Executive Summary I completed my field study at the Los Angeles County Department of Public Health- Maternal, Child, and Adolescent Health (MCAH)

Transcription

1 Executive Summary I completed my field study at the Los Angeles County Department of Public Health- Maternal, Child, and Adolescent Health (MCAH) division between June and September I worked under the Director of Reproductive Health, Dr. Diana Ramos, on three primary projects: 1) research on the primary cesarean section rate 2) analysis of breastfeeding promotion focus groups and 3) evaluation of interconception care practices in the Comprehensive Perinatal Services Program. Los Angeles County (LAC) has one of the highest primary cesarean section (c-section) rates in the state, causing concern among health professionals and the public. The MCAH division was asked to investigate causes of the rising rate and submit a formal report on the topic. Along with another intern, I completed a literature review on current c-section practices, policies, and studies with the goal of determining the best approach for beginning a research study. We then created a provider survey to be distributed to over one thousand LAC obstetricians that inquired about c-section practices and perceptions. I analyzed the results and submitted our findings to several conferences for presentation. The second part of the study was a multihospital chart review to assess actual labor/delivery practices at the five hospitals with the highest primary c-section rates in LAC. We collected detailed data from over 3,500 charts. The County is currently imputing the data into a database we created. This will eventually be analyzed to show the leading indications for primary c-sections, average labor times before c- section, demographic trends, and many other groundbreaking findings. Finally, the third part of the study consisted of a patient education brochure that we created to inform women about the risks of elective c-section without medical indication. We tested the brochure for content, layout, and reading level in two focus groups. African American teen mothers have among the lowest rates of breastfeeding initiation and continuation in LAC. Several years ago, a pilot study held focus groups with African American teen mothers at high schools in LAC to better understand influences on the decision to breastfeed. The results were never analyzed or published. I compiled and analyzed surveys which were collected during the focus groups and records of responses. I found several interesting trends and wrote a report to be used in future initiatives. The Comprehensive Perinatal Services Program (CPSP) provides training and certification for reproductive health providers throughout California that authorizes them to provide extra services for their pregnant and post-natal patients. These certified providers/clinics give an initial risk assessment for pregnant women to assess health risk conditions/behaviors, and then provide immediate referrals for nutrition, counseling, social, and medical services to improve the mother s health and pregnancy outcomes. A newer addition to CPSP is the concept of interconception care care provided to a women between pregnancies to ensure that she is in the best possible health before becoming pregnant again. Many CPSP providers have been trained on the topic but no evaluation had been done to assess whether or not they were actually implementing this care during the 60 days post-partum that women are still covered under MediCal pregnancy insurance. I completed a brief literature review on interconception care, and updated many of the training materials with the newest medical information. I also conducted a small-scale chart review at two CPSP certified clinics to determine whether providers were providing and/or billing for interconception services. Rebekah Mark Advisor: Dr. Anne Pebley September 7, 2011

2 Executive Summary From June to mid-september 2011, I interned at the Los Angeles County Department of Public Health s Maternal Child and Adolescent Health (MCAH) Program s Nurse Family Partnership (NFP). NFP is a nation-wide evidence-based home visitation public health nursing program that targets low income first time mothers. My internship focused solely on Los Angeles County. Many of the new mothers in this program are single, teenage mothers from disadvantaged neighborhoods. My preceptor was Cindy Chow, the NFP Nurse Manager. I also worked closely with Yvonne Williams, the Service Planning Area (SPA) 8 Nurse Supervisor, and many of the SPA 8 NFP nursing staff. My internship focused on one main project for SPA 8 called Planting a Seed of Change: Promoting Healthy Weight for Postpartum Women in Nurse Family Partnership. This project was an educational home-based weight loss intervention for new mothers that wished to participate. SPA 8 nurses aimed to present this project at the annual Public Health Nursing Practice Conference in May I conducted a literature review on postpartum weight loss programs and home-based weight loss programs to support NFP s rationale for engaging in the project. I also conducted a formative evaluation of what the nurses were implementing prior to my internship through an open roundtable discussion. Based on this evaluation, I assisted in modifying the project to fit with the home visit time constraints and the clients level of understanding. I streamlined the original curriculum that was used by creating key point flashcards with nutrition and physical activity guiding questions. To supplement these flashcards, I created a tool kit with nutrition and physical activity material based on the flashcards content. I collected and analyzed all project data on data files that I created. Prior to completing my internship, I trained one of the nurses to manage and collect additional project data and explained how the data files were organized. I also helped write the draft for the abstract for the May nursing conference. Lastly, I helped the nurses plan a social event for the clients in this project which included providing food, gardening lessons, dance lessons, and prize giveaways. My internship with NFP taught me a lot about program design, implementation, and evaluation which is important for much of the public health activities involving community health sciences. It taught me how to work with public health nurses and incorporate this additional project into their already busy schedules. Lastly, I was extremely fortunate to work with a group of compassionate, supportive, and passionate individuals and felt very welcomed in this environment. Hannah Valino Advisor: Dr. May Wang September 9, 2011

