State Violence and Injury Prevention Program (Core VIPP) FY 2014 Background Document State Violence and Injury Prevention Programs Save Lives Deaths and injuries from motor vehicle crashes, traumatic brain injury, prescription drug overdose and youth violence are preventable State public health violence and injury prevention programs have proven they can achieve impressive results with limited resources, as the public health approach allows practitioners to extend the benefits of prevention not just to individuals, but to entire communities and populations Robust state violence and injury prevention programs ensure adequate state data is available to guide and direct interventions; coordinate efforts among a variety of organizations dedicated to violence and injury prevention; and support the development, implementation, and evaluation of state and local program and policy strategies to prevent violence and injuries in their communities The State Violence and Injury Prevention Program (Core VIPP) at the Centers for Disease Control, National Center for Injury Prevention and Control (CDC’s Injury Center) is guided by the belief that through access to the best information and resources, states can help members of their community live life to its fullest potential by putting science into action to prevent injuries and violence Public Health Problem Injuries and their consequences, including unintentional and violence-related injuries, are the leading cause of death for the first four decades of life, regardless of gender, race, or socioeconomic status In fact: Injuries are the leading cause of death for people ages one - 44 in the U.S Each year, injuries kill approximately 180,000 people Every three minutes, a person dies from a preventable injury This adds up to more than 500 preventable deaths each day In 2010, over 31 million people in the U.S suffered nonfatal injuries Injuries and violence cost the U.S $406 billion annually; over $80 billion is in medical costs and approximately $326 billion is in lost productivity Strategies that Work One of the most effective injury and violence prevention strategies is empowering states to identify state-based solutions and assure effective dissemination and implementation of evidence-based programs and policies, which prevent injuries and violence within the state State health department Violence and Injury Prevention programs play this unique role CDC’s Injury Center supports state health departments and other key partners in developing and implementing evidence-based programs as well as linking clinical practice with community programs CDC’s Injury Center uses the best available scientific data to identify effective programs and to determine the optimal strategies to promote widespread adoption of these programs among funded and unfunded states Unique Role of the CDC Injury Center’s Core VIPP CDC Injury Center’s Core VIPP is the only program of its kind in the nation No other federal agency provides financial and technical support to state health departments to build the capacity needed to strengthen injury surveillance programs and develop, implement, evaluate, and disseminate violence and injury prevention programs and policies based on the best available evidence While the National Institutes of Health (NIH) conducts bench science and provides research grants to state academic institutions; the Health Resources and Services Administration (HRSA) provides grants to link injured patients to services; Department of Justice focuses on law enforcement and perpetrator apprehension - the Injury Center’s Core VIPP empowers state health departments to set up adequate systems to prevent injuries from happening This “on the ground” approach not only assures best practices in injury and violence prevention are implemented across states needing them, but cumulatively saves lives and dollars within the states Federal Partnerships Core VIPP partners with other federal agencies to increase impact in violence and injury prevention For example, Core VIPP worked with HRSA on the production of the Special Emphasis Report on Infant and Early Childhood Injury for states This report (which varies across states) details incidence data on early childhood injury with an emphasis on child maltreatment The template, which was developed in coordination with HRSA, CORE VIPP and four Surveillance Quality Improvement (SQI) funded states, gathers state specific data on the incidence of childhood injury and thereby informs efforts by state health departments to tailor programs that implement child maltreatment interventions such as home visitation and Positive Parenting Program (Triple P) Due to the success of the original template within the four SQI states in providing state specific data on a special population (children), all 20 Core VIPP funded states are now using this template to create their own Special Emphasis Reports The goal is for state health departments to begin work with HRSA state programs in implementing child maltreatment prevention practices within their states Core VIPP in Action The varying causes of injuries and violence require a state-by-state approach to addressing the burden of violence and injury to ensure states’ investments are reflective of their greatest needs The Core VIPP supports 20 state health departments to strengthen capacity to collect and use data for a better understanding of local injury issues, and to protect people by putting science into action to prevent violence and injuries and save lives The Core VIPP is comprised of multiple components including: Basic Prevention (BIC); Regional Network Leaders (RNL); Surveillance Quality Improvement (SQI); Older Adult Falls Prevention; and Motor Vehicle/Child Injury Prevention Basic Prevention Component Core VIPP supports all 20 funded states to maintain and strengthen their injury and violence prevention programs with a focus on key components: building a public health infrastructure; collecting and analyzing data; designing, implementing and evaluating strategies, both program and policy; providing technical support and training; and education These states include: Arizona, Colorado, Florida, Hawaii, Kansas, Kentucky, Maryland, Massachusetts, Minnesota, Nebraska, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, Tennessee, Utah, and Washington Regional Network Leader Component Five of the 20 funded states serve as Regional Network Leaders (RNL) and provide a structure for crossstate collaboration and assistance to all states (funded or unfunded) within their designated regions RNLs develop partnerships with various organizations and research centers, and also work with CDC and each other to identify common issues and shape effective program infrastructure at the state, regional, and national level A regional network of states encourages the creation, sharing and effective application