NY State Community Health Partnership Milbank Memorial Fund
Partners in Community Health:
Working Together for a Healthy New York 1998

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Prevention/Treatment of Disease


Arnot Ogden Medical Center Diabetes Awareness and Screening Initiative, Chemung County
Camp Superkids©...The Camp for Kids with Asthma, Albany
Cornell Cooperative Extensionís Community Health Advocates Project, Suffolk County
Glens Falls Hospitalís Breast Screening Program
HealthCarePlan BuddyCheck 2, Western New York
Hunts Point Childhood Health Promotion Initiative/Community Asthma Program
ìLook Mommy! No Baby Bottle Tooth Decay,î Otsego County
Niagara Wellness Council
Oneida County Alzheimerís Disease Assistance Coalition
The PRASAD Project Childrenís Dental Health Program, Sullivan County
The Womenís Health Outreach Program Partnership, Onondaga County
Wellness at Work, New York City




ARNOT OGDEN MEDICAL CENTER
DIABETES AWARENESS AND SCREENING INITIATIVE
CHEMUNG COUNTY




Mission/Purpose

The purpose of the Diabetes Awareness and Screening Initiative (DASI) is to establish a coalition of community organizations to address the issues of undiagnosed and unregulated diabetes in Chemung County. The goal of the initiative is to reduce the incidence of complications (including death) that occur when diabetes goes undiagnosed and unregulated.

The actions that the coalition will take to reach this goal will be to:

The priority action areas are those members of the community 45 years of age and over who are medically underserved due to income, geographic location, or a lack of information.

The initial project strategy was to form a coalition whose members would bring to the project the knowledge and skills necessary to address the issue of diabetes, from increasing awareness to diagnosis, treatment, and support. These members would represent various components of the community, including: health care, public health, care of the underserved, seniors, and other chronic disease organizations who would be willing to work together to achieve a common goal. Community coalitions in health care are an effective way of avoiding duplication of services and combining resources to offer the most effective programs possible.

The ongoing strategy of the initiative is to increase screening and early detection of diabetes through an awareness initiative that includes educational programs, the media, and mass distribution of a brochure, followed by free and accessible screening opportunities at multiple locations throughout the county.

The need for this initiative was demonstrated by the 1996-1997 Chemung County Health Department Community Health Assessment, which identified diabetes as the number 6 cause of death in Chemung County, with a death rate from diabetes twice that of the surrounding counties of Schuyler and Steuben.

A resource inventory revealed that the screening programs available were not being used to maximum capacity due to a lack of awareness. A public survey of persons 45 and over revealed that one-third of the population had never been tested for diabetes, and two-thirds stated they had never spoken with their physician about the disease and were unable to identify one or more symptoms or risk factors. Letters of support for the initiative were tendered by coalition member organizations as well as senior centers, civic and religious organizations, and service organizations that address the needs of the 45 and over population.

The coalitionís vision of a healthy community is one whose health directives include a focus on wellness and prevention rather than only interventionóa community that puts emphasis on nutrition, fitness, education, and screening programs that foster early detection and treatment.


Leadership Role

AOMC maintains a leadership role in the initiative. AOMC gathered together prospective members of the coalition and submitted a grant proposal to the New York State Department of Health to acquire funds to assist with the proposed education and screening activities. AOMC Community Health coordinates coalition activities, including scheduling and overseeing screening and educational events, fiscal management, record keeping, and the preparation of required reports for the grant proposal. AOMC Health on Demand serves as the key information source, handling all requests for information, registration for events, and follow-up for screening programs. AOMC Marketing oversees and implements all communication to the public regarding events and programs, including newsletters, newspaper ads, television and radio public service announcements (PSAs), posters, flyers, and Web site management. In addition, AOMC provides clinical laboratory support and training for Department of Health nurses in the glucose screening procedure. This support and training is arranged through Arnot Ogden Community Health.


Key Partners/Stakeholders

The other principal partners involved in the project include the Chemung County Health Department (CCHD) Public Health Education and Public Health nurses, Cornell Cooperative Extension dietitians, a registered nurse educator from the Retired Senior Volunteer Program (RSVP), and a representative from the American Heart Association. Inclusive representation was achieved by insuring that each member played a specific role within the coalition with respect to education, screening, hosting events, and access to the target population. For example, The Cornell Cooperative Extension is the primary provider of nutrition and diet control information, the CCHD provides the key link to the underserved population, and RSVP provides access to senior groups.

The initiative has fostered collaborative efforts with other chronic disease and risk reduction coalitions. These include the Breast and Cervical Health Partnership, the Southern Tier Tobacco Awareness Coalition, and the Chemung County Healthy Heart Coalition. The initiative recently offered support for a joint effort with the proposed Chemung County Colorectal Cancer Coalition. Representatives from the Department of Health, Cornell Cooperative Extension, RSVP, and the American Heart Association are involved in various aspects of the other coalitions, allowing for the planning and implementation of joint efforts and combining of resources. Additional potential partners who have assisted with programs and events or voiced an interest in diabetes include the Office of the Aging, St. Josephís Hospital, American Red Cross, Southern Tier Business Coalition on Health, and the Chemung County Chamber of Commerce.

Each partner within the initiative has a specific function: AOMC offers its Department of Education for educational programs, screening, and diabetic control classes and support; Health on Demand Information Line for requests for information, education, registration, follow-up, and referral; Community Health for the coordination of activities such as scheduling, reporting, and implementing education and screening events; and the Marketing Department for promotional activities. The Chemung County Health Department provides access to the underserved population and registered nurses for screening programs. The Cornell Cooperative Extension provides diet control information, with dietitians available at screens and educational programs for nutrition counseling. The Retired Senior Volunteer Program provides access to congregate meal programs and senior centers and a registered nurse volunteer for presenting information to small groups. The American Heart Association offers support regarding heart disease, one of the major complications of unregulated diabetes.


Impact/Effectiveness

Since September 1996 the initiative has performed over 30 educational and screening programs, screening over 1,300 persons, surpassing its goal of 1,000. Over 70 participants had results considered ìdangerously highî and were referred for further evaluation, treatment, and education. Those persons receive follow-up initially after each screen and then again in two to four months to determine if they have followed through with referral and to monitor their progress. One-third of those with dangerously high results were not aware that they were diabetic, and the remaining two-thirds, while they may have been aware that the disease was present, were not aware that their blood glucose levels were dangerously high.

The Centers for Disease Control (CDC) estimates that one in every twelve persons has diabetes, and of those, one-half do not know it. Those estimates would indicate that Chemung County, with a population of approximately 95,000, has approximately 3,900 persons walking around with diabetes who are unaware that they have the disease. Therefore, the effectiveness of the program will be determined by the number of persons screened who have high levels of blood sugar that they were unaware of, either because they did not know that they were diabetic or they were unaware that their disease was not under control.

Each partner in the coalition represents a community agency concerned with improving community health, and each benefits from the combined resources that facilitate reaching a larger target population. The overall ìhoped forî benefit to the community is a reduction in the death rate and incidence of complications from untreated and uncontrolled diabetes. The complications include blindness, amputation, heart disease, renal disease, and the ensuing disability that occurs.

The fiscal and staff resources of the initiative include grant funds from the New York State Department of Health to assist with educational and screening activities and ìin kindî commitment of resources and personnel by the partner organizations.

Community support of the initiative has been overwhelming and includes:

At this point, the primary constraint has been reaching those populations that do not regularly access medical care. This includes minority communities that are at increased risk for diabetes. Another problem has been the referral of patients for treatment who are uninsured, do not have the ability to pay, and are not covered by Medicaid or Medicare. These ìfall between the cracksî patients often do not pursue the proper follow-up and remain at risk for complications and death. These patients are assisted, as much as possible, to access the proper resources for assistance, but they often fall out of the system.

Contact: Cathleen Mathey, Coordinator, Diabetes Awareness and Screening Initiative, Health on Demand, Arnot Ogden Medical Center, 600 Roe Avenue, Elmira, NY 14905. Telephone: (607)737-4469; Fax: (607)737-7772.

Call for a brochure that describes the initiative and provides information on diabetes risk factors and complications.

See map, A11





CAMP SUPERKIDS©...THE CAMP FOR KIDS WITH ASTHMA
ALBANY




Mission/Purpose

Asthma affects close to 5 million children in the United States, and its prevalence has increased 73 percent over the past decade. Itís the leading cause of school absenteeism (resulting in over 10 million lost days), childrenís emergency room use, and hospital admissions. Children with uncontrolled asthma typically feel different and isolated. Unmanaged asthma affects a childís ability to learn, socialize, exercise, and play. For most children, summer brings the time-honored ritual of attending overnight camp. But often those with asthma are left home.

Now children with asthma do not have to miss the camping experience. They, too, can experience all the adventure, new skills development, and increase in self-esteem that occur with successfully completing an overnight camping program. In addition, they will learn how to better manage their asthma. Given that less than a quarter of children actually outgrow asthma, these skills will be used for a lifetime. A study published in the Journal of Family Practice found that children with moderate to severe asthma who attended asthma camps may experience a decrease in subsequent asthma-associated illnesses. The study showed that the average number of missed school days due to asthma dropped by 50 percent and that urgent outpatient visits and hospitalizations from asthma attacks dropped as well.

The American Lung Association of Northeastern New Yorkís Camp SUPERKIDS© is an overnight camping program for children 7-15 years of age with moderate to severe asthma who would not otherwise be able to participate in the camping experience. Since the campís inception in 1987, Camp SUPERKIDS© has grown from 30 to 70 participants. Two-thirds of the children require some form of financial assistance.

This unique program offers a fun and active seven-day outdoor camping program with medical supervision to assure a safe, healthy, and happy camping experience. SUPERKIDS© participate in the regular camp program, which is integrated into the regular camp schedule to provide each child with a full range of activities. Activities at camp are as they might be at any other, including canoeing, arts and crafts, nature trail hikes, field sports, and campfires, as well as waterfront activities. In most of these activities, the children set their own level of participation. One of the benefits of the camp experience is that the children learn to set these levels free from parental guidance. Younger children observe how older campers handle their asthma, while older campers respond favorably to their role as models. SUPERKIDS© are housed together in cabins with other children of the same sex and appropriate age. It is perhaps the first opportunity some of these children have to interact with other children with asthma and put their own disease into perspective.

Physicians, nurses, and respiratory therapists provide around-the-clock medical care for all SUPERKIDS©. They supervise use of medication, assess lung function, and provide one-on-one and group asthma education. A very important component of Camp SUPERKIDS© is the asthma education program. Medical staff conducts sessions on living with asthma. Breathing exercises, asthma triggers, medications, emotional aspects of asthma, coping skills, and self-management are all covered. Camp SUPERKIDS© objectives are to:

In 1998 Camp SUPERKIDS© celebrated 11 years of service to children with asthma and their families. Without the collaboration of the individuals and organizations that make Camp SUPERKIDS© successful, a gap in services for children with asthma would exist. Our vision of a healthy community includes these individuals, families, businesses, health care providers and institutions, schools, governments, and community and civic organizations, each representing a link in the chain. When each link participates to the best of its ability, we can know that our mission of a world free of lung disease is within reach.


Leadership Role

The American Lung Association of Northeastern New York (ALANENY), a division of the American Lung Association of New York State Inc., is a 501(c)(3) not-for-profit, voluntary health organization dedicated to the prevention of lung disease and promotion of lung health. Originally founded in the early 1900s to defeat tuberculosis, the scope of the Lung Association has since broadened to include all lung disease, including asthma, lung cancer, and chronic obstructive pulmonary disease. This is accomplished through education, advocacy, research, and the provision of services for those with lung disease, health care professionals, schools, governments, and the general public. Our vision is a world free of lung disease.

The American Lung Association of Northeastern New York is the lead agency in planning, implementing, and evaluating Camp SUPERKIDS© programming. In developing the camping program in 1986 and 1987, ALANENY partnered with the YMCAís Camp Chingachgook located on Lake George. Camp Chingachgook provides daily activities and counselor staff. ALANENY supplies medical staff, sets up a separate infirmary, and conducts asthma education. The board and staff of the YMCA and Camp Chingachgook have been supportive for 11 years, recognizing the positive impact on families with asthma.

Camp SUPERKIDS© is governed by a committee of Lung Association staff and volunteers including physicians, nurses, and respiratory therapists. Thomas Flaim, M.D., of Certified Allergy Consultants is in his third year as Camp SUPERKIDS© medical director. Under his leadership, the quality of care at camp is top-notch. Pam Madej, R.N.P., of Northeast Health has led a team of experienced nurses for the past four summers. Camp policy has been developed and periodically revised by the Camp SUPERKIDS© committee. It is approved by the ALANENY program committee, which is made up of volunteers and members of the ALANENY board of directors. Current camp policy is reflected in a 46-page policy manual.


Key Partners/Stakeholders

It takes a community to offer Camp SUPERKIDS©. Members of the medical staff represent many northeastern New York hospitals and practices. The 1998 staff included Seema Chaudari, M.D. (private practice); James DeMasi, M.D. (private practice); Judy Dunn, R.N.; Barbara Ferrell, L.P.N. (Allergy and Asthma Center of Albany Medical Center); Thomas Flaim, M.D. (Certified Allergy Consultants); Loni Hart, R.R.T.; Darlene Hoffman, R.N.P.; Susan Hoffman, R.N. (Voorheesville High School); Cinda Kerbein, R.P.A. (Allergy and Asthma Center of Albany Medical Center); Pam Madej, R.N.P. (Northeastern Health/ Memorial Hospital); Wendy Mason, R.N. (home care nurse); Stephanie Salenger, R.R.T. (St. Peterís Hospital); Laurie Skinger, R.R.T.; Michael Slaughter, M.D. (private practice); Ginny Spickerman, R.P.A.; and Cliff Tepper, M.D.

Camp SUPERKIDS© also requires the support of businesses, civic organizations, and foundations. The following sponsors have made financial contributions in 1998: Allen & Hanburys; Astra USA; CAP COM Financial Services, Inc.; Certified Allergy Consultants; Dey Laboratories; Forest Pharmaceuticals; Hawley Foundation; Hoechst Marion Roussel; Key Pharmaceuticals; Merck & Company, Inc.; Paine Webber; Pfizer U.S Pharmaceuticals; WGY Christmas Wish Campaign; YMCA Camp Chingachgook; and Zeneca Pharmaceuticals.

Additional support has come from other organizations (funding, staff, equipment, other donations) including Albany Memorial Hospital; Anthem Health Services; Allergy and Asthma Center of Albany Medical Center; Better Breathers Support Group; Brueggerís Bagel Bakery; Burger King; Capital District Physicians Health Plan; Childrenís Aid Association; Delmar Publishers; James DeMasi, M.D.; GE Employees Community Fund; Hannaford Food & Drug of Clifton Park; Karner Video; Key Pharmaceuticals; Little Book House; Monaghan Medical Corporation; Muro Pharmaceutical; MVP Health Plan; Noodle Kidoodle; Partnerís Health Plan; Pizza Hut/Horizon Foods; RV Sales and Rentals of Albany; Seton Health; Southern Saratoga County Womenís Club; St. Peterís Hospital; Standard Rosenbaum Incorporated; State Farm Insurance Companies; Subway; Taco Bell; TCBY at Wolf Road; UCB Pharma; Uniphil; Victory Lane Speedway; Walden Kids; Wise Potato Chips; and Theodore Zeltner, M.D.

Dedicated employees from CAP COM Financial Services held a golf tournament to raise money to help finance the Camp SUPERKIDS© program.

Over the years, we have also had great media participation, including WTEN TV 10; WNYT News Channel 13; the Times Union, Schenectady Gazette, Glens Falls Post Star, WYJB-B95.5 fm., and others.

Sponsors and supporters of the Camp SUPERKIDS© program are rewarded not only by the return on their philanthropic efforts but at a special Camp Sponsor Day initiated in 1996. This allows the community to meet the children with asthma in a fun and rewarding environment. Each cabin of children with asthma represents a team (the name of the team is the name of the business that sponsored the cabin). During the week, children compete and earn points for taking their medicine correctly, doing their peak flows, and learning the steps to their asthma management plan. They also come up with a team cheer or song to be performed at Camp Sponsor Day. The top two teams compete at Asthma Jeopardy for the championship. Camp Sponsor Day is a chance to recognize sponsors and supporters, recognize the children, and show that kids with asthma can be active.


