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Building Community Resiliency

State: FL Type: Promising Practice Year: 2019

The Florida Department of Health in Okaloosa County (DOH-Okaloosa) is located in the Florida panhandle.  DOH-Okaloosa is the host agency for the Okaloosa-Walton Medical Reserve Corps, a team of volunteers trained and prepared to mitigate impacts of emergencies and respond to public health disasters.  http://okaloosa.floridahealth.gov/programs-and-services/emergency-preparedness-and-response/medical-reserve-corps.html

According to Florida CHARTS 15.8% of Okaloosa's population is 65 years of age and older.  23.6% of Okaloosians are limited in activities because of physical, mental or emotional problems.  The biggest threat to Okaloosa County is hurricanes and tropical storms.  The county runs from the Gulf of the Mexico coast to the Alabama state line.  Okaloosa County is the home to three military bases and we have an increasing number of retirees residing here. 

The Lean On Me Project has developed local preparedness materials that address some of the region's unique issues, specifically designed for vulnerable populations including seniors.  The project goals included:

·       Creating a curriculum designed to educate vulnerable populations in emergency preparedness and resiliency

·       Training volunteer staff on the curriculum

·       Obtain grant funding for supplies

·       Collect data and analyze the county for pockets of vulnerable populations

·       Advertise through community partners in vulnerable population areas

·       Execute program to vulnerable populations in both Okaloosa and Walton County

·       Survey current clients to assess public health gaps

·       Add additional educational, resources, and or interventions to curriculum to increase public health impact to clients

In the first 18 months of the Project, volunteers have performed 101 visits and have interest forms for more.  Thus far, we have met all of our objectives and more.  We have shared our best practices around the state and nationally at the Heathy Aging Summit.  Florida Department of Health has adopted the Lean On Me Project as a best practice and has funded two other counties to pilot the program.

We believe that the dedication and commitment of our volunteers and leadership to the project, and the apparent need in the community made it so successful.  Lean On Me Project is providing piece of mind for our clients.  The largest public health impact is that we are strengthening the whole community, reducing the burden on first responder services to the community during disasters, and helping to make recovery from these events less stressful for vulnerable populations because they are better prepared before a disaster strikes. 

Okaloosa County is the home to ~193,247 community members (FlHealthCHARTS, 2016).  DOH-Okaloosa PHP section is responsible for ensuring the continuity of healthcare services and the health and welfare of all Okaloosians during emergencies or disasters.  In order to do this, DOH-Okaloosa utilizes current staffed employees and manages a volunteer corps that trains and credentials volunteers for use in the time of need.  The Okaloosa-Walton Medical Reserve Corps (OWMRC) is a corps of medical and non-medical volunteers.  Currently, there are approximately 100 registered volunteers from both counties.  Their mission is to augment DOH-Okaloosa/Walton Public Health emergency/non-emergency response capabilities.  Over the years, the OWMRC leadership has seen volunteerism ebb and flow.  Some can be attributed to natural attrition of the population due to the strong military presence in Okaloosa County.  Other factors are believed to be caused by lack of volunteer engagement during blue-sky (non-disaster times) events.  Volunteers have expressed boredom and lose interest to leave to another philanthropic organization that provides them the benefit of conducting impactful activities daily.  This identifies the first key area for improvement: volunteer sustainability.

About 80% of older adults have at least one chronic condition that makes them more vulnerable than healthy people during a disaster” (Aldrich, 2007).  Hurricane Katrina was a key cornerstone event in emergency management.  Many lessons resulted from this disastrous storm.  A salient point from post-Katrina data was that 75% of all deaths were elderly (Wingate, 2007).  At the time of Hurricane Katrina, the elderly population only attributed to 15% of the current census of New Orleans, making this statistic staggering!  Older adults are considered to be 65 and older (FIFORS, 2012).  Currently, 15% percent of Okaloosans are older adults (FlHealthCHARTS, 2017).  This indicates that Okaloosa County has a significant key area for improvement due to the significant vulnerable population that needs preparedness assistance.  Additionally, when an emergency or disaster occurs, it has been shown in prior Okaloosa documentation and experience that the elderly or vulnerable are the majority of assistance calls to ESF-8 and 911. Therefore, another key area for improvement is reducing the burden on the ESF-8, first responders, and healthcare systems during an emergency.

