Non-English Speaking Education and Outreach: Partnering with Community Based Organizations for Behavior Change Tamie and Charles Charles Wu Public Health-Seattle & King County Local Hazardous Waste Management Program in King County

King County LHWMP Program Mission To protect and enhance public health and environmental quality in King County by reducing the threat posed by the production, use, storage and disposal of hazardous materials. Charles: Size and key services – Background on the program Program Mission To protect and enhance public health and environmental quality in King County by reducing the threat posed by the production, use, storage and disposal of hazardous materials. The Local Hazardous Waste Management Program in King County (LHWMP) is a multi-jurisdictional program that focuses on reducing public and environmental exposure to hazardous materials. Four government agencies, 37 cities and tribal governments in King County are working together to help citizens, businesses, non-profit organizations and government agencies reduce the threat posed by the production, use, storage and disposal of hazardous materials and wastes. LHWMP provides services to 1.9 million residents and 60,000 businesses throughout King County. LHWMP works with residents and businesses throughout King County to: Reduce the production (upstream) of toxics and hazardous products and to promote stewardship of those products by their manufacturers. Reduce the use of, and properly store, toxics and other hazardous products. Ensure the proper disposal of toxics and hazardous waste. In 2012, LHWMP collected 1,478 tons of hazardous waste from 46,298 residents and 583 businesses, schools and other small quantity generators. Program partners are: King County Water and Land Resources Division, King County Solid Waste Division, Seattle Public Utilities, Public Health - Seattle & King County, and suburban and other cities and towns in King County, represented on LHWMP’s Management Coordination Committee by the Sound Cities Association.

What does Equity mean to you?

King County Equity and Social Justice Ordinance, signed October 11th, 2010 City of Seattle-Race & Social Justice Initiative LHWMP- Service Equity Policy 10 yr Vision http://www.lhwmp.org/home/publications/publications_detail.aspx?DocID=U5gCgSfm7pc%3D Over the past several years, many jurisdictions have established social justice policies. Those policies have recognized that effective engagement removes barriers that have prevented members of historically underserved populations from successfully working with government to receive services. Our goal is to support those initiatives, implement them through our Program, and augment them with additional policies to strive towards the day when historically underserved populations are no longer underserved. Our policies are not intended to duplicate our Program Partner Agencies’ policies nor infringe on any government agency’s authority or prerogatives.

Partnering with the Community Community Grants Program A community participatory approach that supports the community to develop their own strategies to reduce risks and promote sustainable results.

Gov’t and Institutions Community Grant Goal From hierarchical and top down approach to community participatory practice: engage, educate, partner, share resources, build capacity Gov’t and Institutions Local health depts. CBOs, community groups Community residents Residents Gov’t and Institutions Health Depts. Community based Orgs and Groups

Why a community grant? (as opposed to a “traditional” contract) Facilitates creation of a partnership Two-way exchange of information, resources and ideas Partnership—creates a partnership between the community and LHWMP—rather than a contracting relationship, and subsequently promotes a two-way exchange Two-way exchange of information, resources and ideas– LHWMP provides funding, environmental health knowledge, and technical assistance. Our community partner provides entrée into the community, helps us collect information and also disseminate our EH messages to their community members that is culturally appropriate and relevant. Build both parties’ capacity—We are continually learning from each other, adapting and changing as needed. For example, some policies and procedures are being revised to better suit the community’s needs. Build both parties’ capacity

A Specific Community Grant: Community-Directed Partnership Involving the community at the outset Promoted to over 60 community-based groups Technical assistance in applying for grant -Involving community at the outset Had conversations with community leaders about their perceptions about residential chemical hazards, and if they feel that it is relevant to their community. Having one-on-one meetings and explaining what residential chemical hazards mean and how that relates to human health was essential in getting nonprofits interested in the topic and therefore interest in applying for the grant. Had meetings prior to the release of the RFP—discussed with groups the process and timeline in applying for grants from Public Health

The Community Partner SOAR focuses on: Impacting families from underserved, disconnected communities Building community capacity Connecting communities to multiple and complex support systems. SOAR is a community coalition working together to promote the healthy development of children, youth, and families in King County.

Community Engagement Process PROJECT PROMOTION Gathered input from community leaders COMMUNITY CONVERSATIONS Asked 5 ethnic groups their preferences ACTING ON WHAT WE HEARD Created a plan based on their preferences Gathered input from community leaders---about whether they think residential chemical hazards is relevant to their community, and provide technical assistance in applying for grant when requested. Asked 5 ethnic groups their preferences—on environmental health topic and service delivery model Acting on what we heard—created a plan based on their preferences Vetting the plan and getting consensus- met with the community again and confirmed what we heard and how to move forward The community implements the plan- the community plays a leadership role in implementing the plan. ACTING ON WHAT WE HEARD Vetting the plan and getting consensus The community implements the plan ACTING ON WHAT WE HEARD

100% provided input on the direction of the project The Community Voted 5 ethnic groups 10 community conversations 2013 summary 4 environmental health topics CLICK ON PHOTO FOR VIDEO (2:30MIN): 5 Ethnic Groups-Bhutanese, Chinese, Filipino, Latino, Purepecha during their community conversations. 80+ participants 100% provided input on the direction of the project

Community Conversations

The results from 2013 Service Delivery: WHAT WE WANT! Collectively, the two topics that got the most votes are household chemicals (cleaners, pesticides) and lead poisoning prevention. In terms of service delivery model, the community wanted a train-the-trainer model, a home-visiting program, and a one-time special HHW collections event in a natural gathering place (community center, church, etc.)