3 Abstract Between June and September of 2010, I interned at the Los Angeles County Department of Public Health, Maternal, Adolescent and Child Health (MCAH) Program s Nurse Family Partnership (NFP). As one of the numerous programs housed within the MCAH division, Nurse Family Partnership is an evidence-based home visitation program for first time, low income mothers in selected areas of L.A. County. My preceptor was Jeanne Smart, the program director, though I also worked under Cynthia Harding, the head of the MCAH department. During my time with NFP I completed three main projects. The first, most intensive, project I completed was a perinatal needs assessment for Los Angeles County focusing on young women s health and birth outcomes, as well as the general state of maternal and child health and wellbeing. My role in this project was researching and compiling current, documented data regarding prenatal care, substance use, breastfeeding, STI s, mental and physical health of pregnant and newly parenting women, child abuse and neglect, school readiness and performance, and family economic/self sufficiency. This information was compiled into final reports that were distributed to MCAH departmental staff, the NFP Advisory Board, and other L.A. County departments to be used as baseline data and inform future programs and funding applications. After the State specified the information required for a separate purpose, I wrote another version of the report to inform the disbursement of State funding for MCH programs. Separately, I compiled similar information for Los Angeles Service Planning Areas 1, 2, 3, 4, 6, 7, and 8 into an informal report to be used for baseline data upon program expansion. I also collected the aforementioned information for special populations such as Transition Age Youth, Homeless youth, youth recently released from the juvenile or adult criminal justice system, and deaf and/or hard of hearing youth for NFP staff who may seek to work with these populations upon program expansion, and when pertinent funding opportunities arise. The second project was conducting a survey for the California State needs assessment to gather information on existing home visitation programs and the populations they served. This included contacting directors and program administrators from various Los Angeles and national home visitation programs and compiling all responses and data collected. This information was shared with MCAH departmental staff and was and used to inform the final state needs assessment that was due Aug. 10 th. The third project I completed was assisting in the analysis of existing evaluation data collected from NFP Clients. My role was to review, compile and analyze data collected from NFP client satisfaction surveys. In doing so, I also created a new template for future NFP client satisfaction and process evaluation data collection tools. This experience was very valuable and extremely informative regarding the current state of maternal and child health in L.A. County, as well as county public health department operations. Rebecca Sussman Advisor: Dr. May Wang September 2, 2010

4 Abstract During the summer of 2009, I had the opportunity to intern with Dr. Diana Ramos at the Los Angeles County Department of Public Health in the Maternal, Child and Adolescent Health Programs Reproductive Health Unit. I worked on three projects all related to reproductive health. The first project was the American College of Obstetricians and Gynecologist District IX Interconception Care Project of California. The goal of the project is to identify common pregnancy complications in California and then develop evidence-based guidelines for clinicians to use for at-risk women during the postpartum visit and interconception period to reduce adverse outcomes in future pregnancies. My role as the research intern was to obtain California hospital discharge data on pregnancy-related complication in order to identify the most common complications and trends over time. I obtained the hospital discharge data for all pregnancy-related ICD-9 codes from 1999 to 2007 from the Office of Statewide Health Planning and Development; I used descriptive analysis to summarize the data and identify ten categories of common pregnancy complications (e.g., hypertensive disorders complicating pregnancy). In addition to identifying common complications, I also conducted a resource assessment to determine best practices related to the treatment of the common pregnancy complications. Based on my analysis and research, an advisory council made up of clinicians and public health professionals is developing guidelines to address pregnancy complications during the interconception period. An abstract on the work I did was created and submitted to an upcoming conference. The second project I worked on was to develop the Los Angeles County Preconception Health Website. The project involved researching best practices related to preconception health, other preconception health websites, including everywomancalifornia.org, and finding resources for clinicians and patients to improve women s health. Pages on the site included information about the Los Angeles Preconception Health Collaborative, preconception health resources for clinicians, interconception health resources for clinicians, patient educational tools, information for patients (both men and women) and various resources providing evidence supporting the role of preconception health and for the implementation of preconception health practices. After drafting a version of the site, members of the Los Angeles Preconception Health Collaborative provided feedback and suggestions on the site, and after creating a final draft, the website is set to go live. The third project I worked on was to survey Los Angeles Comprehensive Perinatal Services Program (CPSP) providers on their immunization practices and patient immunization trends, including assessing plans to immunize against H1N1 influenza. After designing a ten-item survey based on prior studies assessing immunization practices among obstetrician-gynecologists, I created an electronic version of the survey using SurveyMonkey.com. An was sent out to all CPSP providers requesting they complete the survey, and responses were collected over a 10-day period. After collecting responses, I analyzed the results using both descriptive and inferential statistics. The results of the survey were written up into an abstract to be submitted to an upcoming. Navdeesh Sidhu Advisor: Linda Bourque Date: September 12, 2009

