In this section...Background
II. Background on the Framework
Purpose of the Strategic Framework - The purpose of this strategic framework is to guide and organize the systematic planning, implementation, and evaluation of OMH and other efforts aimed at improving racial/ethnic minority health–and reducing and, ultimately, eliminating racial/ethnic health disparities. Efforts include those aimed directly at racial/ethnic minority health problems, but also those that support a "systems approach" to addressing such problems across the country. This systems approach has not been previously available in efforts targeted to racial/ethnic minority health and health disparities issues.
OMH, through the application of a strategic framework, can sharpen the focus, coordination and dissemination of its work, as well as that of its partners inside and outside of HHS. The ultimate goal, for all stakeholders, is that individual and collective efforts on behalf of racial/ethnic minority health will be more evidence-based and will use available resources effectively and efficiently. The strategic framework provides:
- Rationale for efforts
conducted and supported:
The Framework can provide a rational basis for identifying and
developing effective strategies, practices, and other efforts that are
conducted and supported by OMH, its partners and other stakeholders across
the country. The Framework does this by drawing on existing science
and knowledge about the nature and extent of the long-term problems that
OMH must address, the factors that contribute to those problems and the
effectiveness of various strategies and practices in addressing those problems.
- Support for increased quantity and enhanced quality of
evaluations of the effectiveness of efforts: The Framework will
strengthen OMH's evaluation efforts with its grantees and other partners.
Increased quantity and quality of evaluations will help OMH assess whether
racial and ethnic minority health improvement and health disparity reduction
efforts (funded or supported by OMH and others) are really making a difference
and are producing meaningful results.
- Basis for enhancing effectiveness and efficiency: The Framework can promote the effectiveness and efficiency of efforts by OMH and others to improve racial/ethnic minority health and reduce health disparities through more coordinated and systematic actions.
Approach to Developing the Strategic Framework - To maximize clarity, a logic model approach is employed for developing the strategic framework. Logic models originate from the evaluation field as a way to plan, implement and evaluate programmatic efforts, and to provide the theory or rationale, undergirding what is being done (HHS, 1999; Taylor-Powell, Jones, and Henert, 2002). Similarly, the Framework presents the rational basis for efforts related to racial/ethnic minority health and health disparities by tying together the following components typically found in logic models (Note: Numerous sources exist for information on the use of logic models to enhance program performance. Examples include, but are not limited to, the following sources identified in OMH's evaluation planning guidelines: The Centers for Disease Control and Prevention at http://www.cdc.gov/eval/resources.htm#logic%20model; the University of Wisconsin Cooperative Extention at http://www1.uwex.edu/ces/lmcourse ; and the W.K. Kellogg Foundation at http://www.wkkf.org/Pubs/Tools/Evaluation/Pub3669.pdf [PDF, 1.4MB] .)
- Long-term problem(s) to be addressed
- Factors that must be addressed, which
contribute to the problem(s)
- Strategies and practices , and supporting
resources, which can be mobilized to address the factors and the problems
- Measurable outcomes and impacts that
can be expected to result from implementing the strategies and practices
- Long-term objectives and goals that can be achieved by effectively producing impacts on the factors and the problems.
Figure 1 is a graphic depiction of the general structure of the strategic framework, which builds upon each of these five components.
Figure 1. A graphic depiction of the general structure of the strategic framework
Developing a strategic framework using a logic model development process emphasizes five steps, which correspond to each of the components in Figure 1: (1) examination of the long-term problems that OMH and others are trying to address, (2) review of the major factors known to contribute to or cause the long-term problems, (3) identification of promising, best and/or evidence-based strategies and practices known to impact the causal or contributing factors, (4) presentation of measurable outcomes and impacts that might be expected from the strategies and practices and (5) assessment of the extent to which long-term objectives and goals have been achieved.
As the components of the Framework - using this five-step logic model approach–were developed, extensive literature reviews and environmental scans were conducted to identify what is known–and not known - about the long-term problems, contributing or causal factors, effective strategies and practices to address the factors and identification and measurement of expected outcomes and impacts. As necessary, targeted reviews of the literature from fields other than public health and medicine (e.g., systems research) were also carried out to inform OMH's understanding of the content needed in the Framework. In this way, the components and subcomponents of the Framework build on existing science and knowledge.
Considerations and Limitations in Developing the Framework - The five-step process outlined above results in a strategic framework for addressing racial and ethnic minority health improvements and reducing and, ultimately, eliminating racial and ethnic health disparities. However, several points must be made regarding the task of identifying "best" or evidence-based strategies and practices:
- First, many strategies and practices address multiple contributing factors and may contribute to multiple outcomes and impacts. There is not a one-to-one correspondence or a strictly linear relationship between contributing factors, strategies and practices and outcomes/impacts.
- Second, there is not adequate scientific evidence to demonstrate the effectiveness of all the strategies and practices that are considered effective. Thus, for some strategies or practices, it will be necessary to rely on expert opinion regarding what might be effective, and to continue to stress the importance of sound and systematic evaluation to determine the effectiveness of particular approaches, interventions or activities in producing desired results.
Given these limitations and the certainty that any framework will be used within a complex, public policy and decision-making environment, this framework should be viewed as a dynamic, evolving document that provides guidelines for action rather than as a linear, predictable model for problem-solving and decision-making.
In addition, the utility of this framework does not end with the achievement of some objectives and goals. Rather, results can and should be used to inform OMH and its partners on their level of success in improving racial/ethnic minority health and tackling health disparities. Thus, any knowledge gained can be incorporated into the continuing efforts of all stakeholders. This process will help OMH, its grantees and other partners consistently monitor and adjust program and policy efforts in ways that will result in greater effectiveness, efficiency and success. The logic model approach used in the Framework and its general structure can, thus, also serve as a guide for action in a number of ways, and for a variety of public and private entities.
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