Change Master Projects Class of 2007

Promoting Collaboration Between the Cooperative Extension Service and Public Health

Prepared by: Amelia Brown, MS, BS; Renata Farmer, BA; Ashley Froman, BA, RS; Theresa Howard, MS, BS; Janet Johnson, BS; Ruth Kingkade, RN; Charlotte Sawyers, RN; Debbie Temple, BS

Full Report (pdf format)

The 2006-2007 Kentucky Public Health Leadership Institute provided a unique experience for Public Health staff this year by also incorporating Cooperative Extension Staff to this year’s program. As we began formulating ideas for Change Master projects we found that there was great opportunity for the two groups to come together, share ideas, and create a project.

Our team “Common Ground” is comprised of five Cooperative Extension Family and Consumer Sciences Agents and three Public Health employees. Our project focuses on areas where there has been or could be more collaboration between our two agencies and how to share information easily among ourselves. By tracing the evolution process of each organization it became clear that we share a common mission creating a valuable need for shared resources and renewal of shared commitment. We focused on taking a look at behavior over time and the interaction between the two groups.

The 10 Essential Public Health Services, National Public Health Performance Standards and Healthy Kentuckian 2010 goals were valuable resources for this project. The research for this project was done via electronic survey to the Local Health Departments and Extension Offices throughout the State of Kentucky. The goal of the survey was to receive feedback on past and present collaboration between County Extension Agents and Public Health Employees in their communities. We based our survey topics on the “Healthy Kentucky 2010” objectives and received a total of 74 survey responses.9 This included 78.4% from Cooperative Extension Staff and 21.6% response from Local Health Departments.

We found through this survey that our most prevalent barrier to collaboration was lack of knowledge regarding available resources or programs of the other agency. It is the recommendation of our group for the creation of the “Healthy Kentuckians Collaborative Grants Initiative” which will give the organizations an annual program needs assessment. It is our hope that the development of this initiative would increase knowledge and communication and find “Common Ground” between our two agencies.

Decreasing the Incidence of Cervical Cancer in Kentucky Women

Prepared by: Kim Flora, BS; April Harris, BS, CHES; Melissa Hawks, BS; Tina Whitlow, BS
Mentors: Pam Pfister, RN, BSN and Karen Camarata, MPH, RD, LD, CHES

Full Report (pdf format)

The Pap Peers 2006 -2007 KPHLI group began their journey by expressing interest in the recent media attention concerning cervical cancer and its vaccine. Then we began to ask the question “Why do women not get Pap tests?” since early detection is known to prevent and treat cancers.

The Pap Peers decided to focus on the barriers that under and non - insured women age 40-64 face for not receiving annual Pap tests. As a team, we also wanted to educate women on the importance of having annual Pap tests. This project affects public health by providing an educational tool to increase early intervention of cervical cancer through Pap tests. It is our expectation that this project will be the beginning stage that leads to increasing the number of non-insured and/or under insured women that receive Pap tests by 2%, therefore, decreasing the number of cervical cancer cases in Kentucky.

Setting the Stage for MAPP - Organizing for Success Through Partnerships

Prepared by: Scott Bowden, MPH, BS, AS; Carolyn Burtner, BS; Carol Hisle, ASN, RN, CDE; Amy LaCount, MS; Patricia Poor, BS; Kristian Wagner, MS, RD, LD
Mentor: Bertie Kaye Salyer, MA, AME

Full Report (pdf format)

The initial plan of our Kentucky Public Health Leadership Institute Change Master team project was to begin research and development for the Mobilizing for Action through Planning and Partnerships (MAPP) project for Clark County, with our goal being to identify and address the health care needs of Clark County. After several discussions, we realized a larger issue must be addressed before adequate or sound information about the health care needs could be obtained. Being aware that we did not have knowledge of or cooperation for the MAPP project within our own Health Department, we were certain that we could not successfully engage outside sources/resources. Therefore, we changed our problem statement to reflect what we believe to be a problem for every organization: To identify, engage and retain community partners. This project will support Essential Public Health Service #4: Mobilize community partnerships to identify and solve health problems as well as the Centers for Disease Control (CDC) goal: Encourage and leverage national, state, and local partnerships to build a stronger foundation for public health preparedness.

Our plan included the following:

  • Educating and engaging/involving the Clark County Health Department (CCHD) staff
  • Identifying prospective community partners
  • Surveying those partners to raise their awareness as well as to learn if they have interest in potential partnerships with the CCHD
  • Researching the many elements of identification of and retention of community partners
  • Following up on surveys not returned
  • Organizing a meeting for those who expressed interest in community partnerships
  • Keeping the general public aware, through various media sources, of the need for their involvement in on-going partnerships with local agencies, including the CCHD

Our KPHLI team believes that by the time our project is completed, we will have a much greater awareness of which community partners are truly interested, how we can engage them to cooperate with us for the best outcomes, and how we can retain an on-going, stronger, and successful partnership with them. We believe and understand that every partner desires to know what is in it for them. We expect to convince them and demonstrate to them that there is something in it for all of us: to make us more efficient, more productive and more responsive to public needs; and that our involvement will make our community a better place because we established, maintained, and flourished with these partnerships.

