Delaware Journal of Public Health - Public Libraries and Public Health by Delaware Academy of Medicine and the Delaware Public Health Association

Delaware Journal of

Volume 6 | Issue 4

September 2020

Public Health A publication of the Delaware Academy of Medicine / Delaware Public Health Association

www.delamed.org | www.delawarepha.org

Delaware Journal of

Delaware Academy of Medicine

Board of Directors: OFFICERS Omar A. Khan, M.D., M.H.S. President S. John Swanson, M.D. President Elect

Public Health

Daniel J. Meara, M.D., D.M.D. Immediate Past President Timothy E. Gibbs, M.P.H. Executive Director, Ex-officio DIRECTORS Stephen C. Eppes, M.D. Eric T. Johnson, M.D. Joseph F. Kestner, Jr., M.D. Professor Rita Landgraf Brian W. Little, M.D., Ph.D. Arun V. Malhotra, M.D. John P. Piper, M.D. EMERITUS Robert B. Flinn, M.D. Barry S. Kayne, D.D.S.

Delaware Public Health Association

Advisory Council:

Omar Khan, M.D., M.H.S. President Timothy E. Gibbs, M.P.H. Executive Director Louis E. Bartoshesky, M.D., M.P.H. Gerard Gallucci, M.D., M.H.S. Richard E. Killingsworth, M.P.H. Erin K. Knight, Ph.D., M.P.H. Melissa K. Melby, Ph.D. Mia A. Papas, Ph.D. Karyl T. Rattay, M.D., M.S. William J. Swiatek, M.A., A.I.C.P.

Volume 6 | Issue 4

A publication of the Delaware Academy of Medicine / Delaware Public Health Association

www.djph.org

Lynn Jones Secretary David M. Bercaw, M.D. Treasurer

September 2020

3 | In This Issue

26 | Key Strategic Partnerships Create Greater Impact and Build More Resilient Communities!

Omar A. Khan, M.D., M.H.S. Timothy E. Gibbs, M.P.H.

4 | Guest Editor Annie Norman, Ed.D.

Peggy Geisler

6 | Libraries Play Key Role in Transforming and Keeping Delaware Connected

30 | Mapping Delawarean’s Basic Needs: Asset Mapping Shows Need and Opportunity for Streamlined Service Provision

The Honorable Bethany Hall-Long, Ph.D., R.N.C., F.A.A.N.

8 | A Culture of Commitment to Delaware’s Children Tracey Quillen Carney. B.A.

12 | Libraries and Pediatricians Team Up to Improve Literacy and Health for Delaware’s Children Jennifer Noonan, M.L.I.S. Stacey Garfield Fox, MD., F.A.A.P.

16 | Delaware Public Libraries in the Forefront of Health Initiatives Mary Grace Flaherty, Ph.D., M.L.S., M.S.

20 | Delaware Department of Health and Social Services Library Profile Anne Hiller Clark, M.S., L.I.S., M.S.

22 | Community Partner Support Unit Introduction Natalie Christopher

24 | Libraries as Public Health Partners in Times of Crisis Pat Young

Leann Moore Dabney Brice Kelly Sherretz

36 | Unite Delaware: Seamless Connections to Address Social Determinants of Health Erin Booker, L.P.C. Katie W. Coombes

54 | Partnerships for Health: NNLM MAR and Delaware Partners Make a Lasting Impact Kate Flewelling, M.L.I.S. Erin Seger, M.P.H. Tess Wilson, M.F.A., M.L.I.S.

58 | How Data from the Institute of Museum and Library Services Describe Ways Public Libraries Provide Health and Wellness Information Services Lisa M. Frehill, Ph.D., M.A., B.S.

68 | Global Health Matters Fogarty International Center

80 | Library - Resources 87 | Index of Advertisers

40 | Closing the Gap: Public Libraries and Public Health

Noah Lenstra, Ph.D., M.L.I.S. Mary Grace Flaherty, Ph.D., M.L.S., M.S.

46 | Developing a Model Policy for Public Libraries to Address Homelessness & Mental Illness

Cover photo credits: Library photos by Moonloop Photography Left to right – North Wilmington Public Library – Michelle Walker, Aretha Jarvis Dover Public Library – Brian Sylvester, Susan Elizabeth Cordle Georgetown Public Library – Kody O’Bear, Lesley Koble, Erin Ellenger

Mariekie Barone Stacie Fifelski Alexandra Stocker Thomas Worm Ashley Patterson Jessica Braamse Robert S. Lathers, M.S.W., L.M.S.W.

Delaware Journal of Public Health Timothy E. Gibbs, M.P.H. Publisher Omar Khan, M.D., M.H.S. Editor-in-Chief Annie Norman, Ed.D. Guest Editor Liz Healy, M.P.H. Managing Editor Kate Smith, M.D., M.P.H. Copy Editor Suzanne Fields Image Director ISSN 2639-6378

COVER Public libraries are free and accessible to all and are centers of community engagement and education, making them logical choices as partners for improving population health. Library staff members routinely assist patrons with unmet health and social needs.

The Delaware Journal of Public Health (DJPH), first published in 2015, is the official journal of the Delaware Academy of Medicine / Delaware Public Health Association (Academy/DPHA).

only the opinions of the authors and do not necessarily reflect the official policy of the Delaware Public Health Association or the institution with which the author(s) is (are) affiliated, unless so specified.

Submissions: Contributions of original unpublished research, social science analysis, scholarly essays, critical commentaries, departments, and letters to the editor are welcome. Questions? Write ehealy@delamed.org or call Liz Healy at 302-733-3989.

Any report, article, or paper prepared by employees of the U.S. government as part of their official duties is, under Copyright Act, a “work of United States Government” for which copyright protection under Title 17 of the U.S. Code is not available. However, the journal format is copyrighted and pages June not be photocopied, except in limited quantities, or posted online, without permission of the Academy/ DPHA. Copying done for other than personal or internal reference use-such as copying for general distribution, for advertising or promotional purposes, for creating new collective works, or for resale- without the expressed permission of the Academy/DPHA is prohibited. Requests for special permission should be sent to ehealy@delamed.org.

Advertising: Please write to ehealy@delamed.org or call 302-733-3989 for other advertising opportunities. Ask about special exhibit packages and sponsorships. Acceptance of advertising by the Journal does not imply endorsement of products. Copyright © 2020 by the Delaware Academy of Medicine / Delaware Public Health Association. Opinions expressed by authors of articles summarized, quoted, or published in full in this journal represent

IN THIS ISSUE We are fully and firmly in the information age, and in fact have transitioned to a time where there may be too much of it. The well-known hierarchy of Data → Information → Knowledge → Wisdom (DIKW) is a theoretical framework that can only lead to meaningful public health impact if each element is appropriately curated and presented. This is where libraries come in: as real and virtual portals to DIK (and therefore, W), they and those that run them are indispensable in our current times. From a 2018 original research article published in Preventing Chronic Disease (a peer-reviewed public health journal sponsored by the Centers for Disease Control and Prevention): “Public libraries are free and accessible to all and are centers of community engagement and education, making them logical choices as partners for improving population health. Library staff members routinely assist patrons with unmet health and social needs.”1 This statement is certainly true in the State of Delaware, and we are pleased to welcome Annie Norman, Ed.D., Delaware’s State Librarian, as the guest editor for this issue of the Journal. Delaware is fortunate to have fifteen public libraries in New Castle County, six public libraries in Kent County, and fourteen public libraries in Sussex County. As participants in the statewide Delaware Library Consortium, these public libraries provide full services which are available to all Delawareans, and act as an access gateway to other essential services as shown in Figure 1 below. As you look at this chart, you can quickly appreciate the depth and breadth of services that can be accessed via the state library system. Add to that the multitude of programs that libraries operate for the betterment of our community including the new Dolly Parton’s Imagination Library, STEM program, and a wide variety of virtual events which were enhanced as a result of COVID-19, and you can see how important libraries are. The key to Delaware’s Public Libraries full resources is simple: obtain a free library card. Even without a library card, there is still much that can be accessed. At all times, and especially during these tumultuous times of worldwide pandemic and social strife, our public libraries continue to play a critical role on behalf of our publics’ health and wellbeing. We applaud the critical role of libraries in taking us on the arc from Data to Wisdom, ultimately to improved health for all Delawareans.

Figure 1. Delaware Libraries: Basic Needs Chart2

Omar A. Khan, M.D., M.H.S. President and CEO, Delaware Health Sciences Alliance; President, Delaware Academy of Medicine / Delaware Public Health Association

Timothy E. Gibbs, M.P.H. Executive Director, Delaware Academy of Medicine / Delaware Public Health Association

REFERENCES 1. Whiteman, E. D., Dupuis, R., Morgan, A. U., D’Alonzo, B., Epstein, C., Klusaritz, H., & Cannuscio, C. C. (2018, May 24). Public libraries as partners for health. Preventing Chronic Disease, 15, 170392. https://doi.org/10.5888/pcd15.170392 2. Delaware Libraries. (n.d.). Services and Partners. Retrieved from https://guides.lib.de.us/departners 3

Annie Norman, Ed.D. State Librarian of Delaware

We are grateful to Tim Gibbs and the Delaware Academy of Medicine for the opportunity to feature the contributions of public libraries to public health. The Delaware Academy of Medicine has a long history of partnership with Delaware libraries, providing consumer health information, training for librarians, and much more. Libraries support individuals and communities to achieve their full potential, and health is a key foundation for human growth and development. In Palaces for the people: How social infrastructure can help fight inequality, polarization, and the decline of civic life, sociologist Eric Klinenberg studied the 1995 heat wave in Chicago and the essential role that social infrastructure, including libraries, plays in supporting community health and resilience, especially during a disaster.1 As “second responders,” libraries around the nation adapt their services instantly in response to crisis, more and more frequently. The COVID-19 pandemic is transforming library services significantly, yet again, to help communities evolve from surviving to thriving. Perhaps you remember from school, an information organizer that libraries use called the Dewey Decimal Classification System (there will not be a test!), which represents all the world’s knowledge. Health issues primarily fall under 600s (Applied Science) and 300s (Social Sciences). Libraries also serve all needs,

4 Delaware Journal of Public Health – September 2020

represented by a modified version of Maslow’s Hierarchy of Needs – Find, Connect, Learn, Inspire, Transform. In support of social infrastructure, the statewide Delaware Library Consortium (delawarelibraries.org) infrastructure was established to enable seamless collaboration across libraries for more equitable and effective services in response to community needs. Currently 74 libraries are Delaware Library Consortium members, supporting interests with millions of books, movies, music, magazines, newspapers, Internet access, programs, workshops, community collaborations, and more! And with a computer or smart phone, you can access library services from wherever you are! The strength of social infrastructure is also dependent upon partnerships among all of the subject matter experts. Delaware libraries are proud of our partnerships with Delaware Health and Social Services for Social Workers and the Department of Labor for Employment Specialists, as well as numerous additional partnerships with nonprofits and agencies to support Delawareans’ needs and ambitions. Libraries develop partnerships and services to support health and societal evolution in multiple areas, such as the long term effects of poverty and trauma, racial inequality, gender inequality, and so on, to help the public overcome trauma and rise above the challenges in their lives.

Our contributors for this edition are leaders with perspectives at the local, state, regional, and national levels on library partnerships with health organizations to provide health information and services throughout communities. We hope you find within, ideas to spark additional partnerships with libraries to help you achieve your goals. Special thanks to The Honorable Bethany Hall-Long, Lt. Governor, a nurse and Chair of the Behavioral Health Commission, and to First Lady Tracey Quillen Carney, Honorary Chair of the Delaware Library Card Campaign and Dolly Parton’s Imagination Library, part of the First Chance initiative for children.

REFERENCES: 1. Klinenberg, E. (2018). Palaces for the people: How social infrastructure can help fight inequality, polarization, and the decline of civic life. Crown Publishing: New York.

Emerging from crisis is a powerful opportunity for change, and libraries are standing by to collaborate with you to strengthen the social infrastructure for our communities. Thank you for your passion and partnership! Let’s devote our wisdom, hard work, and ingenuity to design a vibrant healthy future!

