage a systems approach to assessing and improving the accessibility of
personal health care?
7.1.3.2
Review the quality of personal health care?
7.1.3.3
Make recommendations to policy leaders and safety-net providers on methods
to improve delivery of personal health services?
7.1.4
Does the SPHS mobilize its assets, including local public health systems, to reduce health
disparities in the state?
Does this effort produce:
7.1.4.1
A plan for reducing or eliminating health disparities?
7.1.4.2
A preparedness plan, including organizational roles and responsibilities, for
meeting the needs of vulnerable populations in the event of a natural disaster or
other emergency?
53
SPHS Model Standard 7.2: State-Local Relationships
The SPHS works with local public health systems to provide assistance, capacity building, and
resources for local efforts to identify underserved populations and develop innovative approaches for
meeting their health care needs.
To accomplish this, the SPHS:
Provides technical assistance in systems approaches for identifying and meeting personal
health care needs of underserved populations.
Provides technical assistance in quality improvement of personal health care delivery and
management to providers in local public health systems.
Please answer the following questions related to Model Standard 7.2:
7.2.1
Does the SPHS provide technical assistance to local public health systems on methods to
assess and meet the needs of underserved populations?
Does this assistance address:
7.2.1.1
Local partnership development to coordinate personal health service delivery?
7.2.1.2
Assessment methods for identifying underserved populations?
7.2.1.3
Planning tools for designing programs or initiatives to reduce barriers to health
care access?
7.2.1.4
Approaches to coordinate complementary programs (such as WIC and
childhood immunization programs) to optimize access to needed services?
7.2.1.5
Methods for identifying local surge capacity needed in the event of an
emergency?
7.2.1.6
Approaches for planning for the needs of vulnerable populations in the event of
an emergency?
7.2.2
Does the SPHS provide technical assistance to providers who deliver personal health care to
underserved populations?
7.2.2 Discussion Toolbox
In considering 7.2.2, does the technical assistance focus on:
Implementing culturally and linguistically accessible services?
Promoting health literacy?
Case management, including self-management?
Specific needs of underserved populations, including wrap-around services?
Quality improvement processes for personal health care delivery?
54
SPHS Model Standard 7.3: Performance Management and Quality Improvement
The SPHS reviews the effectiveness of its performance in the provision of personal health care to the
state’s population. Members of the SPHS actively use the information from these reviews to
continuously improve the quality of it efforts to link people to needed personal health services.
To accomplish this, the SPHS:
Reviews health care quality, access, and appropriateness (using such resources as Health Plan
and Employer Data and Information Set (HEDIS), reports published by DHHS’ Agency for
Healthcare Research and Quality, and the Guide to Clinical Preventive Services).
Manages the overall performance of its activities to link people to needed health services for
the purpose of quality improvement.
Please answer the following questions related to Model Standard 7.3:
7.3.1
Does the SPHS review personal health care access, appropriateness and quality?
Do these reviews examine:
7.3.1.1
Reports on the extent and quality of prevention services in managed care?
7.3.1.2
Hospital report cards?
7.3.1.3
Reports on patient safety?
7.3.1.4
State or national health care quality reports?
7.3.1.5
State or national health care disparities reports?
7.3.1.6
Opportunities for change to improve health care quality?
7.3.1.7
Changes to barriers to personal health care?
7.3.1.7 Discussion Toolbox
In considering question 7.3.1.7, are the following reviewed:
Changes in the availability of personal health care?
Extent to which clinical preventive care guidelines are followed?
The timeliness of the delivery of the personal health care?
The use of health services by underserved populations?
Feedback from service recipients?
7.3.2
Does the SPHS actively manage and improve the overall performance of its activities to link
people to needed personal health care services?
7.3.2 Discussion Toolbox
In considering 7.3.2, do SPHS organizations:
Use relevant standards or benchmarks to establish system-wide expectations for
linking people to needed services and improving access to care?
Measure performance?
Report on progress to systems partners?
Conduct ongoing quality improvement activities using performance information?
(Examples of QI activities are setting priorities, updating policies to improve
effectiveness, and the continuous application of new knowledge and evidence to
practice)
55
SPHS Model Standard 7.4: Public Health Capacity and Resources
The SPHS effectively invests in and utilizes its human, information, organizational and financial
resources to assure the provision of personal health care to meet the needs of the state’s population.
To accomplish this, the SPHS:
Commits adequate financial resources for the provision of needed personal health care.
Aligns organizational relationships to focus statewide assets on linking people to needed
personal health care and assuring the provision of health care.
Uses a workforce skilled in the evaluation, analysis, delivery, and management of personal
health services.
Please answer the following questions related to Model Standard 7.4:
7.4.1
Does the SPHS commit financial resources to assure the provision of personal health care?
7.4.1 Discussion Toolbox
In considering 7.4.1, do SPHS organizations:
Allocate existing resources to linking people to the health care they need?
Share financial resources to invest in the provision of needed health care?
Seek new resources for health care provision where otherwise unavailable?
7.4.2
Do SPHS organizations align and coordinate their efforts to provide needed personal health
care?
Do SPHS organizations:
7.4.2.1
Align their organizational strategic plans to improve system performance in
linking people to needed services?
7.4.2.2
Coordinate technology resources to more effectively conduct outreach to link
people to needed care?
7.4.2.3
Utilize the leadership of the state public health agency in linking people to
needed personal health care?
7.4.2.3 Discussion Toolbox
In considering question 7.4.2.3, does the state public health agency:
Work collaboratively with systems partners to improve its efforts to link people to
needed personal health care?
Provide leadership in establishing state policy that promotes linking people with
needed personal health care and the reduction of barriers to health care access?
Invest in professional expertise needed to carry out analysis, technical assistance
and improvements in personal health care delivery?
Promote evidence-based solutions for resolving issues that arise in efforts to link
people to needed personal health care?
56
7.4.3
Does the SPHS have the professional expertise to carry out the functions of linking people to
needed personal health care?
Is the SPHS workforce:
7.4.3.1
Skilled in health care monitoring, analysis, management and service delivery?
7.4.3.1 Discussion Toolbox
In considering question 7.4.3.1, do these workforce skills include:
Expertise in health service monitoring and evaluation (e.g., monitoring
availability, utilization, and effectiveness of health services)?
Expertise in the analysis of health services (e.g., policy analysis, financial and
economic analysis, and health care systems analysis)?
Expertise in managing health services quality improvement programs (e.g.,
quality improvement and staff development in health care programs)?
Expertise in the delivery of health services programs and linking people to needed
services (e.g. knowledge of eligibility requirements, cross-cultural communication
skills, interagency collaborative skills, innovative delivery methods to reach
underserved populations)?
7.4.3.2
Sufficiently staffed to carry out activities to link people to needed personal
health services?
