Residential Pool Safety Program

State: NJ Type: Neither Year: 2015

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Middle-Brook Regional Health Commission is a small local health department located in central New Jersey providing public health services to five municipalities in Somerset County.  While Somerset County is the wealthiest county in New Jersey by per capita income and is the ninth wealthiest in the nation, the Commission's service area includes two of the lowest and two of the highest per capita income municipalities within the county, resulting in a very diverse population of approximately 44,000 residents.  Properties range from small, multi-unit housing sites to expansive multi-acre single residential lots.  Private residential pools of varying sizes and types are found on all types of properties and at all levels of income. According to the Centers for Disease Control and Prevention drownings are the leading cause of injury death for children ages 1 to 4, second leading cause for those under age 14 and fifth for all ages, yet in New Jersey there is no single or ongoing mechanism to assure the safety of residential swimming pools.  Following a number of reported residential pool incidents in nearby communities, the Middle-Brook Regional Health Commission took action to prevent such an occurrence in our jurisdiction by developing a residential pool safety program to educate the public and provide a voluntary onsite assessment of residential pools. The goal of the residential pool safety program is to prevent accidental death and injury at private residential pools.  Our objectives were to by May 15, 2014: 1] develop an educational flier for private pool owners highlighting the hazards associated with a pool and the means to abate any identified hazards, 2] promote private residential pool safety and responsibility through paper and video advertising, and 3] provide educational, on-site assessments of private pools that identify specific potential hazards and how to correct them. A health education student completed her required internship at the Commission by researching the rules and standards for residential pools and developing an educational flier and assessment checklist highlighting key safety features. The documents were created in collaboration with permitting entities such as construction, electrical, and plumbing officials as well as staff environmental health specialists and certified pool operators familiar with public recreational bathing establishment operations. Once completed the program and flier were advertised in local newsletters, through local media outlets and at local pool supply stores. A one-minute public service announcement advertising the program was produced at a local cable station and was regularly shown on local access cable networks as well as placed on the health department’s website. A second live action video was produced in collaboration with our local public schools and was also shown on local access television. An on-site assessment of private pools was conducted by certified registered environmental health specialists utilizing the checklist of nearly 30 safety items covering issues ranging from barrier requirements to chemical and electrical safety. This on-site assessment is designed to educate pool owners on pool operation and safety, point out potential safety issues, and address questions and concerns of the pool owner. At the conclusion of the assessment, the property owner is provided a copy of the comprehensive checklist for their reference and a copy is maintained by the department for follow up.   All of the objectives of the program were met as a result of the collaboration of multiple agencies and entities.  Due to the limited availability of funding, the in-kind services provided by many enabled the program to be launched and advertised widely.  The private pool owners who took advantage of the program reported positive feedback on the staff conducting assessments, assessment outcomes, and materials provided.  Pools are clearly a potential public health hazard as evidenced by the CDC statistics noted above and recent events in neighboring communities.  As there are no authorizing rules or regulations no enforcement can be taken by the Health Department, but it is our hope that education and an in person assessment will motivate pool owners to improve the safety of their facilities thereby reducing the likelihood of morbidity and mortality associated with the enjoyment of residential pools. See www.middlebrookhealth.org to access the video and flier.  
As noted, drowning is a leading cause of accidental death, especially among children, and approximately 5000 emergency room visits occur each year in the United States as a result of a pool or spa related injury and yet in New Jersey residential pools are not subject to ongoing inspection or enforcement of safety requirements.  Essentially, once a pool is built or installed the pool owner is on their own to maintain the pool and assure its safety.  This information, along with several local drownings including two siblings under the age of five, and the observations of several pools without fences around them prompted the Middle-Brook Regional Health Commission to take action to prevent a similar occurrence in our service area. While we know that much of our service area is very affluent and residential pools are common, we also know that a significant portion of our population is less well off; lives in apartments and multi-family housing, and portable pools that are completely unregulated are commonplace.  What we do not know is the number and type of residential pools as there is no ongoing permitting process.  Discussions with the agencies responsible for regulating the installation and construction of pools revealed that no comprehensive list of pools exists, and further, that if a permit is not active (meaning the permitted work has been completed), no regulatory action can be taken to address a residential pool, even when problems are reported.  Actions may be taken in the future to address this state-level policy issue but since nothing was or had ever been done to address the hazards associated with residential pools this program was initiated. A search of the literature revealed that many health departments and other agencies have developed educational programs focusing on pool safety as well as other water related recreational activities but no such program was found that incorporated an on-site assessment of the pool.  Because of the health department's public recreational bathing program, it was clear that pointing out specific hazards to a responsible individual was an effective tool in abating the hazards.  Therefore, the on-site activities of reviewing the pool with a responsible party and pointing out potential hazards were deemed an important part of the program, albeit with the understanding that no enforcement would or could be taken.  
