An LHD of the Year Award Winner Explains How to Implement a Tobacco-Free Policy

Interview by Ian Goldstein, Web and New Media Specialist, NACCHO

NACCHO honored the exceptional achievements of local health departments (LHDs) and local health officials at the 2014 NACCHO Annual Conference, held July 8–10 in Atlanta. NACCHO’s LHD of the Year Award recognizes and honors outstanding accomplishment of LHDs across the country for their innovation, creativity, and impact on communities. The following winners were categorized by size of jurisdiction and recognized for accomplishments in outstanding internal and external policy: Small Jurisdiction: Macon County Public Health Center (Franklin, NC); Medium Jurisdiction: Whatcom County Health Department (Bellingham, WA); and Large Jurisdiction: Chicago Department of Public Health (Chicago, IL).

The following is an excerpt from a recent NACCHO podcast featuring an interview with Macon County Public Health Center Health Director Jim Bruckner, who spoke about his health department’s winning tobacco control policy.

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NACCHO: What made you decide to apply for this award?

Bruckner: Macon County has long advocated for strong tobacco control policies for our community. In partnership with our community partners—local youth groups—we set a goal in 2008 to try and get a tobacco-free parks and recreation policy established in the community. We met a bit of resistance at the time. Our county commissioners didn’t feel that they had the ability to set forth such a policy. Things changed for us in 2012 when the North Carolina legislature passed the Smoke-Free Restaurants and Bars law. Although that focused on exposure to second-hand smoke, it also gave authority to local governments to regulate smoking in public places.

NACCHO: How has this policy been implemented in Macon County?

Bruckner: Our timeline for the project was nine months initially and the process began with some legislative and policy research. We utilized folks from the state division of public health’s tobacco control branch and their online toolbox for implementation policies. They also had a model policy that was great to have available; it sped up the process in getting the policy through our county attorney and into the board of commissioners. We then transitioned into building public support and securing some necessary grant funding. Once we verified that we had public support, we set about building evidence-based feasibility and support from community leaders and elected officials. In this phase, we basically went to a lot of meetings.

Once the ordinance was successfully adopted by the commissioners, we transitioned to the implementation phase. This phase was about 90 days long. We did facilities surveys, which looked at where they needed signage and what other needs facilities had. That’s what we were trying to secure the grant funding for. We purchased signage for all the recreation facilities and all of the parks; we purchased rugs for the entryways of the buildings; we did a widespread media campaign with press releases; and we did signs at the movie theaters. We clarified with our parks and rec staff and our sheriff’s department what the enforcement procedures would be and helped them develop talking points and handouts that they could give to folks who had questions or if they met with any violations. The ordinance actually went into effect July 9, 2012. One of the good things about the fact that it’s an ordinance on the enforcement side is that it established penalties if you are caught smoking in a parks and rec area.

NACCHO: For those who don’t know, what is the population of Macon County and where in North Carolina are you located?

Bruckner: We are in far western North Carolina and have a population of about 34,000. We’re a small rural county; about 50 percent of the county is national forest.

NACCHO: North Carolina was traditionally part of tobacco country. Is that part of Macon County?

Bruckner: Not necessarily Macon County but it is part of the state.

NACCHO: What was the biggest challenge, from a governmental standpoint, when implementing this ordinance?

Bruckner: We had three challenges upon which our success was largely dependent. This first was the ability to develop and demonstrate strong community support for the cause. The second was the argument of tobacco-free versus smoke-free. The third was the cost of implementation to the county.

NACCHO: Tell us more about the issue of tobacco-free versus smoke-free.

Bruckner: What we had to do in the beginning was squelch the argument of tobacco-free versus smoke-free. We built support for the tobacco-free argument by showing photos at presentations showing kids running around at the park or under bleachers at the ball field and we made sure to highlight the fact that there were cigarette butts on the ground and tobacco pouches and tobacco plugs where the children were playing. Also, the youth who were involved in advocating for this did cigarette butt pick-ups in parks and actually presented those in 20-gallon trash bags in front of the board of commissioners as an example of what they picked up in just a few hours at the park.

