Change Master Projects Class of 2006

Increasing Access to Colorectal Cancer Screening Materials for Healthcare Providers in Rural Kentucky

Prepared by: Meredith Brown, MS, RD, LD; Bethany Potter, BS; Amy Steinkuhl, MA; Karen Weller, RN
Mentor: Carolyn Lewis, PhD, RN, CNAA, BC

Full Report (pdf format)

The Fab Four KPHLI group started their journey in the spring of 2005. All members expressed an interest in promoting education regarding cancer screening; as screening and early detection is known to prevent cancer mortalities. It was necessary to narrow the scope of this problem by focusing on a specific type of cancer. The Fab Four decided on colorectal cancer because of its high incidence in Kentucky. As a team, we wanted to impact local health departments by providing a toolkit containing educational materials about screening for colorectal cancer. This project affects the infrastructure of public health by providing educational materials to increase early intervention for colon cancer, thereby easing the burden of care for those who may otherwise require extended care for advanced cancer.

Research for the project was done via literature search and via a survey to various health departments. The team narrowed the focus of the surveys to be sent to three Area Development Districts (ADD). We chose the Big Sandy, Kentucky River and Northern Kentucky districts in order to compare rural areas with a large metropolitan area. Various demographic information for the three Area Development Districts were also obtained for comparative analysis.

Father Involvement in the HANDS Program
2006 Balderson Leadership Project Award Runner-Up

Prepared by: Kaye Lynne Depew, ASN, RN, CWS; Brenda Kaye Humphrey, ADN, BSN, RNWS; Lenora Gail Kinney, AA, BA; Anthony Scott Lockard, BA, MSW, CSW; Allison Leigh Napier, BSN, RN
Mentors: Ronald Herald, RN, MSN; Beverly Siegrist, RN, PhD

Full Report (pdf format)

The HANDS program is a program based upon the Healthy Families America model of home visitation. Its purpose is to provide support for first time parents. It was started in the state of Kentucky in 1999 as part of the larger KIDS NOW initiative. Since its inception HANDS leaders have strived to actively involve fathers in all aspects of services. However, what is proposed at the policy development level may not always occur in the actual implementation of a program.

The purpose of this project is to examine how effective HANDS has been in engaging fathers. In order to do this a 2 tiered approach was taken. First, a survey was done of HANDS staff to assess their attitudes of the importance of fathers to child development and how they have involved fathers in services. The second part of this project was to survey fathers’ attitudes about HANDS to get their opinions about the strengths and opportunities for growth of the program. The results of both surveys and their implications are discussed in this paper.

Getting the Crank out of Dodge

Prepared by: Kenny Ratliff, BA, RS, RA; Vijay Munagala, MPH, BDS; Pamela Hendren, BS, RS;
Justin Carey, BS, REHS/RS, RA; Justin Pittman, BS, RS;
Mentors: David E. Jones, BS, MPH, RS; Holly Hopper, MRC

Full Report (pdf format)

Illegal methamphetamine drug abuse has become a national epidemic. By no means are methamphetamines a new drug to this country, as they have been used clinically since the early 1900’s; however, more recently the illegal recreational use has become a dark cultural stamp on many communities and a strain on law enforcement, health care and court systems. The rate at which the drug’s use has increased over the past 10 years is by any standards alarming. As with any product, supply and demand certainly applies to methamphetamines. With the increase in use there has been a tremendous increase in illegal clandestine laboratories that now plague the countries rural and urban communities. In 1995 there were a mere 327 labs busted in the United States. Kentucky has not gone unaffected by the increasing popularity of methamphetamines evident by the fact that methamphetamine laboratories have increased exponentially in Kentucky by a factor of 633% over the past four years. (69 in 1999 to 569 in 2004). In addition clandestine methamphetamine laboratories have been reported in 89 of Kentucky’s 120 counties.

