PACE-EH Marydia: Improvements in a Disadvantaged Community

State: FL Type: Model Practice Year: 2011

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"Protocol for Assessing Community Excellence in Environmental Health (PACE-EH) is an evidence-based program centered on the Institute of Medicine’s core public health definition of “assessment, policy development, and assurance.” PACE-EH was developed by the National Association of County and City Health Officials (NACCHO) and the Centers for Disease Control (CDC) as a means to involve stakeholders in working together to address a community’s environmental and social determinants of health. Osceola County Health Department’s (OCHD) Environmental Health division identified the target community, Marydia, based on several factors that include high rates of fetal and infant mortality; diabetes; cardiovascular illnesses; high school drops-outs; crime; and poverty. Marydia is a small community of approximately 250 residents located within the city of Kissimmee, Florida.

In January 2009, OCHD staff conducted a community walk-through assessment and found poor housing conditions; failing septic systems; abandoned homes used for illegal drug activity; lack of sidewalks or street lights; neglected community park; poor air quality related to dust from a nearby concrete plant; and other social determinants that are contributors to poor health. Staff conducted a door-to-door survey, reaching approximately 22% of the residents. Results showed their top five priorities were access to healthcare, need for street lights, poor air quality, community park, and reduced neighborhood crime. Based on these results, staff applied for and received a grant of $20,000 from Florida Department of Health PACE-EH to fund staff salaries for development of the project.

A Community Kick-off Health Fair was held in June 2009 as an outreach to residents. The project’s overarching direction was to improve the quality of life for the residents of Marydia by improving their health and safety and by building their pride in the community so they have a desire to sustain improvements. OCHD took a leadership role in developing local coalitions; facilitating community meetings; coordinating and implementing action plans; and demonstrating to residents the power of local planning and community involvement. The project’s primary goal was to address built environment and social determinants of health that when improved can lead to and sustain a healthier and safer community. The key objective was to bring built environment and health issues to the attention of key stakeholders and partners that can assist in addressing these issues.

Our partnership included Osceola County’s Parks and Recreation, Road and Bridges, and Extension Services; county commission; law enforcement; churches; hospitals; and businesses.

Outcomes include:
• Partnering with Florida Department of Environmental Protection to bring local cement factory to compliance.
• Partnering with Osceola County government to address issues in built environment and social determinants of health including:
1. Revitalized park with children’s playground to encourage physical activity
2. Law enforcement substation bringing stricter control over illegal drug activities and closer monitoring of neighborhood
3. County Code Enforcement cleaned up neighborhood and condemned / demolished two abandoned dwellings used as crack houses
4. Constructed new road and sidewalk leading to community park
5. Installed street lights and street safety bumps
• Mentoring program to help address low literacy, high education drop-out rate.
• Established Boy and Cub Scout troops.
• Non-profit group of African-American attorneys brought male mentoring program, “Men of Distinction,” into community, giving males positive role models for taking responsibility, becoming community leaders, and being positive role models for younger boys.
