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2013 Model Practices (Public)

Practice Title
Main Streets Go Blue
Submitting LHD/Agency/Organization
Livingston County Department of Health
City
Mt. Morris
State
New York
Submitting LHD/Agency/Organization Web Address (if applicable)
www.livingstoncounty.us/doh_home.php

Provide a brief summary of the practice in this section. This overview will be used to introduce the model or promising practice in the Model Practices Database. Although this section is not judged, the judges use it to get an overall idea about your practice. You must include answers to the following questions in your response:

• Size of population in your health department’s jurisdiction
• Who is your target population/audience, what is the size of your intended population/audience for this practice and what percent of your target population did you reach?
•Provide the demographics of your target population (i.e. age, gender, race/ethnicity, socio-economic status) 
• Describe the nature and gravity of the public health issue addressed
• List the goal’s and objective(s) of the practice and clearly link them to the problem or issue the practice is addressing.
• Describe the potential public health impact of the practice, and the likely effectiveness of the practice being implemented as intended, and the ease of adoption of the practice by other LHDs.

In your description, also address the following
• When (month and year) the practice was implemented.
• Briefly describe how the practice was implemented, what were major activities, and any start-up and in-kind costs and funding services.
• Outcomes of practice (list process milestones and intended/actual outcomes and impacts.
• Were all of the objectives met? 
• What specific factors led to the success of this practice?

According to the Census, the size of the Livingston County Department of Health's jurisdiction is 65,070. The target population for this practice is Livingston County residents who are 50 years and older, specifically individuals who are 50-64 year of age and are uninsured or underinsured. There are approximately 13,782 in the target population, approximately 582 individuals who are in the specific target population. From 2010 to August 31, 2012, 262 individuals received cancer screenings through the Cancer Services Program of Livingston and Wyoming Counties. The Cancer Services Program of Livingston and Wyoming Counties continues to provide breast, cervical and colorectal cancer screenings and follow-up services to uninsured and under-insured individuals. Colon cancer is the public health issue addressed. Colon cancer remains to be the one of the leading causes of death in the nation and in Livingston County. According to the American Cancer Society, "Colon cancer screenings increase the chances of detecting certain cancers early, when they are most likely to be curable". The goals of Main Street Goes Blue are to: raise awareness regarding colon cancer and increase the number of Livingston County resident who received colon cancer screening through the Cancer Services Program by a minimum of 5% by December 31, 2011 and 2012, respectively. The Cancer Services Partnership provides support and free cancer screening services to eligible Livingston County residents. The objectives of the Main Street Goes Blue initiative was to: * have one village participate in the initiative in 2011 and two villages in 2012 * implement a media and outreach campaign to increase the community's awareness regarding the importance of colon cancer screenings and the Cancer Services Program This practice intends to encourage local residents to receive regular, age-appropriate colon cancer screenings. Main Street Goes Blue was implemented in March 2011 and 2012. In 2011, this practice was a pilot project of the Cancer Services Program of the New York State Department of Health (NYSDOH). The NYSDOH provided a community partner packet which included an overview of the initiative including why it's important, how local businesses can participate and a participation form. The NYSDOH Cancer Services Program conducted conference calls to provide guidance to Livingston County Department of Health. A local mayor was approached regarding interest in having their village participate in this initiative. Once the mayor approved, local Main Street Managers and local business owners were contacted regarding their possible participation in the initiative. Information packets were distributed to local businesses. The Livingston County Department of Health enhanced New York State's plan to include bookmarks at the local library of the participating villages, purchasing and hanging a banner on Main Street, an interactive information table at the local grocery store, and Blue Star Sunday at local churches which provided blue star pins and educational materials on colorectal cancer screening. At the end of February, blue items such as light strands and helium balloons, educational materials and boxes for prize drawings were distributed to participating businesses. An outreach and media campaign was developed and implemented in February and March. The campaign included print ads in the local pennysavers which are delivered free of charge to each household in the community, press release, public service announcement, radio interview, flyers, website announcements, list serve email, and large outdoor banners.

