Oak Ridge Reservation: Health Needs Assessment Work Group

Health Needs Assessment Work Group

June 30, 2003 - Meeting Minutes

Attendees:

Donna Mosby, NAWG Chair
David Johnson, ORRHES Member
James Lewis, Co-Chair
Kowetha Davidson, ORRHES Member
Barbara Sonnenburg, ORRHES Member (telephone)
Bill Taylor, ATSDR
Melissa Fish, ATSDR
Theresa NeSmith, ATSDR (telephone),
Marilyn Palmer, ATSDR (telephone),
Terrie Sterling, ATSDR (telephone)

Meeting Minutes:

The June 12, 2003 Draft meeting minutes were accepted as presented in the draft form.

The June 16, 2003 Draft meeting minutes were accepted as presented in the draft form.

Purpose:

Donna Mosby explained that there were two items for tonight’s meeting.

1. Provide feedback on the Needs Assessment report.

Donna explained that it is important that the group pull their collective input together so that the NAWG can give feedback to Rebecca Parkin.

2. Discuss the Recommendation that James Lewis had presented at the June 16th NAWG meeting.

Donna Mosby read the Recommendation aloud for the people on the telephone:

Based upon the review of the Needs Assessment and the ORRHES Chair’s suggestion that NAWG should critique the methods before trying to critique the results, I recommend that we establish an Ad Hoc Committee to review the current Needs Assessment to determine:

• If the appropriate methodologies and/or type of surveys were used.
  
  
• If GWU met the stated goals and objectives for the Literature Review, Resource Interviews, Telephone Survey, and Focus Group Discussion
  
  
• If there is a need for formal implementation of the Phase II portion of the Community Health Education Plan.

Discussion:

Barbara Sonnenburg told the group that she did not receive an email notifying her of tonight’s meeting. Donna Mosby told Barbara that an additional notice of the meeting was not sent out and that she had forgotten that Barbara was not involved in the previous NAWG meeting when tonight’s meeting was announced. Barbara Sonnenburg told the group that the only reason that she knew about tonight’s meeting was because she saw James Lewis in a grocery store. Donna Mosby and Bill Taylor apologized for the confusion.

There was also some confusion expressed about the meeting minute distribution. Marilyn Palmer clarified that the June 16th Draft NAWG meeting minutes were sent out by Bill Taylor on June 23rd at 1:31 p.m. The last page of the June 16th Draft NAWG meeting minutes identified the date and time of the current NAWG meeting.

James Lewis requested that the NAWG meeting minute email distribution list be read aloud. Marilyn Palmer stated that the email distribution is as follows:

• To: Susan Kaplan, Barbara Sonnenburg, Brenda Vowell, James Lewis, Donna Mosby, Karen Galloway, and Pete Malmquist


• Cc: The entire ORRHES and some ATSDR staff
  Marilyn Palmer pointed out that the email distribution follows the distribution strategy that was developed.

Donna Mosby told the group that she thought that Peggy Adkins no longer has email and that the group will need to communicate with Peggy in a different way besides email. However, Donna Mosby will call Peggy to get clarification about her email status.

Donna Mosby also told the group that Mike Knapp wants to be informed about current issues as well and would want to be included on the email distribution as well as the mailing distribution. Marilyn Palmer confirmed that Mike Knapp is only on the mailing distribution and not on the email distribution. Donna told the group that she will contact Mike Knapp to verify that he wants to be included on the email distribution.

Bill Taylor is the person who is distributing the meeting minutes. Bill Taylor requested that if there is someone who should be on the distribution list and is not, that members of the group inform him so that the person can be added to the list.

It was announced that Bill Taylor will assist as the facilitator of tonight’s meeting.

