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Department of Veterans Affairs VHA HANDBOOK 1120.02 Veterans Health Administration Transmittal Sheet Washington, DC 20420 July 5, 2012

HEALTH PROMOTION AND DISEASE PREVENTION CORE PROGRAM

REQUIREMENTS

1. REASON FOR ISSUE. This Veterans Health Administration (VHA) Handbook designates the National Center for Health Promotion and Disease Prevention (NCP), Office of Patient Care Services, as the VHA office responsible for health promotion and disease prevention (HPDP) services, guidance, and coordination within VHA for Veteran patients. This Handbook provides processes and procedures for a comprehensive, evidence-based, population-level interdisciplinary HPDP program at each Department of Veterans Affairs (VA) facility and VA health care system (HCS).

2. SUMMARY OF CONTENTS AND MAJOR CHANGES. This is a revised Handbook that:

a. Defines the responsibilities and execution of VA facility and HCS HPDP Programs;

b. Designates the minimal core elements of these HPDP programs;

c. Designates responsibilities of facility staff, Veterans Integrated Service Network (VISN) leaders, and NCP; and

d. Describes reporting requirements of facility programs.

3. RELATED ISSUES. VHA Directive 1120, Responsibilities of the National Center for Health Promotion and Disease Prevention (NCP); VHA Handbook 1120.01, MOVE!® Weight Management Program for Veterans (MOVE!®); VHA Handbook 1120.4, Veterans Health Education and Information Core Program Requirements; VHA Handbook 1120.5, Coordination and Development of Clinical Preventive Services.

4. RESPONSIBLE OFFICE. The National Center for Health Promotion and Disease Prevention (10P4N), Office of Patient Care Services (10P4), is responsible for the contents of this VHA Handbook. Questions may be referred to the Chief Consultant for Preventive Medicine at (919) 383-7874, or by FAX to (919) 383-7598.

5. RESCISSIONS. VHA Handbook 1120.02, dated October 30, 2006, is rescinded.

6. RECERTIFICATION. This VHA Handbook is scheduled for recertification before the last working day of July 2017.

JRobert A. Petzel, M.D.

Under Secretary for Health

DISTRIBUTION: E-mailed to the VHA Publications Distribution List 7/6/2012

July 5, 2012 VHA HANDBOOK 1120.02 i

CONTENTS

HEALTH PROMOTION AND DISEASE PREVENTION

CORE PROGRAM REQUIREMENTS

PARAGRAPH PAGE

1. Purpose

2. Background

3. Definitions

4. Scope

5. Health Promotion and Disease Prevention Program (HPDP) Requirements

6. Responsibilities of the National Center for Health Promotion and Disease Prevention

7. Responsibilities of the VISN Director

8. Responsibilities of the Facility Director

9. Responsibilities of the Facility Primary Care Patient-Aligned Care Team (PACT) Leadership

10. Responsibilities of the VISN Health Promotion and Disease Prevention Program Leader

11. Responsibilities of the Facility Health Promotion and Disease Prevention Program Manager

12. Responsibilities of the Health Behavior Coordinator (HBC)

13. Reporting Requirements

14. References

APPENDIXES

A Sample Facility Health Promotion and Disease Prevention (HPDP) Program Committee Charter .............................................................................................................................. A-1

B Sample VISN HPDP Program Leader Role Description ...................................................... B-1

C Sample HPDP Program Manager Role Description ............................................................. C-1

VHA HANDBOOK 1120.02 July 5, 2012 ii

CONTENTS cont.

PARAGRAPH PAGE

D Sample HPDP Program Manager Nurse III Functional Statement ...................................... D-1

E Health Behavior Coordinator (HBC) Functional Statement-Psychologist ............................ E-1

F Health Behavior Coordinator (HBC) Functional Statement-Social Worker ......................... F-1

HEALTH PROMOTION AND DISEASE PREVENTION

CORE PROGRAM REQUIREMENTS

1. PURPOSE

This Veterans Health Administration (VHA) Handbook sets forth the core program implementation and reporting requirements for Health Promotion and Disease Prevention (HPDP) programs at each Department of Veterans Affairs (VA) facility and Health Care System

(HCS).

2. BACKGROUND

a. The VHA National Center for Health Promotion and Disease Prevention (NCP), located in Durham, NC, was established in 1995 as a field-based unit of VA Central Office within the Office of Patient Care Services (PCS) to implement the Veterans Health Care Act of 1992, Public Law 102-585, § 511,106 Stat. 4943, 4955-57 (codified at Title 38, United States Code (U.S.C.) 7318) which mandates the NCP to:

(1) Provide a central office for monitoring and encouraging the activities of VHA with respect to the provision, evaluation, and improvement of preventive health services; and

(2) Promote the expansion and improvement of clinical, research, and educational activities of VHA with respect to such services.

b. As VHA transforms from disease-focused to patient-centered health care for Veterans, it is reorganizing care and developing new clinical programs to support HPDP that address the VHA vision of emphasizing prevention and population health.

c. Many diseases that cause disability and death among Veterans can be prevented, mitigated, or delayed. Preventive services can lead to longer and healthier lives, reduce hospitalizations, preserve functionality, and enhance patient satisfaction and quality of life.

Effective preventive services are available for the leading causes of death and morbidity.