Overflow: Please finish the response to the question above by using this text area.  Please be mindful of the word limits.

Start up costs included purchasing a banner for $400; print ads for $1,467; radio ads for $2,921, were purchased through the NYSDOH grant. Blue lights were provided in-kind from the NYSDOH. Additional light strands, copy and mailing costs, and office supplies were purchased using NYSDOH Cancer Services funding, which totaled $200. Personnel costs for the Case Manager of the Program were covered by the Cancer Services Grant, which was approximately $1,000. Mileage costs were $150. In-kind costs included staffing costs for two educators was approximately $700. The LCDOH education budget was utilized to purchase a print ad for $1,092. The goals and objectives of the practice were met as there was an increased awareness regarding colon cancer as a result of the media/ outreach campaigns as per business owner and anecdotal comments from residents. The objective regarding the number of participating villages in 2011 and 2012 was met as there was one village in 2011 and two in 2012. In 2011, 109 residents received screening through the Cancer Services Program, an increase of 18% from 2010, which exceeded our goal of 5%. From January to August of 2012, there were approximately 60 Livingston County individuals who have received screenings through the Program.
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.
Describe the public health issue that this practice addresses. (350 word limit)
This practice addresses colon cancer which is a very important public health issue. According to New York State Department of Health, colon cancer is the second leading cause of cancer-related deaths in the United States.
What process was used to determine the relevancy of the public health issue to the community? (350 word limit)
This issue is relevant, especially to Livingston County, as a recent Mobilizing for Action through Planning and Partnership (MAPP) process revealed from 2001 to 2005 percent of colon cancer diagnosed at any early stage was only 46.9 for females and 42.3 for males. The incidence of color cancer among males was 79.8 and 61.8 for female, both rates were higher than the New York State Rates. Although mortality rates for both genders met the Healthy People 2010 objective, the MAPP Leadership team strongly suggested additional initiatives be development and implemented to improve the statistics and, most importantly, save lives. Additional data review regarding colon cancer was conducted upon completion of the MAPP process. According to the New York State Department of Health, from 2004 to 2008, the incidence and mortality of colon cancer was higher than New York State for males and females. In addition, the percent of cases detected at an early stage for males was lower than the New York State rate. The rate for females was slightly higher. In the first year of the practice, the Livingston County Department of Health chose the village of Geneseo as it is centrally located with many businesses and high traffic flow. The planning committee of the Department believed it would reach a greater number of individuals. In the second year, in addition to the Village of Genseo, the Village of Mt. Morris was chosen as there is a higher number of low income residents and a revitalization of Main Street was drawing an increasing amount of visitors to the area.
How does the practice address the issue? (350 word limit)
The Main Street Goes Blue practice directly addresses the issue by engaging elected officials, local businesses and community partners to engage employees and customers by encouraging individuals who are 50 years of age and older to get screened for colon cancer. The practice works to reduce the stigma and misinformation regarding colon cancer screenings.
Does this practice address any of the CDC Winnable Battles? If yes, select from the following
Please list any evidence based strategies used in developing this practice. (Provide links or other materials for support)
According to the Guide to Community Preventive Services of the CDC, evidence based strategies used in developing this practice was a multi-component intervention which disseminated information to the target population through multiple vehicles such as print, radio, banners and other public sources. In addition, small media such as printed patient communications to promote cancer screening was utilized through distribution to local businesses.
Is the practice new to the field of public health? If so, answer the following questions.
Yes

What process was used to determine that the practice is new to the field of public health? Please provide any supporting evidence you may have, e.g. literature review.

