Assessing Injury and Violence Prevention Programs in North Carolina Local Health Departments: Capstone Summary Report

Background: Injury and violence comprise the leading causes of death amongst North Carolinians ages one to 65. Ensuring that effective programming occurs at the local level is critical to reducing this burden. There is significant unmet need for successful injury and violence prevention (IVP) programming, particularly in motor vehicle crash, suicide, homicide, falls, and unintentional poisoning. The Injury and Violence Prevention Branch (IVPB) of the North Carolina Division of Public Health conducts surveillance, provides statistical reports, technical support and training in IVP, and is a networking hub for IVP stakeholders. Although most IVP programming is carried out at the local level, IVPB lacked a comprehensive statewide assessment of local health departments' (LHD) work in IVP. The primary aims of this Capstone project, therefore, were to fill this knowledge gap for IVPB, identify targets for improving programming, and promote effective initiatives. To this end, the team mapped the IVP work conducted by NC's 85 LHDs, assessed LHDs' priorities, partnerships and readiness to implement evidence-based IVP projects, and compiled case studies to share lessons from successful initiatives. Methods: To assess the state of IVP, the Capstone team conducted key informant interviews (KIIs) and a survey of NC LHDs, and compiled results into a final report and model program case studies. First, the team utilized formative research strategies by conducting a literature review of LHDs' work in IVP, and drafting an evidence table that categorized and summarized best practices for each of the five prioritized areas. Next, the team conducted KIIs with leaders in IVP about their perspectives on successful and evidence-based programs, program selection, and implementation. The team drew on interview findings to develop the online survey assessing NC LHDs' IVP work. The team then identified model programs, conducted interviews with program staff, and developed case studies, which will be shared with NC IVP practitioners to inform their programming. The team compiled findings in a report for IVPB. Results: About half of LHDs reported conducting programs that are evidence-based. In the literature and in the KIIs, the team found varying definitions of evidence-based IVP programs; however, there was consensus across the evidence table, KIIs and case studies on criteria for successful IVP programs: those which meet an identified need, have some evidence of effectiveness, involve community members, demonstrate positive change, and are sustainable. Findings across deliverables highlighted three key themes in NC IVP efforts: capacity, partnerships, and program priorities. Capacity: Most LHDs in NC were active in IVP; however, interviewees and survey respondents recognized a need for technical assistance and staff training in evidence-based interventions (EBIs), specifically in program selection and implementation. Additionally, funding constraints limited their capacity. Partnerships: LHDs played a key role in building community support for IVP, and partnerships they formed were important to program success. Collaboration with hospitals, governmental and non-governmental organizations, and academic institutions expanded LHDs' capacity and potential sustainability of initiatives. Programming: Survey findings confirmed key informants' insight that capacity limitations and conflicting community priorities can outweigh community health assessment (CHA) data, resulting in a misalignment between local burden and local programming. Nearly half of issues identified by survey respondents as the most burdensome injury and violence problems in their respective service areas were not targeted in their programming. LHDs conducted programming most frequently in sudden infant death syndrome (SIDS), unintentional poisoning, and child maltreatment. None addressed homicide specifically; however, several had programs targeting interpersonal violence. The six case studies provide models for LHDs going forward. Exemplifying successful partnerships, sustainability and community engagement, these replicable programs leverage local interest to address high-burden outcomes. Discussion: Through this Capstone project-the first statewide assessment of local IVP-IVPB has gained a rich understanding of the work local practitioners are doing. Project deliverables promote networking and capacity across the state, and provide baseline data and tools for future assessments.Master of Public Healt