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How to Use The Community Guide - Public Health Accreditation Board Standards Crosswalk

Overview

Public health department accreditation aims to improve the quality of practice and performance of public health departments.1 The Public Health Accreditation Board (PHAB; www.phaboard.org External Web Site Icon) has been established as a national voluntary accreditation program for state, tribal, local, and territorial health departments.

The PHAB Standards and Measures External Web Site Icon document serves as the official standards, measures, required documentation, and guidance blueprint for national public health department accreditation.2 The document encourages, and sometimes requires, the use of evidence-based approaches in public health, given their importance in helping health departments achieve their public health goals. Approaches are considered to be evidence-based if the existing data about them—from research studies, program evaluation, or both—shows they are effective in achieving their intended outcomes.3 Systematic reviews are among the strongest types of evidence.3,4 The Community Guide is one of the evidence-based resources cited in the PHAB guidance.

Purpose and Structure

The Crosswalk aims to help health departments identify evidence-based interventions from The Community Guide whose implementation could help document conformity with PHAB standards and measures. In this Crosswalk, the term "interventions" is used to describe intervention approaches (e.g., mass media strategies) rather than specific interventions (e.g., one specific media campaign).

The Crosswalk allows you to choose how you search for connections:

  • Start with a PHAB domain, standard, and measure to find a related evidence-based recommendation from The Community Guide
  • Start with a Community Guide topic area that identifies the PHAB measures that relate to each of the evidence-based interventions within that topic

How to Use the Crosswalk

Read the instructions to ensure you are using the Crosswalk in a way that provides adequate documentation for PHAB. The instructions are set up as answers to a list of questions:

The Crosswalk will be updated on a regular basis to ensure it reflects new and updated evidence-based recommendations provided in The Community Guide as well as modifications to PHAB domains, standards, and measures. Please subscribe External Web Site Icon to be notified when new information is posted to The Community Guide website.

What is national public health department accreditation?

National public health department accreditation consists of adoption of a set of standards, a process to measure health department performance against those standards, and recognition for those departments that meet the standards.1 PHAB's accreditation program aims to protect and improve Americans' health by helping public health departments assess their current capacity and continuously improve the quality of their services.1

As described in the PHAB Standards and Measures External Web Site Icon document,2 PHAB requires health departments applying for accreditation to submit documentation as evidence of their activities within 12 domains.

  • The domains address the 10 Essential Public Health Services, plus management and administration, and governance.
  • Each domain is associated with a number of standards.
  • Each standard, in turn, is associated with a number of measures that provide a way to evaluate whether the standard is met.
  • For each measure, information is provided about the documentation required to demonstrate that a health department conforms to the measure.
  • Although most measures are the same for all (A) health departments, some are specific to state (S), local (L), or Tribal (T) health departments.

A complete overview and details about public health accreditation and the standards and measures for each domain can be accessed at www.phaboard.org External Web Site Icon.

What is The Community Guide?

The Community Guide provides evidence-based recommendations about community-based programs, services, and policies (interventions) that are effective in improving health. These recommendations are made by the Community Preventive Services Task Force. Learn more About The Community Guide and Task Force findings.

How can you use The Community Guide?

The Community Guide provides you with menus of options for meeting your public health goals.5

  • Each Community Guide systematic review team identifies the range of preventive programs, services, and policies that can be used to address a health issue or other topic (topics include risk factors; diseases, conditions, and injuries; age groups; and settings).
  • The Task Force approves a priority work order, and the interventions on the list are evaluated in turn.
  • The result is a "menu" of evidence-based programs, services, and policies. From this menu, you can select one or more options that are best suited to your population, setting, preferences, and available resources.

Since the Task Force is mandated to develop recommendations that are useful to a wide range of U.S. decision makers, it must consider variations in the way public health interventions are developed and delivered. As a result, the Task Force evaluates intervention approaches (e.g., mass media strategies) rather than specific interventions (e.g., one specific media campaign). When the Task Force recommends an intervention approach, it is saying that the intervention is effective even if executed in slightly different ways.