Libraries Play Key Role in Transforming and Keeping Delaware Connected The Honorable Bethany Hall-Long, Ph.D., R.N.C., F.A.A.N. Lieutenant Governor, State of Delaware; Professor, Nursing and Joint Faculty, Urban Affairs, University of Delaware; Chair, Behavioral Health Consortium; Chair, National Lieutenant Governors Association; National Co-Chair, Million Women Mentors

Emergency departments, family care practices, walk-in clinics. We are all familiar with these more traditional sites to access both health care and associated resources. As a public health nurse, I have seen over the years how different populations, especially our most vulnerable, do not always access to these traditional sites. People experiencing these challenges often lack any form of health care. As Lt. Governor, I have the opportunity of working with diverse stakeholders and community members from Blades to Brandywine to improve health outcomes for all Delawareans. That is why I am so proud of the work of the Division of Libraries and the role they play in expanding access to critical health and public assistance resources. It is no secret the critical role libraries play in each of our towns and cities across the State. These community hubs not only provide educational and literacy tools to people but have been tasked in expanding their services in recent years. This means libraries are doing more, like processing passports, embedding social workers, implementing summer reading programs, advancing STEM (science, technology, engineering and mathematics), and expanding arts offerings. As a university professor, I’ve had the opportunity to also work with the libraries as we collaborate with the Delaware Medical Reserve Corps and provide information on disaster preparedness. They even play a key role in our disaster planning acting as “second responders” in our recovery efforts as we try to restore a sense of normalcy after these events. These programs and activities transcend the historic and traditional understanding of what libraries do and what services they provide. All too often, those we are trying to reach with needed resources are faced with transportation and other challenges, making it difficult to serve them. That’s why we’ve connected the services we offer with the folks who utilize them, by going out into their communities. My office, in coordination with the Division of Libraries, set up pop up table events at libraries throughout Delaware. By going directly into these communities, we are able to engage with the citizens and address their concerns and needs, and to hear about the services they utilize at our libraries. For instance, at the Seaford Public Library, our staff engaged a lady who was seeking assistance so that she could purchase healthier foods for her family. My office was able to work with one of the onsite social workers to connect and secure a Supplemental Nutrition Assistance Program (SNAP) voucher. She was able to seamlessly apply and enroll in this program because of the services provided by the State’s pilot program that strategically placed social workers in a community setting and, by extension, increase access to critical public health resources. There are countless examples of how libraries play a larger role in our state’s public health strategy. One of the most pressing issues, despite the global pandemic, is the opioid epidemic. For the past three years, I have been the Chair of the Behavioral Health Consortium. This working group created the road map to curb our State’s fatal overdose rate. Our statewide library 6 Delaware Journal of Public Health – September 2020

system has been on the front line of this epidemic. Through critical community partnerships, the libraries have been integral in Naloxone Points of Distribution (POD). These PODs have ensured countless doses of life saving, overdose reversing medication found their way into family’s hands. This resource alone can be attributed to saving thousands of Delawareans who continue to battle the chronic disease that is addiction. Libraries are also taking a more active role in engaging the community and encouraging broader participation in the 2020 Census. As Chair of the Governor’s Complete Count Commission, it is our goal to make sure we count every single Delawarean. This number is tied to critical funding Delaware receives from the federal government. These funds go toward a variety of services, ranging from transportation, education and even healthcare dollars, to name a few. The more accurate and complete the count, the more adequate our federal funding levels become. Our libraries have been helping educate and promote the importance of completing the census, all while continuing to provide resources for individuals who might struggle with access to broadband or other technology. Libraries across our State are the foundations to so many of our critical interactions. Whether it be reading and learning or using the expanded services offered by our libraries, these services positively impact Delawareans. It’s also so uplifting to see that, despite a global pandemic, the libraries continue to operate. This continued commitment to the community is a true testament to the enduring spirt and sense of community libraries provide. It is clear that many of the services and strong community engagement our library system provides ensure a stronger, healthier Delaware.

https://lib.de.us/healthready/

Join the thousands who have already registered to be part of APHA's 2020 Annual Meeting and Expo, the most important public health gathering of the year. Register now Virtual Means Access to More Content than Ever APHA 2020 is all virtual, which means you have 24/7 online access to sessions and events. You won't have to choose between the content of competing sessions. Content will be available for on-demand viewing until August 2021! The Online Program details this year's sessions and events. Here are some tips to get started: • Already registered? Log in to the Online Program to make a schedule and star your favorite events. • • • • •

This year's Annual Meeting Theme is "Creating the Healthiest Nation: Preventing Violence." A link to sessions related to this year's theme is in the left hand navigation. Our community is at the forefront of the COVID-19 pandemic. Hear lessons learned from your colleagues by searching the COVID-19 related sessions in the left hand navigation. View the APHA-Featured Sessions to see who is speaking in APHA's most distinguished sessions. Browse the list of Poster Sessions. Posters will be available starting Oct. 19. Earn 20.5 Continuing Education Credits. APHA is covering the cost of one CE discipline for every attendee.

Real-time Interactions Being virtual doesn't mean you can't connect with your colleagues. Here are ways to meet your fellow public health professionals: • Attend live oral and roundtable scientific sessions to communicate directly with presenters. • Leave a question on a presenter's discussion board. Oral, roundtable and poster presenters will answer your questions about their research. • Visit the Virtual Public Health Expo. This year, registered attendees can send messages directly to their favorite exhibitors. Learn more about exhibiting, sponsoring and advertising. • Attend a business meeting or social hour. Your university or member organization might be holding an event. • Stay tuned for networking opportunities provided by APHA such as trivia, coffee talks and wellness activities.

A Culture of Commitment to Delaware’s Children Tracey Quillen Carney, B.A. Delaware’s First Lady

When I got this opportunity as First Lady, I knew I wanted to work for Delaware’s children, to do what I could—within this limited and, frankly, kind of weird role—to support efforts that give our children the best possible chance to reach their potential.

success at ages 9 and 10 (the target of our state’s grade-level reading campaign), which then correlates to the likelihood of high-school graduation, which correlates to virtually every positive outcome from then on.

We know that when kids and their families face foundational challenges, each adversity deepens all of the others in a geometric—and often generational—erosion of opportunity. So to be effective and to be efficient, efforts to alleviate those challenges must also be inter-connected and mutually reinforcing. Just as that recognition inspired this DJPH issue’s connection of public health to the mission of our libraries, it also inspired our Governor to revive the Family Services Cabinet Council so that various departments and agencies can collaborate more intentionally.

We know there are particular windows of opportunity during childhood, including very early childhood, when experience can have the biggest, most natural, impact on the brain. And again, it’s not just cold exposure to words, like TV, because so many interdependent foundations are developing at the same time. Kids aren’t just learning the fundamentals of reading; they’re learning the fundamentals of reading the world. They’re learning to think, to analyze, to question, as well as to trust and to form healthy attachments. The interactive component of early literacy is essential, just as everything that strengthens the promise of a child’s future depends on relationships.

The recognition of interconnectedness also inspired the focus on partnerships in our first spouse initiative, First Chance Delaware, with the goal of supporting kids in a way that gives them a cohesive foundation—a true first chance to succeed. First Chance has three pillars: ending childhood hunger in Delaware (one in six Delaware children face food insecurity); building

Imagine if, in coordination with our expansion of the Dolly Parton Imagination Library project in Delaware, we can also expand Reach Out and Read to all of our pediatric and primary care practices. When children receive a book at well visits, from birth to age five, providers can model and give parents and caregivers tips about reading with young children, about “serve-and-return” and similar strategies. It’s an opportunity to support caregivers who may not speak or read English well, or who may not be proficient readers, with information about how to interact using language in a variety of ways. It’s a chance to make sure caregivers know about community resources, like libraries, where they can get support in promoting early language skills. Relationships—from the front desk and phone line to treatment rooms to referrals to trusted community partners. One of the most important lessons I’ve learned over the past threeplus years is that all successful programs for kids take advantage of the rare and precious opportunities to engage children and their caregivers at the same time. Pediatric and primary care offices— along with our research-based home visiting and communitybased programs like those at libraries—are among our best bets. The multi-generation approach is not a fashion; it’s an absolute necessity if we want to make a difference in the lives of children.

our effective recognition of, and response to, childhood trauma (half of our K-12 students have experienced at least one of the research-defined Adverse Childhood Experiences); and promoting foundational language skills to help get young kids on track for learning in school (experts recommend the equivalent of about 7,000 children’s books before kindergarten). Toward that third goal, I am privileged to serve as the honorary chair of both Delaware’s Dolly Parton Imagination Library program and the Delaware Library Card Campaign. Over the last 30 years or so, thanks to research that has tracked developmental milestones over time, we’ve learned so much about brain development, and, fortunately for us non-experts, the lessons are pretty easy to understand. We know that exposure to oral and written language in an interactive, encouraging setting—a setting that involves a positive relationship—is a key foundation for future learning success. The quantity and quality of early language experience, from birth to three, correlates to children’s academic 8 Delaware Journal of Public Health – September 2020

A second, and related, key lesson—one that we cannot scale our way out of—is that successful programs all have a one-to-one component, responding to the specific needs and circumstances of individual children and their families. Again, pediatric and primary care and home visiting offer some of our best opportunities to see kids and families one at a time, and we have to take full advantage. A third lesson takes us back to where we started. If we are to make real progress toward giving every child in Delaware a first chance to succeed, then collaboration is the name of the game. No single entity—no matter how well intentioned and even no matter how well funded—can do it alone. Again, the challenges are intertwined and mutually reinforcing, and so must be the solutions. Children cannot compel our care; they don’t have a lot of leverage. Their well-being depends on our recognition of what we owe them, on our sense of obligation and responsibility. I can’t imagine a more important trust.

The DPH Bulletin

From the Delaware Division of Public Health

August 2020

Catch kids up on their immunizations

August is National Immunization Awareness Month. The Division of Public Health (DPH) reminds parents and guardians to schedule their wellness visits and update their children’s vaccinations before the school year begins. Childhood immunizations are more important as states gradually reopen schools during COVID-19. “As we interact more with others, we need everyone – especially kids – to be protected from vaccinepreventable diseases,” said James Talbott, manager of DPH’s Immunization Program. “Until they’re vaccinated, kids are vulnerable to diseases such as the flu, measles, mumps, rubella, chickenpox, pertussis, and hepatitis.” DPH is running a public awareness campaign on childhood immunizations that includes billboards and print, radio, and social media ads. To see what vaccines are recommended for children or teens at various ages, visit de.gov/immunizations. To support childhood immunization efforts, the Centers for Disease Control and Prevention’s CDC prepared a social media toolkit for providers, parenting groups, and immunization advocates. The providers’ toolkit offers social media posts, Facebook and Instagram ads, newsletter copy, and pre-sized images representing diversity and various ages. Visit https://www.cdc.gov/vaccines/events/niam/index.html.

Delawareans can reduce risk by managing chronic conditions closely

DPH Director Dr. Karyl Rattay asks those with chronic conditions to closely manage their conditions during the COVID-19 pandemic. “When you take good care of yourself, you reduce the chance of having complications from your condition,” Dr. Rattay said. “Providers and hospitals can focus on Delawareans who are seriously ill.” According to the CDC, those with the greatest risk of suffering severe illness from COVID-19 have chronic conditions including cancer, Type 2 diabetes, chronic kidney disease, chronic obstructive pulmonary disease, obesity, serious heart conditions, Sickle cell disease, and those who are immunocompromised. People who might be at increased risk for severe illness from COVID-19 are those who have moderate to severe asthma, cerebrovascular disease, Cystic fibrosis, hypertension, neurological conditions, and liver disease, and those who are pregnant, smoke, and are immunocompromised. Read the CDC’s full list. As of August 7, DPH identified 15,445 total positive cases of COVID-19 among Delaware residents since March 11, and 588 individuals died from COVID-19 complications. There were 8,392 recoveries and 194,784 individuals have been tested. Data is updated daily during the noon hour and available at de.gov/healthycommunity.

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Are you prepared for hurricanes?

August, September, and October are peak hurricane months in the mid-Atlantic region. Take these steps from the National Weather Service: • Determine if you live in a hurricane evacuation zone or in an area at risk for flooding and if so, identify a non-shelter place to go. Shelter capacities may be reduced due to the need to implement social distancing and sick areas during COVID-19. Learn Delaware’s evacuation routes. • Restock household emergency kits with enough food and drinking water for all family members and pets for three days. Store one gallon of drinking water per person per day. Also pack a battery-powered or handcrank powered radio or a NOAA weather radio; batteries; flashlights; phone chargers; soap; cleaning supplies; hand sanitizer; and two cloth face coverings per family member. • Organize and back up important documents and confirm coverage with your insurance agency. Those living in flood-prone areas should buy flood insurance. • Develop family plans for hurricanes and floods. • To reduce flying debris during high winds, trim trees and keep yards uncluttered. Get approved window coverings. Store valuables in plastic tubs on high shelves.

DOE issues school reopening guidance Delaware schools may reopen under a hybrid scenario next month, with a mix of in-person and remote instruction, Governor John Carney announced on August 4. “Safely reopening schools for Delaware children – especially our youngest learners and disadvantaged children who need in-person instruction the most – is the most important and difficult issue we’ll face as we continue to confront this COVID-19 crisis,” Governor Carney said in his press release. There are significant safety requirements to limit COVID-19 transmission, including minimum requirements for social distancing, wearing masks, and handwashing. State Medical Director Dr. Rick Hong said all schools should prepare for a positive case and designate COVID-19 points of contact. Click here for more information.

• Mobile home residents must evacuate when told to do so. Straps and other tie-downs will not protect mobile homes from high winds. For more information, including supply lists, visit PrepareDE.org, Ready.gov, and www.floodsmart.gov.

DHSS seeks comment on draft plan

Public comment is invited on the Delaware Department of Health and Social Services’ (DHSS) draft strategic plan. In a letter to Delawareans, former DHSS Secretary Kara Odom Walker, MD, MPH, MSHS and current Secretary Molly Magarik said DHSS’ vision is to have high-quality operations, and the recommendations in the draft strategic plan “offer us a detailed path forward in achieving this vision.” Send comments by September 15, 2020 to DHSS_TownHall@delaware.gov.

