CHAPS Phases: Phase 3 (Archive)

OPHP CHAPS tools and templates: 

• CHA Data Gathering Guide 
• Qualitative Data Collection Techniques 
• Local CHA and PHIP Requirements, Public Health Act, PHAB Version 2022 Crosswalk

Additional and external tools and guidance: 

Begin this phase by collecting and reviewing requirements, background materials and inquiring with agency staff who have been involved in the process before.

Useful questions to consider:

• What are the requirements for a local community public health assessment?
• What are the priorities identified in your last PHIP?
• Have you reached out to current and potential partners to learn about their recent assessments or priorities in your community, county or region?
• Are there specific efforts to address health inequities happening in your community, county or region?
• What are other current local and/or regional priorities?
• What are the current state public health and environmental health priorities?
• How does this information inform your assessment process?

Meaningful process
It is important to design and carry out a process that meets local needs and is meaningful to your agency, partners and communities. Research other assessment and planning resources to learn more about the process, access different tools and methods, or find more specific guidance on assessment and planning activities. The following resources are recommended and commonly used:

• County Health Rankings and Roadmaps Action Cycle
• The University of Kansas Community Toolbox
• NACCHO Mobilizing for Action through Planning and Partnerships (MAPP)
• CDC Assessment and planning models, frameworks and tools

Use a data gathering outline to guide the assessment. It will include data gathering, collection and analysis, and community engagement. The scope will depend on available data, data needs and capacity. The results will support the design of a comprehensive community health assessment that tells the "story" of the health of your community/ies and environment.

Elements of an outline

Think through the data that you would like to use to describe the story of your community. Here are a few elements to consider:

Definitions

• Define what is meant by "community" with explicit attention paid to populations experiencing health inequities. Develop or use already existing definitions for health, health equity and social determinants of health to guide the data you gather, collect and use in the assessment and planning process. Note that some of these can be informed by community member perspectives in the data collection process.

Here are two recommended examples:

• Equity is when everyone, regardless of who they are or where they come from has the opportunity to thrive. This requires eliminating barriers like poverty and repairing injustices in systems such as education, health, criminal justice and transportation." Colorado Office of Health Equity
• "Social determinants of health are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems." World Health Organization

Framework or model

• Using a framework or model will help you think through the different components or "buckets" that describe the population so that you take a comprehensive look at all the factors influencing the health of the community. It also gives you a way to organize the data that you are collecting and help identify data gaps where you might need to gather more information. Look for frameworks or models that include upstream determinants of health to ensure a comprehensive process. Lastly, the model you select to outline your data gathering activity does not have to be the way you choose to display or report your data results. here are three recommended examples:
  • Bay Area's Regional Health Inequities Initiative (BARHII) Framework
  • County Health Ranking Model

Health Equity Approach

• In addition to using a health equity focused framework, actively embed health equity into the assessment process. The local CHAPS process is a valuable effort that can be used to highlight health inequities while also building inclusive and trusting partnerships. Through your community's lived experiences or use of health equity and social determinants of health indicators and data sources, root causes can be identified.
• It can also be a force for broader, multi-sector partnership building and for new ways of meaningfully engaging community members. Make sure your staff and partners know what health equity is and why it is important in the assessment process. Reach out if you have questions and tap into the plethora of health equity capacity building resources available to apply this approach

Data sources and methods

• A CHA is a method to tell the story of the health of your community/ies, integrating a variety of different data sources together to do so. Use this outline to identify and document an initial list of data sources and methods you intend on using in assessment.
• Include both quantitative and qualitative data sources. Differentiate between already collected sources of secondary data and potential new primary data sources and/or collection methods. Carefully document the sources and methods to support a plan to monitor and refresh the data. Plan on updating or refining this list as you progress in your data gathering and collection efforts.

Existing assessments and priority issues

• If your agency participates in state or non-profit grant programs that require topic or activity specific assessments, action plans, required strategies, etc., work with the program contact to glean data, recommendations, and strategies that can inform your process.
• State grant examples include: CDPHE State Tobacco Education and Prevention Partnership (STEPP) grant, CDPHE Maternal and Child Health grant and youth substance abuse prevention and the CDPHE Communities That Care grant.
• Consider these programs to also be subject matter experts and another group to seek guidance on appropriate indicators, evidence-based strategies and lessons learned in Colorado.

Assets and resources

• When telling the health story of a community, we recommend using a strengths-based approach so that you look for assets and resources throughout the data collection process. This approach may bring more partners to the process, help identify areas of a community that support the health of the population, and even potential solutions to consider when developing the public health improvement plan.

PHAB Community health assessment requirements: See Measure 1.1.1 A of either the Accreditation or Reaccreditation Standards and Measures. 

