STD Program Management Web-Based Course Week 2
Additional handouts will be provided during Live Meeting Sessions
2
Table of Contents
1. Overview of STD Prevention, Control and Program Management, Part 1……………………2
2. Syphilis MMWR Press Cover; 14Feb11..……………………………………………………16
3. NCSD Core Components 2011……………………………………………………………….19
4. Anderson-May Equation Modeling .…………………………………………………………24
5. How Interventions Affect Core Groups & Networks Affect STD Transmission…………….26
6. Overview of STD Prevention, Control and Program Management, Part II……….………....28
7. Performance Measures………………………………………………………………………..47
8. Program Improvement Plan (PIP) Sample…...... ……………………………………………53
9. Costs of STDs..………………………………………………………………………………55
10. Additional Resources for STD Program Management, Leadership, and Administration…...57
DRAFT
STD Program Management
Overview of STD Prevention, Control, and Program Management - Part 1 Prerecorded Module Key Concepts: Public Health/STD Program Essential Functions, Core Components of STD Programs, STD Transmission Dynamics, Targets of STD Interventions
DRAFT Leadership Pyramid Why am I here?
Core Public Health Skills P E STD Specific Content C B R A U P I F Management Skills O A L R C D M Core Leadership Skills I I A T N N Leadership in Y G C Practice E Leadership in Crisis
Best Practice 2 Source: L. Rowitz, Public Health for the 21st Century: The Prepared Leader, 2006
DRAFT
Session Topics and Objectives -1
Participants will be able to: Describe how the essential functions of public health relate to STD prevention & control Describe the federal, state, and local roles in STD prevention & control Discuss the similarities and differences between the CDC and NCSD frameworks for STD Programs List at least 5 factors to consider when prioritizing the STDs a program will address
3
Overview of STD Prevention, Control, and Program Management 2 DRAFT
Session Topics and Objectives - 2
Participants will be able to:
Describe the critical factors in STD transmission
Describe two tools or concepts that can be used to determine the focus/priorities of your program
Explain how levels of prevention, selected interventions, targeted STDs, and priority populations are essential components of STD prevention & control
4
DRAFT
What is Public Health? Handout
One of the efforts of organized society to protect, promote, and restore the people’s health – the population as a whole.
How does the focus of public health practitioners differ from health care providers? 5
DRAFT Core Functions
10 Essential
Services 6
Overview of STD Prevention, Control, and Program Management 3 DRAFT Legal Responsibility for Public Health
Federal Interstate Commerce Defense – National Security
State Primary Responsibility for Public Health
Local Responsibilities Delegated or Permitted by State
7
DRAFT What are Roles of Federal, State a Local Health Departments in STD Prevention?
Federal State Local Funding Policy Development Surveillance
Technical Assure Compliance Disease Assistance, With PH Laws Intervention Training and Surveillance Assure Access Research Funding to Diagnosis Policy and Treatment Technical Development Assistance, Training Assure including and Research Compliance Guidelines With PH Laws Assure Access to Surveillance Diagnosis and Funding (Primarily Treatment Technical National) Disease Assistance, Intervention Training and Research 8
DRAFT Federal, State and Local Government Relationships in STD Prevention
Federal Federal
City City and and County County
State State
CDC Funded City/County Project CDC Funded State Project Areas Areas 9
Overview of STD Prevention, Control, and Program Management 4 DRAFT CDC Comprehensive STD Prevention Systems (CSPS)
CDC grant program to support the coordinated and comprehensive provision of essential program functions to prevent and control STDs within states, communities and special populations.
10
DRAFT
CDC Program Operation Guidelines (POGs)
Purpose – Further STD prevention by providing a resource to assist in the design, implementation, and evaluation of Comprehensive STD Prevention and Control Programs
Framework
8 Essential Services with Related Activities 6 Areas (Populations) of Special Emphasis Extensive Explanations and Tools in Individualized Guidelines
http://www.cdc.gov/std/Program/ 11
DRAFT
CDC Essential Functions 2009-2013
Surveillance Surveillance and Data Management Outbreak Response Plan
Interventions Medical and Laboratory Services Partner Services Community and Individual Level Behavioral Change Services
12
Overview of STD Prevention, Control, and Program Management 5 DRAFT
CDC Essential Functions 2009-13
Evaluation Program Evaluation Performance Measures (PM) Program Improvement Plans (PIP) Evidence-Based Action Plans (EBAP)
Program Support Systems Leadership and Program Management Training and Professional Development
13
DRAFT NCSD Core Components and Strategies for State and Local STD Programs
14
DRAFT NCSD Core Components and Strategies for State and Local STD Programs
Purpose – Provide STD Directors and Managers with action-based STD specific program components and strategies linked to the 3 Public Health Core Functions and 10 Essential Services
Development - NCSD Workgroup developed framework in 2004, ratified by membership and reviewed and updated annually
Framework 25 Core Components 72 Strategies (34 Essential & 38 Optional) 4-Page Grid for Easy Reference and Portability
15
Overview of STD Prevention, Control, and Program Management 6 DRAFT STD Program Core Components and Strategies Format -2011
Essential Public Health Services* Core Components of STD Program Strategies STD Program •Essential/Universal Strategies – Bold •Project-Based Strategies** - Italicized
1. Monitor Health Status to Identify Health Problems • Conduct case surveillance of syphilis, gonorrhea, • Maintain electronic database of reports received from health care provider offices and and chlamydia laboratories • Facilitate computerized transmission of electronic laboratory reporting • Conduct surveillance for LGV and other STDs • Partner with other surveillance programs (i.e. - communicable diseases, HIV, maternal and child health, tuberculosis, and viral hepatitis) to enhance reporting and identify co-morbidities
Handout
• Conduct behavioral surveillance regarding sexual • Support the collection of sexual health behavior information on Youth Risk Behavior health Survey and Behavioral Risk Factor Surveillance System for the purpose of informing prevention efforts • Collect risk-group behavior data through DIS efforts and STD clinic surveys for the purpose of informing prevention efforts
• Generate reports on STD rates • Report STD data on Department of Health website • Publish annual STD report • Periodically distribute data report to stakeholders
2. Diagnose and Investigate Health Problems and Health • Conduct analysis of STD disease trends using • Prepare reports describing STD trends by age, sex, sexual orientation, and race/ethnicity Hazards demographic information • Prepare reports on STD and HIV co-infection rates • Prepare reports describing STD risks and health disparities • Plot STDs using GIS mapping
• Conduct STD prevalence monitoring in high-risk • Establish and support STD screening in family planning clinics, jails, bathhouses, and/or in settings and/or communities other high-risk settings 16
DRAFT Example: NCSD Core Component and Program Strategy – EPHS 7*
Ensure Availability and Access to Adequate STD Clinical Services for People at Risk for STDs Assess STD clinics by analyzing wait times, accessibility and other barriers. (Essential) Annually, conduct STD clinic patient satisfaction surveys. (Optional)
Provide or actively refer STD clinic clients for family planning, HIV services. (Optional)
* EPHS = Essential Public Health Service # 7- Link People to Needed Health Services and Assure Provision of Health Care When Otherwise Unavailable 17
DRAFT Example: NCSD Core Component and Program Strategies – EPHS 7*
Maintain and Support STD Screening Programs in High-Risk Settings Based on Assessment of Local Prevalence Trends Assure routine STD screening in family planning clinics, correctional facilities, and youth detention centers. (Essential)
Support STD screening in adolescent and HIV testing and treatment sites. (Optional)
Support STD treatment at primary health care sites where appropriate. (Optional)
* EPHS = Essential Public Health Service # 7- Link People to Needed Health Services and Assure Provision of Health Care When Otherwise Unavailable 18
Overview of STD Prevention, Control, and Program Management 7 DRAFT
Which STDs to Prevent and Control?
19
DRAFT Factors Influencing STD Transmission
Host/Susceptible
Agent Environment
20
DRAFT
Factors Affecting STD Transmission
Agent Host Environment Genetic Vaginal PH Sexual Behaviors Antibiotic Susceptibility Other STDs Substance Abuse and Resistance Cervical Health Behaviors Virulence Ectopy Socioeconomic Infectiousness Cervical Mucus Sociobehavioral Prevalence Menses Sociodemographic HIV Infection Political Pregnancy Technologic Anatomic Site Epidemiologic of Exposure 21
Overview of STD Prevention, Control, and Program Management 8 DRAFT
Sexually Transmitted Pathogens-1
Transmitted in Adults Predominantly By Sexual Intercourse
Bacteria Viruses Other*
Neisseria gonorrhoeae HIV-1 and HIV-2 Trichomonas vaginalis Chlamydia trachomatis HTLV-1 Phithirus pubis
Treponema pallidum Herpes simplex virus type 2 Calymmatobacterium Human papillomavirus granulomatis
Ureaplasma urealyticim Hepatitis B virus
Cytomegalovirus
Molluscum contagiousum virus
* Includes protozoa, ectoparasites, and fungi 22 Source: Control of STDs: A Handbook for the Design and Management of Programs: FHI
DRAFT
Sexually Transmitted Pathogens-2
Transmitted Sexually But Not Well Defined or Not Predominant Mode
Bacteria Viruses Other*
Mycoplasma hominis HTLV-II Candida albicans
Gardnerella vaginalis ? Hepatitis C virus Sarcoptes scabiei and other vaginal bacteria Group B Herpes Simplex virus type 1 streptocococcus Human herpes virus type 8 Kaposi's sarcoma, Epstein Bar
Transmitted By Sexual Contact Involving Oral-Fecal Exposure
Shigella spp. Hepatitis A Giardia lamblia
Campylobacter spp. Entamoeba histolytica 23 * Includes protozoa, ectoparasites, and fungi
DRAFT Factors to Consider When Determining What STDs to Prevent and Control
Frequency
Severity
Cost
Identifiability
Preventability
Communicability
Public Interest
24
Overview of STD Prevention, Control, and Program Management 9 DRAFT
STD Transmission Dynamics
25
DRAFT Transmission Characteristics That Distinguish STDs from Other Infectious Diseases - 1
Populations at risk are a fraction of the total population rather than entire population.
The intensity of transmission is related to the distribution of sexual activities that facilitate transmission rather than the population density.
