Health Needs Assessment Work Group
Meeting Minutes
September 25, 2003
ORRHES Members:
James Lewis (Co-chair), Donna Mosby (Co-chair), Kowetha Davidson (ORRHES
chair), Karen Galloway, David Johnson, Pete Malmquist (via telephone),
Barbara Sonnenburg (via telephone)
ATSDR Staff Attending:
In the Oak Ridge Field Office: Melissa Fish and Bill Taylor. Via telephone:
Lorine Spencer, Terrie Sterling, Elizabeth Howze, Theresa NeSmith, Subha
Chandar, Jack Hanley, Marilyn Palmer.
The meeting agenda was as follows:
- Call to Order
- Review August 5, 2003 NAWG meeting minutes
- Next weeks meeting October 1 (announcement)
- Setting an agenda for October 1 meeting.
- Sunsetting NAWG
- Sunsetting COWG ?
- New work group charge (Kowetha, ORRHES August 26)
- 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
- Review how the August 26 ORRHES presentations were received (5 minutes)
- Status report of DHEP response to ORRHES recommendations (5 minutes)
- Discussion of previous community studies and surveys (such as the
1994 UT report) as source material for future actions.
- Other business.
James Lewis read the agenda. James Lewis asked that someone provide background
information for agenda item #4 because he was not involved with putting
it on the agenda.
Agenda Item #1. James Lewis called the meeting to order
at approximately 6:40 p.m.
Agenda Item #2. The August 4 NAWG meeting minutes were
approved without modifications or dissent.
Agenda Items #3 & #4. Concerning next week’s
NAWG Meeting, Terrie Sterling stated that it was DHEP’s understanding
that they would have a face-to-face meeting with the NAWG in Oak Ridge
on October 1. This item was put on the agenda because Bill Taylor suggested
that not everyone knew about the meeting.
Terrie Sterling said that she sent out earlier emails indicating that
DHEP was concerned—having referred to Kowetha’s original charge
for the NAWG at the August 26 ORRHES meeting—that the original meeting
agenda that Bill Taylor sent out was moving too fast and that much of
that discussion could be done better in the face-to-face meeting next
week.
Pete Malmquist said he didn’t understand why, or “about what”
we needed to slow down. Pete said that we are almost two years into the
project and have accomplished one thing: the Y-12 Uranium Public Health
Assessment.
Terrie Sterling said she was not talking about the public health assessments.
She said she was talking about where the Needs Assessment Work Group and
DHEP should go now that the NAWG’s charge has been completed.
Pete Malmquist asked whether Terrie Sterling said the Needs Assessment
Work Group has completed its task, and if so that would mean there is
no more need for the NAWG’s work.
Terrie Sterling responded that DHEP wants to move forward from where
the NAWG and DHEP have been, and DHEP does not want to redo another full-blown
needs assessment. DHEP and NAWG may need more information to move forward
but that information may exist or we may be able to get it in different
ways.
Donna Mosby said that the way she looked at the NAWG is that the NAWG
would find information and support the needs assessment process carried
out by George Washington University. Since that task is complete, that
no longer needs to be the function of the group. Terrie Sterling agreed
with Donna’s description.
James Lewis said that the NAWG provided information for GWU early in
the process. Since the report came out the NAWG provided a recommendation
associated with the report. James said that the knowledge that the charge
has been completed is news to him as co-chair. James asked whoever decided
that to explain.
Donna Mosby said this was discussed at the Subcommittee meeting.
James Lewis said that what was talked about at the Subcommittee meeting
was a possible name change and possibly combining work groups based upon
the charge. James Lewis said that in the first agenda that he had Bill
Taylor send out, he included a discussion of the rationale for combining
the work groups.
Kowetha Davison said that a name change reflects that the work has been
completed and the bylaws say that once the work is done that a work group
should be disbanded. If we want to continue in a new direction, it is
best to end what we had before and start with a new work group.
Libby Howze said that it will be better to discuss this item at the face-to-face
meeting October 1, and these issues should be on the agenda for that meeting
rather than debate them over the telephone.
Pete Malmquist agreed with Libby Howze and made a motion that the discussion
of a name change be put on the agenda for the October 1 meeting. David
Johnson seconded the motion.
Donna Mosby asked for some discussion. Donna said that part of the purpose
for the present meeting was to talk about what kind of group might interface
with DHEP and what the charge was and whether the changes were needed.
