Oak Ridge Reservation: Health Needs Assessment Work Group

Health Needs Assessment Work Group

June 12, 2003 - Meeting Minutes

Needs Assessment Work Group Meeting (Continued)

George Gartseff began his comments with the one page Summary of the Needs Assessment. George told the group that after reading the Summary he is not sure who the audience is. George believes that the language in the Summary is written at a level that is too juvenile, the terms that are used in the Summary are extremely vague, and the organization of the Summary is poor. George Gartseff believes that the basic structure of the Needs Assessment should be as follows: What the assessment is about, Why the assessment is being developed, How it was developed, and What are the results of the assessment. Instead, the assessment is written with the opposite organization in a poor and weak fashion. George Gartseff would like to see the entire Summary page revamped because as it stands, it will not educate the public and does not tell anyone anything.

Another major concern that George Gartseff expressed is on the Summary page as well.

• Summary Page-last paragraph, second sentence
  • No one knows how many people have been exposed to chemicals or radiation there, but people who live in the area sometimes worry about exposures and health issues.

George Gartseff remarked that this language is presumptive and inappropriate. This sentence does not belong in the Needs Assessment especially considering the pains that GWU went through to get unbiased results.

George Gartseff said that he agrees with Brenda Vowell that it is difficult to get people to participate in surveys. However, he never saw the ad when it was advertised. He said he saw lawyer ads about being injured by DOE but never saw this ad when the advertisements for the focus groups were occurring. George suggested that perhaps the advertising was not effective.

George Gartseff also added that in the Subcommittee meetings the members never knew of the Needs Assessment process, it was like a big secret. George understands the need to not bias the study, but at some point ORRHES should have known or been told about the minimal participation. If ORRHES would have been aware of the low participation, many of the negative comments about the Needs Assessment would be diminished.

Donna Mosby replied that there were many presentations about the Needs Assessment process. Barbara Sonnenburg replied that none of the presentations were meaningful.

George Gartseff clarified that during the ORRHES meetings, there never was a presentation that provided the status of how the project was going. George is able to see some value in the confirmation of what the group already knows and he does not believe that the Needs Assessment is completely worthless. However, George does not think that ORRHES needs another study to find out how to communicate. There is plenty of market research available which ORRHES/ATSDR does not have to pay for and that will tell ORRHES/ATSDR how to communicate the information contained in the Needs Assessment.

Regarding the recommendations, James Lewis stated that he could not excuse the fact that when you compare the Savannah Recommendations to the Oak Ridge Needs Assessment the recommendations are nearly the same. The recommendations are very generic. James feels that the Oak Ridge Needs Assessment validates the State’s Health Survey on Anderson County. The Needs Assessment does not provide real specifics that have not been previously addressed.

Kowetha Davidson responded by saying that a researcher does not know what will come out of research until the research is actually performed. Kowetha reminded the group that it is not bad to do research and confirm another person’s research. James Lewis responded to Kowetha Davidson by asking if there are points, such as when something is not effective or adequate, that the decision is made to stop the research.

Kowetha Davidson and George Gartseff acknowledged that the Needs Assessment took a long time to develop. However, Kowetha Davidson told James Lewis that she does not agree that the Needs Assessment is not timely.

In trying to keep the group on track, Donna Mosby said that the conversation with Rebecca Parkin should not have criticisms without recommendations.

Pete Malmquist sent an email to ATSDR staff (see attached handout) voicing his comments about the Needs Assessment. Donna Mosby read the email aloud so that the work group was aware of Pete Malmquist’s unfavorable opinion of the Needs Assessment. Donna Mosby pointed out that it would have been more appropriate for Pete to send the email to Theresa NeSmith for her dissemination. Donna felt that Theresa NeSmith should not have been left out of the original email circle.

Barbara Sonnenburg expressed her agreement with Pete Malmquist’s email comments.

James Lewis wondered what the value of the Needs Assessment in assisting the ORRHES. Donna Mosby responded to James by saying that with appropriate feedback, a health education plan will developed from the Needs Assessment.

