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Working Together for a Healthy New York 1998
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Injury Prevention
Injury Prevention Network, New York City
Public Health Priorities Partnership, Injury Prevention for Youth, Upper Hudson Primary Care Consortium
Safe Passage Program, Sisters Hospital, Buffalo
Safety Works, Think First of CNY, Inc., Syracuse
Suffolk County Disaster Response
The Partnership to Prevent Domestic Violence, New York and the Bronx The Rochester Council on Occupational Safety and Health
The Village of Candor 1997 Partners in Rural Traffic Safety
Think Sharp! Madison County Safe Syringe Disposal Program
Ulster County Healthy Start Program
Ulster County SANE (Sexual Assault Nurse Examiner) Program
US Healthcare and Victim Services, Current Concepts in Womenís Health: Domestic Violence and Primary Care, New York-Based
NEW YORK CITY |
Mission/Purpose
The Injury Prevention Network was born in 1997. The Department of Health and Human Services Maternal and Child Health Bureau Injury Prevention Liaison in Region II felt that there was a need to both identify and integrate the efforts of various agencies involved in injury prevention.
Leadership
The Injury Prevention Regional Liaison contacted state and local agencies interested in working together to create safer environments and a better future for city youth. Several of these agencies accepted an invitation to meet at the Federal Office Building to get to know one another. After the first meeting, the group decided to meet again to identify those areas requiring immediate action and to brainstorm what could be done. After analyzing the city and state data/statistics for causes of death and injuries, it was agreed that adolescents were at high risk. The group decided to organize a conference to address the needs and problems confronting the cityís youth.
Key Partners/Stakeholders
The New York Task Force for Immigrant Health, The Door: A Center of Alternatives, and The Mount Sinai Adolescent Health Center were also invited to meet with federal and state agencies and to participate in the network. The Planning Committee was formed and the conference planning got underway. The Hunter College Center for the Study of Family Policy joined the network and provided a site for its first conference, scheduled for June 3, 1998. The members of the Planning Committee committed themselves to the task of finding and inviting knowledgeable speakers to present at the conference. Dr. Donald F. Schwartz of the Childrenís Hospital and the University of Pennsylvania in Philadelphia agreed to be the keynote speaker. Many other highly qualified and motivated individuals also offered their support and expertise.
Impact/Effectiveness
This conference was also designed as a first step toward establishing communication among the many agenciesóstate, local, and communityóworking on the same goals. The conference was held and was well attended.
The Planning Committee consisted of state and local Departments of Health, community and hospital adolescent centers, and other community agencies dedicated to the well-being of adolescents. All of these members deserve a lot of credit for the success of the conference. Evaluations of the conference revealed that those in attendance thought it was a success but that more time was needed to network and to find out about funding sources. Efforts are currently underway to satisfy these concerns through mini conferences. An additional conference has been scheduled to address the need for further information about grants and funding sources.
Funding
The Injury Prevention Network was able to obtain funds for this conference and for a few follow-up activities from the Department of Health and Human Services U.S. Public Health Service: Office of Minority Health, Office of Womenís Health, and Office of Family Planning; the Health Resources and Service Administration Maternal and Child Health Bureau; and the New York State Department of Health.
Contact: Maria J. Diaz, M.P.H., C.H.E.S., Public Health Advisor, Injury Prevention Liaison, Department of Health and Human Services, Region II, Jacob K. Javits Federal Building, 26 Federal Plaza, New York, NY 10278. Telephone: (212) 264-5494. Fax: (212) 264-1324.
INJURY PREVENTION FOR YOUTH UPPER HUDSON PRIMARY CARE CONSORTIUM |
Over the past two years, the Upper Hudson Primary Care Consortium (UHPCC) has been working with two local health units (LHUís), Warren County Public Health Services and Washington County Public Health Services, on an initiative to identify regional health issues prevalent among the 0ñ21 age group and amenable to improvement through intervention.
The project commenced under the leadership of the LHU in each county. Secondary data, previously collected by UHPCC for the purpose of preparing community health assessments for the individual counties, was aggregated and special attention given to causes of morbidity and mortality among those ages 0ñ21 in the bi-county area. It was noted that one of the most prevalent reasons for the need of health care services by this population was preventable injury. Further examination of the data revealed that within the younger portion of that age group, roughly those 0ñ6 years old, both physical and sexual abuse (often occurring in confirmed settings of domestic violence) and neglect were the principal types of injury noted. Primary school and younger middle school children demonstrated a tendency to suffer accidental injury. Health problems in the older age group were largely self-inflicted through means that included tobacco use, drug and alcohol abuse, sexually transmitted diseases, adolescent pregnancy, and suicide or attempted suicide. Thus, for the entire age range, injury was deemed the common denominator.
In order to corroborate the accuracy of secondary data, especially with respect to self-inflicted injuries, a survey of personal habits and lifestyles was developed for completion by students in health education classes at 21 public schools throughout the bi-county area. Teachers at each school agreed to participate, and more than 340 anonymous student surveys were subsequently returned. The aggregated input from those primary data sources was remarkably consistent with both the secondary data and nationally reported findings.
At this point, because of the need for comprehensive input from those agencies that provide direct, mostly non-health-related services to youth, it was determined that the development phase of the project necessitated the involvement of each countyís Youth Bureaus, which routinely interact with these youth service providers. Community Planning Groups (CPGís) were formed with representatives from a variety of community agencies, businesses, schools, and parent groups. The CPGís were given the principal tasks of identifying factors that contribute to the injury phenomenon and suggesting actions that might lead to their resolution. The outcome of these meetings was consistentóparenting skills, readily accessible and routinely applied, were the key element in injury prevention. The CPG group proceeded to draft a strategic plan that addressed three goals related to resources that should be available to parents to assist them with preventing injury to their children: Education should be both comprehensive and coordinated; there should be easy access to these educational resources; and there should be universal awareness of these parenting services.
In order to meet these objectives, the CPG adopted a work plan calling for the convening of public forums for parents in a minimum of two communities in each of the two counties. The purpose of these forums was to engage parents in the identification of comprehensive strategies for injury prevention and to secure their commitment to collaboratively pursue those strategies. In the process of planning the forums, it became clear that a number of groups, among them schools and constituent organizations of the Youth Bureaus themselves, were already promulgating efforts to educate and engage parents in programs of injury prevention. However, it appeared that many of these efforts were broadly focused and, to some degree, lacked continuity. As a result, the CPG determined to pursue a marketing campaign that would reach out to parents with a consistent message in as many of their environments as possible. The campaign was to be based on seasonal, age-specific behavior that could place children at risk of injury.
The strategies selected involved the distribution of injury prevention information to parents at key access points in the community. The goal was to assure that parents would literally be inundated with information at schools, health care providers, youth organizations, community centers, social service agencies, and so on. In order to make the information topical, brochures were prepared for each season of the year and included key preventive tips for each age group. These brochures also included listings of community agencies and area resources available to parents and children in the bi-county region. The effort to evaluate this approach is ongoing. Feedback has been continually gathered from brochure distribution sites and directly from parents/consumers.
The final aspect of the injury prevention campaign calls for establishing a pilot parenting program to encourage and equip parents in conflict resolution/communication skills with a special emphasis on dealing with situations that have the potential to lead to violence at school. Additionally, a special emphasis has been placed on equipping parents with skills to prevent the escalation of conflict as a result of the use of firearms. This component of the campaign will be implemented in the school settings in the last quarter of 1998.
Contact: Lynne Hamilton-Silverberg, R.N., Assistant for Special Projects/Grants Administrator, Upper Hudson Primary Care Consortium, One Broad Street Plaza, P.O. Box 3253, Glens Falls, NY 12801. Telephone: (518)-761-0300. Fax: (518)-745-1378. E-mail: silverly@uhpcc.medserv.net
SISTERS HOSPITAL BUFFALO |
Mission/Purpose
The Safe Passage Program at Sisters Hospital is the first comprehensive hospital-based family violence program in western New York. Recent reassessment of the health care needs of women has revealed that domestic violence significantly affects womenís physical and emotional health; yet, historically, this problem has not been identified or treated as a health care issue.
Research indicates that, other than from law enforcement, women will most likely seek help from their health care provider or facility. In addition, 22-35 percent of women receiving assistance in the emergency department exhibit symptoms of domestic violence and fewer then 5 percent are identified. Once the magnitude of this problem was identified, the Safe Passage Program was established in order to be more responsive to the health care needs of women. The success of the program indicates more than anything else the great need among women for such a service. Since the programís inception in 1994, its services have expanded to include elder abuse, which affects over 2 million older people annually yet is highly underdetected.
The purpose of the Safe Passage Program is to help end family violence in order to improve the quality of life of those affected and to help define, for the hospital and the community, family violence as a health care issue. In order to meet the goals of the program, several priority areas were established including 24-hour advocacy, medical care provided by health care providers trained in family violence intervention, 24-hour spiritual support, outpatient mental health, employee assistance, and educational programs for health care providers and the community. In addition, the hospital renovated a two-family house in the community into a fully furnished transitional living home for victims of family violence. Women and their children are permitted to remain at the facility for up to 18 months. The home is owned and operated by Sisters Hospital and is the first and only transitional living home in Erie County.
When the director, Kathleen Slammon, C.S.W., was hired in 1994 to coordinate the programís development and implementation, it was obvious to her that family violence could not be effectively confronted by a single individual or institution. In order to have a successful hospital-based program, she would have to build strong partnerships with providers in her own hospitalócommunity service providers. Also, it was important to ensure that the programís goals were incorporated and supported by the mission of the hospital. This strategy strengthened the program and empowered her as its leader to invite other providers to feel comfortable in joining the collaboration.
Initially, an internal hospital task force of administrators and health care providers was created to establish a team approach to programming. The director also joined the Erie County Coalition Against Family Violence, a 20-year grassroots coalition, and cochaired the Coalitionís training committee. As cochair, the program director has been responsible for recruiting membership and planning an annual training program on issues of family violence, which is offered to the general public. The 1998 program attracted over 200 people to the three-part series.
In order to implement three main components of the programóadvocacy, mental health services, and case management servicesópartnerships were established with three community agencies: Crisis Services, Monsignor Carr Institute, and Haven House. The director led a pilot project between Crisis Services and Sisters Hospitalís emergency department. The project involved expanding the Crisis Services volunteer advocate program for sexual assault victims to include domestic violence victims. The director trained the volunteers in domestic violence intervention and, together with the coordinator of the advocate program, developed a 24-hour response system.
To assist with facilitation of tenant selection and case management services for the Safe Passage House, a partnership was formed with Haven House, the local battered womenís shelter. Haven House agreed to screen and select the potential Safe Passage House tenants from their acute shelter. To avoid duplication of services, Haven House would follow these tenants from Haven House through their stay at the Safe Passage House and monitor their needs and progress.
To aid in the provision of comprehensive mental health services not offered at Sisters Hospital, a partnership was developed with Monsignor Carr Institute, a community mental health center. As a licensed clinical social worker, the director joined the staff at Monsignor Carr seven hours per week, specializing in counseling victims of family violence. Referrals include patients and employees from the hospital and the general community.
