Responsiveness and Innovation
Statement of the problem/public health issue? What target population is affected by the problem?
Florida is home to over 100,000 swimming pools plus miles of beaches, canals, lakes and other waterways, increasing the risk of drowning. Florida Violence and Injury Prevention 2014 surveillance data shows there were 297 hospitalizations for non-fatal drowning. Children ages 1-4 make up 14.0% of drowning deaths and 41% of the hospitalizations. According to the National Consumer Product Safety Commission 2018 Pool or Spa Submersion report, 76 % of the victims of the reported pool- or spa-related childhood submersion fatalities were younger than 5 years of age. Victims in this age category also accounted for an average of 73% of the childhood submersion injuries related to pools or spas between 2015 and 2017. Residential locations dominated reported incidents involving victims younger than 5 years of age. In 2017, unintentional drowning claimed 43 lives in Broward county. The drowning death rates may vary by age, location, gender, race/ethnicity, ability and exposure. The death rate from unintentional drowning was at 2.9 for 2016 and showed slight improvements in 2017 with a rate of 2.2 (http://www.flhealthcharts.com). However, the unintentional drowning death rate among 1-4 year old is increasing and is the leading cause of death for that age group. The death rate increased from 4.6 (2016) to 6.4 (2017) in Broward County and is comparatively higher than the state rate for the corresponding years. The 2017 data suggest racial disparities in the unintentional drowning deaths rates: White 3.4, Black 7.3, Hispanic 2.7, and Non-Hispanic 5.5. These disparities might be associated with differences in swim skills in the minority population. Gender differences in the death rate were also noted: Male 8.9 and Female 7.0 with males at high risk for drowning. The CDC reports that for every child who dies from drowning, another five receive hospital emergency department care for nonfatal submersion injuries. In addition, more than 50% of the drowning victims treated in emergency departments require hospitalizations or transfer for further care. These nonfatal drownings can also result in severe brain damage that may cause long term disabilities. Further, the median admission charge for drowning-related, nonfatal injury hospitalizations were $16,705. Medicaid paid 31% and commercial insurance paid 31% (Florida Violence and Injury Prevention Surveillance Data, 2014).
What is target population size? What percentage did you reach?
The SPUD program was piloted in 9 high schools in 2017 and reached more than 100 students which exceeded the initial target of 75 students. During the second year, there was 450 club members in 8 schools with two staff working to make the clubs effective and productive with positive feedback received from students and schools. Today the SPUD program's goal is to have clubs in 30 middle and high schools throughout Broward County with a student membership of 2,000.
What has been done in the past to address the problem?
Through funding from the Children's Service Council of Broward County (CSC), DOH-Broward leads the efforts in drowning prevention in Broward County by coordinating a community-wide response to this issue. The Drowning Prevention Task Force – which includes experts in aquatics, public health, law enforcement, fire rescue, local hospitals, pediatricians, family strengthening providers, children services providers, local municipalities and community members – meets monthly to coordinate drowning prevention efforts throughout Broward County. DOH-Broward also serves as a resource for drowning prevention information and education, provides technical assistance, consultations, and training to local public and private organizations. Drowning Prevention education and awareness training is provided through DOH-Broward and the Broward Sheriff's Office Fire Rescue Division for Community Education. Also, the CSC funds the Broward County Swim Central program along with needed staff support for the Drowning Prevention Taskforce with DOH-Broward. In FY 2016/17, the CSC funded Swim Central to manage free water safety instruction and education classes for almost 24,000 children at local community centers, childcare centers, and elementary schools. In addition, the CSC also funded $100,000 for swim vouchers for children 6 months to 4 years old, which provided families with up to eight low or no-cost water safety classes.
Why is current/proposed practice better?
The Students Preventing Unintentional Drowning (SPUD) was formed in the Spring of 2017 in response to the increased drowning deaths in Broward County among children age 1-4 years old. The program was modeled after the successful DOH-Broward tobacco prevention program, Students Working Against Tobacco (SWAT). SPUD is a teen focused Water Smart Ambassador Club devoted to advocating for water safety. The primary goal of the program is to create a ripple effect in the community by building a network of empowered young advocates for water safety and drowning prevention. The club members are educated on water safety practices and actions that can be taken to prevent future drownings. Through the participation in the Water Smart Ambassador club, members engage in various activities that contribute to leadership and character development. Each club is overseen by an Advisor whom is a DOH-Broward employee who is responsible for the club meetings and activities. The Advisor coordinates with local elementary and middle schools and the community for the club members to conduct water safety outreach activities. The club leadership includes a President, Vice-President, Secretary and Social Media Coordinator. Club elections are conducted once a year in the month of September. The club members are required to attend at least 13 of the 15 meetings as well as two outreach activities to maintain the active status and to be eligible for incentives which includes certificates, service hours, a cord for graduation, free swim lessons and a community partner funded lifeguard scholarship for those students who excel in the program. The proposed practice supplements the drowning prevention efforts in Broward County. The SPUD program mobilizes, educates and equips Broward County youth to be advocates for drowning prevention. The two components of the program are education and social media campaigns. The students educate the community through outreach activities and by delivering presentations to elementary and middle school students on water safety. Students also educate influential figures such as principles, city officials, city school board members and community partners on drowning issues. Further, social media, posters, videos and other creative means are utilized to reach their peers as well as the community. The initial year was a great success with nine schools and over 100 students participating in the SPUD program. Seven influential figures were educated on drowning issues within Broward County and 12 collaborative events with the club members were organized. The events included a Water Safety Symposium where the focus was on drowning in South Florida, drowning statistics and the proactive methods that are being developed to address this issue. A career fair in collaboration with community partners was also hosted for the club members where they learned more about various aquatics-related job opportunities.