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Essential Service # 8:
Assure a Competent Public and Personal Health Care Workforce
This service includes:
Education, training, development, and assessment of health professionals--including partners,
volunteers and other lay community health workers--to meet statewide needs for public and
personal health services.
Efficient processes for credentialing technical and professional health personnel.
Adoption of continuous quality improvement and life-long learning programs.
Partnerships with professional workforce development programs to assure relevant learning
experiences for all participants.
Continuing education in management, cultural competence, and leadership development
programs.
SPHS Model Standard 8.1: Planning and Implementation
The state public health system (SPHS) identifies the public health workforce needs of the state and
implements recruitment and retention policies to fill those needs. The public health workforce is the
array of personnel providing population-based and personal (clinical) health services in public and
private settings across the state, all working to improve the public’s health through community
prevention and clinical prevention services. The SPHS provides training and continuing education to
assure that the workforce will effectively deliver the Essential Public Health Services.
To accomplish this, the SPHS:
Assesses the numbers, qualifications, and location of the population-based and personal health
care workforce required to meet statewide health needs.
Based on workforce assessments, develops a statewide workforce plan(s) that establishes
strategies and actions needed to recruit, maintain and sustain a competent and diverse
workforce.
Provides human resource development programs focused on enhancing the skills and
competencies of the workforce.
Assures that the population-based and health care workforce in the state attain the highest
level of knowledge and functioning in the practice of their professions.
Supports continuous professional development through programs focused on life-long
learning.
Please answer the following questions related to Model Standard 8.1:
8.1.1 Does the SPHS conduct assessments of its workforce needs to deliver effective populationbased and personal health services in the state?
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Does the SPHS assess:
8.1.1.1
Population-based workforce needs in the state?
8.1.1.2
Personal health care workforce needs in the state?
8.1.1.1 – 8.1.1.2 Discussion Toolbox
In considering question 8.1.1.1 and 8.1.1.2, do the assessments of the populationbased workforce and the personal health care workforce:
Enumerate the workforce in the state?
Define the required qualifications for the workforce?
Define how many personnel are required to meet statewide service delivery
needs?
Define the geographic distribution of personnel required to meet statewide service
needs?
Determine how well education and credentialing requirements are met by the
current workforce?
Determine if compensation (salary and benefits) is adequate to maintain qualified
technical and professional personnel?
Assess gaps in the geographic distribution and competency of the current
workforce?
For the population-based workforce, utilize information from learning
management systems on individual needs of members of the workforce?
For the population-based workforce, assess the impact of the aging of the public
health workforce?
For the population-based workforce, conduct salary comparisons for major
workforce job titles?
8.1.2
Does the SPHS develop a statewide workforce plan(s) to guide its activities in workforce
development? (Note: the SPHS may have one or more workforce plans, but the plan(s) should
address both population-based and personal health care workforce.)
Does the workforce plan(s) address:
8.1.2.1
The population-based workforce, guiding improvements in this segment of the
SPHS workforce?
8.1.2.2
The personal health care workforce, guiding improvements in this segment of
the SPHS workforce?
8.1.2.1 – 8.1.2.2 Discussion Toolbox
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In considering 8.1.2.1 and 8.1.2.2, do the workforce plans for the population-based
workforce and the personal health care workforce:
Result from a collaborative process by SPHS partners in academic and practice
settings?
Do these partners include schools of public health; health professional schools;
including medical; nursing and dental schools; public health preparedness centers;
public health training networks; and/or community college training programs?
Address long-term strategies to recruit and retain qualified personnel throughout
the state?
Address the SPHS member organizations’ strengths and weaknesses in workforce
core competencies needed to deliver the Essential Public Health Services?
(Public health core competencies include: Analytic Skills/Assessment; Basic
Public Health Science; Cultural Competency; Communications; Community
Dimensions of Practice; Financial Planning and Management; Leadership and
Systems Thinking; and Policy Development / Program Planning.)
Address initiatives needed to improve the education of the future workforce?
Address initiatives needed in in-service programs to meet the education and
training needs of the current workforce?
Identify actions to improve the quality of the workforce?
Identify actions to improve the diversity of the workforce?
Identify actions to improve the understanding throughout the workforce of the
Public Health Code of Ethics?
8.1.3
Do SPHS human resources development programs provide training to enhance the technical
and professional competencies of the workforce?
Does training address, at a minimum:
8.1.3.1
Leadership and management skills?
8.1.3.2
Understanding the multiple determinants of health (i.e., conditions underlying
health including cultural, social, economic, educational, genetic, and
environmental determinants)?
8.1.3.3
Use of information technologies in public health practice?
8.1.3.4
Individual and organizational roles in an incident command system?
8.1.3.5
Core competencies needed to deliver the Essential Public Health Services,
including a basic understanding of public health and emergency management?
8.1.3.6
Bridging medicine and public health training in medical schools and schools of
public health?
8.1.4
Does the SPHS assure that individuals in the population-based and personal health care
workforce achieve the highest level of professional practice?
Are competencies assured through:
8.1.4.1
Educational requirements in the hiring process?
8.1.4.2
Professional certifications, licenses, or credentialing?
8.1.4.3
Recognition for completion of advanced competency-based training?
8.1.4.3 Discussion Toolbox
In considering question 8.1.4.3, examples might include:
Advanced certification for emergency management personnel?
Emergency preparedness competencies?
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8.1.4.4
8.1.5
Informatics competencies?
Genomics competencies?
Epidemiology competencies?
Cultural competencies?
Organizational reviews, including accreditation, that recognize workforce
competencies?
Does the SPHS support initiatives that encourage life-long learning?
Do these initiatives include:
8.1.5.1
Career ladders and other developmental programs to provide advancement
opportunities?
8.1.5.2
Coaching or mentoring programs to assist personnel to begin or advance within
their occupation?
8.1.5.3
Funds or time off to help members of the workforce participate in educational
programs that build additional technical and professional skills?
8.1.5.4
Marketing these opportunities to heighten worker awareness?
8.1.5.5
Encouragement for members of workforce to apply their leadership skills to
health improvement activities in their communities (outside of their agency
work)?
8.1.5.6
Learning management systems supporting distance learning and management
of training needs and resources?
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SPHS Model Standard 8.2: State-Local Relationships
The SPHS works with local public health systems to provide assistance, capacity building, and
resources for local efforts to assure a competent population-based and personal health care workforce.
To accomplish this, the SPHS:
Assists local public health systems in assessing the needs of the population-based and personal
health care workforces.
Provides assistance to local public health systems in recruitment, retention, and performance
improvement strategies to improve the availability and competency of the local workforce.
Assures the availability of educational course work to enhance the skills of the workforce of
local public health systems.
Please answer the following questions related to Model Standard 8.2:
8.2.1
Does the SPHS assist local public health systems in completing assessments of their
population-based and personal health care workforces?
8.2.2
Does the SPHS assist local public health systems with workforce development?
