INTRODUCTION-DRAFT

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INTRODUCTION-DRAFT Powered By Docstoc
					This assessment tool allows state and local health departments the opportunity to measure
current public health required standards against the National Association of County and City
Health Officials (NACCHO) Operational Definition of a Functional Local Health Department.
Subsequently, it will help to identify areas of strength and areas for improvement within
agencies.

The Operational Definition of a functional local health department defines what people in any
community can reasonably expect from their local health department. The definition
comprises standards, and was developed through an extensive selection process with health
officials, governing bodies, and elected officials at all three levels of government. Most
significantly, the definition has been cited as a framework in the national accreditation
program (Public Health Association Board, or PHAB) that is currently under development. 1

FORMAT OF THE ASSESSMENT TOOL:
This assessment tool was developed by using Wisconsin's HFS 140 Local Health Department
Review Tool that was used during the reviews completed in 2004-2005. The HFS 140
Review Tool was formatted around Wisconsin's 12 Essential Public Health Services and
aligned the Level I, or minimum standard requirements, with the Essential Public Health
Services. This tool incorporates that information along with aligning current statute and
administrative rule requirements to the National Operational Definition Standards and
Indicators by Focus Area. In addition, this tool provides national evidence needed to meet
the standards and indicators. The local health department, if they so choose, will be able to
rate how they meet the national standards by using the scale provided below.

FORMAT KEY:

Essential Public Health Services - The language for the 10 essential public health services
is how it is identified under Wisconsin statutes s. 250.03 (1) (L).

WI Standard Language - Whenever possible a statutory citation was used and identified with
the citation number - for example, s. 251.05 (3) (a), Stats.
WI Statutory or Rule Reference # and Citation: The number that appears in bold before
the statutory or rule citation, e.g., (23), corresponds with the citation used in the 2005 HFS
140 Review Tool. In some cases you will find that no number, just the current statute or
administrative rule citation appears. This was an attempt to link current law with the national
standards, indicators and focus area. In addition, an attempt to incorporate new or revised
statutes and rules was made in developing this tool. This tool does not provide the statutory
citations around the establishment of local health departments (s.251.02, Stats.) or the
establishment and some of the power and duties of a Local Board of Health (s.251.04, Stats.)
WI Statutory or Rule Citations for Level II and Level III agencies: HFS 140 and HFS 139
Administrative Rule requirements specific to a Level II and Level III have been identified in
this assessment tool. Consideration around a new format is being made on how to capture
the local health department programs and services that link to the current State Health Plan.

National Standards, Operational Definition Indicator and Evidence: The language used
in these areas come from the National Association of County & City Health Officials
(NACCHO) website. The documents used to develop this tool included NACCHO's
"Operational Definition Indicator Development Metrics" and the "Local Health Department Self-
Assessment Tool". A comparison of the language in both documents was compared and
when different, used the language in NACCHO's LHD Self-Assessment Tool. Note: Both
documents were printed off of NACCHO's website in hopes that it was the most current
information. It was noted that neither document identifies a published date.
The link to the NACCHO website is:
http://www.naccho.org/topics/infrastructure/accreditation/documents/OpDefMetrics_intro.pdf


DIRECTIONS:
▪ In using the nationally established scale below, under each national standard score each
indicator based on your self-assessment of the capacity within your local health department to
fulfull the indicator, including both capacity provided by your health department staff and
through contracts and/or agreements with other entities.
▪ The items listed as "Documents and/or Activities that Demonstrate the Indicators Have
Been Met," provide examples of documentation and types of activities to be used as
reference in determining your capacity for that indicator. These examples may be useful as
you work to improve capacity in targeted areas or move toward accrediation.

▪ If your score is based on capacity of partners at the local, regional or state level (not
including partners with whom you have contracts), please add a note identifying the agency or
entity fulfilling that capacity.

     Score       Description
                 No capacity: There is no capacity, planning, staff, resources, activities, or
        0
                 documentation to fulfill the indicator
                 Minimal capacity: There is minimal planning and staffing capacity to fulfill the
        1
                 indicator but no implementation activity or documentation
                 Moderate capacity: There is moderate planning, staffing and other resources to
        2
                 fulfill the indicator but only minimal activity and/or documentation
                 Significant capacity: There is significant planning, staffing, and other resources
        3
                 and a moderate amount of activity and//or documentation
                 Optimal capacity: There is significant planning, staffing and resources and
        4
                 significant to optimal activity and/or documentation to fulfill the indicator
1 National Association of County and City Health Officials (NACCHO). Revisions by Janan Wunsch-Smith, &
              fulfill the indicator but only minimal activity and/or documentation
              Significant capacity: There is significant planning, staffing, and other resources
      3
              and a moderate amount of activity and//or documentation
              Optimal capacity: There is significant planning, staffing and resources and
      4
              significant to optimal activity and/or documentation to fulfill the indicator



NOTE: When there was a difference in the wording of the NACCHO's National Operational
Definition Standard and Indicators and the Local Health Department Self-Assessment Tool
(Operational Definition of a Functional Local Health Department Capacity Assessment for
Accreditation Preparation), the wording was used from the self-assessment tool.
                                                    Aligning Wisconsin's Required Local Public Health Authorities around Core Functions, Ten Essential Services and National Operational Definitions and Standards

I. MONITOR HEALTH STATUS OF POPULATIONS TO IDENTIFY AND SOLVE COMMUNITY HEALTH PROBLEMS.
WI STANDARD: s.251.05(3)(a), Stats. - A local health department shall regularly and systematically collect, assemble, analyze and make available information on the health of the community, including statistics on health status, community
health needs and epidemiologic and other studies of health problems.

WI Required Services for LHDs by National Focus Area : Data Collection, Processing and Maintenance
WI Statutory /                                                                                                               EVIDENCE - During the HFS 140 review, the local health department provides information to meet this       DPH Finding
                    STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)                                                                                                                                                          Evidence notes:
Rule Refer. #                                                                                                                requirement as indicated                                                                                  YES     NO
                  Assess public health needs and advocates for the reasonable and necessary provision of public              1. Board of Health meeting agendas, minutes, and budget, OR 2. Resolutions, OR 3. BOH letters to
(23) s.251.04 (6)
                  health services. (Board of Health)                                                                         other policy makers, providers, or others (with evidence of advocating for services or resources at
(a), Stats.
                                                                                                                             least one in the past 12 months)
                                                                                                                             Written evidence that shows that the health department, with the involvement of the Board of Health,
                                                                                                                             has an ongoing process to collect and analyze data to assess local health status. Examples of data
(25) 251.05 (3)                                                                                                              may include: Data provided by the Dept. of Health & Family Services, local and state comparison data,
                    A local health department shall participate in community health assessments; collect, review and
(a), Stats. and                                                                                                              local community perceptions of needs, data from local providers; AND Examples of public health
                    analyze data on community health; and undertake case-finding to identify population groups,
HFS                                                                                                                          status information made available to the community (at least 2 in past year). Information about health
                    families and individuals at high-risk of illness, injury, disability or premature death.
140.04(1)(a)1.                                                                                                               status and local needs is made available to policy makers and the general public, may include: media
                                                                                                                             (news articles, radio spots, TV spots), annual reports, newsletters, web pages, town hall meetings,
                                                                                                                             other printed reports, meeting minutes, etc.
(26) s.251.06(3)                                                                                                             Either view or verbal - Memorandum of Understanding or similar agreement with the Register of Deeds
                    The local health officer has access to vital records and vital statistics from the register of deeds, as
(a), Stats. (Ref.                                                                                                            to assure information exchange.
                    specified in ch. 69. (Health Officer)
ch. 69, Stats.)
NATIONAL STANDARD 1-A: Obtain and maintain data that provide information on the community’s health (e.g., provider immunization rates; hospital discharge data; environmental health hazard, risk,
and exposure data; community specific data; number of uninsured; and indicators of health disparities such as high levels of poverty, lack of affordable housing, limited or no access to transportation, etc.).
                                                                                                                                DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                           NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                                  BEEN MET                                                             0 1 2 3 4       Evidence notes:
                                                                                                                          ▪ Assess competency level of staff that provide expertise in collection, management, integration,
                    1. LHD staff has expertise and training to collect, manage, integrate and display health related data
     1-A 1.                                                                                                               displaying, and reporting health related data.
                    (Capacity)
                                                                                                                          ▪ Provide names, degrees and training specific to data related activities.

                    2. LHD uses appropriate equipment and technology (Capacity)                                               ▪ Written description of current computer equipment and technology including brands, model, years
     1-A 2.                                                                                                                  published.

                    3. LHD maintains and uses an information system(s) [e.g. email, shared electronic database files,        ▪ List internal communication methods and protocols for use - e.g., e-mail, databases, files and
     1-A 3.         intranet] (Capacity)                                                                                     intranet.
                                                                                                                             ▪ List of databases used and protocols for data collection, analysis and reporting both internally and
     1-A 4.         4. LHD demonstrates an electronic linkage with local and statewide databases (Capacity)                  with external healthcare providers, state health department and others as appropriate.

                                                                                                                             ▪ Has process and protocols for exchange of disease reporting information between the local health
                                                                                                                             department, healthcare providers and other public health system partners
                    5. An electronic disease reporting system exists between the LHD and health care providers, and          ▪ Current electronic and paper list of healthcare providers and other public health system partners who
     1-A 5.         others in the community who are potential diease reporters (e.g., schools, hospitals) (Capacity)         may be disease reporters, with contact information
                                                                                                                             ▪ Log of data exchange (Date, time, type of data and with whom, any follow-up or feedback)

                    6. LHD collects and reviews primary data (e.g. community surveys; disease reporting) and           ▪ Process/protocols in place for the collection, review and analysis of data from a variety of reliable
     1-A 6.         secondary data (state health department data; census data; hospital discharge data) from a variety sources
                    of reliable sources (Process)

                    7. LHD contributes to and/or maintains a registry [e.g. log of all known events of certain type in the   ▪ Process/protocols for contributing to, or maintaining a registry
     1-A 7.         community immunization; violence; communicable disease] (Process)                                        ▪ Log of contributions to registry - i.e., name of registry, date, type of information
WI Required Services for LHDs by National Focus Area: Disease Reporting Relationships; Make Data and Information Flow
WI Statutory /                                                                                                         EVIDENCE - During the HFS 140 review, the local health department provides information to meet this        DPH Finding
                  STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)                                                                                                                                                       Evidence notes:
Rule Refer. #                                                                                                          requirement as indicated                                                                                   YES     NO
                                                                                                                       State required evidence: View: 1. Documentation of results that verify ongoing review and use of
                  The services to be provided by the 3 levels of local health departments shall provide at least       Communicable Disease (CD) data, AND 2. Examples of charting on 4151 or documentation of contact
(24) s.251.05 (2)                                                                                                      investigation, AND 3. Internal documentation exists to assure appropriate and consistent response to
                  surveillance, investigation, control and prevention of communicable diseases, other disease
(a), Stats.                                                                                                            CD (e.g., CD control; sexually transmitted disease intervention; tuberculosis control). This could be
                  prevention, health promotion and human health hazard control. (Local Health Department)
                                                                                                                       policies and procedures, or other documentation.


HFS 140.04 (1)
                  Maintenance of a surveillance system for communicable diseases reportable under ch. HFS 145.
(b) (3)

NATIONAL STANDARD 1-B: Develop relationships with local providers and others in the community who have information on reportable diseases and other conditions of public health interest
and facilitate information exchange.
                                                                                                                          DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                          NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                            BEEN MET                                                              0 1 2 3 4       Evidence notes:


     1-B 1.       1. LHD staff can be contacted at all times (LHD Self-assessment Tool)                                ▪ A written policy/procedure exists that describes that assures LHD staff can be contacted at all times.


                                                                                                                       ▪ Record of presentations, evidence of meeting held, conferences organized (e.g. agenda), and/or
     1-B 2.       2. Providers (and other appropriate healthcare system partners) are educated and trained in          educational materials distributed to promote provider and other public health system partner to
                  collecting and reporting data to the LHD                                                             promote knowledge and disease reporting procedures.

                                                                                                                       ▪ Written quality improvement process available for evaluation of disease reporting between providers
                  3. LHD uses a quality improvement process between LHD and providers to make it easy for              and the LHD.
     1-B 3.       providers to report (Process)                                                                        ▪ Results of evaluation shared and documentation that the process was improved, if needed, based on
                                                                                                                       a quality improvement process.

                                                                                                                       ▪ Has process for organizing data to determine trends and clusters and for providing the information to
                  4. Health care providers and other public health partners receive reports and feedback on disease
     1-B 4.                                                                                                            healthcare providers and other public health partners
                  trends and clusters (Capacity)
                                                                                                                       ▪ Log of distribution of reports, topics, to whom and any feedback

WI Required Services for LHDs by National Focus Area: CONDUCT OR CONTRIBUTE EXPERTISE TO PERIODIC COMMUNITY HEALTH ASSESSMENTS
WI Statutory /                                                                                                         EVIDENCE - During the HFS 140 review, the local health department provides information to meet this        DPH Finding
                  STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)                                                                                                                                                       Evidence notes:
Rule Refer. #                                                                                                          requirement as indicated                                                                                   YES     NO

                                                                                                                       View: Documentation indicating policies are in place, which include the involvement of key policy
                  Involve key policymakers and the general public in determining and developing a community health     makers and the general public, to determine health status and priority needs of the community, which
(50) s.251.05 (3) improvement plan that includes actions to implement the services and functions specified under       results in program planning, implementation and evaluation. Example documents may include short
(c), Stats.       s.250.03(1)(L). (NOTE: s.250.03(1)(L) refers to the 10 Essential Public Health Services, which are   and long range plans, BOH minutes, minutes of steering committees, contacts, MOUs, media reports,
                  also identified as I. to X. of this tool)                                                            report card, strategic planning results, examples of service coordination and lists of individuals and
                                                                                                                       organizations involved in program planning for the community.

NATIONAL STANDARD 1-C: Conduct or contribute expertise to periodic community health assessments
                                                                                                                          DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                          NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                            BEEN MET                                                              0 1 2 3 4       Evidence notes:
                    1. LHD staff have the appropriate knowledge of standards and processes for conducting community ▪ Assess compentency level of staff to assure someone on staff has appropriate knowledge of
     1-C 1.         health assessments (Capacity)                                                                   standards and process for conducting a community health assessment

                    2. There are LHD staff trained in selecting a community health assessment model (e.g., APEX/PH, ▪ Documentation of appropriate training and knowledge for involved staff in selecting, organizing and
                    MAPP, etc.) organizing and conducting a community health assessment process                     conducting the community health assessment or evidence of plans for using outside consultants or
     1-C 2.         (Capacity/Process)                                                                              public health partners
                                                                                                                    ▪ Process and protocols available for conducting a community health assessment
                    3. LHD organizes community health data (e.g., mortality, disease prevalence, risk factors, and other
                                                                                                                         ▪ Guidelines are available for collection of secondary and primary data for assessment purposes
     1-C 3.         data for assessment process (Capacity/Process)
                                                                                                                         ▪ Data reports are available and updated as new data are available

                                                                                                                        ▪ Documentation of board community stakeholder participation. This may include over one or more of
     1-C 4.         4. Broad participation of community stakeholders in the assessment process is secured (Process)     the following: List of stakeholders and contact information, shared data, minutes of planning meetings,
                                                                                                                        education sessions regarding community health assessment

     1-C 5.         5. A community health assessment process is conducted every five years (Process)                    ▪ Completed community health assessment with a new assessment available every 5 years

WI Required Services for LHDs by National Focus Area: Integrating Data / Data Sharing with Community Partners
WI Statutory /                                                                                                          EVIDENCE - During the HFS 140 review, the local health department provides information to meet this       DPH Finding
                    STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)                                                                                                                                                     Evidence notes:
Rule Refer. #                                                                                                           requirement as indicated                                                                                  YES     NO

s.251.05 (3) (d),   A local health department shall submit data, as requested, to the local public health data system
                                                                                                                        ▪ Evidence: DPH Regional Office provides confirmation of data submission.
Stats.              established by the department.

                    Informing local elected officials, educators and the general public about the incidence and
                    prevalence of the chronic diseases or injuries in the community for which resources are available to
                                                                                                                         View: The health department can show copies of newsletters, newspaper articles, meeting agendas,
HFS 140.04 (1)      the local health department from the department or the chronic diseases or injuries identified
                                                                                                                         meeting minutes, correspondence or other documentation of public education on disease prevention,
(c) 1.              through a community needs assessment under s.251.04(6)(a), Stats, as priority public health
                                                                                                                         at least four in the past 12 months.
                    problems, or by the regular and systematic collection of community health information as required
                    under 251.05(3)(a).
NATIONAL STANDARD 1-D: Integrate data with health assessment and data collection efforts conducted by others in the public health system.
                                                                                                                           DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                           NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                             BEEN MET                                                             0 1 2 3 4       Evidence notes:

                                                                                                                        ▪ Written protocol or process available and used for sharing data
     1-D 1.         1. Data are shared with community partners and integrated into the community health assessment
                                                                                                                        ▪ LHD or other agency reports indicating diverse participation in assessment process

                    2. LHD develops and maintains relationships with community and public health system partners
     1-D 2.                                                                                                             ▪ Minutes demonstrating convening diverse groups in health assessment process
                    (Capacity)

                    3. Assessment processes by community agencies include the LHD and community partners as
     1-D 3.                                                                                                             ▪ Written documentation of participation in Community Health Assessments led by other groups
                    participants (Process)

                    4. Completed community health assessment is shared with healthcare providers, community             ▪ Protocols for sharing community health assessment
     1-D 4.         partners, local, state and federal governance                                                       ▪ Meeting minutes demonstrating that health data and community health assessments are shared


WI Required Services for LHDs by National Focus Area: Data Analysis
WI Statutory /                                                                                                          EVIDENCE - During the HFS 140 review, the local health department provides information to meet this       DPH Finding
                    STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)                                                                                                                                                     Evidence notes:
Rule Refer. #                                                                                                           requirement as indicated                                                                                  YES     NO
s.251.06 (3) (h),   The local health department shall submit an annual report of the administration of the local health   View: Evidence of a local public health agency's Annual Report, Board of Health Meeting Minutes or
Stats.              department to the local board of health.                                                              reports in which the submission of annual reports are discussed.

