Nontraditional Partnerships Strengthen Community Health

State: IL Type: Model Practice Year: 2018

The Kane County (Illinois) Health Department (KCHD) serves a population of about 530,000, according to the U.S. Census Bureau's 2016 estimate. Kane County has a socio-economically diverse population, with two urban centers in the north and south regions, and a center region that is home to more affluent communities. Land use in the western half of the county is devoted mainly to agriculture and some estate-type subdivisions. According to the Census Bureau, Kane County has the largest percentage of Hispanic residents of any county in Illinois. St. Charles East High School (STE), of District 303 (District), has an enrollment of about 2,500 students and is located in St. Charles, whose residents have a higher than average income level. On January 7, 2017, a Saturday, a large number of STE students involved in extra-curricular activities reported feeling ill, with symptoms that included nausea, vomiting and diarrhea. In fact, so many members of the STE boys' varsity basketball team were ill that the game scheduled for that night had to be postponed. Because it was a Saturday and students weren't in school, the District needed an idea of how many of STE students were ill. At the same time, a school District health official contacted the on-call KCHD public health nurse to inform the department of the developing situation. By Monday, Jan. 9, the situation had developed into a full-blown crisis. As many as 800 students, nearly a third of the school's total enrollment, were absent at the beginning of the day. It was clear to District administration officials that it would be impossible to continue functioning efficiently with one third of the students, and a number of staff, absent. The decision was made to close the school and to cancel classes until further notice. The symptoms described by those ill had all the earmarks of a norovirus outbreak: the sudden onset, the quick spread to others, the stomach virus symptoms. To confirm the hypothesis, KCHD disease investigators needed to interview patients and collect stool samples to send to the lab for testing, and this required the gathering of names of minors. This presented a challenge as KCHD investigators and District officials worked out how to accomplish this, while maintaining the confidentiality of the students. Simultaneously, and not surprisingly, the news of so many ill students at a single school spread like the proverbial wildfire. By mid-morning it was already generating telephone calls to the KCHD public information officer (PIO) from downtown Chicago television news staffs. The District's goal was to ensure that parents, students and staff felt safe in the building and to be able to get back to providing an education to the students as quickly as possible. The health department needed to provide disease prevention and educational guidelines, conduct a disease investigation to determine the exact cause of the outbreak and provide the public with up-to-the minute information. At times, the stated goals ran counter to each other. That's where the coordinated messaging came in. The KCHD PIO and the District's Director of School/Community Relations (District spokesman) had worked together in the past on several projects and had developed a close, even personal relationship through the Kane County Public Relations Council. Over the next few days, the long-standing relationship between the KCHD PIO and the District spokesman allowed the communications efforts of both entities to flow smoothly to the parents and the public at large, while keeping other Districts in the county and in the region and other local health departments apprised of the developments throughout the week. By having the personal network of the PR Council already in place, the two agencies were able to navigate the media storm, the parent calls, and the agencies' differing needs. Taking time to get to know the fellow PIO's in city and county government, park district, library, state's attorney's office, along with the elected officials, and business leaders in the region set the foundation for a successful communications campaign.