Screening tests, immunizations, preventive medications, and counseling to support health behavior change are the major strategies employed. The main behavioral factors contributing to preventable disease are tobacco use, physical inactivity, poor diet, unhealthy alcohol use, and overweight or obesity. Key interventions to reduce health risks include system-level, provider-level, and patient-level strategies that assist patients in changing risky behaviors and adopting healthier ones. VHA is committed to raising the awareness of healthy behaviors and encouraging and supporting Veterans in their efforts to adopt healthy lifestyles.

d. In 2009, in close collaboration with other National Program offices, NCP developed the Preventive Care Program as a sub-initiative of the New Models of Care Transformational Initiative within the Office of Healthcare Transformation. The VHA Preventive Care Program is designed to ensure that Veterans receive comprehensive health education, appropriate clinical preventive services, coaching for health behavior change, and support for self-management of chronic disease.

The Preventive Care Program is closely integrated with the Patient Aligned Care Teams (PACT) initiative and supports facility HPDP infrastructure and staff. This support also includes training and mentoring staff in patient-centered health behavior coaching strategies, and providing tools to assist PACT and other clinical staff in assessing and addressing Veterans’ HPDP needs and interests.

3. DEFINITIONS

a. Health Promotion and Disease Prevention (HPDP). HPDP refers to environmental, educational, motivational, and clinical activities designed to encourage improvement in health behaviors and conditions of living that are conducive to improving the health and well-being of populations and individuals. Disease prevention refers to health-related interventions or services that aim to prevent or minimize future morbidity and mortality by delaying or averting the onset or severity of disease, or detecting already existing disease at an early stage when it can be more successfully treated. HPDP services include, but are not limited to: clinical preventive services (screenings, immunizations, health behavior counseling, and preventive medications); related health education; self‐management support; and health coaching. NOTE: The terms HPDP services and preventive care are used interchangeably in this Handbook.

b. VHA Clinical Preventive Services Guidance Statements. Clinical Preventive Services Guidance Statements are statements that define VHA recommendations regarding the delivery of individual clinical preventive services to Veterans. They describe the clinical preventive service, target population, and other factors influencing the use or non-use of the service.

c. Patient-Centered Care. Patient-centered care is a fully engaged partnership of Veteran, family, and health care teams, established through continuous healing relationships and provided in optimal healing environments, in order to improve health outcomes and the Veteran’s experience of care.

d. Self-Management Support. One of the foundations of preventive care is to assist patients in setting goals to optimize health and better manage chronic conditions. Support for self-management includes: guidance, assistance with goal setting, problem solving for personal self-management plans, education, and encouragement through ongoing contact.

e. Health Behavior Change. Health behavior change is the process of considering, initiating, achieving, and maintaining change in health behavior(s), e.g., tobacco use, risky alcohol use, unhealthy diet, and physical inactivity.

f. Health Coaching. Health coaching is an evidence-based method for working with patients to enhance their well-being and achieve their health-related goals. Health coaching is a patient-centered, highly-collaborative method that applies principles and methods derived from health education, health promotion, and health behavior change research. Health coaching includes: assessment of patients’ educational needs, concerns, values, preferences, and past experiences; information sharing; goal setting; action planning; skill building; problem solving;

and arranging a follow-up plan.

Ten steps for successful health coaching are specified in the Patient Education: TEACH for Success course (TEACH). More information on this course can be found at:

http://vaww.prevention.va.gov/VHEI/TEACH_for_Success_web_update.pdf. NOTE: This is an internal VA Web site not available to the public.

g. Motivational Interviewing (MI). MI is an evidence-based clinical method that involves guiding patients to make healthy choices by eliciting and supporting their own motivation to change. MI is employed when patients are unsure about change or have difficulty following through with recommended health behaviors. When employing MI, clinicians embody a "spirit" or style that is highly collaborative, evocative, and supportive of patients’ autonomy. The principles of MI include: resisting directing ("the righting reflex"), seeking to understand the patient’s motivation, listening with empathy, and empowering the patient by supporting self-efficacy. NCP-approved MI training is designed to enhance clinicians' capacity to employ the spirit, principles, skills, and techniques of MI in interactions with Veterans.

h. Patient-Aligned Care Team (PACT). The PACT is an interdisciplinary team of health care professionals that provides comprehensive primary care in partnership with the patient. The PACT manages and coordinates comprehensive health care services consistent with agreed-upon goals of care. PACTs for special populations (e.g., Geri-PACT, Spinal Cord Injury PACT, Women Veterans Health PACT) are designated in the Primary Care Management Module (PCMM) by a specific indicator.

i. Health Education. Health education is any combination of education, information, and other strategies designed to help people enhance their quality of life through HPDP; partner with their health care teams; and develop self-management, problem-solving, and coping skills.

j. VA Central Office-Directed Self-Study Orientation Program. This is a self-paced, self-study orientation program developed by NCP and designed to provide role-specific orientation for HPDP Program Managers, Health Behavior Coordinators (HBC), and VISN HPDP Program Leaders. The program includes instructions, role-specific orientation checklists, topic-specific learning modules, program evaluation, and an automated process to self-certify completion of the program.

4. SCOPE

This Handbook defines the comprehensive, evidence-based, population-level, interdisciplinary HPDP program and services that must be available to all Veterans served at VA facilities and HCSs. The required minimal core elements for Facility HPDP Programs are listed in paragraph 5.

