Safe States Alliance

State and territorial health agencies can optimize programmatic funding through braiding and layering strategies. The Commonwealth Healthcare Corporation, a territorial health agency located on the Pacific Island of Saipan, Commonwealth of the Northern Mariana Islands (CNMI), restructured its Non-Communicable Disease Bureau into 4 new units. Existing funding streams were braided and layered to support the restructuring. A shared vision of strengthening crosscutting connections to improve population health outcomes helped guide the restructuring process. Vision planning with leaders and funding partners, establishing buy-in within agency and external partners, and assessing immediate impacts were a few of the steps taken by the agency to ensure a successful restructuring. The immediate impact of the restructure has been positive. In both the CNMI and select states that have undertaken similar efforts, braiding and layering funding has facilitated more streamlined processes, coordinated approaches across programs and funding partners, and provided deeper levels of trust in partnerships. Although it is still too early to draw long-term assessments in the CNMI, the agency projects that coordinated funds will strengthen its foundational capabilities and promote a more community-centered, collaborative, and effective approach to public health. Restructuring the Non-Communicable Disease Bureau through braiding and layering funds gives the agency the flexibility it needs to more effectively address the social determinants of health and local population health priorities through a client-centered approach, ultimately improving health outcomes for the commonwealth. The agency experienced several challenges throughout the restructuring process that offer lessons learned for addressing effective health financing. For example, ample time is needed at the beginning of the braiding and layering process to establish policies and procedures for efficient accounting, documenting, and reporting. In addition, ongoing support and training opportunities for programmatic teams can smooth out the transition from siloed to braided and layered funding structures. These lessons, in addition to key elements mapped out by experienced state health agencies, can guide and prepare other agencies interested in implementing innovative funding mechanisms.

Background: Public health practitioners, including injury and violence prevention (IVP) professionals, are responsible for implementing evaluations, but often lack formal evaluation training. Impacts of many practitioner-focused evaluation trainings—particularly their ability to help participants successfully start and complete evaluations—are unknown. Objectives: We assessed the impact of the Injury and Violence Prevention (IVP) Program & Policy Evaluation Institute (“Evaluation Institute”), a team-based, multidisciplinary, and practitioner-focused evaluation training designed to teach state IVP practitioners and their cross-sector partners how to evaluate program and policy interventions. Design: Semi-structured interviews were conducted with members of 13 evaluation teams across eight states at least one year after training participation (24 participants in total). Document reviews were conducted to triangulate, supplement, and contextualize reported improvements to policies, programs, and practices. Intervention: Teams of practitioners applied for and participated in the Evaluation Institute, a five-month evaluation training initiative that included a set of online training modules, an in-person workshop, and technical support from evaluation consultants. Main Outcome Measure(s): The successful start and/or completion of a program or policy evaluation focused on an IVP intervention. Results: Of the 13 teams studied, a total of 12 teams (92%) reported starting or completing an evaluation. Four teams (31%) reported fully completing their evaluations; eight teams (61%) reported partially completing their evaluations. Teams identified common facilitators and barriers that impacted their ability to start and complete their evaluations. Nearly half of the 13 teams (46%) – whether or not they completed their evaluation – reported at least one common improvement made to a program or policy as a result of engaging in an evaluative process. Conclusion: Practitioner-focused evaluation trainings are essential to build critical evaluation skills among public health professionals and their multidisciplinary partners. The process of evaluating an intervention—even if the evaluation is not completed—has substantial value and can drive improvements to public health interventions. The Evaluation Institute can serve as a model for training public health practitioners and their partners to successfully plan, start, complete, and utilize evaluations to improve programs and policies.

Across the U.S., states have adopted Complete Streets legislative statutes—state laws that direct transportation agencies to routinely design and operate roadways to provide safe access for all users, including pedestrians, bicyclists, motorists, and public transit users. To date, there has not been a systematic and comprehensive analysis of the content and provisions of these laws. In this study, Complete Streets state statutes were identified using legal research databases. Using established legal mapping methods, a qualitative analysis was conducted of state laws that were effective through December 2018. A codebook and open-source data set were developed to support the public use of the data. Eighteen states and Washington, DC, have adopted Complete Streets legislative statutes. A total of 21 have been adopted, with 76% (n=16) of laws adopted since 2007. While the laws vary in content, detail, and specificity, several common provisions were identified across statutes. Complete Streets legislative statutes may be essential to ensure that road networks throughout states are safe, connected, and accessible for all users. This study provides key insights into the legislative landscape of Complete Streets state laws and makes available a new data set that can support future evaluations of these laws.

