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Needs Assessment Work Group
Meeting Minutes
October 1, 2003
ORRHES Members:
James Lewis (Co-chair), Donna Mosby (Co-chair), Kowetha Davidson (ORRHES
chair), Karen Galloway, Susan Kaplan, David Johnson, Charles Washington
(via telephone), Barbara Sonnenburg (via telephone)
Guests:
Al Brooks, Timothy Joseph.
ATSDR Staff:
Melissa Fish, Libby Howze, Terrie Sterling, Bill Taylor, Subha Chandar,
Theresa NeSmith, Michael Hatcher, Via conference phone: Lorine Spencer,
Marilyn Palmer, Jerry Pereira.
Meeting Agenda
- Call to Order
- Discussion of a new work group
- Sunsetting NAWG
- Sunsetting COWG ?
- New work group charge (Kowetha, ORRHES August 26: Page 17 of the meeting
minutes)
- New work group name
- New work group composition
- New work group ground rules
- Check By-laws and review work group mission/charge
- Require resolution go to ORRHES
- Require By-laws change
- Discussion of previous community studies and surveys (such as the
1994 UT report) as source material for future actions – Mr. James
Lewis (time permitting).
- Other business.
The meeting began at approximately 6:10 p.m.
Donna Mosby asked Kowetha Davidson about the charge for the new work
group. Kowetha Davidson said the charge was discussed at the last ORRHES
meeting. Kowetha said the agenda items concerning renaming or combining
the work groups have to be decided by ORRHES because the work groups are
listed in the Bylaws. Lorine Spencer sent out copies of the Bylaws last
week. Lorine said that in the current Bylaws the Health Needs Assessment
and Public Health Assessment work groups are mentioned and they were not
mentioned in the original ORRHES Bylaws.
Donna Mosby said she could not find a written description of the charge
to the Health Needs Assessment work group and asked Kowetha if she had
it. Kowetha said she had not looked for it. Lorine Spencer said she did
not find the charge for any of the work groups in the Bylaws or on the
web site. Kowetha Davidson said they were included in ORRHES and work
group reports. Donna Mosby said they need to find the charge or mission
of the work groups to discuss combining or forming new ones.
Al Brooks asked if there was agreement that the NAWG was established
as a standing committee. Several people said yes. Libby Howze asked whether
it was expressly created to advise the George Washington University team
or if it had a broader mandate. Al Brooks said it was to address questions
of outreach to the community, questions of concerns, questions of needs,
and to assist George Washington University in any way it could. Kowetha
Davidson said ORRHES originally thought all of it could be covered by
the Communications and Outreach Work Group but decided it would be too
large a task for one work group. So ORRHES formed a separate work group
for the Needs Assessment. James Lewis agreed and said that after listening
to George Washington University and considering the task and the timeline,
they formed the new work group so as not to hold up the IRB approvals.
James said the work group completed their task and met the deadline. James
said he thought the work group members expected to continue to be involved
throughout the process with GWU, but they were cut off and there was no
further discussion between the work group and GWU.
James Lewis said the only outstanding issue for him is that the ORRHES
submitted a recommendation to DHEP but had not received a response. Libby
Howze said the response was coming. James said he did not want a verbal
response. Libby said they were preparing a written response. James also
said the ad hoc group submitted their comments and expected a response.
Donna Mosby said the whole purpose of the work group was centered on the
needs assessment process. Donna said the purpose of the NAWG started out
broader, but every time a meeting was called it was to discuss the needs
assessment. James Lewis added that they had anticipated interaction in
a similar way to the PHA effort. Susan Kaplan agreed with James and said
the meetings stopped happening early in the process.
Al Brooks said that if there is a question about the scope of the work
group it should not be necessary to sunset the NAWG but rather have ORRHES
assign it a new scope. Al said there is a different configuration with
different players, but he did not see why it is necessary to sunset a
working group. Al said there is not a very big pool to draw from in the
community and a new group will consist of mostly the same people. Donna
Mosby said that to be objective they should broaden the group. Al said
it is an open room: If anyone wants to come they can come. You can appoint
more members to it, but you don’t need to dissolve it.
Kowetha Davidson said that the question that came up was combining it
with another work group. Kowetha said she had said they could not do that
because it was named; you can dissolve this work group, but you cannot
just combine two work groups. James Lewis said Jerry Pereira first brought
up the concept of combining the work groups. We talked about collapsing
the work groups into one work group because the same workers were involved
and there was some duplication of effort. Because of having to drive in
for these meetings, and there is a similarity in the work of the two groups
(COWG and NAWG) we were thinking of combining them.
Libby Howze said that if this was the time to talk about merging work
groups and the Needs Assessment group had worked to support the development
of the Needs Assessment document, that this might be the time to create
a health education or health promotion work group with some other name.
Libby said they would continue to look at what the issues are, but there
is a lot of bad feeling about the needs assessment group. Libby said she
is committed to taking a different path and these thoughts are on the
table for discussion.
Donna Mosby said that Libby Howze’s comments made sense and said
the group should see what direction we want to go and develop a committee
that will follow that path. Al Brooks said, “Or assign it to a committee
already in existence that has some knowledge of the problem.” Donna
Mosby said if there is something we could look at in this health education
and promotion direction that we want to go in with the community, then
that should be the task. Donna said the task is no longer the needs assessment
and there are too many bad feelings surrounding the needs assessment and
the group needs to move on into the next thing. Susan Kaplan asked if
the needs assessment is being abandoned. Libby Howze said the report is
being abandoned, but DHEP and the work group would develop a process of
looking at what the issues are and what directions to go in. Libby said
DHEP does not feel like the document can be resurrected. Libby said she
did not know at this time what the key areas were they would focus on.