• Educational classes at local churches including smoking cessation, diabetes, healthy eating, healthy pregnancies/healthy babies, hypertension, and exercise. PACE-EH brought the following funding resources into Maryd"

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Osceola County Health Department
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PACE-EH Marydia: Improvements in a Disadvantaged Community
"Protocol for Assessing Community Excellence in Environmental Health (PACE-EH) is an evidence-based program centered on the Institute of Medicine’s core public health definition of “assessment, policy development, and assurance.” PACE-EH was developed by the National Association of County and City Health Officials (NACCHO) and the Centers for Disease Control (CDC) as a means to involve stakeholders in working together to address a community’s environmental and social determinants of health. Osceola County Health Department’s (OCHD) Environmental Health division identified the target community, Marydia, based on several factors that include high rates of fetal and infant mortality; diabetes; cardiovascular illnesses; high school drops-outs; crime; and poverty. Marydia is a small community of approximately 250 residents located within the city of Kissimmee, Florida. In January 2009, OCHD staff conducted a community walk-through assessment and found poor housing conditions; failing septic systems; abandoned homes used for illegal drug activity; lack of sidewalks or street lights; neglected community park; poor air quality related to dust from a nearby concrete plant; and other social determinants that are contributors to poor health. Staff conducted a door-to-door survey, reaching approximately 22% of the residents. Results showed their top five priorities were access to healthcare, need for street lights, poor air quality, community park, and reduced neighborhood crime. Based on these results, staff applied for and received a grant of $20,000 from Florida Department of Health PACE-EH to fund staff salaries for development of the project. A Community Kick-off Health Fair was held in June 2009 as an outreach to residents. The project’s overarching direction was to improve the quality of life for the residents of Marydia by improving their health and safety and by building their pride in the community so they have a desire to sustain improvements. OCHD took a leadership role in developing local coalitions; facilitating community meetings; coordinating and implementing action plans; and demonstrating to residents the power of local planning and community involvement. The project’s primary goal was to address built environment and social determinants of health that when improved can lead to and sustain a healthier and safer community. The key objective was to bring built environment and health issues to the attention of key stakeholders and partners that can assist in addressing these issues. Our partnership included Osceola County’s Parks and Recreation, Road and Bridges, and Extension Services; county commission; law enforcement; churches; hospitals; and businesses. Outcomes include: • Partnering with Florida Department of Environmental Protection to bring local cement factory to compliance. • Partnering with Osceola County government to address issues in built environment and social determinants of health including: 1. Revitalized park with children’s playground to encourage physical activity 2. Law enforcement substation bringing stricter control over illegal drug activities and closer monitoring of neighborhood 3. County Code Enforcement cleaned up neighborhood and condemned / demolished two abandoned dwellings used as crack houses 4. Constructed new road and sidewalk leading to community park 5. Installed street lights and street safety bumps • Mentoring program to help address low literacy, high education drop-out rate. • Established Boy and Cub Scout troops. • Non-profit group of African-American attorneys brought male mentoring program, “Men of Distinction,” into community, giving males positive role models for taking responsibility, becoming community leaders, and being positive role models for younger boys. • Educational classes at local churches including smoking cessation, diabetes, healthy eating, healthy pregnancies/healthy babies, hypertension, and exercise. PACE-EH brought the following funding resources into Maryd"
The PACE-EH Marydia project addresses the environmental and social determinants which have an impact on the overall health outcomes, healthcare access, and health disparities that exist for Marydia’s residents. Marydia, a disadvantaged community of approximately 100 homes and predominately African-American residents, had some of the highest rates of health disparities in Osceola County. It also had some of the highest rates of high school drop-outs, crime, and poverty. The community had been neglected for years, and residents, many of whom were skeptical of external involvement, had not accepted some of the minimal interventions offered in the past. At the start of the project in January 2009, OCHD Environmental Health staff conducted a walk-through assessment of the community and found the majority of the homes in disrepair. The homes were serviced by individual septic systems of which approximately 25% were in failure, some with raw sewage on the ground. This situation created a major health hazard for residents and the groundwater supply as nearly one-third of the homes obtained drinking water from wells on their property. The walk-through assessment also showed abandoned houses used for illegal drug activity; drug dealing out in the open as staff took pictures of the neighborhood; lack of sidewalks or street lights; a run-down community park; poor air quality related to dust from a nearby concrete plant; and other social determinants that are contributors to poor health. OCHD staff conducted a door-to-door survey which showed the residents’ top five priorities were access to healthcare, need for street lights, poor air quality, need for a community park, and reduced neighborhood crime. Based on the Harvard School of Public Health’s Health-Wealth Gradient, which provides an evidence-based link between low income and health status, OCHD staff had insight into the social determinants of health that exist for Marydia’s residents relative to poverty, high unemployment, transportation barriers, lack of access to services, poor personal health practices, and low coping skills. This network of interacting stress factors increases the likelihood of poorer health outcomes and decreased life expectancy.
