Please watch the following video and answer the questions below. Responses will be due Friday, February 13 at 5 PM.
This video was created by the Genetic Alliance in response to their Cancer Genomics Public Health program and it integrates many of the topics that we have discussed in this class so far.
(1) What are the seven steps that are recommended for creating a successful Tier 1 Public Health program? Which step do you think is the most important and why?
(2) This program was implemented in Michigan and has been very successful. Are there other states that have implemented this program or something that is similar to it? If so, please list the state and the program. (Make sure to cite your sources appropriately.)
(3) If a state wanted to implement this program, which stakeholders would you involve in the process?
(1) Of the seven steps to create a successful Tier 1 Public Health program (set goals by assessing data and available resources, build partnerships, conduct surveillance, provide info to policy makers, make education available to the public, implement bi-directional reporting, and conduct surveillance and assess results), I believe that education is the most important. It’s important to educate the community about how they can use this resource to improve their lives. Without understanding the genomics, people may not reach out and use the program or may misinterpret what the program does. Since the community s who the program serves, the education of its members is the most important.
ReplyDelete(2) Other state genomics programs have been implemented in Utah and Oregon. The program in Oregon’s mission is to “(p)romote the health, well being, and quality of life of Oregonians using up‐to‐date knowledge of genomics” (Oregon Public Health Genetics Program). Utah has an 8 goal "Utah Genomics Plan" they put in place in 2006 (Utah Genomics Plan 2006-2010).
Oregon Public Health Genetics Program. "Strategic Plan:
Mission, Goals, and Objectives". http://public.health.oregon.gov/DiseasesConditions/GeneticConditions/Documents/StrategicPlan2011.pdf
"Utah Genomics Plan 2006-2010". http://health.utah.gov/genomics/pages/projects/minigrants/utahgenomicsplan.pdf
(3) If a state wanted to implement this program, which stakeholders would you involve in the process? Any state programs, like cancer registries, with existing infrastructure we could use. It’s also important to involve any group working in the area of cancer in order to create a wider reach with the program.
I agree with your endorsement of education as the most essential of the seven steps listed for creating a successful Tier 1 Public Health program. Unless patients and providers are aware of the importance of genetics to their health and have a vested interest in genetic education, testing, or research, then any program aimed at these goals seems a waist of time and money. Watching this video encouraged me regarding the value of genetic testing and gave me hope that great improvements to human life will emerge from new collaborative efforts. Simple efforts like sharing this or similar videos can get people interested in genomics and how the field will impact their lives in the near future. It's great to see many states already utilizing genetic research to promote good health in their communities as you mentioned is happening in Utah and Oregon. Spreading awareness about the value of genetics in disease prevention and health should help such programs flourish, so education is essential.
DeleteI agree with your answer to number three, especially when you mentioned that the target should probably be any working group that specializes in cancer to have a wider range. I'm sure that there are many stakeholders out there that are involved with cancer in some way, but it is important to have a variety and range of stakeholders so that many people are able to be covered in all areas. I also liked your reasoning when you said that you think education is the most important. I think as students who study public health, we are taught that prevention, especially through education to the public, is really important and effective. The people who are affected or at risk of being affected should definitely know what is happening and should be able to understand the program so that they are able to apply it to their own lives.
Delete1) The seven steps that these advocates depict are: set goals by assessing data and available resources, build partnerships, conduct surveillance, provide information to policy makers, make education available to the public, implement bi-directional reporting, and conduct surveillance and assess results. I believe that identifying individuals at risk is the most important step. Not only is this the primary step that catalyzes all the others, but I think it really emphasizes the necessity to raise direct awareness amongst the most at risk population. This reminds me of what I learned in my Epidemiology course, recognizing that specifying the at risk population will aid in increasing the numbers in true positive screening test results.
ReplyDelete2) Oregon Public Health runs a statewide program that promotes incorporating genomic studies in order to better health and prevent disease. It encourages people to look at their family health history and be aware about hereditary breast and ovarian cancer.
http://public.health.oregon.gov/DiseasesConditions/GeneticConditions/Pages/index.aspx
3) I would contact hospitals with cancer registries, public health policy makers, university researchers, clinicians, genetic specialists, oncologists, people with past experience in partaking in genetic testing, people who currently have a hereditary disease, and cancer counselors.
Clarissa,
DeleteI like your point about the importance of identifying people at risk. When implementing a public health intervention, I think it is important to think about efficiency. Why waste time and money screening lots of people who are not at any risk of developing cancer? As you said, unnecessary screening may cause undue anxiety for people who are actually not at risk. I also like how you brought up the education/awareness issue: it is important that people who need to be screened know what options are available to them. As one of the speakers pointed out in the video, genetic screening can be scary. If we raise awareness of why it is important and let people know if it could help them, maybe genetic screening will become less intimidating.
I agree with you suggesting that the first step is most important. It is crucial to know who is at risk and from there one can develop the important goals in mind for the program (hence it triggers the rest of the steps that follows). And by identifying these people, a large amount will signify the need for a program like this and hopefully will raise awareness to the public. I also agree with the people/stakeholders who should be involved--anyone with a background in genetics and cancer research is required. It is important to use these peoples' knowledge when trying to plan an effective program.
DeleteI agree with your thought that building partnerships and relationships with healthcare organizations is a crucial step in establishing a Tier 1 Public Health program. By partnering with the community and gaining the support of other organizations, more awareness can be raised for the field of genomics, which can help further develop more preventative measures for diseases.
Delete1. The seven steps of establishing a Tier 1 Public Health program are: Setting goals by assessing data and available resources, build partnerships, conduct surveillance, provide information to policy makers, make education available to the public, implement bi-directional reporting, and conduct surveillance and assess results. In my opinion, building partnerships with hospitals, community health centers, state health agencies, and public health campaign organizations are crucial. By building relationships with hospitals and community health centers, the clinicians working in those areas will receive up to date information on cancer genomics which will lead to the physicians, PA’s, NP’s, nurses, etc… educating their patients and potentially referring them to receive a screening or genetic counselor. Building relations with other state health agencies and public health campaign organizations will ensure that the best policies and awareness about cancer genomics would be announced and spread throughout the state. The more relationships built, the larger and stronger the awareness will be made.
ReplyDelete2. Connecticut is one of the states that have adopted this program as their mission is “The Connecticut Department of Public Health encourages the adoption by clinicians of national guidelines for genetic counseling and testing concerning Lynch syndrome and BRCA‐related hereditary breast and ovarian cancer syndrome”. http://www.ct.gov/dph/lib/dph/genomics/hp2020_actionproj_ca_genomics_best_practices.pdf
3. If any state wished to implement this program, I would suggest discussing with all oncology centers, hospitals, and community health centers. In addition, recruiting other state public health organizations would be most beneficial as they could aid in as many ways as possible.
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DeleteI agree with your thought that building partnerships and relationships with healthcare organizations is a crucial step in establishing a Tier 1 Public Health program. By partnering with the community and gaining the support of other organizations, more awareness can be raised for the field of genomics, which can help further develop more preventative measures for diseases. Trying to gain as much support as possible is crucial in public health, because through this, programs can better educate the general public on specific healthcare issues.
DeleteRyosuke,
ReplyDeleteI completely agree that establishing partnerships is necessary in creating strong support and information about cancer genomics for the long run. Creating partnerships would set off a chain of events that would lead to multiple organizations or hospitals joining in by possible word of mouth. With more health clinicians and other health professionals working together, better quality of care and knowledge would be provided to the patients. Over time, these patients would possible receive a referral to get screening and even a possible genetic counselor.
1) The seven steps recommended for creating a successful Tier 1 public health program as suggested in the video are: setting goals by assessing the data and resources available, build partnerships, conduct surveillance, provide info to policy makers, make education available to public, implement bi-directional reporting and conduct surveillance and assess results. Of the seven steps I think that the most important is the second step, building relationships. To me this is the most important step because without the relationships that the Michigan program built their program wouldn't be as successful as it is. By building the relationships for a program like Michigan's it makes it possible to reach so many people, not just health professionals, but also patients and the government in order to help the overall cause.
ReplyDelete2) Illinois has a statewide program to bring overall awareness to the importance of genetics on health, mortality and morbidity. Many of it's goals are similar to Michigan's.
http://www.idph.state.il.us/HealthWellness/Genetics_07StatePlan.pdf
Wisconsin is also committed to enhancing their genetics awareness throughout the state. Their main focus is on maternal and child health and children with disabilities. Within Wisconsin there is already a partnership between the Wisconsin Statewide Genetics Program, the Wisconsin Genetic Advisory Committee, and the Wisconsin Genetics Systems Integration Hub.
https://www.dhs.wisconsin.gov/mch/genetics.htm
http://geneticsinwisconsin.wisc.edu/public-health.htm
3) Stakeholders I would involve in the process would be hospitals and community clinics, insurance companies, policy makers, advocacy groups, groups focused specifically on genetics and medical research companies. While I would include the public, before trying to get the entire public on board, I would probably try to target neighborhoods or people of certain races with higher cancer rates and work onwards from there.
Natalia,
DeleteI believe the public is just as important as involving professionals. Although, instead of getting through to them by specifying certain neighborhoods or ethnic groups, I think it would be more efficient to reach out and inform the public through the professionals. Hospitals and community clinics have the resources like cancer registries to refer at risk populations. From there, the parts of the public that matter and are relevant to potential genetic testing will be targeted, making the process more efficient and necessary to the right people.