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Listen to the rest of the interview with Jim Bruckner about his community’s response to the ordinance and his advice to other LHDs that are looking to implement similar policies (start at the 5:30 mark) at http://bit.ly/1Ah1d8e.

Interested in listening to more of NACCHO’s podcasts? NACCHO’s podcast series is now available for subscription on iTunes. If you have iTunes or an iPhone, download the podcast app and search “NACCHO.” Once you subscribe, the latest NACCHO Podcasts will automatically download to your phone. You can also subscribe with the following link: http://bit.ly/1zd6xrI.

Chikungunya: Time to Prepare for a New Mosquito-Borne Virus in the United States

On July 17, the Centers for Disease Control and Prevention announced that the first locally acquired case of the chikungunya disease has surfaced in the continental United States. The post below shares how LHDs can prepare for chikungunya.

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The chikungunya (pronounced “chik-en-gun-ya”) virus has expanded its range into the Western Hemisphere as of late 2013. The virus, which has been known throughout Africa and Asia since the 1950s, causes a disease that has been compared to having a terrible case of the flu combined with an abrupt case of arthritis. It is most commonly characterized by fever and joint pain and could include headache, muscle pain, joint swelling, and/or a rash. The disease is spread via bites of two species of mosquitoes that are present and abundant in the United States: Aedes aegypti and Aedes albopictus, the latter is an alien species that has established itself in our country.

Chikungunya disease has been rapidly spreading since its introduction. It has spread in a matter of months throughout the Caribbean and Central America and into the eastern coast of the South American continent. More than 50,000 cases of human disease have been reported through the end of May 2014. Will it reach and become established in the United States? It is virtually certain that it will. We have already seen this happen with West Nile Virus, which entered the United States in 1999 and  spread throughout almost the entire country within five years. In fact, at least four cases of chikungunya in U.S. citizens who became ill with after returning from trips to Caribbean islands were recently documented in Florida and Tennessee. Local health departments should expect to see more of these cases as travel to the Caribbean for business and pleasure purposes increases over time. In addition, hundreds of thousands of soccer fans, many from the United States, are expected to travel to Brazil in July for the World Cup. The opportunities for introduction of the virus via infected fans returning from the games will be many.

Local health departments are on the front lines to prevent and control the expected introduction and spread of this virus and disease. This is the time for assuring that we as a profession and as a nation are prepared for this new disease. Treatments might only diminish the symptoms; there are no cures. There are also no vaccines to prevent infection. Local health departments will need to rely on traditional public health measures of surveillance, response, and education.

NACCHO recommends that local health departments take the following steps to prepare for chikungunya:

  1. Review mosquito surveillance capacities and ability to monitor the mosquito populations, measure for the presence and extent of the virus, and identify human cases.
  2. Review and update mosquito control plans and assure that all participants in that plan are capable of responding to findings that would be a trigger for use of control measures.
  3. Review vector control education plans for the public, medical providers, and laboratories serving the community. Awareness of the virus and disease, recognition of symptoms, personal measures for preventing mosquito bites, and community measures for eliminating Aedes mosquitoes and their breeding sites are all parts of a comprehensive vector disease prevention and control educational campaign.

This post originally ran on NACCHO’s Preparedness Brief blog. For more preparedness news and resources, visit http://www.nacchopreparedness.org.

Interview with Mo Mullet Award Winner Joan Ellison, RN, MPH

By Lindsay Tiffany, Communications Specialist, NACCHO

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NACCHO is pleased to recognize Joan Ellison, RN, MPH, as this year’s recipient of the Maurice “Mo” Mullet Lifetime of Service Award. This award honors current or former local health officials for noteworthy service to NACCHO that has reflected the commitment, vigor, and leadership exemplified by Mo’s distinguished career.

Ellison’s career in local public health spanned more than 43 years, including 34 years as Public Health Director of the Livingston County (NY) Department of Health. Throughout that time, she devoted herself to improving the health of the community and to working with colleagues at state and national levels to better the field of public health. Ellison exemplified continuous quality improvement, as evidenced by her work on APEX-PH, Mobilizing for Action through Planning and Partnerships (MAPP), and public health department accreditation.

