2014 Model Practices

Cobb Public Health Interactive Technology Project

Cobb and Douglas Public Health

1650 County Services Parkway

Marietta

GA

30008

770-514-3104

CobbandDouglasPublicHealth.com

Emily Frantz

Director, Organizational Performance and Strategy Management

erfrantz@dhr.state.ga.us

John D. Kennedy, M.D., M.B.A.

750,000-999,999

1) Cobb and Douglas Public Health (CDPH), with our partners, promotes and protects the health and safety of over 830,000 residents of Cobb and Douglas counties. Cobb County has the 4th largest county population in Georgia, recorded at 688,078 in the 2010 Census. Data from the U.S Census Bureau (2010) illustrates that Cobb County has a relatively young population. Over one fourth of the population in Cobb County (28.9%) is under the age of 19. CDPH relies on long-term partnerships including the local school systems, to provide public health services in the community. The Cobb County School System (the 26th largest in the United States), combined with the Marietta City School System and private and home-schooled children in the county, consists of approximately 60,000 elementary school aged students. Of those 60,000 elementary-school-aged students, approximately 8,690 were in the fourth grade, which is the target audience for the Cobb Public Health Interactive Technology Project. 2) Public health issue: In Cobb County, cardiovascular disease and cancer are the leading causes of mortality. Chronic diseases (diseases lasting longer than 3 months) such as diabetes continue to cause a high number of illnesses and deaths in the county; they also cause high health care costs. Lastly, Behavioral Risk Factor Surveillance System (BRFSS) data indicate that too few of our residents are receiving preventable medical screenings and continue to practice behaviors which put them at higher risk for chronic illnesses such as cardiovascular disease and cancer. The Cobb Safety Village is a direct result of a fast-growing youth population which needed education related to health, safety and injury prevention. Therefore, particular public health issues were selected to be addressed: (1) emergency preparedness, (2) immunizations, and (3) obesity. Offering interactive hands-on education to children in these areas aligns with the shared philosophy of CDPH and the Cobb Safety Village: “Tell me and I will forget, show me and I may remember, involve me and I will understand”. 3)Goals and objectives: The overall goal of the Cobb Public Health Interactive Technology Project was to lay the foundation for the CDPH Safety Village structure so that it would be easier and less costly for other public health programs to add learning modules. This goal was met in July 2011 (see question 4, "Implementation" for a description of how these goals were achieved). CDPH is responsible for measuring the success of the work it conducts throughout its 30 programs. Safety Village instructors (Cobb County firefighters) are actively involved in debriefing sessions and personal interviews with Public Health staff, in order to evaluate these modules. Participant attendance logs and special event attendance records are also documented. Beginning January 2012, the Public Health program integrated pre-post test assessments to measure concept comprehension with existing fire safety programs. This integrated evaluation program aligns with local, state, and federal readiness guidelines and school system educational objectives.

4)Implementation: In April 2011, CDPH learned that a $78,000 funding request for the public health interactive technology project might be approved by the CDC through the Georgia Department of Public Health, Division of Emergency Preparedness and Response, Cities Readiness Initiative Program. A team from CDPH formulated a vision to create highly interactive public health and safety learning modules geared toward elementary students. 5-8) The project's goal was to create and implement hands-on interactive safety and preparedness training for children that aligns with local, state, and federal readiness guidelines as well as school system educational objectives. Out of 20 Cobb County Schools that have participated in the interactive learning modules, results of pre/post tests reveal improved understanding of the importance of hand washing (correct scores related to hand washing increased from 10% on the pre-test to 80% on the post-test) and ways to prepare an emergency kit (from 40% on the pre-test to 90% on the post-test). Over time, as the practice continues to demonstrate effectiveness by improving knowledge and understanding of promoting health among students through the interactive modules, awareness and requests to schedule bus trips to visit the Village have only increased.

1) Brief description of LHD – location, jurisdiction size, type of population served: Cobb and Douglas Public Health (CDPH), with our partners, promotes and protects the health and safety of over 830,000 residents of Cobb and Douglas counties. Cobb County has the 4th largest county population in Georgia, recorded at 688,078 in the 2010 Census. Data from the U.S Census Bureau (2010) illustrates that Cobb County has a relatively young population. Over one fourth of the population in Cobb County (28.9%) is under the age of 19.