Responsiveness and Innovation With a sizeable portion of the student body absent from school, KCHD and the District needed to form messages that addressed concerns of the main target population: parents, students, and staff at STE, as well as those at other schools in the District. Further, the two entities needed to prepare for the inevitable media storm. Communications needed to include prevention messages, rumor control, reassurances, empathy and details of the steps the District and KCHD were taking to deal with the event. Through the social media accounts of the District and the health department, the District's direct communication channels to parents and students, websites and the widespread media coverage, it is believed the vast majority of the target population was reached. Before the formation of the Kane County PR Council, communication and messages were developed in silos. The PR Council enables the PIOs of various agencies, and the District and KCHD in particular, to rely on past networking experiences to smoothly develop crucial messaging to the public. While developing partnerships with local agencies is not in and of itself innovative, the partnership as practiced in this situation proved virtually seamless. According to the Centers for Disease Control and Prevention (CDC), norovirus is the leading cause of illness and outbreaks from contaminated food in the United States. The CDC estimates that each year on average, norovirus causes 19-21 million cases of acute gastroenteritis, and contributes to 56,000-71,000 hospitalizations and 570-800 deaths, mostly among young children and older adults. Norovirus is highly contagious, with the most common symptoms being diarrhea, vomiting, nausea and stomach pain. Some patients can experience fever, headache and body aches. The initial reports from the District indicated a stomach virus, which the District and Department started to publically refer to norovirus-like” symptoms. The rapidity and widespread nature of the STE outbreak pointed to the likelihood of a norovirus. However, the investigation needed laboratory confirmation in order to rule out any other causes. The close relationship between the KCHD PIO and the District spokesman began to bear fruit immediately. That relationship was formed many years before. In a matter that is only coincidental, the PIOs of local government agencies and some NGOs in Kane County began meeting informally in the spring of 2009, just weeks before the first reports of H1N1 influenza began to make the news. The informal group became known as the Kane County Public Relations Council and those first meetings allowed the KCHD PIO to meet and network with the school districts' PIOs, PR folks and marketing professionals. Those early relationships proved to be critical when soon thereafter school districts had to begin closing schools as the first suspected” and confirmed” cases of H1N1 appeared in their buildings. With so many STE students ill during the January 2017 outbreak, the KCHD PIO and the District spokesman promptly saw it as the next crucial step to begin formulating crisis communication messages. Within a few minutes, a telephone call was set up between the KCHD Executive Director and District Superintendent. It was quickly determined that each agency would need to stay within its own boundaries,” i.e., KCHD would respond to questions regarding public health issues, while the District would concentrate on the education, absenteeism, any custodial procedures, etc. For example, the reporters all wanted to know the number of cases,” a question impossible to answer. KCHD had to refer those inquiries back to the District. Likewise, when the reporters asked school officials about the illness or disease investigation, those questions were referred to the health department. The District spokesman said it was a great help when talking to parents or with the press to be able to say the District was working closely with the health department.” We emphasized using the phrase norovirus-like symptoms” when speaking with the press or the public. Again, most of the indicators for norovirus existed, but without confirmation we could not say for certain. At the same time, however, we also tried to emphasize that, while it might be common to refer to a stomach virus as the stomach flu,” it wasn't an accurate definition. Influenza in a respiratory illness that spreads through the air, while norovirus spreads by eating food or drinking liquids contaminated with norovirus, touching surfaces or other contaminated objects or having close contact with someone infected with norovirus (Source: CDC). Interestingly, some members of the press were not familiar with the term norovirus” and asked about this new virus” or the neuro-virus.” The KCHD PIO forwarded to the District spokesman frequently asked questions, talking points and a message map, all developed from the information about norovirus on the CDC website. Further complicating matters was a situation that had occurred more than a decade prior to the norovirus outbreak, and which would begin to make itself an issue in the present day. In 2001, STE was closed for an entire academic year so that the District could conduct mold remediation throughout the building. Numerous illnesses in students and staff were attributed – rightly or wrongly – to the mold. Although the local health department in Kane County has no authority over most issues regarding the physical infrastructure in public school buildings and had no part in the mold remediation issue from 2001, several parents with long memories sent KCHD emails implicitly or explicitly attributing the large number of ill students to the air quality issues from so many years before. As proof” of this hypothesis, it was noted that none of the other schools in the District had anywhere near the absenteeism. Why, the question was raised, weren't younger siblings of the ill STE students in middle and elementary schools also calling in sick? These messages prompted a quick resolution. Rumor control is an essential component in any crisis communication effort and with the social media platforms heating up from both the students' and the parents' postings regarding the closing of the school, it was imperative that the air quality issue not cloud what was important: preventing the further spread of whatever it was that was making the students and staff ill. In Kane County, the responsibility for health and safety inspections of public school buildings falls upon the Kane County Regional Office of Education (ROE). The emails from the parents sparked another phone call between the KCHD PIO and District's spokesman, as well as quick sharing of messages to be approved by both parties. Further, the ROE's communications professional was conferenced in, which allowed the Regional Superintendent to speak with the KCHD Executive Director as a way to keep all parties apprised of the situation. These efforts netted a carefully worded response to the rumors, which emphasized the prevention of the spread of norovirus and dispelled the notion that the outbreak was anything but gastrointestinal in nature. Once these messages went out, any more mention or rumors of the illnesses being attributed to the air quality issue, either through direct communication to the affected agencies, i.e., emails, phone calls, or indirectly via social media posts, ceased.