Information on the intervention's typical components, settings, and target audiences is provided in a) the definition of the intervention and b) the Task Force Finding and Rationale Statement. The Task Force Finding and Rationale Statement also notes where evidence is lacking. It is therefore absolutely critical that you read not only the title of the intervention, but also the intervention definition and Task Force Finding and Rationale Statement. This is the only way you can ensure that any program, service, or policy you are using or plan to develop is similar enough to what was recommended by the Task Force that you can

  • Expect to see similar results
  • Claim that you are using an evidence-based approach recommended by the Task Force
How can the Crosswalk be helpful in preparing for accreditation?

The Crosswalk shows the connections between evidence-based interventions from The Community Guide and PHAB measures that could result in documentation required to help demonstrate conformity with those PHAB measures.

  • It identifies PHAB measures that require the use of evidence-based or promising practices and that specifically cite The Community Guide as a resource:
    • 5.2.2 S,L,T (Domain 5, Standard 2, Measure 2 for state, local, and Tribal health departments): 'process to develop tribal/state/community health improvement plan'
    • 10.1.1 A (Domain 10, Standard 1, Measure 1 for all health departments): 'Applicable evidence-based and/or promising practices identified and used when implementing new or revised processes, programs, and/or interventions'
  • It shows the large number of other connections between evidence-based interventions from The Community Guide and PHAB measures. Connections exist within most of the PHAB domains.

It is important to keep the following in mind as you consider how the Crosswalk can help you prepare for accreditation.

  • You will not necessarily ensure conformity with a PHAB measure simply by selecting one or two interventions from the Crosswalk with the sole focus of meeting the required PHAB documentation. Instead:
    • Preparing for accreditation should involve identifying the documentation that
      • Best reflects what your health department is actually doing—its capacities, processes, programs, and policies to implement the 10 Essential Public Health Services,2 and
      • Best demonstrates conformity with the PHAB standards and measures.2
  • Many of the PHAB measures are meant to be considered on a departmental level, looking at whether there are processes, protocols, and policies in place across your department that will meet the intent of the measure.2

Pay close attention to the guidance provided in the PHAB Standards and Measures document2 to make sure you select the most appropriate examples for each measure.

  • The Community Preventive Services Task Force is charged with evaluating the effectiveness of the full range of community-based prevention programs, services, and policies that can affect public health outcomes. This includes interventions within the jurisdiction of health departments as well as interventions in areas such as mental health, substance abuse, human services, and social services in which some health departments may participate, but that are typically within the scope of other agencies, organizations, or government departments.

    Although this Crosswalk includes interventions from these areas for completeness, PHAB's scope of accreditation authority does not extend to these areas, and documentation from these areas will not generally be accepted for accreditation purposes. Think carefully, therefore, about which of your activities provide the best examples of public health programs according to PHAB's current guidance (p. 9) External Web Site Icon.1

What does the Crosswalk provide?

This online Crosswalk matches PHAB measures and required documentation with evidence-based interventions from The Community Guide.

Search by PHAB Domain

This tool identifies evidence-based interventions from The Community Guide that can help demonstrate conformity with PHAB measures. Select the PHAB domain, standard, and measure of interest to learn about the required documentation and find related Task Force recommendations.

There are three types of connections through which Task Force recommendations could be relevant to the required documentation for a PHAB measure: (1) direct; (2) indirect; and (3) broad.

  • Direct
    • A direct relationship occurs when
      • The intent of the intervention, its components, and its related Task Force recommendation align with the intent of the PHAB domain, standard, and measure; and
      • The aims or main components of the intervention are mentioned in the purpose and guidance for the PHAB measure.
    • Required documentation for PHAB will be obtained because either
      • It is a typical part of carrying out that intervention, or
      • It provides one illustration of a broader series of required processes or practices being in place at the health department.

      For example, the intervention 'Community mobilization with additional interventions to restrict minors' access to tobacco products' relates directly to PHAB Measure 4.2.1 A: 'Engagement with the community about policies and/or strategies that will promote the public's health.' This is because the intervention requires the community engagement that is the subject of PHAB 4.2.1 A.

