National Council on Aging Results from the 2014 ... · A statewide workshop calendar for CDSME. 16...

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Improving the lives of 10 million older adults by 2020 © 2014 National Council on Aging

Results from the 2014 Sustainability Self-Assessment:

Planning for the Future

October 28, 2014

Kristie Kulinski & Cora Plass, NCOA

National Council on Aging

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Background Information

22 states responded to the 2014 Chronic Disease

Self-Management Education Integrated Services

Delivery System Assessment Tool.

Covers six key elements of an integrated services

delivery system: (leadership, delivery

infrastructure, partnerships, centralized and

coordinated logistical processes, business

planning and financial sustainability, and quality

assurance and fidelity).

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CDSME Programs Offered

Chronic Disease Self-Management Program (CDSMP) 22

Diabetes Self-Management Program (DSMP) 21

Tomando Control de su Salud (Spanish CDSMP) 18

Programa de Manejo Personal de la Diabetes (Spanish DSMP) 13

Chronic Pain Self-Management Program (CPSMP) 12

Better Choices, Better Health® (Online CDSMP) 6

Positive Self-Management Program for HIV (PSMP) 5

Arthritis Self-Management Program (ASMP) 2

Better Choices, Better Health® - Diabetes (Online DSMP) 2

Better Choices, Better Health® - Arthritis (Online ASMP) 2

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Element 1: Leadership

0

5

10

15

20

25

Our state unit onaging and state

health departmenthave workedtogether to

identify and targetunderserved

geographic areas.

Our state healthdepartment and

state unit on aginghave an integratedand documented

vision forevidence- basedprogramming.

Strategies tosupport CDSME or

other evidence-based

programming areincluded in our

state unit on agingstate plan.



programming areincluded in our

state healthdepartment state

plan.



programming areincluded in in

anothermanagement

body's state plan.

There is amanagementstructure (e.g.steering group,

coalition, partnerteam etc.)

including the stateunit on aging and

state healthdepartment thatprovides overall

direction andleadership forCDSME in the

state.

Our state unit onaging and state

health departmenthave a signed

agreementdocumenting

responsibilitiesrelated to CDSME.

20

13

19

16

7

20

14

5



Do you have organizational charts/graphics to describe

state’s structure for managing and delivering programs?

59%

Yes

41% No

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THE KEY BODIES THAT ARE INVOLVED IN MANAGING OR DIRECTING CDSME ACTIVITIES AT THE STATE LEVEL:

State unit on aging 22

State health department 20

State advisory council or other management team 10

State coalition 6

Foundation/other oversight agency 0

Other management body* 10

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Which agencies are responsible for these key functions?

State Unit on

Aging State Health Department

Local Agencies Other Management

Body

Develops plan for expanding CDSME 20 18 16 6

Convenes state advisory council/other management structure 14 14 0 7

Holds CDSME license 11 9 10 6

Coordinates master trainings 12 10 4 6

Develops and/or coordinates marketing/promotional activities 18 16 17 9

Manages website 9 10 6 6

Coordinates workshop calendar 5 7 13 8

Responsible for NCOA data entry 9 7 5 7

Conducts fidelity and performance monitoring activities 16 10 16 10

Coordinates evaluation studies 11 11 4 8

Recruits major partners/ host sites 17 19 16 9

Seeks funding support 17 19 16 8

Provides technical support to trainers, leaders, sites 17 15 13 10

Designates agency staff to work on CDSME 18 19 15 10

Recruits and trains T-trainers/MTs/Lay Leaders 12 13 17 8

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Our state has a strong leadership and project management team that will continue

to lead efforts after AoA funding ends.

To a large extent

54%

To a moderate extent

41%

To a small extent 5%

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Element 2: Delivery Infrastructure

WHICH OF THE FOLLOWING ELEMENTS ARE CURRENTLY PART OF YOUR CDSME DELIVERY SYSTEM?

An appropriate number of active CDSME master trainers to meet the needs for leader training. 20

An adequate number of lay leaders to provide CDSME workshops across the state. 11

A mechanism or system to track CDSME master trainers or leaders statewide. 20

Ongoing communications, support, and other retention strategies for CDSME master trainers or leaders that are implemented across

the state. 19

Appropriate Stanford licensing to cover all implementation sites and planned number of workshops and trainings. 22

A delivery structure in place that is capable of delivering CDSME programs throughout the state. 18

10



How many active master trainers?