The practice is new to the field of public health. The New York State Cancer Services Program rolled the pilot project out to Cancer Services Program partners throughout New York State. Research to ensure this was a new practice included review of the NACCHO model practice database and toolkits, Guide to Community Preventive Services Community Guide and Stories of Success National Comprehensive Cancer Control Program of the Centers for Disease Control and Prevention. The use of the blue items used as a theme to increase awareness of colon cancer and the importance of screenings was new to the field of public health.
How does this practice differ from other approaches used to address the public health issue?
This practice differs from other approaches used to address the public health issue as it utilized various best practices such as small media, 1:1 education, and measures to reduce screening costs as Cancer Service Program provides free screenings to eligible residents. In addition, this practice differs as it utilized unconventional community partners such as elected officials and local business owners to increase the community's awareness regarding colon cancer, which also helps to normalize the topic.
Is the practice a creative use of an existing tool or practice? If so, answer the following questions.
No
What process was used to determine that the practice is a creative use of an existing tool or practice?  Please provide any supporting evidence you may have, for example, literature review.

What tool or practice (e.g., APC development tool, The Guide to Community Preventive Services, HP 2020, MAPP, PACE EH, etc.); did you use in a creative way to create your practice?  (if applicable) (300 word limit total)
a. Is it in NACCHO’s Toolbox; (if not, have you uploaded it in the Toolbox)?
b. If you used a tool or practice to implement your practice, how was your approach to implementing the tool unique and innovative for your target area/population?

How does this practice differ from other approaches used to address the public health issue? 

If this practice is similar to an existing model practice in NACCHO’s Model Practices Database (www.naccho.org/topics/modelpractices/database), how does your practice differ? (if, applicable)
Who were the primary stakeholders in the practice?
The primary stakeholders in the practice were New York State Department of Health, American Cancer Society, elected officials of the participating villages, Main Street Manager of the participating villages, local businesses of the participating villages, local school district's honor society, local media, community members/volunteers and community partners including the Genesee Valley Partnership which is a rural health network. In 2012, the University of Rochester Division of Gastroenterology and Hepatology became a new partner in the initiative.
What is the LHD's role in this practice?
The Livingston County Department of Health was the lead role in this practice. The Department approached the elected officials regarding their interest in participation, met with local businesses, and involved vital community partners and stakeholders in the planning and implementation process. In addition, the Department revised the New York State Department of Health's toolkit to localize the information and enhanced the practice by including additional activities such as working with the local theater to kick off the event and incorporate a comprehensive, community-wide media campaign. Finally, the Department continues to review data regarding colon cancer screenings, incidence and mortality to ensure the success of the practice.
What is the role of stakeholders/partners in the planning and implementation of the practice?
The New York State Department of Health played a vital role in the practice as they provided the community partner packet, educational materials at no charge, technical assistance and guidance before, during and after the practice. The American Cancer Society provided educational materials regarding colon cancer screening at no charge. The primary stakeholders in the practice were elected officials of the participating villages who provided permission to implement the initiative and provided guidance on how to work with local businesses. The Main Street Managers of the participating villages were helpful in encouraging participation and in being a spokesperson for the initiative. Local businesses of the participating villages played a vital role as they decorated their windows with blue lights, balloons, and merchandise; distributed educational materials regarding colon cancer screening and Cancer Services Partnership; and provided items for a drawing. A local school district's honor society assisted with this practice by wrapping many boxes to be utilized in each store for a prize drawing. The local media included news articles, photos and radio interviews regarding the initiative, which helped to increase the community's awareness regarding the importance of colon cancer screening. Several community members including the Medical Reserve Corps volunteered to assist with the distribution of information to local businesses. The Genesee Valley Partnership assisted with community outreach as the members posted flyers in their agency, emailed information to their contacts and included information on their websites. In 2012, the University of Rochester Division of Gastroenterology and Hepatology provided funds to the Cancer Services Program of Livingston County to continue to provide outreach regarding colon cancer through the Main Street Goes Blue initiative which will continue to be implemented in 2013.

What does the LHD do to foster collaboration with community shareholders?
Describe the relationship(s) and how it furthers the practice's goals.