NACCHO: How did you get involved with NACCHO?

Ellison: I joined NACCHO in 1990 when I read that NACCHO was accepting applications from LHDs to become demonstration sites for APEX-PH. I applied and had no idea what I committed the department to; however, we were accepted as a demonstration site. NACCHO broadened our public health world. Exposure to the broader scope of public health is difficult in a small health department; NACCHO brings the national level home. After APEX-PH, I volunteered to serve on the MAPP Committee and went on to serve on several other NACCHO committees, the NACCHO Board of Directors, and I chaired the Profile committee.  It has been very rewarding and exciting for me to work with NACCHO and NACCHO staff and my experience has brought depth to the department.

NACCHO: In your nomination, your colleague noted that you and your staff wore buttons with the words “That’s the way we’ve always done it” crossed out with a large red “x.” How important was innovation for you in your career in local public health?

Ellison: Innovation and creativity are extremely important in public health. We are a small-to-medium county health department in upstate New York. Exposure to what larger counties were doing and being on the cutting edge of public health was elusive to us. Thinking outside of the box was critical. Innovation was the turning point for us because it allowed us to implement APEX-PH, starting with an internal assessment. We were then able to identify priorities. We simply weren’t allowed to say “That’s how we’ve always done it.” We needed new ways to address public health concern and to improve our internal structure.

NACCHO: From advocating for funding for LHD bioterrorism efforts to battling the West Nile Virus, you’ve faced all kinds of challenges. What has been the most challenging issue you faced and how did you deal with it?

Ellison: There were a number of challenges. More than any issue, funding was and remains the number one challenge for local health departments. It was challenging to think of different ways to explain what public health is and how it benefits the community. It’s not something you can explain in a few words and expect that they will immediately understand. There are so many other priorities in the community that it is overwhelming to fight for public health funding. We found that we really had to educate people in a grassroots way–from community members and local policymakers to state and federal legislators.

Unfortunately, to this day public health funding continues to get cut. This comes at a time when you read the public health journals and see that more and more problems are being identified as public health issues. In my opinion, public health is the health of public. People are not putting funding where it needs to be to address such a wide range of issues. Funding has been and will be a challenge and we’ll need to continue to work on it forever. We’re really past the phrase “Do more with less.” We’ve already done that. If you don’t have resources to be able to provide the infrastructure that is needed, there is really no other avenue for addressing these critical public health issues.

NACCHO: You were a big champion for the Mobilizing Action through Planning and Partnerships (MAPP) process. How did MAPP strengthen your LHD?

Ellison: The department has implemented the MAPP process several times. It was fantastic because it put the role of the LHD in the community into focus. Through the MAPP process, we became identified by the community as change agent, as a leader, and as a facilitator. It made us a partner in the community. Our partners were also facing financial challenges, similar to us. MAPP encouraged all of us as partners to address the health of community through the community public health system and that was advantageous for everyone. I think community agencies sometimes struggle with turf—“that’s my program” or “that’s not our issue.” MAPP relinquishes that hold and brings partners together.

NACCHO: What are you most proud of in your long tenure in local public health?

Ellison: Two things come to mind. The first is initiating a local law to ban smoking in public places in our county. In the mid 1990’s when we began working on the smoking ban, two counties in New York state already had bans in place. Our county was the third and, more notably, we were the first small county and our local law was stronger than any in the state. We put public health first and our community took action. The hearing for the ban was largest public hearing that our county board had ever had. While there were opponents and proponents, the majority of those that came out were in favor of it.