of best and promising practices to address injury and violence prevention and control within all states Region boundaries were created using Health and Human Services (HHS) regional boundaries, with each RNL comprising two HHS regions The following five states are funded for the RNL component: Massachusetts - HHS regions and 2; Maryland - HHS regions and 5; Kansas - HHS Regions and 8; North Carolina - HHS Regions and 6; and Washington State - HHS Regions and 10 Surveillance Quality Improvement Component Four of the 20 basic prevention funded states are funded for the Surveillance Quality Improvement (SQI) component The purpose of this component is to conduct injury data investigations supportive of promoting and advancing uniform injury case definitions, improving data quality and advancing methodology to improve and standardize injury data collection efforts among all states The result of this work will advance the consensus process for developing and implementing injury surveillance activities and will develop and/or improve existing standardized procedures for specific causes of injury to enhance data quality The funded states for this component include: Colorado, Massachusetts, North Carolina, and Utah Older Adult Falls Component Three of the 20 states are funded for preventing falls in older adults The purpose of this component is to support select states to implement older adult falls prevention interventions in community settings and clinical care practice to determine components, which can be applied to other states There is vast evidence base on falls prevention strategies such as engaging in exercise increasing lower body strength and balance; having doctors or pharmacists review and modify medications to reduce side effects and drug interactions; having annual vision exams and updating eyeglasses to optimize vision; and modifying the home environment to reduce fall risks and improve safety CDC’s Injury Center supports state health departments and other key partners in developing and implementing evidencebased community fall prevention programs as well as linking clinical practice with community programs CDC’s Injury Center works with the states to use the best available scientific data to identify effective programs and to determine the optimal strategies to promote widespread adoption Funded states for this component include: Colorado, New York, and Oregon Motor Vehicle Component Four of the 20 Core VIPP funded states address the issue of motor vehicle-related injuries among children and teens by: using data to better understand who is at risk and what works to prevent motor vehicle-related injury; develop programs; and, inform decision makers about strategies to help keep drivers, passengers, bicyclists and pedestrians safe on the road each day This funding specifically addresses the issue of motor vehicle-related injuries in children and teens by supporting the selection of policy strategies to reduce motor vehicle-related injuries in children, activities to build state capacity for implementing and evaluating policy activities, and the planning, implementation, and evaluation of policy activities The current funded states for this component are: Colorado, Nebraska, New York, and Washington State Program Successes States have used the Core VIPP funding to make significant strides toward reducing the burden of injuries and violence Core VIPP states have also been able to leverage additional resources for injury prevention more than doubling the investment made by CDC Highlighted below are examples of how states utilize Core VIPP funding: Colorado In 2012, the Colorado Department of Public Health and Environment (CDPHE) named motor vehiclerelated injury prevention as one of Colorado’s Winnable Battles, one of the public health priorities where progress can be made in the next five years As a result, CDPHE held a Motor Vehicle Winnable Battle Academy to build local support for the Winnable Battle and increase knowledge about prevention strategies Ninety-six participants from a variety of settings including: public health, hospital systems, law enforcement, schools, local traffic safety coalitions, insurance companies, and small businesses attended the Academy Local teams worked together to address the community-specific motor vehicle problem they identified in their applications using available data The teams conducted stakeholder analyses to identify where they needed to develop partnerships Teams ultimately created local level action plans to take back to their communities After the Academy, CDPHE staff followed up with 10 of the team leads to assess what technical assistance communities need to implement and evaluate the plans they developed As a next step, CDPHE, in collaboration with Core VIPP, will award mini grants to local teams needing additional financial support to implement their plans CDPHE also is planning several webinars and other technical assistance activities based on the needs identified by the teams Future Academies are also planned In 2010, the Colorado State Health Department Injury Program was successful in working with stakeholders to ensure the best available surveillance data and science based interventions were used to inform the development of a comprehensive child passenger safety law The Colorado Injury Program convened a Child Injury Policy group of internal and external partners to review policy options related to child restraints and booster seat use The Colorado Injury Program provided the science and data to their partners, so when the opportunity arose at the state legislature for a policy to be introduced, they were prepared to propose a science-based policy solution The comprehensive child passenger safety law was passed in August 2010 Massachusetts The Massachusetts Department of Public Health (MDPH) worked in collaboration with the MA School Health Program and the MA Interscholastic Athletic Association (MIAA) to provide support and technical assistance to schools across the state to implement recent regulations on the identification and management of concussion in school sports during the 2011-2012 school year This work focused on five key areas: annual training of athletic program staff, school nurses, emergency medical personnel, and other school officials; documentation of concussion incidence during the season; removal from play; graduated re-entry planning; and, medical clearance To date, 262 school districts, 17 charter schools, and 31 MIAA-member private schools have confirmed they have put in place policies complying with the MDPH regulations This represents 78% of the schools and school districts required to provide confirmation MDPH plans to reach out to charter schools, which were not MIAA members, and therefore, require special outreach to enhance their compliance Ohio In response, to the growing epidemic of drug