Barbara Sonnenburg then wondered if a health education plan is a top goal of ORRHES. Both Brenda Vowell and Kowetha Davidson responded that a health education plan is part of the ORRHES goal along with the Public Health Assessments. Barbara Sonnenburg expressed further concern that the Needs Assessment did not address the issue of contaminants. Kowetha Davidson replied that contaminants will be addressed in the PHA’s.

Brenda Vowell thinks that as the contaminants of concern are developed, the Needs Assessment document should be used to develop strategies for getting information out to the medical community and the public in a form that is useful and communicative.

In regards to the list of recommendations that begin on page 61, James Lewis feels that the recommendations are not different from what is already being done. James does not want to waste additional resources and time when there are materials that were developed for Hanford that could be used in Oak Ridge. James Lewis then asked the group if there were any recommendations in the Needs Assessment that the group could truly implement.

Donna Mosby told the group that they need to provide feedback that Rebecca Parkin can use. Donna stated that the group can say that the Needs Assessment is crap and that GWU didn’t do this and didn’t do that, but Rebecca Parkin cannot do anything with that information unless the work group provides helpful feedback. The NAWG should not spend an hour and a half complaining about how crappy the document is. Instead, the group must move on and should give feedback on the recommendations.

Barbara Sonnenburg asked if the committee is required to accept the report. Donna Mosby and Kowetha Davidson said that there will need to be specific reasons as to why to accept or deny the report and those reasons would have to be more than it is late and is a crappy document.

Barbara Sonnenburg requested a copy of Pete Malmquist’s email. Bill Taylor told Barbara that he would forward it to her.

Charles Washington asked the group if they felt that the Needs Assessment study was inclusive enough to provide to the community. Charles pointed out that there are statisticians within the community who will say that the groups were too small. Donna Mosby responded by saying that ORRHES changed the focus group process from holding the groups in the beginning to holding them at the end. Donna also told the group that the focus group results confirmed the telephone results. Thus, one supports the other.

David Johnson stated that the focus group idea is misleading and is a misrepresentation which will lead to misunderstanding. A group usually consists of more than one person. David is worried that the focus group topic may be opening the door for scrutiny. If the NAWG looks at the community history it is apparent that ORRHES should want a quality product. If any product, including the Needs Assessment is poor quality when it leaves ORRHES there will be repercussions.

After listening to David Johnson, Donna Mosby said that the NAWG should request that GWU clarify and validate the methodology that was used in developing and conducting the focus groups.

Kowetha Davidson added that the clarification issue is one reason to consider an ORISE review of the document. Kowetha also stated that she feels ORRHES was the cause of the problem with the focus groups because ORRHES recommended changing the order of the focus groups in the process. James Lewis responded that it is GWU’s responsibility to provide feedback on the recommendation that ORRHES makes and that ORRHES is not responsible for the failure of the focus groups. Barbara Sonnenburg agreed with James that the ORRHES was not the cause of the failure of the focus groups. Kowetha Davidson responded by saying that the group needs to assess the impact of the ORRHES decision and remember that the Needs Assessment was a research project.

Charles Washington stated that the group accepts that the Needs Assessment was a research project but the researcher should have known the methodology well enough that when ORRHES made a suggestion to make changes affecting the order of the process, the researcher could say that A must come before B or vice-versa. Kowetha Davidson responded that researchers do not always know the methodology and that they may have to go back and change their methodology after the research has been conducted.

Donna Mosby added that the telephone and focus group data validate one another and once again she reminded the group that ORRHES is the one who changed the process.

David Johnson stated that when the Needs Assessment process began evolving in March 2001, some of the roadblocks created major concerns as to how the communication would flow in developing this Needs Assessment and how to get people to participate.

Kowetha Davidson told the group that Recommendation #1 is not asking NAWG to sell the document; it is just asking NAWG to disseminate Needs Assessment information.