5. HEALTH PROMOTION AND DISEASE PREVENTION (HPDP) PROGRAM

REQUIREMENTS

The following are the minimal core elements for HPDP Programs:

a. HPDP Program Messages and Goals. VHA’s vision is that Veterans will be provided HPDP clinical interventions that are seamlessly integrated across the continuum of their health http://vaww.prevention.va.gov/VHEI/TEACH_for_Success_web_update.pdf care and are delivered in a variety of modalities tailored to their needs and preferences. VHA clinicians and clinical support staff must value these interventions and incorporate them into each Veteran’s overall plan of care. Evidence-based HPDP services are integrated into clinical care delivery throughout facilities and all affiliated community-based outpatient clinics (CBOCs). To facilitate delivery of HPDP services, the following nine key “Healthy Living” messages and associated program goals for VHA have been developed:

(1) Message: Be Involved in Your Health Care Goal: Increase patient engagement and involvement in health care,

(2) Message: Be Physically Active Goal: Increase physical activity and reduce physical inactivity,

(3) Message: Eat Wisely Goal: Increase consumption of vegetables, fruits, whole grains, low-fat dairy, and seafood in place of some meat and poultry; reduce consumption of sodium, saturated and trans fatty acids, calories from solid fats and added sugars, and refined grains,

(4) Message: Strive for a Healthy Weight Goal: Prevent or reduce overweight and obesity through improved eating and physical activity,

(5) Message: Limit Alcohol Goal: Reduce risky alcohol use,

(6) Message: Be Tobacco Free Goal: Reduce tobacco use,

(7) Message: Get Recommended Screening Tests and Immunizations Goal: Increase appropriate use of recommended screening tests and immunizations,

(8) Message: Manage Stress Goal: Reduce associated symptoms of stress,

(9) Message: Be Safe Goal: Reduce sexually transmitted infections, falls, and motor vehicle crashes,

b. Health Promotion and Disease Prevention (HPDP) Program Manager. Each VA facility or HCS must designate at least one HPDP Program Manager to facilitate coordination, communication, and consistent implementation of HPDP Programming and the integration of HPDP services into clinical care. NOTE: See paragraph 11 for the responsibilities of the HPDP Program Manager.

c. Health Behavior Coordinator (HBC). Each VA facility or HCS must designate at least one HBC to provide health behavior change training and consultation to clinical staff. NOTE:

See paragraph 12 for the responsibilities of the HBC.

d. Interdisciplinary HPDP Committee and Subcommittee. An interdisciplinary, facility-wide HPDP committee or subcommittee must be established with the HPDP Program Manager and HBC as co-leaders. The HPDP Program is coordinated through the committee and specific functions are defined in a committee charter. Core committee members include the MOVE!® Weight Management Program Coordinator, the Veterans Health Education Coordinator, the Smoking and Tobacco Use Cessation Lead Clinician, the My HealtheVet Coordinator, Primary Care-Mental Health Integration (PC-MHI) staff, the Patient-centered Care Coordinator, and PACT representatives from the facility and CBOCs. Additional staff partners may be included on the HPDP Program committee as determined by the facility. A graphic model of a facility HPDP Program can be found at:

http://vaww.prevention.va.gov/images/Model_2_landscape_annotation.JPG. NOTE: This is an internal VA Web site not available to the public. A sample HPDP Program Committee Charter is found in Appendix A.

e. HPDP Program Goals and Strategic Plans. The HPDP committee or subcommittee must establish local program goals that align with the overarching Healthy Living goals detailed in subparagraph 5a. It is recommended that HPDP Program strategic plans are developed every 1-2 years and that those plans are integrated with PACT and facility strategic plans.

f. Staff Learning and Development. Training in patient-centered communication, health education skills, health coaching, VHA Clinical Preventive Services Guidance Statements, and HPDP principles are required to support, sustain, and engage staff in providing quality HPDP services to Veterans.

(1) The Registered Nurse Care Manager (or equivalent from Special Population PACT) from each PACT must complete NCP-approved training in health coaching (i.e., TEACH or an alternative program approved by NCP) and NCP-approved training in MI within 12 months of hire or appointment to a PACT. Details of required training can be found at http://www.prevention.va.gov. Additional training of PACT staff in MI is encouraged. NOTE:

Existing staff should have been trained as part of implementation of the Fiscal Year (FY) 2011- 2014 New Models of Care Transformational Initiatives.

(2) The Clinical Associate (or equivalent from Special Population PACT) and Primary Care Provider from each PACT must complete NCP-approved training in health coaching (i.e., TEACH or an alternative program approved by NCP) within 12 months of hire or appointment to a PACT.

(3) Each facility must maintain the capacity to provide approved training in health coaching and MI to its clinical staff by ensuring a pool of local TEACH and MI training facilitators who have completed NCP-sponsored facilitator training is available. This pool of facilitators must provide initial training in health coaching and MI to PACT clinical staff. Additionally, they must provide individual and group-based staff coaching and follow-up training activities to foster development and maintenance of communication skills.

http://vaww.prevention.va.gov/images/Model_2_landscape_annotation.JPG http://www.prevention.va.gov/

(4) The HPDP Committee must facilitate the dissemination of information about VHA Clinical Preventive Services Guidance Statements to relevant staff members as new or revised statements are released by NCP.

g. Outreach Activities. The HPDP Program Manager and the HPDP Program Committee need to develop relationships with external stakeholders and agencies to enhance, promote, and support healthy lifestyle behaviors among Veterans. They design and organize HPDP-related Veteran outreach events in coordination with other facility outreach programs.

h. Program Evaluation. The program, including components found in preceding subparagraphs 5a-5f, must be evaluated on an ongoing basis and improvements implemented as indicated using VHA-approved processes such as the Vision, Analysis, Team, Aim, Map, Measure, Change, Sustain (VATAMMCS) improvement framework.