Each of the partnerships described above enhances service delivery to victims of family violence without duplication of staff or services. This approach allows for comprehensive and consistent care that is efficient and effective. The directorís vision of a healthy community includes individual and community empowerment and easy access to care. Empowerment is achieved through education and information, which have been established as the foundation of the Safe Passage Programís intervention model. The director has also conducted numerous educational programs for various organizations in the community. In addition, the partnerships described above enable the development of healthy communities by increasing the availability and accessibility to a variety of services.
Leadership Role
Sisters Hospitalís board of directors governs the Safe Passage Program, but daily leadership is the responsibility of the program director. The director reports to the director of Womenís Health and has ongoing collaboration with partnering agencies and departments. A team approach to program planning and implementation has been a primary component of the directorís leadership orientation. Leadership has focused on enabling working groups or partnerships to utilize their strengths in a manner that is beneficial to the whole (i.e., filling gaps in services) . Individuals in the groups must feel that they are an integral part of the process in order for them to remain interested and active partners. This is achieved by actively listening to their ideas and proposals and implementing them into the planning process when applicable.
In leading the effort to define family violence as a health care issue, the director cofacilitates a countywide working group named Healthcare Emergency Response Violence Intervention Project (HERVIP). This group was formed in 1995 following a summit sponsored by former Legislator Len Lenihan that highlighted health care and domestic violence. Significant interest resulted from this summit; therefore, Sisterís Hospital offered to cosponsor a meeting led by Sisters, Legislator Lenihan, and Haven House. As the host, the SPP (Safe Passage Program) director coordinated the planning of the event, in collaboration with Haven House and Len Lenihan, which included a luncheon meeting with CEOs and senior management from each hospital in Erie County. The purpose of the meeting was to address the issue of domestic violence and health care and to find ways to work together as a community to provide consistent care to victims throughout the countyís health care system. Using the Safe Passage Program as a model, participants were able to see the possibilities and positive outcomes of health care intervention. A working group (HERVIP) of representatives from each of the 11 hospitals was formed as a result of this meeting. The group identified the following three goals: the creation of a standardized countywide protocol, education, and funding. To date, HERVIP has successfully developed a protocol to be adapted and used by each hospital; funding was received for research; and HERVIP members are currently working on an educational program that will assist in instituting the protocols.
Key Partners/Stakeholders
The principal partners include Haven House (battered womenís shelter), Crisis Services (rape crisis center), Monsignor Carr Institute (community mental health center), and most recently, Catholic Charities. Haven House staff members provide case management services to the two families who reside in the Safe Passage House. They are also responsible for the screening and selection of the Safe Passage House tenants.
Crisis Services provides 24-hour advocacy to Sisters Hospitalís emergency department and responds on the shifts not covered by Sistersí social work department. Advocates are trained in domestic violence and sexual assault intervention and assist with safety planning and offer support to the victim. All victims receive follow-up, which is provided through either Crisis Servicesí staff or the Safe Passage Program. As mentioned above, Sisters Hospital and Crisis Services piloted the domestic violence advocacy project at Sisters, and because of its success, the program has expanded to other hospitals in the area.
Through the partnership with Monsignor Carr, comprehensive mental health services are available to victims of family violence. Partnering allowed the Safe Passage Program to enhance services, while providing Monsignor Carr with a clinician specializing in family violence.
In order to expand the scope of the Safe Passage Program to include elder abuse, the director organized a task force of hospital and community providers. As a result, a protocol outlining the process of care for elder abuse patients was developed and partnership with Catholic Charities was formed. The partnership was established as a means to close the gap between the provision of hospital-based and community-based services for the elder abuse client. In addition to training the emergency department staff on elder abuse identification and intervention, Catholic Charities will followup on all hospital social work referrals of elder abuse patients discharged to the community. Follow-up will include intensive case management and referral services by the Catholic Charities staff, who will then communicate intervention outcome back to the referring social worker and the patientís primary care doctor.
The selection of community partnerships was based on victimís needs and service gaps, with careful consideration of issues of race, culture, language, socioeconomic status, sexual orientation, religion, and ethnicity. Additional partners will be included as the program changes and evolves. Continual monitoring and evaluation of the program ensures this potential inclusion.
A team approach to decision making is promoted, and subcommittees and planning meetings are organized to discuss and review programming and services. The responsibilities of each partner are to fulfill the roles stated above and to do so with respect to our collaborative process. This would not be a successful approach without the support of each partnerís administering body and commitment to work collaboratively.
Significant effort has been made to promote participation from the community. Sisters Hospital worked together with the Parkside Community Association and the City of Buffalo in the development of the Safe Passage House, which is located in the Parkside community in Buffalo.
Also, last year, in recognition of National Domestic Violence Awareness Month and as a means to promote the availability of family violence services at Sisters Hospital, the Division of Womenís Health at Sisters Hospital sponsored the Safe Passage Programís first annual walk, Heal the Hurt. The walk attracted over 100 walkers from the community, including concerned individuals and service providers. The walk was coordinated in collaboration with the YWCAís national campaign, Week Without Violence. In an effort to gain participation from the three neighborhoods surrounding the hospital, presidents of the three neighborhood associations were invited to be honorary cochairs of the walk. Following the walk there was a reception to promote networking and socializing among the three distinct communities around the common issue of violence. The cochairs and neighbors were recognized and the Safe Passage Programís services were promoted. The 1998 Heal the Hurt walk planning committee will expand to include the recently merged Catholic Health System, which incorporates six hospitals. The purpose of the 1998 walk will include raising awareness of family violence and the services provided by the Catholic Health System, in addition to bringing the diverse Catholic Health System together on a common issue.
Impact/Effectiveness
Historically, family violence has not been considered a health care issue, yet health care facilities and providers are often the first places women go to for help. This fact places health care providers in a unique position to intervene in the familyís chronic cycle of violence. Changing health care providersí perceptions about family violence is the key to providing the most effective care for victims. Not until providers are informed and believe that it is their responsibility to ask about violence, document reports of violence, and discuss safety plans, will their care of victims be comprehensive. Since this approach is a change from how family violence has been treated historically, changing the culture of the health care environment in the way it perceives and treats family violence will be the ultimate measure of effectiveness of the Safe Passage Program.
As a means to this end, in the first year of the program the director developed a curriculum that taught health care providers about the cycle of violence, how to identify and intervene with victims of family violence, and the hospitalís protocol of care. With endorsement from administration, this education program on Family Violence Identification and Intervention was instituted. All providers who have patient care responsibilities are mandated to attend this program once a year. To assist in expanding this educational program, the director developed a train-the-trainer curriculum in 1997 and recruited six hospital employees who agreed to volunteer to complete the train-the-trainer program and teach the family violence classes.
As a result, in 1997 over 1,000 employees completed the one-hour program. Since the inception of the Safe Passage Program, approximately 3,000 employees have participated. Over 300 patients were identified and treated for family violence in 1997 and about 750 since 1995. The Safe Passage House has provided a safe home to six families since it opened in 1995, and for the first time in its year of operation there is a waiting list for mental health services. These statistics indicate an increase in numbers identified each year, which means that more people are receiving services and providers are becoming more sensitized to the issue. These numbers also reflect the results of extensive efforts to expose the program to as many entities as possible through the directorís involvement in public speaking, working groups, committees, and conferences. In addition to tracking numbers, quality review of emergency department cases is completed and feedback from providers and patients is encouraged to ensure that victim care is consistent and comprehensive.
The design of this program was meant to be most beneficial to the client/patient. Again, an objective of the program is to increase victim identification by sensitizing the provider through education. As providers become more aware of this issue, they will feel more comfortable in approaching and treating family violence. This approach will promote patientsí accessibility to consistent, comprehensive, and sensitive care, which will ultimately improve the patientsí safety and quality of life.
Utilizing the Safe Passage Program as a port of entry for victims is beneficial to victims as well as those who are partners in the program. Collaborative programming allows for the availability of an expansive array of services that can be accessed through one program. More clients are served without the risk of ìfalling through the cracks,î and partnering programs receive referrals in a manner that promotes shared responsibility and increased communication.
Currently, the Safe Passage Program is funded by Sisters Hospital. In the past it has received support from the Hospitalís Foundation, the City of Buffalo, and a NYS legislative grant. The director is the only paid staff and utilizes volunteers and other programs to meet the staffing needs of the program.
As described in various projects, the community support has been striking. The Parkside Community Association played an integral role in the Safe Passage House planning process. The hospitalís three surrounding communitiesóParkside, F.L.A.R.E., and Trinidadósupported and participated in the Heal the Hurt walk, along with others throughout the area. It will be important for the growth and the success of the program to continue to involve the community in the programís planning and special projects.
Possibly triggered by competition for resources, collaborative programming has the potential to fail because institutions appear hesitant to share resources and ideas. This inhibits the ability of communities and programs to work together and ultimately affects client/patient care and communities as a whole. The Safe Passage Program and House have demonstrated successful and effective partnerships and prove that a collaborative approach does work.
Contact: Kathleen Slammon, M.S.W., C.S.W., Safe Passage Program Director, Sisters Hospital, 2157 Main Street, Buffalo, NY 14214. Telephone: (716) 862-1947. Fax: (716) 862-1436.
A brochure is available upon request.
THINK FIRST OF CNY, INC. SYRACUSE |
Mission/Purpose
The purpose of the Safety Works project is to make comprehensive injury prevention information available, accessible, and understandable for individuals with poor English comprehension skills and/or poor reading ability.
The goals of the project included:
- the development of a comprehensive manual of safety topics to be included in one system.
- the access to safety information for the target audience. This information would be written and illustrated for adults with a reading ability below the fifth-grade level.
- the accessibility of the manual to tutors. The manual would include instructional goals, background information, and reinforcement activities in each section.
- the development of Safety Works as a collaborative community project in order to include all of the main points that should be covered and to achieve the greatest accuracy.
The projected audience for Safety Works would include tutors from literacy organizations (Literacy Volunteers of America and Laubach), refugee programs, social service agencies such as Head Start that typically serve low-literacy clients and businesses that employ a number of employees who either do not understand English well or who do not read above a fifth-grade level.
The first step in the development of this project involved recognition of the problem: People who do not read, write, or speak English are at greater risk for injury. Injury prevention educational materials are almost exclusively written for a literate population; furthermore, the information (printed material) is fragmented and not readily available.
With the above in mind, this agency approached the Rosamond Gifford Charitable Corporation on an informal basis to explore their interest in the development of a tool to address the problem. The executive director, who is familiar with the community, suggested and encouraged the development of a community partnership.
The first agency to be included and a natural partner was Literacy Volunteers of Greater Syracuse. Meetings with their staff led to the development of a coalition as other partners were identified.
Those partners included representatives from Think First of CNY, Inc.; Literacy Volunteers of America; the American Red Cross; New Justice Services; Onondaga County Public Library; and the Refugee Assistance Program.
Meetings were held on a regular basis beginning in the fall of 1995. An outline of the scope of the project was developed as well as a strategy for achieving the stated purpose. Each partner had an assignment to either research a particular topic (such as water safety for the Red Cross) or to contact a professional in the field. Partners then extended the contacts by interviewing representatives from the CNY Poison Control Center, Lead Poisoning Center of CNY, City of Syracuse Fire Department, Onondaga County Health Department, Laubach Literacy Program, Contact (a local agency), and so on.
