New Hampshire's
Align Phase

Collaboration has begun with cross-sector Community Implementation Teams (CITs) to evaluate and leverage resources, identify top priorities, and devise a plan for optimizing local prevention efforts.

This includes strategizing to align and improve existing prevention services, developing new prevention services where necessary, and tailoring prevention messaging to the unique needs of the community in focus, using a Plan-Do-Study-Act (PDSA) approach.

Plan-Do-Study-Act

PDSA rapid cycle development is an iterative problem-solving method for carrying out change.

Technical Assistance is underway to support the Community Implementation Teams utilizing PAP's PDSA prevention planning and implementation framework.

Our focus: address indicators of child maltreatment identified during the geospatial modeling process and employ high impact prevention efforts for rapid implementation and measurement.

Our First Steps:

Tools and a Framework for Selecting
High Impact Prevention Efforts

We begin with brainstorming, reflecting on the top indicators found, such as:

Elevated serum lead levels in children
Assault by bodily force
Mortality due to acute drug intoxication
Chronic opioid use in pregnant women

We consider what programs could improve these conditions or prevent them entirely while thinking about possible constraints during the brainstorming session, for example:

Limited budget
Limited labor
Need to be implemented in the next quarter

Then drawing boxes from a central focus, we create branches of potential prevention ideas:

Next, we develop an Impact Effort Matrix with four possible categories to sort potential projects:

Our goal for rapid cycle development is to focus our PDSA cycles on high-impact low-effort projects to accomplish the greatest results in the least amount of time.

We then narrow potential projects using the Needs and Assessment Maps while determining how to best leverage available resources addressing the following:

What are the current unmet needs in relation to high-needs areas?
What are the top services your organization or group can provide which could fill these unmet needs?
From the High-Impact, Low-Effort list, which potential projects are complementary to your organization's/group’s currently available resources and proximity?
Given the potential needs, where do you see gaps in your resources?
Task: Identify partners with resources to fill these gaps.
List projects that can fill needs through your combined skills, resources, and external partnerships using a Venn Diagram to visually layout our choices.

A decision matrix is our final step in selecting prevention projects for PDSA cycles:

The Matrix ranks alternative options and criteria, helping to provide groups with an independent assessment of potential programs.

Team Building: Establish a group leader who will recruit a team, develop and organize the project process, and lead the group through at least one PDSA cycle.
Team Members: Select those who are the stakeholders with experience and knowledge about the project's focus. They should be able to make key decisions or have direct access to those who do. Larger teams are not necessarily better.
Who does the team report to?

HOW

Determine what reporting should look like and the schedule it should follow. How will bottlenecks or problems be reported and addressed?
If changing an existing process, what is being done differently?
List the desired project outcome(s).
How can the process be improved?

WHAT

What information needs to be gathered to test if the project is effective?
Was the project carried out as planned per the process defined in the "HOW" step?
What was achieved? Be specific.
Is another PDSA cycle warranted? If so, should the team remain the same?

Hypothetical PSDA Example

Plan

Goal: Educate K-6 children on the dangers of lead in drinking water and advise on best practices.
Hypothesis: Children are not educated on the dangers of lead in their water.
Plan: Have trainers approach local school districts to present to children on the subject of lead in drinking water through assemblies or at the classroom level using a virtual platform and test current knowledge.

Do

Experienced trainers provide a 30-minute session about the dangers of lead and how to handle challenges with consumption and possible family bias. Trainers visit classrooms (in person or via streaming video) at least once to observe, provide support, and encourage implementation. Administer short quiz to students. Use polling tools if online.

Study

After 3 months, measure the number of children engaged with and scores of lead-awareness quizzes. After 6 months, visit the same classrooms again, re-administer the same quiz and compare results.

Act

Determine if the desired outcome was achieved - Goal: 1200 children visited over 3 months with 50% increase in quiz scores.
Goal met – expand the message to older children / more children.
Goal not achieved – determine a new plan with school district input and implement cycle again.

Lastly:

An Alignment Guide for Leading Community Engagement

Identifying Stakeholders

An important step of the Align Phase is gathering organizations that work on the prevention of child maltreatment, or an outcome related to child maltreatment, to collaborate on amplifying shared prevention concepts, programs, etc.

