Accelerating MCH Impact: Integrating Direct Services with Policy,...
Transcript of Accelerating MCH Impact: Integrating Direct Services with Policy,...
Accelerating MCH Impact: Integrating Direct Services
with Policy, System, and Environmental Approaches
AMCHP Webinar
Monday, November 18, 2019
Speakers
Dena Herman, PhD, MPH, RDAdjunct Associate Professor, UCLA Fielding School of Public Health, Department of Community Health Sciences; Director,
Partners in Excellence for Leadership in MCH Nutrition Training Program; Professor, California State University Northridge
Angie Tagtow, MS, RD, LDFounder & Chief Strategist, Äkta Strategies, LLC; Doctoral Candidate, University of Illinois at Chicago, School of Public
Health; Former Executive Director, USDA Center for Nutrition Policy & Promotion
Leslie Cunningham-Sabo, PhD, RDNProfessor, Department of Food Science and Human Nutrition, Colorado State University
Objectives
At the end of this session, attendees will be able to:
Describe the benefits of integrating direct services and policy, system, and environmental approaches to address Title V MCH priorities;
Identify opportunities for building MCH workforce and/or agency capacity to advance policy, system, and environmental approaches; and
Reflect on a case study of how Title V MCH agencies have applied individual and policy, system, and environmental change approaches to their strategic plans, needs assessments, and operations.
Western MCH Nutrition Leadership NetworkDr. Dena Herman, University of California Los Angeles
Western MCH Nutrition Leadership NetworkThe Western Partners MCH Nutrition Leadership Network (NLN) members are state and regional Title V and public health nutrition leaders from the 13 Western states, including Hawaii, Alaska and Inter-tribal Councils.
The NLN began in 1999 and has State members in Regions: VI, VII, VIII, IX, and X.
NLN Purpose: provide leadership training for nutritionists in leadership positions, as well as networking, promoting CE , and supporting TA and opportunities for collaborative learning to strengthen the practice of public health nutrition across the western region.
The Western MCH Partners include nutrition faculty at the following universities: CSU, OHSU, and UW and collaborations with ASU and UCB.
Childhood Obesity Prevention Enhancement Project
Scope: State health departments are charged with addressing childhood obesity, yet often lack resources, skills, and training needed to address multifactorial issues to reduce/prevent obesity at the systems level
Aim: Provide comprehensive I+PSE training to enhance the viability and sustainability of state program efforts to reduce childhood obesity
Process: Provide I+PSE training and TA for 4 western state MCH nutrition teams that result in comprehensive, tailored strategic plans
Teams: California, Oregon, Washington, Winslow Indian Health Care Center (Arizona)
Complete Online Module (1 hr)
Participate in Group & Individual Discussion &
Technical Assistance (1-2 hrs)
Apply Information to Team Strategy
Plan (1 hr)
Chris Mornick, MPH, RDN
Nutrition CoordinatorWashington State Department of Health
Robin Stanton, MA, RDN, LD
MCH Nutrition LeadOregon Health Authority
Suzanne Haydu, MPH, RD
Nutrition & Physical Activity CoordinatorCalifornia Department of Public Health
Nicole Lawrence, MPH, CHES, RDN, LDN
LCDR USPHS , Supervisory DietitianWinslow Indian Health Care Center (AZ)
2018-2019 Childhood Obesity Prevention Enhancement Project Team Leads
MCH Nutrition Training Fact Sheet
Available at https://mchb.hrsa.gov/training/documents/fs/factsheet-NUTRITION.pdf
The State of Nutrition & Health in the U.S.Angie Tagtow, Äkta Strategies, LLC
Current Eating Patterns in the United StatesPercent of the U.S. Population Ages 1 Year and Older Who are Below, At, or Above Each Dietary Goal or Limit
Note: The center (0) line is the
goal or limit. For most, those
represented by the blue sections
of the bars, shifting toward the
center line will improve their eating
pattern.
Data Source: What We Eat in
America, NHANES 2007-2010 for
average intakes by age-sex group.
Healthy U.S.-Style Food Patterns,
which vary based on age, sex, and
activity level, for recommended
intakes and limits.