2) Statement of the problem/public health issue: In Cobb County, cardiovascular disease and cancer are the leading causes of mortality. Approximately 60 percent of Cobb County adult residents are either overweight or obese. Obesity and being overweight have been associated with increased risk of certain diseases and other health problems including, coronary heart disease, type 2 diabetes, cancers (endometrial, breast and colon), high blood pressure, and stroke. Chronic diseases (diseases lasting longer than 3 months) such as diabetes continue to cause a high number of illnesses and deaths in the county; they also cause high health care costs. Lastly, behavioral survey data indicate that too few of our residents are receiving preventable medical screenings while too many are practicing behaviors which put them at higher risk for chronic illnesses such as cardiovascular disease and cancer. Recent events have required public health emergency response in Cobb County, including a 2009 flood, the H1N1 pandemic, and the receiving of Haitian earthquake victims through activation of the National Disaster Medical System (NDMS). The Cobb Safety Village is a direct result of a fast-growing youth population which needed education related to health, safety and injury prevention. Therefore, particular public health issues were selected to be addressed: (1) emergency preparedness, (2) immunizations, and (3) obesity. 3) What target population is affected by problem (please include relevant demographics)? What is target population size? What percentage did you reach? The Cobb Public Health Interactive Technology Project is a direct result of a fast-growing youth population which needed education related to health, safety and injury prevention. Cobb County's school system (the 26th largest in the United States), combined with the Marietta City Schools and private and home-schooled children in the county, consists of approximately 60,000 elementary school-aged students. Of those 60,000 elementary-school-aged students, approximately 8,690 were in the fourth grade, which is the target audience for the Cobb Public Health Interactive Technology Project. During the 2012-2013 school year 5,700 out of 8,690 fourth grade students visited the Cobb Safety Village (approximately 65 percent). 4) What has been done in the past to address the problem? Prior to the Interactive Technology Project proper hand washing and germ stopping education was provided by teachers in the classroom. The Interactive Technology Project provides a fun and interactive approach including videos of germs to highlight the need for proper hygiene. In addition, students learn about emergency preparedness and fire safety- two modules and topics which were not consistently taught across the public school system. Finally, the Interactive Technology Project is innovative in the sense that modules are adaptable and may be changed to create new educational messages to students based on need/changing times.

5) Why is current/proposed practice better? The Cobb Public Health Interactive Technology Project integrates highly interactive public health and safety learning modules geared toward elementary students. The walls literally come alive with knowledge while instructors share advanced techniques and ideas for making the Cobb community safer. State-of-the-art infrared technology is powered by a standard Windows operating system maintained on a Local Area Wireless Network. This network links two computers, two projectors and a wall-mounted tablet. A custom program is accessed through the wall-mounted tablet by a trained public health educator who selects and controls (starts/stops) the desired learning module. Children participate in virtual public health and emergency preparedness experiences that can be modified, updated, monitored and maintained on line. Each one is led by an animated public health nurse and supervised by a live Safety Village educator (fire and injury prevention specialists).

