September
2009
Evaluation research helps local health departments make
informed decisions
Evaluation Services staff was called upon by the Western and South
Central Incubator Partnerships to evaluate two environmental health
data management systems: Custom Data Processing (CDP), designed by
a private vendor, and Best Environmental Technology System
(BETS), recently developed by the state Department of Environment
and Natural Resources. The two systems are used by most local
health departments in North Carolina
Data was collected from over 300 local users of both systems by
Molly Cannon, MPH, and other Institute evaluation staff. Of
CDP users, 61% reported collecting electronic data in the field,
compared to 12% of BETS users. Barriers to electronic data collection
included the bulkiness of the laptops, concern about damaging the
equipment, and technical difficulties with the system.
The greatest benefits of the systems included improving readability
of reports, enhancing reporting capabilities, and improving accuracy.
The greatest challenges included technical problems such as system
crashes and data management issues.
View the complete evaluation report at:
http://www.publichealthincubators.com/
CDP_BETS_Eval.pdf
Cannon and Institute evaluation services conducted another data
collection and analysis for another incubator collaborative, the
Northeast North Carolina Partnership for Public Health, to determine
the costs and benefits of participating in the Partnership.
The evaluation asked about the costs and benefits to each Partnership
agency, and wheter the percent of in-kind contribution is reasonable
compared to benefits.
All 10 health directors in the Partnership and between two to six
staff from each agency responded to the surveys. Cost categories
included health director time, agency staff time, and Partnership
dues. Benefit categories included fiscal agent overhead and administrative
costs and project costs associated with eight Partnership projects:
LEAN, Diabetes Sentinel, Touch No Tobacco, HIV – Health in
Motion, Heart Disease and Stroke Prevention, Health Disparities,
GIS, and Common Billing Initiative.
For all 10 agencies, the dollar benefits calculated were greater
than the dollar costs; the median cost benefit ratio was 6.65. The
greatest in-kind costs for health directors are related to their
administrative roles in the partnership (participating in strategic
planning and board meetings) and the specific roles related to being
on the executive committee or a fiduciary agent. The greatest in-kind
costs for staff are participation in the project activities.
For more information about these research projects, contact Molly
Cannon at mcannon@email.unc.edu.
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Research explores why residents don't evacuate for hurricanes
On September 18, 2003, Hurricane Isabel made landfall as a Category
2 storm between Ocracoke Island, NC, and Cape Lookout, NC. The storm
entered the Albemarle Sound where strong winds of up to 105 miles
per hour and storm surge of four to six feet caused extensive flooding
and downed trees and power lines. One death and over $450 million
in property damage were directly attributed to Hurricane Isabel.
Five years later, Jennifer Horney with the North
Carolina Center for Public Health Preparedness, was in the Albemarle
Sound region where she conducted in-person interviews with nearly
600 individuals who had weathered the impacts of Hurricane Isabel
back in 2003. For her dissertation in the Department of Epidemiology
at the University of North Carolina Gillings School of Global Public
Health, she sought to prove that social reasons related
to friends, family, and social activities are important factors
in determining why people choose not to evacuate from a potentially
dangerous hurricane.
After completing interviews in 2008, Dr. Horney found that high
levels of neighborhood social cohesion, markers of territoriality
(e.g., no trespassing signs), membership in church or civic organizations,
neighbors’ evacuation, and longer length of residence were
associated with a higher risk of failing to evacuate from Hurricane
Isabel. While attending more church or organizational meetings did
not increase the likelihood of evacuation failure, volunteering to
provide assistance following Hurricane Isabel did. Of all the demographic
and storm-related variables on which Dr. Horney collected data,
only homeownership, housing type, age, and having an evacuation plan
were as important with regard to evacuation decision making as these
social factors.
Based on these findings, Dr. Horney hopes to work with local agencies
to determine if it is possible for public health and emergency management
officials to develop targeted messages and interventions that can
take advantage of strong neighborhood ties, civic engagement, and
peer influences to encourage protective behaviors such as evacuation
from impending hurricanes.
Research weighs impact between accreditation and
performance
A research study by Institute Deputy Director Dorothy Cilenti
compared accredited and non-accredited local public health agency
performance. Eighty local health agencies in North Carolina were
part of the study that focused on three areas--policy development
and implementation, community engagement, and leadership behavior.
Data from surveys, interviews, focus groups, time-series comparisons,
and from the NC Center for Health Statistics was used to complete
the picture of how local public health agency accreditation impacts
public health performance.
