Change Master Projects Class of 2010

LHD Leaders Resource Guide: A Resource to Assist LHD Leaders in Program Operations

Prepared by: Deborah Bridges, RN; Renee Durr, RN; Billie Dyer, RN; Marci Flechler, RN, BSN; Valerie Hudson; Brandon Hurley, MPH; Barbara Turner, RN, BSN
Mentor: David Dunn, MPH, DrSc in Hyg, RS

Full Report (pdf format)

Project Deliverables (pdf format)

In 1994, the Core Public Health Functions Steering Committee defined the 10 Essential Public Health Services which elaborated on three core functions: assessment, policy development and assurance. As Local Health Departments (LHD) move toward Public Health Accreditation it is imperative that we ensure our leaders have access to and knowledge of appropriate program data. Access to meaningful data is an integral step in assuring that LHD leaders will be prepared to evaluate programs effectively. Assessment of this data can then increase efficiency, knowledge and thus establish a more competent public health workforce.

The KPHLI Code Blue Team is comprised of six LHD leaders and one DPH nurse consultant. At the KPHLI orientation summit the LHD leaders, some fairly new to their positions, began discussing the need for a resource tool that could be used to assist leaders in LHD program operations. This resource guide will be an important step in assuring a competent public health workforce.

The initial concern identified was the lack of awareness of the available program data during the initial learning period for new leaders. Specific questions identified included: Why are new supervisors and directors not aware of the necessary data to help steer the department and monitor progress? What data is needed? What data is available? Do experienced personnel forget to share this information with others? What information should LHD leaders monitor to assure programs are operated according to regulations, comply with Kentucky statutes, and maintain fiscal responsibility? After identifying this gap, the decision was made to develop a Leaders Resource Guide that could be used to monitor the pulse on LHD program operations.

To create a resource guide, it was imperative to obtain information from the field. To accomplish this, IRB approval was obtained to conduct a survey of LHD leaders. This survey was distributed to LHD leaders via various global LHD email list serves. Results from this survey were used as a baseline to ascertain what data reports were being utilized for specific program operations and to assist in specific information needed in a Resource Guide. LHD key leaders reviewed final data and provided valuable feedback.

At this time, there are some resources available to new LHD leaders, most importantly the Kentucky Department for Public Health Administrative Reference (AR) and Public Health Practice Reference (PHPR). In addition Custom Data Processing (CDP) provides many LHD with numerous data reports. Various local and state organizations provide leader orientations to LHD staff. The addition of this newly developed LHD Leaders Resource Guide will be a valuable addition to the current resources available.

Sharing of this resource guide with key stakeholders, such as the Department for Public Health (DPH), Kentucky Health Department Association (KHDA) and LHDs will enhance the current resources/orientations used to develop competent leaders. Team members are currently working with these key stakeholders to ensure that this document is updated and remains accessible for all leaders.

Outside, Inside, Inside, Outside: It’s Reversible
2010 Balderson Leadership Project Award Winner

Prepared by: Alicia Bloyd, BS; Cindy Gray, RPh; Tanya Young, PsyD
Mentor: Elizabeth W. McKune, EdD

Full Report (pdf format)

The Kentucky Department of Corrections (KDOC) joins other state’s correctional institutions in focusing increased attention to reentry efforts. Our mission involves public safety and preparation for those individuals reentering our communities post incarceration to transition successfully. Public safety is not simply separating offenders from the rest of society and letting them go at some later date. Successful re-entry requires preparation, planning, and coordination. There has been a long history of emphasis on education and vocational training as a means of preparing incarcerated individuals to rejoin family and society. However, healthcare has become an issue of more concentrated and recent concern in examining successful reentry needs and services. Treatment planning and coordination with community service providers working with seriously ill individuals has lacked a coordinated effort in Kentucky.

Team “Outside, Inside; Inside Outside –It’s Reversible!” will provide information about resources available in and out of prison that promote good physical and mental health. Empowering individuals with the knowledge and motivation necessary to attend appropriately and proactively to their personal health care is another step toward responsible thinking and personal accountability. This too is a goal of incarceration, rehabilitation, and re-integration.

The “Crabby Nurses”: New School Nurse Orientation

Prepared by: Donna Keen, RN, ASN; Bethany Oursler, RN, BSN; Donna Parrish, RN, ASN
Shawn D. Crabtree, MPA, LCSW

Full Report (pdf format)


The “Crabby Nurse” KPHLI Leadership team desires for there to be knowledgeable, confident, competent and well trained nurses in the school nurse program in the ten counties of the Lake Cumberland District Health Department (LCDHD) thus enabling the school sites to promote better health practices in the school settings of our health district.

An additional goal of our project is for it to serve as a template for other health departments in Kentucky as to promote consistency of training and service delivery statewide.

