Interventionsand

Subinterventions

SPHERE FrameworkSPHERE Framework

• SPHERE Uses the “Intervention Model” as the Framework for the System

• This model defines the scope of public health practice by:– Level of practice– Type of intervention

SPHERE Documents and SPHERE Documents and Evaluates Public Health Evaluates Public Health

Activities: Activities: • Using the following levels of practice:

Individual/Household (demographics & activities)

Community (activities) System (activities)

• Utilizing 18 interventions

SPHERE ActivitiesSPHERE Activities

Levels of PracticeLevels of Practice

• Interventions at each level of practice contribute to the overall goal of improving population health status

• No one level of practice is more important than another

• Most public health problems are addressed at all three levels, often simultaneously

Public Health Activities -Public Health Activities -Individual/Household FocusIndividual/Household Focus

• Changes knowledge, attitudes, beliefs, practices, and behaviors of individuals and households

• Directed at individuals, alone or as part of a family/household

• Individuals receive services because they are identified as belonging to a population-at-risk

Public Health Activities - Public Health Activities - Community FocusCommunity Focus

• Changes community norms,attitudes, awareness, practices, and behaviors

• Directed toward entire populations within the community or target groups within those populations

• Measured in terms of what proportion of the population actually changes

Public Health Activities - Public Health Activities - Systems FocusSystems Focus

• Changes organizations, policies, laws, and power structures

• Focus is not directly on individuals and communities

• Focus is on the systems that impact health

• Effective and long-lasting way to impact population health

Public Health Problem Public Health Problem Addressed at All Three Addressed at All Three

LevelsLevels• Problem:

Smoking rates continue to rise among adolescents and low-income pregnant women

Smoking Rates Addressed Smoking Rates Addressed at the Individual/Household at the Individual/Household

LevelLevel• WIC nutritionists counsel pregnant

women enrolled in the WIC Program about the effects of smoking on their health and their baby’s health

Smoking Rates Addressed Smoking Rates Addressed at the Community Levelat the Community Level

• Public health nurses coordinate youth led, adult supported, social marketing campaigns intending to change the community norms regarding adolescents’ tobacco use

• Health Educators teach middle school health classes that– increase knowledge about the risks of smoking– change attitudes toward tobacco use– improve “refusal skills” among youth 12-14 years of

age

Smoking Rates Addressed Smoking Rates Addressed at the Systems Levelat the Systems Level

• The Health Officer facilitates community coalitions that advocate the city council to remove cigarette vending machines within the city limits

InterventionsInterventions

Actions taken on behalf of individuals, families, systems, and communities to improve or protect health status

Implementing InterventionsImplementing Interventions• Not every intervention can be applied at

the individual/household, community, or systems level

• Interventions are not distinct from one another and overlap

• Interventions are grouped with related interventions– groups or “wedges” are color coordinated

• In SPHERE, Policy Development and Policy Enforcement are separated into two interventions

Minnesota Public Health Minnesota Public Health Interventions ModelInterventions Model

Activities defined byActivities defined by18 Public Health Interventions 18 Public Health Interventions

(Minnesota Model)(Minnesota Model)• Surveillance• Disease Investigation• Outreach• Case Finding• Screening• Delegated Function• Referral/Follow-up• Case Management• Health Teaching

• Counseling• Consultation• Collaboration• Coalition Building• Community Organizing• Advocacy• Social Marketing• Policy Development• Policy Enforcement

Minnesota Public Health Minnesota Public Health Intervention InformationIntervention Information

http://www.health.state.mn.us/divs/chs/

phn/resources.html

Individual/HH ActivityIndividual/HH Activity

Community ActivityCommunity Activity

System ActivitySystem Activity

SubinterventionsSubinterventions

• Are specific areas/topics that are connected to each intervention

• Some subinterventions include more specific detailed screens

InterventionsInterventions

SubinterventionsSubinterventions

Detail ScreensDetail Screens

SPHERE Examples SPHERE Examples Utilizing Level of Utilizing Level of

Practice and Practice and InterventionsInterventions

SURVEILLANCESURVEILLANCE• Community Level

– WIC Project Directors review Prenatal & Pediatric Nutrition Surveillance Data for trends

– PHNs continue to study trends in the increased rate of STIs in the community

• Systems Level– The Regional CSHCN Center

Provides the central intake function for CSHCN for the entire region

Data is reviewed on the types of referrals received and the types of services needed.