Al Brooks said he could not see why a committee that had done a good
job in a bad situation was being disbanded. Susan Kaplan said it almost
sounded like the committee is getting blamed for a bad report that it
did not have input on. Susan said she is a writer and if she screws something
up in a report and gets comments about it, she has to go fix it. Susan
asked Libby if this means DHEP is not going to fix the needs assessment
report. Kowetha Davidson said work groups are disbanded when their task
is concluded and it has nothing to do with what kind of response results—it
has to do with whether or not the work group has completed its task. Kowetha
said work groups cannot become permanent; under FACA they are temporary.
It is always an option of disbanding a work group and it is in the ORRHES
Bylaws. It is not about whether they function well or not. Susan Kaplan
said that was not her point. Susan asked whether the work is complete;
she said she thought if they scrap the report, the work is not complete—you
have to fix it. Is it over? Al Brooks answered, “It is over.”
James Lewis said we need to wait until we receive the written comments.
But there is another key issue here. James asked whether there is a mandatory
requirement for a needs assessment. Is there something in the needs assessment
that is specifically there to support the public health assessment process?
James said he has been told there is not a mandatory requirement for a
needs assessment—it can be looked upon as an enhancement. James
said he looked at the needs assessment to see what could be extracted
from it. James said Dr. Falk expected some of these things to come out
ahead of the PHA effort to guide or assist with it. James said he kept
wondering what it is that DHEP does and when it is going to come out.
James then presented a table from the Public Health Assessment Guidance
Manual. It included conclusion categories and possible follow-on actions.
James said it amazed him that under the three PHA conclusion blocks it
shows health education whether there is a hazard identified or not. James
said the footnote indicates that some conclusions and recommended public
health actions may occur early in the public health assessment process.
[Barbara Sonnenburg joined the meeting at this time.]
James Lewis said the community has been involved for two and a half years
and a lot of things are going on that appear to fall into some kind of
health education and promotion effort. James said he has seen little or
no input or involvement from DHEP. He said he is still at a loss as to
what DHEP does, when do they do it, and how does it fit into the community.
James said they had asked for some completed work to show how DHEP has
applied these tasks in the past. They had been told, “Go away.”
or “Wait.” And whatever the community will receive they will
receive. James said it would help the entire group for some kind of information
to be presented to get a feel for whatever DHEP does. James asked Libby
Howze if that makes sense.
Libby Howze replied that it does make sense and that is going to be on
the agenda for the next ORRHES meeting. Libby said they are on the next
ORRHES agenda for an hour and 15 minutes. In the interim, for tonight’s
agenda, we had talked about talking about how we want to work together
and is there some value in collapsing the groups so that people will not
be over-extended. The charge from the last ORRHES meeting was to look
at having a new committee. Whether it is a new committee with the same
people reincarnated with a different name, it doesn’t matter. But
DHEP would like to see a fresh start that would involve taking a look
at community needs to the extent that we can as a group, and also for
DHEP to get involved fairly quickly in some direction. Libby Howze said
that was what she took from the last conference call last week.
James Lewis said he always thought maybe DHEP had the cart before the
horse. James said some gaps were created. If there were some products
or items that were supposed to come out of the needs assessment to assist
the PHA effort, they should be identified by the management team and evaluated
to see what they are and how are they going to support the PHA. Terrie
Sterling asked what James meant by “assist the PHA effort.”
Terrie asked whether James was referring to the public health assessments
that are being done. James Lewis answered that he meant the public health
assessments. James said the public health assessments do two things: they
are evaluating whether or not there have been exposure and they are trying
to answer the concerns and issues. Terrie said that when James said “PHA
effort” she did not know what he meant. Al Brooks said that there
are two things about this process: One is the public health assessment
of several contaminants, some for which there have been documented releases,
and one can look at them quantitatively and semi-quantitatively. But also
there is the perception and concerns of the public, which may not be based
upon the physical presence of the contaminants. But those concerns are
sufficiently serious to warrant the public health assessment looking at
the problem and asserting the place is clean. Al said his understanding
was that the listing of the concerns would come out early enough in the
process to tell the public health assessment people what needs to be looked
at.
Libby Howze said DHEP would maybe see it more broadly than that.
Barbara Sonnenburg asked Libby Howze what are the work groups called
in other communities that DHEP works with. Libby responded that having
a FACA is an unusual situation and most of the communities they work in
do not have FACAs. Libby asked Theresa NeSmith what the work groups at
Savannah River or other DOE FACAs are called. Theresa NeSmith said that
Savannah River did have a needs assessment working group for a short period
of time, and they worked closely on that and then disbanded. They do have
an outreach group and an agenda group, and possibly a bylaws group. Theresa
said they have very similar names. Barbara Sonnenburg said she was trying
to figure out why they should change the name or eliminate the committee.
Barbara said she didn’t understand what was going on. Terrie Sterling
said she didn’t think they wanted to eliminate the committee; they
wanted to move beyond needs assessment into what it is that they need
to be doing next to address the concerns of the community. By sticking
with needs assessment, that implies that all they are going to do is assess
needs and not do any kind of program or intervention. Terrie said DHEP
wants to move beyond needs assessment, and that was the understanding
they had gotten from the ORRHES meeting. Al Brooks asked then whether
a name change and a redefinition of purpose would help DHEP abandon the
previous effort including the report. Terrie replied that she thought
it would help everyone. Donna Mosby said she was in favor of disbanding
the group and forming a new work group.