LHD and Community Collaboration and Implementation Strategy Early in 2009, three former colleagues from a local newspaper then employed in public information positions with local government agencies, got together for lunch. Although one worked in a school district, another in the prosecutors' office and the third at KCHD, the ex-news reporters began to discuss the similarities in the experiences and challenges they faced while promoting their agencies to the public, providing the public with vital and transparent news and information and dealing with the same members of the media whose news beats often overlapped. Before lunch was over, it became apparent there were more similarities than differences in their missions. Further, the trio was able to identify numerous potential situations where the agencies could find themselves with overlapping message responsibilities. Thus was born the idea of the Kane County PR Council. Over the next few weeks, the trio began to contact PIOs at school districts, municipalities, police departments, fire departments, park districts, library districts, hospitals, community colleges and other county departments and elected offices. The idea of the council was well received and an initial meeting was scheduled for the middle of April. At the first meeting it was decided on an informal organization. There would no cost to join. The Council would meet at lunch and brown bag” it. Speakers (at no cost) could be arranged, and sometimes were, but for the most part it was a gathering of the troops to network, get to know each other and perhaps swap war stores. The timing of that first meeting was coincidental and serendipitous. It was no more than a few days after that meeting that the first news reports of H1N1 influenza began to hit the media. And three schools, including STE, all of whose district spokespersons attended the first meeting of the Council, were found to have suspect or confirmed cases of H1N1, and were closed per the early CDC guidelines. H1N1 in general and the school closures in particular made big headlines at the time and put a great strain on the public information structure of the agencies. The relationships built with those early PR Council networking opportunities proved to be invaluable as the personnel worked straight through the weekends, and needed to be in constant contact. Later that autumn, KCHD scheduled three mass flu vaccination clinics at local high schools, including one in the St. Charles District 303. Again, the partnerships developed through the Council earlier in the year were vital in getting the word out to the members of the public and the media. The interest was so great that one Chicago TV news station sent its helicopter to capture aerial video of the long lines of people awaiting their flu shots. It was these early experiences that cemented relationships that would serve KCHD and the public well. While as expected over the years, many of the original PIOs, marketing people and community relations staffers left their jobs and were replaced, the District 303 spokesman remained in his job. When the time came to formulate messages and strategies for the 2017 norovirus outbreak, the District's and KCHD PIOs were able to act quickly and decisively to provide the respective leaders with accurate and timely advice. To paraphrase the Community Engagement lesson on NACCHO's website regarding partnerships and coalitions, communications success in a partnership or coalition generally requires: More extensive planning Careful negotiations Frequent conversation to make sure that all members know the group's message points. The PR Council provides the partners with all three: Planning, negotiations and frequent conversations. As an example, KCHD has relied on its PR Council partners to assist in exercises planned around potential emergencies. To illustrate, in 2014, these partners played roles in a mock press conference” that was staged to simulate for the KCHD staff the intense media interest that would occur if there were an Ebola patient diagnosed in Kane County. A scenario was drawn up and the partners, including the District 303 spokesman, played reporters” and grilled” KCHD staffers as if a real Ebola patient had surfaced in Kane County. In June 2016, the Illinois Department of Public Health (IDPH) scheduled a statewide exercise simulating the release of weaponized anthrax and the activation of the Strategic National Stockpile. KCHD went further with its own scenario and localized the attack,” which elicited the establishment of a Joint Information Center (JIC), headed by the KCHD PIO, in which PR Council partners, including the District spokesman, played roles. The exercise reinforced the relationships between PIOs, highlighted the importance of the PIOs' crisis communication roles to each other and to the individual agencies and provided invaluable experience to fall back upon in the event of a real disaster. Having exercised the Ebola and anthrax scenarios, as well as working through a genuine public health emergency with the H1N1 pandemic school closings and clinics, during the 2017 norovirus outbreak the KCHD PIO and District 303 spokesman were able to negotiate delicate topics such as student privacy and government transparency and prevent the type of bureaucratic silos that can often befall