National Summit on PACE EH PACE EH in Rural Settings March 29, 2006 Louisville, Kentucky.

National Summit on PACE EHNational Summit on PACE EH

“PACE EH in Rural Settings”“PACE EH in Rural Settings”

March 29, 2006March 29, 2006 Louisville, KentuckyLouisville, Kentucky

Presenters: Presenters:

• Ricky Elliott, Environmental Ricky Elliott, Environmental Supervisor, Escambia County Health Supervisor, Escambia County Health Department, Brewton, AlabamaDepartment, Brewton, Alabama

• Tom StruzickTom Struzick, , Project Director, Project Director, Southeast Regional Academic Center Southeast Regional Academic Center for Environmental Public Health, for Environmental Public Health, UAB School of Public Health, UAB School of Public Health, Birmingham, AlabamaBirmingham, Alabama

PACE EH in ALABAMAPACE EH in ALABAMAPartnersPartners

• Alabama Department of Public Alabama Department of Public Health, Bureau of Environmental Health, Bureau of Environmental Services Services

• Eight County Health DepartmentsEight County Health Departments• School of Public Health, University of School of Public Health, University of

Alabama at Birmingham – Alabama at Birmingham – Department of Environmental Department of Environmental Sciences and Center for Community Sciences and Center for Community Health Resource Development Health Resource Development

The Alabama PACE EH experience has been The Alabama PACE EH experience has been supported with two grants:supported with two grants:

• Developing Communities of Excellence in Developing Communities of Excellence in

Environmental Health, 2001-2004 funded by Environmental Health, 2001-2004 funded by the Association of Schools of Public Healththe Association of Schools of Public Health

• Southeast Regional Academic Center for Southeast Regional Academic Center for Environmental Public Health,2004-2007 Environmental Public Health,2004-2007 funded by the National Center for funded by the National Center for Environmental Health at the Centers for Environmental Health at the Centers for Disease Control and Prevention Disease Control and Prevention

In Memory of our Friend and In Memory of our Friend and ColleagueColleague

H. Kenneth Dillon, Ph.D.H. Kenneth Dillon, Ph.D.

September 2, 1947 – May 9, 2004September 2, 1947 – May 9, 2004

Present Project Team Members Present Project Team Members • Kent R. Oestenstad, Ph.D., CIH, CSP; Kent R. Oestenstad, Ph.D., CIH, CSP;

Principal InvestigatorPrincipal Investigator• Linda Goodson, R.N. Co-Principal InvestigatorLinda Goodson, R.N. Co-Principal Investigator• Elizabeth Maples, Ph.D.Elizabeth Maples, Ph.D.• Katrina Wright, Research Assistant Katrina Wright, Research Assistant • Patricia A. Burchfield, B.A., Administrative Patricia A. Burchfield, B.A., Administrative

CoordinatorCoordinator• Cheryl Johnson, Website Manager Cheryl Johnson, Website Manager • Sherry Bradley, M.P.A., Bureau of Sherry Bradley, M.P.A., Bureau of

Environmental Services, Alabama Department Environmental Services, Alabama Department of Public Health of Public Health

• Plus, 7 other PACE EH Project DevelopersPlus, 7 other PACE EH Project Developers

Developing Communities of Excellence Developing Communities of Excellence in Environmental Health, 2001 - 2004in Environmental Health, 2001 - 2004

• Building partnership between the Building partnership between the Alabama Department of Public Health and Alabama Department of Public Health and the UAB School of Public Healththe UAB School of Public Health

• Alabama Public Health Environmentalists’ Alabama Public Health Environmentalists’ Training Needs AssessmentTraining Needs Assessment

• Field-testing a New CurriculumField-testing a New Curriculum

• Launching PACE EHLaunching PACE EH

Building the Partnership between theBuilding the Partnership between the

Alabama Department of Public Alabama Department of Public Health’s Bureau of Environmental Health’s Bureau of Environmental Services and the UAB School of Services and the UAB School of

Public HealthPublic Health

Training Needs AssessmentTraining Needs Assessment

• Multiple kinds of dataMultiple kinds of data• Field tested with PHA Area Field tested with PHA Area

Environmental Directors – Environmental Directors – March,2002March,2002

• Revised completed May/June 2002 Revised completed May/June 2002 with Environmental Directors’ supportwith Environmental Directors’ support

• 89% response rate 89% response rate • Findings relating to PACE EHFindings relating to PACE EH

The assessment consisted of six sections: The assessment consisted of six sections:

1)1) Demographic information, Demographic information,

2)2) Experiences with the Ten Essential Experiences with the Ten Essential Services for Environmental Health, Services for Environmental Health,

3)3) Abilities in the Fourteen Core Abilities in the Fourteen Core Competencies, Competencies,

4)4) Experiences working with the Experiences working with the community community

5)5) Attitudes about environmental health Attitudes about environmental health work, work,

6)6) Training experiences and training needs. Training experiences and training needs.