Donna said that she thought they should be doing that before the October
1st meeting.
James Lewis said he understood this similarly to Donna’s understanding,
and he had attempted to set up this meeting as soon as possible to try
to discuss this. James said that after a teleconference with the work
group chairs, Lorine Spencer sent out a “straw man” draft
agenda that included a discussion of renaming or combining the work groups
and Terrie Sterling had responded by email in a complimentary way. James
said he looked at the minutes of the August ORRHES meeting to try to see
what we were going to try and do. James felt the NAWG needed to clarify
what was meant by “combining” the work groups and made some
modifications to the agenda to accommodate that discussion. But after
that, the agenda was changed again (to its present form). James Lewis
then said that the proposal made by Pete was adequate and if we are going
to move through this we need to move on.
Libby Howze asked for a clarification of the motion. Pete Malmquist said
his motion was that we stop all discussion of name change, etc., we meet
on October 1, and we talk about item #4 at that time.
James Lewis said that as a part of item #4 Kowetha Davidson was going
to tell us about the work group charge. The work group then read through
the charge from page 17 of the draft August 26 ORRHES meeting minutes
(paragraphs 2 and 3). James Lewis said that those meeting minutes are
very strange and they don’t flow well.
Kowetha Davidson said that the charge is in the minutes. James Lewis
read them:
“The members should closely collaborate with DHEP to identify
next steps in the health education process for the ORR site; develop a
strategy to achieve these goals; and present the plan to ORRHES for review,
comment and approval. HENAWG should be prepared to present the plan no
later than the December 2003 ORRHES meeting. Any HENAWG member who needs
clarification on the new charge should contact Dr. Davidson.
Dr. Howze asked ORRHES to consider two additions to the charge. First,
the plan should also include a clearly defined process for DHEP to collaborate
and communicate with HENAWG and ORRHES. Second, HENAWG should be renamed
to ensure that the members and DHEP begin developing health education
activities for the ORR site without dwelling on past mistakes in the needs
assessment. Dr. Davidson amended the charge to include Dr. Howze’s
suggestions. The members should develop a strategy for DHEP to collaborate
and communicate with ORRHES and HENAWG. The members should review and
discuss HENAWG’s current role as outlined in the ORRHES bylaws.”
Kowetha Davidson clarified that the copy of the bylaws that Lorine had
at the ORRHES meeting was from the ATSDR web site. It is not the most
recent version and it does not list the NAWG as a work group.
James Lewis commented on the part about “dwelling on past mistakes.”
James said that there is a difference between dwelling on past mistakes
and plugging holes. James said that holes were created in the needs assessment
process. If in the sequence of operations there is a hole, or a perceived
weakness, something has to be done that relates to that if it is tied
into future activities. James said that the needs assessment activities
are not necessarily parallel efforts and appear to have been done in a
series. James said that he hoped that as a part of the discussion in the
future, room is left for discussion in those areas. James said that reviewing
other documents is a good way of filling holes and gaps. James said he
doesn’t consider that as dwelling on the past—that’s
just building on the future.
Next, James Lewis called for a vote on the motion. The motion passed
without dissent.
Donna Mosby asked if the work group members could get a mailing of the
current bylaws. James Lewis asked if the latest version of the bylaws
is on the web site. The answer is no. Lorine Spencer said that the web
site version of the bylaws in Article 9, Section 4 does not include a
listing of the work group names (PHAWG and NAWG) but the only changes
made to the bylaws since the web version was posted is the addition of
those names. Lorine said that since ORRHES is discussing making additional
changes to the bylaws, ATSDR is waiting to make all the updates to the
web site bylaws at the same time. Donna Mosby asked again if they could
get a copy of the bylaws. Lorine Spencer asked Marilyn Palmer if she had
the latest bylaws electronically. Marilyn said that she would have to
get the file from ERG. Kowetha Davidson said she had the current bylaws
electronically and she would send them to Lorine Spencer.
Agenda Item #5. James Lewis proceeded to agenda item
#5: Review how the August 26th ORRHES presentations were received.
James Lewis said that he brought up this item because he had heard differing
opinions from various people about the presentations. James said he wanted
to hear from DHEP or anyone else around the table who felt that the presentations
were not balanced and fair. James said they had tried to do a thorough
job and present in a professional manner.
Libby Howze said that DHEP did not have any negative comments and so
if James had heard them, he didn’t hear them from DHEP. Libby said
that they certainly appreciated the work that everyone on the NAWG contributed.
