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Use this phase to think through how you will engage a range of stakeholders throughout the CHAPS process in order to support equity and create a better assessment, plan and implementation process. Local public health agencies are the required entity to carry out this process but it is intended to be done in partnership with community.
Engaging stakeholders is addressed through the CHAPS phases, which will take places over the course of a few years. Therefore, be mindful of your engagement methods and adapt as necessary to respond to your community needs and capacity for involvement. The community engagement strategies that you use will be one way that you will be able to be transparent, build trust and address equity though your assessment and planning process.
Community engagement is an essential function of public health and found across national and state requirements is a public health best practice. Colorado Core Public Health Services and Capabilities model cites community engagement as a way to operationalize core services and PHAB devotes Domain 4: Engage with the community to identify and address health problems to this work and requires it in both the community health assessment and community health improvement plan processes.
There are many reputable and wonderful community engagement and health equity resources that can guide your assessment and planning process. To maintain focus in CHAPS, we will reference a short list of recommended resources and encourage you to explore and adapt others to inform your local process.
Engaging a variety of different individuals, organizations, and sectors that have a "stake" in the process is a consistent activity throughout the CHAPS process. Regardless of the term used to define individuals that ultimately form the groups involved, it all falls within the definition of community engagement. Terms will be used interchangeably within guidance and local application. Either way, the same principles will apply.
Community engagement, as defined by the Colorado Office of Health Equity in the Authentic Community Engagement to Advance Equity resource, is:
PHAB guidance in Domain 4 expands on the definition to include:
Equity, as defined by the Colorado Office of Health Equity, is:
Equity and community engagement are then paired because you cannot do community engagement without addressing equity and you cannot address equity without doing community engagement. The Colorado Equity Action Guide challenges the CHA/PHIP process to empower communities and to "lift up community-identified needs and solutions." Conducting cyclical assessment, planning and implementation processes can become a way to both "educate and mobilize" your communities. Seek out and build relationships with community champions and community organizers to inform community engagement efforts and data collection.
You and your partners are strongly encouraged to engage community members' lived experience along with traditional data sources to get the reasons for and solutions to equity based health issues.
Furthermore, the Colorado Core Public Health Services and Capabilities operationalizes health equity and social determinants of health in the following capability definition:
To do this work, you need quality engagement practices delivered in culturally and linguistically appropriate ways in order to listen, learn and act. These practices will then provide a foundation to collect data, make decisions, provide leadership, and ultimately inform how you will tell the health story of your communities, county and region.
By engaging in a variety of stakeholders throughout the CHAPS process in an intentional and thoughtful way, you can ensure that your assessment and plan reflects your community's voice and priorities. Without their involvement you may miss aspects of their lived experience which shed light on potential root causes and local solutions that may not otherwise appear in your data collection processes or in the literature. With increasing efforts to address the root causes of your community's health issues in addition to addressing current conditions, their voice is evermore important.
There are many resources on how to go about engaging stakeholders, conducting community engagement and thoughtfully using the results of your engagement (new partnerships, data collection, etc.). Here are a few recommendations:
Use engagement to advance equity.
Use best practices
Apply what you've learned
Link with other community initiatives
With a focus on equity, engagement and a diverse set of stakeholders comes alignment with other health initiatives that are likely occurring within your community. The public health agency's role as leader and convener of this stakeholder process will promote local alignment of priorities, strategies and resources to improve community-driven focus areas.
An initial meeting with these entities can determine whether they're collecting data that can inform your assessments and whether the issue and work they're championing can be supported through the public health improvement process. For example, the local hospital may be mandated to also conduct a community health assessment under the Affordable Care Act. Also, there may be community coalitions that are organized around a particular health issue, determinant of health (e.g., housing, transportation) or population (e.g., seniors/adolescents) that can contribute to or join your process.
True to the Public Health 3.0 "chief health strategist" role, this ongoing effort will result in partnerships building opportunities that may not have been imagined otherwise. Including a variety of perspectives and efforts are necessary in order to tell the lived health story of your community, county or region. It is also essential to addressing health inequities and addressing them with meaningful, locally developed solutions.
Enter into community engagement with an open mind and respect that you may not know what you do not know. Because of this, it can be helpful to use an objective tool that facilitates the process of understanding what you and your partners know, what you need to learn, and where you can learn it from.
Here are two equity assessment tools that can get you started:
The assessment tools will be useful again in the development of the community health assessment (Phase 3), capacity assessment (Phase 4) and public health improvement plan (Phase 5).