The Livingston County Department of Health continues to foster collaboration with community stakeholders by ensuring their participation in the practice prior to, during and after the event. Input and suggestions from stakeholders are strongly encouraged. Recognition of the stakeholders' assistance and dedication to the cause is noted through thank you letters, ads and during committee meetings.
Describe lessons learned and barriers to developing collaborations.
Lessons learned include early collaboration with key stakeholders which include elected officials and local businesses; simplifying the event as much as possible for the businesses by providing a participation packet, suggested activities, and educational materials; take the weather into consideration regarding the delivery of materials to the business and the items used outside of the stores; expect some local business owners not to participate. Barriers include the difficulty of evaluating the total number of individuals who received colon cancer screening as local physician offices may not have a system or the time to track numbers; some business owners did not want to participate due the stigma of colon cancer screening; inclement weather in Upstate New York can make it difficult to place items outside the stores and directly on the street.

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).

List up to three primary objectives for the practice. For each objective, provide the following information:  (750 word limit per objective)

• Performance measures used to evaluate the practice: List the performance measures used in your evaluation. Depending on the type of evaluation conducted, these might be measures of processes (e.g., number of meetings held, number of partners contacted), program outputs (e.g., number of clients served, number of informational flyers distributed), or program outcomes (e.g., policy change, change in knowledge or attitude, change in a health indicator)
• Data: List secondary and primary data sources used for the evaluation.  Describe what primary data, if any were collected for each performance measure, who collected them, and how.
• Evaluation results: Summarize what the LHD learned from the process and/or outcome evaluation. To what extent did the LHD successfully implement the activities that supported that objective? To what extent was the objective achieved?
• Feedback:  List who received the evaluation results, what lessons were learned, and what modifications, if any, were made to the practice as a result of the data findings.


 

The following objectives for the practice were closely monitored throughout and following the implementation of the initiative. The LCDOH utilized a performance management system to ensure the success of the initiative.

Objective 1:

The first primary objective of Main Street Goes Blue is to implement the practice in a minimum of one village in year one and two villages in year two. Performance measures included the number of participating villages. The Cancer Service Program of Livingston County Coordinator sends letters and meets with elected officials to ensure participation. The Department has learned that contact with elected officials at least one year before implementation of the practice is helpful to allow the official time to consider participating and discuss issues with other village officials and business leaders. The Cancer Services Program Coordinator requests feedback from the local elected officials and business owners.

Overflow (Objective 1): Please finish the response to the question above by using this text area.  Please be mindful of the word limits.

Objective 2:

The second primary objective of Main Street Goes Blue is to increase awareness of colon cancer. This was measured by the number of individuals who responded to the free drawings and the number of participant who received information at businesses and display tables. The Cancer Service Program Coordinator tracked the number of individuals impacted by the practice.

Overflow (Objective 2): Please finish the response to the question above by using this text area.  Please be mindful of the word limits.

Objective 3:
The third primary objective is to increase the number of Livingston County resident who received colon cancer screening through the Cancer Services Program by a minimum of 5% by December 31, 2011 and 2012 respectively. The Livingston-Wyoming Cancer Services Coordinator/Case Manager tracks the enrollment and screening numbers of individuals who receive free cancer screenings through the Cancer Services Program of Livingston County via a computer software program and provides them to the Livingston County Department of Health.

Overflow (Objective 3): Please finish the response to the question above by using this text area.  Please be mindful of the word limits.

