Comprehensive Cancer Control Technical Assistance Training and Communication Plan PI: Mandi Pratt-Chapman, MA Cooperative Agreement #1U38DP004972-01 July 2014 Acknowledgement: This work was supported by Cooperative Agreement #1U38DP004972-01 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.
Background In 2013 the George Washington University (GW) Cancer Institute was awarded a 5-year cooperative agreement (#1U38DP004972-01) to work with the Centers for Disease Control and Prevention (CDC) to design and implement comprehensive, high quality training and technical assistance (TA) to National Comprehensive Cancer Control Programs (NCCCPs) and their partners to implement cancer control activities. The project began September 30, 2013 and will last through September 29, 2018. Based on a comprehensive needs assessment of Comprehensive Cancer Control (CCC) training needs and preferred formats, this Training and Communication Plan outlines our approach to support NCCCP priorities and provide a multi-pronged approach to providing TA. The findings of the needs assessment indicate: Many TA resources exist, but they need to be better organized, coordinated and promoted across numerous entities. Despite availability of many TA resources, they are not accessed by everyone and do not fill every gap. The greatest needs for TA include: Adapting evidence-based practices (EBPs) to local communities, Affordable Care Act (ACA) implementation; coalition building and stakeholder engagement; policy, systems and environmental changes; tools for collaboration and information sharing; community-clinical linkages; communication of CCC successes; and successful sustainability strategies. A need exists to strengthen local partnerships and integrate with state-level efforts to enhance CCC activities. The National Partners are a tremendous resource, and there are opportunities to increase collaboration across the entities. Implementation of the ACA is a priority topic for many CCCs. Although resources exist, there is a gap in state-level implementation resources related to cancer. Some states have focused on linking cancer and chronic disease prevention efforts, but more assistance is needed to strengthen this integrated approach. Social media may be useful tools for reaching both the general public and health care professionals, but health care professionals may not prefer social media over other electronic channels. Area Health Education Centers have the potential to assist with local CCC implementation, and an opportunity exists to strengthen their ties with CCC programs and coalitions. Although there are benefits and drawbacks to online adult education, the format is a costeffective mechanism for expanding the reach beyond the limited number of professionals who can participate in expensive in-person programs. However, methods for online instruction differ from in-person methods. Development of online education programs should utilize adult learning theories and promising online education practices. Communication across CCC programs and coalitions is critical. Existing platforms exist, but gaps in available channels should be addressed. Informed by the needs assessment, we have identified the following activities as critical to support CCC efforts: Improve mechanisms for communication and coordination of TA efforts, including an online repository for CCC tools, resources and best practices; a monthly e-newsletter that 1
aggregates TA activities and promotes CCC program efforts; and coordination of the National Partners website. Conduct web-based training through quarterly webinars and free online courses. Develop tools, including social media guides; resource guides; ACA implementation tools; a priority alignment tool; survivorship report cards; a tool for establishing policy, systems and environmental (PSE) change activities; and a tool for advancing patient navigation. Facilitate local-level relationships to support integration of cancer and chronic disease prevention efforts through a series of roundtables in partnership with Area Health Education Centers. Enhance connections across CCC programs through peer-to-peer matching, one-on-one TA and Ask the Expert sessions. Improved Mechanisms for Communication and Coordination Our needs assessment findings indicate that there are various TA resources for CCC programs available online, but CCC practitioners are often unaware of these resources or lack the time needed to identify ideal resources. Additionally, our CCC TA Steering Committee indicated that a need exists to better coordinate resources through an organized online repository and that CCC programs and coalitions need a platform for collaboration and dissemination of best practices. To meet this need, the GW Cancer Institute has launched a monthly TA e-newsletter and a TA repository website, and we will take over coordinating communication for the CCC National Partners website. Monthly TA E-Newsletter Launched in June 2014, the monthly e-newsletter, the GW Cancer Control TAP (Technical Assistance Periodical), is based on gaps identified in the needs assessment. We have created a listerv that is open to any stakeholder working in comprehensive cancer control, and the e-newsletter will be sent through this listserv. The GW Cancer Control TAP e-newsletter contains: Updates from the GW Cancer Institute about tools and resources developed through this project; TA training and events offered through a variety of channels, including the CCC National Partners; Resources on CCC priority topics; Funding opportunities; and Highlights from coalitions and CCC programs. Online Repository The GW Cancer Institute will build a web presence that expands on existing resources to meet the needs of CCC programs. Titled GW Cancer Control TAP (Technical Assistance Portal), the website is designed to serve as a resource repository that will include: GW Cancer Institute TA tools and trainings Descriptions and links to resources created by federal agencies, National Partners and others Relevant reports Interactive tutorials on tools and resources Summaries of queries posted through the Program Director listserv Examples of tools and strategies implemented by CCC programs and coalitions Coordination of National Partners Portal 2
