Log In
My Information
My Membership
My Subscriptions
My Transactions
NACCHO Applications
NACCHO Profile
Report Dashboard
Model Practice Options:   Print Practice   Provide Feedback   Overall Feedback
Please press CTRL+P to print this page

2014 Model Practices

Application Name: 2014 Model Practices : Harris County Public Health : Core Tour Practice of Harris County Public Health and Environmental Services
Applicant Name: Ms. Linda E. Forys
Name of Practice:
Core Tour Practice of Harris County Public Health and Environmental Services
Submitting LHD/Agency/Organization:
Harris County Public Health and Environmental Services
Street Address:
2223 West Loop South
Submitting LHD/Agency/Organization/Practice website:
Practice Contact:
Michael Schaffer
Practice Contact Job Title:
Director, Environmental Public Health Division
Practice Contact Email:
Head of LHD/Agency/Organization:
Umair Shah, MD, MPH
Provide a brief summary of the practice in this section. Your summary must address all the questions below. 
Size of LHD jurisdiction (select one):
In the boxes provided below, please answer the following:
1)Where is LHD located? 2)Describe public health issue 3)Goals and objectives of proposed practice 4)How was practice implemented / activities 5)Results/ Outcomes (list process milestones and intended/actual outcomes and impacts. 6)Were all of the objectives met?  7)What specific factors led to the success of this practice? 8) What is the Public Health impact of the practice?
Harris County Public Health and Environmental Services (HCPHES) is a comprehensive local health department serving the third most populous county, Harris County, Texas, in the United States. It spans over 1700 square miles, and its land area is larger than the state of Rhode Island. The HCPHES jurisdiction includes approximately 2 million people within Harris County’s unincorporated areas and over 30 small municipalities located in Harris County (not including the city of Houston). For certain public health services such as vector control, Ryan White/Title I HIV funding, and refugee health screening, the HCPHES jurisdiction encompasses the entire county including the city of Houston, therefore providing services to over 4 million people in total.Since being charted in 1942 by Harris County Commissioners Court, HCPHES has expanded to include services ranging from disease control and clinical prevention to veterinary public health, all supported by various support functions such as finance and administration; policy and planning; health education; public information; and emergency preparedness and response.Across this broad organizational framework, HCPHES has engaged in significant departmental strategic planning activities,including the development of the HCPHES Strategic Plan 2013-2018 which is grounded in the “Essential Public Health Services” model (e.g., assessment, Policy development and education, and assurance activities). These categories allow HCPHES to engage in a variety of public health sectors including the services provided through its clinical programs. The mission statement of HCPHES is “Promoting a Healthy and Safe Community, Preventing Illness and Injury, Protecting You, HCPHES, Your Department for Life” while its clear vision is “Healthy People, Healthy Communities…a Healthy Harris County.” The over 500 staff members of HCPHES are public health professionals in the truest sense of the word and have a broad range of expertise in various public health program areas. HCPHES staff members pride themselves in upholding the organizational values which include: Excellence, Compassion, Flexibility, Integrity, Accountability, Professionalism, and Equity. With a current annual operating budget of $58 million, HCPHES is organized into four offices that apply specific skills broadly across all public health activities (Health Education and Promotion, Policy and Planning, Public Health Preparedness and Public Information); four divisions that focus on specific programmatic disciplines (Disease Control and Clinical Prevention, Environmental Public Health, Mosquito Control, Veterinary Public Health); and a state-of-the-art Operations and Finance Division that runs the business infrastructure of HCPHES (e.g. financial services, information technology, human resources, etc.).