James Lewis said to Donna there is a difference between cursory involvement
and getting people involved in what we try to do. James said this is a
key item: We were supposed to have surveyed the various counties in this
area to come up with the issues that are out there. We were supposed to
have had various focus groups to deal with these specific issues. We are
going down a path and the train has already left. If the community challenges
ORRHES—how did you survey?, how did you canvas the area?, what are
the issues in those areas?—it seems very important that we gather
the information especially from a historical review, lay it on the table
and see how that can supplement what we are doing, so that the train that
has already left can address those issues, like Al and Susan were saying.
Donna Mosby said she didn’t think anyone was disbanding those ideas.
But if someone has been deeply involved that is another reason for changing
the committee. James Lewis said to Donna that he thinks Donna thinks he
was too deeply involved and he doesn’t mind addressing the issue.
James noted that Kowetha had also noted, that on the PHAWG side of the
house we drafted an approach and we have check points when we can look
at things and when we can deliver things. James said they had attempted
to do that with this current group so they could get things back, but
those things didn’t happen. James said that if the issue is him—that’s
one thing. But he said his concern is about the needs of the public health
assessment: getting the information out to the lay people. And as Dr.
Falk stated, it is about packaging the science. It is a problem if we
don’t capture these issues and put them together in the right place.
James said that Ms. Galloway eloquently stated that it is institutional
arrogance that we don’t want to hear from the community to capture
these issues, and that is a negative thing. So as a group, we need to
look back and look at what impact not completing the needs assessment
may have on what we are trying to do.
Libby Howze said they are not trying to abandon the needs assessment.
James said that is where we should have hit the ground once we knew that
there were weaknesses. Libby Howze said that’s past but we can start
now to begin to identify what we need to have and to do together. Barbara
Sonnenburg asked why do we need to have a whole new committee of different
people? Libby Howze said she did not think that was what was proposed
but was a perception here. Barbara said that’s what Donna just said.
Donna Mosby said she was in favor of establishing a new committee, but
not new people. Donna said she is in favor of a new committee with a new
concept and a new way of thinking. Barbara said to Donna that she (Donna)
also said to have different people on it. Libby Howze said that certainly
is not what DHEP is proposing. Barbara said that that was what Donna said:
Does Donna want to get rid of her (Barbara)? Does Donna want to get rid
of James? Al Brooks said the committee has no control over who is a member.
Charles Washington said he thought James Lewis is right. Charles said
that we had put out in the public arena the idea that we were going to
do a needs assessment and that is what the public is looking for. If that
is not the will of the group then you need to justify why you are changing
in the middle of the stream, and what are you going to call it and why.
Charles said he personally did not find anything wrong with the needs
assessment if it is based on the kinds of materials that were used at
the plant, and stick with the environs of the Oak Ridge community and
the seven county area, and the possible consequences—both short
term and long-term. Charles said he does not understand why there is a
hang-up with the needs assessment. Barbara Sonnenburg said she agreed
with Charles.
Jerry Pereira said everyone’s input is valid but if you will recall
from the last ORRHES meeting, one of the focuses for any health promotion
or health education issue is to develop the effort as needed, based on
the PHAs as they are completed—the eight or nine of them that are
going to be done. That is one obvious avenue to look at. Jerry said he
thought that arguing over whether to call it a needs assessment or some
other name is beside the point. Jerry said what is more important, from
this day on, is that one is very clear, very deliberate, and very purposeful,
and understood by all. That is probably the more critical piece in what
happens from here on in.
Kowetha Davidson had been looking at past ORRHES meeting minutes and
said that this project got started at the second ORRHES meeting when Rebecca
Parkin came in to talk about needs assessment, and she was talking about
focus groups and how we would select them. Jeff Hill moved that the Communications
and Outreach Work Group should explore what issues the focus groups should
address when trying to form a recommendation from the Subcommittee, and
that was voted on. But on the second day of the meeting, it was discussed
that that would be too much work for one work group, and the subject was
reconsidered and a new motion was passed to start a new work group to
provide input to GWU on the health needs assessment with the first task
to address the composition of the focus groups.
Barbara Sonnenburg said she still didn’t understand how we had
gone from that to sunsetting the Needs Assessment Work Group. Kowetha
Davidson said that the discussion that had come to her was combining the
work groups and she said she did not think they could combine the work
groups. We can disband workgroups because the Bylaws say that when the
work group’s work is completed then that work group is supposed
to be ended.
Al Brooks asked Libby Howze: If we proceed from where we are now, including
looking at the various recommendations that were made to look at various
things, how would she feel if someone asked in the future, “Why
did you abandon your needs assessment? Or why did we change horses in
midstream? Libby Howze said she thought they couldn’t ride that
first horse. She said she couldn’t commit to continuing on that
path. Al Brooks said that Libby might be comfortable in saying we had
a crisis, we reacted to it, and this is the course we are on. Libby Howze
agreed. Al Brooks said he wouldn’t try and cover it up; he’d
say, yes—we changed horses in midstream. One of them fell down and
drowned, so we got on another. This is where we came out and we think
we have covered all the issues. (Lorine Spencer, on the conference phone,
said she couldn’t hear Al. James Lewis said, “He said the
horse drowned.”) Libby Howze said what she thinks the group has
the opportunity to do here is decide what we want to know from the communities
in the area and do the focus groups if we think together that’s
the appropriate way to go. And use other methodologies we want to employ
to learn about what the issues are or what directions to go in. And that’s
an assessment—that’s a kind of assessment that Libby said
she thinks we ought to be doing at this point.