                                                                                                                          View: Evidence of a public health nursing program, which may include any of the following:
                    Nursing services through a general public health nursing program. Public health nurses who            ▪ Agency brochure that describes Public Health Nursing programs and services being provided.
HFS 140.04 (1)      conduct the program may be directed by the appropriate local authority do to document and             ▪ Annual report
(a) 5               evaluate the responses of the community or vulnerable population groups to public health nursing      ▪ Activity report
                    services and actions directed at the community or those groups.                                       ▪ Agency web-site that describes Public Health Nursing programs and services being provided.

HFS 140.05 (1) The local health department has established a process whereby it will evaluate and report to the
(b) 4; HFS        community on progress and performance toward achieving program and services objectives that             Evidence provided under Level II or Level III Addendum/Worksheet
140.06 (1) (b) 4. link to the current State Health Plan.
(Level II & III)
NATIONAL STANDARD 1-E: Analyze data to identify trends, health problems, environmental health hazards, and social and economic conditions that adversely affect the public’s health.
                                                                                                                             DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                           NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                               BEEN MET                                                             0 1 2 3 4       Evidence notes:

     1-E 1.         1. LHD analyzes and identifies patterns in data (Capacity)                                            ▪ Internal process reflecting data analysis (e.g., policies and procedures)

                    2. LHD draws inferences from data to identify trends over time, health problems, environmental,
                                                                                                                          ▪ Reports and/or records of presentations that demonstrates a comprehensive understanding of the
     1-E 2.         health hazards, and social and economic conditions that adversely affect the public’s health
                                                                                                                          health status and health problems in the community
                    (Process)

                    3. LHD graphs health data to indicate whether the problems identified by the community health         ▪ Ongoing data is placed in graphs and tables to determine whether problems identified in the
     1-E 3.         assessment are improving or worsening (Process)                                                       community health assessment are trending toward improvement or worsening

                                                                                                                          ▪ Graphs and tables are created to compare local health indicators to other local jurisdictions, state,
     1-E 4.         4. Comparison of local data to other jurisdictions and/or the state or nation (Process)
                                                                                                                          and national health indicators

                                                                                                                          ▪ Documentation such as asset maps of the community, Community Health Profile, GIS map detailing
     1-E 5.         5. LHD conducts a small area analysis using GIS (Process)
                                                                                                                          trends, and health problems, etc. , are available for area analysis


     1-E 6.         6. LHD makes data analysis usable to others (Process)                                                 ▪ Protocols for sharing data analysis with community partners are available

II. INVESTIGATE AND DIAGNOSE COMMUNITY HEALTH PROBLEMS AND HEALTH HAZARDS.
WI STANDARD: s.251.05(2)(a), Stats. - A local health department shall provide at least surveillance, investigation, control and prevention of communicable diseases, other disease prevention, health promotion and human health hazard control.


WI Required Services for LHDs by National Focus Area: Routine Outbreak Investigations
WI Statutory /                                                                                                            EVIDENCE - During the HFS 140 review, the local health department provides information to meet this       DPH Finding
                    STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)                                                                                                                                                       Evidence notes:
Rule Refer. #                                                                                                             requirement as indicated                                                                                  YES     NO

                                                                                                                          View, verbal or written where indicated:
                                                                                                                          ▪ Health Hazard ordinance, policy and procedures, or documentation of investigation and control of
                                                                                                                          human health hazards. (If ordinance, need the number and date signed) AND
(27) s.250.04(7), Local Health Department reports and investigates occurrences of occupational disease,                   ▪ At least one health department employee participates in each county Local Emergency Planning
254.02(5) , HFS- environmental disease or exposure to a human health hazard, as required by any rules the                 Committee. In counties with multiple health departments, the LEPC must have representation from at
140.04 (1) (f)    department may promulgate under s.250.04(7) and s.254.02(5) Stats.                                      least one of the health departments. (Note: Could use the county directory) AND
                                                                                                                          ▪ Provide verbal description at review of access to contacts* to report and respond to environmental
                                                                                                                          and occupational diseases and concerns
                                                                                                                            (*agency, phone number, areas(s) of expertise) [Used EPINET list, local phone list, county directory]
                    Local Health Department provides human health hazard control. Human health hazard, as defined
(31) s.251.05 (2)   under s.254.01 (2), Stats., means a substance, activity or condition that is known to have the
                                                                                                                    Evidence provided under (27)
(a), Stats.         potential to cause acute or chronic illness, to endanger life, to generate or spread infectious
                    diseases, or otherwise injuriously affect the health of the public.
                    Immediately investigates all circumstances concerning appearance of any communicable disease
(28) s.252.03(1)    in the jurisdiction of the local health department, promptly takes all measures to prevent, suppress   Verbal: Describe how you report this information to your Board of Health AND evidence provided
Stats.              and control communicable diseases, and makes a full report to the board of health and the              under (24) - EPHS I
                    department. (Health Officer)

(32) HFS 140.04 Pursuant to s.251.06 (3) (f), Stats., investigates and supervises the sanitary conditions of all
                                                                                                                           Evidence provided under (27)
(1) (e)         premises within the local health department’s jurisdictional area. (Health Officer)


(38) s.252.06 (3), The local health officer investigates and makes or causes examinations of the communicable              Verbal: Describe how you report this information to your Board of Health AND evidence provided
Stats.             disease as are necessary. (Health Officer)                                                              under (24) - EPHS I


(39) s.252.06 (5), The health officer immediately investigates communicable disease occurrences and makes and              Verbal: Describe how you report this information to your Board of Health AND evidence provided
Stats.             enforces necessary orders. (Health Officer)                                                             under (24) - EPHS I


(40) s.252.11 (2), The health officer investigates or causes an investigation of cases and contacts with suspect or        Verbal: Describe how you report this information to your Board of Health AND evidence provided
Stats.             confirmed sexually transmitted diseases. (Health Officer)                                               under (24) - EPHS I

NATIONAL STANDARD 2-A: Investigate health problems and environmental health hazards.
                                                                                                                               DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                           NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                                           BEEN MET                                                0 1 2 3 4      Evidence notes:
                                                                                                                           ▪ Assess compentency level of staff that provide routine outbreak investigation and report competency
         2-A 1.     1. LHD has personnel on staff that can to carry out an investigation (Capacity)                        level, any additional training received to increase competency level
                                                                                                                           ▪ Updated list of names, degrees/credentials of those providing outbreak investigation; reviewed
                                                                                                                           annually
                                                                                                                           ▪ Written documentation of the type of surveillance system that is used to trigger investigations and
         2-A 2.     2. LHD has a surveillance system to trigger investigations (Process)
                                                                                                                           criteria for initiation of an investigation
                                                                                                                           ▪ Written protocols document in investigation process, including identifying information about the
                                                                                                                           disease, case investigation steps, reporting requirements, contact and clinical management, use of
                                                                                                                           emergency protocols, and the process for excercising legal authority for disease control
         2-A 3.     3. LHD uses appropriate investigation techniques                                                       ▪ Information on leading industry in the community and any associated health risks
                                                                                                                           ▪ Information on local employment and related occupational risks
                                                                                                                           ▪ Report showing review process of health problems ans environmental health hazards
                                                                                                                           ▪ Electronic database is used with standardized case invesigation protocols

WI Required Services for LHDs by National Focus Area: Mitigation of Health Problems and Adverse Health Events
WI Statutory /             STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)                           EVIDENCE - During the HFS 140 review, the local health department provides information to meet this     DPH Finding
Rule Refer. #                                                                                                              requirement as indicated                                                                                YES     NO Evidence notes:
(29) s.252.05 (7),
                   The local health officer follows methods of disease control as set out in the most recent edition of    View: A copy of the most recent edition of the Control of Communicable Diseases Manual is available
Stats. and HFS-
                   Control of Communicable Diseases Manual. (Health Officer)                                               on site. Note: Most recent - 18th Edition, David L. Heymann, MD, Editor, formerly Chin.
145.05 (2)
                                                                                                                     Verbal, view ordinance or policy: Describe interventions when a health hazard exists on a body of
                  The department or a local health department shall close or restrict swimming, diving and
(33) s.254.46,                                                                                                       water or associated premise. Could include beach testing ordinance or human health hazard
                  recreational bathing if a human health hazard exists in any area used for those purposes on a body
Stats.                                                                                                               ordinance, etc. (If ordinance, need the number and date signed)
                  of water and on associated land and shall require posting of the area. (Local Health Department)

                  Local Health Officers may do what is reasonable and necessary for the prevention and suppression
s. 252.03 (2),                                                                                                     Verbal: Describe how you report this information to your Board of Health AND evidence provided
                  of disease, may forbid public gatherings when deemed necessary to control outbreaks or epidemics
Stats.                                                                                                             under (24) - EPHS I
                  and shall advise the department on the measures taken.

(41) s.252.11 (2),
                   The local health officer requires examination of suspects of sexually transmitted diseases. (Health    Verbal: Describe how you report this information to your Board of Health AND evidence provided
Stats.; HFS
                   Officer)                                                                                               under (24) - EPHS I
145.17
NATIONAL STANDARD 2-B: Prevent, minimize, and contain adverse health events and conditions resulting from communicable diseases; food, water and vector-borne outbreaks;
chronic diseases; environmental hazards; injuries; and health disparities.
                                                                                                                             DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                          NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                               BEEN MET
                                                                                                                                                                                                                                     0 1 2 3 4       Evidence notes:

                                                                                                                          ▪ Assess competency level of staff that are responsible fo alleviating adverse health events and report
                                                                                                                          competency level and additional training received to meet competencies
                  1. LHD has enough staff trained to alleviate adverse health events and/or has access to the
     2-B 1.                                                                                                               ▪ Undated list of names, degrees/credentials of those providing outbreak investigation; reviewed
                  appropriate expertise (i.e., state epidemiologist) (Capacity)
                                                                                                                          annually and when a change is made
                                                                                                                          ▪ A written process is available for minimizing and containing adverse health events

                                                                                                                          ▪ Protocols and process for educating the public about health risks, nature of the situtation and where
                  2. LHD informs and educates the about adverse health events, including information such as the
     2-B 2.                                                                                                               and how to respond
                  nature of the situation, how to respond, and where to find resources (Process)
                                                                                                                          ▪ Log of education and sharing of information using the principles of risk communication
                                                                                                                          ▪ Copy of an electronic disease reporting form
                                                                                                                          ▪ Form available for internal quarterly self-assessment of investigation and reporting process
                  3. LHD implements the established epidemiological protocol for mitigation (alleviation), including
                                                                                                                          ▪ Policies, procedures, or a detailed flow chart that describes the roles and responsibilities for local
     2-B 3.       disease specific procedures for alleviating an outbreak, such as providing prophylaxis, and
                                                                                                                          response
                  conducting follow-up documentation and reporting (Process)
                                                                                                                          ▪ Log of disease reports not otherwise reported in an electronic form (e.g., well water, lead) with
                                                                                                                          disposition of LHD activities to mitigate problem

                  4. LHD conducts routine programs to protect the public from vaccine preventable conditions, such        ▪ Log of all education programs targeting preventable diseases
     2-B 4.       as pneumonia and influenza (Process)                                                                    ▪ Records of administration clinics and immunization records


WI Required Services for LHDs by National Focus Area: Working with Other Governmental Agencies on Routine Investigation and Response
WI Statutory /                                                                                                            EVIDENCE - During the HFS 140 review, the local health department provides information to meet this        DPH Finding
                  STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)                                                                                                                                                          Evidence notes:
Rule Refer. #                                                                                                             requirement as indicated                                                                                   YES     NO

                  The local health officer promptly reports suspect and confirmed communicable diseases directly to
(30) s.252.05 (1)                                                                                                         Verbal: Describe how you report this information to your Board of Health AND evidence provided
                  the department, or directs nurses and physicians to report suspect and confirmed communicable
Stats.                                                                                                                    under (24) - EPHS I
                  diseases directly to the department. (Health Officer)
                   Unless the manner of employment is otherwise provided for by ordinance, a local board of health
                                                                                                                          Describe and/or view: Evidence of coordination with sanitarians employed by the governing body
                   may employ one or more sanitarians to conduct environmental programs and other public health
                                                                                                                          such as: minutes from planning and needs assessment committees, joint investigation reports,
(34) s.251.04 (8), programs not specifically designated by statute as functions of the public health nurse. The local
                                                                                                                          coordinated enforcement activities, shared data analysis, coordinated ordinance or policy
Stats.             board of health shall coordinate the activities of any sanitarian employed by the governing body of
                                                                                                                          development.
                   the jurisdiction that the local board of health serves. The local board of health is not required to
                   employ different persons to perform these functions. (Board of Health)
                   The health officer receives reports from physicians, nurses, and other persons who have verified
(36) s.254.13,                                                                                                               View: A report or other documentation received by the health officer regarding lead poisoning, and a
                   the existence of lead poisoning, and assures that reports are made to the department. (Health
Stats                                                                                                                        report or documentation made to the department.
                   Officer)

                   The local health officer immediately reports outbreaks and epidemics in the jurisdiction of the local     Evidence provided in #28, #29, and #30 - Verbal description of reporting this information to your Board
(37) s.252.05 (7),
                   health department, and keeps the department apprised of all developments, in a manner as                  of Health, evidence provided under s.251.05(2)(a) [Line 23]; s.252.03(1) [Line 74]; s. 252.05(1) [Line
Stats.
                   directed by the department. (Health Officer)                                                              87]; and s.252.05(7) and HFS 145.05(2) [Line 88]

NATIONAL STANDARD 2-C: Coordinate with other governmental agencies that investigate and respond to health problems, health disparities, or environmental health hazards.
                                                                                                                                DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                           NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                                  BEEN MET
                                                                                                                                                                                                                                       0 1 2 3 4       Evidence notes:

                   1. LHD assists other governmental agencies in responding to specific health problems or hazards           ▪ LHD has protocols established with other governmental agencies for mutuals assistance in
     2-C 1.        (Capacity)                                                                                                repsonding to specific health problems, hazards, or outbreaks

                                                                                                                             ▪ LHD identifies partners in advance and protocols are developed to engage partners during an event
                                                                                                                             ▪ LHD establishes a planning committee with diverse partners
                                                                                                                             ▪ Has guidelines and protocols to work with public health partners in repsonse to health problems and
                   2. LHD coordinates a planning committee including a diverse set of public health partners to
     2-C 2.                                                                                                                  environmental health hazards across the community
                   investigate and respond to health problems (Process)
                                                                                                                             ▪ List of governmental agencies that investigage and respond to health problems and evidence of
                                                                                                                             coordination, including meeting notes, agendas, logs of phone calls, etc.
                                                                                                                             ▪ Copies of memorandums of understandings with other governmental agencies

                   3. LHD routinely communicates with other governmental agencies on health problems in the                  ▪ Written communication plan includes schedule and types of communication with governmental
     2-C 3.        community (Process)                                                                                       agencies


     2-C 4.        4. LHD coordinates action with other governmental agencies                                                ▪ Guidelines for coordinating with other governmental agencies on public health issues


WI Required Services for LHDs by National Focus Area: Take Lead in Emergencies that are Public Health in Nature

WI Statutory /                                                                                                               EVIDENCE - During the HFS 140 review, the local health department provides information to meet this       DPH Finding
                           STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)                                                                                                                                                   Evidence notes:
Rule Refer. #                                                                                                                requirement as indicated                                                                                  YES     NO

s. 250.05 (3) (e), A local health department shall act as agent of the department, if designated by the secretary under
Stats.             s.250.042(1), Stats.; and act as specified under s.252.041, Stats.