6) Is current practice innovative: CDPH used a three-step process to determine whether this interactive technology driven module approach to health education was, in fact, new to the field of public health. First, the CDPH Emergency Preparedness training specialist and risk communicator identified and characterized the need of such education by conducting a broad-based internet search of SNS Emergency Preparedness education strategies, targeting K-5 grade students. During this process, they referenced the CDC Emergency Preparedness website, NACCHO Preparedness Summit Conference materials, and the CDC DSNS (Distributing the Strategic National Stockpile) Extranet site. Next, the team outlined goals and objectives to project success outcomes, therefore maximizing and ensuring the program was innovative and fit into overall CDPH and Cobb County Safety village education goals. Finally, they made comparisons with Emergency Preparedness programs nationwide, all inclusive, to differentiate and reduce initiative redundancies. 6a) The Interactive Technology Project is a new method to communicate public health messages to children through a fun and interactive approach. 7) Is current practice evidence-based? Interactive learning, particularly through the use of new technology and fun activities to engage children have been well documented as an evidence-based strategy to improve comprehension and retaining information. A didactic approach is recommended for health education in "The Guide to Community Preventive Services" and "Guide to Clinical Preventive Services". More specifically, the CDC's Community Guide outlines recommendations from the Community Preventative Services Task Force that school and community based physical education classes have short term outcomes including improved test scores, but also long term implications for improving healthy lifestyles through adulthood. Sources include: Kahn EB,Ramsey LT, Brownson R, et al. The effectiveness of interventions to increase physical activity: a systematic review. Am J Prev Med 2002;22(4S):73-107. Task Force on Community Preventive Services. Recommendations to increase physical activity in communities. Am J Prev Med 2002;22 (4S):67-72. Increasing physical activity. A report on recommendations of the Task Force on Community Preventive Services. MMWR 2001;50 (RR-18):1-16. Icon Task Force on Community Preventive Services. Physical activity. Adobe PDF File. Zaza S, Briss PA, Harris KW, eds. The Guide to Community Preventive Services: What Works to Promote Health? Atlanta (GA): Oxford University Press;2005:80-113. Note regarding CDC Winnable Battles: The modules may be customized to address any/all of these, however, modules currently address those selected below (largely relevant to immunization, injury prevention education, and emergency preparedness).

Global Immunization

Motor Vehicle Injuries

Nutrition, Physical Activity, and Obesity

Healthcare-associated Infections

1) Goal(s) and objectives of practice: The overall goal of the Cobb Public Health Interactive Technology Project was to lay the foundation for a CDPH Safety Village structure that would enable future public health programs to add learning modules. This goal was met in July 2011. CDPH is responsible for measuring the success of the work it conducts throughout its 30 programs. Specific to this project, Safety Village instructors (Cobb County firefighters) are actively involved in debriefing sessions and personal interviews with Public Health staff. Participant attendance logs and special event attendance records are also documented. Beginning January 2012, the Public Health program integrated pre-post test assessments to measure concept comprehension with existing fire safety programs. This integrated evaluation program aligns with local, state, and federal readiness guidelines as well as school system educational objectives.

2) What did you do to achieve the goals and objectives; Steps taken to implement the program: In June 30, 2011 a team from CDPH (Center for Emergency Preparedness and Response and Center for Prevention and Clinical Services) formulated a vision to create highly interactive public health and safety learning modules geared toward elementary students. Their intention was to house these modules on-site at the Cobb County Safety Village, an eight-acre safety training environment that features a fully interactive Educational Building and reduced-scale urban, suburban and rural replicas that include sidewalks, traffic signals, buildings, and other structures and landmarks familiar to Cobb County residents.

An important aspect of the project was to fund and lay the foundation for the CDPH Safety Village structure so that it would be easier and less costly for other public health programs to add learning modules. Upon receipt of the grant award, the CDPH team worked diligently to roll out the project in July 2011. The project's goal was to create and implement hands-on interactive safety and preparedness training for children that aligns with local, state, and federal readiness guidelines as well as school system educational objectives.

The following six modules, each led by an animated public health character, successfully met the project's objective: (1) "The Hand Washing Game" is designed to teach children the importance of hand washing. A hand washing song/rap was written by our Communications Director to reinforce hand washing. (2) "Splat Annie Anthrax" is designed to teach children about germs. When activated, "Annie Anthrax" germs appear on the floor as an animated nurse explains the importance of fighting germs. Children then stomp virtual germs off the floor with their feet or wall with their hands. (3) "Are You Ready?" is part of Emergency Preparedness learning module, in which children learn which items go into an Emergency Kit (aligned with Strategic National Stockpile (SNS) concepts). (4) "Which is Better?" in which children select the most appropriate items to "drag" into the virtual emergency kit. (5) "Immunizations Are Good" helps children understand that vaccines are good, even if shots hurt. When the module is activated, virtual viruses drop down the wall and onto the floor. By stomping them with their hands or feet, children are able to "immunize" against viruses. (6) "Let's Get Moving" was designed to emphasize the importance of physical activity. When activated, an animated public health educator leads kids through a low-impact dance set to upbeat tunes.