6. RESPONSIBILITIES OF THE NATIONAL CENTER FOR HEALTH PROMOTION

AND DISEASE PREVENTION (NCP)

NCP is responsible for:

a. Guidance and Technical Assistance. Guidance and technical assistance are provided to facility and HCS HPDP programs regarding strategies and programming that support the achievement of the overarching program goals about the Healthy Living Messages described in subparagraph 5a. These functions occur through national and regional educational meetings, national conference calls, individual program consultation as requested, national training programs, Web resources, clinical tools, and other means. NCP maintains, evaluates, and routinely updates the HPDP Self-Study Orientation Program.

b. Monitoring of Evidence-Based Guidelines. NCP monitors relevant published literature and clinical preventive services recommendations from the U.S. Preventive Services Task Force, the Advisory Committee on Immunization Practices, Community Task Force on Preventive Services, and other national guidelines groups. As new, evidence-based recommendations for HPDP services are published, NCP evaluates the need for new or revised policies, clinical tools, telehealth technologies, and processes that may be integrated into preventive care for Veterans across VHA. Telehealth modalities must meet VHA’s national conditions of participation in telehealth services.

c. Development of Guidance on Clinical Preventive Services. NCP coordinates the development, approval, updating, and dissemination of Clinical Preventive Services Guidance Statements and support the implementation of guidance statements by VHA clinicians and administrators in the field, as specified in VHA Handbook 1120.05.

d. Monitoring and Oversight. NCP monitors progress toward achievement of the program goals of the Healthy Living Messages as described in subparagraph 5a using applicable national VA databases and VISN and facility reports. NCP may conduct on-site or virtual validation of self-reported information from facilities.

7. RESPONSIBILITIES OF THE VISN DIRECTOR

The VISN Director is responsible for:

a. Designating a VISN HPDP Program Leader and relaying information to NCP regarding:

(1) The name, job title, address, fax, phone number, and e-mail address of the VISN HPDP Program Leader; and

(2) Any changes in the VISN HPDP Program Leader assignment.

b. Ensuring a comprehensive, evidence-based, population approach to HPDP is implemented at all VA facilities, outpatient clinics, and CBOCs in the VISN and that all minimum HPDP Program requirements are in place and sustained.

c. Preparing, securing, and managing fiscal and staff resources needed to support HPDP programs and services.

d. Sharing and recognizing successful HPDP programs.

e. Ensuring that patients are able to access HPDP services across the VISN.

f. Providing feedback and reports on HPDP programs, services, and products.

8. RESPONSIBILITIES OF THE FACILITY DIRECTOR

The facility Director is responsible for:

a. Ensuring that the minimal core elements listed in paragraph 5 are in place, active, and sustained at the facility and HCS.

b. Designating the HPDP Program Manager and HBC and relaying information to the VISN and NCP regarding:

(1) The name, job title, address, fax, phone number, and e-mail address of these individuals;

(2) Any changes in these assignments; and

(3) Providing feedback and reports on HPDP programs to NCP.

NOTE: Directors of HCSs or large facilities may appoint more than one HPDP Program Manager or HBC to meet the needs of the system or facility.

c. Ensuring that HPDP Program strategic plans are aligned with Healthy Living goals as described in paragraph 5 and integrated with the PACT and overall facility strategic plans.

d. Securing and managing the fiscal and staff resources needed to support HPDP programs and services.

e. Sharing and recognizing successful HPDP programs.

f. Ensuring existing staff has been trained as part of implementation of the Fiscal Year (FY) 2011-2014 New Models of Care Transformational Initiatives.

g. Establishing an interdisciplinary, facility-wide HPDP committee or subcommittee with the HPDP Program Manager and HBC as co-leaders.

h. Ensuring that patients are able to access HPDP services at the main facility(ies) and all affiliated outpatient clinics and CBOCs where primary care is delivered.

i. Ensuring that the facility HPDP Program Manager and HBC has sufficient time allocated for administrative, clinical, program development, and staff training responsibilities.

9. RESPONSIBILITIES OF FACILITY PRIMARY CARE PACT LEADERSHIP

Facility Primary Care PACT Leadership is responsible for:

a. Ensuring that the Primary Care PACT staff learning and development requirements, listed in subparagraph 5e, are met, by:

(1) Allotting time for PACT staff to receive NCP-approved training in health coaching and

MI;

(2) Ensuring that PACT clinical staff completes required training;

(3) Supporting PACT staff participation in individual and group-based staff coaching and follow-up training activities to foster the development and maintenance of Veteran-centered communication skills;

b. Ensuring that HPDP clinical services, including screening, immunizations, health behavior counseling, preventive medications, health education, self‐management support, and health coaching are integrated into clinical care provided in all facility PACTs;

c. Collaborating with HPDP Program staff to redesign and improve the quality of the delivery of HPDP-related services within PACT; and

d. Aligning HPDP Program strategic plans with PACT strategic plans.