Recently, I couldn’t be more proud of our department for achieving accreditation. We were first of 11 health departments recognized. It was many, many years of excellence that prepared us for accreditation. Through continuous quality improvement efforts, the department was able to meet the PHAB Standards and Measures. To realize that we met national standards is awesome. It takes a long time for public health to be able to show its successes. The things we address—be it promoting the use of car seats or diet and exercise interventions or reducing chronic disease mortality—it takes years to see the results and it’s rarely one intervention that makes a difference. The staff worked tirelessly through various strategies and interventions with partner agencies to improve the health of the community. Through their efforts, Livingston County has been named the healthiest county in New York State for two years! Staff deserve the credit for accreditation.

NACCHO: What advice would you give to young professionals just starting their careers in local health departments?

Ellison: First, they need to think of public health as the health of the public. Oftentimes when you talk to community partners about a problem, they think it’s the LHD’s problem. By framing public health as the health of the public, it makes community partners see that it’s not just the LHD’s responsibility, but is the work of entire public health system. Partnering with other organizations in your community is critical. Learn how to work with your community. Every community and agency is different. It’s important for public health leaders to understand the focus of programs and to develop community goal through a community health improvement plan.

Second, I would tell them that this is the best career you could have. It’s tireless work. You have to work long and hard but if you do, you will see changes. It’s incredibly rewarding.

Improving the Quality of Public Health Practice through PHAB’s Accreditation Program and the FDA Retail Program Standards

By Stephen Hughes, Consumer Safety Officer, Food and Drug Administration, and Amy Chang, Program Assistant, Environmental Health, NACCHO

For the past 15 years, the Voluntary National Retail Food Regulatory Program Standards (Retail Program Standards) have served as a model for the continuous improvement of retail food regulatory programs throughout the United States. Many of the retail food regulatory programs enrolled in the Retail Program Standards operate within a larger public health agency with a broad public health mission. As public health accreditation becomes more common for public health agencies, it is becoming more important for retail food regulatory programs to understand the relationships between the Retail Program Standards and the standards used for public health accreditation.

The Public Health Accreditation Board’s (PHAB’s) accreditation program defines the expectations for health departments that seek to become accredited and document the capacity of the health department to deliver the three core functions of public health and the Ten Essential Public Health Services. Similarly, the Retail Program Standards serve as a guide to regulatory retail food program managers in the design and administration of a retail food program and provide a means to recognize a program’s accomplishments.

Although each initiative targets different parts of a public health agency, they share many similarities, such as an emphasis on specific, measurable performance metrics and continuous quality improvement. Specific, measurable performance metrics, coupled with continuous quality improvement, will help public health agencies to improve the quality of public health practices.

To assist health departments in understanding that both initiatives complement each other and are not mutually exclusive processes, NACCHO and the Food and Drug Administration created the Crosswalk on Public Health Accreditation and Retail Program Standards. The document provides an overview of the two initiatives, areas of alignment, and examples of how specific documents generated during the Retail Program Standards process might be used to meet certain required documentation examples for the PHAB measures. The table below gives a broad overview of how PHAB’s accreditation program and the Retail Program Standards have many similarities. Access the full crosswalk in NACCHO’s Bookstore.

Broad Overview of Similarities between PHAB Standards and the Retail Program Standards

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NIDA and NACCHO Help Teens Shatter the Myths about Drugs and Drug Abuse

national-drug-facts-weekBy Brian Marquis, Public Liaison Officer, National Institute on Drug Abuse, and Sheri Lawal, MPH, CHES, Program Analyst, Injury and Violence Prevention, NACCHO

Monitoring the Future, an ongoing study by the National Institute on Drug Abuse (NIDA) and the University of Michigan, found that many teens are not aware of the serious risks drugs and alcohol pose to their health. The study surveys approximately 50,000 eighth-, tenth-, and twelfth-grade students each year. NIDA offers a variety of free materials that help adults and advocates take an active role in educating teens about the consequences of drug use.

This year, NIDA partnered with NACCHO to support three local health departments (LHDs) and organizations in planning awareness events to educate youth on drug abuse during National Drug Facts Week, a national health observance to arm communities with information, materials, and tools to influence teens to say no to drugs. NACCHO and NIDA’s partnership educated hundreds of people on the dangers of drug abuse through tailored messages from peers and community influencers that resonated with youth.