Impact/Effectiveness

Throughout the past 11 years, Camp SUPERKIDS© has served approximately 500 children with asthma, teaching them critical asthma management skills that make the difference between a high and low quality of lifeóand even between life and death. Feedback from campers and parents has always been outstanding.

Sponsors and supporters of Camp SUPERKIDS© participate in the program long-term because everyone benefits from joining together in this endeavor. Medical staff continues to donate its time; civic organizations, foundations, and individuals continue to sponsor children who cannot afford the fee; local businesses provide cabin sponsorships and prize donations; and representatives of the media provide continued exposure.

Health maintenance organizations are beginning to recognize the importance of this program. This year CDPHP, MVP Health Plan, and Partnerís Health Plan will identify members who would benefit from camp and pay for them to attend. Others such as CHP have promoted and recommended the program to their members.

Camp SUPERKIDS© continues to reach out to families through health care professionals who promote the program to their patients. Camp SUPERKIDS© medical staff make the rounds and promote the program at physician, nurse, nurse practitioner, physician assistant, and respiratory therapist conferences.

Until a cure for asthma is found, education is the cornerstone in providing a high quality of life for children with asthma. The Camp SUPERKIDS© program is a very special way of reaching out to families struggling with asthma and making a real difference in the length and quality of life of their children. Without the involvement of the entire Camp SUPERKIDS© community, this important work would go undone.

Contact: Joyce Jacobson, American Lung Association of Northeastern New York, 8 Mountain View Avenue, Albany, NY 12205. Telephone: (518) 459-4197. Fax: (518) 489-5864.

See map, C10





CORNELL COOPERATIVE EXTENSION'S
COMMUNITY HEALTH ADVOCATES PROJECT
SUFFOLK COUNTY




Mission/Purpose

Cornell Cooperative Extensionís Community Health Advocates Project is a diabetes prevention and health promotion program that brings together youth, community organizations, and agencies in an effort to reach out to those individuals at high risk for diabetes living in the areas of North Amityville and Wyandanch. The goal of the project is to help African American community members increase their level of awareness and knowledge of diabetes, including prevention and control, and to aid them in seeking appropriate medical assistance. Individuals are identified, screened, and encouraged to undergo testing and to take control of their disease through self-management. Those who have been identified at high risk learn preventive care and how to control the disease through self-management education courses, nutrition education, and weight management classes provided in their community. Participants are encouraged to increase their exercise through activities such as walking and biking. Community members sit on an advisory panel and also provide voluntary assistance to the program in order to reach the greatest number of participants. Early detection and management lessens the chance of complications and diabetes-related hospital admissions.

The project began the fall of 1996 in collaboration with the Suffolk County Department of Health Services. Working with the Tri-Community Health Center Advisory Committee, members from the community were identified as potential participants on an advisory council for the project. The committee was recruited, went through an orientation, and provided guidance for the project. They reviewed all plans and printed materials and made suggestions for inclusions and changes. The advisory committee recommended that Community Awareness Workshops be conducted throughout the communityóin public places, businesses, churches, community groups, and agencies. These workshops were designed to create awareness of who was at risk, what could be done to prevent the disease, and where to seek help for testing and education. A threefold brochure contained information about the project, a short self-administered questionnaire for determination of risk, and a list of additional resources. The cover contained a picture of an African American mother holding a child, illustrated in red, black, and green ink on white paper. Words such as sugar were used as substitutes for diabetes because they are familiar to the target population. The brochures were distributed at all Community Awareness Workshops and in public places such as the library, post office, senior center, and churches throughout the community. Some were concerned that picturing only the mother and child sent the wrong message, therefore, on the advice of several members of the committee, the picture on the front of the brochure was changed for year two to depict a family.

A member of the community who was well respected was identified, recruited, and hired to serve as a community liaison. Her job was to make sure everyone in the community was aware of the project and to encourage participation and help connect people to appropriate resources. She also kept project staff apprised of what was going on behind the scenes in the community. The community liaison, with the assistance of the diabetic educator, conducted the Awareness Workshops. A schedule of classes for self-management was developed. Posters were put up throughout the community. Individuals who had indicated that they wanted to learn more about diabetes or had diabetes received a call from the community liaison encouraging them to attend the next series of classes. In some cases she made referrals to health clinics or other community services. A display for the project was developed and frequently presented at community events, health fairs, even polling places and school basketball games. She was constantly ìin their faceî with the project.

Workers in agencies who work directly with families received training about the project and were instructed in administering the questionnaire. They also made referrals to the project. The trainees included Little Red School House health workers, nutrition teaching assistants from the Expanded Food and Nutrition Education Program (EFNEP), and several classes of home health aides. All were instructed on how to identify those at high risk. As EFNEP staff recruited and worked with homemakers, lessons on diet, exercise, weight management and the location of various health services were incorporated into the sessions.

The seventh- and eleventh-grade health classes, as well as one ninth-grade class in home and career skills, were visited and presentations made. The home and career skills students made posters about the project for the community. The project also linked with SNAP after-school program in Wyandanch and provided sessions twice a month.

A healthy community provides opportunities for its members and encourages them to take responsibility for setting goals to manage decisions concerning their health. It is concerned for the welfare of all, providing opportunities to explore preventive measures to improve health, and provides adequate, accessible resources.


Leadership Role

Cornell Cooperative Extension of Suffolk was the lead agency. It was responsible for writing the grant, implementing the project, hiring, supervising and evaluating staff, and providing the administration for the project. A member of the Suffolk County Health Services assisted with writing the initial proposal. The diabetic educator worked part-time and was shared by both agencies. An advisory committee, representing various community interests, serves as a steering committee for the project. Project staff meet periodically with this committee. The community liaison supervises the volunteers, most of whom are on the advisory committee.


Key Partners/Stakeholders

While Cornell Cooperative Extension of Suffolk was responsible for providing the administration for the project, the Suffolk County Health Services provided technical advice and conducted blood glucose screenings. They included the project in their advisory meetings, and provided some of the educational materials. A local county legislator provided office space. SNAP recruited youth and provided organizational structure to conduct the program. Wyandanch Library, Senior Center, Head Start, the town of Babylon, OEC of Amityville, Tri-Community Health Center, and Martin Luther King Health Center provided space for meetings and classes and helped with promotion. The Metropolitan Chapter of the American Association of Diabetes Educators, American Diabetes Association, and the ADA Minority Initiative Committee provided advice, training, and educational materials. The project partnered with American Diabetes Association to carry out educational programs such as Diabetes Sunday and ADA Walkathon.

To ensure and promote an inclusive and representative partnership with the community, the community liaison attends meetings of the Tree Street Association, Ministerial Alliance, Wyandanch Coalition, and the ADA Minority Initiative Committee. A member of the advisory committee sits on the school board and the Ministerial Association staff also attend the health center advisory committee meetings. Information is shared at staff meetings and in reports.

There are additional youth organizations that could have a role on the advisory committee. They will be approached during the next year and invited to join.

There is one advisory committee for the project. It reviewed all plans and printed materials and made suggestions for inclusions and changes. There were lengthy discussions concerning the stigma of the disease in the African American community and how this could be addressed. The advisory committee recommended conducting Awareness Workshops in public places like businesses, churches, community groups, and agencies. It suggested following up on the self-management classes with a series of classes on weight control and later suggested that a support group be formed. Some members are very active, while others come occasionally but are willing to give input via face-to-face conversations or telephone. The committee has an open membership policy. In the near future new members will be recruited from the community at large and from class participants.


Impact/Effectiveness

Since its inception in the fall of 1996, the program has reached over 8,000 individuals in the communityómainly from the town of Babylon. During year two, 6,468 contacts were made; of these, 69.5 percent were female and 30.5 percent were male. The majority were African American (57.3 percent); 31 percent were white, 11 percent were Latino, and .7 percent, otheróall at high risk for diabetes. Fifty-five community awareness sessions were held and 800 screenings conducted. A series of 15 self-management classes were taught, in addition to a series of seven weight management classes. In a self-administered post-test of classes, members of the self-management classes reported that they had acquired a blood glucose monitor and had begun to change their eating habits and increase their water intake. Some began to exercise and to monitor their blood glucose. Many acquired new information about their diabetes, and one woman talked about how her attitude about the disease had changed. Evaluation of members of the weight management classes also indicated that they had changed their eating habits, increased water intake and had begun to exercise. Class participants will be surveyed to see if they continue to monitor their blood glucose, check glycosylated hemoglobin levels semiannually, visit a health care professional to inspect their feet twice a year, receive an annual dilated eye exam, work on weight control, increase consumption of vegetables, and lower fat in their diets.

Participation in an after-school program with high school youth twice a month was initiated. Seventh-grade and eleventh-grade health classes in Wyandanch and home and career skills classes in Farmingdale were visited. Of the students surveyed, seventy percent had an aunt, uncle, or grandparent who was a diabetic. The Farmingdale home and career skills classes prepared posters that were distributed throughout the community.

Using volunteers, an adult walking club and an adult bike club were established in Wyandanch. The EFNEP program enrolled 62 homemakers who received special nutrition education on diet, exercise, and weight management. Physicians in health clinics were called upon to market upcoming classes in self-management and weight control. Attendance increased after employing this strategy.

During year two, staff participated in eight health fairs, ADA Walkathon, Diabetes Sunday, Black History Month, Wyandanch Community Day, Amityville Community Day, Library Day, and the Wyandanch Day Care graduation. Displays were presented at voter registration areas, basketball games, and Legislative Hall. They partnered with the County Department of Health Services to conduct foot care workshops and collaborated with local food pantries to provide information during the distribution of Thanksgiving baskets.

Nine volunteers were recruited from the communities of Amityville and Wyandanch. These volunteers helped with a variety of activities that the staff conducted. The benefit to the population ranged from changing habits, having a feeling of control, understanding their disease, changing their attitude about the disease (taking it seriously) and developing an awareness. In some cases the stigma of having diabetes was lifted. At the request of a local legislator, project staff helped to train staff at the Dolan Family Health Center in Greenvale to initiate a self-management educational program for diabetics. The administrators of the center were very surprised at the response, and, as a result, they are sending a staff person to be trained as a diabetic educator.

The project operates on an annual budget of $62,000 and has the following staffing pattern:

Health advocate, nutrition teaching assistant, and junior health advocate are paraprofessional positions.

One major difficulty to be overcome involved how to provide blood screenings. CCEís insurance company would not allow CCE staff to do what is considered a medical procedure. Therefore, county health department staff take responsibility for doing the procedure.

Providing finger sticks in the community is not the only hurdle to be overcome. Shortly after the project began, the school was contacted about working through its home and career classes to incorporate the program into the curriculum. Those classes had been discontinued and the teacher had been transferred. A meeting was to be scheduled with the health teacher after the materials were reviewed by the curriculum director. At the time the curriculum received approval from the administrators, it was to be sent to the school board for its approval. At that time a dispute between the school board and the superintendent erupted; the state education department was called in and a lot of dissension occurred in the community. At that point it was decided that youth had to be approached through another strategy. This was accomplished by working through an established after-school program. A compromise was achieved and it was determined that seventh- and eleventh-grade health classes would be provided with an educational program to create awareness.

By being extremely visible in the community, the project has gained acceptance. When the project first started, the members of the advisory committee were reluctant because a number of organizations have come into the community and only stayed a year or two, leaving without accomplishing what they set out to do; members felt abandoned and felt taken advantage of. Then there was the issue of the stigma attached to having this disease. This was something project staff was unprepared for. Little by little, people have begun to be won overóto change their attitude about diabetes and to take prevention seriously. For some it was the first time they really understood the disease. A cry erupted when participants were told that funding would be discontinued. The staff of the health centers was especially concerned because three quarters of the classes in self-management and weight management reaching diabetics were handled by the project. More people were requesting to be tested, and doctors were referring their patients to self-management and weight management classes. Because of the impact on the community, the county legislator where the Community Health Advocates project is located expressed a willingness to introduce a resolution to the county legislature to fund the program under the Department of Health Services beginning in 1999. A meeting with the county health commissioner was held. She had been advised by her staff of the effect a loss of funding would have on the health centers and expressed her support for a resolution if one were to be introduced. However, she could not put it into her current budget request without cutting positions to do so. This she was unwilling to do. However, she did give advice on how to win over the legislature, which will be the next big hurdle.

Contact: Sarah R. Foulke, Ph.D., Cornell Cooperative Extension of Suffolk County, 246 Griffing Avenue, Riverhead, NY 11901. Telephone: (516) 727-7850. Fax: (516) 727-7130. E-mail: sarah_foulke@cce.cornell.edu

A brochure is available upon request.

See map, D10





GLENS FALLS HOSPITAL'S BREAST SCREENING PROGRAM




Mission/Purpose

As the foundation of Glens Falls Hospitalís Cancer Prevention and Early Detection Program, the Breast Screening Program, including the mobile mammography van, is in its ninth year and continues to grow. The purpose of the program is to eliminate geographic, transportation, financial, and educational barriers that have traditionally prevented women, especially in rural areas, from participating in routine breast screening services. Glens Falls Hospital has been a model of excellence in providing quality care to low-income, geographically isolated women in upstate New York. Glens Falls Hospital has formed strong partnerships with community agencies, nonprofit organizations, businesses, churches, and others.

The goal of Glens Falls Hospitalís Breast Screening Program is to decrease the mortality and morbidity secondary to cancer within the community through the implementation of effective prevention and early detection programs. This goal has been achieved successfully through the development and implementation of various educational and screening programs targeted at low-income women residing in this rural region.

The priority action area is to target women who have traditionally been underserved by the health care industry. This program was initiated in order to increase the number of women who participate in routine breast cancer screening in a rural region of upstate New York. Many of the women who reside in this area are low income. Over 85 percent of the women screened by Glens Falls Hospital have an income falling below the federal poverty level. A large percentage of women targeted for breast cancer screening by Glens Falls Hospital have either little or no health insurance and would therefore not be able to afford a mammogram were it not for Glens Falls Hospitalís Breast Screening Program. Over 44 percent of the women screened have no health insurance and over 53 percent qualify for program funds that provide free breast cancer screening to women who meet eligibility criteria (reviewed below under ìreflecting consensusî).

The mobile mammography van enables the Breast Screening Program to target those women who would be unable to travel to a traditional mammography facility. The program is housed in a mobile unit that travels throughout a five-county region visiting over 65 sites annually, including both corporate and community sites. Many women do not have transportation to a mammography facility, and a number of women state that if the van did not come to their community, they would not participate in routine breast screening. A number of these women have to travel over 100 miles one way to reach the nearest mammography facility. Hamilton County, one of the counties served by Glens Falls Hospital, has no mammography facility.

Glens Falls Hospitalís entry into developing a formal Breast Screening Program resulted from a needs assessment in which gaps and barriers to womenís health services were identified. In 1987 Glens Falls Hospital conducted a major market research study to identify the health concerns shared by women in this region. The number one concern identified was fear of breast cancer. Glens Falls Hospitalís Cancer Registry revealed that breast cancer was the second most common cancer reported. Eighty-five percent of all cases were diagnosed in women age 50 or older. In 40 percent of the cases registered, regional or distant metastasis was present at the time of diagnosis. In response to these statistics and womenís concerns, Glens Falls Hospital developed and implemented its Breast Screening Program to address the unique needs of women in its rural region.

The mobile mammography van service provides a comprehensive program that includes a risk assessment, education on breast self-exam, a clinical breast exam, and a mammogram. The van has a processor onboard so that all films can be checked for technical clarity while the woman is still present. The films are then brought back to Glens Falls Hospital for interpretation by a board-certified radiologist. All patients utilizing the van are notified of the results of their mammogram by telephone within two to three working days, and a written report is sent to the patientís physician. The Breast Screening Program has an extensive Quality Assurance Program in place so that any patient with a suspicious screening can be tracked and monitored until a diagnosis is achieved. Based on the outcome, the patient either enters treatment or is returned to routine screening.