                   As agent of the department, the local health department under sub (1) (a) orders any individual to
                   receive a vaccination unless vaccination is reasonably likely to lead to serious harm, or unless the
                   individual for reasons of religion or conscience, refuses to obtain the vaccination; (1) (b) Isolate or
s. 252.041, Stats.
                   quarantine, under s.252.06, Stats. any individual who is unable or unwilling for reasons specified
                   under (a) to receive vaccinations. (2) The department shall promulgate rules that specify
                   circumstances, if any, under which vaccination may not be performed on an individual.
NATIONAL STANDARD 2-D: Lead public health emergency planning, exercises, and response activities in the community in accordance with the National Incident Management System,
and coordinate with other local, state and federal agencies.
                                                                                                                                DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                           NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                                          BEEN MET
                                                                                                                                                                                                                                       0 1 2 3 4       Evidence notes:
                   1. LHD staff demonstrate competency in preparing for and responding to public health                      ▪ Assess competentency level of staff to assure appropriate knowledge is available to prepare for and
     2-D 1.        emergencies                                                                                               respond to public health emergencies
                   (Capacity)

     2-D 2.        2. Emergencies that trigger use of the response plan are defined (Process)                                ▪ Copy of LHD response plan
                  3. LHD develops a plan with emergency response partners that outlines responsibilities,                 ▪ Evidence of LHD preparedness meetings with othe government agencies inlcuding planning
     2-D 3.       communication networks, and evacuation procedures (Process)                                             meetings minutes, calendar of meetings, email exchanges, logs of phone calls etc., written plan
                  4. LHD leads the annual testing of its emergency response plan, through the use of drills and           ▪ Report of real event or exercise that evaluates policies, including meeting minutes from debriefing or
     2-D 4.       exercises, including coordination of public health response capacity with local, state, and federal     After-Action Report
                  agencies (Process)
                  5. LHD leads in an annual revision of its emergency response plan (Process)
     2-D 5.                                                                                                               ▪ Copy of revised emergency response plan (annual revisions)


     2-D 6.       6. LHD identifies volunteers and trains them (Process)                                                  ▪ Contact list of volunteers an protocols for engagement


WI Required Services for LHDs by National Focus Area: Participate When Other Agencies are in the Lead
WI Statutory /                                                                                                            EVIDENCE - During the HFS 140 review, the local health department provides information to meet this        DPH Finding
                          STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)                                                                                                                                                  Evidence notes:
Rule Refer. #                                                                                                             requirement as indicated                                                                                   YES     NO




NATIONAL STANDARD 2-E: Fully participate in planning, exercises, and response activities for other emergencies in the community that have public health implications, within the context
of state and regional plans and in a manner consistent with the community’s best public health interest.
                                                                                                                             DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                         NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                                        BEEN MET
                                                                                                                                                                                                                                     0 1 2 3 4       Evidence notes:
                                                                                                                          ▪ Documentation of LHD participation in partner planning for emergencies including planning meetings
                  1. LHD has staff that is competent in assisting other agencies when emergencies are not directly
     2-E 1.                                                                                                               minutes, calendar of meetings, email exchanges, logs of phone calls, etc., and protocols for
                  related to public health (Capacity)
                                                                                                                          participating in non-public health emergencies
                  2. LHD staff attends preparedness planning meetings and exercises sponsored by other
                                                                                                                          ▪ Invitation to participate in partner excercises or evidence of participation in emergency response
     2-E 2.       organizations (e.g. regional exercises, state planning groups, local emergency management drills,
                                                                                                                          when LHD was not in the lead (e.g., press release, newspaper story)
                  etc.) (Process)


     2-E 3.       3. LHD participates in local, regional and state all-hazards response planning (Process)                ▪ Minutes from participation in local regional an state all-hazards response planning process


WI Required Services for LHDs by National Focus Area: Access to Lab and Biostats Resources
WI Statutory /                                                                                                            EVIDENCE - During the HFS 140 review, the local health department provides information to meet this        DPH Finding
                          STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)                                                                                                                                                  Evidence notes:
Rule Refer. #                                                                                                             requirement as indicated                                                                                    YES   NO
                 Environmental health program. Provide or arrange for public health laboratory services appropriate
HFS 140.06(1)(f)
                 to local health department resources and services that support current and emerging threats to the
[Required for
                 health of the community that are consistent with current state and federal rules governing public
Level III]
                 health laboratories.
NATIONAL STANDARD 2-F: Maintain access to laboratory and bio-statistical expertise and capacity to help monitor community health status and diagnose and investigate public health
problems and hazards
                                                                                                                             DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                         NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                               BEEN MET
                                                                                                                                                                                                                                     0 1 2 3 4       Evidence notes:

                                                                                                                     ▪ Quarterly reports/assessments indicating that staffing requirements are met
     2-F 1.       1. LHD has adequately trained staff to collect and handle clinical and environmental samples in an ▪ List of individuals fulfilling this capacity, job description for personnel (if applicable) or copy of
                  appropriate manner                                                                                 consulting/contracting (if applicable)
                 2. LHD handles clinical and environmental laboratory samples appropriately, based on laboratory      ▪ LHD has current written protocols and/or guidelines for handling clinical and environmental
     2-F 2.      standards using statewide laboratory protocol for reporting, collecting, handling and transporting   laboratory samples based on standards including protocols for reporting, collecting, handling and
                 laboratory specimens (Process)                                                                       transporting laboratory specimens

                 3. LHD assesses the availability and maintains assess to (including call-up protocols)
                                                                                                                      ▪ LHD has current contact list for available epidemiological expertise
     2-F 3.      epidemiological and statistical expertise, including consultations with appropriately trained
                                                                                                                      ▪ LHD call-up protocol for biostatistical epidemiological resources
                 epidemiologists (Capacity)
                                                                                                                      ▪ LHD has written procedures for surge capacity, with descriptions of how expanded lab capacity is
                                                                                                                      made readily available when needed for outbreak response
                 4. LHD has surge capacity including assesses available of laboratory capacity when needed in         ▪ There is a current list of local and regional laboratories having the capacity to analyze specimens
     2-F 4.      response to an outbreak (Process)                                                                    ▪ Records indicating appropriate requests for and response of monitoring, diagnosing and
                                                                                                                      investigating health problems and hazards
                                                                                                                      ▪ Written protocols/procedures for access to state lab services

WI Required Services for LHDs by National Focus Area: Capacity for Emergency Communications and Date Exchange
WI Statutory /                                                                                                        EVIDENCE - During the HFS 140 review, the local health department provides information to meet this     DPH Finding
                         STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)                                                                                                                                            Evidence notes:
Rule Refer. #                                                                                                         requirement as indicated                                                                                 YES   NO




NATIONAL STANDARD 2-G: Maintain policies and technology required for urgent communications and electronic data exchange.

                                                                                                                         DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                        NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                                   BEEN MET
                                                                                                                                                                                                                              0 1 2 3 4       Evidence notes:
                                                                                                                      ▪ Written policy describing data exchange/urgent communications, including protocol of 24/7
     2-G 1.      1. LHD has and maintains appropriate technology for 24/7 communications (Capacity)
                                                                                                                      communications policies
                                                                                                                      ▪ Preparedness quarterly reports have checklist on emergency communication capacity
                 2. LHD maintains appropriate technology for electronic emergency communication data exchange
     2-G 2.                                                                                                           ▪ Update protocols and internal and external contact information at least annually and makes readily
                 (Capacity)
                                                                                                                      available to staff

     2-G 3.      3. LHD uses multiple methods for dissemination of public health messages (Process)                   ▪ Protocols and process for dissemination of public health messages
                 4. LHD tests its emergency data exchange capabilities annually (Process)                             ▪ Report from annual real event of exercise includes communication and data exchange protocols and
     2-G 4.                                                                                                           evaluation report
                 5. Uses After-Action Plan to address effectiveness of the emergency activities and to make
     2-G 5.                                                                                                           ▪ After-Action Plan and evaluation components are part of the emergency response plan
                 improvements
III. INFORM AND EDUCATE INDIVIDUALS ABOUT HEALTH ISSUES.
WI STANDARD: s.251.05(2)(a), Stats. - A local health department shall provide at least surveillance, investigation, control and prevention of communicable diseases, other disease prevention, health promotion and human health hazard control.


WI Required Services for LHDs by National Focus Area: Develop and Implement Media Strategies

WI Statutory /                                                                                                        EVIDENCE - During the HFS 140 review, the local health department provides information to meet this     DPH Finding
                         STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)                                                                                                                                            Evidence notes:
Rule Refer. #                                                                                                         requirement as indicated                                                                                 YES   NO




NATIONAL STANDARD 3-A: Develop relationships with media to convey information of public health significance, correct misinformation about public health issues, and serve as an
essential resource.
                                                                                                                                DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                           NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                                  BEEN MET
                                                                                                                                                                                                                                    0 1 2 3 4         Evidence notes:

                   1. LHD develops and maintains a current database of local media partners and contact information
     3-A 1.                                                                                                         ▪ List of current media contacts
                   (Capacity)
                                                                                                                             ▪ Records of training sessions/education of staff for working with the media
     3-A 2.        2. LHD staff competent in working with the media (Capacity)
                                                                                                                             ▪ LHD maintains a written protocol for communicating with the media
                                                                                                                             ▪ Log/Notes from calls and meetings with media representatives on current and emerging public
     3-A 3.        3. LHD provides media updates on public health events and issues (Process)
                                                                                                                             health issues
                   4. LHD has a media strategy that includes formal (press releases) and informal opportunities for
     3-A 4.        communicating with the media and responding to media requests, along with routine                         ▪ Written media strategy
                   communication to raise awareness of public health issues (Process)

WI Required Services for LHDs by National Focus Area: General Data and Information Exchange on Issues Affecting Population Health

WI Statutory /                                                                                                               EVIDENCE - During the HFS 140 review, the local health department provides information to meet this    DPH Finding
                           STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                                requirement as indicated                                                                               YES     NO
                                                                                                                                                                                                                                                  Evidence notes:
                   The health officer receives requests from physicians to determine the source and contacts of a
                   sexually transmitted disease, and diagnose or treat those persons. (a) Any person licensed under
(35) HFS 145.15;                                                                                                             View: At least 1 completed DPH 4243 (Rev. 1/04), a report, or other documentation regarding STIs
                   ch. 441 or 448, Stats., knowing of or in attendance on a case or suspected case shall notify the
HFS 145.04                                                                                                                   which has been submitted by a physician to the health officer.
                   local health officer or, if required under Appendix A of this chapter, the state epidemiologist, in the
                   manner prescribed in this section. (Health Officer)
(43) s.251.05 (2) Provides services to prevent other diseases as identified in HFS 140.04(1)(c) to include the
(a)               following:

(44) HFS 140.04 Informs local elected officials, educators, and the public about the incidence and prevalence of
                                                                                                                             Evidence provided under EPHS I
(1) (c) 1       diseases and injuries in the jurisdiction. (Local Health Department)

                Disseminates department-endorsed prevention guidance related to these diseases and injuries,
(45) HFS 140.04 including information about behaviors known to reduce the risk of contracting them, and training             Verbal description:The local health department will describe the educational method and locations
(1) (c) 2       interested member of the public in department-endorsed prevention techniques. (Local Health                  where health information is disseminated, including DHFS sponsored materials.
                Department)
NATIONAL STANDARD 3-B: Exchange information and data with individuals, community groups, other agencies, and the general public about physical, behavioral, environmental, social,
economic, and other issues affecting the public’s health.
                                                                                                                                DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                           NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                                  BEEN MET
                                                                                                                                                                                                                                    0 1 2 3 4         Evidence notes:

                                                                                                                             ▪ Nothes from meetings with community stakeholders (e.g., open forums, topical health issue
                   1. LHD works within a network of stakeholders to gather and share data (Process)
     3-B 1.                                                                                                                  meetings, such as infectious disease, preparedness, MCH, etc.) demonstrating communication and
                                                                                                                             exchange with key community partners (e.g., evidence that LHD staff presentation of report)

                   2. LHD continuously develops current information on health issues that affect the                         ▪ LHD has protocols and/or strategies in place to guide the development of up-to-date information to
     3-B 2.        community (Capacity)                                                                                      communicate to the community
                                                                                                                             ▪ Log of health information shared with community and any evaluation outcomes

                                                                                                                             ▪ LHD has a written protocol in place to respond to specific information requests
     3-B 3.        3. LHD responds to data requests in a timely manner (Process)
                                                                                                                             ▪ Log of response to requests for health information

                                                                                                                             ▪ Process in place to assess the information needs of specific populations and also the type of
                   4. LHD uses principles of social marketing to understand the information needs of specific                information and venue to use in providing the information
     3-B 4.        populations (Process)                                                                                     ▪ Evaluation process in place to assess the outcome of the provision of information
                                                                                                                             ▪ Log of information provided to specific populations
                                                                                                                       ▪ Communication plan includes educating the public in how to obtain data and information from the
                                                                                                                       department, including:
                   5. The public knows how to obtain health data and information from the department (Process)         - Multiple venues cited and used in the distribution of information
     3-B 5.                                                                                                            - Topical communication (e.g., in blast faxes, health alerts, etc.)
                                                                                                                       - LHD Newletters
                                                                                                                       - LHD web site with tracking capabilities


WI Required Services for LHDs by National Focus Area: Provide Health Information to Individuals for Behavior Change
WI Statutory /                                                                                                         EVIDENCE - During the HFS 140 review, the local health department provides information to meet this      DPH Finding
                           STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                          requirement as indicated                                                                                 YES     NO Evidence notes:

                                                                                                                       View: The health department will provide information that demonstrates programs and services are in
(46) HFS 140.04 Implements measures and programs designed to promote behavior that is known to prevent or              place to prevent or delay the onset of chronic disease and prevent injuries. Examples may include
(1) (c) 4.      delay the onset of chronic diseases, or prevent or ameliorate injuries. (Local Health Department)      policy and environmental strategies and working with a broad variety of partners such as churches,
                                                                                                                       business and community organizations. (Used the local needs assessment and identify issues)
(47) s.251.05(2)   The local health department disseminates information to the community about the causes, nature
(a) and HFS-       and prevention of diseases and health conditions prevalent in the community or for which the        Evidence provided under (44), (45), (46)
140.04(d)          incidence could be significant in the community, and about how to maintain and improve health.
                  The local health officer promotes the spread/dissemination of information as to the causes, nature
(49) s.251.06 (3)
                  and prevention of prevalent diseases, and the preservation and improvement of health for the         Evidence provided under (44), (45), (46)
(i), Stats.
                  community. (Health Officer)
NATIONAL STANDARD 3-C: Provide targeted, culturally appropriate information to help individuals understand what decisions they can make to be healthy.
                                                                                                                          DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                          NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                                        BEEN MET
                                                                                                                                                                                                                                0 1 2 3 4       Evidence notes:
                                                                                                                       ▪ Publications of health information in different languages represented in the community including
                                                                                                                       brochures, hand-outs, etc.
                   1. Accurate and current information is available in formats that are culturally appropriate,
     3-C 1.                                                                                                            ▪ Examples of programs designed to meet the needs of specific populations designed to meet the
                   linguistically relevant and accessible to target and special populations (Capacity)
                                                                                                                       needs of specific populations, i.e., teen, elderly ethnic groups
                                                                                                                       ▪ Evidence of used of local media for health messages including press release, health story
                   2. LHD staff demonstrates capacity to develop materials and conduct education campaigns             ▪ Evidence of cultural competency training provided for LHD staff and contractors, including copy of
     3-C 2.        designed to improve health behaviors (Capacity)                                                     training, schedule of training, agenda, attendance, or evaluation
                                                                                                                       ▪ Health education planning references finding in the community health assessment as justification for
     3-C 3.        3. LHD uses the community health assessment to develop health education information (Process)
                                                                                                                       choosing a specific topic and population
                                                                                                                       ▪ Log tracking health education meeting atttendance for reaching into target populations including an
                                                                                                                       evaluation component assessing if the target population understood the information
     3-C 4.        4. LHD assesses the target population for how they accept information (Process)
                                                                                                                       ▪ Surveys conducted to evaluate whether target audience understood health messages
                                                                                                                       ▪ Tracking system for program participants by race, ethnicity, gender, sexual orientation
                   5. Members of the target population participate in the development and distribution of health
     3-C 5.                                                                                                            ▪ Protocols are available including target populations in the development and testing health messages
                   education materials (Process)
     3-C 6.        6. Appropriate methods are used for distributing culturally appropriate materials                   ▪ Examples of distribution methods for health education, materials, media, schools, senior citizens

WI Required Services for LHDs by National Focus Area: Health Promotion Programs for Behavior and Environmental/Community Change
WI Statutory /                                                                                                         EVIDENCE - During the HFS 140 review, the local health department provides information to meet this      DPH Finding
                           STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)                                                                                                                                            Evidence notes:
Rule Refer. #                                                                                                          requirement as indicated                                                                                 YES     NO
                  General public health nursing program. Public health nurses who conduct the program may be
                  directed by the appropriate local authority do participate and provide collaborative public health
HFS 140.04 (1)    nursing expertise in the development of community plans that include identification of community
                                                                                                                      Evidence provided under EPHS I - Focus Area: Data Analysis
(a) 2.            health priorities, goals and objectives to address current and emerging threats to the health of
                  individuals, families, vulnerable population groups and the community as a whole, and contribute to
                  planning efforts that support community strengths and assests.

                  Environmental health program. Participate and provide collaborative environmental health
(93) HFS 140.06 expertise in the development of community plans that include identification of community health
(1) (e) 2. (Level priorities, goals and objectives to address current and emerging threats to the health of individuals, Evidence provided under Level II or Level III Addendum/Worksheet
III)              families, vulnerable population groups and the community as a whole, and contribute to planning
                  efforts that support community strengths and assests.

NATIONAL STANDARD 3-D: Provide health promotion programs to address identified health problems.
                                                                                                                         DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                         NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                           BEEN MET
                                                                                                                                                                                                                                0 1 2 3 4         Evidence notes:
                  1. LHD has an overall strategy/plan for its delivery of population-based health promotion and
                                                                                                                ▪ Health Improvement Plan based on Community Needs Assessment
                  disease prevention programs (e.g. which programs are developed, how they are implemented, and
     3-D 1.                                                                                                     ▪ Report/justification that details how health promotion programs are linked to community health
                  when they are evaluated) in relationship to the community health assessment and health
                                                                                                                assessment and health improvement plan
                  improvement plan (Capacity)
                                                                                                                ▪ Staff competency level assessed in health promotion knowledge and skills, including the use of
     3-D 2.       2. LHD staff has health promotion knowledge and skills (e.g. social marketing) (Capacity)
                                                                                                                social marketing
                                                                                                                ▪ Records indicating training and/or materials for health promotion have been provided to community
                  3. LHD provides technical assistance to communities and community agencies on health
     3-D 3.                                                                                                     organizations
                  promotion activities (Capacity)
                                                                                                                ▪ Log or summary of technical assessment efforts
                  4. LHD involves a variety of disciplines in the design and implementation of health promotion
                                                                                                                      ▪ Meeting notes that demonstrate including a variety of disciplines in the design and implementation of
     3-D 4.       programs (e.g. Educators, Faith Institutions, Nursing, Environmental, Community development for
                                                                                                                      health promotion programs
                  the built environment) (Process)
                  5. LHD identifies populations at risk as potential target populations for health promotion          ▪ Documents use Community health Assessment and Health Improvement Plan to identify populations
     3-D 5.       programming (Process)                                                                               at risk
                                                                                                                      ▪ Documentation of evaluation method for use with health education to determine if the information
     3-D 6.       6. LHD assesses the target population for how they accept information (Process)
                                                                                                                      was understood and accepted by
                                                                                                                      ▪ Documentation of source and use of proven intervention strategies/best practices
     3-D 7.       7. LHD program designs use proven intervention strategies (Process)
                                                                                                                      ▪ Record of number, types, topics of programs along with number of participants and evaluation
                                                                                                                      ▪ Program evaluation summaries, progress reports, or summaries of analysis demonstrate that key
                  8. LHD evaluates health promotion efforts every two years, the results of which are used to
     3-D 8.                                                                                                           measure data are used as part of the process to improve the programs or to revise health promotion
                  improve programs. (Process)
                                                                                                                      curricula
                  9. LHD develops and revises performance measures, goals and objectives for annual program           ▪ Written procedures describe the systematic approach to health promotion information, including the
     3-D 9.                                                                                                           development, distribution, evaluation, and revision process
                  planning based on information obtained through evaluation of health promotion activities.
IV. MOBILIZE PUBLIC AND PRIVATE SECTOR COLLABORATION AND ACTION TO IDENTIFY AND SOLVE HEALTH PROBLEMS.
WI STANDARD: s.251.05(3)(c), Stats. - A local health department shall involve key policy makers and the general public in determining and developing a community health improvement plan that includes actions to implement services and
functions specified under s.250.03 (1) (L), Stats.

