Connecting the Dots: An Evaluation of LACDPH HIAs of the Parks After Dark and Women’s Re-Entry Court Programs

Executive Summary

Background

The Los Angeles County Department of Public Health’s Health Impact Evaluation Center (HIEC) hired Human Impact Partners in 2015 to conduct an external evaluation of two of its recently completed Rapid Health Impact Assessments (HIAs). Broadly, the goal was to learn lessons from past HIAs and inform HIEC’s work moving forward. The evaluation focused on the Parks After Dark (PAD) HIA and the Second Chance Women’s Re-Entry Court (WRC) HIA. Parks After Dark is a comprehensive, cross-sector collaboration program designed to prevent violence and promote healthy and active living in parks. The WRC is a specialized court-based jail diversion program that provides mental health and substance use disorder treatment along with housing, employment, and family reunification services. The primary goal of both HIAs was to analyze the impacts of maintaining or eliminating funding for the respective programs upon the populations that they served. The PAD HIA also considered the potential impact of expanding the PAD program to ten additional parks.

Summary of Evaluation Findings

Based on interviews with 30 key informants, document review, and assessment of the HIA’s compliance with established HIA practice standards, we found that both the PAD and WRC HIAs completed a comprehensive HIA process in a relatively rapid HIA timeline and the HIAs resulted in a number of important impacts including:

Both HIAs achieved almost all HIA Minimum Elements, a majority of HIA Practice Standards and achieved their stated objectives.

The HIAs were Very Informative, Timely, and Relevant to Decision-Making Processes

• The WRC HIA “was the number one/touchstone piece of evidence used to propel these efforts [to support diversion programs] forward.”
• The PAD HIA “really changed the landscape and helped frame violence prevention as a health and cost savings measure and was able to concretely show their impact.”

The HIAs Helped Increase Local Commitments to Program Funding

PAD currently receives $2.1 million for 2016 programs, expanding from 6 to 21 parks, and has increased funding commitments from the County Chief Executive Office, Probation Department, LA Health Agency, Kaiser Foundation, and others. The WRC Program is no longer reliant on state CDCR funds and is now supported by LACDPH using AB 109/Realignment funds and the General Fund.

• “This [PAD HIA] Report got all the funding that we have right now.”
• “PAD expanded in a tough budget cycle is something that’s almost unheard of.”
• “The [WRC] HIA helped kickstart a conversation about how to increase local investment that the county has discretion over. It took months, but the HIA helped lead to having AB 109 funding be used to support the program locally and build local support for this type of programming.”

The HIAs Provided Needed Data Which Described Impacts on Health

• “When you put the statistics and data together, it makes the reality of the program’s benefits clear to all, the data speaks volumes.”
• “The HIA helped make a light bulb go off in terms of how PAD impacts mental health, physical health.”

Both HIAs Found Impacts on Health Determinants

• “This HIA opened our eyes that the more holistically you come to problems facing drug users the better. Employment, housing, family – you never know what piece an individual will respond to, but a holistic approach adds more value.”
• “From the beginning, PAD is a good example of how you can have collaboration across sectors that result in a whole host of impacts – e.g. on family, mental health, substance abuse, tobacco, unemployment, etc. The HIA helped document those impacts.”

Both HIAs Highlighted Programs’ Relationship to Priority County Topics

• “This HIA… was able to identify intersecting priorities. For example, the county has invested a lot of money into a plan to address homelessness. This HIA showed how the WRC can impact homelessness, a connection that may not otherwise have been made.”

Both HIAs Strengthened Existing and Fostered New Collaborations Among Government Agencies

• “In general, we tend to be siloed in our departments. The HIA helped show [decision-makers how] health is a part of each of the departments and has cross-departmental impacts – e.g. parks impacts health, which impacts mental health, which impacts costs.”
• “We have a connection with public health that we didn’t have before. We can call them up and ask them any questions. No single entity can solve all problems, but a strong bond can help ensure our network is strong, that we are ‘one county family’.”

Both HIAs Helped Change Institutional Mindsets and Increase Focus on Health

• “When I started at the Parks Department 16 years ago, people used to talk about how living near a park increases the value of your home. This HIA has led to a shift within our department about how we – management and parks staff – talk about the value of our work and of parks in general. We don’t just say we do recreation, we say “we are health people” and we improve the health of the community by decreasing diabetes, improving heart conditions, etc.”
• “This HIA helped open eyes and doors. It showed that we need to do our work differently and that parks are important for good health practices and decreasing violence.”
• “This HIA happened at such a critical point in our department’s institutional change. LACDPH is moving towards a systems approach and focus on environmental change policies. We need systems in place to be able to project what future impacts of policies and programs will be. This HIA is a prime example of what that type of approach looks like.”

Based on our findings, we propose the following recommendations for HIEC to consider in its future work. Our first set of recommendations proposes improvements to HIA steps/processes that, if taken, would support more manageable and effective HIA projects. The second set of recommendations proposes improvements to HIEC’s HIA approach more broadly, that if implemented, would result in a more strategic, meaningful, and impactful HIA practice that aligns with the underlying values of HIA. Please note that these recommendations are not in order or priority.

Recommendations: HIA Steps/Process

• Identify strategic co-leads: Co-lead HIAs with a staff person (ideally a DPH staff person in another division) who is very involved in the program/policy work that is the topic of the HIA.
• Improve focus in screening: Have a clear understanding of decision to be analyzed, what information is most needed, and decision timeline before beginning the HIA.
• Avoid “scope creep”: Have multiple scoping meetings to build relationships, understanding of data needs/availability, and refine the scope at the beginning of the project to avoid scope creep throughout the HIA process and to better conform with the type of HIA you want to conduct (e.g., rapid versus comprehensive).
• Improve documentation: Document who provides input on HIA scope & draft reports. Be clear about the process for characterizing impacts, synthesizing evidence, & developing/prioritizing recs.
• Develop a communications and disseminations plan: Develop a comprehensive communications and distribution plan to disseminate HIA findings to decision-makers, community members, department heads, media, and others. Do active dissemination pre- and post-HIA to stakeholders to build awareness.

Recommendations: HIEC Process Moving Forward

• Increase focus on equity: Engage disproportionately affected community members in HIAs. Analyze avoidable differences and differential impacts. Frame findings with an equity focus. Make sure recommendations address systems change.
• Improve stakeholder engagement: Actively engage a broader range of stakeholders throughout HIA, with a particular focus on engaging impacted communities.
• Seek communications support: Work with communication experts to more effectively frame HIEC’s work and value.
• Re-consider whether “Rapid HIAs” are the right fit: Consider whether using the term “rapid” to describe HIECs HIAs – especially when most would consider the HIAs to be comprehensive, even if conducted on an accelerated timeline – adds value to HIEC’s HIA work.