The mobility of the van has allowed Glens Falls Hospital to reach women who would otherwise have little access to this service. The Glens Falls Hospital Guild agreed that transportation was unquestionably a barrier that prohibited many women from receiving breast cancer screenings. In 1989 the Glens Falls Hospital Guild donated funds to purchase the first mobile mammography van. This innovation was the first mobile mammography van in upstate New York.

At its inception, Glens Falls Hospital received a short-term grant from the American Cancer Society that provided funding for a sliding fee scale and a $50.00 cost for mammograms for low-income women. The following year the Warren/ Washington County Medical Auxiliary provided the program with a grant that would complement the American Cancer Society grant. This allowed women qualifying for the sliding fee scale to have their mammograms performed free of charge.

In 1991 Glens Falls Hospital became a partner in the New York State Department of Health-CDC Breast Cancer Education and Detection Program, further removing any financial barriers. Glens Falls Hospital is one of 55 New York State Department of Health Breast and Cervical Cancer Screening Projects that provide free services to women who are uninsured or underinsured and have an income level that falls below the 250 percent federal poverty line. In addition, the Breast Screening Program has contracts with all HMOs in its service area for mammography screening. Glens Falls Hospital is one of the largest projects in New York State, screening over 2,800 women annually.

The Breast Screening Program has formed strong relationships with the medical community. Physician involvement has been a vital part of this program. Prior to the implementation of this program, mammography was performed by physician referral only. Glens Falls Hospitalís Breast Screening Program accepts self-referrals and over 47 percent of participants are self-referred. Women without a primary care physician are encouraged to select one from a list of providers who will accept new patients, thereby facilitating their entry into the health care system. Program analysis reflects that 36 percent of all patients heard about the program through their physicians.

An analysis of the Breast Screening Program reflects its success in that a significant number of women screened are repeat patients. In other words, they routinely utilize the Breast Screening Program for their breast screening. On the program evaluations, women identified convenience as the primary reason for using the Breast Screening Program.

With the success and growth of the program, Glens Falls Hospital found it necessary to replace the original mammography van. Glens Falls Hospital asked community partners to support them in their efforts to obtain funding for a new van. The response was overwhelming, and numerous letters of support were sent to area legislators. With community support, a dedicated hospital administration, and the assistance of the Honorable Senator Ronald Stafford, a New York State legislative grant was obtained to purchase a new mobile mammography van called the community health screening van. The comprehensive Breast Screening Program has remained intact, but the spaciousness of the new van provides for a more comfortable, private examination. The new community health screening van has enabled Glens Falls Hospital to continue to meet the unique breast cancer screening needs of the women who are served.

The Breast Screening Program is a model program to develop and implement numerous community outreach initiatives. In addition, it serves as the core of the community health vision, which includes forming partnerships, eliminating barriers, increasing access to health services, and developing public education initiatives. This has allowed for integration of additional services that benefit the community. The Breast Screening Program was selected by the New York State Department of Health to be a pilot site for the integration of colorectal cancer screening as an additional service. Both men and women were able to participate in a colorectal cancer screening program. The program has been expanded to include cervical, colorectal, prostate, and skin cancer screening services. Education and outreach is vital to the success of the programs. Again, successful strategies utilized by the Breast Screening Program have been replicated in the integration of these programs. The ultimate benefit is that cancers are found at earlier stages, which results in improved survival rates.

Glens Falls Hospitalís continued commitment to Building Healthier Communities will be to maintain preventive, educational, and early detection services while fostering and developing community partnerships. It is currently involved in several community initiatives designed to reach its priority areas. Some of its prevalent community initiatives include:

Warren-Washington County Healthy Heart Program. Glens Falls Hospital is the lead agency in this program. The mission of this program is to encourage physical activity and better nutrition among community members and thereby improve overall cardiovascular health.

Warren-Hamilton County Healthy Women Partnership. Glens Falls Hospital is the lead agency in this program as well. It is intended to be a catalyst for the integration of chronic disease services and activities for underserved women. Glens Falls Hospital will collaborate with other partners in order to deliver many preventive messages to women in our region.

Healthy Choices Initiative. Glens Falls Hospital has recently been awarded the New York State Department of Health Healthy Choices Initiative to reduce adolescent risk behaviors. Activities will be incorporated that focus on decreasing tobacco use, improving nutrition, and increasing physical activity levels in adolescents.


Leadership Structure

The Breast Screening Program at Glens Falls Hospital is under the direction of the Cancer Prevention and Early Detection Program. Currently, the programís staff consists of the program coordinator, office coordinator, three registered nurses, data coordinator, program assistant and van driver. The program coordinator works collaboratively with the partners, including all four of the Healthy Women Partnerships.

The medical director of the Glens Falls Hospital Cancer Center provides assistance with the Breast Screening Program. The medical director attends quarterly Quality Assurance meetings and assists the program in identifying trends, problem solving, and assuring that follow-up occurs in a timely fashion. The medical director is also utilized as a resource for program planning, implementation and evaluation, and for clinical issues. A radiologist from Adirondack Radiology Associates also provides technical assistance by assuming the role of liaison between the Breast Screening Program and the Department of Radiology. This person also attends quarterly Quality Assurance meetings and assists in identifying trends, problem solving, and assuring that follow-up occurs in a timely fashion. The radiologist is also available as a resource for radiographic clinical issues.


Key Partners/Stakeholders

Glens Falls Hospitalís Breast Screening Program has collaborated with numerous partners in the community in their commitment to battling breast cancer. Partnerships have been developed with Essex, Hamilton, Saratoga, Warren, and Washington Counties. These partnerships consist of representatives from various organizations, such as public health, American Cancer Society, AARP, and area service providers, so that resources are pooled and creative ideas can be generated.

In 1994 Glens Falls Hospitalís Breast Screening Program received a New York State Award for developing the concept of ìcommunity partnerships.î The Partnership Program implemented by the Breast Screening Program was modeled throughout New York State and was the basis for the development of Breast Health Partnerships now present in New York.

Community partnerships also include ìcommunity champions.î Glens Falls Hospital has used the community champion concept since the implementation of the Breast Screening Program. These individuals encourage participation in screening programs by promoting these programs in various forums, including womenís groups, churches, social clubs, and friends. The ìchampionsî have become partners in the community initiatives.

A quarterly newsletter is sent out by the Warren/Hamilton County Healthy Women Partnership to partners, organizations, and health care providers in the service area. The purpose of the newsletter is to increase awareness regarding program services and eligibility requirements and to increase referrals and form new partnerships. The newsletter provides an overview of the program highlights and special events, reviews eligibility criteria, and provides information on how to access the program. The newsletter has been identified as a vehicle for increasing referrals for eligible women and forming new partnerships with breast and cervical screening providers.

The Breast Screening Program has a representative from the New York State Department of Health who serves as its Technical Advisor (TA). The TAís role is to serve as a resource regarding program eligibility, outreach initiatives, follow-up, outcomes, problem solving, and New York State Department of Health policy. In addition, the TA is the liaison to the New York State Department of Health. The TA attends all monthly Healthy Women Partnership meetings as well as regional and state meetings.

County Healthy Women Partnership meetings are intended primarily to update, brainstorm new ideas, receive feedback, look at current trends and volumes, and troubleshoot. Representatives of the Breast Screening Program attend all county meetings.

Partners from Warren, Washington, Essex, Hamilton, and Saratoga Counties as well as Clinton and Franklin Counties attend biannual regional meetings of the Adirondack Healthy Women Partnership.

Representatives from Albany, Schenectady, Rensselaer, and Saratoga Counties meet biannually at Capital District Regional Meetings. Representatives from Glens Falls Hospitalís Breast Screening Program attend because of Saratoga Countyís representation at the meeting.

The annual meeting of the New York State Department of Health, Chronic Disease Bureau reviews the overall outcomes and evaluations, highlights successful programs, and provides an educational resource.


Impact/Effectiveness

Glens Falls Hospitalís Breast Screening Program has made a difference in its communities by having achieved the following:

The recently revised New York State Department of Health-CDC guidelines for the Breast Screening Project, which increase the age eligibility to 50, will have significant implications for our program. The Breast Screening Program follows the American Cancer Societyís screening guidelines, which recommend that women age 40 and older participate in routine mammography screening. Outreach efforts have targeted these women. However, new CDC regulations require that only 25 percent of the women screened in the program can be under the age of 50. The New York State Department of Health had requested New York State funds to cover the cost of screening for program women between the ages of 40ñ49. Through American Cancer Society lobbying efforts, this request was granted for the current contract year. Continuing lobbying efforts will be necessary to ensure continued coverage for women in this age group. If these efforts fail, program women between the ages of 40ñ49 will no longer be eligible for screening by the program and must pay out-of-pocket. This will create a significant burden for low-income women who may not be able to afford the cost of a mammogram and hence will choose not to participate in routine mammography screening.

Contact: Michelle Burke, Manager, Community Health, Glens Falls Hospital, 100 Park Street, Glens Falls, NY 12801. Telephone: (518) 761-2310.

Fax: (518) 761-2216. E-Mail: mburke@glensfallshosp.org

See map, C3-7





HEALTHCAREPLAN BUDDYCHECK 2
WESTERN NEW YORK




Mission/Purpose

One in eight women will develop breast cancer during her lifetime, according to the American Cancer Society. An estimated 180,000 new invasive cases of this disease will be diagnosed in 1998 across the United States. Breast cancer remains the leading cause of death among women between the ages of 35 and 54. When detected early, breast cancer is highly curable.

HealthCarePlan BuddyCheck 2 is the result of a collaborative partnership between HealthCarePlan, an HMO serving the eight counties of western New York, and WGRZ-TV Channel 2, the local NBC affiliate. The objective of the HealthCarePlan BuddyCheck 2 initiative is to increase the likelihood of detecting breast cancer in its early stages, thereby improving survival rates and reducing health care costs. This objective is being achieved by educating the 640,000 women in western New York about the benefit of breast self-examination as one element of an effective approach to breast health. Television media and a grassroots community outreach are being employed to raise awareness of the importance of all breast cancer screening methods, including mammography, consultation, and professional examination by a physician as well as other cancer prevention and detection methods.

The execution strategy has been to invite the public to take responsibility for their health by participating in HealthCarePlan BuddyCheck 2. Channel 2 broadcasts promotional commercials that encourage viewers to call the hotline to receive a free HealthCarePlan BuddyCheck 2 packet and regular news stories about the importance of early detection. A prime-time program is under development and will air later this year.

Viewers interested in participating in HealthCarePlan BuddyCheck 2 call a fulfillment line to request that a packet describing the program be sent to them in the mail. Information contained in the packet allows them to enroll themselves and their buddies and provides information about effective breast care. Itís a simple three-step buddy system:

1. The participant chooses a ìbuddy.î

2. The participant places a HealthCarePlan BuddyCheck 2 sticker on her calendar on the 2nd of every month. (The designation for the 2nd is because of our partnership with Channel 2, not because everyone will conduct her exam on that day.)

3. The participant calls her buddy on the second to remind her to perform her BSE and to schedule other appropriate medical exams and screenings. (The packet includes a 13th sticker for use on the participantís birthday as a reminder to schedule a mammogram, Pap smear, and other key screenings.)

Callers who have questions that require medical expertise are connected by telephone transfer to trained cancer care counselors.

The vision of a healthy community with respect to this particular disease is one in which women take responsibility for their health and well-being by adopting an effective and consistent early detection program to maximize their chances of surviving breast cancer. Women will understand the importance of regular mammograms and examinations by their physician. They will seek regular mammograms in accordance with clinical guidelines based on their age and risk factors and will not be precluded from this and other potentially lifesaving medical care because of their insurance status.

The strategies employed to achieve these objectives are the result of consensus in the western New York physician community and have already proven very effective in increasing mammography screening rates in the HealthCarePlan insured population.


Leadership Role

HealthCarePlan and WGRZ-TV Channel 2, a property of Gannett Broadcasting, are partners in this initiative and have shared responsibility for its implementation.

ìBuddyCheckî is a national trademark and copyright for a program that was originally developed at the Baptist/St. Vincent Health System in Jacksonville, Florida, in conjunction with Channel 12, also a Gannett property.

Channel 2 presented HealthCarePlan with the opportunity to collaborate with them on the program. They were seeking a partner who could provide capital resources to fund the cost of a portion of the on-air media promotion. They required a clinical partner to provide guidance in material development and direction in the creation of broadcast segments, the establishment of a fulfillment process for materials, and the necessary linkage to a telephonic resource for callers who have questions that require medical expertise.

HealthCarePlan created a medical advisory board of community experts from local hospitals, research institutions, and mammography facilities to maximize the credibility of the initiative. Similar experiences at other BuddyCheck sites throughout the country were benchmarked to avoid mistakes and to optimize results.


Key Partners/Stakeholders

The principal partners in the initiative are HealthCarePlan and WGRZ-TV Channel 2. HealthCarePlan has engaged clinicians from the following institutions to assist in an advisory capacity: Roswell Park Cancer Institute; Buffalo General Hospital; Sisters Hospital; Windsong Radiology, PC; and MedicalPartners, LLP. Physicians from these institutions have provided clinical expertise in the development of the clinical information included in the packet material. They have also served as on-air experts for Channel 2 on news stories focused on the importance of regular screening mammography, latest research findings on tamoxifen, and other human interest stories about breast cancer survivors.

HealthCarePlan is in the process of engaging the physician community in the implementation of a plan to improve community-wide mammography screening rates. Existing clinical committee structures and advisory groups will be relied upon to develop and implement improved guidelines and protocols that will enable HealthCarePlan to replicate its organizational success in improving mammography screening rates in the community as a whole.


Impact/Effectiveness

Benchmarks from other communities were employed to measure success to date. In other locations, 10,000-13,000 packets distributed in the first year of operation is the norm. In the first three weeks of HealthCarePlan BuddyCheck 2, over 5,000 packets were requested.

The real objective, however, is to encourage women to adopt an effective early detection program, which research demonstrates will have the most significant impact on health outcomes.

Success in improving mammography screening rates will be measured by evaluating community HEDIS (Health Plan Employers Data and Information Set) data over the next several years. It is believed that the combination of community outreach initiatives and on-air promotion of the message will compel many viewers to take the steps necessary to protect their health.

The anticipated benefit to both Channel 2 and HealthCarePlan is improved public awareness of the organizational missions they are jointly (by way of BuddyCheck 2) and individually committed to. Those missions converge in the objective of providing real value to the residents of western New York by engaging them in the process of taking responsibility for their health and providing them with the information necessary to undertake that process.

The anticipated benefits to residents of western New York include improved health status, fewer deaths as a result of invasive breast cancer, and enhanced quality of life for survivors of the disease and their family members.

Channel 2 has committed resources in the form of ìin kindî broadcast services, which include commercial time, news stories, and a prime-time story segment. Channel 2 has shared in the cost of production of promotional items, sponsorships, and community promotions. Staff resources that have been committed to the project include consultation from the station general manager, sales director, creative director, news director, various members of the on-air news staff, and producers of the news.

HealthCarePlan has committed project time from the marketing and quality assurance units, including the director of quality assurance, associate director of marketing, director of research and education, coordinators of market research and public relations, as well as the services of its advertising agency in the design and production of print collateral.

The anticipated budget for the first year of operations of the initiative is $250,000: $125,000 is dedicated to broadcast time, $60,000 for packet material, $30,000 for the call center and fulfillment processes, and $35,000 for promotional material and sponsorships.

Community interest in the project has been very enthusiastic. Inquiries have been received from a number of groups who are conducting breast cancer awareness initiatives of their own. These groups have requested HealthCarePlan BuddyCheck 2 packets, sponsorships, or various kinds of on-site presence to promote the program. A number of HealthCarePlan client organizations have called to request a BuddyCheck 2 presence at wellness and health promotion events that have been scheduled at their work sites. Community organizations such as Zonta, local municipalities, and professional organizations (the Western New York Mammography Society) have requested that representatives of HealthCarePlan BuddyCheck 2 speak to their members and the public at large.

