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Taking Action With Data: Improving Environmental Public Health at the Community Level

Camponeschi, Jenny MS; Vogt, Christy M. MPH; Creswell, Paul D. PhD; Mueller, Meridith MPH; Christenson, Megan MS, MPH; Werner, Mark A. PhD

Journal of Public Health Management & Practice: September/October 2017 - Volume 23 - Issue - p S72–S78
doi: 10.1097/PHH.0000000000000605
Grantee Programs: Research Article

Context: The Wisconsin Environmental Public Health Tracking Program (Wisconsin Tracking) compiles and provides data on health endpoints and related environmental exposures as a resource to local health departments, tribes, academia, and other stakeholders. The goal of providing these data is that stakeholders use them to develop projects that improve environmental health in their communities—that is, moving from “data to action.”

Objective: To encourage use of Wisconsin Tracking data, we developed a minigrants program and issued a funding opportunity to local health departments and tribes. The opportunity requested proposals for small projects using our data, with the goal of making public health improvements in those communities. Wisconsin Tracking evaluated the minigrants program after its completion.

Design/Setting: Eight local health departments in Wisconsin were awarded up to $10 500 to develop and implement projects over a 9-month period.

Methods: Wisconsin Tracking created a funding opportunity announcement requiring utilization of our data to develop projects by local health departments in Wisconsin. We reviewed and scored applications, evaluating proposals on a range of criteria. During the 9-month project period, Wisconsin Tracking staff members provided a variety of technical assistance to grantees. An evaluation of the overall program followed.

Results: Funded communities used Wisconsin Tracking data to improve public health infrastructure, leverage partnerships, establish new initiatives, respond to emergencies, improve communication with stakeholders and residents, and make a variety of public health improvements in their communities.

Conclusions: Efforts to increase use of our data catalyzed development of small-scale environmental health projects. This minigrants program was successful at building relationships between local health departments and Wisconsin Tracking, increasing awareness of Wisconsin Tracking data and resources, and contributing to numerous documented public health improvements throughout Wisconsin.

Environmental Public Health Tracking Program, Environmental Epidemiology and Surveillance Section, Bureau of Environmental and Occupational Health, Wisconsin Department of Health Services, Madison, Wisconsin (Mss Camponeschi, Vogt, Mueller, and Christenson and Drs Creswell and Werner); and Department of Population Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin (Drs Creswell and Werner and Mss Mueller and Christenson).

Correspondence: Jenny Camponeschi, MS, Environmental Public Health Tracking Program, Bureau of Environmental and Occupational Health, Division of Public Health, Wisconsin Department of Health Services, 1 West Wilson St, Room 150, Madison, WI 53703 (jennifer.camponeschi@wisconsin.gov).

Funding received from the Centers for Disease Control and Prevention, Center for Environmental Health (cooperative agreement no. 5U38EH000951-05), was used for this project.

The authors declare no conflicts of interest.

The Wisconsin Environmental Public Health Tracking Program (Wisconsin Tracking) is one of 26 grantees that comprise the Environmental Public Health Tracking Network (Tracking Network), funded by the Centers for Disease Control and Prevention's National Center for Environmental Health. The Tracking Network is “a system of integrated health, exposure, and hazard information and data from a variety of national, state, and city sources.”1 The mission of the Tracking Network is “to provide information from a nationwide network of integrated health and environmental data that drives actions to improve the health of communities.”2(pS13) Likewise, the use of data to improve public health in communities throughout the state is a main goal of Wisconsin Tracking.

Wisconsin Tracking compiles data from multiple sources and provides those data to stakeholders, primarily through the Wisconsin Environmental Public Health Tracking Data Portal and the Wisconsin County Environmental Health Profiles (Profiles). The data portal is an interactive, query-based public portal that is accessible via computers, tablets, or smartphones and allows the users to explore a number of health and environment-related factors in their community.3 Use of the data portal does not require a username or password, data are presented in a variety of formats (ie, map, chart, graph, table), and data can be downloaded for use with other applications or for further analysis. The Profiles provide a snapshot of environmental health data for each of Wisconsin's 72 counties.4

Local health departments (LHDs) have long been identified as a primary audience of Wisconsin Tracking data and resources. Strong relationships between a state health department and LHDs within that state provide opportunities that may not transpire otherwise. First, LHDs are a direct liaison between the state health department and communities, connecting residents to resources they may be unaware of. LHDs are also on the front line of emerging public health concerns in their jurisdictions and are keenly aware of local health needs. As such, LHDs provide unique understanding and interpretation of local-level public health data.

