with additional support fromdhss.alaska.gov/dph/chronic/documents/01-external/mapp_field_gui… ·...

with additional support from:

2

AcknowledgmentsThe Mobilizing for Action through Planning and Partnerships (MAPP) project was developed through a cooperative agreement between NACCHO and

the Centers for Disease Control and Prevention (CDC). Additional support was provided by the Health Resources and Services Administration (HRSA).The development of MAPP would not have been possible without the time and commitment of the APEXPH Work Group, which included local healthofficials, community representatives, academicians, and federal representatives. Members include: Paul J. Wiesner (Chair), Paul Campbell Erwin, ArtChen, Joan Ellison, Joyce Essien, Patricia Gadow, Paul K. Halverson, Deane Johnson, Patrick Lenihan, Linda McElwee, Jane Nelson, and Lucille Webb.

NACCHO also extends its gratitude to the 45 Review Sites and 40 Advisory Committee members who provided vital input for strengthening andimproving the tool. The following Advisory Committee members devoted extensive time at in-person meetings and through individual work: Ron Bialek,William Dyal, Colleen Hughes, Laura Landrum, Daniel Martin, Erica Salem, James Studnicki, Bernard Turnock, Vaughn Upshaw, and Leonadi Ward.

NACCHO also thanks Charles Bacon, CDC, for his ongoing assistance. Finally, this project would not have been possible without the dedication ofNACCHO staff members: Liza Corso, Carol K. Brown, and Scott Fisher. This document was developed by Liza Corso with Jill Conley and Kim Sharp ofCollage Creative.

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What is MAPP?Mobilizing for Action through Planning and Partnerships

(MAPP) is a community-wide strategic planning tool forimproving community health. Facilitated by public healthleadership, this tool helps communities prioritize publichealth issues and identify resources for addressing them.

The Community Drives the ProcessCommunity ownership is the fundamental component of

MAPP. Because the community’s strengths, needs, anddesires drive the process, MAPP provides the framework forcreating a truly community-driven initiative. Communityparticipation leads to collective thinking and, ultimately,results in effective, sustainable solutions to complexproblems.

Broad community participation is essential because a widerange of organizations and individuals contribute to thepublic’s health. Public, private, and voluntary organizationsjoin community members and informal associations in theprovision of local public health services. The MAPP processbrings these diverse interests together to collaborativelydetermine the most effective way to conduct public healthactivities.

Vision for Implementing MAPP

“Communities achieving improved health

and quality of life by mobilizing partner-

ships and taking strategic action. ”

Introduction

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How MAPP WorksMAPP includes two

graphics that illustratethe processcommunities willundertake.

■ In the MAPPmodel, the“phases” of theMAPP process areshown in thecenter of the model, while the four MAPPAssessments — the key content areas that drive theprocess — are shown in the four outer arrows.

■ In the illustrated “community roadmap,” theprocess is shown moving along a road that leads to “ahealthier community.”

To initiate the MAPP process, lead organizations in thecommunity begin by organizing themselves and preparingto implement MAPP (Organize for Success/PartnershipDevelopment). Community-wide strategic planningrequires a high level of commitment from partners,stakeholders, and the community residents who arerecruited to participate.

The second phase of the MAPP process is Visioning. Ashared vision and common values provide a framework forpursuing long-range community goals. During this phase,the community answers questions such as “What would welike our community to look like in 10 years?”

Next, the four MAPP Assessments are conducted,providing critical insights into challenges andopportunities throughout the community:

■ The Community Themes and Strengths Assessmentprovides a deep understanding of the issues residents

feel are important byanswering thequestions “What isimportant to ourcommunity?” “How isquality of lifeperceived in ourcommunity?” and“What assets do wehave that can be usedto improvecommunity health?”

■ The Local Public Health System Assessment(LPHSA) is a comprehensive assessment of all of theorganizations and entities that contribute to thepublic’s health. The LPHSA answers the questions“What are the activities, competencies, and capacities ofour local public health system?” and “How are theEssential Services being provided to our community?”

■ The Community Health Status Assessmentidentifies priority issues related to community healthand quality of life. Questions answered during thephase include “How healthy are our residents?” and“What does the health status of our community looklike?”

■ The Forces of Change Assessment focuses on theidentification of forces such as legislation, technology,and other issues that affect the context in which thecommunity and its public health system operates.This answers the questions “What is occurring or mightoccur that affects the health of our community or thelocal public health system?” and “What specific threats oropportunities are generated by these occurrences?”


Once a list of challenges and opportunities has beengenerated from each of the four assessments, the nextstep is to Identify Strategic Issues. During this phase,participants identify linkages between the MAPPassessments to determine the most critical issues thatmust be addressed for the community to achieve itsvision.