Agency Community RolesOCHD has been the lead agency in the development and implementation of the PACE-EH Marydia project. Staff identified the target community, Marydia, based on several factors that included high rates of fetal and infant mortality; diabetes; cardiovascular illnesses; high school drops-outs; crime; and poverty. OCHD staff conducted a community walk-through assessment and found poor housing conditions; failing septic systems; abandoned homes used for illegal drug activity; lack of sidewalks or street lights; neglected community park; poor air quality related to dust from a concrete plant; and other social determinants that are contributors to poor health. OCHD staff conducted a door-to-door survey, reaching approximately 22% of the residents. Results showed their top five priorities were access to healthcare, need for street lights, poor air quality, need for a community park, and reduced neighborhood crime. Based on the community assessment, OCHD staff applied for and received a grant of $20,000 from Florida Department of Health PACE-EH to fund salaries to develop the project. OCHD sponsored a Community Kick-off Health Fair in June 2009 as an outreach to the residents. The project’s overarching direction was to improve the quality of life for the residents of Marydia by improving their health and safety and by building their pride in the community so they have a desire to sustain improvements. OCHD took a leadership role in developing local coalitions; facilitating community meetings; coordinating and implementing action plans; and demonstrating to residents the power of local planning and community involvement. The project’s primary goal was to address built environment and social determinants of health that when improved can lead to and sustain a healthier and safer community. A key objective was to bring built environment and health issues to the attention of stakeholders and partners that can assist in addressing these issues. Our partnership includes Osceola County’s Parks and Recreation, Road and Bridges, Extension Services; the district’s County Commissioner; law enforcement; local churches; and businesses. OCHD staff, in collaboration with community partners, identified and implemented strategic activities and goals for advocacy and recommendations for policy change that have brought about substantial improvements in the community. Costs and ExpendituresProtocol for Assessing Community Excellence in Environmental Health (PACE-EH) is an evidence-based program centered on the Institute of Medicine’s core public health definition of “assessment, policy development, and assurance.” PACE-EH was developed by the National Association of County and City Health Officials (NACCHO) and the Centers for Disease Control (CDC) as a means to involve stakeholders in working together to address a community’s environmental and social determinants of health. Osceola County Health Department’s (OCHD) Environmental Health division identified the target community, Marydia, based on several factors that include high rates of fetal and infant mortality; diabetes; cardiovascular illnesses; high school drops-outs; crime; and poverty. Marydia is a small community of approximately 250 residents located within the city of Kissimmee, Florida. In January 2009, OCHD staff conducted a community walk-through assessment and found poor housing conditions; failing septic systems; abandoned homes used for illegal drug activity; lack of sidewalks or street lights; neglected community park; poor air quality related to dust from a nearby concrete plant; and other social determinants that are contributors to poor health. A Community Kick-off Health Fair was held in June 2009 as an outreach to residents. The project’s overarching direction was to improve the quality of life for the residents of Marydia by improving their health and safety and by building their pride in the community so they have a desire to sustain improvements. OCHD took a leadership role in developing local coalitions; facilitating community meetings; coordinating and implementing action plans; and demonstrating to residents the power of local planning and community involvement. The project’s primary goal was to address built environment and social determinants of health that when improved can lead to and sustain a healthier and safer community. The key objective was to bring built environment and health issues to the attention of key stakeholders and partners that can assist in addressing these issues. Our partnership included Osceola County’s Parks and Recreation, Road and Bridges, and Extension Services; county commission; law enforcement; churches; hospitals; and businesses. Outcomes include: • Partnering with Florida Department of Environmental Protection to bring local cement factory to compliance. • Partnering with Osceola County government to address issues in built environment and social determinants of health including: 1. Revitalized park with children’s playground to encourage physical activity 2. Law enforcement substation bringing stricter control over illegal drug activities and closer monitoring of neighborhood 3. County Code Enforcement cleaned up neighborhood and condemned / demolished two abandoned dwellings used as crack houses 4. Constructed new road and sidewalk leading to community park 5. Installed street lights and street safety bumps • Mentoring program to help address low literacy, high education drop-out rate. • Established Boy and Cub Scout troops. • Non-profit group of African-American attorneys brought male mentoring program, “Men of