Carrier phenomenon where persons are often asymptomatic for long periods of time is important in determining net rate of transmission.
Source: Anderson. STDs, Holmes et. al., 3rd Ed. 26
DRAFT Characteristics That Distinguish STDs from Other Infectious Diseases - 2
Many STDs induce little or no acquired immunity resulting in susceptibility to re-infection.
Great variability in the course of infection, between first infection and the diagnosis of symptomatic disease.
Patterns of STD infections in communities are characterized by great heterogeneity in transmission rates within and between different populations.
27
Overview of STD Prevention, Control, and Program Management 10 DRAFT
Who’s at risk for Acquiring/Transmitting STDs?
Persons who are:
Ready to be sexually active (teens)
Uninfected but susceptible to infection because of their behaviors or exposures
Infected but not yet infectious to their sexual partners
Infected and infectious to their sexual partners
28
DRAFT Anderson–May Equation: Handout Foundation of STD Prevention & Control
R0=ß x D x c
R0 Reproductive rate of infection -average number of secondary cases generated in a population by a primary case ß Transmission efficiency -average probability of transmission per sexual contact D Duration of infection – differs by STD c Number of sexual partners per unit time – varies by sexual network
Reference: Transmission dynamics of sexually transmitted infections. Roy M. Anderson. Chapter 3. Sexually Transmitted Diseases: Editors, Holmes, K.K., Sparling, P.K., et. al. 3rd Edition, 1999:McGraw-Hill 29
DRAFT Interventions that Reduce or Prevent STD Transmission
Disease interventions should reduce or prevent transmission efficiency, duration of infection, and/or # of sexual partners.
R0=ß D c
Sexual decision-making, abstinence, monogamy Screening, timely diagnosis & effective treatment, partner care Condoms, microbicides, minimize exposure 30
Overview of STD Prevention, Control, and Program Management 11 DRAFT What are Core Groups and Their Role in STD Transmission?
31 Source: WHO Global Strategy for the Prevention and Control of STDs: 2006 - 2015
DRAFT What are Sexual Networks and Their Role in STD Transmission?
32 Source: Bearman PS, et.al. American Journal of Sociology, July 2004, Vol. 110, No. 1
DRAFT What are sexual networks and their role in STD Transmission?
Time
A B
A C
Infected Partner
Serial Monogamy - after A is exposed to infected partner D, the next partners E and F are potentially infected. 33
Overview of STD Prevention, Control, and Program Management 12 DRAFT What are sexual networks and their role in STD Transmission?
Infected Partner
Concurrency - given the same time period, after A is exposed to infected partner D, all four other partners (B, C, F and E) are potentially infected. Concurrency facilitates more transmission than serial monogamy. 34
DRAFT Levels and Targets of Intervention
35
DRAFT What are the Three Levels of Prevention/Intervention in Public Health?
Primary Prevention: Activities conducted prior to STD exposure to prevent transmission. Upstream
Secondary Prevention: Activities conducted to enable early detection and treatment of an STD to prevent complications. Midstream
Tertiary Prevention: Activities conducted to treat and reduce the severity of complications. Downstream
36
Overview of STD Prevention, Control, and Program Management 13 DRAFT
Targets of STD Interventions
Individuals and Partnerships Behavioral change, condom use
Families & Communities Schools, community-based organizations Social marketing Structures Healthcare systems Educational systems Mass media Social and physical environment Public policy
37 Heidi M Bauer, MD MS MPH, STD Control Branch, CA Department of Public Health
DRAFT What Intervention Questions Should You Ask?
Why – What’s The Need, What’s the Data Indicate?
Who – General Population or Which Target Group? What – What Intervention, What Disease? When – Change the Intervention at What Stage of the Epidemic? Where – What Community and Venue for Which Disease? How – Collaborations, Staffing, Resources, Protocols, Political Support, Evaluation?
38
DRAFT Sample Question: Which population should be targeted and why?
High Infected High Priority persons with Cost per high risk Person behaviors
Infected persons with low risk behaviors
Uninfected persons with high risk behaviors
Uninfected persons with low risk behaviors Low Cost Per Low Person 39 Priority Source: Adapted, Sevgi Aral, CDC, DSTDP 2008
Overview of STD Prevention, Control, and Program Management 14 DRAFT How Interventions, Core Groups and Handout Networks Affect STD Transmission – G1
Indicate the Anderson May Variable for Each STD Prevention Activity Below and if the Intervention Would be Effective in Core Groups and Sexual Networks
Program Activity B D c CG SN
Distribute Condoms to Sex Workers
Provide Treatment for GC Positive Test
Conduct Sex Partner Referral
Promote Use of Oral Contraceptives
Anderson – May Variable Core Groups and Networks ß = Transmission efficiency CG = Core Group D = Duration of infection SN = Sexual Network c = Number of sexual partners per unit time 40
DRAFT STD Prevention, Control and Management Overview Module: Key Take Home Messages
Be able to use common public health concepts when explaining your program priorities, activities and operations. IOM Core Functions – CDC Essential Elements – NCSD Core Components – 3 Levels of Prevention Be knowledgeable about the relationship between STD transmission dynamics and STD program interventions. Anderson-May – Core Groups – Sexual Networks - Concurrency
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Overview of STD Prevention, Control, and Program Management 15
February 14, 2011
Dear STD Program Directors and Managers,
Recent press coverage of the CDC MMWR from the Associated Press and other major media organizations has focused on the fact that approximately 18% of positive results from the newer syphilis antibody test (EIA/CIA) were not verified when they were retested with older syphilis tests (RPR, TP-PA). The coverage asserted that as a result of these positive results patients may have been falsely diagnosed and “may have been given unnecessary treatment.”
There are two problems with this assertion. First, the current report does not document whether or not treatment was provided. Second, in those cases where treatment was provided, it may have been justified based on sexual risk and findings on clinical evaluation. The MMWR analysis, while important, does not allow us to conclude that the newer tests led to inaccurate syphilis diagnoses or inappropriate treatment.
Key messages for syphilis control efforts remain the same: 1. Patients at high risk should continue to be tested at regular intervals 2. Medical providers should conduct comprehensive sexual risk assessments and clinical evaluations in order to diagnose and treat syphilis correctly. The CDC recently published its 2010 treatment guidelines which include comprehensive information regarding management of all STDs, including syphilis. It is available at www.cdc.gov/std/treatment/2010.
In addition, we have created a question and answer document to address some other anticipated programmatic questions you may have.
1) Question: Should DIS follow-up on any of the EIA pos/RPR neg/TP-PA neg?
Answer: No because disease intervention follow-up should focus on cases likely to be actively contributing to transmission of syphilis in a community. An EIA pos/RPR neg/TP-PA neg result is not likely a case of infectious syphilis contributing to further transmission. If clinicians ask, they should be told that high-risk patients with these test results should have repeat serologic testing in several weeks to ensure that they had not recently acquired syphilis. Also, clinicians should ask these patients about symptoms to rule out primary syphilis at the time of the initial test where the RPR test was not yet reactive.
16
2) Question: Should DIS follow-up on any of the EIA pos/RPR neg/TP-PA pos?
Answer: No. An EIA pos/RPR neg/TP-PA pos result is either a previously treated case or a patient with latent syphilis of unknown duration. Because latent syphilis is generally not infectious, DIS follow-up is not recommended.
3) Question: What and how do states report these cases and serologic results to CDC via NETSS (National Electronic Telecommunications System for Surveillance), other systems, in STD*MIS, and state reactor registries?
Answer: Serologic test results for persons who do not meet the surveillance case definition should not be sent to CDC since they are not related to a reportable case. According to the CDC/CSTE case definition, a reportable case of latent syphilis must have a reactive treponemal result and a reactive non-treponemal result. So, an EIApos/RPR neg−/TP-PA pos would not be a reportable case of latent syphilis. Secondary syphilis requires a (non-treponemal) titer of ≥ 4 and concurrent secondary symptoms. Only primary syphilis allows for a reactive treponemal test or a reactive non-treponemal test (along with clinically compatible lesions). For adult cases of syphilis, only non-treponemal results, including titers, should be reported to CDC as part of the morbidity report. For cases of congenital syphilis, serologic test results should be reported for mothers and babies.
4) Question: If we just have an EIA result should we spend time tracking down the RPR and (if neg) the TP-PA results or should we wait for these results and if so how long and what do we do if we don’t get them?
Answer: The issue of actively following EIA positives whose RPRs have not been reported is a local programmatic issue. An accompanying reactive RPR should be reported by the laboratory but a nonreactive RPR may not be. Efforts to follow-up on EIA positives should depend on the local epidemiology and circumstances of the individual patients as well as program resources. Given the severe resource challenges that most STD programs are facing, in general, efforts should not be spent finding RPR results if an isolated EIA positive test result is received. Efforts should focus on the reactive RPRs titers reported for surveillance purposes and DIS action according to local procedures tailored to local epidemiology.
