Indian River County PACE EH Program

State: FL Type: Model Practice Year: 2007

Indian River County Protocol for Assessing Community Excellence in Environmental Health (PACE EH) targets a community of low socioeconomic status individuals. The goal of Indian River County’s PACE EH program was to address the longstanding environmental health issues in the community of West Wabasso. Implementing PACE EH in West Wabasso intended to accomplish a collaborative effort between the health department and the community with the common goal of improving the quality of life based in issues identified by the community. To date, Indian River County Health Department’s PACE EH program has produced over $1.5 million in improvements to the quality of life issues present in West Wabasso.
West Wabasso residents had lost faith and trust in their local government and residents were living in third world conditions. The community was made promises over the past 50 years that were not met and the community did not feel like they had a voice in their future. As county development occurred around them, they felt ignored and shunned by the lack of involvement from government agencies. The Indian River County Health Department’s Environmental Health Division (IRCHD EH) put into action the PACE EH methodology which began with surveying residents to identify what they thought were issues in their community. The identified issues were ranked, and the top five were brought before a community steering committee which helped to develop action plans to solve the issues. The issues were deemed relevant because of the fact that they were longstanding environmental health related problems that the community identified themselves. The practice addressed all identified issues and yielded improvements such as the removal of unsafe abandoned homes, an established bus route, and the construction of: street lighting, new septic systems, water mains and connections, new and repaired homes, sidewalks, and park improvements have been brought to West Wabasso. IRCHD EH’s approach to implementing PACE EH in West Wabasso was unique due to the magnitude of aid that was brought to the small community, but also the focus that was on the built environment as it relates to public health which unfolded once we implemented the process.
Agency Community RolesAs a result of this improved communication and newfound collaboration, all parties involved began to see first-hand how demolishing abandoned houses, installing street lights and sidewalks, and connecting the sidewalk to seamlessly link to the community park, led to people to go out and walk more.  Costs and ExpendituresImplementation of the Indian River County Health Department's PACE EH program entailed receiving an initial $30,000 grant to fund the salary of a PACE Coordinator. ImplementationThe 13 tasks of the PACE EH methodology were completed over 2.5 years. The PACE EH coordinator completed Task 1 (Determine Capacity) and Task 2 (Characterize the Community) during the initial environmental health assessment of the West Wabasso community, as well as Task 3 (Assembling the Team). Community members then assisted in providing guidance for Tasks 1 and 2 and worked together as a team to define Task 4 (Goals of the project). The coordinator contacted the West Wabasso Progressive Civic League, an existing community organization to introduce the project and identify community leaders. Community meetings were held that attracted a large number of community residents. Once the community was on-board with the project, an initial group of 18 community leaders were invited to participate as a steering committee. The community held monthly meetings starting around May 2004. Facilitation for the meetings was provided by the health department. Other county government agencies and decision makers have attended those meetings over time as they have become involved with implementation of community priorities. These meetings provide a forum for planning as well as a mechanism for communication about progress of the project. The PACE EH coordinator facilitated the project and moved the group from one step to the next as needed. The process was not followed in a linear pattern of steps.The PACE group then conducted a survey of community residents (Task 5). The results of this survey were analyzed (Task 6) and were very consistent with several priorities rising straight to the top – street lighting/public safety; water quality; and septic/sewer; housing quality. This consistency of opinion made these issues become the top ranked areas (Task 10). In addition, health department staff saw that installing streetlights in the community was a project that could be brought to fruition in a relatively short amount of time. Once these issues were identified, steps to complete them were concrete (install street lighting, provide county water to residents, improve septic systems, rehab and build homes/demolish abandoned structures, install sidewalks, so the team did not develop indicators (Task 7) or select standards (Task 8). Developing issue profiles (Task 9) was done as part of action planning (Task 12). Steering committee members did set priorities for action (Task 11) and develop action plans (Task 12) for the priorities listed above. They have also seen implementation beginning for a number of their priorities. Staff and community members are now at the point of continuing with implementation and completing a more formal evaluation (Task 13).
The goal of Indian River County’s PACE EH program was to address the longstanding environmental health issues in the community of West Wabasso. The objectives were to identify issues and work together with community to solve them. Performance was measured through monthly progress reports and by the input of community members, which was negative in the beginning months, but then drastically improved. A pre-survey to identify issues was conducted initially. A post-survey has been conducted recently to measure the impact of the improved quality of life in the community. Both were conducted at events and by going door to door. The initial survey was conducted in April and May of 2004. The post-survey was conducted in July and August 2006.
SustainabilityThere is sufficient stakeholder commitment to perpetuate the PACE EH practice because the community is empowered and enlightened enough now to take action themselves. Community and health department relations are excellent and agency partnerships have formed throughout the process that will allow the practice to be sustained over time as another community is selected and the PACE EH practice is implemented. In fact, the next community selected will already have an advantage from all the agencies now familiar with PACE EH on board and ready to find solutions. Lessons LearnedThe PACE EH Coordinator received data results and reported them to numerous individuals. Modifications have been made in the way the survey is conducted, due to the fact that performing only an initial survey did not make it easy to measure the program's involvement and the community’s view of the project. Thus, the post-survey was recently conducted to capture this data. Lessons learned include placing the same questions in both surveys so as to provide more data results.