1、1,Sustainability of Public Health Programs: The Example of Tobacco Treatment in Massachusetts Community Health Settings,Nancy La Pelle, Ph.D. University of Massachusetts Medical School February 2007Grant # RO1 CA86282 funded by National Cancer Institute State and Community Tobacco Control Interventi
2、ons Research Initiative,2,Principal Investigator: Judith K. Ockene, PhD UMMSCo-Principal Investigators:Lori Pbert, PhD UMMS Donna Warner, MBA, CAC MDPHCo-Investigators:Nancy La Pelle, PhD UMMSJane Zapka, ScD UMMSSarah Reiff-Hekking, PhD UMMS Harriet Robbins, MEd MDPHProject Directors:Denise Jolicoeu
3、r, MPH, CHES UMMS Mary Jo White, MS, MPH UMMS,3,Sustainability,“Sustainability” contrasts with the notion of “institutionalization” which implies that a service is continued within the original organizational structure and that it is unchanged Sustainability includes adaptations to scope of services
4、 offered, organizational context, and supporting resources,4,Massachusetts Tobacco Treatment Policy Study (MASSTTPS),Sustainability Substudy Qualitative comparative case study Sample Massachusetts Tobacco Control Program (MTCP) statewide Smokers Helpline funded by MDPH 77 of 86 defunded community-ba
5、sed tobacco treatment programs 21 hospitals; 27 community health centers; 9 substance abuse treatment centers; 6 mental health agencies; 14 “other” agencies,5,Data Collection and Analysis,Telephone-based key informant interviews with community agency staff (77) In-person interviews with DPH/MTCP sta
6、ff regarding Smokers Helpline (5) Tape-recorded and transcribed Thematic and relational analysis conducted to idenify strategies used to sustain services,6,Results: Essential Strategies for Sustainability When Defunded,Redefine Scope of Services: Align services with organizational goals Select accep
7、table and affordable services,Creative Resourcing: Find funding sources for services offered Adjust staffing pattern Assign resources to create demand for services,Sustainable Services,7,Align Services with Organizational Goals,Meet needs of high smoking prevalence populations served Meet needs to p
8、rovide tobacco treatment to patients with co-morbid conditions Support staff needs to quit at smoke-free sites Dovetail with cessation-related research at the site,8,Select Acceptable and Affordable Services,Target specific at-risk subpopulationsOffer selected services onlyReduce availability: hours
9、 and sites when/where services are offered,9,Find Funding for Services Offered,Charge fees Use grant-writing expertise to find other funding Get other entities (departments, collaborators, etc.) to fund, share costs, or provide space Bill as encounter that has insurance coverage,10,Adjust Staffing P
10、attern,Reduce tobacco treatment specialist (TTS) staff Find other roles TTS staff can play part-time in other departments Outsource TTS staff Find non-TTS staff resources to provide services,11,Assign Resources to Create Demand for Services,Create referral system from providers and other departments
11、 Educate healthcare providers about services Program staff networks with other community organizations to generate referrals Enlist marketing resources to advertise services,12,Sustainability Results After 9 Months,13,Level 1: 33% Non-Sustaining (Minimal Scope; No Resources),Redefining Scope: Drop t
12、obacco treatment - low priority Refer to other agencies for treatmentCreative Resourcing: No funding; Fees not acceptable to clients; No grant-writing resources No staff to deliver services No staff to create demand,14,Level 2: 34% Low Sustaining (Restricted Scope; Minimal Resources),Redefining Scop
13、e: Serve high prevalence smokers where possible Limited services for specific populations; No nicotine replacement therapy (NRT) unless covered by insurance; Integrate with other treatment servicesCreative Resourcing: Limited grant-writing resources TTS staff provide fewer sessions at fewer sites; S
14、ervices provided by interns, volunteers, non-specialists No outreach since not staffed for full service; Internal referral systems not optimized,15,Level 3: 27% Mid-Sustaining (Expanding Scope; Expanding Resources),Redefining Scope: Gradually restore services available to all Provide only group serv
15、ices; Provide all previous services except NRT; Provide only phone- or web-based servicesCreative Resourcing: Seek alternate funding sources/charge fees; Seek collaborators with funding; Seek grants to serve specific ethnic groups; Seek NRT funding source Use contract staff or share staff with other
16、 departments; Transfer program to related groups with more resources Emphasize use of internal referral system,16,Level 4: High Sustaining (Similar Scope; Similar Resources),Redefining Scope: Continue services to all smokers Continue to offer same level of services as when fundedCreative Resourcing:
17、 Seek alternate funding sources/charge fees Maintain staff required Provide marketing and outreach support; Encourage internal referrals agency-wide,17,Sustainability Results After 9 Months,* The percentage is of the agency type total,18,Sustainability Strategies,Key Strategies at Defunding Redefine
18、 Scope of Services: Align services with organizational goals Select acceptable and affordable services Creative Resourcing: Find funding sources for services offered Adjust staffing pattern Assign resources to create demand for services,Additional Key Strategies at Planning Program design Standard o
19、perating routines Capacity building Community board involvement Local institutional support Administrative system support Evaluation,19,References,Bracht N, Finnegan JR, Rissel C, et al. Community ownership and program continuation following a health demonstration project. Health Ed Research 1994;9(
20、2):243-255. Claquin P. Sustainability of EPI: Utopia or sine qua non condition of child survival. In. Arlington, VA: REACH; 1989. Evashwick C, Ory M. Organizational characteristics of successful innovative health care programs sustained over time. Fam Community Health 2003;26(3):177-93. Goodman RM,
21、Steckler AB. A model for the institutionalization of health promotion programs. Fam Community Health 1989;11(4):63-78. La Pelle N, Zapka J, Ockene JK. “Sustainability of Public Health Programs: the Example of Tobacco Treatment in Massachusetts.” American Journal of Public Health, Aug 2006, Volume 96
22、: p. 1363-1369. Shediac-Rizkallah MC, Bone LR. Planning for the sustainability of community-based health programs: conceptual frameworks and future directions for research, practice and policy. Health Ed Res 1998;13(1):87-108. Steckler A, Goodman R. How to institutionalize health promotion programs.
23、 Am J Health Promot 1989;3:34-44. U.S. Agency for International Development. Maximizing Program Impact and Sustainability: Lessons Learned in Europe and Eurasia 1999. In: Available at: http:/usaid.gov/locations/Europe_Eurasia/dem_gov/local_gov/maximpact.htm. U.S. Agency for International Development. Sustainability of Development Programs: A Compendium of Donor Experience. In. Washington, DC; 1998.,
