Embedding Interventions in Sustainable Delivery Systems

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Embedding Interventions in Sustainable Delivery
Systems

• Teresa Brady, PhD
• Senior Behavioral Scientist, Arthritis Program
• Centers for Disease Control and Prevention

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Our Current Challenge

• Making evidence-based programs available to
  all the people who need them
• 46 million American adults have arthritis
• 19 million have arthritis attributable activity
  limitations
• Arthritis programs reach less
  than 1 of their target audience

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One Possible Solution

• Embed evidence-based programs into sustainable
  delivery systems to ensure wide-spread and
  ongoing program delivery
• Program becomes part of routine operations
• Serves the constituents of the system partner
• Programs sustained over time

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Purpose of Program Announcement DP08-806

• To build state arthritis programs that
• Exponentially expand access and use of
  evidence-based interventions
• By embedding interventions into existing systems
• Conducting surveillance and data-analysis to
  inform decision-making
• Developing partnerships that further program goals

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Purpose of Arthritis Integrated Dissemination
Projects

• Exponentially expand access to and use of
  interventions by using a systems approach and
  system partners to embed arthritis interventions
  into existing and sustainable program delivery
  systems
• To integrate arthritis intervention expansion
  activities into other chronic disease and/or
  health promotion programs
• NACDD

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Not a News Flash

• Exponentially Expanding Reach
• By embedding interventions
• In sustainable delivery systems
• Integrate these activities with other activities
  in the health department

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Definitions

• System partner an organization providing a
  sustainable mechanism for disseminating programs
  through multiple delivery sites to large numbers
  of people
• Embedding the process of facilitating the
  adoption of a program that results in sustained
  delivery of the program as part of the partners
  routine business.
• AF Step-by-Step Guide

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Critical Characteristics of a Good Delivery
System Partner

• Serves/has constituents likely to have arthritis
• Has multiple points for intervention delivery
• Has the resources to support program delivery as
  part of daily operations
• Delivery of this intervention will help the
  organization meet its mission

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YMCA EnhanceFitness in Lansing

• Oak Park YMCA
• Interested in EF

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YMCA EnhanceFitness in Lansing
Oak Park YMCA (EF at branch)
Westside YMCA (EF at branch)
YMCA of Lansing
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YMCA EnhanceFitness in Lansing
Oak Park YMCA (EF at branch)
Westside YMCA (EF at branch)
YMCA of Lansing
DeWitt YMCA
Downtown Wellness Center
Parkwood YMCA
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Recognizing a Delivery System Partner

• Do people likely to have arthritis already
  congregate there?
• Do they have multiple sites for program delivery?
• Do they have the capacity/resources to keep the
  program going?
• Does delivering this program
• help them meet their mission?

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YMCA EnhanceFitness in Lansing
Oak Park YMCA (EF at branch)
Westside YMCA (EF at branch)
YMCA of Lansing
University Lutheran Church
CACIL
Delta 39ers
Eaton Rapids (potential site)
Mason (potential site)
DeWitt YMCA
Downtown Wellness Center
Parkwood YMCA
St. Jude Church
Meridian Senior Center
Grace Lutheran Church
Mt. Hope United Methodist
Karen McCloskey, June 23, 2009
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Is it a site or a system?

• Oak Park YMCA
• Interested in EF

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Working in Systems

• Opens the Door to Opportunity
• Californias System Partner Case Study
• Or
• The Case of the Pink, Green, and Blue Partners

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California Arthritis Partnership Program

• 2.25 Million PWA in state
• 4 Arthritis Foundation Chapters
• Approximately 1000 program delivery sites
  (2006-2008)

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Opening Opportunity Doors California Case Study

• Analysis of program delivery sites
• Entered all sites into spreadsheet
• Categorized initially by type
• Senior Living Facility Sr. Center
• Faith-based Organization
• Gym/Fitness Medical
• Some of these sites are related