Says Cilenti, “Overall, accredited health departments had
higher scores in two of three categories. These findings may
provide valuable information to North Carolina public health leaders
and the national voluntary accreditation efforts regarding ways to
ensure that local public health agency accreditation drives high
performance.”
Results were presented in July 2009 to the state accreditation board
with various recommendations including more emphasis on leadership
development, greater focus on community partnerships, and the need
for more communication with elected officials and the general public
about the benefits of accreditation.
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Measuring leadership institute's impact
In 2008, the Southeast Public Health Leadership Institute (SEPHLI)
asked NCIPH evaluation staff to assess the program’s long-term
influence on its graduates. Using both quantitative and qualitative
methods, Karl Umble, PhD, MPH, and Chloe Katz, MPH (c), documented
the actions graduates have taken since graduation and their results.
SEPHLI is a year-long leadership development program for administrators
in public health organizations in North and South Carolina, Virginia,
West Virginia, Tennessee, and Arkansas. It is offered by the North
Carolina Institute for Public Health and sponsored by the Centers
for Disease Control and Prevention as well as by participating states.
Umble and Katz found that the program has developed the capabilities
of leaders, strengthened their influence, and encouraged them to
lead within their respective states on personal, organizational,
community and policy levels.
Graduates reported improved skills, increased confidence and knowledge,
broadened perspectives, and a renewed commitment to public health.
They also reported networking with other scholars in their cohorts
and stronger collaborations with other public health officials in
their communities and states.
SEPHLI alumni also explained how they were using their new skills
and insights to strengthen programs, organizations, system, and policies.
Here
is one graduate's story.
In 2007, Debra Harris-Hawkins, MHA, a 2007 SEPHLI scholar, led a
mobile mammography screening community outreach event for underserved
and rural populations in Harnett County. The event was the product
of a unique initiative called The Mammography Outreach Program, or
MOP. MOP is designed to educate women about the importance of early
detection through both education and mammography screenings, and
is the result of Debra Harris-Hawkins' SEPHLI leadership project.
MOP facilitates an innovative partnership between the Harnett County
Department of Public Health, Harnett County Human Resources, Blue
Cross and Blue Shield of North Carolina, Western Medical Group, and
Rex Healthcare’s
Mobile Mammography.
Harris-Hawkins recently reported, "I am pleased to share that
this program is still operational. I have been fortunate enough to
pursue and secure funding from the Susan G. Komen Foundation for
the past two years to support screenings and education for uninsured
women."
The Susan G. Komen for the Cure NC Triangle Affiliate awarded the
Harnett County Department of Public Health approximately $29,000,
which supports working to eliminate barriers that prevent women from
obtaining screenings.
Says Harris-Hawkins, "SEPHLI was a wonderful program and experience!"
To learn more about MOP, contact Debra Harris-Hawkins at dhawkins@harnett.org.
Click
here for the full SEPHLI evaluation report.
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What incentives will encourage health department accreditation?
While accreditation of local health departments in North Carolina
has been going on since 2004, accreditation of state and local health
departments nationwide is just being pilot-tested, and one of the
key questions has been incentives. NCIPH researchers Mary Davis,
DrPH, Margaret Cannon, MPH, and Edward Baker, MD, MPH, addressed
that question in "Incentives to Encourage Participation in the
National Public Health Accreditation Model: A Systematic Investigation",
to be published in the American Journal of Public Health in September,
2009. Liza Corso, MPA, and Dennis Lenaway, PhD, MPH, both from the
Centers for Disease Control and Prevention, also coauthored the article.
With a 50% survey response rate, the research indicates that financial
incentives to prepare for accreditation and to support infrastructure
and quality improvement would be most likely to encourage participation
in the process.
Over 2500 surveys and interviews among state and local health department
representatives also measured the perceived effect of other incentives--streamlining
the grant application process, technical assistance to prepare for
accreditation, and national and local recognition. An earlier accreditation
assessment included quality and performance improvement, consistency
among health departments, and recognition by peers as important incentives.
The Centers for Disease Control and Prevention and the National
Network of Public Health Institutes supported the research.
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From the director
We will be celebrating the 10th anniversary of the Institute on
October 9 on campus in Rosenau Hall at the Gillings School of Global
Public Health. We will be reviewing our accomplishments, outlining
our future, and, most importantly, recognizing our outstanding staff
and partners.
Joining us to share their visions for the Institute as the School's "Service
and Outreach Arm" will be Dean Barbara Rimer of the Gillings
School of Global Public Health, and Institute founders Bill
Friday and Bill Roper. Because we exist to serve the practice community
across the state, we are thrilled that we will also be joined by
Jeff Engel, Leah Devlin, Phred Pilkington, and Sen. Fletcher Hartsell.