WI Required Services for LHDs by National Focus Area: Community Planning Process Engaging Systems Partners

Statutory or                                                                                                          EVIDENCE - During the HFS 140 review, the local health department provides information to meet this       DPH Finding
                         STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                         requirement as indicated                                                                                  YES     NO
                                                                                                                                                                                                                                              Evidence notes:
                   Develops policy and provides leadership that fosters involvement and commitment of the
                                                                                                                              View: Documentation of the identified public health needs, the involvement of the private sector in
                   community, and advocates for equitable distribution of resources including complementary work
s. 251.04 (6) (b),                                                                                                            addressing the needs and policy set by the Board of Health to assure needs are met. Examples of
                   with the private sector, consistent with public health needs in the jurisdiction of the board of health.
Stats.                                                                                                                        evidence may include meeting minutes, planning documents, reports of results.
                   (Board of Health)


                    The local health officer is in charge of the local health department and performs duties prescribed
s.251.06 (3) (h),
                    by the local board of health. The local health officer shall submit an annual report of the               Evidence provided under (58) - EPHS V; possibly answered under (23) - EPHS I
Stats.
                    administration of the local health department to the local board of health.
HFS 140.05 (1)
                    The local health department provides or arranges for services that address objectives in the current
(b) 1. and HFS
                    State Health Plan. Objectives are selected based on assessed need, incorporates the views
140.06 (1) (b) 1.                                                                                                        Evidence provided under Level II or Level III Addendum/Worksheet
                    citizens and leaders from the public and private sectors of the community, and formally recognizes
(Level II and
                    that the objective is a public health priority for the community.
Level III)
NATIONAL STANDARD 4-A: Engage the local public health system in an ongoing, strategic, community driven, comprehensive planning process to identify, prioritize, and solve public
health problems; establish public health goals; and evaluate success in meeting the goals
.                                                                                           DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                           NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                                             BEEN MET
                                                                                                                                                                                                                                      0 1 2 3 4   Evidence notes:
                                                                                                                              ▪ A written plan for a community health needs assessment and community health plan is in place
                    1. LHD has a community health planning structure in place, including community partners                   ▪ Meeting minutes, membership lists, and attendance frequency for coalitions focused on public health
     4-A 1.         (Capacity)                                                                                                topics (e.g., pandemic flu, cardiovascular disease prevention, etc.)
                                                                                                                              ▪ Local performance assessment using National Public Health Performance Standards (NPHPS)
                    2. The planning team uses the community health assessment to inform the selection of priorities           ▪ Written description of the community health planning process and effort to engage the community
     4-A 2.         (Process)                                                                                                 and system partners

     4-A 3.         3. Community assets are identified (Process)                                                              ▪ A list of community assets is created as a result of the community health assessment

                                                                                                                              ▪ Consumer survey is developed to measure the quality and accessbility of healthcare services in the
                    4. Gaps are identified through analysis of the results with periodic surveys and other assessment
     4-A 4.         information (Process)
                                                                                                                              community
                                                                                                                              ▪ Gaps are listed based on the survey
                                                                                                                              ▪ A community health plan based on the Community Health Assessment with at least one measurable
     4-A 5.         5. Community satisfaction is assessed and gaps are identified (Process)                                   outcome objective covering a 5-year time frame related to each priority health need, and at least one
                                                                                                                              measurable impact objective related to each outcome objective

     4-A 6.         6. Partnership effectiveness in improving community health is assessed (Process)                          ▪ Questions in the consumer survey and focus groups provide information on this topic

     4-A 7.         7. The performance of the public health system is assessed (in relationship to targets) (Process)         ▪ Questions in the consumer survey and focus groups provide information on this topic

                    8. LHD leads a process to assess and analyze effectiveness to public policy and community
     4-A 8.                                                                                                                   ▪ Questions on assessment survey tool and community focus groups
                    environment to improve health and shares the results publicly

                                                                                                                              ▪ Community health improvement plan is developed based on the community health assessment.
     4-A 9.         9. Goals and objectives are established in the plan (Process)                                             This includes, goals, objectives, activities, timeline and evaluation components
                                                                                                                              ▪ Same - Community health improvement plan is developed based on the community health
    4-A 10.         10. Plan identifies emerging issues which may require investigation
                                                                                                                              assessment. This includes, goals, objectives, activities, timeline and evaluation components

                                                                                                                              ▪ Same - Community health improvement plan is developed based on the community health
    4-A 11.         11. Strategies and best practices are selected to increase potential for success
                                                                                                                              assessment. This includes, goals, objectives, activities, timeline and evaluation components

WI Required Services for LHDs by National Focus Area: Raise Awareness and Gain General Public Health Support for the Plan and Deeper Understanding of Public Health Issues
WI Statutory /                                                                                                       EVIDENCE - During the HFS 140 review, the local health department provides information to meet this   DPH Finding
                          STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                        requirement as indicated                                                                              YES     NO
                                                                                                                                                                                                                                         Evidence notes:
HFS 140.05 (1)     The local health department provides or arranges for services that address objectives in the current
3. and 4. (Level   State Health Plan. The local health department provides evidence that contemporary public health
II); HFS 140.06    practices of proven merit are being used to provide services to the community to achieve the         Evidence provided under Level II or Level III Addendum/Worksheet
(1) 3. and 4.      objectives. The local health department has established a process by which it will evaluate and
(Level III)        report to the community on progress and performance toward achieving the objectives.

NATIONAL STANDARD 4-B: Promote the community’s understanding of, and advocacy for, policies and activities that will improve the public’s health

                                                                                                                         DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                          NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                           BEEN MET
                                                                                                                                                                                                                           0 1 2 3 4         Evidence notes:

                   1. LHD has current information on health issues that affect the community readily accessible
     4-B 1.                                                                                                          ▪ Needs assessment and community health plan completed in the last 5 years
                   (Capacity)

                                                                                                                     ▪ A written plan for dissemination of the community health assessment and health improvement plan
                                                                                                                     is available
                   2. LHD conducts a community education and marketing process to increase the awareness of the
     4-B 2.                                                                                                          ▪ Presentations at public meetings, meeting agendas, or meeting notes
                   community health improvement plan and its recommendations (Process)
                                                                                                                     ▪ Press release, newspaper clippings about community health priorities and public health
                                                                                                                     ▪ Evidence of plan distributed including LHD website, newsletter, or distributed list

WI Required Services for LHDs by National Focus Area: Support Partners to Implement Action

WI Statutory /                                                                                                       EVIDENCE - During the HFS 140 review, the local health department provides information to meet this   DPH Finding
                          STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                        requirement as indicated                                                                              YES     NO
                                                                                                                                                                                                                                         Evidence notes:



NATIONAL STANDARD 4-C: Support, implement, and evaluate strategies that address public health goals in partnership with public and private organizations

                                                                                                                        DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                          NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                                   BEEN MET
                                                                                                                                                                                                                           0 1 2 3 4         Evidence notes:
                                                                                                                     ▪ Topic oriented coalitions: Lists of members, meeting frequency, meeting notes, etc.
                                                                                                                     ▪ Media reports of partnerships/coaltion implementation activities
                   1. LHD staff establishes and maintains partnerships with public and private organizations to      ▪ Linkage agreements among strategic partners
     4-C 1.        perform collective work to address public health issues (Capacity)                                ▪ Grant proposals to fund community priorities developed/supported by LHD and other community
                                                                                                                     agencies
                                                                                                                     ▪ Letters of support for grant proposals

                   2. LHD partners with community organizations that contribute to the Essential Public Health       ▪ List of community organizations that contribute to the provision of the Essential Services and/or
     4-C 2.        Services/program implementation (Process)                                                         program implementation

     4-C 3.        3. Participate in coalitions addressing community health issues                                   ▪ Meeting minutes and notes from coalition meetings

                   4. System partner organizations align their program activities and/or organization plans with     ▪ System partner organizations' work plans, action plans and program plans to address public health
     4-C 4.        community objectives (Process)                                                                    goals

                   5. Financial and human resources are organized to conduct program activities and maintain
     4-C 5.                                                                                                          ▪ A plan for funding the priority health assessment issues is in place and implemented
                   partnerships (Process)
     4-C 6.         6. Implementation progress is systematically monitored (Process)                                     ▪ Work plan is designed to monitor and evaluate the implementation of activities and programs

WI Required Services for LHDs by National Focus Area: DEVELOP PARTNERSHIPS TO SUPPORT PUBLIC HEALTH

WI Statutory /                                                                                                           EVIDENCE - During the HFS 140 review, the local health department provides information to meet this          DPH Finding
                           STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                            requirement as indicated                                                                                     YES     NO
                                                                                                                                                                                                                                                    Evidence notes:



NATIONAL STANDARD 4-D: Develop partnerships to generate interest in and support for improved community health status, including new and emerging public health issues

                                                                                                                              DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                           NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                                        BEEN MET
                                                                                                                                                                                                                                      0 1 2 3 4         Evidence notes:
                                                                                                                         ▪ Community assessment and plan, including a description of the community participation process, a
                                                                                                                         list of community groups involved in the process and method the community group uses to establish
     4-D 1.         1. LHD maintains a directory of community organizations and systems partners (Capacity)
                                                                                                                         priorities
                                                                                                                         ▪ Annual report listing external relationships maintained by the LHD
                                                                                                                         ▪ Document direct and in-kind contributions from community agencies to support planned public health
     4-D 2.         2. LHD encourages constituent participation in community health activities (Process)                 efforts
                                                                                                                         ▪ Letter of support for grant proposals
                                                                                                                         ▪ List of members of topic-oriented coalitions
                    3. LHD forms alliances or coalitions around specific public health policy issues (Process)
     4-D 3.                                                                                                              ▪ Linkage agreements among strategic partners (informal agreemets or formal agreements such as
                                                                                                                         Memorandums of Understanding)

                    4. LHD recruits individuals and organizations to play leadership roles on public health issues       ▪ List of individuals and organizations playing a leadership role on public health issues, their role, and
     4-D 4.         (Process)                                                                                            length of service

     4-D 5.         5. LHD participates in coalitions led by other community partners (Process)                          ▪ List of coalitions led by other organizations that the LHD participated in

WI Required Services for LHDs by National Focus Area: REPORTING PROGRESS, ADVOCATING FOR RESOURCES TO IMPLEMENT PRIORITIES

WI Statutory /                                                                                                           EVIDENCE - During the HFS 140 review, the local health department provides information to meet this          DPH Finding
                           STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                            requirement as indicated                                                                                     YES     NO
                                                                                                                                                                                                                                                    Evidence notes:
                    Documentation and evaluation of the responses of families and individuals to public health nursing
HFS 140.04 (1)      services and actions, in order to provide evidence of professional nursing servcies provided,
                                                                                                                         Evidence provided under EPHS I - Focus area: Data Analysis
(a) d.              determine progress toward goal achievement for a particular family or individual and provide a
                    basis for updating that family's or individual's nursing plan of care.

HFS 140.06 (1)      Document findings, recommendations and requirements based on environmental health inspections
                                                                                                                  Evidence provided under Level II or Level III Addendum/Worksheet
(e) 5 (Level III)   and inquires.

NATIONAL STANDARD 4-E: Inform the community, governing bodies, and elected officials about governmental public health services that are being provided, improvements being made
in those services, and priority health issues not yet being adequately addressed
                                                                                                                             DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                           NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                                     BEEN MET
                                                                                                                                                                                                                                      0 1 2 3 4         Evidence notes:
                    1. LHD monitors its progress in implementing public health services and interventions and            ▪ Newspaper articles, progress reports, website postings, LHD annual reports, etc.
     4-E 1.         analyzes information to compare to performance to plan targets or benchmarks (Capacity &             ▪ Summary of LHD evaluation of progress in achieving performance goals, including how budget was
                    Process)                                                                                             altered and needed change
                                                                                                                              ▪ LHD maintains a written protocol for working with the legislative process including guidelines for
                                                                                                                              communicating with legislative guidelines for communicating with legislative and governing bodies
     4-E 2.        2. LHD maintains capacity to interact with the legislative process and governing body (Capacity)           ▪ Letter to state from Board of Health confirming adoption of the community health plan
                                                                                                                              ▪ Reports on LHD activities, press releases, annual reports, indicating major health policy, practice
                                                                                                                              and capacity issues

                   3. LHD submits a budget justification that reflects program priorities and community needs
                                                                                                                              ▪ A complete budget and justification is developed including request for additional funding when
     4-E 3.        (Process)
                                                                                                                              appropriate based on the community needs assess and health improvement plan

                                                                                                                              ▪ Has a public health policy agenda
                                                                                                                              ▪ Minutes of meetings where the policy agenda has been shared locally and methods used to share it
                   4. LHD engages in public health policy development, identifying, prioritizing and monitoring public        with state and federal officials
     4-E 4.        health policy issues (Process)                                                                             ▪ List that identifies methods and organizations that provide a venue for the LHD to monitor public
                                                                                                                              health issues, i.e., state health department, state association of county and city health officials,
                                                                                                                              National Association of County & City Health Officials, and American Public Health Association, etc.

V. DEVELOP POLICIES, PLANS, AND PROGRAMS THAT SUPPORT INDIVIDUAL AND COMMUNITY HEALTH EFFORTS.
WI STANDARD: s.251.05 (3)(b), Stats. - A local health department shall develop public health policies and procedures for the community.


WI Required Services for LHDs by National Focus Area: PRIMARY SCIENTIFIC RESOURCE FOR POLICY CHANGE IN PUBLIC HEALTH

WI Statutory /                                                                                                                EVIDENCE - During the HFS 140 review, the local health department provides information to meet this           DPH Finding
                           STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                                 requirement as indicated                                                                                      YES     NO
                                                                                                                                                                                                                                                          Evidence notes:
                   Develops policy and provides leadership that fosters involvement and commitment of the
(51) s.251.04(6)
                   community, and advocates for equitable distribution of resources including complementary work
(b), Stats.
                   with the private sector, consistent with public health needs in the jurisdiction of the board of health.   Evidence provided under (50) - EPHS IV
                   (Board of Health)

                                                                                                                              View: Examples of Board of Health meeting minutes or other documentation which will identify that the
(52) s.251.04 (5), The local board of health shall meet at least quarterly. (Board of Health)
                                                                                                                              board of health meets at least quarterly.
Stats.

(53 - 57)
s.251.10;s.251.1                                                                                                              View: A copy of the operating budget is available. Evidence may have been reviewed under (23)
                 The local board of health prepares an annual budget of a health department specified under
2;s.251.125;s.25                                                                                                              EPHS I
                 s.251.02, Stats. - expenditures for the ensuing fiscal year. (Board of Health)
1.127;s.251.11
(1), Stats.
                                                                                                                              View: A copy of the local health officer's position description, specifically which indicates that they are
                  The local health officer is in charge of the local health department and performs duties prescribed
(58) s.251.06 (3)                                                                                                             in charge of the local health department. This is only required if the position description has been
                  by the local board of health. The local health officer shall submit an annual report of the
(h), Stats.                                                                                                                   revised, or the loal health officer's position description has not been reviewed since the last HFS 140
                  administration of the local health department to the local board of health.
                                                                                                                              review. Additional evidence provided under (23) EPHS I

(59) s.251.04(7), Assures that measures are taken to provide an environment in which the people can be healthy.
                                                                                                                              Evidence provided under (23) EPHS I
Stats.            (Board of Health)

NATIONAL STANDARD 5-A: Serve as a primary resource to governing bodies and policymakers to establish and maintain public health policies, practices, and capacity based on current
science and best practices.
                                                                                                                                 DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                           NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                                   BEEN MET
                                                                                                                                                                                                                                            0 1 2 3 4         Evidence notes:
                                                                                                                           ▪ A respresentative sample of Board of Health, City Council and/or County Board meeting minutes
     5-A 1.         1. LHD staff are up to date with current public health topics (Capacity)
                                                                                                                           indicating discussion of public health policy issues

                                                                                                                           ▪ Board of Health meeting minutes on presentation and discussion of community health assessment
     5-A 2.         2. LHD staff are knowledgeable about the legislative process (Capacity)
                                                                                                                           and plan

                    3. LHD maintains formal and informal relationships with legislative and governing body(s)
     5-A 3.                                                                                                                ▪ Evidence/logs of calls from elected officials, and other government officials
                    (Capacity)


     5-A 4.         4. LHD knows legislative and governing body representatives                                            ▪ LHD maintains a database of legislative and governing bodies


                    5. LHD has a tracking system in place to monitor public health issues under discussion by              ▪ List of methods and sources to use for monitoring public health issues under discussion by various
     5-A 5.         governing and legislative bodies (Process)                                                             governing bodies

                                                                                                                      ▪ LHD maintains a written protocol for working with the legislative process including guidelines for
                                                                                                                      communicating with legislative guidelines for communicating with legislative and governing bodies
                    6. LHD communicates routinely with legislative and governing bodies to raise awareness of current
     5-A 6.                                                                                                           ▪ Letter to state from Board of Health confirming adoption of the community health plan
                    public health issues and emerging issues affecting the community (Process)
                                                                                                                      ▪ Reports on LHD activities, press releases, annual reports, indicating major health policy, practice
                                                                                                                      and capacity issues

                    7. LHD provides expertise to legislative and governing body(s) in setting public health priorities     ▪ Logs of phone calls and meetings where legislative issues are discusses (LHD staff, who from
     5-A 7.         and planning public health programs (Process)                                                          governing bodies, topic discussed and response and follow-up)


     5-A 8.         8. LHD staff attends appropriate legislative events (Process)                                          ▪ Calendar of appropriate legislative event, who will attend and log of actual encounter


WI Required Services for LHDs by National Focus Area: POLICY ADVOCACY FOR HEALTH IMPROVEMENT

WI Statutory /                                                                                                             EVIDENCE - During the HFS 140 review, the local health department provides information to meet this       DPH Finding
                           STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                              requirement as indicated                                                                                  YES     NO
                                                                                                                                                                                                                                                   Evidence notes:
                    The local health officer is in charge of the local health department and performs duties prescribed
s.251.06 (3) (h),
                    by the local board of health. The local health officer shall submit an annual report of the            Evidence provided under (23) EPHS I and (58) EPHS V
Stats.
                    administration of the local health department to the local board of health.

