The Macomb County Health Department is located in Macomb County Michigan, and has been working to protect and promote the health and well-being of all those who live, work, and play here for over 60 years. The Health Department accomplishes its mission by providing a wide range of programs and services through four major divisions: Environmental Health, Family Health, Community Health Planning and Promotion, and Disease Control. Macomb County is located in Southeastern Michigan and is the third largest county in the state, with 871,375 residents (2017 estimate). The county is composed of 27 townships, villages, and cities covering 571 square miles. The southern part of the county is largely urban and suburban, and the north part is agricultural. The highest proportion of Macomb County residents are White (83.6%). About 10.5% of the population identifies as African American or Black, while 3.4% identify as Asian.
According to the 2009 Macomb County Behavioral Risk Factor Survey, only 25.5% of individuals believe their household is well prepared to handle a large-scale disaster or emergency. After surveying fifth grade teachers via e-mail in the county, it was found that emergency preparedness was rarely being covered in the classroom and that students were underprepared for community disasters.
These findings led to the development of our Youth Preparedness Program, an outreach and education initiative that targets Macomb County fifth graders. The Macomb County Health Department (MCHD) utilizes MCHD Medical Reserve Corps (MCHD MRC) volunteers as presenters. School principals are contacted via email and informed of the availability of the program. Interested schools schedule a presentation and on presentation day, an MCHD MRC volunteer presenter arrives at the school with all necessary materials and hands out a survey to each fifth grader. The students put their student numbers on top of the pre-test, and answer a series of questions. The questions start simple (Do you know the first and last names of all the adults in your house?”) and then become increasingly more difficult (Which of these is nonperishable? An apple or a can of soup?”). Once the students have finished answering, the surveys are collected, and the presentation begins. The presentation encourages students to think of common emergencies (car accidents, house fires) and ways they already prevent them (seat belts, smoke alarms). Then we ask about emergencies, or disasters (floods, tornadoes), that affect the community. Next, we show them examples of disasters that have happened in Macomb County. After that, we switch the focus to what they as fifth graders can do to prepare for disasters. A demonstration emergency kit is shown to the children to let them see how simple an emergency kit can be to assemble. We cover the importance of communication plans, and then we explain what is in the packet they get to take home. Each packet has five unique items. The first is a letter to their parents explaining the program and emergency preparedness. The second is an emergency kit list with kid-friendly graphics, and the back is a list of terms and helpful hints about emergency kits. The third is a Family Preparedness Plan Template. The template includes a list of suggested preparedness actions and spaces to write the family specific contact information, prefilled contact information for various Macomb County resources. The last page has a list of scenarios to consider (weekday vs weekend, plan for elderly parents and grandparents, etc.) and the back is space to draw their home, marking where emergency kits are stored, the location of emergency exits, and a map their neighborhood to show their designated meeting place. The fourth item is an online resource list with URLs to kid-friendly preparedness websites, ranging from FEMA's Disaster Master to Sesame Street's Emergency Preparedness website. The last item is a set of four business-card sized communication plan templates. Two weeks after each presentation, the students take the survey again. Once they have turned in their surveys, they receive a classroom certificate of completion from the program.
The impact and effectiveness of our program has been measured through the data analysis of the pre- and post-presentation surveys. Utilizing volunteer assistance for entering survey data into Google forms made data collection much more efficient. Using this process, we were able to collect and analyze data from approximately 1,200 students during the 2017-2018 school year. Results showed growth on every questioned assessed, indicating a greater level of emergency preparedness by these fifth grade students and their families.
For more information on our Youth Preparedness Program, please visit: https://health.macombgov.org/Health-Programs-EPP-Family
The Youth Emergency Preparedness Outreach Initiative is innovative, because it is the only program to address youth emergency preparedness in an accommodating, comprehensive, and sustainable way. An assessment of the county's most vulnerable populations was conducted as part of routine preparedness planning through the Emergency Preparedness Program. After reviewing the data it was shown that elderly and youth populations were those at greatest risk with only a quarter of residents being prepared for emergencies. Among other planning efforts, MCHD decided to reach out to the youth population to start addressing their preparedness levels. Specifically MCHD chose 5th graders due to the concepts being a little more complex than younger students may be able to grasp, but yet not at a grade where students may be less willing to sit down and have a conversation with their parents. This was the concern with older students in middle-school and higher. In late 2013, an email was sent to 235 fifth grade teachers at public schools across Macomb County asking them to complete an anonymous survey regarding emergency preparedness levels of their students. Of the 62 teachers that responded to the survey, none of them had taken the optional emergency preparedness training available to the school districts. 58% reported that they do not teach any emergency preparedness in their classrooms. The survey results also indicated that emergency preparedness is not taking place outside the classroom. Ninety-two percent of teachers reported their students were less than prepared and only had a general idea of what to do in some emergencies (i.e. Stop, Drop, and Roll.)
Since the first presentation conducted in 2014, over 5,400 fifth grade students have received this emergency preparedness information. Out of the approximate 12,000 fifth grade students in Macomb County, we have consistently presented to about 1,200 or 10% per year. The Youth Emergency Preparedness Outreach Initiative aims to reach students for one hour during their fifth grade year. This eliminates interference with the time required to cover common core standards and makes the project sustainable, even as teachers are required to cover more material each school year. It also makes the project comprehensive by only requiring one lesson, rather than a cumulative lesson in every grade. The use of students and volunteers to present the lessons also increases sustainability: teachers do not have to attend training to plan lessons. They only need to distribute and collect surveys. The Youth Emergency Preparedness Outreach Initiative is the only program designed to provide comprehensive, targeted, youth emergency preparedness lessons, while respecting the time constraints of teachers.
