Change Master Projects Class of 2004

A Toolkit To Help Local Health Departments Increase Outreach To Males

Prepared by: Nazenin Assef, MS, Christine Hanshaw, RN, BSN, CDE, Ronald J. Herald, RN, MSN,
Melanie Napier, BS, M. Stuart Spillman, RS
Mentor: Russ Rakestraw

Full Report (pdf format)

Project Deliverables Brochure (pdf format)
Information (ppt)

Males are dying, on average, six years earlier than their female counterparts. It is time for males to take charge of their health. “Widow Busters”, a KPHLI team, has undertaken the task of promoting male health to the general public and local public health departments. According to a CDC report, women's life expectancy rose from 79.7 to 79.8 years, while men rose from 74.3 to 74.4 years. White women have the highest life expectancy, 80.2 years; followed by black women (75.5 years), white men (75 years) and black men (68.6 years). "Men in all socioeconomic levels are doing poorly in terms of health," writes David R. Williams, PhD, MPH, with the Institute for Social Research at the University of Michigan, Ann Arbor.

Males have higher death rates than women for 15 leading causes of death except Alzheimer's disease. Male’s death rates are at least twice as high for accidents, murder, suicide, and liver disorders. Males are slightly more likely to get high blood pressure or cancer, and twice as likely to consume more than five alcoholic drinks a day. Males are more likely than women to be imprisoned, homeless, or to use illegal drugs. Minority males are more likely to live in poverty. While 17% of white males are uninsured, 28% of black males and almost half of Hispanic males have no insurance. Also, females are twice as likely as males to visit a doctor each year. When males do see a doctor, the visits are shorter and are less likely to include advice on lifestyle changes that promote better health.

Work environment also takes its toll; males tend to work in more dangerous jobs than women, and males represent 90% of job fatalities. Stressors and negative emotional states created by poor working conditions can lead to poor sleeping patterns, decreased physical activity, substance abuse, and overeating, all of which negatively impact male’s health.

In our culture, males are expected to be strong and silent, especially when it comes to their health. This leads to apathy among males and healthcare providers regarding male health. In order to change attitudes concerning male health our KPHLI team developed a package for distribution to the general public and public health departments.

The package includes a 60 second Public Service Announcement (PSA) video for distribution to local television stations, a 15 second and a 30 second audio PSA for distribution to local radio stations and a printed press release for local newspapers. Also included in the package is a CD containing a PowerPoint presentation, a local health department (LHD) self-assessment tool, and a brochure of recommended male health screenings. This package will be distributed to all local health departments in the Commonwealth for use in their promotion of male health. The “Widow Busters” team will perform additional distribution of video and audio materials across the Commonwealth.

Currently one-half of the population of the United States is underserved in healthcare; the goal of this project is to begin the process of alleviating this inequity, through promotion increased awareness of male health in the general population.

An Electronic Cancer Screening Follow-up System

Prepared by: Sheila Atwell R.N., B.S.N., Randy Gooch, B.S., Sandy Good, R.N., M.S.,
Mentors: Margaret Stevens, R.N., Paul McKinney, M.D.

Full Report (pdf format)

Project deliverables (ppt)

National 25-year trends in age-adjusted mortality rates, for breast and cervical cancer, show a decline in mortality largely due to more widespread and effective screening among women. The state of Kentucky is closely aligned with the nation in its recent age-adjusted mortality rate for breast cancer, but exceeds the national rate for cervical cancer mortality.

In 1990, Congress passed the National Breast and Cervical Cancer Early Detection Act, freeing federal funds to be administered through Centers for Disease Control and Prevention for state women’s cancer screening programs. CDC continues to monitor screening compliance rates of these state programs. Because of the demand this places on local health departments and their limited staff, Kentucky Women Cancer Screening Program has discovered non-compliance regarding follow-up for patients with cancer screenings.

To assist local health departments with the burden of improving compliance rates, we have designed matrices for breast and cervical screening follow-up and developed an electronic system from the matrices which can replace labor-intensive tracking. The electronic system can generate reminder letters for normal, as well as abnormal reports. In addition, it can generate letters to notify women to schedule their annual mammograms and Pap tests (for home contacts only).

Our project is in Phase I of piloting the electronic system in two counties. We recommend formal testing to compare its effectiveness with standard manual tracking… Phase II. Should there be evidence showing greater effectiveness for the electronic system, we recommend marketing, in partnership with Custom Data Processing and KWCSP, across the commonwealth…. Phase III. Finally, national marketing, through CDC, may be possible… Phase IV.

Finding and Connecting the Missing Piece

Prepared By: Heather Hampton, Melissa Morrison, M.A., Vivian Rakestraw, R.N., M.S.N., Connie Willis, B.S., R.S.
Mentors: Shawn Crabtree, M.S.S.W., M.P.A., J. David Dunn, Dr.Sc. in Hyg., M.P.H.