NATIONAL STANDARD 5-B: Advocate for policies that lessen health disparities and improve physical, behavioral, environmental, social, and economic conditions in the community that
affect the public’s health
                                                                                                                             DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                           NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                                       BEEN MET
                                                                                                                                                                                                                                     0 1 2 3 4         Evidence notes:

                                                                                                                         ▪ Schedule of staff training on policy/advocacy development, copy of training, or list of trainings staff
     5-B 1.         1. LHD staff has the competencies/skills to advocate effectively for public health policy (Capacity)
                                                                                                                         attended

     5-B 2.         2. LHD maintains a directory of potential policy partners (Capacity)                                   ▪ Directory of potential policy partners

                                                                                                                           ▪ Log of activities to document that LHD engages local partnerships, state and national associations in
                    3. LHD engages community partners in policy development process and LHD legislative agenda
                                                                                                                           advocacy/policy development
     5-B 3.         (Process)
                                                                                                                           ▪ Meeting attendance list showing participation in local committees working on community
                                                                                                                           development or environmental issues, etc.
                                                                                                                            ▪ LHD annual reports presenting issues of special populations and root cause of health problems
                  4. LHD conducts advocacy for local, state, and national policies and legislation that protect and         ▪ Special reports on health disparities
     5-B 4.       promote the public’s health (Process)                                                                     ▪ Written summary or meeting minutes of governing body's approval of resources to address
                                                                                                                            disparities

                                                                                                                            ▪ Community health assessment and plan showing populations at risk, differences in health status
                                                                                                                            among various population groups, health disparities
     5-B 5.       5. LHD develops a legislative agenda/strategy to reflect community needs and priorities (Process)
                                                                                                                            ▪ Documentation of meetings or contact with state or local legislators (e.g., keep copy of electronic
                                                                                                                            form letters) where community needs and priorities were discussed


WI Required Services for LHDs by National Focus Area: LHD ROLE IN IMPLEMENTING COMMUNITY HEALTH IMPROVEMENT PLAN

WI Statutory /                                                                                                              EVIDENCE - During the HFS 140 review, the local health department provides information to meet this      DPH Finding
                          STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                               requirement as indicated                                                                                 YES     NO
                                                                                                                                                                                                                                                   Evidence notes:

(60) s.251.05 (3) Develop public health policies and procedures for the community:
(b), Stats.
                  Complete a community health assessment; collect, review and analyze data on community health
HFS 140.04 (1)
                  and identify population groups, families and individuals at high risk of illness, injury, disability or   View community health assessment report or verbal description of process and outcome.
(a) 1.
                  premature death.

                  Participate in the development of community plans that include identification of community health         Copies of at least three (3) examples of the health department setting, maintaining or contributing to
HFS 140.04 (1)    priorities, goals and objectives to address current and emerging threats to the health of individuals,    policies or procedures that have been reviewed and updated since the last review. Examples may
(a) 2.            families, vulnerable population groups and the jurisdiction as a whole, and contribute to planning        include smoke free policies, immunization policies for the community or community wide rabies control
                  efforts that support community strengths and assets                                                       plan.

                  Assure programs and services that focus on reducing health disparities and are based on
HFS 140.04 (1)                                                                                                              View document(s) identifying programs and services that address issues identified in the community
                  evaluation of surveillance data and other factors that increase actual or potential risk of illness,
(a) 3.                                                                                                                      health assessment.
                  disability, injury or premature death. (Local Health Department)

NATIONAL STANDARD 5-C: Engage in LHD strategic planning to develop a vision, mission, and guiding principles that reflect the community’s public health needs, and to prioritize services
and programs
                                                                                                                               DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                          NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                                            BEEN MET
                                                                                                                                                                                                                                     0 1 2 3 4         Evidence notes:
                                                                                                                            ▪ Organizational Capacity Self-Assessment (e.g., using APEX/PH Part I or Operational Definition
                  1. LHD leadership recognizes need for and undertakes an organizational strategic planning
     5-C 1.                                                                                                                 Metrics) is used as a basis for internal strategic plan
                  process (Capacity)
                                                                                                                            ▪ Budget reflects resources allocated for internal strategic planning process

     5-C 2.       2. LHD allocates resources for strategic planning (Capacity)                                              ▪ Budget line item

                                                                                                                            ▪ Staff competency assessment demonstrated expertise in facilitation of a strategic planning process
     5-C 3.       3. LHD staff has expertise to lead and facilitate the strategic planning process (Capacity)
                                                                                                                            or identification of available consultant expertise

                  4. LHD conducts a formal strategic planning process that considers its mission, vision and role in        ▪ Organizational strategic plan document or documentation of strategic priorities including mission,
     5-C 4.       the community in relation to the assurance of the 10 Essential Public Health Services (Process)           vision, guiding principle goals, objectives and activities, including policy development

                  5. LHD uses assessment data on community health problems and emerging health threats to                   ▪ Organizational strategic plan document or documentation of strategic priorities including mission,
     5-C 5.       develop annual program goals to develop policy (Process)                                                  vision, guiding principle goals, objectives and activities, including policy development

                                                                                                                            ▪ Organizational strategic plan document or documentation of strategic priorities including mission,
     5-C 6.       6. LHD identifies new strategic opportunities for promoting public health activities (Process)
                                                                                                                            vision, guiding principle goals, objectives and activities, including policy development
                  7. The LHD widely disseminates its strategic plan and shares with the public and key stakeholders.
     5-C 7.                                                                                                          ▪ Meeting minutes or agendas demonstrating sharing of strategic plan with key stakeholders
                  (Process)


     5-C 8.       8. LHD develops or updates the agency strategic plan every 24 months. (Process)                         ▪ Update to strategic plan at least every 24 months

VI. ENFORCE STATUTES AND RULES THAT PROTECT HEALTH AND ENSURE SAFETY.
WI STANDARD: s.251.04(7), Stats. - A local board of health shall assure that measures are taken to provide an environment in which individuals can be healthy.
 s. 251.06(3)(a), Stats., - A local health officer shall administer the local health department in accordance with state statutes and rules.
 s. 251.06(3)(b), Stats., - A local health officer shall enforce state public health statutes and rules.
 s. 251.06(3)(c), Stats., - A local health officer shall enforce any regulations that the local board of health adopts and any ordinances that the relevant governing body enacts, if those regulations and ordinances are consistent with state public
 health statutes and rules.
WI Required Services for LHDs by National Focus Area: REVIEW AND UPDATE PUBLIC HEALTH AUTHORITY

WI Statutory /                                                                                                            EVIDENCE - During the HFS 140 review, the local health department provides information to meet this   DPH Finding
                          STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                             requirement as indicated                                                                              YES     NO
                                                                                                                                                                                                                                              Evidence notes:
                  The local health officer is in charge of the local health department and performs duties prescribed
(58) s.251.06 (3)
                  by the local board of health. The local health officer shall submit an annual report of the             Evidence provided under (23) EPHS I
(h), Stats.
                  administration of the local health department to the local board of health.

                  The health department has procedures that direct any person who immunizes a student under               View: Signed immunization protocols; policy and procedures for immunization program from the
(73) HFS-
                  s.252.04 Stats., shall maintain records identifying the manufacturer, lot number, vaccine used,         department AND DPH Regional Office will provide confirmation of immunization program compliance
144.03(7)
                  name and title of immunizer. (Records)
                                                                                                                          Evidence provided under (73)
(74) HFS-         The health department has procedures to disclose a student’s immunization information upon the
                                                                                                                          DPH Regional Office will provide confirmation of immunization program compliance
144.03(10)        written or verbal request of a school or day care center. (Records)

                                                                                                                          View: A records retention ordinance/policy has been passed by the local government. The local
                  The local health officer develops and maintains a record system consistent with the provisions of
(75) s.146.82,                                                                                                            health department is aware of and complies with local government policies and procedures governing
                  this section and complies with guidance for the maintenance and destruction of patient health care
Stats.                                                                                                                    records management. Evidence may have been provided under (66), which is provided after National
                  records. (Records)
                                                                                                                          Standard 6-C.

(76) s.146.83,
                  The local health officer provides access to patient health care records as specified in this section.
Stats.                                                                                                                    Evidence provided under (75)
                  (Records)


(77) s.19.21,     The health department, as a governmental entity, establishes, maintains, and retains records
                                                                                                                      Evidence may have been provided under (75)
Stats.            according to statutory provisions concerning public records, property, and other records. (Records)

NATIONAL STANDARD 6-A: Review existing laws and regulations and work with governing bodies and policymakers to update them as needed

                                                                                                                             DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                         NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                               BEEN MET
                                                                                                                                                                                                                                0 1 2 3 4         Evidence notes:


     6-A 1.       1. LHD has legal expertise available to assist in the review of laws and regulations (Capacity)         ▪ List and contact information for legal expertise available to the department


                                                                                                                          ▪ Dates of any formal code review by the County Board or City Council
                  2. The LHD, with the participation of its governing body, reviews policies and procedures within its
     6-A 2.                                                                                                               ▪ Dates of and written procedure for systematic planned review of local ordinances
                  existing legal scope of authority on a regular and periodic basis (Process)
                                                                                                                          ▪ Review of compliance of the local jurisdiction with state laws and regulations
     6-A 3.       3. LHD evaluates the need for changes in rules, regulations, and ordinances (Process)                ▪ Record of regular review of rules, regulations and ordinances for needed changes

                  4. LHD identifies its legal authority to develop, implement and enforce public health policy
     6-A 4.                                                                                                            ▪ Policy and procedures for developing and enforcing public health policy
                  (Process)
                                                                                                                       ▪ Documentation of review and proposed modifications and formulations of laws and regulations,
                  5. LHD and governing body drafts modifications and/or formulations of laws and informal
     6-A 5.                                                                                                            and/or minutes of meetings with legislators to promote public health issues
                  policymakers of the needed statutory and regulatory updates (Process)
                                                                                                                       ▪ Minutes from meetings with policymakers on keeping public health laws up-to-date

                  6. LHD uses a model public health emergency act in reviewing the local public health authority for   ▪ Documentation of the model public health emergency act used in reviewing and establishing local
     6-A 6.       managing emergencies (Process)                                                                       public health authority during emergencies


                  7. LHD provides knowledge of disease trends, best practices and current public health science        ▪ Documentation/meeting notes from provision of expertise to various legal review and legislative
     6-A 7.       when needed for legal reviews (Process)                                                              actions


WI Required Services for LHDs by National Focus Area: LINK LHD PRACTICE TO EXISTING LAW AND REGULATION IN AN APPROPRIATE WAY

WI Statutory /                                                                                                         EVIDENCE - During the HFS 140 review, the local health department provides information to meet this           DPH Finding
                          STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                          requirement as indicated                                                                                      YES     NO
                                                                                                                                                                                                                                                   Evidence notes:
                    Other abatement or removal authority.
                    (a) A county, city, village, or town with a local health department may enact an ordinance
s.254.59 (7) and concerning abatement or removal of a human health hazard that is a least as restrictive as this
s.254.59 (7)(a), section. (b) An ordinance enacted under par. (a) may be enforced in the county, city, village, or
(b) and (c), Stats. town that enacted it. (c) This subsection may not be construed to prohibit any agreement under
                    s.66.0301 between a county and a city, town, or village that has a local health department,
                    concerning enforcement under this section. (This language enacted on 3/20/08)

NATIONAL STANDARD 6-B: Understand existing laws, ordinances, and regulations that protect the public’s health.

                                                                                                                           DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                         NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                             BEEN MET
                                                                                                                                                                                                                                     0 1 2 3 4         Evidence notes:

                  1. LHD studies laws and identifies public health issues that can only be addressed through laws.
     6-B 1.                                                                                                            ▪ Dates of and written procedure for systematic planned review of local ordinances
                  (Process)

     6-B 1.       2. LHD understands the intent of law and regulations (Process)                                       ▪ List programmatic and regulatory activities that are in place to implement the laws and regulations

                  3. LHD reviews its programs to determine whether program changes are needed to better carry out ▪ Dates and written procedure for review of programs to determine whether changes are needed to
     6-B 3.       legal mandates (Process)                                                                        carry out legal mandates, and record of any change are available

                                                                                                                       ▪ Identification and listing of organizations either locally or at the state level that have regulatory and
     6-B 4.       4. LHD identifies organizations with regulatory and enforcement authority (Process)
                                                                                                                       enforcement authority to address public health issues

WI Required Services for LHDs by National Focus Area: COMMUNICATION WITH AND EDUCATION OF REGULATED ENTITIES ON HOW TO COMPLY WITH LAWS

WI Statutory /                                                                                                         EVIDENCE - During the HFS 140 review, the local health department provides information to meet this           DPH Finding
                          STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                          requirement as indicated                                                                                      YES     NO
                                                                                                                                                                                                                                                   Evidence notes:
                                                                                                                       View: Documentation that orders and regulations are published which could include one or more of
(62) s.251.135    The local board of health publishes orders and regulations as a class 1 notice under ch. 985, Stats.
                                                                                                                       the following: ordinance, policy, or other example, such as public meeting notice. (If ordinance need
Stats.            (Board of Health)
                                                                                                                       the number and date signed)
                   The health officer notifies the owner of private property that a human health hazard has been found,
(71) s.254.59 (2),
                   and does so by registered mail requesting that the hazard be removed within 30 days. (Health         Evidence provided under (27) EPHS II
Stats.
                   Officer)
                   If the local health officer deems it necessary to abate or remove a human health hazard on private
(72) s.254.59 (4),
                   property, she/he shall serve notice on the owner or occupant to abate or remove within a                   Evidence provided under (27) EPHS II
Stats.
                   reasonable time that is not less than 24 hours. (Health Officer)
NATIONAL STANDARD 6-C: Educate individuals and organizations on the meaning, purpose, and benefit of public health laws, regulations, and ordinances and how to comply

                                                                                                                                 DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                           NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                                   BEEN MET
                                                                                                                                                                                                                                       0 1 2 3 4         Evidence notes:

                                                                                                                              ▪ List of, and credentials of, current staff who are competent in educating regulated entities
     6-C 1.        1. LHD staff is competent to provide education to regulated entities (Capacity)
                                                                                                                              ▪ Job descriptions of inspectors indicating education is part of their performance expectations


                   2. LHD makes written policies, local ordinances, administrative code, and enabling laws accessible
     6-C 2.                                                                                                           ▪ Log of when regulated entities have received appropriate policies, code and laws
                   to the public. (Process)

                                                                                                                              ▪ Schedule of provision of inspections and documentation of the education provided to the regulated
                                                                                                                              entity at the time of inspection AND/OR
     6-C 3.        3. LHD provides appropriate education to regulated facilities at the time of inspection. (Process)
                                                                                                                              ▪ Formal education process incorporated into regulatory practice and documented in annual reports,
                                                                                                                              inspection reports, etc.

                   4. LHD invites regulated entities to education programs on new and/or updated regulations as               ▪ Schedule of education opportunties for regulated entities to learn about new and/or updated
     6-C 4.        appropriate. (Process)                                                                                     regulations and record of who was invited and who attended


WI Required Services for LHDs by National Focus Area: TRACKING AND UNDERSTANDING PATTERNS OF COMPLIANCE WITH REGULATION

WI Statutory /                                                                                                                EVIDENCE - During the HFS 140 review, the local health department provides information to meet this      DPH Finding
                           STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                                 requirement as indicated                                                                                 YES     NO
                                                                                                                                                                                                                                                     Evidence notes:
                Pursuant to s.254.59 Stats., orders the abatement or removal of human health hazards found on
(65) HFS 140.04 private premises and, if an owner or occupant fails to comply, enter the premises and abate or
                                                                                                                              Evidence provided under (27) - EPHS II
(e) 2.          remove or contract for the abating or removal of the human health hazard. (Local Health
                Department)
                   The local health officer assures that permanent communicable disease records are created and               • Provide verbal description at review of the process used for communicable disease records retention,
(66) s.252.05(6)
                   maintained in the health department, and that the original or a copy of the original report is             including how you ensure that these records are secure.
Stats.
                   transmitted to the department. (Health Officer)                                                            • See transmittal of 4151s under (24) - EPHS I

(67)
                   The local health officer reports violations of communicable disease reporting by nurses and                Provide verbal description at review of any situations of violations of communicable disease reporting
s.252.05(11),
                   physicians to the district attorney in the jurisdiction of the local health department. (Health Officer)   requiring notification of the district attorney.
Stats
(68) HFS-
                 The local health officer receives reports of delinquent cases from physicians whenever her/his
145.16;s.252.11,                                                                                                              Evidence provided under (28) - EPHS II
                 patients do not comply with the treatment plan for sexually transmitted disease(s). (Health Officer)
Stats.