Benefits of a collaborative relationship between a state health agency and LHDs within that state are not well documented, but some studies have shown advantages. One study of a minigrants program in Illinois found that even relatively small amounts of funding can support LHDs and their partners, leading to improved public health in their jurisdictions. This program provided funding to 13 LHDs to support preparedness activities. An evaluation revealed that as a result of the minigrants program, projects identified preparedness training needs, strengthened partnerships, and improved infrastructure. In addition, health departments reported improved public health capacity and capability as a result of the minigrants.5

In a Tracking Network–specific example, multiple national organizations convened local and state health officials to discuss how they can use Tracking Network data to address health concerns at the local level. Benefits that emerged from that relationship included the capacity to compare data at several geographic levels; improved community education, empowerment, and mobilization; and enhanced communication and coordination between agencies.6

While it is not unprecedented for a member of the Tracking Network to provide minigrants to local agencies, this approach has a limited number of examples. The Florida Tracking Program is one Tracking Network member that provided 3 minigrants to LHDs to implement a biomonitoring study on mercury. One of these LHDs found that 25% of women tested for mercury had elevated levels compared with the national average, which was half of that. Following those findings, the LHD developed a project to educate health care providers and create a recipe booklet focusing on selection and preparation of low-mercury fish.6

Wisconsin Tracking sought an innovative way to connect with LHDs to increase awareness and encourage usage of our data and resources, as well as to document positive public health outcomes. With the input of our technical advisory group, we developed a new approach. To learn more about how communities might make use of Wisconsin Tracking data at the local level, we decided to fund small-scale public health improvement projects, also referred to as minigrants, to address identified local needs. LHDs were considered the ideal partners for minigrants funding for a number of reasons: (1) LHDs are a primary audience of Wisconsin Tracking data and resources; (2) LHDs are able to conduct small-scale projects in their communities; (3) LHDs are able to build capacity and partnerships at the local level; and (4) partnerships with LHDs extend the reach of Wisconsin Tracking throughout the state—in both rural and urban areas.

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Methods

In September 2015, Wisconsin Tracking issued a funding opportunity announcement (FOA) to local and tribal health departments, requesting proposals using our data as a foundation for development and implementation of environmental health projects in communities. Applicants had 4 weeks to develop their projects and submit their proposals.

Wisconsin Tracking received 15 applications. Multiple staff members reviewed each application. To ensure consistency among reviewers, staff members used a rubric to score each application. We assessed proposals on a range of criteria, including (1) a strong statement of need, (2) a clearly described target audience, (3) an identified environmental health issue of burden in the applicant jurisdiction, (4) a well-defined project description, (5) well-crafted project goals and objectives, (6) a complete and tangible timeline, (7) appropriate partners, (8) a detailed work plan, (9) an outline of evaluation methods and measures, and (10) a budget within the scope of work.

Successful applicants were expected to do a number of tasks during the grant period as well. These included using data from the Profiles or data portal for their project, participating in discussions and conference calls with Wisconsin Tracking staff members, submitting mid-project and final reports, documenting their successes and disseminating relevant results and lessons learned, and, finally, strengthening partnerships with their own stakeholders.

Decisions on funding of proposals were completed in 1 week, and applicants were immediately notified following selection. Subsequently, Wisconsin Tracking awarded $10 500 to each of 8 communities that completed its projects over a 9-month period. Topics addressed by grantees included carbon monoxide poisoning prevention (n = 1), heat stress (n = 2), and water quality (n = 5).

