Preventive Services Task Force Community Guide

Hello everybody. Welcome to Health chatter. And today's show, we are going to be talking with some wonderful, wonderful guests today, and it's about the Community Preventative Services Guide and the task force that that put that whole thing together. It's going to be quite interesting. So stay tuned. I will get to everybody in just a second. Welcome back to our listening audience. We've had health chatters, had a little bit of a break over the Thanksgiving holiday, but we have lots of shows coming up. We have shows booked through the end of March, so stay tuned for that. We have a great crew that makes our health chatter podcast successful. Maddy Levine-Wolf, Erin Collins, Deondra, Howard, Matthew Campbell, Sheridan Nygard and of course, Barry Baines  is our medical advisor. All these people do background research for us. They do the production, they do the marketing and transcribing. They take care of our website, and Clarence and I, what do we do? We just chat and and about health. And it's, it's been a really pleasure. We'll be, we'll soon be closing in on the start of our third year with health chatter. So thank you all to you the listening audience. So today's show, again is on Community Preventative Services Guide. We've got great people with us. Tom cockey is is really a special colleague. I've known. I was talking to Tom right before the show, we figured out we probably known each other for around 40 years.

He's He's a great colleague. He He is one of a few in the arena that really bridges the the gap between public health and medicine and the medical side of things, and has done it on a variety of different topics and community initiatives over the years.

I can't begin to to describe the the great work that that that he has done, and the insights that he has provided in both of those arenas, and is still committed to to it this day, he's going to be retiring tomorrow, but if I know Tom, he's going to be linked with this subject for quite a while. So thank you. Tom, your special person, special colleague, and I'll let you introduce your colleagues from from out east. Thank you. First, Dr Amy Lansky, Amy serves as the Director of the Community Guide program on your browser. That's the community guide.org

you can sign on and follow as you follow the podcast. The program is at this CDC, the Centers for Disease Control and Prevention in the Office of Science. Amy's responsibilities include supporting the Community Preventive Services Task Force and Dr Allison quayar. Alison Evans quayar is a Professor and Associate Dean of Research in the College of Public Health at George Mason University. She's a research associate at the National Bureau of Economic Research. She currently chairs the Community Preventive Services Task Force. Back to you, Stan, thanks. By the way, I forgot to mention to our listening audience, we have a great sponsor for our shows, human partnership, and they're a great community health organization, and without them, we couldn't be able to do these shows. So thank you to human partnership. You can check them out at huemanpartnership.org, and check us out at at Health chatter podcast.com, all right, so let's get the show going here, Community Preventative Services, Task Force, the and the guide. So let's first start with what is this? What is this guide? And first of all, is this the first iteration? I can answer that question. But for our listening, is this the first iteration? What makes it useful? Who uses it? These types of questions, let's start with that. So maybe Amy, do you want to take that? Start with that.

Sure I can start off, and then I'm sure Allison and Tom can chime in. So the Community Preventive Services Task Force was started in 1996 it was stood up by the Department of Health and Human Services and the charge to the task force was to review population health interventions and identify what works for public health. And this was set up and the oversight for the task force, the support was charged to the Centers for Disease Control and Prevention, and so CDC has been supporting the task force continuously since that time, task force members come on and off the task force and the Community Guide is currently the website. It's the product that is a compilation of all the task force recommendations and findings regarding a variety of population health interventions. And currently, the Community Guide is comprised of around 250 recommended interventions across 20 public health topics.

Ali, you want to add to that? Yeah, Allison, go ahead, sure. I mean, I can tell you a little bit about the task force and how we arrive at recommendations. So the task force is a group of 15 public health and prevention experts. We have a variety of expertise and backgrounds working in health departments or universities or in health coalitions. So the members of the task force have backgrounds in as nurses, physicians, social workers, epidemiologists, health economists and similar.

The role of the task force then is with the support of the Community Guide program staff to review the evidence and provide recommendations and findings on programs and services and interventions that are at the population health level. So that means they're broadly targeted. The audience is communities, schools, public health departments, employers, the military, pharmacies, integrated health care, faith based organizations and related groups. So it's it's more expensive than your preventive service in a doctor's office, you might have your cholesterol checked. That is frequently a one on one, as we call it, visit with a clinician. And what we're talking about here with the Community Preventive Services Task Force are typically services that are delivered one to many, right in a group, population health kind of context. If you don't mind, I would like to add that the structure of the cpsdf is an important part of that structure. Are the liaison organizations. There are 32 of them. They're organizations and federal agencies a wide range. So Indian Health Service, Department of Veterans Affairs, armed forces, NIH, the association, the

backup, the American Public Health Association, National Governors Association, National Association of County and City Health Officials, representatives from pediatrics, physician assistants, school health programs, state and state health departments haven't even covered them all, but they're 32 in all, and they're an incredibly important part of our work. They help promote the guide its findings. They help select and prioritize which interventions we're going to look at next, and they also serve as experts on our coordination teams when we get ready to do a systematic review. They're an important part of the expert

input that we then receive, and ultimately, they help translate our recommendations into practice. So that's basically the structure of the operation.