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17 Additional program questions can be directed to Kevin O’Connor at 404 639-8193 and surveillance questions to Hillard Weinstock at 404-639-2059
Best Regards,
Gail
Gail Bolan, M.D. Director Division of STD Prevention
3
18 STD Program Core Components and Strategies - 2011
Essential Public Health Services* Core Components of STD Program Strategies STD Program • Essential/Universal Strategies – Bold • Project-Based Strategies** - Italicized
1. Monitor Health Status to Identify • Conduct case surveillance of • Maintain electronic database of reports received from health Health Problems syphilis, gonorrhea, and chlamydia care provider offices and laboratories • Facilitate standardized computerized transmission of electronic laboratory reporting • Utilize Quality Assurance strategies for surveillance • Conduct surveillance for LGV and other STDs • Partner with other surveillance programs (i.e. - communicable diseases, HIV, maternal and child health, tuberculosis, and viral hepatitis) to enhance reporting and identify co-morbidities • Conduct behavioral surveillance • Support the collection of sexual health behavior information regarding sexual health on Youth Risk Behavior Survey and Behavioral Risk Factor Surveillance System for the purpose of informing prevention efforts • Collect risk-group behavior data through DIS efforts and STD clinic surveys for the purpose of informing prevention efforts • Generate reports on STD rates • Report STD data on Department of Health website • Publish annual STD report • Periodically distribute data report to stakeholders 2. Diagnose and Investigate Health • Conduct analysis of STD disease • Prepare reports describing STD trends by age, sex, sexual Problems and Health Hazards trends using demographic orientation, and race/ethnicity information • Prepare reports on HIV co-infection rates with other reportable STD’s. • Prepare reports describing STD risks and health disparities • Use GIS tools to describe disease impact • Conduct STD prevalence monitoring • Establish and promote STD screening in family planning clinics, in high-risk settings and/or jails, bathhouses, and/or in other high-risk settings communities • Conduct disease intervention services • Develop and implement follow-up criteria for persons with positive STD laboratory results • Ensure untreated cases of reported gonorrhea, chlamydia, and syphilis receive treatment
19 • Ensure partner notification services are offered for cases of early syphilis • Provide DIS services to at-risk/infected pregnant women as determined by the project area • Incorporate modern technologies into DIS services as directed by data from DIS interviews • Conduct outbreak investigations • Implement Outbreak Response Plan, including health alerts and when appropriate case investigation, when detection systems indicate disease rates are above background levels • Partner with public and private • Assure the availability of laboratory testing for STD services laboratories offering STD testing • Assure testing for GC resistance is available. 3. Inform, Educate, and Empower People • Create and maintain a Department of • Provide list of public-funded clinics where STD services are about Health Issues Health STD web site available • Provide information on disease prevention, symptoms, and treatment • Provide information on condom availability • Promote STD educational materials • Promote and provide medically accurate, culturally sensitive STD materials to STD clinics, the general public, and CBOs • Develop, promote and/or disseminate effective behavioral and community strategies • Participate in expert and community review panels of STD materials • Provide training and technical support for outreach education efforts 4. Mobilize Partnerships to Identify and • Collaborate with public and private • Actively participate as a member in planning groups Solve Health Problems key stakeholders addressing STI Prevention, HIV prevention, infertility prevention, unintended pregnancy, comprehensive adolescent health, viral hepatitis prevention and other related projects. • Collaborate with other key stakeholders such as corrections, substance abuse, schools, HMOs, Medicaid, laboratories, medical professional associations, advocacy groups through coalitions, planning groups, and other associations. • Establish internal and external Department of Health collaborations with colleagues such as HIV/AIDS, Hepatitis, Immunization, Communicable Disease, public health labs, Department of Correction, Department of Education, and Department of Social Services • Actively participate as a member of associations such as NCSD and state and national public health associations. • Establish a comprehensive STD • Prepare a written outbreak response plan and review the plan Outbreak Response Plan annually • Identify health department and other public and private partners to assist in outbreak response efforts
20 5. Develop Policies and Plans that Support • Establish STD legislative agenda • Conduct review of state statutes/ administrative rules regarding Individual and Statewide Health Efforts the management of STDs • Propose/support legislation for Expedited Partner Therapy (EPT) and promotion and funding for STD- related vaccines. • Develop and support legislation to support STD prevention initiatives for at-risk and special populations (e.g. – juveniles, sex venues, homeless persons/runaways) • Develop and include STD objectives • Include STD objectives in Healthy People 2020 State Reports in statewide planning documents • Recommend STD objectives in state, regional, and local HIV Prevention Plans • Recommend STD objectives in health department or project area planning initiatives (e.g. - adolescent health, reducing racial disparities, women’s health) 6. Enforce Laws and Regulations that • Conduct enforcement of STD • Request morbidity reports from health care providers for Protect Health and Ensure Safety (communicable disease) reporting “unmatched” laboratory reports and ensure that positive regulations chlamydia and gonorrhea laboratory tests are counted and reported as morbidity • Seek enforcement of legal violations such as provider refusal to provide information needed to conduct investigations of known positives. • Send annual mailing of STD reporting regulations and project area and community-specific incidence/ prevalence data to prioritized health care providers and/or newly licensed health care providers • Assure laboratory STD reporting • On annual basis, review, assess and assure timely and complete reporting of laboratory results • Establish and distribute public health • Implement prenatal and delivery syphilis screening statutes and administrative rules to regulations promote testing, treatment, • Implement testing and treatment of minors regulations counseling and partner notification of • Implement confidentiality regulations infected persons and their sex • Participate in the development of regulations governing the partners reporting of STDs, HIV, and AIDS 7. Link People to Needed Personal Health • Maintain and support STD screening • Assure routine STD screening in family planning clinics. Services and Assure the Provision of programs in high-risk settings based • Promote STD screening in correctional facilities and youth Health Care when Otherwise Unavailable on assessment of local prevalence detention centers trends • Promote re-screening among individuals after having been effectively treated for Chlamydia • Promote STD screening and referral for sexual health services in adolescent sites, schools, HIV testing venues and primary health care sites when appropriate • Promote the use of EPT to the medical community. • Assure appropriate medical treatment is utilized, if resistant Gonorrhea is suspected
21 • Ensure availability and access to • Assess performance of publicly supported STD clinics through adequate STD clinical services for analysis of wait times, geographic accessibility, and other people at risk for STDs barriers (i.e. costs) • On an annual basis, conduct surveys of patient satisfaction of STD clinic services for quality improvement • Provide and/or actively refer STD clinic clients to reproductive health, family planning, HIV services, and for needed immunizations including HPV and hepatitis B. 8. Assure Competent Public and Personal • Support STD training opportunities • Promote courses offered by regional Prevention Training Care Workforce and distribute STD clinical Centers educational materials to health care • Distribute STD Treatment Guidelines to health care providers providers who report STD conditions (including HIV) and to those health care providers (based on their patient populations) for whom STD screening is an appropriate activity • Provide continuing STD educational opportunities through conferences and workshops • Incorporate STD training/education in academic curriculum of medical schools, nursing schools, social work, residency programs, public health etc. • Meet annually with established labs and providers and as needed with new labs and providers to educate regarding reporting regulations and how to report. • Establish resident STD clinic rotation programs with local medical schools and advanced nursing programs • Assist in medical school STD curriculum development • Maintain adequate workforce to • Conduct regular needs assessment to determine minimum address programmatic needs staffing and educational needs for STD program core components • Advocate for adequate resources for STD program core components • Use surveillance data to allocate STD workforce in support of STD program core components 9. Evaluate Effectiveness, Accessibility, • Measure health care provider • Measure compliance with treatment guidelines on morbidity and Quality of Personal and Population- compliance with STD Treatment reports Based Health Services Guidelines • Document HEDIS measures for managed care organizations • Educate health care providers who report incorrect treatment on case reports through the distribution of treatment guidelines • Evaluate services at STD clinics to determine compliance with STD treatment guidelines or other set criteria 10. Research New Insights and Innovative • Support, participate, and/or conduct • Identify state, local, and national resources to assist in initiatives Solutions to Health Problems activities related to insights and related to insights and solutions to STD prevention concerns solutions to STD prevention • Obtain STD information regarding • Evaluate application of successful/model STD prevention current successful/model programs programs within Project Area
22 for STD prevention • Understand trends in the • Provide updates on STD advancements to stakeholders technological and laboratory • Attend STD conferences advancements in the field of STDs • Subscribe to STD and other public health journals *Public Health Service, Essential Public Health Services Work Group, 1994 ** These are recommended strategies that should be adopted at the discretion of the STD Project Area Director
23 Anderson-May Equation and Mathematical Modeling Overview of STD Prevention, Control, and Program Management
An STD will continue to spread/reproduce among sexually active persons in a community if the average probability of transmission per sex partner contact (times) the average duration of infection (times) the average number of sex partners per unit of time is greater than one.
Ro =(ß x D x c) Where: Ro - Average number of secondary cases generated in a population by a primary case ß - Average probability of transmission per sexual contact D – Average Duration of infection c - Average number of sexual partners per unit time
Diseases spread at different rates. When there is no prevention/intervention occurring in a population, sex partner change rate has the greatest influence in disease transmission.
Ro = average # of secondary cases generated from a new infection. Ro equals the net rate at which transmission occurs within a defined population. If Ro >1, then disease continues to spread
ß = average probability of transmission per sexual contact GC = 50%, CT= 20%, Syphilis = 60%, HIV = 5%
D = Average duration of infectiousness of an infected person in years GC = .5 yrs., CT = 1.0 years; Syphilis. = 0.6 years, HIV = 8-12 years c = average rate of exposure of susceptible-to-infected in a population
Continued…
Overview of STD Prevention, Control, and Management 24 Anderson-May Equation and Mathematical Modeling Overview of STD Prevention, Control, and Program Management How many sex partners (sp) does it take for different STDs to continue to spread if no prevention is occurring? For Slide # 30
If Ro =(ß x D x c) Then c = Ro / ( ß x D) = # sex partners needed to sustain transmission in a population
Gonorrhea: Ro = 1.0, ß =0.5, D=0.5 yrs; and c =? C= 4 =1.0 / ( 0.5 x 0.5) Four sex partners needed to sustain GC transmission
Chlamydia: Ro = 1.0, ß =0.2, D=1.0 yrs; and c =? C= 5 = 1.0 / ( 0.2 x 1.0) Five sex partners needed to sustain Chlamydia transmission
HIV: Ro = 1.0, ß =0.05, D=10 yrs; and c =? C= 2= 1.0 / ( 0.05 x 10) Two sex partners needed to sustain HIV transmission
Syphilis: Ro = 1.0, ß =0.6, D=0.6 yrs; and c =? C~ 3~ 1.0 / ( 0.6 x 0.6) Three sex partners needed to sustain syphilis transmission
Resource: Transmission dynamics of sexually transmitted infections. Roy M. Anderson. Chapter 3. Sexually Transmitted Diseases: Editors, Holmes, K.K., Sparling, P.K., et. al. 3rd Edition, 1999:McGraw-Hill
Overview of STD Prevention, Control, and Management 25 DRAFT How Interventions, Core Groups and Networks Affect STD Transmission – G1
Indicate the Anderson May Variable for Each STD Prevention Activity Below and if the Intervention Would be Effective in Core Groups and Sexual Networks
Program Activity B D c CG SN
Distribute Condoms to Sex Workers
Provide Treatment for GC Positive Test
Conduct Sex Partner Referral
Promote Use of Oral Contraceptives
Anderson – May Variable Core Groups and Networks ß= Transmission efficiency CG = Core Group D = Duration of infection SN = Sexual Network c = Number of sexual partners per unit time 1
DRAFT How Interventions, Core Groups and Networks Affect STD Transmission – G2
Indicate the Anderson May Variable for Each STD Prevention Activity Below and if the Intervention Would be Effective in Core Groups and Sexual Networks
Program Activity B D c CG SN
Screen Detainees in Juvenile Detention
Conduct EBIs with high-risk adolescents
Provide Hepatitis B Vaccine in STD Clinics
Conduct Substance Abuse Programs
Anderson – May Variable Core Groups and Networks ß= Transmission efficiency CG = Core Group D = Duration of infection SN = Sexual Network c = Number of sexual partners per unit time 2
Overview of STD Prevention, Control, and Program Management 26 DRAFT Levels and Targets of STD Interventions – G3
Indicate the level of prevention for each STD prevention activity below and what is the target of intervention.
