Model Practices

I've written before about a team from the Cumberland Plateau district in Virginia -- they wrote a business plan for mass flu vaccination in schools in Tazewell and Russell Counties. Took a few years, but they finally got the pilot completed, and the pilot worked, and they expanded.

Yadda yadda yadda, things progressed, Flu's Clues is now Flu-a-gator, and the team won a "Model Practice" award from NACCHO for the projectd. I hope you will read about the award and the team's implementation here: http://bit.ly/IRZ3Tm

Congratulations (belatedly) to the whole team, especially Kathy Hypes, who always stays in touch on their doings. You've been a model for many other health departments who are trying to build on your success!

--Stephen Orton

Business Planning and Flu Epidemics

Like everyone else in the public health community, we have been thinking a lot about swine flu lately. Public health leaders, managers and practitioners are scrambling to plan for what may come.

I recently contact John Dreyzehner, District Director of the Cumberland Plateau Health District in the Virginia Department of Health. Dr. Dreyzehner has sent many teams to the Management Academy over the years. We wrote about some of those in Chapter 7 of the book, “Competitors and Partners,” pages 68 – 69. One of the programs produced by a team from Dr. Dreyzehner’s district was called “Flu’s Clues,” an influenza vaccination program for children ages 3 – 9, based at the local Head Start programs and elementary schools

Steve and I posted back in November (17th and 20th) about “Flu’s Clues.” The program is now in its third year – now called “See you later fluigator” or “Fluigator” for short, with a sick alligator as a mascot, to avoid intellectual property issues. I asked Dr. Drehzehner whether having the program in place was making swine flu preparation any easier. Here are his thoughts:

“[The vaccination program] certainly increases ours and our partners confidence in being able to push out vaccines and treatments. At this point we can do points of distribution/Dispensing (PODs) in our sleep. The challenge at the moment, as is to be expected, is universal agreement on how/if to widely employ the present Tamiflu resource and to do it in a fashion that is consistent with legal equirements and good medical practice.

“There is understanding that we have to target it to the ill for treatment and, some think, their caretakers to begin at the first sign of illness. In one concept of operations I drafted we have accessible PODs open 8-12 hours daily at various location as drive through or walk -up (will spacing to prevent transmission). No ill (but sometimes exposed people) come in and complete and sign a medical attestation form regarding the illness in the person they are responsible for and get a course for that person(s) AND a reserve course for themselves and any other exposed in the household/place exposed to begin with the onset of fever and respiratory symptoms. In this way, the entire population can be assured the treatment is available for use in 12 hours or less to any one at any time. This works as long as this tricky virus remains sensitive. That is the readers digest version of one of my plans. But it is very doable.”

It sounds as if the Cumberland Plateau Health District is ready to do what it needs to do to address this possible epidemic. The challenge is deciding exactly what ought to be done – but it’s good to have the infrastructure in place to do it. They have that infrastructure in place because somebody thought of an idea, they partnered with important community institutions, they wrote a business plan that accounted for funding it, and they implemented it.

Let's hear from some of our readers -- what are you doing about swine flu? What obstacles are you coming up against?

More on Flu's Clues

I'd be interested in hearing more about the project Steve wrote about Monday. It’s called “Flu’s Clues,” and it provides flu vaccine clinics in local public schools. As of mid-October, Tazewell County, VA, nurses had given 596 flu vaccines in 9 school clinics, with two clinics left to go. That’s quite an achievement! This happened in the Cumberland Plateau Health District of Virginia. We write about the CPHD at length in Chapter 7 of the book (Competitors and Partners) as an example of great partnering activity over several years that has resulted in some amazing projects (pp. 67-69).

Some thoughts and questions about this program:

First, this program is a good example of strategic budgeting. You could never just take the annual costs of this project and divide them by 12 to get monthly costs. How does a program like this deal with the large fluctuations in costs over the course of a year? Have any of you come up against this problem in their program planning?

Also, does this team have a plan to expand the program at some point to offer other products or services to school children? Well-child tests or other immunizations, for example? Or is this an example of something well-focused that should stay that way?

Public schools can be problematic when it comes to private sponsorship. Did you come up against that here? What about the rest of you who have experience working with schools – several teams have attempted such programs over the years. One obvious lesson might be to make sure you include a representative from the local schools on your planning team. What are other lessons learned to share from the process of working with public schools?

Anne Menkens

Outcomes Story

Talked on the phone a couple of weeks ago with Kathy Hypes, a public health manager in southwest Virginia. She and a team of colleagues created a business plan back in 2004 to fund flu shots for kids in the school system of Tazewell County, a rural county in the mountains of Virginia.

Talk about unforeseen barriers: for two years the whole country had problems getting the right flu vaccine. Finally last year the group launched their pilot flu shot program in Russell and Tazewell county elementary schools. From that pilot year the team gathered positive stories and used their pilot success to expand the program to the middle schools this year.

If you have worked with the schools before you realize the challenges associated with permissions, space, and timing for a project like this-- not to mention the challenge of making sure that you can generate enough revenue to support the work. Through a combination of Medicaid billing, insurance, state money for uninsured children and a contract with Anthem Healthcare, they have made the finances work-- and made a well-targeted intervention to prevent flu and the spread of flu with one of the larger institutions in the area.