So Tom, you've been involved with this for a long time. I think you weren't you, if I read right, you were, you were involved with the very first guide that came out. So

put it all in perspective. No,

no, okay, but I'm sure you've had input into it, so tell me put it in perspective a little bit. How have you know as as a practitioner, how have you used the guide? Yeah, thanks for asking, Stan. I'm going to talk about parks and trails greenways with additional support. Okay, so, so we in Saint Paul. I live in Saint Paul, Minnesota, and and the the mayor proposed a little pittance of a sales tax to improve our parks and trails. And so I was able to write a.

Editor to the editor and say and write that the rigorous evidence shows that parks and trails with additional support increase physical activity, and we all know that physical activity prevents multiple diseases, diabetes, heart disease, cancer, etc, etc, OB, city and

so that that, let me do that the other, the other example I'm going to give is community health workers. I'm working with a group from Rondo, Rondo as a historically black neighborhood that was transected by the interstate, and we're trying to reestablish it, but the evidence is clear that community health workers improve control of blood pressure, cholesterol, etc, etc, and and Also, community health workers are an entry level position in health care for somebody who who thinks they might be interested in adopting some sort of health care profession, and it it doesn't cost the hundreds of 1000s of dollars in 10s of years of becoming a physician.

So there are two examples that that are just very clear and and based in the in in the community.

So you know, one thing that came to my mind when, when I read through all the information was all right, how does this guide compliment Healthy People and the objectives for the nation. So in other words, and by the way, one of our own here in Minnesota, Nico Pronk, was on the show a while back and and and talked to because he was co chairing Healthy People and the development of that. And so Okay, so now we have healthy people. We have a community guide. So what? How does, how do they compliment one another? Anybody can be tackle that one. I can certainly take a stab at it and then turn to Amy and Tom. It's a great question, and obviously there are just an enormous number of interventions that we could be looking at. And we go through a prioritization process. We seek input from the from the nation, right through the Federal Register. We say we want your input. We go through our liaisons, we do extensive outreach, and we're guided by Healthy People,

the latest iteration of information in Healthy People both both on, what are the important topics? What are the populations that are impacted what might be the reach of a given kind of intervention. And so we are. We place ourselves within the Healthy People information, I would say, Amy, did you want to add to that?

Yeah, thanks, Alison, I will also add that the relationship between the Community Guide and Healthy People is also reflected in both of their websites. So if you go to the Community Guide website, you'll see the relevant Healthy People objectives listed for each intervention that the task force recommends. And likewise, if you go to the Healthy People website, healthy people.gov

you can look for an objective, and it will give examples from the Community Guide of effective interventions that implement in your community to help reach those healthy people targets. And so they're very cross connected and and have been, really since the the implementation of the task force.

So if I jump in, I'd you know, we're traveling, I'd say Healthy People is where we want to be, and the Community Guide is effective ways of getting there.

So they complement each other. Study boat,

yeah, clearance, yeah. I I'm enjoying the conversation. I want to ask a question about the word community, okay? And the reason why I want to say that is that I know people throw that, that term around. So when I talk about community, I generally talk about grassroots organizations that are doing the work. My question to you is this is, how can we effectively utilize this work in order for us to be able to to be more effective in terms of our work? Because you generally, and I think when, when community is being used, you.

For many people, it's usually from an organizational perspective and but there are a lot of people that are in community that are doing this work. How could we utilize this information for us to be better at what we do?

