Joining up interventions for better outcomes

November 2009 Jim McManus

Designing and Implementing Health Interventions in Neighbourhoods

www.bhwp.nhs.uk

Purpose of this session

• To explore the key issues in health in Birmingham

• To identify the role of the neighbourhood health model in designing and constructing interventions

• To provide some tools for use

www.bhwp.nhs.uk

Where has this come from?

• This is one part of Birmingham City Council’s Health Inequalities Strategy

• It works with Partners but is focused on what the Council can do

• It is a part of the work of the council on– Producing a Health Inequalities Strategy– Having a senior council officer leading on health in each

Department– Having a series of health interventions at local level which touch

on what local authorities can do on health inequalities– Inputing into the Birmingham Health and Wellbeing Partnership

www.bhwp.nhs.uk

Current Status• Model supported by

– Neighbourhoods Board*– Children and Young Peoples

Partnership*– Health and Wellbeing Partnership

(BHWP)Exec*– Housing and Constituencies– Constituency Directors– Neighbourhood Managers– Be Birmingham*– Police Operational Commanders &

Constituency Directors joint meeting– Be Birmingham task and finish group

established under Moira Dumma, Chief Exec SBPCT*

• Linkages– 31 Neighbourhoods managers in

place– Initial “induction” training complete– Health training November 2009– Masterclass in baselining and

target setting for neighbourhood Managers Nov 2009

– Health section within Neighbourhood plan templates

– Completed plan for each neighbourhood by Feb 2010

* indicates fora which includes NHS partners

BHWP Summit event in January 2010 will focus on the model

www.bhwp.nhs.uk

The Idea

• The City Council work on a neighbourhoods approach to health with partners as part of its health inequalities programme.

• There is a significant and growing evidence base for this approach from UK and European as well as US work.

• This could make substantial contributions to the LAA

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The effect of place on health

• The consensus from research evidence

– There is a strong, independent and enduring effect of place on the health status of individuals, families, communities and neighbourhoods

• Findings from JSNA– Wide variations in health outcomes by ward

(statistical problems with analyses of neighbourhoods)

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The Key Point

• Work on improving the place as well as improving the worst health outcomes

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JSNA

• Mini needs assessments on health inequalities for every ward in Birmingham are available on

• http://www.bhwp.nhs.uk/jsna

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Leading causes of death

Common Risk Factors

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Life Style

Key figures for life style Deprivation in Birmingham, West Midlands and England

Year Birmingham West Midlands England

Adults who smoke 2003/5 24.9% 24.0% 24.1%

Binge drinking adults* 2003/ 2005 17.8% 17.9% 18.0%

Healthy eating adults** 2003/ 2005 25.1% 25.1% 26.3%

Physically active adults***2007/8

16.9% 19.1% 21.3%

Obese adults**** 2003/ 2005 23.4% 26.5% 23.6%

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The Joys of Health Promotion Theory

Health Promotion

Health Education

Policy RegulationOrganization

Implementation Evaluation

Predisposing Factors

Enabling Factors

Reinforcing Factors

Behaviour & Lifestyle

HealthQuality

Of Life

Environment

Planning

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BIRMINGHAM NEIGHBOURHOOD HEALTH INTERVENTIONS MODEL

Development of a local plan for each neighbourhood between partners with use of existing community networks

2. WORK ON THE COMMON RISK FACTORS FOR BIG KILLERS

Neighbourhood interventions for

Diet, Physical Activity, Smoking, Alcohol,

3. IMPROVE LOCAL NEIGHBOURHOOD QUALITY

Physical Environment, Green Space, Crime/ASB. INCREASE SOCIAL CONTACT BETWEEN

NEIGHBOURS

4. INCREASE UPTAKE OF PREVENTIVE HEALTH PROGRAMMES

Immunisation, Screening, This may differ from area to area depending on issues

1. Complete a Basic health profile – identification of health issues salient for the neighbourhood by a) providing a basic profile and b) running health typologies through Customer Insight or whatever mechanism is favoured in each PCT/locality (for Ben it is PRIME/DR Foster)

5. Local worklessness and skills programme – deliver public health and literacy for health skills training. Develop local health trainer programmes using WNF to get people into work.

So…the modelexplicitly designed to be as simple as possible so non-health specialists can implement it

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So What?

