Change Master Projects Class of 2012

Childhood Obesity: Feats for Fitness

Prepared by: Elizabeth Hoo, MPH, CLC; Ida Butterworth, CSW; Glenda Bastin, RN, BSN, MA; Stephanie Mosley, MD
Mentor: Jayaram Srinivasan, MD, MPH, CPH

Full Report (pdf format)

The Tons of Fun team was initially formed to address obesity and decided to focus on childhood obesity due to our desire to help improve and educate the next generation. Our team wants children to get excited about fitness and nutrition so that they can have a healthy, full, and productive life. However, education alone is not enough to change the course of the childhood obesity epidemic and many children are obese despite education on healthy eating habits and physical activity. After reviewing numerous nutrition and physical activity interventions we chose the Kentucky Department for Education's Green and Healthy Schools Program. West Hardin Middle School in Stephensburg, KY was contacted and Joe Pike, Physical Education teacher became the liaison for the project. To encourage the students to eat nutritiously and become more active, it was decided that www.dailyfeats.com should be the way to track the activities that the students accomplished. They received points for each healthy activity that they did which is tracked on the website. The program is on-going and our project cost little to no money.

Release of Protected Health Information

Prepared by: Vickie Trevino, RN; Marilyn Loy; Robyn Dickerson
Mentor: J. David Dunn, MPH, Sc.D, RS

Full Report (pdf)

Project Deliverable(pdf)

What would you do if you received a subpoena in the mail requesting a patient's records? What would you do if a physician's office called and requested a patient's PHI (protected health information)? The "HIPAA Helpers" KPHLI team wanted to provide answers to these and other questions in order to make the staff be and feel more competent in handling these requests and in order to protect the patient's PHI. This will also prevent our local health departments from receiving fines and/or penalties for improperly releasing PHI. Upon completion of our project, we will assist the compliance officer in providing a mandatory HIPAA training session in our local health departments and an informational resource book will be available if needed for review.

HIV/AIDS Among African American Females

Prepared by: K. Leanne Kommer, MSM, CHES; Deborah Magsaysay, BA; Gwendolyn Nixon, BS; Ronyale C Sneed, MBA
Mentor: Muriel Harris, PhD

Full Report (pdf format)

African American males are incarcerated at a rate 6 times higher than white males1. Although sexual activity is not allowed in correctional institutions, males infected with HIV expose uninfected males to HIV through "risky behavior", whether voluntary or involuntary. Upon release, these African American males of unknown or undisclosed HIV status may engage in sexual relations with unsuspecting African American females. This is the issue that birthed the CONDOMISTAS. Our initial focus was to initiate policy change that allowed condom distribution in prisons and other correctional facilities. However, this presented itself as a daunting task with a small chance of deliverables within a year.

Since African American females are often the most vulnerable in this situation, we decided to focus on activities that lead to empowering them to protect themselves from HIV. Although our group consists of 4 female public health professionals working in 3 different Kentucky counties, we focused our project on Jefferson County, KY. According to provisional data in the Kentucky HIV/AIDS Surveillance Report of June 20112, Jefferson County has the highest total number of HIV cases in the state. We determined that resources were available, but were not being utilized by our target group. We attended HIV conferences, testing events, listened to several speakers, and interviewed HIV/AIDS Health Educators and individuals infected with HIV. From these outlets, we discovered that there were many barriers to African American females protecting themselves from this disease. These barriers included poverty, low self esteem, and limited access to healthcare and HIV prevention education due to childcare and transportation issues. We were challenged with bringing culturally sensitive HIV prevention education and resource information to African American females in an atmosphere of influential trust, without fear. We chose to provide African American churches with a tool kit containing information and resources to begin HIV/AIDS ministries.

The church is one of the most influential organizations in the African American community3. It is through the church that many people's beliefs and ideals originate. The African American church has been a source of strength and support in this community for centuries. If HIV testing, practicing safe/safer sex, and loving one another regardless of HIV status is promoted in the church, prevention programs could take root and bring about change.