Though I thought that educating the public was the most important step, I agree that building relationships is very important as well. As Juan Rodriguez said in the video, they need to be taking advantage of currently existing infrastructure in order to make their program more successful. This would be the easiest way for them to reach out to people who are not health professionals specifically or who do not necessarily have a lot of knowledge about genomics. For example, I think it is good that their alliance includes patient advocacy groups as well as physicians and researchers, so they can reach out to patients who would not otherwise know about the program as well as possibly their family members. I agree that government involvement would also be helpful in making their program a greater success, as this could help it become more widespread.
DeleteI think that your points about educating the policy makers and the public is very important. I think that when most people look at these two steps they may think that they're important solely because you are educating the person who makes the rules or the person who will actually benefit from the program. However, as you pointed out it is important to educate them because they may not understand in general. Even if the policy makers didn't decide on what laws to pass and even if the person being educated wouldn't necessarily benefit from the program I think that educating these people just for the sake of education is important. You never know how this information could be helpful to them in the future. I also think your point about reaching a narrow audience is valid. Without educating the people who don't know the only people who will get the information are, mainly, people who already know about it or may be associated with it, which doesn't help the public advance.
ReplyDeleteI also said the building partnerships is the most important step in creating a Tier 1 public health program. I think your points on support and information are important. It is true that with more support, information and resources people are able to get the help that they need. Also, people feeling comfortable about asking for help (like you mentioned) is also important. It is easier to ask for help when you know there are people who want to help you and other people who are also in your position. Without the partnerships that are built throughout the formation of programs like Michigan's these resources wouldn't be available, which would result in a program with less comprehensive help and possibly worse health outcomes in their participants compared to programs with more partnerships and resources.
ReplyDelete1. The seven steps that are required for creating a successful Tier 1 Public Health program are as follows: 1) Set goals by assessing data and available resources 2) Build partnerships 3) Conduct Surveillance 4) Provide Info to Policy Makers 5) Make education available to the public 6) Implement Bi-directional reporting 7) Conduct surveillance and assess results. The step that I think is most important is the first step in setting goals based on data and resources. In order to have an effective program one needs to know the issue at hand by looking at the evidence and with this knowledge the program can have targets in which they hope to aim. A program in itself cannot be effective without having goals that strive to help people who are at risk for these diseases.
ReplyDelete2. Connecticut’s department of public health developed a similar program to the Michigan one called Connecticut Genomics Action Plan in 2005 that assess statewide genetic service needs in order to eventually address those needs. In 2008, the state also created a public health genomic office that integrates developing genomic technologies into policies, programs and practice. It also serves as a resource for health professional and the public about the role of genomics in disease prevention and health improvement. (http://www.ct.gov/dph/cwp/view.asp?a=3134&q=387814&dphNav_GID=1822)
3. If a state wanted to implement this program, I would include anyone with past experience of genomics or cancer. This would include hospitals with cancer registries, oncologists, genetic counselors, researchers in these various fields, etc. All to get a better understanding in order to have an overall effective goal in mind to reduce the incidence of these diseases with prevention.
You made a good point about the most important step being to set goals but at the same time being able to identify the individuals at risk is also high in the list of being important. I found it hard to just choose one of the steps at the most important since they all seem equally important. It is also a good idea to include cancer registries in the program in order to better identify individuals at risk. I had not thought about it but it makes a lot of sense.
Delete#1: The seven steps for creating a successful Tier 1 public health program are: (1) set goals by assessing data and available resources, (2) build partnerships, (3) conduct surveillance, (4) provide information to policy makers, (5) make education available to the public, (6) implement bi-directional reporting, and (7) conduct surveillance and assess results. Of these steps, I think that building partnerships is the most important. As stated in the video, one person or group does not know everything. Michigan’s genomic screening program for hereditary cancers involved many stakeholders, including healthcare providers, at-risk families, genetic councilors, public health officials, and community advocates. I think that, by building partnerships with each other, policy makers and providers may feel less overwhelmed by the task ahead of them. They can pool their expertise and resources to look at a problem from many angles and to build a more effective program.
ReplyDelete#2: According to a 2014 CDC report, four states implemented pilot program for genomic screening from 2003 to 2008. During this time period, the state health departments of Michigan, Minnesota, Oregon, and Utah received CDC funding to implement public health genomic programs. The CDC report found that each of these states implemented their programs in a different way. However, one common strategy was to add information about genomics into existing health questionnaires or into existing prevention programs. For example, Utah and Oregon assessed people’s knowledge of genomics by adding family history related questions to the Youth Risk Behavior Surveillance System (YRBSS), Pregnancy Risk Assessment and Monitoring System (PRAMS), and General Knowledge Survey questionnaires. Michigan and Minnesota added educational material about public health genomics into existing prevention programs like the Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN). Although many of these programs were focused on cancer genomics, they also included other chronic diseases like asthma, obesity, diabetes, and stroke. [St. Pierre J, Bach J, Duquette D, Oehlke K, Nystrom R, Silvey K, et al. Strategies, Actions, and Outcomes of Pilot State Programs in Public Health Genomics, 2003–2008. Prev Chronic Dis 2014;11:130267. DOI: http://dx.doi.org/10.5888/pcd11.130267]
#3: I think that at-risk families are the most important stakeholders to include in these types of programs. In order to significantly impact health outcomes, public health professionals must engage with the people who are actually affected by these diseases. By talking to families about their experiences with hereditary disorders, policy makers will be better able to gauge what interventions people want and what interventions they will respond to best. Healthcare providers, insurance companies, and politicians can impact policy. However, at-risk individuals and families should remain the most important stakeholders because they are the ones most burdened by these diseases.
1. Hereditary breast and ovarian cancer and Lynch disease are the most common types of mutations. In order to drop the incidence level what is needed is to engage families and let them know that there are things they can do to reduce these risks. Healthy people 2020 was first time cancer genomics was first included. Michigan incorporated genomics into their healthcare system and made a list of 7 steps that can be taken as a road map for other states. These steps are to set goals by looking at available data, build partnerships, conduct surveillance, provided info to policy makers, make education available to public, implement bi-directional reporting, and to conduct surveillance and assess results.
ReplyDelete2. Another state that has implemented a public health program for genomics is Oregon. They have the goal of improving access to genetic services and also find better ways to utilize public data. The program is called Oregon Strategic Plan for Genetic and Public Health. http://public.health.oregon.gov/DISEASESCONDITIONS/GENETICCONDITIONS/Pages/plan.aspx
3. I believe that the most important step is to making genetic programs work is to identify the individuals that could benefit from early intervention by partnering with existing programs in the field of genomics. That includes implementing the bi-directional reporting and to build partnerships. I could not just pick one but I believe these two are the most important. Michigan Cancer Genetic Alliance is a great example since it is composed of many individuals from different backgrounds. Though I believe this is the most important step it really cannot function well without the other ones. If other states wanted to implement this program they would have to include almost the entire hospital infrastructure and also in one form or another the governor of the state. Other states could also build partnerships to get funding to provide the services necessary.
1. The seven steps that are recommended for a successful Tier 1 Public Health program are:
ReplyDeletea. Set goals by assessing data and available resources
b. Build partnerships
c. Conduct surveillance
d. Provide info to policy makers
e. Make education available to public
f. Implement bi-directional reporting
g. Conduct surveillance and assess results
I think the most important step is to build partnerships because all health professionals should be helping physicians identify individuals and intervene early. By partnering up with others, they would be able to take advantage of existing programs, which makes genomics application easier and feasible. They would also be able to reach out more to the general public and provide the necessary resources.
2. There are probably many states that have a program like Michigan's but the CDC website said that two states that have similar programs are Utah and Oregon. Oregon as a state has a strategic plan for genomics and all of public health, while Utah has a genomics plan. http://public.health.oregon.gov/DISEASESCONDITIONS/GENETICCONDITIONS/Pages/plan.aspx
http://health.utah.gov/genomics/pages/projects/minigrants/utahgenomicsplan.pdf
Both list out goals and objectives of their plan and how they are to implement the plan in their states.
3. If a state wanted to implement this program, some stakeholders that would be involved might be the CDC, state health departments, hospitals with cancer registries, counselors, cancer patients themselves or people at high risk of cancer, and advocacy groups. It would definitely be important to have a big range of stakeholders to reach and communicate with as many people as possible to apply the plan across all areas and types of people.
You made an interesting point about involving advocacy groups in the process of creating a program like the one in Michigan. When I wrote my response, I only thought of medical professionals, genetic counselors, and researchers as those who could be stakeholders in a genetic cancer prevention program. But patient advocacy is extremely important when assessing risk. Patient advocates can help remind other members of the program that the patients are humans and should have distinguished rights. They are not just numbers on a piece of paper, or a name with a mutation next to it. It’s important to remember that the patient’s rights and dignity come first.
DeleteI agree that having partnerships as a base for the program is extremely important. Having some already stable infrastructure to rely on can help get the program off the ground and make it so the ideas actually come to life and are able to help the people in the community.
ReplyDeleteThere seven steps that are introduced in order to achieve a successful Tier 1 Public Health program. They are to (1) set goals by assessing data and available resources, (2) build partnerships, (3) conduct surveillance, (4) provide information to policy makers, (5) make education available to the public, (6) implement bi-directional reporting, and (7) assess the results of the conducted surveillance.
ReplyDeleteIn my opinion, the most important step is the second, which is to build up strong partnerships with state agencies to move the field forward. While genomic applications may seem new, many of the strategies that are already used in state chronic disease prevention programs are similar to genomics. State programs can integrate genomics into their already-existing infrastructure. Rather than trying to build up entirely new programs that work separately from state programs, it is more strategic to partner with existing resources to provide a greater public health impact.