government agencies. Being able to avoid the silos while maintaining goals with counter objectives was only possible through the partnership between the District and KCHD. At one point, the need for KCHD to conduct the disease investigation presented issues for the District Superintendent. He saw his role as having to protect the privacy of the students and their families, while KCHD required a list of students and their contact information in order to be able to interview them, get a food history, learn if any of the people they had had close contact with suffered from the same symptoms and, if possible, collect a stool sample. The Superintendent expressed his concerns during one of the conference calls, at which time he was informed that the Health Department had the statutory authority to conduct the investigation. The KCHD wrote a letter for the Superintendent that he could share with parents that explained the Health Department's role in the disease outbreak. He specifically asked for the code number of the Illinois Revised Statutes that allowed KCHD to contact students (The Kane County Health Department is authorized under the Illinois Administrative Code {Section 690.30} to obtain this information). This letter provided him with the support he needed to communicate with parents the need to cooperate with KCHD in its investigation. Throughout the flurry of media interest, the KCHD PIO was asked numerous times if any similar outbreaks were occurring at any other schools within the District or in the county. There were no any other outbreaks in other schools, either in that District or any other District, a fact which pointed to the ever greater likelihood of a norovirus outbreak. However, the fact that the reporters were broaching the topic was enough for the KCHD PIO to send alerts to the members of the PR Council contact list to let them know of possible calls or contact from local and metro media outlets. Further, the fact that media were asking about other jurisdictions spurred to the KCHD PIO to contact his counterparts in the Northern Illinois Public Health Consortium to give a heads-up that they, too, may be contacted with similar questions. Reaching out to the partnerships created through the PR Council was one more way to ensure consistent messaging was reaching the public.
Evaluation Monday, Jan. 16, was Martin Luther King's Jr. Birthday holiday, a government holiday for both the District and KCHD. Laboratory confirmation of norovirus came to the KCHD disease investigation section that weekend. However, because of the holiday, students were given an extra day to recover, and the school was able to make last minute touches to clean the building. A KCHD press release went out on Jan. 17 announcing the laboratory results, absenteeism at STE was back to normal and the media and public interest in the story died almost immediately. A SWOT (Strengths, Weaknesses, Opportunities, Threats) Analysis was scheduled for early February at KCHD, and the District spokesman was able to attend. While some internal processes were reviewed, communication efforts came out favorably. However, the District spokesman was able to point out the challenge the District staff had when dealing some of the aspects of the disease investigation. The suggestion was made to be more cognizant of the sensitive relationships between District health officials, parents and their children when weighed against the needs of public health disease investigators. One way to measure the influence of the communication efforts during the outbreak would be to include a list of media outlets that covered the story. An inventory of those outlets, both print and electronic, includes: Chicago TV news stations ABC Channel 7, WGN Channel 9, Fox News Chicago Channel 32, CBS Channel 2; Local and regional newspapers were Elgin Courier News/ Aurora Beacon News; Chicago Tribune; Daily Herald; Kane County Chronicle, Wall Street Journal; Radio stations WBEZ, WDCB; Cable news network CNN. In addition, news outlets from the around the country and internationally picked up the story, usually through the Associated Press syndicate as well as the echo chamber” that has transformed modern news coverage. Some of the media outlets included in that category were found to be widespread throughout the country, even internationally: Findlay, Ohio; Redding, Calif.; Redwood Falls, Minn.; Norfolk, Neb.; Cape Girardeau, Mo.; and Daily Mail (London, U.K.). Locally, on social media, a District video posted on the KCHD Facebook page Jan. 10 saw 119 views and had a reach of 307, while there were four retweets of the Jan. 11 KCHD Norovirus FAQ Tweet. The District spokesman wrote a paper about the norovirus outbreak that was presented to his counterparts attending an education communication conference sponsored by the Illinois State Board of Education (ISBE). The theme of the paper was When the crisis hits, it's too late to build bridges. They need to already be in place.” The paper focused on the partnerships developed through the PR Council, especially the relationship between his District and KCHD, and the cooperation during the outbreak, which he tongue-in-cheek dubbed Quarantine '17.” The paper was well received. Simultaneously, the KCHD PIO sent a query to the editors at the American Public Health Association's (APHA) magazine The Nation's Health,” suggesting that a story about the partnership might make a good feature for the publication. Within a few days, a positive response was received and the KCHD PIO and District's spokesman were contacted by Senior Editor Lindsey Wahowiak. The article, Illinois health officials, school district team up during norovirus outbreak,” appeared in the May 2017 edition. The lead paragraph read: Public Health experts are often touting the importance of nontraditional partnerships to strengthen community health. Few communities have put those partnerships into action like Kane County, Illinois.” To further support the idea that the successful collaboration between the school District and local health department helped to keep the community safe and informed, the KCHD PIO submitted an abstract about the partnership between KCHD and the District and the messaging efforts during the January 2017 norovirus outbreak for consideration at the Illinois Department of Public Health's 2017 Integrated Public Health and Healthcare System Preparedness Summit, Power in Partnerships: Building Resilient Communities,” at Illinois State University in Normal, Illinois, in June. The review committee approved the abstract for the Communications and Information Sharing Track and the KCHD PIO made the presentation, When the Crisis Hits, It's Too Late to Build Bridges,” on June 14.The session was well attended by an audience of about 80 people. By having the personal network of the PR Council already in place, the two agencies were able to navigate the media storm, the parent calls, and the agencies' differing needs. Taking time to get to know the fellow PIOs in city and county government, park District, library, state's attorney's office, along with the elected officials, and business leaders in the region set the foundation for a successful communications campaign.
Sustainability The most difficult facet about sustaining a network is the people factor.” The hard truth is, over time people leave positions for other jobs. Before long the partnerships that had been nurtured and developed and that worked so well in the past no longer exist. While this holds true for the mid-level partner, in some instances the top executive retires or otherwise leaves a position. This change in leadership can lead to a change in philosophy, which may or may not have a beneficial effect on communication efforts. One of the outgrowths of the decline of local journalism is the proliferation of former news reporters taking positions in public affairs, public relations and/or marketing with local agencies. Another characteristic of the journalism profession is not only the turnover at each employer, but also the tendency for reporters to gather where the news is. In this model, reporters become known to each other and over the years the knowledge factor can spread far and wide. As a result of a long association, the KCHD PIO has former co-workers now employed in area school districts, library districts and other government offices, as well as some –though not as many as there once were –still employed in the news business. For example, in the spring of 2017 the KCHD PIO was in contact with a former colleague in a local school district when two of its buildings were seeing a jump in the number of mumps cases. In another example, the KCHD PIO reached out to the communications professional at a local library district, another former colleague, to have the KCHD Community Health Action Plan placed in the library for public consumption. In both cases the PR Council has enabled the PIOs and marketing professionals to keep in touch. By relying on these past relationships, as well as those still growing, the sustainability rests on that foundation. Public affairs and public relations professionals more and more understand the importance of consistent messaging, understanding the ever-changing fields of communication technologies and learning best practices from those who have already had the experiences. From this baseline, the key to sustaining the communications partnerships rests with each partner understanding the significance of maintaining them. Experience has taught each of them the importance of maintaining the relationships. Due to the informal nature of the PR Council, there is no additional cost to the agencies for membership, leaving finances out of the equation. One of the best, perhaps easiest ways to impart the importance of these partnerships is by providing evidence in the form of the interest shown by outside agencies, such as APHA. By having a national agency highlight the importance of the PR Council in its official publication demonstrated, literally in black and white, its value. The magnitude was further validated when IDPH selected the Building Bridges” presentation for its 2017 Preparedness Summit. When The Nation's Health” article appeared in May, the KCHD PIO informed the PR Council members and sent electronic copies of the piece. Likewise, sharing the news that IDPH thought enough of the PR council to select the topic as one of its presentations filled its members with a level of pride. With these intangibles, as well as the concrete examples, the partners will feel supported to sustain these critical collaborations.
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