Overflow Group Overview
HCPHES is governed by a robust strategic plan, which is the guiding principles that shape the way HCPHES performs its work internally, with other stakeholders and with the broader public in order to effectively carry out its mission. As HCPHES works towards advancing the priorities outlined in the Strategic Plan, strategies to improve population health are currentlybeing developed and implemented around upstream solutions, leadership development for current and future leaders, leverage and share resources amongst partners, and efficiency and quality improvements. To ensure that this was done effectively, each executive team member must have a better understanding of each division, beyond a high level understanding. It was a gap that was identified and had to be filled, which ultimately produced a highly successful model practice called the HCPHES Core Tour (HCT). Goal of Practice: Enhance HCPHES senior level management staff understanding of the “practice” of each Division to assist in their ability to determine priorities for the health department. Objectives: 1. Develop an interactive/didactic capacity building experience for senior level staff 2. Senior level staff report increased confidence in ability to discuss and analyze health department priorities
Supplemental materials:
You may provide no more than two supplement materials to support your application. These may include but are not limited to graphs, images, photos, newspaper articles etc. (Please use one of the following: pdf; txt; doc; docx; xls; xlsx; html; htm)
Model Practice(s) must be responsive to a particular local public health problem or concern. An innovative practice must be 1. new to the field of public health (and not just new to your health department) OR 2. a creative use of an existing tool or practice, including but not limited to use of an Advanced Practice Centers (APC) development tool, The Guide to Community Preventive Services, Healthy People 2020 (HP 2020), Mobilizing for Action through Planning and Partnerships (MAPP), Protocol for Assessing Community Excellence in Environmental Health (PACE EH). Examples of an inventive use of an existing tool or practice are: tailoring to meet the needs of a specific population, adapting from a different discipline, or improving the content.  
In the boxes provided below, please answer the following:
1)Brief description of LHD – location, jurisdiction size, type of population served 2)Statement of the problem/public health issue 3)What target population is affected by problem (please include relevant demographics) 3a)What is target population size? 3b)What percentage did you reach? 4)What has been done in the past to address the problem?5)Why is current/proposed practice better?  6)Is current practice innovative?  How so/explain? 6a)New to the field of public health OR 6b)Creative use of existing tool or practice 6b.1)What tool or practice did you use in an original way to create your practice? (e.g., APC development tool, The Guide to Community Preventive Services, HP 2020, MAPP, PACE EH, a tool from NACCHO’s Toolbox etc.) 7)Is current practice evidence-based?  If yes, provide references (Examples of evidence-based guidelines include the Guide to Community Preventive Services, MMWR Recommendations and Reports, National Guideline Clearinghouses, and the USPSTF Recommendations.)
The HCT will provide a powerful impact to the executive leadership that will empower them to, in aggregate, make better decisions for the entire department. It is not common that each member of an executive team of a large health department understands the interworking of another division/area as they are focused on running their own. At HCPHES, we make decisions in unity, as each decision we make impacts the public as a Local Health Department. Although our executive team meets two times per month, there was a gap in knowledge and understanding to allow these great minds and leaders to develop and improve on the current strategies being focused on. In order to do this, it was imperative that each member of the executive team understand the department as a whole. Not only should they understand the department as a whole from a high level, but really understand the work that is carried out from the boots on the ground all the way to the head of each division. This approach would enable the executive level team members understand risk, outcomes, and overall better decisions to support the strategic plan.
Overflow Responsiveness - 1
The uniqueness of the HCT is that not only was the executive staff taken on a very comprehensive tour of the division but that the employees of that division were able to interact with member of the executive team. It allowed time for both the employees and the executive team member to find not only the synergies that existed but also to allow the employees to exhibit their expertise and value to the organization. How often does the entire executive team of a large business work side by side with employees down to the lowest member of the organizational chart? Other than a quick walkthrough of an area/location, it’s not common, if done at all. This approach takes the leadership of this health department to a new level of understanding the “Core” business.
Overflow Responsiveness - 2
Overflow Responsiveness - 3
Does practice address any CDC Winnable Battles?  Select all that apply.
The LHD should have a role in the practices development and/or implementation. Additionally, the practice should demonstrate broad-based involvement and participation of community partners (e.g., government, local residents, business, healthcare, and academia). If the practice is internal to the LHD, it should demonstrate cooperation and participation within the agency (i.e., other LHD staff) and other outside entities, if relevant. An effective implementation strategy includes outlined, actionable steps that are taken to complete the goals and objectives and put the practice into action within the community.  
