Community-driven health
assessment & improvement:
A unique model of tribal collaboration in
Michigan
Shannon Laing, MSWa
Kathy Mayo, RNb
Open Forum for QI in Public Health
November 2013
Memphis, TN
aMichigan
Public Health Institute
bKeweenaw Bay Indian Community Department of Health and Human
Services
1
Acknowledgements
• Inter-Tribal Council of
Michigan (ITCM)
• American Indian Health
and Family Services
• Bay Mills Indian
Community
• Hannahville Indian
Community
• Keweenaw Bay Indian
Community
• Little Traverse Bay Bands
of Odawa Indians
• Lac Vieux Desert Band of
Lake Superior Chippewa
• Saginaw Chippewa Indian
Tribe
This work was supported by Cooperative Agreement 5U58DP003004-02 from the Centers for Disease Control and Prevention (CDC) and an award from
the National Network of Public Health Institutes. Its contents are solely the responsibility of the authors and do not necessarily represent the official
views of the CDC or NNPHI.
2
About the Partnership
ITCM Healthy Start
1993: Started
receiving HRSA
Healthy Start funds
and began delivering
coordinated tribal
maternal-child
health services
Partnership with MPHI
2005: MPHI began
Capacity building
working closely with
ITCM and Michigan
2008: MPHI
Enhancement
tribes on health
promotion projects partnered with ITCM
Healthy Start on
2010: MPHI applied
program and staff
for CDC Racial and
capacity building
Ethnic Approaches to
Community Health:
Communities
Organized to
Respond & Evaluate
(REACH CORE)
3
Healthy Native Communities, Healthy
Native Babies (HNCHNB)
• CDC REACH CORE grant
Sept 2010-Sept 2012
• Required a community
health assessment and
community action plan
• MPHI subcontracted
with 7 ITCM Healthy
Start sites
• Multi-level structure and
process
– Statewide Consortium
– 7 Local consortia
4
MPHI
ITCM
Communities
• Grant management
• Reporting
• Training
• MAPP
• Action Planning
• Evidence-based strategies
• Technical Assistance
• Data
• Facilitation
• Action Planning
• Evaluation
• Training and technical
assistance
• Lead the Statewide
consortium
• Align HNCHNB with other
efforts with shared goals
• Represent SC on state-level
initiatives
• Statewide health system
action plan
• Liaison
• Coordinate local consortium
• Participate in Statewide
Consortium
• Engage community
members in state and local
process
• Complete community health
assessment
• Develop focused
Community Action Plans
5
Capacity Building
CIRCLE: Community
Involvement to Renew
Commitment,
Leadership, and
Effectiveness2
A model of program
design and community
development for
indigenous people
2Chino,
M. & DeBruyn, L. (2006)
Promoting
Commitment
Building
Relationships
Working
Together
Building
Skills
6
Community Capacity & Ownership
Building Relationships:
• Compensated costs of
participating in consortia
• Cultural sensitivity and tailoring
• Being present in the community
• Shared vision
Building Skills:
• Training community members
through all phases
• Roles defined by communities
• Shared decision-making
• Providing tailored, site-specific
technical assistance
Working Together
• Partnership Principles
• Plans reviewed and approved by
consortium
• Using consensus
Promoting Commitment
• Performance measures
• Sharing results and being
accountable
• Continued relationship and
commitment to ITCM Healthy
Start and tribal health more
broadly
7
…And the Creator gave humans the ability to have
visions, to find their purpose or reasons for being
here, knowing all along that people sometimes
lose their way…We all stray from the Good Path.
Then we dream of better times and of a better life,
for ourselves and for all who are important to us.
And we live to make it real.
That is what makes us human...”
Thomas Peacock1
Fond du Lac Band of Lake Superior Chippewa
8
Completing MAPP
Mobilizing for Action
through Planning and
Partnerships (MAPP)3
1. Organize for
Success
2. Visioning
3. Four Assessments
4. Identify Strategic
Issues
5. Formulate Goals
and Strategies
6. Action Cycle
3
• Coordinator in each
local site to lead MAPP
• Training of coordinators
and local consortium
members
• Provided resource
materials and TA
throughout the process
National Association of County & City Health Officials
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Adapting MAPP
• Each site defined
“community” and their
tribal public health
system
• Modified or replaced
templates and tools
• Modified or replaced
language, terms,
images, and concepts
• Adapted phases and
components of MAPP
to each site’s needs
• Applied a maternalchild health lens to the
process
• Honored experience,
cultural values, wisdom
10
Organizing for Success
• Formed local consortium
with existing groups
• Defined own community
by geography, population,
or characteristics
• Tribes decided who to
engage and how best to
engage them
• Focus on only tribal
versus including nontribal partners decided by
site
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Visioning
• Defined their own
community,
timeframe, and focus
• Large group
discussion:
brainstorm, check-in,
dialogue, and
consensus
• Facilitated group
process to create an
asset map
Our community will support balance
of physical, emotional, mental, and
spiritual wellbeing through:
• Available healthy, whole, and
traditional foods;
• Access to safe, clean, drug-free,
green space to promote physical
activity;
• A nurturing and respectful social
environment, rooted in tradition,
that empowers individuals to
fulfill their hopes and dreams;
• Providing quality, comprehensive
health care that is available to all.