“While most adolescents are generally healthy, many live in communities where they face more choices and challenges than preceding generations,” said NACCHO Executive Director Robert M. Pestronk. “Local health departments protect and promote the health, safety, and security of children of all ages; provide vital information about injury prevention, sexual abuse, and substance use and abuse; and connect teens to comprehensive services when needed.”

LHD leaders, teachers, guidance counselors, and drug prevention program coordinators use NIDA’s science-based information in their outreach, curriculum, school assemblies, parent-teacher association meetings, and evening workshops to educate teens about drug use and its consequences. During National Drug Facts Week 2014, more than 1,000 local events ranging in size and scope were held across the country and internationally.

NACCHO appreciates the work of NIDA in encouraging local collaborations to educate teens and their families about the effects of drugs and drug abuse. LHDs are encouraged to make a difference in their communities by registering, hosting, or participating in a future National Drug Facts Week event. National Drug Facts Week 2015 will be Jan. 26–Feb. 1.

To learn more about NDFW activities and outcomes of each local health department and organization, read NACCHO’s fact sheet, NACCHO Supports Community Efforts to Shatter the Myths about Drugs and Drug Abuse among Teens. For more information, visit www.naccho.org/topics/hpdp/injuryprevention/, the National Drug Facts Week website, or e-mail drugfacts@nida.nih.gov.

The Changing Public Health Landscape: Findings from the 2014 Forces of Change Survey

By Sarah Newman, MPH, Research and Evaluation Analyst, NACCHO

NACCHO has released the 2014 Forces of Change survey containing new findings on the forces that affect change in our nation’s local health departments (LHDs). Economic forces, health reform, and health department accreditation are among the greatest contributors to change.

Highlights

LHDs continue to experience budgetary challenges. Almost one-third of LHDs (28%) reported a lower budget in 2013 than the prior fiscal year and a similar proportion (29%) expect budget cuts to continue into the next fiscal year. LHDs also continue to lose jobs; since 2008, LHDs have collectively lost 48,300 jobs due to layoffs and attrition.

These budget realities and the choices LHDs are making about their role in the changing healthcare environment have affected the scale and scope of services LHDs provide. In 2013, LHDs reported more expansions than reductions in population-based services, such as population-based primary prevention services. With the exception of immunization (where LHDs reducing services greatly outnumber those expanding them), similar proportions of LHDs reported expansions and reductions in clinical services, such as chronic disease screening and treatment. Most LHDs (81%) are seeking to bolster revenue by increasingly billing public and private third-party payers for clinical services they provide.

Many previously uninsured people gained coverage under the Patient Protection and Affordable Care Act, but the limited role LHDs played in helping community members gain this coverage illustrates a missed opportunity to improve access to healthcare. Few LHDs (17%) served as navigators, a formal role responsible for enrolling people in health insurance programs available through a state or federal health exchange or marketplace. More LHDs assisted in an unofficial capacity, almost always without financial support.

Lastly, more LHDs have been formally engaged in the Public Health Accreditation Board’s voluntary accreditation program. In 2014, one percent of LHDs have achieved accreditation and 11 percent have submitted an application or Statement of Intent, nearly double the level of engagement measured in 2013. Accreditation in LHDs will provide the pathways to ensure accountability, consistency, better synergy between community needs and public health services, and improved performance.

Learn More

Findings from the survey are presented in five research briefs:
Local Health Department Budget Cuts and Job Losses
Changes in Local Health Department Services
Billing for Clinical Services
Role of Local Health Departments as Navigators
Local Health Department Accreditation

Visit www.naccho.org/topics/research/forcesofchange to learn how economic and political forces are changing local public health.

Medical Reserve Corps Units Promote Mental Health for Community Resilience

This post originally ran on NACCHO’s new Preparedness Brief blog. For more preparedness news and resources, visit http://www.nacchopreparedness.org.

