Change Master Projects Class of 2003

Applying Geographic Information Systems To Public Health

Prepared by: Allison Adams, B.S., Shannon Dunn, R.N., B.S.N., Michael Mattox, B.S., M.S.
Mentors: J. Lynn Hulsey, John Poundstone, MD

Full Report (pdf format)

As technology advances and we enter an age where computers are replacing paper, Geographical Information Systems (GIS) will move public health into the new millennium. GIS is a tool that uses maps and data to plot specific points on mapping software. Various states and some areas of Kentucky are already using GIS in public health, so our goal was to explore how this instrument was being used and learn new ways to apply it. Specifically, we wanted to learn how GIS could help local health departments improve the health of Kentucky’s citizens.

Our work led us on a quest to expand our knowledge of GIS, particularly how it worked and how it could be applied to public health. What we discovered was that this system has great potential to mobilize public health. We discovered that although it was technically challenging, it was also extremely versatile and potentially useful in many areas of public health. We demonstrated this through three mini-GIS projects that will improve public health when implemented.

The goal of this project was to make a case for using GIS in public health. To achieve our goal we used a five-part approach. First, we educated ourselves with respect to how GIS was being used around the country. Second, we learned how to use the software. Third, we demonstrated three ways GIS could be applied to public health. Fourth, we surveyed local health department directors to determine their awareness of GIS and their interest in beginning a program. Finally, we developed a resource guide for health departments interested in beginning a GIS program.

Evaluation of Two Public Health Performance Measurement Models

Prepared by: Joel Kent Barrett, BA, B. J. Weathers, RN, Shawn D. Crabtree, MSSW, MPA, BS, Stefanie P. Goff, MSN, BS, RN, Swannie Jett, MS, BS

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Public health has long been charged with the responsibility of health promotion and disease prevention within the communities. It serves both communities and the individuals within them by acting as a catalyst for change, maintenance, and improvement to the overall public health system. With this evolving and enormous task, public health departments must strive to assure quality and accountability to their key stakeholders—the community. Through utilization of performance measurement tools, local health departments have a framework for assessing and evaluating public health practice. In a proactive measure, the Kentucky Department of Public Health teamed with the University of Kentucky to research and pilot public health performance measurement tools in local health departments across the state. The project goal was to identify an assessment tool that could be used to establish a uniform set of standards of public health practice in Kentucky’s local health departments. Furthermore, the tool would be used to provide assistance in the establishment and/or maintenance of continuous quality improvement measures for public health departments throughout the state. The project was presented to the scholars of the 2003 Kentucky Public Health Leadership Institute (KPHLI) class to solicit volunteers to assist with the pilot project. Our KPHLI group began work on this project in June 2002. The primary purpose of our project was to provide assistance to Department of Public Health and the University of Kentucky by serving as consultants during the pilot process. We would also have the opportunity to evaluate the tools to determine if they had relevance to local public health practice, utilized resources wisely, and would be easy to implement. The two models were piloted and tool evaluations were conducted. Those evaluations along with input from the KPHLI scholars were presented to both the Department of Public Health and the University of Kentucky for further analysis and possible implementation.

Growing Healthy Kids in Kentucky: A Look at Advocacy, Leadership, & Adolescent Attitudes

Prepared by: Lana Clevenger-Hunt, MA, MSW, Teresa H. DeLancey, BA, MS, Hazel Forsythe, PhD, RD, LD,
Beverly Gibson, Katherine Rack, BS, Trina Winter, BA
Mentors: Linda Grace Piker, MS, RD, LD, Janet Tietyen, PhD, RD, LD

Full Report (pdf format)

In the last 25 years, the prevalence of overweight and obesity in the United States has increased dramatically. Overweight and obesity substantially raise the risk of illness from high blood pressure, high cholesterol, type 2 diabetes, heart disease and stroke, gallbladder disease, arthritis, sleep disturbances and problems breathing, and certain types of cancers. Not only are overweight children often subjected to negative stereotypes, prejudice, discrimination, and low self-esteem but they are also 10 times more likely to become obese adults. Annual U.S. cost related to obesity is currently 117 billion dollars.