Another Example: The Volunteer Training Network “Opening Doors into Communities” Another example of a community partnership.

The Promotora Model Promotora Same culture Trusted Same language Community member Lay person The Volunteer Training Network is based on the Promotora model—which builds capacity within the community by training members of that community to conduct health promotion and education to their peers and friends. Essentially, a train-the-trainer model Based on the Promotora Model -- a Public Health community engagement model. Developed for outreach into Hispanic communities. Promotora means “one who promotes”

Capacity Building: Preparing and Supporting the Volunteer Trainers “LHWMP College” Field Logistics Recruit and train Promotoras Host “College” trainings Help Promotoras organize their community Supply materials to Promotoras Receive input on materials and curriculums Supply food at community trainings LHWMP staff = “Professors” Develop LHWMP curriculums Certify ‘Graduates” as Volunteer Trainers (includes background checks) Provide educational tools and materials Program evaluation We support our partners and volunteer trainers in ways that ensure their success in the project. For example, we provide funding, train them in environmental health knowledge, and provide them with practical tools and materials. Currently, we partner with Refugee Women’s Alliance to reach the Vietnamese, Chinese, Burmese, and Somali communities. The word “Promotora” does not always translate cross-culturally, so we refer to them as our Volunteer Trainers.

Tools for the Trainer TEACHING KITS Maximize pictures and hands-on activities, minimize words Designed to meet the needs of visual, auditory, and kinesthetic learners Translated to multiple languages Components of a teaching kit: 11” x 17” posters “Touch” Box Demonstration Kit One of the most useful and practical tool is the teaching kit. This is what the volunteer trainers use in the field to teach their peers in a small group setting. Participants tend to be non-English speakers, and some cannot read their own language. The materials need to be conveyed verbally and in an interactive manner. Real-life samples, photos, and demonstrations are key components of the lessons. The volunteer trainers/promotoras find these extremely helpful in conducting their workshops.

Teaching Kits in Action! Photos (clockwise from top left) Filipino group talking about how lead affects adults (language is Tagalog) Somali woman testing an old piece of wood for presence of lead Bhutanese man talking about where less toxic cleaning can be used in a home (language is Nepali)

20 volunteer trainers taught A Measure of “Reach”: So far in 2014, 20 volunteer trainers taught > 120 participants We are currently preparing 15 more volunteer trainers, and by year’s end, we’ll have 35 volunteer trainers reaching around 600 participants.

Encouraging Behavior Change Participants receive a “Takeaway Kit” to practice what they learned Safer Cleaning: Baking Soda Vinegar Bon Ami® Scouring Powder Murphy Oil Soap Microfiber Cloth Spray Bottle DIY cleaning product recipe card Takeaway Kits encourage behavior change, and reinforces what they learned in the workshops.

Behavior Change: A Measure of “Impact” Tried most frequently on Wall Furniture Toys/window frames Paint Etc. 3 positive!!! 64% used the lead swab tester

69% changed their cleaning habits (90 days later) Behavior change 69% changed their cleaning habits (90 days later) Of the 30 people that said yes, did a change, the majority mentioned that they Started wet washing Started wet mopping Clean daily Started cleaning children’s toys Bought a hepa vacuum- none Of 15 people did additional things to prevent lead (not cleaning), including 9 people testing paint (lead swab successful) 3 tested water 1 repainted 1 aware of different products 1 cleans daily

What we’ve learned: Next Steps: Adaptive Management Learning as we go, adapting as needed Still learning…failing forward…don’t be afraid of making mistakes Partnerships requires careful and thoughtful relationship building and maintenance But when done right, partnerships create sense of ownership, buy- in, and commitment Next Steps: Smaller grants, but reaching more nonprofits Formal evaluation plan 1) Smaller but more grants—-we want to be able to support more groups in doing this work, but same level of project funding means smaller grants 2) Formal evaluation plan – in the future, develop an evaluation plan prior to project implementation

For more information: Charles Wu, REHS, MBA Charles.Wu@kingcounty.gov (206)263-8534 Public Health-Seattle & King County, Local Hazardous Waste Management Program All photos courtesy of www.lhwmp.org and www.facebook.com/lhwmp