What CCHE is learning

CCHE takes a developmental approach to evaluation,  to help community health initiatives evolve and improve

We present evaluation findings in formats to engage a variety of audiences, including reports, presentations, videos, webinars, infographics, and peer-reviewed journal articles. Whenever we can, we share our results to build the fields of both evaluation and community health improvement.

Lessons from the California safety net on managing cardiovascular risk during a pandemic

PHASE (Preventing Heart Attacks and Strokes Everyday) and TC3 (Transforming Cardiovascular Care in our Communities) supported safety net organizations in providing care for their patients at risk of cardiovascular disease (CVD) and cardiovascular events. Funded by Kaiser Permanente Northern California and Southern California Community Health, respectively, the two programs supported organizations through quality improvement coaching, expert webinars, and a learning collaborative for peer sharing of successes and challenges.

HomeBPmonitor_300x200.jpg When the COVID-19 pandemic hit the state in March 2020, PHASE and TC3 grantees needed to quickly pivot and innovate how to deliver care in a vastly different environment. The implementation of COVID-19 safety protocols had immediate effects on organizations’ ability to do chronic disease management generally and CVD risk management specifically, because patients were not able to come in for office visits. CCHE’s evaluation of the two programs highlighted how these organizations were able to virtually manage patient populations at high risk for cardiovascular events, how they pivoted care within the limits of their existing capacity, and how the learning collaborative contributed to their success.

Learn more: Read CCHE's evaluation report

Community ambassadors have a positive impact on safety net clinic and patient outcomes

Matthys-Palazzo-community-clinics-ambassador-program_1col.jpgThe Community Ambassador Program (CAP)—is a unique partnership launched in 2011 in the Kaiser Permanente Mid-Atlantic region. The region’s Community Health program and Kaiser Permanente’s Labor Management Partnership placed the “ambassadors,” who are Kaiser Permanente nurse practitioners, midwives, and physician assistants, into safety net clinics throughout Virginia, Maryland, and Washington, D.C. These practitioners brought their skills and expertise, including Kaiser Permanente’s clinical best practices, to those sites. The overall goals of the program included increasing clinic capacity and improving access and quality of care for underserved populations.

In 2018, CCHE worked with Kaiser Permanente Mid-Atlantic States staff to evaluate the impact of CAP through a retrospective analysis of clinical data and stakeholder interviews that included community ambassadors, clinic staff, and clinic leaders. We found that the ambassadors are having an overall positive impact on clinics and patient outcomes.

Read more in the KPWHRI Healthy Findings blog and our Permanente Journal paper.

CCHE shares lessons about clinical screening for ACEs 

We now know that trauma early in life can have a significant impact on an individual’s health and wellness throughout their life. As a result, health care organizations are beginning to focus on providing more trauma-informed care, or care where all parties involved recognize and respond to the impact of traumatic stress and resiliency factors on children, caregivers, and service providers. Screening for adverse childhood experiences (ACEs) in pediatric clinical settings promotes early intervention and can be a tangible entry point for organizations interested in providing trauma-informed care.

Girl+Doctor_300x170.jpg CCHE is evaluating two programs that are implementing ACEs/trauma screening in pediatric settings. We have compiled findings from that work into a brief and believe learning from these two programs can provide guidance to professionals of all types that are interested in or already implementing ACEs screening.

Read CCHE's brief about ACES/trauma screening in pediatric settings

The SPARCC initiative: What we've during the first three years

CCHE has been evaluating the Strong, Prosperous and Resilient Communities Challenge (SPARCC)—a massive, three-year, $90 million initiative supporting multi-sector collaborative work focused on built environment changes in six U.S. regions. By providing grant funding, technical assistance, and access to capital in six regions, the initiative aims to build ground-up partnerships across sectors to ensure that investments in disenfranchised communities are community driven and ensure all can thrive.

SPARCC-Report_1_column.jpgSPARCC has always been about building relationships and connections. As a result, all sites developed new relationships among partners who had never worked together, with most sites establishing or strengthening formal collaborative structures. Since its formation, SPARCC has had an ambitious goal—help shift decades of racial discrimination in housing and community development, affecting equity, health, and climate resilience. Over its first threee years, the SPARCC initiative has strengthened its emphasis on racial equity over time, which brought energy, momentum, new ways of working, and new partners to the collaboratives. 

The SPARCC evaluation is funded by the Robert Wood Johnson Foundation. Read CCHE's SPARCC evaluation report with lessons from SPARCC'S first three years.

California clinics build capacity

MobileHealth_300x170.jpg The Sierra Health Foundation asked CCHE to evaluate the effectiveness of its Clinic Capacity Building Program, launched in 2013 as part of the Sacramento Region Health Care Partnership.

The goal of the program was to strengthen community health centers’ capacity in response to anticipated patient population growth after implementation of the Affordable Care Act. The number of high performing federally qualified health centers in the region was expected to increase through improved clinic leadership, care quality, and financial sustainability.  

The evaluation found that the Sierra Health funding gave health centers the flexibility to respond to increased demand created by health care reform and the expansion of Medi-Cal. During the past two years, all of them served more patients, expanded their workforce, increased clinic efficiencies, and implemented care innovations.

Learn more: Read CCHE's evaluation report

How do communities participate in HIAs?

Health impact assessments (HIAs) are evidence based analyses that predict health benefits and risks and inform decisions on policies and projects related to land use, transportation, housing, energy, agriculture, and other sectors. HIA practitioners place high value on increasing participatory democracy, empowering communities, and decreasing health inequities.