The DPH Bulletin – August 2020

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Libraries and Pediatricians Team Up to Improve Literacy and Health for Delaware’s Children Jennifer Noonan, M.L.I.S. Children’s Librarian, Lewes Public Library; Board Member, Cape Henlopen Educational Foundation Stacey Garfield Fox, MD., F.A.A.P.

There are millions of children in the United States who have no books of their own at home. In fact, in some low-income neighborhoods, access to books is astoundingly meager, with just one book available for every 300 children.1 Pediatricians and librarians know that early literacy and healthy brain development are closely connected, and see the lack of access to books for young children as the crisis it is. That’s why in Delaware, libraries and pediatricians are working with policy makers and hospitals to get more books into the hands of every child in the state – and as early as possible.

BOOK DISTRIBUTION PROGRAMS IN DELAWARE Over the last several decades, several book distribution programs have sprung up at the national and international level with the aim to improve book access and positively impact early literacy. Two of the most recognizable are in Delaware: Dolly Parton’s Imagination Library and Reach Out and Read. Dolly Parton launched the Imagination Library in her home county of Sevier County, TN in 1995, and it has since grown to be an international effort, mailing more than 1 million books a month out to children in the U.S., U.K., Canada, Australia, and Ireland.2 Children, if enrolled in the Imagination Library at birth, amass a 60 book library by the time they “graduate” from the program at the age of five – at no cost to their families. In 2003, after expanding the original program from Sevier County to the full State of Tennessee, the Dollywood Foundation created a

12 Delaware Journal of Public Health – September 2020

model that allowed local organizations to replicate the program in their own communities by becoming Local Champions. That’s just what Marie Cunningham, of Delaware Division of Libraries, and Friends of Harrington Library did in 2012, to bring the program to the Harrington School District, in Kent County, DE. In 2018, the Lewes Public Library followed suit, and became the Local Champion for the Cape Henlopen School District in Sussex County, DE. The success and popularity of those programs caught the attention of state policy makers, and in January 2020, the State of DE began supporting a pilot that included five school districts, which consequently expanded statewide in August of 2020. “It’s a great privilege for me to serve as the honorary chair of Delaware’s Dolly Parton Imagination Library program,” said First Lady Tracey Quillen Carney. “The quantity and quality of early language experience, starting at birth, correlates to children’s academic success at ages nine and 10—the target of our state’s grade-level reading campaign—which then correlates to the likelihood of high-school graduation, which correlates to virtually every positive life outcome from then on. Expanding the Imagination Library program in Delaware is a great investment in our families and in our future.” Reach Out and Read was founded by pediatricians at Boston City Hospital (now Boston Medical Center) in 1989, with a mission to help make routine reading a part of families’ lives.3 Since then, it’s grown to 6400 program sites, spread over all 50 states, and provides 7.4 million books a year to children all over the country. Pediatric and family practices that provide pediatric care can become Reach Out and Read sites. As such, they receive training in anticipatory literacy guidance, and distribute books to children at well-child visits starting at six months. By the time a child reaches five years old, they will have built a collection of 8 – 10 quality books. Each Reach Out and Read site also creates a literacy-rich environment, which can include books, early literacy hand-outs, and even volunteer readers in the waiting room. Medical providers give caregivers guidance on age-appropriate ways to share books with children at each visit. Dr. Shirley Klein was the first to bring Reach Out and Read to Delaware at Christiana Care in 1998. In 2008, Pediatrician Dr. Aguida Atkinson founded the program at Delaware Nemours DuPont Pediatrics,

where it has since expanded to 11 out of 12 Delaware practices. Those practices distributed 19,232 books to children and their families in 2019 alone. “The importance of reading aloud to children from a very young age is that it promotes and develops language, which is crucial for overall child development. It also strengthens the bond between parent and child,” says Dr. Atkinson. “Caregivers trust pediatricians - they really listen to us. Pediatricians have a great opportunity to relate the importance of early literacy during periodic well visits, so parents can incorporate reading into their children’s daily routine starting as early as birth.” In 2016, Dr. Stacey Garfield Fox established Beacon Pediatrics, in Rehoboth Beach, as a Reach Out and Reach site, which has since distributed more than 11,300 books to children in its practice. Beacon Pediatrics is the exclusive provider of pediatric care for newborns at Beebe Hospital, which serves Sussex County, and is working toward an early literacy partnership with Delaware Libraries that will get books into the hands of families as soon as their children are born.

DELAWARE LIBRARIES AND PEDIATRICIANS COME TOGETHER Both Dolly Parton’s Imagination Library and Reach Out and Read are time-tested programs, each with a significant base of research supporting their efficacy. So, one might rightly ask, “Do we really need both?” With book access for so many children in critical condition, the answer is a resounding, “yes.” And that’s because each of these programs approaches the complex early literacy puzzle from a different angle. Both provide brand new, high quality books to children – an important piece of that puzzle they both share. Dolly Parton’s Imagination Library focuses on volume and early reach, while Reach Out and Read targets oneon-one caregiver education and support. Quality books matter, but so does quantity. The more high quality books in the home, the better.4 In fact, literacy increases with the number of books children have access to in their homes.5 Children are eligible to register for Dolly Parton’s Imagination Library the day they are born, and will start receiving books immediately. If they remain in the program, 60 brand new, industry curated, high quality books will be theirs forever. Getting books to them early also matters. Reading to babies – even the very youngest - helps to improve language development, as well as social and observation skills. Since 2014, The American Academy of Pediatrics has recommended caregivers read to their children from birth, because the more words babies hear, the better their literacy, vocabulary, and reading comprehension will be in the future.6 Reach Out and Read begins giving books to children at their six month well-child visit, and while it distributes fewer books to them overall than Imagination Library, it packs a formidable punch in its efforts to educate caregivers on the importance of reading to their children daily; demonstrating to them how they can share books in age appropriate ways, no matter what their child’s age. It’s the combination of books and information given together that makes the program so effective. There’s a strong correlation between this intervention combination practiced by Reach Out and Read and improvement in oral early language

skills.7 When a pediatrician gives caregivers early literacy information and direction at a well visit, while also giving them a book to read with their child, it positively impacts early language development. By inspiring read-aloud time together, both Imagination Library and Reach Out and Read help capitalize on the way books can help children and caregivers to bond, and to form loving, healthy relationships. According to Reach Out and Read,3 “Spending time together while reading aloud helps to create strong parent-child bonds and promotes healthy brain development. Children that are read to more often have improved language and listening skills, experience stronger emotional connections to their loved ones, and gain a lifelong love of reading.”

THE FUTURE FOR DELAWARE’S CHILDREN Delaware Libraries and pediatricians came together in late 2019/ early 2020 and began work toward a partnership that would ensure all of Delaware’s children and their families get early access to books and quality early literacy information from these two book distribution programs. Their ultimate goal is to increase the number of pediatric practices that are Reach Out and Read sites, and to work with birthing hospitals to register children in the Imagination Library before they even leave the hospital. “We know that early intervention makes a difference. That’s why it’s so important to Delaware Libraries to get every child in the State of Delaware free access to books, at home, and early. As soon as they are born.” says Delaware State Librarian, Annie Norman. It’s a mission inspired partly by Tennessee’s Governor’s Early Literacy Foundation, which has been successful in getting children registered with Imagination Library early, through its partnerships with birthing hospitals in that state. The connection between early brain development and literacy is well documented. But there are strong and predictive ties between literacy and general health in adults, as well. “Studies have shown that patients with inadequate literacy have less health-related knowledge, receive less preventive care, have poorer control of their chronic illnesses, and are hospitalized more frequently than other patients.”8 And with nearly 21% of American adults (about 43 million) falling into the illiterate or functionally illiterate category,9 the need for intervention is more important than ever. Book distribution programs like DPIL and ROR have been proven to advance kindergarten readiness. According to a longitudinal study by Applied Survey Research (ASR) in Alameda County, CA, children who are ready for kindergarten are more likely to be reading on grade level by the 3rd grade, and that success improves their chances of future academic success.10 It’s difficult to succeed in life if you can’t read well. And it’s very difficult to get good at reading if you don’t have books to practice with at home. There may be no better way to impact children’s overall futures than by making sure they have a steady supply of quality books to read in their homes. And in the long run, it’s cheap. It costs less than $160 to provide a child with 60 books from Dolly Parton’s Imagination Library and 8 – 10 books from Reach Out and Read. That’s less than the MMR/Varicella vaccine.11 More than 90% of U.S. children are inoculated against those two diseases.12 If we could inoculate children against illiteracy, would we? Because we can. 13

REFERENCES 1. Neuman, S. B., & Celano, D. (2001). Access to print in lowincome and middle‐income communities: An ecological study of four neighborhoods. Reading Research Quarterly, 36(1), 8–26. https://doi.org/10.1598/RRQ.36.1.1 2. Dolly Parton’s Imagination Library. (n.d.). About. Retrieved from https://dollyparton.com/imagination-library 3. Reach out and Read. (2020, March 04). About. Retrieved July 31, 2020, from https://www.reachoutandread.org/about/ 4. Elley, W. B. (2000). The potential of book floods for raising literacy levels. International Review of Education, 46(3/4), 233–255. https://doi.org/10.1023/A:1004086618679 5. Jacobs, T. (2018, October 8). Home libraries confer long-term benefits. Pacific Standard. Retrieved from https://psmag.com/education/home-libraries-confer-long-term-benefits 6. Robb, A. (2014, June 24). Does it matter what you read to your baby? The New Republic. Retrieved from https://newrepublic.com/article/118361/what-should-you-read-yourbaby-does-it-matter 7. Theriot, J. A., Franco, S. M., Sisson, B. A., Metcalf, S. C., Kennedy, M. A., & Bada, H. S. (2003, March). The impact of early literacy guidance on language skills of 3-year-olds. Clinical Pediatrics, 42(2), 165–172. https://doi.org/10.1177/000992280304200211

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8. Dewalt, D., & Pignone, M. (2005, August 01). The role of literacy in health and health care. Retrieved from https://www.aafp.org/afp/2005/0801/p387.html 9. Rea, A. (2020, April 29). How Serious Is America’s Literacy Problem? Library Journal. Retrieved from: https://www.libraryjournal.com/?detailStory=How-Serious-IsAmericas-Literacy-Problem 10. Kindergarten readiness and later achievement: a longitudinal study in Alameda County [Scholarly project]. (2018). In ASR. Retrieved from https://www.appliedsurveyresearch.org/ 11. FastStats - Immunization. (2017, March 17). Retrieved July 31, 2020, from https://www.cdc.gov/nchs/fastats/immunize.htm 12. Vaccine Price List, C. D. C. (2020, July 01). Retrieved from https://www.cdc.gov/vaccines/programs/vfc/awardees/vaccinemanagement/price-list/index.html

Delaware Public Libraries in the Forefront of Health Initiatives Mary Grace Flaherty, Ph.D., M.L.S., M.S. Associate Professor, School of Information and Library Science, University of North Carolina at Chapel Hill

University of North Carolina at Chapel Hill, School of Information and Library Science Public libraries are increasingly becoming recognized as community organizations that can and do help support community health and well-being. For example, in 2018, the monthly newsletter from the American Public Health Association, Nation’s Health, highlighted public libraries as important community health partners, stating: “people are more likely to visit their library than a doctor.”1 Research has shown that public libraries are serving as community level resources for advancing population health, as they have extensive geographic reach, and are widely trusted by community members.2 Delaware has been in the forefront of this shift in service provision in the public library setting. In 2004, an innovative model of collaboration was employed in a statewide initiative to provide consumer health information. The state library organization, the Delaware Division of Libraries, and the Delaware Academy of Medicine, a private, nonprofit health information delivery organization teamed up to disseminate consumer health information to all state residents. The project began with the recruitment of consumer health librarians, who were hired by the Delaware Academy of Medicine, and embedded in public libraries in each of the three counties in the state. Funding for the positions was initially provided through the state’s tobacco money settlement.3

16 Delaware Journal of Public Health – September 2020

The embedded librarians provided health reference training and support to public library staff throughout Delaware. They were involved in a wide variety of services, such as assistance with collection development and resource evaluation, confidential reference services, outreach and education, health programming, and participation in local and regional health fairs. They also collaborated with other public health providers and agencies.4 For example, for children’s summer programming, the consumer health librarian arranged for children to grow fruits and vegetables in the community garden adjacent to the library, and then hosted a public health nutritionist to join them for a presentation on preparing healthy snacks. Each of the three embedded librarians had a “circuit,” where they regularly travelled to all of the libraries throughout the county where they were assigned, offering workshops and guidance on consumer health information provision and health promotion activities. Over the course of the initiative, they addressed approximately 300-600 health reference queries per year; this amounts to one to three questions per day for each of the three embedded librarians.5 The initiative continued until 2009, when it was phased out due to fiscal constraints. In 2012, an effort to explore any residual effect of the embedded librarians took place, using unobtrusive reference visits, a process where service is assessed by the researcher

posing as a library patron. Researchers visited approximately half of the libraries throughout the state (15 of 32), and posed the following question to library staff: “I’d like to know: do vaccines cause autism?” In close to two-thirds of Delaware library visits (67%), public library staff provided authoritative health information resources (defined as accurate, timely, and consistent with current medical literature and findings) to address the question, and in the majority of cases, they referred to an online health resource (i.e. cdc.gov or the National Library of Medicine’s consumer health resource, MedlinePlus) to address the query.5 A similar study conducted at the same time with the same protocol in upstate New York libraries, where no such statewide effort took place, found authoritative resource provision in only one in three reference encounters.6 Further findings using the same unobtrusive reference approach throughout North Carolina were similar to those in New York; in two-thirds of cases, authoritative health information was not provided.7 It is difficult to directly attribute the difference in responses to the effect of the embedded consumer health librarians, as there were no baseline measures in place. But it does appear that the collaborative effort with embedded librarians may have had a positive effect on health information provision, especially when compared to other states. A very small percentage of public libraries have the wherewithal to fund expansive efforts or a dedicated consumer health resource center.8 Thus, as with many consumer health center initiatives that have taken place in public libraries, the Delaware statewide program was funded through external grants, a model which makes sustainability at such a level difficult. It may very well be, however, that the embedded librarians left a lasting mark in terms of organizational culture, staff mindsets, and expectations for how staff approached health reference services, leaving Delaware library staff and patrons better informed and equipped in the health information arena as a lasting result.