Michigan is not the only state that has implemented this type of program. According to the Center for Disease Control (http://public.health.oregon.gov/DISEASESCONDITIONS/GENETICCONDITIONS/Pages/plan.aspx), Oregon has also started a similar program called the Oregon Public Health Genetics Program Strategic Plan. It involves improving access to and quality of genetic services, collecting and utilizing population level data, educating public health providers, developing partnerships with state health professional organizations, and educating the public about genomics and their health.
If a state wants to implement a program that is similar to Michigan’s or Oregons, it would need to get involved with certain stakeholders such as state health departments, the CDC, hospitals with cancer registries, public health advocacy groups, and the general public. The state would have to reach different levels of the community, from the state government to hospitals to individuals at home. It would also be effective to target parents and children to implement a solid and consistent systematic way of screening infants or children. This could help the state reach all communities, races, and areas of the state.
Stephanie, I find your take on the most important step for a successful Tier 1 Public Health program being the second step (build partnerships) both interesting and efficient. Although I stated that making education available to the public is the most important, I was debating between the two steps, but I personally appreciate the spin that you have placed with the second step. By almost "piggy-backing" on already-existing infrastructures, this is a great example of using resources that are already being made available to the public. Although it is inevitable that some new sectors be made for this growing field, even taking the backbone of other Tier 1 Public Health programs and implementing them would lessen the load.
Delete1. The seven steps recommended for creating a successful Tier 1 Public Health program are: set goals by assessing data and available resources, build partnerships, conduct surveillance, provide info to policy makers, make education available to the public, implement bi-directional reporting, and conduct surveillance and assess results. I believe that making education available to the public and providing policy makers with information are the two most important steps that go hand-in-hand. Education is always crucial because it builds awareness and you need awareness and understanding in order to make a change. In many instances regarding public health, backlash comes from ignorance and a lack of understanding, so it's important that people are properly educated on the issues at hand. Additionally the policy makers need to be aware of the problem/situation and also have all the facts so that they can create and implement suitable and effective policies, rather than waste time and money coming up with ones that are inadequate.
ReplyDelete2. In addition to Michigan, Minnesota, Oregon, and Utah are three more states that have explored the integration of genomics and chronic disease programs, regarding the identification and prevention of such diseases. Conditions include asthma, cancer, cardiovascular disease, and diabetes.
St. Pierre J, Bach J, Duquette D, Oehlke K, Nystrom R, Silvey K, et al. Strategies, Actions, and Outcomes of Pilot State Programs in Public Health Genomics, 2003–2008. Preventing Chronic Disease 2014;11:130267. Retrieved February 10, 2015 from http://www.cdc.gov/pcd/issues/2014/13_0267.htm.
3. If a state wanted to implement this program, I would suggest that all health care facilities be involved such as hospitals/hospitals with cancer registries, community health centers, advocacy groups, oncologists, and other healthcare providers. It's also important that policy makers be involved as well, as they are the ones creating and putting into action the policies that will help make a difference.
Hi Emily,
DeleteI agree that policy makers will play a big role in assuring that people's genetic information is not being used for the wrong purposes. I also think that policy will be critical for minimizing any possible discrimination that may accompany implementing these genetic screenings.
Chloe,
ReplyDeleteI completely agree with you when you write that building partnerships is one of the most important steps in creating a successful tier 1 public health program. I think that while it is important that relationships are built with the government public health and advocacy groups, as well as health professionals, it is also vital that a relationship is built between the state and the general public. This means individual parents, workers, children, infants, etc. That way, as you said, people will better understand what genomics is all about and will be more likely to be screened earlier.
I completely agree with the everything you wrote and I find it interesting that you brought up funding because money is another crucial aspect of implementing any sort of program but I think it often gets overlooked until the money becomes the issue at hand. Hopefully that makes sense. I personally didn't take into account funding when I wrote my response, but it's necessary for research and other resources--it's also important to think about where that money will come from. It certainly takes precedence over education because you most likely need funding to train your educators and to actually educate. I'm glad you brought that up!
ReplyDeleteThe 7 steps are:
ReplyDelete-Set goals by assessing data available resources
-Build partnerships
-Conduct surveillance
-Provide info to policy makers
-Make education available to the public
-Implement bi directional reporting
-Conduct surveillance and assess results
I think the most important step is definitely making education about the program available to the public. What good is implementing any sort of program if people are not aware of its benefits, risks, and potential impact it can have one their lives? I think by not only educating people about genomics but also the specific conditions the program identifies will at least catalyze consideration in numerous individuals.
Other states that have began to implement cancer genetics are Ohio, Massachusetts, Texas:
Ohio Medical Genetics and Genomics Program: "Medical Genetics and Genomics Program." :: Internal Medicine Division of Human Genetics. N.p., n.d. Web. 08 Feb. 2015.
Texas Cancer Genetics and Genomics Program: "Cancer Genetics and Genomics Program | Texas Children's Cancer Center."Texas Children's Cancer and Hematology Centers. N.p., n.d. Web. 08 Feb. 2015.
Massachusetts Dana Farber Cancer Genetics and Prevention Program: http://www.dana-farber.org/Adult-Care/Treatment-and-Support/Treatment-Centers-and-Clinical-Services/Cancer-Genetics-and-Prevention-Program.aspx
Stakeholders to involve in process:
1. Patients: they are the individuals signing up to be tested
2. Physicians/Hospital: they might need to get more training in dealing with genetic information
3. Government: to help maintain the privacy of citizen’s genetic information
4. Insurance Company: involved in funding of the tests/screening
5. Academic Institutions: interested in promoting further research
I completely agree with you that education of the public is super important and that people will not use the program if they don't know about it. I also agree with you that insurance companies are important stakeholders. I didn't think about them before, but insurance companies have a ton of power in the medical field and I know there have been issues in the past with discrimination based on genetic testing so the insurance companies need to be involved in the process and they can't change their policies to discriminate against people who have genetic mutations.
Delete1) The seven steps that are recommended to create a successful tier 1 public health program are:
ReplyDelete1- Set goals by accessing data and available resources
2- Build partnerships
3- Conduct surveillance
4- Provide information to policy makers
5- Make education available to the public
6- Implement bi-directional reporting
7- Conduct surveillance and assess results
The step that I think is most important is the second one because partnerships can help build a strong network and with promotion of the program. A lot of different people need to be involved to make the program work like clinicians, public health leaders, policy makers, patient advocacy workers, etc. By building partnerships you can take advantage of lots of other programs and information, as well as making it easier to reach a wider pool of people.
2) Michigan is not the only state with this kind of program. Numerous states across the U.S. have started implementing such programs, Missouri amongst them. The State Plan for Genetics Services in Missouri provides lots of newborn screenings, genetic centers, outreach centers, and makes genetic services more accessible. (http://health.mo.gov/living/families/genetics/pdf/geneticsstateplan.pdf )
3) If a state wanted to implement this program the stakeholders I would involve are: the CDC, genetic counselors, patient advocacy groups, clinicians, policy makers, public health professionals, and state health departments.
I think it's interesting that you choose building partnerships as the most important step in creating a Tier 1 Public Health program. I like the point you make that by building partnerships, you can take advantage of other programs and the information they have. I had not quite considered this as an important step in the process of implementing a program, but your points make it clear that it is a crucial part of the process.
DeleteI like your idea of also incorporating people who have undergone the screening. I think this will reassure new patients undergoing the screenings. and they can serve as an advocate not just in hospitals but on the national level of the importance of implementing these programs. however I still think that step 7, education is the most important step. because this way we can assure the public of the usefulness of this tool. once we have public support I think it will be easier for hospitals to partner up because people will want the screenings, thereby increasing supply from hospitals.
DeleteI agree with you that it is really important to educate the public. Many people are actually in the dark about programs that are available and miss out on opportunities. Additionally, sometimes people just don't have prior knowledge on things so health education is really important. I didn't even know that these programs existed until recently. Having resources that no one uses because they're not educated about them seems like a waste
ReplyDelete1. The seven steps that are recommended for creating a successful Tier 1 Public Health program are: set goals by assessing data and available resources, build partnerships, conduct surveillance, provide info to policy makers, make education available to public, implement bi-directional reporting, and conduct surveillance and assess results. In my opinion the most important step is to make education to the public available. People cannot get help if they have no clue that it is available. I think that the film we watched in class, In the Family is a good example that education is very important. Many of the women who had breast cancer wish that they had known about genetic testing before getting cancer since many of them said that they would have had the surgeries if they knew they had the gene. For example, you can choose to find out if you have the brca genes and then you can decide what to do from there. But if you don't even know genetic testing exists then you don't have control over your future even though you could.
ReplyDelete2. One state that has a similar program is Connecticut. The Katherine Ann King Rudolph Hereditary Cancer Genetics Program at The Hospital of Central Connecticut is a genetic counseling and testing program for adults at risk of specific hereditary cancers including breast cancer, ovarian cancer, colon cancer, and endometrial cancer.
Genetic counseling and testing. Retrieved February 11, 2015, from http://thocc.org/services/cancer/genetics.aspx
3.Important stakeholders include physicians, hospitals, oncologists, nurses, genetic counselors, epidemiologists, state public health department, advocates, the residents of the state, and policy makers. In order for a state to create a similar program, they need all these stakeholders to be in sync with each other and communicate to create a good program. The medical professionals have to explain how genetic testing is important and convince the government and policy makers that this program is beneficial to the people and how this will help the overall health of the public. Once the program is implemented, advocate groups and educators are needed to educate the public on genetic testing and what it is and who it can benefit.