Adapted from Figure 2-1 (page 39), U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th Edition. December 2015.
Leading Causes of Death in the US, 1980 & 2017 (adapted from the National Center for Health Statistics, 2018)
Rank
1980 2017
Cause of Death # Deaths Cause of Death # Deaths
All causes 1,989,841 All causes 2,744,248
1 Diseases of heart 761,085 Diseases of heart 635,260
2 Malignant neoplasms 416,509 Malignant neoplasms 598,038
3 Cerebrovascular diseases 170,225 Accidents (unintentional injuries) 161.374
4 Unintentional injuries 105,781 Chronic lower respiratory diseases 154,596
5 Chronic obstructive pulmonary diseases
56,050 Cerebrovascular diseases 142,142
6 Pneumonia and influenza 54,619 Alzheimer’s disease 116,103
7 Diabetes mellitus 34,851 Diabetes mellitus 80,058
8 Chronic liver disease and cirrhosis 30,583 Influenza and pneumonia 51,537
9Atherosclerosis 29,449
Nephritis, nephrotic syndrome, nephrosis
50,046
10 Suicide 26,869 Intentional self-harm (suicide) 44,965
GDP & National Health Expenditures in the US1960, 1980 & 2017 (adapted from the National Center for Health Statistics, 2018)
1960 1980 2017
Amount (billions)
Gross Domestic Product (GDP) $542.4 $2,857.3 $19,485.4
National Health Expenditures $27.2 $255.3 $3,492.1*
National Health Expenditures as Percent of GDP 5.0% 8.9% 17.9%
Health Expenditures Per Capita $146 $1,108 $10,739
* 34% private health insurance, 20% Medicare, 17% Medicaid, 10% Out-of-pocket
Conformance with Healthy Eating Patterns Reduces Health Care Costs
A daily increase of 2 cups of fruits and vegetables consumed would save an estimated $32 billion in health care expendituresa
A 20% increased conformance to a healthy eating pattern as measured by HEI-15 would save an estimated $31.5 billion in health care expendituresb
An 80% increased conformance to a healthy eating pattern as measured by HEI-15 would save an estimated $55.1 billion in health care expendituresb
Rinehardt S. Delivering on the Dietary Guidelines. How Stronger Nutrition Policy Can Cut Costs and Save Lives. 2019. Washington, DC: Union of Concerned Scientists.
Scrafford G. Bi X, Multani J, Murphy M, Schmier J. Barraj L. Health economic evaluation modeling shows potential health care cost savings with increased conformance with healthy dietary patterns among adults in the United States. J Acad Nutr Diet. 2019; 119(4): 599-616.
“This modern public health world that we are quickly
moving into, one in which public health as the local
governmental institution has a responsibility and an
opportunity to lead our collective impact around improving
the public’s health. This is a multi-sectoral approach that
takes the opportunity to address environmental, systems
and policy-level change.”
Dr. Karen DeSalvo
Former HHS Assistant Secretary for Health
October 26, 2015
CDC. The Public Health System and the 10 Essential Public Health Services. Available at https://www.cdc.gov/publichealthgateway/publichealthservices/essentialhealthservices.html
Core Functions & Essential Public Health Services
Nested Systems
The Public Health System
Where’s the food?
CDC. The Public Health System and the 10 Essential Public Health Services. Available at https://www.cdc.gov/publichealthgateway/publichealthservices/essentialhealthservices.html
Maternal and Child Health
Bureau
To improve the health and well-being of America's mothers, children, and families.
We envision an America where all children and families are healthy and thriving, and where each child has a fair shot at reaching their fullest potential.
