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The Future of the Public’s Health in the 21st Century B Models for Collaborative Planning in Communities Chapter 4 discusses the models available to guide collaborative planning for communities. Three examples are provided below. The MAPP Model The MAPP (Mobilizing for Action through Planning and Partnership) tool was developed by the National Association of County and City Health Officials (NACCHO) in collaboration with the Centers for Disease Control and Prevention (CDC). MAPP (see Figure B–1) was built on the foundation of the Assessment Protocol for Excellence in Health, or APEXPH. APEXPH was developed as a tool to guide local health officials in conducting assessment and planning (NACCHO and CDC, 2000). The MAPP work group vision is “Communities achieving improved health and quality of life by mobilizing partnerships and taking strategic action.” MAPP is targeted to communities, and its goal is to equip them with a structured framework for planning health programs. The MAPP process is centered on community organizing and partnership development and includes four assessments: assessing community themes and strengths, assessing the local public health system, assessing the community’s health status, and assessing the forces of change. Next, MAPP involves the identification of strategic issues, the formulation of goals and strategies, and a continuous cycle of planning, implementation, and evaluation.
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The Future of the Public’s Health in the 21st Century FIGURE B–1 The MAPP (Mobilizing for Action through Planning and Partnerships) model. SOURCE: NACCHO and CDC (2000). The PATCH Model PATCH, the Planned Approach to Community Health, is a community health planning model developed by CDC in 1983. PATCH was created for application among diverse partners at the local level, but also within the context of vertical collaboration within the governmental public health infrastructure (federal, state, and local levels) and horizontal collaborations with voluntary organizations, academia, and other partners at all levels (Kreuter, 1992; CDC, 1997; Green et al., 2001). PATCH has five critical elements or phases (see Figure B–2). These include (1) community member participation, (2) data-based program development, (3) collaborative development of a comprehensive health promotion strategy, (4) evaluation for feedback and improvement, and (5) the enhancement of community capac-
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The Future of the Public’s Health in the 21st Century FIGURE B–2 The PATCH (Planned Approach to Community Health) model. SOURCE: CDC (1997). ity for health promotion. In a survey conducted by NACCHO between 1992 and 1993, 239 local health agencies were using PATCH (NACCHO and CDC, 1995). Although PATCH encourages the active engagement of local governmental health agencies, it recognizes that these may not always be the “most appropriate and/or effective focal point for PATCH” and “primary care clinics, university groups, businesses, and other nongovernmental organizations may be in a better position to exercise leadership for a PATCH program” with the support and facilitation of the local health agency (Kreuter, 1992). The implementation of PATCH highlighted several elements that seem to be associated with successful community-based public health planning and action. These include the existence of a core of community support and participation, data collection and analysis, setting of objectives and standards to help with planning and evaluation, the adoption of multiple strategies on multiple fronts, sustained monitoring and progress evaluation to fine-tune projects, and the support of the governmental public health infrastructure nationally and locally (Kreuter, 1992). One of the major applications of PATCH is carrying out the assessment function of public health, described in the 1988 IOM report (IOM, 1988). Assessment is a core function of the public health infrastructure, but public health activities in the private sector and the efforts of communities can also contribute to the process of assessing population health status.
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The Future of the Public’s Health in the 21st Century The CHIP Model CHIP, the Community Health Improvement Process, is a tool for community health planning and evaluation through inventory taking and performance monitoring. CHIP (Figure B–3) has two interacting cycles: the problem identification and prioritization cycle, which includes phases of community organizing, assessment, and selection of priority areas, and the analysis and implementation cycle, which includes seven phases that range from planning, through implementation, to evaluation (IOM, 1997). CHIP’s FIGURE B–3 The CHIP (Community Health Improvement) model. SOURCE: IOM (1997).
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The Future of the Public’s Health in the 21st Century resource inventory step is related to the concepts of asset-based community development (identifying strengths on which to build) and ultimately addresses health problems and needs (Kretzmann and McKnight, 1993). CHIP also uses the performance measurements provided by Healthy People 2000 (USPHS, 1991) and Healthy Communities 2000 Model Standards (IOM, 1997; APHA, 1999). CHIP’s process of developing indicators has been further elaborated in CDC’s Principles of Community Engagement and incorporated in a wide range of community and regional health report cards (CDC, 1997). REFERENCES APHA (American Public Health Association). 1999. Healthy Communities 2000: Model Standards. Washington, DC: APHA. CDC (Centers for Disease Control and Prevention). 1997. Principles of Community Engagement. CDC/ATSDR Committee on Community Engagement. Atlanta, GA: CDC. Green L, Daniel M, Novick L. 2001. Partnerships and coalitions for community-based research. Public Health Reports 116(Suppl. 1):20–31. IOM (Institute of Medicine). 1997. Improving Health in the Community: A Role for Performance Monitoring. Washington, DC: National Academy Press. Available online at http://www.nap.edu/catalog/5298.html. IOM. 1988. The Future of Public Health. Washington, DC: National Academy Press. Kretzmann JP, McKnight JL. 1993. Building Communities from the Inside Out: A Path Toward Finding and Mobilizing a Community’s Assets. Evanston, IL: Institute for Policy Research. Kreuter MW. 1992. PATCH: its origin, basic concepts, and links to contemporary public health policy. Journal of Health Education 23(3):135–139. Available online at http://www.cdc.gov/nccdphp/patch/. NACCHO (National Association of County and City Health Officials) and CDC (Centers for Disease Control and Prevention). 1995. 1992–1993 National Profile of Local Health Departments. Atlanta, GA: CDC. NACCHO and CDC. 2000. A strategic approach to community health improvement: MAPP. Available online at http://mapp.naccho.org/MAPP_Home.asp. Accessed October 16, 2002. USPHS (U.S. Public Health Service). 1991. Healthy People 2000: National Health Promotion and Disease Prevention Objectives. DHHS Publication 91–50212. Washington, DC: U.S. Public Health Service.
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