3

8

3

5

1

2

10 or less

11-20

21-50

51-75

75-100

100+

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What percentage of your counties would you estimate have enough sites

and leaders to provide workshops at least twice a year?

0 1 2 3 4 5 6 7 8 9 10

100%

75-99%

50-74%

25-49%

Less than 24%

10

6

5

12



What percentage of your population is included in the counties where you

are able to offer workshops at least twice a year?

100% 1 state 4.55%

75-99% 11 states 50.00%

50-74% 6 states 27.27%

25-49% 1 state 4.55%

Less that 24% 1 states 4.55%

Don’t know/unsure 2 states 9.09%

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Element 3: Partnerships

0

5

10

15

20

25

We collaborate withagencies already

reaching targetedunderservedpopulations.

Our partnershipsinclude agencies with

host sites with multipleimplementation sites

and/or capacity toscaling up statewide.

We are effectivelycoordinating andintegrating with

existing CDSME andother community-

based evidence-basedprevention programs.

We are coordinatingwith chronic care

management programsand demonstrationsbeing sponsored by

physician groups andhospitals.

We have signedagreements

documentingresponsibilities with allof our major partners.

22 21 21

15 14

14



What percentage of your AAAs are part of your delivery system?

Under 50% 50%-74% 75%-99% 100%

6 6

3

7

15



How do you interact with ADRCs in your state?

0 2 4 6 8 10 12 14 16 18

They serve as CDSME host sites.

They serve as CDSME referral sites.

They serve as CDSME implementation sites.

They have integrated CDSME into their Options Counseling program.

They have integrated CDSME into their Care Transitions program.

We do not have ADRCs in our state.

Other, please describe:

10

17

8

5

6

9

16



Besides AAAs/ADRCs, who are your other major partners and what role have

they played?

Roles: Embedded program, provides statewide delivery system, referral

source, funding source, license holder (select all that apply)

Organization Count of Partner Roles

Agencies that reach rural populations 48

Hospitals/ health care systems 46

Federally Qualified Health Centers 37

Primary care practice/local health organizations 35

Health insurers/health plans 34

Ethnic/minority agencies 32

Faith-based organizations 30

Veteran’s Administration 30

YMCA’s and Recreation Centers 28

Groups working with people with disabilities 28

Mental/behavioral health care providers/clinics 27

Area Health Education Centers (AHECs) 27

Senior housing 25

University/academic institutions 24

Centers for Independent Living (CILs) 23

Advocacy/support groups 21

Worksite programs/employee benefits programs 21

Native American tribal organizations 20

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Which of the following sources provide referrals to your programs?

0 5 10 15 20 25

Aging and Disability Resource Centers (ADRCs)

Cross-referrals from other evidence-based programs

Health care systems (including physicians, HMOs and Retiree…

Local public health agencies

Medicaid

Medicaid Dual Eligible Plans

Medicaid Managed Care

Medicaid Waiver

Other, please specify:

State Health Insurance Assistance Program (SHIP)

State Health Insurance Exchange

Tobacco cessation programs/quit lines

19

21

19

18

6

1

3

4

11

12

1

9

18



We have at least two major partners/host organizations (outside of

AAAs/ADRCs) that have embedded CDSME into their system.

To a large extent

54% To a moderate extent 23%


To a very small extent

9%

19


Element 4: Centralized and Coordinated Processes

WHICH OF THE FOLLOWING ARE CURRENTLY IN PLACE IN YOUR STATE? # OF STATES

A statewide brand name for your evidence-based initiatives. 13

A statewide brand name for your CDSME programs. 18

An ongoing public relations plan with multiple promotional strategies. 8

Standardized CDSME marketing materials. 18

A formal process for using former participants or other ambassadors to promote the program. 4

