KSDFS Health Program Implementation Process Assignment

Chapter 8 Program Implementation Learning Objectives With this chapter, readers will be able to:

1. Articulate the inputs and outputs of a service utilization plan of a program.

2. Justify the inputs and outputs of the organizational plan of a program.

Presentation Outline

• Key terminology • Effort across the life of a health program • Organizational and services utilization plan elements • Organizational plan inputs • Human resources considerations • Physical resources • Informational resources • Managerial resources • Organizational plan outputs • Service utilization plan inputs • Social marketing • Overinclusion and underinclusion • Scope of coverage • Intervention delivery • Service utilization plan outputs • Process and effect theory examples • Business plans vs. process theories and logic models • Across the pyramid • Internet resources Key Terminology • • • • • • • • • • KSDFS Health Program Implementation Process Assignment

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Business plan

Full-coverage programs Indirect costs Logic model Overinclusion Partial-coverage programs Place Price Product Promotion • • • • • • • • • Recipient Sensitivity Social marketing Specificity Target audience Target population Timeline Underinclusion Units of service Effort across the Life of a Health Program Organizational and Services Utilization Plan Elements of the Process Theory Organizational Plan Inputs • • • •

Human resources

Physical resources

Transportation Informational resources

• Time • Managerial resources • Monetary resources Human Resources Considerations • Licensure and/or certification – Program needs and regulatory requirements • Training – Aligns theory-in-use and espoused theory with effect theory • Cultural diversity and sensitivity • Volunteers Considerations for Health Disciplines

Discipline State Licensure Required? State Regulation of Scope of Practice Professional Certification Exists Dentistry Yes Yes Yes Community health worker No No Certificate programs Dietitian Yes, as RD Yes Yes Health administration No (except for long-term care) No Yes Health education No No Yes Industrial hygiene Yes Yes Yes Medicine Yes Yes Yes Nursing Yes, as RN Yes Yes Physical therapy Yes Yes Yes Social work Optional Yes, for those with licensure Yes Physical Resources • • • • Material resources Facilities Supplies Equipment Informational Resources • • • •

Professional networks

Street smarts Professional knowledge and experience Important to maximize staff retention Managerial Resources • • • • • • Organizational abilities Communication skills, including negotiation Team-building skills Leadership qualities Coping skills for complex tasks Technical skills Organizational Plan Outputs • • • • • Timeline Operations manual Organizational chart Information system Budget Timeline Example Budgeting Terminology • • • • • Fixed costs Variable costs Direct costs Indirect costs Charges Break-Even Analysis • Point at which expenses ≤ revenues • Qty of services = fixed cost / (price per client – variable cost per client) More on Budgets • Must include evaluation expenses – Generally ≥ 10% of direct program costs • Budget justifications are required for funding proposals

Service Utilization Plan Inputs • • • • Social marketing Eligibility screening Queuing Intervention delivery Social Marketing • Also called health marketing • Four P’s of classic marketing – Product, price, place, promotion • Additional P’s – Partnership, policy Overinclusion vs. Underinclusion • Overinclusion – May dilute the estimated program effects on the target audience’s outcomes – May falsely increase the estimated size of the target audience • Underinclusion – Too few participants may make it difficult to detect program effects – More intensive services to a small group may inflate the true program effect – Increases cost per participant Minimizing Over- and Underinclusion • Specifying how recipients get into the program – Sensitive and specific screening tools • Sensitivity (identifying true cases) reduces underinclusion • Specificity (identifying true non-cases) reduces overinclusion – Screening enhances program efficiency and effectiveness • Good marketing plan Relationship of Sensitivity and Specificity to Inclusion Sensitivity High Low Specificity High Low Ideal inclusion Overinclusion and coverage Underinclusion Over- and underinclusion. KSDFS Health Program Implementation Process Assignment