During the 2018/2019 school year, the clubs were successful with eight schools and over 450 students enrolled in the SPUD program. 120 meetings were held throughout the school year, 280 children from local Head Start Elementary schools were taught about water safety, 63 hand written letters were written by club members and sent to foundations in honor of a loved one lost to drowning, 102 students were taught CPR, 8 students were taught how to swim, a total of 2,968 service hours were given for their time devoted to the SPUD program and over 50 seniors received cords at graduation. 5 students were provided a lifeguard certification scholarship.
Is current practice innovative? How so/explain?
The SPUD program is a revolutionary educational program and is unique in the drowning prevention field. A decrease in drowning deaths can only be achieved through education, environmental engineering and enforcement. SPUD compliments the drowning prevention efforts in Broward County through educating youth, subsequently creating a generation of advocates for drowning prevention.
LHD and Community Collaboration
Goal(s) objectives of practice
The goal of the SPUD program is to mobilize, educate and equip Broward County youth to be advocates for drowning prevention. The objectives of the SPUD are: 1) collaborate with club members to educate their community on water safety during different outreach events, 2) utilize innovative ways to reach their peers and public on water safety topics by using social media, posters, video and other creative means, 3) coordinate a water safety event, 4) educate influential figures on drowning issues within Broward County, and 5) teach club members lifesaving skills such as CPR and to swim.
What did you do to achieve the goals and objectives?
DOH-Broward developed an informational handbook which includes the vision, mission, goals, student organization membership roles and responsibilities and SPUD member's agreement form. In addition, a work plan was developed so that qualitative progress on the goals and objectives can be captured. Utilizing the existing relationships with Broward County Public Schools, DOH-Broward Health Educators set-up an information table to recruit students to the SPUD club. At the information table, the students can learn about the club as well as to register. A date is set for the inaugural ceremony of the clubs where a formal information session on the club is provided. Once registered, the members are required to sign the SPUD Ambassador Member Agreement form which is a non-formal agreement to abide with the SPUD club guidelines. The meeting dates are set for the year and the activities are carried out in accordance to the work plan which includes social media, water safety assembly/presentations to educate elementary and middle school students on water safety and drowning prevention. The students also provide presentations to influential figures such as principals, city officials, city, county school board, and community partners to create awareness on SPUD and water safety. The program was implemented during the fiscal year 2016-2017. Swim lessons and lifeguard certification are provided to the club members in partnership with the pool industry and McGovern Foundation. Collaboration with community partners facilitated financial support for the start-up cost of $500 for program initiation. These funds were used to purchase supplies and incentives.
The SPUD workplan is reviewed on a quarterly basis to ensure the program meets its annual target. The reach of the program was calculated using the number of clubs formed in schools and the number of club memberships. After launching the initiative in 2016, nine SPUD clubs were formed in schools. More than 100 high school students were engaged in SPUD activities during the fiscal year 2017-2018. 2018-2019, eight schools implemented the SPUD Club with 450 students.
DOH-Broward utilizes Active Strategy performance management system to track metric achievement. This practice was recognized by NACCHO as a Model Practice. Metric results are discussed at monthly business review meetings which all DOH-Broward supervisors and senior leaders attend. SPUD indicators include:1) Number of clubs, 2) Number of active club members, 3) Number of outreach activities conducted by the club members, 4) Number of posters /media content provided by the club members on water safety topics, 5) Number of influential figures educated, 6) Number of club members taught CPR, 7) Number of club members taught how to swim, 8) Number of club members that received Lifeguard Certification scholarships, 9) Number of club members that received a cord at graduation, 10) Number of service hours provided for SPUD club activities, and 11)Number of club members who educated influential figures. Underperforming metrics are discussed, and action plans developed to ensure a productive program.
The program is currently sustained through funding received from the Children Services Council which is an indication of the community-wide acceptance of the program. The Children's Services Council increased the funding to $6,000 to help with supplies and snacks for the students. The program has made a great impact in the community by educating youth on drowning prevention. To meet the goal of the program to expand the SPUD into 30 middle and high schools throughout Broward County, additional staff and supplies will be needed to grow the clubs to this level. As the program expands more staff and staff time are required to sustain at a level that the program was initiated and the program is seeking additional funding through grants.
I am a previous Model Practices applicant