Kowetha Davidson said that in listening to this discussion she thought
one thing that needs to happen is to get finality on the GWU document,
ASAP. Kowetha said the next thing we need is a blueprint from ATSDR to
envision the next step. If the group does not have that blueprint, we
cannot tell if we need a communications and outreach work group or a needs
assessment work group or what type of work group. But if we don’t
have that, we have no idea, because we do not know where we are going.
Until we know where we are going, we do not know what we need to get there.
James Lewis added that we have a PHA effort that’s going down this
track, which has covered a lot of ground. Is there something that is a
part of that effort that is missing that you could help with or assist?
We ought to do an internal assessment where we are. (While James was speaking,
Libby was saying she agreed: Yes, yes.) James continued and asked, based
on DHEP’s skill sets and backgrounds, is there something in those
areas that DHEP can pull out and give?
Al Brooks responded, “Of course there are.” Al said we know
there is a small population of off-site residents who believe they have
been exposed. And we have no knowledge of any exposure possibility in
the area. But that is a concerned group. And the question is, do you try
to address that or not. Kowetha Davidson said that before we get to there
we need a blueprint of how we are going to get there. But we do not know
where we are going and until we know where we are going, we do not know
what we are going to need to get there. We do not know whether we are
going to need a plane, whether we are going to need a car, or whether
we are going to need a cart or a bicycle. We have got to have a plan.
Lorine Spencer said we have a clear understanding of what the Communications
and Outreach Work Group does. They are providing insight and input to
communicate the findings of the PHA. If you look around you in the room,
a lot of those charts of pathways and flow diagrams were created with
input from the Communications and Outreach Work Group. Another thing that
they are to do is get community input and find ways to get the community
to be more involved, and that is the piece that we have had the biggest
struggle with. There is a briefing book put together and the web site
that we are continuing to work on. We have got a budget together to make
that more user friendly; if we can get that approved we will be moving
forward with that. We have fact sheets that we have put together with
the community’s involvement, and all the other fact sheets that
you see there in the office. Until we are sure that we know where we are
headed with the health education—health promotion—needs assessment,
then I guess we are not really clear. The COWG does a lot of their work
around the PHAs and it is pretty clear what its task is, and I’m
not really clear where we are going to go with the second stage, or whatever
we are going to call this.
Kowetha Davidson said she would like to have a response on her earlier
comment on the finality on the GWU report.
Donna Mosby said that all the discussions we are having are cast in what
the group can look at. Donna said she did not think it has anything to
do with forming a group. Whether the group looks at the needs of the community
or looks at other reports or back gathering—all those are tasks,
which the group will do. They have nothing to do with whether the name
will be NAWG or COWG or both or something else.
Kowetha Davidson said she would like a response to her comment before
we go on.
Terrie Sterling said that concerning “finality” of the needs
assessment document, she was not sure what Kowetha meant. DHEP has said
it would respond to the recommendations that were made by this group to
ORRHES, that ORRHES passed, one of which was that the document not be
used as a basis for health education—health promotion effort. DHEP
responded verbally in that meeting that we concurred that it could not
be used to form a health education effort. There were some other components
that were in that recommendation. We had said that we would respond to
all the recommendations in writing. The deadline we are shooting for is
the December ORRHES meeting. Is that what you mean by “finality”?
Kowetha Davidson said yes, but also in that finality, if DHEP is not
going to use that document, what is it going to do instead? And Kowetha
said she needs something more than “work together.” Kowetha
said she needs to see a blueprint because otherwise, we are the blind
leading the blind. Kowetha said to Terrie and Libby, you are the experts
and Kowetha would like to see them lay a plan on the table so that the
group will have something to work on. Otherwise, the effort will be disjointed
and is going to go here, there, here, and there with no real plan that
is laid out. If you want to talk about the PHA—the PHA has a plan
that is laid out: We are going to do these documents this way… That
came from ATSDR. The work group and the Subcommittee had an opportunity
to comment on their plans. Al Brooks added that there was a lot of input
to that plan. Kowetha said that there was input, but ATSDR brought something
to the table to start with initially. There was something for us to discuss
and to develop.
Libby Howze said she asked Michael Hatcher to draw on the board a diagram
that will give an idea of what points of intervention and points for assessment
that we can talk about and use as a template. Libby said she takes issue
about them being the experts. Libby said they are the experts about knowing
some things to ask questions about. DHEP can do focus groups and a lot
of process things. But the group knows the community. Libby said she would
be offended if she lived here and some expert came in and told her what
she needed in terms of community. Libby said that’s what happened
the first time around, and she does not want to do that. Libby said that
we could take an hour to lay out some issues. Libby said Al has already
talked about the perception of a problem in this community and that has
economic ramifications in terms of housing values, jobs, relocation here,
and on and on. So it is not the same as the PHA process in a sense, but
if we were to come in and tell you what you need and here is the package—Libby
said she could not do that.
Kowetha Davidson said that is not at all what she is saying. Kowetha
said that DHEP should come and say these are some of the things that can
be done, this is one way of doing it, and will this work for your community?
Then we have something to discuss. We might say, this may not work, you
may need to do this, and we may need to do this. But at least we have
somewhere to start to put this in a coherent way. Kowetha said she does
not want to bounce from one thing to the next: Why don’t we do this?