The goal of the youth preparedness outreach initiative was to increase the preparedness of students and families and increase overall community resiliency throughout Macomb County. A committee of MRC volunteers and the MRC coordinator developed the program which includes a pre-presentation survey, an interactive PowerPoint presentation facilitated by a trained presenter, a demonstration emergency kit, a five-piece packet of educational materials for each student, and a post-presentation survey. Additional materials include teacher and presenter evaluation forms, and Certificates of Completion for each classroom. The program is designed to be delivered to fifth grade students within a 40-60 minute period.
Macomb County Health Department provides a two hour training to volunteer presenters to prepare them for the presentations to the fifth graders. Macomb County Health Department facilitates the scheduling of the presentations at the schools to ensure schools are not being contacted multiple times for the same presentation.
This program was initiated through the Macomb County Health Department MRC, and the presenters are MCHD MRC Coordinator and volunteers. The MCHD MRC has partnered with Oakland University School of Nursing, as well as HOSA (formerly Health Occupation Students of America, now Future Health Professionals) students at the local high schools to participate in the Youth Preparedness Program as presenters. RN-to-BSN nursing students have also reviewed the presentation and associated materials to provide feedback. Their term papers must include suggestions for improvement based on currently published research on elementary education, youth preparedness, and health literacy. Elementary schools, fifth grade teachers, and principals are also an essential partnership to the program's success. The program is voluntary, so we rely on schools and teachers choosing to engage in the program. Beginning this school year in the Fall 2018, we have also collaborated with the Michigan State Police's Student Tools for Emergency Planning (STEP) program. Establishing this partnership for the Youth Preparedness Program has allowed for each student participant to receive a free emergency starter kit, which includes a tote bag, emergency blanket, flashlight, batteries, and a whistle.
The costs associated with the program are general operating supplies: printing, computer, software, office supplies, and cell phone. The majority of the cost comes from the printing of student materials and pre-paid postage envelopes used to receive student post-tests. The estimated cost for these is about $330.00 per year. This can fluctuate depending on the number of presentations and students we have each year. This program's funding was initiated by a 2014 NACCHO MRC Challenge Award and is supported continually by the health department.
By evaluating our program, we have determined that our objective of improving the emergency preparedness of fifth grade students and their families has been met. A comparison of pre- and post-presentation surveys shows us whether there is improvement in the students' answers. We have used this data to determine the effectiveness of our presentation. For example, during the first year of the program we found there to be statistically significant results (95% confidence) showing improvement in responses to two of the survey questions. This year we utilized Google forms to have volunteers enter survey data from over 1,200 students. Once data entry was complete, the percentage of improvement on post-presentation surveys was calculated. We observed growth on all survey questions, including how many students have family communication plans and emergency kits. Understanding the difference between perishable and nonperishable foods was found to have the most substantial improvement at a 20% increase.
Teacher evaluation forms also give us feedback about the design of the program and the ease of access to the program. These responses are all logged into Excel and compiled each year to analyze the program. The feedback we have received has been very positive, with nearly all teachers requesting the program in proceeding school years. This shows us that they believe the presentation is valuable.
One of the best measures of success is the reaction of the students in the classroom. After presentations, presenters debrief with each other about their experiences. From these debriefs, we are able to compile the best examples and analogies and continuously improve the presentation.
Through our experiences in the classrooms, along with the survey results, teacher feedback forms, and university student research, our youth preparedness committee has made modifications to the content of the program over the past five years. We have made changes to make the program more interactive and engaging for students, while also placing greater emphasis on sharing the information we present with their families. Our partnership this year with the Michigan State Police has also increased excitement for the program as each participant will receive an emergency starter kit. By continuously seeking ways to improve our program, we have made changes that have positively impacted student understanding.
This program was initially funded by a 2014 NACCHO MRC Challenge Award and is continually supported by the health department. The only recurring costs of the program are the printing of surveys and packet materials, as well as envelopes and postage. Since the Challenge Award, these costs have be paid for with PHEP award money. It may also be possible to provide the student materials electronically in the future to reduce printing costs. Due to the low costs of operation and consistent volunteer help, we have been able to successfully run this program for the past five years.
In addition to low operational costs, our partnerships have helped us increase our sustainability. Our partnerships with Oakland University and HOSA students are mutually beneficial, which is important in maintaining the sustainability of the program. The Oakland University students who present in the elementary school also research and write their papers on the program. HOSA students that partner with the MRC use student presentations as a key portfolio piece to demonstrate their impact on the public health of the community. While these partners are invested in the program, university students rotate after one semester and HOSA students change every year or two. Although the support of the schools allows for continued operation of the program, some effort is required on the behalf of the MCHD MRC to train new groups of presenters periodically.
Fortunately, this program can be used in any school program across the country and applies to students in all social economic settings. There is little cost associated with the program which allows any agency to use the presentation materials. This program can be replicated in any school setting and used to build community resiliency in any community.