Take It Outside

Prepared by: Alicia Banta, RN; Vickie Cleaver, RN; Carolyn Fogle, BSN, RN; Megan Folkerth, MPH, CHES
Mentor: Louise Kent, MBA

Full Report (pdf format)

Exposure to secondhand smoke can lead to increased risk of heart disease, asthma, sudden infant death syndrome and cancer. The home is often times a source of secondhand smoke exposure for many individuals, especially children. By eliminating smoking in the home, many individuals will have a significant decrease in secondhand smoke exposure and reduced risk of illness related to the exposure. Smoke-free housing policies among local housing authorities have gained support in recent years and are effective in eliminating exposure to secondhand smoke in the home. The Health Outreach Providing Empowerment (HOPE) team set out to work towards the implementation of a comprehensive smoke-free housing policy that would cover all residents and staff residing and working in Housing Authority of Covington (HAC) properties. Although a comprehensive policy is not in place currently, the HOPE team laid the groundwork for a future policy and made significant progress towards the education of HAC residents, staff and board members.

The utilization of systems thinking throughout the project allowed us to develop a picture of the current reality related to secondhand smoke exposure among HAC residents. Systems thinking allowed us to understand the root causes, identify the key stakeholders and develop strategies that would allow us to reach the key stakeholders and begin moving them towards the desired level of support needed for success of the project. Identification of mental models related to the problem as well as the key stakeholders was instrumental to our project and gave us a look into various perspectives and beliefs that surrounded and contributed to the problem. This process then allowed us to develop specific strategies that were targeted at different stakeholders and would address the mental models identified. Systems thinking allowed us to look at the whole picture while also focusing in on the individual components and how we could improve those areas to achieve the end result.

The HOPE team administered a resident survey to collect data on resident attitudes, perceptions and behaviors related to tobacco use and secondhand smoke exposure. Following the results from the resident assessment the HOPE team created educational materials for residents that addressed the harms of exposure to secondhand smoke. The materials focus on asking smokers to "Take It Outside" and create a smoke-free indoor living environment to protect the health of others in the home as well as neighboring units. Air nicotine testing will also be done in HAC apartment units and common areas to gather data and the levels of air nicotine present. This testing will take place in April 2012. The data gathered from the resident assessment and the future air nicotine testing is instrumental in gaining support and building the case for smoke-free public housing to the HAC staff and board members. The work that the HOPE team completed will continue as the Northern Kentucky Health Department (NKHD) continues to work with HAC residents, staff and board members to develop policies that provide smoke-free housing options for residents with the long term goal of a comprehensive smoke-free housing policy that covers all residents, staff and HAC properties.

Accessing the Lack of Performance Management Models and Quality Improvement Methods as Barriers to Data Usage in Local Health Departments

Prepared by: Ma'isah Edwards, MBA, CMBA, MPH, CPH; Jennifer Harris, MS; Rhea Michelle Wilburn, AAS; Elizabeth Willett, MS
Mentor: Brandon Hurley, MPH

Full Report (pdf format)

Data driven decision making is critical to the future success of public health and specifically Local Health Departments. Whether data is related to services, quality of life, or health performance, the requirement to use data is an innovative concept as it pertains to the operation, management and performance of Health Departments. Several data sources have been used to determine how health departments are meeting these requirements in the area of Accreditation. The NACCHO 2010 National Profile of Local Health Departments, The Accreditation Resource Inventory and Accreditation Coordinator Workgroup Survey, the pre and post surveys from the QI training held by the Center for Performance Management, and The LADS Survey of LHD Directors were all reviewed to show a picture of the current infrastructure and capacities of LHDs.

The NACCHO survey showed 45% of LHDs have conducted formal quality improvement programs and activities. Similarly, in the Accreditation Coordinator Workgroup survey, 19.4% of Kentucky Health Departments have developed a quality improvement plan. In the LADS survey, results show, 59% of health departments are not able to move forward with accreditation due to lack of funding and resources. Additionally, 63% of health departments responded that they need training regarding how to evaluate programs and services using data. Each survey summarizes areas where data builds a case for closing the gap between using data and making informed decisions that move LHDs towards improvement.