We will also be hearing from leaders beyond our state who have been
key Institute partners and beneficiaries.
The Institute has much of which to be proud. We have trained and
educated public health professionals to conduct environmental health
inspections, thereby protecting the health of North Carolinians.
We have trained public health nurses to provide care for underserved
mothers and children, thereby protecting the health of the youngest
and most vulnerable. We have helped frontline public health workers
detect epidemics, such as H1N1 influenza, thereby strengthening health
surveillance systems.
Our public health leadership and management development programs
are nationally-recognized and constitute a model which we are helping
to replicate outside the United States. Our two distance-based certificate
education programs directly benefit North Carolina's public health
professionals as well as professionals across the nation and around
the world.
The Institute is a national leader in public health preparedness,
prevention of childhood obesity, and the public health quality movement,
which encompasses local public health agency accreditation. Furthermore,
we are becoming a national leader in public health systems and services
research, with a focus on preparedness and accreditation systems
research.
In all of these programs, we are committed to serving those who
serve the public's health. As the largest practice unit in any of
the nation's schools of public health, the North Carolina Institute
for Public Health carries on UNC’s proud tradition of serving
the public health practice community. We are widely recognized as
the best academically-based public health practice unit in the nation
and we are committed to remaining so.
Despite these impressive accomplishments, the current recession
has resulted in unprecedented budget cuts which will limit our capacity
in the months ahead. This will cause us to reevaluate priorities,
redesign programs, and reconnect with our partners. We intend to
emerge as a stronger organization with a recommitment to serving
the public health practice community. We invite you to join us as
we move into the Institute's second decade of leadership, innovation
and impact.
Edward L. Baker, MD, MPH
Director, North Carolina Institute for Public Health
Professor, Health Policy and Epidemiology
UNC Gillings School of Global Public Health
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Trial by water
A look back at Hurricane Floyd September, 1999
One month after the new North Carolina Institute for Public Health
was named, Hurricane Floyd pounded into eastern North Carolina with
20 inches of rain and 15 foot storm surges. Just weeks prior, Hurricane
Dennis had dumped 15 inches of rain on southeastern North Carolina,
making area rivers exceed 500-year flood levels.
Flooding and strong winds affected many homes across the state,
destroying 7,000, leaving 17,000 uninhabitable, and damaging 56,000
more. Ten thousand people resided in temporary shelters following
the storm. Because that part of the state houses numerous livestock
farms, environmental contamination by animal waste and dead animals
was a major health concern.
The Institute was asked to coordinate the UNC School of Public Health
response to come to the aid of state emergency health services and
to the communities of eastern North Carolina.
"What we did ranged from muddy clean-up to drinking water testing,
manning hotlines, encouraging donations, organizing nurses and social
workers for the shelters, and even going door-to-door to find out
what people needed," said Dr. Rachel Stevens, then deputy director
of NCIPH. "It was a huge first test of our organization and
its response."
The Institute hosted a videoconference with emergency procedure
experts from the Division of Public Health and later distributed
tapes and transcripts of the telecast. The booklet and a condensed
flyer were printed in both Spanish and English and distributed in
affected areas.
The lessons learned from Floyd in Pitt County was the subject of
a January, 2000 Public Health Grand Rounds, produced by the Institute,
entitled Disasters,
People and Public Health: Are you ready?
"We worked with faculty and students in every department in the School,
the Schools of Medicine, Nursing, and Social Work, Area L AHEC, and the Carolina
Center for Public Service," added Stevens. "It was quite a collaborative
effort."
There were 35 deaths in the state attributed to Hurricane Floyd.
Said then North Carolina Secretary of Health and Human Services H.
David Bruton, "Nothing since the Civil War has been as destructive
to families here."
NOTE: Each month the Institute has been featuring a
Year 10 vignette on its website to help commemorate our 10th anniversary. Read
the archive here.
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New toolkit assists local health departments in planning
for at-risk groups
How does a local health department help the elderly, the disabled,
and other vulnerable groups during an emergency? The on-line toolkit,
Emergency Planning for At-Risk Groups, provides guidance to planners
for identifying, engaging, communicating with, and providing services
to at-risk populations during public health emergencies, such as
pandemic influenza.
Developed by the North Carolina Center for Public Health Preparedness
(NCCPHP) in partnership with the Office of Public Health Preparedness
and Response at the North Carolina Division of Public Health, the
toolkit covers the five areas of preparedness for at-risk populations
developed by the Association of State and Territorial Health Officials.