The GW Cancer Institute participated in the June 2014 National Partners meeting and the GW Cancer Institute was designated as the coordinator of the National Partners website. Although there may be some cross-posting of resources between this site and TAP, the National Partners website will focus exclusively on TA opportunities offered through these partner organizations as well as on National Partner meetings and events. Web-Based Training Our needs assessment indicated the desire for more web-based training opportunities. Webinar in particular is a preferred format, and online trainings were identified as a way to increase access to resources for a broader group of participants. Our approach will leverage technology and our existing infrastructure to implement webinars as well as free online courses. Quarterly Webinars Despite the existing availability of TA webinars, the needs assessment indicated that, due to the large variety of issues addressed, CCC programs would benefit from greater sharing of information through additional webinars. To meet this need we launched a monthly TA webinar series on topics identified in the needs assessment. The webinars are archived and available for viewing on our website after the event and will be promoted through our TA Periodical, emailing lists and social media accounts. Examples of priority webinar topics include: Overview of CCC TA Needs Assessment Findings (completed June 2014) Coalition management tools Spotlight on the CCC National Partners Area Health Education Centers: A Resource for CCC Programs State Efforts to Support Delivery of Survivorship Care Plans Tips and Tools for Creating State Cancer Plans Funding CCC Activities: Opportunities and Tips Free Online Courses Online learning has emerged over the past several years as a mechanism for reaching a broader group of adults. The creation of web-based educational programs that accommodate learners from all geographic and professional backgrounds will facilitate dialogue with peers and experts. The trainings will be created using Adobe Captivate, award-winning software that helps to rapidly author a wide range of interactive HTML5-based elearning, and will be hosted on Learn Something, a Learning Management System (LMS). Based on feedback from past participants and our literature review, a key component of our trainings will be interactivity. We will also seek ways to connect participants during and after trainings to foster relationships and communication across CCC programs. A list of expected release dates, training topics and overviews of training programs is illustrated in Figure 1. 3
Figure 1: Online Course Approach Year 1: September 30, 2013- September 29, 2014 Executive Training on Navigation and Survivorship Patient Navigation: From Outreach to Survivorship Program planning skills for launching and sustaining patient navigation and clinical survivorship programs Competency-based training for non-clinically-licensed patient navigators (sometimes called lay navigators) Year 2: September 30, 2014- September 29, 2015 Best Practices for Enhancing Communication Stakeholder Engagement: The Value of Networks in Cancer Care Communicating successes across multiple audiences Tools and resources for working collaboratively to implement cancer control activities Year 3: September 30, 2015- September 29, 2016 Cancer Policy 101 An overview of national cancer policy issues and strategies for advancing policy priorities Development of Tools and Resources Additional tools are also needed to support CCC activities. We have identified six new tools and resources to develop: social media toolkits, resource guides, resources on ACA implementation, a priority alignment tool, survivorship report cards and a tool for creating a PSE agenda. Social Media Toolkits The need for TA related to communication strategies has emerged through our needs assessment. We will create social media toolkits to aid CCC programs efforts related to key topics to be identified in year 2. The toolkits will leverage expertise from GW distinguished faculty member Monique Turner, PhD, who is an expert on health communication and risk communication, as well as the expertise from John Hussey, GW Director of Digital Marketing Strategy. We will coordinate with ACS and CDC to ensure no overlap in efforts and that the toolkits address priority topics. Resource Guides Our needs assessment clearly identified a need for helping CCC programs and coalitions better identify and sort through useful resources. As part of our Executive Training on Navigation and Survivorship, we developed an award-winning resource guide to help synthesize large amounts of resources and information for trainees. We will use this approach to develop easy to use resource guides in years 2-5. Based on feedback from our project steering committee, we will start with guides on coalition structure and stakeholder engagement, and we will create a communication guide to accompany our year 2 training. We will identify additional topics in subsequent years to ensure topics are relevant so the resource guides will be useful. 4
Affordable Care Act Implementation Our needs assessment indicates that a significant amount of resources around the ACA exist; yet, these resources are often general and not cancer-specific. With the enactment of the ACA in 2010 and its evolution since then, questions about its impact on CCC programs persist. Based on feedback from our project steering committee, we plan to: Create one or more fact sheets on some of the federal issues in the ACA. These topics include clinical trials coverage and genetic counseling. These fact sheets may also contain information on some state-level issues, such as oral chemotherapy coverage, that may be impacting states in different ways. Identify a forum to share key challenges related to ACA implementation and strategies to address those challenges. To address this need we will continue to work with our steering committee to identify the most appropriate mechanism(s) to facilitate this dialogue. Promote AHEC s existing training program that is broadly focused on the ACA and the health exchanges. We will also work with AHEC to disseminate cancer-specific tools and resources to AHECs across the country. Priority Alignment Tool CCC programs indicated that there are many priorities for cancer control, including Healthy People 2020 and the CDC s CCC priorities. To help states better align their goals and activities with these national priorities and indicators, we will create a National Priority Alignment Tool that summarizes these priorities and can be used as a guide for goal setting at the state and local levels. In year 2 we will pilot the tool with 3 CCC programs and in the Year 2 AHEC roundtables and revise it based on their feedback. We will then promote the final tool