CERC Transcript 06 21 2016

Zika CERC Discussion: Community Engagement

Presenters: Barbara Reynolds, PhD

Date/Time: June 21, 2016 1:00 pm ET

---------------------------------------------------------------------------------------------------------------------

Operator:

Welcome and thank you for standing by. At this time your lines have been placed on listen-only until we open for questions and answers. Please be advised today's conference is being recorded. If you have any objections, you may disconnect at this time. I would now like to turn the conference over to Ms. Barbara Reynolds. Please go ahead.

Barbara Reynolds:   

Thank you, Laura, and welcome everyone to this week's Zika Crisis and Emergency Risk Communication Discussion. Our topic today is a little broader, it's about community engagement and we're going to look at some of the reasons that you may want to be considering at this point in mosquito season the idea of some community engagement.

And I hope that I can present some basic ideas for you this morning that - I mean this afternoon for some of us - that will get you energized enough that we can have a real conversation. So as you're listening to me, if you have questions or you're interested in some aspect of this that you'd like me to expand on, if you could make a little note so when we open it up for discussion, you're ready to jump in on it.

And for those of you who are following along with slides at your computer, I'm going to the next slide, and as you know from week to week, that the next slide is always the right message at the right time from the right person can save lives and reduce harm. I add that as we talk about Zika related issues.

I was sitting here waiting for people to come in on the call and I was thinking how do I start this? What's the most important thing that I might want to bring to you around the topic of community engagement?

And I realized if I link it back to crisis and emergency risk communication, for those of you who are familiar with CERC, I talk often about those six principles, and if you follow along with the slides, you know that I always include two slides that talk about the six principles of crisis and emergency risk communication.

And one those principles that seems to not get as much attention from us when we're having discussions about CERC is the last one, show respect. And I thought, hmm, if there was ever a time that the show respect principle could be the center of attention is when we're talking about community engagement.

So I just want you to know that first and foremost, what we're trying to do is to design a program of engagement with a community in a way that is respectful, and even the attempt to have engagement with the community as important decisions are being made about this new health threat that in itself is showing respect.

And so if you go to the next slide, you've seen this slide perhaps in other times but it's important to remember what is the public looking for from our communication? And we've already discussed the idea of they want the facts, and last week we talked about empowering decision making. We talked about social pressures that come into play with individuals.

And community engagement is done at the individual, at the organizational and the community level. So today we're going to kind of combine organizational and community levels of community engagement. Last week we talked a little bit more about the individual and engaging the individual in those kinds of practices that are really important to help people do what's necessary to protect women who are pregnant and themselves from Zika virus illness when it happens.

So the other thing that we say this public seeks from communication is they want to be involved as a participant, not just a spectator when there is some kind of public health emergency in their community. And a participant doesn't mean that they actually have to physically be doing something, but they do want to be a part of our process.

And it's not even being a part of the process as in making decisions, they may or may not want to be a part of that, that's something to explore in the community, they certainly want to be aware of the process and having some input to that process as you go forward.

And then other things that the public wants from us is they want to watch over resource allocation. And we all know that when we're addressing a public health emergency threat that resources will be outstretched more often than not and there will be opportunities for people to make decisions about the best way to use those resources.

And in a well-formed government at the local level, those decisions may be made by the people who were elected and chosen and authorized to make these decisions but still people are wanting to know how does that happen.

And you have to be very careful that we don't fall into a situation in a community where there's the perception of the haves versus the have nots, and the only way to do that if you're making decisions based on public health needs in the emergency is to help people understand how those decisions are being made and why things are being done the way they are.

And I often caution that at the point that the resources are being allocated is not the time to start to talk to people about why it's allocated the way it is. In fact it's much more important to help a community understand before that allocation happens what is the fair and equitable way that those allocations will be made.

So there's some real work that needs to be done in the community engaging people and organizations in the entire community in those decision making processes.

