C

Delaware Cross-Sector Case Study

Submitted by presenters
Mary Beth French, Mary Kate Mouser, and Helen Riley¹

DESCRIPTION OF CROSS-SECTOR MODEL USED

Nemours Health & Prevention Services (NHPS), headquartered in Wilmington, Delaware, works with families and communities to help children in Delaware grow up healthy, both physically and emotionally. It is a division of Nemours, a nonprofit organization dedicated to children’s health and health care that provides hospital and clinic-based specialty care, primary care, prevention and health information services, as well as research and medical education programs to improve the lives of children and families throughout the Delaware Valley and Florida. NHPS was created to expand Nemours’ reach beyond clinical care to consider the health of the whole child within his or her family and community.

NHPS uses a population health approach, beginning with the establishment of clear outcomes for a geographic region, to work with community partners across sectors to make policy, systems, practice, and environmental changes in the places where children live, learn, and play. We build sustainable capacity within our partners by providing tools, training, and technical assistance in evidence-based practices. We also include a focus on evaluation from the onset of initiative design and provide data to our partners that they can use to drive their decision making and action. Through policy, advocacy, and capacity-building in and across organizations, we support partners to invest resources in creating and sustaining environments in which children have the opportunity to make healthy choices,

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¹Reprinted as submitted by the presenters.

practice healthy behaviors, and, ultimately, achieve improved health outcomes. Social marketing was utilized to accelerate early policy and practice changes. To date, NHPS has focused on initiatives related to obesity prevention, asthma, and emotional and behavioral health.

SECTORS INCLUDED

NHPS works with other health care organizations; schools; child care providers; local, county, and state governments, including the state agencies that provide public health, Medicaid, education, social service, child welfare, and child mental health services; youth-serving and other community nonprofit organizations; faith community; universities and colleges; and businesses. We serve as an “integrator” that works intentionally and systematically across sectors to improve the health and well-being of children.

LESSONS LEARNED FROM OBESITY PREVENTION INITIATIVES

• Focus on child well-being outcomes, including but not limited to, increasing the percentage of Delaware children, birth through age 17, in a healthy weight range, for a specific population and intervene early to focus on primary prevention;
• Coordinate programs and connect services so that program silos are eliminated and children are better served;
• Be opportunistic in determining which policy, systems, and environment changes to drive at which time, balancing a portfolio of reactive and proactive engagements and shorter- and longer-term implementation horizons;
• Develop a shared measurement system across silos to ensure joint accountability for improving child and family outcomes related to obesity prevention;
• Consider sustainability at the front end and throughout the life of the project;
• Reach children where they live, learn, and play;
• Create policy and systems change/development to impact populations with sustainable change—essential elements of a comprehensive children’s system in addition to practice changes;
• Be intentional about harnessing and leveraging lessons learned to inform spread, scale, and sustainability; and
• Identify the champion integrators and stakeholders for obesity prevention and support them to get state and local buy-in and to spread and sustain the work.

BARRIERS TO ESTABLISHING THE INITIATIVE

• Workforce Development—developing a workforce, both internally and with our partners, that is capable and empowered to utilize a population health approach. For example, child care providers, teachers, etc., need to be trained in how to integrate this work into their daily priorities for sustainability. Also a workforce that is able to work cross-sector—speak the different languages, make multiple compelling arguments for involvement, etc.—is critical for implementation and sustainability.
• Telling Our Story—gleaning the anecdotal and statistical data and packaging it effectively to tell the story of the accomplishments and impact of implementation to reach various strategic audiences who can create buy-in and interest in implementation.
• Sustainable Revenue Generation—identifying and mobilizing grants and identifying and maximizing other funding streams.

WHAT IS NEEDED TO ACCELERATE MOVEMENT FORWARD IN YOUR CROSS-SECTOR WORK?

• Strengthen targeted partners to enhance spread, intensity, and sustainability among diverse populations by building their capacity in the ways that are most helpful to our partners in their environments.
• Place more emphasis on building comprehensive, integrated systems of care for children and their families.
• Continue work on leadership development and leveraging resources among our partners and in community coalitions toward shared outcomes related to obesity prevention.
• More targeted evaluation and performance measurement to ensure that we are measuring the most relevant indicators to demonstrate progress and impact for all sectors.
• Continue to work on incorporating an equity approach in all work, to assure that all children have equal opportunities to optimal health.

WHAT ARE THE CORE FEATURES OR ELEMENTS OF YOUR INITIATIVE THAT ARE NECESSARY FOR SCALE AND SPREAD?

• Build trusting relationships and capacity across sectors, including determining policy, systems, and environmental changes to spread and sustain within the context and environments of the partners and communities.

• Mobilize resources with partners in which responsibilities are clearly defined and shared so that the partners are actively engaged and understand their role in meeting shared outcomes.
• Use data to drive decisions, including mining existing or conducting community needs assessments, researching the best evidence of what works, and designing evaluations to produce the information necessary to drive action.
• Work with partners to share decision making on planning and implementation.
• Identify an integrator to take responsibility for advancing the shared and agreed upon policy and practice change agenda that can be adopted by multiple sectors.
• Communicate openly on what is working, what is not, and how to make improvements.

WHAT ARE THE FEATURES THAT NEED TO REMAIN FLEXIBLE TO ALLOW FOR LOCAL ADAPTATION?

Adaptation can lead to spread outside of the initial area of implementation as well as deeper implementation in the original geographic area.

• Determine the readiness of partners and communities to embrace the policy, systems, and environmental changes that are being recommended and be flexible to move through the change process at the pace that the partners or communities are comfortable with, focusing on the policy and practice changes in a targeted fashion to take advantage of the knowledge gathered.
• Adapt methods of the intervention to what is feasible in the local context based on the local needs with the resources available.
• Determine the best sectors and adopters with whom to partner.

For more information, please contact: Nemours Health & Prevention Services, 2200 Concord Pike, 7th Floor, Wilmington, DE 19803, Kelli Oliver Thompson, kothomps@nemours.org, (302) 298-7638 or (302) 298-7600.