Change Master Projects Class of 2002

A District-Wide Community-Based Bioterrorism Response

Prepared by: Linda M. Foley, MS, Judy G. Gilmore, BSN, Mark E. Sears, BS and Daniel T. Troutman, MPA
Mentors: W. Paul McKinney, MD and Timothy W. Stump, MPA

Full Report (pdf format)

It is necessary for health departments to have a system in place to detect and respond to acts of bioterrorism. Generally, by developing a comprehensive plan that is effective yet practical, an accurate and timely response will save lives, curtail epidemics and conserve resources. Specifically, our project goals included: implementing a community-based response plan that recognizes possible causative agents of bioterrorism; eliciting participation from the appropriate agencies; increasing disease surveillance; and educating health department employees, responders from other agencies and the public. It was assumed that an act of bioterrorism is possible in the United States and that health departments would take the lead role in responding to such acts. It was also assumed that an act of bioterrorism would have serious ramifications that may affect the entire population of a community. Additionally, health departments and communities alike are not prepared to deal with the consequences.

Key stakeholders included: the Federal Bureau of Investigation (FBI); the director of the health department; the medical community including hospitals, doctors, nurses, veterinarians, pharmacists, and other health care providers; public safety, including ambulance, fire, and police; government officials; the media; and public works - utilities such as power and water.

As a result of establishing and strengthening community partnerships, educating responders and the public, and increasing our surveillance for diseases that could be possible indicators for bioterrorism we are protecting our communities at the highest level possible.

Fluoride Varnish Pilot Program

Prepared by: C. Ann Bray, AA, Ryan O. Irvine, RDH, BS, and Meloney Russell, BSMT
Mentors: James C. Cecil, III DMD, MPH and Linda Grace Piker, MS, RD, LD

Full Report(pdf Format)

The fluoride varnish project will initiate and establish oral health programs in the local health department. Dental screening, application of fluoride varnish, and oral health education are preventive measures to reduce the incidence of Early Childhood Caries. This project will broaden the ownership for improving dental access beyond the dental professional by involving trained non-dental professionals. Routine dental care along with proper oral hygiene could results in a decrease of dental caries and loss of teeth. Proper oral hygiene must be associated with good health.

Fluoride varnish is a simple, safe, painless, cost affordable compound that can be applied to children’s teeth by trained non-dental professionals. The varnish has been approved by the Federal Drug Administration for use in the United States since 1997. Early results are encouraging in a number of states that are currently using fluoride varnish.

To meet our objectives, time was spent researching and reviewing models from other states. Planning was done by effectively using those models. After sending written letters and making presentations to the dental and nursing boards, they had no objection to non-dental professionals applying fluoride varnish, as long as the professionals completed a training course. This course would include how to screen children, apply varnish, and make proper referrals. The WIC program agreed that fluoride varnish could be administered during a WIC visit as long as application was within the provider’s scope of practice and did not require WIC funding.

Assessment of the survey that was sent to local health department directors revealed a need for this program especially in rural areas for children of high risk due to socioeconomic status. Finding dentists that accept these children as patients, transportation issues, and reimbursement problems are a list of factors that health departments must face.

This change master project prepared an innovative pilot project model of preventive oral health care to be used in the Kentucky Public Health setting for Early Childhood Caries. The Kentucky KIDS’ SMILES fluoride dental pilot project will begin in 2003 funded by KIDS’ NOW. The funds will be used to select pilot sites, provide dental screening, purchase dental fluoride varnish, oral health education, follow up of dental screening, and program evaluation. The fluoride varnish pilot project can make a difference in the oral health of Kentucky children.

Health Access: Nurturing Development Services, Too

Prepared by: Russell W. Briggs, MBA, CHE, Curtis Rowe, MPH and Bertie Kaye Salyer, MA, AME
Mentors: Bonita A. Bobo, RN, IBCLC and Dr. David D. Gale

Full Report (pdf format)

More than 15,000 babies are born in Kentucky every year to first-time parents. Many of these parents are ready to accept the new responsibilities of their new roles. Other parents, however, may face burdens of everyday life that affect how they are able to care for their new baby. These burdens – staying in school, finding employment, caring for the baby, assuring well-child visits, and making sure the child is immunized on time – all are situations for which the new parent may need a helping hand. The Health Access Nurturing Development Services (HANDS) program offers new families the tools for becoming the best parents possible.