Why don’t we do this? Why don’t we do this? It will turn out
to be disjointed in the end and it will not be any better than what we
have now. You can have all reasonable things come in. If they are not
done in a coherent way, you are still going to end up with a mess.
James Lewis said that in the body of the recommendation that ORRHES submitted
to DHEP is a comment. It says that the efforts that you go forward with
should be tied to the PHA effort. James said as we go down the path and
we flag those things and identify them for DHEP, they could respond how
they want. Kowetha Davidson asked, “What do you do with that?”
Nothing has been laid out to tell Kowetha what is done when information
is given to DHEP. Libby Howze said that is what we need to talk about.
The next couple meetings are about drafting a plan.
Michael Hatcher described the diagram that he drew on the board. He explained
that if we know there are documented exposure pathways of contaminants
in the human population the schematic sends us down different trails,
whether it is past or current exposure, or future. If it is past and there
are medical issues relative to diseases or screenings we would want to
go into an advisement type of education activity to try to get the affected
population in for whatever kinds of medical screenings that may be appropriate.
Or educate them to risk behaviors that they need to be avoiding so they
do not complicate any disease they have developed based on that past exposure.
Also we would want to be sure that the medical community was prepared
to deal with the particular kinds of toxicity and kinds of disease that
could come out of it. What we have done over the last month or two is
look at each of the kinds of media and look at the pathways of ingestion,
inhalation, and dermal. If those were current, we would want to limit
the concentration. These are the kinds of recommendations that come out
of the public health assessment. Educational needs need to be based on
exposure or perceived exposure.
Libby Howze said if there is not an exposure or if there is a perception
of one, they have to deal with people’s perceptions. And also she
said that some leaders in the community, such as the mayor or the ministerial
association or others could help reinforce what we know. Al Brooks said
there is no mayor for the eight counties.
Michael Hatcher said there would be recommendations from the public health
assessment on how to limit concentrations or limit exposure. DHEP’s
role becomes—if this is a documented exposure—we work to get
adoption of those recommendations in whatever form we can. It may be efforts
concerning mercury in fish, it may be a different way to prepare the fish
so that fatty tissue is removed and it lowers the concentration of mercury
in the fish being eaten. It may be that the community already has a program
or wants to develop the response to that issue. So we are looking at how
to educate the community to understand their risk and what can be done
to lower it and how can we support them to adopt the kinds of individual
behaviors that may be appropriate to lower their risk. And what are the
enabling kinds of programs and services that the community can take to
support individuals or the broader community on ways to lower risk or
exposure. DHEP needs to take this to the next level based on what we understand
may be useful from past assessments as well as what the group knows in
terms of what the issues are. Looking at how we best communicate, there
are specific approaches in terms of understanding ways to communicate
with different populations. And that is one of the things that we would
want to do that might involve some focus group work. There are specific
ways in which we can help people adopt behaviors, whether on a community-wide
or individual level. So those are the kinds of things we have to go to
the next level on. This is where our educational planning starts becoming
much more tangible, once we are able to agree on what those perceived
risks are. If there is no documented exposure pathway then we have to
educate and work with the community to help understand and trust the science
or at least be comfortable with the things that they can do to prevent
what they themselves perceive as a risk. So there are educational and
communication activities relative to the perceived risk whether there
are documented exposures or not.
Al Brooks said: “And Michael, you will fail as everybody else has
failed.” If you don’t go out and sample some of their environment
and establish in their environment that there is no damage, you will not
sell it. Michael Hatcher said, “I agree…” Al Brooks
said they have spent billions of dollars in this community trying to sell
this point of view. Michael said he is hoping that this is what the public
health assessments will do. Since they are not out yet, we do not have
the evidence to use. Al Brooks said this is an official ATSDR study and
rendering an opinion, but this is not a de novo study by any means. Libby
Howze said that the work Michael described is not a health assessment;
these are points of intervention. Libby said that Kowetha asked about
how we might approach things. DHEP looks at issues that people might be
concerned about, like what contaminants might be in their water or their
air. You have to help people understand the science process, the results,
and prepare the physicians.
Kowetha Davidson said the needs assessment that George Washington University
did that we are not using was supposed to plug into this to tell you certain
things to do to help you carry this out. We do not have that information
so we are going to have to come up with another way of plugging into this.
James Lewis said he has a problem. When you say no hazard, which does
not mean that there is not a pathway or that something did not get to
the public. The issue is that the category relates to the amount of exposure
and whether it constitutes a hazard. Sometimes when we make statements
like this, everybody expects that if I receive any amount no matter how
minute, then there is going to be some action taken. When we go into these
various categories you will see that if there is a hazard there is a health
education piece, if there is no hazard there is a health education piece.
Also if the hazard is unknown, there is a health education piece. James
said his question for DHEP is, if there is no hazard, what is the health
education piece you do then?
Michael Hatcher said the diagram he drew would address James’ question,
but that the diagram is not chemical specific. James said the Public Health
Assessment Guidance Manual says, “Some conclusions and recommended
public health actions may come early in the public health assessment process.”
James said he asked himself, What does this mean? Next James put up a
transparency with some work he did. The transparency has the key parts
from the needs assessment document in a table. For each part James noted
the effort was either “Not Successful” (Telephone Survey,
Focus Groups, Literature Review) or “Questionable” (Key Informants
only). For each item James listed “Proposed Corrective Action.”