In the boxes provided below, please answer the following:
1)Goal(s) and objectives of practice
2)What did you do to achieve the goals and objectives? 2a)Steps taken to implement the program 3)Any criteria for who was selected to receive the practice (if applicable)? 4)What was the timeframe for the practice 5)Were other stakeholders involved? What was their role in the planning and implementation process? 5a)What does the LHD do to foster collaboration with community stakeholders? Describe the relationship(s) and how it furthers the practice goal(s) 6)Any start up or in-kind costs and funding services associated with this practice?  Please provide actual data, if possible.  Else, provide an estimate of start-up costs/ budget breakdown.
Goal of Practice: Enhance HCPHES senior level management staff understanding of the “practice” of each Division to assist in their ability to determine priorities for the health department. Objectives: 1. Develop an interactive/didactic capacity building experience for senior level staff 2. Senior level staff report increased confidence in ability to discuss and analyze health department priorities The HCT was designed to take a full day (up to 13 hours in some cases) to take each member of the executive team, a total of 8, and allow them to experience each portion of a division from the front line employee up to the executive that lead a particular division. This was a “hands on” field experience, not a full day “classroom” type presentation. Our executive staff spent their day next to Doctors, Nurses, Technicians, Investigators, Call Center Staff experiencing their daily activities. The following is the activities each executive staff member experienced (Attached-HCT schedule -WORD document)
Overflow LHD1
Mosquito Control (MCD) 09:30 to 10:00 – Office: MCD Overview 10:00 to 10:30 – Office: Educational Outreach/Employee Training 10:30 to 11:00 – Lab: Mosquito Identification and Processing 11:00 to 11:30 – Lab: Avian Identification, Processing, and Testing 11:30 to 12:00 – Lab: Virology – Testing of Mosquito Samples for WNV 12:00 to 12:30 – Lab: Applied Research – Hands on Approach 13:00 to 14:00 – Field: Mosquito Trapping and Collection 14:00 to 15:00 – Field: Avian Trapping and Collection 15:00 to 16:00 – Field: Collection of Mosquito Eggs for Insecticide Resistance Tests 16:00 to 17:00 – Field: Neighborhood Inspection and Area Profiling 17:00 to 21:30 – Field: Mosquito Spray Operations Technology Review and Ride Along Environmental Public Health (EPH) 08:00 to 08:15 – Office: Overview of Business Support 08:15 to 09:15 – Office: Home Abatement/Lead/Occupational Health and Safety Reviews 09:15 to 09:45 – Office: Regulation Compliance Review 09:45 to 12:30 – Field: Pool and Public Water Supply Inspections 12:30 to 13:30 – Field: Mobile Food Unit Inspection 13:30 to 15:30 – Field: Food Establishment Inspection(s) 15:30 to 17:00 – Field: Neighborhood Nuisance Inspections
Overflow LHD2
Veterinary Public Health (VPH) 07:30 to 08:00 – Shelter: Euthanasia - Explanation of the process and watch the procedure 08:00 to 11:00 – Field: Shadow Animal Control Officer 11:00 to 11:30 – Shelter: Surgeries - Explanation of the process and watch the procedure 11:30 to 12:00 – Shelter: Veterinary Evaluations - Explanation of the process and watch the procedure 12:00 to 13:00 – Shelter: Zoonosis - Explanation of the program activities/responsibilities 13:00 to 14:30 – ShelterFront Desk/Kennel - Explanation of the program activities/responsibilities and shadow kennel supervisor – Front Desk/Intake/Adoptions/Kennel Searches/Etc. 14:30 to 15:00 – Shelter: Education/Outreach - Explanation of the program activities/responsibilities 15:00 to 15:30 – Shelter: Unload Trucks (Animals) 15:30 to 16:00 – Shelter: Phones - Explanation of the program activities/responsibilities and shadow phone operators Disease Control and Clinical Prevention (DCCP) 08:00 to 09:15 – Main Office: DCCP Overview Disease Control and Medical Epidemiology (DCCP) Clinical Health and Prevention (CHP) Clinical Quality Management Program (CQMP) Nutrition and Woman Infant Children Services (NWS) 09:15 to 11:00 – Field: CHP School Outreach 11:00 to 13:00 – Field: WIC – Certification process including intake and nutrition counseling 13:00 to 15:00 – Field: Tuberculosis Directly Observed Therapy 15:00 to 15:30 – Field: Refugee Program Patient Interaction 15:30 to 16:00 – Field: Tuberculosis Control Program Patient Instructions 16:00 to 17:00 – Field: Dental Clinic – Observe patient receiving services 17:00 to 18:00 – Field: Health Clinic – Observer patients receiving services
Overflow LHD3
The process to go through the four divisions took four months; each division assigned a particular month. The devotion to this exercise was so great that not one person cancelled a tour the entire four months. Although as a health department official there comes with it a hectic schedule, there was total commitment to this endeavor.