On the next slide, we talk a little bit about just generally what community engagement is. I will tell you the World Health Organization has started to talk about community empowerment and so perhaps our terminology here in the States will pick up at some time and we'll start to talk about not just community engagement but community empowering.

And again, it's the idea of giving a community a sense of ownership, and this is really important, there has to be a sense of power being shared. If you get to a point where you're sharing the power, that means that there is true collaboration in the process and the people have a leadership role in decision making.

And one of the things that we have to be comfortable with if we're going to truly engage the community is that it has to go beyond just giving people facts. They have to be engaged, there has to be discussion along the way.

And to do it well, someone who wants to engage the community on a public health issue, they need to have an understanding of what's at work in the community and there's a number of factors around that.

If we have time today, I'll talk a little bit about community resilience and we'll talk about what can increase or decrease a community's resilience. If we don't get to it today, I promise we'll pick it up on another week along the way.

So on the next slide, we talk about increasing levels of community involvement and as you can see, most of us have plans where we plan to do outreach to the community and we may do it through mass media and social media channels, we may even do it in some kinds of community settings but it's outreach when you're giving people information.

When you involve the community in a more robust way, you're actually looking at them giving them information and you're giving them a feedback loop to seek more information and to get additional answers.

That's probably in the form often times the frequently asked question or perhaps even you have social media Twitter chats or something like that where you're allowing people to ask questions and you're giving them answers. And it's important to move a community from just informing them about what's happening to engaging them in a way that they're actually asking questions and seeking answers on the issue.

As the continuum goes on in that level of community involvement, they actually become involved as participants. We talked about that already but that is one of the key aspects of what the public wants from us in a crisis situation. And then if things are really going well, you may be at a point where you're collaborating on issues where there is information following both ways and decisions are being made more mutually.

There is a level partnership building and true trust among the organizations that are involved and leadership is shared ultimately. When we get to the point where there are co-deciders and there are responsibility spread across different individuals or organizations within the community working together for a shared goal, then you really have the ideal of community involvement.

And there's absolutely no reason why as we look at the Zika public health concern that there isn't an opportunity to try to approach your community engagement in this way. I shouldn’t say there's no reason why, I would say it's a - it is a possibility to be able to do it, of course recognizing that resources always come into play in terms of the amount of hours and people you have to do it.

But I suggest that if you start to do your community engagement in a robust way now involving your community's participants, sharing power and leadership, that probably as this heats up, and it may or may not in some communities, but if it does heat up in your community, you're going to be much better prepared to manage whatever comes your way.

And we never know for sure what wrinkles might show up, and when we're looking at an emerging infectious disease like Zika virus, it's already thrown us a few curve balls along the way.

But if you've already started to do that community engagement and people are feeling trustful, then it will save you time and effort down the road. So an investment in the community engagement process today may pay off tenfold in the future if something goes wrong along the way.

In terms of empowering group decision making which is the next slide, it's important that you engage a community in a way that the decisions are not already made and that's hard. That's really hard.

Now there are some things that where there isn't exactly room for a negotiation necessarily but in many cases there may be places where and a community may have choices about how they want to approach something.

And I think it's important if you're engaging the community in a discussion about what may happen to the related to Zika virus for example in mosquito vector control, you might want to look at helping them identify alternatives and then analyze those alternatives.

And one of the things that you can do is analyze them based on what's already been agreed upon is the outcome that you're looking for, and then try to decide what's a want versus a must have in choosing among the alternatives.

So you must have something that protects women who are pregnant from Zika virus. That would be one of the musts. You may want to do that in a way that's the least disruptive to industry and tourism in the community. So look at your wants and your musts and have a discussion about it.

Is it messy? Yes, yes it is. There's no question that as you start to have more people and share power in decision making in the community that it's not as neat and linear as some of us might like it to be.

But, again, I'd rather have that messy part done up front when people’s emotions are not as high and when the stakes are not as high than to try to do this kind of work when there isn't a - there's a real time pressure and people's emotions are higher.

