OVERVIEW

Q: What is the PACE EH methodology?

A: The methodology consists of a series of tasks to engage the public’s involvement, collect necessary and relevant information pertaining to community environmental health status, rank issues, and set local priorities for action. The tasks include:

• Determining Community Capacity to Undertake the Assessment
• Defining and Characterizing the Community
• Assembling Community Environmental Health Assessment Team
• Defining the Goals of the Assessment
• Generating the Environmental Health Issue List
• Analyzing Issues with a Systems Framework
• Developing Appropriate Community Environmental Health Indicators
• Selecting Standards
• Creating Environmental Health Issue Profiles
• Ranking the Environmental Health Issues
• Setting Priorities for Action
• Developing an Action Plan
• Evaluating Progress and Planning for the Future

Q: What is the value of undertaking such an initiative?

A: Though each of the pilot site communities approached the process differently, each one has indicated that they would repeat the process because of the benefits accrued. These include:

• Beneficial new work skills
• New and improved leadership role in community regarding environmental health issues
• New professional partnerships
• Confidence to take on large initiatives
• New relationship between local health agencies and communities

Q: Who does the assessment work?

A: The team composition is important to ensure that needed resources, perspectives, and representatives are engaged. A team typically consists of program managers in the local health and environmental agencies working in partnership with community members. While no hard-and-fast rules exist, the majority of pilot site coordinators found that between 12 and 15 assessment team members is a workable number.

Q: What role should/would the LPHA play in the CEHA process?

A: The methodology assumes the LPHA will organize and facilitate the process from beginning to end. The emphasis of the methodology is on community collaboration and great care is taken to assist the LPHA with facilitating a process that honors community involvement over agency empowerment. The majority of LPHA’s that have used PACE EH find their role is primarily setting the stage to ensure the process can happen (everything from getting necessary support from community power blocs to offering meeting space and snacks to the assessment team) to serving as a conduit to acquire necessary data and locate technical assistance as needed.

Q: What if the CEHA team gets into non-traditional EH problems? What should the LPHA do about that?

A: The LPHA need not feel a need to do anything if the team gets into non-traditional EH problems. If the CEHA team learns that the community is extremely concerned about an EH issue the LPHA deems “non-traditional” perhaps the LPHA should consider possible means for addressing aspects of the issue, but this is not necessary. Further, it is important to remember that the process can also help locate community partners to assist the LPHA in action planning, but the LPHA is not responsible for the entire weight of the action plan.

Q: What if the CEHA team is unable to come up with short-term goals?

A: Short-term goals allow participants to feel they are accomplishing something. Perhaps the team can locate an issue that is not among the highest priorities but can be acted upon rather simply. Or, perhaps the team can develop action plans that specify some short-term goals on the way toward longer term ones.

Q: How can I ensure that PACE EH is integrated into the health department’s daily activities?

A: Most PACE EH users report that it was not a matter of making sure the methodology was used every day. Rather, they found that skills developed and lessons learned through the PACE EH process fundamentally affected the way they approached their everyday work tasks. In particular, they stress the value of establishing community outreach built on collaboration and trust in day-to-day work.

Q: What kind of time commitment is required from health department staff?

A: The parameters of the project (as determined by the assessment team) will define the necessary time commitment. The facilitating agency should be prepared to provide the equivalent of 1 to 1.5 full-time employees to organize and coordinate the process during its initial stage (anywhere from 12 months to three years). However, they also feel that the time commitment will significantly decrease following the initial stage as those engaged in the process from the outset will develop a sense of ownership and responsibility for ongoing activities and evaluation efforts.

COMMUNITY INVOLVEMENT

Q: What does PACE EH say about community involvement?

A: A community-based environmental health assessment is a complex process. As such, a successful assessment team should be diverse because it reflects the community it represents and also serves as a system of checks and balances. The methodology calls for the formation of an assessment team incorporating a range of community members. Further, it calls for the collection of an environmental health concern list devised from community outreach efforts. PACE EH also reminds users that action plans developed through a community-based process is more likely to effectively engage community members as key facilitators of change.

Q: Why include diverse counties and differing issues?

A: As a rule of thumb, the PACE EH process is most effective when the parameters around the “community” are firmly established. Diversity and differing issues within the targeted community are exactly what the team has been put together to address and LPHA’s are already addressing this. PACE EH provides a methodology to do so fairly and in collaboration with community members.

Q: How can I ensure commitment on the part of community stakeholders?

A:

Q: Is there evidence that PACE EH works?

A: A supplemental publication to PACE EH, entitled PACE EH in Practice, will be released in August 2002. This companion piece describes the experiences of 10 communities across the nation that pilot-tested an earlier version of the guidebook by providing potential PACE EH users lessons learned, obstacles faced, and strategies implemented. Because every locale is unique, PACE EH is designed to be adaptable to meet the needs of the community and the public health agency. Overall, however, all pilot testers concurred that engaging in the process was worthwhile for both the facilitating agency and the community as a whole.

Q: How can the pilot sites help the LPHAs just starting PACE?

A: All of the pilot site coordinators have agreed to serve informally as part of a “peer assistance network.” This means users of PACE EH in the field can be referred to pilot site coordinators through NACCHO in order to answer specific questions or to receive advise on specific tasks in the methodology. NACCHO intends to continue to develop the scope and abilities of the “peer assistance network” in the coming year. Further, the experiences and successes of the pilot site coordinators have been captured in PACE in Practice, a new document produced by NACCHO and made available with every copy of PACE EH.

Q: How long have the pilot sites been operating on their own?

A: The pilot testing process ended in early 1999. However, NACCHO continues to have access to pilot site progress, and the sites are still receiving limited technical assistance.

Q: Can/should a PACE EH process be combined with other local assessment processes?

A: A PACE EH process can be combined with any number of complimentary assessment activities, but pilot testing suggests it is likely to be most successful when undertaken with clear objectives identified and among a relatively discreet community. In so much as complimentary assessment activities assist in achieving these two conditions they are likely to be beneficial.

The PACE EH pilot site communities that conducted their CEHA process as a component of larger assessment processes felt it benefited greatly from such an association.

FUNDING

Q: What is the cost of doing PACE EH?

A: The Pace EH process was designed to be flexible in terms of cost outlays and there has been a great deal of range among users in regards to the investments. For some users who decide to use outside consultants or professional surveyors, they incurred a greater cost. If PACE EH facilitators hire additional staff to “lead” their PACE EH process, then salary can become a major cost. On the other hand if you assign the work to pre-existing staff and utilize the CEHA team to do the survey development, distribution and analysis then you would have to recognize the costs in terms of hours.

GETTING STARTED

Q: How can I get involved in a PACE EH process?

A: The PACE EH guidebook can be ordered through the NACCHO Publications Department at (202) 783-5550, Ext. 237, or www.naccho.org. NACCHO also offers technical assistance to communities implementing the methodology, ranging from telephone consultation to on-site training. Call Jennifer Li at (202) 783-5550, Ext. 234, to find out if communities near you are considering engaging in a PACE EH process.