The strategies used to develop Safety Works were arrived at through discussions with individuals and agencies who are in daily contact with recent immigrants or persons with literacy problems. Several members of the coalition had immigrated years ago, and their recollections of difficulties were helpful. Initially, the coalition interviewed tutors from the Refugee Assistance Program and from Literacy Volunteers of Greater Syracuse. Tutors from the Refugee Assistance Program are paid staff and see a rapid turnover of their students, many of whom are often out in the workforce within a few weeks. They were overwhelmingly in favor of the development of an easy-to-use tool for injury prevention education. They referred to awareness of topics such as fire safety, poison prevention, and street smarts as ìsurvival skillsî for people new to this country.
Tutors from Literacy Volunteers see their students for a longer duration. They are always looking for educational materials that include lesson plans and reinforcement activities. They were excited to hear about the possibility of a tool that would help teach basic English speaking skills and at the same time convey important safety information.
On the basis of these interviews, a grant application to the Gifford Foundation was written. That it was approved reflects the cooperation of the executive director and the board of directors from the Gifford, who represent diverse backgrounds.
Once the grant was approved, RFPís were circulated to advertise the availability of contracts for a writer and an illustrator. Their assignment was to use the information gathered by the coalition partners and to write and design the manuscript.
When samples of the first draft were available for a pilot study, they were distributed to the above-named organizations for feedback. Initial corrections and suggestions were incorporated into the final design.
The standards of a healthy community are achieved by an educated and empowered citizenry. A healthy community will include:
- Excellent schools with teachers and staff that are motivated to bring out the best in their students; a physical plant conducive to learning; and the necessary resources to maintain a high standard of achievement.
- A healthcare system that is available and utilized by all citizens as they require it. Infant mortality rates will be within normal limits as a result of available and accessible pre- and post-natal care and pediatric services. The numbers of preventable diseases and unintentional injuries will be on the decrease because individuals know how and choose to play their required part in their personal well being.
- Safe neighborhoods with satisfactory homes, streets, parks, and playgrounds that are a deterrent to violence and intentional injuries.
- A healthy job market so people are able to earn an adequate living; thereby creating a sense of well being and respect for themselves and others.
Leadership Role
The leadership structure for this project was initially established by Think First of CNY, Inc. Initial inquiries concerning the problem and the possibility for an innovative project were carried out. Once affirmed, Literacy Volunteers of Greater Syracuse, Inc. (LVGS) quickly became a partner. LVGS provided the expertise in literacy aspects of the project, screening applicants for the writing and illustrations, and is a continuing presence in determining the quality of the final product. Both organizations attended meetings, interviewed potential teams, and contributed to the design. Think First scheduled and held meetings; collected the information and topic outlines; interfaced with the writer, illustrator, subsequent graphic designer, and printer; and saw to it that logistical details were managed. Think First also developed and presented the budget to the partners and has since handled the finances of the project. At completion, it is Think Firstís job to distribute the manuals throughout the community, to report to the Gifford Foundation, and to collect evaluations of the finished project.
Technical assistance was solicited with respect to how to effectively proceed with this project. The initial conversations with Dean Lesinski (executive director of the Gifford Foundation), Ruth Colvin (founder of Literacy Volunteers of America), and the successive executive directors of LVGS provided the direction that subsequently led to the success of this project. Partners asked other community resources for their input, and these conversations were recorded and reported back to the coalition.
Key Partners/Stakeholders
Key partners/stakeholders included the following:
- Think First of CNY, Inc.: Nancy Stewart, (executive director); Mike Davison (brain injury survivor), and Mary Jeschke (social worker in an inner city school). Think First board members include representatives from the Onondaga County Health Department who are interacted with on a regular basis and whose input is significant.
- Literacy Volunteers of Greater Syracuse, Inc.: Mark Cass (initial executive director), Kathy Scholl (current executive director), Wendy Edwards, Joanne Delaney, Joan Newland (all staff), in addition to their tutors.
- Refugee Assistance Program: Bob Huss, (executive director), in addition to their tutors.
- American Red Cross: Bob Bewley (water safety resource person).
- New Justice Services: John McCollough, executive director (weapon safety advisor).
- Onondaga County Public Library: Melina Hansen, a librarian who immigrated to this country years ago.
- An unofficial partner but ongoing and valued advisor is Ruth Colvin, founder of Literacy Volunteers of America.
The process of this project depended on developing a representative partnership of agencies within the community who are involved with safety issues. Initial discussions with LVGS and a knowledge of safety topics provided an outline of the areas of concern. Once those were identified, the coalition members contacted the agencies that address such needs. Think First is involved in brain and spinal cord injury prevention and therefore had information and resources pertaining to motor vehicle, pedestrian, and bicycle safety. The Syracuse Chapter of the American Red Cross helped with water safety as well as first aid and emergency measures. New Justice Services helped with weapon safetyóan area of political dissension that had to be handled tactfully but effectively. The partners identified areas to be covered and then spoke extensively to educational staff from the local fire department, poison, and lead poisoning centers. They also spoke with intensive care nurses about the current atypical type injuries they were seeing (like children falling out of second-story windows). Their up-to-date concerns are covered.
The partners were selected because of their expertise and their connection with the targeted community. Through their contacts, the development of Safety Works was expanded. Several members of the coalition attended meetings with tutors from the Refugee Assistance Program and LVGS in order to discern their interests and needs. Other members helped with revisions and editing of the copy. It was a process that necessitated the input from a variety of viewpoints.
There were separate phases for the first edition of the manual:
- Once the partners were identified, consensus was reached regarding the scope of the project and the way in which technical aspects would be contracted for.
- Material was gathered by individual partners and was written up before discussion and approval in committee.
- These materials were turned over to the writer, who designed the format, did the writing, collaborated with the illustrator, and then reviewed his results with the contact person.
- The partners then reviewed the results, made corrections and suggestions, and sent the revisions back. This review involved prioritization in addition to content suggestions.
The initial edition of the manual, Safety Works, is now in the evaluation phase. Copies are being circulated to encourage use and evaluation. The next phase will involve making the necessary revisions and then publishing the work for wider use. The evaluations will determine future stakeholders. Literacy Volunteers of America, Inc. and Think First of CNY, Inc. will be involved in making revisions. Local experts will be contacted for any area that needs to be strengthened.
Impact/Effectiveness
Success will be measured by: (1) the extent of the use of Safety Works; (2) the degree to which it facilitates injury prevention education, and (3) feedback on how the target audience views its effectiveness. The highest measure of success will come from knowing that injury has been avoided because information shared has kept someone from getting hurt, but at this point the only tool for measuring that is anecdotal evidence.
A needs study was conducted before the project got underway. It confirmed the fact that there was no comprehensive injury prevention tool to address those who possess low-literacy or poor English comprehension skills. Included in the manual are evaluation forms requesting feedback from its users once theyíve employed it for a period of time (six weeks to two months). Details about how tutors regard this effort will be gathered; necessary revisions will follow.
An initial measure of success is the demand for the manual, Safety Works. One example: After circulation to the initial target audience, requests have been received throughout the state from Head Start representatives. They say that it provides them with a complete resource and that as they make site visits, they can survey the home situation. Depending on what they find, they can decide which portions of the manual to use.
There is satisfaction in knowing that the initial layout is working. The tabulated sections make the location of a topic easy. The content of each section can stand alone; it is not necessary to have completed one unit before moving on to another.
Safety Works has been funded by a grant from the Gifford Foundation. It has been carefully budgeted to cover costs of development, printing, circulation, and administration, and this budget is realistic and on target.
The targeted audience was identified by definition of the project, and there was keen interest from the organizations that serve that population. With contacts and inquiry, other logical uses have been realized. Head Start is a major supporter. The SUNY Health Science Center Library has a community resource service, and they were happy to have a copy. The Onondaga County Public Library works with literacy training so they were receptive. BOCES will be able to use Safety Works as well.
There have been suggestions to translate Safety Works into Spanish and other languages. Support has been strong enough to indicate that this edition is just a beginning.
The first significant milestone was getting the document completed! It was more work than anyone envisioned to finish this project so that it met standards and expectations.
Another milestone was achieved with the receipt of an Allstate grantóbased on initial draftsóto take this project to another level with a wider circulation through Literacy Volunteers of America. This was not anticipated at the outset.
Further significance: Safety Works was on display at the Think First Foundation National Conference late in April, and the interest from directors was notable. The coordinator from Alabama could anticipate wide use in that area of the country. A person from Vermont who worked with a huge immigrant population was very supportive. And a director from Montreal thought that it would be wonderful to have such a resource available in French.
Although there are natural territorial issues for all organizations, there were no significant problems in the development of Safety Works. If there has been a problem, it is a lack of recognition of the importance of prevention and of this ìsubspecialtyî of low-literacy information. However, reputable medical journals have published articles on the importance of attention to literacy abilities in many aspects of health care (for example, patient information and medication instruction), so there is an expectation that acceptance of this need will be more widely acknowledged.
Contact: Pam Porter, Board President, Think First of CNY, Inc., Rehabilitation Center, University Hospital, 750 East Adams Street, Syracuse, NY 13210. Telephone: (315) 464-2330. Fax: (315) 464-2305.
E-mail: Pporter@syr.iroquois.org
Kathy Scholl, Executive Director, Literacy Volunteers of Greater Syracuse, Corner of East Colvin and South Salina Streets, Syracuse, N. Y. 13205. Telephone: (315) 471-1300.
A copy of Safety Works (manual) is available for interested individuals on request. A charge of $15 will also cover shipping and handling costs. Please send requests to Think First of CNY, Inc., 750 East Adams Street, Syracuse, NY 13210, or call (315) 464-2330.
On the night of July 17, 1996, at approximately 8:35 p.m., TWA Flight 800, bound for Paris, France, crashed into the ocean approximately ten miles off the coast of Suffolk County after taking off from JFK Airport in New York City. As the chief elected official in Suffolk County, County Executive Robert J. Gaffney immediately took charge of the situation.
The first action to be taken was to secure an area at a site in close proximity to where the aircraft had crashed. It was obvious from the start that this was a major incident, and securing the area would prevent onlookers from interfering with the work of professionals trained in handling disasters. County Executive Gaffney decided to utilize the Coast Guard Station in East Moriches as the primary staging area. Suffolk County Police Department officials immediately established a perimeter extending one mile from the Coast Guard Station. Within the next half hour that perimeter was extended to approximately three miles from the site.
The county executive made sure that access to the site was severely restricted to emergency personnel, law enforcement officials, and government officials. Immediately following the crashóand over the next several weeksómore than 1,200 police officers were involved in the operation. Their duties were many. They established an investigative command post to brief various emergency personnel. They maintained traffic control and coordinated the movement of debris removed from the water. The departmentís Marine Bureau worked on body and evidence recovery, and they assisted FBI personnel in fingerprinting and photographing the victims.
Police department officials werenít the only ones at the scene. The countyís Department of Fire, Rescue, and Emergency Services came to the scene within minutes of the crash. Additionally, the county maintains an Emergency Operations Center, which the county executive ordered immediately and fully staffed. The Center established clear radio contact with all fire departments and emergency medical units in the county, as well as all law enforcement agencies. All of these links were opened, and the EOC began operating in a 24-hour mode.