The Lean On Me (LOM) Project was the answer to all these key areas for improvement. It engaged volunteers and increased resiliency in vulnerable populations which will lead to an expected reduction of emergency services during an emergency.

The specific goals of this project include:

·       Creating a curriculum designed to educate vulnerable populations in emergency preparedness and resiliency

·       Training volunteer staff on the curriculum

·       Obtain grant funding for supplies

·       Collect data and analyze the county for pockets of vulnerable populations

·       Advertise through community partners in vulnerable population areas

·       Execute program to vulnerable populations in both Okaloosa and Walton County

·       Survey current clients to assess public health gaps

·       Add additional educational, resources, and or interventions to curriculum to increase public health impact to clients

We have currently 101 clients enrolled in the LOM Project database.  Of the 15% of Okaloosians 65 and older, we have reached 3.5% of this population in the first year and half of the program. 

The Lean on Me program is a new and novel field in public health.  Currently the LOM Project is the only home visit-based program targeting vulnerable populations with the goal of building community resiliency. 

Upon research into Public Health initiatives that serve the same mission of Lean on Me, there was only one entity that utilized volunteers in a similar fashion with the focus of preparing vulnerable populations.  Brookline, MA hosts the Emergency Preparedness Buddies Program.  The buddies program was developed to assist elder residents to improve their readiness for disasters.  This project pairs one coach” with one buddy” and allows them to keep in constant contact with each other to provide daily support.

            After interviewing Brookline Medical Reserve Corps leadership and comparing notes on both programs, we decided to share resources to incorporate best practices from Brookline.  We did note the LOM project is similar in mission and nature; however, Brookline had a larger pool of volunteers which allowed them to commit a coach to a buddy.  The OWMRC has a smaller pool of trained volunteers, thus allowing volunteers to have multiple contacts in the community.  LOM has also secured funding to allow for incentives into the program and provide the vulnerable populations with resources for after the visit concludes.

            Another significant difference in LOM from Brookline's initative, LOM is integrated into the ESF-8 emergency operations and will be a point of contact for all LOM clients from within the Emergency Operations Center during the entire duration of a disaster.


The specific goals of this project include:

o   Creating a curriculum designed to educate vulnerable populations in emergency preparedness and resiliency

o   Training volunteer staff on the curriculum

o   Obtain grant funding for supplies

o   Collect data and analyze the county for pockets of vulnerable populations

o   Advertise through community partners in vulnerable population areas

o   Execute program to vulnerable populations in both Okaloosa and Walton County

o   Survey current clients to assess public health gaps

o   Add additional educational, resources, and or interventions to curriculum to increase public health impact to clients

Project Design and Implementation utilized a planning team of leadership and volunteers to establish goals including target audience, drafting preparedness curriculum, locating and securing funding, establishing and building community partnerships, executing the project, and evaluating the system and community interest. Training and client information, flyers, and pamphlets were created. Partnerships with community members and national associations assisted in the funding and securing of resources to incentivize the project. Community partners were engaged to assist in conducting marketing.  Okaloosa County Elder Services shared LOM information in their Meals on Wheels program. Passive advertisement was utilized. Community members would obtain the advertisement through community partner or outreach venues and solicit the LOM service.  We partnered with Okaloosa County emergency medical services, fire departments, churches, and other community venues to advertise to the target population.  Our goal is to conduct marketing in a specific census tract per month and completely canvas all identified locations of vulnerable populations within 3 years.

