Audit of DHCS Health Promotion Interventions 2004 05

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Description

An Audit of Health Promotion Interventions 2004/05 in the four Northern Territory Department of Health and Community Services program areas of Alcohol and Other Drugs, Mental Health, Preventable Chronic Disease and Child and Family Health. Prepared by Paula Convery Health Promotion Strategy Policy Officer March 2005 BACKGROUND In order to progress health promotion reform following the DHCS restructure of 2003 an audit of current DHCS health promotion interventions was proposed. The audit was planned as part of the Health Promotion Evidence in Policy and Practice Project (HPEiPP), a project developed following the restructure and endorsed by the CEO, whose primary aims are to improve coordination and effectiveness of DHCS health promotion interventions through increased use of evidence. HPEiPP is focused on the key program areas of Alcohol and Other Drugs, Mental Health, Preventable Chronic Disease and Child, Youth and Family Health. The aim of the audit is to profile the status of health promotion interventions across these four key program areas. Figure 1 illustrates the context of the audit within the HPEiPP project. Figure 1: The place of the health promotion interventions audit in integrating Health Promotion Evidence into Policy and Practice. Appraisal/audit ofprogram interventions Research Gaps What works, what doesn’t Policy & ...

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• Publié par: Enku
• Nombre de lectures: 19
• Langue: English

Extrait

                                              An Audit of Health Promotion Interventions 2004/05   in the four Northern Territory Department of Health and Community Services program areas of Alcohol and Other Drugs, Mental Health, Preventable Chronic Disease and Child and Family Health.  

        Prepared by Paula Convery Health Promotion Strategy Policy Officer March 2005

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BACKGROUND     In order to progress health promotion reform following the DHCS restructure of 2003 an audit of current DHCS health promotion interventions was proposed. The audit was planned as part of the Health Promotion Evidence in Policy and Practice Project (HPEiPP), a project developed following the restructure and endorsed by the CEO, whose primary aims are to improve coordination and effectiveness of DHCS health promotion interventions through increased use of evidence.   HPEiPP is focused ental Health, Preventable Chroni   The aim of the audi s across these four key program areas. Fig P project.     Figure 1: The place  Evidence                                                     Information from this audit will be used to help determine best practice, health promotion interventions, in the NT and will form the basis from which the integration of health promotion evidence into policy and practice will be progressed by the Health Promotion Evidence in Policy and Practice Project.    

 

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The aims of the audit are to:   • Identify and describe current health promotion interventions in the program areas of Alcohol and Other Drugs, Mental Health, Preventable Chronic Disease and Child, Youth and Family Health; • Identify effective health promotion interventions in these program areas • Identify areas of duplication and gap in the delivery of health promotion interventions across the four priority program areas • Provide tools/mechanisms to assist program decision-making around the implementation of health promotion interventions.   This project does not aim to provide a comprehensive audit of all programs and activities relevant to health promotion within DHCS program areas other than those mentioned or beyond DHCS. However the process of im lementin this audit can rovide a framework for the conduct of audits in the future. The ne of initiative but will form part of a rep n policy and practice.     Project Plan dev   A comprehensive steps involved in   Table 1: Steps i Defining health pr • Identificatio • Exploration   Key stakeholder e • Identificatio • Establishme • Meetings wi   Development of information dissemination strategies • Development and maintenance of Health Promotion Strategy website • Preparation and submission of articles for the Chronicle • Preparation and delivery of presentations regarding the project -Preventable Chronic Disease Workshop -Dimensions in Health Care National Casemix Conference Sydney -Australian Physicians Workshop    Establishment of links with national and international experts • Department of Human Services Health Promotion, Victoria   • Health Development Agency UK • Public Health Research and Evaluation Group •      Endorsement of audit implementation plan by Steering Committee   • Monthly steering group meetings   Final endorsement of audit implementation plan •  

 

ress of this project. The le 1. ions                             September 2004 October 2004 October 2004                   November 2004

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Direction of the audit   A Steering Committee set up to guide and advise the Health Promotion Evidence in Policy and Practice Project, provided direction on all aspects of planning and conduct of the audit including determining the role of the audit in the overall HPEiPP project. The Steering Committee, chaired by the Director of Health Development and Oral Health, is comprised of a range of experts. These include the Directors of the four key program areas, the Principal Medical Officer, representatives from the Cooperative Research Centre for Aboriginal Health (CRCAH), Menzies School of Health Research (MSHR) and DHCS Top End and Central Australia. A list of Steering Committee members is provided in Attachment 1.   To facilitate conduct of the audit, a Working Group was convened consisting of representatives from the 4 key program areas, representatives from the Menzies School of Health Research Audit and Best Practice o tion Strategy Policy Officer conducting   • define the infor • devise an audit • develop an imp • facilitate inter p   Members of the Au     DEFINING HE   It was anticipated t hen conducting an audit of health pro en with previous projects. Investigat n found the most useful framework, for the Human Services, Health Promotion, Victori categories of activity defined as health promotion. Table 2 outlines these categories. Evidence suggests that a combination of these is most effective.     Table 2: Health Promotion Interventions I NDIVIDUAL FOCUS  P OPULATION FOCUS Screening, Health Health Public Community Organisational Policies and individual risk information education education development development structures assessment and and   immunisation marketing    medical approach                                      behavioural approach                                                                                                 socio-environmental approach     From: Health Promotion, Department of Human Services, Victoria.      