As a result of its growing popularity, the health risks of using methamphetamines are increasing. Some of the known effects of meth use include but are not limited to, severe physical and mental addiction, tooth loss (also known as “meth mouth”), neurological effects including permanent brain cell damage, weight loss, and even death. Many public health experts fear that the drug’s popularity will also lead to increased spread of disease as it is most commonly smoked or injected intravenously and associated with promiscuity and unsanitary conditions. Injuries and property damage due to explosions and fires caused by methamphetamine laboratory operators or “cooks” can be found in nearly every community, small and large, urban and rural. Indirectly, households that have users are also thought to have higher incident rates of child and spousal abuse, which also results in increased medical costs and emergency room use.

Drug treatment facilities are also experiencing difficulties due to methamphetamines and its impact on resources and staffing as Kentucky reported a 52 percent increase in admissions of users from 1998 to 2003. Sadly, these numbers continue to grow. Contributing to the concern is the fact that many of the explosive and often times toxic laboratories have now become “mobile” in order to reduce the chance of being discovered. Clandestine laboratories have been discovered throughout Kentucky in cars, trucks, motor homes, campers and boats. Additionally, the use of public facilities such as hotels, parks, restaurants, mobile home parks, and campgrounds create potential exposure to the public health workforce and general public. Outside of highways and public facilities, these groups may still be exposed or in danger with the majority of labs being found within residential communities.

In most cases, the hazardous and highly toxic waste created during the production of methamphetamines is left behind or illegally disposed of which creates additional environmental hazards. These environmental hazards create public health concerns for many years as they can contaminate soil, groundwater, and even homes. Studies have shown that producing one pound of methamphetamine creates approximately six pounds of toxic waste that is most commonly discarded in residential drains, trash or on the ground. An issue that continues to be a mystery in many locations used to produce methamphetamines is the amount and duration of contaminants that can be found in walls, carpet and other portions if a home. Despite clean up efforts, many contaminants may linger and continue to adversely effect residents long after production has stopped.

Perhaps what is most overlooked with the use of methamphetamines is the potential for a non-user to encounter danger or violence when in proximity of a user or addict and their laboratory facility. This is evident by the fact that the Federal Bureau of Investigations has a standardized protocol for officers/agents that may encounter methamphetamine users or cooks which addresses the need to avoid personal injury when encountering a suspected user or laboratory. Today, Kentucky’s local health departments have staff working in Environmental Health, HANDS, Home Health, First Steps and other programs that may be affected by methamphetamine production during their daily activities outside of the office setting. Despite the increasing risk and expanded role of the local health departments in many counties, training and educational materials for local health department staff and at risk populations is somewhat limited and many have little or no knowledge about how to recognize and/or address warning signs for the use and production of methamphetamines. Recognition, understanding and responding to social and environmental indicators and factors are now vital to preventing and avoiding exposure, injury or death for public health employees working in the field.

In 2005, Kentucky community leaders and legislators recognized the growing problem of methamphetamine production and introduced Senate Bill 63 that went into effect in June of 2005 that gives the state an additional measure to track and combat the production and distribution of methamphetamines by implementing more stringent control measures for over the counter products and precursors that contain an essential ingredient to make methamphetamines. Although it is a tremendous step towards eliminating the production of methamphetamines in Kentucky, it is too early to distinguish if this legislation will ultimately affect the spread of the drug’s production and use. Additionally, current proposed legislation (HB 591) would create better avenues of information sharing by requiring law enforcement to report contaminated properties to local health departments. The plan is to create a website to publicize this information and track the decontamination process to completion.

This project will help to establish additional educational needs in the interest of public health officials and potentially at-risk areas of the state. Findings from the project will be shared with all stakeholders and targeted/high risk areas in hopes of improving recognition of potential hazards associated with methamphetamine production and clandestine laboratories. It is our vision that this project will serve as a catalyst for future KPHLI teams to develop additional tools for public health workforce education.

How We Know Our Clients: Understanding the Impact of Poverty on Public Health Service Delivery

Prepared by: Melanie Adams-Johnson, RN, MSN; J.A.T. Mountjoy, MHA, BA; Katie H. Bathje, MA, LPCC;
Pam Pfister, RN, BSN; Margaret Mahaffey, M.Ed, BA; Andrea Tapia, MSEd; Michelle Malicote, RN, ADN
Mentors: Randy Gooch, BS; Vickie L. Sanchez, EdD, CHES

Full Report (pdf format)

The pioneering public health workers in this country, Lillian Wald, Margaret Sanger and Mary Breckenridge recognized the impact of poverty on public health and public health service delivery. Now more than a century later, populations both urban and rural are still facing great health disparities related to socioeconomic status and class.