So next slide, acting trustworthy. I don't think that I have spoken in one of these discussions yet that I haven't talked about the importance of trust and what happens if people don't trust us but I haven't really spent a lot of time talking about what it means, how do you act trustworthy?

And when you're talking specifically about engaging the community and empowering them to help make decisions and to share that leadership, one of the things that we know really matters is share information early. Give people information that they can use to help to build their decision making process along the way.

It's not unreasonable to acknowledge the concerns of others. You're going to have a number of constituents in that community that's going to come from different perspectives wanting and needing different things and just acknowledge it.

I think sometimes we want to tip toe around the big white elephant in the room and we're hoping that nobody will notice it but the fact is we might as well go ahead, and I'm going to mix my metaphors now, strip off the band aid and get to work and figure out what the concerns really are.

We may believe we know what those concerns are in the community, and we may very well do, but it's worthwhile to open it up and allow people have a forum in one way or another to talk about what those concerns might be.

And, frankly, there may be competing values that come to surface in the community and that's not unusual. We have a lot of diverse people with diverse points of view and perspectives but ignoring that and trying to force everyone into line isn't going to get us anywhere either.

While we're working on this community engagement and empowerment process, I want to caution you that we don't go into it in a way that we're so happy and gleeful that we're doing this that we have a tendency to want to overpromise what we're going to deliver at the end.

Because there's no guarantee even if you're doing your community engagement in a respectful and trustworthy way that the ultimate outcome is going to be neat and tidy and wrapped up in a pretty bow.

The fact is that you may have some conflict that just goes on through the process and so be careful about what you promise this engagement process will do, and also be very careful about implied or overt promises of what can be done in terms of the response to Zika in your community. So be careful about making promises that can't be kept.

And I would say that unfortunately there are examples in other settings where we have seen people make the promises, leaders make promises and that the community feels like trust has been violated when they had every intention of making that promise come true and the thing that you'd never anticipated happens in the process and it all falls apart.

Or there may be some legal authority that you're not even aware of this moment that would allow - wouldn't allow you to do what you need to do. That's often the case around funding or something like that. So just be really careful about what you promise, and more than anything, allow that you want to work towards something but under promise and then we hope over deliver along the way.

As you're talking about your community engagement and thinking about who's going to actually engage the community if it's not through social media or electronic methods.

And I would suggest if you're in a local community that you would want to have the opportunity to do some face to face engagement with the community either as organizational reps of the community with media involved or public meetings and town hall meetings of some sort, community meetings.

So when you're making these decisions, think long and hard about who will represent your organization whether it has to do with environmental health issues, public health, hospitals and clinicians, tourism, whatever the organization is, think about who's going to be selected to represent you.

And whoever that person is has to be someone who can be flexible and adaptable enough to go along with the messy process of community engagement but at the same time is not so flexible that they bend over and just let things roll over them and nothing gets done. So at some point you'll have to have people involved who will be able to hold the line if there is a line that of things that have to be done along the way.

And if possible, try to bring people along into the process who will validate your intentions and help build your trustworthiness in the dynamic.

So let's talk about the possibility of having a town hall or a community meeting around issues perhaps related to Zika and vector control. I think that would be a reasonable topic area that you might want to look at. And often times, I challenge people to ask themselves why do people come to the town hall.

And if I went back to that earlier slide where we talk about community involvement, I sometimes hear right off the bat, well they want information. Really?  Do you think that that is the reason that someone, you know, picks up the remote, turns off the TV, gets out of their La-Z-Boy, gets in the car, drives down to the local high school and sits on hard bleachers? It's because they want information? Honestly, I don't think that that's what's going on.

I think if we explore it a little more, and I'd have time and the opportunity, I'd have you all come together and I know that you would be ultimately telling me they want to be heard.

When people make the effort to come to an in-person event, they want as much to be heard as they want to hear. And unfortunately we often set up the dynamics in our community meetings in such a way that we spend most of the time talking at people instead of listening to the people and their concerns.