(70) s.254.59 (1) The health officer orders the abatement or removal of a human health hazard on private premises
                                                                                                                              Evidence provided under (27) - EPHS II
Stats.            within a reasonable time period. (Health Officer)

NATIONAL STANDARD 6-D: Monitor, and analyze over time, the compliance of regulated organizations, entities, and individuals
                                                                                                                            DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                         NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                              BEEN MET
                                                                                                                                                                                                                                      0 1 2 3 4         Evidence notes:

                  1. The LHD conducts inspections of regulated entities as appropriate (e.g., CD, animal control,        ▪ Updated lists of regulated entities in the jurisdiction
     6-D 1.       environmental health) and monitors compliance (Process)                                                ▪ Protocols for frequency and types of inspections including follow up for non-compliance


     6-D 2.       2. LHD staff is capable of analyzing data trends over time (Process)                                   ▪ List of staff with data analysis expertise assigned to review the reports for trends


                  3. LHD has a system to track compliance records over a period of time. This system includes
                                                                                                                         ▪ A tracking system that includes compliance over a period of time for each regulated entity (violation
     6-D 3.       compliants, response time, corrective action, compliance and enforcement. These activities are
                                                                                                                         trends over time)
                  assessed for timeliness, appropriateness and effectiveness (Capacity)

                  4. LHD evaluates a selected number of enforcement actions each year to determine compliance            ▪ Protocols for selection of a number of enforcement activities to be reviewed each year for
     6-D 4.       with and effectiveness of enforcement procedures; Evaluation used for quality improvement (QI)         compliance and to review the effectiveness of enforcement procedures in securing compliance
                  activities (Process)                                                                                   ▪ Quality Improvement activities based on results of evaluation

WI Required Services for LHDs by National Focus Area: COMPETENT AND FAIR ENFORCEMENT ACTIONS

WI Statutory /                                                                                                           EVIDENCE - During the HFS 140 review, the local health department provides information to meet this          DPH Finding
                          STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                            requirement as indicated                                                                                     YES     NO
                                                                                                                                                                                                                                                    Evidence notes:
                 A Level I local health department may provide any services that a Level II or Level III health          ▪ Level II: In addition to meeting the requirements under HFS 140.04, the local health department
                 department is required to provide by law. Determine if the Level I Local Health Department is           provides programs or services as defined under s. 251.20 (3), Stats and HFS 140.05.
(63) HFS         providing the following services and review according to established rule: • Conduct inspections and    ▪ Level III: In addition to meeting the requirements under HFS 140.04, the local health department
140.04(2); HFS investigation, issue permits and enforce the department’s environmental health sanitation rules,
                                                                                                                         provides programs and services as defined under s. 251.20 (3), Stats. and HFS 140.06 (1) (a) and (b),
192; s.254.69,   chs. HFS 172, 175, 178, 195, 196, 197 and 198. • Has the health department entered into an              the local health department conducts an environmental health program defined under HFS 140.06 (1)
Stats.           agreement with the department under s.254.69 Stats., and ch. HSS-192 to serve as the                    (c) to HFS 140.06 (1) (f), with environmental health staff who meet the qualifications under s. 440.98
                 department’s agent for this purpose in the local health department’s area of jurisdiction. (Local       (1) (b) and s. 440.98 (5), Stats.
                 Health Department)
                 The local health officer authorizes the release of an individual from tuberculosis isolation or shall   Verbal, written or view: The Health Officer is aware of their authority regarding discharge from isolation
                 petition a court to order the release of an individual from commitment if: adequate therapy has been    or confinement.
(69) HFS-145.11;
                 initiated; sputum or bronchial secretions are free of acid-fast bacilli or the number of same are
s.252.07, Stats.
                 declining; specific arrangements have been made for post-isolation or post-commitment care; and,        Identify whether policy and/or procedures are in place.
                 the person being considered is not a threat to the health of the general public. (Health Officer)
NATIONAL STANDARD 6-E: Conduct enforcement activities

                                                                                                                            DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                         NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                              BEEN MET
                                                                                                                                                                                                                                      0 1 2 3 4         Evidence notes:

     6-E 1.       1. LHD workforce is skilled in enforcement procedures and credentialed as appropriate (Capacity) ▪ List of enforcement workforce and their credentials

                                                                                                                         ▪ Written procedures and protocols for conducting enforcement actions are maintained, i.e., protocols
                  2. LHD uses a risk analysis method (i.e., identify restaurants with frequent violations) and a work
     6-E 2.                                                                                                              for establishing timeframes and frequencies of inspection and enforcement activities for routine
                  plan to guide the frequency and scheduling of inspections of regulated facilities (Capacity)
                                                                                                                         inspections and for entities with frequent violations
                                                                                                                         ▪ Log/record of all enforcement activities kept in accordance with procedures and protocols
                  3. LHD routinely conducts enforcement activities according to procedures and protocols and rules
     6-E 3.                                                                                                              ▪ Enforcement intervention reports, including administrative interventions and legal interventions
                  are applied consistently (Process)
                                                                                                                         ▪ LHD annual report summarizing enforcement activities by type
                                                                                                                         ▪ Log/record of all enforcement activities kept in accordance with procedures and protocols including
     6-E 4.       4. LHD promptly conducts enforcement activities needed in response to an emergency (Process)           quality assurance components which compare the situtation/report, response time, corrective action,
                                                                                                                         compliance, and maintenance of compliance over a period of time
WI Required Services for LHDs by National Focus Area: NOTIFY OTHER GOVERNMENT AGENCIES OF ENFORCEMENT VIOLATIONS

WI Statutory /                                                                                                        EVIDENCE - During the HFS 140 review, the local health department provides information to meet this   DPH Finding
                          STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                         requirement as indicated                                                                              YES     NO
                                                                                                                                                                                                                                          Evidence notes:
                By November 15 of each year, the local health department reports to the department statistical        Evidence provided under (73)
(78) HFS 144.08
                information concerning the degree of compliance with s.252.04 Stats., of students within the          DPH Regional Office will provide confirmation of immunization program compliance.
(2)
                jurisdiction of the local health department. (Local Health Department)
NATIONAL STANDARD 6-F: Coordinate notification of violations among other governmental agencies that enforce laws and regulations that protect the public’s health

                                                                                                                         DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                         NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                           BEEN MET
                                                                                                                                                                                                                            0 1 2 3 4         Evidence notes:

                  1. Rapid communication capability can be demonstrated between the LHD and other enforcement
     6-F 1.                                                                                                           ▪ File/log of "inter-organizational" notifications with back-up notification forms
                  entities (Capacity)

                  2. LHD has a comprehensive knowledge of other agencies involved in enforcement in the
     6-F 2.                                                                                                           ▪ A chart or map of government agencies with enforcement responsibilities and contact information
                  protection of the public health (Process)

                  3. LHD develops and executes communication protocols for the notification of other enforcement      ▪ Procedures for inter-agency communication Memorandum of Understanding or other formal written
     6-F 3.       agencies (Process)                                                                                  inter-agency agreements as needed

VII. LINK INDIVIDUALS TO NEEDED PERSONAL HEALTH SERVICES

WI STANDARD: s.251.05(2)(a), Stats. - A local health department shall provide at least surveillance, investigation, control and prevention of communicable diseases, other disease prevention, health promotion and human health hazard control.


WI Required Services for LHDs by National Focus Area: COMMUNITY-ORIENTED PROGRAM PLANNING

WI Statutory /                                                                                                        EVIDENCE - During the HFS 140 review, the local health department provides information to meet this   DPH Finding
                          STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                         requirement as indicated                                                                              YES     NO
                                                                                                                                                                                                                                          Evidence notes:
                                                                                                                      View: One or more of the following:
                Arranges for screening, referral and follow-up for population groups for which these activities are   ▪ Examples of screening, referrals & follow-up completed.
(81) HFS 140.04
                recognized by the department as effective in preventing chronic diseases and injuries. (Local         ▪ Policies and procedures that are in place.
(1) (c) 3
                Health Department)                                                                                    ▪ Sample records
                                                                                                                      ▪ Annual report – indicating screening, referral and follow-up numbers.

NATIONAL STANDARD 7-A: Engage the community to identify gaps in culturally competent, appropriate, and equitable personal health services, including preventive and health promotion
services, and develop strategies to close the gaps
                                                                                                                         DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                         NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                           BEEN MET
                                                                                                                                                                                                                            0 1 2 3 4         Evidence notes:

                                                                                                                      ▪ Community Health Assessment including community forum reportsand community surveys identify
     7-A 1.       1. LHD staff has a working understanding of access to care issues in their community (Capacity)
                                                                                                                      access issues

                                                                                                              ▪ List of staff with program planning experience and/or credentials in community development
     7-A 2.       2. LHD staff are competent in program planning and community development methods (Capacity) methods and/or staff have conducted program planning or community development activities (e.g.,
                                                                                                              Program staff have gone through MAPP training)
                                                                                                                         ▪ Written program plans directly reflect the needs of the population as indicated in the community
                                                                                                                         health assessment, other consumer satisfaction surveys, and surveys of special population groups
                 3. LHD engages a diverse set of community partners, representing communities of color, tribal
     7-A 3.                                                                                                              ▪ Protocols for including diverse sets of community partners, including communities of color, tribal
                 representatives and specific populations, to identify program gaps and barriers (Process)
                                                                                                                         representatives, and specific populations to assist in identification of programs gaps and barriers to
                                                                                                                         accessing care

                 4. LHD, in partnership with community partners, interprets qualitative and quantitative information
     7-A 4.      on program gaps, developed through surveys, focus groups, interviews or other means of primary          ▪ Program assessments and plans (e.g., HIV plans, MCH plans)
                 data collection. (Process)

                 5. LHD uses criteria periodically to evaluate access, quality, appropriateness and effectiveness of
     7-A 5.                                                                                                              ▪ Utilize community surveys, including consumer satisfaction surveys, every two years
                 preventive and personal health services in the community. (Process)

                 6. LHD identifies community health and prevention priorities to reduce access barriers every five       ▪ To evaluate the access, quality and effectiveness of both preventive and personal health services
     7-A 6.      years (Process)                                                                                         ▪ Conduct a community health needs assessment every 5 years


WI Required Services for LHDs by National Focus Area: PREVENTION AND PERSONAL HEALTH CARE SYSTEM BUILDING

WI Statutory /                                                                                                           EVIDENCE - During the HFS 140 review, the local health department provides information to meet this      DPH Finding
                         STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                            requirement as indicated                                                                                 YES     NO
                                                                                                                                                                                                                                                Evidence notes:
                 Public health nursing program. Provide or arrange for the availability of services and actions to
                                                                                                                         View: Evidence of a public health nursing program, which may include any of the following:
                 promote, maintain or restore health and prevent disease and injury that are directed at current and
HFS 140.04 (1)                                                                                                           Agency brochure that describes Public Health Nursing programs and services being provided; Annual
                 emerging needs of the community, vulnerable population groups and families and individuals
(a) 4.                                                                                                                   report; Activity report; Agency web-site that describes Public Health Nursing programs and services
                 referred by physicians and other health care providers, health maintenance organizations and other
                                                                                                                         being provided. Evidence also provided under (23) EPHS I
                 sources for health education and follow-up.
                                                                                                                         Evidence provided under (73) - EPHS 6
(82) HFS 144.08 The local health department assists the department in informing schools and day care centers of
                                                                                                                         DPH Regional Office will provide confirmation of immunization program compliance.
(3)             the immunization provisions of s.252.04, Stats. (Local Health Department)

NATIONAL STANDARD 7-B: Support and implement strategies to increase access to care and establish systems of personal health services, including preventive and health promotion
services, in partnership with the community
                                                                                                                            DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                        NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                                    BEEN MET
                                                                                                                                                                                                                                  0 1 2 3 4         Evidence notes:

                 1. A plan is in place for prevention and health promotion which identifies efforts to link public and   ▪ Community planning processes/an written plans for collaborative efforts to link public and private
     7-B 1.      private partnerships into a network of personal health and prevention services (Capacity)               healthcare services

                 2. LHD maintains the capacity to provide health care services when local needs and authority exist, ▪ Community assessment data demonstrates a need for increased access to some services with
     7-B 2.      and the appropriate agency capacity and adequate additional resources can be secured (Capacity) documentation in meeting minutes of sharing this information with the LHD governing body

                 3. LHD convenes or participates in a collaborative process with community health care providers,        ▪ List of coalitions and networks and their members working on collaborative processes to reduce
     7-B 3.      social services organizations, and community stakeholders to coordinate service delivery and to         barriers to accessing primary care and preventive services
                 reduce barriers to accessing primary and preventive services. (Process)                                 ▪ Partnership meeting notes on implementation strategies

                 4. LHD develops and implements strategies to increase utilization of public health programs and         ▪ Memorandum of Understanding
     7-B 4.      services (Process)                                                                                      ▪ Subcontracts in the community to implement services

                 5. LHD, in partnership with other community agencies, identifies gaps in access to critical health
                                                                                                                         ▪ Grant applications by members of community partnerships
     7-B 5.      services through analysis of the results of periodic surveys and other assessment information and
                                                                                                                         ▪ Letters of support for grants to other community agencies
                 work collaboratively to address the gaps (Process)


WI Required Services for LHDs by National Focus Area: INDIVIDUAL-FOCUSED LINKAGES TO NEEDED CARE
WI Statutory /                                                                                                         EVIDENCE - During the HFS 140 review, the local health department provides information to meet this        DPH Finding
                          STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                          requirement as indicated                                                                                   YES     NO
                                                                                                                                                                                                                                                Evidence notes:
                   Provide or arrange for continuity of health care for individuals and families requesting or referred for
                   nursing services and provide them with or otherwise arrange for the availability of timely, cost-
                   effective and quality nursing and clinical preventive services through the following: a) assessment
(92) HFS 140.04
                   of their current an emerging health care needs; b) development of effective, efficient and equitable Evidence provided under EPHS I - Focus area: Data Analysis
(1) (a) 6. a and b
                   nursing plans of care for families and individuals who will be receiving services for a period of time;
                   c) implementation of nursing plans of care and collaboration with other agencies and organizations,
                   as necessary, to achieve goals included in the plans of care.

NATIONAL STANDARD 7-C: Link individuals to available, accessible personal health care providers (i.e., a medical home)

                                                                                                                           DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                         NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                                    BEEN MET
                                                                                                                                                                                                                                  0 1 2 3 4         Evidence notes:

                                                                                                                       ▪ LHD maintains a current inventory of available personal healthcare resources
     7-C 1.       1. LHD refers to personal health care resources as needed (Capacity)
                                                                                                                       ▪ Inventory of safety-net programs providers

                                                                                                                       ▪ Formal process is established to track healthcare referrals, i.e., to who, was the appointment made
     7-C 2.       2. LHD uses a tracking system for health care referrals (Capacity)
                                                                                                                       and/or kept, is there any follow-up to be made by the LHD

                  3. LHD engages local lay health advocates for outreach to special populations in need of health      ▪ Protocols for and Log of use of local lay advocates for outreach, i.e., faith community, Area Agency
     7-C 3.       care (Process)                                                                                       on Aging, youth groups, etc.


                  4. LHD provides community outreach and linkage services making es referrals to a current,            ▪ Current list of community health and wellness resources
     7-C 4.       comprehensive list of community health and wellness resources. (Process)                             ▪ Current reports on outreach and case management services


                  5. LHD enrolls or links to enrollment agents potential beneficiaries in Medicaid or Medical          ▪ Protocols/Process for enrolling or linking clients to enrollment agents for Medicaid and other Medical
     7-C 5.       Assistance Programs (Process)                                                                        Assistance Programs


                  6. LHD informs the public, through a variety of methods, about services and resources available      ▪ Communication plan targeting various special populations to inform the entire population about the
     7-C 6.       through the LHD to reduce specific barriers to access to care (Process)                              services available to everyone thorugh the LHD

VIII. ASSURE A COMPETENT PUBLIC HEALTH WORKFORCE.

WI STANDARD: s. 251.06(3)(e), Stats. - A local health officer shall appoint all necessary subordinate personnel that they meet appropriate qualifications and have supervisory power over all subordinate personnel. Any public health nurses or
sanitarians hired for the local health department shall meet any qualification requirements established in rules promulgated by the department. Subordinate personnel under this paragraph my include any of the following: A public health
educator, a public health nutritionist, and a public health dental hygienist who meets the qualification requirements specified under s.251.06(3)(e), Stats., or by department rule.