5 Executive Summary/Abstract Student Name: Agnieszka Spatzier Agency: Los Angeles County Department of Public Health: Maternal, Child, and Adolescent Health Programs; Reproductive Health Unit. Location: Los Angeles, CA Preceptor: Diana Ramos, MD, MPH Year: 2009 This internship was a part of Summer Administrative Aid Training Program organized by the Los Angeles County Department of Public Health from June to September The internship was held at the Reproductive Unit of Maternal, Child, and Adolescent Health (MCAH) Programs in Los Angeles, CA. Two projects were completed under the guidance of the director of MCAH Programs Reproductive Health Unit, Diana Ramos, MD, MPH. Both projects involved work in Comprehensive Perinatal Services Program (CPSP), a statewide Medi Cal program for low income pregnant women. The objective of CPSP Perinatal Depression Screening Project was to assess depression screening practices among CPSP obstetrical providers in Los Angeles County and to increase the number of CPSP providers who screen their patients for depression. Work included conducting literature reviews on perinatal depression screening best practices, scheduling depression screening training for CPSP providers, revising training curriculum and materials, inputting baseline, pre and posttest, and training evaluation data, and presenting results from the project at the MCAH Annual Poster Presentation Session. Two abstracts with descriptive analysis of perinatal depression screening practices among CPSP providers were also submitted for national conferences. The second project involved updating content of CPSP website and restructuring its layout in order to improve navigation for CPSP staff and providers. The work included evaluation of Los Angeles County home website, CPSP California State website, and websites from public health departments from other counties providing CPSP services. In addition, documents posted on the website were updated and links to additional resources verified and supplemented. The new CPSP layout was presented during staff meeting to obtain feedback. Changes were incorporated and updated website launched. Agnieszka Spatzier Advisor: Dr. Judith M. Siegel September 14, 2009

6 Field Placement: LA County Department of Public Health: Maternal, Child, & Adolescent Health Location: Los Angeles, CA Preceptor: Diana Ramos Student Name: Laura Camberos Year: 2008 This Preconception Health Internship was held at the Maternal, Child, and Adolescent Health Programs (MCAH) within the Los Angeles (LA) County Department of Public Health from June to September Three projects were completed with Diana Ramos MD MPH, the Director of MCAH Reproductive Health and a member of the Los Angeles Preconception Health Collaborative. The purpose of these projects was to assist MCAH and the Preconception Health Collaborative in their efforts to spread preconception health care among LA County women. The first project was, Evaluation of the Preconception Health Curriculum. The purpose of this project was to analyze pre and post questionnaires from The ABCDE S to a Healthy Future: Speaker Bureau s Preconception Health Curriculum and to make recommendations on how to improve the curriculum. An abstract was also created and submitted for publication. The second project was, Preconception Health Messaging Among College Women. The purpose of this project was to conduct focus groups with undergraduate and graduate students in LA County to assess their preconception health knowledge and behaviors and to find types of social marketing messaging they would respond to. Work included creation of a focus group script, informed consent form, pre and post discussion questionnaires, and a preconception health handout. Institutional Review Board approval was also gained. Focus group findings were distributed at the California Preconception Health Council Meeting and an abstract was also submitted for publication. The final project was, Incorporating Preconception Health into the Comprehensive Perinatal Services Program (CPSP). The purpose of this project was to present preconception health information in the CPSP monthly trainings for CPSP workers to incorporate it into their encounters. Work included creation of a PowerPoint presentation, pre and post questionnaires, and handouts. Results were distributed at the California Preconception Health Council Meeting.

7 Field Placement: LA County Department of Public Health: Maternal, Child, & Adolescent Health Division Location: Los Angeles, CA Preceptor: Eleanor Long Student Name: Summer Hamide Year: 2008 My field studies experience was completed with the Los Angeles County Department of Public Health in the Maternal, Child, and Adolescent Health (MCAH) Division. I began the field studies in early August and finished in mid-january. I averaged about 20/hours per week during this period. The office that I worked out was at 600 S. Commonwealth, in the Koreatown area. My preceptor was Eleanor Long, MSPH, who is a health educator in the MCAH Division. My project title was Understanding and Promoting Healthy Weight for Women of Reproductive Age. Overall, my main objectives for this project were to 1) better understand barriers for women of reproductive age (especially low-income and minority women) in achieving a healthy weight and exhibiting such behaviors as healthy eating and exercise, and 2) examine the usage of guidelines related to the treatment of overweight/obese patients by physicians, especially reproductive-aged women. The overarching concept addressed by my project is generally know as preconception health care the idea that the health of a woman before she becomes pregnant, including her weight status and the many complications that can arise from being overweight, can affect the course of her pregnancy, birth outcomes, and the health of her child as he/she grows and develops. Regarding the first objective of better understanding barriers for women of reproductive age to achieving a health weight, the main activities that I undertook were to help conduct focus groups at various WIC clinics in LA County in which myself and other interns gathered qualitative data from the women about various social, economic, environmental, structural, personal, and other barriers that these women face in achieving a health weight, as well as qualitative data through a self-administered questionnaire which addressed demographic questions, questions about eating and exercise behaviors and other lifestyle behaviors, and attitudes and beliefs about weight and body image. These results were then analyzed by me and other interns. As the same process had been undertaken in 2007 among sample from the same target population, another one of my main activities was to compare the two sets of data with one another and to then create a report/article summarizing the findings. The intent is to attempt to have the article published. Regarding the second objective of examining the usage of guidelines by physicians related to the treatment of overweight/obese patients by physicians, the main activity I undertook was to develop a provider questionnaire for each of the toolkits that had been developed by the California Medical Association (CMA). These include the Adult Obesity Toolkit and the Child/Adolescent Obesity Toolkit. I worked with the staff at the CMA to develop questionnaires which would address knowledge, attitudes, beliefs, and