Targeted Marketing and Scale-up included utilizing the United States Census Bureau individual income and disability data from the 2012-2015 American Community Survey estimates. Analysis identified pockets of vulnerable populations that would most benefit from the project. The data was analyzed by percentage of total population within every census tract in Okaloosa County. Data analysis included the following steps:

       Ranking of the percentages of individuals among each variable in all Okaloosa census tracts from highest to lowest.

       From that ranking, identify the top 10 census tracts with the highest percentage of each variable measured.

       Collecting and entering those top 10 census tracts into a cross-matrix along with the top 10 census tracts from all the other variables.  The matrix was used to compare all census tracts with all 8 variables analyzed.

       Based on the rankings and number of variables, a vulnerability score was determined.

       Lastly, each census tract received a score based on how many of the 8 variables was each census tract within the top 10 percentages.

The more variables a census tract scored in the top 10 percentages, the more vulnerable they were considered.

Advertisement and marketing is being conducted in each census tract.  We advertise to allow community members to contact us to request the service.  Our target population is anyone 65 or older or at least one disability.  However, we have never turned anyone away.  The program is most popular with the elderly, 100% of our clients have been 65 and older.  This audience should not be patients of a current in-patient healthcare system.  Those inpatient services are required to provide emergency assistance and assume responsibility for their clients under Florida Statutes.


·       Lean on Me project mission of increasing resiliency and reducing disparities in the vulnerable population, the project was added as an activity in the DOH-Okaloosa Strategic Plan.  It aligns with the DOH Strategic Priority #3: Readiness for Emerging Health Threats. With the local Goal# 3.1.2: Increase partnerships to promote and improve community planning and response readiness for disaster (man-made and natural) and emerging health threats. And Strategy 3.1.2 3.1.2 Develop and strengthen community partnerships to provide preparedness education and resources to vulnerable populations and reduce the burden of emergencies. Objective 3.1.2 By December 2018, implement a preparedness education and resource program designed to reduce disparities for vulnerable populations through direct counseling, community partnerships and emergency preparedness.

Financial assistance included receiving of two grants, one from Florida Department of Health (FDOH) and the other from the National Association of County and City Health Officers (NACCHO).  Both, the one-time special project funding from FDOH and the NACCHO Challenge Award, totaled $13,000 each and were used to purchase printing of curriculum and flyers, first aid kits, weather radios, flashlights, and disaster supply kit boxes for each of the clients we intended on visiting. We received a total funding for 300 clients to each receive the incentive go-kit.

A break down of the budgets are as indicated:

EquipmentWaterproof Container309$10.00$3,090.00$0.00$3,090.00
EquipmentBatteries (AA) for Radios (packs of 36)30$27.00$810.00$0.00$810.00
EquipmentWeather Radio260$35.00$9,100.00$0.00$9,100.00
Contractual 
Printing of books/Flyers/manuals 300
$13,000.00
$13,000.00

In-kind volunteer and staff hours were donated to this project in large. The program development and research required significant manpower hours. Once the program was developed and functional, the bulk of the work was conducted by volunteers.

The Lean On Me Project design and implementation resulted in approximately 15 trained LOM volunteers.  The volunteers attended 16 community outreach events to promote the program and increase participation.  The volunteers conducted 101 home visits of vulnerable community members.  During each visit, they executed the curriculum, gathered information from the client, and left them with a specific, tailored emergency plan.  Along with the emergency plan, each client was provided a sturdy file box to keep their plan and emergency documents in.  They received first aid kit, flashlight, and a NOAA weather radio.  The planning team identified multiple areas for improvement in the curriculum and marketing.  Areas for improvement included adding additional check lists, assisting clients with Special Needs Shelter registry, and obtaining the clients' feedback on the forms.  Upon return from the visit, client information was entered into a database that ensured LOM volunteers had contact information on each client. This information is essential, so volunteers can conduct emergency call-downs and relay crisis emergency risk communication and tailor messaging per acuity level of each client. 