HRSA Maternal & Child Health Bureau. About the Maternal and Child Health Bureau. Available at https://mchb.hrsa.gov/about
Maternal and Child Health
Maternal/ Women’s
Health
Perinatal/ Infant Health
Child Health
Adolescent/ Young Adult
Children with Special Health
Care Needs
Cross-Cutting SystemsMCHB
Strategic Framework
WorkforceResearch
Adapted from Carolyn Gleason, Title V Block Grant Project Officer, Division of State and Community Health, MCHB, Overview of the Title V Block Grant Program. MCH Nutrition Grantee Conference Call. October 7, 2019
Oscar Fleming W, Apostolico A, Mullenix A, Starr K, Margolis L. Putting implementation science into practice: Lessons from the creation of the National Maternal and Child Health Workforce Development Center. Matern Child Health J. 2019; 23:722-732. https://doi.org/10.1007/s10995-018-02697-x
MCH Workforce Development Training & Technical Assistance Implementation Drivers Framework
Systems Science
A transdisciplinary study of interactions, and the degree of those interactions, among components. This includes identifying the intended and unintended consequences of those interactions.
Applies theories and models from various sciences (biological, social, economic, environmental) to analyze and solve problems.
Formulates multidimensional/holistic approaches or representations of different systems to effectively solve problems and avoid negative consequences.
Angie Tagtow, Scholar-in-Residence, Green Mountain College, Masters in Sustainable Food System Program, 2018
Do Systems Approaches Have a Role in Title V MCH?
Systems Science
Systems Thinking
Systems Practice
I
Direct Services - Evidence-based interventions directed to individuals and families that support increased knowledge and positive behavior changeIndividual
I+P
Direct Services - Evidence-based interventions directed to individuals and families that support increased knowledge and positive behavior changeIndividual
Organizational & Community Policy – Changes to procedures or organizational practices
Public Policy - Changes to or creation of laws, ordinances, resolutions, mandates, regulations or rules
Policy
I+PS
Direct Services - Evidence-based interventions directed to individuals and families that support increased knowledge and positive behavior changeIndividual
Organizational & Community Policy – Changes to procedures or organizational practices
Public Policy - Changes to or creation of laws, ordinances, resolutions, mandates, regulations or rules
Policy
Infrastructure & Operations - Changes to infrastructure that impacts all elements of an organization, institution, or framework
*Result of individual, policy PLUS environmental changes
Systems
“I+PSE”
Direct Services - Evidence-based interventions directed to individuals and families that support increased knowledge and positive behavior changeIndividual
Organizational & Community Policy – Changes to procedures or organizational practices
Public Policy - Changes to or creation of laws, ordinances, resolutions, mandates, regulations or rules
Policy
Infrastructure & Operations - Changes to infrastructure that impacts all elements of an organization, institution, or framework
*Result of individual, policy PLUS environmental changes
Systems
Built Environment - Modifications to physical spaces and settings in organizations, institutions, or public areas
Natural Environments – Changes to ecological resources, landscapes and ecosystems that impact soil, water, energy, climate, biodiversity, and energy
Environment
Policy
System
Individual (Direct
Services)
Environment
Building Blocks for Optimal Impact
Benefits of I+PSE
Tackle wicked problems
Reciprocal support
Multisectoral and interdisciplinary
Multi-level action
Applicability and adaptability
Iterative
Community and population benefits
Operationalize and institutionalize
Individual Behavioral Change Theories
Health Belief Model
Health Promotion Model
Integrated Theory of Health Behavior Change*
Self-Regulation Model
Social Cognitive Theory*
Theory of Planned Behavior
Theory of Reasoned Action
Transtheoretical Model (Stages of Change)*
Social Cognitive Theory (Social Learning)
Adapted from Bandura, A. Social foundations of thought and action: A social cognitive theory. 1986. Prentice-Hall, Inc.
Behavior
Environmental Factors
Personal Factors (cognitive, affective,
biological events)
Observation
Integrated Theory of Health Behavior Change
Knowledge & Beliefs
Condition-specificKnowledgePersonal Perceptions
Self-efficacyOutcome ExpectancyGoal Congruence
Social Facilitation
InfluenceSupport
EmotionalInstrumentalInformational
Self-Regulation Skill & AbilityGoal SettingSelf-Monitoring Reflective ThinkingDecision-MakingPlanning and Plan EnactmentSelf-EvaluationManagement of Emotional Response
Outcomes -Proximal
Engagement in Self-Management Behavior
Outcomes -Distal
Health Status
Adapted from Ryan P. Integrated theory of health behavior change. Background and intervention development. Clin Nurs Spec. 2009; 23(3):161-172.