After issues have been identified, participants FormulateGoals and Strategies for addressing each issue.

The final phase of MAPP is the Action Cycle. Duringthis phase, participants plan, implement, and evaluate.These activities build upon one another in a continuousand interactive manner and ensure continued success.

■ A conceptual overview

■ Practical guidance

■ Tools

■ References and resources

■ Case vignettes

In-depth MAPP information isavailable at www.naccho.org.For each phase of the process,

the following is available on theMAPP website:

A Healthier

Community

Our Vision

Action Cycle

Organize for Success / Partnership Development

IdentifyStrategicIssues

FormulateGoals andStrategies

4 MAPP Assessm

entsCommunity Themes

& Strengths Assessment

Assessment

Forces of Change

Local Public Health

System

Assessment

Community HealthStatus Assessment

Evaluate Implement Plan

MAPP - Your CommunityRoadmap to Health!

IntroductionA successful community-wide strategic planning process

requires careful preparation. The purpose of this phase isto lay out a planning process that builds commitment,engages participants, uses participants’ time well, andresults in a plan that can be implemented successfully.These activities are crucial to putting a community on thepath toward a successful community health improvementprocess.

Two interrelated activities occur during this phase:

■ Organize for Success — A decision is made toundertake MAPP and the planning process is outlined.

■ Partnership Development — Participants, includingthe MAPP Committee, are identified and recruited.

How to Conduct the Organize forSuccess/Partnership Development Phase

— Determine the necessity of undertakingthe MAPP process

The first step in organizing the MAPP process is gaininga clear understanding of why such a process is needed.This understanding helps focus planning efforts and assistsin the recruitment and sustained involvement ofparticipants. In addition to identifying reasons forinitiating MAPP, participants should also consider thebenefits they hope to gain from the process and theobstacles that may be encountered along the way.

— Identify and organize participantsDuring this step, careful consideration should be given

to identifying and recruiting participants. Convenorsshould seek broad representation from local public healthsystem partners, other community organizations, andcommunity residents. Participants’ expectations, timecommitments, and logistics should determine how thegroup will be organized. While the MAPP Committee willprovide oversight throughout the process, subcommitteesshould be identified to carry out specific activities.

— Design the planning processDesigning a process involves answering several related

questions: “What will the process entail?” “How long willit take?” “What results are we seeking and how will weknow when we are finished?” and “Who will do the work?”All of the MAPP phases should be carefully reviewed andused to develop a timeline and workplan that meets thecommunity’s needs.

Step 3

Step 2

Step 1

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Organize for Success/ Partnership Development


— Assess resource needs and securecommitment

While the principal resources for the planning effort willbe time and energy contributed by the participants, otherresources will be needed as well. Some of these include:meeting space, refreshments, report production andprinting, and costs associated with information gatheringand data collection. Participants should identify resourceneeds and determine sources for meeting those needs.Some resources may be available through in-kinddonations from participating organizations.

— Conduct a readiness assessmentThe information collected in the previous four steps

should provide a clear picture of the community’spreparedness to begin the MAPP process. As a finalreview, the readiness assessment should ensure that all ofthe critical elements are in place.

— Manage the processThe final step in organizing the MAPP process is to

consider how the process will be managed as it movesforward. This involves paying attention to the manydetails that may affect the success of a communityplanning process. Tools such as a project proposal,master calendars, and meeting agendas should bedeveloped. A process for clarifying assignments andmanaging the work should also be outlined. Carefulpreparation puts the community on the path to asuccessful MAPP process.

Step 6

Step 5

Step 4

■ Vignette - Chicago, IL

■ Tip Sheet - Guidance for Participant Selection

■ Tip Sheet - MAPP Budget Development

■ Example Timeline/Workplan for the MAPP Process

■ Matrix of Participation and Roles within Each Phase ofMAPP

■ Worksheet - Organizing the Planning Effort: Reasons,Benefits, and Sponsorship

■ Worksheet - Organizing the Planning Effort: Barriers

■ Worksheet - Participation Selection

■ Worksheet - Readiness Assessment

Tools and Tip Sheets for theOrganize for Success/Partnership Development

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Visioning

IntroductionThe second phase of MAPP — Visioning — guides the

community through a collaborative and creative processthat leads to a shared community vision and commonvalues.

Vision and values statements provide focus, purpose, anddirection to the MAPP process so that participantscollectively achieve a shared vision of the future. A sharedcommunity vision provides an overarching goal for thecommunity — a statement of what the ideal future lookslike. Values are the fundamental principles and beliefs thatguide a community-driven planning process.