10. RESPONSIBILITIES OF THE VISN HEALTH PROMOTION AND DISEASE

PREVENTION PROGRAM LEADER

The VISN HPDP Program Leader is responsible for facilitating and supporting the activities of facility HPDP Programs within the VISN. A sample VISN HPDP Program Leader role description is included in Appendix B. The VISN HPDP Program Leader is required to complete the VA Central Office-directed HPDP Self-Study Orientation Program.

11. RESPONSIBILITIES OF THE FACILITY HEALTH PROMOTION AND DISEASE

PREVENTION PROGRAM MANAGER

The facility HPDP Program Manager must have sufficient time allocated for administrative, clinical, program development, and staff training responsibilities. A sample HPDP Program Manager role description is found in Appendix C. NOTE: VA facilities and HCSs serving more than 25,000 unique patients annually must anticipate the need to dedicate a minimum of 1.0 full-time equivalent (FTE) without collateral assignments to successfully accomplish the work of this position. Facilities serving fewer than 25,000 unique patients may consider allocating occupation-specific collateral assignments to the HPDP Program Manager.

The HPDP Program Manager is responsible for:

a. Completing the VA Central Office-directed HPDP Program Manager Self-Study Orientation Program within 60 days of hire or appointment to the position. NOTE: Existing staff needs to have completed this requirement as part of implementation of the FY 2011-2014 New Models of Care Transformational Initiatives.

b. Establishing, maintaining, and leading the facility or HCS HPDP Program Committee or subcommittee. NOTE: A sample facility HPDP Program Committee Charter is found in Appendix A.

c. Ensuring that relevant clinical reminders for clinical preventive services (screening, immunizations, brief behavior counseling, and preventive medications) are aligned with VHA Clinical Preventive Services Guidance Statements.

d. Coordinating and engaging teams to redesign or improve the quality of the delivery of HPDP-related services.

e. Planning, developing, implementing, monitoring, and evaluating the overall HPDP Program.

f. Serving as the communication liaison between VISN HPDP Program Leaders, NCP, and the facility HPDP Committee or subcommittee.

g. Serving, in collaboration with other clinical content experts, as a subject matter expert in HPDP and providing education on evidence-based HPDP services to PACT and other clinical staff.

h. Ensuring that HPDP services are integrated into clinical care provided in PACT.

i. Providing and developing content expertise on preventive health as it relates to the Healthy Living goals as described in subparagraph 5a.

j. Providing HPDP-related clinical services as required for occupation-specific licensure.

12. RESPONSIBILITIES OF THE HEALTH BEHAVIOR COORDINATOR (HBC)

The HBC must have sufficient time allocated for administrative, clinical, and staff training responsibilities. A sample functional statement for a clinical health psychologist is found in Appendix E and a sample statement for a social worker is found in Appendix F. NOTE: VA facilities and HCSs serving more than 25,000 unique patients annually needs to anticipate the need to dedicate a minimum of 1.0 FTE without collateral assignments to successfully accomplish the work of this position. Additional support may be needed in facilities with high turnover or expansion to ensure that clinical PACT staff members have the training and skills in health coaching and MI necessary to effectively partner with patients to change health behavior.

Facilities serving fewer than 25,000 unique patients annually may consider allocating occupation-specific collateral assignments to the HBC. HBC work is intended to be embedded in the PACT clinical setting.

The HBC is responsible for:

a. Completing the VA Central Office-directed HBC Self-Study Orientation Program within 60 days of hire or appointment to the position. NOTE: Existing staff should have completed this requirement as part of implementation of the FY 2011-2014 New Models of Care Transformational Initiatives.

b. Serving as co-leader of the facility or HCS HPDP Program committee or subcommittee and assisting in the development, implementation, and evaluation of HPDP programs and services.

c. Collaborating with the Veterans Health Education Coordinator to provide TEACH training to facility PACT and other clinical staff who provide health coaching and health behavior change counseling to Veterans.

d. Providing MI training and ongoing follow-up and skills training to facility PACT and other clinical staff, as needed. This includes coaching staff following the didactic training to develop their skills. Coaching options include participating in team huddles, facilitating role-play type practice sessions, providing joint appointments with patients and clinicians, and encouraging case reviews and discussions, as needed. In addition to coaching staff in developing specific motivational communication skills, HBCs provide as-needed consultation to providers on health behavior patterns or change concerns, both informally in a curbside manner and more formally in presentations and discussions.

e. Collaborating with PACT, PC-MHI, and other Mental Health staff to ensure effective coordination of behavioral and mental health interventions that impact on the overall health of Veterans.

f. Providing limited (no more than 25 percent), direct HPDP-related patient care as required for occupation-specific licensure.

g. Serving as a subject matter expert in health coaching, MI, patient self-management, and health behavior change.

h. Providing and developing content expertise on preventive health as it relates to the Healthy Living goals as described in subparagraph 5a.

13. REPORTING REQUIREMENTS

Reports on the status of the HPDP program must be submitted to NCP and higher-level VHA offices, as requested.

