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2013 Model Practices (Public)Application Title: Reducing Seniors’ Exposure to West Nile Virus by Repairing Screens Please enter email addresses you would like your confirmation to be sent to. brian.supalla@yavapai.us; nathan.peterson@yavapai.us Practice Title Reducing Seniors’ Exposure to West Nile Virus by Repairing Screens Submitting LHD/Agency/Organization Yavapai County Community Health Services Head of LHD/Agency/Organization Phil Bourdon, Interim Director Street Address 1090 Commerce Drive Practice Contact Person Brian Supalla Title Manager, Public Health Protection Submitting LHD/Agency/Organization Web Address (if applicable) www.yavapaihealth.com 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? Yavapai County has a population of approximately 211,000 with 24.1% being above the age of 65, compared to the national average of 13.1%. Seniors are among the groups most at-risk for serious complications from West Nile virus infection and have the highest fatality rate of reported cases. To help mitigate this risk our department has annually conducted an extended public information campaign using Fight the Bite materials, presentations to community groups, information tables at health fairs and the County Fair, and other strategies focused on encouraging individuals and communities to take responsibility. This year we decided to redirect staff time normally spent on this campaign to a new approach.
Every community has at-risk residents who are unable to take action on recommended measures. Seniors are often physically or financially unable to ensure their open windows and doors are properly screened to keep mosquitoes out. Census data indicates that there are over 50,000 households in our county with persons aged 65 or older. This target population is too large to help on an individual basis. Therefore, our goal was to focus on the clients of Meals-on-Wheels, who we properly assumed were most likely to be physically or financially stressed. In the Verde Valley, which includes a population of about 50,000, three organizations provide this food service. They do daily home deliveries of meals to approximately 140 clients.
Seniors are likely to open windows and doors in the evening to take advantage of falling autumn temperatures and save on air conditioning costs. If screens are torn or missing, residents can be exposed to biting mosquitoes. Every year our surveillance picks up hot spots of high mosquito numbers and confirmations of positive West Nile test results.
To determine which Meals on Wheels clients needed help, our Environmental Health staff accompanied volunteer drivers on their routes to the 140 clients. At each stop, they were able to do a quick survey of the residence, taking measurements of screens that needed replacement or repair. In some cases, staff was able to make immediate spot repairs using inexpensive screen patch costing about 30-cents. Some survey findings only required us to re-install existing screens that had been taken down, at some time in the past, for perhaps window washing. This project was conceived in September and carried out during the month of October. Overnight temperatures are still in the fifties into November when exposure risk to biting mosquitoes begins to decline.
Overflow: Please finish the response to the question above by using this text area. Please be mindful of the word limits. The average cost per residence where materials were necessary to repair or replace screens was $ 9.37 in supplies; our business partner, a major home improvement chain, gave us a 45% discount on purchases. Note: by partnering in the future with a non-profit organization we would be able to get an outright donation of supplies. Average staff labor per residence was less than one hour, not including travel time. The number of screens that had to be rebuilt or assembled from scratch ranged from 1 to 5 per residence. We believe we can continue this service in future years with less Environmental Health staff involvement by partnering with community groups that can provide the labor; this could include Medical Reserve Corps volunteers. This was a project where no barriers had to be overcome, the community was receptive, and staff was motivated to be able to provide a service to residents in need.
The objective to assist Meals-on-Wheels clients before the end of October 2012.This was a low cost, low tech, high visibility project. By changing our focus from the regular information campaign, we were still able to keep up with our other routine environmental health program responsibilities. 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) Although locally we were not facing an actual increase in human infections there was growing concern over the threat of West Nile virus in this nationally record-setting year. What process was used to determine the relevancy of the public health issue to the community? (350 word limit) Public Health is responsible for monitoring communities and when necessary, to take appropriate actions to help protect residents. Residents being willing to take personal responsibility is important but all it takes is one non-compliant property owner allowing mosquito breeding to make life throughout the neighborhood miserable. Just as sleeping under bed netting in malarial areas is important, having window screens in good repair will help minimize the West Nile virus threat. We approached this need by mobilizing a community partnership and took actions to identify and solve an environmental health problem, an essential community service. How does the practice address the issue? (350 word limit) This is a novel approach to addressing the issue; our department moved beyond public education to providing a necessary service that was not being offered by any organization or agency. Please list any evidence based strategies used in developing this practice. (Provide links or other materials for support) A literature review, an Internet search, NACCHO database review, and a query to the National Environmental Health Association did not find evidence that this practice has previously been done in the field of public health, nor did we find evidence that a health department had taken the lead in a like project carried out by community partners.
Public Health’s approach to vector-borne disease is normally surveillance and control, supplemented with public education and sometimes resorting to compliance action to enforce Codes. Public Health does not normally delve into home repair issues.
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. We searched the Internet for relevant literature and contacted NACCHO and NEHA. No evidence of another health department taking this action was found. How does this practice differ from other approaches used to address the public health issue? Public health approaches to this health issue are generally confined to providing public education. On occasions, when Environmental Health staff is investigating a mosquito complaint they may take on the spot actions (dumping rainwater out of a wheelbarrow, etc.). At most, residents may be advised to hire a local company or consider doing the work themselves. 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. Not applicable 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? Not applicable How does this practice differ from other approaches used to address the public health issue? Public health programs are not known for taking a hands-on approach to mitigation of hazards, leaving that work to others more traditionally involved. Who were the primary stakeholders in the practice? Before starting the project in each community, we met with municipal officials, with hardware and home improvement stores, and with Senior Centers that provided Meals-on-Wheels services. The primary stakeholders were the Verde Valley Senior Center, Sedona Senior Center, and Black Canyon City Senior Center. These Centers distributed a flyer we had produced, informing their clients that an Environmental Health employee would be visiting with a Meals-on-Wheels driver. The health department’s role was to identify and assist residents in need of simple window and door screening repairs. What is the LHD's role in this practice? Our role was to identify the problem and gather community support to fix the problem. What is the role of stakeholders/partners in the planning and implementation of the practice? The stakeholders/partners assisted with both the planning and implementation of this practice. We needed the senior centers and meals-on-wheels programs to help us identify homes in the community in needs of screens. What does the LHD do to foster collaboration with community shareholders?