Specifically, we updated the current LCDHD School Nurse Orientation Manual with all the new or updated protocols that have been implemented since the manual was last updated in 2009. In addition, we developed a series of companion training video segments which demonstrate scenario based situations that provide the new school nurses a firsthand look at what a typical day can be in the life of a school nurse. It is one thing to read about what to do in a manual, and another thing altogether to watch by video the services actually being performed. Hopefully the companion video will provide a significant degree of additional clarity.

To further facilitate the expedition of practice competency, we will enlist the assistance existing, seasoned school nurses to serve as mentors to new school nurses. The mentoring process will enable each new school nurse to have someone to contact if a situation should occur requiring help or advice.

In summary, we have updated our existing school nurse training manual, developed a series of companion video segments, and are in the process of implementing a new mentoring process between existing and new school nurses. Finally we hope our model will prove not only to be vitally useful for LCDHD, but can also serve as a template for other health department school nurse programs across Kentucky.

Diabetes Health Disparities in Rural Kentucky

Prepared by: Diana Williams, MSN, RN; Eva Stone, ARNP, MSN, RN
Mentor: Torrie T. Harris, DrPH

Full Report (pdf format)

The Equalizers are two nurses working with patients in different settings in separate parts of the state: one working in the community outreach department of a small medical center in Eastern Kentucky and the other in a school setting, with some volunteer time in a free medical clinic in Central Kentucky. While one nurse is working hard to provide health screenings and preventive services, the other one is seeing how diabetes impacts those in an indigent setting where many of the patients served have less than a high school education. She sees a barrier created by this limited education that can only be overcome by facilitating the successful navigation of children through school. Both are seeing the impact of diabetes on our communities, our health care resources, and the ever increasing epidemic that shows no signs of declining.

It has been noted that this millennium generation may be the first to suffer a shorter life span than their parents, and certainly diabetes is a major contributing factor. This project hopes to identify specific gaps in care and services—particularly for patients with diabetes who live in rural areas—and use that information to develop effective strategies for improving disease control and preventing the development of diabetes in patients with multiple risk factors.

In order to identify these gaps, we ‘took it to the streets’ (and the mountains and the hollers) in an effort to obtain accurate information from the target population. We developed a survey of 24 questions designed to obtain information on educational level, income, age, gender, A1C level, diabetes self-care, and opportunities for diabetes education. Our survey was designed and administered using Survey Monkey, one of the world’s leading providers of web-based surveys. Participants also had the option of using a ―hard copy‖ survey if they preferred as Survey Monkey allowed us to enter the surveys manually as we received them. Diabetes educators, diabetes support groups, diabetes coalitions, churches, local health departments and our present and past KPHLI cohorts helped us distribute our surveys and we had a total of 279 participants.

We also used Survey Monkey to analyze our data. The program gave us a composite of the responses to each question and also the capacity to cross-tabulate responses. For example, using educational level as a control question or independent variable, we could cross-reference that with A1C levels or whether or not a participant had health insurance to determine the impact of educational level on that specific dependent variable. For our project, we were particularly interested in income and educational level as our independent variable or control questions, and the relationship these variables have on A1C level, perception of how well patients are controlling their disease, who their providers are, and what are the most challenging aspects of their diabetes care.

We now have some very rich data that can be shared throughout the state. The capacity for cross-tabulating this data is overwhelming and we are still in the process of exploring some of these relationships. But, we have succeeded in identifying some very specific gaps and can now focus on developing some effective strategies to bridge these gaps.

Organized Chaos in Disaster

Prepared by: Amber Azbill, BS; Shelly Greenwell, RN, BSN; Christopher Smith, MPH; Melissa Sparks, BA; Shawna D. Thomerson, MSW, CSW
Mentor: A. Scott LaJoie, PhD, MSPH

Full Report (pdf format)

Project Deliverables (pdf format)

Project Deliverables (pdf format)

A disaster, pandemic, or other crisis, by definition, exceeds the capabilities of local healthcare workers and first responders to provide necessary care. During the 2009 H1N1 pandemic, in some areas of the country, hospitals turned to field tents for patient care and activated volunteer medical responders, such as the Medical Reserve Corps. The Federal government’s pandemic preparedness plan dictates that states must be able to provide for themselves at least during the initial wave. This means that state preparedness planners must build in surge capacity.

In many disasters or pandemics, the mental health footprint is significantly larger than the medical footprint. For example, following the September 11, 2001 terrorist attacks, an estimated 228,000 people required medical attention; 50 times as many persons required mental health support. The so-called worried well and those with real mental health distress or disorders can easily over-run the existing mental health system.

