1 ANCHOR Partnerships ProgramThe ANCHOR National Implementation Model: Engaging Communities for Sustainable Policy, Systems, and Environment Change Laura King Hahn Sr. Program Manager ANCHOR Partnerships Program

2 Presenter DisclosuresLaura King Hahn (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose

3 Otherwise known as by CDC and our public health partners…What is ANCHOR? Accelerating National Community Health Outcomes through Reinforcing Partnerships Program Otherwise known as by CDC and our public health partners… Category “A”

4 National Organizations That Were FundedAwardee Category A: National WIC Association American Planning Association American Heart Association Category B: Society for Public Health Education Directors of Health Promotion and Education

5 Role of Category As: National Project ScopeNational awardees (American Heart Association, National WIC Association, American Planning Association) will use their annual award to identify, fund, monitor, and support two cohorts of 15 sub-recipients from among their chapters/affiliates. Selected locations (chapters/affiliates) will develop or strengthen their local coalition(s) and examine community needs assessment data. Then implement a locally-driven community action plan that addresses one or more of the following chronic disease risk factors selected by their national organization: tobacco use and exposure, poor nutrition, physical inactivity. Sub-recipients implementation timeline: Cohort one: March 2015 – April 2016 Cohort two: Feb 2016 – July 2017

6 Role of Sub-recipients: Local Project ScopeIncrease collaboration between local community partners Build a local community action plan (CAP), a work plan, that outlines that activities and tactics that will be undertaken to build policy, systems and environmental (PSE) changes. Increase the community’s capacity by: Build or leverage an existing multi-sectorial coalition Identify community priorities by reviewing local data and conducting a situational assessment Identify the settings that this effort would occur Identify the audience who would be benefit from by the PSE change Project the number of people who will benefit (reach)

7 Additional CDC DeliverablesCommunication Deliverables: Communicate to the public about the importance of PSE improvements and the activities underway to build PSE changes within the selected local communities; Communicate to partners about the project and engage them on PSE improvements; and Develop success stories

8 Alignment with AHA PrioritiesReasons for pursuing the National Implementation for Chronic Disease Prevention funding: To accelerate the AHA’s 2020 goal: To improve cardiovascular health by 20% To reduce deaths from cardiovascular diseases and stroke by 20% To build policy, systems and environmental improvements at the local level AHA’s Approach to Sustainability: Fits within AHA’s pre-existing goals Accelerated and expanded on AHA’s existing priorities Reasons for pursuing the project Support 2020 Goal Improve cardiovascular health by 20% Reduce deaths from cardiovascular diseases and stroke by 20% Focus policy priorities at the local level Sustainability Fits within AHA’s preexisting goals Accelerate and expand current work

9 ANCHOR’s unique niche…Accelerating National Community Health Outcomes through Reinforcing (ANCHOR) Partnerships program provides the following value add: Facilitates multi-sectoral collaboration with stakeholders, partners, volunteers and community members on community-identified priorities Accelerates the momentum to build policy, systems or environmental changes or Support the implementation in the wake of policy adoption.

10 Supporting ImplementationAccelerating Change in Communities: The Policy, Systems and Environmental (PSE) Campaign Pendulum Building Momentum Supporting Implementation Momentum for Change Support the Change ANCHOR ANCHOR Policy, Systems and Environmental changes is the ultimate goal based on AHA’s priorities. Approach is the same, activities different on “front end” vs. “back end”. Just because a PSE is complete doesn’t mean ANCHOR has no role to play. ANCHOR is here to accelerate on both ends of the pendulum. PSE Change Occurs Implementation Approach: Defining the Problem Identify Solutions Plan Strategies Implementation Sustainability Implementation Approach: Defining the Problem Identify Solutions Plan Strategies Implementation Sustainability

