Planning for Action: Initial Steps for Implementing the Healthy Brain Initiative Road Map

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This planning tool guides state and local public healthprofessionals through quick steps in selecting Healthy Brain Initiative (HBI) Road Map actions and getting started with implementation. Its six steps will direct you to a path for success that best meets your specific needs. Easy-to-use worksheets and resources will help you prioritize, plan, and promote Road Map actions.

You can enter into this planning process with confidence because the HBI’s State and Local Public Health Partnerships to Address Dementia: The 2018–2023 Road Map actions are strategies that experts identified as having the greatest potential public health impact, while being adaptable for different capacities. Also, the HBI Road Map is a credible citation source for justifying plans and initiatives around Alzheimer’s and other dementias.

>>SIX STEPS TO PLANNING YOUR PUBLIC HEALTH RESPONSE TO ALZHEIMER’S

Make an impact in addressing Alzheimer’s and other dementias using the HBI Road Map with six steps to guide your planning. The Know.Plan.Go.TM Mobilization Model (Blais & Colleagues, 2015) diagram (page 4) captures these steps in a quick-reference format so you can turn strategy into action that reaches a broad audience.

Step 1: Prioritize potential actions within your area of focus (Know)

Use the HBI Road Map as a tool to guide decisions about where to prioritize your efforts to promote brain health, expand early detection and diagnosis, improve safety and quality of care for people living with dementia, and attend to caregivers’ health and well-being.

The key is to begin, whether you first raise awareness of the HBI Road Map within your division or you create a plan around an easier Road Map action. Initial momentum gives you a base on which to keep building where you have capacity and interest.

Start by reviewing the HBI Road Map and its agenda of 25 actions as well as the compelling data presented. Educate your staff and other health professionals about Alzheimer’s and other dementias. Then, use the Prioritizing Road Map Actions worksheet (page 5) to identify Road Map actions that are achievable, align with existing areas of focus and priorities (Step 2), and fit with available resources and capacity.

Step 2: Integrate and align strategies into your existing plans (Know, Plan)

You do not have to start from scratch. Many Road Map actions can be integrated into existing plans and initiatives such as programs for chronic disease, health promotion, and public safety; Alzheimer’s state plans; or state or community health improvement plans. Do a scan of current initiatives and plans within your organization and by other groups or organizations. Find places where you can align Road Map actions with existing initiatives or goals and add the information to the Prioritizing Road Map Actions worksheet that you started in Step 1. See the Aligning Actions Examples table for examples (page 3).

Not finding obvious alignment? Gather a few colleagues for a conversation about using Road Map actions to create a plan to address Alzheimer’s. Together you could conduct a quick environmental scan or needs assessment to uncover priorities or opportunities in your community that relate to cognitive health. A table with Potential Data Sources is on pages 8–9.

Step 3: Orchestrate across the state public health system (Plan)

Whether you serve at the state or local level, your work interfaces with other parts of the public health system. It takes us all working together — across community systems — to improve outcomes for all people living with Alzheimer’s and their  caregivers.

Consider how your priority Road Map actions can be integrated across the entire public health system or community. How might actions in the HBI Road Map complement the strategic plans and key initiatives that exist? Integration into other areas of health, where appropriate, enables you to leverage resources and build partnerships for sustainable initiatives. Reach out to discuss the possibility of integrating Road Map actions into those plans or as part of their existing initiatives.

Step 4: Mobilize for Action (Know, Go)

Successful public health occurs through collaborative partnership, planning, and networking to garner support, assistance, best practices, and training. Organize a network of mobilizers, a community coalition, or task force charged with building and taking the action plan to the next level. Consider traditional and nontraditional partners so that engagement is inclusive across all audiences you wish to serve. Suggestions for potential partners are in Engaging Partners and Stakeholders (page 10).

Completing a Stakeholder Analysis Matrix worksheet (page 11) may help you prioritize partners to engage now in the planning stage and others to mobilize at a later stage.

With these partners, use the Action Planning worksheet (page 7) as a template for determining activities and resources needed to achieve the HBI Road Map action. If you will pursue multiple Road Map actions, replicate the worksheet template. As with all plans, identify some measurable goals. Assign accountable people, partners, and measure success. Identify champions to promote the importance and urgency of acting now on the plan.

Step 5: Ask for additional technical support and assistance (Plan, Go)

A plan is only as good as its implementation, and implementation takes forethought, execution, and accountability. Ask for guidance from the Alzheimer’s Association or CDC’s Alzheimer’s Disease and Healthy Aging Program (see callout box below). They can provide insights into the recommended strategies and suggest strategies that might work best for your organization. View Road Map resources at alz.org/publichealthexternal icon and cdc.gov/aging for emerging implementation practices and success stories.

Step 6: Tell the compelling public health story of Alzheimer’s and refer others to the HBI Road Map (Grow)

The goal of the HBI Road Map is to enable the public health community and its partners to anticipate and respond to the growing impact of Alzheimer’s and other dementias on every facet of society. Use the HBI Road Map’s compelling data to create your own talking points about why and how you support Alzheimer’s in your work.

As you capture data and anecdotes about your successes, proactively tell the story about how these actions translate into meaningful outcomes across the lifespan, across other chronic diseases, and support health and safety more broadly.

