1. City of Fort Worth Public Health Department
Emerging Issues in MCH: Integrating MCH into Public Health Preparedness Plans Using Integrated Public Health Methods to Identify and Effectively Provide All-Hazards Preparedness Education to Underserved and High Risk Populations
American Public Health Association Annual Conference (November 5, 2007)
Mr. Daniel Reimer MPH
City of Fort Worth Public Health Department

2. BACKGROUND
Fort Worth represents a diverse major metropolitan municipality of over 618,000 (18th largest in the country).
Massive Community Needs Assessment conducted every five years; provides reliable, detailed data (especially in identifying underserved populations geographically).
Fertile environment for integrating all hazards and public health by identifying and targeting high risk and/or underserved populations; synergistic benefit.
Health Department is divided into 5 Divisions, including Outreach and Epidemiology/Assessment, therefore:

3. …Proven History of Community Linkage
Optimize effectiveness of interventions through community collaborations
Cooperative and supportive relationship with other city departments
Partnerships with external organizations, including community centers
Proven record of effective community integration and cooperation (Albert Galvan Clinic)
*Albert Galvan Community Clinic: This facility offers a unique opportunity for the program being proposed by the grantee in that the clinic serves as pilot program for providing primary care services to underserved and non-English speaking are already being offered to the Hispanic population. The BHEP team has helped organize open-house events to promote distribution of Emergency Preparedness information at the clinic.
FW Catholic Diocese: Distribution of emergency preparedness information at several of the largest local churches, including All Saints, Holy Name, Saint Mary and Saint Andrew.
All Saints Catholic School: Distribution of emergency preparedness information to each of the families enrolled.
Local Community Centers: Distribution of emergency preparedness information was made to community centers throughout Fort Worth, including those in the North side of town.
Fort Worth Independent School District: Distribution of emergency preparedness information to all FWISD students, many in Spanish.
Mexico Embassy/Consulate: Distribution of emergency preparedness information to local Spanish speakers was made via the Mexico Consulate. The consulate recently opened a Fort Worth office in North side of town.
Near Northside Partnership: A non-profit community organization thru which emergency preparedness information was provided to its customers, who are mostly minorities.
Health Fairs: Health fairs have shown to be one of the most effective ways to provide information to the hard-to-reach sectors of the population. People who often attend health fairs are those who are uninsured or underinsured and that consequently have no access to any kind of health information.
Spanish Media: The Spanish media has been very receptive to the BHEP team’s emergency preparedness messages, often providing free coverage and message dissemination.
Regional soccer league: Distribution of emergency preparedness information was made to leaders of a regional soccer league, resulting in over 2,000 contacts.
Other partnerships established in the underserved, predominantly Hispanic Northside of Fort Worth include the Northside Inter-Church Agency (NICA), the Near Northside Partners Council, INC. and the Boys and Girls Club of Greater Fort Worth, North FW Branch

4. Data Driven Programming
Mobilizing for Action through Planning and Partnership (MAPP) / High Risk Workbook
GIS Capabilities of Community Needs Assessment Data allows for identification of un-served and underserved high-risk groups (inc. geo-spatial ID)
Proven Bioterrorism and Health Emergency Preparedness Program (BHEP)
Culturally and linguistically appropriate service and information modalities

5. Results of Community Needs Assessment specified target group
Non-English speaking Hispanics were most worried, least informed and had lowest access to emergency preparedness and health/social service information.
GIS identified specific ZIP code/areas of Fort Worth
Target area conveniently served by Galvan Community Clinic (history of rapport & cooperation)
Focus groups and local survey specified needs of the target community (7.6 x less insurance; >40% of non-English speaking residents had difficulty getting health care for their children (vs. 8.8%); consistent disparities reflected by target population.
History of service in area historically established by Outreach Division

6. Project Description
Focus Groups and Planning Sessions Held with Both Community Partners and Stakeholders and with Community Members
Accurately Identified Issues, Needs and Preferred Interventions Representing the Target Population
Developed Preferred Modalities for Service Delivery (For Both Preparedness & Health Education/Services)
Pre/Post-Evaluation to Specifically Capture Behavior Change

7. Project Activities Small planning meeting with key stakeholders
Large focus group with partner organizations and all stakeholders
Focus groups with community members
Organization of service providers
Community kick-off luncheon to introduce target popualtion to service providers

8. Service Impact
Focus group and surveys served to identity which organizations and services needed to be represented at the kick-off and follow-up events.
Service providers used kick-off event to identify those with needs
Services introduced to residents
Once residents sought out services, linkage with other services provided
Both service providers and community members benefited from enhanced awareness of resources
Referral network included: banking, housing, insurance, dental, medical, public health, emergency preparedness and other health and social services represented ( at total of 43 organizations!)
Survey indicated statistically significant impact in terms of awareness and access to needed services; services that respondents would not otherwise have been aware of.

9. Supporting Activities
Focus Group analyses conducted by grantee Epidemiologists to direct/redirect program efforts (in-kind activities accounted for nearly three times the $9,000 funded for the program by NACCHO)
Clinical Personnel Training: Personnel in the Galvan clinic trained in referral and emergency preparedness education.
Outreach actively assisted with liaison and linking community members to other services as needed by participants
Kick-Off and Culmination / Summit luncheons attracted large local turnout and subsequent linkage to services.
Quarterly and Final Report indicated that not only knowledge of services increased but the actual behavior of seeking out needed services realized a statistically significant improvement among community participants.

10. Conclusion
Data driven project specifically identifies and targets participants and optimizes resources and impact.
Multi-Disciplinary planning, development and implementation (including both stakeholders and community members) ensures that needs specific to the target population are addresses via culturally and linguistically appropriate modalities.
Multi-dimensional modes of presentation optimize success (printed media, inter-agency referral education, video media, educational items, community events / luncheons, and organizational coordination)
Synergistic Benefit: health and social services as well as All-Hazards preparedness initiatives presented simultaneously to captive audience.
Pilot program can be replicated based on best practices as indicated by evaluation process (Kickoff event: 101 surveys, p=.001; final event: 62 surveys, p=.001)

11. Questions?
For more information visit the City of Fort Worth public health web page or call the Epidemiology Division at
Thank you!