Underneath the table are “Other Recommended Future Activities and
Revised Approaches.” (Copies of James’s transparency are available
in the ATSDR Oak Ridge Field Office.) James explained that this was a
rough attempt to look at the issues and pull them together to present
to see if DHEP could work with us and is this a possible approach.
Libby Howze said, “Absolutely.” Libby then read through the
Proposed Corrective Actions for those on the telephone. Libby said those
are the kinds of things that would be highly appropriate and exactly the
kind of thing we want to do together. We should sit down and look at what
we know, where the gaps are, if we have the information we should look
at it, if we need to create it we should create it. Libby said she was
glad James made up the table and she likes it. Though Libby said this
was only one part of the work of the new group and they would move on
after that.
Barbara Sonnenburg moved to drop any procedures from going forward from
the items listed under #2 of the agenda. Barbara said she just wanted
to move forward in the way that Libby had said. Charles Washington seconded
the motion. Al Brooks asked Libby Howze if the baggage of the old name
would seriously hamper Libby. If we pass this motion to perpetuate this
committee without a name change and move along in the lines that James
has projected on the wall; if we truly make a clean break with the past,
abandon the old report, and get on with the new approach, will the baggage
brought along by the old name cause Libby a problem? Libby Howze said
yes. Libby said it is time for a fresh start. Al Brooks said it would
be a fresh start for everything except the name. Barbara Sonnenburg asked
Libby if she needed to have the name changed. Libby Howze said she would
like to. Barbara asked what name she would like. Libby said it was for
the group to decide and suggested Community Health Education (Work Group).
Barbara asked, How can we educate before we’ve assessed? Libby said
it is part of the process. Barbara asked, Can we say Needs Assessment
and Education?
Jerry Pereira said part of the problem that the agency and he (Jerry)
has is that the term “needs assessment” refers to a specific
product, and not a process. Al Brooks asked if it is true beyond Oak Ridge.
Jerry said yes.
Al Brooks moved to amend the motion to say that the committee name be
changed to (with input from Libby Howze): “community health promotion
working group.” Jerry Pereira said you might want education in there.
Libby and others said “health promotion” includes education.
Barbara asked if Libby wanted anything about assessment in the name. Libby
said that is part of “promotion” too. Al Brooks said that’s
a part of it, but it has a lot of baggage that everybody from ATSDR agrees
we should not take with us. David Johnson seconded the amended motion.
Donna Mosby asked Barbara whether her concern was that the needs assessment
part not be lost. Barbara said that’s right because it has to be
done. But Barbara did not care if the group did not want it in the name.
Libby Howze suggested they form a new group with a new name and they outline
very specifically what it’s going to do: finish the assessment,
take actions that come out of the assessment, and whatever other language
we want to put in so that it is very clear exactly what we are going to
do. Donna confirmed with Barbara that that was her concern. Barbara said
that that was her concern along with Donna’s effort to disband the
committee and start out with all new members. Donna Mosby said to Barbara,
“If you heard me say that, then hear me say this: I did not say
that.” Barbara said all right. Kowetha said that when the group
was talking about combining work groups that she (Kowetha) said there
is no basis for it, but that you can disband them. Next everyone was talking
at once.
Al Brooks said let’s work on the motion. Donna Mosby said she thought
that what had been said was the needs assessment process would not stop
even if there were a new committee. Tim Joseph said that although ATSDR
and most of us know that education and outreach are included in promotion,
he did not think the public knows that. Jerry Pereira agreed. Tim Joseph
said he does think the name is important because a working group that
is working on something that is going to go out into the public is going
to have the public’s eye. Tim said he really likes the words “education”
and “outreach.” Tim said he knows what “promotion”
means but he wasn’t sure the public knows. There was more discussion
about the words. Finally Libby Howze suggested “community health
education and promotion work group” and “community promotion
and education work group.” Different people repeated one or the
other of these. Barbara Sonnenburg asked Charles Washington if he would
accept the amended motion and Charles said yes. Barbara Sonnenburg said
that that would be the main motion. Jerry Pereira asked if they would
have the same membership. Barbara said yes. Libby Howze said that’s
a separate question. There was some discussion. Donna Mosby said if this
motion passes it will go to the Subcommittee in the form of a recommendation
and then there will be a new work group and anyone who wants to be on
it can join. Al Brooks said no, because it is a motion that calls for
a change of name; it doesn’t say a brand new work group. Barbara
Sonnenburg said, I think we need to settle that. Donna said that Kowetha
said we couldn’t rename a group. Barbara asked why not. Kowetha
said she said we couldn’t combine work groups. Kowetha and Al agreed
that the work group could take this motion to the Subcommittee as a recommendation.
Al asked to see if the group had an agreement on the name. After a couple
tries, Donna Mosby read, “community health education and promotion
work group.” Barbara added, “with the same members plus any
others that wish to join us.” Kowetha Davidson said work group membership
is a voluntary thing anyway. Barbara said, I think there’s something
going on here that we don’t know. Donna Mosby said, “You’re
creating it, Barbara.” Kowetha said membership has always been voluntary.
Donna Mosby called the question and the motion is to establish “community
health education and promotion work group.” Al Brooks said that
wasn’t the original motion and he thought it was to rename the work
group. Barbara Sonnenburg said that was her understanding, too. Kowetha
asked Barbara if what Al said was what her motion is. Barbara said yes.
