1. National Summit on PACE EH PACE EH in Rural Settings March 29, 2006 Louisville, Kentucky

2. Presenters: Ricky Elliott, Environmental Supervisor, Escambia County Health Department, Brewton, AlabamaRicky Elliott, Environmental Supervisor, Escambia County Health Department, Brewton, Alabama Tom Struzick, Project Director, Southeast Regional Academic Center for Environmental Public Health, UAB School of Public Health, Birmingham, AlabamaTom Struzick, Project Director, Southeast Regional Academic Center for Environmental Public Health, UAB School of Public Health, Birmingham, Alabama

3. PACE EH in ALABAMA Partners Alabama Department of Public Health, Bureau of Environmental ServicesAlabama Department of Public Health, Bureau of Environmental Services Eight County Health DepartmentsEight County Health Departments School of Public Health, University of Alabama at Birmingham – Department of Environmental Sciences and Center for Community Health Resource DevelopmentSchool of Public Health, University of Alabama at Birmingham – Department of Environmental Sciences and Center for Community Health Resource Development

4. The Alabama PACE EH experience has been supported with two grants: Developing Communities of Excellence in Environmental Health, 2001-2004 funded by the Association of Schools of Public HealthDeveloping Communities of Excellence in Environmental Health, 2001-2004 funded by the Association of Schools of Public Health Southeast Regional Academic Center for Environmental Public Health,2004-2007 funded by the National Center for Environmental Health at the Centers for Disease Control and PreventionSoutheast Regional Academic Center for Environmental Public Health,2004-2007 funded by the National Center for Environmental Health at the Centers for Disease Control and Prevention

5. In Memory of our Friend and Colleague H. Kenneth Dillon, Ph.D. September 2, 1947 – May 9, 2004

6. Present Project Team Members Kent R. Oestenstad, Ph.D., CIH, CSP; Principal InvestigatorKent R. Oestenstad, Ph.D., CIH, CSP; Principal Investigator Linda Goodson, R.N. Co-Principal InvestigatorLinda Goodson, R.N. Co-Principal Investigator Elizabeth Maples, Ph.D.Elizabeth Maples, Ph.D. Katrina Wright, Research AssistantKatrina Wright, Research Assistant Patricia A. Burchfield, B.A., Administrative CoordinatorPatricia A. Burchfield, B.A., Administrative Coordinator Cheryl Johnson, Website ManagerCheryl Johnson, Website Manager Sherry Bradley, M.P.A., Bureau of Environmental Services, Alabama Department of Public HealthSherry Bradley, M.P.A., Bureau of Environmental Services, Alabama Department of Public Health Plus, 7 other PACE EH Project DevelopersPlus, 7 other PACE EH Project Developers

7. Developing Communities of Excellence in Environmental Health, 2001 - 2004 Building partnership between the Alabama Department of Public Health and the UAB School of Public HealthBuilding partnership between the Alabama Department of Public Health and the UAB School of Public Health Alabama Public Health Environmentalists Training Needs AssessmentAlabama Public Health Environmentalists Training Needs Assessment Field-testing a New CurriculumField-testing a New Curriculum Launching PACE EHLaunching PACE EH

8. Building the Partnership between the Alabama Department of Public Healths Bureau of Environmental Services and the UAB School of Public Health

9. Training Needs Assessment Multiple kinds of dataMultiple kinds of data Field tested with PHA Area Environmental Directors – March,2002Field tested with PHA Area Environmental Directors – March,2002 Revised completed May/June 2002 with Environmental Directors supportRevised completed May/June 2002 with Environmental Directors support 89% response rate89% response rate Findings relating to PACE EHFindings relating to PACE EH

10. The assessment consisted of six sections: 1)Demographic information, 2)Experiences with the Ten Essential Services for Environmental Health, 3)Abilities in the Fourteen Core Competencies, 4)Experiences working with the community 5)Attitudes about environmental health work, 6)Training experiences and training needs.

