FLORIDA INTERNATIONAL UNIVERSITY PUBLIC HEALTH TRAINEESHIP (FIU PHT) Collaborative Community-Based Project Ideas FLORIDA DEPARTMENT OF HEALTH IN MIAMI-DADE COUNTY Environmental Health One of the core Environmental Health functions in Miami Dade County is to protect the health of all its residents and visitors by preventing illnesses and injuries related to environmental health factors. An effective method for disease prevention, according to the Florida State Health Improvement Plan (FL-SHIP 2013-2015), is educational outreach, human behavior change, and county and community collaborations. For this reason, the state has set specific objectives to meet this goal and by December 31, 2015, Environmental Health will carry out the implementation of a Protocol for Assessing Community Excellence in Environmental Health (PACE EH) in our county. PACE EH has been successfully used in communities to improve the quality of life in underserved communities by interactions and collaborations between regulatory agencies, private industries and communities. In Miami-Dade, PACE EH is of extreme importance as we have many communities in need of environmental public health prevention activities Unfortunately, Environmental Health in Miami Dade County is currently experiencing budgetary constraints that cannot allow the designation of a full time employee to undertake this noble project. Thus, the help of a public health trainee to assist in the assignment would be of great significance for the community and the student. Environmental Health staff skilled in PACE-EH and the community will provide the necessary training and guidance for the student throughout this effort. PACE EH will allow the student to apply the classroom knowledge and gain hands on experience by helping underserved communities to build and sustain a healthier place to live. Community Health Improvement Plan In 2013, the community participated in the Mobilizing for Action through Planning and Partnerships (MAPP) process that focuses on community health priorities, goals and strategies in Miami Dade County. MAPP is a community wide strategic planning framework for improving public health. It helps communities prioritize their public health issues, identify resources for addressing them, and implement strategies relevant to their community settings (Health Council of South Florida, 2013). After reviewing current community health improvement efforts, The Florida Department of Health in Miami Dade in collaboration with the Health Council of South Florida conducted the following four assessments: 1. Local Public Health System Performance Assessment 2. Community Themes and Strengths Assessment 3. Forces of Change Assessment 4. Community Health Status Assessment Upon the completion of the comprehensive community assessment, twenty health priorities were identified. Upon further evaluation, five focus areas were established as the foundation for the Miami-Dade Community Health Improvement Plan: 1
I. Access to Care, II. Chronic Disease Prevention, III. Healthcare Disparities, IV. Mental Health & Mental Disorders, V. STD and Infectious Diseases The Florida Department of Health in Miami-Dade County organized the Community Health Improvement Plan by incorporating the twenty health priorities identified in the MAPP process into the five focus areas. Priorities (MAPP Priority ranking in parenthesis) Access to Care (1) Chronic Disease Prevention (2) Primary Care & Medical Homes (4) Heart Disease & Stroke (9) Special Needs populations (12) Tobacco use (20) Cultural competencies (16) Increased Interagency Coordination (8) Oral Health (18) Cancer (11) Increased Interagency coordination (8) Nutrition & Physical activity (5) Undocumented population (15) Workforce (17) Healthcare Disparities (3) Mental Health & Mental Disorders (6) Socioeconomic factors (7) Substance Abuse & Excessive Drinking (13) Injury & violence prevention (19) Increased Interagency Coordination (8) Maternal and Child Health (14) Increased Interagency Coordination (8) HIV, STD and Infectious Diseases (10) Increased Interagency Coordination (8) Proposed Project: Students would be able to pick an area of the Community Health Improvement Plan and work on the goals strategies and objectives with the respective program within the Florida Department of Health. A comprehensive database mapping out all of the goals, objectives and strategies has been developed however there is a need to obtain baseline data and indicators for this project. Students would be able to help design the tool and help with the implementation and evaluation of the five year plan. Examples of strategies: 1. Establish database to capture community resources within the community and identify gaps. 2. Tract neighborhood level health indicators 3. Identify areas within the county with shortages of primary medical care, dental or mental health providers 4. Conduct an assessment in order to identify providers of mental health services 5. Develop an educational awareness campaign that encourages Miami-Dade individuals to participate in preventative Oral Health Care Coverage. 2
6. Develop a process to promote essential health services for pregnant women in Miami-Dade 7. Create an educational campaign that informs provider of resources that are available within Miami-Dade for persons age 60 and older. 8. Develop an educational campaign for the community educating on the importance of being immunize to protect against vaccine preventable diseases. 9. Develop strategies to reduce bacterial STD cases and increase testing. 10. Provide educational outreach testing, behavior change early identification treatment and community collaboration in Miami Dade to reduce the TB case rate. 11. Promote awareness and education in the community by implementing HIV/AIDS prevention behavioral models to target adults in high incidence areas of Miami- Dade. Consortium for a Healthier Miami-Dade The FDOH-MDC works closely with organizations in the community to provide coordination and collaboration within the county without duplication of services. In 2003, due to the increasing rates of Chronic Disease in the county the FDOH-MDC established the Consortium for a Healthier Miami-Dade. The convergence of partners reflected a need for instituting a community-based planning approach to reduce chronic disease risk factors and improve community health. Consortium initiatives are guided by the goals and objectives established in Healthy People, the national blueprint for health. The Consortium works in a committee structure with each committee focused on a key area of health. The Consortium is comprised of over 200 organizations and over 500 individual members (Florida Department of Health in Miami-Dade County, 2013). The mission of the Consortium is to be a major catalyst for healthy living in Miami-Dade through the support and strengthening of sustainable policy, systems and environmental changes. Its vision is healthy environments, healthy lifestyles, and healthy community. The Consortium is comprised of the following eight committees focused on key areas of health: Children Issues, Elder Issues, Health and the Built Environment, Health Promotion and Disease Prevention, Oral Health, Marketing and Membership, Tobacco- Free Workgroup and Worksite Wellness. The FDOH-MDC, OCH&P has experience working with the community through the Consortium. In 2009, a grant writing team from organizations within the Consortium came together and applied for the Communities Putting Prevention to Work grant (CPPW). In 2010, the FDOH- MDC was awarded $14.7 million through the CPPW grant to reduce obesity and its associated risk factors by implementing policy, systems and environmental changes. The areas with the greatest need and disparity were given priority. The FDOH-MDC contracted with 30 community partners to create environments that encourage healthy eating and physical activity. At the inception of CPPW, the FDOH-MDC provided the contracted community partners with maps reflecting the areas of Miami-Dade County that have the greatest need based on poverty level, chronic disease, and rate of uninsured/ underinsured individuals. These areas were predominantly located in the northern part of the county, which the exception of one area located in the southernmost part, and included the areas of Liberty City, Opa-Locka, Overtown, Florida City, among others. When implementing initiatives, the partners prioritized locations in those areas of 3
greatest need. To ensure that we were reaching the target populations, the local CPPW media campaign was branded as Make Healthy Happen Miami and developed in three languages, English, Spanish and Haitian-Creole. This initiative was supported by five of the Consortium committees, Children Issues, Health and the Built Environment, Health Promotion and Disease Prevention, Marketing and Membership, and Worksite Wellness. Through this collaboration and partnerships CPPW worked to encourage healthy lifestyles by implementing the following 11 goals: 1. Enhance/ Strengthen Consortium: Increase number of high-level community leaders who enact and support evidence-based policies. 2. Mass Media Campaign: Raise awareness of healthy eating and promote healthy food choices and physical activity. 3. Child Care Centers: Increase access to healthy food and beverages, require daily activity, and limit screen time. 4. Farm-to-School Nutrition: Improve access to healthy foods and reimbursable meals in public schools. 5. Physical Activity in Miami-Dade County Public Schools: Increase physical activity in public schools. 6. Access and Consumption of Healthy Foods via Convenience Stores: Increase community access to healthy and affordable foods. 7. Farmer s Markets and Farm-to-Institutions: Increase access to healthy foods, fruits, and vegetables through farmers markets. 8. Breastfeeding Practices and Facilities: Increase breastfeeding practices and breastfeeding friendly facilities. 9. Active Transportation and Recreation: Increase active transportation and recreation through the built environment. 10. Safe Routes to Schools: Increase sustainable Safe Routes to School initiatives 11. Worksite Wellness: Increase the number of worksite wellness programs that implement nutrition policies and physical activity. Within the 11 goals 30 objectives were outlined in the CPPW Community Action Plan, of which 24 were completed and six were not completed. Of the six that were not completed, three were partially met and community partners will continue to work to meet the objective. CPPW has made a significant impact on the quality of life of residents and visitors in Miami-Dade County. The community has increased access to opportunities to participate in physical activity and make healthier choices. The accomplishments and successes of CPPW are being sustained through the work of the Consortium. Proposed Project: Students would design projects to follow up on one or more of the 11 goals that were implemented with CPPW. EVALUATION OF HOUSING MODELS FOR PEOPLE LIVING WITH HIV/AIDS IN KEY WEST, FL Esneider Gomez - Biostatistics Florida Health Monroe County Robert B. Eadie, J.D., Administrator and Preceptor 4
Dr. Odale Williams, Faculty Advisor Fall 2013 Practicum extended into Spring 2014 A Biostatistics student conducted his practicum at a County Health Department Florida Health in Monroe County, where he examined the performance of a Modified Housing Approach created and implemented by AIDS Help of Monroe County, Inc. (AHI) to permanently house people living with HIV/AIDS (PLWHA) in Key West, Florida. The student compared the Modified Housing Approach model to the widely used Housing First model with the use of health and housing outcomes of all past and current tenants from two AHI housing properties (Poinciana Royale and Seebol Place); each employing one of the two aforementioned housing models. No significant differences were found in health outcomes (with the exception of clinical visit adherence) when comparing both models. Housing outcomes (i.e. retention rate, turnover rate and status at exit) were significantly different. These findings suggest that the best model for housing PLWHA in Key West, FL is the Modified Housing Approach model. Housing First, at its core, is an aggressive approach to rapidly housing the homeless/chronically homeless with no requirements/expectations attached. Its central premise consist of the idea that by eliminating the burden of finding and maintaining a stable home the individual will be more easily engaged in clinical services and by extension leading to improved medical outcomes (National Alliance to End Homelessness, 2006). A Modified Housing Approach means all tenants that were also PLWHA would have to adhere to a personalized case management program. These programs would include life skills training, drug/alcohol interventions & mental health counseling (if necessary), and monitored clinical visits. A proposed project would analyze additional data from the Modified Housing Approach model. HEALTH COUNCIL OF SOUTH FLORIDA Design and conduct an evaluation of Florida State Legislature s award to the Florida Association of Free Clinics under the preceptorship of Health Council of South Florida s Executive Director, Marisel Losa and faculty mentorship of Dr. William Darrow, Professor in Health Promotion and Disease Prevention, RSCPHSW. 5