Donna asked if we are ready to vote on changing the name of the existing
work group. Kowetha said no, it was on naming the group. Then Kowetha
said they could not make that motion. Libby Howze said that’s what
she thought and that they really have to create a new group. Kowetha said
if we vote to change the name then we’ve also voted on both functions.
Barbara said she dropped the original motion because she was talking about
the entire #2 on the agenda. Kowetha said that for expediency, we should
vote on Al’s motion. Al said his motion was to change Barbara’s
motion as an amendment, and to change the name. Kowetha said the motion
is to change the name to “community health education and promotion
work group.” Al said that would cover it. Barbara asked Al if he
also had put in that the existing membership would continue. Kowetha said
all membership is voluntary; we cannot compel membership on a work group.
Barbara asked Kowetha, “What are you trying to do?” Kowetha
said we can not do what Barbara asked. Donna said: “All those in
favor of changing the name from Needs Assessment Work Group to Community
Health Education and Promotion Work Group.” There were many “ayes.”
Donna then said, “Opposed?” Donna said “aye.”
The motion passed.
Bill Taylor said he would like to raise a point about membership. It
is true that anyone can come to these meetings and vote. But ATSDR maintains
a list of membership of the work groups, and those individuals have to
be ORRHES members, and those individuals who are officially members of
the work group are paid for coming to the work group meetings. Kowetha
Davidson suggested that if the motion is passed by ORRHES that everybody
re-sign-up for the work group if you are going to continue so that ATSDR
will know exactly who is on the work group. And then there won’t
be a question. Kowetha said she would ask for that.
Al Brooks asked Libby Howze if she would be willing to draw up a draft
statement of purpose of this new committee as she sees it. Libby Howze
said yes. Al added that they could then work on it. Al said that it would
indicate the direction that DHEP is thinking. Donna Mosby said that then
perhaps we should have one more meeting before the Subcommittee meeting
to hash through that so that the scope of the work group could become
a part of the recommendation. Kowetha said that another thing she recommends
is to go back and look through the minutes and find the original focus
of the work group. Kowetha said it needs to be found and those things
that are still there need to roll over, otherwise what we are looking
at is a brand new work group and not a continuation of an old one. Kowetha
said it should be in the ORRHES minutes after January 2001. Charles Washington
said he thought Barbara Sonnenburg had addressed that. Barbara said she
was out of this circle and just listening.
Donna Mosby referred to the agenda. Donna said it didn’t look like
they would have to change the bylaws, other than the name, if all they
were doing is changing the work group name and if some of the tasks on
the original needs assessment work group are remaining under the new one.
Al Brooks said they had certainly covered all the items under #2 on the
agenda.
Al Brooks asked to once more clarify if they were a standing committee
or an ad hoc committee. Al said he asked once whether they were a standing
committee and everyone agreed, then Kowetha pulled out the bylaws and
read where they were all ad hoc committees and all have to be abandoned
at the end of their mission. Al said they all ought to have a mutual understanding
of what kind of committee they are. Kowetha Davidson said that according
to FACA, we cannot have a work group that is permanent, so all work groups
are considered not permanent. Al said usually a non-standing committee
is one that has a very limited special task and then it’s gone.
And usually one that extends over several meetings is known as a standing
committee. Kowetha said that all she is saying is what we are. We are
a work group and that is a committee; but you cannot be a permanent work
group. That’s why we put in the statement about them being disbanded.
Al asked, “From meeting to meeting?” Kowetha said, no, for
the whole process: It means that the work group can be disbanded when
the task is completed. Al said a work group could be disbanded at anytime.
Kowetha read from the ORRHES bylaws: “Once a work group has fulfilled
its purpose the Subcommittee shall determine whether to continue or disband
the group.” Al said that is the definition of a standing committee.
Kowetha said it is a description that we have in our bylaws that determines
how we function. Donna Mosby asked whether anyone else had an issue with
whether we were an ad hoc or standing or whatever kind of committee we
are? Charles Washington said no and Donna said okay.
Donna Mosby said the only thing left on the agenda that they had not
addressed is new work group ground rules.
Barbara Sonnenburg asked Kowetha if she would accept all volunteers on
the new committee. Kowetha said yes; she said she does not tell volunteers
that they can or cannot serve on work groups, nor does she propose to
do so. Barbara said, all right.
Al Brooks asked Donna Mosby why she said “new work group ground
rules” when we do not have a new work group. Donna said she was
just referring to the agenda. Al asked whether the old ground rules would
come across. Libby Howze said that what she does not have a sense of is
there being ground rules. Donna said there are some ground rules in a
document they adopted from the Guidelines and Procedures Work Group. Donna
said they had worked real hard on that document. Libby said there needs
to be a discussion about it because from DHEP’s perspective there
are questions about what procedures are followed. Libby said Al follows
Robert’s Rules of Order, but nobody else does, for example. Libby
said that is not a criticism, that is an observation, but it impedes the
functioning of the work group effectively. Libby said there are issues
of communication between the co-chairs that seem to be getting in the
way of effective functioning. Then there are issues of speaking over people
and storming out of meetings. Libby said she comes in as an outsider,
but it seems if we want to attract people to the meeting, we have got
to talk about how we want to work together. We want to communicate effectively
and have a certain amount of predictability. Karen Galloway said they
had established those types of ground rules but they were termed as suggestions
to work group chairs on how to manage a meeting.
[Charles Washington exited the meeting at this time.]
Kowetha Davidson read from the bylaws: During work group meetings all
participants shall adhere to all rules of conduct and decorum that govern
participants and Subcommittee members.