Overflow LHD4
Overflow LHD5
Overflow    LHD6
Overflow LHD7
Overflow LHD8
Evaluation assesses the value of the practice and the potential worth it has to other LHDs and the populations they serve. It is also an effective means to assess the credibility of the practice. Evaluation helps public health practice maintain standards and improves practice.

Two types of evaluation are process and outcome. Process evaluation assesses the effectiveness of the steps taken to achieve the desired practice outcomes. Outcome evaluation summarizes the results of the practice efforts. Results may be long-term, such as an improvement in health status, or short-term, such as an improvement in knowledge/awareness, a policy change, an increase in numbers reached, etc. Results may be quantitative (empirical data such as percentages or numerical counts) and/or qualitative (e.g., focus group results, in-depth interviews, or anecdotal evidence).
In the boxes provided below, please answer the following:
1)What did you find out?  To what extent were your objectives achieved?   Please re-state your objectives from the methodology section.
2)Did you evaluate your practice? 2a)List any primary data sources, who collected the data, and how (if applicable) 2b)List any secondary data sources used (if applicable) 2c)List performance measures used.  Include process and outcome measures as appropriate. 2d)Describe how results were analyzed 2e)Were any modifications made to the practice as a result of the data findings?
The practice objectives were achieved: 1. Develop an interactive/didactic capacity building experience for senior level staff 2. Senior level staff report increased confidence in ability to discuss and analyze health department priorities. HCPHES Core Tour model was developed providing an interactive field experience for senior level staff. The outcome of the HCT was an outstanding success. Qualitative methods were used to demonstrate increase staff confidence. Based on feedback from Executive staff through electronic communication and at Executive level meetings, each member of the team, regardless of tenure, gained exceptional knowledge and understanding, which in turn allowed for deeper and more robust discussions that will affect the overall outcomes to the health department. Our teams that were designed to support the strategic plan, which included the members of the executive team, are now able to understand each piece of the department and apply the intangible wealth of knowledge to gain a tangible outcome in new directions.
Overflow Eval1
Sustainability is determined by the availability of adequate resources. In addition, the practice should be designed so that stakeholders are invested in its maintenance and to ensure it is sustained after initial development. (NACCHO acknowledges fiscal crisis may limit the feasibility of a practices continuation.)  
In the boxes provided below, please answer the following:
1)Lessons learned in relation to practice  2)Lessons learned in relation to partner collaboration (if applicable) 3)Is this practice better than what has been done before? 4)Did you do a cost/benefit analysis?  If so, describe 5)Sustainability – is there sufficient stakeholder commitment to sustain the practice? 5a)Describe sustainability plans
The HCT was such as success that it will be implementing it to the next level of management, future leaders, and used as employee recognition. The costs to maintain HCT is a sunk cost in that it is primarily time of the employee to attend with the exception of possible mileage expenses that would need to be paid, but would be very minimal. The minimal amount of costs with the intangible value that is returned is something HCPHES is willing to invest in and maintain.
Overflow Sustain1
Please identify the topic area(s) the practice addresses. You may choose up to three public health areas:
Practice Category One:
Organizational Practices
Practice Category Two:
Practice Category Three:
Check all that apply:
I am a previous Model Practices applicant
Colleague in my LHD
Are you a previous applicant?:
Yes, and was awarded Promising