WI Required Services for LHDs by National Focus Area: OVERALL HUMAN RESOURCES FUNCTION / WORKFORCE CAPACITY

WI Statutory /                                                                                                         EVIDENCE - During the HFS 140 review, the local health department provides information to meet this        DPH Finding
                          STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                          requirement as indicated                                                                                   YES     NO
                                                                                                                                                                                                                                                Evidence notes:
                                                                                                                        Shall have at least a bachelor’s degree from a nursing program accredited by the national professional
(83) s.251.06 (1) The local health officer of a Level I local health department shall meet requirements under s. 251.06
                                                                                                                        nursing education accrediting organization or from a nursing program accredited by the board of
(a), Stats.       (1) (a), Stats.
                                                                                                                        nursing. (Health Officer)
                                                                                                                           Have at least 3 years of experience in a full-time position with a public health agency, including
                                                                                                                           responsibility for a communicable disease prevention and control program, preferably in a supervisory
                                                                                                                           or other administrative position, and at least one of the following: 1. A bachelor's degree from a nursing
                   The local health officer of a Level II local health department shall meet requirements established
                                                                                                                           program accredited by the national professional nursing education accrediting organization or from a
                   under s. 251.06 (1) (b), Stats.
                                                                                                                           nursing program accredited by the board of nursing, either of which shall include preparation in public
                                                                                                                           health nursing. 2. A bachelor's degree in public health, environmental health, the physical or biological
                                                                                                                           sciences or a similar field.
                                                                                                                           Shall have at least one of the following: 1. A master's degree in public health, public administration,
                                                                                                                           health administration or, as defined in rules promulgated by the department, a similar field and 3 years
                                                                                                                           of experience in a full-time administrative position in either a public health agency or public health
                                                                                                                           work.
                                                                                                                           2. A bachelor's degree and 16 graduate semester credits towards a master's degree in public health,
                                                                                                                           public administration, health administration or, as defined in rules promulgated by the department, a
                   The local health officer of a Level III local health department shall meet requirements under s.
                                                                                                                           similar field and 5 years of experience in a full-time administrative position in either a public health
                   251.06 (1) (c), Stats.
                                                                                                                           agency or public health work. 3. A license to practice medicine and surgery under ch. 448 and at least
                                                                                                                           one of the following:
                                                                                                                            a. Three years of experience in a full-time administrative position in either a public health agency or
                                                                                                                           public health work; b. Eligibility for certification by the American board of preventive medicine in public
                                                                                                                           health or general preventive medicine; c. A master's degree in public health, public administration,
                                                                                                                           health administration or, as defined in rules promulgated by the department, a similar field.
                                                                                                                           View: Evidence that there is a process to check licenses and certifications and assure that all staff
                  Shall employ qualified public health professionals, including qualified public health nurses, who
                                                                                                                           meet qualification requirements before hiring and on a regular basis. AND
                  meets qualifications under s. 250.06, Stats., to conduct a public health nursing program, and may
(84) s.251.04(8),
                  employ one or more sanitarians, who meets qualifications under s. 440.98 (1)(b) and s. 440.98 (5),
Stats.                                                                                                                     If having agent status, evidence that the Registered Sanitarian(s) meet the requirements under HFS
                  Stats., to conduct environmental programs and other public health programs not specifically
                                                                                                                           160, and has a current certificate of registration under s. 440.98 (5).
                  designated by statute as functions of the public health nurse. (Board of Health)

                  The local health officer appoints all necessary subordinate personnel and assures such personnel
(85) s.251.06 (3) possess necessary qualifications (including licenses and certifications required by the department
                                                                                                                           Evidence provided under (58) - EPHS V, and (84)
(e) Stats.        and State of Wisconsin) and has supervisory power over all subordinate personnel in the health
                  department. (Health Officer)

                  The local health officer assures that any public health nursing director, public health nurses,
(86) s.251.06 (3)
                  environmental health director, and sanitarians hired meet the qualifications set forth in WI Statutes    Evidence provided under (58) - EPHS V, and (84)
(e) Stats.
                  and and Administrative Rule HFS 139. (Health Officer)

                  The local health officer shall employ as many persons as are necessary to execute his or her orders
                  and promptly guard any place if quarantine or other restrictions on communicable disease are        Verbal, written or view: The Health Officer is aware of their authority related to employing and swearing
(87) s.252.06 (5) violated or intent to violate is manifested. These persons shall be sworn in as quarantine guards,
                                                                                                                      in quarantine guards.
Stats.            shall have police powers, and may use all necessary means to enforce that state laws for the
                  prevention and control of communicable diseases, or the orders and rules of the department or any
                  local health officer. (Health Officer)
                   If there is more than one full-time employee of a Level I local health department, including a full
(88) s.251.06                                                                                                              Evidence provided under (83) and (84)
                   time public health nurse who meets the qualifications specified under s.250.06, the local health
(1)(a) 3, Stats.                                                                                                           Identify policy and/or procedures which are in place.
                   officer may meet the qualifications of a Level II or Level III local health officer. (Health Officer)

NATIONAL STANDARD 8-A: Recruit, train, develop, and retain a diverse staff.

                                                                                                                               DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                           NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                                         BEEN MET
                                                                                                                                                                                                                                         0 1 2 3 4   Evidence notes:
                                                                                                                           ▪ Human Resources Manual
      8-A 1.       1. LHD has formally organized human resources function (Capacity)                                       ▪ LHD organizational chart that includes the functional elements of the organization and their
                                                                                                                           relationship to each other
                                                                                                                          ▪ Written policies on staff access to training, i.e., who is eligible, continuing education policies,
     8-A 2.      2. LHD has policies that promote and facilitate staff access to training (Capacity)
                                                                                                                          furthering education at a college, tuition reimbursement, paid time off etc.

                                                                                                                          ▪   Written policies in Human Resources Manual
                                                                                                                          ▪   Written plans or policies regarding staff recruitment, selection, development, and retention
     8-A 3.      3. LHD has a non-discriminatory employment policy (Capacity)
                                                                                                                          ▪   Statement on equal opportunity
                                                                                                                          ▪   Affirmative action plan


     8-A 4.      4. LHD develops, uses, and revises job standards and position descriptions (Process)                     ▪ Job descriptions with minimum qualifications for each position revised annually


                 5. LHD determines needed competencies, composition, and size of its workforce and seeks job              ▪ Public Health Competencies incorporated into all LHD job descriptions
     8-A 5.      applicants to fill those needs (Process)                                                                 ▪ Written review of staffing needs on an annual basis

                 6. LHD periodically assesses its capacity (staff size, staff education and experience requirements,
                                                                                                                          ▪ APEX Part I - Organizational Capacity Self-Assessment or Operational Definition Metrics
     8-A 6.      financial resources, and administrative capacity) in relation to the needs of the population it serves
                                                                                                                          Assessment or Organizational assessment within a larger agency strategic plan
                 (Process)

                 7. LHD provides new employee orientation, employee in-service and continuing education
     8-A 7.                                                                                                               ▪ Formal orientation manual and program exists for all employees
                 experiences where appropriate (Process)


                                                                                                                          ▪ Documentation of schedule for training in cultural competent healthcare and record of each
     8-A 8.      8. LHD provides for staff training in cultural sensitivity and cultural competency (Process)
                                                                                                                          employee receiving the training within a predetermined time frame


WI Required Services for LHDs by National Focus Area: PUBLIC HEALTH COMPETENCIES OF EXISTING WORKFORCE

WI Statutory /                                                                                                            EVIDENCE - During the HFS 140 review, the local health department provides information to meet this     DPH Finding
                         STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                             requirement as indicated                                                                                YES     NO
                                                                                                                                                                                                                                                Evidence notes:




NATIONAL STANDARD 8-B: Evaluate LHD staff members’ public health competencies, and address deficiencies through continuing education, training, and leadership development activities

                                                                                                                             DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                        NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                                       BEEN MET
                                                                                                                                                                                                                                  0 1 2 3 4         Evidence notes:

                 1. A learning management system is in place to organize competency assessments and training              ▪ Report on annual reassessment of all staff competency levels and training needs using a learning
     8-B 1.      and educational opportunities to address deficiencies (Capacity)                                         management system that is available on line

                                                                                                                          ▪ LHD tracking system for staff participation in training and education
     8-B 2.      2. Training and leadership opportunities are available (Capacity)
                                                                                                                          ▪ Staff training plan

                 3. LHD assesses its staff members to identify deficiencies in knowledge, skills and authority; and       ▪ Performance evaluations including worker objectives and continuing education and training plans,
     8-B 3.      remedial action is taken when required (Process)                                                         based in part on worker self-assessments


     8-B 4.      4. LHD provides incentives for the workforce to pursue education and training (Process)                  ▪ List of criteria for workforce educational opportunities and training


                                                                                                                          ▪ List of LHD staff who have participated in workforce development activities including web-casts,
     8-B 5.      5. LHD provides opportunities for continuing education, training (Process)
                                                                                                                          online trainings, workshop, etc., and list of these events
     8-B 6.      6. LHD provides opportunity for leadership development for its staff (Process)                         ▪ List of criteria for workforce accessing leadership development

                 7. LHD encourages or requires relevant certification and credentialing programs for individuals, not
                                                                                                                       ▪ Policies are available that identify required relevant certification and credentialing programs for
     8-B 7.      otherwise licensed or monitored by the state and whose activities can affect the health of the public
                                                                                                                       positions within the LHD
                 (Process)

                 8. LHD assures that each staff member has attended training within the past 24 months to maintain
     8-B 8.                                                                                                        ▪ Written policy for frequency of staff participation in training
                 competency (Process)

                 9. LHD provides a coordinated program of continuing education for staff which includes attendance
     8-B 9.      at seminars, workshops, conferences, in-service training, and/or formal courses to improve        ▪ Written policy for coordination of continuing education for staff members
                 employee skills and knowledge in accordance with their professional needs (Process)

    8-B 10.      10. LHD supports staff conference attendance and peer exchange opportunities. (Process)                ▪ Written policy for conference attendance and peer exchange opportunities for staff


WI Required Services for LHDs by National Focus Area: DEVELOPING THE FUTURE WORKFORCE

WI Statutory /                                                                                                          EVIDENCE - During the HFS 140 review, the local health department provides information to meet this     DPH Finding
                        STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                           requirement as indicated                                                                                YES     NO
                                                                                                                                                                                                                                              Evidence notes:




NATIONAL STANDARD 8-C: Provide practice and competency based educational experiences for the future public health workforce, and LHD staff expertise in developing and teaching
public health practice curricula, through partnerships with academia.
                                                                                                                       DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                        NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                                     BEEN MET
                                                                                                                                                                                                                                0 1 2 3 4         Evidence notes:
                                                                                                                    ▪ Policies and MOUs exist between the LHD and universities, colleges, schools, or programs of public
                 1. LHD has partnership agreements in place with universities, schools or programs of public health
     8-C 1.                                                                                                         health for provision clinical experience at the local level
                 and/or colleges to enrich public health practice and academic settings (Capacity)
                                                                                                                    ▪ Use of LHD expertise as guests in the classroom
                 2. LHD partners with academic institutions to provide clinical sites for training programs (e.g.       ▪ Record of Internships/preceptorships at the LHD for students at multiple levels (e.g., high school,
     8-C 2.      internships, field training) and for using LHD staff as guest lecturers or adjunct professors          college and graduate school)
                 (Process)                                                                                              ▪ Record of LHD staff serving as guest lecturers for public health classes

                 3. LHD implements plans for developing research focused interactions with academic institutions,       ▪ Record of LHD participating in research by providing data and also by promoting practice based
     8-C 3.      including practice based research projects (Process)                                                   research with partnering institutions


WI Required Services for LHDs by National Focus Area: EFFECTIVE PUBLIC PRACTICES USED BY OTHER PRACTIONERS EXTERNAL WORKFORCE

WI Statutory /                                                                                                          EVIDENCE - During the HFS 140 review, the local health department provides information to meet this     DPH Finding
                        STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                           requirement as indicated                                                                                YES     NO
                                                                                                                                                                                                                                              Evidence notes:




NATIONAL STANDARD 8-D: Promote the use of effective public health practices among other practitioners and agencies engaged in public health interventions.
                                                                                                                              DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                            NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                                       BEEN MET
                                                                                                                                                                                                                                  0 1 2 3 4         Evidence notes:
                                                                                                                          ▪ MOUs or other agreements in place for LHD to provide public health education/best practices to
                                                                                                                          public health system partners to assure use of effective public health practice by both public and
                     1. LHD has agreements in place with public health systems partners for workforce assessment,         private providers
      8-D 1.         training and professional education (Capacity)                                                       ▪ Annual Reports to Board of Health on basic evaluation of programs, target groups, reach into the
                                                                                                                          population at risk
                                                                                                                          ▪ Meeting notes indicating LHD communication of best practices with other public health practitioners
                                                                                                                          ▪ Log of presentations given to community groups and local providers, sharing public health best
                     2. LHD shares best public health practices with community partners at meetings in the community      practices, with recorded evaluation of the learning outcomes, numbers and types of professionals
      8-D 2.         (e.g. hospital meetings to plan a community health promotion initiative, Chamber of Commerce         attending
                     meetings to promote workplace wellness, etc.) (Process)                                              ▪ Participation on advisory committees developing best practices
                                                                                                                          ▪ Participation in Grand Rounds at local hospitals with physician committees
                                                                                                                          ▪ Log of presentations given to public health and healthcare conferences, sharing public health best
      8-D 3.         3. LHD makes presentations at public health and health care conferences (Process)                    practices, with recorded evaluation of the learning outcomes, numbers and types of professionals
                                                                                                                          attending

WI Required Services for LHDs by National Focus Area: ADEQUATE RESOURCES (Educational and Equipment) FOR JOB PERFORMANCE

WI Statutory /                                                                                                            EVIDENCE - During the HFS 140 review, the local health department provides information to meet this     DPH Finding
                             STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                             requirement as indicated                                                                                YES     NO
                                                                                                                                                                                                                                                Evidence notes:
                   A local board of health shall develop policy and provide leadership that fosters local involvement
s. 251.04 (6) (b), and commitment, that emphasizes public health needs and that advocates for equitable distribution
                                                                                                                      Evidence provided under (50) - EPHS V
Stats.             of public health resources and complementary private activities commensurate with public health
                   needs.

s. 251.06 (3) (d), A local health officer shall administer all funds received by the local health department for public
                                                                                                                          Evidence provided under (23) - EPHS I and (58) - EPHS V
Stats.             health programs.


HFS 140.05 (1)       The local health department has identified resources or services which it will commit to achieving
                                                                                                                          Evidence provided under (23) - EPHS I and (58) - EPHS V
(b) 2. (Level II)    the objectives.


HFS 140.06 (1)       The local health department has identified resources or services which it will commit to achieving
                                                                                                                          Evidence provided under (23) - EPHS I and (58) - EPHS V
(b) 2. (Level III)   the objectives.

NATIONAL STANDARD 8-E: Provide the public health workforce with adequate resources to do their jobs

                                                                                                                             DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                            NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                               BEEN MET
                                                                                                                                                                                                                                  0 1 2 3 4         Evidence notes:

                                                                                                                          ▪ LHD budget has job support line items (e.g., basic office supplies and equipment, maintenance,
                                                                                                                          provisions for a safe work environment, workforce safety, violence prevention, and required education
      8-E 1.         1. LHD has identified funding sources for workforce job support activities (Capacity)
                                                                                                                          for job performance, etc.)
                                                                                                                          ▪ Inventory of computer and other equipment to assist staff in efficiently carrying out work tasks.

                     2. LHD routinely makes public health and discipline specific journals available for staff to stay
      8-E 2.                                                                                                              ▪ Staff receives an updated list of journals available for their use
                     updated in the field (Process)
IX. EVALUATE EFFECTIVENESS, ACCESSIBILITY, AND QUALITY OF PERSONAL AND POPULATION-BASED HEALTH SERVICES.


WI STANDARD: (89) s.251.04(4) Stats. - The local board of health reports to the Department of Health and Family Services as required by rule, HFS 140.04(3).
s. 251.05(3)(d), Stats. - A local health department shall submit data, as requested, to the local public health data system established by the department.
s. 251.05(3)(h), Stats. - The local health officer shall submit an annual report of the administration of the administration of the local health department to the local board of health.

WI Required Services for LHDs by National Focus Area: LHD EVALUATION STRATEGY FOCUSES ON COMMUNITY OUTCOMES

WI Statutory /                                                                                                         EVIDENCE - During the HFS 140 review, the local health department provides information to meet this     DPH Finding
                  STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)                                                                                                                                                    Evidence notes:
Rule Refer. #                                                                                                          requirement as indicated                                                                                YES     NO

HFS 140.04(3)     Annual Reports. Within 120 days after the close of the calendar year, a local health department shall submit the following reports to the department:

                                                                                                                      View: A copy of the annual report, if required by the Board of Health. DPH Regional Office will
(90) HFS 140.04 A copy of the local health department’s annual report for the preceding calendar year, if required by
                                                                                                                      provide confirmation that annual report was received.
(3) (a)         the local governing body.

                                                                                                                       View: Evidence of participation in the public health data system (SPHERE, WIC, and Immunization
(91) HFS 140.04 Annual survey of local health departments for the Wisconsin public health data system in a format
                                                                                                                       registry data) and future 2010 data. DPH Regional Office will provide confirmation of data
(3) (b)         prescribed by the department.
                                                                                                                       compliance.
                Provide or arrange for continuity of health care for individuals and families requesting or referred for
                nursing services and provide them with or otherwise arrange for the availability of timely, cost-
(92) HFS 140.04 effective and quality nursing and clinical preventive services through following: d) documentation
(1) (a) 6. d    and evaluation of the responses of families and individuals to public health nursing services and        Evidence provided under (81) - EPHS VII
                actions, in order to provide evidence of professional nursing services provided, determine progress
                toward goal achievement for a particular family or individual and provide a basis for updating that
                family's or individual's nursing plan of care.
                                                                                                                       DPH Proposed language - Report on activities which:
                A report, in a format prescribed by the department, on the activities of the local health department   1) Describes progress and performance toward achieving objectives identified as part of its
(94) HFS 140.04 for the preceding calendar year, including a narrative which describes the progress and                community assessment process.
(3) (c)         performance toward achieving the objectives that the local health department has identified as part    2) Includes a narrative that describes how the community plan is linked to the state health plan.
                of its community health assessment process.                                                            3) Describes how it includes and involves a representative cross-section of the community.


