Summary

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.

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 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.
• The HIAs Provided Needed Data Which Described Impacts on Health
• Both HIAs Found Impacts on Health Determinants
• Both HIAs Highlighted Programs’ Relationship to Priority County Topics
• Both HIAs Strengthened Existing and Fostered New Collaborations Among Government Agencies
• The HIAs Provided Needed Data Which Described Impacts on Health
• Both HIAs Helped Change Institutional Mindsets and Increase Focus on Health

Recommendations

Based on our findings, we propose the following recommendations for HIEC to consider in its future work.

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.

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.