To help ensure success of these projects, Wisconsin Tracking offered no-cost technical assistance to minigrantees throughout the project and several months after. Requested assistance included (1) data interpretation, (2) identification and use of supplementary data sources, (3) connection with subject matter experts, (4) development of surveys and outreach materials, (5) evaluation expertise, (6) documentation of positive public health outcomes, (7) development of a journal manuscript, and (8) review of educational, promotional, and resident recruitment materials.

Wisconsin Tracking staff members were assigned to be primary and secondary leads for each minigrantee, acting as a direct connection between our agency and the grantee. The primary lead staff member organized conference calls and had the most contact with the minigrantee. We held a kickoff conference call at the beginning of the grant period to introduce ourselves and give an overview of expectations. We held 2 additional conference calls with each minigrantee during the grant period to get updates from minigrantees about their projects. In cases where it was beneficial to connect minigrantees working on the same topic, we held their conference calls together.

In addition to informal phone calls and e-mails, the mid-project update, final report, and budget updates helped us monitor minigrantee progress and accountability. Grantees were also asked to participate in a panel discussion at the annual Wisconsin Public Health Association (WPHA) conference. All 8 minigrantees participated in the panel along with Wisconsin Tracking staff members. Minigrantees evaluated their projects in a variety of ways; some examples of evaluation measures included increased well water testing, development of new partnerships, increased or improved resources, and connection with new populations.

Wisconsin Tracking undertook a multifaceted evaluation of the minigrants program following its completion in August 2016. In their final reports, we asked funded communities to provide feedback on implementation of the program and aspects of the program that were most helpful. We also asked for potential improvements to the program and ideas for additional technical assistance we could offer in the future. In addition, we held a breakfast focus group at WPHA with minigrantees and asked questions to delve deeper into their thoughts on overall implementation of the program. We incorporated evaluation findings in the second round of this minigrants program, which is currently in progress. (For those interested in more detail on developing the FOA and implementing the minigrants program, or to receive copies of all materials, please contact Wisconsin Tracking directly.)

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Results

Overall, the minigrants program was deemed successful from the standpoint of Wisconsin Tracking. The funding opportunity was an effective way to reach out to LHDs to encourage them to take a look at Wisconsin Tracking data and resources. Through implementation of the program, we forged new relationships with LHDs, and those connections may lead to long-lasting partnerships. Minigrantees collaborated with us to learn about our data and resources, work with our staff members, and use Wisconsin Tracking data to make positive changes in their communities. In addition, all applicants became more familiar with Wisconsin Tracking as a resource for environmental public health data and technical assistance in understanding and utilizing those data in their communities.

Wisconsin Tracking provided technical assistance to minigrantees as necessary. The time investment for Wisconsin Tracking staff members varied depending on the needs of the minigrantee. We estimate the provision of technical assistance for each staff member ranged from 10 to 15 hours for each of 5 staff members over 9 months. Administration of minigrants (eg, responding to e-mails, conference calls, reviewing reports) probably totaled an additional 15 to 20 hours for each staff member. Our health educator likely devoted more time to technical assistance than other staff members, due to the outreach focus of most minigrantee projects. The most time-intensive period for staff members was the week that applications were reviewed and scored; however, following that, staff time commitment significantly lessened. The amount of time for administration and implementation of the minigrants program was about what we expected and perhaps even a bit less than expected.

Evaluation results from the minigrants program helped us make adjustments for a second year of grantees. There were 2 components to evaluating this program: feedback from the minigrantees on program implementation and feedback from Wisconsin Tracking staff members on program implementation.

LHDs provided very positive feedback on overall implementation of the program. They reported that the minigrants program was well-designed, provided useful technical assistance, and was helpful in improving public health in their jurisdictions. Minigrantees found technical assistance useful in that it avoided duplicating efforts and saved time. For example, some of the fact sheets we helped minigrantees revise were based on existing resources from partners. Minigrantees recognized the benefit of the program in helping improve or expand their outreach efforts, with one grantee noting: “We provided a great service to our rural communities by offering test kits, clearer lab results, and educational information. We were able to make it easier for our communities to make informed decisions impacting their health.” They found that even a small amount of funding helped them make progress in an area needing attention. Several grantees stated their projects would not have happened without the Wisconsin Tracking funding. Minigrantees had minimal suggestions for future iterations of the program.