11. Experiences working with the Community When asked how often they work with community agencies, leaders, and lay people, one-third of the participants reported working with community agencies at least once a month, one- fourth reported working with community leaders once a month, and about one-third of the participants reported working with lay people at least weeklyWhen asked how often they work with community agencies, leaders, and lay people, one-third of the participants reported working with community agencies at least once a month, one- fourth reported working with community leaders once a month, and about one-third of the participants reported working with lay people at least weekly County and city agencies were the agencies with which the participants reported having the most contact. County commissioners were the community leaders that they reported having contact most often. They worked with other community leaders mostly on garbage and illegal dumping issues and with community lay people mostly on sewage problems.County and city agencies were the agencies with which the participants reported having the most contact. County commissioners were the community leaders that they reported having contact most often. They worked with other community leaders mostly on garbage and illegal dumping issues and with community lay people mostly on sewage problems.

12. The Curriculum Communities Working for Environmental Health: A Community-focused Training Curriculum for Environmental Public Health Practitioners [ A Primer for PACE EH ]

13. Curriculum Design Challenges Cover content required by ASPH/CDCCover content required by ASPH/CDC Provide background for understanding community EPH workProvide background for understanding community EPH work Establish foundation for conducting PACE EHEstablish foundation for conducting PACE EH Minimize trainee/agency travel expensesMinimize trainee/agency travel expenses Minimize trainee absence from work stationMinimize trainee absence from work station

14. Participants Training began May and ended November, 2003Training began May and ended November, 2003 Began with 11 (one from each of the states Public Health Areas); ended with 10Began with 11 (one from each of the states Public Health Areas); ended with 10 All participants were experienced EPH workers with between 10 and 31 years experience; average 15 yearsAll participants were experienced EPH workers with between 10 and 31 years experience; average 15 years Participants valued their curriculum experience and made one recommendation – move the PACE EH material to the first day.Participants valued their curriculum experience and made one recommendation – move the PACE EH material to the first day.

15. Curriculum Content Seven Modules – 4 Training Days Fundamentals of EPHFundamentals of EPH PACE EHPACE EH EPH Community LeadershipEPH Community Leadership Working with Communities for EPHWorking with Communities for EPH Community OutreachCommunity Outreach Community-based Participatory ResearchCommunity-based Participatory Research Strategic Planning for Community-focused EPH ProjectsStrategic Planning for Community-focused EPH Projects

16. Setting the Stage for the Alabama PACE EH Experiment

17. PACE EH in Alabama: Pragmatics CDC/NCEH interest in PACE EHCDC/NCEH interest in PACE EH Universitys buy-in: The Spirit of PACE EH captured our attention; Engaging community members in planning, implementing and evaluating EPH services/programsUniversitys buy-in: The Spirit of PACE EH captured our attention; Engaging community members in planning, implementing and evaluating EPH services/programs University project staff trained on PACE EHUniversity project staff trained on PACE EH Working with the PACE EH Project in Anniston, ALWorking with the PACE EH Project in Anniston, AL Earlier project experiences led us to focus on a modified version of PACE EH - getting through Tasks 1-5 and beginning to address some of the concernsEarlier project experiences led us to focus on a modified version of PACE EH - getting through Tasks 1-5 and beginning to address some of the concerns

18. Alabama Pace EH Target Communities At least 30 minutes from any urban area; include high percentages of ethnic minority populations with large numbers of people living in poverty; and have slight community resources (e.g., a church or a school)At least 30 minutes from any urban area; include high percentages of ethnic minority populations with large numbers of people living in poverty; and have slight community resources (e.g., a church or a school) Population demographics not always availablePopulation demographics not always available Few EPH practitioners are available to serve these widely dispersed communities; sometimes one worker does all the EPH work for one countyFew EPH practitioners are available to serve these widely dispersed communities; sometimes one worker does all the EPH work for one county EPH practitioners who do serve communities in these counties must travel to remote locations which are far from their base of operationsEPH practitioners who do serve communities in these counties must travel to remote locations which are far from their base of operations