Because visioning is done at the beginning of the MAPPprocess, it offers a useful mechanism for convening thecommunity and building enthusiasm for the process,setting the stage for planning, and providing a commonframework throughout subsequent phases.

How to Conduct the Visioning Phase

— Identify other visioning efforts andmake connections as needed

The MAPP Committee should revisit the inventory ofother community initiatives to see whether or not visioningefforts have taken place. It is a good idea to rescancommunity efforts to ensure that no similar efforts haveemerged since the Organize for Success phase occurred. Ifa similar visioning process is in progress or has beencompleted, try to link it with the MAPP process.

— Design the visioning process andselect a facilitator

Visioning can be conducted through either of thefollowing approaches:

■ Community visioning — a broad-based process with40-100 participants. Community visioning is useful for

engaging and mobilizing the broader community, butcan be more challenging to manage and may requiremore resources to implement.

■ Advisory committee/key leadership visioning —Participants include members of the MAPPCommittee, as well as other key leaders in thecommunity. This type of visioning process may beeasier to manage and requires fewer resources, but willnot include the ideal level of broad involvement.

Once an approach is selected, a small group is chargedwith preparing the visioning sessions, identifying andworking with the facilitator, recording the results of thesessions, and drafting the resulting vision and valuesstatements.

— Conduct the visioning process Visioning sessions are conducted using the method

described on the MAPP website or another approach. Asthe process is implemented, it is important to ensure that abroad range of participants are included in the effort.

Both a shared vision and common values should beidentified through brainstorming and open discussions.

Step 3

Step 2

Step 1

Sample questions for brainstorming ashared vision:

1. What does a healthy Anywhere County meanto you?

2. What are important characteristics of ahealthy community for all who live, work, andplay here?

3. How do you envision the local public healthsystem in the next five or ten years?

Sample questions for brainstormingcommon values:

1. Taking into consideration the vision that hasbeen developed, what key behaviors will berequired from the local public health systempartners, the community, and others in thenext five to ten years to achieve the vision?

2. What type of working environment or climatewill be necessary to support these behaviorsand achieve the vision?


— Formulate vision and values statementsNext, a small group formulates the vision and values

statements based on the outcomes of the visioningsession(s). The vision statement should be strong andpowerful and represent the ideal future outlined duringthe visioning process. The values statement shouldemphasize a positive climate and supportive behaviorsthat contribute to the achievement of the vision.

— Keep the vision and values alivethroughout the MAPP process

As the community moves through the MAPPprocess, it is important to ensure that the visionstatement continues to drive the MAPP effort. Waysto keep the vision and values alive include reading thestatements at meetings or including them oninformational materials. Both may be refined as thecommunity progresses through the planning process.

Step 5

Step 4

■ Vignettes - Miller County,GA, Stratford, CT, andChicago, IL

■ Tip Sheet - A Step-by-StepApproach to Visioning

Tools and Tip Sheets forthe Visioning Phase

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IntroductionThe Community Themes and Strengths Assessment

answers the following questions: “What is important to ourcommunity?” “How is quality of life perceived in ourcommunity?” and “What assets do we have that can be used toimprove community health?”

The Community Themes and Strengths Assessment is avital part of a community health improvement process.During this phase, community thoughts, opinions, andconcerns are gathered, providing insight into the issues ofimportance to the community. Feedback about quality oflife in the community and community assets is alsogathered. This information leads to a portrait of thecommunity as seen through the eyes of its residents.

By including Community Themes and Strengths in theMAPP process, several benefits are gained.

■ Community members become more vested in theprocess when they have a sense of ownership in andresponsibility for the outcomes. This occurs whentheir concerns are genuinely considered and visiblyaffect the process.

■ The impressions and thoughts of community residentshelp to pinpoint important issues and highlightpossible solutions.

■ The themes and issues identified here offer additionalinsight into the findings uncovered in the otherassessments.

Listening to and communicating with the communityare essential to any community-wide initiative. Mobilizingand engaging the community may be a daunting task.However, when successful, it ensures greater sustainabilityand enthusiasm for the process.

How to Conduct the Community Themes andStrengths Assessment

— Prepare for the Community Themesand Strengths Assessment

Establish a subcommittee to oversee the CommunityThemes and Strengths Assessment. This subcommitteeshould determine the most effective approaches forgathering community perspectives. Possible approachesinclude:

■ community meetings

■ community dialogue sessions

■ focus groups

■ walking or windshield surveys

■ individual discussions/interviews

■ surveys

The subcommittee should carefully select a variety ofapproaches that will best reach broad segments of thepopulation. Then, identify the skills and resources neededto conduct the activities.