The county executive activated the countyís Incident Management System (IMS). The IMS coordinated the efforts of more than 60 agencies, determining which jobs would be performed by whom and which agencies would handle various responsibilities.
The Coast Guard and Suffolk Police Marine Units arrived at the crash scene minutes after being notified. In less than half an hour after the crash, experts from the County Medical Examinerís Office arrived. They, along with Coast Guard and police personnel, immediately set up a temporary morgue. Refrigerated transport trucks were called in to help transport bodies back to the Medical Examiners Office.
Sanitarians from the countyís health department were also called to the scene, as were other health department officials including the departmentís Emergency Medical Services Division. The health department notified Brookhaven Memorial Hospital and Stony Brook University Hospital to immediately implement their External Disaster Plan. The hospitals, under that plan, are equipped to handle the immediate influx of up to 150 emergency cases. They remained on alert under this plan until approximately 11 p.m. that evening, when it became obvious that there would not be any survivors of the crash.
The county health departmentís Mental Health Unit was also on hand. It was their charge to activate the unitís Critical Incident Stress Debriefing. However, these individuals were not needed at the crash site that evening. Their first duty would be to meet with the families of the victims of the crash. Later on, they would work with the Police Department; Fire, Rescue, and Emergency Services; other health department officials, and civilians in the community who were affected by the crash.
Within minutes of the incident, members of the media descended on the scene. After being briefed by the various officials at the site, the county executive briefed the media on the events of the evening.
Officials from the countyís sheriffís department were also on the scene. They arranged for all 21 police agencies in the county to communicate together on one frequency and relieved police personnel from time to time. Additionally, they used department vans to transport emergency personnel to different areas of the command site.
The county executive also made sure that the countyís Department of Public Works was on the scene. One of their first jobs was to establish an explosives disposal area in case any explosive devices were picked up. Also, knowing that officials would be coming to the site from around the state, they constructed a helicopter landing pad.
The county executive also mobilized the Suffolk County Park Police. Their duty was to secure the beaches around the crash site. They inspected the beaches for any debris that might have washed up and, at the same time, kept the general public away. They considered the beaches a potential crime scene and treated it as such.
The County Medical Examinerís Office worked around the clock. During the days immediately following the disaster, some 400 peopleófour times the normal numberóworked to identify bodies.
In addition, medical personnel from around the state responded to the sceneóprimarily dentists. Because of the condition of the bodies being retrieved from the water, dental records were used for identification. X-ray technicians also assisted in the identification process.
The county has four mental health counselors. It is their job to help people who have been traumatized by a particular incident. Because of the magnitude of this disaster, an additional 61 counselors offered their services. The County Medical Examiner likened the impact suffered by those onboard Flight 800 to that of a person traveling at 400 miles per hour and slamming into an immovable object. Most of the personnel conducting the recovery operation had never experienced the results of such a disaster, and the work of the mental health counselors proved invaluable. Even so, many of the personnel at the site were severely traumatized by what they witnessed and did not return to work for an extended period of time. To this day several people who were at the site are still undergoing counseling.
Divers worked in shifts, recovering bodies and personal belongings. There are numerous risks with diving at 100 feet in cold water. Therefore, a nutritionist and other medical professionals were available to address the needs of divers.
A top priority for all at the site was identification of the bodies recovered. Some of the victims had identification on them. Others could be identified through fingerprints or dental records. Still, some of the bodies were so damaged by the crash, and subsequent immersion in over 100 feet of water, that traditional means of identification were useless.
In many cases, the office utilized DNA profiles. This was the first time in history that DNA technology was used extensively in a mass catastrophe. Specialists went to the homes of those persons who were on Flight 800 and collected personal items. DNA was extracted from these items and compared to the DNA of the victims. Positive matches confirmed the identity of the remaining victims. Using this and other technologies, all victims of Flight 800 were identified.
Less than two hours after the downing of the plane, hundreds of reporters were at the scene. After 24 hours, that number had doubled. In those first hectic hours County Executive Gaffney provided them with the absolute latest developments. Still, many were unsatisfied. Some tried to contact the families of the victims, who were being housed at a hotel outside Kennedy Airport. Police officers shielded family members from the press while information on the disaster was being assembled.
Natural disasters such as severe storms can often be foreseen and are therefore dealt with more easily. In an unforeseen disaster such as Flight 800, planning is the key. Past incidents around the world had demonstrated the chaos that arises as a result of the failure to control response efforts and access to the scene. Following the downing of Flight 800, these problems were almost nonexistent due to the intensive planning and training undergone by emergency personnel.
Under the direction of County Executive Gaffney, local, county,and state agencies worked with the Coast Guard to establish a unified IMS within an hour of the incident. This multiagency coordination is critical to a successful outcome. In general, the response to TWA Flight 800 was exceptional. The dedication and involvement of personnel exceeded all expectations. And, as FBI and NTSB officials testified, the coordination during the Flight 800 tragedy was unparalleled.
Throughout the evening and into the following morning, County Executive Gaffney was at the scene monitoring and coordinating the entire situation. It wasnít until 6 a.m. on July 18 that officials from the FBI and the National Transportation Safety Board arrived on the scene and assumed control of the operation.
Contact: Lori Benincasa, Director of Health Education and Public Information, Suffolk County Department of Health Services, 225 Rabro Drive East, Hauppauge, NY 11788. Telephone: (516)853-3009. Fax: (516)853-2927.
NEW YORK AND THE BRONX |
Introductory Profile
Maureen is pregnant and due to deliver her baby soon. Itís a high-risk pregnancy, and her blood pressure has been elevated. In a HIP-affiliated New York Medical Group (NYMG) waiting room, the receptionist mentions that she has missed some of her prenatal visits. In a halting voice, Maureen tells the receptionist, who is newly trained in domestic violence recognition, that her husband is tired of her, screams and curses at her, and plans to take the child and refuses to support her once the child is born. The receptionist mentions this event to Maureenís doctor. Both the receptionist and physician were trained through the Partnership to Prevent Domestic Violence, a project of HIP/Victim Services Inc., to recognize that domestic violence occurs in one in four pregnant women. The NYMG doctor asks Maureen a key question: ìAre you safe at home?î Maureen says that she is not, but that she does not want to leave her husband before the childís birth. Together, she and her doctor call their domestic violence care manager, who is also part of the Partnership to Prevent Domestic Violence. Later that day the care manager meets with Maureen for the first time. She will help Maureen devise a safety plan to cope with her husbandís abusive behavior and will meet with her weekly to boost her self-esteem, link her with free legal information on her rights to custody and child support, and help her join a support group for victims of domestic violence. Maureen is doing better. Sheís making all her prenatal visits, is under less stress, and knows that she has options as she awaits her babyís birth and makes plans for their future.
Mission/Purpose
In 1996 Health Insurance Plan of New York (HIP) and Victim Services (VS) initiated a unique collaboration designed to foster innovative and cost-effective responses to domestic violence in health care settings. On August 1, 1997, the two announced the beginning of a groundbreaking three-year project designed to identify and treat victims of domestic violence and their families. Together, the two agencies are designing and implementing a multidisciplinary services strategy targeted to more than 186,000 HIP members and hundreds of affiliated physicians in Manhattan and the Bronx. Patients identified by their primary care providers through the partnershipís screening and assessment protocols will have access to an integrated network of medical, mental health, and community-based services and to continuous follow-up care. Major funding of this phase of the partnership is provided through grants from HIP and from the Robert Wood Johnson Foundation Local Initiatives Funding Partners Program, with additional support from the Chase Manhattan Bank and the New York State Department of Health.
Domestic violence is a major public health crisis, affecting 2 to 4 million women annually from all socioeconomic groups. As one of the few services battered women regularly seek, the health care system offers a strategic opportunity to help victims obtain support and assistance. More than one in ten adult women seen in an ambulatory care setting are involved in an abusive relationship, and studies indicate that as many as one in four pregnant women seen for prenatal care are so involved. These rates are as high as those for women seen in emergency rooms, where domestic violence screening is an emerging practice. However, despite the role that domestic violence plays in causing or exacerbating medical conditions ranging from asthma and gastrointestinal disorders to high-risk pregnancies, most primary care providers are not prepared to identify or respond to the many victims of domestic violence who cross their thresholds.
To address this potent health problem, HIP Health Plans, New York Medical Group affiliated with HIP, and Victim Services began a yearlong pilot project at the NYMG Manhattan West Center and HIPís Manhattan Mental Health Center. During the pilot, NYMG and HIP providers were trained to identify possible victims of abuse and refer them to a partnership care manager who worked exclusively with HIP patients. The care managers, who are Victim Services employees, in turn, provided patients with ongoing educational counseling, information, referrals, and advocacy. The response of patients and providers confirmed that domestic violence requires coordinated treatment responses on many levels. It also pointed to the need to move beyond the current strategy of medical screening and referral out to social services. Therefore, HIP and VS began to think about ways to expand the effort and serve victims identified through the screening with the most appropriate services. In the fall of 1997 the project was expanded to three years and to encompass all HIP centers in Manhattan and the Bronx. The goal of this project is to improve the physical and emotional well-being of HIPís members who are involved in domestic violence. It is being accomplished through the design and development of an integrated domestic violence service strategy that emphasizes prevention and harm reduction by anticipating patterns of coercive behaviors experienced by victims. The strategy will consist of:
- client-centered, outcome-oriented treatment guidelines for providers to use in treating victims of domestic violence and their families
- a network integrating medical and mental health services with community-based services
- case coordination for HIP patients to ensure timely access to appropriate, coordinated, and continuous network services
- training and ongoing technical assistance for all NYMG staff
The project will consist of three phases:
Phase One: A multidisciplinary development team including senior clinical administrative staff from HIP, NYMG, and Victim Services met regularly to design the integrated service strategy, a set of practice guidelines, an integrated service network, and the role of three care managers who will work with providers and patients.
Phase Two: Involves introducing the program to NYMG staffs through training sessions designed by the development team and conducted by Victim Services.
Phase Three: Will begin in the fall of 1998 and extend through the fall of 2000, during which time the intervention strategy will be fully implemented at each NYMG center.
Physician and Support Staff Training
Training of doctors and support staff began in March 1998. By June 1, 1998, it is anticipated that 130 doctors in every NYMG center in Manhattan and the Bronx will have been trained. Physicians are trained in domestic violence screening, documentation, and intervention; the medical effects of domestic violence; and the referral process by which patients are assigned to a partnership care manager who will provide supportive counseling, facilitate access to domestic violence services, coordinate the care of the patient, and refer back to the physician for additional medical referrals. Mental health practitioners receive similar training, but the focus is on the psychological impact of domestic violence. Other staff members learn about the prevalence of domestic violence and how they can assist the partnership by flagging suspected cases.
Nationwide, key medical and public health policymakers have come to the consensus that domestic violence poses a significant health risk and is worthy of attention both in medical practice and in public health initiatives. As early as 1985 Surgeon General Koop convened a high-level working group, which identified domestic violence as a key public health concern. In 1992 the American Medical Association issued diagnostic and treatment guidelines for domestic violence. Similarly, the American College of Obstetrics and Gynecology and the Joint Commission of Accreditation of Healthcare Organizations have recognized domestic violence as a serious problem among their patient population.