I definitely agree with you that educating the public is the most important step because if no one knows about these programs, then all the effort will go to waste. Additionally, it will not be a sustainable program and continue on without any participation from the public. But something to think about would be how to educate people who do not frequently go to doctors or know how important family history truly is.. I think another stakeholder to take into account are lawyers as well as who may have to deal with lawsuits regarding genetic discrimination. Overall, I think that you made a good point about bringing up advocacy groups because I initially didn't realize they had such a huge role in this, but they are vital to spreading information to the public.
Delete1) The seven steps that are recommended for creating a successful Tier 1 Public Health program are as follows:
ReplyDelete1) Set goals by assessing data and available resources
2) Build partnerships
3) Conduct surveillance
4) Provide information to policy makers
5) Make education available to the public
6) Implement bi-directional reporting
7) Conduct surveillance and assess results
I think the most important step is step 3, conducting surveillance. Through surveillance, data is collected and analyzed which allows for more accurate use by programs to control and prevent various diseases. Additionally, through data surveillance, programs can work to understand the burden of the disease in their state. By understanding the burden of disease, the programs can be tailored to monitor and prevent them.
(2) In addition to Michigan, the CDC has awarded agreements to four other states including Minnesota, Oregon and Utah (1). They are the Utah Chronic Disease Genomics Program and the Oregon Cancer Genomics Surveillance Program (2&3).
1) http://www.cdc.gov/genomics/translation/states/
2) http://health.utah.gov/genomics/
3)https://public.health.oregon.gov/DiseasesConditions/GeneticConditions/Pages/genomics_grant.aspx
(3) The stakeholders needed in order to implement this program include physicians/specialists, state agencies, public health departments, as well as hospitals and the CDC. In addition, involving community centers would be an ideal way to spread knowledge of the program so that more individuals could participate in it if they wanted. These are all stakeholders that should be involved in order to make sure the program runs smoothly and effectively so individuals can use it properly.
I think you're absolutely right about the involvement of community centers. In theory, it seems like a great and efficient way to spread information on not just the possibility of genetic testing but also on what genetic testing how it can help them live longer and healthier lives. Perhaps by reaching out to whole communities from an establishment they trust (as opposed to it being mandated by insurance companies for example), there is a much better chance that a larger number of individuals would be willing to participate in these genetic screenings.
DeleteI too believe that the first step is the most crucial in creating a successful Tier 1 Public Program. Goals must be set in order to be effective and one must also assess the information that is currently available in order to do so. I too also agree with that the stakeholders involved should be people who have a background related to genomics, epidemiology and the healthcare system.
ReplyDelete1. The steps necessary to create a successful Tier1 Public Health Program are to: (1) set goals by assessing data and available resources, (2) build partnerships, (3) conduct surveillance, (4) provide information to policy makers, (5) make education available to the public, (6) implement bi-directional reporting, and (7) conduct surveillance and assess results. I personally think the 5th step is one of the most important ones, because I believe the fear of getting tested stems from the lack of information on what genetic tests do and how genetic counselors can use the results to improve their patients' lives. It's also important to make them understand that these tests are meant to help them live longer healthier lives, not just put them at unnecessary risk for discrimination.
ReplyDelete2. There are several programs working in collaboration with the Michigan Department of Community Health, including but not limited to the Oregon Department of Health and Georgia Department of Health. These programs work together to improve primary care providers' ability to identify, evaluate and manage patients at risk of the hereditary Breast and Ovarian Cancer gene, as well as improve access to the tests necessary for their detection. One of the main goals is to help increase awareness on genetic testing in order to identify more individuals at risk who would benefit from early screening and risk-reducing strategies so as to avoid preventable deaths.
3. I think that the participation of certain stakeholders is most important for the success of this type of program. That includes the participation of other state health departments to build said "partnerships" in step (2) and cancer registries from the majority of, if not all, health care facilities. Of course, policy makers would have to be involved as well for changes to be carried through and not just planned.
I really agree with your choice of education as the most important step, which I also selected, but I think your point about the fear that comes with it is very important. Many people do not understand genetic testing, and without an understanding, the results can become intimidating, or can even push a person away from getting the test in the first place. By seeing this fear and using education to counteract it would greatly help public health, so I completely agree with your point!
Delete
ReplyDelete1) The seven steps that are recommended are:
1. Set Goals by Assessing Data and Available Resources
2. Build Partnerships
3. Conduct Surveillance
4. Provide Info to Policymakers
5. Make Education Available to the Public
6. Implement Bi-directional Reporting
7. Conduct Surveillance and Assess Results
I believe that the most important step is to make education available to the public. This is because even if policymakers know about a program and doctors are familiar with it, a patient will not request the tests or be aware of their options without first being introduced to it. Also, sometimes even though doctors know about policies, or even diseases, the possibility that a disease could be hereditary or that there is new treatment may not cross there mind. Sometimes it is up to the patient to suggest treatments or programs in order to improve their health.
2) Other states that have implemented a similar program are Oregon and Connecticut, which have partnered with Michigan to act as “pioneer states” for creating programs about cancer genomics. Oregon’s program is called the Oregon Genetics Program, which worked from 2008-2011, and worked to provide BRCA testing and surveillance to more individuals. The Connecticut program joined with Healthy People 2020 to implement bidirectional reporting to track diagnoses of breast cancer that are related to the BRCA gene. called http://www.cdc.gov/genomics/implementation/toolkit/HBOC_2.htm
3) I believe that a new program would have to involve stakeholders who are doctors, geneticists, counselors, oncologists, epidemiologists, hospitals, state public health department members, and advocates for the particular genetic disease. You would need a mix of people who have personal experience with the disease as well as those who work for the cause but are not directly affected by it in order to keep the program inclusive but realistic.
I agree that the education step is the most important step as well. If people are unaware of the programs available to them, they have no reason to seek it out. It is important that policy makers and doctors make these programs available and also make the community aware of them. You make a great point that the doctors and policy makers having knowledge, but not sharing it, does not do anything effective.
DeleteI think that your suggestion that the first step is the most important is interesting, because with genetic diseases many people would assume that it would affect a population that exists throughout the country. I did not think that some areas would not be affected enough to warrant the program because, in my opinion if there is anyone affected they should have the possibility to be a part of any sort of treatment or awareness. But i do agree that this does not always make monetary sense, as difficult as that is.
ReplyDeleteThe 7 Recommended Steps are:
ReplyDelete1 Set Goals by assessing Data and Available Resources
2 Build Partnerships
3 Conduct Surveillance
4 Provide info to Policymakers
5 Make Education Available to the Public
6 Implement Bi-directional Reporting
7 Conduct Surveillance and Assess Results
Making education available to the public is the most important set. The masses need to be made aware of the programs if not there will be no patients. patients might be scared to come because they do not know that these tests are not there to put them at risk or discrimination. The tests are there to help them understand themselves better and to reduce morbidity and mortality. Some other states that have implemented something similar is Idaho's heart disease and stroke state plan. This plan screens for heart disease and stroke risk factors. http://www.cdc.gov/genomics/implementation/toolkit/state_local.htm
The stake holders that I would involve would be other hospitals particularly with doctors within the hospital so they can properly advise their patients about the program. Insurance companies can also be advised on the issue so that they do not alienate people just because they may be a carrier for the disease. There should be a nationwide ban against this.
Ezinne,
DeleteYou make a good point about education, it is definitely important that people become aware and are not afraid of genetic testing services, because even if lots of surveillance is done if no one gets tested it is all for nothing. Also I had never heard of Idaho's heart disease and stroke plan, it looks like it does a good job of preventive screening. Having a plan for heart disease and stroke prevention like they do is a great first step towards decreasing preventable deaths.
(1)The seven steps that are recommended for creating a successful Tier 1 Public Health program are: set goals by assessing data and available resources, build partnerships, conduct surveillance, provide info to policy makers, make education available to the public, implement bi-directional reporting, and conduct surveillance and assess results. I believe that out of these seven steps, education is the most important. If people are not educated on the resources out there or the potential risks then the resources are irrelevant. People need to be made aware of how they can improve their health and they need to know why these resources are relevant to them.
ReplyDelete(2) According to the CDC (http://www.cdc.gov/genomics/translation/states/) three other states, besides Michigan, that have implemented state genomics programs are Minnesota, Oregon and Utah. The CDC has awarded them “cooperative agreements” for integrating genomic knowledge and tools into state programs. These programs have promoted genomics screenings and educated the public on how to approach the process.
(3)The stakeholders I would involve in the process are local hospitals, policy makers and definitely the CDC. The video mentioned that the CDC is a great resource for funding programs and providing resources to address health issues in the community. The policy makers can help promote education on the process and can aid in leading people towards screening and educating themselves.
The seven steps that are recommended for creating a successful Tier 1 Public Health program are: set goals by assessing data and available resources, build partnerships, conduct surveillance, provide information to policy makers, make education available to the public, implement bi-directional reporting, and conduct surveillance and assess results. Although all of these steps are important, I consider the step of making education available to the public the most important. This is because there needs to be education with a subject like genomics, because it is harder for the common person to understand. By allowing the public to understand, it will allow them to evaluate if they could possibly be at risk, and the possible steps they may need to take. This is essential for awareness, but the education needs to come first so the public can understand the implications of the project. Without this step, the project is fruitless.