The LADS used the 10 Essential Public Health Services, Accreditation Essential Services 8 and 9, and Healthy People 2020: Public Health Infrastructure (PHI) PHI-14, 16, and 17 as foundations for the goals LHDs need to be striving for. We also performed key informant interviews to find out how public health agencies will focus on performance management, QI and accreditation as relating to trainings, approaches, and future plans being developed to assist LHDs. Representatives from the Kentucky and Appalachian Public Health Training Center, Kentucky Center for performance Management and Foundation for a Healthy Kentucky have training schedules in place to help assist health departments with moving towards quality improvement and accreditation. This knowledge helped us formulate recommendations regarding how LHDs can move towards making informed, data driven decisions.

Access to Care Among Rural Veterans in Kentucky

Prepared by: Dennis Peyton, BS, MPH, CCRP; Carrie Reshke, MD; Shannon Urbon
Mentor: Karen Hunter, MPH

Full Report (pdf format)

The Veterans Health Administration (VA) provides comprehensive healthcare services to approximately 7.8 million of the 23 million veterans across the United States. Military personnel are increasingly drawn from rural areas and, therefore, rural VA users are growing proportionate to urban VA users. Veterans who use the VA are sicker, older, and of lower socioeconomic status than the general population. Previous cross-sectional analyses have demonstrated that veterans who live in rural settings have greater health care needs than their urban counterparts, as measured by health-related quality of life (HRQoL) scores. These differences in HRQoL scores were substantial and likely to have clinical meaning and be associated with increased demand for health care services. Further, these disparities in health status persisted after adjustment for demographic differences between rural and urban populations, and within cohorts of veterans with specified medical and psychiatric illnesses; however, despite their greater illness burden and health care needs, rural veterans were less likely to access health services either through the VA or the private sector.

Access to healthcare has been identified as a critical issue, both by the Department of Veterans Affairs (VA) and the larger medical community. Travel barriers, including greater distance to care and lack of public transportation contribute to limited access to care for rural as compared to urban veterans. To address these distance and access barriers, VA has invested in a full spectrum of telemedicine technologies for chronic disease care, and audio-visual telemedicine diagnostic strategies for a variety of conditions. Studies to date suggest these distance strategies are feasible, acceptable, and cost-effective.

Over the past several decades, VA has transformed itself from an in-patient tertiary care system to an out-patient health care system with an emphasis on prevention and patient-centered care using the electronic health record and patient aligned care teams. The Office of Rural health was created to bring this model of care to Veterans in rural and highly rural areas. In Kentucky, a state with a highly rural population of veterans, this model can provide not only the specialty care that can meet the unique health needs of veterans, but one that can also provide care to meet the needs associated with chronic illness and aging.

Tele-health medicine offers the rich potential of supplementing traditional delivery of services and channels of communication in ways that extend the healthcare organization's ability to meet the needs of its patients. The goal of our project was to investigate what role, if any, the local health department could play in providing tele-health services to rural veterans in Kentucky.

Web Communications by Local Health Departments

Prepared by: Doraine Bailey, MA, IBCLC, RLC; Martin Hensley, BA; Tonya Shankle, BS
Mentors: Georgia Heise, DrPH

Full Report (pdf format)

The purpose and programs of many Health Departments across the country are surprisingly not well known to the public. This was the motivation for the "Gabriels" KPHLI Leadership Team to devise a plan that would assist health departments to spread the word regarding services and resources offered. We began with the general idea of getting the word out there and what a large task this could be. The idea quickly became much more focused with web media winning the spotlight. If we could assist health departments with their web-based communications by providing a tool kit to maneuver the sometimes daunting world of "the internet," then they would be empowered to share the message of public health and the Gabriels could live with the knowledge that they had done a service to mankind. A review of Kentucky health departments identified those with existing web-based communication resources (website, Facebook page(s), Twitter feed). A survey of Kentucky health department directors further assessed their sense of website utility, public information needs, and barriers to web-based communications. Based on this data, a set of model web pages were developed into an on-line toolkit, which meets the website information requirements of the Public Health Accreditation Board and the Kentucky Public Health Administrative Reference. An introduction to web-based communications targeting public health staff and model web communications policies were developed as supplemental information to the model web pages. The entire product will be hosted on a publicly accessible website of the Kentucky Health Department Association. KHDA will assist in marketing the toolkit among members, especially those with minimal or no digital presence.