A sample outline to get you started can be found here: 

• CHA Data Gathering Guide

Your outline will depend on how you design your community health assessment. Contact the Office of Public Health Practice, Planning and Local Partnerships to discuss any questions, data collection needs or ideas that you may have.

Community engagement is an "essential ingredient" in a community health assessment and throughout the CHAPS process. Refer back to the equity and engagement assessment tools recommended in Phase 2 for additional information. It is worth learning more about it, building the necessary relationships to do it well, and allotting time and resources to make it happen. Engagement of your community members should span the geography covered in the assessment, capture community strengths and assets and include communities experiencing health inequities.

Use tools like the CHAPS Community Engagement Spectrum to decide why, when and how you will meaningfully engage along with results of any equity and engagement tools you may have completed thus far.

As expressed in Phase 2, there are many resources to guide community engagement work. Below are recommended resources for this step but continue to look for the right tools that wok well for your local process.

• Health Equity Guide: A Human Impact Partners Project
• Checking Assumptions to Advance Equity - Colorado Office of Health Equity
• Authentic Community Engagement to Advance Equity - Colorado Office of Health Equity

Use the data gathering outline you've developed in Step 2 to guide you through this step. First, you will gather quantitative and qualitative data that has been previously collected. Then ask, "What else do we need to know to tell the story of health of our communities?" Next you will collect additional secondary or primary data to complete the "story".

Data support

Engage internal agency staff and/or partners who have expertise in data collection, analysis and interpretation. These initial activities can be challenging so make sure you are involving the right people with the skill sets needed to help. This can include epidemiologists, planners with past assessment experiences and even state or national program staff who can offer insights into the types of indicators and measures you can use. Having this support system set up will help prepare you for handling gaps in data or suppressed data, especially if you are in a rural or frontier area. Also, you can reach out to the Office of Public Health Practice, Planning, and Local Partnerships throughout this process for guidance on all aspects of data collection, analysis, interpretation and communication.

Gather quantitative data

Here are some suggestions of places to start looking for data, and some sites to explore for additional data. The sites to start with compile data points from different primary data sources and help you compare your community to other counties, the state or nation.

There are lots of places to find quantitative data and it's easy to get sucked into the vortex of information. Refer back to your data gathering outline to help focus your data gathering efforts. you can also reach out to the Office of Public Health Practice, Planning, and Local Partnerships to ask for technical assistance in finding certain data.

Gather qualitative data

Incorporating qualitative data into your community health assessment broadens your overall findings and enriches the story you are able to tell. This type of information can include lived experience and why a health issue may exist from the perspective of someone who experiences it. This context may uncover health issues that the quantitative data don't illustrate, or provide a context for the quantitative data, enabling you to delve into a specific issue more thoroughly.

Start by reviewing the community health assessments you collected in Step 1 for qualitative data or stories. Reach out to partners to see if they have gathered any qualitative data recently that they are willing to share so that you do not overburden any one community. Plug the available qualitative data into your data gathering outline.

Collect quantitative data

Now that your data gathering outline has been populated with existing quantitative and qualitative data, it is time to ask the question, "What else do we need to know to tell the story of the community?"

Are there areas you weren't able to populate in your data gathering outline with already suggested sources? Think about other local partners who might already be gathering data locally on the topic you're interested in. Think about non-profit, other government agencies and hospitals that might be willing to share data with you. If you still can't find the quantitative data you want to help tell the story of the community, consider gathering qualitative data or reach out to discuss whether it makes sense to collect primary data for your assessment with the Office of Planning, Partnerships and Improvement.

Collect qualitative data

After you have reviewed the recent qualitative data specific to your community that already exists, it is time to reference your data gathering outline and determine what additional qualitative data you will collect in order to help tell the story of your community.

Qualitative data can help describe factors unique to your community, capture the perceptions of residents, provide a context for the quantitative data and enable you to delve into a specific issue more thoroughly. You can choose from a variety of qualitative data gather techniques, such as:

• Community meetings.
• Focus groups/listening sessions.
• Key informant interviews.
• Asset mapping.
• Photovoice.
• Nominal group technique.

For more on how to conduct these techniques, check out this list of recommended resources or see the Rotary International Community Assessment Tools document for helpful guidance.

Alignment with State Plans

Both the Public Health Act of 2008 and the following CHAPS guidance require LPHAs and the State to align their public health improvement plans and strategies. One way to begin working towards alignment is by utilizing shared datasets. Throughout Colorado’s 2018 Public Health and Environmental Assessment dashboard, there are links to the data sources that were used. These are indicated by the blue text that says “Data source” under each visual. Try clicking on these links to explore different data sources for your own CHA. 