In terms of critiquing the report, she thought the observations, criticisms
and comments were very good and on target. She said she appreciated the
comments and thought it was good for the ORRHES to hear them as well.
James Lewis said that, on behalf of all of those who took the time to
work on this, he appreciated Libby’s comments. A lot of people committed
time to do the work and gave their volunteer time to this. James said
that some of the comments he heard from some ORRHES members were that
some of their comments at the ORRHES meeting were not picked up in the
meeting minutes. James said when people put extensive amounts of effort
and free time to drive up here, and get in work sessions, and review these
things, as a minimum we should consider ensuring that when they put this
kind of effort forward and we fill up this place with new people and with
as many new people that came up here to listen to this, that we ought
to at least see that the minutes are reflective of this type of effort.
James said that it hurts when their comments are not put forward. Others
had indicated to James that their comments were not in the minutes. James
said that some ORRHES members had had a number of discussions about meeting
minutes and it is an issue that needs to be reviewed at this level and
maybe taken to ORRHES to get some resolution of the level of detail people
appreciate and need. James Lewis said thank you to Libby Howze; they had
worked hard as a group, the community showed up, they were focused, and
pulled together to try to give DHEP the best answer that they could.
Libby Howze responded to James and said that she could only say again
that DHEP very much appreciated what they all did.
James Lewis added that the NAWG wants to work with DHEP and provide some
corrective action, but as Pete indicated at the beginning of the meeting,
the train has already left the station. James said we are talking about
the need to sit down and get things together again. It’s nice to
get ideas on the table, especially if we’re behind and we’re
complaining about resources. Why can’t we just get ready and start
moving on with life? James said that the community—and most of the
Subcommittee people and work group members that he comes in contact with,
would like to get this out of the way, get these things done, and move
forward.
Libby Howze said that DHEP would like to do the same. But there are fundamental
issues that we need to talk about, and they are listed in item #4, and
came out of the ORRHES meeting, and from previous conversations with the
NAWG, and DHEP’s own discussions. And once we deal with them, moving
on will be very much easier. Libby said she thinks we can use some of
the October 1 meeting, if we have time at the end, to begin looking at
next steps. But Libby said she feels very strongly that we need to all
be in agreement on how we communicate, how we make decisions, how we want
to operate, and who ought to be involved. Libby said that DHEP does not
have a predetermined view of how that ought to be, but since she is saying
they want to define a different way of working than has been the case
in the past, we need to spend time on doing that.
Agenda Item #6. James proceeded with agenda item #6:
Status report of DHEP response to ORRHES recommendation.
James Lewis asked DHEP staff how it would respond to the ORRHES recommendation.
Would ORRHES get a written response?
Terrie Sterling said they do plan to respond. DHEP is still gathering
information from George Washington University to help them (DHEP) understand
some issues that they could possibly share with ORRHES to answer some
of the questions that were brought up. On the one-page resolution, there
are several items that DHEP will definitely respond to, some which were
verbally responded to already at the last Subcommittee meeting. But there
will definitely be a written response to those items that will come to
ORRHES. DHEP is still pulling that together.
Pete Malmquist asked about Terrie’s wording about information that
DHEP was going to share, or was willing to share. Did she mean there was
some information DHEP did not want to share?
Terrie Sterling said there is nothing DHEP is trying to keep secret.
Pete Malmquist said that what he heard was there were some things DHEP
would share with them (the work group or ORRHES) but there were some things
DHEP did not want to share with them.
Terrie said she did not know what she said.
Pete Malmquist said, “That’s fine. If you don’t want
to tell us about some things, that’s fine. Just tell us what you
don’t want to talk about.”
Terrie Sterling said she didn’t intend to imply that.
Kowetha Davidson asked Pete Malmquist to explain to her what he is saying.
Kowetha did not get the same sense as Pete from Terrie’s response.
Pete Malmquist said that when Terrie started speaking, she said there
were some things she would like to share with us, implying there were
some things they did not want to share with us. Now, if that’s the
case, then just say there are some things that we don’t want to
share with you. If that’s not the case, that’s fine. Just
tell us what you want to share and what you don’t want to share.
Terrie Sterling said that all she could say was that that was not her
intent, and she was sorry if that came across that way. DHEP intends to
share with them all that they learn.
Pete Malmquist said all right; he understands and accepted Terrie’s
explanation. Terrie Sterling said thank you.