Each topic area includes stories of local initiatives that have
strengthened disaster preparedness and response for at-risk populations.
A total of 11 stories from communities around North Carolina are
featured, with audio clips of key contacts who describe the activity
and how it was implemented. Each topic area also includes topic spotlights
(which provide in-depth analysis of key issues relevant to local
planners interested in at-risk population planning), resources, and
suggested planning activities. The toolkit also includes ready-to-use
PowerPoint templates that may be customized for presentations to
at-risk groups or partner organizations in the community to obtain
support for planning activities.
While primarily designed for local health departments, and with
an emphasis on North Carolina, planners at other emergency response
agencies and organizations may also find these materials useful.
The toolkit is available online at
nccphp.sph.unc.edu/at-riskplanning.
For additional information about the toolkit, contact NCCPHP Research
Associate Richard Rosselli at richross@email.unc.edu.
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2009 H1N1 influenza outbreak update
The North Carolina Center for Public Health Preparedness (NCCPHP)
continues its work in responding to the 2009 H1N1 influenza outbreak.
This fall, NCCPHP will partner with the North Carolina Division of
Public Health (NC DPH) on several projects designed to better prepare
state and local agencies for the upcoming influenza season. One
such project is a community survey of public acceptability and intention
to receive the new H1N1 vaccine. Results from this survey may
help inform and improve any proposed H1N1 vaccination campaign.
NCCPHP will also provide technical assistance to local health departments
in revising their pandemic influenza plans in light of changes due
to H1N1. NCCPHP worked with NC DPH and local health departments in
2006-2007 when these plans were first developed. In addition, the
Institute will work with NC DPH to anticipate and address legal concerns
of volunteers assisting in H1N1 activities.
NCCPHP continues to offer a number of online trainings related to
influenza on the NCCPHP
Training Web Site. Check the NCCPHP
Web site for updates on these and other NCCPHP pandemic influenza
projects.
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Field Epidemiology Certificate honors its 100th graduate
The online Certificate in Field Epidemiology celebrated its 100th
graduate at a ceremony at the Carolina Club in August 2009.
Started in 2005, the Certificate in Field Epidemiology was designed
to meet the educational needs of public health practitioners working
in the area of epidemiology. Recent outbreaks and emerging health
threats have only increased the need for a prepared workforce. This
twelve credit hour program consists of four courses: Principles in
Epidemiology, Methods in Epidemiology, Fundamentals of Public Health
Surveillance and Applied Infectious Disease Epidemiology.
Not only do students benefit from online discussions with their
classmates, but they incorporate the coursework into their current
jobs. Participant Shawn Johnson says, “I used the course information
and strategies while investigating two norovirus outbreaks in our
community. I was able to develop linelists, epicurves, and write
up a scientific report for the outbreaks. I would recommend the course
to any professionals working in local health departments."
While some students choose the Certificate to enhance their careers,
many others view the Certificate as a preparation for degree program.
Jerry Rhodes commented, "I love the program and am very glad
to have completed it. I hope to continue on in the MPH program in
the future and feel like I have a good grounding in public health
that will aid me in the masters program.” Approximately 25%
of the certificate graduates have continued their education at UNC
in a degree program at the Gillings School of Global Public Health.
Find out more about enrolling at the Certificate
in Field Epidemiology website.
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SPHTC takes the lead in the development of
entry level core public health competencies
Crafting entry level public health core competencies is a new undertaking
of the Southeast Public Health Training Center. SPHTC Director Janet
Place is leading a national committee made up of representatives
from other public health training centers, other academics, and practitioners
to draft the Tier 1 Core Competencies. The work is being facilitated
by the Council on Linkages (COL) of the Public Health Foundation.
In 2001, the COL developed the national Tier 2 Core Public Health
Competencies, which have been widely used to assess skills and develop
public health practitioner education and training. The COL recently
modified the Tier 2 competencies to more accurately reflect the expected
skills of those with an MPH and five years career experience. Place
served on the Tier 2 Committee.
But only 20 percent of the traditional public health workforce has
any formal public health education, and it is problematic to use
the MPH level competencies to assess the skills of those without
MPHs. In addition, the Tier 2 competencies include skills that an
entry level public health worker would not use, particularly those
involving policy development, management, and leadership.
The Tier 1 Core Competency Committee will soon finish the draft entry-level
competencies. They will then go to the COL for review and then out
for public comment. A draft of the new competencies will be available
at the American Public Health Association conference in November.