There currently exists a wealth of information regarding the subject of persons in poverty, those individuals and families without, or with less, than those of a more robust economic status. National and state statistics (with accompanying maps) keep advocates, concerned citizens and politicians informed with dry, flat tables and bureaucratic definitions. In more salient terms, the number of people living below the poverty level continues to rise steadily each year. The official United States (U.S.) poverty rate was higher in 2002 than 200l, and the number of Americans living below the official poverty thresholds increased by 1.7 million. Kentucky fares much worse than the U.S. with considerably higher percentages of families (12.7%) and individuals (15.8%) living below the poverty level. According to U.S. Census data, Kentucky’s median household income ranked 45th in the nation in 2004.1,2

The Knocking Out Poverty’s Stigma (KOPS) Change Master Team chose to examine and investigate poverty from a different angle – a more humanistic perspective. Writer Su Ann Aday eloquently encapsulated this perspective in her book, At Risk in America, writing “As members of human communities, we are all potentially vulnerable.”3 Our team hypothesized that the more ways we as providers can understand our clients, and they with us, the more effective we will be. The facet of understanding we chose to explore towards this end was that of socioeconomic class.

We proceeded by building on the work of Dr. Ruby K. Payne, a leading force in facilitating understanding between economic classes, by investigating the pervasive and prevalent problem of poverty in Kentucky, its impact on the delivery of public health services, and the knowledge base of public health workers who facilitate those services to some of the state’s most vulnerable citizens.4, 5

The KOPS team was initially confronted with perplexing findings. A high proportion of persons seeking health care services through the state network of health departments are living in poverty. Nevertheless, there are no courses, programs or trainings offered by the Kentucky Department for Public Health (KDPH) on poverty issues for the public health workforce. Research conducted by this group also indicates a lack of public health training courses on the impact of poverty available nationally. Therefore, public health workers are likely to have limited knowledge regarding the “hidden rules” of poverty and their ramifications for the delivery of services, even though a majority (60%) of clients seen in public health department clinics are living in poverty.

Dr. Payne defines “hidden rules” as the "unspoken cues and habits of a group” and there are distinct rules for the lower-, middle-, and upper-class.5 This is clearly demonstrated in a quiz testing your knowledge of the hidden rules of class (Appendix A). People from different economic classes live by “hidden rules” not necessarily known by others outside that group. Many rules serve as useful coping strategies, but may put someone from the lower-class at a disadvantage when interacting with institutions based on middle-class rules, such as health departments.

During 2005-2006, four KOPS Team members administered an assessment instrument to public health employees from four different geographic regions in the state – east, west, north and central. The assessment instrument consisted of six statements about poverty, and staffers were asked to indicate whether a statement was true or false. Results of the assessment indicate that the public health workforce in Kentucky demonstrates some misconceptions, and/or lack of knowledge, regarding poverty and its impact on clients seeking health care services.

The KOPS Team recognized that health care workers often do not share the same ethnic and/or class background and lived experiences as the people they serve. Such differences have the potential to create misunderstanding and frustration for both parties. Often the results are health interventions incongruent with clients’ experiences, needs or perceptions. An example might be a piece of health literature not written at the appropriate level, or services offered at inappropriate times for the clients they aim to reach. The cultural competence of providers and institutions is important in encouraging utilization of the health care resources available in an area.6 The goal of this project is to increase public health workers awareness and knowledge of poverty related issues and, ultimately, increase program effectiveness and efficiency, as well as satisfaction of public health workers and clients.

With survey data supporting initial perceptions, the KOPS Team developed a training module focusing on the culture of poverty for the state’s public health workforce. Much of the module’s content and direction was adapted from the text “Bridges Out of Poverty,” by Ruby Payne.5 The adaptation was necessary to make the information salient to our intended health department audience. The module focuses on three important aspects of poverty that may impact the interaction between patients and health department personnel: use of language, importance of relationships, and the “hidden rules” of poverty.