Many calls have been received from Channel 2 viewers thanking HealthCarePlan and the station for their involvement in this project. Most calls have been from survivors of breast cancer who wanted to encourage BuddyCheck 2 to continue to remind women that BSE alone is not enough. Some of these callers said that they would never have detected their lump that wayóthat mammograms or physician examination led to their diagnosis. Some callers have had clinical questions or concerns to resolve. Others are seeking second opinions on their diagnoses. In each case, the staff at the clinical phone service has been able to provide information or direction to assist participants with their concerns.

The true measure of impact and effectiveness will be an increase in mammography screening rates for the western New York community. HealthCarePlan has achieved great success in this regard with its own insured population and is embarking on a plan to employ some proven strategies to increase screening rates for the community as a whole. New partnerships with other community entities are being pursued to maximize the effectiveness of this important element of the initiative.

The only significant ìcontroversyî encountered has involved the issue of mammography guidelines. The American Cancer Society recommends annual screening mammograms for women ages 40 and up. Other leading experts suggest that women between the ages of 50ñ75 benefit from an annual mammogram and that women outside of this age cohort should seek the advice of their physician, who will make a recommendation on the basis of risk factors for each individual.

Many of the clinical experts consulted felt strongly about an age 40 or possibly even an age 35 initiation guideline for screening mammograms. They were undaunted by supplemental research that indicates significant potential for false positive results for women in this age range.

The HealthCarePlan Health Promotion Committee had just recently adopted a mammography guideline as a result of an extensive research review and collaborative agreement process among key policy groups. This resulted in the recommendation that annual mammograms be given to women ages 50ñ75 and that women consult their physician before age 50 and after age 75 for a recommendation for appropriate and effective care.

The final consensus (as it appears in the print collateral) produced the following recommendation:

Although the controversy may seem a relatively trivial point, it was a cause of considerable dissension at the beginning of a fragile community collaboration. The compromise was largely the work of a senior consultant to the process who is well known in the western New York medical community and is a nationally recognized expert on managed care.

Contact: Pamela Pawenski, Associate Director, Marketing, HealthCarePlan, 28 Church Street, Room 100, Buffalo, New York 14202. Telephone: (716) 857-6317. Fax: (716) 847-1257.

Materials available upon request:

See map, A1-8





HUNTS POINT CHILDHOOD HEALTH PROMOTION INITIATIVE




The Hunts Point Childhood Health Promotion Initiative is a partnership effort spearheaded by the New York City Department of Health (NYCDOH). The project is a collaborative effort involving a variety of community representatives, including schools, day care, community boards, health care providers, and environmental advocacy groups, in addition to the Medical & Health Research Association of New York City (MHRA) and Columbia University. The project received its initial funding support from a private company in the Bronx and has been in operation for two years.

The Hunts Point Childhood Health Promotion Initiative is a community-based effort designed to address a variety of child health issues such as lead poisoning, immunizations, injury, and asthma. The initial focus of the project is asthma. This innovative prevention model focuses on establishing stronger linkages between home/community/medical care in order to reduce childhood asthma morbidity through education and improved service delivery. The program has established a storefront asthma resource center, provides asthma education, offers home assessment and care management through its Community Health Worker Program, and has developed a model asthma action planódeveloped by the Medical Advisory Committeeóthat provides guidance to patients and families about how to effectively treat and prevent asthma episodes.

The initiative is guided by a Community Planning Group (CPG). The CPG is chaired by community members and has three subcommittees: (Environmental, Education/Outreach, Schools and Day Care). In its second year of operation, CPG was budgeted $50,000 from the New York City Department of Health to support priority areas related to its committee work.

The NYCDOH is establishing community partnerships in other parts of New York City (Brooklyn, East Harlem, Washington Heights) in order to more effectively involve and empower community groups in priority-setting and implementation of its asthma prevention and child health promotion activities.

Contact: Monserate ìCathyî Villegas, Hunts Point Childhood Health Promotion Initiative, 866 Manida Street, Bronx, NY 10474. Telephone: (718) 861-5496 or (212) 788-4656. Fax: (718) 861-5497.

See map, D4





"LOOK MOMMY, NO BABY BOTTLE TOOTH DECAY"
OTSEGO COUNTY




Mission/Purpose

Baby bottle tooth decay is a form of dental decay that occurs in infants and toddlers as a result of bottle propping and bottle pacification when the bottle is filled with anything but plain water. It can be mild or it can be extremely severe. If it is mild and it isnít treated, it will become much worse. It is also called bottle rot or nursing bottle mouth or nursing bottle caries. It is a very common disease among preschool children and is entirely preventable. The purpose of the ìLook Mommy! No Baby Bottle Tooth Decayî Project is to educate parents of infants and toddlers about the causes of baby bottle tooth decay, the effects of bottle propping, and the alternative parenting strategies they can use to comfort their children in lieu of the baby bottle as a pacification tool. The goal of the project is to reduce the number of children who require dental treatment for decay related to baby bottle tooth decay. The priority action area is dental health, specifically, early childhood caries in deciduous teeth.

The concern about baby bottle tooth decay led to the development of the project. It had been noticed that year after year there were numerous children within the Head Start program with advanced decay and that their parents did not know what had caused this decay. Additionally, it has become increasingly more difficult in Otsego County to find dentists who are willing to treat children with serious decay. Few dentists accept Medicaid. Many families do not qualify for Medicaid even though their income is low. Ever present is the inability of many parents to afford costly dental treatment. Local dentists do not want to work on preschool children and refer them to pediatric dentists in other countiesóat great distances from their own communities. Transportation to dentists in other counties becomes an issue. The belief is that if parents of infants could be educated about baby bottle tooth decay as soon as possible, ideally before their children develop teeth, then the incidence of this disease could be reduced.

The project began with the idea of reducing baby bottle tooth decay by providing parents with in-depth education on the topicógoing into much greater detail and enhancing the information that is only sometimes provided by pediatricians during well-child visits. In June of 1996 the following outline of a plan was developed by Nancy Berman, health coordinator of the Head Start Program of Opportunities for Otsego, Inc.: (1) to develop a book with simple text, graphics, and photos of preschool childrenís teeth in various states of decay; (2) to teach parents about baby bottle tooth decay and how they can teach others about it; (3) to set up a schedule of home visits during which these parents would teach other parents; (4) to compensate these parent tutors with gifts that would be obtained from donations of local merchants; and (5) to give the parents who received the education a gift for their participation. This idea was discussed with Norma Neilen Dayton, nutritionist of the WIC Program of Opportunities for Otsego, Inc.. The sites were changed from home visits to WIC sites because it became apparent that home visits were not feasible and may not always be safe. Nancy Berman then developed an initial draft of the book and presented the project idea to Dr. Anne Gadomski, a pediatrician at Bassett Healthcare and the liaison with the Otsego Public Health Partnership. This was in September 1996. Dr. Gadomski liked the idea and the book and said that she would support it with education money from the Otsego Public Health Partnership. This money would be used as incentives to encourage parents to attend training on the topic and then to provide education to other parents. It was agreed that the payment to tutors would be $50 for attending the trainings (two trainings at two hours each) during which they would (1) learn about baby bottle tooth decay and (2) learn how to educate others about it. It was decided that each tutor would be required to visit WIC sites four times during a one-year period for two-hour blocks of time. At the end of each two-hour block, the tutor would be paid $10 no matter how many parents he or she counseled that day. Dr. Gadomski also said that the Otsego Public Health Partnership would cover the cost of having copies of the book printed and the reproduction of the four photos included in each book. The book was then re-written several times and reviewed by both Dr. Gadomski and Dr. Gerald Bers, a dentist and co-owner of Northern Catskill Dental Associates. Dr. Bers suggested a number of additional ideas for inclusion and made some corrections so that the material would be accurate. Dr. Carol Lewis, a researcher with Bassett Healthcare and a member of the Otsego Public Health Partnership, edited the text. Amanda Stulz, an art teacher at Norwich High School, volunteered her time and drew many of the pictures included in the book. Others were chosen from computer clip art files. The negatives of the photos were donated by (the late) Dr. Paul Wiggins, a dentist in Oneonta. Finally, in November 1996 the first 500 copies of the book were printed. It was also decided that the parents who took the time to receive the education from the tutors would receive their own copy of the book used for the lesson and, if they had a small infant, a T-shirt for their baby. The T-shirt design would be a baby bottle in a circle with a slash across it, along with the words ìLook Mommy! No Baby Bottle Tooth Decay.î (At this time we have given out all of the T-shirts and have replaced them with training [sippy] cups with the same logo but with the words ìStop Baby Bottle Tooth Decay.î) The T-shirts and training cups were also purchased with education money from the Otsego Public Health Partnership. In December 1996 the first nine prospective tutors attended training. They were recruited by sending flyers home with all the Head Start children and by giving flyers to parents at WIC sites. Immediately following their training the tutors began teaching parents. More tutors were trained in July 1997 and again in November 1997 to replenish the ranks as some tutors dropped out. (When the first 500 copies of the book were gone, some minor revisions were made to the book and 500 more were printed. Those are now gone. The book underwent further revision and 200 more have been printed.)

Widespread word-of-mouth awareness of the project has unexpectedly taken place. Nancy Berman has done presentations on this project at the New York State Health Conference for Head Start, the New York State Migrant Conference, the FoxCare Childbirth Fair, the Otsego County Expanded Food and Nutrition Education Program (EFNEP), and the home day care providers of Catholic Charities of Delaware and Otsego Counties. Requests for copies of the book have come in from dentists and physicians, from the childbirth educators at both A. O. Fox Hospital and Bassett Hospital, and from numerous other programsóother countiesí Head Start and WIC programs, Cornell Cooperative Extension programs in many counties, the New York State Migrant Program, the Eastman School of Dentistry of the University of Rochester, Family Services Association of Oneonta, the health departments of other New York State counties, and the Rural Health Education Network of Delaware, Otsego, Montgomery, and Schoharie Counties. Additionally, the book has been translated into Spanish at the request of the New York State Migrant Program for their use with Spanish-speaking clients. Books were given at no cost to programs that serve residents of Otsego County. To accommodate requests from programs serving residents of other counties, Opportunities for Otsego purchased a quantity of the books and resells them at a small profit. All profits from the sale of the books go back into the project. Over 350 books have been sold to programs outside of Otsego County.

Discussions of baby bottle tooth decay taking place over the past ten years between the programís developers have always focused on the tragedy of this problem: the pain, cost, and so on, involved; the ongoing repetition of this preventable health problem; and the fact that, by the time children enter the Head Start program at age three or four, the damage has been done and it is too late. All have agreed that it is necessary to educate parents early to prevent the establishment of bottle propping and bottle pacification and the ensuing damage.

The vision of a healthy community that the partners hold is one in which young children are free from dental decay because baby bottles are used for feeding and not for pacification. This vision includes the education of parents about the damage caused by bottle propping. The partners imagine the pain, discomfort, time, parent dollars, taxpayer dollars (Medicaid), and so on, that would be saved. The first-year costs of this program, approximately $2,000, equal the amount a parent might have to pay for just one childís dental restoration. If, through this program, one child has been spared, then it is worth it. Hopefully many more than that have already been spared.


Leadership Role

The project is and has been under the leadership of Nancy Berman, with assistance from Norma Neilen Dayton, Anne Gadomski, M.D., Gerald Bers, D.D.S., Carol Lewis, Ph.D., Edie Colton, R.N., and Kathy Hoyle, L.P.N.. As noted above, the project was developed by Nancy Berman, Norma Neilen Dayton, Ann Gadomski, Gerald Bers, Edie Colton, and Carol Lewis. There are no formal roles in the project, although the leadership/lead agency is generally that of Nancy Berman due to her initial development of the idea and spearheading of the project. The other individuals were recruited by Nancy as a result of her association with them on other committees and/or projects in the past.

Although the group did not have formal training in team building, accessing resources, and so on, the above-named individuals, provided leadership at appropriate times in the development and implementation of this project based on their expertise. The leadership provided was both spontaneous and role-driven, depending on the situation, to meet the needs of the project.


Key Partners/Stakeholders

Principal partners directly involved in the project are:

The progress of the project has been discussed at meetings of the Otsego Public Health Partnership Advisory Committee, which includes Nancy Berman, Ann Gadomski, Carol Lewis, and Edie Colton among its members. Its progress has also been discussed at meetings of the Otsego County Health Planning Advisory Council, the Health Advisory Committee of Head Start, the Delaware, Otsego, Schoharie Perinatal Network, and the New York State Head Start Health Coordinators Task Force. Invitations to participate and requests for suggestions have been extended to members of each of these groups. To date, there have been no requests to join, but numerous suggestions from these advisory bodies have been incorporated into the project.

A description of the project and a copy of the book have been sent to the Committee on Access, Prevention, and Interprofessional Relations of the American Dental Association for their perusal. The partners are currently awaiting their input as to whether they see a role for themselves in this project and, if so, what that role will be.

Meetings were held frequently during the development of the project. Decisions were made informally based on consensus. Meetings are now held on an as-needed basis. Decisions have been made by the principal developers of the project on an informal consensus basis. The project has been one for which there has not been a need for advisory groups or subcommittees.

Parents who are enrolled in WIC are required to participate in two education sessions at WIC. Baby bottle tooth decay is one of the risk factors that make children eligible for WIC; therefore education on baby bottle tooth decay satisfies one of WICís education requirements. Typically, though, the mechanism for gaining meaningful parent participation in the education sessions is that the tutor simply approaches a parent at a WIC site and asks, ìMay I talk with you for a few minutes about baby bottle tooth decay?î Unfailingly, the WIC parents have been extremely receptive, eager, and interested in acquiring the information the tutors have presented. Parents say such things as ìI never heard of this beforeî or ìIím so glad you told me about this. I am going to get rid of the bottle right away now that my child is drinking from a cup.î These typical comments demonstrate why this project is so valuable to the parents, resulting in changed behaviors of the parents and satisfaction of the baby bottle tooth decay tutors.


Impact/Effectiveness

When a WIC parent receives baby bottle tooth decay education from a tutor, the WIC parent is asked to give some information for statistical purposes. A brief registration form is filled out that includes the parentís name, address, phone number; the names and birth dates of children enrolled in WIC; the parentís previous knowledge of baby bottle tooth decay; and whether the parent has children who have been affected by baby bottle tooth decay. This information is entered into a database for the purpose of noting whether there will be a lower incidence of baby bottle tooth decay when the WIC babies are old enough to enter Head Start at age three. Since it is a requirement of the Head Start program that enrolled children receive an annual dental exam and any needed dental treatment, tracking the occurrence of baby bottle tooth decay should be fairly easy to accomplish. As of April 1998 nearly 400 children have been entered into the database. At this point, however, it is too early to determine whether there has been a reduction in the incidence of baby bottle tooth decay since the WIC babies are not yet old enough to enter the Head Start program.

The benefits to the targeted population are the reduction in frequency and severity of baby bottle tooth decay. Obviously this will be very beneficial for the children. It will also be beneficial for their parents because they will have healthier children. Perhaps parents will even take on more positive parenting styles. Certainly they will not have the expenses, time away from work, long-distance travel to dental health providers for specialized treatment, and numerous other issues associated with accessing extensive and expensive dental treatment for their children. In addition, unexpected benefits have already been reaped by several of the trained tutors. Anecdotal reports have come back indicating great growth in self-confidence and self-esteem. A few have been able to obtain paid employment as a result of their participation in this project.

The primary source of funding for this project has been obtained from the education money of the Otsego Public Health Partnership. Sales of the book have generated a profit of $775, which has gone back into the project to cover future expenses.

With the exception of Nancy Berman, the project has required little work in terms of time for those involved. Although her initial time commitment was great during the development phase, now that the project is underway it requires only a very minimal amount of time. Because of the small time commitment required of professional staff, it has not been difficult to recruit persons who have an interest in the project.

