Use of the Community Assessment for Public
Health Emergency Response to Conduct
Community Health Assessments for Public Health
Accreditation
Ashley M. Conley, MS, CPH, CHEP; Sara Vagi, PhD; Jennifer A. Horney, PhD, MPH, CPH
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community health assessment (CHA) is a collaborative departments (LHDs) should be explored and proposed
A process of collecting and analyzing data to learn about
the health status of a community. Community health
assessments are also a requirement of public health
a model program for accreditation.3 A nonprofit entity
the Public Health Accreditation Board (PHAB) was
created, and in February 2007, the initial accreditation
process and draft standards and measures were
accreditation for state and local health departments and of the developed and released for stakeholder comment and
Affordable Care Act for nonprofit hospitals. One element of a review. Six years later, in February 2013, 11 public
health departments were accredited for 5 years. In or-
CHA is primary data collection. This article describes the use of
der for a health department to apply for accreditation, 3
the Community Assessment for Public Health Emergency prerequisites must be met: completion of a community
Response (CASPER) method for primary data collection to meet health assessment (CHA) followed by a community
public health accreditation requirements in 2 case study health improvement plan (CHIP) and finally a strategic
plan. This report from New Hampshire and North
communities—Nashua, New Hampshire, and Davidson County,
Carolina highlights the usefulness of the Community
North Carolina; CASPER is a flexible and efficient method for the Assessment for Public Health Emergency Response
collection of population-based primary data in an urban or rural (CASPER) toolkit4 for routine CHAs to assist public
setting. health departments in achieving national accreditation
by the PHAB or a state accreditation body.
KEY WORDS: accreditation, community health assessment,
public health
Author Affiliations: NH Division of Public Health and Community Services, City
of Nashua, Hillsborough, New Hampshire (Ms Conley); LCDR, US Public Health
Accreditation of state, tribal, local, and territorial Service, and Office of Public Health Preparedness and Response, Centers for
public health agencies has received substantial at- Disease Control and Prevention, Atlanta, Georgia (Dr Vagi); and Department of
tention in the last decade. In 2003, the Institute of Epidemiology, University of North Carolina at Chapel Hill (Dr Horney).
Medicine’s report, The Future of the Public’s Health, The authors thank Angelo Marino and Pam Andruskevich from the City of
called for establishing a national committee to research Nashua, NH; Assessing Department for developing the map of the City of Nashua;
the benefits of public health department accreditation.1 and to Health Studies Branch, National Center for Environmental Health, Centers
for Disease Control and Prevention for their technical assistance.
The Centers for Disease Control and Prevention (CDC)
The opinions expressed by authors contributing to this journal do not neces-
pointed to accreditation as a key strategy for strength-
sarily reflect the opinions of the Centers for Disease Control and Prevention or
ening the public health infrastructure and proactively the institutions with which the authors are affiliated.
sought opportunities to catalyze progress toward state Supplemental digital content is available for this article. Direct URL citation
and local agency accreditation.2 In 2004, the Robert appears in the printed text and is provided in the HTML and PDF versions of this
Wood Johnson Foundation convened a stakeholder article on the journal’s Web site (www.JPHMP.com).
meeting to determine whether a voluntary national The authors declare no conflicts of interest.
accreditation program for state and local health Correspondence: Jennifer A. Horney, PhD, MPH, CPH, Department of
Epidemiology, University of North Carolina at Chapel Hill, CB 8165, 400 Roberson
J Public Health Management Practice, 2014, 20(5), 490–497 St, Chapel Hill, NC 27599 (jen.horney@unc.edu).
Copyright C 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI: 10.1097/PHH.0b013e3182a99918
490
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
, Use of CASPER for Accreditation ❘ 491
Conducting a CHA is a collaborative process of resources to collect primary data.4 It is a door-to-
collecting and analyzing data to learn about the health door survey based on a commonly used 2-stage
status of a community. For the PHAB process for cluster sampling methodology. First developed in
accreditation, there are standards, or required levels of the 1960s as a tool for LHDs to conduct assess-
achievement; measures, or indicators to assess if the ments of immunization coverage, the “30×7” sam-
standard was met; and required documentation that ple methodology was later adapted by the World
needs to be provided to assure the CHA meets the Health Organization’s Expanded Program on Immu-
requirements for accreditation.5 Conducting a CHA nization to assess immunization coverage in develop-
is highlighted in Domain 1: Conduct and disseminate ing countries6-9 and later modified by CDC for use dur-
assessments focused on population health status ing emergencies.9 During the first stage, 30 clusters,
and public health issues facing the community. This which can be designated by census blocks or block
domain focuses on maintaining, collecting, analyzing, groups, are selected with “probability proportionate to
and disseminating data to monitor the health status of population size.” In other words, a census block or
a community. Conducting a CASPER may fulfill certain block group with more households is more likely to be
measures within standards 1.1 and 1.2 for accreditation. included than one with fewer households. At the sec-
The standards, measures, and required documentation ond stage, 7 houses are randomly selected from within
for completing a CHA and collecting valid data on the each of the 30 clusters to conduct interviews. Using
health status of the population are detailed in Table 1. this 30 × 7 survey methodology reliably produces es-
The CASPER tool provides a methodology that is timates accurate to within 10% of the true level in the
standardized—yet flexible, rapid—and requires few population with 95% confidence.8 The CASPER toolkit
TABLE 1 ● Public Health Accreditation Board Standards and Measures (Version 1.0) for a Comprehensive Community
Health Assessment for Local Public Health Department Accreditation
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Measure Required Documentation
Domain 1: Conduct and disseminate assessments focused on population health and public health issues facing the community.
Standard 1.1: Participate in or conduct a collaborative process resulting in a comprehensive community health assessment.
Measure 1.1.1L/T: Participate in or conduct a tribal/local partnership for the Participation of representatives of various sectors of the tribal or local
development of a comprehensive community health assessment of the community.
population served by the health department. Regular meetings.
Description of the process used to identify health issues and assets.
Measure 1.1.2T/L: Complete a tribal/local community health assessment. A tribal or local community health assessment dated within the last 5 years
that includes the following:
Documentation that data and information from various sources
contributed to the community health assessment and how the data
were obtained.
A description of the demographics of the population.
A general description of health uses and specific descriptions of
population groups with particular health issues.
A description of contributing causes of community health issues.
A description of existing community or tribal assets or resources to
address health issues.
Documentation that the tribal or local community at large had an
opportunity to review and contribute to the assessment.
Standard 1.2: Collect and maintain reliable, comparable, and valid data that provide information on conditions of public health importance and
on the health status of the population.
Measure 1.2.3 A: Collect additional primary and secondary data on Document aggregated primary and secondary data collected and the
population health status. sources of each.
Documentation of standardized data collection instruments.
Measure 1.2.4 L: Provide reports of primary and secondary data to the Reports of data to the state health department and to a tribal health
state health department and tribal health departments in the state. department (if one or more is located in the state).
Measure 1.2.4 T: Provide reports of primary and secondary data to the Reports of data to the state and local health department.
state health department and local health departments in the state.
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