NATIONAL STANDARD 9-A: Develop evaluation efforts to assess health outcomes to the extent possible

                                                                                                                           DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                         NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                                  BEEN MET
                                                                                                                                                                                                                               0 1 2 3 4       Evidence notes:
                                                                                                                       ▪ Examples of monitoring health outcomes that result in redirected program efforts
                  1. LHD has data from the community health assessment on community health outcomes and risk
     9-A 1.                                                                                                            ▪ Community health assessment examine a wide scope of health outcomes and inform future service
                  factors readily available for evaluation purposes (Capacity)
                                                                                                                       delivery

                  2. LHD has staff or external consultative resources with evaluation expertise assigned               ▪ Names and credential of staff qualified with evaluation expertise or identification of consultative
     9-A 2.       responsibility for evaluation within the organization (Capacity)                                     capacity



                  3. LHD has plans in place to reduce specific gaps in access or make other improvements in public
     9-A 3.                                                                                                        ▪ Written plan for reducing gaps in access to care and to improve services
                  health services (Capacity)
                    4. LHD has and executes an internal policy to guide its overall evaluation efforts, including
                                                                                                                       ▪ Evaluation plan, including frequency, scope of programs to be evaluated, timeline, and outcome
     9-A 4.         frequency and scope of program evaluations, organizational evaluations, use of health outcomes as
                                                                                                                       indicators to use in evaluation process
                    benchmarks for evaluations (Process)
                    5. LHD conducts evaluation activities that include an analysis of local data (e.g., analyzing age
     9-A 5.         specific participation in preventive services) with established community health goals, objectives ▪ Annual reviews of progress in reaching outcome and impact (addressing risk factors) objectives
                    and performance measures (Process)
                    6. LHD identifies and uses community health targets (e.g. Healthy People 2010) as benchmarks
     9-A 6.                                                                                                                ▪ Annual report cards on progress in improving health outcomes
                    for evaluating the effectiveness of public health services (Process)


WI STANDARD: Regularly evaluate the public health’s systems performance, processes and outcomes to provide information necessary to define accountability, allocate resources, reshape policies and redefine services.

WI Required Services for LHDs by National Focus Area: USE OF EVIDENCE-BASED METHODOLOGY FOR EVALUATION

WI Statutory /                                                                                                             EVIDENCE - During the HFS 140 review, the local health department provides information to meet this   DPH Finding
                           STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                              requirement as indicated                                                                              YES     NO
                                                                                                                                                                                                                                               Evidence notes:
                    Participates in the development of programs and services for vulnerable population groups that are
HFS 140.04 (1)
                    based on evaluation of surveillance data and other factors that increase actual or potential risk of
(a) 3
                    illness, disability, injury or premature death.

HFS 140.05 (1)      Comtemporary public health practices of proven merit are being used to provide services to the
(b) 3 (Level II)    community to achieve the objectives.

HFS 140.06 (1)      Comtemporary public health practices of proven merit are being used to provide services to the
(b) 3 (Level III)   community to achieve the objectives.

NATIONAL STANDARD 9-B: Apply evidence-based criteria to evaluation activities where possible

                                                                                                                              DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                           NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                                BEEN MET
                                                                                                                                                                                                                                 0 1 2 3 4         Evidence notes:

                    1. LHD uses an acceptable evaluation framework that connects the public health intervention with       ▪ Protocol(s) for LHD program evaluation describing reasonable evaluation frameworks, including use
     9-B 1.         health outcomes produced, based on the collection and use of evidence (Process)                        of externally-developed standards, benchmarks, baseline data


                    2. LHD periodically evaluates its key processes of service delivery for efficiency and effectiveness, ▪ Use of CDC's Framework for Program Evaluation or other evaluation framework on a regular basis
     9-B 2.         using established criteria (e.g., from research literature, management literature, etc.) (Process)    ▪ References for research, such as literature search, or use of experts in evaluation process

                                                                                                                           ▪ Documentation that evidence based methodology has been applied
                    3. LHD makes formal efforts to identify best practices or benchmarks for evaluation purposes
     9-B 3.                                                                                                                ▪ References fo research, such as literature search, or use of experts in evaluation process
                    (Process)
                                                                                                                           ▪ Documentation that evaluation has resulted in program modification


WI Required Services for LHDs by National Focus Area: EVALUATE LHD PROGRAMS

Statutory or                                                                                                               EVIDENCE - During the HFS 140 review, the local health department provides information to meet this   DPH Finding
                           STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                              requirement as indicated                                                                              YES     NO
                                                                                                                                                                                                                                               Evidence notes:
NATIONAL STANDARD 9-C: Evaluate the effectiveness and quality of all LHD programs and activities and use the information to improve LHD performance and community health outcomes.

                                                                                                                       DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                        NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                         BEEN MET
                                                                                                                                                                                                                            0 1 2 3 4         Evidence notes:

                1. LHD has a systematic process for assessing consumer and community satisfaction with agency ▪ Reports, summaries of analysis, or meetings minutes or materials that demonstrate program
    9-C 1.      services (Capacity)                                                                           monitoring activities

                                                                                                                    ▪ Sample evaluation documents
                2. LHD monitors program performance measures and analyzes data to document the progress             ▪ Report of an evaluation findings
    9-C 2.      toward goals and grant/funding requirements (Process)                                               ▪ Program review documents that demonstrate LHD compliance with applicable professional and
                                                                                                                    regulatory standards

                3. LHD evaluates the quality of clinical and preventive population based programs, identifies the   ▪ Document use of a performance management system to improve the quality of programs
    9-C 3.      need for change and uses a quality improvement process to apply the evaluation findings             ▪ Document use a Quality Improvement Process to improve programs and services based on
                (Process)                                                                                           evaluations


WI Required Services for LHDs by National Focus Area: EXTERNAL EVALUATION OF OTHER’S PROGRAMS

Statutory or                                                                                                        EVIDENCE - During the HFS 140 review, the local health department provides information to meet this     DPH Finding
                        STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                       requirement as indicated                                                                                YES     NO
                                                                                                                                                                                                                                          Evidence notes:




NATIONAL STANDARD 9-D: Review the effectiveness of public health interventions provided by other practitioners and agencies for prevention, containment, and/or remediation of problems
affecting the public’s health, and provide expertise to those interventions that need improvement
                                                                                                                       DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                        NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                         BEEN MET
                                                                                                                                                                                                                            0 1 2 3 4         Evidence notes:

                1. LHD maintains data systems for capacity, availability, quality, cost and utilization of health   ▪ Written protocols or summary of CHP progress, indicating level of coordination among community
    9-D 1.      services (Capacity)                                                                                 organizations in providing services that improve the health of the public.


                2. LHD provides consultation and technical assistance on program implementation and evaluation      ▪ Examples of reviews of the effectiveness of community agencies and coordination with LHD to
    9-D 2.      of prevention services provides by other community agencies (Process)                               improve service delivery


                3. LHD evaluates the accessibility, quality, and effectiveness of personal health services          ▪ Monitoring of progress of local public health system towards meeting community health objectives as
    9-D 3.      (Process)                                                                                           stated in the community health plan


                4. LHD assures that a systematic process for assessing consumer and community satisfaction with ▪ Process for ongoing evaluation and update of the Community Health Assessment data on consumer
    9-D 4.      external agency services is in place (Process)                                                  and community satisfication with external agency services


X. PROVIDE RESEARCH TO DEVELOP INSIGHTS INTO AND INNOVATIVE SOLUTIONS FOR HEALTH PROBLEMS.


WI STANDARD: Develop partnerships with institutions, colleges, vocational/technical schools, and universities to broaden the range of public health research (to include, for example, issues and communities that were historically ignored and
emerging issues that need attention). Conduct timely scientific analysis of public health issues. Engage testing of innovative solutions at the local and state levels.
WI Required Services for LHDs by National Focus Area: PARTICIPATE IN RESEARCH ACTIVITIES

WI Statutory /                                                                                                         EVIDENCE - During the HFS 140 review, the local health department provides information to meet this          DPH Finding
                 STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)                                                                                                                                                          Evidence notes:
Rule Refer. #                                                                                                          requirement as indicated                                                                                     YES     NO




NATIONAL STANDARD 10-A: When researchers approach the LHD to engage in research activities that benefit the health of the community,
         i. Identify appropriate populations, geographic areas, and partners;
         ii. Work with them to actively involve the community in all phases of research;
         iii. Provide data and expertise to support research; and,
         iv. Facilitate their efforts to share research findings with the community, governing bodies, and policy makers.
                                                                                                                          DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                        NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                            BEEN MET
                                                                                                                                                                                                                                    0 1 2 3 4         Evidence notes:

                 1. LHD has resources that make it possible for the LHD to participate in research (e.g., data and     ▪ Documentation of participation in research in either sharing of data or identification of populations or
    10-A 1.      expertise) (Capacity)                                                                                 research topic

                                                                                                                       ▪ Policies for participatory research
                 2. LHD has policies which endorse participatory research and ensuring the rights of participants in
    10-A 2.                                                                                                            ▪ LHD policy on data sharing
                 local public health research programs (Capacity)
                                                                                                                       ▪ Participation in public health surveys

                 3. LHD partners with academic/research institutions of higher education that are interested in        ▪ Relationship with a university, where available, such as meeting notes, agenda, etc.
    10-A 3.      conducting public health research (e.g., provide data, content expertise) (Capacity)                  ▪ Collecting data that can be used in research (e.g., West Nile data)

                 4. LHD proposes public health practice issues to be used by academic institutions when they select
    10-A 4.                                                                                                         ▪ List of practice based research topics proposed to an academic institution for research
                 research agendas, as appropriate. (Process)

                 5. LHD convenes community members and key community partners, as appropriate, to identify
    10-A 5.                                                                                                            ▪ Minutes from meetings with community partners to identify practice based research
                 opportunities for community participatory research that would benefit the community (Process)


WI Required Services for LHDs by National Focus Area: DISSEMINATE RESEARCH FINDINGS

WI Statutory /                                                                                                         EVIDENCE - During the HFS 140 review, the local health department provides information to meet this          DPH Finding
                        STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                          requirement as indicated                                                                                     YES     NO
                                                                                                                                                                                                                                                  Evidence notes:




NATIONAL STANDARD 10-B: Share results of research, program evaluations, and best practices with other public health practitioners and academics

                                                                                                                          DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                        NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                            BEEN MET
                                                                                                                                                                                                                                    0 1 2 3 4         Evidence notes:

                 1. LHD has access to expertise to evaluate current research and participate in research               ▪ Documentation of LHD communication of best practices with other public health practitioners
    10-B 1.      dissemination activities (Capacity)                                                                   ▪ Presentations at community groups
                 2. LHD disseminates research findings to public health colleagues, public health system partners,   ▪ Annual Reports to Board of Health on basic evaluation of programs, target groups, reach into the
    10-B 2.      governing body, policy makers and the community at large (Process)                                  population at risk

                 3. LHD provides expertise, in creating innovative solutions based upon research, and shares them
    10-B 3.      with elected officials and community organizations involved in developing and analyzing public   ▪ Documentation of consultations with other agencies on effective public health practices
                 policy and in planning implementation of population-based strategies. (Process)


WI Required Services for LHDs by National Focus Area: APPLY RESEARCH RESULTS IN LHD ACTIVITIES

WI Statutory /                                                                                                       EVIDENCE - During the HFS 140 review, the local health department provides information to meet this   DPH Finding
                        STATUTORY or ADMIN. RULE CITATION (some citations may be paraphrased)
Rule Refer. #                                                                                                        requirement as indicated                                                                              YES     NO
                                                                                                                                                                                                                                         Evidence notes:




NATIONAL STANDARD 10-C: Apply evidence-based programs and best practices where possible

                                                                                                                        DOCUMENTS and/or ACTIVITIES that DEMONSTRATES the NACCHO INDICATORS HAVE
                                        NACCHO OPERATIONAL DEFINITION INDICATOR
                                                                                                                                                          BEEN MET
                                                                                                                                                                                                                           0 1 2 3 4         Evidence notes:




                                                                                                                     ▪ Inventory of intervention strategies by source (e.g., evidence-based approaches and/or best
    10-C 1.      1. LHD evaluates current research and participate in research translation activities (Capacity)     practices from grants, CDC's Guide to Community Preventive Services, Guides to Clinical Preventive
                                                                                                                     Services, etc.




                 2. LHD seeks information about applicable evidence-based research and programs model before
    10-C 2.                                                                                                          ▪ Written summary or protocol of how LHD evaluates research for applicability to practice
                 implementing interventions (Process)

                 3. LHD implements, on a priority basis, newly developed and innovative strategies, methodologies,
                                                                                                                   ▪ Program/policy examples from LHD that are based on best practices (e.g., state-determined best
    10-C 3.      programs, and projects, which have been demonstrated to be effective in improving public health;
                                                                                                                   practices)
                 and records outcomes for further validation and use in future planning (Process)

    10-C 4.      4. LHD provides technical assistance to external organizations in applying relevant research results ▪ Meeting notes documenting participation in a Best Practices Committee
                             Source: NACCHO LHD Self-Assessment Tool
Operational Definition of a Functional Local Health Department Capacity Assessment for Accreditation
                                              Preparation

Topic Area Descriptions

Data: These indicators focus on a variety of aspects related to data reporting, collection, analysis,
recording, sharing and use in improving health outcomes.

Community Health Needs Assessment and Health Improvement Plan: This topic area
encompsses many indicators in the survey. Without an adequate community health needs
assessment and health improvement plan, it is very difficult or impossible to:
     ▪ accurately identify existing and emgerging health issues for prioritization and development of
goals, objectives, and work plans for new activities and programs;
     ▪ establish benchmarks and outcome indicators to measure the changes related to progamming,
environmental and other demographic factors that impact the public's health;
     ▪ communicate the health needs of the community to the community at large, local governing
bodies, legislators and congressional representation for the purpose of securing partnerships and
adequate financial resources to address the community health needs;
     ▪ engage additional community partners/stakeholders to work together to address health issues
and create a community-wide health improvement plan;
     ▪ redirect resources to the most urgent/emerging issues.

Culturally competent health information, education and resources: Local health departments
should demonstrate programs and educational activities where information is prepared in a culturally
appropriate manner for the target audience.
Emergency Planning: Emergency planning encompasses a wide variety of plans and activities. One
of these is the need to identify exiting labs, their capacity and a plan for surge capacity during an
event.

Community/stakeholder involvement: The involvement of community in public health is essential.
Public health can increase the capacity to acomplish essential activites by enlisting the help of
community stakeholders. Often it is community stakeholders that are advocates for public health; are
asked to serve on thehealth assessment team and be involved in community health improvement
planning. Building these relationships provides the basis for collaborative programs and activities.

Internal strategic plan: The indicators under this topic pertain to a formal, internal strategic planning
process to guide the health department activities. These indicators provide activities required to
prepare, implement and update an internal strategic plan on an ongoing basis.

Policy an legislative process: This topic area focuses on the process of policy development,
awareness of currrent policy issues that affect the public, and knowledge of the policy making process
at all levels (local, state, and national). Policy indicators include not only actively participating in
working to identify the need for policy development, but also an ongoing relationship and exchange of
information with policy makers. Uniformed policy makers will not have the ability to make decisions
that are good for the health of the public.
Public health must remember that there are areas of policy development that are not always
considered. Remember, school boards develop policies that affect the health of school age children,
city councils develop policies that impact the environment, such as putting in and maintaining
sidewalks, creating and maintaining parks, and public safety. County Commissioners pass policy and
budgets that impact public health, the hospital, (if one exists), safe roads, etc. In addition, the state
and national policy makers must be kept up-to-date on local public health issues.
Environmental health is based on regulatory legislation, ordinances and codes. Constant review of
these, and all legislation affecting the health and well-being of the public, is a responsibility of public
health.

Communication is a critical component of policy development and the legislative process.

Internal workforce: The key areas under this topic are focused on assessing the public health skills
of staff and management. A learning management system provides a means to assess the
competencies of the staff and identify educational/training opportunities (often at no cost) to meet their
individual educational needs.

Evaluation and program planning: Evaluation encompasses two key areas. The first, internal
program evaluation includes:
▪ Process outcome evaluation which tells the number of services provided, i.e., number of clients,
number of visits, and number of immunizations given.
▪ Indicator outcome evaluation. This type of evaluation is based on selected indicators which
demonstrate the effectiveness of programs in improving outcomes and are usually measured in
percent (i.e., increase of 10% of children two and under who are current on their immunizations, 5%
reduction in the number of teens ages 13-18 who smoke, etc.).

The indicators, either in process (numbers) or indicator outcomes (percentages) provide the
justification to continue with the same interventions or the need to revise programming.
The second evaluation area is customer satisfaction with service and/or the materials and education
provided. Without ongoing evaluation of customers, there is no way to know how clients are receiving
the information or what changes to service delivery would better meet their needs.
Evaluation reports are necessary for funding requests. Funders (foundations, governmental grants
and earmarked dollars) require evidence that the population in receiving the intended benefit from the
dollars and that the projected outcomes in both process an indictors are being met.

Relationship with academia (research and future workforce): Local public health often fails to
think of the role it may play in identifying practice based topics for research, review and dissemination
of research, and science-based practice. However, the practice community is where research and
science-based practice is implemented. This focus on bridging the gap between academia and
practice is critical to establishing local public health as an integral part of the ongoing development
and recognition of public health as a profession. A process needs to be established an implemented
to work with academic instititutions on research projects, to provide sites for student experience and
review and use of science-based practice.
Communication: Many aspects of communication are addressed through the indicators under this
topic area. Examples may include determining who to communicate with, what information needs to
be shared, who is responsible and how the information will be disseminated. Often public health
shares information on an emergency basis and fails to continue to update the public, governing body,
stakeholders and public health system partners with information on existing, new or emerging public
health issues in a proactive manner.
The formal preparation of a communication plan will increase the capacity under many of the
communication indicators.
Access and linkage to care: One of the core functions of public health is access to quality health
care for all people. Adequate capacity for the indicators in this topic area is essential to assuring
public health has its finger on the pluse of community health access issues.