ReplyDeleteAccording to the CDC, other than in Michigan, there are programs in Connecticut, Oregon, and Utah (http://www.cdc.gov/cancer/breast/what_cdc_is_doing/genomics_foa.htm). These programs are very similar to the one in Michigan, with the same focus on hereditary breast and ovarian cancer, and Lynch syndrome. These all include educating the public on hereditary cancer, but also physicians. Although they are slightly different programs, they all work to educate and increase surveillance of these cancers. Connecticut is taking a slightly different strategy, by putting genetic counselors in primary care practices, while still focusing on education. Utah and Oregon both are focusing on education, with Utah implementing education services online for not only the public, but also for providers.
Some stakeholders to involve would be physicians and other healthcare providers, cancer agencies, activists, and public health agencies. They are all individually important, because they all can contribute something different.
Kerrin, I completely agree with your belief that education is the most important step. Many people are wary of getting genetic testing because they are unaware of how easy and noninvasive the testing actually is and how beneficial it can be. I agree that if the public does not support this testing, then it will be impossible for the project as a whole to succeed.
DeleteI also agree with the idea that education is the most important step. It is important to spread awareness about how your genes are related to you help, and the benefits that these programs can provide. I also agree that healthcare providers should be stakeholders in these types of programs, as they can also educate their patients about the program, along with those who are already involved with it.
DeleteThe seven steps that are recommended for creating a Tier 1 Public Health program are:
ReplyDelete1 Set Goals by assessing Data and Available Resources
2 Build Partnerships
3 Conduct Surveillance
4 Provide info to Policymakers
5 Make Education Available to the Public
6 Implement Bi-directional Reporting
7 Conduct Surveillance and Assess Results
I think that the second step of building partnerships is the most important because it can be very difficult for any program to be successful without outside support
After some research, I found that Wisconsin, Georgia and Oregon had public health programs that were similar to the one in Michigan.
https://www.dhs.wisconsin.gov/mch/genetics.htm
http://www.georgiacore.org/breast-cancer-genomic-health.aspx
https://public.health.oregon.gov/DiseasesConditions/ChronicDisease/Cancer/Documents/cancer_plan_v32.pdf
If a state wanted to implement a program similar to this they should involve hospitals and other organizations that are already working with cancer research and prevention. These stakeholders would be a great resource for the most recent information in cancer research.
Eva,
DeleteYou make a good point to involve other organizations that are already working on research. This goes back to building partnerships. Their expertise in the subject would be a great source of leverage to get started on a successful program. I think you make a good point about programs not being able to be successful without outside support but I wish you could have expanded on that and maybe given an example or said why that support is necessary or helpful.
I also found it interesting that you chose Building Partnerships as the most important step. After watching the video, I understood its importance but did not fully think through its necessity to the plan. You are right though - rarely can a program be successful without support from an already established institution.
DeleteI also found Oregon’s cancer genomics program. I did not see Georgia’s and Wisconsin’s in my research. Good finds – thanks for sharing!
I agree that it would be a great idea to involve companies that are already working with cancer screening and prevention so that once people have undergone genetic testing and find they are at a higher risk, they already have a resource for prevention. Also Idaho’s Tier 1 program sounds very interesting, especially with the focus on heart disease.
ReplyDelete(1) The seven steps are:
ReplyDelete1. Set Goals by Assessing Data and Available Resources
2. Build Partnerships
3. Conduct Surveillance
4. Provide Info to Policymakers
5. Make Education Available to the Public
6. Implement Bi-directional Reporting
7. Conduct Surveillance and Assess Results
In my opinion, conducting surveillance is the most important because there is no proper measurement of goal attainment or failure without this important aspect. There would be no way to properly measure the impact of an intervention without this vital step. This plays a part in surveillance in both steps 3 and 7.
(2) There are 3 other states that piloted the very idea that Michigan had. These states are: Minnesota, Oregon and Utah. The goal of the programs they implemented is:
“to integrate genomics knowledge (e.g., genetic risk factors) and tools (e.g., family history assessments) into state chronic disease prevention programs and core public health functions. These genomics programs have focused on building infrastructure and partnerships, training the public health workforce, educating the general public, using surveillance surveys to assess genomics integration, and promoting genomics screening tools.” [http://www.cdc.gov/genomics/translation/states/] Basically, the main aim of these programs is to st up a good foundation for the integration of genomics in public health.
(3) Important stakeholders to involve would be the state public health department to handle administrative stuff, public schools to begin to build awareness and normalcy around this issue at a younger age and of course the Doctors themselves to begin making this an important component of their care.
Corinne,
DeleteI found it really interesting that you decided to include public schools as stakeholders in the implementation of a genomics program! It was honestly something I didn’t even think of, and I think that educating younger generations and promoting normalcy is a wonderful way to help spread the benefits of genetic testing to previously unaware audiences. Would you build genomic health into the regular health classes at public schools, or make it a separate class? What about a Peer Health Exchange-style system, where older students come in and teach younger students about public health topics, genomics included? This system would help with the normalization you promote, as students would hear the information from other older students instead of teachers ( with whom there is often a greater divide). The only problem I can foresee with involving the public school sector is inviting more bureaucratic entanglements into the health sector---an area that already has so many of them. However, if a streamlined, clear plan is put in place, then I think your idea is great!
The seven steps recommended by the Michigan Department of Community Health are as follows; set goals by assessing data and available resources, build partnerships, conduct surveillance, provide info to policy makers, make education available to the public, implement bi-directional reporting, and conduct surveillance and assess the results. While I think all steps are important and directly connected to one another, making genomic testing education available to the public seems the most paramount to me. From watching the video, I gathered that educating the public on the benefits of genetic testing has been challenging. This is largely because of the stigma and fear surrounding hereditary diseases; people are unwilling or scared to have their genome mapped. Also, there is an element of the unknown – some people simply have never heard of genetic testing because it is a relatively new concept to ordinary people. Genomic education is so important, though, because having knowledge of your genetic code can ultimately prolong or save your life.
ReplyDeleteAccording to the Centers for Disease Control and Prevention, four other states besides Michigan have received funds from the Office of Public Health Genomics to explore the benefits of genomic information; Utah, Minnesota, Oregon, and Utah. These states used similar 7 step programs, including the very important creation of educational curricula and materials. While all states had their differences, all were able to improve their budding heredity cancer prevention programs. Many other states are in the process of implementing such programs, and inevitably, they must think about what stakeholders to involve. If I was starting a 7 step program of my own, I would want to involve as many stakeholders as possible. Such as: physicians, insurance companies, cancer registries, school systems, hospitals, and state leaders in healthcare. Having a fluid working relationship between all of these stakeholders would be of utmost importance in order to make genetic testing both affordable and easily accessible.
*References: St. Pierre J, Bach J, Duquette D, Oehlke K, Nystrom R, Silvey K, et al. Strategies, Actions, and Outcomes of Pilot State Programs in Public Health Genomics, 2003–2008. Prev Chronic Dis
http://www.cdc.gov/pcd/issues/2014/13_0267.htm
When I read your point about education being the most important step I was interested because I originally felt a different way. I guess my biggest question to you would be what level of education. Would you be for early education in public high schools about the issue to equip them with the knowledge of the subject before they are adults or would you be for adult education of the subject of genetic testing because they are more relevant in age to the need of genetic testing. I'd be interested in peoples thoughts/comments.
ReplyDeleteHi Stephanie,
ReplyDeleteI think you bring up a really good point about the importance of establishing partnerships while creating a tier 1 public health program. Without many different agencies and parties working in concert with one another, especially considering all of those involved in genetic testing, it will be nearly impossible to implement such a massive public health effort in an efficient way. By creating a fluid relationship between all of these agencies, marketing genomic testing to the masses can be possible.
The seven steps mentioned in the video are:
ReplyDeleteSet goals by assessing data and available resources 2. Build partnerships 3 Conduct surveillance 4. Provide info to policy makers 5.Make education available to public 6. Implement bidirectional reporting and 7.Conduct surveillance and assess results.
I think the most important step is undoubtedly number 5: Make education available to the public. The best programs, tests, and information may exist, but they will make no discernible difference if people are not educated about the options and the resources available to them. Misconceptions and fear can be extremely detrimental to public health (See: the current resurgence of measles), so ensuring people are properly informed and able to take advantage of healthcare resources is nothing short of vital. It is ultimately the public that we are concerned with, so the uptake of health information and access to resources is the single most important factor in bolstering public health.
The Utah Genomics Plan (http://health.utah.gov/genomics/) and the Oregon Public Health Genetics Program Strategic Plan (http://public.health.oregon.gov/DISEASESCONDITIONS/GENETICCONDITIONS/Pages/plan.aspx) have followed Michigan’s lead.
If a state wanted to implement a Genomics program, the state’s Department of Public Health should be the driving force behind it. Hopefully, this would allow the program to be tailored to the health needs of the state. On a wider scale, the effort should also involve the CDC and NIH as guiding institutions to help with research, planning and logistical challenges. State legislators should also be involved peripherally to ensure that adequate funding and resources can be diverted to the program, and also so that those who decide to have genetic tests will have their legal rights protected.
I agree that educating the public is one of the most important steps involved in this program. The video mentioned how many people are often afraid to see genetic counselors, which I would attribute to a lack of knowledge/education. If the general public is informed of the benefits of cancer genomics as a whole as well as understanding that genetic counselors are a fantastic resource, then this information will certainly lead to additional lives being saved in the future.
DeleteSarah,
DeleteI too feel that educating the community is very important because if the people are not educated on genomics or resources, the program will not prosper to its fullest capability. There is no sense in creating a program that won't be used and the way to gain recognition is to promote knowledge and understanding. I also believe that building partnerships may be a key goal because that will ensure that an abundance of resources will be available for the public. I also agree that it is vital to involve the CDC and other researchers when implementing a program like this in a state. I believe programs on genomics and public health deserve adequate funding as they can reduce the number of lives lost by diseases which could have been detected/treated earlier.