Oh, I love that question, and I'm excited to say that I think the community guide can help the

locus of what is the priority for your community is going to be with your community, and where the Community Guide can help is to say, well, let's say you want to focus on substance use, and you want to focus on substance use for for youth, let's say then The Community Guide can help you understand the evidence of what, what's likely to work, because if you think about the kinds of interventions we're talking about,

we want to help communities save time and resources tackling the literature right? Because these are, these are a broad range of health challenges, obesity, mental health, smoking cessation, HIV, prevention, anti bullying, just as examples. And those studies can be in the medical literature, the public health literature, the social sciences literature, it's vast. So the Community Guide is there to help go systematically through the evidence and present it to your community organizations and let them decide where they want to start, but help filter the ways in which they might start. Another really neat feature, I think of the Community Guide, is the section on implementation considerations, and I think that's really rather unique, which is to say, we'll have a recommendation and then we'll have the implementation considerations around it, such as,

then we'll have recommendations, or just information about implementation considerations, and those aren't necessarily they can be from the studies we looked at. They can also be from talking to experts. They can be looking at the broader literature, and it's to help you figure out what you might encounter, or what we do or don't know about this intervention that might impact your community.

Question, one more question, how do people, again, we talk about that community level, like myself, how do we access this information? I think, I think it's very, very important, but, you know, we don't know about it. How do we? How do we, how do we, how do, how do we help to get people to know more about how to utilize this information? Lawrence, let me jump in. Well, first of all, just the community guide.org and then you start to also one pagers. It comes in multiple pagers. I think it's really a matter of engaging with the website and

the

So,

Allison is frozen. Stan, do you hear me? Yep, I hear ya. Okay.

I mean, I'm gonna say that when we start on a topic, we turn up 1000s of articles and it boils down. And I know being a cardiologist, if like nephrology or specialist, I can't read that literature, because I'm not a specialist there and and we're not just a team of physicians looking at all this. It's, it's like Allison pointed out, we have many, many different perspectives and expertise on there, and so

we can trust that. And one of the things using the community guide does is saves both time and money. And so if we start off we think we have a great idea, and we implement it doesn't work. We've not only wasted a lot of money, but we've wasted a lot of time, and using the Community Guide prevents that from happening. The like Allison said, there's one pagers, there's long papers, there's papers in the American Journal preventive medicine, however you want to use it, it will fit your your needs. Make sure you can trust that what the Community Guide recommends is evidence based and well vetted.

Barry,

thanks. Yeah, I want to try and create just a little bridge here between some things that Clarence was was talking about and the information that Allison was presenting. And Tom you as you as well, a lot of these recommendations there, to me, they're they're sort of like the gold standard, and they have a great, you know, research.

Space behind it, great evidence base behind it. And oftentimes,

I've always had a conundrum between what's going to be again, from the time and money piece that you know. I think of that in terms of operationally, how you do it and then, and how much does it cost to do that in the recommendations and in the community guide, and even back to the Community Preventive Service Task Force work, is there ever a prioritization

about, sort of, like the, you know, the likelihood of success of operationalizing something that, from a financial perspective, from a money perspective, it just could never be done. In other words, we have the answer. You know, if we could buy, you know, Vax a vans and send them around to every community, knocking on every door, we can get a lot more people, you know, immunized, but that's not going to be practical because of workforce issues and financial issues. So I'm just trying to reflect that from a community hat perspective and even a clinician in an office. Are there some of these recommendations? Do they get

ranked in any way in terms of likelihood of success or ease of implementation, so that you can sort of make that impact, but in a more efficient way, recognizing limitations on our time and money. I hope that makes it, that makes your question makes a lot of sense, and I think that community guide addresses a piece of it, so for

when we do an evidence review, we follow it with an Economic Review. So in the case of the costs and benefits of parks, Trailways and Greenway infrastructure interventions, The Community Guide also found we studied the economic costs and benefits of those interventions, and we found that the cost ratio was three to one, meaning every dollar you spent led to $3.10

worth of health benefits or benefits in total. So we do those economic analyzes of the cost benefit, the cost effectiveness of the interventions, and then we have the implementation consideration. So in the example of cognitive behavioral therapy programs in schools, you might want to think about confidentiality, the role of parents. Do you have professional

mental health professionals on staff in your schools? And those are all fleshed out that said we don't rank them based on those implementation considerations

we do in the prioritization

talk speak to

Okay, I'm going to just back up and cut that. Just drop that thought.

Can I add, here's my here's my question about this. So you know, again, reading through this some of the recommendations. It says,

recommended strong evidence,

recommended sufficient

evidence.

Etc, etc. Help, help our audience, distinguish between, between that, what's sufficient, what's recommend? You know, it's like, help us here.

Which one should we really be digging deep into, or which one should we forget about? Does that make sense?

No, I yeah, thank you. I think that when you look at the level of evidence, so the strong level of evidence, or the sufficient level of evidence,

I would say that is

the way the task force has examined the evidence and and looked at the strength of the recommendation. But from an implementation standpoint, from a community standpoint, when they come to the Community Guide and they're looking for an intervention to use in their community or their health system, if it's a if it's recommended, it's recommended and is good for use. And it's a level, it's the strong and sufficient are more reflective of the body of evidence that stands behind the recommendation, and that's important from a standpoint of how the Task Force operates. By.