After reviewing the recommendations in the Needs Assessment document, George Gartseff stated that all of the recommendations are very general and generic. However, George said that as flawed as the assessment may be, the group does have the document so the question is what can be done with it. George also said that a major flaw in the document is how generic the recommendations are, but he feels that it is a flaw that can be corrected. George Gartseff went on to further explain that the Needs Assessment should be related to what is going on with the Oak Ridge Reservation. George said that maybe there is no need to educate the public about iodine because according to this study, education about iodine is not one of the top priorities to the residents in the Oak Ridge community. Thus, George suggests that NAWG makes recommendations that are specific to the task at hand which is the PHAs. George also stated that the group does not need a full blown strategic community education plan developed in order to stay focused on the task at hand. Once again George reiterated that the section on recommendations is totally generic and does not refer to any health effects associated with the Reservation. Thus, any recommendations should be made specific to the PHA’s.

Brenda Vowell believes that the Needs Assessment can be useful if the group takes the Action Plan on pages 57-60 and develops strategies for disseminating health information about the contaminants of concern as they are identified. George Gartseff responded to Brenda by reminding her that a health effect has not been identified.

James Lewis believes that there are concerns in the local neighborhoods because of lack of facts and/or trust. James has found that the Hanford site covers certain topics of interest such as cancer. The Hanford site also has a two page brochure available that is related to iodine that is helpful and informative in regards to concerns about iodine.

George Gartseff wanted clarification on what the specific effort of the Needs Assessment is. George wants to know if the Needs Assessment is a Health Education effort or a Community Communications and Outreach effort. George also wanted to know how the Needs Assessment relates to what ORRHES and ATSDR are doing in Oak Ridge.

James Lewis wanted a Community Involvement Branch (CIB) perspective on the difference between educating and communicating health findings and suggestions to the public on the approach that they should take in getting answers to their health issues. LaFreta Dalton responded to James Lewis by explaining that the Division of Health Education and Promotion (DHEP) has a two-pronged approach to health education. LaFreta explained that DHEP provides information to health providers so that health providers have information about contaminants of concern and the related health effects. DHEP also provide the community members with information that they can share with their physicians.

James Lewis then asked how the community will be provided with information about the findings associated with releases. James wants to know how the process for getting information out into the community in a way that will help them make decisions about their health. LaFreta Dalton responded that CIB typically works with DHEP but LaFreta does not know what Theresa NeSmith is planning for the Oak Ridge site.

Still on the topic of DHEP, James Lewis drew a table on the board explaining that there are two components to DHEP. One component is health provider education and the other is community education. James stated that when he looks at the Needs Assessment document he is unsure of which category it fits into. James would like to see past examples of the health provider education component so that he can relate the health provider component to the Needs Assessment. James Lewis stated that he would like to see what has been done in the past and how it relates to the recommendations in the Needs Assessment. Donna Mosby responded by telling James Lewis that he needs to ask for specific examples from Theresa NeSmith because the issue of past examples is a separate issue from feedback relating to the Oak Ridge Needs Assessment document. LaFreta Dalton also urged James to talk with Theresa NeSmith to get the specifics of what she envisions doing for Oak Ridge.

Donna Mosby feels that the NAWG is not ready to be on the telephone with Rebecca Parkin on Monday, June 16th. Donna would like NAWG members to develop feedback to give to Rebecca Parkin by looking at pages 57-60 and thinking about how the Health Education Action Plan relates to the contaminants of concern and Oak Ridge.

George Gartseff commented that the Needs Assessment document is so generic that ORRHES does not need to wait another year for additional generic information.

Kowetha Davidson feels that GWU is not responsible for developing specifics; she feels that NAWG and ORRHES are responsible for developing the specifics that relate to Oak Ridge. George Gartseff replied to Kowetha Davidson by saying that the Needs Assessment is generic to health education in general. The Needs Assessment implies that there are certain health outcomes that the community is concerned about and that ORRHES needs to have a health education effort about those outcomes. On the other hand, ORRHES is producing Public Health Assessments that do not presume a health outcome. A PHA looks at exposures and doses in the effort to see if there is a health outcome. George went on to give an example of health outreach on diabetes. George is concerned that ORRHES, in the effort to educate the public about a disease, will create a fear about something that turns out to not be a problem.