Experiences working with the CommunityExperiences working with the Community

• When asked how often they work with community When asked how often they work with community agencies, leaders, and lay people, one-third of the agencies, leaders, and lay people, one-third of the participants reported working with community participants reported working with community agencies at least once a month, one-fourth reported agencies at least once a month, one-fourth reported working with community leaders once a month, and working with community leaders once a month, and about one-third of the participants reported about one-third of the participants reported working with lay people at least weekly working with lay people at least weekly

• County and city agencies were the agencies with County and city agencies were the agencies with which the participants reported having the most which the participants reported having the most contact. County commissioners were the contact. County commissioners were the community leaders that they reported having community leaders that they reported having contact most often. They worked with other contact most often. They worked with other community leaders mostly on garbage and illegal community leaders mostly on garbage and illegal dumping issues and with community lay people dumping issues and with community lay people mostly on sewage problems.mostly on sewage problems.

The CurriculumThe Curriculum

Communities Working for Communities Working for Environmental Health:Environmental Health:

A Community-focused Training A Community-focused Training Curriculum for Environmental Curriculum for Environmental

Public Health PractitionersPublic Health Practitioners

[ A Primer for PACE EH ][ A Primer for PACE EH ]

Curriculum Design ChallengesCurriculum Design Challenges

• Cover content required by ASPH/CDCCover content required by ASPH/CDC• Provide background for understanding Provide background for understanding

community EPH workcommunity EPH work• Establish foundation for conducting Establish foundation for conducting

PACE EHPACE EH• Minimize trainee/agency travel Minimize trainee/agency travel

expensesexpenses• Minimize trainee absence from work Minimize trainee absence from work

stationstation

Participants Participants

• Training began May and ended November, Training began May and ended November, 20032003

• Began with 11 (one from each of the Began with 11 (one from each of the state’s Public Health Areas); ended with 10state’s Public Health Areas); ended with 10

• All participants were experienced EPH All participants were experienced EPH workers with between 10 and 31 years workers with between 10 and 31 years experience; average 15 yearsexperience; average 15 years

• Participants valued their curriculum Participants valued their curriculum experience and made one recommendation experience and made one recommendation – move the PACE EH material to the first – move the PACE EH material to the first day. day.

Curriculum ContentCurriculum ContentSeven Modules – 4 Training DaysSeven Modules – 4 Training Days

• Fundamentals of EPHFundamentals of EPH• PACE EHPACE EH• EPH Community LeadershipEPH Community Leadership• Working with Communities for EPHWorking with Communities for EPH• Community OutreachCommunity Outreach• Community-based Participatory Community-based Participatory

ResearchResearch• Strategic Planning for Community-Strategic Planning for Community-

focused EPH Projects focused EPH Projects

Setting the Stage for theSetting the Stage for theAlabama PACE EH Alabama PACE EH

“Experiment” “Experiment”

PACE EH in Alabama: PragmaticsPACE EH in Alabama: Pragmatics

• CDC/NCEH interest in PACE EHCDC/NCEH interest in PACE EH• University’s buy-in: The Spirit of PACE EH University’s buy-in: The Spirit of PACE EH

captured our attention; Engaging community captured our attention; Engaging community members in planning, implementing and members in planning, implementing and evaluating EPH services/programsevaluating EPH services/programs

• University project staff trained on PACE EHUniversity project staff trained on PACE EH• Working with the PACE EH Project in Working with the PACE EH Project in

Anniston, ALAnniston, AL• Earlier project experiences led us to focus on Earlier project experiences led us to focus on

a “modified” version of PACE EH - getting a “modified” version of PACE EH - getting through Tasks 1-5 and beginning to address through Tasks 1-5 and beginning to address some of the concernssome of the concerns

Alabama Pace EH Target Alabama Pace EH Target CommunitiesCommunities

• At least 30 minutes from any urban area; include At least 30 minutes from any urban area; include high percentages of ethnic minority populations with high percentages of ethnic minority populations with large numbers of people living in poverty; and have large numbers of people living in poverty; and have slight community resources (e.g., a church or a slight community resources (e.g., a church or a school) school)

• Population demographics not always available Population demographics not always available

• Few EPH practitioners are available to serve these Few EPH practitioners are available to serve these widely dispersed communities; sometimes one widely dispersed communities; sometimes one worker does worker does allall the EPH work for one county the EPH work for one county

• EPH practitioners who do serve communities in EPH practitioners who do serve communities in these counties must travel to remote locations which these counties must travel to remote locations which are far from their base of operationsare far from their base of operations

ALABAMA PACE EH TARGET ALABAMA PACE EH TARGET COMMUNITIESCOMMUNITIES

Launching PACE EH – February, Launching PACE EH – February, 20042004

• Project Roles – Developer and Project Roles – Developer and FacilitatorFacilitator