8 behaviors of physicians and other healthcare providers towards the use of guidelines in general and obesity-related guidelines in particular, and which would obtain feedback from the responding providers about the Toolkits that the CMA had developed. These questionnaires have now been finalized by both the CMA and the MCAH Division and the next step will be for them to be distributed to providers for them to complete. Overall, my experience at the MCAH Division was a little disappointing because it proved to not provide many challenges or many opportunities to apply what I had learned in the classroom. I was under the impression that I would be working more in the community in order to help the Division to implement a curriculum that I was told it was developing that would help women change their eating and exercise behaviors. However, when I began my internship, I quickly realized that this was not the route that the project had taken, and that instead I would be doing a substantial amount of data analysis work and report drafting.

9 Field Placement: LA County Department of Public Health: Maternal, Child, and Adolscent Health Program Location: Los Angeles, CA Preceptor: Eleanor Long Student Name: Jacqueline Torres Year: 2008 I completed my internship between June and September, 2008 at the Maternal, Child and Adolescent Health Programs (MCAH) division of the Los Angeles County Department of Public Health. My project, Overcoming Barriers to Healthy Weight Among Women of Reproductive Age provided me with experience in health education, health communication and the creation of culturally competent materials and programs. Specifically, I created a brochure in Spanish for low-income Latinas to address common barriers to achieving a healthy weight, including lack of time to exercise and family preferences for high fat, traditional foods, among many others. I pretested this brochure with Spanish-speaking WIC clients at a WIC center in metropolitan Los Angeles (n = 46). The results of the project were written up as a poster and a manuscript to be submitted for publication. My preceptor, Eleanor Long, MSPH is the health education coordinator for MCAH and currently oversees the Healthy Weight for Women of Reproductive Age Action Learning Collaborative (HWWALC). The HWWALC brings together health care providers, community-based organizations, university professors and programs and personnel from other programs within LADPH to promote healthy weight amongst women of reproductive age. The climbing rates of overweight and obesity among women of reproductive age, and the implications for perinatal health, has meant that the promotion of healthy weight is a priority for public health at national and local levels. The creation of materials promoting healthy weight can be an important starting point, and is the current priority for the HWWALC. Efforts to promote healthy weight should also go beyond the development of messaging to help overcome barriers at all levels from individual to environmental.

10 Field Placement: Los Angeles County Department of Public Health, Child & Adolescent Health Location: Los Angeles, CA Preceptor: Robert Gilchick Student Name: Jennifer Lowe Year: 2007 Who? For my field studies experience for CHS, I was offered a position as a graduate student intern with the Los Angeles County Department of Public Health. I was chosen by the newly hired medical director of the Child and Adolescent Health (CAH) programs, Dr. Gilchick, because of my undergraduate background in dietetics. The project s target audiences are both children aged 0 to 5 and child care providers of child development programs in Los Angeles County. What? I was given this executive assignment from Dr. Jonathan Fielding, the Director of the Department of Public Health and Health Officer for Los Angeles County. The project I was assigned to spearhead was to implement nutrition and physical activity guidelines in Los Angeles County child development programs (child care centers and family care homes). Where? The internship was located at 600 S. Commonwealth Avenue in downtown Los Angeles. The project s target area is Los Angeles County child development programs. When? 12 weeks; June 28th August 12th, Why? Since there are approximately 50 percent of children in Los Angeles County are enrolled into child development programs and the epidemic of obesity has risen drastically over the past 5 years, this project was aimed to prevent the prevalence and incidence of overweight and obesity in Los Angeles County s youngest children; aged 0 to 5 years old the ages of which behaviors and attitudes are shaped and sustained into childhood and later adulthood. I penned this project ACHIEVE: Attaining Childhood Health in EnVironments for Excellence. I planned to do this by mirroring similar guidelines and policies that are outlined by the New York Department of Health, Office of Mental Health. But, since the political environment of Los Angeles County differs from that of New York, my strategy would be unique. How? By critically reviewing the literature and policies and guidelines set forth by the New York Department of Health and the State of California, I was able to determine pertinent information on how to incorporate better nutrition and physical activity guidelines into child development programs. I conducted interviews with key informants