[Barbara Sonnenburg exited the meeting at this time.]
Libby Howze suggested that a couple people could meet to set up regularly
established meetings and set up an agenda that everyone could agree on.
Kowetha said she thought the two co-chairs and ATSDR should do that.
Donna said that from the past it seemed that there were separate tracks
on establishing agendas and establishing meetings, and different people
sending out emails and most of the work was established without the department
that was involved with that. Donna said it was an issue for her that those
types of things were generated outside of the department that the group
was supposed to function and work with. And then we would get an agenda
that was sent out and then we would get another agenda that was sent out.
And sometimes James and she would talk about the agenda and every time
they would come to a meeting there would be a whole long schpeel about
the agenda and the things on it that were not agreed upon. Donna said
the agenda and the meeting time have always been a source of confusion
to her. Donna suggested establishing a general day of the month for the
meetings, and if we do not have business then we do not have a meeting.
But have the day and time on the calendar and know that that is the time
in which we meet. Then the people who are involved with the department
and the chair will be involved with establishing the agenda and then the
chairs make sure that the email gets out. But various conversations that
“he said” and “she said” and “I didn’t
know” need to not continue.
James Lewis said that he agreed with Donna Mosby. James said that Bill
Taylor and Melissa Fish have done a good job and if the chairs would spend
some time to set down the agenda and set down goals, and make sure we
got our ducks in a row, we would be better off. We almost need to have
work session meetings to get our things together so we will know what
it is that we are going to do. That is very helpful to us. Our problem
is that we have got volunteer help and a lot of times everybody cannot
meet at the same time. That coupled with not a whole lot of things coming
to us to do, we wind up fighting amongst ourselves. In order to draw people
to the room, I think we need to talk about getting the web site up to
date so we can identify things and people will be familiar with the work.
So there is a point there, and this is the same problem we run into on
the PHA work group. And if chairs adopt a philosophy to work the meeting
agendas out in advance, we can move forward.
Libby Howze said DHEP would really like to be a part of that process,
and work with the co-chairs and Bill and Melissa and Kowetha, and come
up with an agenda at a specified time of the month. Kowetha Davidson said
she thought the two co-chairs should get together first to work on the
agenda then bring their suggestions for the agenda to ATSDR. Kowetha said
the co-chairs need to be in communication with each other first. Libby
Howze said that she is not sure she wants to work that way. If time is
short and precious, why go through the two-step process when we can just
sit down together on the phone and deal with it. Kowetha said, as long
as both of the co-chairs are there it will work. But if only one of them
is there, it is not going to work. They have to both be there or they
have to communicate before the meeting.
David Johnson said that when Michael Hatcher made his presentation he
made reference to trust. In order to work in this community you have to
be flexible. If you come in with a rigid plan of action, you will be thrown
out of the community. So whatever you say and whatever you do, if you’re
not flexible and sensitive to the mood of the community you’re at
a disadvantage. With trust—that’s something that has to be
built and developed.
Al Brooks said, concerning the agenda process, the chairs should be putting
out a message to the permanent membership of the committee to turn in
items for the agenda. Anybody who wants to bring up a topic for discussion
ought to have an opportunity to have it on the agenda.
Donna Mosby said that the action items are to get our hands on the Guidelines
and Procedures document, to go back and try and find out what is the original
mission of the NAWG, and try to write down a focus or mission or purpose
for the Community Health Education and Promotion Work Group (the “CHEP”
Work Group). Kowetha added that the group should review the section in
the bylaws and the appendix having to do with meeting decorum. That information
is already there.
Lorine Spencer said that it seems we will have to have a bylaws change
to have a new work group.
James Lewis said that the key to having an effective work group is preparation.
We have to take a little time in the committee to bring everybody up to
speed. But if everybody is prepared and has done their homework, we should
click off rather well.
Libby Howze said she is checking her calendar. After some discussion
of available dates and times to hold another NAWG meeting before the next
ORRHES meeting (October 21) it was decided to hold it the morning of the
ORRHES meeting: October 21 at 10:00 a.m. It is understood that not everyone
will be able to come that early because some people work at their regular
jobs in the morning and have to travel to Oak Ridge. But Libby and Terrie
want to meet once more, face-to-face, to try and get more accomplished
before the ORRHES meeting. Libby Howze and Terrie Sterling said that they
could start at 10:00 a.m. and look at the documents. And for people who
couldn’t join until 11:00 a.m., they could say this is what we have
looked at, and then make assignments about how we want to review those
or what else we need to look at.
Lorine Spencer asked Donna Mosby if the group had established a regular
meeting date. Donna Mosby looked at her calendar. After some discussion
Donna said it looks like the fourth Monday or fourth Tuesday of the month
will work best for most of the group. The group will look and see which
of those dates will be better for them and it will be discussed again
at another meeting. Donna asked if the next meeting was going to cover
finding the scope of the group, looking at James Lewis’s document,
and considering the next step. Libby Howze said that she also would like
to schedule when the chairs and DHEP would talk about the agenda. Donna
Mosby suggested that since the meetings would be the fourth Monday or
Tuesday of the month, the agenda discussion should be the second Monday
or Tuesday of the month—two weeks prior to the meeting. Libby said
the other thing to develop is the ground rules. Libby said she would look
at what we already have.
Finally, Libby Howze asked how long Donna Mosby and James Lewis had been
co-chairs. The response was, since the work group was formed, since the
second ORRHES meeting. The meeting was adjourned at approximately 8:10
p.m.
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