Is assistance provided to improve workforce development strategies for:
8.2.2.1
Using competency-based workforce standards?
8.2.2.2
Employee recruitment and retention to fill gaps?
8.2.2.3
Improving workforce performance?
8.2.3
Does the SPHS assure educational course work and training is available and accessible to
enhance the skills of the workforce of local public health systems?
8.2.3 Discussion Toolbox
In considering 8.2.3, does the training include, at a minimum:
Cultural competency?
Leadership development?
Management training?
Core competencies needed to deliver the Essential Public Health Services?
The multiple determinants of health?
Emergency preparedness and response competencies?
Incident command system and emergency operations?
The Public Health Code of Ethics?
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SPHS Model Standard 8.3: Performance Management and Quality Improvement
The SPHS reviews the effectiveness of its performance in assuring a competent population-based and
personal health care workforce. Members of the SPHS actively use the information from these
reviews to continuously improve the quality of workforce development efforts.
To accomplish this, the SPHS:
Reviews both the implementation of its workforce development plans to determine their
effectiveness in developing a workforce that meets current and future demand for health
services in the state and the use of quality improvement resources to improve the skills of
individual workers.
Through an academic-practice partnership(s), reviews the preparation of personnel entering
the workforce.
Manages the overall performance of its workforce development activities for the purpose of
quality improvement
Please answer the following questions related to Model Standard 8.3:
8.3.1
Does the SPHS review its workforce development activities?
8.3.1 Discussion Toolbox
In considering 8.3.1, do these reviews examine whether:
Skilled personal health care workers are available to meet the state’s needs?
Skilled population-based workers are available to meet the state’s needs?
Recruitment of public health workers is effective?
Retention of personal health care workers is effective?
Education, training, and credentialing programs are of high quality (i.e., effective
in helping workers attain core competencies and professional skills)?
Learning management systems are used to identify needed competency-based
training and educational opportunities for workers?
8.3.2
Does the SPHS review the extent to which academic-practice partnership(s) address the
preparation of personnel entering the SPHS workforce?
8.3.2 Discussion Toolbox
In considering 8.3.2, do the academic-practice partnerships review whether:
Entry-level workforce is adequately prepared to meet needs in the state?
Consultations between practitioners and teachers assure that curriculum meets the
needs of practice?
Instructors are competent to prepare entry-level workforces to meet the health
services needs of the state?
Education programs are properly accredited to prepare individuals to meet
standards of credentialing in health-related occupations?
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8.3.3
Does the SPHS actively manage and improve the overall performance of its workforce
development activities?
8.3.3 Discussion Toolbox
In considering 8.3.3, do SPHS organizations:
Use relevant standards or benchmarks to establish system-wide expectations for
workforce development?
Measure performance milestones?
Report on progress to systems partners?
Conduct ongoing quality improvement activities using performance information?
(Examples of QI activities are setting priorities, updating policies to improve
effectiveness, and the continuous application of new knowledge and evidence to
practice)
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SPHS Model Standard 8.4: Public Health Capacity and Resources
The SPHS effectively invests in and utilizes its human, information, organizational and financial
resources to assure a competent population-based and personal health care workforce.
To accomplish this, the SPHS:
Commits adequate financial resources to support workforce development.
Aligns organizational relationships to focus statewide assets on workforce development.
Uses the skills of the SPHS workforce in the management of human resources and workforce
development programs supporting the delivery of high quality personal and population-based
services throughout the state.
Please answer the following questions related to Model Standard 8.4:
8.4.1
Does the SPHS commit financial resources to workforce development efforts?
8.4.1 Discussion Toolbox
In considering 8.4.1, do SPHS organizations:
Allocate existing financial resources to assure adequate numbers of skilled
personnel in the SPHS workforce?
Seek new resources for workforce development activities?
Share financial resources to invest in workforce development? Are there
investments in: system-wide cultural competency in its workforce; life-long
learning programs; leadership development programs; expanding the
competencies of the current workforce in all areas of the state; learning
management systems; and or recruitment and retention of qualified personnel?
8.4.2
Do SPHS organizations align and coordinate their efforts to effectively conduct workforce
development activities?
Do SPHS organizations:
8.4.2.1
Align their organizational strategic plans to improve system performance in
workforce development?
8.4.2.2
Coordinate technology resources to more effectively conduct workforce
development?
8.4.2.3
Utilize the leadership of the state public health agency in workforce
development?
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8.4.2.3 Discussion Toolbox
In considering question 8.4.2.3, does the state public health agency:
Work collaboratively with systems partners to improve workforce development
efforts?
Provide leadership in establishing state policy that promotes workforce
development?
Invest in professional expertise needed to carry out workforce development?
Promote evidence-based solutions for resolving issues that arise in workforce
development efforts?
8.4.3
Does the SPHS have the professional expertise to carry out workforce development activities?
Is the SPHS workforce:
8.4.3.1
Skilled in human resource development?
8.4.3.1 Discussion Toolbox
In considering question 8.4.3.1, does this expertise include:
Defining competencies required to deliver quality health services in the state?
Assessing competencies of the health services workforce?
Examining credentials and credentialing opportunities for individual worker
improvement?
Establishing workforce performance appraisal systems?
Developing curricula to build workforce competencies?
Presenting curricula in a training or educational format to build workforce
competencies?
8.4.3.2
Sufficiently staffed to carry out workforce development activities?
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Essential Service #9:
Evaluate Effectiveness, Accessibility, and Quality of Personal and
Population-Based Health Services
This service includes:
Evaluation and critical review of health programs, based on analyses of health status and service
utilization data, are conducted to determine program effectiveness and to provide information
necessary for allocating resources and reshaping programs for improved efficiency, effectiveness,
and quality.
Assessment of and quality improvement in the State Public Health System’s performance and
capacity.
SPHS Model Standard 9.1: Planning and Implementation
The state public health system (SPHS) conducts evaluations to improve the effectiveness of
population-based services and personal health services within the state. Evaluation is considered a
core activity of the public health system and essential to understand how to improve the quality of
services to the state’s population. Routine evaluations identify strengths and weaknesses in programs,
services and the public health system overall and are actively used in quality and performance
improvement.
To accomplish this, the SPHS:
Evaluates the availability, utilization, appropriateness, and effectiveness of population-based
health services (e.g., injury prevention, promotion of physical activity, immunization) within
the state using national guidelines, such as CDC’s Guide to Community Preventive Services.
Evaluates the effectiveness of personal health services within the state using national
guidelines, such as the Guide to Clinical Preventive Services.
Evaluates the performance of the state public health system in delivering Essential Public
Health Services to the state’s population.
Note: Also see Essential Service # 7 for Personal Health Care Evaluation.
Please answer the following questions related to Model Standard 9.1:
9.1.1
Does the SPHS routinely evaluate population-based health services within the state?
Do these evaluations address:
9.1.1.1
Use of evaluation designs that involve stakeholders in the program, including
local public health systems?