11 Designing a Policy, Systems and Environmental Changes (PSE) Continuum ModelDefining the Problem Identify Solutions Planning Strategies Implementation Sustainability Community needs assessment Resources and barriers identified Potential stakeholders convened Develop leadership team Strategies tailored for sites CAP developed, modified Promotion of new PSE change PSE strategy carried out Organization adoption Institutionalized PSE change Strategy identified Sites identified An issue is identified as a policy, systems, or environmental change is needed to improve local health status AHA staff convene statewide and/or local stakeholders vested in the issues identified If identified, decision is made to explore potential PSE changes AHA staff convene stakeholders to identify resources and barriers to address the issue. AHA staff convene leadership group of stakeholders to help in the planning and implementation of PSE changes Decision is made to conduct a PSE intervention Leadership group identifies sites that are willing to implement PSE changes Leadership group tailors PSE change strategy to be site specific AHA staff develop and/or modify the community action plan to incorporate new PSE activities. AHA staff and/or leadership team work with sites to carry out PSE changes AHA staff, setting, and/or leadership team promotes new PSE changes Site adopts organizational procedures to continue the PSE change Once implemented, site staff embed the PSE change in to organizational budget, practice and policy AHA staff helps to promote PSE changes, so community support influences sustainability

12

13 As a result, ANCHOR Cohort One…15 sub-recipients across 13 States 11 – led by advocacy 3 – led by multicultural 1 – led by community health Strategic Areas of Focus per ANCHOR Market: Nutrition: Procurement - 8 sites Healthy Food Financing Initiatives (HFFI) - 4 sites Farmers Markets - 5 sites Physical Activity: Shared Use - 2 sites Physical Education (PE) - 3 sites Tobacco: Smoke-free Environments - 3 sites 15 Locations Across 13 States

14 As a result, ANCHOR Cohort Two…15 sub-receipients across 14 states: 13 led by advocacy 2 led by multicultural 0 led by community health Strategic Areas of Focus per ANCHOR Market: Nutrition: Procurement – 10 sites Healthy Food Financing Initiatives (HFFI) – 1 sites Farmers Markets – 3 sites Physical Activity: Shared Use – 1 sites Physical Education (PE) – 3 sites Community Physical Activity – 2 sites Tobacco: Smoke-free Environments – 3 sites 15 Locations Across 14 States

15 Ensuring We All Spoke the Same LanguageWe needed to ensure we were all speaking the same language to avoid anyone getting lost in terminology. We had to understand the goal and the metrics that could or could not be measured. Policy, Systems, and Environment changes were the metric of success. Once complete, PSE changes were used to attain reach numbers towards ANCHOR’s CAP reach goal. We needed to ensure we were all speaking the same language and did not get lost in terminology. We had to understood the goal and the metrics that could or could not be measured. Policy, Systems, and Environment changes were the metric of success. Once complete, PSE changes were used to attain reach numbers towards ANCHOR’s CAP reach goal.

16 Building a Comprehensive Community Action Plan (CAP)CAP Development Approach – “Being of the Community”: Assess and understand the needs of the community in relation to reaching your end goal – the PSE change. What activities are partners already undertaking? Can ANCHOR serve as a maximizer? What gaps are there which are unmet? Select effective support activities. What support activities will best position your setting(s) for change? Utilize the CAP as a roadmap to PSE change. Are some support activities dependent on one another or on efforts of partners? What timing is best suited for each support activity? How can they work cohesively to build momentum? Guidance was provided to determine how each RCM was planning to reach their ANCHOR reach number. This was a critical in CAP the planning process. The RCM needed to consider and articulate the settings, sites and opportunities and how these aligned with their campaign goals. Multi-pronged approach to build PSE changes included engaging internal and external partners, key stakeholders, community members, AHA volunteers. The CAP then was to reflect the collaborative action plan on how to move the priority forward based on identified needs.

17 Campaign Planning for PSE ChangesSmoke-free Environments Businesses Restaurants and Bars Colleges and Universities Public Spaces (Parks, trails, beaches, etc.) PSE Changes within the following settings ANCHOR Businesses go smoke-free Restaurants and bars go smoke-free Departments adopt smoke-free for public spaces Campuses adopt smoke-free policy PSE Changes Educational presentations and materials provided to community Letters of support and/or pledges drafted Communications to celebrate and publicize changes Signage to promote change and informs community Assessments to inform change and community Support Activities