REFERENCES 1. Wahowiak, L. (2018) Libraries, public health work together on community health: Settings serve as community hubs. Nation’s Health, October. Retrieved from: http://thenationshealth.aphapublications.org/content/48/8/1.2 2. Philbin, M. M., Parker, C. M., Flaherty, M. G., & Hirsch, J. S. (2019, February). Public libraries: A communitylevel resource to advance population health. Journal of Community Health, 44(1), 192–199. https://doi.org/10.1007/s10900-018-0547-4 3. Delaware Division of Libraries. (n.d.). Consumer health information services: Best practices in libraries report. Retrieved from: https://libraries.delaware.gov/wp-content/uploads/ sites/123/2016/09/ConsumerHealthBestracticesPublicLibraries.pdf 4. Flaherty, M. G. (2018). Promoting individual and community at the library. Chicago: American Library Association, 27-28. 5. Flaherty, M. G., & Grier, P. J. (2014). Statewide initiative to embed consumer health librarians in public libraries: A case study. Public Library Quarterly, 33(4), 296–303. https://doi.org/10.1080/01616846.2014.970109 6. Flaherty, M. G. (2013). Consumer health information provision in rural libraries: A comparison of two library systems. The Library Quarterly, 83(2), 155–165. https://doi.org/10.1086/669548 7. Flaherty, M. G. (2016). From Google to MedlinePlus: The wide range of authoritative health information provision in public libraries. Library & Information Science Research, 38(2), 101–107. https://doi.org/10.1016/j.lisr.2016.04.001 8. Chobot, M.C. (2003). Health information outreach: case studies from a field test at eight public libraries. AAAS Healthy People Library Project Report, 4-30.

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18 Delaware Journal of Public Health – September 2020

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Delaware Department of Health and Social Services Library Profile Anne Hiller Clark, M.S., L.I.S., M.S. Director of Library and Information Services, DHSS Library

Today the Delaware Department of Health and Social Services (DHSS) Library provides virtual access to scholarly and professional information for Department employees 24 hours a day. During business hours the three librarians connect DHSS employees with ideas, information, and innovative programming to empower all to provide quality services to Delawareans. They also support the public’s health information needs through reference assistance, access to the print collection and library programs. Until 2015, the unit was a medical library serving the information needs of doctors, nurses, researchers and other employees of the Division of Substance Abuse and Mental Health, the Delaware Psychiatric Center and their predecessor organizations. In 2016, following a brief closure and a Department-wide needs assessment, the Secretary expanded the library’s scope to include all eleven divisions of DHSS and the public. The mission of DHSS is to improve the quality of life for Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations. The DHSS Library supports all aspects of the mission.

WHY EXPAND THE LIBRARY’S SCOPE? To better understand the information needs of DHSS and generate stakeholder buy-in, a needs assessment was undertaken in 2015 in cooperation with the Delaware Division of Libraries. The joint needs assessment inquired about gaps in existing information services and resources, priorities for services and resources needed by employees and the level of department interest in these services and resources. Response to the survey was high, with 797 responses from approximately 4,300 employees. The Divisions of Social Services, Substance Abuse and Mental Health, and Public Health provided the most responses. The needs assessment found that DHSS staff routinely require information that is not readily available on the internet. They depend upon access to reliable, authoritative resources to fulfill their job responsibilities and provide quality care to Delaware residents. Some employees were purchasing individual books and subscriptions to meet their own needs, but that approach did not meet the Department’s needs. Topics of interest included: behavioral health, social work, mental health, public health, management training, case management, leadership, policy, administration, data management and wellness. These areas continue to guide our activities. Specific services and resources desired included: • Desktop access to online library resources; • Access to computers and quiet study spaces; • Training materials, eBooks, online peer-reviewed articles, print books, journals and trade publications, patienteducation sheets, evidence based clinical decision-making tools, clinical assessment tools, and point of care guides; 20 Delaware Journal of Public Health – September 2020

• Guides to suggested websites, electronic resources and library materials; and • Virtual reference services. Division directors also desired the library to: • Provide current, quality information to contribute to evidence-based outcomes, supported by standards of care; • Contribute to employees’ professional growth and development; • Help employees increase their information literacy; and • Foster interagency collaboration among DHSS and community partners, for example work with the Delaware Division of Libraries.

RESPONDING TO THE NEEDS ASSESSMENT, 2016 - PRESENT Most of the items brought out by the needs assessment were addressed after the results were gathered. The directions set at that time continue to guide the library’s activities today. One-click access to the library’s website and electronic resources is through a desktop icon on all DHSS computers. Remote access to electronic resources for employees working off-site is available upon request. Since 2016, DHSS employees have accessed library resources, services and librarians tens of thousands of times. Thousands of electronic journals, eBooks and other professional materials form the majority of the library’s collections so employees throughout the state can easily use them. Current materials are routinely added, keeping collections up to date and relevant. Books and DVDs are added to the collection through purchases and donations. These items can be borrowed by employees and the public. Librarians regularly create electronic guides to information resources and subjects of interest and connect with users through newsletters and blog posts. Research and reference assistance through email, phone and in-person meetings help employees complete job responsibilities and provide quality care to Delawareans. Collaboration with other organizations inside and outside of the Department strengthens the resources and services the DHSS Library provides. Work with partners inside the Department such as the Divisions of Public Health and Substance Abuse and Mental Health ensures that the library provides resources they need and helps the library reach potential users. The library borrows journal articles for employees from other medical libraries through a reciprocal lending program through the National Library of Medicine. Participation in the Delaware Library Consortium and work with the Delaware Division of Libraries make the library’s book collection available to the public and supports other library activities. Training and programming are another way the library meets the needs assessment desires. Librarians developed a range of

programs and training offerings over the last four years. One with a large public health focus is the annual DHSS Research, Innovation and Humanity Day. This judged poster session event, coordinated by the library, brings Department employees together to share recent projects and network with colleagues. The library’s physical location was remodeled in 2015-16 to include shared computers, Wi-Fi, group and individual study areas, and a computer training lab, as well as providing greater access to the book and journal collections. Members of the public can find the DHSS Library’s books in the Delaware Library Catalog and borrow them through their local public library. Librarians also provide answers to health-related questions through email, phone and the Ask-A-Librarian DE service. Plans for a new needs assessment are in development.

PANDEMIC RESPONSE Since much of the DHSS Library’s collection was already electronic, pivoting to all-virtual services when the COVID-19 pandemic began was easier for the library than for some other DHSS units. Electronic outreach about library resources and services increased to raise employee awareness, and to share how remote access to the library’s electronic resources could be arranged. Librarians built an online information hub to provide DHSS employees, managers and supervisors with forms, links and other information needed as many employees transitioned to telework during the State of Emergency. Librarians also built an extensive webpage gathering links to

COVID-19 research portals from scientific journal publishers, government agencies, universities and others and publicized these through the library community. Visits to the library’s website and use of electronic resources, especially the pages described above, jumped dramatically in March and April 2020.

CONTACTING THE DHSS LIBRARY The DHSS Library is found online at https://guides.lib.de.us/ dhsslibrary. Librarians can be reached at dhsslibrary@delaware.gov, (302) 255-2789. The library is in the Springer Building on the DHSS Herman Holloway campus, 1901 N. DuPont Highway, New Castle, DE. As of August 2020, the physical site is temporarily closed during the COVID-19 pandemic. 21

Community Partner Support Unit Introduction Natalie Christopher Communications Coordinator, Community Partner Support Unit (CPSU), Delaware Department of Health and Social Services

Jonaye Anderson Library Supervisor, Community Partner Support Unit, Delaware Department of Health and Social Services

The Community Partner Support Unit (CPSU) is a subdivision of the Delaware Department of Health and Social Services (DHSS) that helps increase access to social services and promotes self-sufficiency by providing ongoing, personalized support to organizations that serve those in need. The CPSU uses a network of more than 250 community and business partners to connect their clients to employment opportunities and other crucial benefits and services. The CPSU’s goal is to strengthen the connection between underserved clients in the community and the partners who serve them. Some of the teams under the CPSU include Transportation, Re-Entry, Workforce Development, and a partnership with the libraries. Case workers, social workers, and many others work together at various service centers and libraries across the State of Delaware to provide access to resources and services for all Delawareans.

through the internet. Case workers, social workers, and library staff have gradually begun allowing in-person services as well with necessary COVID 19 protection. Additionally, staff is continuing to contact their community partners to see if they are open and offering additional resources due to the pandemic. The libraries and CPSU overall will continue to aid those in need and persevere through the pandemic to provide services and resources to all in Delaware.

CPSU PROVIDES SPECIAL SERVICES DURING COVID 19 PANDEMIC The CPSU has shifted gears to helping those in need during the pandemic in unique ways. Meals and supplies from the Food Bank of Delaware and DHSS Campus Café are delivered to community members every day, as well as personal protective equipment (PPE) and hygiene boxes. CPSU South, in conjunction with the libraries, has been helping distribute food from Food Bank Mobile Food Pantries. They have also made phone calls to set up appointments for families to receive grocery store gift cards courtesy of the Mana from Heaven Food Project. CPSU South and the libraries continue to provide services through online appointments, phone calls, and teleconferencing

22 Delaware Journal of Public Health – September 2020

CPSU CASE MANAGER CLIENT SUCCESS STORY One of the CPSU’s main missions is to assist clients in improving their way of life by overcoming barriers that would hinder them from becoming self-sufficient. The team recently had an individual come into the Porter State Service Center seeking resources regarding employment. She was greeted by Mr. Michael Colden, a Case Manager for the Golden Ticket Team, whom sat down with her to discuss viable employment options. Mr. Colden assessed the individual’s skill sets and recommended her for a position with the state. As a result, she was interviewed and hired as a case manager at the Maryland Avenue Resource Center (MARC). She complimented Mr. Colden on his professionalism, willingness to help, and commented that “he is a special one!” She also stated she is grateful for this opportunity, is excited to begin her new adventure, and is looking forward to helping the CPSU’s clients. This is one of the many recent successes that have been made possible by the hard-working case managers, social workers, and CPSU staff that continue to provide service through the COVID 19 pandemic.

Libraries as Public Health Partners in Times of Crisis Pat Young

Staff Member, South Coastal Library, Bethany Beach; Chair, Delaware Libraries and Disasters Initiative (DLDI) Libraries have a long and positive relationship with their users. As far back as the mid-1800s citizens in the United States have turned to libraries for information, entertainment, and physical, mental, and social development and support. Libraries are generally held in high esteem by those who access the myriad resources offered there. In addition to the print and e-resources of modern times, staff members are valued as important resources by library users as well. Along with providing a broad range of services and resources, libraries are also seen as trustworthy and as credible sources of information. For example, a recent survey conducted by the Pew Research Center indicated that “about eight-in-ten adults (78%) feel that public libraries help them find information that is trustworthy and reliable.”1 As a result, libraries are well positioned to play a key role in addressing and supporting emergency and disaster preparedness, response, and recovery within the communities that they serve. One of the ways in which libraries can actively support effective public preparedness is to disseminate public health information. Libraries have become very adept at leveraging many different tools and channels to communicate with their patrons including Web sites, social media apps and tools, print and e-newsletters, and even creative signage within and around their facilities. Libraries use all of these tools and resources to communicate important preparedness information such as creating an emergency evacuation, or, “go” kits, how to develop a family evacuation plan, and what information resources can be trusted during emergencies, to name a few. Libraries have a long history of dispelling myths and promoting the truth in an unbiased way. As a result, libraries can serve as effective collaborators in disseminating truthful information on any number of topics, including such public health subjects as safe public interaction during viral outbreaks and how to safely return to disaster impacted areas and homes. The current coronavirus pandemic is an excellent example of how libraries in general, and especially public libraries, can support community wellness and wellbeing. When positive cases of COVID-19 began to climb back in March of this year public libraries where temporarily shuttered like so many other entities. Only in mid-June did public library staff begin to return to their buildings. However, upon their return, staff quickly adapted many of the programs and services that they had provided in the past to continue serving their patrons while additionally doing everything possible to ensure patron and staff safety. 24 Delaware Journal of Public Health – September 2020

Throughout the time that libraries were closed, many staff members were diligently working from home to provide patron access to critical information and updates regarding the pandemic using pre-existing Web sites and social media accounts. As the pandemic continued to unfold, staff turned to Web based platforms such as Zoom to offer virtual programming focused on pandemic related information, and highlighting ways in which the public could continue to stay healthy and well while limiting the virus’ spread. But libraries did not limit themselves to providing these critical resources. Their focus has also included supporting good mental health. One of the most evident public health concerns resulting from the current coronavirus pandemic is a significantly increased level of stress. As a recent article published in the New England Journal of Medicine points out, current major stressors such as lack of routine, economic concerns, conflicting guidance from authority sources, and mandated public health measures that are unfamiliar will undoubtedly “contribute to widespread emotional distress…associated with COVID-19.”2 Libraries have long been a mental and emotional sanctuary for many users. Patrons often seek out their local library to connect with others through activities and programs, to tap into staff expertise on a wide range of subjects, or simply to take a break from life’s often hectic pace by finding a comfortable spot to read. During times of elevated stress such as the current pandemic, libraries have been able to continue offering a mental and emotional haven in new and creative ways.