For more than 50 years HIP has dedicated itself to the advancement of one class of high-quality health care, with an emphasis on primary care and prevention. HIPís pioneering accomplishments have been officially recognized by the most prestigious health care rating services. HIP provides grants, sponsorships, and direct contributions to a wide range of community -based nonprofit organizations to enhance access to health care and related social services, especially for the disadvantaged, elderly, children, and young adult populations. It believes that it has a responsibility to take a leadership role and takes that self-imposed obligation very seriously.
Leadership Role
The Partnership Project is being conducted jointly by a team under the overall leadership of Moishe Labi, M. D., medical director of NYMG; Mary Bleiberg, the original Victim Services program director, who was succeeded by Terri Pease, Ph.D.; and Carmen Verdejo, HIPís managing director of external affairs, who serves as HIP project coordinator.
The Team
A multidisciplinary team including senior medical, mental health, and administrative staff from HIP, NYMG, and Victim Services met regularly during the first six months of the project (September 1997 to February 1998) as the development team. It began by analyzing the medical records of patients who had been served in the pilot project and by sharing the distinct perspectives of its constituents on how to best care for these patients.
Practice Guidelines
Out of these discussions the team created a set of practice guidelines that include treatment goals, the methodology used to achieve those goals, and a common language for all providers to use. It also planned the logistics of implementing the service strategy, beginning with the training of all of NYMGís primary care doctors in the two target boroughs, Manhattan and the Bronx.
Care Managers
The development team also designed the role of care managers, who work with providers and patients to secure the most appropriate mix of services within the network or to help clients obtain needed services elsewhere. The care managers are also responsible for coordinating the flow of information among network providers as well as monitoring patient utilization and quality assurance and assisting providers in using the practice guidelines.
HIPís Expertise
While the teamís next effort will be to create an integrated service network that includes new interventions focused on early identification and concrete services, HIPís Medical Economics and Data Analysis department is providing the technical assistance needed to allow Victim Services to develop actuarial data for cost models of these servicesóa key component to ensure that the strategy is one that can be extended to the wider marketplace.
This project has been a true partnership of HIP, NYMG, and Victim Services. These organizations have worked together closely to evaluate the initial pilot project and determine how to proceed with its expansion. Beyond the substantial financial commitment required to support the effort, additional HIP resources have been made available to ensure the projectís success. HIPís Medical Economics and Data Analysis department helped to design the patient record form and provided appropriate access to patient and provider data in order to assess the effectiveness of the intervention protocol and discern utilization and clinical profiles that characterize battered women. HIP and NYMG staff have also been active in familiarizing the care managers and other Victim Servicesí staff with the functions of their employees and centers. NYMG system coordinators have given technical assistance to the care managers within the centers and with patients. Victim Services has, in turn, trained HIP and NYMG about domestic violence and has been an active force in coordinating day-to-day care of patients recognized through the screening and care guidelines, linking them with the wide range of publicly funded services available through the organization.
Key Partners/Stakeholders
Representatives from HIP include: Arthur H. Barnes, Senior Vice President for External Affairs; Carmen Verdejo, Managing Director of External Affairs; Mark Schachter, Vice President, Medical Economics and Data Analysis; Neil Meyerkopf, M.B.A., M.S.W., Director, Mental Health Services; Suzanne Appel, M.D., Director, HIP Manhattan Mental Health Center; and David Yokell, M.D., Director, HIP Bronx Mental Health Center.
Representatives from the New York Medical Group included: Moshe Labi, M.D., Medical Director; Joseph Zeitlin, M.D., Chair of Quality Improvement; and
Maria Bazdekis, Director of Quality Improvement.
Representatives from Victim Services included: Michael Kaiser, Associate Director, Development and External Affairs; Mary S. Bleiberg, Program Director, Partnership to Prevent Domestic Violence; Terri Pease, Ph.D., Deputy Program Director, Partnership to Prevent Domestic Violence; Nigel Ferguson, Partnership Program Assistant; Connie Boris, Care Manager; and Wanda Vasquez, Care Manager.
The Need
Domestic violence occurs in all walks of life. No social group is free of it. And HIP, whose affiliated medical groups in the Bronx and Manhattan care for New Yorkers from a very broad range of class, ethnicity, and economic strata, has come to recognize that the partnershipís services are needed in every area. The makeup of the participants in the partnership, including HIP, NYMG, and VS senior staff, the partnership care managers, and NYMGís professional and support staff, encompasses the natural diversity that is part of the social and ethnic fabric of New York City. The partnership staff is prepared to work with patients from New Yorkís large Spanish-speaking communities and can link other patients with specialized domestic violence services in a range of languages from Hindi and Greek to Cantonese and Russian.
Cultural Differences
The training curriculum strives to be inclusive of the multiple cultures represented in the HIP membership and to take into account the cultural influences on domestic violence in order to offer appropriate, sensitive responses to these influences. This includes an awareness of abuse in gay and lesbian relationships, abuse of elders and of teens in relationships, and the needs of men abused by women, as well as the ways in which immigration status, class standing, and membership in minority communities might have an impact on oneís ability to access domestic violence services.
While domestic violence has an impact on all aspects of patientsí well-being, much of the intervention that is needed can come from mental health and behavioral health care providers. HIP has, as the centerpiece of its response to patientsí mental health needs, community-based mental health centers in the Bronx and Manhattan. In addition, HIP has developed a network of independent mental health providers in the two boroughs, and throughout New York City, who meet more specialized mental health needs of HIP members. These groups include the Jewish Board of Family and Childrenís Services (JBFCS), Fordham-Tremont Mental Health Center, the Ackerman Institute, the Karen Horney Institute, and many others. Network providers also work with the Partnership to Prevent Domestic Violence care managers to ensure that membersí needs for psychiatric and substance abuse treatment are addressed in an appropriate manner.
HIP has medical centers located in New York Cityís other three boroughs. Informal contacts with HIP social workers in other boroughs demonstrate their eagerness to make use of the partnershipís specialized services for the domestic violence patients they have already identified. As the intervention strategy is refined and shown to be effective, the Partnership can be expanded to encompass all of New Yorkís boroughs, as well as similar HMOs in other parts of the country.
Although day-to-day decision making is left in the hands of the program director, the partnership is organizing an advisory board of healthcare providers and experts in the field of domestic violence, including Robert McAfee, M.D., past president of the American Medical Association, and Dr. Anne Flitcraft, pioneer in the field of domestic violence.
The development team is charged with creating the integrated service strategy, which includes the intervention protocols and practice guidelines, a network of care providers, the care management system, and training and technical assistance for providers. This team meets regularly to review the partnershipís progress to date, to discuss policy, strategize future activities, and to confront any emerging difficulties in project implementation. In addition, frequent informal communication among the members of the development team has been a hallmark of the partnership and has been key in moving the effort forward.
HIP Health Plans
HIP provides corporate leadership for the project, which includes its ongoing commitment of funds and technical assistance from its legal, quality improvement, data analysis, and public affairs and external affairs departments. HIPís director of medical economics and data analysis is a member of the development team. This department has been collaborating with Victim Services to construct an evaluation and to analyze the projectís outcome data. HIP Mental Health provides an integral part of the service delivery system. Recognizing the complementary nature of their work, domestic violence screening and referral to and collaboration with the care managers have become institutionalized as important elements of their practice.
New York Medical Group
NYMGís 130 primary care physicians are the backbone of the project. Their responsiveness to training and openness to adopting domestic violence screening as a new medical practice constitute the sine qua non of the partnershipís success. Unless doctors ask patients, ìAre you safe at home?,î there are fewer patients to treat and more victims surviving in isolation. The administrators and medical directors of the 15 NYMG and 2 mental health centers have encouraged these physicians to screen, identify and refer patients, and maintain the supportive public education materials at each site. The site administrators also facilitate and coordinate the training of employees at each center.
Victim Services
VS is responsible for the day-to-day operations of the Partnership to Prevent Domestic Violence. It coordinates the entire program, including scheduling and managing the training, convening the development team and advisory board, supervising the care managers, soliciting funding, and taking care of the administrative details of the partnership. The care managers receive referrals from the doctors and patients (95 percent of referrals involve females) and then meet with each referred patient to determine the level of risk she or he is facing and develop an intervention plan. This frequently includes creating a safety plan, either for escape or for harm reduction. The care managers are also responsible for providing written comments to the referring doctor or therapist regarding the patientís progress. Their work with doctors includes scheduling case conferences as appropriate, encouraging physicians to screen, and providing technical assistance.
Impact/Effectiveness
The partnership has trained 157 doctors in 15 centers that serve over 186,000 members. Of these members, 69,000 are women between the ages of 15 and 65, who are at greatest risk for domestic violence. It is anticipated that the project will result in a greater number of physicians who are aware of domestic violence and routinely screen for its presence among their female patients (abuse occurs in male patients too, and doctors are being trained to recognize this as well). More patients and providers will be aware of the health consequences of domestic violence, and a greater number of battered women will be identified by their physicians and have access to supportive services. Additionally, the partnership expects evaluation to show that utilization of medical resources will improve by considering domestic violence as a potential cause of injury and illness. The physical and mental health status of patients identified and served should also improve.
It also anticipates that the identified patients will be less likely to seek emergency shelter and less likely to abuse drugs and alcohol. The project will be evaluated in several phases, including a pre- and post-test of physicians about their knowledge of domestic violence and screening rates, an analysis of the medical and social service utilization rates of battered women before and after they have been identified, as well as an examination of the physical and mental health of victims. There will also be focus groups with physicians to determine the accessibility and usefulness of the training and identification protocol.
HIPís Commitment
The integration of a social service intervention into a health insurance companyís network of services has the effect of redefining the meaning of health care in the New York City area. The commitment of HIP and NYMG to respond to the issue of domestic violence without requiring that programs operate under the constraints of showing cost or utilization reductions has allowed the development of a wholly new intervention. While that intervention may ultimately result in reductions in costs, by funding and supporting the partnership, HIP has demonstrated commitment to address the well-being of its members, recognizing that domestic violence takes a toll on all who are involved: the members who are victims, their partners (who are often also HIP members), and the children in their families. The primary benefit to HIP arises as more women are identified as being in abusive relationships and are given access to social services for themselves and their children, resulting in a reduced risk of injury and illness.
NYMG Physicians
NYMGís physicians also gain. As they know more about domestic violence and its potential health problems, they will experience improved diagnostic precision and become more cognizant of the difficulties faced by patients in abusive relationships. They will recognize situations in which medical noncompliance is indicative of a patientís abusive home environment and, by being aware of appropriate referral procedures and services, theyíll be in a position to offer immediate and effective help to abused patients.
HIP and NYMG are able to provide improved services for patients and achieve greater satisfaction with their health plan. There is a potential reduction in inappropriate medical utilization, and the improved physical and mental health status of their patients improve as a result of early intervention in cases of domestic violence.
Victim Services
VS gains experience in working with clients who are identified earlier in the course of a violent relationship and is able to reach clients who otherwise might not seek services. In addition, the agency has the opportunity to pioneer new domestic violence interventions at sites where clients are less reluctant to acknowledge their need for help.