And I guess it's my week to talk about doing things in a messy way but I want you to know that we can change our approach to those community meetings and by doing so, we may actually get more out of it and people will leave having a belief that their intents of what they wanted out of that community meeting has been fulfilled if we do it in a respectful, again, way.

So next slide I'm talking about convening a citizen's forum or a community meeting or a town hall, whatever you want. I would say that we need to acknowledge the concerns of the community up front, we talked about that, introduce the topic, encourage fact finding but also share power.

And sharing power means that you don't dominate the stage. We can't have a 90-minute town hall meeting or a community meeting about Zika and vector control and spend most of that time, you know, as 60 minutes of it telling people what you want them to know about it. You need to allow them to ask questions.

And perhaps you may even have the opportunity in that setting to set some rumors to rest that you might not even know were out there unless you heard it directly from the people.

So when you want to set up that community meeting, think about trying to do a limited amount of actual content from the representative organizations, from the public health and environmental people and instead tell them you're here, who you are, what you're there to talk about and say let's have a discussion, what do you - what are you interested in? What do you want to know about?

Again, it sounds messy but ultimately by giving them facts in response to their questions, remember that answer seeking, you're building more trust and credibility in that environment.

And then as you move through that meeting, if you are getting ideas and capturing them and saying, you know, we want to make a commitment to explore this or that, you have your white board there and you're writing down the things, the topics that people are interested in, all of those things add to that sense for the public that they are participating in that response, not just spectators.

And I think that if we're talking about Zika and we're talking about vector control and we're talking community participation, we know what we want is for people to do some very important things to help us protect pregnant women.

One is to wear insect repellent if they've been to a place and could have been exposed to Zika after travel, and the other is to eliminate sources of standing water where the mosquitos might breed. That's important, this is one of those situations where they don't have to be spectators, we want them to engage, we want them to involve themselves.

And the more they are involved and invested in helping reduce the amount of mosquitos that could be circulating this season, as we try to buy time to have treatments or vaccines that could protect people from Zika, and engage them, help them become part of the cause.

And in so doing, if it does turn out that just because of the sheer numbers and the type of environment in your community that you need to do more community-level mosquito control, you have already set up the dynamics for them to be invested and working towards trying to do those things and it won't be as much of a surprise for them along the way.

So next slide is don't lecture at the town hall. It's an easy way to do it, just telling people what you want them to know. A messier way to do it is to engage them by asking for their questions, asking what have they heard, what do they want you to address.

And if you're still worried that perhaps you won't get to them all the information they need in that setting, you have some specific messages that you want to share, I would suggest a reasonable thing to do is to create ahead of that community meeting some fact sheets or handouts.

And make sure there is a Website that you can give people a Website to or Facebook or other things and tell them that there is more information out there.

I would want to physically if it were me, it could be a product of age, but I would want to physically hand them a factsheet because once they have felt a sense of community that they have been engaged and they're a participant, they may be very willing to sit down and read some of the most important points that you want to get across in that moment.

So again, it may seem messy in that 90 minutes but it also might be effective because you want people to have the opportunity to be heard in the moment.

On the next slide, I want you to - I want to talk a little bit about some research related to public comment or community engagement, and I've just pulled some of the things that I think are really important. Some of this research we did in advance of pandemic influenza planning. So I think that it could apply here, you decide for your community whether it's important or not.

But just understand that in a public comment period, if you bring people into a town hall and there's a single dominate view, now I will tell you that if you do this process early enough, it may not be that there will be a dominate view and people will have a fair exchange of ideas and interests.

If you delay it until there is an uprising going on in the community, you may end up with a lot of people there who have one point of view, and unfortunately if there is one dominate view and it gets aired very early on in the process and repeated, that others who have a different point of view may feel isolated and may not feel willing to come out and offer their point of view.