Exploring the Voluntary National Accreditation Program for Kentucky's Public Health Departments

Prepared by: Jeffery Florek, BS, OTR; James House, BS; David Knapp, BA; Mary Ann Myhre, BS, RD, LD
Mentors: F. Douglas Scutchfield, MD and Shawn Crabtree, MSSW, LCSW, MPA

Full Report (pdf format)

Accreditation for state and local health departments has become a hot topic in the world of Public Health during recent years. In September 2006, after more than two years of work, the National Association of County and City Health Officials (NACCHO) released a definitive report, The Final Recommendations for a Voluntary National Accreditation Program for State and Local Health Departments. Standards developed through an accreditation program would be designed to promote the pursuit of excellence among public health departments, continuous quality improvement, and accountability for the public’s health. 1

This Kentucky Public Health Leadership Institute (KPHLI) Change Master Project is intended to raise awareness of the Voluntary National Accreditation Program for State and Local Health Departments. Another objective is to assess knowledge of the logistics of accreditation among Local Health Department Directors in Kentucky and to compare that data with actual information on the accreditation process from North Carolina health departments. North Carolina has recently implemented a statewide mandatory accreditation program and is gradually completing the process for all local health departments. The North Carolina project received legislative funding to begin implementation. Currently there are sixteen states involved in developing performance and capacity assessment or accreditation programs. 2 Surveys were sent to health department directors in both states and results tabulated. In general, health department directors in Kentucky were in favor of pursuing accreditation, but expressed concern about funding the initiative. Health department directors in North Carolina provided information about their process and the positive outcomes they anticipated as a result.

The deliverable of this Change Master Project is a TRAIN module designed to educate public health employees about the status of the accreditation initiative, the merits of accreditation, and the likelihood of the development and implementation of an accreditation process for the Kentucky Department for Public Health and local health departments in Kentucky.

Self-Help Wellness: Leading by Example

Prepared by: Betty (BJ) Adkins, MEd; Dorothy DeYoung, RN; Kathy Harrison, BS; Laurie Heddleson, BA;
David Hunter, BA; Louan Martin, RN, BSN; Kelly Monahan, BA, RS; Scott Nethery, BA, RS; Priscilla Pursiful, RN, ADN; Karen Smith, BA
Mentors: David Langdon, BS and Richard Wilson, DHSc, MPH

Full Report (pdf format)

Project Deliverables (pdf format)

The United States Department of Health and Human Services established a goal for Healthy People 2010. Under this ambitious effort, the department established 28 categories which each have multiple objectives. In response to Healthy People 2010, the Commonwealth of Kentucky proposed to reduce the prevalence of overweight Kentuckians to 25%. Will we reach that goal by 2010? Probably not. In 2002, 62.5% of the population in Kentucky was overweight. As public health workers, we have a challenge to educate the population on the importance of wellness, provide resources and recommend tools toward achieving health and wellness. As leaders in the community, we have a responsibility to increase an understanding of the importance of healthy lifestyles and their impact on wellness.

Before public health workers assume that responsibility, we need to assess our personal wellness. Do we practice healthy behaviors? Are we credible role models for our community? Do we exemplify healthy leadership? Again, probably not. With this awareness, the Mucho Madness Team developed the following problem statement: Despite being in a leadership and training role, the Louisville Metro Department of Public Health & Wellness and the Green River District Health Department employees do not model the healthy behaviors they expect of their communities.

After a fitness assessment, the members of the team questioned if their mission to improve personal wellness was possible. We had twelve weeks to develop patterns of behaviors that modeled healthy lifestyles. In a brief period of time, our team became a community with a focus upon the six dimensions of wellness: intellectual, spiritual, physical, career, social, and emotional. At the beginning of our twelve-week journey we identified Healthy People 2010 objectives as a baseline to measure physical results. However, our community and personal experiences brought each of us more than physical achievements. We have formed supportive relationships and developed an environment for us to explore all of the dimensions of wellness.

This self-help model is achievable by anyone who desires a better lifestyle. It is not demanding; it is changing thoughts and behaviors with awareness. It is not expensive; it is a commitment of time. It is not exclusive; it is for anyone who desires to identify one or more objectives toward personal wellness. It is being a leader as a public health worker.