11 (representatives from the Office of Child Care, Nutrition Program, Chronic Disease Program, various Child Care Providers in Long Beach and Santa Monica) to determine which was the most effective way to communicate this important information. From these interviews I created an ACHIEVE Toolkit for child care providers, ACHIEVE pamphlets, and a website prototype addressing the importance of both nutrition and physical activity. I was also given the opportunity to participate in many other projects, such as drafting a legislative bill analysis, drafting an amendment to the Mental Health Services Act, and designing a prenatal brochure for the LA Best Babies Network.

12 Field Placement: LA County Department of Public Health: Office of Organizational Development & Training Location: Los Angeles, CA Preceptor: Cherie Forsha Student Name: Serene Ho Year: 2008 My field study placement was with the Leadership and Technology Unit and the Emergency Preparedness Unit within the Office of Organizational Development and Training (ODT) of the Los Angeles County Department of Public Health. My preceptor was Cherie Forsha, RN, MSN/MPH, CNS, the current Assistant Nursing Director/Deputy of ODT. Located in downtown Los Angeles, the main function of ODT is to develop, plan, facilitate, and evaluate trainings for all employees of the Department of Public Health. ODT takes a more administrative approach in executing Public Health knowledge, as it is geared towards training employees of the County, rather than outreaching to the community. This office emphasizes on maintaining the well-being and knowledge of the County s employees as quality assurance of the work they pass on to the communities employees outreach to. For the duration of my field study, from July to September 2008, I had two main projects. I created a training module for the Leadership Unit called Building a Positive Work Environment for the New Supervisor Development Program ODT is launching. This training module was designed to be implemented by the Leadership Unit staff for a cohort of new supervisors across the Department of Public Health. In addition to the development of the module, I helped implement the program and assisted in the preliminary stages of the evaluation of the module. For the Emergency Preparedness Unit, I also assisted in the development of several training modules for Emergency Preparedness across the Department of Public Health. However, for these modules, I assisted more with the evaluation process of creating questionnaires, analyzing previous data to be compiled into reports, and other evaluation tools. In addition to developing my curriculum designing skills, formative research skills, and evaluation skills, my field study provided me the opportunity to experience many of the internal organizational dynamics within LA County Department of Public Health. I had the opportunity to visit various sites and listen to various presentations from different offices within LA County to gain a better viewpoint of how the Department of Public Health works.

13 Field Placement: Los Angeles County Department of Public Health, Organizational Development & Training Office (ODT) Location: Los Angeles, CA Preceptor: Ernesto Hinojos Student Name: Amanda Higgins Year: 2007 My field study placement was with Los Angeles County Department of Public Health s Organizational Development and Training Office (ODT). Within ODT I was assigned to the Emergency Training Unit (EPrep). My preceptor was Ernesto Hinojos, who is currently the manager for the EPrep Unit. The Office of Organizational Development and Training s EPrep Unit is located in downtown Los Angeles. The primary goal of ODT is to develop a skilled and effective workforce. According to Policy 911, which has been in effect since October 1st, 2004, all Department of Public Health (DPH) employees are members of the Emergency Response Team, and in the event of an emergency are expected to report to work. A required training course, Prep 101, was developed to help educate DPH employees about Policy 911, as well as to prepare employees to be skilled and ready to assist their families, community, and the people of Los Angeles County if, and when, a disaster occurs. In response to a national Public Health Emergency Preparedness grant requirement from the CDC, ODT acquired a set of web based management tools designed to support employee trainings. Los Angeles County has identified a need for a standardized Learning Management system to enable all of Los Angeles County Departments to share educational and training resources. The Office of Organizational Development and Training is responsible for deploying the LMS to the Department of Public Health. For the duration of my field studies, from July October of 2007, I had three primary objectives: 1) Analyze the Prep 101 course evaluation, pre-test, and post-test data and to create quarterly reports based on this data. 2) Assist in overhauling the current Prep 101 course. 3) Assist in revising the Learning Management System (LMS) deployment plan. To help update Prep 101, I worked on updating the information in the Participant Manuals to ensure that they matched current recommendations, created a bio terrorism agent education game called Master of Disasters, and created Emergency Preparedness snippets designed to reinforce Prep101 concepts. In addition to training development, I was responsible for taking pre-existing Prep101 evaluation data and developing quarterly reports. These reports will be used to help guide future changes to Prep101 content as well as to advise facilitators regarding areas needing improvement. I also assisted ODT in helping to plan the future deployment of a training management database, referred to as the LMS.