CCHE partnered with Oakland, California-based Human Impact Partners to find out how community members participate in HIAs and what outcomes this participation leads to. The study, funded by the W.K. Kellogg and Kresge foundations, included a national survey of completed HIAs, an in depth study of four HIAs in progress, and a literature review. SafeRoutesToSchool_300x170.png

The evaluation found there are compelling benefits of engaging communities in conducting HIAs, including increased civic agency and increased HIA success. The findings are intended to inform the work of HIA practitioners, but are relevant to all who are interested in authentic community engagement as part of policy, program, or planning processes.

Learn more: Read results of the evaluation, released January 2016.

Creating leaders  for healthier communities

NLAPHteam_300x170.jpgCCHE is evaluating the National Leadership Academy for the Public’s Health (NLAPH), a one-year applied leadership training program for cross-sector teams throughout the United States. Teams like the Design 4 Active Sacramento group shown at right engage in action learning projects to improve community health and achieve health equity. NLAPH was funded by the Centers for Disease Control and Prevention and is led by the Public Health Institute’s Center for Health Leadership and Practice.

The Robert Wood Johnson Foundation commissioned an expanded evaluation to assess the longer-term impact of NLAPH on development of critical leadership capacities and the impact on community health. CCHE found that NLAPH strengthens practitioners’ ability to work in cross-sector teams to tackle complex population health issues and that the teams’ action learning projects benefit community health.

The Kresge Foundation also asked CCHE to conduct an expanded evaluation to explore critical leadership competencies and learn how programs like NLAPH contribute to their development. CCHE’s evaluation found that competencies fell into three broad categories: prerequisites and characteristics, collaborative ability—the area where participants showed the most growth, and skill building, and that leadership programs are most effective when they are well aligned with intended outcomes and the target audience.

Read results of the NLAPH evaluations:

Getting to a healthy dose

FarmToSchool_300x170.jpg Over the past several years, CCHE has been working with colleagues at Kaiser Permanente and the University of California Berkeley to figure out how communities can implement strategies that have a greater impact, or "dose."  The dose measure takes into account the number of people touched by a strategy—or reach—plus the estimated strength of the strategy.  

To help evaluators and community practitioners use the dose method in their work, we've created Healthy Dose: A Toolkit for Boosting the Impact of Community Health Strategies.  You can download the toolkit, which includes an interactive guide with an overview of the methodology, a "dose calculator" that helps users plan strategies, and a PowerPoint presentation that introduces audiences to the dose concept. 

Do health impact assessments make a difference?

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Health impact assessments (HIAs) are evidence based analyses that predict health benefits and risks and inform decisions on policies and projects related to land use, transportation, housing, energy, agriculture, and other sectors.

CCHE conducted a three-year evaluation to assess the impact of HIAs in the United States and identify elements critical for success. The study, funded by the Robert Wood Johnson Foundation, included site visits and interviews with 166 practitioners, stakeholders, and decision makers for 23 completed HIAs in 16 states, as well as a web-based survey of 144 HIA practitioners.

The evaluation found that HIAs contribute to the decision-making process and help achieve policy outcomes that are better for health.  The evaluation team also identified opportunities to advance the HIA field in the areas of stakeholder and decision maker engagement, dissemination, and follow-up.

Lean more: Read CCHE's evaluation report and article in the February 2015 issue of Preventing Chronic Disease. 

Improving access to specialty care

In 2007, as a faltering economy pushed more people into the ranks of the uninsured, health care providers struggled to provide and coordinate specialty care to meet complex patient health care needs. In response, Kaiser Permanente Northern and Southern California Regions’ Community Benefit Programs and the California HealthCare Foundation (CHCF) jointly funded the Specialty Care Initiative (SCI) to find more effective strategies for providing specialty care to vulnerable populations in selected counties.

SCI primary care capacityRecognizing the need for a coordinated response across health care delivery systems, SCI required a coalition-driven approach to developing community-based solutions.

CCHE's five-year evaluation found that this approach built and strengthened relationships among safety net providers, which led to systemic changes that improved the timeliness of specialty care access, enhanced referral coordination, and increased the availability of specialty care appointments. 

Read results of the SCI evaluation and case studies about specific strategies:

View our webinar on results of the Specialty Care Initiative (November 21, 2014)

Overcoming parental vaccine hesitancy

CCHE recently concluded a three-year evaluation of the Immunity Community program, an intervention to address parental concerns about vaccine safety that have resulted in delayed or skipped immunizations. 

The program was designed by Vax Northwest, a public-private partnership formed to address vaccine hesitancy in Washington State that was implemented in two focus areas.

Parent advocateIn both areas, parent advocates (PAs) were recruited and engaged to have positive conversations about immunizations with other parents in their communities in person and via social media. For the evaluation CCHE surveyed 700 parents, conducted interviews with PAs and others, held focus groups with parents, and tracked Immunity Community website and social media traffic. 

The evaluation found that the program successfully accomplished key short- and immediate-term outcomes: Parent volunteers can be trained to be effective immunization advocates in their communities, the program raised awareness of vaccine-related issues, and parents surveyed in focus area communities are more supportive of vaccination.

For a copy of the evaluation report, please contact Clarissa Hsu


CCHE team members present findings at the American Evaluation Association 2019 annual conference in Minneapolis

I would easily put CCHE in a small group of folks who already have what is needed to guide evaluation for learning in initiatives aimed at the structure of the system.

Bobby Milstein, PhD, MPH, Director of System Strategy, ReThink Health and Visiting Scientist, MIT Sloan School of Management

Contact CCHE

cche@kp.org 206-287-2035