Step 1

The Four MAPP AssessmentsCommunity Themes and Strengths

Assessment

Three levels of information-gathering occurduring the Community Themes and

Strengths Assessment:■ Open discussion to elicit community concerns,

opinions, and comments in an unstructured way -Asking open-ended questions ensures that issuesof concern and interest to the community areraised. If concerns are properly addressed, thisactivity can raise the credibility of the process andunderscore its community-driven nature.

■ Perceptions regarding community quality of life -Questions about quality of life in the communityhelp pinpoint specific concerns. This may highlightaspects of neighborhoods and/or communities thateither enhance or diminish residents’ quality of life.

■ A map of community assets - Asset mapping is animportant tool for mobilizing community resources.Through this process, the capacities of individuals,civic associations, and local institutions areinventoried.

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— Implement information-gatheringactivities

When implementing selected activities, the broadestparticipation possible should be included. Thesubcommittee should identify groups or individuals whosevoices are not being heard. Also, the subcommittee shouldensure that the logistics — how, when, and where themeetings are held — promote good participation.

— Compile the results of theCommunity Themes and Strengths Assessment

The subcommittee should keep a running list of ideas,comments, quotes, and themes while the activities arebeing implemented. Subcommittee members should alsonote possible solutions to identified problems or innovativeideas for providing public health services. The results ofthis phase are compiled into one central list.

— Ensure that community involvementand empowerment is sustained

While the specific activities conducted (i.e., focus groups,windshield surveys) occur on a finite timeline, the dialoguethat has opened up within the community should benever-ending. Participants involved in the CommunityThemes and Strengths activities should continue to beinvolved throughout the remaining phases of the MAPPprocess.

Step 4

Step 3

Step 2

■ Vignettes - Alameda, CA, Santa Clara, CA,Jasper County, SC, and Chicago, IL

■ Tip Sheet - Conducting a Community Dialogue

■ Tip Sheet - A Step-by-Step Approach toConducting a Focus Group

■ Worksheet - List of Issues, Perceptions, andAssets

Tools and Tip Sheets for theCommunity Themes andStrengths Assessment


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IntroductionThe Local Public Health System Assessment (LPHSA)

answers the questions, “What are the components, activities,competencies, and capacities of our local public health system?”and “How are the Essential Services being provided to ourcommunity?”

The LPHSA focuses on the local public health system —all organizations and entities within the community thatcontribute to the public’s health. The LPHSA uses theEssential Public Health Services as the fundamentalframework for assessing the local public health system.The Essential Services list the ten public health activitiesthat should be undertaken in all communities.

How to Conduct the Local Public Health SystemAssessment

— Prepare for the Local Public HealthSystem Assessment

A subcommittee should be established to oversee theLPHSA process. Subcommittee members should representdiverse segments of the local public health system. Oncethe subcommittee is convened, members review LPHSAsteps and tools and plan how each step will beimplemented.

— Discuss the Essential Services andidentify where each organization/entity is active

The first LPHSA meeting should focus on orientingparticipants to the Essential Services. After a brief overviewof the Essential Services framework, each participant sharesinformation about where his/her organization is active.Posting the information on flip charts can be a fun andeasy way to do this. The last part of the meeting should bedevoted to a dialogue about the Essential Services and howeach organization contributes to them. This discussion willhelp identify opportunities for collaboration, gaps inservice provision, and overlapping activities.

— Discussand complete theperformancemeasurementinstrument

During the nextstep the MAPPCommittee discussesand completes theperformance measuresinstrument. The instrumentprovides two to four indicators (or activities) under each

Step 3

Step 2

Step 1

The Four MAPP AssessmentsLocal Public Health System

Assessment

The LPHSA uses the local-

level standards found in

the National Public Health

Performance Standards

Program (NPHPSP). This

instrument was developed

collaboratively by CDC and

NACCHO. (See

www.phppo.cdc.gov/dphs/

nphpsp)

The Essential Public Health Services1. Monitor health status to identify community health

problems.

2. Diagnose and investigate health problems andhealth hazards in the community.

3. Inform, educate, and empower people about healthissues.

4. Mobilize community partnerships to identify andsolve health problems.

5. Develop policies and plans that support individualand community health efforts.

6. Enforce laws and regulations that protect healthand ensure safety.

7. Link people to needed personal health servicesand assure the provision of health care whenotherwise unavailable.

8. Assure a competent public health and personalhealth care workforce.

9. Evaluate effectiveness, accessibility, and quality ofpersonal and population-based health services.

10. Research for new insights and innovativesolutions to health problems.


Essential Service. By responding to the questions related toeach indicator, participants get a good idea of the activities,capacities, and performance of the local public healthsystem. To respond to the instrument, the MAPPCommittee should discuss the information in the tooluntil a consensus emerges. This discussion should includeperspectives from the organizations conducting publichealth activities as well as community resident input.