Minigrantees effectively spent all of the funding that they received. Because of the nature of some of the projects having a seasonal component, spending was not always incremental. However, communication between minigrantees and Wisconsin Tracking ensured funds were fully spent at the end of the budget period. Grantees met the expectations of Wisconsin Tracking: they used our data to develop and implement their projects, actively participated in conference calls, utilized our technical assistance to improve aspects of their initiatives, submitted mid-project and final reports, documented success stories, and presented their project results.

Although LHDs had very positive feedback, we also wanted to thoroughly evaluate the minigrants program from the standpoint of Wisconsin Tracking staff members. We identified several areas for improvement in forthcoming years. First, many of the projects focused on the individual level of the Social Ecological Model. The Social Ecological Model is a concept originally proposed by Urie Bronfenbrenner that recognizes that the entire ecological system must be considered in addressing behavior. A person's health is influenced by multiple levels—that is, individual, interpersonal (eg, family, peers, social networks), organizational (eg, employer, local and state health departments, community-based organizations), community (eg, coalitions, media, health disparity collaboratives), and public policy (eg, legislatures, federal governmental agencies, national nonprofit organizations).7 Ideally, we wanted minigrantees to think upstream and address public health issues at a systems level—for example, at the organizational, community, or public policy levels of the Social Ecological Model.

Second, the projects that minigrantees completed did not necessarily align with their community health assessments or community health improvement plans, which can have implications for sustainability. Third, there was a need for evaluation assistance, as LHDs often lack staff capacity in this area. Fourth, there were only 3 different topics selected by minigrantees (and 5 minigrantees addressed water), and we sought out diversity among selected topics. Finally, there was lack of uniformity in applications we received, making them hard to score consistently. Wisconsin Tracking decided to have a second round of minigrants during the 2016-2017 funding year and addressed all areas noted earlier in developing the FOA for year 2.

At the conclusion of the 9-month period, grantees reported more than a dozen positive public health outcomes as a result of these minigrants. Funded communities used Wisconsin Tracking data and resources to improve public health infrastructure, leverage new and enhance existing partnerships, establish new programs, respond to emergencies, increase awareness and knowledge of community members, increase community resources, improve communication with stakeholders and residents, and make a variety of public health improvements in their communities. Grantees established concrete plans, programs, and partnerships, and in many cases created sustainability beyond the grant's end. Some of the highlights of the minigrants program are expanded upon in the Table. For additional information on minigrantee projects, contact Wisconsin Tracking directly or visit our Web site to read minigrantee success stories (dhs.wisconsin.gov/epht/resources.htm#success-stories).

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Discussion

Simply making data available to LHDs and other partners does not automatically translate into positive health improvements in communities. Translating data to action is often a challenging undertaking since LHDs must deal with a number of public health prevention, protection, and promotion responsibilities in their communities. In addition, LHDs have limited resources, staffing, and time. To help translate data to action, Wisconsin Tracking initiated a minigrants program to engage LHDs to use our data to improve health in their communities.

The minigrants program improved communication, collaboration, and shared goals for both the minigrantees and Wisconsin Tracking. For example, LHDs discovered the extent to which Wisconsin Tracking can be a resource for them in providing data and assistance in reaching goals of their particular communities. The lines of communication were opened through this project and LHDs have an easier time reaching out with questions or the need for additional assistance, even after the grant.

LHDs acted as a direct liaison between our agency and their communities to specifically target projects that were important for them to address. They were able to use a relatively small amount of funding to make substantial positive public health changes that they would not likely have had the resources to address otherwise. For example, Lincoln County almost doubled the number of cooling centers available, Florence and Marinette counties simplified well water test results for residents, and Rock County identified multiple nitrate sources that will improve future planning.