In response to the epidemic of overweight children in Kentucky, the Office of Lieutenant Governor Stephen L. Henry MD created the Task Force on Childhood Nutrition and Fitness, which issued a position paper calling for public policy changes to improve school nutrition and physical activity. Proposed legislation was defeated in Spring 2002 and again in Spring 2003.

In Fall 2002 a conference was cosponsored by Kentucky Cooperative Extension Service and Kentucky Department for Public Health to encourage leadership and advocacy around improving nutrition and physical activity in the public schools. This Change Master group project determined how participation in this conference translated into action plans by participants.

Additionally, input was collected from adolescents on their perspectives regarding healthy food choices and regular physical activity. The goal was to involve them in creating an identifiable message or image that would encourage other young people to make healthy lifestyle choices. This was accomplished through participation in focus groups and a competition.

A second conference is already being planned to facilitate leadership and advocacy in adolescents to promote nutrition and fitness. Additional focus groups with young people, activities with adults, and projects to build healthy communities throughout Kentucky are also being planned and will build on the work documented by this Change Master group. The Change Master group project findings are published in this report with the hope that continued efforts to improve nutrition and fitness levels for Kentucky’s children will benefit from this process evaluation and progress report.

HANDS Across Kentucky

Prepared by: Brenda Chandler, BA, C. Renee` Knight, MSW

Full Report (pdf format)

Are you or someone you know a new parent? Could you use an extra pair of HANDS? Although there isn’t an instruction manual for newborns or toddlers, support for new parents can be found across all 120 Kentucky Counties in a new and exciting program called HANDS. So, you may be asking, ‘What is HANDS?’

HANDS (Health Access; Nurturing Development Services) is a voluntary, home visitation service for first-time parents. It is part of the KIDS NOW Early Childhood Initiative passed by the 2000 General Assembly. The HANDS program reaches out to parents during the prenatal period or within three months after the birth of the child. The goal of HANDS is to build upon parents’ strengths to improve the health and development of Kentucky children over the first two years of life. There are no income guidelines, and the service is free to the family.

New parents often have many questions or reservations about participating in a home visitation program. Traditionally, home visitation is associated negatively with social service programs. In order to break this stereotype our KPHLI team chose to create a visual account of what parents could expect from HANDS, specifically focusing on what they could expect from a HANDS home visitor. The promotional video reflects actual home visitors from across the state interacting with several HANDS families. Our goal is to show the positive aspect of home visitation and spark an interest in receiving support through HANDS. Parents may find that they also could use a second pair of HANDS.

A 21-minute promotional video (16 minutes English; 5 minutes Spanish) has been developed introducing the HANDS program. The video covers all the aspects of the original design, which include: addressing questions regarding having a baby/toddler, HANDS introduction, addressing questions about HANDS, Parent Visitor introduction, Home Visitor introduction and testimonies of participating HANDS families. The video will be available for all the local health departments along with extra copies for community agencies.

HANDS currently serves 6500 families, while our goal is to reach all first-time parents in the Commonwealth who are identified as in need of services. Our KPHLI team anticipates increased HANDS enrollment and participation due to the positive, promotional account.

Kentucky Public Health Nurse Competencies
2003 Balderson Leadership Project Award Runner-Up

Prepared by: Carla Baumann, RN, MSN, Carolyn J. Beaty, RN, BSN, Ruth Davis, RN, MSN, Joy Hoskins, BA, RN, Jennifer Hunter, RN, BSN, Kimberlee J. Vanderbilt, RN, BSN, Delena Young, RN, BSN
Mentor: Margaret Stevens, RN

Full Report (pdf format)

Today’s public health workforce faces many new challenges that did not exist a half century ago. The American population has undergone changes in lifestyles, chronic diseases, and communicable diseases. New challenges include bioterrorism and emergency preparedness. A competent workforce is essential to rendering public health services in this ever-changing environment. The Kentucky Department for Public Health (KDPH) is working to assure competence among public health professionals throughout the state’s local health department system. KDPH’s Training Branch initiated Transition Training in Fall 2000 that included:

  • Public Health 101
  • Core Functions and Essential Services of Public Health
  • Developing, Implementing, and Evaluating Health Department’s Disaster
  • Emergency Management Plans
  • Documentation Can Be Your Best Friend or Your Worst Enemy

Along with these educational offerings, nurses formed a task force to discuss job description changes. The progress of this task force was significant, but was diverted by more urgent efforts to provide training in disaster preparedness and bioterrorism.

In April 2002, seven participants in the Kentucky Public Health Leadership Institute (KPHLI) expressed an interest in defining nursing competencies for local health department nurses. This Change Master Project group was comprised exclusively of public health nurses. Dialogues were initiated among the Change Master group, the Department for Public Health Local Personnel Branch and Training Branch, and the Department for Public Health Chief Nurse to review and discuss the accomplishments and current status of the task force. Proposed new job descriptions were examined. A review of nursing and public health literature was conducted.

Several group members attended the 2002 Kentucky Department for Public Health Fall Conference presentation by Kristine Gebbie, Dr.P.H., RN. Gebbie, a nationally recognized public health nurse leader who has made significant contributions in the area of public health nurse competencies as it relates to the Ten Essential Public Health Services, addressed public health workforce competency in a post-September 11 world.

The final product of this group’s work is the development of the “Registered Nurse Initial Employment Competency Validation Checklist” (Checklist). This Checklist is designed as a tool to assure uniform competencies among newly hired public health nurses. The Checklist includes Core Functions of Public Health activities and links each function to one or more of the Ten Essential Services of Public Health.

A presentation regarding nursing competencies was delivered in February 2003 to the local health departments’ Directors’ of Nursing and Supervisors. The Checklist was favorably received, but evaluations revealed a need for implementation training. In April 2003, the Checklist and the final report were presented at the KPHLI graduation summit. Future plans include several presentations to local health departments and nursing faculty throughout the state. A Public Health Nursing brochure and poster presentation has been developed to further promote this project.

A Pilot Project Using Non-Traditional Community Partners For Risk Communication
Risk Communication Training for Non-Clinical Health Department Staff and County Extension Staff in Times of Disasters

Prepared by: Vivian Lasley-Bibbs, MPH, Phyllis Skonicki, MA, James Donofrio, Ph.D, Richard Wellinghurst BLS

Full Report (pdf format)

Within the United States, the potential for the use of weapons of mass destruction (WMD) by terrorist has become a major national security concern. Continuing fears of attacks on U.S. soil haunts Americans. The recent events both abroad and within the United States have left an unsettling aura of stress, confusion, anger, frustration and bitterness. Organizations and agencies are realizing that they need to collaborate and partner with like agencies and organizations in addressing the issues of homeland security and bio-terrorism. In Kentucky there are 120 counties and in each of these counties there is a public health department and a county extension office. Both of these agencies have a common goal of responding to the public’s need in health and other services. One might not readily think of a partnership between the Kentucky Department for Public Health and the Kentucky Cooperative Extension System as one that would be logical and feasible, however the Cooperative Extension Service has a proven foundation in delivering disaster education. Most public health departments have disaster plans that clearly define what clinical personnel will be doing, but the non-clinical personnel’s task have been poorly defined. This tabletop exercise was designed to cross train extension personnel and public health non-clinical personnel to understand each other’s responsibilities, to blend the resources to best respond during a disaster, and test the ability to disseminate risk communication to the community. Without exercises like this one, a community will not have people who are properly prepared to adapt plans and be creative in a time of crisis.