Transtheoretical Model – Stages of Change
Adapted from Prochaska J, DiClemente C, Norcross J. In search of how people change: Applications to the addictive behaviors.American Psychologist. 1992;47, 1102-1114. PMID: 1329589.
Precontemplation
Contemplation
Preparation
Action
Maintenance
1
2
3
4
5
System Change Theories & Conceptual Frameworks
Community Organization Model
Culture of Health Framework*
Diffusion of Innovation Theory
Life Course Theory*
Organizational Change Model
PRECEDE-PROCEED Framework
Social Determinants of Health*
Social-Ecological Model*
Increase focus on community and population
health
Culture of Health Framework
From Vision to Action. A Framework and Measures to Mobilize Health. Robert Wood Johnson Foundation. 2015. Available at https://www.cultureofhealth.org/content/dam/COH/RWJ000_COH-Update_CoH_Report_1b.pdf
Florida Health. Programs and Services. Women’s Health. Life Course Theory. Available at http://www.floridahealth.gov/programs-and-services/womens-health/florida-life-course-indicator-report/life-course-theory-1.html
Helman H, Artiga S. Beyond Health Care: The Role of Social Determinants of Health and Health Equity. Kaiser Family Foundation. 2015. https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/
Social Determinants of Health
Social Ecological Model
FIGURE 3-1. A Social-Ecological Model
for Food and Physical Activity
Decisions (page 65), 2015-2020 Dietary
Guidelines for Americans.
Data Source: Adapted from: (1) Centers
for Disease Control and Prevention.
Division of Nutrition, Physical Activity, and
Obesity. National Center for Chronic
Disease Prevention and Health Promotion.
Addressing Obesity Disparities: Social
Ecological Model. Available at:
http://www.cdc.gov/obesity/health_equity/a
ddressingtheissue.html. Accessed October
19, 2015. (2) Institute of Medicine.
Preventing Childhood Obesity: Health in
the Balance, Washington (DC): The
National Academies Press; 2005, page 85.
(3) Story M, Kaphingst KM, Robinson-
O’Brien R, Glanz K. Creating healthy food
and eating environments: Policy and
environmental approaches. Annu Rev
Public Health 2008; 29:253-272.
Public Health Services for MCH Populations: Title V MCH Services Block Grant
Direct
Services
Enabling Services
Public Health Services & Systems
MCH Block Grant Services Program, Title V, SEC. 501 (a) (1) (A-B)
Appropriations to states ”to improve the health of
all mothers and children.”
Applying Theory to PracticeI+PSE Conceptual Framework for Action
Spectrum of Prevention
The Spectrum of Prevention: Developing a Comprehensive Approach to Injury Prevention. The Prevention Institute. Available at http://www.preventioninstitute.org/component/jlibrary/article/id-105/127.html
Modified Spectrum of Prevention
Enhancements• Re-order• Action verbs• Added “Modify
Physical Spaces & Natural Settings”
• Changed ‘Influence’ to ‘Inform Policy and Legislation’
• Colors• “I+PSE Conceptual
Framework for Action”
Tagtow, A. I+PSE Conceptual Framework, Western Region MCH Nutrition Learning Network Annual Training. May 2017.
