Chronic Disease and Health PromotionProgram Integration

Rosemarie Henson, MSSW, MPHDeputy Director

Kaetz Beartusk, MPHTeam Lead, Public Health Practice

National Center for Chronic Disease Preventionand Health Promotion

Vision and Mission of NCCDPHP

Our VisionAll people living healthy lives free from the devastation of chronic diseases

Our MissionLeading efforts to promote health and well-being through prevention and control of chronic diseases

NCCDPHP Goals

• Prevent, delay, detect, and control chronic diseases• Contribute to chronic disease research and apply

that research to put practical and effective intervention strategies into practice

• Achieve equity in health by eliminating racial and ethnic disparities and achieving optimal health for all Americans

National Center for Chronic Disease Prevention and Health Promotion

Office of PublicHealth Genomics

Muin J. Khoury, M.D.Director

Division of Adult andCommunity Health

Wayne H. Giles, M.D., M.S.Director

Division of Nutrition,Physical Activity, and Obesity

William H. Dietz, M.D., Ph.D.Director

Office onSmoking and Health

Matthew T. McKenna, M.D., M.P.H.Director

Division of CancerPrevention and Control

Barbara Bowman, Ph.D.Acting Director

Division ofDiabetes Translation

Ann Albright, Ph.D.Director

Division for Heart Diseaseand Stroke Prevention

Darwin Labarthe, M.D., M.P.H., Ph.D.Director

Division ofOral Health

Kathleen Ethier, Ph.D.Acting Director

Disease-Focused Divisions Risk Factor Divisions

Division of Adolescentand School Health

Howell Wechsler, Ed.D, M.P.H.Director

Division ofReproductive Health

John LehnherrActing Director

Population/Setting Divisions

Framework for Preventing Chronic Disease and Promoting Health

Priority Conditions

Life Span and Settings

- Heart Disease - Stroke- Cancer- Diabetes- Obesity- Arthritis - Oral Health

- Tobacco- Nutrition- Physical Activity- Alcohol- Family History

Underlying Risk Factors

- Worksites- Schools- Communities - Health Systems- Infants- Children and Adolescents- Adults and Older Adults

Prevent, Delay, Detect & Control Chronic Disease

Heart Disease

Division for Heart Disease and Stroke Prevention

Office on Smoking and Heath

Division of Nutrition, Physical Activity and Obesity

Division of Adolescent and School Health

Division of Adult and Community Health

Office of Public Health Genomics

Early Efforts

• WISEWOMAN• Comprehensive Cancer Control • REACH (Racial and Ethnic Approaches to

Community Health)• Steps to a HealthierUS• Chronic Disease Program Linkages with Quitlines

Integration Initiative Background FY '05• Began working with states to understand the program integration efforts implemented by

states• Siloed programsFY '06• Integration workshop sponsored by CDC and NACDDFY '07• Offers to Participate (Negotiated Agreements) FY '08• Activities

- Simplified FOAs- Negotiated Agreements- Collaborative FOAs

NCCDPHP Vision for Program Integration

To nurture and sustain a culture for programintegration across chronic disease and healthpromotion, and other related programs

Goals for Integration

• Improve program reach and impact by enhancing synergies among approaches to different diseases, risk factors, populations, and settings

• Promote opportunities for greater flexibility, creativity and responsiveness by our partners

• Increase efficiencies across categorical disease programs• Provide consistency of CDC processes, reporting and

interpretation of policy across programs for states and other partners

• Maximize and leverage limited federal resources

Evaluation

What integration efforts seem to create the favorable environment that is necessary for implemented programs to achieve their intended chronic disease outcomes.

• Do/did integration efforts produce improvements in intra-organization collaboration, efficiencies etc

• Do/did integration efforts produce the intended external improvement such as increased outreach/access to populations, leveraged funding etc

• Do/did the increased leverage, efficiencies, collaboration lead to enhanced reach and /or significant policy or environmental changes

NCCDPHP’s Integration Approaches

• 2008 Streamlined FOAs for all Center programs • 2009 Collaborative Performance Agreements for Pacific

Basin Programs (BRFSS, Diabetes, Tobacco)• 2009 Collaborative FOA for National Programs

(BRFSS, Tobacco, Diabetes + DACH Healthy Communities)

• 2009-2011 Negotiated Agreement Pilots

Integration Challenges

• Organization norm change• Technical Assistance/Consultation• Business Processes• MIS (Management Information Systems)• Reporting Requirements• Evaluation• Sharing lessons learned, challenges, successes

Early Successes

• Integrated work plan (process & the document) • Increased communication and engagement among staff• Recognizing need for consistency in our terminologies,

processes, and messages• Engagement with PGO in new ways of doing business

Early Observations

• Organizational change is difficult, it takes time• Good relationships between categorical Project Officers

and Program Managers need to be preserved• Staff at all levels must be engaged• Processes must be transparent • Need to create a learning organization where people

share information freely and create new systems for open communication

Chronic Disease Program Integration Learning Community

Vision: An opportunity for continuous learning across chronic disease programs to exchange relevant tools and approaches for building collaborative knowledge and to propel program integration and integrative thinking

• Program Integration – On Demand• Program Integration Networking Calls• Program Integration Webinar Series