Scope of Coverage • Partial-coverage programs – Often at the direct care or enabling services levels of the pyramid • Full-coverage programs – Population services level of the pyramid Examples of Partial and Full Coverage Programs, by Pyramid Level Pyramid level Partial coverage Full coverage Individual – direct services •Early intervention for children at developmental risk •Hospice care •Ambulance and emergency medical care •Immunization clinics available to all Aggregate – enabling services •Needle exchange for some substance abusers •Head Start for low income children •Medicaid coverage for dialysis of those with kidney failure Population-based •WIC •SCHIP •Seat belt laws •Medicare for all age 65+ •Water fluoridation Infrastructure Laptop computers for nurses making home visits •Licensure for physicians, nurses, etc. •National cancer registry Intervention Delivery • Requires the most effort • Made easier via: – Thorough planning – Well-conceived process theory • Must follow the developed protocols • Pilot testing prior to implementation – Intervention itself – Evaluation instruments Service Utilization Plan Outputs • # units of service provided • Quantity of service completions • Materials developed to provide the health program • Work flow Examples of Tracking Service Utilization Plan Outputs Intervention activity Target audience: Persons with health problem

Target audience: Clinics Target audience: City Individual education 100 persons at risk 76 providers visited Individual screening 600 persons 30 providers 1000 persons screened at health fairs Group education 15 groups at hospital 8 groups at 3 clinics 15 groups at library; 6 groups at school Population education 2000 flyers; 600 stickers 50 posters 25 public service announcements; 10 health fairs Individual support for behavior 125 persons at risk in 22 groups 32 providers in 8 groups Process Theory Example for NTD Prevention Program Effect and Process Theory Example for NTD Prevention Program Hypothetical Program Logic Model for Reducing Congenital Anomalies Assumptions Health problem is important to community of providers & residents Residents have access to health care and food sources Inputs Program personnel: RNs, primary care Funding for 2 years, information MDs, geneticists system for tracking participants Activities Create a timeline and tracking system Conduct staff training; create program protocol and manual; create PSAs and recruitment materials Outputs # of education materials; program manual; # of staff trained # women screened for type of employment and serum folic acid; % women who start prenatal folic acid supplementation Immediate outcome Improved folic acid knowledge % births with NTD or cleft lip/palate Long-term outcome

Rate of congenital anomalies Business Plans vs. Process Theories and Logic Models Business plan format Purpose Process theory element Logic model element Title/cover page First impressions Executive summary First impressions Business concept Describes program design with goals and objectives Entire program theory Entire logic model Market analysis Analyzes demand, need, competition, & effect on existing services & health status Community needs assessment Financial analysis Projects revenues & expenses; states fiscal assumptions used in analyses Organizational plan inputs: monetary resources, budget Business Plans vs. Process Theories and Logic Models, Continued Business plan format Purpose Process theory element Logic model element Risk and competitive analysis Discloses sources and types of possible failures, with alternatives to avoid those failures; balances failure risks with program merits Operational plan Shows how personnel, management, space, and equipment come together; delineates resource requirements Organizational plan inputs: human, informational, physical, managerial, time resources, transportation Inputs, activities Marketing plan Describes strategy to reach target audience, branding, distribution, price, promotion Service utilization plan: social marketing, participants Activities Milestones Time frame to accomplish key tasks and outcomes Process and outcome objectives Immediate and long-term outcomes

The Public Health Pyramid Program Implementation across the Pyramid • Direct services level – Tailor human resources to the intervention – Social marketing plan will target individuals and individual behavior • Enabling services level – Providers likely to need a social services background – More likely to use volunteers – Social marketing tailored to the targeted aggregate Program Implementation across the Pyramid, Continued • Population-based services level – Also requires a skills match between providers and the intervention – Social marketing likely to use mass media • Infrastructure level – Strong organizational and services utilization plans are indicators of a solid infrastructure – Adequate infrastructure is essential to program success Internet Resources • Kellogg Foundation Evaluation Manual on developing program theory:

http://www.wkkf.org/Pubs/Tools/Evaluation/Pub77 0.pdf • ReCAPP BDI audio logic model course: http://www.etr.org/recapp/logicmodelcourse/ • CDC – Meta-site for logic models: http://www.cdc.gov/eval/resources.htm#logic%20model – Scholarly papers on marketing: http://www.cdc.gov/healthmarketing Internet Resources, Continued • Break-even analysis calculators – http://dinkytown.com/java/BreakEven.html – http://legacy.ncsu.edu/classes/ted430/java/mecon.html • Tools of Change links for social marketing: http://www.toolsofchange.com/English/firstsplit.a sp • Social Marketing Institute: http://www.socialmarketing.org/papers.html • Business plans resources – http://www.entrepreneur.com/businessplan – http://www.myownbusiness.org/s2/ KSDFS Health Program Implementation Process Assignment