  • Indirect:
    • An indirect relationship occurs when an evidence-based intervention from The Community Guide is not fully aligned with a PHAB measure's purpose, but the intent of the PHAB measure may be addressed as part of carrying out the intervention. If this is the case in the way your health department delivers an intervention, then implementing that intervention approach could help you obtain the required PHAB documentation.
      • For example, in addition to having a direct connection with a number of interventions (as described above), PHAB measure 4.2.1 A is also indirectly related to a number of interventions. These include 'Tobacco Use and Secondhand Smoke Exposure: Smoke-Free Policies,' as well as all of the other interventions listed in the Crosswalk alongside PHAB 5.1.3 A: 'Inform governing entities, elected officials, and/or the public of potential intended or unintended public health impacts from current and/or proposed policies.' Although community engagement—the intent of 4.2.1 A—is not a specific aim or main component of the interventions listed for 5.1.3 A, the community would likely be engaged to gain support for the interventions listed for 5.1.3 A.
    • To avoid incorrect assumptions, the Crosswalk only includes indirect connections likely to occur in most health departments. These indirect connections appear below the after direct connections.
    • You might identify other indirect relationships where the intent of a PHAB measure is met in the particular way that you have implemented an intervention from The Community Guide. If you decide to use any of these indirect connections in your PHAB documentation, be sure connections with the PHAB measures are clear and meaningful.
  • Broad:
    • Following are the PHAB measures for which it is recommended you look broadly at all evidence-based interventions from The Community Guide. Implementing any Task Force recommendation may help you obtain the required PHAB documentation.
      • PHAB measure 10.1.1 A : 'Applicable evidence-based and/or promising practices identified and used when implementing new or revised processes, programs and/or interventions' specifically cites The Community Guide as a source for illustrating that the health department is using evidence-based practices.2
      • PHAB measure 5.2.2 S, L, T: 'A process to develop a tribal/state/community health improvement' requires improvement strategies in the health improvement plan to be evidence-based or promising practices and specifically cites The Community Guide as a resource.2
      • For PHAB measure 9.1.3 A: 'Implemented performance management system,' outputs from Community Guide reviews can help you set performance goals, objectives, and measures, and evaluate whether you are meeting your goals. These outputs are available for all evidence-based interventions and include
        • Logic models showing how multiple reviews address a health issue.
        • Analytic frameworks that show how an intervention relate to outcomes.
        • Estimation of the amount of impact (i.e., the size of the effect) you can expect if you implement a Task Force-recommended intervention.
      • For PHAB measure 9.2.1 A: 'Establish a quality improvement program based on organizational policies and direction,' consulting all of the findings in The Community Guide can help you assess whether your current practices are evidence-based, and prioritize and select improvement approaches. Outputs from Community Guide reviews can also help you set goals, objectives, and measures, and monitor your progress. (See list of outputs above for 9.1.3 A.)
Search by Community Guide Topic

This tool lets you search by Community Guide topic area and identify the PHAB measures that relate to each of the interventions within that topic. Select a topic and an intervention approach to find related PHAB domains, standards, and measures along with details about the required documentation.

This tool may help accreditation preparation staff (e.g., Accreditation Coordinator, Accreditation Team)6 engage with program staff who are not as familiar with PHAB domains, standards, and measures.

It can also be helpful in showing how evidence-based interventions you are already doing can help you meet specific PHAB measures.

  • For example, if your health department is already using the Task Force-recommended intervention, 'Cancer Screening: Small Media Targeting Clients – Breast Cancer' (small media include videos and printed materials such as letters, brochures, and newsletters), you may be able to use existing documentation to help meet PHAB measures 3.1.1 A and 3.1.2 A.
What other information from The Community Guide might assist you with accreditation and continuous improvement?

The Crosswalk only includes interventions recommended by the Task Force. Health departments may also benefit from looking at interventions that the Task Force recommended against, and interventions for which there was insufficient evidence for the Task Force to recommend for or against.