James Lewis pointed out that in the past few NAWG meetings there have been suggestions for three different approaches for addressing the Needs Assessment document. The three approaches that have been suggested include:

• Sending the Needs Assessment to ORISE for review


• Collecting individual comments regarding the Needs Assessment and pulling all of the comments together in one document


• The Recommendation of forming an Ad Hoc Committee to review the Needs Assessment and bring the information back to the work group

James Lewis feels that the NAWG is in agreement as far as the process for getting comments to ATSDR. James feels that members of the work group generally agree that any comments coming from the work group should be in written form and sent to the ORRHES for a vote. If ORRHES approves, the written document will then be sent to ATSDR. James pointed out that the real disagreement between the NAWG members is in the approach that will be used to initiate the process.

Bill Taylor reiterated that in the past two NAWG meetings, three potential approaches have been suggested by NAWG members and suggested that each approach should be discussed.

Kowetha Davidson stated her reasons for suggesting that ORISE review the Needs Assessment document. Kowetha told the group that ORISE has completed a Needs Assessment at the Savannah River site, ORISE has employees that are experienced in performing Needs Assessments, and she feels that ORISE could let the work group know if the Needs Assessment by George Washington University is acceptable.

Donna Mosby wants clarification as to how the process of having ORISE review the Needs Assessment would actually work. Donna Mosby asked if the work group would make a recommendation to ORRHES. Kowetha Davidson responded by saying that she thinks the work group would ask ORISE for the review.

Donna Mosby asked if there would be money attached to having ORISE review the document. Kowetha Davidson responded by saying that it depends. Sometimes people will review a document for no charge and other times there will be a cost associated with a document review.

Bill Taylor wants to know how Kowetha Davidson will approach ORISE. Kowetha Davidson stated that she would go through the Project manager that was in charge of the Savannah River Needs Assessment to see if the Oak Ridge Needs Assessment follows acceptable procedures.

Bill Taylor then asked if ORISE completed the Savannah River Needs Assessment as a contractor to ATSDR. Theresa NeSmith responded that ORISE completed the Savannah River Needs Assessment as part of the cooperative agreement with ATSDR.

Barbara Sonnenburg stated that she is skeptical about having ORISE review the Needs Assessment and asked if it likely that one contractor would criticize another contractor. Bill Taylor stated that it would depend on the approach used by the work group and the questions that the work group wants answered. Bill Taylor feels that if the NAWG had specific questions, they would be likely to get an honest response.

Kowetha Davidson added to the discussion that she is involved in critical reviews all of the time. The company that Kowetha works for, ORNL, produces honest reviews regardless of who the review is for.

Barbara Sonnenburg asked if the reviewers would know about the suggestions that the work group had made years ago. Kowetha Davidson stated that past work group suggestions should not be a part of the specific questions that would be asked of the reviewer. It is important that the reviewer is not provided with information that could bias the review.

Barbara Sonnenburg reminded the group of all of the time that was spent narrowing down the focus groups. Kowetha Davidson responded by saying that ORRHES had only provided suggestions and that they were not requirements. Kowetha added that GWU did not force people into a group; participants could only be in a group if they fit into a specific focus group title.

Donna Mosby stated that the point is that GWU did not narrow the focus groups; rather the limited participation was responsible for the limited number of focus groups. Donna Mosby added that ORRHES members should have supported the focus group process. If members would have been more supportive, perhaps there would have been more focus groups.

Kowetha Davidson stated that the NAWG could ask ORISE specifically about the weakness of the focus groups and how it affects the overall Needs Assessment.

David Johnson wanted to know how long it would take ORISE to review the Needs Assessment document. Kowetha Davidson responded that it would probably take two days for a document of the Needs Assessment length to be reviewed. However, it always depends on who is available to perform the review.

David Johnson had questions relating to subcontractors reviewing subcontractors. David Johnson wanted to know if the ORISE review process would give credibility to the Oak Ridge Needs Assessment. Kowetha Davidson responded by saying that the expectation for all document reviews is that the review will be impartial. Kowetha also added that ORISE and GWU do not work together and are separate entities.