Walk in My Footsteps: A Template for New Employee Orientation and Job Shadowing

Prepared by: Alicia Bragdon, R.S., Clayton Horton, R.S., Sharon Burke, Mark Reed, R.S., MPA, Lisa Daniel, MPA, Veronica Stallings
Mentors: J. David Dunn, MPH, Sc.D., R.S., Angela Woosley, RN, BSN

Full Report (pdf format)

Project Deliverables (pdf format)

An examination of the state-administered personnel system for Kentucky local health departments reveals that each health department should include the employee receiving a handbook pertaining to the LHD operational procedures and guidelines, as stated in the Administrative Reference for Local Health Departments. However, no template for a standardized manual exists. “Walk in my Footsteps,” a two-part concept, seeks to develop a uniform employee orientation and job-shadowing model for use by Kentucky local health departments.

The templates created in this project are designed to assist and encourage local health departments to initiate their own “customized” employee orientation manual, and an in-house job-shadowing experience which can conceivably be effective for all employees—not just specifically new hires. The goals of this change masters project are to (1) develop an adaptable employee training manual template that meets all regulatory requirements and includes necessary information for new hire orientation; and (2) to develop an employee job-shadowing template for health professionals to use as a guide, in leading both new hires and “seasoned” employees alike, through a job-shadowing experience. The objectives of this project, once implemented, are to (1) help address a perceived internal identity crises; (2) to improve the local health department employee’s understanding of the overall functions of the department as a public health institution; (3) to increase the professional success, job satisfaction, and productivity of public health professionals within the local health department; (4) to promote cohesion and a spirit of mutual cooperation, trust and respect among local health department employees; and ultimately, (5) to help strengthen the field of public health through the professional growth and retention of local health department employees.

The methodology exercised to achieve our objectives included examination of existing employee manuals, researching statues and regulations, and correspondence between group members and mentors. The resulting project includes an orientation manual template and a job-shadowing template.

This project embraces one of the ten essential public health services—that of assuring a competent public and personal health care work force (Rowitz, 2001, 95-96). Participant gains are likely to include increased self-confidence, heightened “inside” knowledge of the organization, a greater sense of personal worth, and greater employee knowledge, skills, and abilities.

The finished template included in the manual contains essential employee-related issues and programs. Some examples include internal and external chains-of-command, insurance, and confidentiality statements. The job-shadowing instrument provides a guide to lead employees and trainers through the job-shadowing experience, as well as providing a tool for program evaluation.

This change masters team is excited about the possibilities of a standard orientation manual and a job-shadowing program, as the two relate to both employee retention efforts and a greater sense of professional identity. As such, the authors of this document recommend that future KPHLI scholars consider as their change masters project, actual implementation and follow-up on the hybrid model presented here.

Training Wheels

Prepared by: Clyde Bolton, BGS, MSA, Sheri Erwin, BA, Vivian Gaines, Kathy Hembree R.N., BA, Traci M. Powell, P.E., BSCE, MSCE, Russ Rakestraw

Full Report (pdf format)

State audit and assessment processes have consistently revealed over the past several years that public health employees lack sufficient uniform training necessary for them to deliver quality services across the full spectrum of public health. Based on this information, in-services with leadership and the numerous years of combined experience of the work group, we began to explore the development of a more accessible statewide training program. The Change Master Group decided the most efficient and effective solution was to develop a program of onsite training delivery for health departments and their partners throughout the state. The Group named the project “Training Wheels.” The creation of a mobile training delivery program would assist health departments statewide in receiving consistent, affordable and convenient training. The Training Wheels program would enable staff to consistently formulate, promote, maintain, implement, conduct and execute policies, plans and programs to safeguard the health of Kentuckians and protect overall public health.

The Change Master group developed a survey assessment tool, which established that mobile computer training would assist with meeting training needs. Based on the evaluation of the results of the assessment, we developed three (3) computer curricula, which included a pre- and a post-test for each participant. The group chose basic computer training as the project focus due to the fact computer operations support the entire spectrum of public health services. This project is being piloted in five locations including an urban area, a rural area and a geographically diverse eleven (11) county district to provide comprehensive feedback. Following these pilots, results were evaluated and minor revisions were made. These pilots revealed that this concept would be effective and result in Kentucky health care workers being better trained.