3) Any criteria for who was selected to receive the practice (if applicable)? The interactive modules of the project are open to the public free of charge, although the target audience is school children (kindergarten to high school).

4) What was the timeframe for the practice? In April 2011, CDPH learned that a $78,000 funding request for the public health interactive technology project might be approved by the CDC through the Georgia Department of Community Health, Division of Emergency Preparedness and Response, Cities Readiness Initiative Program. Upon receipt of the grant award, the CDPH team worked diligently to roll out the project in July 2011. All six educational modules (see above) were operational and ready by the start of the 2012 school year (September 2012). Beginning January 2012, the Public Health program integrated pre-post test assessments to measure concept comprehension with existing fire safety programs, which continue to be used among all visitors.

5) Were other stakeholders involved: CDPH has built strong, long-term partnerships with more than 100 area health care providers, businesses, and community agencies, including the WellStar Health System (community NFP), Good Samaritan Health Center in Cobb (private NFP), Community Health Center at Sweetwater Valley, West-End Medical Center (FQHC), Community Service Boards (mental health), individual medical practices, local county and city governments, Dobbins AFB, local school systems (3 w/140,OOO-plus students), local colleges and universities (3), Chambers of Commerce (2), numerous businesses, and faith-based organizations. Our Community Family Connection Collaborative (CFCC)-the Cobb Collaborative -also provides tremendous partnering opportunities. The Cobb Safety Village is a model for community partnerships, bringing together numerous community leaders for the initial concept research, national site visits, project design, implementation, policy development, corporate sponsorship and ongoing operational support. More than 25 members are active with the safety Village Board of Directors (list available upon request) and work tirelessly to raise funds, advise about operational issues and support community events related to the Village. Members represent county government, public safety, public health, education, the local hospital system, marketing, private businesses, and civic groups. All have worked diligently to make the Safety Village a reality without priority on individual credit. Stakeholders and partners have influenced the project every step of the way- from initial ideation of the Cobb County Safety Village as a whole to helping conceptualize education modules for the Cobb Public Health Interactive Technology Project. The Cobb Safety Village Board of Directors, through the Design and Development Committee (comprised of engineers, educators and construction experts) is tasked with reviewing, advising and approving all building and structures within the Village. They assisted with the initial design and future vision of the CDPH building.

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. Direct costs associated with incorporating interactive technology into the Public Health building of the Safety Village was absorbed through funding from the CDC in the amount of $78,000. The in kind costs associated with planning and consultation hours spent among CDPH Emergency Preparedness and Community Health Center staff were tremendous. Even so, the end product resulted in improved pre/post test scores among children and saved countless hours which would have otherwise been spent in providing in person trainings. Ongoing costs associated with the modules include 1 FTE staff person (estimated at 60k, including fringe) to coordinate interactive learning module visits. Additional costs may be incurred when/if new modules are developed or changes to the existing modules are required.

1) What did you find out? The overall goal of the Cobb Public Health Interactive Technology Project was to lay the foundation for the CDPH Safety Village structure so that it would be easier and less costly for other public health programs to add learning modules. This goal was met in July 2011. 2(a-c)) Did you evaluate your practice? CDPH is responsible for measuring the success of the work it conducts throughout its 30 programs. Specific to this project, Safety Village instructors (Cobb County firefighters) are actively involved in debriefing sessions and personal interviews with Public Health staff. Participant attendance logs and special event attendance records are also being documented. Beginning January 2012, the Public Health program integrated pre-post test assessments to measure concept comprehension with existing fire safety programs. This integrated evaluation program aligns with local, state, and federal readiness guidelines as well as school system educational objectives. Specific to outcome measures, on average, results of pre/post tests reveal improved understanding of the importance of hand washing (correct scores related to hand washing increased from 10% on the pre-test to 80% on the post-test) and ways to prepare an emergency kit (from 40% on the pre-test to 90% on the post-test). During the 2012-2013 school year approximately 5,700 out of 8,690 fourth grade students visited the Cobb Safety Village (65 percent of all fourth graders). Student’s pre-test scores resulted in an average 42% understanding of learning modules and the post-test scores resulted in an average of 94%. Data are collected through the pre-post test surveys and tabulated by Safety Village staff. The results of these data are shared by the Safety Village with public health staff (in order to monitor modules and identify opportunities for improvement) and the public school system.