— Review the results and determinechallenges and opportunities

During this step, participants discuss the results andidentify challenges and opportunities. The results ofthe previous steps should highlight activity levels andcoordination among partners. Through discussion,participants should be able to categorize the indicators(from the performance measures instrument) into alist of challenges and opportunities. The list shouldbe comprehensive enough to include the issuesidentified in the assessment, but short enough (i.e.,10-15 items) for the local public health system toaddress many of them.

Step 4

■ Vignettes - East Tennessee Region, TN, St.Louis County, MO, and Chicago, IL

■ Local Public Health System PerformanceMeasures Instrument

■ Worksheet - LPHSA Challenges andOpportunities

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The Four MAPP AssessmentsCommunity Health Status Assessment

IntroductionThe Community Health Status Assessment (CHSA)

answers the question, “How healthy are our residents?” and“What does the health status of our community look like?”The results of the CHSA provide the MAPP Committeewith an understanding of the community’s health statusand ensure that the community’s priorities consider specifichealth status issues, such as high lung cancer rates or lowimmunization rates.

The CHSA provides a list of core indicators (dataelements) for 11 broad-based categories. Communitiesmay also select additional indicators. By gathering data foreach of the categories and assessing changes over time ordifferences among population subgroups or with peer,state, or national data, health issues are identified.

How to Conduct the Community Health StatusAssessment

— Prepare for the Community HealthStatus Assessment

A subcommittee should be designated to oversee theCHSA. Members should include individuals that canassist with access to data as well as data collection, analysis,and interpretation. Community representatives alsoprovide an important perspective. Once the subcommitteeis assembled, members should review the CHSA steps andidentify the skills and resources needed to conduct theactivities.

— Collect data for the core indicators onthe CHSA indicator list

During this step, data related to the MAPP “coreindicators” (see MAPP website) should be collected,including trend and comparison data. Trend data will helpto identify changes in data over time, while comparisondata will measure a community’s health status against otherjurisdictions. Data collection may require considerabletime and effort. Therefore, it is important to begin thisactivity early in the MAPP process.

— Identify locally-appropriate indicatorsand collect the data

The selection of locally-appropriate indicators helpsthe MAPP Committeebetter describe thecommunity’s healthstatus and quality of lifein terms that are ofparticular interest to thecommunity. Additionalindicators might be selected

Step 3

Step 2

Step 1

NACCHO’s Protocol forAssessing CommunityExcellence inEnvironmental Health(PACE EH) is a usefulresource for identifyingenvironmental healthindicators.

Categories of Data Collected in the CHSA

Who are we and what do we bring to thetable?

1. Demographic Characteristics

2. Socioeconomic Characteristics

3. Health Resource Availability

What are the strengths and risks in ourcommunity that contribute to health?

4. Quality of Life

5. Behavioral Risk Factors

6. Environmental Health Indicators

What is our health status?7. Social and Mental Health

8. Maternal and Child Health

9. Death, Illness and Injury

10. Infectious Disease

11. Sentinel Events


related to community interest in a specific topic,demographics in the area (e.g., an aging population) orinformation found in the core indicators (e.g., the need tolook closer at cancer rates). To keep data collection effortsreasonable in terms of time and resources, select indicatorsof high priority and relevance only.

— Organize and analyze the data; developa compilation of the findings; and disseminate theinformation.

Individuals with statistical expertise should analyze data.Disparities among age, gender, racial, and other populationsubgroups are especially important. Once the data areanalyzed, a compilation of the findings or a “communityhealth profile” should be developed. The communityhealth profile should include visual aids, such as charts andgraphs, that display the data in an understandable andmeaningful way. The community health profile should bedisseminated and shared with the community.

— Establish a system to monitor theindicators over time

During this step, the subcommittee establishes a systemfor monitoring selected indicators. This helps to ensurethat continuous health status monitoring occurs andestablishes baseline data upon which future trends canbe identified. This system will also be instrumental inevaluating the success of MAPP activities.

— Identify challenges and opportunitiesrelated to health status

The CHSA should result in a list of challenges andopportunities related to the community’s health status.Data findings should be reviewed to identify challenges,such as major health problems or high-risk behaviors, andopportunities, such as improving health trends. Ideally, thefinal list will include 10-15 community health status issuesthat will be more closely examined in the Identify StrategicIssues phase of MAPP.