The State of Colorado also used the following data sources to identify metrics for measuring progress and success in various priority areas:

• What are the top health issues in the community?
• Do you know why these are the top issues?
• What health behaviors and determinants of health are influencing these?
• Do these differ by age, race/ethnicity, gender, and neighborhood?
• Who is impacted the most?
• Have these issues changed over time?
• How do these health concerns compare to the state?
• What concerns do community members have?
• Were emerging issues uncovered that we did not necessarily expect to find?

Data points won't stand on their own, they need context and understanding of an issue. Remember that how you frame the data can influence the story you tell. The frame can either highlight or mask disparities in outcomes and it can either make connections to determinants of health or let the reader draw their own connections. Refer to the Office of Health Equity's Framing Data to Advance Health Equity tool for additional guidance to consider in these initial activities to summarize the assessment. This will be addressed further in Step 8.

Topics to consider for prioritization
While the assessment work is fresh, include a list of main topic areas to consider for prioritization. This will help you prepare for the next phase of the assessment and planning process. Work with your advisory group and interested partners to select 5-10 issues that have "risen to the top" due to their importance to community health, level of community need or window of opportunity to address.

Share the findings of your community health assessment with your local board of health (BOH). Engaging your BOH throughout the CHAPS process allows them to provide feedback and direction and to be advocates for potential priority areas that will be identified in your public health improvement plan.

Upon review and approval from the BOH:

1. Post on your agency and/or partnership website.
2. Submit your completed community health assessment and website link to OPHP via the Google Form linked below. Please include documentation of BOH discussion/approval or a copy of meeting minutes/agenda.
3. Submit your completed community health assessment: click here to access the Google Form upload.
4. If you have any questions about submitting your assessment online, contact us at ophp@state.co.us 

The Office of Public Health Practice, Planning, and Local Partnerships public health planner will post a link to your assessment on the CHAPS website.

How do you choose to communicate the health assessment results is based on both the purpose and the target audience(s). The results will be used to educated and mobilize stakeholders and community members, identify priorities, create a local public health improvement plan and garner resources to support plan implementation.

Change the narrative

As Colorado's public health system moves to address issues that are considered upstream or root causes to your communities' health and environment issues, this is the opportunity to choose how you describe issues in ways that connect social, environmental, political and economic inequities to prioritize health and environmental issues.

Recommended resources:

• Office of Health Equity's Framing Data to Advance Health Equity tool.
• FrameWorks Institute communication recommendations.

Communication plan
You can create a communication plan to strategically think through how, when and to whom you will communicate the findings and next steps. We strongly encourage referencing Phase 2 to follow community engagement best practices in your communication. This will help you address equity issues in your community while being inclusive, culturally and linguistically appropriate in your communications style, transparent with your process and able to build trust while communicating issues that may be difficult to understand and act upon.

A communication plan may include:

• Target audience(s) for the findings of your community health assessment, such as:
  • Community members.
  • Partner agencies.
  • Local Board of Health.
  • Local leadership.
  • Stakeholders identifying priorities for an improvement plan.
• How much, what kind, and what level of data is most useful for your audience(s).
• Culturally and linguistically appropriate messaging, methods and channels.
• Data collection framework you chose to use when collecting data and a discussion about the best way to present the data to your stakeholders.
• Next steps in the process and potential opportunities for engagement.

Your communication process should include the following practices and activities:

• Use plain language by incorporating health literacy principles and plain language communication tools.
• Craft culturally and linguistically appropriate messaging, methods and channels.
• Use emerging communication recommendations from resources like FrameWorks Institute to articulate complex health issues in ways that resonate with your audiences and can lead to action.
• Test your communication messages and materials with a variety of audiences to ensure your community's health story is understood and is relatable.
• Use principles of community engagement to inform how you craft your communications and when to employ them.
• Use this step as a tool to model the changes you are aiming to make in the ways that you need. How public health describes the connections between health issues and the underlying racial, social and historical inequities can be a powerful strategy in and of itself.
• Discuss the merits and limitations of various communication formats and methods and decide what works best for your community.

Format examples include:

• Data dashboard
• Agency and/or partnership website
• Video
• Fact sheets
• Report
• Executive summary of key findings

Examples of sharing out the CHA that communities across Colorado have used include:

• Community open house
• Presentations to local leadership and partners
• Email to community partners
• Posting on website
• Press release
• Paid/earned media
• Announcements via social media (Facebook, Twitter, etc.)

Regardless of the format(s) you choose, be consistent and systematic with documenting the methods and data sources of the community health assessments so that the effort can be monitored, refreshed and replicated.

Locally developed resources: Coming in 2022.

Click here for examples of local CHAs