9.1.1.2
Examinations of comparisons of current population-based program experience
with nationally recognized standards of best practice and program
effectiveness?
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9.1.1.3
9.1.1.4
Examinations of consumer satisfaction with population-based services,
including the perspectives of consumers who experience problems with
population-based health services?
Focus on the effectiveness of population-based programs?
9.1.1.4 Discussion Toolbox
In considering 9.1.1.4, do population-based services evaluations address:
Availability and utilization of population-based health programs?
Appropriateness of population-based health programs?
Outcomes of population-based health programs?
Reach of services into populations in need or at risk?
9.1.1.5
9.1.1.6
9.1.2
Monitoring of credentials and licenses of population-based health
professionals?
Regular use of evaluation findings in state health improvement activities?
Does the SPHS evaluate the effectiveness of personal health services within the state?
Do personal health services evaluations address:
9.1.2.1
A broad scope of personal health care facilities and services that are routinely
evaluated for compliance with applicable state and national standards and
benchmarks?
9.1.2.1 Discussion Toolbox
In considering question 9.1.2.1, are the following services evaluated:
Primary health care services?
In-patient hospital services?
Emergency care services?
Ambulatory surgery services?
Rehabilitative care services?
Home health care services?
Long-term care services?
Hospice services?
9.1.2.2
9.1.2.3
9.1.3
Monitoring of credentials and licenses of health care professionals?
Regular use of evaluation findings in state health improvement activities?
Does the SPHS establish and/or use standards to assess the performance of the state public
health system?
Do evaluations of the state public health system:
9.1.3.1
Use standards for the evaluation of systems, capacity, and infrastructure?
9.1.3.2
Address the effectiveness of the delivery of the Essential Public Health
Services throughout the state?
9.1.3.3
Identify strengths and areas of needed improvement in the SPHS?
9.1.3.4
Examine the extent to which statewide organizations operate as a system?
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9.1.3.4 Discussion Toolbox
In considering 9.1.3.4, does the SPHS possess these system attributes:
Strong partnership, where partners recognize they are part of the SPHS?
Effective channels of communication?
Sharing resources, including coordinated approach to seeking new resources?
System-wide objectives for improving health are addressed in organizational
strategic plans?
State public health agency plays a key leadership role in SPHS?
Local public health systems provide feedback on SPHS performance?
9.1.3.5
Examine the role of statewide organizations in evaluating the organizational
performance of their local counterparts, through program evaluation,
certification, accreditation, licensing, or other means (e.g., role of the state
public health agency in evaluating local public health agencies, role of state
Red Cross in evaluating local Red Cross chapters)?
69
SPHS Model Standard 9.2: State-Local Relationships
The SPHS works with local public health systems to provide assistance, capacity building, and
resources for local efforts to evaluate the performance and effectiveness of population-based
programs, personal health services, and local public health systems.
To accomplish this, the SPHS:
Provides technical assistance to local public health systems in the evaluation of populationbased programs, personal health services, and overall local public health systems performance,
using performance benchmarks, such as the Baldrige National Quality Program and the
National Public Health Performance Standards.
Shares results of state-level performance evaluations with local public health systems for use
in local health improvement and strategic planning processes.
Please answer the following questions related to Model Standard 9.2:
9.2.1
Does the SPHS provide technical assistance (e.g., consultations, training) to local public health
systems in their evaluations?
Do SPHS organizations provide assistance in:
9.2.1.1
Evaluating population-based services?
9.2.1.2
Evaluating personal health services?
9.2.1.3
Evaluating local public health systems?
9.2.1.1 – 9.2.1.3 Discussion Toolbox
In considering question 9.2.1.1 - 9.2.1.3, does this assistance include:
Designing evaluation studies?
Routine monitoring of population-based programs?
Use of nationally-developed assessment and evaluation instruments, such as the
National Public Health Performance Standards?
Use of state-based performance assessment tools?
Using evaluation findings in performance improvement processes?
Conducting consumer satisfaction studies?
Evaluating organizational performance (e.g., using the Baldrige criteria, state
accreditation standards and measures)?
9.2.2
Does the SPHS share results of state-level performance evaluations with local public health
systems for use in local planning processes?
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SPHS Model Standard 9.3: Performance Management and Quality Improvement
The SPHS reviews the effectiveness of its performance in evaluating the effectiveness, accessibility,
and quality of population-based programs, personal health services, and public health systems.
Members of the SPHS actively use the information from these reviews to continuously improve the
quality of evaluation efforts.
To accomplish this, the SPHS:
Reviews its evaluation activities to assure their appropriateness in scope and methodology,
using nationally recognized resources, such as CDC’s Principles of Program Evaluation.
Manages the overall performance of its evaluation activities for the purpose of quality
improvement.
Please answer the following questions related to Model Standard 9.3:
9.3.1 Does the SPHS regularly review the effectiveness of its evaluation activities?
Do these reviews examine:
9.3.1.1
The scope of evaluations to assure they are appropriate to inform program and
service delivery decisions?
9.3.1.2
The use of robust evaluation methodologies?
9.3.1.3
Evaluation protocols used when weaknesses in program or service quality become
apparent?
9.3.2
Does the SPHS actively manage and improve the overall performance of its evaluation
activities?
9.3.2 Discussion Toolbox
In considering 9.3.2, do SPHS organizations:
Use relevant standards or benchmarks to establish system-wide expectations for
evaluation?
Measure performance milestones?
Report on progress to systems partners?
Conduct ongoing quality improvement using performance information?
(Examples of QI activities are setting priorities, updating policies to improve
effectiveness, and the continuous application of new knowledge and evidence to
practice)
71
SPHS Model Standard 9.4: Public Health Capacity and Resources
The SPHS effectively invests in and utilizes its human, information, organizational and financial
resources to evaluate the effectiveness, accessibility and quality of population-based and personal
health services. Evaluations are appropriately resourced so they can be routinely conducted.
To accomplish this, the SPHS:
Commits adequate financial resources for evaluation activities.
Aligns organizational relationships to focus statewide assets on evaluating population-based
and personal health services.
Uses a workforce skilled in monitoring and analyzing the performance and capacity of the
state public health system and its programs and services.
Please answer the following questions related to Model Standard 9.4:
9.4.1
Does the SPHS commit financial resources for evaluation?
9.4.1 Discussion Toolbox
In considering 9.4.1, do SPHS organizations:
Allocate existing financial resources to a broad scope of evaluation efforts (e.g.,
program monitoring, process evaluations, outcome evaluations, self-evaluations,
etc.)?
Share financial resources to support evaluation activities?
Seek new resources for evaluation activities?
9.4.2
Do SPHS organizations align and coordinate their efforts to conduct evaluations?
Do SPHS organizations:
9.4.2.1
Align their organizational strategic plans to improve system performance in
evaluation?