The module is intended for all members of the health department. KOPS Team members anticipate a high degree of participation in the program based on its practicality (including length of the module, relevance of the content) and its accessibility via Kentucky TRAIN. Moreover, the increased knowledge base of the public health workforce regarding the dynamics of poverty will significantly enhance the “provider-client relationship” and ultimately contribute to both improved care delivery and health outcomes for persons seeking care through the health department system.

LEAPH Project: Leadership Empowerment Academy for Public Health

Prepared by: J. Wayne Crabtree, B.S., M. Div., CADC; Eileen M. Deren, A.D., RN; Donna H. Dooley, B.S., RN;
Kenneth R. Kring, B.B.A, CPA; Candice G. Malone, B.S., NSCA-CPT; William (Bill) Anthony Wetter III, B.S., M.S., EMT-P
Mentors: Darlene Walls, B.A., M.A.; Paul McKinney, M.D.

Full Report (pdf format)

Project Deliverables (ppt)

The Louisville Metro Health Department is taking a progressive role in addressing future labor shortages, which will occur, due to baby boomer retirements. Kentucky Retirement rules make it advantageous to retire before January 1, 2009, and more than 23% of the current workforce at the Louisville Metro Health Department will be eligible for retirement on or before January 01, 2009. We believe the labor shortages will affect all areas of labor, including leadership. The Super-visionary team has designed a Leadership Institute to be able to provide entry-level leadership training to 80 participants each year. The training will be for all levels of employees within the public health field.

Leadership, and the need for leadership training, is not an idea exclusive to public health. On a particular day, the word leadership typed into a popular search engine’s search function revealed over 31 million hits, the term public health leadership over 1 million hits, and the term public health leadership institutes over 200,000 hits.

Based on an article published on “The National Public Health Leadership Development Network”, financed by a CDC grant, there are approximately 2,000,000 public health practitioners currently in the workforce in need of training, including leadership training. By 2012 The U.S. Department of Labor (DOL) estimates there will be 165 million jobs and only 162 million people available in the workforce to fill those jobs and of those available, 20% will be 55 and over.

In addition to baby boomer and other retirement concerns, through a 3-year period the Louisville Metro Health Department employed 5 different directors. One thing that became apparent was the under developed leadership skills below the director level.

A survey was sent to all health department employees and 223, or approximately 70% of all employees, responded to the survey. Approximately 79% of the responding employees felt that management of the health department needed additional leadership skill development, 41% of the respondents thought they themselves needed leadership training, 50% of the respondents disagreed that good communication skills were used at the health department, and 48% of respondents disagreed that sound time management, delegation, and planning practices were followed.

To meet the demand for leadership skills in the future, the team developed a Leadership Institute to be a 1-day per week, for 10-week program. It will touch on many basic leadership topics, including, style, personality type, communication skills, cultural diversity, and other topics. There will be 20 seats available per class, open to all levels of leaders. Instruction will be by leaders of the Louisville Metro Health Department, including many KPHLI fellows. In addition, the University of Louisville has expressed an interest in assisting with the class by offering instructors, classroom, Master level students to help as needed, and other resources. The class will be made available to other public health departments around the state and nation, but initially will concentrate on employees of the Louisville Health Department.

The current KPHLI team, the Super-visionaries, will act as an advisory board over the Institute, selecting candidates, approving projects, revising the curriculum, and other ongoing tasks. The Training Coordinator of the Health Department will also provide long-term assistance and guidance, as needed.

The initial class is to be offered starting in October 2006, running through mid December 2006. The Institute will be offered 3 to 4 times a year, 20 in a class.

Preparing Kentucky's Preparedness Staff for the Challenges of Tomorrow Through Competency Based Education
2006 Balderson Leadership Project Award Runner-Up

Prepared by: Sara Jo Best, M.P.H; Kristy Bolen, B.S., M.P.A.; Dianne M. Coleman, R.N, A.S.N.; Shelly Fryman, B.S.; Jasie L. Jackson, B.S., M.P.H; Carol Lane, A.A.S
Mentor: Dr. George Graham

Full Report (pdf format)

Project Deliverables (pdf format)

How then can Public Health be prepared? We can be prepared by ensuring that our workforce is prepared. It is imperative that we develop our workforce and educate them so they can respond to a disaster, but at the same time do their everyday job better. Through the development of competencies, this can be achieved. Competencies give the ability to measure performance and set forth a path for achievement.