To achieve multidisciplinary and cross-sector representation, we recommend community teams recruit at least one expert from each of the following relevant categories.

Child Care
Child maltreatment fatality
Child maltreatment
Disability services
Domestic violence
Elder abuse
Foster care
Homelessness
Homicide/police department
Illicit drug use
Infant mortality/Premature Birth
Injury-related fatality
Juvenile justice
Low 3rd-grade reading proficiency
Maternal morbidity/mortality
Mental health
Poverty
Prison recidivism
Sex trafficking
Suicide
Teen pregnancy
Violent crimes

Connect with Faith-Based Organizations

Identify places of worship in the highest Needs areas and send an introductory email. Follow-up with a personal invitation to the leadership of each location to attend a virtual convening at which details about the program and findings will be shared. The goal is to recruit faith organizations to participate in prevention efforts and share prevention messaging with their congregations.

An example of an introductory email

PAP Program Guide to Alignment Meetings Sample

Considerations to discuss during Align Planning Meetings

Media Advocacy: Start to develop relationships with local media and ask if they will help share the program with the community. You will most likely want to write letters to editors and create press releases, focusing on the issue and prevention messaging needed for change as the program unfolds.
Local University Partnerships: Develop partnerships with your local university graduate programs to support program efforts. From creating prevention messaging materials to helping form community partnerships, graduate students are a fantastic resource and want to help their community. Graduate Capstone projects can be developed around program needs. This benefits the community and provides students with real-world experience.
Survey Data on Community Needs/Voice: Collect relevant existing surveys that have been completed in your community which identify the perceived needs of residents. This will help teams to ensure the voice of the community is incorporated in prevention planning.

Sample Agenda for Kick-Off Meeting

Sample Agenda for Follow-up Meeting 1

Sample Agenda for Follow-up Meeting 2

Planning Community Prevention Efforts

With our tools and framework in place, the DPHS Project Director for Community Collaborations, Data Analytics Team, and the PAP Technical Assistance Team have shared population health and safety Needs Maps with community teams and stakeholders to educate, discuss results, and answer questions.

A communication plan was developed for the Community Implementation Teams to share program details with existing and new partners.

Based on analysis results, community prevention efforts are now focused on the identified top risk factors of child maltreatment and teams are working to develop and implement prevention efforts using PDSA cycles.

The PAP analysis results are used to align, support, and further existing prevention work and establish and strengthen needs cases for new initiatives.

Needs Maps are currently being reviewed to support the following:

Foster family recruitment, improved utilization of foster homes, and reduced distance between children in foster care and placement location
Human trafficking risk group identification
Health equity initiatives
Bias prevention training
School parenting class development
Expanding mobile lab offerings and routes
Increased lead screening and resources
Education/community awareness regarding services around Lead
Early Childhood Alliance initiatives
Increased enrollment for the Woman, Infants, and Children program
Open airways / asthma -- reduce school absences due to asthma
Education health -- urinary tract infections / chronic conditions
Improved water quality
Family Resource Centers: increased enrollment and new location placement

... and the list continues to grow.

Precise identification of high needs areas within the communities provides diverse and impactful prevention opportunities.

Discovering Reach and Impact

Representing
Community Voice
in Prevention Planning

The collection and review of community survey data conducted in our program areas ensures the voice of the community is represented in prevention efforts.

Example: Southern New Hampshire Services (SNHS) provides services such as workforce and economic development, child development, education services, health and nutrition, community services, and energy assistance. This group conducted a community needs assessment in June 2020 of SNHS service recipients in Hillsborough and Rockingham counties.

Survey respondents were asked to select from a list of 17 needs which they or their family are facing and choose what they perceived as the most critical resources.

The “Family Needs” chart[1] below indicates all needs that were selected by at least 100 respondents.

The "Services Families Would Utilize if Available in the Community" chart[1] below provides an overview of the most commonly identified services respondents reported.

Survey data such as this provides insight and information for collaborations to consider and address when developing community prevention strategies.

Whenever possible, PAP recommends utilizing existing community surveys, assessments, and focus group data as just one of the many ways to remove redundancy and create efficiency in prevention planning efforts.

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New Hampshire'sAlign Phase