18 Campaign Planning for PSE Changes Cont.Healthy Food Financing Initiatives (HFFI) PSE Changes within the following Settings Farmers markets Grocery stores Mobile markets Corner stores ANCHOR Increased number of markets Increased acceptance of SNAP and WIC Addition and promotion of healthier food and beverage offerings PSE Changes The actions that ANCHOR was conducting are based on AHA advocacy best practices and could be led by other sections within the organization. Meaning when the federal funds supporting this initiative go away the approach does not need to end. Advocacy, community health and multicultural initiatives could collaborate and lead on the multi-prong approach to support changes that lead to “Little p” and “Big P” policy levels Policy, Systems, and Environment changes are the metric of success in ANCHOR’s work. I would argue this is where being “of the community fits” and multicultural initiatives and community health have a role to play in the same sphere that ANCHOR played. Support Activities Educational presentations and materials provided to community Letters of support and/or pledges drafted Communications to celebrate and publicize changes Signage and guides to promote change and inform community Assessments to inform change and community

19 CAP Implementation: Training and Technical AssistanceCommunity Action Plan (CAP) planning: Including a detailed work plan and a RASCI (to ensure internal and external partners were appropriately engaged) Program management training Additional Technical Assistance Offerings: 1:1 CAP review calls (CAPs to be updated quarterly) Face-to-face team mtgs Affinity (peer) calls Coaching calls (campaign planning, PSE changes, messages research results, evaluation tools/resources etc.) Monthly calls between Affiliate supervisor and the Sr. Program Manager Monthly dashboards reports Consultation services provided by Sr. Program Manager, Program Performance Improvement Specialist and Texas A&M (ANCHOR evaluators)

20 Leveraging AHA Assets AHA internal partners: Local Board of DirectorsGovernment Relations Volunteers (including grassroots and grass top) Community Health Multicultural Initiatives Communications Science and Legal Youth Market Market Quality & Systems Improvement AHA resources and materials: Healthy food and beverage toolkit Tobacco control resources Voices for Healthy Kids toolkits (e.g. shared use) Healthy Ways to Grow materials NEMS assessment tools Sodium reduction materials

21 Sustainability PlanningANCHOR sub-recipients developed sustainability plans that addressed: What does success look like? What potential barriers could hinder progress? What campaign components/activities/projects should continue in the future? How do these support AHA priorities and/or the communities’ priorities? Who needs to be responsible and what resources will be required for sustaining the campaign components in the future (i.e. partner/ community organization, AHA staff, monetary resources, institution contacts or supports, individual contacts or support, tools, communications, data, and other materials). What are considerations for organizational and community capacity? What significant milestones or deliverables are required for these efforts to be successful? What are the dependencies for the milestones/deliverables? Note: On-going technical assistance and training will address these items with staff from both local and organizational perspectives, leveraging all assets and opportunities.

22 Highlights from Cohort OneBismarck, Mandan, ND: The Capitol Café stocks beverage machines on the capitol grounds. A policy was developed for all beverage machines to offer plain water and a minimum of 50% healthy beverages. Healthy box lunch project provided healthy options for meetings and caterings and the addition of a healthy entrée salad to the daily cafeteria menu. Sanford Health-Bismarck increased healthy food and beverage in their employee/visitor cafeteria and vending which resulted in increased revenue. The Sanford Health Enterprise worksite wellness leadership is interested in to additional sites within the hospital system.    The Sanford Health Healthy Food and Beverage Task Force was awarded the HERO team award.

23 Highlights from Cohort One Cont.Providence, RI: AHA partnered with the RI Department of Health (RIDOH) to increase healthy food and beverage selections at the Dunkin Donuts Center concessions (entertainment and sports arena). Incline Village, NV: Incline Village Parks & Recreation pilot tested smoke-free signs at outdoor events, beaches and playgrounds. Decided to make their parks, beaches and trails smoke-free. Permanent signs installed (Fall 2016).

24 Potential Reach* and Settings (Cohort One)Settings included: hospitals, schools, colleges/universities, early childcare centers and home care centers, workplaces, government buildings/property, parks/beaches/trails, and more. Cohort Two potential reach will be available at the end of the cohort (July 2017). Table developed by Texas A&M University Evaluation team *Potential Reach – Not referring to actual population reached but rather those who have the opportunity to benefit from the change.