James Lewis asked if DHEP had a general idea as to when they would have
a response. Terrie Sterling said that they could have a response to the
recommendations at the next Subcommittee meeting. Terrie said that when
they learn more information from GWU, they would share that information
as soon as they get it. Terrie reiterated that they—at the Division
of Health Education and Promotion—do not think that the product
they have for the needs assessment can be used as a basis for health education/health
promotion efforts. She said they can put that in writing, but that was
one of the main recommendations that came from the work group/ORRHES,
and DHEP agrees with that and thinks that is a good recommendation.
James Lewis said that he appreciates that because Terrie Sterling said
DHEP was going back to GWU for some clarifications, and he wondered whether
the needs assessment was going to come alive again. Terrie said she did
not mean to mislead them. James said there was no problem.
Kowetha Davidson added that there were some things that came from the
Subcommittee meeting that may get lost, and they have to do with general
health concerns expressed in the needs assessment report. Those were concerns
that were included in the report that should not get lost.
James Lewis said that there had been some discussion in that area. When
we get information from the public, regardless of the expertise, how do
we treat that? There is a major charge for us as related to trying to
capture the community’s issues and concerns.
Pete Malmquist said that the health council groups of each of the eight
counties determine the priorities of health concerns such as heart disease.
Pete said he thought the NAWG could look at the priorities of those eight
counties and assign a number to each and come up with a list of concerns
that the health councils had compiled in the last couple years. Pete said
he thought this is an exercise that the NAWG or the new work group could
accomplish and bring back information. Pete said he talked with Brenda
Vowell and learned that a lot of these concerns are not reportable diseases.
Also, many of them are probably not applicable to what the ORRHES/work
group is doing. But at least we can say, as a group, we have looked at
these things. And we can say they do not fit into our criteria of what
we are studying or doing and we can move forward from there. At least
we can then tell the public we have looked at these things and say so
if the concerns are not in our charge.
Libby Howze said she thought that is an excellent idea. Libby thought
the health departments probably have some really good data or they could
be generated. Pete said the data are already generated and they are in
the literature review. Libby said we need some newer data. Pete said they
are from the last couple years. Libby said that that would be something
we would want to look at together. And even if the data are not in the
domain we decide we are working in, it might be important to say we looked
at it. Also, it might be important to see what is being done to become
familiar with heart disease prevention, and screening activities that
are going on.
Pete Malmquist said that in Roane County, among the primary concerns
are drug addiction, teenage pregnancy, and diabetes. Roane County started
a “Stars” program that involved students going into the schools
and talking about teenage pregnancy, which has reduced the rate in the
county. That is not in our purview up here and we can explain that to
people. If we move in that direction we can show that we have done some
work here.
Kowetha Davidson said that these things should be put into a general
overall plan of action for what we are going to do next. Kowetha said
her concern is that they develop a plan and lay out what they are going
to do and not go bouncing around doing one thing here and one thing there.
The group should lay out the plan for what they are going to do and how
they are going to do it. Pete’s suggestion could be put into that.
But we need to know what we are going to do and where we are going.
Pete Malmquist agreed with Kowetha. He said that his concern was that
Jeff Hill brought up at the last ORRHES meeting that heart disease is
a concern. And it is probably a high concern in each of the eight counties.
We aren’t going to do anything about heart disease. But let’s
say we have looked at it and this is a local problem—or whatever
we want to call it—but we have considered this, and let’s
go forward.
Libby said that we can do that with a number of issues in the county,
and what will evolve from that—review of documents, review of agenda,
and talking with people—will give us some pretty clear ideas of
where we need to go and the plan Kowetha is talking about. But we have
to do our “taking a look” as Pete is saying, to know what
is going on.
James Lewis said that he would like to add to the discussion: Karen Galloway
issued a memo that James thought did a good job of explaining how technical
arrogance has a tendency to overflow into what people say or think about
what needs to be done. James said he thinks people have been hurt by that
and Karen’s memo really needs to be read by those who are involved
in community involvement who are going to be out here educating the people,
to get a better idea of the feelings resulting from some of the things
they are doing. James said he thinks Pete has an excellent suggestion.
James said we have had these types of discussions and people want to get
these things on the table. James said he applauds Kowetha for talking
about an action plan, which he thinks of as a project plan with some dates
to do things in an organized manner. He said he doesn’t think the
work group has been as bad as some people think. He said Barbara Sonnenburg
has had some very good ideas about some holes that need to be filled.