9.4.2.2
Coordinate technology resources to more effectively conduct evaluation?
9.4.2.3
Use the leadership of the state public health agency in conducting evaluations
of programs, services and systems?
9.4.2.3 Discussion Toolbox
In considering question 9.4.2.3, does the state public health agency:
Work collaboratively with systems partners to improve its evaluation efforts?
Provide leadership in establishing state policy that promotes evaluation?
Invest in professional expertise needed to carry out evaluation activities?
Promote evidence-based solutions obtained in evaluations to improve the practice
of public health?
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9.4.3
Does the SPHS have the professional expertise to carry out evaluation activities?
Is the SPHS workforce:
9.4.3.1
Skilled in evaluation?
9.4.3.1 Discussion Toolbox
In considering question 9.4.3.1, do these workforce skills include:
Quantitative evaluation methods?
Qualitative evaluation methods?
Service-specific performance standards development?
Public health systems performance standards use?
Database development, data collection and evaluation analysis?
Application of performance evaluation findings to quality improvement activities?
9.4.3.2
Sufficiently staffed to carry out evaluations?
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Essential Service #10:
Research for New Insights and Innovative Solutions to Health
Problems
This service includes:
A full continuum of research ranging from field-based efforts to foster improvements in public
health practice to formal scientific research.
Linkage with research institutions and other institutions of higher learning.
Internal capacity to mount timely epidemiologic and economic analyses and conduct needed
health services research.
SPHS Model Standard 10.1: Planning and Implementation
The state public health system (SPHS) contributes to public health science by identifying and
participating in research activities that address new insights in the implementation of the Essential
Public Health Services. SPHS organizations foster innovation by continuously using best scientific
knowledge and new knowledge about effective practice in their work to improve the health of the
state’s population.
To accomplish this, the SPHS:
Establishes a statewide public health academic-practice collaboration to foster innovations in
public health and personal health care practice by disseminating and applying research
findings and new knowledge to improve the practice of public health.
Develops a public health research agenda focused on public health performance, public health
problems and public health systems issues, bridging the interests of the research community
and the needs of the practice community.
Conducts and participates in public health research to maximize learning about more effective
methods of improving health.
Please answer the following questions related to Model Standard 10.1:
10.1.1 Does the SPHS maintain an active academic-practice collaboration(s) to promote and organize
research activities and disseminate and use research findings in practice?
Does the academic-practice collaboration:
10.1.1.1
Produce joint research projects?
10.1.1.2
Facilitate faculty-staff exchanges (e.g. joint appointments, student placements)?
10.1.1.3
Organize Academic Health Departments?
10.1.1.4
Produce reports that translate research findings into specific practice
applications?
10.1.1.5
Carry out a statewide dissemination process for sharing research findings on
public health practice innovations, including best practices?
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10.1.1.5 Discussion Toolbox
In considering question 10.1.1.5, are research findings disseminated:
To local public health systems?
To other states?
On a web site?
In easily accessible libraries with relevant professional, scientific and research
journals?
Through consultations and technical assistance?
In an understandable “best practice” format?
10.1.2
Does the SPHS have a public health research agenda?
Is the research agenda:
10.1.2.1
Designed to improve health outcomes?
10.1.2.2
Developed through academic-practice collaboration(s)?
10.1.2.2 Discussion Toolbox
In considering question 10.1.2.2., do participants in agenda-setting include:
Research institutions?
Institutions of higher education?
Local public health systems?
Public health agencies in other states?
Other public health system partners?
10.1.2.3
10.1.2.4
10.1.2.5
10.1.2.6
10.1.2.7
10.1.3
Focused on gaining a better understanding of performance factors
associated with delivery of the Essential Public Health Services?
Focused on research issues identified in the state public health
improvement plan?
Relevant to research issues for diverse populations and communities?
Designed to examine the connections among health-related problems?
Regularly updated to reflect current public health issues and concerns?
Does the SPHS participate in and conduct research relevant to public health services?
Does the SPHS:
10.1.3.1
Contribute to the design of research studies?
10.1.3.2
Implement and/or participate in research studies to identify or test
innovative population- based health interventions?
10.1.3.3
Publish research findings in recognized public health literature?
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SPHS Model Standard 10.2: State-Local Relationships
The SPHS works with local public health systems to provide assistance, capacity building, and
resources for local efforts to carry out research for new insights and innovative solutions to health
problems.
To accomplish this, the SPHS:
Assists local public health systems in their research activities, including promoting
community-based participatory research.
Assists local public health systems in the interpretation and application of research findings to
improve public health practice at the local level.
Please answer the following questions related to Model Standard 10.2:
10.2.1 Does the SPHS provide technical assistance to local public health systems with research
activities?
Is this assistance focused on:
10.2.1.1
Building skills in research design and methods?
10.2.1.2
Partnering with research organizations?
10.2.1.3
Obtaining academic health department designation for interested local health
departments?
10.2.1.4
Conducting population-based research studies?
10.2.1.5
Community-based participatory research projects?
10.2.1.5 Discussion Toolbox
In considering question 10.2.1.5, are:
Incentives provided for communities to get involved in community-based
participatory research?
Local public health systems prepared to partner with community members in the
design and execution of a research study?
10.2.2 Does the SPHS assist local public health systems in their use of research findings?
Does assistance include:
10.2.2.1
Disseminating research findings to local public health systems (e.g., through
libraries, Internet, best practice reports)?
10.2.2.2
Applying research findings in practice settings?
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SPHS Model Standard 10.3: Performance Management and Quality Improvement
The SPHS reviews the effectiveness of its performance in conducting and using research for new
insights and innovative solutions to health problems. Members of the SPHS actively use the
information from these reviews to continuously improve the quality of research efforts.
To accomplish this, the SPHS:
Regularly monitors its research activities for relevance to current issues in practice and for
appropriateness in scope and methodology.
Manages the overall performance of its research activities for the purpose of quality
improvement.
Please answer the following questions related to Model Standard 10.3:
10.3.1
Does the SPHS review its public health research activities?
Do these reviews examine:
10.3.1.1
The relevance of the public health research agenda?
10.3.1.2
Implementation of research studies, including data collection, testing
and analysis?
10.3.1.3
Dissemination of research findings within practice community?
10.3.1.4
Evidence-based public health practices?
10.3.2
Does the SPHS actively manage and improve the overall performance of its research
activities?
10.3.2 Discussion Toolbox
In considering 10.3.2, do SPHS organizations:
Use relevant standards or benchmarks to establish system-wide expectations for
research?
Measure performance milestones?
Report on progress to systems partners?
Conduct ongoing quality improvement activities using performance information?
(Examples of QI activities are setting priorities, updating policies to improve
effectiveness, and the continuous application of new knowledge and evidence)
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SPHS Model Standard 10.4: Public Health Capacity and Resources
The SPHS effectively invests, manages, and utilized its human, information, organizational and
financial resources for the conduct of research to meet the needs of the state’s population.