Full Report (pdf format)

The U.S. population is aging and increasing in racial and ethnic diversity. Improving health for all populations in the U.S. is currently a major challenge for health departments. In order to overcome this challenge, public health needs qualified, educated and trained professionals. Currently health departments are finding it difficult to hire new professionals for expanding programs and replacing the increasing number of retiring staff. The purpose of this change master’s project was to identify the reasons why public health departments are not able to satisfy their workforce needs and develop a mechanism to help supply the increasing demand for public health professionals.

The process began by surveying college students from UK, EKU and WKU to determine their knowledge of and interest in public health career opportunities. Concurrently health department directors or their delegates were surveyed to determine their methods of integrating and recruiting college students in their public health organizations. Based on information obtained from the surveys, it was decided that there is a need to develop methods to perpetually link college students and local health departments, therefore increasing student involvement in public health.

Student involvement as well as opportunities for involvement has increased over the course of the year-long project through several mechanisms. A student committee was created in the Kentucky Public Health Association, KPHA, to increase student involvement within the organization. After establishing bylaws and procedures for the committee, a $4000.00 student scholarship was secured. Current KPHA student chapters were contacted and reinvigorated and student chapter interest was raised at three additional Kentucky colleges. A student involvement web page and chat room was created on the KPHA website, linking students to career opportunities, internship / co-op opportunities, local heath departments, career fairs and other public health related programs. Templates for establishing new KPHA student chapters, marketing fliers, internship guidelines and sample agreements were also created and listed on the web page. All of this information was reproduced on CDs and deliverable folders to be distributed to health department directors and colleges to increase student involvement in public health.

During this process, many new partnerships were formed. The Kentucky Cabinet for Health Services, Personnel Office is presently partnering with local health departments and Kentucky Area Health Education Centers, AHEC, to staff Kentucky college career fairs and develop new internship opportunities. The Kentucky Association of Milk Food and Environmental Sanitarians, KAMFES, is beginning to partner with KPHA and Kentucky colleges to increase student activity in both professional public health organizations. Louisville Metro Health Department staff has linked with University of Louisville and Jefferson County Public Schools to create public health curriculum and participate in high school career fairs.

In conclusion, we hope that the links connected between students, colleges, public health departments and professional organizations will continue to increase student involvement in public health and subsequently fill current as well as future public health workforce needs. We also hope this project will serve as the foundation for future Change Master Projects and professional organizations to further the development of a quality, educated, public health work force.

Job Satisfaction of Public Health Employees in Kentucky

Innovation comes from people who take joy in their work. - Edwards Demming

Prepared by: Christy Brooks, BA, MSSW, CSW, Evette Hudson, Major Eric Hunter, Darlene Walls, BA, MA
Mentor: Suzie Hamm

Full Report (pdf format)

There are many definitions of public health set forth by the National Association of City and County Health Officials (NACCHO) Center for Disease Control (CDC), World Health Organization (WHO), American Public Health Association (APHA), Healthy People 2010 and so forth. Yet whatever definition and goals that follow, they all rely on a satisfied workforce to put them into practice. This change master project will create an awareness to the level of job satisfaction among public health employees; and how important a satisfied workforce for the Commonwealth’s success in its mission to promote and safeguard the health and wellness of all Kentuckians. This awareness will be created with the promotion and adoption of a job satisfaction survey by local public health directors to use as part of part of their strategic planning and monitoring.

The Kentucky legislature adopted in February 2004, Healthy Kentuckians 2010. This initiative reflects the nation’s health agenda and trends facing public health in the next decade. Healthy Kentuckians recognizes that public health workers, the heart of all successful public health initiatives, need to improve their performance of the essential public health services through continuing education and training (Healthy Kentuckians 2010). Other measures Kentucky has taken to ensure the health and well being of its citizens include strategies from Bioterrorism Preparedness to Public Education and Prevention Programs.

Not only do the state’s initiatives depend on a workforce with a high level of job satisfaction, but also so does the health of the public. Approximately half of the 2 million deaths in the U.S. each year could be prevented. Public health professionals – in their roles as environmental monitors, inspectors, consumer educators and health care providers – significantly reduce the number of preventable deaths. Only 20 percent of the nation’s estimated 400,000 to 500,000 public health professionals have the education and training needed to do their jobs most effectively. (HRSA)

The benefits of a satisfied workforce for public health are nothing short of a “win-win” situation. When people are more satisfied in their jobs they have better attendance records, are healthier, feel more valued.