14 Through my field studies I had the opportunity to develop curriculum development skills, and evaluation skills. Additionally, I had the opportunity to network with professionals both in the public sector and the private sector of the disaster management field.

15 Field Placement: LA County Department of Public Health: Office of Organizational Development & Training Location: Los Angeles, CA Preceptor: Cherie Forsha Student Name: Serene Ho Year: 2008 My field study placement was with the Leadership and Technology Unit and the Emergency Preparedness Unit within the Office of Organizational Development and Training (ODT) of the Los Angeles County Department of Public Health. My preceptor was Cherie Forsha, RN, MSN/MPH, CNS, the current Assistant Nursing Director/Deputy of ODT. Located in downtown Los Angeles, the main function of ODT is to develop, plan, facilitate, and evaluate trainings for all employees of the Department of Public Health. ODT takes a more administrative approach in executing Public Health knowledge, as it is geared towards training employees of the County, rather than outreaching to the community. This office emphasizes on maintaining the well-being and knowledge of the County s employees as quality assurance of the work they pass on to the communities employees outreach to. For the duration of my field study, from July to September 2008, I had two main projects. I created a training module for the Leadership Unit called Building a Positive Work Environment for the New Supervisor Development Program ODT is launching. This training module was designed to be implemented by the Leadership Unit staff for a cohort of new supervisors across the Department of Public Health. In addition to the development of the module, I helped implement the program and assisted in the preliminary stages of the evaluation of the module. For the Emergency Preparedness Unit, I also assisted in the development of several training modules for Emergency Preparedness across the Department of Public Health. However, for these modules, I assisted more with the evaluation process of creating questionnaires, analyzing previous data to be compiled into reports, and other evaluation tools. In addition to developing my curriculum designing skills, formative research skills, and evaluation skills, my field study provided me the opportunity to experience many of the internal organizational dynamics within LA County Department of Public Health. I had the opportunity to visit various sites and listen to various presentations from different offices within LA County to gain a better viewpoint of how the Department of Public Health works.

16 Field Placement: Los Angeles County Department of Public Health, Organizational Development & Training Office (ODT) Location: Los Angeles, CA Preceptor: Ernesto Hinojos Student Name: Amanda Higgins Year: 2007 My field study placement was with Los Angeles County Department of Public Health s Organizational Development and Training Office (ODT). Within ODT I was assigned to the Emergency Training Unit (EPrep). My preceptor was Ernesto Hinojos, who is currently the manager for the EPrep Unit. The Office of Organizational Development and Training s EPrep Unit is located in downtown Los Angeles. The primary goal of ODT is to develop a skilled and effective workforce. According to Policy 911, which has been in effect since October 1st, 2004, all Department of Public Health (DPH) employees are members of the Emergency Response Team, and in the event of an emergency are expected to report to work. A required training course, Prep 101, was developed to help educate DPH employees about Policy 911, as well as to prepare employees to be skilled and ready to assist their families, community, and the people of Los Angeles County if, and when, a disaster occurs. In response to a national Public Health Emergency Preparedness grant requirement from the CDC, ODT acquired a set of web based management tools designed to support employee trainings. Los Angeles County has identified a need for a standardized Learning Management system to enable all of Los Angeles County Departments to share educational and training resources. The Office of Organizational Development and Training is responsible for deploying the LMS to the Department of Public Health. For the duration of my field studies, from July October of 2007, I had three primary objectives: 1) Analyze the Prep 101 course evaluation, pre-test, and post-test data and to create quarterly reports based on this data. 2) Assist in overhauling the current Prep 101 course. 3) Assist in revising the Learning Management System (LMS) deployment plan. To help update Prep 101, I worked on updating the information in the Participant Manuals to ensure that they matched current recommendations, created a bio terrorism agent education game called Master of Disasters, and created Emergency Preparedness snippets designed to reinforce Prep101 concepts. In addition to training development, I was responsible for taking pre-existing Prep101 evaluation data and developing quarterly reports. These reports will be used to help guide future changes to Prep101 content as well as to advise facilitators regarding areas needing improvement. I also assisted ODT in helping to plan the future deployment of a training management database, referred to as the LMS.

17 Through my field studies I had the opportunity to develop curriculum development skills, and evaluation skills. Additionally, I had the opportunity to network with professionals both in the public sector and the private sector of the disaster management field.