Shannon,
ReplyDeleteYou make a good point about the most important step being building partnerships. When I looked at it I just looked at the education portion, but I can see how this would be equally as important when it comes to creating a successful tier 1 public health program. In building partnerships you would be able to reach a larger group of people and thus furthering the public health program. I also agree with the initial step when building a program being involving the physicians. They are in direct contact with patients who would be potentially receiving these tests and could better advocate for them than others.
(1) The seven recommended steps for creating a successful Tier 1 public health program stated in the video are: setting goals by assessing the data and resources available, build partnerships, conduct surveillance, provide info to policy makers, make education available to public, implement bi-directional reporting and conduct surveillance and assess results. From these steps, I think the most important is building partnerships. Doing this brings education, awareness and resources to the public. A great part of the Michigan program’s success was a result of their strong and resourceful relationships that reached out to people in the community, health professionals and the government.
ReplyDelete(2) Along with Michigan, Minnesota, Oregon, and Utah are all states that have implemented similar programs. They have all utilized genomics, including family health history, in chronic disease prevention programs. These programs mainly focus on prevention of asthma, cancer, cardiovascular disease, diabetes, and other chronic conditions.
This information was found on the CDC website: http://www.cdc.gov/pcd/issues/2014/13_0267.htm
(3) I think it is essential to include a broad range of fields and partners. This goes back to the building partners step. I would involve government and private organizations, NGOs, public health professionals, medical technology companies, hospitals, and doctors (particularly oncologists and genetic specialists).
1) The seven steps that are recommended for creating a successful Tier 1 public health program are: set goals by assessing data and available resources, build partnerships, conduct surveillance, provide information to policy makers, make education available to the public, implement bi-directional reporting, and conduct surveillance and assess results. I believe that the most important of these steps is properly educating the public regarding the importance of genetic testing. The public must understand the numerous benefits of genetic testing, which include its low cost, effectiveness, and efficiency. It is also important to dispel any negative stigma and fear associated with genetic testing. Any other efforts would be ineffective unless the public is aware of genetic testing as a viable and effective option.
ReplyDelete2) A similar program has also been implemented in Oregon by Oregon Public Health (State Genetics Strategic Plan), which aims to reduce morbidity and mortality from genetic conditions, educate the public and health care providers, promote a supportive policy environment for genomics and health, and increase Oregon Public Health genomics capacity. https://public.health.oregon.gov/DiseasesConditions/GeneticConditions/Pages/plan.aspx
3) If a state wanted to implement a similar program, I would suggesting involving groups that are familiar with cancer and genomics. This could include the CDC, oncologists, genetic counselors, epidemiologists, and hospitals. I believe personal experience and expertise in the related field is essential in order to maximize efficiency and effectiveness of the program.
Jonathan, I think you brought up a good point in mentioning that educating the public will help dispel fear. As the genetic counselor said in the video, many people misinterpret the job of a genetic counselor. In order to get the most widespread use out of genetic testing to improve health, it is important for fear to be addressed. Addressing fear will also aid in genetic testing becoming a more "normalized" thing.
DeleteKelvin,
ReplyDeleteI agree with you that the most important step is making education available to the public. The public must understand the benefits of genetic testing before it could become a widely popular method. I think education is also important in that it could dispel any fear and uncertainty people feel toward genetic testing. The public fears what they do not understand, and the only way to popularize genetic testing is to teach people both the effectiveness and painlessness of the method.
To answer Corrine, I believe that education would be most effective if executed in multiple levels. Educating the youth is important because their perceptions are still relatively malleable,but it is also important to educate the current decision makers in order to popularize genetic testing as quickly as possible.
The seven steps that are recommended in order to create a successful Tier 1 Public Health program are to set goals by assessing data and available resources, build partnerships, conduct surveillance, provide information to policy makers, make education available to the public, implement bi-directional reporting, and conduct surveillance and assess results. I believe that the most important step is to make education available to the public. Providing education to the public will help raise awareness about why the program is important and necessary. It can also help the public understand the benefits these programs, along with the potential risks, and help them understand how their genes relate to their health.
ReplyDeleteAccording to the CDC, three other states have implemented this type of program. These states are Minnesota, Oregon, and Utah. These programs spread awareness of genetic risk factors and provide genetic screening. Source: http://www.cdc.gov/pcd/issues/2014/13_0267.htm
If other states wanted to implement a program like this, it would need to involve multiple different stakeholders. The most important would be to get the state and local governments involved, and the local health departments. These different agencies should work together to create ways to spread awareness about the program, and show the public why it is important.
I agree that making education available to the public is an important step. However, I think that building partnerships are just as important because one program will not be able to spread the implementation plan to as many people with just their network and resources. Partnerships allow one program to be implemented in similar forms in a wider range and impact more people.
Delete7 steps:
ReplyDelete1. Set goals by assessing data and available resources
2. Build partnerships
3. Conduct surveillance
4. Provide info to policy makers
5. Make education available to public
6. Implement bi-directional reporting
7. Conduct surveillance and asses results
Of these steps, I believe public education is the most important. Before this class, I was aware of cancer genomics but did not fully understand how genetic testing works. Many people decide not to seek out genetic testing not because they do not want it, but because they are not aware that it could add years onto their life. One woman in the video explained how people shy away from the term “genetic counselor” because it sounds scary. If they knew how they could benefit from genetic counseling, they would be more likely to use the service. The work that Genetic Alliance has done in the field of cancer genomics is fruitless if the public is not even aware of it.
Connecticut and Oregon are two other states that have implemented a Tier 1 Public Health Genomics plan. Both Connecticut and Oregon, in addition to Michigan, are considered pioneer states in this new field. Connecticut has issued a Cancer Genomic Best Practices resource. Oregon has implemented a Cancer Genomics Surveillance Plan.
http://www.ct.gov/dph/lib/dph/genomics/hp2020_actionproj_ca_genomics_best_practices.pdf
https://public.health.oregon.gov/DiseasesConditions/GeneticConditions/Pages/genomics_grant.aspx
If I were to implement this program in a new state, I would involve the CDC because they play a vital role in current programs. The CDC has the most information about what works and what does not work in a cancer genomics public health plan. I would also involve physicians as they are the primary means of communication to the patient. In addition to these most important stakeholders, I would involve hospitals, research institutions and Universities, and clinics.
1) The seven steps that are recommended for creating a successful Tier 1 Public Health program are:
ReplyDelete1. Set goals by assessing data and available resources
2. Build partnerships
3. Conduct surveillance
4. Provide info to policy makers
5. Make education available to the public
6. Implement bi-directional reporting
7. Conduct surveillance and assess results
- I think that building partnerships is the most important step because one program does not have the resources and reach to spread information and implement their program wide enough to make a big enough impact. By networking with other programs that have similar goals in different areas, the range of people and places where the program can be implemented will be great enough to spread word about the program and make a difference.
(2) Aside from Michigan, the CDC awarded cooperative agreements to three other state health departements: Minnesota, Oregon, and Utah. Their goal is to “integrate genomics knowledge and tools into state chronic disease prevention programs and core public health functions.” (http://www.cdc.gov/genomics/translation/states/index.htm)
(3) If a state wanted to implement this program, the stakeholders I would involve in the process would be policy makers and the community. Policy makers are important to make the program a statewide program, and to ensure it would be implemented throughout the state. The community is just as important so that the program meets their demands and is something that the public would be willing to take on. The community is the most important stakeholder to include because they are the ones who the program makes the most impact on.
If I had to choose the second most important step it would have been building relationships. My first step was educating the public. I completely agree with networking with other programs that have similar goals. By sharing resources and data between projects is how ideas are spread and how new ideas and solutions are formed. Also, in my opinion the community and the policy makers are the most important stakeholders to have. You are implementing this study for the community, so you want to make sure that this is something community is interested in enough to participate.
Delete1) The seven steps that are recommended are:
ReplyDelete1. Set goals by assessing data and available resources
2. Build partnerships
3. Conduct surveillance
4. Provide information to policy makers
5. Make education available to the public
6. Implement bi-directional reporting
7. Conduct surveillance and assess results
Of the seven steps recommended, I think making education available to the public is the most important. If the public is educated they can perhaps figure out how to make the public health program more efficient and adaptable to their needs. They would be able to view things in a more educated manner and assess matters accordingly.
2) According to the CDC, three other states with similar programs as Michigan are Utah, Minnesota, and Oregon. They all have similar steps in introducing the program and they all focus on genetic testing to help prevent chronic illnesses.
http://www.cdc.gov/pcd/issues/2014/13_0267.htm
3) The stakeholders I would choose are the community and policy makers. The community are the people we are trying to help, so we need to make sure that they are just as interested in this study as we are. The policy makers are the people that can help push things along as far as the research implantation goes within the state.
Rather than just involving the community, I think it would be best to involve specifically community leaders. Not only do they understand the mindset and need of the community, they also have the power to lead the community. If the program reach out to community leaders and let them understand the benefit of the program, I think it would be a lot easier to raise awareness and educate the people about the program than if the program sends in outside advocates.
DeleteI also agree that the community will be important stakeholders. Since it is important that they are interested by the program, it is best if they are also stakeholders. This way they are actively following the program and ensuring that it gets implemented. I believe that the community is a large factor when it comes to feasibility of implementing programs.