What is Public Health? Public Health Orientation TRAIN Module For Public Health Employees

Prepared by: Andrea Adams, MBA, MPH; VivEllen Chesser, RN, BSN, MBA; Leah Maybrier, BBA, MCSE;
Sherra Morgan, RN; Rona Stapleton, MPA, BA, AA, CMF
Mentors: Georgia Heise, BS, MS and Beverly Siegrist, EdD, MS, RN, CNE

Full Report (pdf format)

Project Deliverables (pdf format)

In an effort to find ways to cope with budgetary constraints, Kentucky offered a retirement package to State employees designed to encourage retirement for eligible employees by 2008, thereby reducing the overall cost of salaries. Unfortunately, this approach to cost savings has resulted in many challenges associated with losing a large knowledge pool and attracting, hiring, training, and deploying a new generation of Public Health employees. According to the National Association of Local Boards of Health as many as 45% of the Public Health workforce may be eligible for retirement by 2008.

The Institute of Medicine released The Future of Public Health in 1988, which emphasized many deficiencies in Public Health, including the Public Health workforce. In 1994, the Core Public Health Functions Steering Committee defined the 10 Essential Public Health services, which elaborated on the three core functions identified by the Institute of Medicine in their 1988 Publication, The Future of Public Health. The 10 Essential Public Health Services specifies, as number 8, the necessity of ensuring a competent Public Health workforce. Additionally, the Essential Public Health Services specifies, as number 3, the necessity of informing, educating and empowering people, including Public Health employees, about health issues. Clearly, the new generation of Public Health employees must receive adequate orientation and training to be able to provide communities with the Essential Public Health Services.

While there will be many new challenges Public Health will face during this massive turnover of Public Health employees, our Change Master Group chose to address the challenge of efficiently and effectively orienting the new generation of Public Health employees. Our research revealed that although most Health Departments report they offered an orientation to their employees, no standard tool was available. Additionally, the Health Departments’ orientation of staff was conducted by a supervisor or Human Resources staff member. An informal discussion with many Health Department employees revealed that their orientation included very little information on Public Health’s historical contributions, or the Core Functions and Essential Services of Public Health. These conversations with current Public Health employees indicate that, if current employees received orientation on Public Health, their orientation was not as complete as it should be. Our research exposed a gap between orientation methods and tools and a competent workforce.

As a result, we developed a four-part training module and made the module available online via the Training Finder Real-time Affiliate Integrated Network (TRAIN). Public Health has an obligation to ensure the new generation of employees are adequately oriented and trained, and it is our goal that this online module will offer a thorough, accurate, and standardized training tool that will be more efficiently delivered than face to face training.

Four For Food: WIC Farmers' Market Nutrition Program

Prepared by: Anna Littleton; Christine Atkinson, BA, RS; Morgan Barlow, BA; Neal Rosenblatt, MS, BA
Mentors: Kenny Ratliff, BA, RS and David Dunn, MPH, Dr.Sc. in Hyg.

Full Report (pdf format)

Think globally, act locally. This can apply to many aspects of our lives: recycling, fuel efficiency, and the food that we eat. In our global economy there are a myriad of food choices. To act locally, to “eat” locally, is a challenge. Our supermarkets are brimming with raspberries from Brazil, strawberries from Mexico, blueberries form Guatemala, bananas from Ecuador, papaya from Belize. Global industries, with multi-million dollar buying power, bring such luxuries to our market, for a price.

Hunger needs are changing. Malnutrition is declining, at the average rate of 1.7 percent a year since 1990. Research from the World Health Organization and the U.N. Food and Agriculture Organization reflect for “every two people who are malnourished, three are overweight or obese.” In the United States, low-income Americans struggling with obesity reaches 35 percent while middle- and high-income Americans rest at 29 percent. Americans are “food-insecure,” not because they are hungry, but because they are undernourished. Nutritional epidemiologist, Barry Popkin, notes the achievement over lack of food as an important sociological shift. With this shift, though, comes an alternate cost; “we’re dying not of starvation or infection, but of abundance.”

Socioeconomic factors permeate food choices and healthy food accessibility. Supermarkets in more affluent neighborhoods tend to stock more fresh produce and fruits, key to nutrition. In more disparate communities nationally, food choices are limited and healthy foods are nearly nonexistent. Stores are often stocked with starches and bulk purchasing. Fast food chains fill the gap. “The rich have Whole Foods… The poor have 7-11 [stores]… When money’s tight, you feed your kids at Wendy’s and stock up on macaroni and cheese. At a lunch buffet, you do what your ancestors did: store all the fat you can.” Nutrition is not a consideration.

Is there a way to challenge behavioral patterns and support access to healthier foods, reversing the nutritional disadvantage?

Local farmers’ markets have the potential to change the health of a community. Our project focuses on the broad social problem of poor nutrition and obesity by partnering the efforts of two established preventative health programs. Health Access Nurturing Development Services (HANDS), a first-time parent program, and the Women, Infants and Children Farmers’ Market Nutrition Program (WIC FMNP), a nutritional voucher program, are both programs with targeted, healthy outcome goals. In joining HANDS’ efforts to support the work of WIC FMNP with specific education and interventions, Kentucky will begin to see healthier families.