18 Field Placement: Los Angeles County Department of Public Health, Office of AIDS Programs and Policy, Provider Support Services Division Location: Los Angeles, California Preceptor: Heather Northover, MPH, CHES Student Name: Marisa Cohen Year: 2009 During my 2009 field studies placement, I worked for the Los Angeles (LA) County Department of Public Health (LADPH), Office of AIDS Programs and Policy (OAPP) in their Provider Support Services Division (PSSD) in LA, California. OAPP is a county government office. Their mission is to respond to the HIV/AIDS epidemic in LA County by preventing its spread, maximizing health and social outcomes, and coordinating effective and efficient targeted services for those at risk for, living with, or affected by HIV/AIDS. PSSD s function within OAPP is to provide educational and technical assistance to organizations and programs that target those affected by HIV/AIDS and who receive funding from OAPP. HIV/AIDS is a concern for LA County, as approximately one third of all HIV/AIDS infections in California occur in LA County. As a result, state and local health officials see the epidemic as a priority. As a part of PSSD, I sought to further develop my own professional skills, while assisting the department in carrying out their mission. My duties at PSSD included curriculum development, facilitating health education sessions, and various professional development activities. I spent the majority of my time in the office, but there were several occasions when I worked outside the office at locations across LA County. My major task at PSSD was to develop a curriculum and corresponding materials for a new training on Health Literacy and Plain Language. This involved defining the goals and objectives of the training, conducting research and a literature review on the subject, developing a curriculum, training activities and a presentation. This will be delivered to participants at the 2010 HIV/AIDS update session that will be held multiple times in the coming year. I was also required to attend different trainings offered by PSSD, to gain a better understanding of the way their trainings are run and to learn more about HIV/AIDS. In addition to this, I was responsible for facilitating a health education training session. This required me to co-facilitate an eight-hour session, providing basic HIV/AIDS knowledge to professionals working with the community. Finally, I was responsible for attending meetings, assisting in the planning committee for a plenary session on defining youth friendly services and taking part in various other professional development activities. I took minutes at meetings and provided summary reports for my preceptor when she was not able to be in attendance. I learned a tremendous amount from my time at PSSD, and also made valuable connections. My preceptor has become a mentor as well, offering me advice on valuable classes, job advice for the future and alerting me of good opportunities to gain more experience and further develop as a professional. I plan to continue that relationship. Also, since PSSD works with so many community organizations and I was able to develop relationships with professionals working outside of PSSD. Marisa Cohen, Dr. Michael Prelip, October 29, 2009

19 Field Placement: Los Angeles County Department of Public Health Office of AIDS Programs and Policy Location: Los Angeles, CA Preceptor: Jacqueline Rurangirwa Student Name: Stacey To Year: 2007 During the summer of 2007, from July to September, I had the opportunity to work with the County of Los Angeles- Department of Public Health, Office of AIDS Programs and Policy (OAPP) in their Planning and Research Division. The department is located in the Superior Court building, which is situated near MacArthur Park. My advisor was Jacqueline Rurangirwa, who is an epidemiologist in the division. When I started my internship, Jacqueline was working on the pre-implementation activities of the CDC Rapid Test Algorithms for Diagnosis of HIV Infection and Improved Linkage to Care Study (RTA). Therefore, I had the chance to help out and contribute to the project. OAPP received a grant from the CDC to pilot and evaluate a new HIV testing algorithm. Currently, when someone gets tested for HIV, he first gets an oral rapid test, and if that comes back positive, then blood is drawn and sent to a laboratory for confirmation results. However, the confirmatory test results do not come back until a week later, and that person is not linked into care until then. During the one-week wait period, he could change his mind and not return for his confirmatory test results. The RTA study, which entails two additional rapid tests with greater sensitivity and specificity than the first oral test, looks to eliminate the week-long waiting period by giving more accurate results and linking people into care the same day. My responsibilities with the RTA project included creating part of the provider s manual, making pre-implementation visits to the intervention agencies, and helping conduct competency tests with HIV counselors to ensure that they remember how to use the new HIV rapid tests. I was also given the task of quantitatively analyzing the competency test results. Although Jacqueline was my advisor and the person I worked with the most, I also had the opportunity to work with other OAPP staff, both research analysts and epidemiologists. Additional projects that were occurring during my internship, in which I was able to participate in, were conducting needs assessment. The assessment helps to research information regarding HIV services and needs for the Los Angeles Commission on HIV and HIV Prevention Planning Committee, the planning bodies responsible for creating annual plans for treatment and prevention services. My role with the Los Angeles Coordinated HIV Needs Assessment (LACHNA) was to not only go out into the field and conduct surveys with the public, but to also be a communitygovernment liaison and coordinate with health clinics for OAPP to go and perform their needs assessment. The needs assessment also entailed my involvement in focus groups, where I attended, took notes, and transcribed discussions. Overall, I am very happy to have worked at OAPP. All members of the Planning and Research staff are passionate and dedicated to their work, which made my internship experience that more enjoyable by working with such inspirational people. I hope to have the chance to work at OAPP again or at least the county in general.