19. ALABAMA PACE EH TARGET COMMUNITIES

20. Launching PACE EH – February, 2004 Project Roles – Developer and FacilitatorProject Roles – Developer and Facilitator PACE EH Task #1 – Checklist and Resource ListPACE EH Task #1 – Checklist and Resource List PACE EH Task #2 – Community DescriptionPACE EH Task #2 – Community Description (begun during training) PACE EH Task #3 – Assembling the CEHA TeamsPACE EH Task #3 – Assembling the CEHA Teams

21. PACE EH Task #4 (Summer, 04) Planning for the Community Surveys University IRB Approval Project Start Up Funds

22. PACE EH Task #5 (July – December, 04) Conducting the assessments; survey form selectionConducting the assessments; survey form selection Data entry and analysisData entry and analysis

23. PACE EH Task #5 Environmental Health Issues of Concern 415 total surveys from the 8 target communities415 total surveys from the 8 target communities All of the environmental issues on the survey forms were checked; though numbers were smallAll of the environmental issues on the survey forms were checked; though numbers were small Majority of respondents felt safe at work, in their own homes, and at outdoor recreation areasMajority of respondents felt safe at work, in their own homes, and at outdoor recreation areas Top five concerns were similar across all communitiesTop five concerns were similar across all communities

24. PACE EH Task #10 Top Five Concerns Safe Drinking WaterSafe Drinking Water Vector Control – MosquitoesVector Control – Mosquitoes Abandoned BuildingsAbandoned Buildings Septic SystemsSeptic Systems Waste ManagementWaste Management

25. Where Are We Now? PACE EH Tasks 11, 12, and 13 Several teams have had some success in resolving some issuesSeveral teams have had some success in resolving some issues All of the teams are loosing momentumAll of the teams are loosing momentum Running up against the reality of limited resources for major problem resolutionRunning up against the reality of limited resources for major problem resolution

26. Alabama PACE EH Successes New players involved in EPH program planningNew players involved in EPH program planning Lower connection fees for public water accessLower connection fees for public water access Waived fees for private well testingWaived fees for private well testing Distribution of mosquito larvicide briquettesDistribution of mosquito larvicide briquettes Public education and awareness campaigns:Public education and awareness campaigns: –Drinking water –Mosquito control Engaging public water authorities in community educationEngaging public water authorities in community education Formation of 501(c) (3) for community sewer systemFormation of 501(c) (3) for community sewer system

27. Joining forces with county commission to support community water surveyJoining forces with county commission to support community water survey Doggy roundupDoggy roundup Cleaning up abandoned buildings and lotsCleaning up abandoned buildings and lots Reduced numbers of illegal solid waste dumpsReduced numbers of illegal solid waste dumps Local Ordinances:Local Ordinances: - noise control (Jake Brakes) - licenses for selling food at alternate locations - licenses for selling food at alternate locations Engaging local media in food safety campaignEngaging local media in food safety campaign

28. Work Yet to be Done Most of the target communities identified two critical EPH issues which remain to be tackled: Safe Drinking Water Systems and ResourcesSafe Drinking Water Systems and Resources EPA Environmental Priority grant application Septic Tanks and other systemsSeptic Tanks and other systems Symposium on Rural Waste Water Treatment Both requiring major multiple agency support and large amounts of funding.

29. Lessons Learned The University/Community Partnership can workThe University/Community Partnership can work Resources (especially peoples time and effort) make or break the PACE EH processResources (especially peoples time and effort) make or break the PACE EH process University – working with state and county health departments was surprising, frustrating, and challengingUniversity – working with state and county health departments was surprising, frustrating, and challenging County – working with university was …County – working with university was …

30. In Closing … With an appreciation for the spirit of PACE EH, a comfort with modifying the PACE EH agenda, the right mix of resources, some serious determination, and a whole lot of luck … The voices of community leaders and lay people can be heard and brought into consideration for community-focused environmental public health planning, implementation, and evaluation