Wisconsin Tracking also benefited significantly through this program. First, we were able to develop deeper relationships with LHDs that had not been present before. This gave us insight into the work that LHDs do and how best we can assist and work with them. Second, we were able to meet our goal of increased usage of Wisconsin Tracking data and resources, resulting in positive public health changes in local Wisconsin communities. Finally, Wisconsin Tracking staff members found this to be an exciting and enjoyable program to carry out. Some of the work involved in administering the program and providing technical assistance added variety to our work, and it was energizing to hear about how Wisconsin Tracking data and resources were being used to effect real change in communities.

Through implementation of this minigrants program, multiple positive public health outcomes resulted from LHD projects. Strengthened public health infrastructure was demonstrated through assembling multiple agencies to coordinate resources and protocols, developing an extreme heat communication and response plan, and increasing the number of cooling centers. Enhancing existing and leveraging new partnerships was evident by convening multiple entities to develop a task force, forging a relationship with hospital staff members to better understand populations seen in the emergency department, and connecting with new partners and community members in promoting education and outreach. New programs and resources were developed, including a fan donation program, identification of nitrate sources, and creation of letters to accompany testing results. Even an unfortunate major flooding event provided an opportunity for one minigrantee to reach out to community members and encourage testing of well water.

Awareness and knowledge of community members were increased in a number of ways, including educating members about carbon monoxide poisoning and how to prevent it, revising materials addressing water quality concerns, and informing residents about heat-related illness. Community resources were also enhanced, as evidenced by increasing cooling centers, distributing water testing kits, and distributing carbon monoxide detectors. Finally, improved communication with stakeholders and residents also occurred. Examples include developing a task force, enhancing outreach and education on water testing and carbon monoxide poisoning, and creating letters to communicate test results to residents.

We discovered that an innovative minigrants program that connects a state Tracking program to LHDs has great potential to create public health improvements in local communities, and we believe this program could be easily replicated by other state health departments. Many of these positive outcomes in communities, such as improved infrastructure, stronger partnerships, and enhanced access to resources, have a high degree of sustainability and will have long-lasting implications that will continue to be relevant well into the future.

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Implications for Policy & Practice

* Despite strong interest in using data to improve public health at the local level, many local health departments find it challenging to get the right resources. One approach to address this dilemma is for a state health agency to award minigrants to local health departments so that they can develop and implement small-scale projects to improve health in their jurisdictions.

* Collaborations between state health agencies and local health departments have the potential to generate multiple benefits to both. This article addresses positive outcomes seen by implementing a minigrants program in Wisconsin.

* Awarding minigrants to local health departments to develop and implement projects in their communities can lead to multiple public health improvements, including enhanced public health infrastructure, new partnerships, establishment of new programs, improved emergency response, and better communication with stakeholders and residents.

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References

1. Centers for Disease Control and Prevention, National Center for Environmental Health. National Environmental Public Health Tracking. http://http://www.cdc.gov/nceh/Tracking. Accessed December 12, 2016.
2. Qualters JR, Strosnider HM, Bell R. Data to action: using environmental public health tracking to inform decision making. J Public Health Manag Pract. 2015;21(2)(suppl):S12–S22.
3. Wisconsin Environmental Public Health Tracking Program. Wisconsin Environmental Public Health Tracker. Wisconsin Environmental Public Health Portal. http://gis.wi.gov/DHS/tracking. Accessed December 12, 2016.
4. Wisconsin Environmental Public Health Tracking Program. Environmental Public Health Tracking: County Environmental Health Profiles. https://http://www.dhs.wisconsin.gov/epht/profile.htm. Accessed December 12, 2016.
5. Wiebel V, Welter C, Aglipay GS, Rothstein J. Maximizing resources with mini-grants. J Public Health Manag Pract. 2014;20(5):S83–S88.
6. Dunlop TS, Porter D, Washam R, Li J, Ho J, Johnson R. Local perspectives on the environmental public health tracking program. J Public Health Manag Pract. 2014;20(3):358–360.
7. McLeroy K, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q. 1988;15(4):351–377.

communities; environmental public health tracking; funding opportunity announcement; local health departments; minigrants; public health actions; public health improvement; state health department; tracking

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