• The model gives you the chunks of “what you do”

• All you need to do is fill them in• Now we are going to give you a model for how

you do it• And we are going to illustrate what you do within

each stage of the how

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The Sequence

Assess the

needs of your area

Identify what needs

to happen

Methods

and Strategies

Adoption & Implementation

Programme

Development

Evaluation

www.bhwp.nhs.uk

The Key Point

• You should come out of this cycle with some programme objectives

www.bhwp.nhs.uk

How to do the Sequence

Assess the

needs of your area

Identify what needs

to happen

Methods

and Strategies

Adoption & Implementation

Programme

Development

EvaluationHealth Needs Assessment

Workbook / Ward Profile

Objectives

www.bhwp.nhs.uk

Assessing Needs

Assess the

needs of your areaHealth Needs Assessment Workbook / Ward Profile

• Establish a planning group that includes potential program participants and plan the needs assessment (note: this group will evolve over the course of the planning process);

• Conduct the needs assessment using core processes, organize the resulting information and determine priorities;

• Balance a needs assessment with an assessment of community capacity; • Link the needs assessment to evaluation planning by establishing desired program

outcomes.

• This may already be done for you

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Identifying what needs to happen

Identify what needs

to happen

• State the expected change or program outcomes for health-related behavior and environmental conditions;

• Subdivide behavior and environmental conditions into performance objectives;

• Select important and changeable personal and external determinants of at-risk group behavior and environmental conditions; and

• Create a matrix of change objectives for each level of intervention planning (individual, interpersonal, organizational, community, and societal) by crossing performance objectives with determinants and writing change objectives.

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Methods and Strategies

Methods

and Strategies

• Review program ideas with the intended participants and use their perspectives when choosing methods and strategies;

• Use core processes to identify theoretical methods that can influence changes in determinants and identify the conditions under which a given method is most likely to be effective; consult specialists

• Consider preliminary ideas on the program in light of information from theory and evidence.

• Select or design practical strategies for delivering the methods to intervention groups; and

• Assure that the final strategies [still] match the change objectives from the matrices.

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Programme Development

Programme

Development

• Consult with the intended participants for and implementers of a health education and promotion program and bring their preferences to program design;

• Create program scope and sequence, themes and list of needed program materials;

• Prepare design documents that will aid various professions in producing materials that meet the program objectives and adhere to specific guidelines or parameters for particular methods and strategies;

• Review available program materials for possible match with change objectives, methods, and strategies;

• Develop program materials; • Pretest program materials and oversee the final

production.

www.bhwp.nhs.uk

Performance Objectives

What do people have to do?

DeterminantsWhat helps

and hinders?

SubpopulationsOlder people?

Programme Objectives

Devising the implementation plan

+ +

Get on with it, then

www.bhwp.nhs.uk

Performance Objectives

What do people have to do?

DeterminantsWhat helps

and hinders?

SubpopulationsOlder people?

Programme Objectives

Devising the plan

+ +

Get on with it, then

www.bhwp.nhs.uk

Adoption & Implementation

Adoption &

Implementation

•Identify potential users of the health promotion program (revisit the planning group and linkage system to assure representation); •Specify performance objectives for program adoption, implementation, and sustainability; •Specify determinants of adoption, implementation, and sustainability and create change objective matrices for program use; •Select methods and strategies to address the change; and •Design interventions and organize programs to affect change objectives related to program use.

www.bhwp.nhs.uk

Evaluation

Evaluation

•Describe the program and complete the logic model; •Describe program outcomes for quality of life, health, behavior and environment and write objectives and evaluation questions; •Write evaluation questions based on the matrix, i.e. concerning performance objectives and determinants as expressed in the change objectives; •Write process evaluation questions based on the descriptions of methods, conditions, strategies, program and implementation; •Develop indicators and measures; •Specify evaluation design.

www.bhwp.nhs.uk

How to do the Sequence

Assess the

needs of your area

Identify what needs

to happen

Methods

and Strategies

Adoption & Implementation

Programme

Development

EvaluationHealth Needs Assessment

Workbook / Ward Profile

Objectives

www.bhwp.nhs.uk

Why bang on about intervention mapping?

• Good prevention needs a combination of

– Knowledge, Evidence, Skill and Direction

• Intervention mapping is a means of ensuring an intervention is consistent with the evidence and needs assessment

• It has paid dividends where it has been properly implemented, not just in health but in community safety, regeneration and other areas of work

• Intervention Mapping should be a key technology for rolling out any health model. This will be a key part of the roll out of training and of plans.

www.bhwp.nhs.uk