During discussions with the clients, they declared a reduction in fear of emergencies after the visit and generally felt more prepared.  The clients displayed immense appreciation to the volunteers and took comfort in knowing someone was available to help them.  The clients bonded with the volunteers in the short hour or two visitation.  The program became popular and word began to spread, the LOM coordinator began getting calls requesting the service from a referral of a LOM client.  There was sufficient evidence to conclude we successfully met the objective of Phase 1; to build a project that was informative and well desired.


Targeted Marketing and Scale-up included utilizing the United States Census Bureau individual income and disability data from the 2012-2015 American Community Survey estimates. Analysis identified pockets of vulnerable populations that would most benefit from the project. The data was analyzed by percentage of total population within every census tract in Okaloosa County. Data analysis included the following steps:

       Ranking of the percentages of individuals among each variable in all Okaloosa census tracts from highest to lowest.

       From that ranking, identify the top 10 census tracts with the highest percentage of each variable measured.

       Collecting and entering those top 10 census tracts into a cross-matrix along with the top 10 census tracts from all the other variables.  The matrix was used to compare all census tracts with all 8 variables analyzed.

       Based on the rankings and number of variables, a vulnerability score was determined.

       Lastly, each census tract received a score based on how many of the 8 variables was each census tract within the top 10 percentages.

       The more variables a census tract scored in the top 10 percentages, the more vulnerable they were considered.


Targeted Marketing and Scale-up is in progress and will lead to future work. Analysis of the United States Census Bureau data in the 47 census tracts in Okaloosa County resulted in the following:

# of Census Tracts

Vulnerability Score

1

Severely Vulnerable

8

Moderately Vulnerable

10

Mildly Vulnerable

12

Vulnerable

16

Not Vulnerable


A county census tract map was created to visually identify the concentrations of vulnerable populations within Okaloosa. Based on the vulnerability score, the map reflects the color-coded areas of vulnerable populations.

The greatest concentration of Severely and Moderately Vulnerable census tracts were targeted first.  A significant area of vulnerability is located within Ocean City, Wright, and Fort Walton Beach areas.  These areas are densely populated and have been high risk areas in other DOH-Okaloosa disease risk analyses.  The LOM team will begin advertisements and promotion within each of these census tracts identified, beginning with the most vulnerable to the least.  Utilizing asset mapping, communal areas are identified that are assumed community members living within each census tract likely frequent.  Volunteers will utilize these locations to advertise and conduct outreach activities.  They will also leverage the County EMS, City police, and Fire Districts that service that specific census tract to engage them in assistance for promotion.

The Project is widely accepted and popular. Word of mouth has been a successful marketing technique among the vulnerable populations.  Clients maintain linkage and build bonds with the volunteers. This     creates trust and relationships to the vulnerable populations to ensure crisis risk messaging reaches them. Ocean City, Wright, Fort Walton Beach and Crestview are among the most vulnerable. The targeted messaging will begin in Ocean City and work outward using the vulnerability scale. Targeted marketing and promotion will be conducted in communal areas within the most severely vulnerable census tracts. Community partners have expressed an interested in this program, because they can envision the impact that it is making individually to better the resiliency throughout Okaloosa County.

Limitations of the project including the passive recruitment in social settings, vulnerable populations with social restrictions may go unreached.  The 2012-2015 American Community Survey is a 5-year estimate based off 2010 Census data and some data was limited or missing. The impact of income on the data may bias data and was not accounted for in this study. Focusing on debilitating variables biased the data for age. Younger, vulnerable populations may not have been identified. Lack of baseline data for vulnerable populations to compare preparedness and response before and after LOM interventions limited measuring success.

The purpose of this project was to implement a community resiliency education project among vulnerable populations in Okaloosa County focused on disaster preparedness.