A statewide website for CDSME. 19

A statewide workshop calendar for CDSME. 16

A statewide toll-free number for CDSME. 14

A single or coordinated referral mechanism. 5

Online registration for CDSME. 7

A statewide mechanism for tracking wait time or a waitlist. 2

A consistent or coordinated intake, enrollment and registration process. 7

Ongoing activities to educate potential advocates and decision makers about CDSME in your state. 18

Agency bulletin boards for CDSME. 3

Mass mailings for CDSME. 5

Bulk or coordinated ordering of CDSME materials for the state. 12

Regular in-service or update training around CDSME. 20

A listserv or other information sharing tool for CDSME personnel and stakeholders. 17

Coordinated data reporting and entry procedures. 21

20



In addition to CDSME to you cross-promote or use your CDSME distribution

system to deliver any other evidence-based programs?

EVIDENCE-BASED HEALTH PROMOTION AND DISEASE PREVENTION PROGRAMS # OF STATES

A Matter of Balance 13

Active Living Every Day 2

Fit and Strong! 1

EnhanceWellness 1

EnhanceFitness 7

Program to Encourage Active Rewarding Lives (PEARLS) 1

Healthy IDEAS 3

Arthritis Foundation Walk with Ease Program 11

Arthritis Foundation Exercise Program 13

Arthritis Foundation Tai Chi Program 8

Other: 16

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We have a coordinated, statewide process for marketing, referral, and

recruitment.

To a large extent 18%

To a moderate

extent

41%


To a very small extent

4%

Not at all 5%

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Element 5: Business Planning and Financial Sustainability

WHICH OF THE FOLLOWING ARE CURRENTLY IN PLACE IN YOUR STATE? # OF STATES

A business plan for sustaining CDSME. 6

A sustainability plan for sustaining CDSME. 10

A requirement that community partners complete a business plan for sustaining CDSME. 1

A requirement that community partners complete a sustainability plan for sustaining CDSME. 4

A statewide distribution system. 5

Calculated and accurate operating costs for CDSME. 6

An established per participant cost for CDSME. 10

An established rate for programs using costs and local market information. 2

An established annual operating budget for CDSME. 6

Break-even analysis (calculation of how many workshops and participants you need to break even with income and

expenses). 0

Cash flow management system established (includes accounts receivable and payable systems to track and manage

revenue and payment of expenses). 5

Regularly monitored operational performance through monthly financial statements and accounts receivable reports. 7

Partnerships with health care organizations to provide CDSME. 18

Use of a consumer survey or needs assessment in business planning. 2

None of the above. 2

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Are any of your sites charging a fee for participating in a CDSME program?


No

55%

Yes 45%

Participation fees are being charged in 10 states (range from $5-$120)

10 states have established per participant costs (range from ~$200-$455)

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Other sources of funding being used to support your evidence-based

program system:


Older Americans Act, Title IIID. 22

Other, please specify:* 12

Foundation support or other non-ACL grants. 11

CDC – Arthritis. 10

CDC – Diabetes. 7

Older Americans Act – Other.** 6

Fee for service. 5

Health plan. 5

CDC – Coordinated Chronic Disease. 4

Accountable Care Organization. 3

Care Transitions 3

CDC – Heart Disease. 3

Medicare - DSMT. 3

National Association of Chronic Disease Directors (NACDD). 3

Affordable Care Act Initiatives. 2

CDC – Communities Putting Prevention to Work. 2

CDC- Other. 2

Medicaid Waiver. 2

CDC – Injury Prevention. 1

Medicaid Managed Care. 1

CMS Innovation Funds. 0

Medicaid Dual Eligible Plan. 0

Medicaid State Plan (Long-term Services and Supports). 0

Medicare. 0

25


We have an effective business plan and processes in place to fund CDSME

after the grant period:



To a moderate

extent

50%


To a very small extent 18%

Not at all 5%

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How would you describe your state’s approach to fidelity?

Element 6: Quality Assurance and Fidelity

Our state programhas implemented itsfidelity monitoring

plan.

Our state programhas a fidelity

monitoring plan,which we have notyet implemented.

Fidelity monitoringactivities are takingplace in some sites,without state-wide

coordination orleadership.

We have begun developing a state-

wide fidelity monitoring plan, but we don’t currently

have one.

We do not have afidelity monitoring

plan, state-wide norsite-specific.