What are the specific tasks taken that achieve each goal and objective of the practice?
Specific tasks taken to achieve each goal and objective of the practice include creation of a letter to local elected officials, revision of the State's community partner toolkit which was distributed to local businesses, ordering supplies from NYSDOH and purchasing additional items for the practice, creation and purchase of an outdoor banner, requesting permission from the elected official to place the banner on Main Street, creation and implementation of the media and outreach campaign prior to and after the event, contact with local volunteer groups to assist with the event, and collaborate with local officials to announce a proclamation regarding Main Street Goes Blue. In addition planning and debriefing meetings were helpful to ensure the success of the practice.
What was the timeframe for carrying out these tasks?
The time frame for carrying out these tasks was October 2010 to May 2012. This time frame encompasses two years of implementing this initiative.
Please provide a succinct outline of some basic steps taken in implementing your practice.
Basic steps taken to implement the practice are as follows: 1.)Develop outreach and media plans 2.)Contact local elected officials such as mayors regarding participation in the initiative 3.) Prepare cover letter and packet for local businesses 4.) Distribute packets to local businesses 5.) Follow up with businesses 6.) Order supplies such as blue lights and office supplies 7.) Purchase outdoor banner 8.) Contact local elected official to get approval to place the banner on Main Street 9.) Develop media and outreach items such as print ads and flyers 10.) Contact local volunteers to assist with distribution of blue / program items 11.) Deliver items to participating businesses 12.) Kick off event 13.) Gather items from participating businesses upon completion of the event 14.) Monitor Cancer Services Program data to ensure the success of the program 15.) Thank participants and volunteers

What were some lessons learned as a part of your program's implementation process?

Lessons learned include placement of the outdoor banner to improve recognition, how to best approach the business owners which is to work closely with the Main Street Manager and to make participating in the event as easy as possible by providing concise information packets and possible activities. In addition, another lessons learned includes conducting a community survey prior to and after the event to ensure there was an increase in awareness regarding colon cancer. Due to the success of the practice with one village in year one, the Department decided to expand the practice to two villages in year two. In year three, the Department plans to implement the practice county wide.
Provide a breakdown of the overall cost of implementation, including start-up and in-kind costs and funding services.
The breakdown of the overall cost is as follows: Start up costs included purchasing an outside banner, which was approximately $400; print ads which were $1,467; radio ads which totaled $2,921 and was purchased through the NYSDOH grant funding. Strands of blue lights were provided in-kind from the NYSDOH. Additional light strands, copy cost for letters and items for the packet, mailing costs and office supplies such as paper and folders for packets was purchased using NYSDOH Cancer Services funding which totaled approximately $200. Personnel costs for the Case Manager of the Cancer Services Program of Livingston County were covered by the New York State Department of Health Cancer Services Grant which was approximately $800 for the project. Mileage costs were approximately $150. In kind costs which included staffing costs for two health educators which was approximately $700. The general health education budget was utilized to pay for the cost of a print ad which was $1,092.
Is there sufficient stakeholder commitment to sustain the practice?  Describe how this commitment is ensured.
There is sufficient stakeholder commitment to sustain the practice as the Livingston County Department of Health administration and staff are committed to the practice as it saves lives and it was identified in the MAPP process as a priority. The Cancer Services Program Grant continues to be implemented in our community. Additional local elected officials have expressed an interest in participating in the practice as they have seen the success in the past two years. The University of Rochester Division of Gastroenterology and Hepatology has agreed to continue to fund the practice for 2013. The educational materials are free of charge and the participation packets for local businesses need minor revisions from year to year which make the practice easy to expand to the entire county.
Describe plans to sustain the practice over time and leverage resources.
Plans to sustain the practice over time include continuing to contact local elected officials and volunteers prior to and during the event to ensure participation. The LCDOH has planned to sustain the current implementation by expanding the practice county wide. Letters were sent to local elected officials and a print ad was placed encouraging participating for the event in 2013. A planning meeting was held in October 2012 and was well attended. In addition, the LCDOH plans to leverage resources by requesting donations from local businesses, contacting the University of Rochester Division of Gastroenterology and Hepatology to ensure their commitment to sponsoring the event and utilization of the NYSDOH Cancer Services Grant.
Practice Category Choice 1:
Access to Care
Practice Category Choice 2:
Community Involvement
Practice Category Choice 3:
Other?
No

Please Describe: