Change Master Projects Class of 2009

Environmental Health Metrics

Prepared by: Karen Allen; Natasha Collins; Rebecca Murphy Colligan; Phillip Rosell, MS; Lora Beth Spears
Mentor: Clayton Horton

Full Report (pdf format)

The Department for Public Health’s Division of Public Health Protection and Safety (PHPS) includes programs related to the enforcement of public health regulations for environmental health and community safety. As the department’s regulatory arm, the division is charged with the oversight of approximately 20 statutorily mandated environmental health (EH) programs and regulates over 31,000 active establishments across Kentucky. The division’s staff works closely with local health departments to make sure that Kentuckians are protected from unsafe consumer products, lead hazards, unnecessary radiation exposure, unsanitary milk, adulterated and misbranded food, unsanitary public facilities, and malfunctioning sewage systems. State staff are also responsible for Grade “A” milk production, and certification of public swimming pool designs. The division works daily to enable new businesses to open, provide assistance to citizens’ inquiries, and address citizens’ complaints. The staff routinely provides informational requests and technical assistance to a multitude of industries and citizens. PHPS and the Local Health Department’s regulatory processes have an impact across the state and affects over 20% of the state’s economy and business. This division uses the expertise of approximately 400 Registered Sanitarians or Environmental Health Specialists located at the state and throughout the 56 local health departments to perform the mandated regulatory work.

The current data system used to collect and store all the information from these EH activities is the Environmental Health Management Information System (EHMIS), and it has existed since the 1980s. EHMIS is a state-wide system supporting 74 local state and federal mandated programs and is used by all 56 local health departments and the state as a critical information management tool. It also houses all the inspection/compliance data along with the permitting and licensing information that annually generates over $5 million dollars of agency funds. Management staff has the capability of reviewing standard reports to help them in making decisions that impact the EH community. These reports have changed minimally since their inception. Thus, the decision-making capabilities and potential of the state and LHDs have also changed minimally throughout the years.

MRSA – How to Combat the Panic

Prepared by: Rebecca Baird, BS; C. Janie Cambron, BS, MPH
Mentor: Margaret A. Riggs, PhD, MPH, MS

Full Report (pdf format)

It was our goal to try to increase aware and uniformity of training and teaching material for MRSA to release to the general public so that people would be educated and informed on the disease and not give into media panic. The more that people knew about the disease, the better equipped they were to handle the facts and know that these MRSA deaths did happen occasionally, but weren’t the norm and they had the tools to protect themselves against it.

We originally set out to do a 30 minute training video on MRSA and were going to distribute that to local health department staff, food workers, and school personnel across the commonwealth of Kentucky. Due to time constraints and us losing a team member in the middle of our project and being only down to two of us, we had to set a more realistic goal. We decided to write a 60 second public service announcement (PSA) for MRSA. This would still get pertinent information out to our audience and would be much less preparation than a 30 minute training video.

Three PSAs were recorded; two at the state level using their media relations employee and the other was done locally through the Cromwell Radio Group utilizing the actual team member voices. All PSAs were written by written by KPHLI team members and submitted to our mentor for final review. The Cromwell Radio Group serves western Kentucky and southern Indiana and has seven radio stations in all, reaching a very large audience. The PSA from the Cromwell Radio Group was set to air on all seven stations, at an interval of five times a day for two weeks at a time.

We also wanted to do a questionnaire to see what types of MRSA information and how it was best disseminated and received from the school audience to see where to focus our efforts on in regards to that population. A questionnaire was developed and sent out to all the high schools in our seven county area inquiring about what types of information they received and utilized and how we could help them in future situations. Results were analyzed and used to plan for future educational summits at several schools within the district. Most of these summits are scheduled for the fall of 2009, as this is when the majority of cases are reported due to contact sports injuries, such as football.

Our KPHLI group still has plans to produce a training video that can be utilized in many different areas in regards to MRSA education, but we know this will take time. We also have plans to help update the state website for MRSA information at a later date. Currently, the state website mostly links to the Center for Disease Control and Prevention (CDC) website and is not as user friendly as we think it could be, so we wanted to change that and make it more applicable for the general public.

Research for New Insights and Innovative Solutions to School Interventions

Prepared by: Carolyn Blair, RN, BSN; Kimberly Jackson, RN, BSN, CDE; Steve Salt, MBA; Ellie Schweizer
Mentor: Muriel Harris, PhD, MPH

Full Report (pdf format)

In spite of the pledges of politicians and policy-makers, states and counties have spent the majority of the tobacco settlement money on things that have nothing to do with public health or smoking. Teen smoking rates have stopped dropping. In a recent article from National Journal Magazine, “Nearly half the states have passed ‘smoke-free’ laws limiting smoking in workplaces, public places, or both. The effect of the state initiatives is dulled by what might be called the ‘tobacco paradox.’ The states that have moved the most forcefully against tobacco are those with the fewest smokers; the states with the most smokers have been least likely to act.”

Education requirements for federal, state, and individual county schools widely differ. On March 27, 2009, Gov. Steve Besmear signed a bill that eliminates the state's Commonwealth Accountability Testing System (CATS). The Kentucky Department of Education will develop new educational standards and a new comprehensive test for the 2011-12 school year. As students prepare for the annual testing cycle, segments in the arts, humanities, vocational studies, and practical living have been eliminated. These changes will make a tremendous impact on the education of KY students. The result of the elimination of the CATS test is tobacco education/prevention curricula is no longer required.

Children make decisions by modeling attitudes and behaviors. They need the proper tools to provide a framework to grow and progress developmentally. Children require guidance, instruction, role models, mentors, and life lessons to empower the child to make appropriate choices/decisions at that time. A child’s decision to experiment with tobacco has been a very long road in a child’s short life. With or without the child’s knowledge, the behaviors and values of the media, policy makers, role models, mentors, friends, and families affect the choices they make. Choosing whether or not to use tobacco, will be one of the most important decisions, affecting their entire life. Children spend six to seven hours each day, five days a week, interacting with other students. Without the Practical Living component, children will lack the necessary tools to help them make life-changing decisions. Practical Living curriculum offered children the knowledge and tools to use in situations they will experience though development, role-playing, instruction, and modeling behaviors.

Tobacco is the single most preventable cause of death and disease in the United States. It harms nearly every organ in the body. Our study on youth smoking and evidence based school tobacco curricula has been illuminating. Evidence based school tobacco curricula really does work when done with fidelity. The average parent relies on schools to provide youth with tools necessary to make appropriate decisions. Our research has shown this assumption is incorrect. We learned of the exceptional marketing strategies of tobacco companies; they are true masters of their craft. Children see and hear hundreds of subliminal messages in the television programs they watch, movies they attend, candies they eat, activities in which they participate, or the places they visit daily. A few simple items put into effect would drop the smoking rates for youth and adults, improve health care, and allow people to live longer. Increasing state and federal tobacco taxes prohibit tobacco product advertising to children in movies with a G, PG, and PG13 rating and television programs. Clever mass media social norms campaigns show the power of the majority (accompanied with other prevention & cessation programs) and that not everyone smokes.

The Kentucky Department of Education must include tobacco prevention and cessation curricula in the new testing plan. It must involve parents and family members in the education process to improve the health of our state. The non-judgmental inclusion of families and changing policy to make all school campuses and school events smoke free, will save millions of lives and healthcare dollars in Kentucky. It is our vision is to educate every child in Jefferson County, K-12 to identify, hone, and sharpen tools to keep them living longer and healthier lives. Efforts must increase in preventing initiation to tobacco by educating children on the health benefits of avoiding tobacco. It is the best strategy to save lives and future healthcare costs. A well-developed mass media campaign educating the community on the harmful effects of tobacco and providing multiple resources to increase cessation and eliminate barriers for current smokers will reduce health care expenses as well.

Eastern Kentucky Public Health Inc.