Based on the results of your community engagement discussions and assessments thus far, assess the need to develop community engagement and equity skills to carry out this work as well as what resources you will need to sustain ongoing engagement with stakeholders throughout the CHAPS process. Reference the Colorado Office of Health Equity's Measuring Performance to Advance Equity for indicators that you can use to design a process and support your stakeholders so that you can achieve equitable outcomes.
Questions to consider:
This type of engagement and with who will depend on the level and type of expertise you need to incorporate into the process. With your advisory group, identify the points at which it would be most helpful to engage stakeholders in your process and consider your community capacity for managing engagement efforts.
Local customization of community engagement techniques is the key to making them work. While some of your stakeholders, such as advisory group members, will play a consistent role throughout your process, others may engage only at specific times. Also, consider any differences in power or communication skills among your stakeholders and explore ways to ensure that each participant has an equal voice in any given process. It is also very important that all stakeholders have a role that's purposeful, specific and defined, and that their time and contributions are recognized and celebrated.
When to involve stakeholders depends on the role they'll play and those associated activities. The scheduling of stakeholder activities will be driven by the timeline of your overall project and the related outputs and milestones.
You will know who you need to involve in this process. However, as public health works to address evermore complex health issues and the social determinants that influence health, consider this recommended list of potential stakeholders.
Impact the leading causes of disease, injury, disability and death and/or the greatest health risk to our community?
Represent populations that should be assured a voice in the process?
Provide lived experience with the issue we are working to address?
Adapted from CHAPS 1.0 and PHAB reaccreditation requirements.
Stakeholders will be engaged throughout the process, so while they all don't need to be contacted immediately, it will be good to have a plan for who gets contacted when, in what manner, and by whom. Here are general recommendations:
Potential stakeholders will need to understand the "why" behind your work in order to find shared beliefs and values that would motivate engagement. Learn more about messaging and communication, especially around complex issues such as housing and mental health at the FrameWorks Institute. The County Health Rankings and Roadmaps Action Center also provides concrete tools and resources to develop sound communication plans.
Your recruitment will be more successful if you determine the best method of making contact, instead of a one-size-fits-all approach. So, while some of the "usual suspects" may agree to participate after simply receiving a letter or email, you may get better results from other stakeholders, especially those who are new or deemed absolutely essential, through a face-to-face meeting.
The health of a community is influenced by a number of factors, not all of which are under the public health agency's control. For some issues, other community entities may be in a better position to carry out strategies that improve the public's health. Learn more about addressing social determinants of health and how to create effective messaging from resources like the Colorado Office of Health Equity.
This approach can also help you negotiate the type of participation by specific stakeholders. For example, if an organization's leader can't commit to regular meetings, ask her or him to delegate a representative and see if she or he would agree to serve as a subject matter expert. This will keep her or him engaged, even if she or he can't participate in an ongoing manner.
When engaging stakeholders for the first time, it will be particularly important to define expectations such as their role, time commitment, level of decision-making authority, how communication will occur, and intended outcome (e.g., a public health improvement plan). Many times, community members are overextended and may be reluctant or unable to participate in one more local effort. Providing them with a well-defined role, timeline and a vision of the outcome communicates your resolve to getting things done.
Some stakeholders may "wear many hats" within the community and be involved in many volunteer and community efforts. Be mindful of this challenge and use it to inform how often they are engaged, in what methods or mode, and why. Hone in your facilitation skills to be the most efficient with their time.
LPHAs are more commonly including aspects of communities or partners engaged, how often and in what ways in the action plans so that this effort is done in tandem with key activities to address the priority issue. Action plans are discussed in Phase 6.
Determine if additional stakeholders would benefit the process. This may occur through mechanisms such as:
New stakeholders may be added at any time. If new members are added to the advisory group, consider providing them with an orientation before their first meeting. Likewise, stakeholder positions may change individuals, such as county commissioners and leadership positions. Do your due diligence to get them up to speed so that you can maintain institutional knowledge in the process and incorporate the expertise and insights that a new individual will bring to the process.
Throughout the process, use a positive engagement strategy to acknowledge the contributions of all your partners and invite them to celebrate the achievement of milestones. A key part of the celebration is to acknowledge progress. When any milestone is reached, establish or maintain an ongoing communication mechanism to keep them informed and engaged to the degree that's appropriate for their role and level of interest.
The CDC cites common and instructive guiding principles of a community health assessment process. As you prepare for the process or reflect back on engagement, look at how many are tied to meaningful community engagement of diverse stakeholders.
- From Principles to Consider for the Implementation of a Community Health Needs Assessment Process (June 2013), Sara Rosenbaum, JD, The George Washington University School of Public Health and Health Services, Department of Health Policy.