But from a perspective of using the Community Guide, I think a recommendation

is, is a recommendation, and they're useful, and it's, you know, it's a trustworthy resource for communities to use that that's that's helpful. Tom, go ahead, yeah, I want to jump into this. So I think most people who come to the guide are passionate about something. Okay, so I have my passions around around community, around healthy, black pregnancies, around physical activity, and so I'm going to go in there and ask, what, what can I do to promote my passions for the community in

you not? I don't think they approach it. The average person says, What are the strong I'm going to do the strongest. It's, what's the How can I promote a particular thing, like very immunizations,

and so like, like Amy just said, yes, if it's the strength of evidence, frequently is how much research has been done and and so it either strong or sufficient. The the reader can be assured that

what was examined by the cpstf was, in fact, found to be effective.

Clarence, go for it, but you're on mute.

Someone asked a question because that that would both That was excellent, because that's that leads to the question I wanted to ask. I was looking at the at the substance abuse around youth, and what I saw was that it was evidence. It was the most of the studies were conducted in urban, I mean, in rural or suburban communities. Okay, so my question would be, then, where can I find those studies that would talk more about the urban area so that I would be able to be it would apply. It could it could apply to me more. I love this, you know, but I'm thinking that if we're going to use the guy we want to be able to, as we talked about a little bit earlier, just to kind of go to some things that might be a little bit more relevant to us. Is there a way for us to do that? Yes, there is. So I have two answers for that. One is, if it's listed as an evidence gap, what we're basically saying is there aren't studies. And you can stop there we've looked for you, or you can look at frequently, a breakdown that we do is urban, suburban, rural, very often. And you'll see kind of the table, and you can just pull out those studies that would be in the long version of our recommendation.

In the example of cognitive behavioral therapy in schools, we were looking at 81 studies. They're all in there for and summarized, it's if someone expert as yourself, wants to dig in the information is there on the evidence. I did also want to add that we have occasionally had insufficient evidence findings. A recent one was on multi tiered trauma informed school programs, meaning you have a universal component where you're reaching all children in the school, a tier two, mild symptoms. A tier three, more intensive and there, unfortunately, there was just a lack of evidence. It didn't mean that the intervention isn't effective. It meant that we don't have the body of work to help guide us. So the studies found reduced PTSD, but they weren't a rigorous study, so occasionally there will be insufficient, and that would be one where we just can't tell you.

So Clarence, I want to jump in here about this, and in the value of the evidence gaps section of refined and so what I would do is, with the program you were discussing, is write a letter saying, Dear my senator, there is an evidence gap here. Please ask the NIH or the CDC about funding programs that will help me understand how I can deal with substance use disorders in urban communities and so. So there's another value there, beyond the recommendation, it's the finding of evidence gaps, which is helpful for for community activists.

Thank you for that. That's wonderful. We should put that in our

in the show too. Yeah, exactly. So

can I add one piece on about that Clarence? Because,

you know, I, I would not want you to walk away and say I'm an urban community. This intervention is.

Not for me, what we're saying is what we know from the evidence

Stanton Shanedling:
So, you know, my feeling about this is, in this fast-paced world we're all involved with, it's almost like speed dialing—where to get information or one-stop shopping. It's like, don't tear your hair out. Click, and here you are. In this day and age, that's worthwhile too.

What I appreciate about it is confidence. You know that when you go to a guide like this, you can be confident there's truth behind it, good judgment, and solid guidance. To me, that's golden.

So first, I want to thank you all for the work you've put into this and your willingness to help get the word out. I'll tell you this—if as this proceeds there's any indication that we need to do another podcast to share more information, just contact Health Chatter. We'll get you back on. If there are updates or other developments, let us know. We'd love to have you back.

Allison, Amy, and in the background, Tom—and Richard Corderone, who's also provided background information as we've been talking—we'll definitely share that on our website for our listening audience.

Again, many thanks. We have some great shows coming up! Our next episode, actually being recorded this week, is on pediatric hematology, which will be really interesting as we dive deep into that subject. We're also looking at pharmacy deserts and even tackling a show on health insurance—all the different types of coverage. God help us as we try to break that down! I have a feeling that might turn into more than one episode.

Lots of great content ahead on Health Chatter, so keep listening, and everyone out there in Health Chatterland, keep health chatting away!