A great deal of interest in the project has been expressed by other programs and agencies in the community. This has resulted in their adapting the program to fit their own needs. The EFNEP nutrition aides in Otsego County (and other counties) now use the materials to provide lessons on baby bottle tooth decay with their clients during home visits, as do the staff of the Migrant Program in this area. The same is true for those doing home visits as part of Community Maternity Services. In addition, material and/or lessons on baby bottle tooth decay are provided at local hospitals for parents of newborns. Physicians and dentists have placed copies of the material in their office waiting rooms and have given copies to patients to read.

One significant milestone/work product achieved is the number of parents reached by the baby bottle tooth decay tutors. This has far exceeded expectations for the amount of time the project has been underway. Also significant has been the widespread community support of the project in Otsego County and elsewhere. The bookís translation into Spanish has been an important factor in attempting to reach a diverse population.

Significant political problems or community conflicts have not been encountered. Financial resources have been adequate; however, there exists awareness of the tenuous nature of the sponsor. Because the Otsego Public Health Partnership is dependent on grant money from the New York State Department of Health for its continued existence, it is obviously hoped that it will remain viable for many reasons, only one of which is so that the partners can continue working toward the goal of eradicating baby bottle tooth decay in Otsego Countyís young children.

Contact: Nancy Berman, Health Coordinator of Opportunities for Otsego, Inc. Child and Family Development Department, 3 West Broadway, Oneonta, NY 13820. Telephone: (607) 433-8360. Fax: (607) 433-8327. E-mail: bermanbh@digital-marketplace.net

ìLook Mommy! No Baby Bottle Tooth Decayî books can be ordered at a cost of $5 each plus shipping and handling. Call Nancy Berman at (607) 433-8360.

See map, B9





NIAGARA WELLNESS COUNCIL




Mission/Purpose

The mission of the Council is to create a coalition intended to share, network, and advocate for health promotion activities in Niagara County. Through this coalition, a culture will be established that provides opportunities for individuals to adopt lifelong behaviors conducive to healthful livingóa community in which there is communication, coordination, and collaboration among work sites, schools, and communities to foster partnerships for the facilitation of community health promotion program enhancement. Customer satisfaction is the primary principle upon which the actions of the Council are based. ìCustomersî comprise members and nonmembers, organizations, and individuals. Agreed-upon values include a good reputation, innovation, and team spirit.

Initially, the membership of the Council has elected to address the health promotion strategies of the Healthy People 2000 national initiative. These eight priority areas include physical activity, nutrition, tobacco issues, alcohol and other drugs, family planning, mental health and mental disorders, violent and abusive behaviors, and educational and community programs.


Development
The inaugural of the Niagara Wellness Council took place on January 12, 1993, at Niagara County Community College. One hundred and five individuals from various agencies, schools, and the community at large participated in this official kickoff. This event was the culmination of several months of organizational efforts aimed at sustaining projects and wellness endeavors initiated by the Niagara County Healthy Heart Program (NCHHP), a cardiovascular community intervention program funded by the New York State Department of Health. Members of a Steering Committee were recruited from partner agencies of the NCHHP, Niagara County Health Department, Cornell Cooperative Extension, American Red Cross, and American Cancer Society as well as representatives of various agencies, work sites, and schools who share a common concern for the increase of wellness and health promotion opportunities in the county.


Action Plan

Communication. The Steering Committee met to brainstorm, to network, and develop a focusóa sense of common purpose with respect to shared concerns about community problems. Several agencies that might be of assistance in getting started were identified. Expertise was sought from the neighboring Greater Buffalo Wellness Council, already in existence.

Coordination. Members of the Steering Committee met in an attempt to synchronize services to avoid loss of individual agency identity. Wellness and health promotion were defined. A mission statement was developed, and a major goal was identified: to facilitate the achievement of the Healthy People 2000 goals and objectives in the health promotion category.

Collaboration. Three focus group areas were identified: school, community, and work site. The first phase of organization of the focus groups was accomplished at the January 1993 Inaugural. Those present were asked to join the focus group of their choice. Future meeting dates were set. Focus group members continue to develop their own goals and objectives. Collaboration among groups is accomplished through individual member representation on the board of directorsí Executive Committee and through a newsletter/monthly calendar.


The Steering Committee
Members of the Steering Committee held a series of meetings to identify and establish goals and objectives, using the framework of Healthy People 2000 as a springboard to assist them in their endeavor. Members included the American Red Cross, Niagara Falls Chapter; Cornell Cooperative Extension of Niagara County; DeGraff Hospital; McLaughlin Center; Emmanuel Temple; Family and Childrenís Services; Inter-Community Memorial Hospital; Lockport Memorial Hospital; Medical Society of Niagara County; Mental Health Association; Mt. St. Maryís Hospital; Niagara County Unit of the American Cancer Society; Niagara County Community Hospital; Niagara County Health Department; Niagara County Healthy Heart Program; Niagara Falls Memorial Medical Center; Niagara University; Starpoint Central Schools; and Corporate Wellness Consultant Brenda Simonson.


Leadership Role
The bylaws of the Niagara Wellness Council read: The Councilís affairs shall be managed and controlled by a board of directors that shall consist of not less than 10 or more than 15 persons. It shall consist of the Executive Committee officers, chair and vice chair of each focus group, and others as designated by the board of directors. Executive Committee officers shall consist of a president, vice president, recording secretary, treasurer, and the immediate past president.


NWC Major Committees
The major committees consist of the Worksite, School, and Community Wellness Committees. These groups are the mechanism by which the Council fulfills its mission and vision. Other standing committees are designated by the board of directors.

Individuals who subscribe to the Councilís mission shall, whenever possible, offer their special talents, skills, and community influences and shall act as advisors. They may also provide volunteer assistance on limited projects.

A coordinator/executive director employed by the Council is responsible for the Councilís direction, budget management, and consultant services, and, in addition, oversees programs and the business administration of the Council.

The three Wellness Committees are represented on the board. Goals and objectives of each group are developed by consensus in order to enhance existing health promotion programming and services provided by NWC members.

These committees meet on a monthly basis and develop their own objectives. For example, the School and Worksite Committees collaborate on the planning of the annual ìPartnerships for a Healthy Niagaraî conference. Its purpose is to bring together the necessary players in a partnership for a healthy citizenry and to provide strategies and skills through model programs that reinforce healthy behaviors and environments.

The committee chairpersons work with committee members to establish goals and objectives. Representatives of each ìpartnerî agency within these groups work within their own settings to accomplish the agreed-upon objectives.

In 1997 a Community Health Task Force was formed to identify major barriers to health promotion in the areas outlined by Healthy People 2000 and to collaborate with existing health service providers and agencies to develop a strategic plan to coordinate existing services and community health resources. As a result, the NWC coalition was expanded.


Key Partners/Stakeholders

Membership in the Niagara Wellness Council falls into two categories: regular members and associate members. The regular membership category is fee-based and structured into business/organizational group members and individual members. The benefits of regular membership include an annual subscription to the Hope Heart Newsletter; monthly NWC calendar of events; and discounts to NWC workshops, conferences, and select provider member services. Associate membership is free and comprises individuals and groups who belong to the network of those who support the mission, vision, and goals of NWC but do not currently hold a paid membership. Communication is maintained via the NWC monthly calendar.

Business/organizational members in the Niagara Wellness Council include:

American Red Cross, Niagara Falls Chapter; Bridge to Wellness; Carborundum Abrasives Company; DeGraff Memorial Hospital; FMC Corporation; Orleans Niagara BOCES; Goodyear Tire Company; Independent Health; Independent Nursing Care; Lockport Memorial Hospital; Mental Health Association in N.C.; Mountview Health Facility; Niagara County Community College Wellness Committee; Niagara Escarpment Volksport Association (NEVA); Niagara County Head Start; Niagara County Nutrition Council; Niagara Hospice Inc.; Sherwood Corporation; Brenda Simonson, Corporate Wellness Consultant; Starpoint Central High School; United Auto Workers Amalgamated Local 686; and YMCA of Lockport, NY.

Individual memberships include additional Niagara County community members and professionals from various agencies, schools, and work sites. Agencies represented include: Alcoholism Council in Niagara County Inc.; Fidelis Care, New York; Community Education Center-Niagara Falls; Domenico Chiropractic Services; E. I. Dupont, Niagara Falls; Edward Town Middle School; EPIC Program, Inc.; Family and Childrenís Services; Lockport Memorial Hospital Ambulatory Center; Lowry Middle School; Lewiston Porter Schools; Mental Health Association in Niagara County; Niagara County Health Department; Niagara County Head Start Program; Niagara County Youth Bureau; Niagara Falls Memorial Medical Center; Niagara University; Niagara University College of Nursing; Niagara County Department of Social Services; Niagara County Office for the Aging; Niagara Wheatfield Central School District; North Tonawanda School District; Reszel Middle School; Royalton Hartland Schools; SUNY at Buffalo Nursing Program; and Wilson Central Schools.

Additional membership consists of independent professionals in the areas of exercise and fitness, corporate wellness, physical therapy, public relations/ media, and nutrition. Dialogue has been initiated with representatives of the Niagara County Chambers of Commerce, Department of Parks and Recreation, YM & YWCAís, Department of Transportation, local government, and media.


Impact/Effectiveness

The success of the Niagara Wellness Council will be determined by its ability to:

Enhancement of existing health promotion programming of partner agencies will benefit the community as a whole. In addition, members of school boards and government leaders will be informed of health promotion programming opportunities of NWC partners. Clarification of health information through the media will expand public awareness of the importance of healthy behaviors.

Fiscal/staff resources consist of the in-kind services of the Wellness Committees, media committee, volunteer Board of Directors, and the Niagara County Health Department through the financial services as well as those of the project director, staff, coordinator, and program assistant of NWC. Funding sources include the New York State Department of Health, County of Niagara, membership fees, and periodic sponsorships.

Those who have cooperated in the New York State Healthy Heart Program Key Informant Survey for Community Coalitions will participate in a community leadership luncheon to develop a comprehensive plan to increase access to community resources for physical activity and nutrition. Where there is an identified need for the creation of resources, this may also become integral to the overall plan.

Significant milestones included the fifth annual ìMoviní in Mayî campaign, which was held to promote community involvement in physical activities. The campaign was promoted by the Worksite, School, and Community Wellness Committees. At the fourth annual ìPartnerships for a Healthy Niagaraî conference held March 18, 1998, minigrants were awarded to 14 successful applicants for proposals to conduct programs to increase physical activity in school, work site, and community groups.

The demographic makeup of Niagara County creates unique challenges to health promotion. The county has both urban and rural populations, each with its own particular needs. Because of the location of the countyís three major population centersóthe cities of Lockport, Niagara Falls, and North Tonawandaó there is no one centralized media locale. Each has its own newspaper, hospital, and cable TV stations. Corporate downsizing, hospital mergers, competition among hospitals over turf issues, the special needs of both urban and rural populations, and limited financial resources are special problems facing NWC and other health promotion organizations in Niagara County. The absence of strong leadership from a county executive may be another matter of concern. There are 19 county legislators whose agenda may reflect the special concerns of their particular district.

On the positive side, however, it must be noted that NWC and Niagara County Health Department have joined in partnership to address the needs of the unserved and underserved of Niagara County. It should also be noted that the Health Services Committee of the Niagara County legislature continues to recognize the value of the work of the Niagara Wellness Council through its recommendation to partially fund the Niagara Wellness Council each year.

Contact: Patricia L. Bishop, M.S., R.N., Niagara Wellness Council, 719 Ashland Avenue, Niagara Falls, NY 14303. Telephone: (716) 284-9091. Fax: (716) 285-9025. E-mail: bish0381@cdc.gov

A list of programs and products offered by the Niagara Wellness Council is available upon request.

See map, A7





ONEIDA COUNTY ALZHEIMER'S DISEASE ASSISTANCE COALITION




Mission/Purpose

The mission of the Oneida County Alzheimerís Disease Assistance Coalition (ADAC) is to preserve and enhance the functioning and quality of life of persons with Alzheimerís disease and to help maintain their independence in the community through referral to appropriate medical care and the provision of service coordination, counseling, and education.

To fulfill its mission, ADAC has established the following goals: to help facilitate a correct diagnosis and provide service coordination for the individual with Alzheimerís disease and to provide counseling and information to families to help ease the emotional burden. ADAC has identified five priority action areas:

In 1988, Ronald Lucchino, Ph.D., director of the Institute of Gerontology at Utica College of Syracuse University, and a group of health care providers recognized, based upon their research and experience, the need for diagnostic and supportive services for people with Alzheimerís disease and other dementias. The local health care provider group consisted of the Mohawk Valley Chapter of the Alzheimerís Association, Oneida County Offices for the Aging, Department of Social Services and Adult Protection, Visiting Nurse Association, Mohawk Valley Mobile Geriatric Team, Institute of Gerontology of Utica College, Masonic Home, Presbyterian Nursing Home, and Resource Center for Independent Living. Dr. Lucchino, representing the Utica group, contacted the Alzheimerís Disease Diagnostic Center in Syracuse. The Diagnostic Center agreed to work collaboratively with the local group, using it as a referral source for individuals experiencing symptoms of Alzheimerís disease.

A $30,000 Community Service Grant for individuals with Alzheimerís disease was awarded by the New York State Department of Public Health. A part-time coordinator was hired, and the Coalition began to receive referrals and started meeting on a monthly basis. The Coalition members included the Oneida County Office for the Aging; Visiting Nurses Association; Adult Protection Unit and the Community Alternative Placement Agency within the Oneida County Department of Social Services; Masonic Home Nursing Home; Presbyterian Home; a caregiver; the Mohawk Valley Chapter of the Alzheimerís Association; discharge planners from area hospitals; representatives of local Social and Medical Adult Day Service programs; and Resource Center for Independent Living. Since then, representatives from numerous other groups have been added. The Coalition was housed for several years at the Institute of Gerontology, Utica College. In November 1997 ADAC moved to the Resource Center for Independent Living (RCIL), becoming a component of the Elderly Services Department.

ADAC documented the following needs:

Oneida County has one of the largest aging populations in upstate New York. Of the over 200,000 people residing in Oneida County, 22 percent are 60 years of age and overó40 percent of whom are residents of Utica, the largest cityóand 12 percent are 85 years and over. Oneida County has 19 skilled nursing homes, 2 assisted living facilities, and 1 enriched housing program. There are a total of 20 family adult homes, 9 of which are certified by the Department of Social Services. There are also 7 social adult day services programs and 3 adult day health programs. Since we are seeing individuals earlier than ever in the course of the disease, the areaís senior centers are utilized as a referral source.

ADAC is a working coalition vs. a policy-making coalition. Referrals from various health care providers, family members, neighbors, and physicians are filtered through a central intake point. A home visit by the ADAC coordinator is done at the convenience of the family and caregivers. Staff adjusts work hours to fit the familyís schedule. The symptoms, work history, and hobbies of the individual are discussed. In addition, efforts are made to determine whether the individual has had an appropriate medical workup to rule out reversible dementias. Education, counseling, home modifications, and community services available are also discussed. The needs of the caregivers are also addressed. Offers of support and assistance are made to affirm the importance of their role and to prevent caregiver burnout. The assessment information is brought back to the monthly meeting of the Coalition. The case is brainstormed to ensure that all needs are being metófor the individual and his or her family.

Members of the Coalition can receive and/or make a referral at this time. Updates on past cases are provided. Further discussion of existing cases is often solicited due to progression of the disease and the need for increased services. Each case is ongoing; contact with families continues from the onset of disease until death. Some families who started working with the Coalition eight years ago are currently on the agenda.

Five strategies have been developed to address the identified needs:

1. Direct Services to Consumers

To fill some of the gaps in the system and to help families cope with Alzheimerís disease, ìAfternoon Out,î a free weekly respite program, was initiated in an attempt to prevent caregiver burnout and to delay crisis. The person with Alzheimerís was dropped off at the afternoon program, thus enabling the caregiver to have free time, assured that the care recipient was safe, comfortable, and enjoying time away. Five Afternoon Out programs were initiated, two in urban centers and three in rural areas. They were held in the buildings of various organizations that had liability insurance, such as churches, colleges, and a nursing home. The coordinator, along with members of the Mohawk Valley Alzheimerís Association Chapter, provided training for volunteers who assisted with supervision and care. The volunteers consisted of church members and Utica College occupational therapy and gerontology students who received class credit for their participation. The Association provided funding for an aide at one of the busier sites and also for activity materials. Snacks were donated.

Afternoon Out provided informal education on Alzheimerís disease to the caregivers, the church community, and students (and they, in turn, to their classmates). Family members were encouraged to observe communication and interaction with their loved one. As the disease progressed or as caregivers requested more than one afternoonís respite, they were referred to one of the established adult day services programs. Other programs recognized the benefit of their services to a person with Alzheimerís and began to accept referrals. While this put the Afternoon Out programs out of business, it expanded the services available for individuals and their families. The program that was based in the nursing home had other additional benefits. It provided educational opportunities for the nursing home staff and a smooth transition to the home for individuals with Alzheimerís and their caregivers. Afternoon Out operated for five years. ADAC now refers directly to adult day services programs.

With Adult Day Services now available across the county, ADAC continues to:

2. Education

ADAC developed a Regional Educational Committee that serves a three-county area including Oneida, Herkimer, and Lewis Counties. Educational programs included:

3. Advocacy

ADAC actively advocates on the local, state, and national levels for persons with Alzheimerís disease and their caregivers.

4. Interaction with Members of the Coalition


5. Marketing and Fund-raising

ADAC plans to develop and implement a marketing plan to raise awareness of its services and the benefits it provides. Public and private funding will be pursued in an effort to expand services. ADACís vision of a healthy community is one in which services are available to preserve and enhance the function and quality of life of its citizens and to help them maintain their independence in the community through appropriate medical care, counseling, and education.


Leadership Role

ADAC was established by a group of health care providers under the leadership of Ronald Lucchino, Ph.D., as described above. At present, ADAC is a program of the Elderly Services Department of the Resource Center for Independent Living and is housed at RCIL. Mary Rogers is the full-time ADAC coordinator and is supervised by the RCIL director of Elderly Services, Marie Testa. Ms. Rogers and Ms. Testa, in conjunction with coalition members, develop the long-range plan that outlines one-, two-, and five-year goals and objectives. In addition, RCIL is the fiscal agent and provides management services, grant writing, and resource development assistance.

Ms. Rogers convenes the monthly Coalition meetings and provides the direct services. The Coalition benefits from a minimum of formal structure. Members are dedicated to the goals of the Coalition and faithfully attend the monthly meetings providing valuable input.


Key Partners/Stakeholders

Members of the Coalition include: American Red Cross, Ombudsman Program; Ava Dorfman Adult Day Program; Charles Sitrin Health Care Center; Community Health and Behavioral Service; Hospice, Inc.; Loretto Adult Facility; Lutheran Care Ministries; The Meadows; Memory Loss Clinic of St. Lukeís Memorial Hospital Center; Mohawk Valley Alzheimerís Disease Association Chapter; Oneida County Office for the Aging; Oneida County Department of Social Services; Oneida County Department of Health; Presbyterian Residential Community; St. Lukeís Home; Senior Day Center; Resource Center for Independent Living; Utica Senior Center representatives; Visiting Nurse Association of Utica, Inc.; and Veterans Administration.

The central intake and referral system and the monthly Coalition meetings ensure an inclusive and representative partnership in the community. Since the Coalition is not bound by a formal structure, new members are easily accomodated. Expanding the membership is an annual goal, and the group has been successful in adding members over the years.

The Coalition essentially operates itself. Ad hoc committees are appointed for specific projects. For example, the Regional Education Committee develops educational programs for caregivers and was responsible for the publication of the handbook.

Each Coalition member brings referrals and participates in the problem-solving process.


Impact/Effectiveness

The primary expected outcome is the prevention of premature institutionalization. An evaluation survey is provided to each family and results demonstrate that the Coalition has been remarkably effective. The evaluations are reviewed by the Coalition members, with service adjustments made as indicated. The coordinator presently receives 1ñ3 new referrals a day and makes 30ñ35 home visits each month. This level of activity provides another measurement of the need for and the effectiveness of the Coalition.

The Coalition members experience the following benefits:

The benefits to individuals and families are many.

The Coalition members and the ADAC coordinator begin to prepare caregivers for that time early on in their relationship. When the need for more intensive care arrives, the family has already developed a trusting relationship with the coordinator and Coalition members who assist with the placement. The Coalition provides referral, education, and needed services in a continuum of support from the onset of the disease to death. While nothing can prevent the eventual progression of the disease, ADAC provides the services necessary to support the individual and the family.

The Oneida County Alzheimerís Disease Assistance Coalition at RCIL is funded by a Community Service Grant from the New York State Department of Health, with additional funding provided by the Oneida County Department of Social Services.

The establishment of the Memory Loss Clinic clearly demonstrates community support and the mobilization of community interest and involvement. The success of the Clinic speaks to the need it is addressing.

The handbook and Memory Loss Clinic were significant milestones.

A video showing the progression of the disease is currently being produced. One of the consumers, Barb, is very open about her disease and expressed a desire to educate the public. She wanted her family, neighbors, and friends to know what she is experiencing and hopes that the video will help them feel comfortable around her and others with dementia. In August 1996, Barb and Mary Rogers sat down together and had a conversation that was videotaped. Another taping was completed in August 1997, and the third was done in August 1998. Although there is a notable decline in Barbís thought processes, communication, memory, and even physical appearance, she is still able to share her thoughts about having Alzheimerís disease. This video will educate professionals, persons with dementia, service providers, families, and caregivers about Alzheimerís and the losses experienced by the person affected, his/her family, and caregivers.

Significant problems affecting the project include:

Contact: Marie Testa, Director of Elderly Services, Resource Center for Independent Living, 401ñ409 Columbia Street, P.O. Box 210, Utica, NY 13503-0210. Telephone: (315) 797-4642. Fax: (315) 797-4747.

See map, B3-5





THE PRASAD PROJECT
CHILDREN'S DENTAL HEALTH PROGRAM
SULLIVAN COUNTY




Mission/Purpose

The PRASAD Project, an international not-for-profit voluntary organization dedicated to serving people in need, initiated the Childrenís Dental Health Program in November 1996 to address the unmet dental needs of low-income children in Sullivan County, New York.

The mission of the program is to improve the dental health of children by providing comprehensive high-quality dental services through education, prevention, detection, and treatment. With the aid of volunteer dental hygienists, parents, and other community residents, the school-based dental health program provides oral health classroom instruction, a fluoride mouthrinse and tablet program, dental screenings, and restorative dental treatment available on a mobile dental clinic. The Childrenís Dental Health Program was developed as a model program to fill the gaps in dental services and education.

With the intention of reaching all elementary school children in the county, the components of the program include:

Dental Health Education
Classes are conducted by dental hygienists and trained volunteers. Special assemblies and activities are provided for students in conjunction with National Childrenís Dental Health Month.


Fluoride Mouthrinse and Tablet Program
Weekly fluoride mouthrinse and daily tablets are provided for all children at the elementary level with parental permission.


Dental Screenings
Screenings are offered at regular intervals to children to assess the need for restorative care. Oral Health Treatment Assessment Screenings will be provided every three years, in conjunction with the State Department of Health, Bureau of Dental Health, to determine the status of childrenís dental health in Sullivan County and to evaluate and document the programís effectiveness.


Treatment
Comprehensive preventive and restorative care will be provided on a two-operatory, fully staffed mobile dental clinic for children who are deemed, through screening, in need of such care and who meet financial eligibility requirements.

All the services of the program are provided free of charge to all participants, and all children receive these services, except treatment, no matter what their financial status might be.

Recognizing that dental disease and access to treatment are major problems for children from low-income families, the Sullivan County Department of Public Health Nursing approached the PRASAD Project in regard to developing a means of providing access to dental services for children in need.

Though the prevalence of dental caries among children has been declining, dental disease rates for children living in poverty continue to be higher than those in the middle and upper classes. Public funding for oral health programs has been continually decreasing, and health care services available to middle- and upper-class Americans are often not available to the poor and underserved.

With the assistance of the New York State Department of Health, Bureau of Dental Health, an Oral Health Treatment Assessment Survey was performed on second-grade students in four school districts. It was found that 30 percent of the students screened were in need of immediate restorative dental care. Forty-one percent of the respondents indicated that they were on the Medicaid program, and only 40 percent indicated that they had a family dentist. The student poverty level (based on the free school lunch program) averages 36.5 percent, ranging from 12 to 58 percent among schools. Sullivan County has the highest ìdmfsî (decayed, missing, filled surfaces) rate per child in the Hudson Valley region. There is no dental clinic, a lack of Medicaid providers, and an absence of an organized dental health program in the county. Many children are subject to dental neglect because of lack of funds, insurance, services, or transportation. Often, because of the obstacles mentioned, many parents are unable to seek treatment for their children. Just one village in the county has a fluoridated water supply, serving only 10 percent of the countyís population. One of the 10 school districts in the county participates in New York Stateís school-based fluoride mouthrinse and tablet program. Most of the school districts at one time had staff dental hygienists. At present, just three do, on a limited basis, each employing a hygienist only one day per week.

Because the majority of the countyís population lacks a fluoridated water supply, a school-based fluoride mouthrinse and tablet program was established with the guidance of the State Bureau of Dental Health. A dental health education program was put into place in which volunteer dental hygienists and dental health educators trained by the programís coordinators teach dental health education classes in the schools. A mobile dental clinic was purchased, which will travel to the schools to provide restorative dental treatment to children who otherwise have no access to dental care. A dentist, dental hygienist, dental assistant, and driver will staff it. The program is currently available to children at the elementary school level. As the program grows, all children in the county from infancy to age 18 will have the opportunity to avail themselves of the services offered.

The strategies of the Childrenís Dental Health Program have been discussed with county dentists and dental hygienists, service organizations, parent groups, and school personnel. There is a consensus that the county lacks services for low-income children and that the strategies used will help to alleviate this situation.

The vision of the Childrenís Dental Health Program is:


Leadership Role

Working with respect and in partnership, PRASADís mission is to improve the quality of life and to offer opportunities for self-reliance. PRASAD is an acronym that stands for Philanthropic Relief, Altruistic Service, and Development. The humanitarian work carried out by The PRASAD Project began in the 1930s in the Tansa Valley of Maharashtra, India. Incorporated in the United States in 1992, PRASAD supports programs in India including a mobile hospital, a mobile dental clinic, eye camps for cataract surgery, a tuberculosis program, scholarship and academic programs, and a feeding program. PRASAD is currently in the process of planning a hospital and research center in India. The programs of PRASAD continue to grow and expand in India, Mexico, and in underserved, rural Sullivan County, New Yorkóthe site of its international headquarters. After consulting with the county department of health, PRASADís board of directors decided that the inauguration of the Childrenís Dental Health Program would mark its first long-term local project.

With the boardís approval, PRASAD management hired a registered dental hygienist to design and coordinate the program. As the fluoride and education portions of the program grew, a registered nurse came on staff to coordinate those areas. A dentist, dental hygienist and dental assistant will staff the mobile dental clinic, and volunteer professionals will have the opportunity to provide treatment services. The Childrenís Dental Health Program is an incorporated subsidiary of The PRASAD Project.

The program coordinator partnered with the school districts by obtaining permission from the respective school boards and superintendents to allow the program to function in their buildings. School principals, nurses, teachers, auxiliary staff, and parent volunteers are trained to administer the fluoride program. The fluoride program coordinator provides training, materials, and technical assistance as needed. Parents and other community members are informed of the services that the program provides through presentations at PTA meetings, back-to-school nights, and other community forums. Dental health information and presentations are available to any community group upon request. Partnering with the local component of the American Dental Hygienistsí Association has enabled the program to obtain volunteers from its ranks in the education portion of the program. Dental hygienists volunteer to teach dental health education classes, and other community members are provided training in basic dental health and education techniques in order to offer dental health presentations in the schools. These ìTrain the Trainersî seminars, devised by the program coordinators, are available to any interested community members. A dental health resource center was set up at The PRASAD Project offices in order to provide educators with the resources they need to prepare lessons.

Technical assistance was obtained from the New York State Department of Health, Bureau of Dental Health, in gathering baseline data on the dental health status of children, using the Oral Health Treatment Assessment Survey. The bureau also provides guidance and support in the fluoride mouthrinse and tablet portion of the program. Staff of Eastman Dental Center in Rochester, New York, have also provided assistance in regard to the setup of the mobile dental clinic. The Sullivan County Department of Public Health Nursing has partnered with the program by providing information and assistance when needed, especially by allowing a county-employed health educator to participate in school programs offered during National Childrenís Dental Health Month. Other school-based and mobile dental program coordinators around the country have provided information that has aided in the formation of the program.


Key Partners/Shareholders

The principal partners involved in the project include The PRASAD Project, the Sullivan County Department of Public Health Nursing, the local school districts, and program volunteers.

Five of the 10 school districts in the countyóplus BOCESóare now being served. These districts represent approximately 75 percent of the countyís elementary school population.

Before the project was initiated, local dentists were invited to meet with program partners to discuss the objectives and to gain their feedback. Information was also gathered regarding their perceptions of the access to dental care for low-income children in the county and whether this program would have any impact on their practices. The group understood the needs of the targeted population and that the patients to be served by the Childrenís Dental Health Program would not otherwise receive dental services. Support and encouragement for the programís initiatives were gained. A questionnaire was devised and sent to all county dentists regarding their practices. They were asked if they would want to have patients referred to them from the Childrenís Dental Health Program, at what age they begin to accept children as patients, if they offer payment plans for their patients, and if they would be willing to accept Medicaid patients. Dentists and pediatricians were also informed of the ways in which the fluoride program would dovetail with their prescribing practices.

To promote and ensure an inclusive and representative partnership, information about the program is put out in local media, both printed and radio, and at community organization meetings detailing the programís services and the volunteer opportunities available. Focus groups consisting of school nurses, parents, teachers, and other community members have been formed in the education and fluoride programs. The Childrenís Dental Health Program is represented on the Access to Care Task Group in ìPartners in Community,î the Sullivan County Community Health Improvement Project. This project was developed through a collaborative assessment and planning process. The key community improvement strategies include access to services/care, promotion of healthy lifestyles, and community improvement related to economic development and community image. Alliances have been formed with Sullivan County Community Collegeís Early Childhood Education Program, the S.U.N.Y. Migrant Education Outreach Program, and Hudson Health Plan, which enrolls families in the Child Health Plus state insurance plan. Parents who have no dental insurance are given information about the services that are available to their children through the Childrenís Dental Health Program. Plans are being made to invite participation of high school students enrolled in the local Health Academy which works with students interested in health careers.

The remaining five school districts in the county, all of the districtsí middle and high school programs, and the countyís Head Start and WIC program sites will be included in the program in the future so that all children may eventually access the services of the Childrenís Dental Health Program.

Decisions on the eligibility of children to be provided dental treatment and protocols to be followed are made by PRASADís management. An advisory group consisting of dental professionals is consulted regarding fluoride supplementation, amalgam usage, and other treatment modalities.

To gain meaningful participation from the community, efforts are made to promote the program so that services will be available to the greatest number of children possible. The Department of Public Healthís WIC clinic personnel refer patients in need of dental care to the program. The schools publicize the program to parents in order to gain participation in the fluoride and treatment areas. New students are given fluoride program permission forms. The PRASAD Project publishes brochures and newsletters and gains media attention whenever possible. Public service announcements are aired on local radio stations during National Childrenís Dental Health Month at the request of the Childrenís Dental Health Program, and requests for volunteers are posted in local newspapers. Community groups are addressed, informing them of the program in order to gain support and volunteers. Orange County Community Collegeís dental hygiene class is also presented information about the program on a yearly basis to gain its support and future volunteerism.


Impact/Effectiveness

The expected outcome of this project is that children and their parents will gain useful information regarding the care of their teeth, decay rates will drop, and children who would otherwise not receive dental treatment will receive care.

The success of the project will be evaluated based on the dental health objectives of the Healthy People 2000 initiatives. Oral Health Treatment Assessment Screenings will be performed at regular intervals in conjunction with the State Department of Health, Bureau of Dental Health, to determine the status of childrenís dental health in Sullivan County and to evaluate and document the programís effectiveness. A database for fluoride program participation was devised in order to track levels and years of participation. The information will be used to study the effects of the fluoride mouthrinse and tablet program on the dental health of children.

The county health department benefits from the program in that the provision of dental services is in place for low-income children, a service that the county had not been able to provide previously. The school districts benefit from the oral disease prevention programs, which had been cut from their educational programs because of budget reductions and are now in place with a higher level of services available. Trained volunteers now provide dental health education in the classroom, and the program enhances the dental health modules for classroom teachers who provide instruction on dental health to their students. Fluoride mouthrinse and tablet programs, which previously had not existed, are in place. Oral health screenings, which were provided in many of the school districts at one time but were terminated due to budget constraints, are now available and treatment is offered at no cost to children in need. The only cost that the school districts have incurred is that of the installation of electrical hookups for the mobile dental clinicís shore power needs. Each school board voted on this matter and agreed that this was a small price to pay for the number and level of services that would be available to their student populations. The benefit to the volunteers, who give so generously of their time, is the satisfaction of knowing what a great service they are helping to provide. It also offers an opportunity for those considering careers in teaching, medicine, or dentistry to gain experience working with children.

The benefit to the target populationóthe childrenóis great. All children, regardless of their financial status, receive dental health education classes and are able to participate in the fluoride program. Screenings are made available to all children and parents are advised of the results. If a child is deemed in need of treatment, a parent may provide information regarding their inability to pay for treatment. As children are reached, so too are their parents and other caregivers. Every effort is made to reach out to adult populations so that the increased knowledge that they gain in the area of dental health will be imparted to their children and may also help them gain a better understanding of their own dental health.

The staff resources include a registered dental hygienist who coordinates the program and provides screenings and treatment on the mobile dental clinic. A registered nurse coordinates the fluoride and education portions of the program and participates in the overall planning of the program. A dentist and dental assistant provide treatment on the mobile dental clinic. A program manager is the Childrenís Dental Health Program liaison with The PRASAD Projectís management team. The PRASAD Project has funded the program since its inception through donations and fund-raising events.

Support from the community has been great. There are over 50 volunteers in the program to date. With the incorporation of the treatment portion of the program in the near future, increased community interest and involvement will follow. Word of the availability of treatment for low-income children has already spurred inquiries regarding volunteer opportunities on the mobile dental clinic. All levels of school personnel have demonstrated interest, support, and appreciation for the program, and the inception of the treatment phase of the program is anxiously awaited. Recognizing the dental health needs of their students, school personnel are pleased that the opportunity for receiving dental care is being presented to children who they know would not otherwise receive treatment.

This year over 4,300 children in 11 schools in Sullivan County will receive the services of the Childrenís Dental Health Program. Three thousand of these children are enrolled in the fluoride program. The mobile dental clinic will begin serving patients in May. In the coming years the Childrenís Dental Health Program plans to expand its scope of services so that all children in the county will be reached. Future plans include the initiation of a dental sealant program, a dental awareness campaign to ensure that all children six months to preschool age have access to fluoride drops or tablets, and the development of an education program for parents involved with Head Start, Public Health Nursing, and the WIC programs. Last year, during National Public Health Week, the Childrenís Dental Health Program received a certificate of appreciation from the Sullivan County Department of Public Nursing in recognition of ìcomprehensive childrenís dental health initiatives in Sullivan County, New York.î

Contact: Julia Pavese, R.D.H., Childrenís Dental Health Program Coordinator, 465 Brickman Road, Hurleyville, NY 12747-5314. Telephone: (914) 434-0376 ext. 101. Fax: (914) 434-0377. E-mail: juliep@prasad.org

A brochure is available upon request.

See map, D1





THE WOMEN'S HEALTH OUTREACH PROGRAM PARTNERSHIP
ONONDAGA COUNTY




Mission/Purpose

The mission of the Womenís Health Outreach (W.H.O.) Program Partnership is to ensure that women in Onondaga County receive current breast health education and that they have a place to go for breast screening regardless of their financial status. The partnership is committed to removing barriers to care and to providing advocacy so that all women are able to receive the highest quality service available. Priority action areas of the partnership include implementing effective intervention strategies, improving delivery of mammography services, increasing health education opportunities, expanding the current network to include additional contributing partners, targeting services to underinsured and uninsured populations, and monitoring and evaluating our progress.

Onondaga County has had a Breast Cancer Screening Program since 1988. It was established with funds from the New York State Department of Health to provide breast education and screening for uninsured or underinsured women ages 35 and older who live up to 250 percent above the poverty level. The B.E.S.T. Program (an acronym for Breast Education Screening and Testing) has since merged with the Womenís Health Outreach or W.H.O. Program, a chronic disease screening program for underserved women. Since 1988 the breast health partnership has offered education on breast self-examination, clinical breast exam, and/or mammography screening to over 8,800 underserved women; of those, 53 were found to have breast cancer. Services were provided to these women through the W.H.O. Program Partnership, a larger, community-wide network of medical providers, social service agencies, cancer advocacy groups, and other citizens concerned with fighting breast cancer.

Previous and current strategies used to address identified needs have included assembling community providers invested in breast health issues. In 1978 local county government worked with the National Cancer Institute to establish the W.H.O. Program. After one year the grant funds ran out, so local county government and local taxpayers picked up the costs. By 1988 a group of community leaders from area hospitals, the American Cancer Society, the Onondaga County Health Department, and the Syracuse Community Health Center met and reviewed local breast cancer data. They found that even though women lived in a service-rich county, many did not access local health services. Of particular concern were minority women who were more likely to die from breast cancer despite having the same incidence rates as white women. This group of community leaders submitted proposals for grant funds to establish the B.E.S.T. Program, and many remain active today as W.H.O. Program Partnership Advisory Board members.

The current members of the W.H.O. Program Partnership Advisory Board represent a wide array of areas: hospitals, radiology groups, private medical/surgical practice, health department, wellness programs, cancer service organizations, an oncology group, a local minority service organization, and breast cancer survivors. Advisory Board meetings provide a forum in which to meet and discuss current breast cancer education and screening issues. The board receives information on W.H.O. Program activities such as education, outreach, breast screening data, and cancer findings. Each board member, in turn, returns to his or her facility/agency and has an opportunity to influence local provision of service.

The W.H.O. Program Partnership, like many health care service providers in Onondaga County, collects patient medical outcome data. During 1996 the partnership looked for community-wide data on rates of breast self-examination, clinical breast exams, and mammography. They found that individual provider information was collected; however, no central depository for such information existed. With no available primary prevention for breast cancer, secondary prevention activities such as individual and group health education, breast exams, and mammography are the best early detection methods for women. However, in the absence of community-wide data, there was no measure of local effectiveness in fighting breast cancer. The Onondaga County Health Department consulted with the W.H.O. Program Advisory Board and conceived the idea of collecting community-wide data on breast screening behaviors via a local telephone survey.

Upon implementation of these identified strategies and others, the partnershipís vision for a healthy Onondaga County focuses on improved access to mammography services, affordable or free health services, expanded health education opportunities, and sustained and focused community attention on improving services and service delivery within the county. Onondaga County would offer broad-based, coordinated services to address the needs of a larger percentage of community residents. And finally, this vision includes a documented commitment of stakeholders to actively participate in ìA Community of Solutions,î which would result in improved health outcomes.


Leadership Role

The Onondaga County Health Department took the lead by applying for grant funds from the Central New York Chapter of the Susan G. Komen Breast Cancer Foundation to conduct the survey. In December 1996 the Onondaga County Health Department was awarded $500 from the Komen Foundation to conduct a 1997 telephone survey. The plan involved reaching a sampling of local women ages 50 and older to determine their utilization of breast cancer screening services, breast self-exam (BSE), clinical breast exam (CBE), and mammography. The results of this October 1997 survey would become a catalyst for directing future community activities relative to breast cancer screening. The kickoff event was held March 27, 1998, and was called ìOur Report Card on Breast Cancer: A Community of Solutions.î

Initial planning activities related to the Mammography Utilization Survey involved assembling the core health department work team: Lloyd F. Novick, M.D., M.P.H., commissioner of health; Don Cibula, Ph.D., director of surveillance and statistics; Diane Adler-Farnach, M.S., R.N., assistant bureau director, Bureau of Health Promotion & Disease Prevention and Womenís Health Outreach Program coordinator; and Katherine Mogle, public health educator, Womenís Health Outreach. In addition, Mary Rogers, Ph.D., medical epidemiologist from S.U.N.Y. Health Science Center, Department of Medicine, and Womenís Health Outreach Advisory Board member, joined the core group. The task of this team was to design the overall survey and to discuss how results would be presented to the community. Standard questions from the New York State Department of Health Behavior Risk Factor Surveillance System were integrated into the local questionnaire. The work team anticipated and dealt with concerns about professional, community, patient, and data collection aspects of the survey and how these results would be conveyed to the public and the health care provider community. From this, ìOur Report Card on Breast Cancer: A Community of Solutionsî took shape. Women 50 years and older were selected because current literature indicates that women in this age group derive the most benefit from continuous breast cancer screening in terms of decreased mortality and fewer years of productive life lost. We had expected to meet or exceed established benchmarks for mammography in Onondaga County.


Key Partners/Stakeholders

The success of ìA Community of Solutionsî was a direct result of outreach to numerous community partners and their individual contributions. The initial subcommittee that was formed to consolidate ideas and assist in the ìhands-onî work and to see this project to fruition consisted of a subset of the current Womenís Health Outreach Program Partnership Advisory Board. These members, who then became the planning subcommittee for this program, included a nurse manager from S.U.N.Y. Health Science Center Breast Care Program; a current member of the Central New York Chapter of the Susan G. Komen Breast Cancer Foundation; a nurse coordinator from St. Josephís Hospital: The Wellness Place; a breast cancer survivor who utilized the services of the breast and cervical cancer partnership; and a community health nurse from the Onondaga County Health Department. This subcommittee was chaired by the public health educator from the W.H.O. Program. Brainstorming about the purpose, objectives, goals, and target audience was conducted to ensure a focused and quality event.

Other principal partners in this project consisted of a ìpanel of expertsî who addressed our multifaceted audience. These partners were fundamental to the success of this program. Their expertise enabled them to successfully stimulate the interests of a varied group of individuals, all of whom were committed to breast health and early mammography screening. The panel contributed their personal expertise in the area of breast cancer, and their individual presentations complemented one another. The panel included County Executive Nicholas Pirro; Lloyd Novick, M.D., M.P.H., commissioner of health, Onondaga County Health Department; Dr. Paul Reznikov, radiologist from a current partner; Mary Sabin, breast cancer survivor who utilized the services of the W.H.O. Program; and Diane Adler-Farnach, M.S., R.N., project coordinator for the Onondaga County Womenís Health Outreach Program.

The success of this breakfast event was dependent upon community-wide participation. The goal was to generate interest from a broad spectrum of breast health advocates, with the underlying commitment to reach individuals who work with the priority population: medically underserved women, ages 50 and older, who are uninsured or underinsured. Numerous community agencies and representatives were invited and encouraged to attend, including the American Cancer Society; Southwest Community Center; Community General Hospital; St. Josephís Hospital; University Hospital and its Breast Health Program; media representatives (television, radio, and print); clergy; legislators; local government officials; physicians; health care providers; and breast cancer survivors. As the response to these invitations grew, the W.H.O. team expedited the process by personally inviting specific individuals to this event, faxing additional invitation flyers to health care providers and community-based organizations and ultimately sending a second invitation to a core group of individuals. These recruitment strategies resulted in success, with a total of 135 individuals attending ìOur Report Card on Breast Cancer.î At this event, all of the programís previous breast cancer survivors were also recognized, reinforcing the importance and purpose of the program. The vast audience included members of the Black Nurseís Association; County P.E.A.C.E. Offices; Native American Service Agency; Spanish Action League; Southwest Community Center; Foster Grandparents Program; area health care providers; and breast cancer survivors. These groups were significant because of their diversity and their commitment to reaching underserved women within the community.

Potential partners not currently involved in the partnership will be added to this effort as the follow-up to registered commitments is completed. These commitments include such events as hosting town meetings on breast cancer in the community, sponsoring breast health education programs for church groups, and fulfilling agreements that have been made to offer mobile mammogram programs. Also, several breast cancer survivors agreed to speak about breast cancer at media-sponsored events. The potential for expanding our current partnership is significant due to the number of current commitments that have been generated as a result of A Community of Solutions.

The W.H.O. health educator will be sending thank-you/reminder letters to each agency that has agreed to sponsor a breast health event. This letter will include an offer of support and assistance to help them complete their commitment from the breakfast event. Regardless of the agreed-to activity, consistent coordination and follow-up will be implemented. For example, radiology staff agreed to hold a W.H.O.-sponsored no cost/low cost mammography screening event that will require collaboration to secure date, time, location, and payment agreement as well as advanced preparation for promotion, outreach, and education. These cosponsored events will involve pre-planning to ensure a quality and efficient screening and a successful program.

In addition, many potential partners agreed to host Breast Cancer Awareness Month activities during October 1998. During August 1998 the W.H.O. health educator facilitated this process by following up with personal telephone calls and offers to provide educational materials, breast health videos, and education programs.

Additional agencies have made commitments to include breast health information in their paycheck stuffers. Information inserts about upcoming mammography screening programs will be provided in employee newsletters and in flyers distributed at the work site. W.H.O. outreach staff will be responsible for making follow-up inquiries into materials and quantities requested and the security and delivery of these materials.

A record-keeping system was implemented to track fulfilled commitments. Locations that did not complete their task by September 1998 received an additional ìencouragement letterî from W.H.O. staff.

The decision-making process for this effort was a collaborative one among the Onondaga County Health Departmentís Womenís Health Outreach Program; the W.H.O. Advisory Board; current community-wide providers for the W.H.O. Program, such as Central New York Diagnostic Imaging; and the Central New York Susan G. Komen Foundation. This group met and was involved in the planning, implementation, and promotion of this project. Decisions were made by consensus and implemented by the committee for the March 27, 1998 event.

The success of this program relied heavily upon the participation of each member of the audience. Each partner played a specific role in facilitating A Community of Solutions with the audience. This diverse audience was composed of women with personal experience with breast cancer, physician specialists, and individuals representing neighborhood-based agencies serving minority and underserved populations. To help coordinate this effort, a team of table leaders would become the catalyst in these discussion and solution groups. These 15 community partner table leaders included nursing staff from breast care centers; a reporter from a Syracuse newspaper; mammography technicians from Syracuse Community Health Center and Community General Hospital; staff from the American Cancer Society; a nurse from the Black Nurses Association; and administrative staff from a local hospital, Crouse Health; and a radiology facility. To help ensure a thorough understanding of this process, a training was conducted prior to the breakfast event to introduce the matrix of A Community of Solutions and to explain the matrix options, expectations of each facilitator, and desired outcomes.


Impact/Effectiveness

The Onondaga County Health Department took the lead with the Mammography Utilization Survey due to its experience in conducting such surveys, the availability of qualified staff, and its connection through the W.H.O. Program Partnership to community resources. The municipal health department had been accustomed to employing standards by which to measure its effectivenessófor example, Healthy People 2000 goalsóand was therefore qualified to measure and manage survey results. Research revealed several benchmarks to measure local CBE and mammography rates against. American Cancer Society literature indicated that a national survey commissioned by Avon and the National Alliance of Breast Cancer Organizations found that 62 percent of women age 50 and older reported having an annual CBE and mammogram. In 1996 the New York State Department of Health Behavior Risk Factor Surveillance System report found that 64 percent of women ages 50 and older had had a mammogram in the past year and 73 percent had had a clinical breast exam. The Healthy People 2000 goals were for 60 percent of women over age 50 to have obtained a mammogram within the two preceding years. Community-wide data revealed a mammography rate of 68 percent, a clinical breast exam rate of 75 percent, and a breast self-exam rate of 64 percent. The CBE and mammography rates exceeded current standards. However, mammography results were found to vary by region. In particular, southeast county, northwest county, and zip codes 13203, 13204, 13207, and 13208 were found to have mammography rates ranging from 53 to 60 percent. In addition, women with incomes under $10,000 per year with Medicaid or without insurance had lower mammography rates. African American women received a higher rate of clinical breast exams than other groups, but their mammography rates fell dramatically. The survey also indicated the following reasons that women had not obtained a recent mammogram: There was no problem, so no reason to go; they were not told they should have one; they didnít think of it; had other priorities; found the cost prohibitive; or feared bad news. These were the most frequently cited reasons.

Each partneróas well as the targeted audienceóbenefited from the ability to collect specific data to mark progress to date with regard to mammography screening. The data revealed reasons for lack of screening and identified geographic areas or subgroups in need of enhanced service. Women in need would directly benefit from having an assessment of need and a service provision personalized to meet their local or community needs. Ultimately, everyone would benefit by having a positive, outcome-oriented program that would focus attention on breast cancer locally. A new goal was established to increase the local mammography rate to 80 percent by 2010 in an attempt to decrease the breast cancer mortality rate by 30 percent.

Fiscal resources were limited: A 1997 grant application to the Susan G. Komen Breast Cancer Foundation provided minimal funds to cover survey costs. A 1998 Komen award provided marketing funds used to pay for the breakfast event. Staff members were recruited as well as volunteers from the Komen Foundation, Advisory Board, current partner agencies, and other organizations. The staff solicited and received food and beverage contributions to feed volunteers who conducted the survey and worked with subcommittee members, partner agencies, and Advisory Board members to implement both the survey and community breakfast. These above-mentioned groups now have a coordination role, whereas the identified contributing partners are responsible for the implementation of their selected strategies.

The matrix summary details the variety of new and existing partnersótheir contributions, involvement, commitment, and proposed allocations to these efforts.

To date, significant milestones have included:

There was surprising coalescence of community effort for both the survey and the breakfast event. Perhaps this was because this was the first event of its kind to be held locally. Local county government took the lead in this project and had support from the county executive and W.H.O. Program Partnership staff. When volunteers were needed to actually conduct the telephone survey, a call went out to health department staff and volunteers, board members, the Komen Foundation, and local health care providers. Little difficulty was experienced in staffing five nights with 20ñ25 people each night. Komen funding made it possible to provide dinner to these volunteers.

Two key health department staff basically dedicated their time for about one month prior to the event. This made carrying out daily work assignments challenging. With additional planning time, the ìcrunch periodî could have been avoided. With a short planning time, funding for the breakfast initially had to be shifted to the state grant until local funding could be found. Had local funding fallen through, there was a risk of spending state grant funds intended for other uses. This was resolved when 1998 Komen Foundation funds held for marketing were used. The funds were thought to have been very well spent and to have benefited all. This event also provided a great deal of media coverage through television, radio, and print, ultimately gaining much publicity and fulfilling the marketing agreement with the Komen Foundation.

Contact: Diane Adler-Farnach, M.S., R.N., Project Director, Womenís Health Outreach Program, Onondaga County Health Department, 421 Montgomery Street, 9th Floor Civic Center, Syracuse, NY 13202. Telephone: (315)435-3280.

Additional materials available upon request.

See map, B7





WELLNESS AT WORK
NEW YORK CITY




Mission/Purpose

Cardiovascular disease causes more deaths in New York State than any other disease. The death rate in the state from cardiovascular disease has consistently been the highest in the nation. Similarly, heart disease is the leading cause of death in New York City, with an age-adjusted death rate of 357 per 100,000 in 1991. The most important risk factors for heart disease include excessive dietary fat, sodium, and calories; inadequate physical activity; and tobacco use.

To reduce the rate of cardiovascular disease, New Yorkers must improve their health habits. However, with work, families, and duties to contend with, most New Yorkers donít have much time for planning and eating healthful meals or for engaging in adequate physical activity. A supportive workplace culture, however, can reduce the incidence of heart disease by encouraging these activities during the workday. Workplaces that develop and implement policies and procedures that foster healthful behaviors during work hours can encourage and empower employees to focus on healthy habits during the day.

Wellness at Work (WAW) is a work site wellness program designed to improve the health and well-being of municipal employees. Moreover, the WAW program is designed to assist with changing the environments at ten work sites, nine municipal sites, Department of Health (three locations), Department for the Aging, Department of Transportation (two locations), Human Resources Administration, Department of Sanitation, Health and Hospitals Corporation, and the Medical and Health Research Association of New York City, Inc. (MHRA), a nonprofit agency, to make them more supportive of healthful lifestyle choices. The WAW program goals are two-pronged: (1) to help establish the infrastructure at each site necessary to advocate, implement, and enforce policy changes, and (2) to build a desire for and an awareness of environmental supports for healthful choices so that employees will request much-needed policy changes and participate in programs that enact and enforce these policies.

The purpose of the Wellness at Work (WAW) program is to implement policy and procedure changes to positively influence the food consumption, tobacco use, and physical activity behaviors of municipal employees at their work sites in the city hall vicinity and outer boroughs.

Initially, five separate work sites located in the 125 Worth Street area of New York City were identified. Letters of support were requested from senior management in the human resources departments of these agencies. Since the initial year of the project, work sites have doubled and continue to follow the same procedures for securing a commitment from the participating agencies. It is essential to get senior management to commit to making the work site policy changes and incentives necessary to meet the proposal objectives. In addition, the agencies must be willing to assign a site coordinator who is directly involved with the WAW program components. Each site coordinator is part of the work site wellness team and participates in organizational program components such as focus groups, surveys, discussion teams, and material distribution.

Once a work site becomes active, a focus group is established. The focus groups consist of the most active participants at each work site. These work site ìinfluentialsî attend focus groups to identify specific health concerns involving food consumption, physical activity, and tobacco use.

Once these focus groups have convened, the WAWís strategies for policy and procedure changes can be implemented and tailored to meet the needs of the specific agency. These changes address food consumption, physical activity, tobacco use, lunchtime programs, and environmental changes. The food consumption program consists of working with on-site food vendors and vending machine suppliers to establish a policy to encourage healthful foods at meetings, in addition to working with local restaurants to prepare and promote healthful food choices. The physical activity program consists of an established walking club and participation in the national physical activity campaign and stair-walking campaign. WAW worked with Project ASSIST through NYC Smoke-Free Coalition, an antitobacco advocacy coalition, to change workplace environments to reduce the incidence of tobacco use in New York City agencies. Lunchtime presentations and demonstrations on program initiatives such as low-fat eating, general wellness habits, physical activity, and tobacco use were also available. Environmental changes were brought about by establishing health information centers at each site. Health literature, videos, and professional and physical activity referrals were provided.

The programís vision is to expand the current work site wellness initiative into a comprehensive work site wellness program for all municipal employees and to extend this program into the cityís residential communities. This entails establishing policy changes in the workplace that are supportive of healthful lifestyle choices.

Effective health promotion among the New York City municipal workforce is in line with national health goals. For example, Healthy People 2000 recommends increasing the proportion of work sites that offer comprehensive health promotion programs. In addition, the demographic profile of the municipal workforce reflects the population targets identified in Healthy People 2000 (i.e., adult Blacks and Hispanics, in addition to women of lower socioeconomic status). According to 1995 data, Blacks and Hispanics constitute 47 percent of the cityís workforce; of the cityís female employees (approximately one-third of the workforce), 75 percent are Black and Hispanic. Moreover, in 1993, two-thirds of all city employees earned no more than $40,000, with over 40 percent making $30,000 or less.

A work site wellness initiative is also in line with many of the priority areas identified in ìCommunities Working Together for a Healthier New York.î This document acknowledges that all sectors of our society must be seriously engaged in improving the health of New Yorkers. Communities Working Together specifically promotes the workplace as a logical site for a variety of health promotion activities, including tobacco control, reductions in cardiovascular disease risks, weight control, and nutrition education. All are components of Wellness at Work.

An innovative aspect of this work site wellness program will be its ability to expand beyond the work site setting into the community at large. Municipal employees who are leaders in their respective communities will be trained to establish fitness awareness and wellness programs in the neighborhoods where they reside. This training will be based on the ìTrain the Trainerî model used successfully by community organizations to optimize local outreach. Thus, the workplace will act as both a support structure and a training center to help employees spread the wellness message deep into the cityís communities.


Leadership Role

The Wellness at Work Program has been incorporated in the New York City Department of Health Center for Integrated Prevention Programs (CIPP), a new unit of the health department that organizes services structurally rather than around disease entities and is committed to forming a strong partnership with community-based organizations. One of the centerís primary objectives is to provide public health technical expertise to the various communities in the city. Based on its experience in work site wellness, Wellness at Work can now help the center reach its objective by offering technical assistance in work site wellness to businesses throughout the city.

Wellness at Work is a three-year project funded by the New York State Department of Health Healthy Heart Program. The grant is administered by the Medical and Health Research Association of New York City, Inc. (MHRA), which is a not-for-profit organization aimed at improving the health status of New Yorkers.

As the lead agency, the NYCDOH is a corporate member of the Wellness Councils of America (WELCOA), a national nonprofit organization dedicated to promoting healthier lifestyles through health promotion activities in the workplace. As such, the NYCDOH has access to appropriate materials, experts, and other resources that can be tapped readily at no cost. In addition, the Center for Integrated Prevention Programs houses Project ASSIST, a federally funded, MHRA-administered antitobacco advocacy coalition dedicated to reducing the incidence of tobacco use in New York City. The NYCDOH, through CIPP, continues to act as the lead agency in providing the program design and implementation. During its second year, the WAW program implemented the CDCís Physical Activity Challenge ìMarch Into Mayî and received recognition from the new NYCDOH Commissioner Dr. Neal Cohen as a model program. As the Wellness at Work Program expands into new sites, the initial program strategies are followed. In addition, a Council on Wellness has been created and will be implemented in the third year. The Council on Wellness was established because some of the original sites have gone beyond the design of the original Wellness at Work Program and have requested assistance in implementing additional health initiatives.


Key Partners/Stakeholders

The principal partners include the NYC Department of Health (three locations), Department for the Aging, Department of Transportation (two locations), Human Resources Administration, Health and Hospitals Corporation, Department of Sanitation, and the Medical and Health Research Association of NYC, Inc. WAW serves on the Quality of Worklife Committee, which is an interagency board served by management from various city agencies, union representatives from ten professional and nonprofessional trades, and employee assistance programs for individual agencies. The Quality of Worklife Committee is responsible for instituting policy changes, such as flexible scheduling, compensatory time, and the Family Leave Act, and for addressing general wellness issues in the workplace.

Wellness at Work continues to develop a public-private partnership. For example, Merck Pharmaceuticals (Osteoporosis Group) has contributed services and goods to Wellness at Work. Merck sponsored a speaker and a dinner at the Plaza Hotel for five representatives of the initial five sites as well as program staff. The speaker, a work site wellness consultant, helped the representatives to plan infrastructures and incentive programs for enhancing employee awareness and participation. Merck also sponsored buffet lunches and a speaker at each site to increase awareness about osteoporosis. In addition, a total of 50 free bone density hand scans were given out by Merck. Merck also underwrote the cost of Thera-Bands, which were distributed to all participants at the lunchtime resistance exercise program.

Wellness at Work is soliciting donations from a variety of private and health insurance providers that serve city employees. GHI has pledged to provide professional services to perform basic blood pressure and cholesterol screenings at the request of some participating sites. GHI and Empire Blue Cross/Blue Shield contributed money toward a participant recognition luncheon, which was held on National Work Site Wellness Day (May 21, 1997). The recognition luncheon for year two was held on June 10, 1998; HIP and Empire Blue Cross/Blue Shield contributed to the day. In addition, contributions for program awards were solicited from many local New York City businesses.

Additional collaborations have been established with the American Cancer Society (ACS) and American Lung Association (ALA). ACS has given over 25 free presentations at these sites on various topics related to cancer. Recently, WAW supported two NYSDOH proposals for cancer screening: the Breast Partnership Program from Columbia University and the Colorectal Cancer Screening and Prostate Education Initiative from Kings County Hospital Center. These collaborations will allow program participants to take part in cancer screening projects.

During its second year of funding, the WAW program created funds for community wellness minigrants. The minigrant proposals had to be submitted by WAW participants and addressed issues of wellness in their home communities. Three minigrants were awarded to three participants who reside in the outer boroughs of New York City. The community collaborations include the Gates Avenue and Medgar Evers Tenants Association (Brooklyn, NY), Community Service Society of New York (Bedford Stuyvesant, Brooklyn, NY) and the Lenox Road Baptist Church (Brooklyn, NY). Collaborations have been established with Brooklyn College Department of Health & Nutrition Sciences through an on-site internship program that offers program support from students who are trained in community health.


Impact/Effectiveness

The primary outcomes of the WAW program are threefold: to establish a work site environment for all municipal employees that is supportive of healthful lifestyle choices; to spread wellness awareness and activity throughout New York City by empowering municipal employees, through work site supports, to establish initiatives in their home communities; and to optimize wellness awareness and activity throughout New York City by helping to create citywide work site wellness partnerships/collaborations.

Outcome number one continues to be achieved by enhancing the scope of services at the intervention sites, engaging a work site wellness consultant to prepare a feasibility plan for expanding the program to all municipal agencies and to present the plan to appropriate government and labor leaders.

Outcome number two continues to be achieved by identifying and supporting employees who submit plans to bring wellness activities to their home communities that are consistent with the goals expressed in ìCommunities Working Together for a Healthier New York.î

Outcome number three continues to be achieved by creating and coordinating work site wellness partnerships among programs, researchers, local businesses, health agencies, and other interested parties and by seeking funds to host a conference on work site wellness strategies and interventions in minority populations.

Additional impact activities include the Heart Check Survey, a survey developed by the New York State Department of Health to assess the level of environmental health support in the workplace. This survey, administered to active sites, showed very low levels of environmental support for wellness activities at these sites. An independent survey was administered to six sites to assess participantsí knowledge of the smoking policy at their agency. The results from the survey assisted in planning with the human resources directors to educate participants about their agencyís smoking policies. A cooperative effort with the Smoke-Free Coalition is currently underway to implement a smoke-free policy in all New York City agencies. These agencies have been encouraged to send out reminders to participants about their smoking policy. All sites continue to evaluate the lunchtime presentations/demonstrations. The results from year one were helpful in scheduling the presentations for year two. Participating sites in the WAW CDC Physical Activity Challenge ìMarch into Mayî program followed the evaluation protocol for participants. These evaluation forms assist in targeting promotional activities to specific groups. WAW developed the ìConnect with the City Hall Circuit: A Physical Activity Guide,î which was distributed to all sites and is used as a guide for the WAW Friday Walking Club. Policy on ìFood Served at Agency Meetingsî was approved by the NYCDOH. A WAW Newsletter was developed for NYCDOH employees. Other agencies have implemented newsletters at their sites. A ìGuide to Choosing Healthful Foods When Eating Out at Workî was developed, and a press release announced the Recognition Luncheon.

The WAW has been fortunate to have dedicated employees, consultants, and interns who have gone beyond the scope of their jobs to offer this program to city employees. The program has received increased funding from the NYSDOH Healthy Heart Program. Additional funds would enable the WAW to extend the program to all municipal employees and to the outer boroughs. The potential outreach includes approximately 250 city agencies, each housing 30 bureaus and employing approximately 400 city workers per bureau throughout the five boroughs of New York City.

Contacts:

Andrew Goodman, M.D., M.P.H. Telephone: (212) 788-4656.
Fax: (212) 788-4920. E-mail: Agoodman@dohlan.ci.nyc.ny.us

Daria Luisi, Ph.D., M.P.H. Telephone: (212) 442-1860. Fax: (212) 442-1855.
E-mail: Dluisi@brooklyn.cuny.edu

Gloria McNamara, M.S., R.D. Telephone: (212) 442-1851. Fax: (212) 442-1855.

Susan Wilt, Dr.Ph. Telephone: (212) 676-2161. Fax: (212) 676-2161.
E-mail: Saw2@columbia.edu

See map, p.viii. D4-8



 


 
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