Distinction,” into community, giving males positive role models for taking responsibility, becoming community leaders, and being positive role models for younger boys. • Educational classes at local churches including smoking cessation, diabetes, healthy eating, healthy pregnancies/healthy babies, hypertension, and exercise. Specific factors that lead to the success of this project include the development of a strong community partnership and grass-roots community leaders; open communications with residents in meetings and daily contact has helped build a strong trust, bridging the gap that had existed between the community and government; and the results that have been achieved has helped build a sense of pride in the community leading to more community involvement ImplementationProcess Objectives during September 2008 through June 2009: 1. By March 15th - select a PACE-EH community based on health data. • During September through February 2009 - used various state and local community profiles to identify health indicators prevalent in the community. Marydia was selected based on identification of environmental and social determinants having an impact on the overall health outcomes, health care access, and disparities that existed in this community. 2. By March 30th - complete a walk-through assessment of the community. • Findings included: majority of homes in disrepair; 25% of septic systems were in failure; some with raw sewage on the ground; abandoned houses used for illegal drug activity; lack of sidewalks or street lights; neglected community park; and poor air quality related to dust from a nearby concrete plant. 3. By April 15th - develop a community health needs assessment survey and go door-to-door conducting survey and meeting residents. • Staff conducted a door-to-door survey, reaching 22% of community residents. • Identified residents’ top five priority issues as street lights, poor air quality, a community park, reduction in neighborhood crime, and access to healthcare services. 4. By May 1st - start meeting with county government and community stakeholders to begin building a team of partners. • Engaged community partners in planning and supporting efforts to address identified issues. • Enlisted district’s County Commissioner (who played an integral role in the coordination of county services to address the needs). 5. By May 15th - meet with stakeholders, share survey results, and begin to develop a strategy for improving the health and safety needs identified by the survey. • Initiated quarterly Town Hall meetings, led by community faith-based leaders, to mobilize residents for discussion and involve them in planning. • Set up a Resident Action Council 6. By June 30th - hold a Kick-off Health Fair to introduce the community to our partners and share plans based on community survey results. • Set up 35 booths offering health education, health screenings, referral to OCHD primary care medical home, nutrition education, and general information • Set up quarterly community health education classes The strategy listed above includes the actionable steps we took to implement PACE-EH within the Marydia community. From there we were able to further develop community involvement that resulted in the many accomplishments of this project (listed in the preceding sections). We started the PACE-EH concept by assessing needs and identified the Marydia community during September 2008 through February 2009. Our process objectives listed in action steps 1 through 6 were accomplished from March through June 2009. From that time until now we have continued work with our community partners, the residents, and other stakeholders to achieve the many accomplishments. This is an ongoing, open-ended project that will continue as OCHD acts in a facilitative role to support the community’s grass-roots leaders as they take their community forward.
PACE-EH Marydia’s goal is to engage the community to build partnerships to address built-environment and social determinants of health that when improved will lead to and sustain a healthier and safer community. Objective: Bring built-environment and health issues to the attention of key stakeholders and partners that can assist in addressing these issues. Data Collection: Data for the evaluation sections below were collected by OCHD PACE-EH Marydia staff. Methods included contact logs; community surveys; community meetings and focus groups; reports from county government; and anecdotal observations. Performance Measures and Evaluation Results: Process Evaluation. Osceola County Environmental Health Survey conducted during September-December 2008: • OCHD staff conducted a door-to-door survey, reaching 22% of community residents. • Top five priority issues were access to healthcare services, need for street lights, poor air quality, a community park, and reduced neighborhood crime. Community Walk-Thru Assessment by OCHD staff in January 2009: • Findings included: majority of homes in disrepair; 25% of septic systems were in failure, some with raw sewage on the ground; abandoned houses used for illegal drug activity; lack of sidewalks or street lights; neglected community park; and poor air quality related to dust from a nearby concrete plant. Quarterly Community Meetings: • March 11, 2010 – 12 participants. • June 10, 2010 – 25 participants. • August 19, 2010 - 82 participants. • 583% increase in attendance March to August 2010. Community Kick-Off Health Fair June 12, 2009: • 35 booths offering health education, health screenings, referral to OCHD primary care medical home, nutrition