Poor health behaviors, high teen pregnancy rates, substance abuse (including tobacco use), lack of preparation for child rearing, and lack of knowledge of the health care system may hamper a new parent. Kentucky’s HANDS seeks to address these challenges for first time parents.

HANDS is part of Governor Paul Patton’s Early Childhood Initiative, KIDS NOW, passed by the 2000 general Assembly. It is under-written by the Kentucky Tobacco Settlement. HANDS currently serves 4900 new families. The goal is to reach first-time parents in the Commonwealth. The mission statement reads: Kentucky’s HANDS supports families as they build healthy, safe environments for the optimal growth and development of children. Goals of the program are positive pregnancy outcomes, optimal child growth and development, that children live in healthy, safe homes, and that families make decisions that enhance long term independence over meeting short-term or immediate needs. Early evaluation would indicate that the program is on its way to achieving goals. In HANDS families we have seen changes in rates of abuse when compared to comparable non-HANDS families and improved birth outcomes.

While first time, or new families, face a number of burdens, experience tells us families with subsequent births face many of the same burdens, as well as others that are unique to multiple child households. In addition, grandparents are taking on the nurturing role of families as parents return to their educational activities or the work force.

Therefore, the purpose of HANDS, Too is to propose that the benefits of the HANDS home visitation program for first time parents be expanded to all families. The proposal that follows will support the need and anticipated outcomes.

HIPAA in Kentucky’s Local Health Departments

Prepared by: Teresa Cox, C. Gail Timperio, B.S., Jan Hatfield, R.N., Kathleen Croley, B.A., Margaret Stevens, R.N. and Melody P. Hamm
Mentors: Debbie Acker, R.N. and Juliann G. Sebastian, ARNP, PhD, FAAN

Full Report (pdf format)

How can we help assure that Kentucky’s local health departments are HIPAA compliant in regard to patient privacy? This was the question our Kentucky Public Health Leadership Institute workgroup chose to address. Initial work centered predominately on expanding our own knowledge of the Health Insurance Portability and Accountability Act of 1996. We then consulted with health department administrators across the state to determine what would be the most logical way to assist in their compliance efforts. Our idea to generate a HIPAA Checklist geared toward health department operations was met with universal approval.

The Checklist was developed utilizing knowledge obtained regarding HIPAA patient privacy regulations and attempting to apply these regulations to our clinic operations. Our group envisioned a “walk-through” of clinic operations in a typical health department setting. We then applied the HIPAA regulations step-by-step throughout the process. We also kept in mind the administrative activities involved in the overall operation of the health department. Thus we considered not only patient contact, but also administrative functions such as account billing, faxing, contracts, employee training and information systems.

We piloted the checklist in one Kentucky health department where no employee was involved with its development. This pilot resulted in favorable reviews by both the agency Public Health Director and the Public Health Nursing Supervisor. Both agreed that it served to raise awareness regarding HIPAA patient privacy issues, while educating staff about the regulation. Items marked “NO” on the checklist will be addressed and positive changes will be made.

If our efforts with this project serve to raise the level of HIPAA awareness in Kentucky’s health departments and throughout public health, we have achieved our goal. While no health department will be in perfect compliance, attempts to address shortcomings and protect the patient’s private health information are the desired end result.