Primary funding for the partnership has come from HIPís Department of Corporate External Affairs. Additional funding comes from the Robert Wood Johnson Foundation Local Initiatives Funding Partners Program. These funds pay for staff resources provided by Victim Services. HIP/NYMG staff, especially the medical directors and site administrators, have played a key role with program implementation and by endorsing the use of the protocol and practice guidelines. In addition, the rich variety of Victim Servicesí publicly funded programs for victims of domestic violence are available to those identified through the partnership. The care managers help patients to access advocacy services, assistance in filing for Orders of Protection, emergency housing transfers, emergency financial assistance, lock replacement, crisis intervention through the domestic violence hotline, support groups at community offices, and shelter for themselves and their children.
Even before the partnership began, HIP showed its commitment to the issue of domestic violence by underwriting the cityís bus and subway poster campaign advertising the Domestic Violence Hotline. Since that time, HIPís commitment to address domestic violence in a bold and proactive manner has been recognized throughout the entire HIP organization. Dramatic positive steps have been taken to address domestic violence as a serious health problem. By agreeing that HIP support staff be trained along with affiliated NYMG physicians, sensitivity to domestic violence is becoming part of the HIP culture. Furthermore, a patient education campaign utilizing attractive brochures and posters advertising the HIP/VS partnership lets HIPís members know that the HIP-affiliated center is a place where safety at home is taken seriously and where knowledgeable staff at all levels will respond to their needs for information and for help. This type of education about the project and about domestic violence encourages those who have not yet been identified to self-refer to the partnership care managers.
Although the current partnership is only a year old, it has already had significant success and developed a variety of products that are being integrated into HIP and NYMG. They include:
- clinical practice guidelines and intervention protocols for both medical and mental health care
- development of a unique care management function to track a patient from the time domestic violence is identified and coordinate medical, mental health, and social service interventions
- a one-hour training curriculum for both physicians (with CME credit) and support staff that introduces domestic violence, the practice guidelines, and intervention protocols
- a domestic violence client record that facilitates careful tracking of patient progress and coordinated reporting to referent and primary care providers
- public education materials that include posters, buttons for physicians, a palm card, and brochures that ask ìAre You Safe At Home?î
- a newsletter that is distributed to HIP staff and physicians, giving more details about the partnership and highlighting successes from across the HIP centers
In the early stages of development are intervention groups to be held at the NYMG centers. These groups will be operated on a drop-in basis, allowing anyone to partake of them. The groups will cover topics such as parenting under stress, relationship issues, and managing the stress of caregiving. They will be designed to address domestic violence and family abuse without the negative connotations of those particular words.
There have been nearly 120 referrals; at least half of these women have children who are also HIP members. Children are also assisted through the partnership, with services including safety planning and referrals to social services and mental health treatment.
The Hidden Factor
Traditionally, domestic violence has been a hidden, private matteróthe concern of only clergy, family members, or marriage counselors. This hidden factor has kept some, including doctors, from recognizing that domestic violence is a widespread problem and a contributor to significant health problems for its victims. Physicians thus may be reluctant to speak about domestic violence with their patients for fear of offending them, although studies have shown that patients would prefer that doctors ask about violence and see this intervention as well within the physicianís sphere of concern. Doctors also express reluctance to address domestic violence because they doubt there is enough time during the appointment to address the issue and/or they do not have confidence in the patientís access to resources. Overcoming this reluctance has been a significant challenge to be met by the partnership.
Shelter for Victims
Shelter beds in New York City are limited and cannot accommodate every victim of domestic violence who might want shelter. Fortunately, the partnershipís early intervention strategy tends to identify cases of domestic violence before the radical step of seeking emergency shelter is needed. Still, not every patient who needs shelter is assured of an immediate shelter placement, and this challenge is one that affects any program that identifies and serves victims of domestic violence.
Access to the Program
Access to the Partnership to Prevent Domestic Violence begins with a patientís membership in HIP. When a battered woman divorces a husband who is the primary health insurance subscriber, she could lose her health insurance. This creates a paradoxical situation in which the partnership intervention may have facilitated the loss of a victimís health insurance. Responding to this challenge is a task that the development team will face in the immediate future.
Addressing the Abuser
Another thorny issue yet to be faced is the problem of recognizing and responding to the needs of the HIP member who is abusive to his or her partner. Programs for abusers are far more scarce than those for victims. The partnership will need to address patients who will invariably become more visible as victims are increasingly identified and helped.
HIP Health Plan Contact: Carmen V. Verdejo, Managing Director, HIP Health Plans, 7 West 34th Street, New York, NY 10001. Telephone: (212) 630-8578. Fax: (212) 630-8616.
Victim Services Contact: Terri Pease, Ph.D., Program Director for the Partnership to Prevent Domestic Violence, 2 Lafayette Street, 3rd Floor, New York, NY 10007. Telephone: (212) 577-1369. Fax: (212) 577-7355.
Available Publications and Materials (HIP and Victim Services joint authorship):
ìAre You Safe at Home?î Brochure, poster, palm card, buttons; Physicianís ìTip Cardî
OCCUPATIONAL SAFETY AND HEALTH |
Mission/Purpose
The Rochester Council on Occupational Safety and Health (ROCOSH) is an organization of labor, health, and legal professionals and others working together to improve the health, safety, and environmental conditions for workers in the greater Rochester area. Its mission is to prevent occupational injury and disease by giving people the knowledge, information, and skills they need to make Rochester-area workplaces safer. The councilís philosophy is to focus on workplace leaders who are in a position to bring about changes that will affect many workers. ROCOSH was founded in 1981 by a group of union members, physicians, and educators, who organized several conferences on occupational safety and health and provided technical assistance to area unions. It has maintained an office and paid staff since 1986. ROCOSH is a nonprofit organization, operating with funds from grants, individual and union membership dues, and donations. Membership includes 47 unions, 16 organizations, and 103 individuals.
Trainings, Workshops, and Seminars
ROCOSH provides high-quality, low-cost, practical training in the field of occupational health and safety. Its workshops range from trainings designed to address the specific hazards faced by particular unions to public programs on topics of broad interest to labor and the community. Examples include: fall protection; art hazards; chemical hazards of fire fighting; back injury prevention; workplace violence; stress/wellness; repetitive motion injury prevention; health hazards of lead; controlling workplace noise; office ergonomics; health hazards of physical plant workers; lock-out/tag-out; confined space; blood-borne pathogens; indoor air quality; TB in the workplace; chemical hazards of waste water workers; leadership development; collaboration for a democratic workplace; advocacy/ empowerment; workplace hazard evaluation and monitoring; effective communications; personal protective equipment; integrated pest management; asbestos awareness; health and safety representative training; health and safety committee training; understanding Workersí Compensation; OSHA 10-hour construction course; and OSHA 10-hour industry course.
Other Programs and Activities
ROCOSH maintains a library of reference materials on occupational health and safety issues, including weekly updates of OSHA-related information. Through a newsletter, targeted educational mailings, and mass media, ROCOSH provides information on occupational health and safety issues to its membership and the general public.
By phone and in person, ROCOSH provides referrals, advice, and answers to questions about workplace hazards, occupational diseases, health and safety regulations, Workersí Compensation, and related topics. ROCOSH works on an ongoing basis with unions, individuals, and health and safety committees to help them address these health and safety hazards. ROCOSH engages consultants to address specific health and safety problems. For example, industrial hygiene consultants are hired to deal with problems of indoor air quality.
In addition to training, information, and technical assistance, ROCOSH provides staff support (through such efforts as ROCOSH Injured Workers Group support program) to empower union and community members to bring about changes in attitudes and beliefs that will lead to more humane societal and organizational practices, thus eliminating or reducing workplace health and safety problems.
ROCOSH conducts research on issues related to occupational health and safety. It is currently working in collaboration with the Finger Lakes Occupational Health Services of the University of Rochester School of Medicine (FLOHS), Cornell University School of Industrial and Labor Relations, and the University of Toronto Centre for Applied Social Research to research issues of occupational stress.
This research agenda is particularly focused on the institution of democratic workplaces in order to bring about organizational and societal practices that can eliminate or reduce the negative human and organizational consequences arising from occupational stress.
Examples of Recent Programs
General Trainings
ROCOSH provided training for New York State teachers. The training included the fundamentals of indoor air environment, including the source of problems; typical health symptoms related to poor quality air; and how occupants and building materials can be affected. The training consisted of a lecture with handouts. Training was conducted by Bill Benet, M.S.Ed., Res. Dip. S.W. Thirty-five participants attended the one-hour training.
ROCOSH provided training for individuals with occupationally related chronic health conditions due to an injury or disease. The program consisted of six two-hour sessions. Training included pain management, assertiveness and effective communication, redefining self, and other issues of concern to injured workers. Training consisted of a lecture, small-group exercises, and discussion. Training was conducted by Alice Armstrong Rahill, Ph.D., a neuropsychologist with the Finger Lakes Occupational Health Services. Four participants attended each session.
ROCOSH provided training to Rochester Institute of Technology professors on safety and health issues surrounding sweatshop conditions and child labor . The training addressed inadequate enforcement of OSHA safety and health regulations in sweatshops, the employment of young children, and actions participants can take to improve enforcement. Training was conducted by Bill Benet. The one-hour training consisted of a lecture, overheads, and discussion. Twenty participants attended.
ROCOSH provided training to labor unions, politicians, and members of the community on safety and health issues surrounding sweatshop conditions and child labor. The training covered inadequate enforcement of OSHA safety and health regulations in sweatshops, the employment of young children, and actions participants can take to improve enforcement. Training was conducted by Bill Benet. The one-hour training consisted of a lecture and was attended by 75 participants.
ROCOSH provided training for waste water treatment operators at the Monroe County Water Authority. The training covered basic toxicology, hazard communication, Right-to-Know and Material Safety Data Sheets, and hazards of specific chemicals. Training consisted of a lecture, discussion, and small-group exercises. The one-hour training was conducted by Jean Douthwright, Ph.D., professor of biology at the Rochester Institute of Technology, and 12 participants attended.
ROCOSH provided training for Rochester Labor Council officials and delegates. The training addressed the importance of safety and health in the workplace, employee rights under OSHA, and organizing around the issue of safety and health. Training was conducted by Bill Benet. Training was one hour, with 75 participants attending.
ROCOSH provided training for union members and community members. The training covered the importance of safety and health in the workplace and employee rights under OSHA. Training consisted of a lecture and a question-and-answer period. The one-hour training was conducted by Bill Benet, with 125 participants attending.
ROCOSH provided training for the Rochester Institute of Technologyís Economic Education Center. Training consisted of a lecture and handouts, with time for questions and answers. The training covered the impact of world economics on workplace safety and health. Nineteen participants attended the one-hour training.
ROCOSH provided training to Cornell students in the ILR Contract Administration Course. Training covered introduction to OSHA, employee rights under OSHA, bargaining for safety and health in contracts, and overall issues of safety and health in the union movement. Fifteen participants attended the one-hour training conducted by Bill Benet. Training consisted of a lecture with handouts.
At the New York State Occupational Health Clinic Network Health and Safety Conference, ROCOSH provided information on the Injured Workers Support Group, which is sponsored by ROCOSH and the Finger Lakes Occupational Health Services. Training was conducted by Koralee Bernardo, program director for ROCOSH. The two-hour training consisted of a poster presentation with a question-and-answer format. Topics included stricter enforcement of OSHA regulations in the workplace, status on OSHA ergonomics standard, and Workersí Compensation. Eighteen participants attended.