After listening to Kowetha’s comments James Lewis stated that both ORISE and GWU had subcontracts from ATSDR. James said that some people believe that their future work could be impacted if they tarnish another organization’s document. Thus, some people may hold back critical comments. Kowetha Davidson responded by saying that ORNL always gives EPA an honest review of their documents although EPA pays the checks.

Bill Taylor wondered if the work group could formulate the types of questions that they want answered and if the ORISE review could be done in a timeframe that would be useful.

Barbara Sonnenburg stated that she does not feel that she or other work group members need an outside contractor to provide opinions. Many people have already developed their opinions and concerns. Thus, Barbara Sonnenburg feels that some people are trying to cover up the Needs Assessment, say that everything is fine, and just move on.

Kowetha Davidson responded to Barbara Sonnenburg by saying that the NAWG can not make the assumption that ORISE will say everything is fine concerning the Needs Assessment document. Donna Mosby added that an ORISE review might help the work group formulate reasons as to why the Needs Assessment is not “fine”.

Donna Mosby told the group that a second approach that has been suggested for addressing the Needs Assessment document. The second approach involves getting individuals to turn in comments and feedback and then the individual comments are put into a summary form. Thus, the various individual comments all become part of one work group document. Donna Mosby added that this task has not been accomplished and that the work group has not moved forward toward developing a summary of comments relating to the Needs Assessment.

David Johnson said that there is still a big void. David Johnson feels that the work group is here to bring a level of credibility to the Needs Assessment process and he is concerned about how to make the Need Assessment document credible. David Johnson suggested that one way of making the Needs Assessment more credible would be to interview the general public about how they feel about the Needs Assessment. David feels that this approach would let the work group know what the average person knows and/or thinks about the Needs Assessment.

Bill Taylor responded by reminding the group that the average person does not know about the Needs Assessment because it is still in draft form and has not been widely distributed. Bill Taylor also said that it is not the work group’s job to validate the document. The work group needs to look at what it has and figure out where the group wants to go with the Needs Assessment document.

James Lewis stated that the NAWG has had two meetings. Someone needs to summarize the concerns and issues that have been raised in the last two work group meetings.

Bill Taylor volunteered to compile the individual Needs Assessment comments. Bill Taylor told the group that he would compile the comments and then give the comments back to the work group for review. Bill feels that by compiling the comments, there will be an opportunity for structure. The work group would need to set a deadline for comment submission and the work group would have to set a NAWG meeting date for review of the submitted comments.

Barbara Sonnenburg wanted to know what the work group is trying to do. Barbara asked if the work group is trying to say whether the Needs Assessment is good or bad. Kowetha Davidson responded by saying that the NAWG is not trying to pass judgment but is trying to develop comments about the Needs Assessment document.

Bill Taylor disagreed with the statement that the work group is not here for judgment. Bill feels that judgment has a place in this process.

Donna Mosby stated that the role that the work group wants is to place judgment on the Needs Assessment document. The NAWG asked for the opportunity to review the Needs Assessment and in allowing the work group to review the document, ATSDR opened the door for the work group to pass judgment.

Barbara Sonnenburg wanted to know what the key issue is regarding the Needs Assessment. Is the key issue that ORRHES does or does not endorse the Needs Assessment?

Bill Taylor told the group that ORRHES can make any recommendation that it wishes and can pass that recommendation to ATSDR.

Kowetha Davidson stated that ORRHES may decide that the Needs Assessment requires clarification. Barbara Sonnenburg responded to Kowetha’s statement by asking if ORRHES would have to pay more to get GWU to do something that the group feels should have been done originally. Barbara added that she would hate to spend more money on the Needs Assessment.

Donna Mosby explained the importance of making statements that are useable. Donna said that statements such as “this is a piece of trash” are not useable.

Barbara Sonnenburg does not understand why the group has to use the Needs Assessment document.

