PSEP Meeting – October 16th, 2012

PSEP Meeting – October 16th, 2012

The Brownson Model: Evidence-based Public Health from Concept to Application in MCH

Barbara Gabella, MSPH – Epidemiology, Planning, and Evaluation

Mandy Bakulski, RD – Maternal Wellness Unit Manager

OBJECTIVES Concept: the Brownson Model of EBPH

Describe each step

Application: addressing pregnancy-related depression Handouts:

Concise statement Logic model Excerpt of Action Plan

WHAT AND WHY?EVIDENCE-BASED PUBLIC HEALTH (EBPH)

EBPH: A systematic method to identify, prioritize, implement, and evaluate public health strategies

Applies scientific method to practice

An approach, not a bar

Why use an EBPH approach? Informed decision making accountable to funders

Higher likelihood of successful implementation

Greater impact on the population

Reduction in costs or leverage funding

CONTEXT

A pilot “portfolio” project for the MCH priority:

pregnancy-related depression

BROWNSON MODELBrownson, RC; Fielding JE; Maylahn CM. Ann. Rev. Public Health 2009.30:189

Logic Model

Timeline

May-Sep 2011:Steps 1-3

Aug-Sep 2011:Lit review

Oct-Nov 2011:Logic model

Nov 2011:Prioritization

Nov-Dec 2011:Action plan

TIMELINEMay 9, 2011 Overview training on each step of the 7-step model

May – Dec Meeting twice a month w/ Maternal Wellness Team• Work together through each step, assign homework

May-Sep Step 1 Community assessmentStep 2 Quantifying issues Step 3 Concise statement

August - Sept Step 4 Literature review (training 8/9/2011)

October-Nov Logic Model development (trainings 9/28 & 9/29/11)

November Step 5 Prioritization (SurveyMonkey end of Nov)

Nov - Dec Step 6 Action planning: work plan w/ SMART objectives (trainings 11/21 & 11/29/11)

January 31, 2012

Goal: State MCH logic models & action plans for each priority

Pregnancy-related depression

PREGNANCY-RELATED DEPRESSION

Colorado MCH Priority State Performance Measure

Improve screening, referral, and support for pregnancy- related depression.

Percent of mothers reporting that a doctor, nurse, or other health care worker talked with them about what to do if they felt depressed during pregnancy or after delivery.

2010 PRAMS = 75.1%

PRAMS: Pregnancy Risk Assessment Monitoring System

STEP 1: COMMUNITY ASSESSMENT

Define the health issue according to the needs and assets of the population or community of interest

• Population characteristics, needs, values, and preferences

• Resources, including practitioner expertise

• Environmental and organizational context

STEP 1: COMMUNITY ASSESSMENT

Defined pregnancy-related depression: During pregnancy or postpartum, including after a

pregnancy loss

Persists beyond early postpartum up to one year after birth


STEP 1: COMMUNITY ASSESSMENT (CONT.)

Recorded Structured Input at Key Stakeholder Meetings

MCH Roundtables (Sept 2010) Capacity Issues; Local vs. State Role

Maternal Wellness Summit (Aug 2011) Target Audience; Assets; Threats;

Opportunities; Gaps; additional Concerns


STEP 2: QUANTIFY THE ISSUE

Measure behaviors, risk factors and disease frequency in a defined population and time frame

STEP 2: QUANTIFY THE ISSUE

In Colorado, 11% of women experience postpartum depressive symptoms.

15% among women who did not indicate that they were married

21% among African-American women


(Colorado Department of Public Health And Environment, Health Statistics Section, Pregnancy Risk Assessment Monitoring System, 2009-2010)

STEP 3: DEVELOP A CONCISE STATEMENT

OF THE ISSUE

Purpose: To build support for the issue and focus the literature review

Includes: Health condition or risk factor considered

Population affected

Size and scope of the problem

Prevention opportunities

Potential stakeholders

Often describes gap between the current status of a program and the desired goal.

STEP 3: CONCISE ISSUESTATEMENT

Public Health Issue

Programmatic Issue

Program & Policy Options


STEP 4 WHAT WE KNOW (LIT REVIEW)

Determine what strategies work to address the issue(s) identified in Steps 1-3

Objective, systematic search and summarization of previous research

Classify or rate the level of evidence

WHAT IS “EVIDENCE?”Scientific literature in systematic reviews

Scientific literature in one or more journal articles

Public health surveillance data

Program evaluations

Qualitative data

Community members

Other stakeholders

Media/marketing data

Word of mouth

Personal experience

Objective

Subjective

Figure 2 in Brownson RC, et al. Evidence-Based Public Health. Annu. Rev. Public Health 2009: 30

STEP 4: LEVELS OF EVIDENCE

Click icon to add picture

Level Established byEvidence-based or proven

Peer review via systematic or narrative review Community Guide, Cochrane Review, Campbell

Effective or likely effective

Peer review Scientific research in individual journal articles

Promising Written program evaluation without formal peer reviewGrounded in a theory of change

Emerging Ongoing work, practice-based summaries or evaluation works in progress

Brownson, RC; Fielding JE; Maylahn CM. Ann. Rev. Public Health 2009.30:180

STEP 4 – LIT REVIEW

What is and is not effective in increasing early identification of pregnancy-related depression?