Future work of the LOM project includes a deeper strategic analysis to control for income and or age. Another analysis that combines census tracts into to commonly known communities might be helpful to increase the impact of targeted messaging.

As a preparedness education program, the planning team has future plans to scale up. Increasing quantitative measures by increasing clientele through marketing and promotion. Increasing functional scope by including annual Influenza immunization clinics to new and existing LOM clients that qualify for the adult vaccine program.  The team is exploring options to deliver TDAP as well.  Leadership is working with the Community Health Improvement Programs' Injury Prevention work groups to include safety inspections to reduce falls at home. Volunteers are conducting mosquito abatement to reduce arbovirus transmission in LOM client homes. Increasing political coverage of the project will include collaborating with organizations such as County EMS, Fire and Rescue Services (City and Special Fire Districts), Okaloosa County Sheriff's Office to promote dissemination of LOM flyers in their response vehicles.  Fort Walton Beach Medical Center and the Andrews Institute are interested including a LOM referral upon discharge from the hospitals. At an organizational level, leadership is working on sustainability plan to include funding sources for continued resources and training community leaders to utilize and promote LOM referrals for their encounters

The LOM program builds resiliency and increases communication channels within vulnerable populations.  Building resiliency improves emergency outcomes and empowers vulnerable populations to make educated decisions during an emergency for survival, thus reducing the burden on the response healthcare system. The project increases volunteerism by providing energy toward an immediate and achievable positive impact on the community.



Before Hurricane Michael made landfall, Lean on Me volunteers conducted call downs to all 87 clients in the Lean on Me Data Base. Once contact was made with the client, they were informed to activate their disaster plan. Of those clients that were spoken to, they had already begun to activate their disaster response plan or were in the middle of doing so. After the storm, the same call down took place to check on the client. Lessons Learned:

         Instead of calling every individual in the data base, an LCHD employee will enter each client in the Everbridge call down system that is used for MRC volunteers and CHD staff. The client will be instructed of how to respond to the emergency and given an option if they want a personal phone call from Lean on Me managers or team members.

         Some clients were not able to be reached, because they had already evacuated, per their plan, to their family's location, a shelter, or to a friend's location that was previously established through the buddy system. To fix this issue, the contact information of where they will be evacuating to or riding out will also be added to the Everbridge Lean on Me call down system.

Partner collaboration has been key to the success of the Lean on Me program. Without help from Faith Based Organizations, private companies, and local county offices allowing our volunteers to leave brochures and flyers at their location or conduct speaking events to inform possible clients about the services Lean on Me offers, it would be very difficult to reach the vulnerable population we are targeting. Lessons learned:

      During Lean on Me monthly meetings, our volunteers discuss which vulnerable populations they have worked in, where they have left Lean on Me material, and the response from the organization or company representatives.

      Lean on Me volunteers have established a large clientele in two, large, independent living facilities in our county. In these facilities, they have also established a buddy system, so clients don't have to experience an emergency or disaster alone.

The cost/benefit for Lean on Me is based on MRC cost/benefit, since Lean on Me is operated by MRC volunteers.

         Since Lean on Me's inception in 2016, Lean on Me volunteers have worked 661.25 hours and saved the county $27,239.33 in in-kind donations.

Lean on Me is sustainable because it is MRC volunteer driven. MRC volunteers hand out educational material, conduct public speaking engagements, go to the client's home and do the evaluations, assist in preparing the clients disaster plan, and conduct client checks before, during and after the emergency.

Lean on Me does require some financing to restock participant books, checklists, and resources for future sustainability.  This project could accept donations from the FBOs or Community Partners but would not actively solicit donations on behalf of the project per agency rules. Should the team run out of incentive resources, the project will continue without the incentives.

·       OWMRC team members realize how important Lean on Me and disaster preparedness is. By continuing to visit different facilities and doing public speaking engagements, it will continue to increase the counties preparedness and make our response, for those that are participating in this program, much easier to manage.

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