Bill Taylor responded to George’s comments by saying that an issue like the diabetes example could be addressed in the community concerns portion of the PHA. For example, the PHA would state that diabetes is not caused by a particular contaminant. Bill told the group that the effort has two focuses. One effort is the PHA itself and the other is the community concerns that are specific to the Oak Ridge community.

Bill Taylor told the group that throughout the meeting, there have been two major comments voiced.

• The first is that, for the most part, the Needs Assessment document is generic. Bill told the group that before deciding on the next step, the NAWG needs to consider the implication of the assessment being so generic.
  
• The second comment or issue is a question of whether or not the results of the work are representative of the community. Bill Taylor commented that benchmarks do not seem to have been met. He then asked if the group is comfortable with the results if they consider them to be unrepresentative. Bill Taylor also added that because the group does know certain information, such as that one focus group only had one person, an outside review may not be justified.

James Lewis asked Bill Taylor if a Needs Assessment is mandatory at all sites. Bill Taylor told James that it is not mandatory. James Lewis then stated that the Needs Assessment is considered to be an enhancement and that a Needs Assessment does not have to occur in order to perform Public Health Assessments. Bill Taylor told James that that is correct.

Kowetha Davidson feels that poor cooperation from the focus groups was detrimental to a portion of the Needs Assessment. Because the focus group number was so much below the target number, it is important to look at the methodology that was used when criticizing the conclusions that were derived from the focus groups.

Donna Mosby wants to know where the group goes from here. The group needs to have specific comments.

Kowetha Davidson responded to Donna’s request by stating that she agrees with George Gartseff on the Summary page. Kowetha would like to see the Summary page rewritten.

Donna Mosby told the group that it is important to bring up the fact that the Needs Assessment is so generic.

Charles Washington is concerned that given the insignificant number of people contacted, GWU may not have an acceptable formula to derive some of their conclusions.

James Lewis commented that the Needs Assessment process was extremely secretive and that he had heard a comment that the Needs Assessment appeared to be more secretive than the Manhattan Project.

Kowetha Davidson said that it is important to ask about the impact of the small number of people that were involved in the focus groups.

James Lewis voiced his concern over the advertising of the focus groups. James told the group that GWU was given feedback from members of ORRHES that the ad would not be effective. Thus, the lack of participation in the focus groups is GWU’s problem. GWU consists of highly paid professionals that should know what they are doing. James Lewis expected the ads to contain focus group titles so that more people would be interested in the process. The ads put out by GWU were not effective. Donna Mosby responded to James Lewis’s comments by saying that members of the group told GWU that they did not know what they were doing and had them change the process. Thus, now the ORRHES needs to live with the results. Donna feels that some members of the ORRHES sabotaged the focus group process. Kowetha Davidson told James that GWU could not advertise for specific groups regardless of if it was effective or not.

Bill Taylor suggested to the group that they focus on pages 57-60, as Brenda Vowell had recommended, and how the strategies could be geared toward the PHA and community concerns. Bill also said that it may be time to consider how the community concern database information will be used.

James Lewis stated that he thought the Needs Assessment would provide a detailed listing of specific concerns. Kowetha Davidson told James that GWU never agreed to lay out all of the concerns in detail.

Kowetha Davidson reminded the group that if anyone finds a statement or recommendation that is not supported by data that statement should be mentioned to GWU to find out if it is justified because information cannot be included unless it is supported by data.

It was decided that NAWG members review pages 57-60 over the weekend and develop recommendations. The NAWG will meet on Monday, June 16th without Rebecca Parkin on the telephone. However, Theresa NeSmith should be involved in the Monday meeting because she is the appropriate contact from the ATSDR Division of Health Education and Promotion, which sponsored the Needs Assessment. A third meeting that will include Rebecca Parkin will be set for a later date.

The meeting was adjourned at 9:00 p.m.