14. REFERENCES

a. Veterans Health Care Act of 1992, Pub. L. 102-585, sec. 511, 106 Stat. 4943, 4955-57 (codified at 38 U.S.C. 7318).

b. VHA National Center for Health Promotion and Disease Prevention Intranet Web site:

http://vaww.prevention.va.gov/. NOTE: This is an internal VA Web site not available to the public.

c. VHA Smoking and Tobacco Use Cessation Web site:

http://vaww.publichealth.va.gov/smoking/index.asp. NOTE: This is an internal VA Web site not available to the public.

d. Home Telehealth Conditions of Participation:

http://vaww.telehealth.va.gov/telehealth/ccht/cop/index.asp NOTE: This is an internal VA Web site not available to the public.

e. National Center for Health Promotion and Disease Prevention Internet site at:

http://www.prevention.va.gov/.

http://vaww.prevention.va.gov/ http://vaww.publichealth.va.gov/smoking/index.asp http://vaww.telehealth.va.gov/telehealth/ccht/cop/index.asp http://www.prevention.va.gov/

APPENDIX A

A-1

Sample Health Promotion and Disease Prevention (HPDP) Program Committee Charter

VHA HK 1120.02,

App. A

Sample Facility Health Promotion and Disease Prevention (HPDP) Program Committee Charter

(Insert Facility Name) Health Promotion and Disease Prevention Program Committee Charter Sample

Health Promotion and Disease Prevention (HPDP) Program Committee Mission The mission of the (insert facility name) HPDP Program Committee is to ensure the integration of HPDP services into clinical care delivery within the medical center and affiliated community-based outpatient clinics (CBOCs). The committee will assess patient and programmatic needs, identify internal and community resources, and develop, implement, coordinate, and evaluate evidence-based HPDP programming that addresses the following nine key “Healthy Living” Messages and associated program goals.

Message: Be Involved in Your Health Care Goal: Increase patient engagement and involvement in health care

Message: Be Physically Active Goal: Increase physical activity and reduce physical inactivity

Message: Eat Wisely Goal: Increase consumption of vegetables, fruits, whole grains, low-fat dairy, and seafood in place of some meat and poultry; reduce consumption of sodium, saturated and trans fatty acids, calories from solid fats and added sugars, and refined grains

Message: Strive for a Healthy Weight Goal: Prevent and/or reduce overweight and obesity through improved eating and physical activity

Message: Limit Alcohol Goal: Reduce risky alcohol use

Message: Be Tobacco Free Goal: Reduce tobacco use

Message: Get Recommended Screening Tests and Immunizations Goal: Increase appropriate use of recommended screening tests and immunizations

Message: Manage Stress Goal: Reduce associated symptoms of stress

Message: Be Safe Goal: Reduce sexually transmitted infections, falls, and motor vehicle crashes

HPDP Program Committee Membership HPDP Program Committee members will be appointed by the Medical Center Director and consist of a diverse group of employees involved and interested in the delivery of HPDP services and programs. To ensure an effective Veterans Health Administration (VHA) Preventive Care

Program, the facility HPDP Program Committee requires certain core members; additional members may be included at the facility’s discretion. The Medical Center Director will designate an Executive Leadership Liaison to ensure two-way communication between the Executive Leadership Team and the HPDP Program Committee.

Required Committee Members:

HPDP Program Manager (Chair): Coordinates (insert facility name) HPDP program.

Establishes, maintains, and chairs the facility HPDP program committee. The HPDP Program Manager is responsible for strategic planning, program development and implementation, monitoring, and evaluation of the overall HPDP Program. The Program Manager ensures that the HPDP strategic plan is aligned with national program goals and aligned and integrated into Patient-Aligned Care Team (PACT) and facility strategic plans. The Program Manager serves as a communication liaison between the Veterans Integrated Service Network (VISN) HPDP Program Leaders, the VHA National Center for Health Promotion and Disease Prevention (NCP), and the facility HPDP committee, and is a content expert in HPDP.

Health Behavior Coordinator (HBC; Co-Chair): Provides health behavior change training and consultation in addition to providing some direct clinical services. The HBC serves as a facilitator for the Patient Education: TEACH for Success (TEACH) Program. The HBC facilitates HPDP Program Committee meetings in the absence of the HPDP Program Manager.

The HBC serves as a content expert on health coaching, motivational interviewing (MI), patient self-management and health behavior change. As co-chair of the committee, the HBC supports the HPDP Program Manager and assists in the development, implementation, and evaluation of HPDP programs.

MOVE!® Coordinator: Serves as a content expert in weight management and leads the facility’s weight management activities.

Smoking and Tobacco Use Cessation Lead Clinician: Serves as the facility lead in smoking and tobacco use cessation programming and resources. Serves as a communication liaison between the VHA Office of Public Health, as outlined in VHA Directive 2008-081, and the facility. At some facilities, the HBC may also serve in this role.

Veterans Health Education Coordinator: Has lead responsibility for the facility’s Veterans health education programming and services. Provides an ongoing assessment of existing health education programs, services and materials, and coordinates planning for those that are needed.

Serves as a lead facilitator for the TEACH Program. Serves as the facility’s content expert in patient education and health literacy. Supports the HBC in providing consultation on effective patient communication.

My HealtheVet Coordinator: Serves as the content expert in My HealtheVet , including in-person authentication, program content and secure messaging. Serves as communication liaison between the national My HealtheVet program and the facility HPDP program committee.

Representative from Primary Care at parent facility: (e.g., Associate Chief of Staff [ACOS] for Primary Care/Ambulatory Care, Clinical Nurse Leader, Nurse Manager, or designee) Leader and expert in primary care, including knowledge of the facility’s process related to the implementation of PACTs, which is the Department of Veterans Affairs Medical Home model of care delivery. Serves as content expert regarding team roles, care delivery, and documentation.

Assists in implementing tools and processes to integrate HPDP into care delivery within PACT.