17

2 2 2

0

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WHICH OF THE FOLLOWING ARE PART OF YOUR STATE’S FIDELITY SYSTEM AND PROCESSES? # OF STATES

Fidelity standards are disseminated throughout the state. 20

New leaders are paired with experienced leaders to increase program fidelity. 20

Workshop data is tracked to monitor potential fidelity issues. 20

Fidelity checks are conducted for new leaders during their first workshop. 19

The Stanford Implementation/Fidelity Manual is used throughout the state. 18

Leaders sign an MOU agreeing to follow fidelity manual/fidelity protocols. 17

A system of regional mentors is in place to facilitate fidelity monitoring, coaching, and technical assistance. 14

New leaders are required to conduct a workshop within 4-6 months of training. 14

On-site technical assistance visits are conducted with leaders. 14

Leader evaluation forms are used to monitor fidelity. 12

Enhanced leader training on fidelity process and tools is provided. 11

Leaders are observed once per year. 11

28


We have a quality assurance plan and ongoing mechanisms in place to

monitor fidelity and ensure continuous quality improvement:



To a moderate extent

50%


29


Are you conducting evaluation work or planning to do so?


Yes

82%

No 18%

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Overall Strengths

Collaborative Leadership:

20 of 22 states reported joint leadership with SUA and SHD

Integrated, shared vision

Management structure with SUA and SHD represented to provide

direction

75% or more of the states reported:

Targeting underserved geographic areas

Strategies to support EBPs in SUA and SHD state plans

95% reported strong leadership that will continue to lead

efforts after funding ends

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Overall Strengths (continued)

Delivery Infrastructure:

100% have licensing to cover all workshops and trainings

20 out of 22 states reported:

Appropriate number of Master Trainers

System to track Master Trainers and Leaders

More than 80% reported:

Ongoing communications, support, and retention strategies for

Master Trainers and Leaders

A structure in place to deliver CDSME programs throughout the

state

73% of states cover 50% or more of counties in the state and

half of states cover 75-99% of all counties

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Partnerships:

A diverse array of partners have been developed with a

variety of roles:

Almost ¾ of states work with 50% or more of AAAs as part

of their delivery system

82% of states work with ADRC as implementation or host

sites

More than half of states work with FQHCs

More than 80% receive referrals from hospitals or other

health care systems

Nearly two-thirds have embedded programs in

hospital/health care systems

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Partnerships:

More than half also have programs embedded in faith-

based, ethnic/minority, disability, CIL, rural, AHECs,

mental health and other organizations

Strong referral relationships with tobacco cessation,

SHIP, local health departments, health care systems,

ADRCs, and cross referrals from other EBPs

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Centralized and Coordinated Processes:

More than 80% of states report:

Coordinated data reporting and entry procedures

Statewide website for CDSME

Ongoing public relations plan with multiple promotional strategies

Activities to educate decision makers about CDSME

59% of states report having coordinated, statewide process for

marketing, referral, and recruitment to a moderate or large

extent

Quality Assurance and Fidelity:

20 of 22 states have fidelity standards, track fidelity, and

match experienced Leaders with new ones

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The Major Area That Needs Further Work…

Business Planning and Financial Sustainability:

Only half of the states have:

A sustainability plan

To a moderate extent, processes in place to fund CDSME after

the grant period

A per participant cost for CDSME

Only 6 out of 22 states have:

A business plan

Calculated and accurate operating costs for CDSME

An established annual operating budget for CDSME

*On a positive note, all are using Title IIID funds and close to half are using CDC

Arthritis Program funds and/or other non-ACL funds

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Sustainability Resources - www.ncoa.org/cha

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Sustainability Resources (continued)

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Sustainability Resources – Online Learning Modules

Creating a Business Plan for EBHP Programs

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Next Steps…

CHA developing additional products to guide

partners in building community-clinical linkages

and integrating CDSME with health care

NCOA National Resource Center Meeting April

28-30 will provide opportunity for additional

learning re: sustainability and business plans

Monthly webinars with topics to help grantees

continue to scale and sustain CDSME programs

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Questions/Discussion

National Council on Aging Results from the 2014 ... · A statewide workshop calendar for CDSME. 16...

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