The Kentucky public health system finds itself with the responsibility and obligation to provide for the community’s needs through the establishment of shelters for the special medical needs population in the event of disaster or pandemics. In caring for those individuals and for responders, the arena of emotional wellness must be addressed and provided by the public health system and we find ourselves ill equipped in that regard.

The goal of the project/deliverable is to provide a framework to both state and local public health agencies to equip their staff and develop policies which will allow the system to attend to complex emotional first aid needs of the community and to the responders of disasters. While training and structure is early in its conception, it begins to provide a systematic approach for agencies to create competency in their staff. Through a special project of the University of Louisville, there are collaborative partnerships being formed for an evidenced-based training model of psychological first aid which Kentucky public health will be able to access and implement.

Avoid the Scratcher
2010 Balderson Leadership Project Runner-up

Prepared by: Laura Strevels, RS; Ted Talley, RS
Louise A. Kent, MBA, ASQ CQIA

Full Report (pdf format)

The Northern Kentucky Independent District Health Department (NKIDHD) has approximately twenty permitted tattoo and body piercing studios within Boone, Kenton, Campbell, and Grant counties. This number will certainly grow as questions about the process and requirements needed for a new studio are common. Demand for such studios has increased as tattoos and piercings have become more culturally accepted. The nature of body art lends itself to the possible exposure of bloodborne pathogens. Currently, the tattoo and body piercing programs lack educational requirements for artists regarding the understanding and application in the precautions, the risks, and types of infectious diseases. Upon successful completion, this project will serve as the framework for a local regulation requiring bloodborne pathogen education within NKIDHD’s jurisdiction.

Why Aren’t Public Health Agencies Ready for Accreditation?

Prepared by: Russelyn Behanan, BSN; Wendy Hawkins, MS, REHS; Nicolette Jones, MS, CADC;
                      Megan LaFollette, RD, LD
Mentor: Muriel Harris, MPH, PhD

Full Report (pdf format)

When The Accreditators first came together, we wanted to put to together a tool-kit to help health departments achieve ‘Accreditation.’ We had been hearing about this elusive ‘Accreditation’ through grapevines at work and from our supervisors, but when we started out, we had no idea what a large undertaking this could be. It was definitely a project that would exceed our deadline. As we started brainstorming about the direction the project would go, we decided to provide an overall strategy on how an agency could ready itself for accreditation and to pick one specific domain from the national accreditation standards and provide a more detailed approach to help ensure competencies within that particular domain.

The domains identified by the Public Health Accreditation Board (PHAB) mirror the Ten Essential Public Health Services. We chose Domain 8: Maintain a competent public health workforce, to examine individually. We felt that if an agency could ensure the competency of their workforce, then meeting the measures in the other domains would be easier. We felt that if everyone involved was well informed, well notified, and had a part to play, success would be more readily obtained. We have particular interest in measure 8.1.4.B – Establish relationships and/or collaborate with schools of public health and/or other related academic programs to promote the development of qualified workers for public health. This measure stood out because education is where the whole creation of a competent worker begins. A workforce that has been properly prepared, exposed to the actual facility and its inner workings, and allowed to grow while there is a workforce that is engaged and takes ownership.

It is not our intention to create an all-inclusive manual on exactly what a public health agency needs to do to ready them for accreditation. But, more so to create a guideline for agencies to consider that includes outcomes, both positive and negative for preparation strategies and a more detailed look at ways to meet a specific measure. It is our hope that by sharing the feedback we have received from our peers and some of the possible outcomes we have discovered, we can bring to the forefront specific ways to meet an individual measure and in return other agencies can use it as a template to apply it to the needs of their entity.

Kentucky Adult Medicaid Tobacco Use: An Opportunity for Change

Prepared by: Stephanie Rose, MD, MPH; Lisa Shook, MA, CHES; Kelly Thompson; Jon Walz, DO
Mentor: Karen Hunter, MPH, CHES

Full Report (pdf format)

Medicaid recipients have a higher prevalence of smoking and associated medical expenditures than non-Medicaid recipients. Kentucky has a high prevalence of both smoking and poverty. 12% of Kentucky’s total annual Medicaid expenditure is attributable to smoking. Current Kentucky law has created a comprehensive smoking cessation program including counseling and medications, it has but remained unfunded since its passage in 2007. Despite high health costs, physicians do not routinely perform tobacco cessation counseling, and are not aware of tobacco cessation treatment options covered by Medicaid. The Kentucky Public Health Leadership Scholar Team (KPHLIST) used Kentucky Medicaid Adult Patient survey data to assess physician-patient discussions on tobacco cessation and specific options for treatment of tobacco addiction. We (KPHLIST) also piloted a survey of Medicaid physicians in northeast Kentucky about their tobacco cessation counseling attitudes and practices. As a result of both studies, we have developed tools for physicians to use regarding tobacco cessation counseling and treatment.