Communicate about your successes to build momentum that can lead to changes to policies, systems, and environments over the long term. Plan forward for sustainability.

>>ALIGNING ACTIONS EXAMPLES

Many Road Map actions can be integrated into existing public health priorities. Consider how the HBI Road Map actions
can align to the following goals and initiatives.

KNOW.PLAN.GO.^TM FOR ROAD MAP SUCCESS

• Familiarize yourself and others with the Road Map and its action agenda
• Understand how the Road Map can be used to integrate and align with existing plans and initiatives
• Know the Road Map is a credible source to support and prioritize strategies
• Gather key staff and stakeholders to identify which Road Map actions best meet these priority needs and are most feasible to implement

• Assess individual, community, and system needs around cognitive health
• Use resources below to prioritize which actions to do first and create a plan to implement each
• Map out a series of proactive communications to promote the importance and urgency of your actions
• Incorporate actions within existing plans and initiatives where possible

• Engage key staff, stakeholders, and partners to help in implementing strategies
• Learn about success stories, case examples, and best practices from other departments of health
• Measure achievement of your activities and report progress to maintain support and mobilize others
• Seek additional support from the CDC and the Alzheimer’s Association; review the Road Map resources on alz.org/publichealthexternal icon and cdc.gov/aging

• Create calls to action to inform and motivate a prioritized list of others to be a part of the movement
• Incorporate updates on progress into standing agenda items, key leadership presentations, newsletters, and other messaging
• Use the case studies and resources provided in the Road Map to encourage others to take action
• Strive for policy, system, or environmental (PSE) changes to elevate cognitive health and Alzheimer’s as priority public health issues

>>PRIORITIZING ROAD MAP ACTIONS

Of the 25 Road Map actions, the following 12 actions are those primed for implementation by state and local public health leaders. You can use these actions as a starting point in creating your plans. The following two worksheets help identify priority actions, your activities, and resources.

1. Start by assessing each of the 12 actions in terms of the following:
   • Priority level as it relates to the need within the community/region/state and organizational priorities
   • Difficulty level in implementing the action in terms of complexity, available time, resources, staff/partner capacity and strengths
   • Alignment with other initiatives or plans already underway — it may be easier to make progress on actions where there is already momentum and work is happening
2. Determine which items are feasible based on their priority, difficulty, and alignment. Consider that an action may meet an extensive need in the community and thus, may be worth allocating time and resources even if it has a higher level of difficulty. Or, if a Road Map action already aligns with a current initiative underway, it may increase the priority level and decrease the difficulty if there can be synergy of effort that enhances the current initiative.
3. Next, in the Rank column, place a number by each action in order of which actions you will pursue first.

>>ACTION PLANNING WORKSHEET

Once you have your Road Map actions identified and prioritized, use this worksheet to determine what activities and resources will be needed to achieve the action. Create one worksheet for each Road Map action.

>>POTENTIAL DATA SOURCES

The following references can be used to gather citations, data points, and information to support pursuing specific Road Map actions.

*The BRFSS Cognitive Decline module measures the prevalence of “subjective cognitive decline” (SCD) — a non-medical term that identifies the percentage of individuals who self-report they are having increasing memory problems. A growing number of studies has shown that SCD is associated with an increased risk of future dementia; these data indicate potential future problem and burden of dementia.
**Access to such data varies and may not be universally available due to inconsistencies in data collection and management. Consider consulting the state aging department to learn more about state/regional data sets.

*Access to such data varies and may not be universally available due to restrictions on database access and use. Consider consulting a health department or university-based epidemiologist for additional guidance on state/local data sets.

>>ENGAGING PARTNERS AND STAKEHOLDERS

Who do you need to engage for support in implementing your selected Road Map actions?

Government

• Governor/Mayors/County supervisors
• State public health officer
• Chronic disease director
• State epidemiology/surveillance branch
• Division of aging services (state and county level)
• State and local policymakers, legislators
• State/Regional planning commissions
• Public safety (police, fire, transportation)

Healthcare

• State hospital association
• State provider associations (primary care, specialty care, pharmacy)
• Rural and urban health associations or clinics
• Health systems
• Federally Qualified Health Centers (FQHCs)
• Physician practices (primary care, family practice, geriatrics, internal medicine, neurology)
• Other health care service providers (EMS, physical therapy, home health, hospice, pharmacy, community health workers)

Senior Service Providers and Organizations

• State and local chapters of the Alzheimer’s Association
• Area Agency on Aging (AAA) and Aging and Disability Resource Centers (ADRC)
• Nursing home and assisted living communities at local level as well as state associations
• Independent living and continuing care communities
• AARP chapters
• Local foundations and non-profits serving seniors and caregivers
• Senior centers

Other Entities

• State public health association
• Healthy living coalitions/livable communities
• American Heart Association and American Diabetes Association
• Area Health Education Centers (AHEC)
• Schools of public health
• Public health institutes
• Large employers (help in reaching caregiver population)
• Academic institutions
• Geriatric Workforce Enhancement Programs (GWEP)
• YMCA
• Religious organizations/faith community
• Organizations serving populations at higher risk for dementia (Hispanic, African American)

>>STAKEHOLDER ANALYSIS MATRIX

Use this template to identify stakeholders for activities related to Road Map actions, including their level of influence, which issues are important to them, and how they will be engaged.