Oak Ridge Reservation: Health Needs Assessment Work Group

Health Needs Assessment Work Group

June 12, 2003 - Meeting Minutes

Attendees:

Donna Mosby, NAWG Chair
Charles Washington, ORRHES Member
David Johnson, ORRHES Member
James Lewis, Co-Chair
Kowetha Davidson, ORRHES Member
Barbara Sonnenburg, ORRHES Member (telephone)
George Gartseff, ORRHES Member
Brenda Vowell
Lorine Spencer, ATSDR (by telephone)
LaFreta Dalton, ATSDR (by telephone)
Bill Taylor, ATSDR
Melissa Fish, ATSDR

Purpose:

The purpose of the meeting was to discuss the Needs Assessment document so that the NAWG could provide feedback about the Oak Ridge Needs Assessment to Rebecca Parkin on June 16, 2003 from 7:00 p.m. to 8:30 p.m.

Announcement:

Donna Mosby began the meeting by informing the group that the June 16th conference call/meeting has been changed from the original time announced at the June 3rd ORRHES meeting of 6:00-7:30 p.m. to 7:00-8:30 p.m. Donna stated that the time had changed for Rebecca Parkin’s convenience. On Monday, June 16th, the meeting will occur with Rebecca Parkin and Theresa NeSmith on the bridge line from 7:00 p.m. to 8:30 p.m.

Discussion:

Donna Mosby stated that she is aware that some people are of the opinion that the Needs Assessment is less than expected. She is also aware that some people are more disappointed than others. However, before any discussion began, Donna reviewed the Project Summary report dated March 2001 that was submitted by Rebecca Parkin. Donna also reminded the group of the flyer titled Health Education Needs Assessment (See attachments for copy of Project Summary report dated March 2001 and for Health Education Needs Assessment flyer). Donna Mosby requested that comments about the Needs Assessment should be based on the previous two documents.

(James Lewis wanted it noted in the record that someone was on the bridge line and got off without giving their name.)

Donna Mosby read aloud sections and key points directly from the minutes of the February 25, 2003 COWG and NAWG joint meeting. Donna felt that there were four discussion points that directly related to the Oak Ridge Needs Assessment.

• In terms of the Oak Ridge Needs Assessment, Barbara asked about the names of the focus groups, numbers of people in the groups and where the groups were held.
  
  
• Donna asked when the report would be available and if the NAWG would be able to review it prior to it coming to ORRHES. Theresa responded that the report would be available in the spring and would speak with Rebecca.
  
  
• James was concerned about the timeliness of the report and apathy of the community due to the lack of momentum.
  
  
• Peggy expressed the community’s lack of trust, need for two way communication, and the importance of true community input and participation.
  
  • Under the heading-Review of the Savannah River Site (SRS) Needs Assessment, Donna referred to statements made by two people.
    
    
• James stated that we were reviewing this report to see what a Needs Assessment may look like, what to expect and what has happened in other sites where ATSDR has been involved.
  
  
• Peggy was particularly interested in the recommendation having to do with schools and felt that having children do service learning projects would be a good community outreach and education tool.
  
  
• Donna also reminded the group that they had looked at only particular parts of the Savannah document and not the entire Needs Assessment. The members had the cover page, appendix, Executive Summary and Recommendations from the SRS Needs Assessment for review.

James Lewis pointed out that some items in the Savannah River Needs Assessment are the same as in the Oak Ridge Needs Assessment. One example of this is the issue of the website/self-study. Thus, James pointed out that citizens of Oak Ridge are not the only people pushing the issue of the website. It is important that the website be updated in a timely manner so that additional trust can be developed throughout the community in regards to ORRHES and the ATSDR process.

James Lewis went on to compare the Savannah River Needs Assessment report to a Communications 101 course. James added that in turn, the Oak Ridge Needs Assessment can also be compared to the Savannah River Needs Assessment. James stated that there was nothing unique; both documents were very generic and very simplistic.