Strengthen Individual Knowledge & Skills
Promote Community Education
Educate Providers
Foster Coalitions & Networks
Change Organizational Practices
Modify Physical Spaces & Natural Settings
Inform Policy & Legislation
Strengthen Individual
Knowledge & Skills
Promote Community Education
Educate Providers
Foster Coalitions &
Networks
Change Organizational
Practices
Modify Physical Spaces & Natural Settings
Inform Policy & Legislation
Enhancingpersonal, individual, or household’s decision-making and capability of participating in or benefitting from healthy eating and active living
Reach groups of people with information and resources by promoting healthy eating and active living
Inform and educate providers or intermediaries who transmit information about healthy eating and active living to others
Foster relationships and cultivate multisector collaborations by convening individuals and groups around healthy eating and active living
Revise or adapt policies, regulations, and procedures within institutions that support healthy eating and active living
Design physical spaces and natural settings within institutions or public environments that support healthy eating and active living (behavioral design/built environment)
Develop strategies to change laws, regulations, and public policies (local, state, federal) that support healthy eating and active living
Application: Healthy Eating & Active Living (HEAL)
A. Tagtow, MCHB Childhood Obesity Prevention Enhancement Project, 2019
I+PSE Conceptual Framework for Action
A. Tagtow, MCHB Childhood Obesity Prevention Enhancement Project, 2019
Strengthen Individual Knowledge & Skills
Promote Community Education
Educate Providers
Foster Coalitions & Networks
Change Organizational Practices
Modify Physical Spaces & Natural Settings
Inform Policy & Legislation
I+PSE Conceptual Framework for Action
A. Tagtow, MCHB Childhood Obesity Prevention Enhancement Project, 2019
Strengthen Individual Knowledge & Skills
Promote Community Education
Educate Providers
Foster Coalitions & Networks
Change Organizational Practices
Modify Physical Spaces & Natural Settings
Inform Policy & Legislation
Context/Capitalo Healtho Social/Culture o Economic o Environmental o Political
Social Determinants of Health
I+PSE Conceptual Framework for Action
A. Tagtow, MCHB Childhood Obesity Prevention Enhancement Project, 2019
Strengthen Individual Knowledge & Skills
Promote Community Education
Educate Providers
Foster Coalitions & Networks
Change Organizational Practices
Modify Physical Spaces & Natural Settings
Inform Policy & Legislation
Context/Capitalo Healtho Social/Culture o Economic o Environmental o Political
Social Determinants of Health
Systemic Transformation
Adaptive Organization
Collective Action
Sustained Impact
Adaptive Leadership
I+PSE Conceptual Framework for Action
A. Tagtow, MCHB Childhood Obesity Prevention Enhancement Project, 2019
Strengthen Individual Knowledge & Skills
Promote Community Education
Educate Providers
Foster Coalitions & Networks
Change Organizational Practices
Modify Physical Spaces & Natural Settings
Inform Policy & Legislation
Context/Capitalo Healtho Social/Culture o Economic o Environmental o Political
Social Determinants of Health
Systemic Transformation
Adaptive Organization
Collective Action
Sustained Impact
Strategic Communication
Nurturing an Adaptive Culture
Adaptive Leadership
Mobilize people to tackle tough challenges and to thrive
Establish an iterative process using previous wisdom and experience
Use diversity to create collective intelligence
Integrate action learning and systematic reflection
Build upon and support evidence-based practice
Adaptive Organization
Addresses all issues, regardless of the sensitivity (“elephants”)
Shares responsibility for the organization’s future
Values independent judgment
Builds leadership capacity
Institutionalizes reflection and continuous learning
Allows for innovation, experimentation, and risk of failure
Heifetz R, Grashow Al, Linsky M. The Practice of Adaptive Leadership. Tools and Tactics for Changing Your Organization and the World. 2009. Cambridge Leadership Associations: Boston, MA.
Strategic Communication
Intentional Coordination
Management/Organizational
Marketing
Public Relations/Media
Technical
Social Marketing
Informing and Educating
Political
Principles
Accessible
Actionable
Credible and Trusted
Relevant
Timely
Understandable
Hallahan K, Holtzhausen D, van Ruler B, Vercic D, Sriramesh K. Defining Strategic Communication. International Journal of Strategic Communication. 2007; 1(1):3-35.
WHO. WHO Strategic Communications for Effective Communications. (2017). Available at https://www.who.int/mediacentre/communication-framework.pdf.
Know Your Audience!