Step 6

Step 5

Step 4

■ Vignettes - Miller County, GA, PeoriaCity-County, IL, and Chicago, IL

■ Core Indicators for the 11 CHSA Categories

■ Appendix - Menu of Possible ExtendedIndicators for the 11 CHSA Categories

■ Tip Sheet - Presenting Data

■ Tip Sheet - Data Issues in Areas with SmallPopulations

Tools and Tip Sheets for theCommunity Health StatusAssessment


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IntroductionDuring the Forces of Change Assessment, participants

answer the following questions: “What is occurring or mightoccur that affects the health of our community or the localpublic health system?” and “What specific threats oropportunities are generated by these occurrences?” The Forcesof Change Assessment should result in a comprehensive,but focused, list that identifies key forces and describestheir impacts.

While it may not seem obvious at first, the broaderenvironment is constantly affecting communities and localpublic health systems. State and federal legislation, rapidtechnological advances, changes in the organization ofhealth care services, shifts in economic forces, andchanging family structures and gender roles are allexamples of Forces of Change. These forces are importantbecause they affect — either directly or indirectly — thehealth and quality of life in the community and theeffectiveness of the local public health system.

During this phase, participants engage in brainstormingsessions aimed at identifying forces. Forces are a broad all-encompassing category that includes trends, events, andfactors.

■ Trends are patterns over time, such as migration inand out of a community or a growing disillusionmentwith government.

■ Factors are discrete elements, such as a community’slarge ethnic population, an urban setting, or thejurisdiction’s proximity to a major waterway.

■ Events are one-time occurrences, such as a hospitalclosure, a natural disaster, or the passage of newlegislation.

How to Conduct the Forces of Change Assessment

— Prepare for the Forces of ChangeAssessment

During this step, a small group responsible for overseeingthe Forces of Change Assessment should prepare for thebrainstorming sessions. This group determines who willfacilitate the process and how the sessions will be run.Additionally, each member of the MAPP Committeeshould begin thinking about the major forces that affectpublic health or the community. This helps to ensure thateveryone comes to the meeting prepared.

— Convene a brainstorming session toidentify forces of change

Next, the MAPP Committee should hold abrainstorming session to identify forces of change.Through facilitated and structured brainstormingdiscussions, committee members share ideas, identify newforces, and develop a comprehensive list.

Step 2

Step 1

The Four MAPP AssessmentsForces of Change Assessment


Once a comprehensive list of forces has been developed,the MAPP Committee (or a small group of designatedindividuals) reviews and fully discusses each item on thelist. An organized list is developed by combining forcesthat are similar or linked. Other items on the list mayneed to be deleted, added, or further refined.

— Identify potential threats andopportunities for each force of change

Committee members evaluate each force, and for each,identify associated threats and opportunities for thecommunity and the local public health system. In somecases, a force might only be identified with a threat,while in other instances, it may be perceived as both athreat and an opportunity.

The final list is tabled until it is time to conduct theIdentify Strategic Issues phase of the MAPP process.Participants then review each of the issues identified inthe other MAPP assessments in light of the forces ofchange, and discuss the associated threats andopportunities. This activity ensures that strategicissues are relevant to the changing environment.

Step 3

■ Vignettes - Miller County, GA, East Tennessee, TN,and Chicago, IL

■ Worksheet - Forces of Change Brainstorming

■ Worksheet - Forces of Change - Threats andOpportunities

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IntroductionDuring this phase ofthe MAPP process,

participants developan ordered list of themost importantissues facing thecommunity. When

addressing “strategic”issues, a community is

being proactive inpositioning itself for the

future, rather than simply reacting to problems.

Strategic issues should reflect the results of all of theprevious MAPP phases. Up to this point, the process haslargely focused on developing a shared vision andidentifying challenges and opportunities for improvingcommunity health. Strategic issues reveal what is trulyimportant from the vast amount of information that wasgathered in the four MAPP Assessments. Identifyingstrategic issues can be compared to pouring the assessmentfindings into a funnel — what emerges is a distilled mix ofissues that demand attention.

How to Identify Strategic Issues

— Brainstorm potential strategic issues Participants should begin by reviewing the shared vision,

common values, and results of the four MAPPAssessments. They should ask, “What factors identified inthe assessments must be addressed in order to achieve thevision?” As participants discuss this question, they shouldtry to identify where results converge. The adjacentexample shows how results from each of the fourassessments can point to a major issue. Each potentialstrategic issue should be phrased as a question.

— Develop an understanding about whyan issue is strategic

After strategic issues are identified, participants shoulddiscuss each issue until they understand why it is strategic.The definition and criteria for strategic issues — providedon the MAPP website — is a useful resource. Thisdiscussion will help to separate strategic issues from otherproblems. Participants must understand the issues to beable to make wise decisions about how to address them.

— Determine the consequences of notaddressing an issue

Next, participants should consider each strategic issueand ask, “What are the consequences of not addressingthis?” This will help participants determine whether or notaction is required. Strategic issues may have significantconsequences for the community or the local public healthsystem and failure to address them could lead to seriousrepercussions.