  • Workers’ involved in friendly, relaxed and congenial worker groups with supervisors who listen to them, and show concern about the employee’s needs, become more supportive and productive than others, even under less favorable working conditions.
  • Workers’ satisfaction with the social and interpersonal relationships with their peers significantly influences productivity, and workers feel substantial pressures from their peers to conform to the norms of their work group. (Conrad, 1990)

Kentucky has approximately 1,500 public health workers working in independent, district, and single county agencies. Like so many public service working environments, employees are expected to do a lot with less. They are some of the most dedicated and committed professionals who help individuals and families struggling to maintain a reasonable level of productive health. Yet, how often do supervisors and directors look to the needs of their employees as much as they do to the needs of the community or the initiatives imposed on them?

Another dependent on a satisfied public health workforce includes the Kentucky Public Health Leadership Institute. Over the past four years, the institute has brought together selected public health employees with leadership abilities to enhance their skills and start them on the road to becoming Public Health leaders. As part of this program, change master teams introduced many projects that have contributed to improving the quality, either directly or indirectly, of the health of Kentucky citizens. These initiatives also assume the state has a satisfied workforce and therefore will take on their missions.

The Employee Job Satisfaction Survey produced by this change master project will offer local health department directors an avenue to address employee job satisfaction. This tool, divided into three categories; Overall Job Satisfaction, Job Characteristics, and Role Ambiguity will give insight to the issues for directors to build on the strengths of their employees and rectify those factors that contribute to their dissatisfaction.

Public Health: Can We Live Without It?

Prepared by: Betty Ford, R.N., Melissa D. Harris, R.N., B.S.N., Read G. Harris, M.P.A.,
Surinder (“SAM”) K. Kad, M.D., F.A.C.P., M.P.H., M.B.A., Janet Overstreet, B.S. Becky Simpson, M.S.S.W.
Mentor: C. Ann Bray, A.A.

Full Report (pdf format)

The United States (U.S.) has the science and ability to address some of the top health and health system problems, but has failed to act. Excessive costs, widening disparities in health status, high prevalence of chronic disease, high numbers of uninsured and inadequate investment in the continuum of health services contribute to a poor state of national health. Despite spending more money on health care than other nations, in 2000 the United States ranked 25th among all nations in life expectancy. Only one percent of health dollars are spent on public health efforts to improve overall health (1,2).

The nation’s public health capacity is being seriously compromised at the very time that emerging threats to the public's health require advances in public health science, training and leadership. Bioterrorism preparedness is crucial, but we need to ensure that it is not diverting resources from other public health programs. An unhealthy population cannot protect the nation (3).

Chronic diseases are among the most prevalent, costly and preventable of all health problems. According to the Centers for Disease Control and Prevention (CDC), seven in 10 Americans die each year of a chronic disease. Yet interventions to prevent some of the nation’s leading causes of death and disability remain grossly underutilized and underfunded.

Our system is tilted toward treating people after they get sick rather than keeping people healthy and preventing these diseases. We know the root causes of the most deadly and debilitating diseases, such as cancer, heart disease, stroke and diabetes, and we know how to prevent them. Our nation should put a higher priority on disease prevention and health promotion, and put more resources behind them. Tobacco use, unhealthy diet and physical inactivity are the leading causes of preventable death and illness.

The number of Americans with little or no health insurance contributes to the poor state of the nation’s health. Widespread lack of health care coverage affects not only the uninsured and their families, but also the communities in which they live. Without health insurance people do not get care when they are sick and do not get routine preventive health services that can avert or detect serious illnesses early.

Title VI: Compliance Guidance for Local Health Departments

Prepared by: Melinda Copenhaver, Lisa Walls, David Jones, Melody Prunty, Christie Green
Mentors: Swannie Jett, MS, BS, Dr. John Poundstone

Full Report (pdf format)

Healthy People 2010 states that, although “the diversity of the American population may be one of the Nation’s greatest assets, it also represents a range of health improvement challenges. Healthy People 2010 is firmly dedicated to the principle that - regardless of age, gender, race or ethnicity, income, education, geographic location, disability, and sexual orientation - every person in every community across the Nation deserves equal access to comprehensive, culturally competent, community-based health care systems that are committed to serving the needs of the individual and promoting community health.”

Title VI of the Civil Rights Act of 1964 (Section 601 42 U.S.C. 2000d) provides that no person shall “on the ground of race, color, or national origin, be excluded from participating in, be denied the benefits of, or be subject to discrimination under any program or activity receiving federal financial assistance.” The purpose of Title VI is to prohibit programs that receive federal funds from discriminating against applicants, participants or consumers on the basis of race, color or national origin. Specifically, Title VI addresses the mandate that all recipients of federal funds refrain from national origin discrimination against “Limited English Proficiency” persons.

Individuals who do not speak English as their primary language and who have limited ability to write, read, speak, or understand English are “Limited English Proficient” (LEP). Community members seeking to participate in health promotion or awareness activities and persons who encounter the public health system are two examples of LEP contacts most relevant to Local Health Departments in Kentucky.