To accomplish this, the SPHS:
• Commits adequate financial resources for research to foster innovations and increase the
effectiveness of public health practice.
• Aligns organizational relationships to focus statewide assets on research and applying new
evidence to practice.
• Uses a workforce skilled in conducting and applying research relevant to the practice of the
Essential Public Health Services.
Please answer the following questions relating to Model Standard10.4:
10.4.1
Does the SPHS commit financial resources to research relevant to health
improvement?
10.4.1 Discussion Toolbox
In considering 10.4.1, do SPHS organizations:
Allocate existing resources to research studies designed to increase the
effectiveness of public health?
Share financial resources to invest in the research function?
Seek new resources for research activities through grant writing or budget
requests?
10.4.2
Do SPHS organizations align and coordinate their efforts to conduct research?
Do SPHS organizations:
10.4.2.1
Align their organizational strategic plans to improve system
performance in research?
10.4.2.2
Coordinate technology resources to more effectively conduct research
relevant to public health practice (e.g., database development to support
research studies)?
10.4.2.3
Utilize the leadership of the state public health agency in conducting,
participating in and using public health research?
10.4.2.3 Discussion Toolbox
In considering question 10.4.2.3, does the state public health agency:
Work collaboratively with systems partners to improve its research efforts?
Provide leadership in establishing state policy that promotes research?
Invest in professional expertise needed to carry out research activities?
Promote evidence-based solutions for resolving issues that arise in research
efforts and in using research results to improve the practice of public health?
78
10.4.3
Does the SPHS have the professional expertise to carry out research activities?
10.4.3.1
Is the SPHS workforce skilled in research activities?
10.4.3.1 Discussion Toolbox
In considering question 10.4.3.1, is the workforce skilled in:
Epidemiology, including the availability of doctoral level expertise
Biostatistics, including the availability of doctoral level expertise
Public health systems research, including the availability of doctoral level
expertise?
Health services research, including the availability of doctoral level expertise?
Research methods?
Applying research findings to practice?
Writing research proposals to pursue funding?
10.4.3.2
Sufficiently staffed to carry out research activities?
79
National Public Health Performance Standards Program
State Public Health System Performance Assessment Instrument
RESPONDENT INFORMATION FORM (RIF)
Demographic Information
User ID#:
Name of State Public Health Agency:
Name of State Health Official:
Title:
Address:
City
State
Zip:
Email:
Phone:
Fax:
Name of Contact Person
Title:
Email:
Phone:
Fax:
1. What is the current population of your state?
a.
Population: ____
b.
Year of population estimate: _____
2. How many people are employed by your state public health agency?
Total FTEs: _____
3. What is the total agency budget? _________
4. Categorize your state public health agency relationship to local public health agencies
a. ____ Centralized (Local public health services are provided through units and/or staff of
the state public health agency)
b. ____ Decentralized (Local public health services are provided through agencies that are
organized and operated by units of local government)
c. ____ Mixed authority (Local public health services are provided through agencies
organized and operated by units of local governments in some jurisdictions and by the state
in other jurisdictions)
d. ____ Shared authority (Local public health services are subject to the shared authority of
both the state agency and the local government)
e. ____ None (There are no local public health agencies in my state)
5. How much time has the state health official held his/her position?
____ years _____ months
80
About Your State’s Assessment Process
Please tell us about your state’s experience with the NPHPSP assessment. The assessment coordinator should
answer evaluation questions on behalf of the site, based on observations of the process and input from
participants.
6. During the assessment process, what type of decision making process was used?
(Check the response that best describes your process.)
Walked through the instrument and voted on questions one-by-one.
Discussed the model standards with follow-up voting on each question.
Reviewed, discussed, and voted on sub-questions before voting on stem (first tier questions).
Discussed the model standards with facilitator/recorder judgment on responses.
Other (Please describe):
7. What process was used to complete the 10 sections of the assessment?
(Check only one response.)
One large meeting during which the group was broken into separate small
groups to
address 2-3 Essential Services per group.
One large meeting during which the same group responded to the entire assessment instrument
together.
A series of meetings during which one or two Essential Services were addressed at each
meeting by the same group throughout the entire process.
A series of meetings during which one or two Essential Services were addressed at each
meeting by a core group which invited specific expertise to the meetings, based on the
Essential Service that was completed.
Other (Please describe):
8. Participation - please indicate the number and type of public health system representatives involved in the
assessment process.
3a. Total number of participants: _______
3b. From the list below, select the types of organizations that participants represented.
State public health agency
The state governing entity (e.g., board of health)
Local health departments
Hospitals
Managed care organizations
Primary care clinics and physicians
Social service providers
State businesses and employers
Neighborhood organizations
Faith institutions
Transportation providers
Educational institutions
Public safety and emergency response organizations
81
Environmental and occupational health organizations
Advocacy groups
Community residents
Other governmental entities (e.g., other state agencies, other local agencies)
Other: ____________________
9. To date, what effect has the assessment process had on the following among public health systems
partners?
Negative
Effect
Somewhat
Negative
Effect
No Effect
Somewhat
Positive
Effect
Positive
Effect
Communications
Collaboration
Knowledge of the
public health system
Knowledge of system
improvement needs
Intent to implement
system improvements
10. How satisfied were you with the following aspects of the National Program?
Dissatisfied
Somewhat
dissatisfied
Neutral
Somewhat
satisfied
Satisfied
N/A
User Guide
On-line Toolkit
Trainings
User Calls
Toll-Free
Helpline (800#)
Email Help box
11. How satisfied were you with the overall experience of the NPHPSP assessment process?
Dissatisfied
5
Somewhat dissatisfied
4
Neutral
3
Somewhat satisfied
2
Satisfied
1
12. Would you complete the NPHPSP assessment process again?
Yes
No
Maybe
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13. Please provide any additional comments on your experience with the NPHPSP process:
Next Steps: Performance Improvement
14. As a result of completing the assessment, which of the following performance improvement steps do you
expect to implement in the next six months to address particular Essential Services or indicators?
Convene participants for performance improvement
Prioritize areas for action
Analyze “root causes” of performance
Develop action plans
Implement action plans
Monitor progress
Report progress
None
83
National Public Health Performance Standards Program
State Public Health System Assessment
Supplemental Questionnaire - Priority of Model Standards
OVERVIEW: This optional questionnaire is made available so that states may consider the priority of
each model standard to their system. States choosing to complete this supplemental questionnaire will
receive an additional component to their reports which will depict their performance scores in relation to
how they have prioritized model standards. This information may serve to catalyze or strengthen the
performance improvement activities resulting from the assessment process.