Examples include: • Providing programming that provides patrons with essential social and mental diversions such as virtual art classes, virtual story times for children, virtual book discussion groups, and similar activities; • Providing access to reading material that serves as a mental diversion or break from current stressful situations; • Providing physically safe activities in outdoor spaces to engage patrons of all ages such as window scavenger hunts; • Providing informational resources that help enable patrons impacted by public health crises, emergencies, and disasters to be resilient; These programs can engage patrons and help support their desire to stay fulfilled and productive during stay-at-home ordered periods in healthful ways. In addition, libraries are making every effort to provide elements of “normal” library use as it was experienced prior to the current pandemic. For example, the library-based statewide Summer Reading Program is taking place just as it has for over forty years. And although some elements are slightly different – participation is completely online, goals are focused on total time spent reading rather than total number of books read (due to patrons possibly having more limited access to books) – participating in the program enables patrons to feel that this summer is at least somewhat more similar to past virus-free summers. Recovering from emergencies or catastrophic events can be extremely challenging and is critically important to sound mental health. Resilience – the ability to face and overcome traumatic experiences – is an essential skill in recovering well and resilience is more easily fostered and developed through social contacts and in social settings. Since libraries are inherently social places, they can serve as vital resources during this stage for their patrons as well. One of the many functions libraries serve during non-crisis times is as a physical place for people to gather to enjoy common experiences. In post-crisis times, libraries can provide gathering spaces for people who have shared a common crisis to work through their collective experience together. Also, often members of the public may find themselves without reliable Internet access in the wake of a disaster. This can cause additional stress because many critical resources are available exclusively online. Such examples might include key forms and documents necessary for FEMA financial assistance or necessary insurance forms and documents. Libraries can fill this overwhelming void by providing free public computer access. In addition, libraries can offer safe, comfortable spaces for those impacted by disasters to meet with representatives from organizations that can facilitate their recovery.

ways in which libraries can assist their users and communities in being better prepared and better able to respond to and recover from various types of emergencies and disasters. Over time and as a result of the initial summit, the Delaware Libraries and Disasters Initiative (DLDI) developed. Currently the DLDI hosts a quarterly Roundtable meeting of library staff, emergency managers, and representatives from other interested organizations to exchange ideas and resources. Through this exchange, libraries can continue to develop and foster partnerships that will support and enhance patrons’ abilities to be as prepared as possible for different types of crises, including pandemics and natural disasters. In addition, the DLDI Roundtable provides an important opportunity to broaden the perspective of all involved when considering critical and unique ways that libraries can collaborate effectively with emergency managers and others.

Pat Young can be reached at patricia.young@sussexcountyde.gov

REFERENCES 1. Geiger, A. W. (2017, Aug). Most Americans – especially Millennials – say libraries can help them find reliable, trustworthy information. Retrieved from https://www.pewresearch.org/fact-tank/2017/08/30/most-americansespecially-millennials-say-libraries-can-help-them-find-reliabletrustworthy-information/ 2. Pfefferbaum, B., & North, C. S. (2020, August 6). Mental health and the Covid-19 pandemic. The New England Journal of Medicine, 383(6), 510–512. https://doi.org/10.1056/NEJMp2008017

To better enable libraries to serve as partners in emergency and disaster preparedness, response, and recovery, the Delaware Libraries and Disasters summit was held in 2017. This event brought together library staff members, first responders, disaster planning experts and others to discuss, explore and consider 25

Key Strategic Partnerships Create Greater Impact and Build More Resilient Communities! Peggy Geisler, PMG Consulting

The Sussex County Health Coalition has been in existence for over 15 years in Sussex County, Delaware. With over 175 member organizations and over 400 members who support the work we do, we understand and value partnership.1 Our mission is to “engage the entire community in collaborative family-focused effort to improve the health of children, youth, and families in Sussex County.”1 This is no easy undertaking given that Sussex County, Delaware is the one of the largest rural counties east of the Mississippi.2 Sussex County hosts a high rate of children living at or below the poverty level and has a limited pipeline of workforce opportunities that provide a livable wage. When this is coupled with significant provider shortages in key health and wellness areas, social and health issues become prevalent. These large-scale public health and social problems are best addressed through strategic partnerships and shared resourcing. The Delaware Division of Libraries is one of the main strategic partnerships that allows the SCHC to make progress on reducing these major social and health issues. The Sussex County Health Coalition is extremely grateful for the ability to partner with several anchor institutions in Sussex County. However, most do not have the extensive reach, resources, and place-based services as compared to libraries in helping build a more resilient community. Public libraries provide to our organization and our partners a trusted community-based venue in which a citizen can access information and support both in person and virtually. The local libraries in our state and across the nation have become the go-to community centers through their open and inclusive approach and have elevated community services and supports as a top priority. The ways in which the library has provided us – and our partners – support includes: information dissemination, public education, family support services, workforce training, individual growth, and partner support. Our organization has utilized the reach of the libraries in Sussex County to inform the public on upcoming webinars, screenings, food distributions and community activities. They have also provided us with meeting space to offer classes through our partners on nutrition, diabetes, stress reduction, child development, addiction, grief and more. In addition, they are working alongside of us and many others to ensure literacy for young children and adults through Dolly Parton’s Imagination Library and Literacy Delaware, respectively.3 The libraries bridge social isolation amongst our community’s elderly along with establishing support groups for others seeking connection on a myriad of issues. During Covid-19, the libraries stepped up to ensure many of our residents have access to the internet, making every location a virtual hub. Libraries offer a partnership opportunity that is timely, responsive, engaged and directive; this is directly aligned with the mission of the SCHC which recognizes the importance of partnership and collaboration. Population health is complex with a myriad of social determinants that contribute to poor health outcomes. SCHC alongside our partner, Delaware Libraries, are on the front lines deploying the resources directly to our citizens and our collaborative partners who seek their support. The library system reaches over 1,000,000 26 Delaware Journal of Public Health – September 2020

people in our state which aids to combat these negative health outcomes and, in turn, generate positive social and health results.3 SCHC will continue to link partners into our local libraries and align our work alongside of them. We would recommend that other organizational partners engage the library system in their work as well. Utilizing larger systems like SCHC and the library partnership can help your organization deliver your services to broader populations more efficiently.

“Creating impact takes many hands pulling together in the same direction on the same lines.” I would argue the Delaware Library Consortium in and of itself is a collective impact model. This creates a system that any organization can participate in which adds to greater social impact for our citizens and their community. Look to your local library to address social determinants of health issues and find real world solutions for our communities in real time. Delaware libraries are more than checking out a book, it is about helping to support and nurture lives.

REFERENCES 1.

Sussex County Health Coalition. (2019). About us. Retrieved from https://www.sussexcoalition.org/schc/about-us/

U.S. Census Bureau. (2019). QuickFacts: Sussex County, Delaware. Retrieved from: https://www.census.gov/quickfacts/sussexcountydelaware

Division of Libraries. (2020, August 19). About. Retrieved from https://libraries.delaware.gov/about-libraries/

The DPH Bulletin

From the Delaware Division of Public Health

●

Vector-borne illnesses issue - August 2020

Outsmart mosquitoes with yard tactics

Delaware’s freshwater and saltwater mosquito species can carry dangerous diseases such as Eastern Equine Encephalitis and West Nile virus. By making your Aedes aegypti yard unwelcoming to mosquitoes, you will reduce the chances of becoming ill from mosquito bites. Mosquitoes lay their eggs in standing water. The Centers for Disease Control and Prevention (CDC) recommends a weekly effort to empty and scrub, turn over, or throw out objects that hold water. Mosquitoes breed in birdbaths, air-conditioner trays, flowerpot saucers, toys, animal dishes, clogged gutters, and storm drains. Litter, used tires, and discarded appliances also catch rainwater. To further prevent mosquito bites, the CDC advises: ● Stay in places with air-conditioning or window

and door screens.

● Wear long sleeves and pants when weather

permits.

● Use insect repellent with ingredients registered by

the Environmental Protection Agency (EPA) such as DEET, picaridin, or lemon or eucalyptus oils on exposed skin and/or clothing. Use Permethrin on clothing only. Follow product instructions. When using sunscreen, apply it before insect repellent. Use the EPA’s insect repellent search tool: https://www.epa.gov/insect-repellents/findrepellent-right-you

● Mow lawns and trim vegetation regularly to reduce

the places where adult mosquitoes rest. Use an outdoor insect spray made to kill mosquitoes in dark, humid areas like under patio furniture.

● Store buckets, wheelbarrows, and children’s

wading pools upside down. Drill holes in tire swings so water drains out.

For more information about preventing mosquitoes, visit the Delaware Mosquito Control Section at https://dnrec.alpha.delaware.gov/fishwildlife/mosquito-control/mosquito-borne-diseases/.

Mosquito-borne diseases West Nile virus (WNV) is the most common mosquito-borne disease in Delaware and the United States. WNV symptoms appear three to 14 days after being bitten by an infected mosquito. Symptoms are fever, headache, body aches, joint pains, vomiting, and diarrhea, sometimes with a rash. Symptoms of severe infections are high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness, and paralysis. See your health care provider if symptoms develop. Eastern equine encephalitis virus (EEEV) is a rare, sometimes fatal, cause of brain infections caused by the bite of infected mosquitoes. EEEV can be found in Delaware. Symptoms of infection are fever, chills, listlessness, and joint or muscle pain. In severe cases, symptoms are the sudden onset of fever, headache, vomiting, diarrhea, seizures, behavioral changes, drowsiness, and coma. EEEV can result in encephalitis (swelling of the brain) or meningitis (swelling of the membranes that surround the brain and spinal cord) and can have long-lasting health effects. Immediately see your health care provider if symptoms develop. Unvaccinated horses can die from EEEV. There is no EEEV vaccine for humans. Zika virus is spread mostly by the bite of an infected Aedes species mosquito (Ae. aegypti and Ae. albopictus). Zika infection during pregnancy can cause microcephaly (small heads) and other birth defects. No local mosquito-borne Zika virus transmission was reported in the continental United States in 2018 and 2019. Those traveling outside the continental United States should review the CDC’s Zika Travel Information.

Prevent Lyme disease Lyme disease, the most common tickborne disease in Delaware, is caused by bites from the blacklegged or deer tick. It usually takes 24 to 36 hours of attachment for a tick to transmit bacteria that cause disease.

BLAST Lyme disease

Bathe or shower within two hours of coming indoors.

Look for ticks on your body and remove Adult female Black-legged or deer tick.

Lyme disease symptoms include an expanding red, “bull’s-eye” rash, fever CDC photo. and chills, fatigue, severe headaches, muscle and joint aches, heart palpitations, dizziness, and Bell’s palsy (when facial muscles temporarily droop on one side). There may also be severe joint pain and swelling, particularly affecting the knees; and neck stiffness due to meningitis. Untreated infections can lead to chronic joint, heart, and neurological problems. Those bitten by a tick who develop symptoms should immediately contact a A “bull’s-eye” rash physician. Oral antibiotics cure often accompanies Lyme disease. CDC most cases.

them. Check head and body hair, under the arms, in and around the ears, inside the belly button, and behind the knees.

Apply repellent to your body and clothes.

Safeguard your yard. Treat your pet. Adapted from the Ridgefield, Connecticut, BLAST Program (used with permission).

Providers: Access a free CDC course on tickborne diseases and other resources at https://dhss.delaware.gov/dhss/dph/epi/lyme.html.

photo.

The Division of Public Health (DPH) recommends taking these precautions: ● Apply tick repellent (containing less than 50

percent DEET for adults and less than 30 percent DEET for children) to the skin. Do not use repellents with DEET on infants younger than two months old. Use repellents with permethrin on shoes and clothing only.