In August 2000, the Department of Health and Human Services issued guidance for all recipients of their funding on how to comply with the Title VI mandate. A second, revised, policy guidance document was issued on August 8, 2003. Titled “Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons,” this guidance is meant to be the format by which all recipients of federal funds develop individual compliance plans.

The Title VI federal mandate for the provision of fair and equitable services to LEP persons is significant for both the Kentucky Department for Public Health and all Local Health Departments across the state. The Kentucky Department for Public Health must develop a plan that outlines the means by which it will assure the compliance of all sub-contractors (or sub-recipients of federal funds) with the Title VI mandate. In that capacity, DPH is responsible for assuring the compliance of all Local Health Departments because they are considered sub-recipients of federal funds. Los Cincos Amigos also recommends that DPH assume responsibility for translating any written material required for use in program services at Local Health Departments. Translating materials at the state level reduces the overall cost of Title VI compliance; it also guarantees consistency and quality of written materials statewide.

To ensure meaningful access, covered entities must provide language assistance and written translation of documents into regularly encountered non-English languages. Communication must be effective and provided at no cost to client/patient/beneficiary. What does this mean for Local Health Departments? Each LHD must develop a compliance plan that reflects the demographics of the community in which service is provided. Each LHD must find cost effective ways to employ medically competent interpreters and translators.

Demographics vary from region to region across Kentucky, and sometimes even from county to county. Therefore, a “boilerplate” compliance document from DPH will not be applicable for each Local Health Department. For example, metropolitan areas have larger populations of LEP persons and may have to employ a number of interpreters to carry out their public health activities. On the other hand, a small, rural Local Health Department may have a very tiny population of LEP persons, and their compliance may be simply carried out by means of a telephonic interpreting service contract. Although Spanish is overall the most common language spoken by LEP persons in Kentucky, other languages vary across the state.

For this reason, Los Cincos Amigos determined that developing a guidance document for Local Health Departments would simplify the process and enable LHD’s to tailor their compliance plans to meet the needs of their own communities.

Fourteen (14) National Standards for Culturally Appropriate Health Care (CLAS) have been issued by the U.S. Department of Health and Human Services to ensure that all people entering the health care system receive equitable and effective treatment in a culturally and linguistically appropriate manner. There are three Categories of Standards:

  • Mandates are current Federal requirements of all recipients of Federal funds.
  • Guidelines are activities recommended for adoptions as mandates by Federal, State and national accrediting agencies.
  • Recommendations are suggested as voluntary adoption by health care organizations.

The following standards apply specifically to the Department for Public Health and the Local Health Departments:

Standard #4

Health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation. The following are acceptable means of providing language assistance:

  • Bilingual staff
  • Face-to-face interpretation by trained, contract or volunteer staff
  • Telephone interpreter services should be used as a supplemental system
Standard #5

Health care organizations must provide to patients/consumers in their preferred language both verbal offers and written notices informing them of their right to receive language assistance services. Notification methods include:

  • Language identification or “I speak” cards;
  • Posting signs in regularly encountered languages,
  • Creating uniform procedures for effective telephone communication, and
  • Statements about services available and the right to free language assistance services
Standard #6

Health care organizations must assure the competence of language assistance provided to LEP patients/consumers by interpreters and bilingual staff. Family and friends should not be used to provide interpretation services (except by request of the patient/consumer).

Standard #7

Health care organizations must make available easily understood patient-related materials and post signage in the languages of commonly encountered groups and/or groups represented in the service area. Examples relevant to the public health realm of written materials that must be translated include, applications for services, intake and consent forms, medical treatment instructions, patient history forms, etc.

Wireless Training for the Public Health Workforce

Prepared by: David A. Reed, BBA, Mark A. Vaughn
Mentor: Clyde Bolton, BGS, MSA

Full Report (pdf format)

Assuring a competent public health workforce in today’s fact-paced and ever-changing environment has become an increasingly difficult task. Training efforts to improve the knowledge and skills of public health workers face many obstacles. There are financial constraints and work-related constraints on both sides of the training equation: those who provide the training and those who receive the training. Our Change Master team focused on adding an additional option to the current training mix that would be beneficial to both groups; and hopefully, would be more efficient and effective at meeting the true training need.

Our project began as a continuation of the “Training Wheels” project from one of last year’s KPHLI Change Master groups. The idea was to create a mobile learning center that would travel to local health departments to provide hands-on training. The mobile lab would consist of computer workstations where employees could receive small-group classroom-style training specific to their need.

Our Change Master team set out to promote and coordinate the “Training Wheels” initiative with a desire of successfully implementing a program that would result in a better-trained public health workforce.