Implementing a Public–Private Community Health Partnership

Prepared by: Debra K. Armstrong, MSW, MP, Linda H. Linville, Ph.D., Joan Buchar, MSEd,
William P. McElwain, MD, MPH, Steve Davis, MD, Melody Nall, BHS and Sandy Fawbush, RN
Mentor: F. Douglas Scutchfield, MD

Full Report (pdf format)

The public and private sectors are increasingly recognizing the importance and value of combining strengths to form mutually beneficial partnerships that address public health problems. Because the complexity of health problems, the sky rocketing costs of medical care and the expanded roles of public health agencies, it has become necessary to utilize health care resources in wise and economic ways. One novel and growing approach to a solution for the aforementioned situation, is public-private partnerships. These are the joint efforts of a public profit or non-profit organization working with private hospitals, clinics or individual providers. The literature sites many examples of public-private partnerships at national, state, and local levels. Groups such as the World Health Organization, Centers for Disease Control and Prevention, Human Resources and Services Administration promote and demonstrate successful examples of partnerships between the public and private sectors. States and local communities have demonstrated a need for and success in implementing such health partnerships.

The Change Master Project, Implementation of a Public Private Community Health Partnership, elected to develop a public-private partnership that focused on low birth weight babies and prenatal health issues. Risk Factors such as smoking during pregnancy, low maternal weight gain, and low pre-pregnancy weight contribute to approximately two thirds of all low birth weight infants.

The success of national and state partnerships provided an impetus to develop and implement the following four objectives:

  1. The establishment of a public-private partnership that would identify a health concern;
  2. The development of an intervention to address prenatal health education through a partnership and community health efforts;
  3. The conduct of a collaborative program that provides expectant mothers with free educational opportunities; and
  4. The linking of expectant mothers with needed community, family, health and social services.

The partnership between the Franklin County Health Department and private obstetric providers began by surveying patients’ interests and was followed by the development of a series of prenatal health education classes. The physician practices provided access to their patients, conducted the survey and encouraged pregnant women to participate. The local health department coordinated the curricula and facilitators. Community interest in the project led to an expansion of the partnership and the commitment of time and resources from additional organizations and businesses.

In addition to meeting the objectives of the project, the criteria for a successful partnership as identified by public health experts were met. This Change Master Project demonstrated that public-private partnerships can be a model for public health initiatives.

Marketing Plan for Public Health
2002 Balderson Leadership Project Award Runner-Up

Prepared by: Genie Prewitt, RN, BSN, Gracia Pruitt, Lisa Pollock, BS, Janet Tietyen, Ph.D., R.D., L.D., and
Judy McCrackin, RN, MSN, ARNP
Mentors: John Poundstone, M.D. and Jim Rousey

Full Report (pdf format)

Public health currently faces unprecedented challenges. It is no longer enough to protect the health of the public. The public health community must work to increase public awareness of the role it plays in our society and to garner support for this role. The Kentucky Health Department Association (KHDA) requested a marketing plan of scholars in the Kentucky Public Health Leadership Institute (KPHLI) to address concerns about the image of local health departments and to develop a unified promotion campaign for public health services in Kentucky. Local health departments are thought to be a service only for the limited-resource segment of the community rather than an organization to protect the health of the entire community. In April 2001, our group began work on this project. The project goal is to develop a marketing plan for use by local health departments to promote Kentucky Public Health. The primary purpose of the marketing plan is to raise public awareness about the services provided by public health organizations and professionals. Further, the plan should encourage public support for funding to continue and expand public health efforts. Finally, the marketing campaign will educate and motivate Kentucky residents to adopt healthy behaviors. A slogan and logo, “Working for You, Kentucky Public Health”, was developed and made available for review by key stakeholders. Sample marketing kits were developed and presented to the key stakeholder organization for review. This design and a presentation of the project were presented to the KHDA/Kentucky Public Health Association business meeting in late March 2002. Sample marketing materials and the final project report were presented at the April 2002 KPHLI graduation summit.

Public Health Career Marketing In 9th Grade

Prepared by: Gregory D. Brewer, BBA, Tracy G. Pierceall, RN, Florence G. Pittman, RHIA, and Tina Rodgers
Mentors: Marcia Stanhope, RN, DSN, FAAN and Angela Woosley, RN, BSN

Full Report (pdf format)

Project Deliverables (pdf format)

Statistics prove that many public health employees are leaving the workforce and there are few adequately trained replacements; thus there is a shortage in public health workers. The goal of this project is to increase the awareness by development of a multi-media CD to spark interest in public health in students across Kentucky.