There are people who are taking time to get involved and dig into these
issues and there are already a lot of ideas on the table. James said to
Libby if people had listened and these ideas had been documented, we would
be further along than we are now.
Pete Malmquist said he had to leave the conference at this time and said
he looked forward to seeing everybody on October 1.
Libby Howze said the group could start the discussion of filling holes
after we have dealt with the agenda item #4 at the October 1 meeting.
James Lewis said that there are undercurrents that are associated with
item #4 that maybe should not be discussed in the present meeting. James
said people don’t always have time to come to various meetings when
they have to drive to them. Sometimes we need to take into consideration
that when people do have the time to speak, we need to listen to them,
capture those issues, put them together, keep them some place, roll them
up into something and move forward. That’s why the minutes have
been so beneficial to us. James said we try to reach out and check everybody’s
dates for the best meeting times; but sometimes you have to take it where
you can get it. James said some people, like Pete, have given of themselves.
And when others come to the meetings unprepared and not understanding
the issues, they get things out of context and say others are running
over them. But those things were discussed. In another example, we had
some suggestions from Barbara in the chairs meeting. If Barbara doesn’t
show up for the October meeting, and nobody captured those suggestions—since
we don’t have minutes from the chairs meeting—this is the
kind of problem that we run into. And this is truly an issue for volunteer
help.
Libby Howze said this is an issue we need to talk about and why we need
to have the conversation (item #4 at the October 1 meeting). There are
a lot of questions about how to make decisions that are perceived as having
everybody’s input, that are equitable. That just needs to be the
discussion that we have on October 1.
James Lewis said he agreed with Libby but said it is bigger than just
NAWG. This thing permeates a lot of areas that we’re dealing with
and that truly has to be addressed.
There was a short discussion of where the group was on the agenda. Libby
Howze said she thought they would talk about agenda item #7 after they
had talked about #4 at the October 1 meeting. James Lewis said that he
felt strongly that they needed to have some discussion about the items
in #7 before they had a discussion about those in #4. James said sometimes
we put the cart before the horse. Libby Howze said that she didn’t
think we can begin to talk about #7 until we have a way that we can agree
to agree—at least on some of the items that we talk about. Item
#4. How we’re going to just do business should precede #7, which
is really the next step. Item #7 takes us past or into the transition.
James Lewis said he thought he understood Libby Howze but his point is
that he doesn’t want to lose the recommendations and suggestions
or ideas. Libby Howze said she didn’t think that any of us wanted
that but that they need to deal with the (item #4) stuff up front. James
Lewis said that his remarks were not directed to Libby Howze but to the
process that we have had here. He said that when one looks at the process,
some of the minutes of the meetings are helping people. Even when we got
to the process of giving our comments we had been told, quit the sidebar.
So we put our comments in writing. Now our comments are negative. James
said his point is the work group is going to give DHEP as much information
as it can. And whenever it is collected he would like to see it made available
and put into the discussion.
Donna Mosby said she had concerns about how we work as a group, how we
call meetings and how meeting agendas are established. Although it will
be part of the conversation that the work group is going to have, her
concern is how it will be handled for next week. James Lewis said we need
to be thinking about something similar to PHAWG and setting one day a
month, or something, for meetings because all the bouncing around, trying
to figure out who is where and when has been total confusion. Libby Howze
agreed.
The group discussed the meeting time for the October 1 meeting and agreed
upon 6:00 p.m. The group discussed the meeting agenda and agreed that
it would include item #4. Libby Howze said that if there was time we would
begin discussing item #7.
Kowetha Davidson said she would like to see a plan of action developed,
something laid out. She said her fear was that they would end up with
another disjointed effort like with GWU. Terrie Sterling said that that
would not happen. Kowetha Davidson said she wants to see something laid
out and see where they are going. She said right now she feels like the
blind are leading the blind and she wants a plan of action. Kowetha said
if you want to do like PHAWG, PHAWG has a plan of action. The dates concern
her. She wants to see what we are going to do and how we are going to
get there.
James Lewis said PHAWG has check points for the plan of action, and that
is the way you control things so that you don’t wind up, two and
a half years into a project, with nothing. Nobody had check points with
the needs assessment, and that was stated pretty clearly in previous discussions.
That’s the key.
James Lewis adjourned the meeting at approximately 7:40 p.m.
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