Delete(1) There are seven steps to creating a successful public health program and they are set goals by assessing data and available resources, build partnerships, conduct surveillance, provide info to policy makers, make education available to the public, implement bi-directional reporting, and conduct surveillance and assess results. Although all the steps are important in ensuring a successful program, I believe that the most important step is build partnerships. It is hard to run a public health program without external support and the best way to ensure support is to establish a partnership with other groups and more importantly the government. Public health programs are usually catered to a large population and it is difficult for a small non-profit organization to extend their reach to the whole population without some help and support. Physician groups and local community centers can help spread awareness to the local people and help educate them about what the program does. Also, the more partnership that is built, the more effective the program will be.
ReplyDelete(2) The state of Washington also has a similar program called the Seattle Cancer Care Alliance. The Seattle Cancer Care Alliance offers genetic testing and counseling as part of their prevention and early detection program. They specialize in cancer research and treatment and also seek to help those at risk through genetic testing and counseling.
http://www.seattlecca.org/scca-nw-hospital.cfm
(3) I would most definitely involve state programs like the cancer registries, hospitals, and local clinics. By looking at how cancer has affected the people in this state, I can create a partnership in hospitals and clinics and offer genetic counselors to places that don’t have one in place. Working with the hospitals and clinics are a great way to spread awareness for genetic testing quick and also to begin taking advantage of this technology.
Renee,
DeleteI wanted to reply on your response because you chose a different step than I did for the first question. I chose that the most important step was making education available to the public. After reading your response, I can understand why building partnerships is just as important as any of the other steps involved in the process. Support is something that is essential to creating a successful public health program, especially since, like you stated earlier, most public health programs are implemented into larger populations, and without the help from other groups that support the program's mission, it would be hard to build a strong and successful program that reaches out the entire public. By building partnerships with physicians and local health groups, the public health program has a better chance of being known to individuals. I do not believe that there is a wrong or right answer to deciding which step is the most important, because in the end, each step is just as equally important as the next in creating a cohesive and successful public health program.
I think your thoughts on having the group of shareholders are very good. I agree that they also need to have an active role in achieving good health within a community.
ReplyDeleteJennifer,
ReplyDeleteI agree that building partnerships is the most important step in program implementation for similar reasons. Each area of expertise, like you said, has varying degrees of knowledge and beliefs that can all come together to better improve cancer genomics. Any one individual or area of expertise will not be sufficient enough to make a strong and long-lasting state program. When thinking about major accomplishments in science and medicine, such as the Human Genome Project, most have been continuous collaborative efforts with a team of individuals. Ultimately, stakeholders involved in a program implementation all have similar goals in mind, which is to better improve the lives of state residents and help prevent chronic disease. Although many different types of people would be involved, I agree that building partnerships is the best way to form a foundation for a successful program.
(1) The seven steps recommended for creating a successful Tier 1 Public health program are:
ReplyDelete1. Set goals by assessing data and resources available
2. Build partnerships
3. Conduct surveillance
4. Provide info to policy makers
5. Make education available to the public
6. Implement bi-directional reporting
7. Conduct surveillance and assess results
I believe that of these steps, the most important is educating the public. It was stated in the video that many people will choose not to see a genetic counselor even if they have a family history that could indicate a mutation because they are too afraid to do so, and that the main reason for their fear is that they don’t really understand what it is that genetic counselors do. If people have the BRCA mutations or Lynch syndrome but do not get tested, they will be unable to take precautionary measures such as prophylactic surgery in order to prevent the cancers that are likely to occur as a result. Fear of a positive test result may prevent people from getting the test that they need in the first place, and they need to know that they have options in the event that they have the mutation to prevent the disease. Quelling fear is important of many aspects of public health, including prevention.
(2) I was able to find a few other states with similar programs as that of the successful one in Michigan. Oregon has the Oregon Genetics Program, which also emphasizes family health history and offers screening for genetic predispositions to breast and ovarian cancer (http://public.health.oregon.gov/DiseasesConditions/GeneticConditions/Pages/index.aspx). In Connecticut, the Department of Public Health has a Genomics Action Plan with several goals to better incorporate genomics into the public health system, which include educating the public, assuring genetic counseling for those who need it, and evaluating direct-to-consumer marketing. (http://www.ct.gov/dph/lib/dph/genomics/ct_genomics_actplan_2007_update.pdf). The ultimate objectives of this program seem to be very in depth and well thought-out.
(3) Stakeholders that should be involved in the implementation of these programs include the CDC, local health departments, genetic councilors, physicians, patient advocacy groups, community health centers, and genetic researchers.
1) The seven steps that are recommended for creating a successful Tier 1 Public Health Program are:
ReplyDelete1. Set goals by assessing data and available resources
2. Build partnerships
3. Conduct surveillance
4. Provide information to policy makers
5. Make education available to the public
6. Implement bi-directional reporting
7. Conduct surveillance and assess results
Though all steps are key points, I think the most important step is making education available to the public, giving them leverage to learn and seek more about their family history so that they are aware of their genetic makeup. It can be frightening-the unknown of whether you carry genetic risk factors, but it is even more frightening to not seek out those questions, answers and solutions. All of this research is being done and data is being found giving us the upper hand in combating against diseases, so why not use that education as tool of medical intervention. With that education available to the public, we have the ability to be screened, see if we carry any genes that may increase our risk for cancer, and if so seek treatment. I think public education is a great tool in making decisions and choices best suited for our lifestyle, building awareness within our community, and allowing for innovation and intervention to ensue.
2) According to the Center for Disease Control and Prevention, state health departments in Minnesota, Oregon and Utah (alongside with Michigan) have “integrated genomics into their infrastructure of state chronic disease prevention programs and core public health functions” to work towards improving the overall health of their community and prevention strategies against diseases.
(http://www.cdc.gov/genomics/translation/states/)
3) I think key stakeholders in implementing state health programs would be the CDC, clinicians, researchers, hospitals, and local health departments and cancer registrars. As noted in the video, for a program to be successful, strong partnerships have to be established within these stakeholders, as well as with existing programs and infrastructure. These stakeholders would be congruent with one another, working together, researching, getting this information out to policy makers and then bringing forth preventative methods and solutions to the community.
Cierra,
DeleteI believe you have complied a thorough and cohesive group of organizations to comprise of the stakeholders. You have chosen agencies from all over the health disciplinary that in turn will have the greatest impact on the health of those with a genetic disorder.
I do have some disagreement with your first response in regards to which principle is most important to focus on in a public health program. I feel that the public health program is reliant on partnerships of health organizations. If there lacked partnership of health agencies to assist those with genetic disorders, that educating the public about said disorder is irrelevant. If people cannot access organizations easily, and readily, what good will the information available have?
Hi Laura,
ReplyDeleteI like how you mentioned the limits of your program, especially pointing out funding issues and the fact that it is a program targeted towards young children. I think having a program with a target population is positive in the sense it gives you more structure and focus on that specific population, such as the children. For example, if I'm not mistaken, leukemia is the leading and most common type of cancer in children, so a specified program could yield more results in research, methods, implementations, and interventions focused on the children, instead of targeting all populations with a certain type of cancer in a state. I'm not saying I'm against state programs, as public health is focusing on the health of the public, yet it is interesting and cool when there are also programs focused on one aspect, such as a specific population.
-Cierra
1). The seven steps that are recommended for creating a successful Tier 1 Public Health program are as follows:
ReplyDelete1. Set goals by assessing data and available resources
2. Build partnerships
3. Conduct surveillance
4. Provide info to policy makers
5. Make education available to the public
6. Implement bi-directional reporting
7. Conduct surveillance and assess results
I feel that the most important step is number two, building partnerships. The video discusses the Michigan Cancer Genetics Alliance that is comprised of clinicians, researchers, patient advocacy groups, as well as many other individuals. By connecting these various groups of people, the Genetic Alliance is better equipped to network with other outside groups that are also proactive contributors to cancer genomics. These connections allow different people to feed off of each other’s ideas, in hopes of achieving the same goal, which is to ultimately save the lives of as many people as possible.
2) Along with a handful of other states, Texas Children’s Cancer Center has implemented a cancer genetics and genomics program. The mission of the program includes patient care, research and education. To be more specific, the mission states, “our goal is to to provide state-of-the-art evaluation of and management for children and their families with hereditary predisposition to cancer, to investigate genetic susceptibility to cancer and fundamental mechanisms of genomic instability, biologically and clinically-relevant genetic alterations driving childhood tumors, and the clinical implementation of genome-scale testing, and to train future clinicians and scientists at all educational stages in cancer genetics and genomics.” (Retrieved from: http://txch.org/cancer-center/cancer-genetics-and-genomics-program/)
3) If another state wanted to implement a cancer genomics program, they would need to recruit numerous stakeholders. Some of these stakeholders would include, hospitals, insurers, oncologists (including various specialists) public health departments, genetic counselors, as well as advocates and policy makers.
I like how you bring up that building partnerships is an essential component of creating a successful public health plan to combat cancer. Although each area is needed for the overall achievement, I did not previously consider building partnerships to be a large role. I do agree with you that it is very important to involve multiple aspects of the community so that connections and ideas are spread. I also think that if multiple areas are involved, funding could be shared amongst different public health areas so that a burden isn't placed on one group. Important knowledge can be lost without building these close partnerships since each group has their own specific task to focus on. There needs to be communication between the researchers, physicians, registries and educators so that each component is added to the overall goal of controlling and preventing cancer.