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Strategic issues are

those fundamental policy

choices or critical

challenges that must be

addressed for a

community to achieve itsvision.

Identifying Strategic Issues - ExampleStrategic Issue: How can the public health

community ensure access to population-based andpersonal health care services?

Vision: Accessible services.

Community Themes and Strengths Assessment: Lackof insurance; language/cultural barriers; need formore services for seniors; lack of day care;inconvenient hours.

Local Public Health System Assessment: Somewhathigh use of referral mechanisms; outreach istargeted, but possibly not at correct populations.

Community Health Status Assessment: High need foraffordable health care; high use of emergencyrooms; lack of insurance.

Forces of Change Assessment: Inadequate insurancecoverage; disparities exacerbated by accesschallenges and racism.


— Consolidate overlapping or relatedissues

At this point, a large number of strategic issues mayhave been identified. Participants should examine allof these issues and consolidate them into a limitednumber of non-overlapping issues. Ideally, acommunity should have no more than 12 strategicissues; the fewer, the better.

— Arrange issues into an ordered listFinally, the strategic issues should be ordered into a

list. When developing this list, participants determine ifcertain issues should be addressed first, if there are issueswith immediate consequences, or if there are timelines orupcoming events that may help or hinder addressing anissue. In some cases, communities may decide to addresssimpler issues first in an effort to build the necessarymomentum and teamwork for addressing more complex,controversial issues.

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■ Vignette - Chicago, IL

■ Worksheet - Strategic Issues RelationshipDiagram

■ Worksheet Example - Strategic IssuesRelationship Diagram (Chicago, IL Example)

■ Worksheet - Strategic Issues Identification

Tools and Tip Sheets for theIdentify Strategic Issues Phase


Community Themes &

Local PublicHealth

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Status Assessment

SystemAssessm

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Community Health

Organizefor Success


Visioning




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IntroductionDuring this phase, participants formulate

goals and specific strategies for each of thestrategic issues identified in the previousphase. Goals and strategies provide aconnection between the current reality(what the local public health system andthe community look like now) and thevision (what the local public healthsystem and community will look like inthe future). Together, the goals andstrategies provide a comprehensivepicture of how local public healthsystem partners will achieve a healthycommunity.

In developing goals and strategies,communities answer the following questions:

Goals — What do we want to achieve by addressing thisstrategic issue?

Strategies — How do we want to achieve it? Whataction is needed?

How to Formulate Goals and Strategies

— Develop goals related to the visionand strategic issues

Participants begin by revisiting both the vision and thestrategic issues. By identifying how the strategic issues linkto the vision, participants develop goals that will beachieved when those issues are resolved. Whereas thevision presents what the community wants to ultimatelyachieve in an idealistic manner (e.g., “healthy children”),goals capture these results in more concrete terms (e.g.,“Age-appropriate vaccinations for all children.”). Thisactivity may be best accomplished by a small group that

later presents its results to the MAPP Committee fordiscussion.

— Generate strategy alternativesDuring this step, participants identify potential strategies

for achieving goals and attaining the community vision.Several strategies should be identified for each strategicissue. These strategy alternatives reflect the range ofchoices from which the community may select to reach itsvision. Strategy alternatives should build upon strengthsand opportunities while also countering the threatsreflected in the strategic issues. This step may beundertaken through small group brainstormingdiscussions.

— Consider barriers to implementation Next, the small groups continue brainstorming

discussions in an effort to identify barriers to

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implementation. Barriers may take the form of insufficientresources, lack of community support, legal or policyimpediments to authority, technological difficulties, etc.Barriers will not necessarily eliminate strategy alternatives.However, they should alert the community to obstaclesthat may be encountered if that alternative is pursued.

— Consider implementation detailsHere, the small groups flesh out details related to

implementing each strategy alternative. Participants shouldexplore issues such as needed activities, timelines,participation, and resources. Thinking aboutimplementation details at this stage helps to identify andrefine the best strategies. It also lays the groundwork forthe next phase — the Action Cycle.

— Select and adopt strategiesAfter the previous steps have been completed, the best

strategy alternatives should become clearer. At this point,participants should examine the alternatives together tounderstand their relationships to one another.Understanding the interrelationship between strategiesoffers a comprehensive picture of the larger strategy thatthe community will implement to achieve the vision.Next, participants test the strategy alternatives against

agreed-upon selection criteria. Once the strategies areselected, they should be adopted.

— Draft the planning reportThe final step is to develop a draft planning report. A

written planning report: serves as a reference; testsconsensus about agreements; and communicates the vision,goals, and strategies to partners and the broadercommunity. Once the document is complete, it should beadopted by the MAPP Committee. This step marks thecompletion of the planning process and a time to celebratethe hard work. The plan should also be disseminated andshared throughout the community.

