BACKGROUND: CDC, in its funding of health systems interventions has asked states, such as the Washington State Department of Health (DOH) who received 1305 grant funding to determine the, “…ways working across categorical program areas may have enhanced coordination with critical partners.” When evaluating this question it is essential to understand the degree to which coordination may have already been occurring prior to the implementation of 1305, and how 1305 may have both positively and adversely affected coordination with critical partners. CDC’s second process question asks how the 1305 grant changed organizational structures and approaches. CDC’s question assumes that the 1305 grant caused organizations to work more frequently across categorical program areas, and asks the evaluations of enhanced states to, “…include information on ways working across categorical program areas may have increased or decreased operational efficiencies.” The following analysis responds both to CDC’s explicit evaluation questions, and to the implicit assumptions behind them.
METHODS: Washington State’s 1305 grant evaluation used mixed-methods, both qualitative and quantitative. From October 2014 to February 2015, the researcher completed semi-structured interviews, which lasted from 30 minutes to two hours and ten minutes, with 23 people. 12 of the interview participants were from local health jurisdictions and non-governmental organizations, and 11 participants were staff members of DOH involved in the implementation of the 1305 grant. From February 2015 to March 2015, 63% (69/110) of the staff members in DOH’s Office of Healthy completed a fifteen item survey. The main portion of the survey was adapted from the synergy scale of the widely used and validated Partnership Self-Assessment Tool (PSAT), originally developed by Elisa Weiss, Rebecca Anderson and Roz Lasker (2002).
RESULTS: Both internal and external interview participants in the evaluation felt that real collective impact and the enhancement of synergy requires more structure and extensive ties than critical partners are able to develop. The main perceived cause: categorical program funding, with program requirements from funders that require a focus on a single disease category.
CONCLUSIONS: Since implementation of 1305, changes in coordination with partners external to DOH have occurred in which a number of health partners have created a plan which advocates a prevention framework. This has taken the form of state House bill 2572, which addresses BMI, nutrition, physical activity, screening and other prevention measures. CDC considers this to be a major finding of DOH’s year-two evaluation, which should be shared with other states.