And so I - you can do this a couple of ways, I would encourage that you ask in the community meeting, is there anyone else who has an alternate point of view or who has something else on the topic that they would like to bring up and people may or may not bring it up.

But what you may also want to do is provide a comment card for people to either ask questions in advance on the card or to offer a comment afterwards in writing. Sometimes people can't say it in a, you know, high school gymnasium.

I don't think I'm every inclined to walk up to a microphone and ask a question even in scientific sessions, I'm always hoping that somebody will ask the question or make the point that I want made. So there are probably others like that out there, maybe some of you are.

So give those people their voice by allowing them some other means to give a comment in the situation so we can reduce that spiral of silence and all the different perspectives might be heard.

You know, frankly, people who come to town hall meetings are not necessarily a cross section of the community, they are often people who do have some point of view that's strongly held, some sort of value or belief that they want to get across and they can't leave it to chance that it'll happen, and so those few who may be there will have a different point of view, give them an opportunity to talk.

One of the things that can really go wrong in a community meeting is if you're just doing it for show so you can check the box and say, oh, yes, we engaged the public on this but all of the decisions have been - have really kind of been made. If you're bringing people to the table too late, then the goodwill may not be there and the process might not truly do what you hope it to do.

So you have to examine your conscience a little bit and say are we just doing this so we can say we engaged the public or are we doing this because we really want to hear the public and perhaps alter our perspectives in some way?

I'm not saying you have to do that but it is worthwhile to ask yourself, where are you in this process because if you are having a back and forth discussion and you've already made up your mind, when the person's talking, what you're doing is getting your counterargument together and you're not listening to them in the way that you might need to truly engage in the community as full collaborators and shared decision makers.

A few other things on public comment that I just wanted to bring forward based on research that we have done in the past and that is that some people maybe don't feel a need to engage at all or to talk, they just want to put their finger in the wind. They want to know what their neighbors are doing or thinking or saying.

They may be there just to offer support to neighbors or friends. They feel the same way, they just want to be there as a sort of that silent supporter to someone who's more outspoken.

And then they maybe wanting to come because they have a sense of urgency, they feel like there's something needs to be done and they're trying to do something and by coming to the town hall meeting they feel like at least they're trying to participate, they're trying to be helpful in some way. So some of it may be just socialization along the way.

Now I want to stop talking about town hall meetings but I want to talk about conflict too because I'm not suggesting that every town hall meeting will end or begin in conflict but there is the potential when we're dealing with new threats and we're managing people's values and beliefs about changes and decisions that need to be made, there is the possibility that there could be conflict.

And I attended a Harvard MIT course on public comment, public perception, community involvement and it was eye opening to me because they told us that all conflict is caused by the perception of either party of one or more of five different things.

And they said whether it's an interpersonal conflict or a geopolitical conflict, that one of the - one or more of these five things will be at play in that, the perception by either party of these five things. Those five things and this is on the slide is superiority, injustice, distrust, vulnerability and helplessness.

And so while we don't have a lot of time today to really dive into this, I suggest you think about a conflict that you're aware of recently and ask yourself are one or more of these five elements involved in that situation. And I have put it to the test time and time and time again.

And in fact, I think that I would do a better job of avoiding unnecessary conflict if I could just take a moment along the time, be empathic enough to think it through and say, what -where is this conflict coming from? What might be causing this?

And that's where it's very helpful if you know your own community because you may know the historical context for some of this conflict too but it is worthwhile to ask these questions when you're in a conflict situation. Not suggesting that if you have a community meeting, there will be conflict but I just wanted you to be aware of it because it is another way to listen when emotions are high and decisions needs to be made.

So if you do find yourself - next slide - in a high-outrage public meeting where there is potential conflict and things get a little crazy, try to be empathetic but don't say the words I know how you feel. So if you've taken my training you know that what I want is you to express empathy by putting into words what people are feeling.

I think you could say I understand you're frustrated as you, you know, as you're talking to us about this and, you know, actually use the emotion that you think people are sharing in that moment.