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MAPP Assessments
Grant
Year
Year 1
Year 2
4Public
Assessments Completed
Tailoring
Community Health Status
Assessment (CHSA)
Assessed, discussed, and selected
short list of indicators for use
Community Themes and
Strengths Assessment (CTSA)
Used a variety of formal and informal
methods to gather qualitative
information
Forces of Change (FOC)
Most adaptable and accessible to
community members
Local Public Health System
Assessment (LPHSA)
Replaced NPHPSP instrument with
tribal-specific tool (PHAB Standards
& Measures v. 1.0)4
Health Accreditation Board (2011)
13
Strategic Issues
• Evolving discussion
about root causes
• Compiled and
reviewed assessment
information in multiple
phases
• Synthesized and
organized all results
into diagrams for key
topic areas
• Facilitated consortia
meetings to prioritize
issues using ToP
Consensus Workshop
method
14
15
Goals and Strategies
• Relational
Worldview Model3
• Training on
evidence-based and
best practice
strategies
• Local consortia
brainstorm, discuss,
and select strategies
3Cross,
T. L., Earle, K. A., Echo-Hawk Solie, H., & Manness, K. (2000)
16
Planning for Action
Each local community
consortium:
– Prioritized their strategic
issues
– Selected 1 - 4 issues to
develop a detailed action
plan
– Completed an action plan
with timelines,
responsibilities, and
outcome measures
MPHI supported their
efforts by:
– Providing templates and
resources
– Reviewing or drafting
SMART objectives
– Conducting lit review on
strategies and examples
– Reviewing plans and
providing feedback
– Providing site-specific TA
as requested
17
Overall Challenges
 Keeping realistic and feasible
timelines
 Dedicated staff—services
came before assessment
 Presenting technical public
health concepts in a way that
engages community
members
 Balancing capacity building
and empowerment with TA
 Tailoring TA to each unique
community
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Overall Lessons Learned
 Priorities of the community
must come first
 Flexibility, adaptability of
process, timelines, and
methods
 Communicating key messages
continuously, using different
words, approaches, and
modalities
 Engaging community
members, practitioners, and
decision makers
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Overall Successes
 Enhanced partnerships at
multiple levels
 Community ownership
 Increased staff capacity
 Improved understanding of
health issues
 Increased buy-in for importance
of public health strategies
 Mutual learning: non-Native
partners increased
understanding of tribal
sovereignty and tribal
perspectives
 Good public health practice
 Sustainability
20
Sustaining Momentum
21
About KBIC
• PHAB Beta Test site
• Working toward PHAB accreditation
• Worked with Tribal Epi Center to strengthen
their Community Health Assessment
• Worked with MPHI with funding from NNPHI
‘Community Guide’ grant
• Continue working to complete a
comprehensive Community Health
Improvement Plan
22
Our Story
23
Preparing for CHIP
• Planning calls to assess capacity and decide on
process
• Recruitment to enhance the consortium and
form an advisory group
• Orienting advisory group to key concepts and
process
• Staff training on evidence based strategies and
The Community Guide
24
Review CHA results
Identify underlying factors
Select priorities
25
Consensus Workshop:
Action areas for the CHIP
26
27
• Meeting to review the
workbook and steps
• Formed action
planning teams for
each strategic issue
• More recruitment of
key people
• Team meetings to
select goals,
objectives, strategies
• Drafting action plans
using workbook
28
Reflections
What went well
What we will do better
• We developed a unified
vision of what we wanted
to accomplish
• Gathered input from
different sectors of the
community
• Collaboration and
communication with
existing tribal programs
and external agencies
• Allow staff more time to
devote to coordinating
this process
• Recruit more people to
participate in the advisory
group
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Learnings
Before you get started…
• You need champions
• Be inclusive
• Plan enough time for
staff to participate
Keep in mind…
• It doesn’t have to be
perfect
• You can always make
changes
• Keep it realistic and
manageable
• Keep moving forward
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“It is slow and difficult
work.
Good work is never easy.
And it will take the
efforts of many more
courageous people until
the work is complete.
Patience is the key...”
Thomas Peacock5
Fond du Lac band of
Lake Superior
Chippewa
31
References
1.
2.
3.
4.
5.
Peacock, T. & Wisuri, M. (2002) The Good Path: Ojibwe learning and
activity book for kids. St. Paul, MN: Minnesota Historical Society
Press.
National Association of County & City Health Officials. Mobilizing for
Action through Planning and Partnerships: Achieving Healthier
Communities through MAPP. A User’s Handbook. Washington, D.C.
Cross, T. L., Earle, K. A., Echo-Hawk Solie, H., & Manness, K. (2000)
Promising practices: Cultural strengths and challenges in
implementing a system of care model in American Indian
communities. Washington, DC: Child, Adolescent and Family
Branch/Center for Mental Health Services, Substance Abuse and
Mental Health Services Administration.
Public Health Accreditation Board (2011). Standards and Measures:
Version 1.0. Available online:
http://www.phaboard.org/accreditation-process/public-healthdepartment-standards-and-measures/
Peacock, T. & Wisuri, M. (2002) The Good Path: Ojibwe learning and
activity book for kids. St. Paul, MN: Minnesota Historical Society
Press.
32
Contact Information
Shannon Laing, MSW
Program Coordinator
Center for Healthy
Communities
Michigan Public Health
Institute
2342 Woodlake Drive
Okemos, MI 48864
slaing@mphi.org
517.324.7344
www.mphi.org
Kathy Mayo, RB
Community Health
Director
Keweenaw Bay Indian
Community
33