By Alyson Jordan, Communications Specialist, Public Health Preparedness, NACCHO

Mental health plays a critical role in ensuring prepared and resilient communities. Individuals and families with positive mental health can care for themselves and others in both routine and emergency situations and rebound more quickly after a disaster. Communities can lay a foundation for resilience by addressing their residents’ psychological health and helping them to foster adaptive coping skills in the face of adversity.[1]

Local health departments (LHDs) play a key role in cultivating community resilience and ensuring that individuals within their community can access mental health services both before and after a disaster. To bolster their mental health outreach efforts, LHDs can engage the assistance of the Medical Reserve Corps (MRC), a national network of local volunteers who augment the local public health workforce. Many MRC volunteers are trained in psychological first aid; in fact, nearly half of the nation’s 990 MRC units engaged in psychological first aid/behavioral health activities in 2012.2 By engaging the MRC, LHDs can extend their reach of providing early mental health interventions and working with underserved populations.

Recognizing the importance of the MRC in building community resilience through improved mental health outcomes, NACCHO offered MRC Challenge Awards in 2013 for projects related to mental and emotional health and well-being and in three other focus areas. Out of the 29 selected projects, nine proposed improving their communities’ overall mental health and emotional well-being. Many of these projects are underway currently and serve diverse populations within their communities to address each group’s unique risk factor or their communities’ overall challenges.

The following are a few of the projects that MRC units are conducting to encourage positive mental health outcomes and increase community resilience:

The Southwest Mental Health Net (Southwest New Mexico MRC; Silver City, NM)
The overall goal for the Southwest Mental Health Net (SMHN) program is to reduce instances of teen suicide and mental health crises by creating a network of trained youth in the fields of suicide prevention and psychological first aid in southern New Mexico. The program will empower and train 100 young adults ages 18–25 with the skills to address teen suicide and psychological first aid, who will serve as the first line of intervention and prevention for mental health issues in youth. In the course of at least 12 training sessions, young adults in the program will develop positive relationships and environments for nearly 300 youth ages 11–17. The SMHN not only trains young adults and key community members in psychological first aid, but is also designed to meet youth where they are; provide supportive relationships with adults; offer a safe, welcoming environment for youth to collaborate and express themselves; and empower youth by involving them in governance and decision-making.

Psychological First Aid for Families Experiencing Homelessness (Greater Taunton MRC; Taunton, MA)
The Greater Taunton MRC is partnering with Community Counseling of Bristol County (CCBC), a nonprofit behavioral health provider, to develop a psychological first aid team to work with homeless families living in local shelters. Based on research suggesting that many families facing homelessness—especially women and their children—have experienced domestic, interpersonal, and community violence, the project aims to build emotional resiliency in individuals and families experiencing the trauma of violence and losing their home. Specialized training for MRC staff, volunteers, and CCBC staff will help them to engage with homeless families and work with them to develop a set of skills to make them feel safe and more willing to engage in the services the shelter has to offer. The psychological first aid team will later train shelter staff to become more sensitive to the difficulties of families entering their programs, leading to shorter stays, quicker connections to mental health services in the community, and fewer disruptions for children.

Mind Your Community! (Campbell County MRC; Gillette, WY)
Campbell County, WY, has one of the highest suicide rates in the country, along with high rates of substance abuse and related problems. The Mind Your Community! program addresses these mental and behavioral health challenges by implementing a mindfulness-based stress reduction program to build resiliency in individuals, families, and the broader community. Participation in mindfulness groups not only builds the individuals’ resilience in the face of trauma and distress, but it also builds a sense of unity and commonality, further adding to community resiliency. Program goals include training for 40 MRC mental health volunteers, who will then train professionals/educators in a range of organizations to reach a broad span of community members through presentations about mindfulness to groups, schools, and other community organizations. Learn more about Mind Your Community! in this video.

Read more about the role of LHDs in community resiliency.

References
1. http://www.phe.gov/preparedness/planning/abc/pages/community-resilience.aspx
2. National Association of County and City Health Officials. (2014). 2013 Network Profile of the Medical Reserve Corps. http://www.naccho.org/publications/emergency/upload/ttc-naccho-mrc-report-2013-lo-res.pdf