education, and general information. • 125 residents attended. Community Health Education Classes: • Diabetes and Nutrition – 22 residents attended. • Healthy Babies – 8 expectant mothers attended. • Children’s Nutrition – 8 mothers, 12 children attended. • Adult Nutrition – 11 attended. Resident Action Council: • 17 members: 8 residents, 6 staff from various county government divisions, 3 OCHD staff. Resident-Operated Community Crime Watch: • Osceola County Sheriff provided residents with uniforms and a patrol vehicle. Men of Distinction Male Mentoring: • 1 retreat for 6 community men. • Monthly meeting with 6-10 community men attending. Boy Scout/Cub Scout Troup: • 12 Cub Scouts. • 5 Boy Scouts. Outcome Evaluation: • Cement plant brought under code compliance. • Osceola County Sheriff reported crime reduced by 15% in Marydia during July-Aug 2010 compared to only 6% county-wide. This gave Marydia the lowest crime rate of any neighborhood in the county. • County repaired four homes that had failing septic systems with sewage spilling onto the ground. • City water supply made available to all homes in the community, replacing many malfunctioning private well. Residents were not charged a hook-up fee. • Community park area was remodeled with all new equipment for a children’s playground; drinking fountain and baseball goals were added. • County Code Enforcement demolished two abandoned dwellings used as crack houses; two houses are scheduled for demolition; and two houses are being remodeled by Habitat for Humanity. • Law enforcement substation established in Marydia. • County constructed one new road and a sidewalk leading to new park. • County completed installation of 50% of scheduled street lights, street safety bumps, and sidewalks. Money brought into community due to PACE-EH: • Board of County Commissioners. 1. $300,000 spent on built-environment projects. 2. $2,030,659 budgeted for 2010-2011 to complete current projects including new community center with two playgrounds. • State Senator. 1. $200,000 committed to the new community center. • Federal Community Development Block Grant award for $1 million. • Wal-Mart Inc. – $1,000 in gift cards f
Two specific factors that helped lead to PACE-EH Marydia’s tremendous success were the development of a strong community partnership and the development of committed grass-roots community leaders. The active involvement of the community is an essential component of the program. PACE-EH is designed to strengthen community participation by encouraging their involvement in the decision-making processes from the very beginning. This serves to ensure that the community’s values and priorities are considered and encourages a sense of community ownership for long-term sustainability. From the beginning of the PACE-EH Marydia project, OCHD staff encouraged a strong emphasis on developing partnerships between community residents, community leaders, community partner organizations, county government, and elected officials. As these partnerships were developed, they started identifying local issues, setting priorities for action, and working collaboratively to strategically address the identified issues. Significant new relationships have been established as the faith-based leaders and residents began working with community organizations, Osceola County government, and local businesses. A community Resident Action Council, which is a strategic planning and decision-making group of residents, is working to address issues related to neighborhood change. The goal of this council is to empower the residents to continue the work that has been initiated by the PACE-EH Marydia program, by learning to work directly with local government and leaders, and thereby ensuring greater sustainability of the program. OCHD will continue working in a facilitative role to help ensure long-term sustainability. The PACE-EH Marydia program fits well within OCHD’s mission to “promote, protect, and improve the health of all people in Osceola County” and our 2008-2013 Strategic Plan objectives that address improving the community’s environmental and health status indicators. OCHD currently is in the process of working with county-wide community partners to develop a Community Balanced Scorecard (CBSC) strategic planning system to align collaborative efforts of a broad range of stakeholders by focusing them on addressing Osceola County’s environmental and health priorities. PACE-EH Marydia will be included in this larger effort in order to leverage other resources than those involved thus far in the project. Our CBSC is represented graphically by a “strategy map,” the heart of the CBSC, which is a powerful communication tool to help all partners understand overall strategy. The visual communication power of the strategy maps encourages “system thinking” that communicates how resources from all partners and other funding sources can be leveraged as part of a larger strategy. Most importantly, the CBSC‘s strategic management practices and tools align efforts around the “community strategy” rather than around strategies and agendas of individual organizations. This strategy-centered approach to linking objectives and projects is especially well-suited to identifying where other programs and resources can be leveraged to increase sustainability. Additionally, on the most basic level of where the work actually gets done, the CBSC is a way to identify who commits to what and holds partner organizations accountable for doing what they say they’ll do by measuring outcomes.
 
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