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This framework was easily understood by staff involved with the project and provides a workable definition of health promotion. A full range of resources associated with the DHS framework is available on their web site -http://www.health.vic.gov.au/healthpromotion / .   The distinction has previously been made between opportunistic and planned health promotion (DHS, 2003). Opportunistic health promotion is undertaken as part of best practice service delivery during Primary Health Care consultations or sessions. Planned health promotion, the subject of this audit, involves health promotion projects over the longer term. This distinction would indicate that parallel, but necessarily different, processes are required to maintain the quality of both components of health promotion.   The focus of this audit is then planned health promotion projects currently being conducted by the 4 key program areas of Alcohol and Other Drugs, Mental Health, Preventable Chronic Disease and Child, Youth and Family Health.     METHODOLOGY     Development of an audit tool   A range of existing audit tools for collecting information on health promotion interventions were identified and these were used to begin discussions on the scope of information to be collected and proposed methodology rs and the Audit Working Group, the St n (Attachment 3) and an audit tool (Atta   The key information id the implementation plan:   • The range of health   Demographics of t • • Specific outcomes • Positions of the sta • Reason why interv • Types of activities • Number of interve • Number of interve • Types of systems i • Areas of duplicatio   The location of this key information in this report is outlined in attachment   Information Collection     Following consideration of a variety of methods for collecting information, a process, outlined in the audit implementation plan along with amendments resulting from a pilot, was devised by the

 

 interventions    ieved or not

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Working Group and endorsed by the Steering Committee. This process involved preparing Program staff by sending background information on:   • the background to the audit, its purpose and outcomes; • details of the type of information required; • information on the HPEiPP project; and • DHS information providing definitions of health promotion for the purpose of the audit.   Meetings with Program teams, where the audit tool questions and the DHS range of interventions would be used as a focus for staff to identify details of health promotion interventions. Two of the program areas felt that staff meetings would be an appropriate avenue for collection of information and the other two program areas suggested meeting with specific program staff responsible for particular interventions.   A pilot meeting to implement the audit tool was held with the Child, Youth and Family Health team. Approximately 15 staff attended the meeting. Using the process developed detailed information on only one health promotion intervention was collected. This pilot identified the following problems with the tools and process:   • staff had many issues they wanted to raise that were unrelated to the audit • the audit tool had too many questions • there were a large number of staff at the meeting • discussion of each DHS health romotion activit enerated lar e amounts of discussion.   As a result of this meet he audit tool was refined and converted t of questions designed to gather the rmation collected would be categorised u otion Strategy Policy Officer after the meetings would be used to identify interve sponsible for them. The Health Promotion t information about the interventions and t   A range of options for survey, a survey of all     Coding of informatio   Where necessary infor sis. Categorising and coding of information otion Strategy Policy Officer which ensured consistency.   Data entry   Information collected by the audit was entered onto a Microsoft Excel spreadsheet that was also used for data analysis.  

 

ing a web based

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Information accuracy   In order to ensure that information collected was accurate following data entry the information from each program area was sent, on an Excel spreadsheet, to the Program Directors to clarification and comment. One person commented that it was difficult to use the spreadsheet to look at the information. On further exploration it was found the difficulty was related to the columns that reflected the categories of DHS interventions. An explanation of this resolved the problem. Feedback from program directors was positive and avenues for clarification of information were identified and followed up.   Limitations of this audit   As explained previously this project has drawn a distinction between opportunistic and planned health promotion. Auditing opportunistic health promotion is beyond the scope of this project. Given that health promotion is core business for DHCS staff and assuming, given the DHCS structure, that a large part of this will be opportunistic health promotion there is a clear need for strategies to ensure the quality of this service. One approach might be to adapt and apply an audit tool such ACIC, currently used by the Menzies ABCD project for auditing and enhancing best practice in chronic disea   Despite improvements in ntacting DHCS personnel over long dist f are contactable by e-mail, telephone and that has been missed as a result of staf formation about the project will have vari formation relevant to the project may not ha stralia and East Arnhem.   The audit has focussed o 4 key program areas of Alcohol and Oth nd Child, Youth and Family Health. It ma to these program areas being conducted th it. For example Family and Childrens S s that overlap or are duplicates of interve th. This project did not have the capacity to i ilable on the Health Promotion Strate ntify interventions that relate to their area.   This audit has not collected information on health promotion interventions conducted by Non Government Organisations or by Northern Territory Government Departments other than Health.   Despite these limitations the project has set out a clear process that can be used to collect this information if desired.