ROCOSH provided information to the community on potential development of improved occupational health and safety practices through worker-owned cooperatives. The training covered introduction to OSHA, employee rights under OSHA, OSHA enforcement problems, and worker-owned cooperative strategies for improving occupational health and safety conditions. Training was conducted by Bill Benet. The two-hour training consisted of a lecture followed by a question-and-answer period. Thirty-eight participants attended.
ROCOSH Injured Worker Programs
Each session was two hours and consisted of a question-and-answer plus lecture format.
ROCOSH and the Finger Lakes Occupational Health Services provided a workshop on Workersí Compensation. Panelists included Lani Bauer, a social worker with the Rochester Workersí Compensation Board; attorney Steve Modica; and Bill Benet, executive director of ROCOSH. Nineteen people attended.
ROCOSH and FLOHS provided a workshop for injured workers on VESIDó the Vocational and Educational Services for Individuals with Disabilities Agency. Lori Baumann, senior counselor with VESID, was the guest speaker. Topics included VESIDís services and how to get started. Six people attended.
ROCOSH and FLOHS provided a workshop for injured workers. The guest speaker was local labor attorney Matt Fusco. Topics included when to file a claim for Workersí Compensation, how to get the benefits you deserve, what happens when claims are denied, and how claimants can work effectively with their attorney. Sixteen people attended.
ROCOSH and FLOHS provided a workshop with three panelists to address issues raised by injured workers who are receiving Workersí Compensation. Topics included definition of doctors and terms, how to get timely medical reports, and patient rights. Panelists included Dr. Bill Beckett, medical director of FLOHS; Lanie Bauer, a social worker; and an injured worker. Five people attended.
ROCOSH and FLOHS provided a training on handling personal finances while on Workersí Compensation. The workshop was conducted by Joanne Schroeder, director of education, Consumer Credit Counseling Service. Topics included debt attack plans, prioritizing bills/debts, and ways to increase income and reduce expenses. Three people attended.
ROCOSH and FLOHS sponsored a workshop on federal disability benefits. Paralegal Anne Lang was the speaker. Topics included how to apply for SSDI/SSI benefits and what to expect. Five people attended.
ROCOSH and FLOHS provided a workshop on dealing with chronic pain. Dr. Alice Armstrong Rahill was the guest speaker. Topics addressed the development of effective coping skills, the identification of limitations on the job and around the house, and the use of exercise in coping with chronic pain and handling physical and psychological changes. Five people attended.
ROCOSH and FLOHS provided a workshop on chronic fatigue and sleeplessness. Dr. Rahill was the guest speaker. Topics dealt with issues and concerns surrounding chronic fatigue and sleeplessness related to chronic pain. Four people attended.
Summary of 1997ñ1998 Activities
ROCOSH conducted a total of 71 training programs from July 1997 through June 1998; a total of 844 individuals attended. Technical assistance was provided to a total of 257 people, and a series of ten newsletters were distributed to an average of 500 people per mailing.
Contact: Bill Benet, M.S.Ed., Res. Dip. S.W., Rochester Council on Occupational Safety and Health (ROCOSH), 46 Prince Street, Rochester, NY 14607. Telephone: (716) 244-0420. Fax: (716) 244-0956. E-mail: BillBenet@aol.com
1997 PARTNERS IN RURAL TRAFFIC SAFETY |
Mission/Purpose
The purpose of the Partners in Rural Traffic Safety Program was to reduce the number of traffic-related injuries and fatalities in rural areas through a community involvement program. The goals included (1) increasing the use of seat belts in the village of Candor and (2) raising awareness of issues regarding occupant protection devices, such as proper use of infant and car seats and air bags. This program focused on the priority action area of ìunintentional injury.î
The project began when the National Rural Health Association announced the 1997 Partners in Rural Traffic Safety Program in April 1997. Dean Mary Collins and Dr. Pamela Stewart Fahs, assistant professor of the Decker School of Nursing (DSON), Binghamton University, approached the Tioga County Health Department about identifying a rural community in which traffic safety was an issue. The village of Candor was identified by Wanda Wanck, health educator, and Gail Rhodes, director of patient services at the Tioga County Health Department (TCHD). The village of Candor met the community size guidelines (fewer than 2,500 residents) of the funding agency and was a community whose residents were interested in the issue of traffic safety and were willing to work as a team to increase seat belt use. Mayor Chad Showers and Chief Damir Lazaric of the village of Candor helped identify the community team members. These individuals represented six sectors, including health care, law enforcement, business, places of worship, education, and the community at large. Thus, a successful collaboration was forged when the people of the village of Candor, the Tioga County Health Department, and Binghamton Universityís Decker School of Nursing, came together to write a proposal for the 1997 Partners in Rural Traffic Safety Program. The Partners in Rural Traffic Safety Program was conceived and administered by the National Rural Health Association (NRHA) and sponsored by the National Highway and Traffic Safety Administration (NHTSA).
The Candor Partners in Rural Traffic Safety Community Team was one of four initial grants provided by NRHA and NHTSA. The community received $2,000 to fund a monthlong traffic safety intervention program.
Strategies to Build Consensus
After the project had been funded, each community sector representative identified community members and invited them to a 11/2 hour ìcommunity visioningî session in July 1997. A nominal training strategy was used at this session in order to gather community insight into the issue of traffic safety, specifically focusing on seat belt use. In addition to the team itself, approximately 20 community members attended the visioning session. They ranged from 10 to over 70 years of age. The group was asked to identify the barriers and benefits to using seat belts. Small groups were assigned to identify ways to increase seat belt use in the village of Candor. Each group came up with a list of ideas, negotiated, and voted for five ideas to be presented to the overall group. A master list of these ideas was placed on sheets of newsprint, and each community member was able to ìvoteî by placing sticker dots beside the idea or ideas he or she preferred. The ideas receiving the most votes were considered a high priority for inclusion in the intervention.
Interventions Chosen by the Community
The community-generated suggestions included:
- displaying a banner over the street
- the ìConvincerîóstate police
- road stops/spot checks with warnings leading to tickets
- giving fact sheets to drivers
- an awareness day
- target information for each audience
- poster contest, displaying winners and awarding small prizes
- parent awareness video about car seats
- Vince and Larry dummies
- event for checking child seat installation
- mock seat belt activities for preschool
- encourage young children to use seat belts
- give awards for seat belt use
- encourage health providers to ask all patients if they wear their seat belts
- encourage drivers to say ìMy car doesnít go if all the seat belts arenít buckledî
- statistics brochure to be distributed to the public
These suggestions were used by the Partners in Rural Traffic Safety Community Team in the planning of the monthlong intervention program.
Consensus of Service Providers, Public, and Key Policymakers
The community visioning session brought together a variety of ìplayersî and made the planning process inclusive. Many of these players were citizens who would not have been consulted in a more traditional planning scheme. The public health department had identified reducing the number of unintentional injuries as a goal in their 1997 assessment, and this project worked toward achieving that goal. Two members of the community team (education and worship) were also members of a countywide traffic safety committee and felt that this project fit well with the goals of that committee. The DSON is interested in the health of rural citizens and is actively involved in issues of rural health care.
Vision of a Healthy Community
The Candor Partners in Rural Traffic Safety saw this project as an opportunity to bring together the entire community to work on what is essentially a public health issue. The teaming of health care and law enforcement in a prevention activity was an unusual but successful aspect of the project.
Leadership Role
Type of Leadership Structure
The collaboration among the major players (village of Candor, TCHD, and DSON) was forged to write a successful grant application. Faculty from the DSON wrote the grant application with a great deal of input from the mayor and police chief of Candor and the TCHD. This collaboration continued as representatives from each of the major players as well as the six sectors were included in the formation of the community team. The actual running of the team was very much a collaborative process. A natural leader from the community emerged who helped move the meeting agenda forward. The school of nursing representative helped formulate the agendas, communicated with the funding agency, and generally facilitated the actions of team members as needed. Team members divided portions of the planned interventions among them and went to work on securing resources and making it happen. Progress on goals was reported to the team at each planning meeting.
Technical Assistance
A representative from the NRHA and a ìteam builderî from a consulting firm hired by NRHA to implement the nationwide program came to Candor in late July 1997 for two days of team building skills. They helped the team members to identify team strengths and potential weaknesses, worked on ìcommunity visioningî skills, and assisted as the team carried out the community visioning session. They also worked with a group of residents identified by the community team on how to carry out the ìindex surveyî of seat belt use.
Jim Allen of the New York State Governorís Traffic Safety Committee assisted in getting past some of the barriers to securing resources such as posters, coloring books, the Vince and Larry costumes, and the Convincer. His office was also helpful to the mayor in deciding how to get permanent signs that focused on increasing seat belt use in the community. C-Troop of the state police was helpful by being at the awareness day, bringing and running the Convincer, and talking to citizens about the importance of seat belts. The TCHD provided a great deal of technical assistance and resources, sending their health educator to various sites to assist with identification of properly installed car seats, and making the ìmake it clickî program available for use with preschoolers. This representative also served on the community team as a resource and worked diligently toward the campaign goals. The DSON provided technical assistance and resources in encouraging a faculty member to write the grant and to participate on the community team. In addition, a graduate research assistant was assigned for one semester to work with the faculty on the Partners in Rural Traffic Safety project.
Key Partners/Stakeholders
Principal partners on the community committee, the sectors they represented, and their contributions included the following:
- Health Representative
David Kwiatkowski, M.D., Candor Family Practice Center, distributed age and developmentally appropriate fact sheets to patients regarding seat belt safety and health.
- Business Representative
Eva Musgrave, Owner, Edge of Thyme Bed & Breakfast, worked with the local Chamber of Commerce to build support for the project. She also acquired the town banner, produced and distributed placemats, and advertised events.
- Law Enforcement Representative
Chief of Police Damir Lazaric, Village of Candor Police Department, distributed fact sheets, conducted road stops for seat belt inspections, and provided canine team demonstrations at the safety awareness day.
- Education Representative
Art Cacciola, Candor Central School District, provided photography for the project and worked with the school system. He coordinated the in-school coloring contest and worked with high school students to develop age-appropriate bulletin boards.
- Decker School of Nursing, Binghamton University
Pamela Stewart Fahs, D.S.N., R.N., Assistant Professor, Decker School of Nursing, Binghamton University, wrote the original grant application and helped the community coordinate, carry out, and evaluate the project.
- Tioga County Health Department
Wanda Wanck, R.N., Health Educator, Tioga County Health Department, planned the ìmake it clickî seatbelt practice for preschoolers and worked with registered nurses to develop car seat check program.
- Place of Worship Representative
Elizabeth Grippen, parishioner, United Methodist Church, worked with the religious community to include information in church bulletins, newsletters and so forth, and coordinated the Sunday school coloring contest.
- Community At Large Representative
Chad Showers, Mayor, Village of Candor, chaired planning meetings, coordinated many of the project components, and acquired permanent seat belt signs for the community.
In addition, Wendi Galliger, R.N., Decker School of Nursing graduate student, assisted in carrying out the ìmake it clickî and seat belt checks, and did the data entry for the statistical analysis. Margaret Young, R.N., Decker School of Nursing graduate student, carried out the six-month recheck using seat belt safety index.