For most programs, whether funded through governmental agencies or nongovernmental organizations, demonstrating the impact of implemented activities is vital to ensuring continued funding and support. Program evaluation is a critical tool that serves the dual purpose of describing impact and identifying areas for program improvement. From a funder's perspective, describing the individual and collective impact of state-based programs can be challenging due to variations in strategies being implemented and types of data being collected. A case study was used to describe the actionable, mixed-methods evaluation of the Core Violence and Injury Prevention Program (Core VIPP), including how the evaluation design and approach shifted to address evolving challenges faced by award recipients over time. Particular emphasis is given to innovative methods for collecting, analyzing, and disseminating data for key state and federal stakeholders. The results of the Core VIPP evaluation showed how this funding played a vital role in building injury and violence prevention capacity in state health departments, leading to a decrease in both intermediate and long-term outcomes. The lessons learned through the mixed-method evaluation of the Core VIPP informed the structure of the subsequent funding cycle (Core SVIPP) to include more prescriptive requirements for evidence-based implementation and a state support team structure for delivery of training and technical assistance.

In the present study, we assess the effects of the Expect Respect Support Groups (ERSG) on frequency of teen dating violence (TDV) and general youth violence. ERSG is a school-based violence prevention program for youth who have been exposed to violence in their home, school, or community. Boys and girls (N=1,678, Mage=14.3, S.D.=1.7, Range = 11–17) from 36 schools in Texas participated in this accelerated longitudinal (7-year trajectory) study beginning in 2011. Latent growth curve analyses were conducted using three waves of data from three cross-sectional cohorts of adolescents. Among boys, the number of ERSG sessions attended related to incremental declines in psychological TDV perpetration and victimization, physical TDV victimization, sexual TDV perpetration and victimization, reactive aggression, and proactive aggression. Girls attending ERSG demonstrated reductions in reactive and proactive aggression. The present findings suggest ERSG may be an effective cross-cutting strategy to reduce TDV and other forms of violence among high-risk boys and possibly girls. This information provides valuable understanding of TDV and youth violence in high-risk populations and may be useful in tailoring future prevention efforts to different groups of teens.

Despite the growing recognition of violence as a public health issue, public health involvement in violence prevention remains limited. According to the Prevention Institute, there are a number of roles and skills sets that public health can bring to the table in preventing violence, including measuring the problem and progress in addressing it; coordinating the range of needed efforts; and building capacity among multiple players to prevent violence. In addition, public health professionals can develop data-informed strategies and serve as an invaluable advocate for the prevention of violence. During this session, the Safe States Alliance (formerly the State and Territorial Injury Prevention Directors Association) will share recommendations from an expert roundtable meeting held on 13 April 2010 to clarify and prioritise the roles of national, state, and local public health departments in preventing violence.

The goal of the Safe States Alliance's (formerly the State and Territorial Injury Prevention Directors Associations – STIPDA) Poison Injury Surveillance Workgroup (ISW) is to promote better surveillance around poisoning in our states and nation with an emphasis on drug poisonings. In order to do that the ISW is developing a framework for states and national-level organisations to use that includes: a conceptual definition of all types of poisoning that differentiates by type of exposure, and where possible, by intent, chronic and acute; poisoning surveillance and risk factor data sources at the national and state level; and an operationalised definition for drug poisoning using International Classification of Diseases (ICD)9-CM and ICD-10 for as many poison data sources as possible. The Workgroup developed a proposed conceptual definition of a poisoning: an exposure to a synthetic chemical or a naturally occurring plant, animal, or mineral substance resulting in at least one related, adverse clinical effect. The Safe States Alliance's Poison ISW is composed of approximately 15 members from private, state, federal and national organisations. Each member brings a unique perspective to poison surveillance and years of experience. The Poison ISW will continue to meet throughout 2010 to improve overall poisoning surveillance and develop a consensus report.