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RESULTS   Number of health promotion interventions   Thirty-three health promotion interventions were identified as being conducted by the four program areas that participated in the audit, Alcohol and Other Drugs, Mental Health, Preventable Chronic Disease and Child, Youth and Family Health. A list of the interventions is provided in Attachment   X . The amount of information collected on the interventions varied from comprehensive for most interventions to nil for two interventions.   Figure 2 shows the number of interventions conducted by each program area. Only one intervention was defined as a cross program initiative, conducted by Alcohol and Other Drugs and Mental Health, although, as information on who delivers the interventions indicates, there are interventions delivered by staff from more than one program area.   Figure 2: Number of health promotion interventions by program (n 33).   =

Darwin Urban Top End Katherine Central Australia Urban Central Australia Remote Nhulunbuy East Arnhem

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Fifteen (15) are conducted on an NT wide basis. Of the remainder, 8 are conducted in either the Top End (4) or in Darwin Urban (4). Only two have been identified in Central Australia remote and none identified in Nhulunbuy or Central Australia Urban. This may reflect the difficulty in collecting information on interventions in these areas or it may be that the NT wide interventions are the sole health promotion interventions covering these areas and that none have been developed specifically for these locations.   Health issues addressed by health promotion interventions   The health issues addressed by health promotion interventions in the four program areas are very varied. Categorising these proved extremely difficult so the groups are small and the number of categories large. All health promotion interventions conducted are very specific to the program areas for example all the health promotion interventions conducted by PCD are targeted at chronic disease issues. Table 3 outlines the wide range of health issues addressed.   Table 3: Health issues targeted by program interventions Growth 3 Parenti 1 Skin he 1 Chroni 2 Chroni 4 Comm 2 Wome 1 Mental 3 Mental 2 Client 2 Suicide 1 Alcoho 1 Drug u 3 AOD i 2 AOD c 1 Drink driving 1 Smoking 2

      Target populations   Figure 4 outlines the target populations for health promotion interventions for all four program areas. In some cases interventions target more than one population group. Information was not available on the target group for 3 interventions. No interventions are targeted to older adults and 50% are targeted at adults in general.

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  Figure 4: Population target groups for health promotion interventions Infants/Prschoolers 3% 8% Mothers 18% 5% Child& Adol to 16 yrs 5% Young adults>16 3% Adults Older adults Carers and NG workers Health Prof's Other  

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    Table 4 outlines the o ulation tar et rou s in more detail b ro ram area. The large number of interventions targ defined as being targeted at the general pu ve been included in the adult category. Si targeted for rural and/or remote populatio   Table 4: Populati   P OPULATION T ARGET G ROUPS   AOD MH PCD CYF   Infants & preschoolers → 5 yrs  3 Mothers  2 Child and adolescent school age  1 1  children 5-16 Young adults > 16 yrs  1 Adults 8 4 4  Men 1  Women 1 Older adults      Carers and non govt workers  2 1 Health professionals 1 4 1   Other  1 ∗   Total 9 7 12 8        Rural/Remote specified 1 2 5 8 ∗   Community   identified target group     Major outcomes expected as a result of interventions   Information was collected on the major outcomes expected from the health promotion interventions. Two of the 33 interventions do not specify an expected major outcome as a result of the intervention. Thirty one interventions have specified one or more major outcomes 17 of these have

 

        1     1   2     -

3 (8%)   2 (5%)   2 (5%)   1 (3%)   19 (50%)     3 (8%)   7 (18%)   1 (3%)   38   16

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specified a second major outcome and 10 of these have specified a third major outcome. Major outcomes were categorised as outlined in Figure 5 showing the number of expected outcomes by category for each program area.   Figure 5: Major outcomes expected as a result of interventions by program (n=58).   7 6 5 4 3 2 1 0

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  All expecte generally br contributin   Who delive   The audit p S health promotion interventio ntions in the 4 key program areas invol red by 1 or more staff from the relevant pro ered by program staff in conjunction with staff from another program. This is interesting given the identification of only one (3%) intervention of 33 as a cross program intervention. This would suggest more cross program interaction than is being acknowledged. Seven (21%) of the 33 interventions are delivered primarily by Aboriginal staff. Nine (27%) of the interventions have a person with health promotion training in a lead role.      

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