Downstream
Putting the I+PSE Conceptual Framework for Action to Work
Strengthen Individual Knowledge & Skills
Promote Community Education
Educate Providers
Foster Coalitions & Networks
Change Organizational Practices
Modify Physical Spaces & Natural Settings
Inform Policy & Legislation
“Downstream”
• Communication• Training & Technical
Assistance• Program Planning
(Logic Model)• Local Coalition
Building• CHNA HIP• Monitoring &
Evaluation
“Upstream”
• Communication• Performance
Measures• Agency Strategic
Planning• Monitoring &
Evaluation• Staff Competencies• Partnerships• Funding
Adapted from Raskind I, Chapple-McGruder T, Mendez D. et al. MCH workforce capacity: Maximizing opportunities afforded by a changing public health system. Matern Child Health J. 2019;23:979. https://doi-org.proxy.cc.uic.edu/10.1007/s10995-018-02728-7
Systems Integration
Health in
All Policies
Assessing array of factors that influence
public health problems
Understanding relationship between new policy and public
health problems
Evidence-Based Decision-Making
Evidence-Based
Public Health
Finding evidence on public health efforts
that work
Applying evidence-based approaches to
solve public health issues
Change Management &
Adaptive Leadership
Implementation of the Affordable Care
Act
Managing change in response to dynamic
evolving circumstances
Anticipating the changes in your
environment that may influence your work
MCH Workforce Capacity Core Training Areas
Trends in Public Health Practice
Associated MCH Job Skills
NLN Obesity Enhancement Project OutcomesDr. Leslie Cunningham-Sabo, Colorado State University
Results of Childhood Obesity Prevention Project
Recap of childhood obesity prevention project with 4 teams
Evaluation processes
Summary notes from CoP and individual TA sessions
Surveys and interviews with teams
Review of team’s strategic plans and other developed products
Outcomes – All Teams
Advance from their (different) starting places
Gained knowledge and value for I+PSE approach
Engaged stakeholders (upstream, downstream, outside agency)
Developed MCH strategic plan incorporating I+PSE
Challenges
Competing priorities for self and others
Changing mindset to incorporate I+PSE into current work
Communicating I+PSE to others
Example: Oregon Public Health Department
Population/Audience Title V grantees (local and health agencies)
Project Goals1. Promote community education and educate providers on I+PSE
approaches
2. Foster communities of practice at the local level
3. Support partner engagement through existing coalitions to expand reach of I+PSE strategies
Example: Oregon Public Health Department
I + PSE Framework (definition) Activities Partners Engaged Inputs OutputsShort-term Outcomes
Success (Mid- and Long-term
Outcomes)
Measurements & How Shared
Strengthen Individual Knowledge & Skills/ Professional Development
Enhance personal, individual, or household's capability of healthy eating and active living
Deepen I + PSE knowledge & skill of staff through Systems Approaches for Healthy Communities Modules (professional capacity building)
MCH Title V priority leads; Center Director; Public Health Division staff in PHD Director’s office; SNAP-Ed Advisory Group partners
Staff from MCH section, Center Director and PHD Director’s office; Systems Approaches for Healthy Communities modules
Adoption of modules for community partners
Module series scheduled for local grantee partners & promoted by Title V leads and staff in Director’s officeWithin PHD form Community of Practice (or some similar type of support) to spread PSE approaches into work
Modules completed by local grantee partners
Increased knowledge about I + PSE approaches that are incorporated into Title V priority workstreams
# of individuals who completed modules
# of priorities with PSE approaches included in guidance documents; priority strategies in guidance documents have PSE approaches identified using Spectrum of Prevention frame
Promote Community Education
Reach groups of people with information and resources to promote healthy eating and active living
Incorporate nutrition, food security, breastfeeding and physical activity into Title V needs assessment process
Title V needs assessment work group
Title V program lead and research analyst staff
Needs assessment a.k.a. Partner Survey includes opportunity for input for state Title V program on breastfeeding, physical activity, nutrition, food security and obesity; survey is qualitative; survey assesses public health system needs
Survey results informs state Title V program priorities for next 5 years; survey elicits responses on nutrition topics; results shared with stakeholders
Nutrition topics identified as important issues for state Title V program to address, especially as part of SDOH upstream interventions
Survey results analyzed for breastfeeding, physical activity, nutrition, food security and obesity; results shared widely