Prepared by: Holly West, MS, MPM; Rhonda Woolum, RN; Erin Schaffner, BS
Mentor: Karen Hunter, MPH, RD, LD, CHES

Full Report (pdf format)

Project Deliverables (power point presentation)

Project Deliverables (pdf format)

Project Deliverables (pdf format)

To examine recent state budget cuts for public health departments and address the unmet health care needs of Kentuckians, the Kentucky Public Health Leadership Institute (KPHLI) team, $how Me The Money created Eastern Kentucky Public Health Inc. (EKPHI), a public non-profit charity. Establishment of this public charity will create greater access to grant funding to support public health services in Eastern Kentucky. The goal of our project is to increase financial support to public health departments and compensate for recent budget cuts that threaten progress and opportunity to improved community health.

A focus group research study was employed as a means to collect qualitative data from health department directors. Of the seven Public Health Directors who participated in the study, 100% reported that their health department had been directly affected by budget cuts from the state; 42.67% of participants had decreased program services to offset the budget cuts, 28.41% utilized local monies, 14.46% cut training and travel expenditures and 14.46% reduced staff.

Team $how Me The Money has completed all processes in establishing EKPHI and are awaiting IRS 501(c)3 determination to further our project objectives. To assist others with the process of establishing a public non-profit charity we developed an in-depth “Step-by-Step Reference Guide to Creating a 501(c)3.”

Going Green: Basic Steps to Save Our Planet

Prepared by: Shelly Austin, LSW; Brenda Edge, RN, BSN; Laura Lindsey; Connie Nalley, RN, BSN; Anita Owens, RN, BSN; Rebecca White, MPH, BS, RS
Mentor: Angela Woosley, RN, BSN, MEP

Full Report (pdf format)

The Green River District Health Department Leadership team acknowledges the importance of becoming a responsible role model in our community by practicing environmental strategies which enhance a healthy environment. We have identified that the Public Health sector should take a lead role in promoting eco-friendly behaviors. By reducing the carbon footprint within our organization we will demonstrate our commitment to protect our planet, promote environmental education and prevent further destruction to our earth.

Operation Headed Home (OHH)
2009 Balderson Leadership Project Award Winner

Prepared by: Health Dolen, BA; Elizabeth McKune, EdD; Ava Wright, RN, ADN
Mentor: A. Scott LaJoie, PhD, MSPH

Full Report (pdf format)

More soldiers than ever before are returning home from war with Traumatic Brain Injuries (TBI). Family members are often ill-prepared or equipped for the changes they find in their loved ones suffering from TBI. No services directly targeting family members to increase their knowledge about TBI are offered at this time that we have discovered. Operation Headed Home will provide information, resources, and support for family members with wounded warriors suffering from TBI as they transition home.

Risky Business Home Visitation Safety Training

Prepared by: Rebecca Hill, BSW, LSW; Natasha Lucas, BS, MS; Crystal Osborne, BS; Rebecca Wilson, BSN
Melody Stafford, RN

Full Report (pdf format)

Project Deliverables (pdf format)

The desire for an online Home Visitation Safety Training began to take form several years ago. The HANDS (Health Access Nurturing Development Services) Administrative and Technical Assistants team identified that HANDS home visitors were in need of more comprehensive, consistent, and easily accessible safety training. At the time, workers were required to obtain two hours of safety-related training within twenty-four months of employment. The training was not standardized or consistent from worker to worker, and workers often did not receive it until after many months, or even years of employment, during which they were already completing home visits.

In the Spring of 2007, a HANDS Worker Attrition study was conducted to determine reasons for worker turnover and opportunities for retention. Among others, one identified reason for attrition was workers lacking a sense of safety. Administrative staff had made some preliminary progress on creating a training module, but resources had not been made available for its completion. A practicum student was given the task of creating an online home visitation safety training module, however, was unable to complete it in the course of the semester. Program and Administrative staff was not available to pick up where the student had left off, and no progress was made on the project for the next year.