through our monthly webinar series, the e- newsletter and our resource repository website. Survivorship Report Cards The number of cancer survivors in the U.S. is growing and a new focus on post-treatment quality of life has emerged. Despite this new focus, few resources are available to guide states on how to improve survivorship from a public health perspective. To inform state cancer plan goal development and implementation, we will create Survivorship Report Cards to pilot with 10 states. The report cards will: Assess the availability and quality of survivorship-specific goals included in the state cancer plan, Identify available state survivorship resources, Provide case studies of states with successful survivorship initiatives and Provide concrete recommendations to help CCCs improve the public health of cancer survivors in their state. Policy, Systems and Environmental Changes Tool One priority for CCC programs is PSE changes to support cancer control efforts. Our needs assessment indicates that, while states have had some successes, many states need additional education and assistance to address this priority. In year 2 we will develop a tool to assist CCC programs with creating PSE agendas that will be partially based on an assessment of state cancer plans. These efforts will be coordinated with the American Cancer Society to ensure there is no overlap with their planned activities. Patient Navigation Guide 5
Patient navigation has emerged as a critical profession for reducing barriers to access to care. Based on successes from the Community Health Worker field, state health departments will likely play an important role in advancing the profession. To support patient navigation efforts at the state level and supplement our competency-based patient navigation training, we will create a guide that will include: an overview of roles, definitions and terminology based on our previous work in defining the unique role of non-clinically licensed patient navigators; patient navigation program planning tips; suggestions for creating a customized hybrid training that leverages our free training; tips for states for providing TA to patient navigators; policy approaches to support patient navigation; and a list of state patient navigation networks to facilitate communication across states. Support for Cancer and Chronic Disease Integration Efforts One of the CDC s priorities is to integrate cancer and chronic disease prevention efforts as these diseases share similar risk factors (lack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption), disease burden and prevention and quality of life implications. The CDC is working towards making two major impacts on the state-level: 1) reducing cost burden on individuals, businesses, employers, governments and the nation and 2) improving health outcomes across multiple risk factors. To support this integration, we will co-host regional roundtables with Area Health Education Centers with the goals of 1) creating stronger linkages at the communitylevel and 2) identifying successes, challenges and needs related to integrating cancer and chronic disease prevention efforts. The roundtables will occur in years 2-4 of the project, and in year 5 we will create a set of recommendations for the CDC on ways to support or advance cancer and chronic disease integration efforts. Enhanced Connections The sharing of information, resources and best practices has been identified by numerous sources as essential for enhancing CCC activities. We plan to enhance connections across different stakeholders through several mechanisms: an Ask the Expert series, a peer-to-peer matching database and one-on-one technical assistance. Ask the Expert CCC programs indicated the need for more direct time with experts. For example, webinars often allow time for questions and answers, but participants sometimes have additional, more complex questions about how they can adapt the content presented in their own setting. To facilitate greater access to experts, we will implement 5 Ask the Expert small group TA sessions each in years 2-5 (for a total of 20 sessions) that will allow participants to more actively engage speakers and solicit more tailored advice. Potential topics for these sessions include: CCC program and evidence-based program implementation and evaluation PSE changes and the Affordable Care Act Developing collaborations and partnerships Coalition structure and functioning Peer Mentorship Program In addition to small group TA, we will also facilitate more intensive one-on-one TA through a Peer Mentorship Program. We conducted a survey of CCC practitioners to identify areas of expertise needed and acquired as the basis of a database. We will connect practitioners and assist them with creating an action plan to ensure their goals are met. 6
One to One TA While the other TA activities described in this plan are responsive to priorities identified in the needs assessment, programs may need TA on additional topics. In years 2-5 we will provide one-onone TA to 10-15 CCC programs based on their individual needs. For example, one program asked us to assist with the creation of an infographic, and we have been invited to present to other CCC programs on navigation and survivorship. The TA will be driven by the CCC programs on a firstcome, first-served basis, pending staff capacity. The One-on-One TA will include connections fostered and evaluated through the Peer Mentorship Program, as well as GW Cancer Institute staffassisted TA. Summary This Training and Communication Plan outlines the GW Cancer Institute s approach to providing TA to support and enhance CCC efforts. Our approach has been informed by a comprehensive needs assessment and will include a multi-pronged approach to better coordinate TA, provide webbased TA opportunities, develop tools and resources, partner with Area Health Education Centers to promote cancer and chronic disease prevention integration and enhance connections across CCC programs. We will continue to conduct ongoing assessment to ensure project activities are aligned with the greatest areas of need, and we will conduct ongoing evaluation to track our progress and outcomes. Our evaluation findings will be summarized each year and posted publicly on our TAP website for CCC programs to review and provide feedback. Comprehensive cancer control is a much-needed approach to addressing public health issues related to cancer, and we look forward to providing assistance and working with different stakeholders to implement this plan. 7