nancy la pelle, ph.d. university of massachusetts medical school february 2007
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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 2007 Grant # RO1 CA86282 funded by National Cancer Institute - PowerPoint PPT PresentationTRANSCRIPT
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Sustainability of Public Health Programs: The Example of Tobacco Treatment
in Massachusetts CommunityHealth Settings
Nancy La Pelle, Ph.D.University of Massachusetts Medical SchoolFebruary 2007
Grant # RO1 CA86282 funded by National Cancer InstituteState and Community Tobacco Control Interventions Research Initiative
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Principal Investigator: Judith K. Ockene, PhD UMMS
Co-Principal Investigators: Lori Pbert, PhD UMMS Donna Warner, MBA, CAC MDPH
Co-Investigators: Nancy La Pelle, PhD UMMS Jane Zapka, ScD UMMS Sarah Reiff-Hekking, PhD UMMS Harriet Robbins, MEd MDPH
Project Directors: Denise Jolicoeur, MPH, CHES UMMS Mary Jo White, MS, MPH UMMS
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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 offered, organizational context, and supporting resources
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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-based tobacco treatment programs
- 21 hospitals; 27 community health centers; 9 substance abuse treatment centers; 6 mental health agencies; 14 “other” agencies
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Data Collection and Analysis
Telephone-based key informant interviews with community agency staff (77)
In-person interviews with DPH/MTCP staff regarding Smokers’ Helpline (5)
Tape-recorded and transcribed Thematic and relational analysis
conducted to idenify strategies used to sustain services
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Results: Essential Strategies for Sustainability When Defunded
Redefine Scope of Services:1. Align services with
organizational goals2. Select acceptable and
affordable services
Creative Resourcing:3. Find funding sources for services offered4. Adjust staffing pattern5. Assign resources to create demand for services
Sustainable Services
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Align Services with Organizational Goals
Meet needs of high smoking prevalence populations served
Meet needs to provide 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
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Select Acceptable and Affordable Services
Target specific at-risk subpopulations
Offer selected services only
Reduce availability: hours and sites when/where services are offered
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Find Funding for ServicesOffered 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
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Adjust Staffing Pattern
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
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Assign Resources to Create Demand for Services
Create referral system from providers and other departments
Educate healthcare providers about services
Program staff networks with other community organizations to generate referrals
Enlist marketing resources to advertise services
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Sustainability Results After9 Months
Level 1: Non-Sust.
Level 2: Low-Sust.
Level 3: Mid-Sust.
Level 4 : High-Sust.
Totals
Volume of Prior Services Still Provided
0% 5-19% 20-49% 50-100%
Totals 25 26 21 5 77
% of Total # Agencies
33% 34% 27% 7%
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Level 1: 33% Non-Sustaining (Minimal Scope; No Resources)
Redefining Scope:1. Drop tobacco treatment - low priority2. Refer to other agencies for treatment
Creative Resourcing:3. No funding;
Fees not acceptable to clients; No grant-writing resources
4. No staff to deliver services5. No staff to create demand
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Level 2: 34% Low Sustaining (Restricted Scope; Minimal Resources)
Redefining Scope:1. Serve high prevalence smokers where possible2. Limited services for specific populations;
No nicotine replacement therapy (NRT) unless covered by insurance; Integrate with other treatment services
Creative Resourcing:3. Limited grant-writing resources4. TTS staff provide fewer sessions at fewer
sites; Services provided by interns, volunteers, non-specialists
5. No outreach since not staffed for full service; Internal referral systems not optimized
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Level 3: 27% Mid-Sustaining(Expanding Scope; Expanding Resources)
Redefining Scope:1. Gradually restore services available to all 2. Provide only group services;
Provide all previous services except NRT; Provide only phone- or web-based services
Creative Resourcing:3. Seek alternate funding sources/charge fees;
Seek collaborators with funding; Seek grants to serve specific ethnic groups; Seek NRT funding source
4. Use contract staff or share staff with other departments; Transfer program to related groups with more resources
5. Emphasize use of internal referral system
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Level 4: High Sustaining(Similar Scope; Similar Resources)
Redefining Scope:1. Continue services to all smokers2. Continue to offer same level of services
as when funded
Creative Resourcing:3. Seek alternate funding sources/charge
fees4. Maintain staff required 5. Provide marketing and outreach support;
Encourage internal referrals agency-wide
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Sustainability Results After9 Months
Level 1: Non-Sust.
Level 2: Low-Sust.
Level 3: Mid-Sust.
Level 4 : High-Sust.
Totals
Volume of Prior Services Still Provided
0% 5-19% 20-49% 50-100%
Hospitals 1 (5%)* 8 (38%)* 9 (43%)* 3 (14%)* 21
Community Health Centers
8 (30%)* 12 (44%)* 6 (22%)* 1 (4%)* 27
Substance Abuse Treatment Agencies
5 (56%)* 3 (33%)v 1 (11%)* 0 9
Mental Health Treatment Agencies
1 (17%)* 3 (50%)* 2 (33%)* 0 6
Other Agency Types 10 (71%)* 0 3 (21.5%)* 1 (7.5%)* 14
Totals 25 26 21 5 77
% of Total # Agencies 33% 34% 27% 7%
* The percentage is of the agency type total
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Sustainability Strategies
Key Strategies at DefundingRedefine Scope of Services: Align services with
organizational goals Select acceptable and
affordable servicesCreative 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 operating
routines Capacity building Community board
involvement Local institutional
support Administrative
system support Evaluation
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