• PACE EH Task #1 – Checklist and PACE EH Task #1 – Checklist and Resource ListResource List

• PACE EH Task #2 – Community PACE EH Task #2 – Community DescriptionDescription

(begun during training)(begun during training)• PACE EH Task #3 – Assembling the PACE EH Task #3 – Assembling the

CEHA TeamsCEHA Teams

PACE EH Task #4 PACE EH Task #4

(Summer, ’04)(Summer, ’04)

Planning for the Community Surveys Planning for the Community Surveys

University IRB ApprovalUniversity IRB Approval

Project Start Up Funds Project Start Up Funds

PACE EH Task #5 PACE EH Task #5

(July – December, ’04)(July – December, ’04)

• Conducting the assessments; survey Conducting the assessments; survey form selectionform selection

• Data entry and analysis Data entry and analysis

PACE EH Task #5PACE EH Task #5Environmental Health Issues of Environmental Health Issues of

ConcernConcern

• 415 total surveys from the 8 target 415 total surveys from the 8 target communitiescommunities

• All of the environmental issues on All of the environmental issues on the survey forms were checked; the survey forms were checked; though numbers were smallthough numbers were small

• Majority of respondents felt safe at Majority of respondents felt safe at work, in their own homes, and at work, in their own homes, and at outdoor recreation areasoutdoor recreation areas

• Top five concerns were similar Top five concerns were similar across all communities across all communities

PACE EH Task #10PACE EH Task #10Top Five Concerns Top Five Concerns

• Safe Drinking WaterSafe Drinking Water• Vector Control – MosquitoesVector Control – Mosquitoes• Abandoned BuildingsAbandoned Buildings• Septic SystemsSeptic Systems• Waste ManagementWaste Management

Where Are We Now?Where Are We Now?

PACE EH Tasks 11, 12, and 13PACE EH Tasks 11, 12, and 13• Several teams have had some Several teams have had some

success in resolving some issuessuccess in resolving some issues• All of the teams are loosing All of the teams are loosing

momentummomentum• Running up against the reality of Running up against the reality of

limited resources for “major” limited resources for “major” problem resolutionproblem resolution

Alabama PACE EH SuccessesAlabama PACE EH Successes

• New players involved in EPH program planningNew players involved in EPH program planning• Lower connection fees for public water accessLower connection fees for public water access• Waived fees for private well testingWaived fees for private well testing• Distribution of mosquito larvicide briquettesDistribution of mosquito larvicide briquettes• Public education and awareness campaigns:Public education and awareness campaigns:

– Drinking waterDrinking water– Mosquito controlMosquito control

• Engaging public water authorities in Engaging public water authorities in community educationcommunity education

• Formation of 501(c) (3) for community sewer Formation of 501(c) (3) for community sewer systemsystem

• Joining forces with county commission to Joining forces with county commission to support community water surveysupport community water survey

• ““Doggy” roundupDoggy” roundup• Cleaning up abandoned buildings and lotsCleaning up abandoned buildings and lots• Reduced numbers of illegal solid waste Reduced numbers of illegal solid waste

dumpsdumps• Local Ordinances:Local Ordinances:

- noise control (Jake Brakes)- noise control (Jake Brakes)

- licenses for selling food at alternate - licenses for selling food at alternate locations locations

• Engaging local media in food safety Engaging local media in food safety campaigncampaign

Work Yet to be DoneWork Yet to be Done

Most of the target communities identified two Most of the target communities identified two critical EPH issues which remain to be critical EPH issues which remain to be tackled:tackled:

• Safe Drinking Water Systems and ResourcesSafe Drinking Water Systems and ResourcesEPA Environmental Priority grant applicationEPA Environmental Priority grant application

• Septic Tanks and other systemsSeptic Tanks and other systemsSymposium on Rural Waste Water TreatmentSymposium on Rural Waste Water Treatment

Both requiring major multiple agency support Both requiring major multiple agency support and large amounts of funding. and large amounts of funding.

Lessons LearnedLessons Learned

• The University/Community Partnership The University/Community Partnership can workcan work

• Resources (especially peoples’ time and Resources (especially peoples’ time and effort) make or break the PACE EH effort) make or break the PACE EH processprocess

• University – working with state and University – working with state and county health departments was county health departments was surprising, frustrating, and challengingsurprising, frustrating, and challenging

• County – working with university was … County – working with university was …

In Closing …In Closing …

With an appreciation for the spirit of PACE With an appreciation for the spirit of PACE EH, a comfort with modifying the PACE EH, a comfort with modifying the PACE EH agenda, the right mix of resources, EH agenda, the right mix of resources, some serious determination, and a whole some serious determination, and a whole lot of luck …lot of luck …

The voices of community leaders and lay The voices of community leaders and lay people can be heard and brought into people can be heard and brought into consideration for community-focused consideration for community-focused environmental public health planning, environmental public health planning, implementation, and evaluation implementation, and evaluation