Accreditation History

Background

In 1981, the Missouri Department of Health’s Board of Heath established a task force to develop model standards for local public health agencies. The report by this task force identified the primary responsibilities of local health departments.

In 1988, The Institute of Medicine report opened a nationwide discussion about the need for improvement in public health at all levels of government.

A second Missouri task force, formed in 1989, defined standards and objectives for local agencies and recommended:

• Minimum core services to be performed by local public health departments in exchange for state Cooperative Agreement funding;
   

• A local pubic health department evaluation system to be used as a Missouri Department of Health monitoring mechanism; and
   

• Legislative authority for standards and for the funding necessary to implement them.

In 1993, the Missouri General Assembly engaged in debate over health care reform. Because of concern about the potential impact this might have on the public health system, the Director of the State Department of Health established a technical advisory team of local and state personnel to define the practice of public health in Missouri. The first mention of accreditation standards for local public health practice occurred during discussion within this advisory team.

In 1995, this task force was appointed to further define the three core functions of public health, (assessment, policy development and planning, and assurance) as recommended in the Institute of Medicine report. The task force divided the three core functions into fourteen principal elements. These elements were then further described as key activities and roles that a statewide pubic health system should carry out. A report, Defining Public Health for Missouri, was prepared and released in February 1997.

Over the next nine months, local and state public health professionals reevaluated each of the 189 local public health roles for clarity, relevance to current standards/guidelines, staffing and resource needs, and desired outcomes. A similar process began in July 1998, in which state roles were evaluated. The result of this work was a revised and updated Defining Public Health for Missouri II report, published in September 1999.

Developing and Implementing the Missouri Accreditation Program

Following the release of Defining Public Health for Missouri II, the Director’s Advisory Council on Local Public Health selected two local public health agency administrators from each of the six health districts in the state to develop Missouri’s accreditation model. Additional task force members included a representative from the St. Louis University School of Public Health, Missouri Department of Health representatives from District Offices and from the Center for Health Information Management and Epidemiology, and local agency governing body representatives, including a County Commissioner and a member of a local Board of Trustees.

Accreditation work being done by other states and at the national level was researched. Two members of Missouri’s task force were involved with in National Association of City and County Health Officials (NACCHO) efforts, and shared information of their progress. The task force was also informed of the work being done at Centers for Disease Control and Prevention (CDC) with performance measures based on the ten essential public health services, and with work by the American Public Health Association on infrastructure. The Missouri Accreditation Task Force met eight times over a nine-month period and developed an accreditation model based upon roles and activities outlined in Defining Public Health for Missouri II. Standards were developed to define core staff, their qualifications, competencies, and training requirements. Another section of standards set minimum standards for physical facility and operations. This group determined that accreditation should be voluntary rather than required, and that there should be 3 types of accreditation so as to not exclude agencies with fewer resources.

At the completion of the work of the Accreditation Task Force, an Accreditation Implementation Committee was formed in September 2001. This committee was composed of three local public health administrators who served on the Accreditation Task Force (one representing each of the proposed three types of accreditation); a district health director; a representative from St. Louis University School of Public Health, Southwest Missouri State University, and Kirksville College of Osteopathic Medicine (schools that currently offered public health degree programs); a representative from the Missouri Association of Local Public Health Agencies, Missouri Public Health Association, Missouri Nurses Association, Missouri Environmental Health Association, and Missouri Society for Public Health Education. This committee developed a self-assessment tool and piloted it in seven local public health agencies. A guidance document for the accreditation model was developed with information learned during the pilot visits.

In 2002, with support from the Robert Woods Johnson Foundation’s Turning Point Project, the Missouri Institute for Community Health (MICH) was formed. This 501 c (3) organization, governed by a board with public and private entity representation, established workgroups to carry out the work of the Institute. In August of 2002, the Implementation Committee became the Standards Workgroup in MICH to finalize and publish the accreditation standards.

During 2003, using feedback from the agencies and reviewers involved in trying out the model, the Standards Workgroup for MICH further refined and published the Missouri Voluntary Accreditation Standards. This group developed a fee structure that would cover cost to administer the accreditation program, and a scoring method to evaluate agency performance. The group also established methods to evaluate the process and the outcome of the accreditation program, and a process for agencies to appeal accreditation decisions. On-site reviewers were recruited and trained and, in collaboration with the Missouri Association for Local Public Health Agencies, 2 workshops were held to assist local public health agencies with interpretation of the standards.

In September 2003, MICH, the accrediting body, announced an opportunity for local public health agencies in Missouri to apply for accreditation.

In September 2003, MICH, the accrediting body, announced an opportunity for local public health agencies in Missouri to apply for accreditation. Kansas City Health Department was the first to become accredited in July 2004, and 11 other health departments applied for and achieved accreditation over the next two and one half years.

Using feedback from these 12 pioneer agencies and the on-site reviewers that evaluated them, the MICH Accreditation Council again reviewed and refined accreditation standards. A revised set of standards announced in early 2007 also reflects results of national efforts such as Operation Definition of a Local Public Health Agency, a document created through a collaborative effort led by NACCHO.

The RWJ Foundation has continued to support public health accreditation efforts in Missouri and in other states through a Management Learning Collaborative bringing state representatives together to learn from each other. In 2007, 5 states offer local public health agency accreditation programs, though Missouri’s model is the only one that is voluntary and is the only one not supported in whole or in part by state revenue.

A project called Exploring Accreditation http://www.exploringaccreditation.org/ is working on a national public health accreditation model recommending voluntary accreditation for both local and state health departments.
 

ACKNOWLEDGMENTS

(Revised 1/04)

The Missouri Local Public Health Accreditation Program would like to recognize the following individuals who served as invaluable members of the Accreditation Task Force, Implementation Committee, and/or the Standards Workgroup for MICH:

The Missouri Local Public Health Accreditation Program would like to recognize the efforts of the local public health agencies that graciously piloted the accreditation process in the fall of 2002:

Butler County Health Department
Cole County Health Department
Grundy County Health Department
Henry County Health Center
Lincoln County Health Department
Springfield-Greene County Public Health Center
St. Louis County Department of Health

The Missouri Local Public Health Accreditation Program would like to recognize the efforts of the following staff of the Missouri Department of Heath and Senior Services for their efforts:

Center For Local Public Health Services

Mahree Skala
Shirley Rutz
Judy Alexiou
Kathleen Wojciehowski
Irene Donelon
Hilda Eichholz
Brenda Buschjost

MICH Staff

Janet Canavese

● Member of Accreditation Task Force 1998-2001
√ Member of Accreditation Implementation Committee 2001-2002
† Member of MICH Standards Workgroup