Dr. Alison Cuellar
Appearances
Health Chatter
Preventive Services Task Force Community Guide
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.
Health Chatter
Preventive Services Task Force Community Guide
It also comes in one-pagers. It comes in multiple pages. I think it's really a matter of engaging with the website.
Health Chatter
Preventive Services Task Force Community Guide
I think your question makes a lot of sense. And I think the community guide addresses a piece of it. So for... When we do an evidence review, we follow it with an economic review.
Health Chatter
Preventive Services Task Force Community Guide
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.
Health Chatter
Preventive Services Task Force Community Guide
So we do those economic analyses of the cost benefit, the cost effectiveness of the interventions, and then we have the implementation considerations. 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.
Health Chatter
Preventive Services Task Force Community Guide
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.
Health Chatter
Preventive Services Task Force Community Guide
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.
Health Chatter
Preventive Services Task Force Community Guide
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 and summarized. If someone, an 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.
Health Chatter
Preventive Services Task Force Community Guide
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.
Health Chatter
Preventive Services Task Force Community Guide
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.
Health Chatter
Preventive Services Task Force Community Guide
So I am over in the land of universities and I encourage my faculty to use this resource to help them get up to speed on what is known and where if they want to test new interventions with their community partners, kind of what is the jumping off point? I think Amy can speak more directly to how this is used in calls for proposals and evaluation.
Health Chatter
Preventive Services Task Force Community Guide
So depending on the intervention, we'll sometimes even use international studies, but it depends on the body of evidence and what the expert group that's working on that particular topic feels are sort of like conditions, settings, and interventions. And if we have 81 studies, we don't have to go back very far.
Health Chatter
Preventive Services Task Force Community Guide
We have to watch our bandwidth and resources in terms of how frequently we can go back to any particular intervention, but this is a very dynamic space and the ways in which we're tackling some of our public health problems today are different from how we might have done it 20 years ago. So we're guided by the what is it we're studying and what seems like a comparable set of interventions.
Health Chatter
Preventive Services Task Force Community Guide
Well, we're constantly, continuously looking at different topics and they're in different stages of review. So we're prioritizing the next ones. We get a theme, cognitive behavioral therapy in schools. The program staff go and they say, well, there's kind of these two different types along with our expert group, universal and targeted therapy.
Health Chatter
Preventive Services Task Force Community Guide
then we that's actually ends up making we're going to do two separate reviews so it it's somewhat organic so it'll depend on the complexity of the topic how quickly we can do the review
Health Chatter
Preventive Services Task Force Community Guide
I want to come back to something Clarence said earlier, because to me, when communities are thinking about, for example, their opioid settlement funds, this is the perfect time to be going to the community guide.org and thinking about the many ways and populations for whom you could start to tackle substance use prevention at different stages.
Health Chatter
Preventive Services Task Force Community Guide
Turn that one to Amy, perhaps. Because the community guide relies on the existing evidence, much of which needs to be peer-reviewed and published, we're not the ones out at the front end suggesting new and novel things, right? We're solidly in the world of what is known, and that's our sweet spot. But Amy, do you want to describe how it might pertain? Yeah.
Health Chatter
Preventive Services Task Force Community Guide
One way we do it is our annual report to Congress.
Health Chatter
Preventive Services Task Force Community Guide
And we highlight work that we do each year. So in some years, we focused on, let's say, a rural community and sort of the theme of rural communities. One year, the thematic locus was around children's mental health. I think there's a lot of areas where we have agreement, where there's challenges that we would like to address together. And so there's definitely that communication.
Health Chatter
Preventive Services Task Force Community Guide
It's also the guide has lots of friends, as I said, through its liaison organizations, and they too help pick up the recommendations and turn them into practice. The guide isn't telling communities what their priorities are. are or should be. It's given that a community has decided it wants to tackle a given topic. Here's some places where it can start.
Health Chatter
Preventive Services Task Force Community Guide
We just, we want to accelerate that and help make it possible.
Health Chatter
Preventive Services Task Force Community Guide
It's a deal, Clarence. We can definitely provide that to you.
Health Chatter
Preventive Services Task Force Community Guide
Yeah, Alison, 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.
Health Chatter
Preventive Services Task Force Community Guide
So the members of the task force have backgrounds 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.
Health Chatter
Preventive Services Task Force Community Guide
So that means they're broadly targeted. The audience is communities, schools, public health departments, employers, the military, pharmacies, integrated healthcare, faith-based organizations, and related groups. So it's more expansive 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.
Health Chatter
Preventive Services Task Force Community Guide
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 CPSTF is an important part of that structure are the liaison organizations. There are 32 of them.
Health Chatter
Preventive Services Task Force Community Guide
They're organizations and federal agencies, a wide range. So Indian Health Service, Department of Veterans Affairs, Armed Forces, NIH, the Association, the... Back up.
Health Chatter
Preventive Services Task Force Community Guide
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 health departments. I 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.
Health Chatter
Preventive Services Task Force Community Guide
They help select and prioritize which interventions we're gonna 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.
Health Chatter
Preventive Services Task Force Community Guide
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 community from the nation, right, through the Federal Register. We say, we want your input. We go through our liaisons. We do extensive outreach.
Health Chatter
Preventive Services Task Force Community Guide
And we're guided by Healthy People, the latest iteration of information in Healthy People, 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 place ourselves within the healthy people information, I would say. Amy, did you want to add to that?
Health Chatter
Preventive Services Task Force Community Guide
Oh, I love that question. And I'm excited to say that I think the community guide can help. 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 youth, let's say.
Health Chatter
Preventive Services Task Force Community Guide
Then the community guide can help you understand the evidence of 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 a broad range of health challenges, obesity, mental health, smoking cessation, HIV prevention, anti-bullying, just as examples.
Health Chatter
Preventive Services Task Force Community Guide
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.
Health Chatter
Preventive Services Task Force Community Guide
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 what? Hmm. then we'll have recommendations or just information about implementation considerations.