Place is using this initiative as her leadership project for the
Southeast Public Health Leadership Institute. For more information,
contact jplace@email.unc.edu
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News from the Public/Private Legal Preparedness Initiative:
Six states pass entity emergency liability protection in
2009
During the first six months of 2009, six state legislatures have
passed laws that provide liability protection for businesses and
non-profit entities that assist their governments during emergencies
(Arkansas, Louisiana, Minnesota, Oklahoma, Oregon, and Virginia).
These states join five previous states that revised their entity
liability protection provisions in the 2007 and 2008 legislative
sessions (Georgia, Iowa, North Carolina, Utah, and Washington).
A total of 28 state jurisdictions (including the District of Columbia)
have now developed entity emergency liability protection. In addition
to the eleven states listed above, 15 states have determined that
entity liability protection is provided under the terms of their
existing law. (Alabama, Delaware, District of Columbia, Idaho, Kansas,
Michigan, Mississippi, Nevada, New Hampshire, New Jersey, Ohio, Pennsylvania,
Rhode Island, Vermont, and Wisconsin). The states of Florida and
South Carolina have administrative arrangements in place to provide
liability protection to business and non-profit organizations.
Given the prospect of an increase in the spread of a novel H1N1
virus this winter, it is timely that significant progress has
been made to encourage voluntary public/private cooperation in emergency
situations.
The Institute’s Public/Private Legal Preparedness Initiative
is designed to improve emergency preparedness and response by removing
the legal barriers that hinder effective and timely collaboration
between the private, nonprofit, and public sectors.
Most state laws do not extend Good Samaritan liability protection
to businesses and non-profit entities that assist communities in
preparing for and responding to public health emergencies.
Visit the Public/Private
Legal Preparedness Initiative Website.
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Institute presenters at the American Public Health Association
conference in November
Accreditation and Public Health Preparedness
John B. Wayne, Glen Mays, Mary Davis, DrPH
James Bellamy, Cammie Marti, Rachel Willard, Edward Baker,
MD, MPH
(Oral - Monday 11/ 9, 2009, 1:10 pm)
Traveling down the pathway of competency-based online trainings:
Helping learners navigate to meet targeted training needs
Lorraine K. Alexander, DrPH,
MPH, Rachel A. Wilfert, MD, MPH, and
Kristen B. Van Dole, MSPH
(Poster - Monday 11/9 2:30 pm)
Enhancing interaction in a graduate-level online certificate program
in field epidemiology using wikis, blogs, and Web conferencing
Lorraine K. Alexander, DrPH, MPH, Debra
E. Irwin, PhD, MSPH, Amy Nelson, PhD, MPH, CPH,
and Karin B. Yeatts, PhD
(Poster - Monday 11/9 2:30 pm)
Developing an online course for international public health practitioners
using Lectora
Laura Alexander, BA, Amy
Nelson, PhD, MPH, CPH, Jennifer Michalove, MPH, Joshua
Mott, PhD, and Jennifer A. Horney, PhD, MPH, CPH
(Oral - Monday 11/9 2:30 pm)
Applying the incident command system to public health: Developing
a self-guided training for local health departments on using incident
command with outbreak investigations
Carol Gunther-Mohr, MA, Martha J.
Salyers, MD, MPH, Meredith K. Davis, MPH, Laura Alexander,
BA, and Rachel A. Wilfert, MD, MPH
(Oral - Monday 11/9 10:30 am)
Moving to electronic disease surveillance: Lessons learned from
a trainer's perspective in designing and delivering a comprehensive
statewide training program for local health departments
Lauren M. DiBiase, MS, Amy
B. Sloane, BA, Meredith K. Davis, MPH, Lauren N. Bradley, MHS, Michael
E. Scott, BS, and Rachel A. Wilfert, MD, MPH
(Oral - Tuesday 11/10 10:30 am)
Effects of Interdisciplinary Training on MCH Professionals, Organizations
and Systems
Lewis H. Margolis, MD, Angela Rosenberg, Karl Umble, PhD, MPH,
Linda Chewning, Jan Dodds , Michael Milano, Mary Nyan, and Kathleen
Rounds
(Poster - Tuesday 11/10, 4:30 pm)
Lessons learned: Training and implementation of an electronic surveillance
system in North Carolina
Lauren M. DiBiase, MS, Amy
B. Sloane, BA, Allison M. Connolly, MA, MPH,
and Rachel A. Wilfert, MD, MPH
(Poster - Wednesday 11/11 8:30 am)
Impact of North Carolina local public health agency accreditation
on public health performance
Dorothy Cilenti, DrPH, MPH, MSW
(Panel – Wednesday, 11/11 12:30 pm)
Visit www.apha.org for more information
about the conference.
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