Donna Mosby stated that there is a process and that the process involves the NAWG developing reasons as to why the group has a specific opinion.

Bill Taylor provided an example of a hypothetical situation. Bill Taylor said that the work group could suggest to ORRHES that they conditionally accept or approve the Needs Assessment on the condition that there is not enough information regarding the contaminants of concern and that more information needs to be developed before the work plan is ready to address these issues.

Donna Mosby reiterated that her point is that the work group can not just make a general statement. Barbara Sonnenburg responded by saying that she understands that any statement must be backed up by facts.

Kowetha Davidson recommended that the group develops a list of facts before developing their general conclusion.

Barbara Sonnenburg still wanted to know what difference the recommendations will make to ATSDR. Does ATSDR need this report?

Kowetha Davidson believes that until written comments are available, the group should not be discussing whether or not ATSDR needs the report.

Barbara Sonnenburg wanted to know if the Needs Assessment is necessary in regards to the scope of ORRHES’s work over the past three years.

Theresa NeSmith responded to Barbara Sonnenburg by saying that probably at the beginning of the process when the Needs Assessment was discussed and how it would fit into the overall plan of health education and promotion at the site, one of the things that we said is that we needed to do some sort of assessment to give us information such as community concerns. ORRHES and several other sources provided a lot of information about community concerns. We also said that we needed information on the best way to communicate information to the community. DHEP will use information from the Needs Assessment that will help to guide the Health Education and Promotion activities for the site. So the Needs Assessment was a necessary step and we will use the information to help develop our plan for future activities. Those future activities could include working with healthcare providers, conducting Grand Rounds for healthcare providers, and working with the community through avenues such as churches, health fairs, and other activities.

Barbara Sonnenburg asked Theresa NeSmith if the group would use the Needs Assessment as the basis for all of the Health Education and Promotion activities.

Theresa NeSmith said that the Needs Assessment would not necessarily be the basis. Theresa gave an example that if part of the information that comes from the Needs Assessment is that community members talk about the importance of getting information from their healthcare provider, and Theresa reminded the group that the Needs Assessment does show that there are different groups who do want information from healthcare providers, this type of information will help target the audience that ATSDR is trying to reach.

Bill Taylor stated that the Needs Assessment document does not contain anything that says healthcare providers need more information. Bill does not know where the physician education idea is coming from. Theresa NeSmith responded by saying that maybe she and Bill could talk about this issue off-line.

Theresa NeSmith continued by saying that the Needs Assessment will provide DHEP with additional information. Theresa then provided two examples of information that could possibly come from the Needs Assessment document. One example was that DHEP might learn that people want to pick up flyers at a healthcare provider office. Another example that Theresa provided was that through the Needs Assessment DHEP might learn that community members want to get health information on line.

Bill Taylor wants to know what the basis is for these examples. Theresa NeSmith responded that she was only using those as examples.

James Lewis told the group that a proposal to do a Needs Assessment was submitted by GWU in the Fall of 2000 and that statements in the draft Needs Assessment document imply that GWU met all of its required commitments. However, James and the rest of ORRHES do not know what the commitment was. Thus, James Lewis does not understand how the NAWG can tell ORISE to review a document when ORRHES is unaware of what GWU’s requirements were in the first place.

James Lewis stated that in trying to figure out what the Needs Assessment will be used for and when looking at the recommendations that came from the document, Theresa NeSmith continues to refer to Health Education and Promotion. James Lewis wonders if there is a need for health education if there is no conclusive evidence that there is something to be concerned about. It would be rational to table and hold the Needs Assessment effort until ORRHES has evidence which warrants educating doctors.

Donna Mosby told James Lewis that his statements about Health Education and Promotion is part of feedback and that feedback is the route that the NAWG must take when reviewing the Needs Assessment document.

James Lewis told the group that the only way to get feedback about the Needs Assessment is to lay a structure for a plan of how the Needs Assessment should be reviewed.

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