  • Interventions the Task Force Recommends Against:
    Knowing about interventions the Task Force recommends against (because they are not effective or cause harms), can help you in at least two ways:
    • If your health department is using, or thinking about using one of these interventions, you might consider implementing another intervention instead for which there is evidence (in The Community Guide or elsewhere) of effectiveness.
    • Knowing about these interventions can also help you not to inadvertently include documentation about ineffective or harmful interventions as support for PHAB measures that require use of evidence-based approaches.
  • Interventions for Which the Task Force Finds Insufficient Evidence to Recommend For or Against:
    Remember that an insufficient evidence finding does not mean that an intervention does not work. Instead, it means that insufficient evidence is currently available to determine whether or not the intervention works. Information on why the Task Force came to this conclusion is provided in the Task Force Finding and Rationale Statement for each review. You might use information about an insufficient evidence finding in a number of ways:
    • If you see that an intervention you are using or thinking about using has an insufficient evidence finding, and the intervention is expensive, resource-intensive, or does not fit well with your other interventions, you might try replacing it with another intervention that has documented evidence of effectiveness. You might also choose to select a different example for your PHAB documentation.
    • If you see that an intervention you are using or thinking about using has an insufficient evidence finding, and if there are no Task Force-recommended intervention options that fit your needs and resources, then you might choose to implement this intervention. You might also decide to feature this example in your PHAB documentation. In all such cases, it will be very important for you to conduct a careful evaluation of whether the intervention is working as you intended.

This website includes a complete list of all Task Force recommendations and other findings.

How can you contribute to building the evidence base for public health?

Sometimes there is not enough consistent, high quality evidence to make a solid recommendation for a particular intervention, but there might be some evidence suggesting that the intervention appears to be effective in at least some situations. Such interventions are sometimes referred to as "promising practices." This may be the case for

  • Some interventions with insufficient evidence findings from the Task Force, where the available studies showed some positive effects, but there were too few studies to determine if the positive effects would be seen consistently across settings and populations. Information on why the Task Force came up with an insufficient evidence finding is included in the Task Force Finding and Rationale Statement.
  • Some interventions that have published findings but whose effectiveness has not yet been evaluated by the Task Force or others.
  • Some common interventions or new innovations whose findings may not yet be published or otherwise available.

PHAB encourages the use of promising practices in the Standards and Measures documentation guidance.1

A promising practice is, by definition, "promising." It may or may not be effective in different situations. If you choose to use a promising practice, it is important that you evaluate it carefully—to determine if it is having its intended effect in your jurisdiction.

Community Guide reviews include both research studies and practice-based evidence (e.g., evaluations of existing programs). The Task Force is particularly interested in knowing which interventions work for different populations and in different settings. If you publish the results of your evaluation in the peer-reviewed literature or in another format that can be used by the Task Force, your evaluation could be included in future Community Guide reviews. In this way, not only will you evaluate the effectiveness of the intervention in your jurisdiction, but your evaluation may contribute to building the overall evidence base for public health.

References

1. Public Health Accreditation Board. Guide to National Public Health Department Accreditation. Version 1.0. May 2011. http://www.phaboard.org/wp-content/uploads/PHAB-Guide-to-National-Public-Health-Department-Accreditation-Version-1.0.pdf External Web Site Icon. Accessed February 12, 2015.

2. Public Health Accreditation Board. Standards and Measures, Version 1.5. December 2015. http://www.phaboard.org/wp-content/uploads/SM-Version-1.5-Board-adopted-FINAL-01-24-2014.docx.pdf External Web Site Icon. Accessed January 22, 2015.

3. Brownson RC, Fielding JE, Maylahn CM. Evidence-based public health: a fundamental concept for public health practice. Annual Review of Public Health. 2009;30:175-201.

4. U.S. Department of Health and Human Services. Introducing Healthy People 2020. 2012. http://healthypeople.gov/2020/about/default.aspx External Web Site Icon. Accessed January 22, 2015.

5. Community Preventive Services Task Force. 2013 Annual Report to Congress and to Agencies Related to the Work of the Task Force. 2013. https://www.thecommunityguide.org/content/2013-annual-report-to-congress. Accessed October 4, 2016.

6. Public Health Accreditation Board. Accreditation Coordinator Handbook, Version 1.0. April 2012. http://www.phaboard.org/wp-content/uploads/PHAB-Accreditation-Coordinator-Handbook-Version-1.0.pdf External Web Site Icon. Accessed February 12, 2015.