25 Highlights from Cohort One Cont.Southern Chester County, PA: The Nourish Mobile Market obtained a USDA license to accept SNAP but they were not processing SNAP transactions as they were unsure of how to obtain EBT equipment. The AHA identified a vendor that provides free EBT equipment to farmers markets and provided TA to the employees to set up the equipment and process transactions. The Nourish Mobile Market and the YMCA partnership resulted in expanding the mobile markets to seven new locations (YMCA branches). Beaverton, OR: The Beaverton School District Oregon Kids Move with Heart pilot (occurred in 16 schools) each elementary school began the school day with 10 minutes of physical activity (Brain Boosts), have recess before lunch, and incorporate Brain Boosts activities throughout the school day. Decided to expand the across all 33 elementary schools beginning September 2016.

26 Cohort One Momentum (Sustainability) Continues…Providence, Rhode Island: The Providence Public School District has trained 7 more schools to implement the Comprehensive School Physical Activity Program (CSPAP) which provides guidance to develop, implement, and evaluate comprehensive school physical activity programs. 18 schools (of 39 in the district) have signed up as an Active School on the “Let's Move! Active Schools” website. Bismarck/Mandan, North Dakota: The Bismarck Event Center adopted healthy choices on their standard catering menu offerings. The concession stands has added a select number of healthy items including fresh fruit and low sugar beverages. Image copyright American Heart Association

27 Cohort One Momentum (Sustainability) Continues…Kanawha County, West Virginia: The Kanawha County Coalition for Community Health Improvement is utilizing AHA’s Healthy Food and Beverage Toolkit for their “Wellness at Work” initiative. Oklahoma City, Oklahoma: The Oklahoma City Council unanimously passed a resolution implementing a healthy vending policy to ensure that local officials, staff, and visitors to city property have access to healthier food and beverages. ANCHOR provided critical education outreach in advance of this decision.

28 Cohort Two Progress Pawtucket, Central Falls, RI:The RI Department of Health has adopted AHA’s nutrition guidelines as their standard for providing support to government and outside organizations. In collaboration with the RI Department of Health, the McCoy Stadium agreed to increase healthy food and beverage options. Technical assistance is being delivered to meet the AHA guidelines. The RI Department of Health (DOH) requested local ANCHOR collaboration to deliver a healthy food and beverage policy training for all Health Equity Zones (HEZ) in RI in addition to a training already planned for the Pawtucket/Central Falls HEZ. It is an opportunity for DOH to announce the adoption of the AHA nutrition guidelines. All HEZ members have been asked to adopt healthy food and beverage policies.

29 Cohort Two Progress Cont.Austin, TX: Collaborating with the local Good Food Purchasing, the University of Texas Department of Housing (UT-Housing) and Austin Independent School District (AISD) on a pilot to improve food procurement standards. Led to a national opportunity whereby the AHA is advising on the Center for Good Food Purchasing national nutrition procurement standards.   Developed a public education campaign to educate the public on the issue of access to healthy food in collaboration with AHA’s Voices for Healthy Kids team. The City of Austin recently allocated resources for food access initiatives including $300K to SNAP double dollar programming and $400K for grocery incubator grants.

30 Cohort Two Progress Cont.Chesapeake, Newport News, Suffolk, VA: ANCHOR collaborated to bring in the Virginia Department of Agriculture's Mobile Lab to sign up farmers participating in farmers markets to be able to accept Supplemental Nutrition Assistance Program (SNAP) payments. Four farms were set up; these farmers were equipped with free terminals for processing the payments. The AHA goal is to encourage other farmers/farmers markets to increase SNAP acceptance. Image copyright American Heart Association -

31 Lessons Learned: Reflections from AHA Sub-recipientsBegin by creating a relationship - POWER of Connection AWARENESS, TRUST, and ACTION PAINT A PICTURE of a different way Stepping stones build confidence Engage grassroots and grass top champions There is more than one way to Have a Plan B…plus a Plan C … It won’t be perfect but it will be better. Start communications activities early and keep it consistent (i.e. public education and partner messaging) Paperwork Timelines

32 What questions do you have about…Ask the Audience What questions do you have about… Pursuing PSE Changes? Building or strengthening coalitions? Community Action Plans? Planning for sustainability? Other items?

33 Interested in learning more?ANCHOR success stories are online! Please visit Laura King Hahn, Sr. Program Manager ANCHOR Partnership Program