Specific to Title V MCH
Example: Oregon Public Health Department
I + PSE Framework Activities Partners Engaged Inputs OutputsShort-term Outcomes
Success (Mid- and Long-term
Outcomes)
Measurements & How Shared
Educate Providers
Inform providers or intermediaries who will transmit skills and knowledge of healthy eating and active living to others
Promote and facilitate Title V local grantees participation in Systems Approaches for Healthy Communities; support or lead community of practice for specific priorities:-draft meeting invitation to preview modules-develop elevator speech about public health, nutrition, I + PSE approaches-get buy-in at meeting
Title V staff; local Title V grantees including tribes
Staff from MCH section and Director’s office; Systems Approaches for Healthy Communities modules
Module series scheduled; Community of practice topics identified and scheduled
Title V grantees participated in modules and in a community of practice
Increased knowledge and application of I + PSE approaches into local Title V plans; guidance documents for Title V priorities incorporate I + PSE strategies for local level action;Increased understanding how I + PSE supports addressing SDOH
# grantees / # individuals per grantee participated;# & type of community of practice formed
Foster Coalitions & Networks
Convene groups and individuals around healthy eating and active living to meet broader goals and greater public health impacts
Leverage existing partnerships to participate in Title V needs assessment process
Engage with Northwest Portland Area Indian Health Board (NWPAIHB) to learn how to engage with and support needs of tribes in breastfeeding and food security work using I + PSE approaches
Nutrition Council of Oregon (NCO); SNAP-Ed Advisory Group; Oregon WIC program; NWPAIHB
Nutrition Council of Oregon (NCO); SNAP-Ed Advisory Group; Oregon WIC program
NWPAIHB staff and tribal breastfeeding coalition lead
Title V Nutrition Consultant staff; share Systems Approaches for Healthy Communities license to interested partners
Needs assessment completed by partners
Partners request access to I + PSE modules
Contact (meetings, email, etc.) between Title V Nutrition Consultant and Tribal members
Partners participate in I + PSE modules and share / promote within their networks
Increased understanding of tribal needs related to breastfeeding and food
Increased coordination or integration among SNAP-Ed, WIC and NCO partners of I + PSE approaches
Strengthen relationships and shared understanding
# partner licenses shared
# of contacts
Specific to Title V MCH
Example: Oregon Public Health Department
I + PSE Framework Activities Partners Engaged Inputs OutputsShort-term Outcomes
Success (Mid- and Long-term
Outcomes)
Measurements & How Shared
Change Organizational Practices
Adapt regulations and procedures by shaping norms that support healthy eating and active living
Local Title V action plans incorporate PSE approaches in addition to the individual approaches
Title V local grantees Title V staff Title V priorities have guidance documents
Title V grantee yearly action plans and reports
Guidance documents from Title V priority leads include application of PSE approaches at local level
Grantee action plans and reports include PSE approaches in addition to individual approaches
Increased understanding of PSE enhancing individual approaches and ability of local grantees to incorporate PSE into Title V plans
Evaluate Title V grantee plans (breastfeeding, food security) by spectrum of prevention approaches each year
Modify Physical Spaces & Natural Settings
Change physical spaces or setting within organizations or larger public environments that support healthy eating and active living
NA-Existing policies and practices are in place at OPHD to support healthy meetings, wellness at work, expression of breast milk, active transport
NA NA NA NA NA NA
Inform Policy & Legislation
Develop strategies to change laws, regulations, and policies that support healthy eating and active living
Develop 2 White Papers (i.e. policy brief) on Breastfeeding and Food Security highlighting I + PSE approaches, illustrating nutrition is one of foundations for addressing SDOH
Title V staff; Title V local grantees; PHD internal partners (e.g. WIC); PHD external partners
Title V staff; student intern and preceptor to evaluate data
Title V grantee stories, data, testimonials gathered from all annual plans and reports 2015-2019
2 white papers developed
Increased understanding of nutrition I + PSE as foundational in addressing SDOH;Briefs used to inform / change policies and practices around breastfeeding and food security at state and local level
Brief developed, shared widely with internal partners and external stakeholders
Specific to Title V MCH
Thank You!
Q & A
Contacts: Dr. Dena Herman, [email protected]
Ms. Angie Tagtow, [email protected]
Dr. Leslie Cunningham-Sabo, [email protected]