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BEST PRACTICES
These are not services developed
for a community; rather they are developed from within the community.
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The practices that have been identified by local community participants
through focus group sessions as being successful in improving the lifestyles
and health outcomes in most minority populations are grassroots programs
with direct neighborhood connection.
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These are not services developed for a community; rather they are
developed from within the community. Essential to the success of this
type of program is support from leadership and resources from the broader
area who are committed to listening and understanding the issues and
concerns of the neighborhood. Examples of successful local programs
include:
- Faith ministry programs such as the Parish Health Ministry, Central
Texas Nurses Parish Health Ministry, and Health Ministry Teen Projects
are successfully serving local neighborhoods with a variety of health
promotional services. While these programs do not reach large numbers,
their connectiveness to the community gives the community a sense
of ownership and pride in their success.
- Thurmond Heights Wellness Center serves neighborhoods in the 78753
and 78758 zip code areas of Travis County, providing wellness and
health promotion services. A public health nurse and two community
health workers staff the Center. Some of the specific services provided
are immunizations, blood pressure and blood glucose checks, pregnancy
testing, and counseling on healthy behaviors. This is not a medical
care facility but provides services to help individuals improve their
lifestyle for an overall better health outcome.
- St. David's Root Cause Project is a new project started in 1999
serving a mixed neighborhood of about 50,000 people in North Central
Austin. This is a long-term project to work with a specific community
to help them improve their health by identifying and addressing the
root cause(s) of their major health issues. The community residents
themselves work with project leadership to design the activities
of this project.
- The annual Flu Fight campaign is a collaboration of public and
private entities joining forces to deliver flu vaccines to people
at various locations around the community.
- Skippy Express Mobile Health Clinic is an outreach project from
Children's Hospital of Austin. The unit travels to various neighborhoods
providing comprehensive health services to medically under-served
children. The unit provides free immunizations, low cost well child
exams, sports physicals, vision and hearing exams, and minor illness
treatments.
- Programs that employ one-on-one prevention counseling and case
management services, such as used in communicable disease prevention
programs, are successful in preventing the spread of infectious diseases.
However, this practice should be limited for those at greatest risk
to unhealthy behaviors because it is labor intensive and serves a
limited number of people.
- Proactive food safety programs where sanitarians take advantage
of the opportunity during food establishments inspections to coach
and problem solve with operators on ways to improve operations and
reducing the risk of foodborne illness are also successful. The Austin/Travis
County HHSD sanitarians are well adapted to this process, which builds
cooperation and expectance from within the food service community.
In addition to the local programs identified by the community focus
groups, other initiatives and programs have been developed in other
areas of the United States that can serve as models of successful approaches.
For example, to improve access to health services:
- The Robert Wood Johnson Foundation initiative "Communities in
Charge" assists local communities interested in improving access
to health care services for low-income uninsured individuals. The
program is designed for local communities interested in improving
access to care for low-income, uninsured individuals by rethinking
the organization and financing of local care delivery. The initiative
will help broad-based community consortia design and implement sustainable
new delivery systems that manage care, promote prevention and early
intervention, and integrate services. This program is open to communities
with a minimum population of 250,000 and at least 37,500 low-income,
uninsured individuals.
- One nationally recognized community model is the Hillsborough
HealthCare System, a county-sponsored managed care program in Hillsborough
County, Florida, that was created in 1992 to provide health care
services to low-income, uninsured individuals.
The Hillsborough HealthCare System enrolls and serves 30,000 uninsured
individuals each year, integrating community-based medical and social
services under a coordinated managed care framework. The program
has reduced per capita monthly health care costs from $600 to $233
by promoting prevention and early intervention. The Hillsborough
County program is a direct result of the county's decision to restructure
services to create a new enrollment-based safety net program. Hillsborough
County has received national attention and awards for their achievements,
including the Ford Foundation's prestigious award for Innovations
in Local Government.
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In efforts to address health
disparities:
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- The Centers for Disease Control and Prevention has budgeted $10
million for support of 30 communities to conduct community planning
activities. The planning activities include establishing infrastructure
for community-level data collection, establishing collaborative partnerships,
establishing linkages with other state and local agencies, and working
with federal agencies and other partners to identify "best practices".
These community planning projects promote program activities which
will underpin intervention activities, and award community planning
cooperative agreements to community-based demonstration projects
testing science-based approaches to achieve health disparity reduction
goals. Results from these demonstrations will be important in shaping
strategies to eliminate disparities, and for improving the focus
and effectiveness community-based wellness programs (Centers for
Disease Control and Prevention, November 2000).
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In promoting wellness and prevention:
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- There are three comprehensive community-based disease prevention
models that are universally accepted as standards for community prevention
strategies. The Stanford Five-City Project, the Minnesota Heart Health
Program, and the Pawtucket Heart Health Program all targeted reduction
of cardiovascular disease risk but have been applied to multiple
prevention and wellness programs. Each study lasted from five to
eight years and included multifaceted campaigns of education and
risk reduction, simultaneously addressing the prevention, treatment,
and control aspects of hypertension, cigarette smoking, high dietary
fat, obesity, and sedentary lifestyles. The three projects shared
a common intervention strategy of primary prevention, including direct
education of health professionals and the public through media and
personal contact as well as community organization to foster institutional
and environmental support (Winkleby, Feldman, & Murray, 1997).
- The Pawtucket Heart Health Program, which focused on community
organization, campaigns of risk reduction, and screening, counseling,
and referral activities, was the most successful, producing improvements
in total cholesterol, systolic and diastolic blood pressures, smoking
reduction, and body mass index. The hypothesis that cardiovascular
disease risk can be altered by community-based education was correct
but statistically significant differences were lost after the programs
were discontinued. Accelerating risk factor changes will likely require
a sustained community effort with reinforcement from state, regional,
and national policies and programs (Carleton et al., 1995).
- Workplace and school wellness programs are a proven strategy for
developing a foundation to improving healthy behaviors. These programs
have also shown to be effective in increasing productivity, reducing
absenteeism, and improving the overall effectiveness of individuals
participating (see figure 4-1: Wellness in the Workplace, Section
IV). There are many different models of varying degrees. The more
inclusive and accessible the more successful the results. Models
that provide onsite services or allow work-time for participation
have demonstrated overall increases in productivity. Recent research
suggests that multiple behavioral risk factors are likely to cluster
among adult workers. For example smokers are more likely to have
multiple other risk factors, and nonsmokers are more likely to engage
in health behaviors such as exercise. Addressing one behavioral change
results in improvements in multiple behaviors. (Campbell et al.,
2000).
- The Centers for Disease Control and Prevention, Guidelines for
School and Community Programs Promoting Lifelong Physical Activity;
and CDC's Guidelines for School and Health Programs Promoting Lifelong
Healthy Eating are excellent standards for school and community wellness
programs. (CDC Guidelines. Online, 2000).
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