20 Executive Summary This summer, I interned at the Los Angeles County Department of Public Health in the Tobacco Control and Prevention Program under Deputy Director Monty Messex, MPH. From late June through early September, I worked full-time at the office on multiple objectives that engaged me in several areas of the department. My primary objective was to develop the public education campaign for Los Angeles City s Smoke-Free Outdoor Dining ordinance. This ordinance, which passed in March 2010 and is set to take effect in March 2011, mandates that LA City s outdoor dining and café patios must become non-smoking starting in that month. Since the majority of Los Angeles s citizens and business owners are unfamiliar with this ordinance and how it will impact themselves and their businesses, it was one of my duties to work on figuring out a cost-effective strategy for disseminating this information. Continually meeting up with a task force that included representatives from the American Heart, Lung, and Cancer Associations, as well as a representative from Councilmember La Bonge s office, we devised a strategy for the public education campaign. I also organized a roundtable discussion that hosted various tobacco control advocates from a number of cities in Los Angeles County that have already implemented similar regulations in their own jurisdictions. The purpose of this meeting was to glean insights for how to most effectively run the public education campaign, and indeed, much valuable information was gathered from this session. Apart from planning and on the larger-scale, I got involved with the more practical aspects of the campaign, like getting quotes from various vendors who will produce the public education materials, drawing up a budget, and creating a presentation to request city funding for the initiative. My second large objective took me to a different part of the department, working with the new team of staff, Project TRUST, who are funded by the Center for Disease Control and Prevention s recent 16 million dollar grant. With this team, I got to sit in on numerous meetings and learn about their various strategies for impacting tobacco control changes in Los Angeles County. My chief assignment in this area was to create an observational survey that measures point of purchase advertising in Los Angeles County tobacco-selling retailers. These surveys will be used by TRUST staff as they go into the jurisdictions where they intend to affect policy change including requiring health warning and cessation information signage at point of purchase in stores that carry tobacco. The surveys will function as a tool to measure the level of point of purchase tobacco advertising on the local level, and will help the staff demonstrate need for increased health warning signage to the community. The observational tool will also be used after the policies have been passed, to monitor compliance by the retailers. Overall, my experience at TCPP was a positive one. The most influential part of the experience was getting to witness a well-run department that strategizes deliberately, adheres to an evolved theory, and relies on time-tested best practices. TCPP s staff are intelligent, hard-working, and dedicated, and they provided excellent role models for my own professional development. Liz Bartlett Advisor: Dr. Mike Prelip 10/06/2010

21 Field Placement: LA County Department of Public Health, Tobacco Control and Prevention Program Location: Los Angeles, CA Preceptor: Montgomery Messex Student Name: Lana Sklyar Year: 2008 I conducted my field studies at the Los Angeles County Department of Public Health (LACDPH), Tobacco Control and Prevention Program (TCPP). From June 7, 2008 until October 31, 2008, I worked on various activities for the Tobacco-Free Pharmacy and Koreatown Objectives, which were negotiated between TCPP an the California State Department of Public Health for the fiscal years TCPP is led by the Program Director, Linda Aragon, and supervised by Dr. Paul Simon, the director of the Division of Chronic Disease and Injury Prevention of the LACDPH. TCPP was first funded by the California Department of Health Services through the Prop 99 tobacco tax initiative 19 years ago. Since that time, TCPP has worked hard to offer public education and create policies to reduce tobacco use in L.A. County and support its mission of reducing the disease, disability, and mortality associated with tobacco use. In order to achieve its objectives, TCPP works closely with community-based organizations and coalitions to educate the public about tobacco control issues. TCPP also works closely with city staff to educate them about the ill effects of tobacco use within the community and advocate for tobacco control policies. During my field studies, I worked extensively with my preceptor, evaluation staff, and the TCPP health educators to make sure that the work I did fit well with the activities that TCPP had negotiated with the CA State Department of Health Services. Specifically, I worked on two objectives that fall into TCPP s priority areas of decreasing exposure to secondhand smoke and to reducing tobacco availability. The Koreatown Objective aims to increase compliance with the California Smoke-Free Workplace Law among restaurants, cafes, bars, and nightclubs in Koreatown. To address this issue of noncompliance, TCPP works with the L.A. City Attorney s Office, the L.A. City Fire Department (LAFD), and numerous other organizations on various activities to develop an intervention. In working on this objective, I was responsible for creating a baseline survey instrument to obtain a valid measure of noncompliance with the Smoke-Free Workplace Law among bars and restaurants in Koreatown. Furthermore, I had to create a key informant survey instrument and accompanying protocol, and then conduct interviews with city staff and researchers about the barriers to increasing compliance with the law. TCPP s Tobacco-Free Pharmacy Objective aims to increase the percentage of independent pharmacies in L.A. County that adopt a voluntary policy not to sell tobacco. In working on this objective, I was responsible for conducting research on pharmacy schools and organizations that would support TCPP in this campaign, creating a strategy chart for the campaign, and reviewing materials from previous tobacco-free pharmacy campaigns. Furthermore, I assisted TCPP staff in creating and conducting a baseline survey to assess how many independent pharmacies in L.A. County sell