Process for Inclusion
Planning meeting times were scheduled so that all members could participate. (It was known prior to the planning meetings that the physician on the team was unavailable for the planning meetings; therefore the nurses on the committee represented the health care sector in the planning process.) Each member chose certain tasks to spearhead; these were often a natural extension based on the sector of the community they represented. For example, the representative from education organized the coloring contest in the school and the setting up of bulletin boards in the high school. The community-at-large representative (the mayor) took care of proclamations and obtained signs for the community. The business representative obtained donations from the Chamber of Commerce and had the banner made.
Students in the local school district assisted in carrying out the planned interventions, i.e., painting signs and helping at the Festival of Safety.
Potential Partners for Inclusion
The health care provider who works on this project in the future should be one who is able to devote the necessary time to the planning process. A nurse or nurse practitioner, emergency squad member, or health educator might be an appropriate representative. The involvement of more adolescents in the process would be beneficial. In addition to participation in the community visioning, an adolescent could provide representation and become an active member of the team.
The group decision-making process was by consensus. In large part this was made easier by the ìcommunity visioning tally, î which guided what would be done in the campaign.
Roles
Each sector representative was given guidance with respect to potential roles. Notebooks were provided at the training session in July containing a ìsample 30-day campaignî with suggestions for each representative. For example, the health care provider was given a notebook that offered suggestions such as writing ìprescriptionsî for using seat belts and making literature on traffic safety and health issues available in the waiting room. The law enforcement officer received material on the use of warning tickets during the campaign as well as reinforcements for the use of seat belts (coupons for goodies at an area fast-food restaurant).
This team proved to be collaborative and fun. It was felt that ideas had come from a cross section of the community and had thus generated increased community interest and participation in the project.
Impact/Effectiveness
Expected Outcomes and Strategies to Evaluate
The expected outcome was to increase seat belt use in the community. This outcome was accomplished. Seat belt use was evaluated by ìindex surveyîóa method whereby strategic sites within the community are chosen and measures are taken for a specific frame of reference. In this case, the team chose 12 sites (locations in the village) during the two-day training session. A volunteer or pair of volunteers took responsibility for one or two sites. A date and time was chosen that best reflected traffic in the area, and the volunteers were given index survey sheets. Volunteers were to observe front-seat occupants at their appointed site on a chosen date precampaign and again postcampaign. They circled Y (yes) or N (no) to indicate whether the driver and passenger of each vehicle were wearing a shoulder belt. Although this may not be the best scientific measure of seat belt use, it met the objectives of the project and succeeded in involving members of the community. The planning team members did not do counts to avoid conflict of interest in measuring outcomes.
Benefits to Partners and Community
The representatives of the three major partners (the village of Candor, TCHD, and DSON) all had a sense of accomplishment in planning and carrying out a community intervention project that was successful yet not overly time consuming. The outside funding assisted in providing seed money and generated the initial excitement that continued and grew as the project took shape and became a reality. One important benefit was that the public health problem of accident and injury from motor vehicle crashes was addressed in a manner that was embraced by the community.
Fiscal and Staff Resources
A grant of $2,000 was awarded to the Candor Partners in Rural Traffic Safety Community Team to assist in planning, implementing, and evaluating this project. The Tioga County Health Department was supportive of the project, sharing its knowledge of existing programs that could be implemented as part of this project and getting a staff member involved (who participated on her own time). Faculty and administration from the Decker School of Nursing spearheaded the forming of the collaborative partners and provided resources (faculty and student time) for the implementation and evaluation of the project. The mayor and chief of police were instrumental in the identification of segment representatives from the village. The segment leaders planned and implemented the project.
Community Support and Efforts
The people of the village of Candor donated many hours of service in the assessment, planning, implementation, and evaluation of this project. The sector representatives were the backbone of this project, truly involved and committed to its goals. The synergy that was created by the three major partners brought together resources and made possible a beneficial project that any one organization alone would have had trouble carrying out. The involvement of the major stakeholders made it possible to avoid the territorial issues that can sometimes generate barriers. In addition, the guidance, team building, and resource support by the funding agency were very helpful in getting the project underway. The community was able to actually implement the project and evaluate the outcomes.
Milestones/Work Products Achieved by the Group
Seat belt index surveys were taken prior to and after the 30-day campaign. Materials for a public awareness campaign were chosen by the community team and ordered from NHTSA and the New York State Governorís Traffic Safety Committee. These materials included posters, fact sheets, stickers, coloring books, and so on. The materials were free and NHTSA waived the shipping fee; however, they were out of stock on many of the materials ordered. NHTSA representatives and Jim Allan from the New York State Governorís Traffic Safety Committee worked with the community team to find material appropriate to the campaign.
Materials were distributed to the local primary care health clinic, the schools, and the library. The team chose the slogan ìCandor CaresóBuckle Up.î The police department gave out warnings and fact sheets for first stops of vehicles whose occupants were not wearing seat belts. A reward of a fast-food coupon was given to those who were. Police road stops for seat belt checks were planned and implemented soon after the campaign. The Chamber of Commerce donated money to have place mats printed with a traffic safety message. These were then distributed to local eateries and restaurants. Businesses in the village and region were solicited for donations to be used in the campaign. These businesses were very generous in their donations.
Coloring contests were sponsored in grades K through 5. The local bank donated savings bonds as prizes for the category winners. Children attending local Sunday schools were also asked to color ìVince and Larryî pictures, which were then displayed. T-shirts with a traffic safety slogan were printed at cost ($5.00/shirt) and distributed to coloring contest participants and at the Candor Festival of Safety. In addition, each restaurant in the village held a T-shirt raffle. A banner stating ìCandor CaresóBuckle Upî and ì30 Days to Build a Better Habitî was strung across Main Street for the duration of the campaign. Businesses and organizations were urged to place these messages on their billboards and flashing signs. The local gas station had the message added to the voice recording that plays continuously as patrons pump gas. Permanent signs stating ìCandor CaresóBuckle Upî were placed at the entrances to the village. Bulletin boards in the schools and local library also addressed the theme.
The nurses from the TCHD and the DSON went to WIC clinics to talk about appropriate car seat use and to do checks for proper installation. This free service was also provided at the Candor Festival of Safety. Nurses from the DSON went to the local preschool to teach the kids how to buckle their seat belts. A song (to the tune of ìWheels on the Busî) was used to reinforce the steps of buckling up. The children also received safety stickers. Literature on air bag safety and proper seat belt and car seat use was provided for each childís parents.
The Candor Festival of Safety was held at Jacksonís Pumpkin Farm on a beautiful fall Saturday. This awareness day was very successful, with an estimated 300 people attending. Emergency vehicles from the local police, fire and EMS departments were there for people to see. In addition an EMS advance life support ambulance from a nearby hospital was there. There were police canine team demonstrations. The state police attended and brought the ìConvincer,î which was used to demonstrate the need for seat belts even in low speed crashes. Vince and Larry were there to greet attendees and give out information on traffic safety. Nurses from the TCHD and the DSON performed car safety seat checks and taught children how to buckle up. Chuckles the Clown attended with her clown carócomplete with seat belt. A regional radio station donated and performed a ìremoteî broadcast for four hours during the event. Many prizes were donated by businesses and given away in frequent drawings at this event. In order to enter the drawing it was necessary to sign a pledge to buckle up. Two regional TV stations as well as the local newspaper provided media coverage.
During the campaign two tragedies occurred that focused attention on seat belt use: The first was an accident that involved a family in the county. There were several fatalities and the media reported that the victims were not wearing seat belts. The second was the death of Princess Diana of England. There was a great deal of media speculation about the role of seat belts in that crash. Its only survivor had been wearing a seat belt. This helped to spur local media interest in the issue and the campaign.
Political Problems, Conflicts, and Resource Constraints
No political problems or conflicts were encountered. One potential conflict concerning resources arose at the community visioning session. A town of Candor citizen asked why the money went to the village of Candor and not the town. The answer was straightforward: The funding agency specified a community with fewer than 2,500 residents (rural guideline), and the village met that criteria whereas the town did not. However, town residents were included in the community visioning session. The community team was well aware of the fiscal restraints prior to initiating the project ($2,000) and worked within that budget, so there were no perceived resource constraints.
Actual Outcomes
The objective of increasing seat belt use in the village of Candor was met! Preprogram seat belt use by drivers was 60 percent and rose to 72 percent postintervention. This was a significant increase using a binomial comparison. Six-month follow-up data was collected in late April and showed that seat belt usage was again declining. It was noted that some areas and times produced higher usage rates than others. For example, the highest percentage of use both pre- and postintervention was on Sunday morning when the count was taken in a church parking lot. One of the lowest counts occurred after school hours at a local roadside eatery and popular teen gathering spot.
Use of seat belts by front-seat passengers preprogram was 54 percent (well below the New York State average of 72 percent), and postprogram it rose to 57 percent. One unexpected outcome noted was the number of car seats that are being used properly. Moms in the WIC Program were using car seats at a high rate. The seats were found to have been properly installed when checks were done at the local WIC site on two different days.
The community was enthusiastic about the project and it was the talk of the village for quite a while. A sign on the Village Office door about a month after the program summed it up nicely. It read: ìCandor Still Cares, Buckle Up.î
Contact: Dr. Pamela Stewart Fahs, Decker School of Nursing, Binghamton, University, Box 6000, Binghamton, NY 13902-6000. Telephone: (607) 777-6805. E-mail: psfahs@binghamton.edu
DISPOSAL PROGRAM |
Mission/Purpose
In the late 1990s Madison County identified as a health threat the issue of home medical waste disposal, specifically, safe disposal of ìsharpsî (syringes, needles, and lancets.) Larry Carpenter, chair of the Madison County Board of Supervisors, and administrators from the Madison County Department of Solid Waste and Sanitation wanted to find a way to insure the safety of the workers at the Alternatives Recycling Center (ARC).
Working with James Zecca, Director of the Department of Solid Waste and Sanitation, and David Dorrance, Director of the Madison County Department of Public Health, Carpenter began looking into ways to insure that workers at the recycling center and private waste haulers throughout Madison County are protected from contact with home medical waste.
Madison County officials reviewed the New York State Department of Health regulations regarding Managing Regulated Medical Wasteómore specifically, Subcategory 4 ó Sharps. According to this information, ìThe single most important aspect of sharps which gives rise to fear and apprehension is their ability to cause puncture wounds and/or lacerations which may cause a portal of entry for infectious agents.î
Officials also looked at programs already in place at the Albany Medical Center and in Ulster County.
Carpenter oversaw the application by Zecca for funds to purchase containers in which private homes could dispose of sharps. The containers were distributed to private homes, at no cost, for use in the disposal of medical waste.
Individuals incarcerated in the county jail were brought into the project to apply informational stickers to the containers to inform private individuals of the proper way to dispose of their syringes. This initiative was instituted prior to the passage of the stateís home medical waste legislation. Madison County was the first county in New York State to have a syringe disposal program. Since the programís inception in May 1991, the county has distributed special disposal containers to the 13 pharmacies in Madison County at no cost.
Special ìSharp!î brochures were designed by the Department of Solid Waste and distributed throughout Madison County, along with numerous news releases and public service announcements describing the new disposal program.
The biggest problem or concern facing Madison County officials was the health and safety of those working at the recycling center and that of private waste haulers throughout the county.
Leadership Role
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