DeleteThe seven steps that are recommended for a successful tier one public health program are: set goals by assessing data and available resources, build partnerships, conduct surveillance, provide information to policy makers, make education available to the public, implement bi-directional reporting and conduct surveillance and assess results. Although each of these steps is essential in creating a prosperous program, making education available to the public is one particular step that is especially important. This step incorporates program educators to spread knowledge to both health care workers and the public as a whole. It was mentioned in the video that many individuals fear seeking out genetic counselors because they do not understand the importance of early testing and genetic sequencing. This lack of education has created an environment where individuals are being diagnosed with later stages of debilitating diseases as well as missing out on early secondary prevention techniques that could catch diseases in their earliest stages. The public may have preconceptions about genetic testing and only see it as a way to be discriminated against pertaining to employment and receiving insurance. Even when individuals choose to use genetic sequencing, they may not fully understand their results without a genetic counselor to explain the details and future health decisions they can make. It is equally important for policy educators to teach health care workers, so that genetic counselors are not the only professionals responsible for educating the public. Many health care workers do not look at genetic sequencing as a feasible option for a prevention technique since it is expensive and still relatively new. With the expansion of knowledge to primary care providers, this practice can be promoted and made available to the public, without giving them misconceptions and fear typically related to genetic sequencing.
ReplyDeleteMassachusetts has also implemented a similar program to combat both cancer and lynch syndrome. Officials have used the comprehensive cancer and prevention control plan to increase efforts in reducing the burden of cancer within this state. The plan is proposed to take place from 2012-2016 and include major areas pertaining to advocacy and community engagement, health equality, early detection and screening, treatment and research and evaluation. With the engagement of policy workers, researchers and health care officials, Massachusetts is creating an opportunity for high risk cancer individuals to have advanced prevention practices and treatment options.
Massachusetts Department of Public Health. (2013). Massuchesetts comprehensive cancer prevention and control plan. Retrieved from website: http://www.mass.gov/eohhs/docs/dph/cancer/cancer-state-plan-2012.pdf
If a state were to implement this program there are a few major stakeholders that would need to be involved. The first is policy makers and public health officials. Other individuals would include health care workers, researchers, genetic counselors, educators and cancer registrars.
part 2
ReplyDelete3.
States wanting to implement a genetics Strategic Plan should collaborate first with health care centers, state education outreach programs, registries for genetic-based diseases, and counseling services. Health care centers because that’s where people receive health-based services, and to be able to provide services available to those that-enter the facility. State outreach programs, to inform the public about genetic diseases, and create awareness for those that might have not been exposed to genetic realm of health, and to make known the new available resources that are available. Registries of genetic diseases, to see how prevalent and serious the genetic conditions are in a specific region, and counseling, to help those with genetic disorder to help mentally and emotionally cope those living with the disease to provide reassurance of ways that living.
The stakeholders need to be related to providing the knowledge of the genetic conditions, and be able to provide resources to help alleviate the symptoms, promote years of healthy living to those living with a potentially debilitating genetic disorder.
part 1
Delete1. The seven steps that are recommended for creating a successful Tier 1 Public Health program are:
1 Set Goals by Assessing Data and Available resources
2 Build partnerships
3 Conduct surveillance
4 Provide info to policy makers
5 Make education available to the public
6 Implement bi-directional reporting
7 Conduct surveillance and assess results
I believe that most important step is step 2: building partnership.
Without having access to clinical and counseling support resources, surveillance, public education, reporting, would be meaningless. The issue will be know, the solution to said issues would be known, but the means to get to the solution would be missing, and thus any means to improve health outcomes of the population would be futile.
1. The seven steps proposed for creating a successful tier 1 public health program are: 1) set goals by assessing data and available resources, 2) build partnerships, 3) conduct surveillance, 4) provide information to policy makers, 5) make education available to the public, 6) implement bi-directional reporting, and 7) conduct surveillance and assess results. In regards to which step is the most important, I am caught between building partnerships and education. Of course it is very important to let the public know about genomics and how they can use resources to their advantage through preventative measures. Since programs are aimed at helping the community, it is important that the public understand the program. However, it is also equally important to build partnerships to gain resources, support, and information.
ReplyDelete2. The state of Oregon has also implemented a similar type of public health program for genomics. Their plan is called The Strategic Plan for Genomics and Public Health. They want to promote health for the public by using public health surveillance and genomic resources. http://public.health.oregon.gov/DiseasesConditions/GeneticConditions/Pages/index.aspx
3. For a state to take on a program like this, they should develop strong relationships with researchers that focus on genomics and cancer in general, hospitals, the CDC, cancer registries, clinics, and definitely genetic counselors. Also, it is important to have people that will be responsible for educating the public on the available resources created by the program. It is vital to have a relationship with CDC as they can provide a great amount of funding.
1) The seven steps that are recommended for creating a Tier 1 Public Health Program include; setting goals by assessing data and available resources. Build partnerships to identify and intervene. Conduct surveillance such as surveys. To provide information to policy makers, make education available to the public. Implement bi-directional reporting and finally to conduct surveillance and assess results. Although I believe that all the steps are important, making sure that the public has access to this information is crucial, so therefore education is the most important. Educating the public will allow further identification and raise awareness. There will also be a reduction in the fear that people have of genetic counselors and testing alike, this in turn will further the amount of people that would screen and increase further access.
ReplyDelete2) Another similar plan is the Florida State Cancer Plan in 2010. The mission was to reduce the burden of the disease. In order to set the course, there were four main goals in order to achieve this. Goal One: a coordinated approach among public and private cancer control stakeholders to implement cancer activities statewide. Goal Two: Floridians practice the healthy behaviors associated with prevention of cancer or to reduction of risk. Goal Three: Floridians have access to appropriate health information and effective health services for the timely detection, diagnosis, and treatment of cancer. Floridians affected by cancer are aware of and have access to quality, appropriate services for quality of life, palliative care, and survivorship. The program targeted strategies in infrastructure, lifestyles and disparities and linked them to access to care and educational promotion.
3) If a state wanted to implement this program I would involve several stakeholders. Cancer registries along with the CDC and state health departments. Healthcare workers, educators, researchers and genetic counselors would all be crucial to its implementation.
The seven steps for creating a successful Tier 1 public health program are: set goals by assessing data and available resources, build partnerships, conduct surveillance, provide info to policy makers, make education available, implement bi-directional reporting, and conduct surveillance and assess results. To me, the most important step here is education because it is the building block to making the public aware of potential risks. Without education we would not even know about genetic mutations in the first place.
ReplyDeleteAnother state to implement a public health program for genomics is Connecticut as the Connecticut Department of Public health “encourages the adoption by clinicians of national guidelines for genetic counseling and testing concerning Lynch syndrome and BRCA- related hereditary breast and ovarian cancer syndrome.”
http://www.ct.gov/dph/lib/dph/genomics/hp2020_actionproj_ca_genomics_best_practices.pdf
Some important stakeholders are the CDC because they are prominent when it comes to funding many things for public health. The tests for these mutations can be expensive and may cause people at risk to not get them because of their high prices. If we get more funding we could make these tests more practical. Another important stakeholder is oncologists and researchers. The more we understand about genomics and cancer, the better we will be able to treat those at risk.
Karly,
ReplyDeleteI liked how Oregon was committed to increasing its surveillance systems and how it would support and cover expenses through Medicaid. It would be interesting to see Medicaid's terms and conditions with regards to its coverage. I would have liked to see your opinion on the 7 steps of the Public Health Program, but other than that great post!
I liked how Oregon was committed to increasing its surveillance systems and how it would support and cover expenses through Medicaid. It would be interesting to see Medicaid's terms and conditions with regards to its coverage. I would have liked to see your opinion on the 7 steps of the Public Health Program, but other than that great post!
ReplyDeleteI agree that the first step is one of the most important steps to implementing a successful program. I totally believe that a new program cannot be successful if they don't understand how the old program worked and what resources are available
ReplyDeleteI agree that the CDC would be a valuable player. Their years of experience and pool of experts that work for them would be really useful to bringing the best results possible out of a program such as one in cancer genomics. Plus they have access to so much great census data that could also be useful.
ReplyDeleteThe seven steps presented to create a tier 1 health program are: set goals by assessing data and available resources, build partnerships, conduct surveillance, provide information to policy makers, make education available to the public, implement bi-directional reporting, and conduct surveillance and assess results. I think that making education available to the public is the most important step because knowledge is power, and the more people who are aware of an issue, the more concern there is and the more likely policy and health outcomes will change from knowledge alone.
ReplyDeleteOregon currently has a state-wide system in place that serves to reduce cancer morbidity and mortality by increasing access to genetic screening and services, educating the population, informing policy makers and advocates, and increasing the capacity of genetic services (http://public.health.oregon.gov/DISEASESCONDITIONS/GENETICCONDITIONS/Pages/plan.aspx).
If a state wanted to implement a similar program, the government and current policy makers would need to be on board, as well as the local public health department and local physicians. Physicians would be very important because they provide the gateway to supportive genetic testing and access to counseling, while the public health department would use data collected from physicians to asses the current state of cancer and improvements who would then inform policymakers.
I agree that educating the public is the most important step. Widespread knowledge of a public health concern will stand to improve lifestyle risk factors and encourage the at risk population to seek genetic testing. When the public is more informed they can become advocates for policy change as well.
ReplyDeleteI agree that building partnerships is the most important, but I don't think it's because it leaves room for mistakes... if anything, involving more people provides more chances to make mistakes! I would argue, however, that with additional collaboration, there are more experts available to catch each others mistakes and provide an array of solutions. Because of how involved processes like this program are, many players are required to ensure effectiveness and success.
ReplyDelete