The majority of our Change Master Group is preparedness staff from across Kentucky, who have been employed in their current position for at least 2 years. Upon hire, many of us did not receive a lot of guidance from the State Department for Public Health or our local health department as to our job duties. Some were given copies of the grant deliverables and told, “go forth and do your job.” What was our job? How were we supposed to do our job? We really did not know.

Our Change Master Group wanted to positively impact public health preparedness in Kentucky. We wanted to ensure that others who were hired in positions similar to ours had a tool to guide their learning process and guarantee they are properly trained to perform the required job functions. We felt that through the development of competencies, we could achieve this.

The competencies developed are based upon the Core Competencies for Public Health Professionals. The Epidemiology Competencies are those developed by the Council for State and Territorial Epidemiologists for Tier 2: Applied Epidemiologists. The competency sets for the other positions were developed based upon the Core Competencies but made specific to the Preparedness Coordinator and Preparedness Training Coordinator positions. Competency development was aided by “Competency to Curriculum Toolkit” developed by the Columbia University School of Nursing Center for Health Policy.

Our project team talked with numerous people across the state as well as Dr. Kristine Gebbie, Director of the Columbia School of Nursing Center for Health Policy. All those we talked with thought our initiative was very important to advance everyday public health practice, as well as public health preparedness. There are several initiatives within our state that are working to address workforce development based upon competency. The Kentucky Department for Public Health Division of Epidemiology has convened a stakeholder group from agencies across the state to build epidemiologic capacity for Kentucky. The Local Health Department Personnel Section has convened groups from across the Kentucky to revise the current job classification system to be based upon competencies.

Our project deliverables are:

  • Job descriptions local health departments can use to recruit and develop staff
  • A mentoring program that would assist new public health preparedness staff in becoming more familiar with their roles by offering guidance and direction
  • A listing of suggested trainings to narrow down the search for quality trainings that directly tie to competencies identified
  • A skills check off for mentors to track the progress of new public health preparedness staff
  • Outline a recommended credentialing system for Kentucky Department for Public Health
  • A checklist for the Kentucky Department for Public Health for project implementation

It is our expectation that this project will be used to further the professional development of the preparedness staff within Kentucky; serve as a framework for those who are newly hired to preparedness positions; and serve as a guide for local health departments for staff recruitment and development.

Public Health Workforce

Prepared by: Emily Anderson, RN; Tammie Bertram, RN, BSN; Cynthia Brown, BS, CHES, LPN;
Carolee Epperson, ASN, RN; Jill Ford, RN, BSN; Georgia Heise, BS, MS
Mentors: F. Douglas Scutchfield, MD; Margaret Stevens, RN

Full Report (pdf format)

Upcoming changes to the Kentucky local public health merit system will make 2008 an attractive time to retire. Retirement benefits will change from being based on 3 years of highest salary to 5 years of highest salary. In addition, the National Association of Local Boards of Health stated that public health has high vacancy rates, high turnover rates, and an aging workforce. In fact, the National Association of Local Boards of Health reported that on average, 25% (range 6% to 45%) of the public health workforce is eligible for retirement. Where will all these replacement employees come from?

Number 8 of the Ten Essential Public Health Services is to ensure a competent workforce. A competent workforce exists only when an adequate number of employees are learning and applying new information while taking responsibility for their roles and progress. Our infrastructure must be comprised of individuals trained not only in their individual fields but in public health as well. In fact, it can be postulated that the health status of our citizens and subsequent expense are the results of our poorly performing public health system. We simply can no longer afford our current system, in fact, we’ve been unable to afford it for some time now. Strategic succession planning, sound financial practices and population-based social change, developed and implemented by qualified professionals, are the only ways we can successfully address the threats to our society that exist today. Again, where will these employees come from?

The answer is, we will recruit them and grow them within our own public health system. This is imperative if we are to meet the mission of public health. This KPHLI project proposes legislation for the development of funds for student loan repayment, tuition reimbursement, and continuing education for the development of a strong public health workforce.