● Wear light-colored clothing, long sleeves, and

long pants tucked into socks.

● Avoid walking in wooded and brushy areas with

high grass and leaf litter.

● Search for and remove ticks on yourself, your

children, and pets after coming indoors.

For more information, visit the CDC at https://www.cdc.gov/ticks/index.html and DPH at dhss.delaware.gov/dhss/dph/epi/lyme.html.

Landscaping tips for less ticks

How to properly remove a tick Use fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible. 1. Pull upward with steady, even pressure to avoid having its mouth-parts break off and remain in the skin. If this happens, try to remove the mouth-parts with tweezers. 2. After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol or soap and water. 3. Never crush a tick with your fingers. Dispose of a live tick by putting it in alcohol, placing it in a sealed bag/container, wrapping it tightly in tape, or flushing it down the toilet. Do not coat the tick with nail polish or petroleum jelly or use heat to make the tick detach.

● Mow lawns and remove leaf litter. ● Use plantings that do not attract deer or fence the yard to exclude deer. Adult ticks feed on deer. ● Create a three-foot or wider wood chip, mulch, or gravel barrier between the lawn and woods.

The DPH Bulletin – August 2020 28 Delaware Journal of Public Health – September 2020

Page 2 of 3

Dogs need protection against bites from fleas, ticks, and mosquitoes

Other ticks can cause serious illness

Delaware’s second most common tick-borne disease is Rocky Mountain Spotted Fever, carried by the American dog tick.

Adult female

Symptoms are high fever, severe American dog tick. CDC photo. headache, malaise, myalgia, edema around eyes and on the back of hands, and gastrointestinal illness. A small, flat, pink, non-itchy spotted rash initially appears on the wrists, forearms, and ankles, then spreads to the trunk and sometimes the palms and soles. If a red to purple petechiae rash develops, seek urgent medical care, as severe disease can lead to amputation, coma, and death. A white dot or “lone star” on the backs of adult females distinguishes the Lone Star tick. This tick, which is found in Delaware, aggressively bites people and pets. The Lone Star and blacklegged tick carry Ehrlichiosis, a group of diseases. Symptoms are fever, chills, severe headache, muscle aches, Adult female Lone nausea, vomiting, diarrhea, loss Star tick. CDC of appetite, confusion, and a rash photo. of red splotches or pinpoint dots. If antibiotic treatment is delayed, late stage ehrlichiosis can cause meningoencephalitis, (inflammation of the brain and surrounding tissue), uncontrolled bleeding, respiratory failure, and death. Persons bitten by Lone Star ticks have reported allergic reactions associated with the consumption of red meat, called Alpha-Gal Allergy.

Fleas, ticks, and mosquitoes carry diseases that are harmful to pets as well as to people. When fleas and ticks ride into your house on the fur of your pets, they are putting your family at risk for Lyme disease, tapeworms, plague, and other illnesses. The Centers for Disease Control and Prevention (CDC) recommends that dogs be given a tick preventive product after consulting with your veterinarian. A tick preventive product is medicine that a dog takes orally, or which is applied to the dog’s skin. Some products kill both ticks and fleas. Since cats are extremely sensitive to chemicals, do not apply any tick prevention products to cats without asking your veterinarian. Check pets daily for ticks, especially after being outside. Use fine-tipped tweezers and not your fingers to carefully remove ticks. Discard by wrapping them tightly in tape or flushing them down the toilet. Clean the bite area and your hands with rubbing alcohol or soap and water. Mosquitoes carry heartworms which can develop into foot-long worms that infest the heart and clog up major vessels in the lungs. According to the American Veterinary Medical Association (AVMA), heartworm disease is a progressive, life-threatening that is nearly 100 percent preventable with heartworm preventive products. For more AVMA pet care tips, visit https://www.avma.org/resources-tools/petowners/petcare. Talk to your veterinarian if your dog or cat shows any signs of illness.

Asian Longhorned ticks were first reported in the U.S. in 2017 and have been found in Delaware, according to the CDC. In other countries, their bites caused serious illness in people and animals. Researchers continue to investigate this species’ ability to transmit disease.

If you find an Asian Longhorned tick, carefully remove it and save it in in a jar or a plastic bag containing rubbing alcohol. Watch carefully for symptoms such as fever and chills, aches and pains, and a rash. If symptoms develop, visit your provider and take the tick with you.

Adult female Asian Longhorned tick. CDC photo.

For more information, visit https://www.cdc.gov/ticks/longhorned-tick/index.html.

The DPH Bulletin – August 2020

Page 3 of 3 29

Institute Institute forfor Public Public Administration Administration June June 2020 2020

Mapping MappingDelawarean’s Delawarean’sBasic BasicNeeds: Needs: Asset Asset Mapping Mapping Shows Shows Need Need and and Opportunity Opportunity forfor Streamlined Streamlined Service Service Provision Provision

introduction introd uction ThisThis briefbrief is theis culmination the culmination of the of Institute the Institute for Public for Public Administration’s Administration’s workwork withwith the Delaware the Delaware Manufacturing Manufacturing Extension Extension Partnership. Partnership. Prepared Prepared for the for Delaware the Delaware Division Division of of Libraries Libraries (DDL), (DDL), this this briefbrief begins begins by describing by describing the current the current process process to accessing to accessing social social services services in Delaware, in Delaware, the barriers the barriers for accessing for accessing services, services, and and recommendations recommendations to streamline to streamline service service provision. provision. ThisThis workwork was was completed completed through through the lens the lens of of Delaware Delaware librarians, librarians, whowho serveserve as liaisons as liaisons between between the general the general public public and and the social the social services services theythey seek.seek. The The briefbrief is meant is meant to to update update partner partner organizations organizations on the on current the current workwork of Delaware of Delaware Libraries Libraries and and seekseek out partners’ out partners’ engagement engagement moving moving forward. forward. Delaware Delaware is a small is a small statestate withwith a high a high degree degree of connectivity of connectivity between between people; people; yet, many yet, many Delawareans Delawareans struggle struggle to find to find the the services services theythey need.need. Delaware Delaware public public libraries libraries are on arethe on front the front lineslines of this of this struggle struggle everyevery day. day. In addition In addition to providing to providing books books and and Internet Internet access, access, Delaware’s Delaware’s library library system system is also is also the social the social infrastructure infrastructure that that connects connects customers customers to applications to applications for for unemployment, unemployment, jobs,jobs, housing, housing, and and more. more. Seeing Seeing the difficulty the difficulty Delawareans Delawareans face face whenwhen trying trying to find to find and and request request services, services, the Delaware the Delaware Division Division of Libraries of Libraries seeksseeks to connect to connect all ofallthe of the current, current, statewide statewide efforts efforts to streamline to streamline the access the access to services. to services.

Authors Authors Prepared Prepared by by Institute Institute for Public for Public Administration Administration Leann Leann Moore Moore Assistant Assistant Policy Policy Scientist Scientist Dabney Dabney Brice Brice Graduate Graduate Public Public Administration Administration Fellow Fellow KellyKelly Sherretz Sherretz Policy Policy Scientist Scientist In coordination In coordination withwith Delaware Delaware Manufacturing Manufacturing Extension Extension Partnership Partnership LisaLisa Weis Weis Enterprise Enterprise Excellence Excellence Leader Leader Sponsored Sponsored by by Delaware Delaware Division Division of Libraries of Libraries Annie Annie Norman Norman State State Librarian Librarian AltaAlta Porterfield Porterfield Statewide Statewide Social Social Innovator Innovator

30 Delaware Journal of Public Health – September 2020

Connecting to Services A team of DDL Social Innovators and AmeriCorps VISTAs worked with Delaware public libraries to develop connections and services for people in need. Over a decade, stories of those that they served were collected. After analyzing these stories, specific needs and patterns were identified and sorted based on prevalence. These basic-needs categories focus on the lower levels of Maslow’s Hierarchy of Needs, such as food and shelter, and social determinants of health, which include aspects of an individual’s social, physical, and built environments, as well as their access to health services. The initial analysis confirmed that there is a sequence to addressing needs and providing a stable foundation for people to move forward. Using their professional information management expertise, DDL created a taxonomy to organize the resources available to meet these basic needs. In partnership with the University of Delaware’s Institute for Public Administration (IPA) and the Delaware

Manufacturing Extension Partnership, DDL mapped the needs of those experiencing a crisis, current providers, and services in place to address the crises.

Mapping Community Assets Mapping is a tool that relies on a core belief in assetbased community development. Communities offer needed services—assets—that should be highlighted and encouraged. An asset map is created by identifying available community resources, which can be physical, financial, human, or organizational. Overall, asset mapping provides better insights into the location and distribution of services in present time. An asset map can take a variety of forms. It can be an actual map, which shows the location, services, programs, and other assets. It also can be a list of programs delineated by category. Furthermore, a map can be based on the need or desire of the community and/or stakeholder group.

Provider

Needs

State Service

Basic Needs Chart Developed by the Delaware Division of Libraries

Food/Nutrition

Shelter/Housing

Clothing/Hygiene

Health/Mental Health

Delaware Health and Social Services (DHSS), Department of Education (DOE)

Delaware State Housing Authority

Delaware Health and Social Services (DHSS)

Access to healthy food

Heating assistance

Financial assistance for food purchase

Rent assistance

Meals for self and children

Storage (physical items or documents)

Shelter

Transitional, temporary, or substandard housing

Coats Clothing

Access to doctors, clinics

Hair cut

Dental and optical coverage

Laundry

Insurance

Shoes

Medicaid

Showers

Specialist appointment

Technology

Cellphone Credit/Debit Card Stable email account State and social security ID cards

Counseling (for mental health, substance abuse, trauma)

2 31

Mapping assets is a crucial communications tool. The mapping process:

Through interviews and combining existing databases, IPA found that:

• Educates the public on existing services in their community

1. Despite hundreds of service providers in Delaware, the services are not always accessible to the populations that need them most. For example:

• Identifies the gap areas where services are needed • Highlights high-density areas, where duplication or oversaturation of services might occur • Informs State decisions for distributing fiscal resources and diverse programs • Supports interagency cooperation in meeting community needs

Delaware’s Current Assets Utilizing DDL’s network, IPA mapped known assets by putting together a list of services, providers, and access points.

• In western Sussex County, childcare facilities are too far away for families in need to access. • Homeless shelters are specific to sex, age, or veteran status. Thus, many men with children struggle to find available beds. 2. On average, Delawareans must visit three different places to access a single service. For example: • Someone looking for childcare must first get doctor’s records for their child, then search for facilities in their area, then see if there is space available at the centers they find. Caregivers also need to reach out to see if they qualify for Purchase of Care benefits and daycare facilitates that accept the benefit.

Training/Education Literacy

Childcare

Transportation

Legal

Employment/ Income

Department of Education (DOE), Higher Ed

Department of Education (DOE), Office of Early Childhood

Delaware Department of Transportation (DELDOT)

Courts

Department of Labor

Immigration

Adequate pay

Outstanding tickets or warrants

Assistance to complete/submit application online

Probation/parole

Benefits

Record expungement

Interview Wardrobe

Computer skills GED English language skills Literacy Study skills Workplace skills

Access to childcare Affordable childcare Purchase of Care

Access to transportation, public or private Bike share DART bus tickets Funds for gas or bus tickets License, insurance

Job and income, financial literacy and management

3 32 Delaware Journal of Public Health – September 2020

Based on the Basic Needs Chart, the comprehensive map includes 10 categories of needs: 1. Food & Nutrition 2. Shelter & Housing 3. Clothing & Hygiene 4. Health & Mental Health 5. Technology 6. Training & Education 7. Childcare 8. Transportation 9. Legal 10. Employment & Income

Since various entities and providers have their own databases of services that address these needs, IPA compiled a list of the most prominent and robust databases, such as DHSS, Delaware211, Food Bank of Delaware, UnitedWay, Christiana Care, and Unite Delaware. All of these databases are housed separately and may have different target audiences. Some are meant for consumers to use independently; others are meant to be used by providers themselves, or even to be used by social workers. All differ in their level of comprehensiveness, and all struggle to continuously keep their platforms up-to-date with programs, contact information, availability, and specialty populations. DDL has now linked to these resources on LibGuide.

LiBGuide for Delaware Service Providers, from the Delaware Division of Libraries

4 33

Ideal State With multiple databases available to find services, it can be very overwhelming for a person in crisis to navigate. Thus, people often seek assistance in gaining necessary services. However, if someone needs several services, they may need to see multiple people to gain just one service. This map illustrates the flow of seeking assistance from the customer’s perspective in an ideal

experience. The ideal state focuses on streamlining the process in which the service(s) are provided to the customer. This will improve the customer experience and ensure the customer receives the appropriate service when needed with minimal hand-offs to different providers. Ideally, one provider would be able to access information on all areas of need, regardless of the provider’s specialization.