Barbara Sonnenburg read in the Oak Ridge Needs Assessment that George Washington University (GWU) gave weekly reports. Barbara wanted to know who received the weekly reports and said that it would have been beneficial for members of the work group to see the reports and that she would have liked to be part of the process. Donna Mosby responded that the idea of weekly reports came out over one year ago in an effort for the work group to be able to communicate with GWU. Donna said that she can retrieve all of the emails. However, the weekly reports were more like status reports on how the project was moving along. Donna provided examples of what a weekly report might say such as “made ten telephone calls” or “still working on IRB approval”. Donna said that the reports were nothing that would have made any sense if they had been shared.

James Lewis added some background information to the weekly report issue. James Lewis stated that at one time it was indicated by GWU that Theresa was receiving information on a weekly basis. I asked Theresa to summarize the information that she was receiving and send it to either the NAWG or ORRHES. Theresa ended up allowing GWU to send cryptic type information directly to Donna rather than explaining it to the entire group.

Barbara Sonnenburg stated that the NAWG should have demanded more updates and that the group should have known what was going on with the process. In response James Lewis reiterated that he had pushed the issue of keeping the work group informed but Theresa still decided against providing summarized GWU information to the group.

Barbara Sonnenburg had a specific concern relating to the Summary page and page 8 of the Needs Assessment document.

• Summary page-second sentence
  • Very few people linked any health concerns to Oak Ridge Reservation (ORR).
    
    
• Page 8-second sentence under the heading Telephone Survey
  • The study was not designed to test any hypotheses about what health effects were caused by specific exposures, but to determine what health issues residents were concerned about and how they located health information and if they viewed health resources as a way to address their concerns.

After reading these two sentences, Barbara Sonnenburg expressed concern that the second sentence on the Summary page is misleading because GWU did not ask questions about exposure. Barbara feels that people will not express health concerns linked to Oak Ridge unless they are asked. Donna Mosby replied to Barbara that her comment will be made into a specific question for Rebecca Parkin to answer. Donna stated that it is important that we ask what questions were asked so that the group does not make assumptions.

Lorine Spencer pointed out that there is a copy of the questions that were asked in the Appendices. Kowetha Davidson pointed out that on page 87, question 4 asks about environmentally related health problems. Kowetha added that when conducting a survey the surveyor wants a response initially without prompting. In the case with the telephone survey for the Oak Ridge Needs Assessment, if a response was not given, then the surveyor read the list of choices to the respondent.

Barbara Sonnenburg feels that this one question does not provide a connection to the statement made on the Summary page.

Responding to the survey conversation, Brenda Vowell stated that the point of conducting a survey is to learn what people actually think. It is important that the person conducting the survey does not feed the participant information that will lead to the answers that are desired or expected. Brenda reminded the group that the answers given in a survey will not always be the answers that were expected.

Barbara Sonnenburg responded by saying that there are many questions that need specific answers and none of the questions seem to ask whether people have had specific exposures. Kowetha Davidson told Barbara that if questions in a survey are too specific the survey will be biased.

After listening to the discussion, Barbara Sonnenburg stated that her point is that the issues surrounding the survey should be explained and that the wording should be clear in the summary so that the summary is not misleading.

James Lewis told the group that random telephone calls may need some prompting but not too much. James said that there will be times when limited prompting is necessary. Kowetha Davidson responded to James Lewis by saying that a person who has a major concern or issue will voice the issue without being prompted to do so.

Brenda Vowell commented on the entire Needs Assessment document. Brenda stated that the report does not say what we do not already know. Brenda has been through survey exercises before so there is nothing new in the document. However, Brenda Vowell does not believe that the report is particularly faulty because it is important to remember that the results from a survey are not always what the surveyor wanted or expected to receive. Brenda added that it is extremely difficult to get the public to participate in surveys.

David Johnson agreed completely with Brenda Vowell. David Johnson added that for him the Needs Assessment was nothing new or nothing dynamic that allowed him to “sink his teeth into”. David had high expectations going into the Needs Assessment process and now that he has seen the document in black and white he feels let down.

David Johnson asked the group if this is the final draft? James Lewis and Donna Mosby both replied no, and that NAWG is providing feedback and there will be opportunity for ORRHES and others to comment.

