The Decisions For Health Initiative -- Successful Implementation Strategies

The Decisions for Health (DFH) Initiative is the newest of all the federal U.S. Department of Agriculture (USDA) initiatives. As recently as five years ago, who would ever have thought that Cooperative Extension would have been programming for the topic of health? When the DFH Initiative was first announced, many traditional Cooperative Extension System (CES) educators made comments like, "why are we programming in health?" "I'm an educator, not a health professional, so how can I conduct programs in health?" "We don't have enough personnel to carry out programming that we're already committed to do, how can we be expected to take on new responsibilities?"

In reality, health education outreach perspectives are so broad and the need so great that all segments of society and all aspects of Extension programming are impacted by this initiative. While there is a natural match between health and diet and nutrition, most of the ideas that have worked best for Idaho emerged from integrating health into community development functions. CES is in a strategic position to give leadership to this task.

Two factors have been instrumental in bringing successful strategies to a focus in Idaho. The first is internal: administrative support and specialist leadership. Through continued critical issues funding for the last three years and recognition of related issues (need for disease prevention education, increasing costs of health care), UI Extension administrators sent the message that the initiative is an important element in programming priorities. The specialist role has been equally important as a leader, an advocate, and watchdog, seeking programming opportunities, developing coalitions for programming, and searching for funds to support programming.

The second factor is external: the changing community health landscape. Transitions to managed care, rising costs of health care, the growing population of elderly persons and concurrent need for long-term care options, and changes in federal support for health care have emerged at an astoundingly fast pace, affecting every local community and every citizen. These changes propelled Idaho's success with the initiative.

Whether there is a need to identify programs that meet respective needs, or because of reduced faulty and operating dollars, there is a need for more efficient coordination of already existing resources necessary for county programming. New low cost ideas regarding DFH programming might prove useful. Programs that Idaho has found to be highly successful and "ideas that could work" for other cooperative Extension specialists and county educators include:

Conducting community or area one-day conferences on health related issues. Some one-day events were planned exclusively by Extension personnel, but others were planned by community groups with encouragement from Extension. The assumption was that change or control could be developed at the "grass roots" and that the function of local coalitions would be to educate local citizens, identify resources, and otherwise advocate for resources/services.

The one-day events took different directions, given the needs of the community, but the general objective was to generate discussion and identify resources. Some were workshops using local resources, some used the "health fair" approach, and one concentrated on adolescent health. Specific strategies were implemented in every situation to get the involvement of physicians, health clinic personnel, nursing home, home health, Alzheimer's program administrators, area Agency on Aging personnel, community leaders, and local politicians. This programming effort was significant because it greatly increased the awareness of both the lay public and the local agencies about services and the needs of various groups.

This effort grew out of multiple factors. Local organizations and civic-minded citizens identified a need to draw the community together and focus their energy on local challenges, but they lacked the time or expertise. The local hospital provided some assistance and county Extension educators provided leadership to create a strategy for a healthier community. A comprehensive survey was developed and conducted. A series of town meetings were held to disseminate the findings and to begin identifying solutions to the problems identified through the survey. The county is now evaluating these solutions. Work on this project is continuing.

This programming effort represented a "grass roots" effort to solve local health and social related problems. It also illustrated that no one agency has all the answers to local problems. Rather, it takes a coalition of agencies.

Minidoka County is developing an Elderly Functional Assessment Instrument. The instrument will be integrated into a local coalition attempt to identify rural elderly who might be in need of assistance, but who are not likely to call for help. It will be a tool for volunteers to use. It is important because very rural elderly citizens do have people who are concerned about them and reinforces the importance of neighbors in rural areas. Thirdly, it reinforces the need for trained volunteers. Training volunteers is a known strength of Cooperative Extension.

"Bustin' The Barriers" is a barrier free environment 4-H project developed by a team of human development, 4-H, farm safety, and developmental disabilities specialists. It consists of a leaders manual and four youth project work books: Walking in Different Shoes, Assistive Technology for People with Disabilities, Home/Building Accessibility Check List, and Job Opportunities in the Disability Field. A large color poster of urban and rural disability environments is included.

This project focuses on disability education from a comprehensive youth education perspective. While 4-H programming is a great strength of Cooperative Extension, this program fills a unique place in the overall programming scheme. It not only encourages youth programming in general, it is designed to educate these youth about others with disabilities, and it encourages youth with disabilities to enter 4-H.

"Every Child by Two" the Idaho Child Immunization Program had an initial CES contribution from the specialist and one county joining with the Distract II Idaho Health Department and Vista volunteers. Together they promoted a state immunization logo and assisted in designing a training manual for "Baby Track," which matches a volunteer with a new mother and her baby. The intent is to follow the new mother and baby throughout the first two years, encouraging immunizations for the baby at the appropriate dates. This model has been highly successful.

The Idaho Department of Health subsequently adopted the district logo for statewide use and the training manual has been modified to meet the needs of all seven health districts.

These program examples show that Idaho has had successful experiences in implementing the DFH Initiative. If Idaho, with few faculty and funding resources, can do it, any state can! Opportunities are endless and implications for Extension audiences far reaching. Programs can increase awareness, identify resources, and inform citizens about health care alternatives that impact the quality of life for each person. DFH programming has the potential of reaching every individual and every family.