Future State Map: Libraries, High Level Map of Services & Resources to Meet Basic Needs

Customer/Patron seeks Assistance

Visits Library

Library Greeter directs Patron to Librarian/ Social Innovator/ Partner

Librarian/Social Innovator/Partner Listens & Assess Need

Librarian/Social Innovator/Partner Uses Basic Needs Chart to Identify Available Resources

Standard Consistent Triage Protocol • People connector: Librarian/Social Innovator/Partner

Standarized Assessment Protocol • Professional development in listening, coaching, and problem solving skills

Standard Approach Using Basic Needs Chart

Customer/ Patron Receives Appropriate Assistance

Life Journal Provides Tailored simple direction on service(s) and Program Information

Librarian/Social Innovator/Partner Makes Referral, Provides Info/services

• Identifies available resources. Co-location of resources at public libraries (dHss, dOL, etc.)

Data Collection on Impact • data collected to measure impact and improve process to provide assistance/ services

Librarian/Social Innovator/ Partner Meets, Assess, Provides Info/service

Life Journal • Program information included in the life journal. Customers return seeking additional help.

5 34 Delaware Journal of Public Health – September 2020

Countermeasures & Next Steps Equipped with their maps, DDL invited librarians and partners to a town hall meeting in December 2019. Partners were asked to discuss the maps and gaps they experienced. Over 160 librarians and partners participated and noted that they already have an established resource guide for sharing this information, but struggle to identify services available in real time (i.e., hard to know when shelters are full). Furthermore, there is not a streamlined database of services designed for providers who are responsible for service delivery. At DDL’s town hall, providers expressed interest in an inward facing database, which would allow providers to communicate directly with one another in real time regarding new program updates, availability or atcapacity status, and updated contact information.

CALL TO ACTION In order to address the need for a single, up-to-date, inward and outward facing streamlined database and platform of services, Delaware services providers must

better integrate partnerships and database platforms. This means working toward a single, streamlined database of services with both an outward and inward facing mechanism. When partners begin working on this streamlining, it is important to keep the Basic Needs Chart taxonomy at the forefront. Without this common language and organization, any platform will struggle to be userfriendly, complete, and effective. Ultimately, creating a streamlined, public-facing platform, grounded in an organized taxonomy, will allow service providers to effectively address and meet Delawareans’ basic needs. By participating in a shared platform, service providers will be equipped to address community needs and make progress. DDL looks forward to collaborating with all partners to make this vision a reality. For more information, please see the LibGuide or contact the State Librarian, Annie Norman at annie.norman@delaware.gov.

Abou t the Institute for Public Administration The University of Delaware’s Institute for Public Administration (IPA) addresses the policy, planning, and management needs of its partners through the integration of applied research, professional development, and the education of tomorrow’s leaders. Visit us online at www.ipa.udel.edu. 180 Graham Hall, University of Delaware, Newark, DE 19716-7380 phone: 302-831-8971 | fax: 302-831-3488 | e-mail: ipa@udel.edu

6 35

Unite Delaware: Seamless Connections to Address Social Determinants of Health Erin Booker, L.P.C. Vice President Community Health and Engagement, Office of Health Equity, ChristianaCare Katie W. Coombes

ChristianaCare’s Office of Health Equity, in partnership with Unite Us, launched Unite Delaware on November 4, 2019. Unite Delaware is a coordinated care network of health and social care providers. Partners in the network are connected through a shared technology platform, Unite Us, which enables them to send and receive electronic referrals, address people’s social needs, and improve health across communities. Once a participating community-based organization identifies a person’s social needs, they are able to instantly send a secure, electronic referral to the most appropriate network partner(s) for that specific service, via Unite Delaware. Partners involved in the person’s care will be able to see if that referral was accepted or not. Once accepted, they will learn whether the person received the services. Unite Delaware is designed to resolve the issues that make referrals and connecting to services difficult. Perhaps most importantly, Unite Delaware takes the onus off the individual to track down needed services. Once a participating organization accepts a referral, it is their responsibility to connect with the individual. Participating organizations can search for the needed service and connect an individual to organizations that they may not have even known existed. Unite Delaware serves both individuals by connecting them to services and the participating organizations by empowering them to better serve their communities. ChristianaCare decided to partner with Unite Us to address Social Determinants of Health because health is impacted by so much more than what happens in a doctor’s office. To complete ChristianaCare’s Community Health Needs Assessments in early 2019, the Office of Health Equity held town halls at which the communities ChristianaCare serves were asked to tell us about their barriers to good health. Much of those discussions focused on poverty, transportation, education, and other social needs that have an obvious impact on health, but that our clinicians cannot address without community resources. ChristianaCare has long prized its partnerships with community organizations and Unite Us provided us with the tool to strengthen those connections to comprehensively address the needs of Delawareans. Unite Delaware also provides a unique data collection opportunity for participating organizations. Every organization on Unite Delaware has access to and ownership of their own data so they can see how many individuals they have served, who they are serving, and what needs were met and unmet. Network aggregate information, particularly what the most in demand services are and what services go unmet, will help the Office of Health Equity direct its community investment. For example, if referrals sent for individuals in the 19802 zip code are primarily for food assistance, the Office of Health Equity will seek out community partners in that area to determine how to address this need. The desire to help address all our patients’ needs – even those needs outside of our area of expertise, is what links us to the libraries. Just as patients at a doctor’s appointment may express concern over childcare or utility payments, a patron of the library 36 Delaware Journal of Public Health – September 2020

may also come to the library needing to use a computer and reveal that they need health insurance or recently lost a job. At libraries and in healthcare settings, we are confronted with the complex and fundamental needs of those we serve, and often, we do not know enough about the resources available or that need to offer them much in the way of support. Under the leadership of Dr. Annie Norman, the libraries have undergone a transition to help comprehensively address their patrons’ needs. You can now, for example, connect to a Department of Health and Social Services Social Worker through the library website. This past December 2019, the libraries hosted Better Together: Serving Delawareans’ Basic Needs Networking Meeting. At this meeting, community and government organizations came together to talk about the needs of Delawareans, the services that are available, and the question of how Delawareans can be connected to the services they need, when we may not know the first thing about that need. Without knowing it, participants at this meeting were describing Unite Delaware as the solution for connecting Delawareans to services. Very soon after that meeting, representatives from the Office of Health Equity met with Dr. Norman and Alta Porterfield, Statewide Social Innovator for the Delaware Libraries, to describe Unite Delaware, and it was not much later that the Delaware Libraries joined Unite Delaware. We have been grateful for the support of the libraries and the encouragement they routinely give to other community organizations to join the network. During the COVID-19 pandemic and what many of us are calling the “new normal” with working from home and community events and meetings postponed for the foreseeable future, Unite Delaware is uniquely suited to address the heightened health and social needs. The pandemic has demonstrated the importance of Unite Delaware as the referrals sent on the platform more than doubled between March and June in comparison to the referrals that were sent from launch in November to March. Given the growing need and obvious utility of Unite Delaware, the Office of Health Equity made the determination to expand Unite Delaware rapidly. When Unite Delaware launched, it only served New Castle County. Our intention was always to expand statewide, but the pandemic gave us the motivation we needed to pursue that expansion much sooner. Since June, the Office of Health Equity in partnership with Unite Us have been working to recruit organizations in Kent and Sussex Counties. New Castle County organizations continue to be welcomed to the platform as well. There is no cost to joining the network and we are eager to continue to recruit organizations. As of this writing, there are over 50 participating organizations on the network, and this number is growing daily. If you are interested in learning more or joining, please visit our website: https://delaware.uniteus.com/ . At ChristianaCare, we are looking forward to fostering the growth of Unite Delaware throughout the state, and excited to see the positive impact we, along with other community providers of social services, can all achieve working together to address the social determinants of health.

CUGH 2021 Addressing Critical Gaps in Global Health and Development Virtual Conference March 12-14, 2021, Satellite Sessions March 1-11 Host Institutions:

Submit a Panel Proposal

Deadline: October 16, 2020

Submit an Abstract Deadline: October 23, 2020

Host a Satellite Session Deadline: November 15, 2020

Sponsor or Exhibit Deadline: December 15, 2020

Tracks Addressing the Social Determinants of Health Covid-19, Emerging Infectious Diseases, & Other Communicable Diseases Politics, Law, Corruption, Human Rights, Governance, Diplomacy, Strengthening Public Institutions Planetary Health, One Health, Environmental Health, Climate Change and Pollution Strengthening Health Systems, Public Health, Primary and Surgical Care Non-Communicable Diseases Translation & Implementation Science, High Impact Development Initiatives, Bridging Research to Policy, Reforming Academia

www.CUGH2021.org

38 Delaware Journal of Public Health – September 2020

Delaware Virtual PrEP Summit 2020 Get more information

There is a once-a-day pill that may help us eliminate HIV/AIDS. It's called PrEP. Come learn about PrEP from leading national and local experts at this first of its kind conference in Delaware. •

Thursday, October 15, 2020 from 8:00 AM to 12:10 PM EDT Add to Calendar

Where This is an online event. Continuing Education For Physicians

• •

After participation in this educational activity, learners will be able to: * Discuss treatment efficacy through clinical studies * Summarize appropriate treatment protocols * Discuss real world issues related to prescribing this therapy •

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Medical Society of Delaware and the Delaware HIV Consortium. The Medical Society of Delaware is accredited by the ACCME to provide CME activities for physicians. The Medical Society of Delaware designates this live continuing medical education activity for a maximum of 2.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. It is the policy of the Medical Society of Delaware to comply with the ACCME Standards for Commercial Support of Continuing Medical Education. In keeping with these standards, all faculty participating in continuing medical education activities jointly provided by the Medical Society of Delaware are expected to disclose to the activity audience any real or apparent conflicts of interest related to the content of their presentation. Joint providership of CME by the Medical Society of Delaware in no way implies endorsement or recommendation of any product or service. This activity is supported by a grant from Gilead Sciences, Inc. All other commercial funding will be disclosed at the event.

The first hour of the event, ChristianaCare Department of Medicine Grand Rounds, is covered as a different CME activity. This activity has been approved for a maximum of 1 AMA PRA Category 1 Credit™.

TARGET AUDIENCE Target Audience for this activity is: physicians, physician assistants, nurses, specialists, social work professions, public health professions, pharmacists, community health workers, and other healthcare providers. NO COST TO ATTEND LEARNING OBJECTIVES

AGENDA

7:45 AM Join the Zoom meeting and chat with your colleagues 8:00 to 9:00 AM Christiana Care Medical Grand Rounds Clinical Perspective on PrEP Dawn K. Smith, M.D., M.S., M.P.H. Biomedical Interventions Activity Lead Centers for Disease Control and Prevention, National Center for HIV/AIDS 9:00 AM to 9:10 AM Conference Welcome 9:10 to 9:50 AM PrEP in a time of physical (but not sexual) distancing Eric Halpern M.D., ChristianaCare Lisa Skedzielewski, Pharm.D., Walgreens 9:50 to 10:30 Racial disparities and PrEP access TBD 10:30 to 10:45 Break 10:45 to 11:30 AM PrEP in Delaware VS Nationwide Deborah Kahal, M.D., M.P.H., ChristianaCare Nina Bennet, M.S., ChristanaCare 11:30 to Noon New in the world of PrEP Mark Watkins, D.O., Mazzoni Center Noon to 12:10 PM Closing Remarks https://www.delawarehiv.org/

Closing the Gap: Public Libraries and Public Health Noah Lenstra, Ph.D., M.L.I.S. Associate Professor, Department of Library and Information Science, University of North Carolina at Greensboro Mary Grace Flaherty, Ph.D., M.L.S., M.S. Associate Professor, School of Information and Library Science, University of North Carolina at Chapel Hill

INTRODUCTION In June 2018, Beth St. Jean, Associate Professor in the University of Maryland’s College of Information Studies, and an affiliate faculty member of the Horowitz Center for Health Literacy, released a Call for Papers for a special issue on the topic of “Health Justice” in the International Journal of Information, Diversity, & Inclusion (IJIDI).1 The response received was overwhelming. The peer-reviewed journal ended up publishing two special issues in Summer 2019, featuring articles written by Library and Information Science (LIS) scholars on such topics as: “Scenarios of Health Engagement Experiences and Health Justice in Rural Libraries,” “Health Insurance Literacy and Health Disparities in the United States,” “The Lived Experience of Work and Career Among Individuals with Bipolar Disorder,” and “Food Justice in the Public Library: Information, Resources, and Meals.”2 So successful was the call for papers, that St. Jean and her colleagues at Maryland decided to launch a second special issue, this time in the monograph series Advances in Librarianship on the “Roles and Responsibilities of Libraries in Increasing Consumer Health Literacy and Reducing Health Disparities.”3 The book comes out November 30, 2020. This recent history illustrates how interest in the topic of public health in our field of LIS has never been higher. This scholarly interest mirrors widespread interest in health promotion in the public library profession. Nonetheless, cross-sectoral collaborations between libraries and public health are not as robust as they could be. This essay aims to explore some of the promising avenues for future collaborative work, as well as to highlight some of the major public health-public library trends already underway. Our focus here is on public libraries, although there are also gaps that need to be closed between public health and other sectors of librarianship, including academic, school, and medical libraries.