When beginning the Kentucky Public Health Leadership Institute process, Team Risky Business determined that by completing the training started by the practicum student, they would be able to fulfill an unmet need by increasing HANDS workers’ feeling of safety. This would allow the home visitors to be more effective in completing their jobs, and would also hopefully increase worker retention rates. The team also determined that the training would be beneficial to other home visitation programs throughout the state.

A multi-media online training module was made available nationwide via TRAIN at the end of February 2009. The hope of Team Risky Business is that the training will be utilized throughout the state by all home visitors, including HANDS and other Department for Public Health (DPH) programs, Department for Community Based Services (DCBS) staff, school social workers, mental health practitioners, University of Kentucky Extension EFNEP (Expanded Food and Nutrition Education Program), etc. The DPH Adult and Child Health Branch Manager has committed to making the training mandatory for all staff completing visits. The training has been approved for Nursing and Social Work CEU’s (Continuing Education Units).

SuperHEROs: Health Environmentalist Reaching Others

Prepared by: Robert Thompson Jr., BS, CADC; Ginger Dereksen, MS; Faye Saleh, BS, RS, CPO; Gretchen Weisenburger, BS, RS, RA
Richard Wilson, DHSc, MPH

Full Report (pdf format)

The SuperHEROs (Health Environmentalist Reaching Others), KPHLI team decided to implement this education piece for environmental health specialists (EHS). This idea arose from the concerns of the internal environmental staff they have brought to the forefront. The main concern is the lack of the public’s knowledge for services provided by environmental health specialist. Through research and questionnaires, we developed a plan to assess the depth of the problem. These assessments help decide how we would approach these concerns and what deliverables would be the most benefit to solving the problem.

Many educational deliverables were developed including a public service announcement presented by Dr. Adewale Troutman, Director, Louisville Metro Department of Public Health and Wellness. Posters, magnets, cards, and brochures were designed and produced to promote environmental health services awareness. Many of the deliverables will be displayed in local government buildings and will be readily available for staff to facilitate distribution to the public. In addition to the deliverables produced, Louisville Metro’s Mayor, Jerry Abramson proclaimed an Environmental Health Specialist Awareness day. An environmental health week will be observed once a year in May continuing to promote service awareness.

This project was made possible through partnerships with University of Louisville graphic art design students, Metro TV, Louisville Metro Department of Public Health and Wellness communications department, environmental staff and their supervisors.

Health Educators Literate in Policy for Kentucky (HELP-KY)

Prepared by: Angela Deokar, MPH, CHES; Judy Mattingly, MA; Sarah Phillips, BS
David Dunn, DrSc in Hyg, MPH, RS

Full Report (pdf format)

Even though health departments have historically focused on individual behavior change in their efforts to improve the health status of our state, little progress has been made in moving the needle toward improved health outcomes for our Kentucky communities and our state as a whole. The goal of our Kentucky Public Health Leadership Institute’s (KPHLI) “Health Educators Literate in Policy for KY” (HELP-KY) team was to determine the involvement of health educators at local Kentucky health departments in activities that influence health policies and environmental change. This is of utmost importance since it has been demonstrated that focusing on behavior change at the policy level is crucial to the improvement of health outcomes. In addition, several reports including the Institute of Medicine’s, Who Will Keep the Public Healthy?, and the National Health Educator Competencies Update Project (NHECUP) recognize the increasing responsibilities of health educators in policy, law and advocating for health and health education.

In pursing “HELP-KY’s” ultimate objective of empowering health educators to make policy level health changes we were able to survey health educators at local Kentucky health departments and determine the barriers that need to be overcome and the knowledge and training that will be required to build their capacity in the arena of health policy and advocacy. Information obtained from the survey will inform future trainings and systems changes to address the barriers currently faced by health educators. Within our KPHLI project timeframe our team began the development of a resource kit, available on CD, for health educators addressing these identified needs. Decreasing barriers for health educators to engage in advocacy and environment change will fulfill many Essential Public Health Services and other national health goals by providing the opportunity for health educators across Kentucky to play a pivotal leadership role in impacting the development of public health policies and improving Kentucky’s currently poor health indicators.