And we already talked about active listening, how important it is, and one of the ways to do that is to try to put into words, your words what you believe you just heard. And don't do it in a condensing way because sometimes it can be such an exaggerated process, people know they're being managed.

And try really hard to avoid interrupting people when you already know where they're going, you know what they want to say, let them say it. Just let them say it. Let them get it out.

And some of us culturally are less inclined to be able to do that so that's why, again, it's important to pick the right spokesperson who has the patience, flexibility, adaptability but also the stalwartness - I don't know if that's a word or not - the strength to stand up to things when it needs to be done.

Some things that I would really, really suggest that you think through and try very hard not to do in a public meeting is there is a point where the personal abuse can get outrageous, and I'm not saying that's going to happen around Zika, but there are some topic areas were sometimes that's the case.

And I never suggest that you as a human being representing your organization is required to take personal abuse. So I say don't take it but the question is so what do you do? And for me the answer is if it's really that bad, you need to, you know, calm yourself and one of the ways to do that is just to take yourself out of the situation.

So politely say I think it's gotten a little heated here, I want to make sure that things don't go too far, I think what's best for me in this moment is I'm going to take a five minute break and I will be back to continue this conversation.

That's the worst situation I think that I could allow for someone. I mean that's the - bad as it can get. Just take yourself out of the situation, remove yourself from the situation if it's so bad that you think you're going to blow or do something that would be disrespectful as you represent your organization.

One little tip though, what I have found in my experience, if you take a little bit more abuse than most people think is fair, at some point the audience might actually turn in your favor and say to the hecklers or whomever, you know, let the guy have a minute or, you know, okay, okay and kind of shut down the angry stuff. It depends.

There's going to be less of that if you get the people in the community before things get heated but if it does, just know sometimes standing there and allowing it to come at you may be a way to show that you really are committed in the situation.

But if it gets bad and you really don't think you can take one more minute of it, then just remove yourself for a break. Just take a break and then come back.

And one of the ways to kind of reduce that high emotion is to have other people there who are neutral third parties who could step in and say, you know, okay, guys, okay, you know, we - let's just go ahead and move this forward, I think we all understand what's going on or, you know, just diffuse the situation in some way.

I feel like I've spent a lot of time talking about community engagement, I hope you know that there's real value in community engagement. In fact one of the leaders in that field says that community engagement and participation is starting where the people are.

And it's starting where the people are so we need to know where the people are on a topic and community engagement is one way that we can do that along the way. And coalition building is an important component of community engagement.

Coalition building is something that you can do on a specific problem, and it's a union of people and organizations working to influence outcomes on a specific problem. That's what coalition building is. And it motivates the community to do things together.

But to be a good coalition it requires that each party believe it needs help to reach its goals, and I question sometimes when we're officials working on a public health emergency, do we really believe that we need other people to help us get there?

And I would certainly say that if we get help from other people, we'll probably get there a little easier than if we were trying to do it by ourselves so it's an important component of coalition building.

We need to have goals and perspectives among the members of the coalition and it requires delicate negotiation among participants and a distribution of power and benefits to the members. And that's why it is important to acknowledge everyone who's coming together to work on a problem if you're building your coalition.

So there's real value in community engagement and when we look at what the public needs from us that being a participant and not a spectator is critical.

I'm going to leave it here as far as the topic, we'll talk about community hardiness in another week since I don't want to get to the point that we have no opportunity for discussion. So, Laura, I think I'm finished with the official formal presentation, I'd really like to open it up to discussion if you could open the lines please.

Operator:         
    
Thank you. And at this time if you would like to ask a question, please press Star followed by 1 on your touchtone phone. You'll be prompted to record your name for proper registration. Your name is required to introduce your question. Once again, if you have a question, please press Star 1 and record your name clearly when prompted. One moment please.