Representative from each affiliated CBOC: (e.g., CBOC medical director, Lead Primary Care RN Care Manager, Clinical Nurse Leader, Nurse Manager, or designee) Leader and expert in primary care, including knowledge of the facility’s process related to the implementation of PACTs. Serves as content expert regarding team roles, care delivery, and documentation.

Assists in implementing tools and processes to integrate HPDP into care delivery within PACTs.

Primary Care-Mental Health Integration (PC-MHI) representative: Leader in the integration of mental health services within primary care and serves as a content expert in mental illness, alcohol, and substance abuse treatment and counseling.

Specialty Care Representative: Leader and expert in the implementation of PACTs within specialty care services.

Optional Committee Members: (consider as a committee member or project team and/or subcommittee member; for each committee member, include a brief description of the expertise each brings to the committee)

• Women Veterans Program Manager or representative

• Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Program Manager or representative

• Rural Health Program representative(s)

• Telehealth Program representative(s)

• Geriatric Program representative(s)

• Chief, Voluntary Service

• Public Affairs Officer

• Chief, Social Work or designee

• Nutrition and Food Service representative(s)

• Chief, Veterans Canteen Service

• Physical Activity Specialist

• Quality Management representative

• Employee Wellness Coordinator

• Flu Campaign coordinator

• MOVE!® Physician Champion

• Pharmacy Services Representative

• Additional Primary Care representatives

• Additional Mental Health representatives

• Additional Specialty Care Program representatives

• Others

HPDP Program Committee Leadership The HPDP Program Manager is the designated chair of the facility HPDP Committee. The HBC will serve as the Committee co-chair.

HPDP Program Committee Responsibilities

1. Develops and implements strategies to assess, coordinate, enhance, and improve HPDP programs and services throughout the medical center and affiliated CBOCs.

2. Develops and implements strategies to ensure the integration of HPDP into clinical care delivery in PACTs and throughout the facility.

3. Develops and implements a plan to provide training of facility clinical staff in evidence-based HPDP, health coaching, and other patient-centered communication strategies (e.g., TEACH) and MI.

4. Develops and implements continuous quality improvement activities to monitor the overall facility HPDP Program and to ensure effective utilization of health coaching, MI, and other patient-centered communication strategies by clinical staff in the delivery of HPDP services.

5. Complies with facility, VISN, and national HPDP reporting requirements.

6. Champions local and national HPDP initiatives, programs, and activities.

7. Participates in national HPDP training, conferences, educational offerings, and events.

HPDP Program Committee Communication and Planning The (insert facility name) HPDP Program Committee will meet (insert frequency; recommend no less than 10 times per year) with authority to convene additional meetings as circumstances require. All committee members (or designees) are expected to attend each meeting in person, or via teleconference or V-Tel. Meeting agendas will be prepared by the chair and/or co-chair and provided in advance to members, along with appropriate briefing materials. Minutes and attendance of each meeting will be maintained by the chair and/or co-chair and shared with committee members and facility and VISN leadership (insert specific facility procedure for posting minutes, format, reporting, etc.). Meeting dates and times should be specified at least (insert time period; recommend 6 months) in advance.

The HPDP committee or subcommittee will establish local program goals that align with the overarching Healthy Living Messages goals. Strategic plans will be developed (enter frequency;

recommend every 1-2 years), reviewed, and approved by (insert facility-specific deadline and requirements) and integrated into PACT and facility strategic plans.

Reports VHA HANDBOOK 1120.02 requires that reports on the status of the HPDP program and special initiatives must be submitted as requested by NCP. Committee members will participate in providing relevant and accurate information to complete reports.

(Add specific facility or VISN reporting expectations)

Sample Facility Health Promotion and Disease Prevention (HPDP) Program Committee Sample Facility Health Promotion and Disease Prevention (HPDP) Program Committee VHA HK 1120.02, App. A.pdf

APPENDIX B

B-1

Sample VISN HPDP Program Leader Role Description

App. B

VISN HPDP Program Leader Role Description Sample Introduction

Many diseases that cause disability and death among Americans can be prevented, mitigated, or delayed. Key interventions to reduce health risks include system-, provider- and patient-level strategies that assist patients in adopting healthy behaviors. The Veterans Health Administration (VHA) is committed to raising the awareness of healthy behaviors and encouraging and supporting Veterans and staff in their efforts to adopt healthy lifestyles. The challenge is not only to prevent progression of existing disease, but to proactively prevent or delay the onset of new disease.

The Veteran Integrated Service Network (VISN) Health Promotion and Disease Prevention (HPDP) Program Leader is responsible for facilitating and supporting the activities of HPDP Programs throughout the network, working closely with the facility HPDP Program Manager and the Health Behavior Coordinator (HBC). The VISN HPDP Program Leader collaborates with VISN-level leads for Primary Care, MOVE!®, Veterans Health Education, Smoking Cessation, Women’s Health, and others to ensure integration of program efforts.

The VISN HPDP Program Leader:

1. Serves as the liaison for the VISN Director with the VHA National Center for Health

Promotion and Disease Prevention (NCP) and other national program offices within Department of Veterans Affairs (VA) Central Office for HPDP-related issues and activities.

2. Provides oversight, monitoring, and validation of facility HPDP programs and implementation of national HPDP recommendations, guidelines, and policies through regular contact with facility HPDP Program Managers and HBCs.