Describe the relationship(s) and how it furthers the practice's goals. Yavapai County is proud of its ongoing collaboration with community shareholders in the Verde Valley. We have many years of building strong and positive relationships with many entities. In this case, our relationship with the senior centers helped us to carry out this project. Describe lessons learned and barriers to developing collaborations. In the future, we would strive to get more engagement for our Medical Reserve Corps volunteers. This year, there just was not enough lead-time. We did not encounter any barriers to this project.
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.
Process evaluation was used to assess the effectiveness of the steps taken to achieve the desired practice outcomes.
We did not encounter any difficulties in getting buy-in from local business, municipal governments, Senior Centers, etc. There was great interest in taking a practical “just do something to help people” approach.
We identified 59 out of 140 residences needing repair and all agreed to participate, allowing us to make repairs at no cost to them.
All clients were aware that West Nile virus can be spread by biting mosquitoes. Interestingly, about 10 percent of the properties had conditions that promoted mosquito breeding.
• 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.
Our department learned that for a small investment we could directly provide protection and a tangible benefit to seniors exposed to a vector borne disease. We gained a great deal of good will and positive feedback from both the individuals involved and the community. Our objectives were entirely met. Results of the project were shared with municipal governments and county elected officials, and with environmental health peers in other Arizona counties.
Complete survey of Meals on Wheels clients’ residences and identify the need for window and door screening: staff completed ride-alongs with volunteer drivers and surveyed 140 residences. Overflow (Objective 1): Please finish the response to the question above by using this text area. Please be mindful of the word limits. Complete repairs to window and door screens: staff completed repairs to approximately 100 windows and doors at 59 residences. 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: Provide news release to local media highlighting the success of this project and outline advocacy for community groups to identify seniors in their community who could benefit from similar services.
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? Week One: discuss partnership opportunity with hardware or home improvement stores.
a. Discuss willingness to consider a request
b. Send formal request to store manager
Week One: discuss partnership opportunity with local Senior Centers.
a. Discuss Center’s ability to partner
b. Provide information flyers for distribution to clients
Week Two: obtain project approval from Health Officer.
Week Three: Senior Centers distribute fliers to clients
a. Print flyers
b. Deliver flyers
Week Three: EH staff accompanies Meals-on-Wheels drivers
a. Spot repairs made
b. Measurements taken for replacement screens
Weeks Four and Five: return visits to install replacements.
What was the timeframe for carrying out these tasks? We completed these tasks between September 10 and October 26, 2012. Please provide a succinct outline of some basic steps taken in implementing your practice. Planning:
1 Discuss partnership opportunity with hardware or home improvement stores
2 Discuss their willingness to consider a request
3 Send formal request to store manager
4 Discuss partnership opportunity with local Senior Centers
5 Discuss senior center’s ability to partner
6 Obtain approval for project from health officer
Implementation:
1 Provide information flyers to senior centers and meals-on-wheels staff for distribution to clients
2 Distribute fliers to clients of senior centers and meals-on-wheels clients
3 EH staff accompanies Meals-on-Wheels drivers and makes on-the-spot small repairs
4 EH staff take measurements for replacement screens
5 EH staff schedule return visits to install replacement screens
6 EH staff installs replacement screens
What were some lessons learned as a part of your program's implementation process? We had hoped that local Medical Reserve Corps volunteers would be interested in participating in the project; emails and a newsletter did not attract any volunteers, perhaps due to the short notice between the time the project was first conceived and when it began. Departments that may wish to use less public health staff time will want to begin the recruiting process for individual volunteers or with potential partner volunteer organizations well in advance. Provide a breakdown of the overall cost of implementation, including start-up and in-kind costs and funding services. No significant implementation or start-up costs were required. The only direct costs were minor tools such as spline rollers, cutting blades and tape measure, totaling under $20. Screen assembly kits, replacement screens were purchased as needed. Is there sufficient stakeholder commitment to sustain the practice? Describe how this commitment is ensured. Environmental Health staff will continue to work with Senior Centers because screens will continue to deteriorate over time and the Meals on Wheels clientele changes from year-to-year. These senior centers are motivated to continue this beneficial partnership, which costs them nothing. Businesses are motivated by the public acknowledgement of their community service. We will bring down the department’s labor costs by enlisting volunteers who can do this low-skill task. Describe plans to sustain the practice over time and leverage resources. We will continue this practice on an annual basis, encourage other agencies and organizations to provide similar services to other at-risk groups, and take advantage of what we believe will be a good volunteer response, provided we begin the recruiting process earlier in the year. Practice Category Choice 1: Environmental Health Practice Category Choice 2: Vector Control Practice Category Choice 3: Check all that apply. NACCHO Web Site NACCHO Connect E-mail from NACCHO Colleague in my health department Are you a previous applicant? |
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