The goal of the residential pool safety program is to prevent accidental death and injury at private residential pools. Our objectives were to by May 15, 2014: 1] develop an educational flier for private pool owners highlighting the hazards associated with a pool and the means to abate any identified hazards, 2] promote private residential pool safety and responsibility through paper and video advertising, and 3] provide educational, on-site assessments of private pools that identify specific potential hazards and how to correct them. Development of the program was initiated in January 2014 with the recruitment of a health education student from a local university. She completed her required internship at the Commission by researching the rules and standards for residential pools and developing an educational flier and assessment checklist highlighting key safety features. The documents were created in collaboration with permitting entities such as construction, electrical, and plumbing officials as well as staff environmental health specialists and certified pool operators familiar with public recreational bathing establishment operations. They were then vetted by subject matter experts prior to printing and distribution. Once completed the program and flier were advertised in local newsletters and by local media outlets. Local pool supply stores also agreed to advertise and promote the program. In addition, the Commission’s health educator worked with a local cable station to produce a one-minute public service announcement advertising the program. The cable station volunteered their studio and expertise and a professional narrator was identified who also volunteered his services. Once the video was completed, it was shown on local access cable networks frequently and placed on the health department’s website. Finally, a second live action video was produced in collaboration with our local public schools. The school administration assisted by identifying a teacher and visual arts student who worked with a Board member and local residents to identify a neighborhood pool and ‘actors’ to produce a video publicizing the key aspects of the program. While the educational materials are distributed widely and available on our website all homeowners and residents of the Commission who have a pool at their place of residence with a depth of two feet or more are eligible and encouraged to actively participate in the program by arranging an on-site assessment. A key aspect of the program is to provide this on-site assessment of private pools by certified registered environmental health specialists. This on-site assessment is designed to educate pool owners, point out potential safety issues, and address questions and concerns of the pool owner. These environmental health specialists are very familiar with the rules governing and the operations of a public recreational bathing facility and much of their knowledge is relevant to a residential pool. However, issues such as barrier requirements for a residential pool are not a part of their knowledge base and therefore, some minimal training was required. Staff training included a review of the barrier requirements for a residential pool and a complete review of the checklist. Staff was also made aware of other potential hazards not common to public pools such as electrical concerns and options for mitigating potential hazards. Inspection kits created specifically for this program were purchased and provided to each of the specialists. These kits included familiar items such as a pool chemical test kit, but also a tape measure so an assessment of existing barriers could be made. At the conclusion of the assessment, the property owner is provided a comprehensive checklist of nearly 30 safety items for follow up covering issues ranging from the barrier requirements to chemical and electrical safety. While this assessment can be conducted at any time of the year, since the majority of residential pools are outdoor, the timeframe of the program is from approximately May through September, depending upon weather. Collaborations from the community included the public schools, a university with a public health program, other government agencies, private businesses, local media outlets, and even residents who volunteered to participate in the video production. Much time was spent meeting with these various organizations and individuals to develop relationships and encourage participation in the program. It was essential that although there are no rules governing residential pools after installation, that the information being provided to residents was accurate and in compliance with construction regulations. Several local construction officials reviewed the materials and provided comment and feedback on the final products. A very motivated member of our governing board took it upon himself to assist in these activities as well as the video production. He mentored and worked with the high school student to identify ‘actors’ and a site for filming as well as to film and edit the video. These collaborations not only resulted in a quality product but also eliminated the need to hire consultants and individuals to produce marketing materials. Therefore, start-up costs were limited to staff time, printing of materials, and purchase of inspection kits. Excluding staff costs total funds needed was less than $400.00. During program development, the staff costs were primarily that of the Director's and Health Educator's time. Upon implementation of the program, the majority of staff costs were the environmental specialists’ time conducting assessments, approximately one hour per assessment.  
An evaluation of the service by way of surveying the pool owner is completed immediately following the assessment and follow-up with the pool owner after several months is conducted to ascertain what, if any, steps may have been taken to abate any safety issues identified. Since are no authorizing rules or regulations no enforcement can be taken by the Health Department, but it is our hope that education and an in person on-site assessment will motivate pool owners to improve the safety of their facilities thereby preventing any negative outcomes.  The feedback received from those participating in the first year of the program has all been favorable.  Pool owners are very satisfied with the service and the resourced provided.  One participant reported, "Having a pool for the first time, the whole thing was very overwhelming. Robin put me at ease and spoke to me in a way where things made sense, and gave me the confidence that things were safe and I could handle this." The secondary evaluation to determine if action has been taken by pool owners will be conducted in the spring.  Since assessments did not occur until well into the summer season it was determined to review actions by pool owners as they open their pools for the next season. Finally, as more assessments are completed, a review of the assessment results will be performed to ascertain if there are any commonly identified hazards.  If so, this will enable us to focus our educational efforts on these regularly identified hazards.  To date, no commonalities have been identified, likely as a result of the limited number of assessments performed thus far.  
The biggest lesson learned was that more and broader advertising is necessary.  Since it is a voluntary program, residents need to be continually reminded of the service and encouraged to participate.  Showings of the videos and distribution of the fliers will occur earlier in the year, prior to opening of private pools.  In addition, it seems the most likely candidates for an on-site assessment are those who recently acquired a pool through either construction or purchase of a home with a pool.  Therefore, a new partnership with local realtors is planned for next season in hopes that we can identify new homeowners with pools.  Continued partnership with local construction officials will be important to identify those property owners who obtain permits to construct new pools.  Collaboration with the retail pool suppliers was beneficial in distributing the fliers and will continue in the future as will the showing of the videos on local access cable networks, but a more focused advertising effort will be made on new pool owners.  If new pool owners can be identified then active recruitment may also be initiated. The major costs of implementing the program are in advertising and staff time conducting the assessments.  In order to minimize the advertising costs the continued collaboration of local media outlets including local access television and local newsletters is essential. Thankfully, these entities are continually seeking content for their products so we anticipate a long and mutually beneficial relationship. With regard to staff costs, the program is currently limited enough that staff are able to build the assessments into their regular inspection routines and daily activities.  If the program expands to the point where demand for the on-site assessment exceeds our capacity to deliver, we will have to evaluate other options for delivering the service.  One option being considered is partnering further with other inspectors such as construction and electrical officials who may be at properties with pools for other reasons.  This may not only lessen the time burden on health department staff, but also provide greater access to homeowners with pools.   One great advantage we have is that this program was an initiative of our governing board and therefore, they are fully supportive of the program.  We anticipate that this support will be sustained based on the positive feedback received from both the public and board members.  
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