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■ Vignettes - St. Louis County, MO, Peoria City-County, IL, and Chicago, IL

■ Worksheet - Strategy Development

■ Worksheet - Strategy Development Matrix

Tools and Tip Sheets for theFormulate Goals and StrategiesPhase


Community Themes &

Local PublicHealth

Forc

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Status Assessment

SystemAssessm

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Community Health

Organizefor Success


Visioning




Plan

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The Action Cycle

IntroductionThe Action Cycle links three key activities — Planning,

Implementation, and Evaluation. Each of these activitiesbuilds upon the others in a continuous and interactivemanner.

The Action Cycle may be the most satisfying andchallenging phase of the MAPP process. During thisphase, the efforts of the previous phases begin to produceresults, as the local public health system develops andimplements an action plan for addressing the strategicissues. Yet, this is where it becomes increasingly importantto sustain the process and continue implementation overtime.

The Action Cycle can be summarized as follows:

■ Planning — Determining what will be done, who willdo it, and how it will be done.

■ Implementation — Carrying out the activitiesidentified in the planning stage.

■ Evaluation — Determining what has beenaccomplished.

How to Conduct the Action Cycle

Planning for Action

— Organize for actionThe first step in this phase is organizing for action. A

subcommittee should be designated to oversee theimplementation and evaluation activities. Thissubcommittee prepares for the subsequent steps and plansfor how they will be implemented. If key participants —those who will play a role in implementing and evaluatingstrategies — are not currently involved in the MAPPprocess, they should be recruited to participate.

— Develop objectives and establishaccountability

For successful implementation, it is important to knowwhere you are headed, who is responsible for getting youthere, and how you are going to get there. To accomplishthis, MAPP participants develop measurable outcomeobjectives for the identified strategies. Participants thenagree on accountability or responsibility for each objective.

— Develop action plans The outcome objectives must now be translated into

specific action plans to be carried out by accountableparticipants. Action planning will help to identify specificactivities, timeframes, and needed resources. Action plansmay be organization-specific or may call for collectiveaction from a number of organizations.

Implementation

— Review action plans for opportunitiesfor coordination

After individual and collective action plans have beendeveloped, the MAPP Committee reviews them to identifycommon or duplicative activities and seeks ways tocombine or coordinate the use of limited communityresources. A quick review of the four MAPP Assessmentsmay be useful for exploring assets, strengths, andopportunities.

— Implement and monitor action plans Each MAPP participant should be involved in

implementing a minimum of one strategy. In addition,MAPP participants should regularly consider whetherother organizations or individuals should be brought onboard to more effectively implement strategies.Community awareness and participation ensures thataction plans are appropriately and effectively implemented.

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Evaluation

— Prepare for evaluation activitiesWhen preparing for evaluation, participants should first

consider what they are evaluating. An evaluation of theentire MAPP process and each strategy should beconducted. Next, participants should think about thestakeholders that should be involved. These may includeindividuals whose professional work relates to the activitybeing implemented, or people who will be affected by itsimplementation.

— Focus the evaluation designThe next step is to design the evaluation. At this stage,

the evaluation team should select: the questions that theevaluation will answer, the process for answering thesequestions, the methodology to be used in collectinganswers, a plan for carrying out the evaluation activities,and a strategy for reporting the results of the evaluation.

— Gather credible evidence and justifyconclusions

During this step, MAPP participants collect data toanswer the evaluation questions. Once credible data aregathered, the evaluation team decides what the dataindicate: Did the activity do what it set out to do? Howeffective was it? The evaluation team should also justifyits conclusions.

— Share lessons learned and celebratesuccesses

Finally, results of the evaluation are used and sharedwith others. Evaluation results can improve existingprocesses and help create new strategies and activities.

Evaluation results may also pinpoint successes and positiveresults. Participants should celebrate these successes.Continuous celebration and recognition of the hard workwill go a long way toward sustaining momentum andkeeping the process alive.

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■ Vignettes - Peoria City-County, IL, St. LouisCounty, MO, Miller County, GA, and Chicago, IL

■ Tip Sheet - Description of Terms Used inObjective-Setting

Tools and Tip Sheets for theAction Cycle

MAPP ProjectNACCHO, 1100 17th Street, NW, 2nd Floor, Washington, DC 20036

Phone: (202) 783-5550 ■ Fax: (202) 783-1583email: [email protected]

www.naccho.org

For more information about MAPP, please contact:

with additional support fromdhss.alaska.gov/dph/chronic/documents/01-external/mapp_field_gui… ·...

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