Barbara Reynolds:               

And while we're waiting for people to come into offer a comment or ask a question, I'm just going back to my six principles of crisis and emergency risk communication, the sixth one, I told you I think that was the star for today which is show respect and that means treat people the way you want to be treated, the way you want your loved ones treated, always, even when hard decisions must be communicated.

So there is something to be said for - I think all of us don't want other people making decisions for us that we consider to be critically important without some of our input, and so showing respect can be done through community engagement. So, Laura, do we have any questions or a discussion?

Operator:           
        
Yes, we do have a question from (Colleen Rank). Your line is open.

Colleen Ranky: 

Hi. Thank you. I think that one of the ways you can help avoid those high-outrage meetings or where things get out of control is a technique that I've used occasionally that's creating a covenant of right relations right at the beginning of the meeting.

And saying, you know, we're - we know this is a highly-charged topic but we want to make sure that everyone gets heard and everyone's respectful and all of that. And that's sometimes really helpful, it kind of gets people to think before they get too outrageous.

So that's one thing, and then when you were talking about conflict and the perception of either party of superiority and justice, are they perceiving that for themselves or for the other party?

Barbara Reynolds:      
          
Okay, great. So first I want to comment on your idea about how to reduce the potential for a high-outrage meetings and I think your approach is a good one. It has to be done delicately so people don't feel like they're being stifled because sometimes people just want to be angry along the way and you have to give them room to sort of blow off steam but your approach is a very good one.

And I remember that Mayor Giuliani who had more than one delicate topic along the way as the Mayor of New York City would say that he chose to hold his community meetings in school libraries.

Because then he would talk about, you know, this is an esteemed institution and libraries are, you know, a place for learning and, you know, we want to set a good example, you know, in a school and it was actually the setting itself made a difference.

And if you think about it, we talk about the school gymnasium, that's where the ruckus happens so maybe we should move them all to - a school libraries or something but this idea of setting the tone ahead of time is a good one.

And I would think that what would make that work best is if the tone setting, the covenants were offered by a neutral third party, someone that didn't represent the people, who other people might be angry at. And now to your question about those five aspects that contribute to conflict. It could be one or more of those and it could be in either.

It could be your sense of helplessness might be causing conflict, it could be that the other people perceive your helpless - or perceive your vulnerability so it goes back and forth. I mean you don't distrust yourself, you distrust the other guy but you may be feeling helpless. Does that help?

Colleen Ranky:
      
That...

Barbara Reynolds:  
              
Does that make sense?

Colleen Ranky: 

Yes, that makes perfect sense. That's kind of what I thought but I wanted to verify that. Thank you (Unintelligible).

Barbara Reynolds: 
               
No, I'm glad you asked the question.

Colleen Ranky:
      
Yes.

Barbara Reynolds:          
      
Thank you.

Operator:            

Thank you. And once again, as a reminder, if you have a question please press Star 1 and record your name clearly when prompted. The next question comes from (Jennifer Donnelly). Your line is open.

Jennifer Donnelly: 

Hi, Barbara. This is (Jennifer Donnelly) with the Johnson County Department of Health and Environment in Kansas and I just have a question about working with airlines and airports about doing travel advisories on mosquito protection. Do you have any advice for that or is CDC planning to do anything with that?

Barbara Reynolds: 
               
So I can't answer the question specifically but I do know that we do have signage in airports. I don't know what is happening directly with airlines but we do have a really useful resource on our Website around Zika. So if you go to the Zika - the CDC.gov/Zika, that there is a resource page by industry or a topic area and I would expect that that information would be available there.

And if it's not, there should be a way for you to be able to ask questions specifically to the Emergency Operations Center Response Group for Zika and they'll have details on that. So if you're thinking about it, probably others are too and it would be great to get you plugged in with what's going on.

Jennifer Donnelly:  

Okay. Thank you.

Barbara Reynolds:     
           
Uh huh.

Operator:            
      
Thank you. The next question is from (Anne Row). Your line is open.