INSTRUCTIONS: Using a scale of 1 to 10 (with 1 being the lowest and 10 being the highest), please
rate the priority of each model standard without regard to performance scores or rank order. In
considering this questionnaire, the following questions may be helpful for participants. Example A: "On
a scale of 1 to 10, what is the priority of this model standard to our public health system?" Example B:
"On a scale of 1 to 10, how important is it to improve our performance in this activity (e.g., through a
quality improvement process, increased emphasis or resources)?" States may complete this
questionnaire in a single group, either at the same time of the assessment or shortly thereafter, so that
there is a consistent approach to responding to the questions across the model standards.
Model
Standard
Number
Question
Response
Essential Service #1 - Monitor health status to identify health problems
On a scale of 1 to 10, what is the priority of this model standard Planning and Implementation around Essential Service #1 - to our state
P1.1
public health system?
On a scale of 1 to 10, what is the priority of this model standard State-Local Relationships around Essential Service #1 - to our state
public health system?
P1.2
P1.3
P1.4
On a scale of 1 to 10, what is the priority of this model standard Performance Management and Quality Improvement around Essential
Service #1 - to our state public health system?
On a scale of 1 to 10, what is the priority of this model standard Public Health Capacity and Resources around Essential Service #1 - to
our state public health system?
Essential Service #2 - Diagnose and investigate health problems and health hazards
On a scale of 1 to 10, what is the priority of this model standard Planning and Implementation around Essential Service #2 - to our state
P2.1
public health system?
On a scale of 1 to 10, what is the priority of this model standard State-Local Relationships around Essential Service #2 - to our state
public health system?
P2.2
84
P2.3
P2.4
On a scale of 1 to 10, what is the priority of this model standard Performance Management and Quality Improvement around Essential
Service #2 - to our state public health system?
On a scale of 1 to 10, what is the priority of this model standard Public Health Capacity and Resources around Essential Service #2 - to
our state public health system?
Essential Service #3 - Inform, educate and empower people about health issues
On a scale of 1 to 10, what is the priority of this model standard Planning and Implementation around Essential Service #3 - to our state
P3.1
public health system?
On a scale of 1 to 10, what is the priority of this model standard State-Local Relationships around Essential Service #3 - to our state
P3.2
public health system?
P3.3
P3.4
On a scale of 1 to 10, what is the priority of this model standard Performance Management and Quality Improvement around Essential
Service #3 - to our state public health system?
On a scale of 1 to 10, what is the priority of this model standard Public Health Capacity and Resources around Essential Service #3 - to
our state public health system?
Essential Service #4 - Mobilize partnerships to identify and solve health problems
On a scale of 1 to 10, what is the priority of this model standard Planning and Implementation around Essential Service #4 - to our state
P4.1
public health system?
On a scale of 1 to 10, what is the priority of this model standard State-Local Relationships around Essential Service #4 - to our state
P4.2
public health system?
P4.3
P4.4
Model
Standard
Number
On a scale of 1 to 10, what is the priority of this model standard Performance Management and Quality Improvement around Essential
Service #4 - to our state public health system?
On a scale of 1 to 10, what is the priority of this model standard Public Health Capacity and Resources around Essential Service #4 - to
our state public health system?
Question
Response
Essential Service #5 - Develop policies and plans that support individual and statewide health
efforts
On a scale of 1 to 10, what is the priority of this model standard Planning and Implementation around Essential Service #5 - to our state
P5.1
public health system?
On a scale of 1 to 10, what is the priority of this model standard State-Local Relationships around Essential Service #5 - to our state
P5.2
public health system?
85
P5.3
P5.4
On a scale of 1 to 10, what is the priority of this model standard Performance Management and Quality Improvement around Essential
Service #5 - to our state public health system?
On a scale of 1 to 10, what is the priority of this model standard Public Health Capacity and Resources around Essential Service #5 - to
our state public health system?
Essential Service #6 - Enforce laws and regulations that protect health and ensure safety
On a scale of 1 to 10, what is the priority of this model standard Planning and Implementation around Essential Service #6 - to our state
P6.1
public health system?
On a scale of 1 to 10, what is the priority of this model standard State-Local Relationships around Essential Service #6 - to our state
P6.2
public health system?
P6.3
P6.4
On a scale of 1 to 10, what is the priority of this model standard Performance Management and Quality Improvement around Essential
Service #6 - to our state public health system?
On a scale of 1 to 10, what is the priority of this model standard Public Health Capacity and Resources around Essential Service #6 - to
our state public health system?
Essential Service #7 - Link people to needed personal health services and assure the provision of
health care when otherwise unavailable
On a scale of 1 to 10, what is the priority of this model standard Planning and Implementation around Essential Service #7 - to our state
P7.1
public health system?
On a scale of 1 to 10, what is the priority of this model standard State-Local Relationships around Essential Service #7 - to our state
P7.2
public health system?
P7.3
P7.4
On a scale of 1 to 10, what is the priority of this model standard Performance Management and Quality Improvement around Essential
Service #7 - to our state public health system?
On a scale of 1 to 10, what is the priority of this model standard Public Health Capacity and Resources around Essential Service #7 - to
our state public health system?
Essential Service #8 - Assure a competent public health and personal health care workforce
On a scale of 1 to 10, what is the priority of this model standard Planning and Implementation around Essential Service #8 - to our state
P8.1
public health system?
On a scale of 1 to 10, what is the priority of this model standard State-Local Relationships around Essential Service #8 - to our state
P8.2
public health system?
P8.3
On a scale of 1 to 10, what is the priority of this model standard Performance Management and Quality Improvement around Essential
Service #8 - to our state public health system?
86
P8.4
On a scale of 1 to 10, what is the priority of this model standard Public Health Capacity and Resources around Essential Service #8 - to
our state public health system?
Essential Service #9 - Evaluate effectiveness, accessibility, and quality of personal and populationbased health services
On a scale of 1 to 10, what is the priority of this model standard Planning and Implementation around Essential Service #9 - to our state
P9.1
public health system?
On a scale of 1 to 10, what is the priority of this model standard State-Local Relationships around Essential Service #9 - to our state
public health system?
P9.2
P9.3
P9.4
On a scale of 1 to 10, what is the priority of this model standard Performance Management and Quality Improvement around Essential
Service #9 - to our state public health system?
On a scale of 1 to 10, what is the priority of this model standard Public Health Capacity and Resources around Essential Service #9 - to
our state public health system?
Essential Service #10 - Research for new insights and innovative solutions to health problems
On a scale of 1 to 10, what is the priority of this model standard Planning and Implementation around Essential Service #10 - to our
P10.1
state public health system?
On a scale of 1 to 10, what is the priority of this model standard State-Local Relationships around Essential Service #10 - to our state
public health system?
P10.2
P10.3
P10.4
On a scale of 1 to 10, what is the priority of this model standard Performance Management and Quality Improvement around Essential
Service #10 - to our state public health system?
On a scale of 1 to 10, what is the priority of this model standard Public Health Capacity and Resources around Essential Service #10 to our state public health system?
87
National Public Health Performance Standards Program
State Public Health System Assessment
Supplemental Questionnaire - Agency Contribution
Please use this questionnaire to indicate the contribution of the state public health agency to each model
standard. The responses to this questionnaire can be developed at the same time of the assessment or
shortly thereafter.
Indicator
Number
Question
Response
Essential Service #1 - Monitor health status to identify health problems
How much of this model standard - Planning and Implementation
around Essential Service #1 - is achieved through the direct
A1.1
contribution of the state public health agency?
A1.2
How much of this model standard - State-Local Relationships
around Essential Service #1 - is achieved through the direct
contribution of the state public health agency?
A1.3
How much of this model standard - Performance Management and
Quality Improvement around Essential Service #1 - is achieved
through the direct contribution of the state public health agency?
A1.4
How much of this model standard - Public Health Capacity and
Resources around Essential Service #1 - is achieved through the
direct contribution of the state public health agency?
Essential Service #2 - Diagnose and investigate health problems and health hazards
How much of this model standard - Planning and Implementation
around Essential Service #2 - is achieved through the direct
A2.1
contribution of the state public health agency?
A2.2
How much of this model standard - State-Local Relationships
around Essential Service #2 - is achieved through the direct
contribution of the state public health agency?
A2.3
How much of this model standard - Performance Management and
Quality Improvement around Essential Service #2 - is achieved
through the direct contribution of the state public health agency?
How much of this model standard - Public Health Capacity and
Resources around Essential Service #2 - is achieved through the
A2.4
direct contribution of the state public health agency?
Essential Service #3 - Inform, educate and empower people about health issues
88
A3.1
How much of this model standard - Planning and Implementation
around Essential Service #3 - is achieved through the direct
contribution of the state public health agency?
A3.2
How much of this model standard - State-Local Relationships
around Essential Service #3 - is achieved through the direct
contribution of the state public health agency?
A3.3
How much of this model standard - Performance Management and
Quality Improvement around Essential Service #3 - is achieved
through the direct contribution of the state public health agency?
A3.4
How much of this model standard - Public Health Capacity and
Resources around Essential Service #3 - is achieved through the
direct contribution of the state public health agency?
Essential Service #4 - Mobilize partnerships to identify and solve health problems
A4.1
How much of this model standard - Planning and Implementation
around Essential Service #4 - is achieved through the direct
contribution of the state public health agency?
A4.2
How much of this model standard - State-Local Relationships
around Essential Service #4 - is achieved through the direct
contribution of the state public health agency?
A4.3
How much of this model standard - Performance Management and
Quality Improvement around Essential Service #4 - is achieved
through the direct contribution of the state public health agency?
A4.4
How much of this model standard - Public Health Capacity and
Resources around Essential Service #4 - is achieved through the
direct contribution of the state public health agency?
Indicator
Number
Question
Response
Essential Service #5 - Develop policies and plans that support individual and statewide health
efforts
A5.1
How much of this model standard - Planning and Implementation
around Essential Service #5 - is achieved through the direct
contribution of the state public health agency?
A5.2
How much of this model standard - State-Local Relationships
around Essential Service #5 - is achieved through the direct
contribution of the state public health agency?
89
A5.3
How much of this model standard - Performance Management and
Quality Improvement around Essential Service #5 - is achieved
through the direct contribution of the state public health agency?
A5.4
How much of this model standard - Public Health Capacity and
Resources around Essential Service #5 - is achieved through the
direct contribution of the state public health agency?
Essential Service #6 - Enforce laws and regulations that protect health and ensure safety
A6.1
How much of this model standard - Planning and Implementation
around Essential Service #6 - is achieved through the direct
contribution of the state public health agency?
A6.2
How much of this model standard - State-Local Relationships
around Essential Service #6 - is achieved through the direct
contribution of the state public health agency?
A6.3
How much of this model standard - Performance Management and
Quality Improvement around Essential Service #6 - is achieved
through the direct contribution of the state public health agency?
A6.4
How much of this model standard - Public Health Capacity and
Resources around Essential Service #6 - is achieved through the
direct contribution of the state public health agency?
Essential Service #7 - Link people to needed personal health services and assure the provision of
health care when otherwise unavailable
A7.1
How much of this model standard - Planning and Implementation
around Essential Service #7 - is achieved through the direct
contribution of the state public health agency?
A7.2
How much of this model standard - State-Local Relationships
around Essential Service #7 - is achieved through the direct
contribution of the state public health agency?
A7.3
How much of this model standard - Performance Management and
Quality Improvement around Essential Service #7 - is achieved
through the direct contribution of the state public health agency?
A7.4
How much of this model standard - Public Health Capacity and
Resources around Essential Service #7 - is achieved through the
direct contribution of the state public health agency?
Essential Service #8 - Assure a competent public health and personal health care workforce
90
A8.1
How much of this model standard - Planning and Implementation
around Essential Service #8 - is achieved through the direct
contribution of the state public health agency?
A8.2
How much of this model standard - State-Local Relationships
around Essential Service #8 - is achieved through the direct
contribution of the state public health agency?
A8.3
How much of this model standard - Performance Management and
Quality Improvement around Essential Service #8 - is achieved
through the direct contribution of the state public health agency?
A8.4
How much of this model standard - Public Health Capacity and
Resources around Essential Service #8 - is achieved through the
direct contribution of the state public health agency?
Indicator
Number
Question
Response
Essential Service #9 - Evaluate effectiveness, accessibility, and quality of personal and populationbased health services
A9.1
How much of this model standard - Planning and Implementation
around Essential Service #9 - is achieved through the direct
contribution of the state public health agency?
A9.2
How much of this model standard - State-Local Relationships
around Essential Service #9 - is achieved through the direct
contribution of the state public health agency?
A9.3
How much of this model standard - Performance Management and
Quality Improvement around Essential Service #9 - is achieved
through the direct contribution of the state public health agency?
A9.4
How much of this model standard - Public Health Capacity and
Resources around Essential Service #9 - is achieved through the
direct contribution of the state public health agency?
Essential Service #10 - Research for new insights and innovative solutions to health problems
A10.1
How much of this model standard - Planning and Implementation
around Essential Service #10 - is achieved through the direct
contribution of the state public health agency?
A10.2
How much of this model standard - State-Local Relationships
around Essential Service #10 - is achieved through the direct
contribution of the state public health agency?
91
A10.3
How much of this model standard - Performance Management and
Quality Improvement around Essential Service #10 - is achieved
through the direct contribution of the state public health agency?
A10.4
How much of this model standard - Public Health Capacity and
Resources around Essential Service #10 - is achieved through the
direct contribution of the state public health agency?
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| File Type | application/pdf |
| File Title | Microsoft Word - State Instrument for OMB.doc |
| Author | uap3 |
| File Modified | 2007-04-03 |
| File Created | 2007-04-03 |