While the pre-post test data reflect project outcomes related to increased understanding of public health messages through the interactive modules, process performance measures have also been identified over time. Process evaluation results conclude: While the interactive learning modules have demonstrated effectiveness to achieve intended goals related to 1) laying a foundation for future interactive learning models and 2) increased knowledge among children visiting the Safety Village, opportunities exist to adapt and refine the modules based on student understanding. A process evaluation revealed an opportunity for necessary improvements to 1) expanding the number of children (and schools) visiting the Safety Village through improved scheduling techniques, 2) reducing direct and indirect costs associated with staffing the Safety Village by training County staff who were already onsite to facilitate and coordinate the learning modules for visiting students, and 3) identification (through the pre and post tests, as well as student/teacher interactions) to modify the title of Annie Anthrax. Younger students have had trouble grasping the concept of anthrax. A new module is being created for younger children visiting the Safety Village in place of Annie Anthrax.

1-2) Lessons learned in relation to practice? Lessons learned in relation to partner collaboration (if applicable): As with all new community-based Initiatives, particularly during challenging economic times, the Cobb Safety Village Leadership assured success by involving community partners from the initial concept stage, through all stages of planning and implementation. The Board has worked hard to develop a collaborative atmosphere that puts the goal of educating our children and keeping them safe above individual/agency acclaim. Many agencies have freely given their time, expertise and products to make the Safety Village a reality. Our one challenge for the Village has been the economic downturn over the past few years, which has resulted in many sponsors who anticipated hosting buildings but who had to delay this involvement because of business economics. It was also one of the factors in finding funding to expand the CDPH interior technology modules. 3) Is this practice better than what has been done before: After implementing the pre-post test assessments to measure concept comprehension, the Cobb and Douglas Public Health has been able to evaluate and improve learning modules at the Cobb Public Safety Village. This integrated evaluation program has allows CDPH to align modules with local, state, and federal readiness guidelines as well as school system educational objectives. 4) Given the diversity of the learning modules (which are largely focused on population based health issues- obesity, emergency preparedness, vaccination), a cost/benefit analysis would be difficult (and might not be accurate). However, the value of educating school aged students on these topics, far outweighs direct costs associated with building and maintaining the modules (approximately $78k in start-up and 60k in staff annually). The value of the learning modules (and success in terms of increased comprehension among students) is further evidenced by funding to sustain the modules through the school system, county government, and state Department of Public Health.

5) Sustainability – is there sufficient stakeholder commitment to sustain the practice? Cobb and Douglas Public Health, along with partners including the Cobb County School District and Safety Village Board of Directors are committed to sustaining the practice. More than 25 members are active with the safety Village Board of Directors (list available upon request) and work tirelessly to raise funds, advise about operational issues and support community events related to the Village. Members represent county government, public safety, public health, education, the local hospital system, marketing, private businesses, and civic groups. All have worked diligently to make the Safety Village a reality without priority on individual credit. To further highlight commitment from stakeholders and partners, at the start of the 2012 school year, the Cobb County School System commited to requiring 4th grade students attend the learning modules at the Safety Village as part of the 4th grade curriculum for all students. 6) Describe sustainability plans: Over time, as the practice continues to demonstrate effectiveness by improving knowledge and understanding of promoting health among students through the interactive modules, awareness and requests to schedule bus trips to visit the Village have only increased. The current modules are self-sufficient and county resources have been allocated to provide for health education staff to guide students through each session. New modules may be added to further educate students and adapt to changing public health needs and emerging issues.

The Safety Village learning modules continue to grow in popularity. This past year, Cobb and Douglas Public Health staff were delighted to host visits from Dr. Ali Khan, Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (PHPR), Director. Also, we enjoyed sharing more about the Safety Village through the July 2013 issues of NACCHO's "Stories from the Field" website (located online at: http://www.nacchostories.org/safety-village-educates-children/)!

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