Program Activity P S T I F S
Distribute clean needles to IDUs
Produce and air safer sex radio commercials
Discordant Sex Partner Takes Daily Acyclovir
Provide Treatment for Neurosyphilis
Level of Prevention P = Primary Target of Intervention S = Secondary I = Individuals T = Tertiary F = Family S = Structures 3
DRAFT Levels and Targets of STD Interventions – G4
Indicate the level of prevention for each STD prevention activity below and what is the target of intervention.
Program Activity P S T I F S
Conduct CT Screening at Team Sports Physical
Promote Sexual Abstinence and Monogamy
Provide Emergency Contraception in STD Clinic
Pass Expedited Partner Therapy Law
Level of Prevention Target of Intervention P = Primary I = Individuals S = Secondary F = Family T = Tertiary S = Structures 4
Overview of STD Prevention, Control, and Program Management 27 DRAFT
STD Program Management
Overview of STD Prevention, Control, and Program Management - Part 2 Prerecorded Module Key Concepts: Management and Leadership, Resource Allocation & Staffing, Program Planning, Evaluation, Advocacy
DRAFT Leadership Pyramid Why am I here?
Core Public Health Skills P E STD Specific Content C B R A U P I F Management Skills O A L R C D M Core Leadership Skills I I A T N N Leadership in Y G C Practice E Leadership in Crisis
Best Practice 2 Source: L. Rowitz, Public Health for the 21st Century: The Prepared Leader, 2006
DRAFT
Session Topics and Objectives -1 Participants will be able to: Discuss at least three distinctions between the key elements of management and leadership.
List five Key Skills for STD Program Managers. List “Essential” and “Important” Activities for STD Programs, explain you ranking of each, and the importance of budget prioritization. Identify Key STD Program staff roles & functions
Describe how Program Collaboration and Service Integration (PCSI) increases public health impact and available resources. 3
Overview of STD Prevention, Control, and Program Management 28 DRAFT
Session Topics and Objectives - 2 Participants will be able to: List at least 5 reasons for funding your STD program Explain how STD-related data can be used to advocate for your STD program
Discuss how evaluation can improve the effectiveness of STD programs & services
Discuss three evaluation tools the assist program managers in monitoring and improving their program’s services & activities.
Develop a Professional Self Development Plan
4
DRAFT Administration, Management, Leadership
Administration
Management
Leadership
5
DRAFT Key Roles for STD Program Directors
Administration Conducting a common set of functions to meet the organization's goals. Management Organizing people, projects and systems to maintain order and control and achieve agency mission. Leadership Mobilizing others to want to struggle for shared aspirations and alter the status quo.
6
Overview of STD Prevention, Control, and Program Management 29 DRAFT Core Elements of STD Administration
Personnel (Recruiting, Training, Evaluation, Development)
Reporting (Agency, State/local, Community and CDC) Data Collection/Analysis (incidence, prevalence, outcomes)
Accounting (fiscal and programmatic) Logistics (space, technology, infrastructure, etc.)
Organizing (people, projects, systems) Quality Assurance (organizational/staff performance) Communication (staff & management meetings, written)
Compliance for all of above
7
DRAFT Core Elements of STD Management
Planning & Budgeting Building Capacity (staff, Evaluating resource, organization development) Communicating Collaborating Advocating Networking Managing Change Developing partnerships Making Decisions (internal & external) Solving Problems Grant and Report Writing Managing Projects Managing Time Managing Diversity Managing Conflict
8
DRAFT Core Elements of STD Leadership
Strategic analysis Facilitating (group-based Setting direction problem-solving and decision- making, running meetings, etc.) Achieving organizational performance (influencing People Skills: others to follow direction) Interpersonal Communication Communicating (written & oral) Counseling Training Instituting organizational change Coaching Managing conflict Mentoring Maintaining mission Networking skills awareness Community involvement
9
Overview of STD Prevention, Control, and Program Management 30 DRAFT Comparison of Characteristics and Responsibilities of Managers and Leaders
The Manager The Leader Administers Innovates Maintains Develops Focuses on systems and Focuses on people structures Relies on control Inspires trust Has short-range view Has long-range view Asks how and when Asks what and why Eye on bottom line Eye on horizon Imitates Originates Accepts the status quo Challenges the status quo Linear thinker System thinker
Does things right Does the right thing 10 Source: Public Health Leadership: Putting Principles into Practice. 2nd Edition, 2009
DRAFT Key Skills: STD Program Managers and Directors
Management and Leadership
Resource Allocation
Program Planning
Evaluation
Advocacy
11
DRAFT Resource Allocation: Ranking STD Program Activities Conducted at the State & Local Level
Essential Every program must conduct these activities regardless of size or funding
Important* Most if not all programs should conduct some level of these activities
Desirable* Programs should conduct these activities if the need exists and resources and staff are available
12 * Depends on amount of available resources and staff
Overview of STD Prevention, Control, and Program Management 31 DRAFT
Resource Allocation Exercise
Thinking about the state or local STD Program in which you work or are most familiar with, list key activities that are conducted under the headings of “Required, Important and Desirable”. Be prepared to justify your rankings.
13
DRAFT
Resource Allocation: Essential Activities
Surveillance and Evaluation Lab and Health Care Provider Reporting Incidence and Prevalence Monitoring Co-morbidity with HIV and other CDs Outcomes of Program Activities Dissemination of Data to Stakeholders
Counseling Infected Persons and Conducting Sex Partner Notification and Referral Services
Outbreak Identification and Response
Policy Development and Assurance
14
DRAFT
Resource Allocation: Important Activities*
Assuring STD and HIV Screening and Linkage to Care Services in the Public Sector
Providing or Assuring Timely, Accessible and Affordable STD Diagnostic Testing, Treatment and Partner Services in the Private Sector
Providing Training and Technical Assistance
Health Education (Health Communication and Behavioral Interventions) including provision of condoms and educational materials
Consulting and Collaborating with Stakeholders
15
Overview of STD Prevention, Control, and Program Management 32 DRAFT Resource Allocation: Desirable Activities*
Encouraging Screening in Private Sector
Supporting Timely and High Quality Diagnostic Testing and Treatment in Private Sector
Conducting or Participating in Research
* If resources and staff are available 16
DRAFT Resource Allocation: STD Program Staffing
17 STD Leader Who Made The Cover of Time Magazine
DRAFT Ideally, What Key Program Roles or Staff Should STD Programs Have?* -1
Program Director
Surveillance Coordinator (Epidemiologist**) Screening & Testing Coordinator Counseling & Partner Services Coordinator
Evaluation Coordinator** Information Systems Coordinator**
*Staff may have to perform multiple roles depending on program size and available resources. **May not be feasible for project areas with small budgets or lack of program-specific federal, state or local funding. 18
Overview of STD Prevention, Control, and Program Management 33 DRAFT Ideally, What Key Program Roles or Staff Should STD Programs Have?* -2
Disease Intervention Specialists (DIS) and Supervisors Administrative and Data Entry Staff Medical Director, Clinic Operations Coordinator and Clinic Support Staff (If program is responsible for STD clinics)** Outbreak Coordinator**
*Staff may have to perform multiple roles depending on program size and available resources. **May not be feasible for project areas with small budgets
or lack of program-specific federal, state or local funding. 19
DRAFT Ideally, What Key Program Roles or Staff Should STD Programs Have?* -3
Health Education Coordinator** Program Operations Manager** Syphilis Elimination** and Infertility Prevention Project Coordinators Program Collaboration and Service Integration and Viral Hepatitis Prevention Coordinator(s)** Research Coordinator**
*Staff may have to perform multiple roles depending on program size and available resources.
**May not be feasible for project areas with small budgets or lack of program-specific federal, state or local funding. 20
DRAFT Resource Allocation: Program Collaboration and Service Integration (PCSI) What Is It? A mechanism of organizing and blending inter-related health issues, separate activities, and services in order to maximize public health impact through new and established linkages between programs to facilitate the delivery of services Why Do It? To provide prevention services that are holistic, science based, comprehensive, and high quality to appropriate populations at every interaction with the health care system.
21
Overview of STD Prevention, Control, and Program Management 34 DRAFT Improving Systems and Services Through PCSI
HIV
STD TB Health PCSI Protection
Hepatitis Other
Independent Specialist Services Integrated and Holistic Limited Connectivity Increased Connectivity Program Centered Client Focused 22 Unleveraged Leveraged
DRAFT Program Planning Steps:
Documenting the Problem Surveillance Data (Epi and Behavioral) Community Assessments & Input Developing Objectives Process Outcome Planning Evaluation Developing Interventions Disease Intervention Health Communication & Behavioral Interventions Budgeting
23
DRAFT
Logic Models: A Program Planning Tool
A Diagram depicting interrelationships between
goal - longer term public health outcomes
objectives - shorter term intervention impacts priority populations
action strategies Also called
Analytic framework
Causal frameworks
http://www.cdc.gov/std/Program/ 24
Overview of STD Prevention, Control, and Program Management 35 DRAFT Example of Logic Model for Reducing STDs Among Teens
Problem Activities Outcome Impact Objectives of Ï Screening Interest Ï # Teens EPT Getting High Clinic-based Treated Rates of RX Reduced Teen Social Rates of STDs Marketing Ï condom Teen STDs use by Advocacy Teens with School Boards EBIs in schools Ï Teen & CBOs Sexual Abstinence
http://www.cdc.gov/eval/resources.htm
DRAFT
S.M.A.R.T. Objectives
Specific (concrete, detailed, well-defined) Measurable (numbers, quantity, comparison) Achievable (feasible, actionable) Relevant (realistic resources & time frame) Time-Bound (timed, timely, in a defined time line)
By ______will ______by______. When? Who? Where? Do what? How much?
Effective (Achieving the objective leads to the desired result) http://www.thepracticeofleadership.net/2006/03/11/setting-smart-objectives/ 26
DRAFT What is Program Evaluation?
“…the systematic collection of information about the activities, characteristics, and outcomes of programs to make judgments about the program effectiveness, and/or inform decisions about future development.” Michael Quinn Patton - Utilization Focused Evaluation, 1997
27
Overview of STD Prevention, Control, and Program Management 36 DRAFT CDC’s Evaluation Framework
Steps 1 Engage Stakeholders 6 2 Ensure use Describe and share Standards the program lessons learned Utility Feasibility Propriety 5 Accuracy 3 Focus the Justify evaluation conclusions design 4 Gather credible evidence
Source: Centers for Disease Control and Prevention. Framework for Program Evaluation in Public Health. MMWR1999; 48 (No. RR-11).
DRAFT
STD Evaluation Resource
Division of STD Prevention http://www.cdc.gov/std/Program/
Narrative Description of Process Step-by-step Instructions STD Examples Case Studies Exercises with Answer Key
29
DRAFT Some Types of Evaluation
Formative – pilot or field testing something new Process – determines if staff implements program activities and output as planned Outcome – determines if an intervention achieved the planned/desired results with the targeted population Program – determines effectiveness and efficiency of program activities and outcomes and informs decisions about needed adjustments as well as future development Research – strict methodology and control to
determine causal relationships between variables30 and interventions
Overview of STD Prevention, Control, and Program Management 37 DRAFT
Applied Evaluation Methods
Monitoring Programs Assuring Quality of Programs Performance Measures (PMs) Program Improvement Plans (PIPs) Evidence-Based Action Plans (EBAPs)
31
DRAFT
CSPS Performance Measures* Handout
Organized into 3 Categories Medical and Laboratory Services Partner Services Surveillance & Data Management
Each Grantee Must Capture complete, accurate data Utilize quality assurance mechanisms Use PM data to inform program planning, implementation, evaluation and improvement.
http://www.cdc.gov/std/Program/ 32
DRAFT Example of 2011 Lab and Medical Services Performance Measures*
CSPS MLS2a: Among clients of IPP family planning clinics, the proportion of women with positive CT tests that are treated within 14 and 30 days of the date of specimen collection. Example Numerator: 80 women RX for CT within 14 days of specimen collection Denominator: 100 women screened for CT
Performance Measure Outcome: 80/100 = 0.80
* Performance measure is calculated and posted semi- annually by project area on CDC PM Website 33
Overview of STD Prevention, Control, and Program Management 38 DRAFT
Program Improvement Plans (PIPs) CSPS grant requirement to use surveillance and evaluation data to improve program performance at least annually. PIPs should: Address program gaps and needs identified through review of data and evaluation findings. Identify steps necessary to build on program strengths and remedy weaknesses.
Include key milestones, timelines, champions for implementation, and indicators for evaluating success. Include a request for technical assistance from outside sources, as needed.
34
DRAFT Sample STD Program Improvement Plan
Program Area: _ CSPS _X_ IPP _ SEE Program Goal statement: Increase Chlamydia Handout treatment timeliness rates at Family Planning and STD clinics
Essential Program Function: Medical and Laboratory Services
Objective: By December 31, 2010 increase by five percent the percentage of female FP and STD clinic clients treated for Chlamydia within 14 days of initial test. (Baseline: 2008: Family Planning Clinics; 71% of females with Chlamydia were treated within 14 days, STD Clinics; 74% treated within 14 days)
1 2 3 Change(s) Needed to Plan of Action to Achieve Change Evaluation/Assessment Results Data Supporting Evaluation/Assessment Meet Objective 9 Results or Data Sources to Determine if Change(s) Needed Change Improved Program 7 to Objective 4 5 6 8 Indicator What worked/Didn’t work/ Step/Activity Person Responsible Timeline Data Sources (for Step) And why
Even though the 2008 Chlamydia treatment 2008 IDPH STD incidence data for Chlamydia Agencies performing Generate 2009 Chlamydia The STD Counseling and Quarterly Chlamydia Quarterly Treatment timeliness (within 14 days) goal was met by the infections -date of test and date of treatment below the 2008 treatment timeliness data Testing Coordinator will treatment timeliness treatment timeliness reports combined Family Planning (FP) and STD for FP and STD clinics. Chlamydia treatment (within 14 days) for FP and be responsible for (within 14 days) data will be generated 2010 treatment timeliness data will timeliness reports be reviewed by 3/15/2011 to Clinics, 16 of 64 (24%) FP Clinics and 5 of 14 timeliness (within 14 STD clinics and forward the contacting STD clinic will be generated 6 will be generated. from IDPH STD (36%) STD Clinics did not meet the 2008 All positive tests for Chlamydia identified in the days) goal should be reports to STD clinic managers. weeks after the end of morbidity determine if objective was met. Chlamydia treatment timeliness (within14 days) IIPP prevalence database will be matched with contacted to determine managers. the quarter and A corrective action surveillance goal. case reports to ensure all positive Chlamydia why the goal was not The Illinois Department of forwarded to clinic plan tool will be database on a tests are counted as cases. meet and a corrective Contact program managers Human Services (IDHS), managers. used to document quarterly basis. action plan developed to for clinics performing below Family Planning Program contacts and Individual agency technical assistance contacts meet the 2010 goal. the 2009 goal to discuss Administrator and staff STD Counseling and corrective actions. Data from did not occur in 2008 for FP and STD clinics why the goal was not meet will work with FP Clinic Testing Coordinator corrective action performing below the 2008 treatment timeliness and develop a corrective managers. and IDHS FP staff tool. action plan. meet via conference goal. Factors to Consider When calls with sites Determining What STDs to Generate data at the end of performing below the the project period to monitor 2009 goal to discuss Prevent and Control improvement. barriers and develop a corrective action plan.
2nd, 3rd and 4th quarter data will be generated and monitored to determine if treatment timeliness rates have improved.
DRAFT Use Evaluation and Data to Improve Program Outcomes and Services
Data Program Interpretation Evaluation
Program Data Information Improvement Program Analysis Dissemination Planning
Data Program Collection Implementation
36
Overview of STD Prevention, Control, and Program Management 39 DRAFT
Evidence-Based Action Planning (EBAP)*
CDC funded syphilis elimination grantees must submit annual plan describing their syphilis elimination interventions.
EBAPs guide the collection of information on target populations, interventions provided, resources allocated, and outcomes in order to: Direct efforts toward emerging at-risk populations Improve effectiveness Inform decisions about future program development
*2009 Guidance for Syphilis Elimination Effort Evidence-based Action Planning http://www.cdc.gov/std/Program/ 37
DRAFT
Evidence-Based Action Planning (EBAP)
The target population for the intervention. The intervention. The implementation plan - the type, amount and cost of the resources to conduct the intervention. The performance indicators used to evaluate the intervention. The expected outcomes - short term, immediate and long term outcomes expected from the intervention. The outcomes achieved. The examination and evaluation of the data and reconsider the intervention.
38
DRAFT Importance of STD Prevention & Control: Advocating for Your Program
39
Overview of STD Prevention, Control, and Program Management 40 DRAFT What Rationales do You Use in Advocating for Your STD Program? - 1
High Incidence and Prevalence of STDs
STDs Facilitate HIV Acquisition & Transmission
STDs Cause Serious Complications in Women and Adverse Pregnancy Outcomes
STD Related Costs are Very High
40
DRAFT What Rationales do You Use in Advocating for Your STD Program? - 2
Preventing STDs Reduces Health Disparities and Inequities
STDs Disproportionately Affect Specific Communities and Subpopulations
STD Prevention is Cost Effective and Past Successes in Reducing Incidence and Prevalence
Provision of STD Services can Provide a Gateway to Other Health and Social Services
41
DRAFT
Examples of Data for STD Program Advocacy
Person Place Time Cost Multifactorial
42
Overview of STD Prevention, Control, and Program Management 41 DRAFT CT Prevalence by Age Compared to Iowa’s Population
2007 Estimated Population 2007 CT Prevalence = 8,643 7% 8% 6% 40%
7% 6%
15%
6%
2%
66% 3% 34%
All Other Ages 15-19 20-24
43 25-29 30-34 35-39
DRAFT Rates of Chlamydia, Gonorrhea, and Primary/Secondary Syphilis by Selected Age Groups and Gender, Missouri, 2007
4,000 Chlamydia Female Male 3,000 2,000 1,000 0 10-14 15-19 20-24 25-29 30-34 35-39 40+
1,200 Gonorrhea 1,000 800 600 400 200 0 10-14 15-19 20-24 25-29 30-34 35-39 40+ Rate per Rate population 100,000
25 P&S Syphilis 20 15 10 5 0 10-14 15-19 20-24 25-29 30-34 35-39 40+ Percentages are calculated from numbers rounded to one-tenth. 44 Nat. Am. = Native American; A/PI – Asian/Pacific Islander; P&S = Primary and Secondary Source: IDPH STD Section
DRAFT Health Disparities in Reported STDs in the US (1997-2009)
B/W Rate 1997- 1997 1998 1999 2000 2001 2002 2003 2004 2009 2009 Ratios % change
P & S Syphilis 42:1 32:1 29:1 24:1 15:1 8:1 5:1 6:1 9:1 - 79%
Gonorrhea 32:1 31:1 31:1 28:1 26:1 23:1 20:1 19:1 20:1 - 38%
Chlamydia 10:1 10:1 10:1 9:1 9:1 9:1 8:1 8:1 9:1 - 10%
B/W = Black White Case Rate Ratio
Percentages are calculated from numbers rounded to one-tenth. 45
Overview of STD Prevention, Control, and Program Management 42 DRAFT Comparison of Two Epidemics: Rates of Chlamydia and Gonorrhea – Chicago, 2007
46
DRAFT 2007 Illinois Chlamydia Rates By County
Jo Daviess Winnebago Stephenson BooneMcHenry Lake
Carroll Ogle Kane DeKalb DuPage Chicago Whiteside Lee
Kendall Cook Will Rock Island Henry Bureau La Salle Grundy Mercer Putnam Kankakee Stark Marshall Knox Warren Peoria Livingston Woodford Iroquois Henderson
Tazewell McLean Ford McDonough Hancock Fulton >=400 Mason De Vermilion Schuyler Logan Champaign Witt Menard Piatt Adams Brown Cass 200 - 399 Macon Morgan Sangamon Douglas Scott Edgar 100 - 199 Pike Christian Moultrie Coles Greene Shelby Calhoun Clark MacoupinMontgomery Cumberland 20 - 99 Jersey Effingham Jasper Crawford Fayette Bond Madison Clay RichlandLawrence Rate per 100,000 Marion Clinton Wabash Population St. Clair WayneEdwards Washington Monroe Jefferson
Perry Hamilton White Randolph Franklin
Jackson WilliamsonSalineGallatin
Pope Hardin Union Johnson
Pulaski Massac 47 Alexander
DRAFT Reported Chlamydia Cases By Health Care Provider Type, Illinois 2007
Neighborhood H.C. Hospital 3% 22%
Correctional 2%
School-based 1% Hlth Dept Clinic Private MD 2% 41% Prenatal 0% University 2% Other 1% Military 1%
Family Plan. STD Clinic 48 11% 14%
Overview of STD Prevention, Control, and Program Management 43 DRAFT Primary and Secondary Syphilis Cases Iowa,1997-2007
40 35 30 25 20 15 10 5 0
0 1 5 6 97 02 03 07 9 00 00 0 0 00 00 0 1 1998 1999 2 2 2 2 2004 2 2 2 49
DRAFT
Illinois Reported Primary and Secondary Syphilis Cases by Sex and Sexual Orientation, 2000-2007
100%
90%
80%
70%
60% Females 50% Hetero.* Males 40% MSM
30%
20%
10%
0% 2000 2001 2002 2003 2004 2005 2006 2007 50 *heterosexual or sexual orientation not stated Source: IDPH STD Section
DRAFT
Chlamydia Case Rates by Race & Ethnicity* Arizona 1998 - 2007
800
700
600
500
400
300
200
100
0 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 African American White Hispanic 51
Overview of STD Prevention, Control, and Program Management 44 DRAFT Chlamydia Complications
Untreated Genital Chlamydia Infection
70-80% Asymptomatic >50% Asymptomatic
Female Urethritis Male Urethritis
20-50% Neonatal Orchitis Infection PID Epididymitis (Acute & Silent) 18% 9% 14-20% Source: CDC Chlamydia in the Chronic Ectopic United States. April 2001 Pelvic Pain Pregnancy Infertility 52
DRAFT
Annual Direct Medical Cost (DMC) of STDs
$12-$20 Billion in USA for All Age Groups (CDC 2010)*
$6.5 Billion in USA for 15-24 Year Olds (Chesson, et at 2004)*
$1.1 Billion in CA for 15-24 Year Olds (Jerman et al 2007)*
$36.5 Million in IL for 15-24 Year Olds (Pultorak et al 2009)**
* Reportable and Non-Reportable STIs, including HIV, HSV, HPV
** Chlamydia, Gonorrhea, Syphilis only 53
DRAFT
New Realities of Leadership
Power Shift from Titles to Technology and Skills Resulting in Hierarchy Flattening
Knowledge is the New Currency and has Replaced Land and Capital as the New Economic Resource
Disappearance of Job Security & Loyalty Replaced With New Social Contract of Interesting Work and Greater Employability in Exchange for Commitment to Excellence
Source: The Leadership Challenge. Kouzes and Posner. 1995 54
Overview of STD Prevention, Control, and Program Management 45 DRAFT 5 Fundamental Leadership Practices 10 Leadership Learning Behaviors
Challenge the Process Inspire a Shared Vision Enable Others to Act Model The Way Encourage the Heart
Source: The Leadership Challenge. Kouzes and Posner. 1995
DRAFT STD Prevention, Control and Management Overview Module: Key Take Home Messages
Be able to: Identify and justify the essential activities for your STD Program. List and describe and justify the essential and appropriate staff/roles for your program. Effectively practice administrative, management, and leadership skills to maintain and improve STD program performance and STD prevention Plan, implement, and evaluate effective STD programs and to make appropriate program adjustments based through use of program planning and evaluation tools. Know where and how to obtain information, technical assistance and training on the bullets above. 56
Overview of STD Prevention, Control, and Program Management 46
2011 PERFORMANCE MEASURES
Quick Reference Guide
DIVISION OF STD PREVENTION
NATIONAL CENTER FOR HIV/AIDS, VIRAL HEPATITIS, STD AND TB PREVENTION
CENTERS FOR DISEASE CONTROL AND PREVENTION
January 2011
47 2010 Performance Measures – Quick Reference Guide
Who should Report: All performance measures are applicable to each project area unless indicated otherwise in the guidance. Project areas with an evidence-based justification for not reporting on any required performance measure should forward documentation of the justification to the CDC Program Consultant for consideration. The justification of not prioritizing a specific performance measure for program improvement is not sufficient reason for not reporting on the performance measure at all. For example, a project area may not have the resources to increase Chlamydia screening coverage at a Juvenile Detention Center, but they still must report data on that performance measure.
Where to Report: Performance Measure data should be reported using the online Performance Measures database. The database can be found at the following URL: https://webappx.cdc.gov/STDPM/
When to Report: Performance data for the period January 1 – June 30, 2011 should be entered into the PM database by September 30, 2011. Performance data for the period July 1 – December 31, 2011 should be entered into the PM database by March 31, 2012.
Where to Direct Questions: Please refer questions about the Performance Measures to your CDC Program Consultant.
What to Report: The following tables provide definitions for the numerator and denominator for each performance measure.
I. Medical and Laboratory Services (MLS) 1a. Chlamydia Testing in Juvenile Detention Facilities (CSPS -MLS1a): Proportion of female admittees to large juvenile detention facilities who were tested for Chlamydia. Numerator: For each juvenile detention facility, the number of female admittees tested for Chlamydia. Denominator: For each juvenile detention facility, the total number of female admittees or bookings. If a female walks in the door, she’s counted. Duplicated count, so if a female walks through the door four times in a reporting period, she’s counted four times. Facility Reporting Criteria: Project areas must report on each county juvenile detention facility that books 500 or more adolescent females annually. Please report on each facility individually. The Performance Measures database will automatically total data for all the facilities in your project area. Project areas with no county juvenile detention facilities that booked 500 or more adolescent females annually must report on one or more county juvenile detention facilities of their choice.
48 1b. Chlamydia Positivity in Juvenile Detention Facilities (CSPS MLS1b): Proportion of females tested in large juvenile detention facilities diagnosed with Chlamydia. Numerator: For each juvenile detention facility reported on in MLS1a, the number of female admittees diagnosed with Chlamydia. Denominator: For each juvenile detention facility reported on in MLS1a, the number of female admittees tested for Chlamydia. 2a. Timely Treatment of Women with Chlamydia at Family Planning Sites (CSPS MLS2a): Among clients of IPP family planning clinics, the proportion of women with positive CT tests who are treated within 14 and 30 days of the date of specimen collection. Numerators: Number of women treated for Chlamydia within 14 and 30 days of the date of specimen collection. Denominators: Total number of women diagnosed with Chlamydia. 2b. Timely Treatment of Women with Gonorrhea at Family Planning Sites (CSPS MLS2b): Among clients of IPP family planning clinics, the proportion of women with positive GC tests who are treated within 14 and 30 days of the date of specimen collection. Numerators: Number of women treated for gonorrhea within 14 and 30 days of the date of specimen collection. Denominator: Total number of women diagnosed with gonorrhea. 3a. Timely Treatment of Women with Chlamydia at STD Clinics (CSPS MLS3a): Among clients of STD clinics, the proportion of women with positive CT tests who are treated within 14 and 30 days of the date of specimen collection. STD clinics selected for this measure must be recorded by name in the Performance Measures Database in the Comments section. Numerators: Number of women treated for Chlamydia within 14 and 30 days of the date of specimen collection. Denominator: Total number of women diagnosed with Chlamydia. 3b. Timely Treatment of Women with Gonorrhea at STD Clinics (CSPS MLS3b): Among clients of STD clinics, the proportion of women with positive GC tests who are treated within 14 and 30 days of the date of specimen collection. STD clinics selected for this measure must be recorded by name in the Performance Measures Database in the Comments section. Numerators: Number of women treated for gonorrhea within 14 and 30 days of the date of specimen collection. Denominator: Total number of women diagnosed with gonorrhea. 4. Timely Treatment of P&S Syphilis Cases (CSPS MLS4): Proportion of P&S syphilis cases treated within 14 and 30 days of the date of specimen collection. Numerators: Number of P&S syphilis cases treated within 14 and 30 days of the date of specimen collection (count all cases reported during the performance measurement period) Denominators: Total number of P&S syphilis cases reported as morbidity during the performance measurement period, regardless of whether there was an interview.
49 5a. Syphilis Testing of Women at Select Adult Jails (CSPS MLS5a): Proportion of female admittees entering selected project area adult city and county jails who were tested for syphilis (refer to the appendix at the end of this document for a list of selected jails required to report). Numerator: Number of female admittees tested for syphilis. Denominator: Total number of female admittees. If a female walks in the door, she’s an “admittee” and is counted. Duplicated count, so if a female walks in four times during the reporting period, she’s counted four times. 5b. New Syphilis Cases Diagnosed in Select Adult Jails (CSPS MLS5b): Proportion of females tested that are newly diagnosed with syphilis (any stage) in select adult jails. Numerator: For each adult jail reported on in MLS5a, the number of female admittees newly diagnosed with syphilis. Denominator: For each adult jail reported on in MLS5a, the number of female admittees tested for syphilis. 5c. Timely Syphilis Treatment in Select Adult Jails (CSPS MLS5c): Proportion of females newly diagnosed with syphilis (any stage) treated within 14 and 30 days of the date of specimen collection. Numerators: For each adult jail reported on in MLS5a, the number of female admittees newly diagnosed with syphilis treated within 14 and 30 days of the date of specimen collection. Denominator: For each adult jail reported on in MLS5a, the number of female admittees newly diagnosed with syphilis.
II. Partner Services (PS) 1. Timeliness of Primary and Secondary (P&S) Syphilis Interviews (CSPS-PS1): Proportion of P&S syphilis cases interviewed within 7, 14, and 30 calendar days from the date of specimen collection. Numerators: Number of persons with P&S syphilis who were interviewed within 7, 14, and 30 days from the date of specimen collection (count all interviews from cases reported during the performance measurement period) Denominator: Total number of P&S syphilis cases reported as morbidity during the performance measurement period, regardless of whether there was an interview. 2a. Timeliness of Prophylactic Treatment for Contacts to P&S Syphilis Cases (CSPS-PS2a): Number of contacts prophylactically treated within 7, 14, and 30 calendar days from day of interview of index case, per case of (P&S) syphilis. Numerators: Number of contacts of persons with P&S syphilis with disposition of preventive/prophylactic treatment (Dispo A) within 7, 14, and 30 days after the date of the interview of the index case. Contacts named by more than one index case should be counted only once for each time they are treated (count all contacts treated on reported cases during the performance measurement period). Denominator: Total number of P&S syphilis cases reported as morbidity during the performance measurement period, regardless of whether there was an Ix.
50 2b. Timeliness of Treating Infected Contacts to P&S Syphilis Cases (CSPS PS2b): Number of contacts newly diagnosed and treated within 7, 14, and 30 calendar days from day of interview of index case, per case of (P&S) syphilis. Numerators: Number of contacts of persons with P&S syphilis with disposition of Brought to Treatment (Dispo C) within 7, 14, and 30 days after the date of the interview of the index case. Contacts named by more than one index case should be counted only once for each time they are treated (count all contacts treated on reported cases during the performance measurement period). Denominator: Total number of P&S syphilis cases reported as morbidity during the performance measurement period, regardless of whether there was an interview. 3. Required For Non- HMAs ONLY- Timeliness of Gonorrhea Interviews (CSPS PS3) Proportion of ALL gonorrhea cases interviewed within 7, 14, and 30 days of the date of specimen collection. Numerators: Number of persons with gonorrhea who were interviewed within 7, 14, and 30 days from the date of specimen collection (count all interviews reported during the performance measurement period) Denominator: Total number of gonorrhea cases reported as morbidity during the performance measurement period, regardless of whether there was an interview.
III. Statistics and Data Management (SDM) For this set of measures (CSPS SDM1 – SDM3), proportions do not have to be calculated locally. Results are provided by DSTDP and are uploaded into the Performance Measures database on an annual basis. 1. Completeness of Data (CSPS-SDM1): Proportion of reported cases of gonorrhea, Chlamydia, P&S syphilis, EL syphilis, and congenital syphilis sent to CDC via NETSS that have complete data for age, race, sex, county, and date of specimen collection. 2. Timeliness of Data (CSPS-SDM2): Proportion of reported cases of gonorrhea, Chlamydia, P&S syphilis, EL syphilis, and congenital syphilis sent to CDC via NETSS within 30 and 60 days from the date of specimen collection. 3. Completeness of Data (CSPS-SDM3): Proportion of reported cases of P&S syphilis and EL syphilis sent to CDC via NETSS where the sex of the sex partner(s) is known.
For More Information: Visit the Division of STD Prevention’s Program Tools webpage at http://www.cdc.gov/std/program/ . The site contains this document and the online Performance Measures database User Guide.
51 Appendix – Select Adult Jails for CSPS MLS5a – c Jails were selected using the syphilis jail index formula, which was modified in 2009 ((Total Female Cases in County/Female Population in County) x Female Admittees Reported by Grantee). A jail was selected for reporting if the index was .05 or greater. If a selected jail’s screening coverage rate is 25% or greater AND the percentage of total female cases (all stages) identified in the jail is less than 10% (of total female cases in the project area) in any given report period, the project area may opt to not report the data to CDC. Each project area that opts out of reporting should make an informed decision as whether to continue some level of screening even if they choose not to report.
Project Area Jail Facilities Arizona Maricopa County Florida Hillsborough, Duval, Dade, Orange, Broward Counties Georgia Dekalb, Fulton Counties Illinois Cook County Los Angeles Los Angeles County Louisiana East Baton Rouge, Orleans, Caddo Parishes Maryland* Baltimore Central Booking & Intake Center New Jersey Essex County New York City* Rikers Island Oklahoma Oklahoma County Philadelphia* Philadelphia County Tennessee Shelby, Davidson Counties Texas Bowie, Bexar, Dallas, Gregg, Harris, Jefferson, Tarrant Counties * May opt to not report due to sufficient screening coverage and low yield
52 STD Program Improvement Plan
Program Area: _ CSPS _X_ IPP _ SEE Program Goal statement: Increase chlamydia treatment timeliness rates at Family Planning and STD clinics Essential Program Function: Medical and Laboratory Services
Objective: By December 31, 2010 increase by five percent the percentage of female FP and STD clinic clients treated for chlamydia within 14 days of initial test. (Baseline: 2008: Family Planning Clinics; 71% of females with chlamydia were treated within 14 days, STD Clinics; 74% treated within 14 days)
1 2 3 Change(s) Plan of Action to Achieve Change Evaluation/Assessment Data Supporting Needed to 9 Results Evaluation/Assessment Meet Objective Data Sources to Results or Determine if Change 7 8 Change(s) 4 5 6 Improved Program Indicator Data What worked/Didn’t work/ Needed Step/Activity Person Timeline (for Step) Sources And why to Objective Responsible
Even though the 2008 2008 IDPH STD incidence Agencies Generate 2009 The STD Quarterly Quarterly Treatment chlamydia treatment data for chlamydia infections performing chlamydia Counseling and chlamydia timeliness treatment 2010 treatment timeliness (within 14 days) -date of test and date of below the treatment Testing treatment reports will timeliness timeliness data will goal was met by the treatment for FP and STD 2008 timeliness data Coordinator will timeliness be reports will be reviewed by combined Family Planning clinics. chlamydia (within 14 days) be responsible (within 14 generated be 3/15/2011 to (FP) and STD Clinics, 16 of treatment for FP and STD for contacting days) data will from IDPH generated. determine if 64 (24%) FP Clinics and 5 of All positive tests for timeliness clinics and STD clinic be generated STD objective was met. 14 (36%) STD Clinics did not chlamydia identified in the (within 14 forward the managers. 6 weeks after morbidity A meet the 2008 chlamydia IIPP prevalence database days) goal reports to STD the end of the surveillance corrective treatment timeliness will be matched with case should be clinic managers. The Illinois quarter and action plan database (within14 days) goal. reports to ensure all positive contacted to Department of forwarded to tool will be on a chlamydia tests are counted determine why Contact program Human clinic used to quarterly as cases. the goal was managers for Services managers. document basis. Individual agency technical not meet and a clinics performing (IDHS), Family contacts assistance contacts did not corrective below the 2009 Planning STD and Data from occur in 2008 for FP and action plan goal to discuss Program Counseling corrective corrective STD clinics performing below developed to why the goal was Administrator and Testing actions. action tool. the 2008 treatment timeliness meet the 2010 not meet and and staff will Coordinator goal. goal. develop a work with FP and IDHS FP corrective action Clinic staff meet via plan. managers. conference calls with sites
53 1 2 3 Change(s) Plan of Action to Achieve Change Evaluation/Assessment Data Supporting Needed to 9 Results Evaluation/Assessment Meet Objective Generate data at performing Data Sources to Results or the end of the below the Determine if Change Change(s) project period to 2009 goal to Improved Program What worked/Didn’t work/ Needed monitor discuss And why to Objective improvement. barriers and develop a corrective action plan.
2nd, 3rd and 4th quarter data will be generated and monitored to determine if treatment timeliness rates have improved.
54 Costs of STDs – Justifying Your STD Program Overview of STD Prevention, Control, and Program Management
Sample Cost–Benefit of Chlamydia Screening & Rx (slide 51, Part 2)
Cost benefit data can be an effective tool to convince policy makers and the public of the success of STD prevention strategies. Focus on cost saving at the end and don’t go through every calculation.
18,000 women screened x $20/women screened = $360,000 in screening costs 18,000 screened x 5% prevalence = 900 infected women detected 900 infections x $50/treatment = $45,000 in treatment costs $45,000 + $360,000 = $405,000 in Total Tx and Rx costs $405,000/900 infections = $450 per case identified and treated 900 women Rx for CT x 36% = 324 cases of CT PID Prevented 324 cases of PID x $1,995/case = $646,380 saved in preventing PID ______ $646,380 Cost Savings preventing PID by screening and treating infected women for Chlamydia/$405,000 in screening and treatment costs = $1.60 saved for every dollar spent on screening and treatment
Costs of STDs (slide 53, Part 2) Take Home Message: National or local cost data can be effective in convincing policy makers that investing in STD prevention programs can help reduce the enormous burden that STDs cost the health care system – both public and private. References from Slide 53: CDC 2009 Surveillance Report Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2009. Atlanta, GA: U.S. Department of Health and Human Services; November 2010. Printed copies and the on-line version of this report can be obtained at the following web site: http://www.cdc.gov/std/pubs/
Continued…
An Overview of STD Prevention, Control, and Management 55 Costs of STDs – Justifying Your STD Program Overview of STD Prevention, Control, and Program Management
Chesson HW, Blandford JM, Gift TL, et al. Estimated direct medical cost of sexually transmitted diseases among American youth, 2000. Perspectives on Sexual and Reproductive Health, 2004; 36:11–19.
Jerman P, Constantine NA, Nevarez C. Sexually Transmitted Infections Among California Youth: Estimated Incidence and Direct Medical Cost, 2005, California Journal of Health Promotion 2007, Volume 5, Issue 3, 80-91
Pultorak E, Wong W, Rabins C, et al. Economic Burden of Sexually Transmitted Infections: Incidence and Direct Medical Cost of Chlamydia, Gonorrhea, and Syphilis Among Illinois Adolescents and Young Adults, 2005–2006, Sexually Transmitted Diseases, 2009; 36:629-636.
An Overview of STD Prevention, Control, and Management 56 Additional Resources for STD Program Management, Leadership, and Administration ______
Books on Management and Leadership
Essentials of Public Health Management. L. Fleming Fallon, Eric J. Zgodzinski Jones & Bartlett Publishers, Inc., September 2008, ISBN-13: 9780763756819 2nd Edition
Public Health Administration: Principles for Population-Based Management. Novick, Lloyd F./ Morrow, Cynthia B./ Mays, Glen P; Jones & Bartlett Publishers, Inc., June 2007, ISBN-13: 9780763738426, 2nd Edition
The Manager’s Guide to Program Evaluation: Planning Useful Results. Paul W. Mattessich. Fieldstone Alliance. 2003. ISBN-13: 9780940069381.
Analyzing Performance Problems: Or, You Really Oughta Wanna-- How to Figure Out Why People Aren’t Doing What They Should Be, and What To Do About It. Robert F. Mager and Peter Pipe. Center for Effective Performance. 1997. 3rd Edition
Strategic Planning for Public and Nonprofit Organizations. John M. Bryson. John Wiley and Sons, Inc., 2004. ISBN-13: 9780787967550. 3rd edition
The 7 Habits of Highly Effective People. Stephen R. Covey, Simon & Schuster Adult Publishing Group, November 2004, ISBN-13: 9780743269513
The Five Dysfunctions of a Team: A Leadership Fable by Patrick M. Lencioni. Wiley, John & Sons, Incorporated, 2002, ISBN-13: 9780787960759, 1st Edition
Leadership and Self-Deception: Getting out of the Box. Arbinger Institute. Berrett-Koehler Publishers, Inc., 2002, ISBN-13: 9781576751749, 1st Edition
The 21 Irrefutable Laws of Leadership: Follow Them and People will Follow You. John C. Maxwell. Thomas Nelson Publisher. 2007. ISBN-13: 9780785288374. 10th Edition
Human Resources Management for Public and Nonprofit Organizations. Joan E. Pynes. John Wiley and Sons, Inc., 2004. ISBN-13 9780787970789. 2nd Edition
CDC Guidance: Practical Use of Program Evaluation among STD Programs (Covers program planning, evaluation, objectives, etc.) http://www.cdc.gov/std/program/pupestd.htm
2009 Guidance for Syphilis Elimination Effort - Evidence-based Action Planning http://www.cdc.gov/stopsyphilis/
CDC Performance Measures http://www.cdc.gov/std/program/
Program Operation Guidelines http://www.cdc.gov/std/Program/default.htm#guidelines
Leadership and Program Management http://www.cdc.gov/std/Program/leadership/TOC- PGleadership.htm
Program Evaluation http://www.cdc.gov/std/Program/progeval/TOC-PGprogeval.htm
Training and Professional Development http://www.cdc.gov/std/Program/training/TOC- PGtraining.htm
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Web-based Resources:
Free Management Library's Online For-Profit Organization Development Program Module #4: Basic Skills in Management and Leadership http://www.managementhelp.org/fp_progs/mng_mod/mng_ldr.htm http://www.managementhelp.org/ldr_dev/cmptncy/cmptncy.htm
Tannenbaum Leadership Continuum Model http://www.valuebasedmanagement.net/methods_tannebaum_leadership_continuum.html
Leadership Styles Theory – Goleman http://www.valuebasedmanagement.net/methods_goleman_leadership_styles.html
Management Methods – Management Models – Management Theories http://www.valuebasedmanagement.net/
Web-based Training from the American Academy of Medical Administrators (AAMEDA) http://www.myplacetolearn.com/AAMA-EduLink/index.html
Team Management Skills http://www.mindtools.com/pages/article/newTMM_92.htm
Quality Improvement Resources from NACCHO http://www.naccho.org/topics/infrastructure/accreditation/QIresourses.cfm
Public Health Foundation:
National Public Health Performance Standards Program: On-line resources http://www.phf.org/nphpsp/ Public Health Foundation
Performance Management and Quality Improvement Resources http://www.phf.org/infrastructure/phfpage.php?page_id=55&pp_id=52
Turning Point Resources: Performance Management Collaborative http://www.turningpointprogram.org/Pages/perfmgt.html Leadership Development http://www.turningpointprogram.org/Pages/leaddev.html
Public Health Statute Modernization http://www.turningpointprogram.org/Pages/ph_stat_mod.html
Public Speaking: Toastmasters http://www.toastmasters.org Dale Carnegie Courses http://www.dalecarnegie.com/
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Logic Models: Enhancing Program Performance with Logic Models - Course Resource Pages www.uwex.edu/ces/lmcourse/Resources/ContentPages/bibliography2.htm
Logic Model Development Guide (W.K. Kellogg Foundation) http://www.wkkf.org/Pubs/Tools/Evaluation/Pub3669.pdf ETR Associates: BDI Logic Model Course CD (Doug Kirby and Lori Rolleri, ETR Associates) http://programservices.etr.org/index.cfm?fuseaction=pubProds.prodsummary&ProductID =5 www.etr.org/recapp/BDILOGICMODEL20030924.pdf http://www.etr.org/recapp/forum/forumsummary200209.htm#name http://www.apa.org/pi/aids/introprogrameval.html A compendium of links related to constructing logic models (not HIV specific) from CDC’s Evaluation Working Group. http://www.cdc.gov/eval/resources.htm#logic%20model
SMART Objectives: http://www.thepracticeofleadership.net/2006/03/11/setting-smart-objectives/ http://www.cdc.gov/healthyyouth/evaluation/pdf/SMARTcards.pdf North Carolina Arts for Health Training Institute, Raleigh, NC, March 28, 2003 http://www.ncartsforhealth.org/developingmeasurableobjectives.html
National Network of Prevention Training Centers (NNPTC) http://depts.washington.edu/nnptc/index.html The National Network of STD/HIV Prevention Training Centers (NNPTC) is a CDC-funded group of regional centers created in partnership with health departments and universities. The PTCs are dedicated to increasing the knowledge and skills of health professionals in the areas of sexual and reproductive health. The NNPTC provides health professionals with a spectrum of state-of-the-art educational opportunities including experiential learning with an emphasis on prevention.
Within the National Network of STD/HIV Prevention Training Centers, 10 centers provide STD Clinical Training, four centers provide Behavioral Intervention Training, and four centers provide Partner Services and Program Support Training. Core Curricula Outlines for Clinical Training Courses form the foundation for NNPTC clinical training. Exact course offerings vary by PTC. Contact the PTCs serving your geographic area for additional information and a schedule of courses.
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Grant Writing:
The Grantsmanship Center http://www.tgci.com The Grantsmanship Centers was founded in 1972 by Norton J. Kiritz to offer grantsmanship training to nonprofit and government agencies. The Center began as a local project in Los Angeles, but as word of its alumni's successes spread, demand for trainings rapidly expanded. Soon organizations in other cities were asking to host training programs in their own communities. By 1975, The Grantsmanship Centers was conducting more than 100 workshops a year across the country.
Program Planning and Proposal Writing (PP&PW), The Grantsmanship Center's proposal writing guide written by Norton J. Kiritz, is the most widely read publication in nonprofit history. There are more than a million copies of PP&PW in print- and scores of government, foundation, and corporate grantmakers have adopted it as their preferred application format. The Grantsmanship Centers conducts some 150 workshops annually in grantsmanship training. Each year, thousands of new graduates join our roster of more than 110,000 alumni.
The Grantsmanship Center Publications (partial listing) www.tgci.com/publications.shtml
Program Planning & Proposal Writing – Introductory Version ($7)
Program Planning & Proposal Writing – Expanded Version ($10)
Proposal Checklist & Evaluation Form ($7)
The Process of Program Evaluation ($7)
The Grant Center http://www.grantcenter.org The Grant Center was formed in 1992 by concerned community leaders who recognized that the needs and challenges of Memphis far outweighed the financial resources available locally. The Grant Center is the only nonprofit agency in the country helping all types of organizations with the entire grant process, from researching funding to managing grants. The Center requires its clients to have well-developed program plans and methods of accountability for projects seeking grant funds. The Center has been successful in bringing together diverse organizations, many which had previously viewed themselves as competitors, to apply jointly for funds.
The Grant Center Publications (partial listing) www.grantcenter.org/publications.htm
Designing and Planning Programs for Nonprofit and Government Organizations ($60.00 members, $65.00 non-members)
The “How To” Grants Manual: Successful Grantseeking Techniques for Obtaining Public & Private Grants. ($54.00 members, $59.00 non-members)
The Only Grant Writing Book You’ll Ever Need: Top Grant Writers and Grant Givers Share Their Secrets! ($16.00 members, $20.00 non-members)
The Process of Program Evaluation ($10.00 members, $15.00 non-members)
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US Conference of Mayors http://www.usmayors.org/
Technical Assistance Report (TAR) Writing Proposals for HIV/AIDS Prevention Grants. March 2003 http://www.usmayors.org/hivprevention/proposal.pdf
Technical Assistance Reports (TARs) are designed to assist organizations conducting HIV/AIDS prevention education programs. http://www.usmayors.org/hivprevention/hiv_pubs.asp The TARs below are very applicable to STD prevention and control programs.
1. Evaluation for HIV/AIDS Prevention Programs (December 1990) (Pub. #1-8749-001)
2. Showing Program Effectiveness through Case Studies (October 1992) (Pub. #1-8749-002)
3. Knowledge, Attitudes, Beliefs and Behaviors (KABB) Surveys (December 1994) (Pub. #1-8746-003)
4. Proposal Writing for HIV/AIDS Prevention Grants (Update October 1996) (Pub. #1-8673.13-004)
5. Needs Assessment for HIV/AIDS Prevention and Service Programs (Update October 1996) (Pub. #2-8676.13-005)
6. Focus Groups: Using Them to Enhance Your HIV Prevention Programs (November 2000) (Pub. #1-8676.17-006)
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