Focus of the literature search:

Policy

Systems-building

Population-based services aimed at prevention or early identification


STEP 4 – RATING THE LITERATUREPregnancy-related depression

STEP 5: PRIORITIZATION

Select:

1. Team – include partners, stakeholders

2. Criteria

3. Tools

Assemble & share information from Steps 1-4


Advisory group of internal and external experts and stakeholders prioritized 5 potential strategies:

Improve insurance coverage Enhance referral network Develop statewide training to support

providers Raise public awareness Explore self-administered options



Rated 6 criteria from “little” to “great” for each strategy:

Promise (likelihood to lower rates)

Capacity to implement

Lasting impact

Political feasibility

Return on investment

Appropriateness for state public health


STEPS 6 & 7: ACTION PLAN, EVALUATION

Logic Model Step 6: Action Plan Step 7: Evaluation Plan

Purpose Describes relationships between investments

[inputs], strategies, and results [outcomes]

If / then relationships

Detailed activities to accomplish SMART

objectives or how to operationalize

strategies & achieve outcomes

To answer specific questions to improve programs or inform

future programming:-Process

-Outcome

Duration 7-10 years 3 years Variable

Length Brief (~1 pg) Moderate (~5pgs) Long (~10pgs)

Who Reads Many Some Less

MCH / MIT Template

Yes Yes Stay tuned…

LOGIC MODELS

Whirlwind tour

Overarching Goal ~ other programs can contribute to reaching it

Impact = long-term accomplishments

Short term Outcomes = What will be different in 1-3 years?• Informs the SMART objectives in your 3-year action plan

Medium-term Outcomes = What will be different in 4-6 years? Most likely include performance measures

Outputs = Strategies & Participants (in the change that influences the outcomes)

Inputs = staff & skills, funding, previous work? Be specific.

LOGIC MODEL TO CRAFT ACTION PLAN

Logic Model Action PlanGoal, Mid- & Long-term Outcomes

Program goals

Short-term Outcomes Objectives (SMART)Output: Strategies Strategies broken down into

Milestones (or “Key Activities”)

Output: Participation Target Population--- Team member responsible--- TimelineInputs ---Evaluation Focus ‘Criteria for Success’ & ‘As

Measured By’

DETAILED EXAMPLES

Logic Model Handout

Action Plan Handout

“PORTFOLIO” OF LIVING DOCUMENTS

To sustain capacity ~ tools, templates, and resulting documents:

1. Community assessment report

2. Summary data figures and tables & data analysis plan

3. Concise issue statement

4. Evidence ratings of strategies & relevant articles

5. List of prioritized interventions or policies

6. Logic model, work plan with SMART objectives

7. Evaluation plan

What are some of the challenges and barriers

to using an EBPH approach?

BARRIERS AND CHALLENGES

Additional work on top of our existing commitments

Some of this work was very new

Not a lot of peer-reviewed research

Timeline for pulling together action plan was tight

Some items in action plan depended on other partners – have to be willing to adjust if their priorities change

What are your session takeaways?

What are your next steps in applying EBPH?

RESOURCESCourse, articles, and textbook by Ross C. Brownson, PhD et al. at Washington

University in St. Louis http://prcstl.wustl.edu/EBPH/Pages/Evidence-BasedPublicHealthCourse.aspx

Colorado School of Public Health, Center for Health Practice http://publichealthpractice.org/

Mobilizing for Action through Planning and Partnerships http://www.naccho.org/topics/infrastructure/mapp/

Brownson RC, Gurney JG, Land GH. Evidence-based decision making in public health. J Public Health Manag Pract 1999;5:86 –97Brownson RC, Fielding JF, Maylahn CM. Evidence-Based Public Health. Annu. Rev. Public Health 2009; 30: 175-201.Jacobs JA, Jones E, Gabella BA, Spring B, Brownson RC. Tools for Implementing an Evidence-Based Approach in Public Health Practice. Prev Chronic Dis 2012;9:110324. DOI: http://dx.doi.org/10.5888/pcd9.110324

http://prcstl.wustl.edu/EBPH/Pages/Evidence-BasedPublicHealthCourse.aspx

http://publichealthpractice.org/

http://www.naccho.org/topics/infrastructure/mapp/

http://dx.doi.org/10.5888/pcd9.110324

ACKNOWLEDGEMENTS

Team from MCH: Linda Archer, MSN, RNMandy Bakulski, RD

Julie Davis, RNRebecca Heck, MPHFlora Martinez, MPH

Technical team developed tools & trainings: Renee Calanan, PhD ~ chronic disease epidemiologistBarbara Gabella, MSPH ~ supervising epidemiologist

Julie Graves, PhD (ABD) ~ evaluatorIndira Gujral, PhD ~ senior epidemiologist

Ashley Juhl, MSPH ~ epidemiologistKristin McDermott, MA ~ supervising evaluator

Kerry Thomson, MPH ~ senior evaluator

Dr. Ross Brownson and the Prevention Research Center in St. Louis

Q&[email protected]@state.co.us

Logic Model

Documents

PSEP Meeting – October 16th, 2012