3. Collaborates with HPDP Program Managers and HBCs to assess staff educational needs, working at the VISN level to ensure appropriate educational opportunities are offered.

4. Contributes to the VISN strategic plan by evaluating facility HPDP Program data and programming. The Program Leader provides feedback to VISN leadership on HPDP gaps, barriers, and educational needs.

5. Collaborates with VISN leads for MOVE!®, Veterans Health Education, Smoking Cessation, Women’s Health, and Primary Care to develop VISN-level HPDP program goals and objectives.

6. Promotes collaborative relationships with external stakeholders such as Veterans Service Organizations, community organizations, and government agencies around HPDP programs to improve the health of Veterans.

VHA HK 1120.02, App. B.pdf

APPENDIX C

C-1

Sample HPDP Program Manager Role Description

App. C

Health Promotion and Disease Prevention Program Manager Role Description Sample

Introduction

The Veterans Health Administration (VHA) faces a very large and increasing burden of chronic illness in its patient population. Many of these chronic conditions are based on poor health behaviors and inadequate preventive care. In order to diminish the development of common chronic illnesses, and as part of the treatment plan for these conditions, a strong emphasis on health promotion and disease prevention (HPDP) is needed in all areas of VHA clinical care.

VHA has recognized this need and has developed a set of initiatives, collectively referred to as the VHA Prevention Program, to provide an enhanced and targeted focus on helping patients with their health promotion, disease prevention, and health education needs. One component of the VHA Prevention Program is the establishment of an HPDP Program Manager in each medical facility. This position will provide direction for and coordination of HPDP efforts across the facility or health care system, including community-based outpatient clinics (CBOCs).

Although they may be tailored to local circumstances, the responsibilities detailed below must be incorporated into occupation-specific functional statements or position descriptions.

Definitions

Health promotion refers to informational, motivational, and clinical activities designed to encourage improvement in the health and well-being of individuals.

Disease prevention refers to health-related interventions or services for individuals or groups that aim to prevent or minimize future morbidity and mortality by delaying or averting the onset or severity of disease, or detecting already existing disease at an early stage when it can be more successfully treated.

Clinical preventive services are services delivered in the clinical setting for the primary prevention of disease, or for the early detection of disease in persons with no symptoms of the target condition, with the goal of preventing or minimizing future morbidity and mortality.

Duties and Responsibilities

Leadership/advocacy

1. Advises facility and primary care leadership on clinical and administrative issues related to HPDP, including clinical preventive services.

2. Advocates for policy and program development and resource allocation to support HPDP programs and services for Veterans.

3. Leads the effort to identify HPDP challenges, priorities for improvement, and opportunities for disseminating and sustaining best practices.

4. Primary facility point of contact for national health promotion campaigns and events, ensuring local implementation and participation.

5. Primary facility point of contact for planned national Health Risk Assessment (HRA) for Veterans. This includes:

a. Responsibility for engaging all relevant VHA stakeholders within the facility including but not limited to Chief of Staff (COS), Nurse Executive, Associate Chief of Staff (ACOS) for Ambulatory Care, My HealtheVet point of contact, HPDP Committee, providers, and clinicians to implement HRA, and;

b. Assisting in the development and completion of monitoring reports related to facility uptake of the HRA when available.

6. VHA Handbook 1120.05 describes the coordination and development of clinical preventive services guidance for VHA. The HPDP Program Manager is the primary facility point of contact for dissemination of the VHA Clinical Preventive Services (CPS) Guidance Statements that are described in this handbook and for implementation, alignment, and evaluation of the services as defined in guidance statements. This includes:

a. Responsibility for engaging all relevant stakeholders within the facility including, but not limited to, COS, Nurse Executive, ACOS for Ambulatory Care, HPDP Committee, providers, and clinicians.

b. Responsibility for collaborating with facility staff to develop consistency between facility strategies (e.g., local policies and procedures, local protocols, local clinical reminders, and standardized templates) and CPS Guidance Statements.

Program Development and Implementation

Responsible for strategic planning, program development and implementation, monitoring, and evaluation of HPDP programs and services in the facility. Ensures that HPDP strategic plans are aligned and integrated with Patient-Aligned Care Team (PACT) and facility strategic plans.

1. Promotes and utilizes evidence-based guidelines at all stages of program development and implementation.

2. Contributes to quality- and systems-improvement projects regarding HPDP programs and services.

3. Responsible for effective management of resources allocated by the facility for HPDP programs and services.

4. Develops or coordinates the development of user-friendly tools to assist in successful implementation of HPDP programs and services.

5. Provides leadership in the development or modification of service delivery processes to support the successful implementation of HPDP programs and services.

6. Designs and organizes evidence-based HPDP outreach events including strategies to evaluate outcomes of events.

7. Establishes and maintains lead points of contact at each CBOC to ensure implementation of HPDP programs and services at the CBOC.

8. Occupation-specific duties and responsibilities regarding the delivery of selected HPDP services may be assigned locally as appropriate.

Consultation and technical assistance

1. Serves as a facility content expert in HPDP, including clinical preventive services.

2. Assists all services and departments in developing, implementing, and evaluating HPDP

Communication and coordination

1. Collaborates with primary care and all clinical and administrative services as needed to ensure that HPDP programs and services are provided to Veterans at the facility.

2. Maintains effective working relationships with other facility staff responsible for related programs and services, including MOVE!®, Veterans Health Education, My HealtheVet,…