James Lewis agreed with Brenda Vowell but wanted to point out that timing is everything. James told the group that the Needs Assessment hints that people lose interest over time. James Lewis believes that the length of time it took to get the survey out may have negatively impacted this effort.

Charles Washington expressed his concern relating to surveys. Responses must be linked to data from the community. Charles said that it is important to not add information to the data and the data should not be made all inclusive if it is not. Studies need to state a lack of inconclusiveness up front.

Kowetha Davidson told the group that when looking at the Needs Assessment it is important to critique the methods before trying to critique the results. The results cannot be changed.

Barbara Sonnenburg stated the GWU did not conduct the 8-10 focus groups as the work group had asked for. Kowetha Davidson responded saying that GWU did the best that they could to assemble as many focus groups as they could. It is important that the work group know the reasoning for the lack of focus groups.

Barbara Sonnenburg also expressed criticism about the lack of specificity of the advertisements that were used to get people to attend the focus groups. Kowetha Davidson responded saying that questions need to be asked about the reasoning for the lack of specifics within the advertisements and the group must listen to the reasons.

Barbara Sonnenburg expressed her frustration that the NAWG had met approximately 6 times and GWU had ignored the work group efforts.

Donna Mosby reminded the group that when the focus group advertisements came out there was a lack of support from ORRHES pertaining to the advertisement. Barbara Sonnenburg responded that the group had criticized the ad but did not change it. Donna Mosby responded to Barbara saying that ORRHES only tore the process down and did nothing to help pull people together.

James Lewis responded to Donna Mosby’s comments saying that GWU did not want to acknowledge what the focus groups were about and that this is noted in the body of the Needs Assessment. James said that ORRHES members could not recruit if members did not know who to recruit.

Kowetha Davidson told the group to remember to look at the methods and to understand survey methods/standards.

Barbara Sonnenburg expressed frustration that the group was required to narrow focus groups down to more specific groups when the focus group advertisements were not specific and suggested that people come discuss general health issues.

Kowetha Davidson proposed that the Needs Assessment be critiqued and reviewed by ORISE who conducted the Savannah River Needs Assessment. Kowetha Davidson stated that the group thought highly of the Savannah document. This statement was met with much disagreement by a few of the NAWG members. In response James Lewis asked, Who said that we liked the Savannah document? James stated that the group had only wanted a sample of the type of document that would be produced. Barbara Sonnenburg added that nobody asked the group if the document was good or not.

Kowetha Davidson stated that ORISE could provide an unbiased opinion of the Needs Assessment. Someone from the outside could explain the methods and standards that the group does not understand. Kowetha added that methods must conform to standard procedures.

In response to Kowetha Davidson’s idea of hiring ORISE to review the document, Barbara Sonnenburg reminded the group that it will cost money to have ORISE critique the document. ORRHES does not have much money and ATSDR keeps talking about the budget.

James Lewis stated that research for the purpose of research is no good. The NAWG is looking at GWU’s methodology to see if an effective document has been produced in a timely manner that meets our needs. James Lewis gave an example of a video of the 1-18-01 ORRHES meeting in which Dr. Falk stated that a Needs Assessment would be very beneficial if it was produced in a timely manner that would help guide the efforts of the Public Health Assessments. Next, James Lewis posed the question: Is this a timely document? James stated that putting a product out at the end of the process is not helpful.

Kowetha Davidson disagreed with James Lewis and said that because the document has been produced, it should be used. Kowetha stated that the group cannot go back. James Lewis asked Kowetha Davidson what the document should be used for. Kowetha responded that the PHA’s have not been completed.

James Lewis again stressed that timeliness is the key for effectiveness as it relates to the Needs Assessment. James provided two examples of issues (using briefing documents with color & the need to critique existing ATSDR documents and handouts) that were raised in the Needs Assessment that have resulted in drawn out processes between ORRHES and ATSDR. If the Needs Assessment would have been available at an earlier date some of the process could have been avoided.

Kowetha Davidson told the group that the process of the Public Health Assessments has just begun and that the group should not be close minded to the Needs Assessment document just because it was not here one year ago.

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