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Opening Opportunity Doors California Case Study

• Internet searches to identify corporate related
  sitespotential system partners
• Classified each potential system partner
• Pink Partner (Known System Partner already have
  several sites)
• Green Partner (Potential System Partner--working
  with 1 site, others in system)
• Blue Partner (Unknown Systems Partner --Multiple
  sites already, not realize relationship)

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Opening Opportunity Doors California Case Study
Known System Partners
19 other potential Atria sites
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Opening Opportunity Doors California Case Study
Potential System Partners
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Opening Opportunity Doors California Case Study

• System partner analysis facilitated
• Identifying opportunities within existing
  partnerships
• Increasing sites with known system partners
• Expanding from 1 site to multiple in a system
• Using individual site as foot into door of system

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Embedding into the System

• Embedding the process of facilitating the
  adoption of a program that results in sustained
  delivery of the program as part of the partners
  routine business.
• AF Step-by-Step Guide

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How embedded are your interventions?

• Ask yourself
• How am I spending my time?
• How am I spending my money?

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How embedded are your interventions?

• How am I spending my time?
• Developing relationships with decision-makers at
  potential delivery system organizations
• Facilitating the adoption decision at potential
  system partners
• Problem solving/technical assistance with the
  delivery system program coordinator
• Developing leader support strategies for all
  leaders in an area

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How embedded are your interventions?

• How am I spending my money?
• Off setting start-up costs?
• Removing barriers to initial implementation?
• ???Paying partners to implement programs???

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Embedding Intervention in the Delivery System

• Presbyterian Villages of Michigan (PVM)
• Mission committed to providing quality and
  affordable services, care and housing to older
  persons of all faiths.
• 23 Villages in Michigan
• Sr. Apartments (some subsidized)
• Assisted Living
• Skilled Nursing
• CDSMP currently offered in 5 Villages

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Embedding CDSMP in PVM

• Champion Wellness Director (Corporate)
• Progressive Strategy (encourage new village
  director to call his colleague already offering
  it)
• Questions Wellness Director is asking
• Who can be leaders?
• Wellness staff? Residents?
• How can I pay for it?
• Restricted HUD funds? Registration fee?
• Will this make us a good community citizen?

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Just a word about Integration

• Can integrate at multiple levels
• Multiple definitions
• formed into a whole or introduced into another
  entity
• composed and coordinated to form a whole
• become one
• the act of combining into an integral whole

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Integration

• Evidence-based Interventions provide a great
  integration opportunity
• Our integration hope providing interventions
  beneficial to PWA becomes part of the routine
  work of other chronic disease programs

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Adults with Select Chronic Diseases Who Also
Have Arthritis, 2007
CDC, Behavioral Risk Factor Surveillance System,
2007 median state estimates
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Integration in AID Projects

• Alaska Diabetes Prevention and Control Program
  assisting 3 system partners to expand CDSMP
• Indiana Diabetes Prevention and Control Program
  integrating EnhanceFitness into AAA expansion of
  CDSMP
• New York Healthy Heart Program working with a
  managed care organization and two regional
  Diabetes Coalitions to expand CDSMP

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State Arthritis Program Integration Example

• California WiseWoman Program
• Select WiseWoman clinics added arthritis case
  finding questions to intake form
• Participants referred to local AF chapter to
  locate services
• Community Health Workers at clinics trained to
  provide self management education programs

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And a final word

• On defining success

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Success
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Success
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The reason the work seems hard
is because this is hard work.
But also important work!
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Lessons to Listen For

• What delivery system partnerships have been
  productive?
• How have others fostered embedding the
  intervention in the delivery system?
• Where have the integration successes occurred?
• How have others gotten around the obstacles you
  are encountering?

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Contact Info

• Teresa J. Brady, PhD
• Senior Behavioral Scientist
• Arthritis Program
• Centers for Disease Control and Prevention
• tob9_at_ cdc.gov
• 770-488-5856