overdoses in Ohio, the Ohio Core VIPP and the Ohio Injury Prevention Partnership (OIPP) developed the prescription Drug Abuse Action Group (PDAAG) Since its inception PDAAG membership has grown to over 100 organizations representing a multidisciplinary group of healthcare providers, coroners, law enforcement, substance abuse providers, poison center reps, public health, etc At the local level, this group provided data and resources to support awareness raising efforts At the state level, this group developed consensus recommendations for policymakers In May 2011, the Ohio legislature passed a law containing many of the PDAAG policy recommendations including: licensure of pain management clinics; in-office dispensing limits; Medicaid lock-in program; and PDMP changes Oregon Oregon's Prescription Drug Monitoring Program (PDMP) was launched by the state Injury and Violence Prevention Section in June 2011 The PDMP offers healthcare providers a monitoring tool, which is available 24 hours a day, seven days a week and provides information to help patients and providers better manage their prescriptions By mid-October 2011, 76% of pharmacists were submitting to the PDMP system, over 699,000 prescriptions had been submitted to the system, and there were 8,999 queries by health care providers Data from the PDMP should provide a vast new data source for understanding prescription practices in Oregon and help to identify prevention strategies South Carolina The South Carolina Department of Health and Environmental Control (DHEC) used surveillance data collected and analyzed by staff supported through CDC’s Core VIPP to thoroughly understand the burden of older adult falls in their state, and to inform partners on how this issue impacts the quality of life for senior citizens DHEC sponsored a workgroup to develop a strategic plan for falls prevention and to work with state partners, which led to the funding for, and implementation of, the Matter of Balance (MOB) program in select communities The MOB sessions focused on controlling falls and fear of falling, setting realistic goals for increasing activity, changing the environment to reduce fall risk factors, and promoting exercise to increase strength and balance among elderly Lay coaches lead the eight week program in diverse settings such as senior centers, community centers, churches, and senior housing In addition, using resources available through the Core VIPP, DHEC directly invested in the implementation of MOB in South Carolina by providing personnel time to for instruction of exercises and funds to purchase training materials Utah The Utah Department of Health’s Injury Prevention Program, with support from CDC’s Core VIPP, analyzed 20 years of data on motor vehicle crashes This analysis highlighted a decrease in teen crash fatalities over the last 20 years, with a 61% decrease occurring after the 1998 passing of a Graduated Driver’s License policy According to a statewide randomized survey, 56% of adults in Utah were not aware of night time driving restrictions for teen drivers, and 21% were not aware of passenger restrictions A further review of Utah’s teen driver education program in high school overseen by the Utah Office of Education, found the driver education curriculum was outdated and lacked parental involvement despite national recommendations to the contrary The Utah Department of Health through the Utah Teen Driving Task Force (TDTF) worked closely with the Office of Education to rewrite Utah’s driver education curriculum, so it is based on evidence, informed by local data, supported by local and national resources, and includes parent classes The Utah Department of Health has also contracted with eight local health departments and trained staff at each to collaborate with the Zero Fatalities Program and their local high school driver education instructors to teach parent classes throughout the state on teen driving and passenger restrictions Utah Department of Health is planning on getting the curriculum approved by the Utah Board of Education and making parent education mandatory for parents of teen drivers Future Goals CDC’s Injury Center envisions a national program of five core components, which are crucial to the development, growth, and sustainability of state injury and violence prevention programs The five components, described by the Safe States Alliance in the publication SAFE STATES: 2003 Edition, are: build a solid public health infrastructure; collect and analyze injury and violence data; design, implement, and evaluate programs; provide technical support and training; and affect public policy When all five components are in place and functioning well, states are equipped to reduce injury and violence With new investments, CDC’s Injury Center would work on broad-based goals to strengthen the capacity of state health departments (SHDs) to deliver topic specific, evidence-based practices, programs, and policies including: Establishing a coordinated and comprehensive violence and injury prevention program in every state in the United States, Washington DC and U.S Territories so violence and injury prevention are a core component of the activities in every state health department Improving quality by providing support and developing tools for the implementation and evaluation of evidence-based programs and policies Providing adequate funding and targeted technical assistance to state health departments through the Core Violence and Injury Prevention Program (Core VIPP), focusing on ensuring widespread adoption and evaluation of best practice injury and violence prevention programs and policies Enhancing the effectiveness of SHD injury and violence prevention programs through the expansion of a CDC Injury Center funded leadership network promoting communication and sharing of best practices, state level strategies and innovation across all SHD’s This will maximize SHD’s efficiencies by providing a depository of working solutions to problems shared by all SHD’s Improving long term health impact by facilitating state based program and policy interventions or strategies for priority areas or emerging issues through funding of 50 SHDs Improving the efficacy of state level programs and policies by increasing the SHD’s evaluation capacity ... within the states Federal Partnerships Core VIPP partners with other federal agencies to increase impact in violence and injury prevention For example, Core VIPP worked with HRSA on the production... State Program Successes States have used the Core VIPP funding to make significant strides toward reducing the burden of injuries and violence Core VIPP states have also been able to leverage... targeted technical assistance to state health departments through the Core Violence and Injury Prevention Program (Core VIPP) , focusing on ensuring widespread adoption and evaluation of best