Anne Row:       

Hi. This is (Anne Row) with the Florida Department of Health, I just wanted to make a statement actually. Going back to talking about setting the boundaries, you know, at the beginning of your town hall meeting.

I recall back in 2000 when we were taking our Growth Management Study Commission meetings throughout the State of the Florida, you know, this is - this was a very effective way of engaging our participants not only coming to where they were and we held various meetings throughout the state to get input from the stakeholders and the public so providing comment cards at the beginning of the meeting.

That way that gives them an opportunity to put down on paper what their thoughts are, and then, you know, they are called up and they maybe have two or three minutes to, you know, state their position, provide information and then the leaders of the meeting, you know, can take what they've shared, ask questions, maybe share solutions ask for the audience to provide solutions.

So it really is a great way of engaging your community in that respect and but, again, the, you know, holding those meetings, you know, where they are, not, you know, where we think the best place should be but where your communities are, where they frequent so they feel more comfortable when you're coming into their community. So just a statement there. Thank you.

Barbara Reynolds:               

Thanks, (Anne), I think your point is well taken and I think that more than anything you're reinforcing the idea that we have to be respectful in the process. And by allowing people to have comment cards - going where they are, and then having comment cards, you're really offering an environment where people feel there's a sense of equity. That there is an opportunity for other positions to be heard which can be really important.

And it sounds like you were doing some thinking of information from the participants in the moment, and it sounds like you were reaching them at a time when they really could have some sort of impact and that's really important too.

It - the - I think that if we're really genuinely interested in what the community is thinking and looking for them to help us find solutions. That we're much more participatory in the approach to a community meeting.

When we've already made up our minds and we're just doing it out of a sense of obligation is when we're more likely to have those town hall meetings where it's all lecture and very little discussion.

And that really does build a bad dynamic because while we're all talking, lecturing, lecturing, giving information and we think we're being very helpful, the people are sitting there who want to be heard and they're stewing because they're like, okay, shut up, shut up, I want to go, you know, I want to tell you what I think or whatever and so I think your approach is an excellent one.

I also want to suggest that sometimes people will offer cards at the end and there'll be just two or three or questions. Do you believe that your perspective, your point of view was shared today? You know, that they may or may not have talked and it's just a yes or no. Would you like to have more of these? Yes or no.

Would you like us to contact you on a specific question or topic? If so, then give us a way to contact you and it could be a e-mail address or a telephone number or whatever so that if people want to take the conversation beyond that timeframe where you're face to face that they have a way to do that.

So - and (Anne), I'm looking forward to seeing you in August, I hope that you will be here for our Global Crisis and Emergency Risk Communication Training.

Anne Row:       

Yes. My team and I will be there. We're looking forward to seeing you at that time.

Barbara Reynolds:          
      
Great, great, (Anne). Okay.

Operator:            

Thank you. And at this time we have no further questions. Again, as a reminder, if you have a question just press Star 1 and record your name clearly.

Barbara Reynolds:              
  
Okay. Well, since we have some discussion and questions while we're waiting to see if anybody else has a last minute idea or a question, I just wanted to share a little tidbit with you.

A couple of months ago, there was research done that showed that nearly a third of the population in the United States believed that they could get Zika through coughs or sneezing.

So a couple of weeks ago I told you one of the things we have to worry about is people will think flies will transmit Zika and we're going to have to put that rumor to rest but we also need to recognize that people may think coughing or sneezing is a way that Zika is transmitted and we need to help them understand that along the way. So, Laura, are there any other questions or comments?

Operator:            
      
We have no further questions.

Barbara Reynolds:               

Okay. Good. Well, next week we're going to talk about working with spokespersons and I will fit in some stuff about community hardiness in the next couple of weeks or so to come, and I look forward to engaging with you next Tuesday. Take care. Bye-bye.

Operator:            

Thank you. This does conclude today's conference. We do thank you for your participation and you may disconnect your lines at this time.