DISEASE & HEALTH EVENT DISEASE & HEALTH EVENT INVESTIGATIONINVESTIGATION

• Individual/Household Level– Conducting a SIDS/Other Infant Death Follow-

up with parents who recently lost a 4 month-old– Investigating a fever/rash illness in a 6 year-old

• Community Level– Staff work with people in the shelter following a

tornado in the community– Concerns arise about the mental health of the

children who have been displaced Special activities are set-up for the children

OUTREACHOUTREACH

CASE-FINDINGCASE-FINDING

• Operates only at the Individual/Household Level

• Serves as the individual/household level of intervention for– Surveillance– Disease and Other Health Event Investigation– Outreach– Screening

• Implemented to locate those most at risk

SCREENING & CASE SCREENING & CASE FINDINGFINDING

• Individual/HouseholdPHN works with a family that has an 8 month-old child with suggested possible delays in some developmental areas

– Screening Done with Denver 2

– Case-Finding Delays found on Denver 2 Rescreen in 1 month

SCREENINGSCREENING• Individual/Household Level

– WIC Nutritionist completes a Height/ Weight on a child– PHN completes an Oral Health Assessment on a 10

year-old child – Health Educator conducts a Nutrition and Physical

Activity Assessment/Screening on a Pregnant Woman

• Systems Level– The LHD receives family planning monies

contract to a local clinic for the provision of family planning services to low-income women

LHD negotiates a requirement in the contract that the clinic must routinely screen all family planning clients for STIs

SCREENING VERSUS SCREENING VERSUS DELEGATED FUNCTIONSDELEGATED FUNCTIONS

• Many different disciplines using the system

• Needed to protect the practice of all disciplines and the System was designed taking that into account

• What is a delegated function for one discipline may not be for another but need to protect those with the strictest practice acts and laws

DELEGATED FUNCTIONSDELEGATED FUNCTIONS

• Individual Level– Doing a pregnancy test on a 16 year-old and

providing contraceptive services– Doing a hemoglobin level on a child in the WIC

Clinic– Collecting a blood specimen on a child for lead

testing

• Community Level– An 8 year old child is diagnosed with active

infectious TB PHNs coordinate with the school nurse to screen

all contacts at the child’s school

CASE MANAGEMENTCASE MANAGEMENT

• Individual/Household Level– Perinatal Care Coordination serves are

provided to 25 pregnant women not qualifying for PNCC

– CSHCN Service Coordination is provided to 15 families identified with a child with special needs

HEALTH TEACHINGHEALTH TEACHING• Community Level

– Illness Prevention is taught to Child Care Staff at the Wee Care Day Care Center

– Prenatal classes are taught to low-income pregnant women

– High Risk Sexual Behavior is taught to Middle and High School Health Education Classes in the community

– Healthy Food Choices is taught to overweight elementary students

– Proper Car Seat Installation is taught to parents in the community

COUNSELINGCOUNSELING• Individual/Household

– The WIC Nutritionist facilitates a support group for breastfeeding mothers

– The Nurse Practitioner at the Family Planning Clinic counsels a 20 year-old with a positive pregnancy test regarding pregnancy outcome choices

• Community– The Health Educator raises community awareness

about domestic violence Goal is to change community acceptance of

domestic violence through the use of radio talk shows

COLLABORATIONCOLLABORATION

• Systems Level– A variety of professionals (i.e. speech and

physical therapists, nurses, health educators, physicians, social workers, etc.) meet to discuss a centralized intake process to simplify access to services for children with special needs

ADVOCACYADVOCACY

• Individual/Household– The Public Health Nurse works with a family

seeking developmental services for their child

• Systems– The Health Officer works with the local county

board to secure funds for developmental screening of refugee children

– LHD staff work with a multi-disciplinary team seeking legislative mandates for proper use of car seats for children

SOCIAL MARKETINGSOCIAL MARKETING• Systems Level

– The LHD coordinates mass media efforts on various public health and maternal and child health issues:

POLICY DEVELOPMENTPOLICY DEVELOPMENT

• Systems Level– Health Officer recommends to the

city council that they establish an ordinance prohibiting cigarette vending machines within the city limits

POLICY ENFORCEMENTPOLICY ENFORCEMENT

• Individual/Household– The Health Officer enforces lead

abatement orders in a house where a child with lead poisoning resides