A public health informational survey was conducted with ten percent of the ninth grade population in Marshall and Bath counties in Kentucky participating. The results of this survey reflected inappropriate public health career awareness and this prompted the creation of this project’s interactive multi-media CD that could be utilized throughout the Commonwealth of Kentucky.

Collaboration between public health, Murray State University Technology Department, Marshall and Bath County School Systems and Area Health Education Centers (AHEC) occurred through the development of this CD. This coordination of agencies created a mutual understanding of the necessity for increased public health career opportunity awareness.

The availability of this educational tool should peak interest in the target age group. The long - term goal of this educational endeavor is to guide students into public health careers ensuring the future of the public health workforce. This goal directly relates to the assurance of a competent health care workforce, which is the # 8 essential public health function.

Our innovative approach used the development of mixed media educational tools in providing an effective method of reaching the age group selected, which is related to #10 essential public health function. Our choice of this educational tool was deemed appropriate to this age group due to availability of computers in the majority of school settings and this method peaking their interest.

This educational tool was not only a project sponsored by health departments/Kentucky Public Health Leadership Institute, but included collaboration with other community agencies, which not only addressed public health careers, but included health education topics, which can be used to inform, educate and empower individuals relating to the # 3 essential public health function.

It is the hope of this change master project group that a similar endeavor will be continued to further the development of the educational tool and to measure the impact of this project.

Technology in Environmental Programs

Prepared by: Matthew T. Rhodes B.S., R.S., Heather Egan B.A., R.S., Dan Roller B.B.A., R.S and
Gary Coleman, Jr. B.A., R.S.
Mentors: J. David Dunn, M.P.H., Sc.D., R.S and Judy Nielsen B.S., R.S.

Full Report (pdf format)

The Jefferson County Health Department’s Division of Environmental Health and Protection is comprised of seven program areas, which regulate up to thirty health services. The daunting task of providing service to the community is a daily challenge. Moreover, with an ever-growing and diversified community our challenges continue to expand. The community and its citizens expect prompt and courteous service and set the benchmark to which we strive to achieve. Therefore, in this changing age, it is imperative that we also change to meet client demands. A need for upgrading the division’s technological status is clear. The private sector, as well as other health departments, has set a good precedent.

Formulating a plan to implement the project was one that would take some time. After selecting this change master project, group members were faced with the task of clearly defining the scope. A streamlined focus was essential to ensure results. The knowledge that public health information is neither easily available nor readily disseminated acted as a catalyst in the decision making process. Therefore, creating a Jefferson County Environmental Health Website was chosen as the group project. The website would allow anyone to access health information anytime and provide the division with a forum for disseminating sound and accurate information. The site was also intended to act as a model for other communities to utilize when establishing a website.

Stakeholder identification is imperative to any project, because their buy-in is crucial to the success. Therefore, the group began a process of listing individuals and/or positions that would influence the project. The identified stakeholders are Information Systems personnel, inspectors, medical personnel, administrators, citizens, politicians, schools, etc.

Following stakeholder identification, the group decided that assessing the client need was necessary. A non-scientific survey was prepared and administered to a cross section of the public. Individual respondents ranged from those that work closely with the health department to others who could not recall any interaction with the health department. The results from the survey were queried and utilized to establish material to be included on the website. A client need for the information was also confirmed through application of the survey. Without disagreement, an overall buy-in was gained from the surveyed stakeholders.

Through further research, the group discovered that an existing website is in place. However, little attempt has been made to update information. Administrators agree that the project is worthwhile and have expressed a buy-in, but a limitation of resources (personnel and monetary) was identified as an obstacle to project implementation. With proper marketing a website can be utilized and viewed as necessary. An evaluation tool will allow the group to show substantiated results confirming usefulness. The use of the website will be evaluated by the number of visitors who log on and feedback from a voluntary survey.