HARNESSING THE POWER OF PUBLIC LIBRARIES In January, 2020 the Iowa Department of Public Health launched Harnessing the Power of Iowa’s Libraries through a pilot in two counties: Linn and Dallas, one urban, one rural. In its press release, the health department states “Many libraries already understand the importance of healthy lifestyles. For instance, the Cedar Rapids Public Library has installed walking treadmill desks. The funding will allow libraries to build off existing health promotion efforts, in addition to expanding their offerings in partnership with their local public health agency.”4 What makes the language and approach of the Iowa Department of Public Health worth emulating is that it recognizes the following facts about public libraries: 1.

Even before the public health department got involved, public libraries had already been working towards promoting public health and healthy lifestyles.

40 Delaware Journal of Public Health – September 2020

The project starts small, based on the fact that public libraries are idiosyncratically local institutions, and thus change, of necessity, begins at the grassroots.

This approach of the Iowa Department of Public Health also grasps two fundamental attributes of public libraries. Public libraries are: 1) Public spaces open to all community members, and as such can serve as an excellent community hub and as a place to help build local social capital; and 2) Run by public librarians, who tend to be trusted community members with known expertise in bringing together information and connecting it to community needs. We see the mobilization of these two dimensions of public libraries in public health responses to the current COVID-19 Pandemic. Public libraries as public spaces were mobilized in cities like Toronto, where local media reported on “How the Toronto Public Library turned its branches into food banks.”5 After closing to the public, branches became hubs for receiving, packing, sorting, and distributing food to those in need. Similar efforts occurred in San Francisco, where “food bank officials say that ultra-organized librarians created a more efficient way to pack the food bags and even to maximize the number of bags per bin to meet delivery trucks’ capacity.”6 Public librarians themselves were also mobilized in response to COVID-19 by cities harnessing librarians’ ability to quickly and efficiently collect, collate, organize, and disseminate information. In Raleigh, North Carolina, public librarians became contact tracers.7 In Rochester, Minnesota, public librarians staff a COVID-19 hotline anyone can call.8 In good times and bad, harnessing public libraries for public health reveals: 1) Librarians frequently have the ability to launch and sustain local experiments. One such example is in Farmville, North Carolina where the public library was able to quickly start checking out pedometers, do health assessments, and even become the town’s wellness coordinator9; 2) Innovation begins at the grassroots and spreads upward. In fact, after public libraries closed to the public during COVD-19, librarians across North America started spontaneously creating chalk- and paint-based obstacle courses on their sidewalks to promote some fun, safe, family physical activity outdoors.10 Given the grassroots nature of public library efforts to promote public health, knowledge of this tendency at the state and national level remains somewhat underdeveloped, despite the fact that public libraries have promoted health since their inception in the mid-19th century.11 When Flaherty worked with public health professors on the article entitled “Public libraries: A communitylevel resource to advance population health” published in the Journal of Community Health,12 it was apparent that knowledge of

public libraries as partners in public health promotion remains underdeveloped in the field of public health. This finding was affirmed by Lenstra’s participation on the advisory board of the American Heart Association’s Voices for Healthy Kids’ Activating Rural America initiative, in which during board meetings other members expressed surprise that public libraries were doing so much to promote healthy child development. Nevertheless, despite some difficulties understanding overall missions, public library and public health professionals increasingly work together at local, state, and even at national levels, as the example of Healthy Ireland at Your Library in the European Union illustrates.13

and sustain their capabilities. Similar to public health, the Master’s degree (in this case the M.LIS) is the primary credential and terminal degree. However, as with the variation in public library governance, there are differing requirements for education of library managers and directors; over half of all public libraries in the U.S. are headed by non-MLIS level directors.16 The faculty who teach in LIS programs increasingly study and teach about public health. Some programs offer courses on “Health Literacy and Public Libraries,”17 while others have, with federal funding, sought to develop new approaches to preparing librarians to work with public health professionals. The University of Missouri is developing a program in which LIS students take courses both in LIS and in public health before deploying this knowledge as public librarians in small towns and rural communities.18 At the University of Tennessee, faculty worked on a federally funded project focused on supporting public libraries as health partners in Central Appalachia.19 One sign of the integration of this topic into the LIS curriculum is the arrival of its first textbook, published with the American Library Association Promoting Individual and Community Health at the Library in 2018.20 After public librarians finish their degrees, they often seek continuing education. Here again, we see a growing focus on public health. In 2013, the national non-profit OCLC/ WebJunction, “the learning place for libraries,” received funding from the U.S. Institute of Museum and Library Services (IMLS) to develop Health Happens in Libraries.21 The project initially focused on preparing public librarians to help patrons navigate the Affordable Care Act. Over time its focus widened to promote other facets of public health, including physical activity, nutrition, mental health, and more. One product of the initiative was the “Library Heroes Make Health Happen” infographic, which highlights the many and varied ways libraries support healthy living.22

UNDERSTANDING PUBLIC LIBRARIES AS PUBLIC HEALTH PROMOTERS Given all that public libraries already do to promote public health, why are partnerships not more robust? Part of the challenge of fostering and sustaining partnerships relates to the very different systems in which these professionals operate. The field of public health is more organized nationally, with a strong infrastructure for communication. In contrast, although approximately 96% of the US population lives within a public library service area,14 the nearly 10,000 public library administrative entities across the nation are run largely independently from each other. Nearly 90% of library funding comes from municipal or county funding sources, and there are no national standards one has to meet to become a public library. There are three main types of public libraries across the country: a General-Purpose Government library, in which the library is a sub-unit of municipal or county government (64%); a Library District, in which the library is an independent taxing district (19%); and a Nonprofit-Organization (NPO), in which the library is run like a 501(C)3 (15%).15 Public libraries can also be part of tribal governments or school districts. In short, this is a national infrastructure with high levels of local autonomy and variation from place to place. Uniting this vast infrastructure are the professional and continuing education providers to which librarians go to build

America’s largest professional association of public librarians, the Public Library Association, part of the American Library Association, also supports this trend. A study commissioned by the American Library Association found substantially more voters said in 2018 they think public libraries should provide “activities and entertainment not found elsewhere” in a community (48% versus 38%), and many of these activities center around public health.23 The American Library Association’s 2020 annual report states, “Libraries provide a diverse array of health literacy and awareness services for their communities. Some libraries take healthy lifestyle services even further by offering walking, hiking, bicycling, or running programs that take place outside the library building. Nearly 23% of public libraries host fitness or yoga classes.”24 Programs involving or associated with walking promotion, in particular, have become especially common.25 There are also signs that the field of public health increasingly attends to public libraries. The 2019 conference of the APHA featured numerous sessions and papers on public libraries, many of them associated with the Healthy Library Initiative26 at the University of Pennsylvania, including “Occupational hazards in public libraries,” “Four public health emergency preparedness partnership projects with the Free Library of Philadelphia,” “Health information needs assessment of public library patrons and staff: A public health partnership,” “Integrated health and social service delivery at the Free Library of Philadelphia,” 41

“Community Based Health: Evaluation of Public Library Stress Reduction Offerings,” “Improving the nation’s health: The role of librarians in an activist boot camp,” and two sessions on public libraries and the opioid crisis: “Public libraries address the opioid crisis” and “Public health and public libraries: Partners in addressing the opioid crisis.”27

WHAT FACTORS HAVE LED TO THESE INCREASINGLY CLOSE COLLABORATIONS?

A third factor shaping increasing public health partnerships has been the growth of the idea of public libraries as venues for programs and classes. LIS scholar Lili Luo found that during one year the San Jose Public Library offered 76 health programs, including oral health education classes, yoga, summer lunches, blood drives, and tutorials to sign up for health insurance.38 Public libraries increasingly work with partners and entities like the USDA’s Cooperative Extension to offer hands-on cooking and nutrition programming.39

Perhaps one of the influential catalysts to this trend came in 2015, when the Robert Wood Johnson Foundation (RWJF) included public libraries as one of their measures of cultures of health in From Vision to Action: Measures to Mobilize a Culture of Health.28 Since then, RWJF has continued to document and support public libraries as public health catalysts, including in a video on how “Line dance leader Kit Cheung teaches her class of ChineseAmerican women in an unlikely place —the parking lot of a local library. No other public location offers both the outdoor space and sun cover the group requires for their twist on the traditional Chinese exercise of tai chi. The relationship that forms between the initially-reluctant library and Kit’s dance group has created some unexpected opportunities.”29 More recently, RWJF and the RAND Corporation wrote in Health Affairs on how public libraries do everything from check out bicycles to distribute free summer meals to connect the most vulnerable with life changing social services.30

The fourth trend driving these collaborations is increased interest in the public library as a physical space embedded in the built environment. Sociologist Eric Klinenberg calls public libraries Palaces for the People, and these palaces are increasingly being designed in ways to maximize public health outcomes.40 In Boise, Idaho, the city released a report entitled Boise Library Campus Health Impact Assessment: Library Site Visit & The 7 Dimensions of Health focused on how library renovations could support public health.41 More recently, architect Traci Lesneski released the report Sensory Library Design: Responding to a Pandemic’s Impact on Built Environments, focused on the public health dimensions of library re-openings.42 The report includes the suggestion that libraries offer as many of their programs outside to promote social distancing, and indeed during the COVID-19 pandemic in summer 2020 we see public libraries offer everything from storytime to Yoga and Zumba classes in local parks and library parking lots.

Recent catastrophes have also instigated increasingly close relationships between public libraries and public health. After Hurricane Sandy, public libraries in New Jersey and New York worked closely with the Federal Emergency Management Association (FEMA) on recovery efforts, and as a result FEMA has now offered training to East Coast librarians. The state library associations in New York and New Jersey are currently working with FEMA on a program for librarians called “Preparedness Ambassadors.”31 Similar efforts are underway in areas vulnerable to hurricanes in the southeastern United States. It should be noted that the Stafford Disaster Relief and Emergency Assistance Act was amended in 2011 to include public libraries as essential service outlets during disasters.32

These four trends converge with the fact that during 2018, the fourth most read article in the newsletter of the American Public Health Association was “Libraries, public health work together on community health: Settings serve as community hubs.”43

Researchers across the country, both in LIS33 and in public health34 also quickly grasped that public libraries were on the frontlines of the opioid crisis. Interestingly, however, public health partnerships around this crisis appear to be driven more by librarians than by public health professionals. The federally-funded report Public Libraries Respond to the Opioid Crisis with Their Communities found that “In almost all cases, the library initiated the partnership and outreach. To develop these partnerships, some libraries relied on personal relationships they had from previous work and others used the credibility of the library institution.”35 Public librarians led the charge, out of necessity, with the field of public health slower to realize what was happening. Public librarians have also been on the frontlines of crises related to homelessness and housing insecurity,36 and have responded by working to bring social workers into their libraries to help with these social issues.37 Due to the nature of public service and the mission of open access to all community members, public librarians often encounter social problems early on, and respond to them as best they can, given available resources. 42 Delaware Journal of Public Health – September 2020

Nevertheless, despite increasing attention to the fact that public libraries 1) contribute to local cultures of health, 2) nimbly respond to disasters and crises, 3) increasingly offer health classes, and 4) constitute part of the community’s health-enhancing built environment, our general understanding of how best to, as the Iowa Department of Public Health calls it, Harness the Power of Public Libraries, remains in its infancy.

A CALL TO ACTION: CLOSING THE GAP BETWEEN PUBLIC LIBRARIES AND PUBLIC HEALTH On that note, this article concludes with a call to action. To ponder the myriad ways public health professionals and public libraries can work together, let’s consider the 32 sections of the American Public Health Association44 to identify where partnerships are already robust, and where additional work is needed. One section of the APHA focuses on Public Health Social Work. Here, we have seen over the last decade an explosive growth in social work-public library partnerships. When the Kansas City Public Library hired its first Health and Wellness Librarian, they hired social worker Amanda Landayan.45 In hundreds of public libraries across the country, students completing their MSW degrees now have the option of fulfilling internship requirements by working as social workers in public libraries.46 The American Library Association now has a Social Worker Task Force,47 composed primarily of social workers who work full-time in public libraries. Research on this trend has been published both in the LIS and Social Worker research literatures,37

and has been featured both at the conferences of the Public Library Association and at the Council on Social Work Education conferences. There is similar potential for collaboration in many other sections of the APHA, perhaps most notably in the Public Health Nursing section. Public health nurses already provide services in some public libraries, notably the Pima County Public Library in Tucson, Arizona.48 There are also obvious opportunities for Community Health Workers. There are many opportunities around topical sections of the APHA as well. Those interested in Food and Nutrition could look to libraries as partners in efforts to increase, as the Free Library of Philadelphia puts it, culinary literacy.49 The roles of libraries in promoting food security has also been explored in a series of articles in Public Health Nutrition on the State Library of California’s Lunch at the Library initiative.50 Those interested in other topical sections could also find many opportunities for partnerships. Based on our knowledge of contemporary public library initiatives, we could easily point those interested in the following APHA sections to work already underway in public libraries across the country around the following topics: Aging and Public Health; Alcohol, Tobacco, and Other Drugs; Community Health Planning and Policy Development; Disability; Environment; Health Informatics Information Technology; HIV/AIDS; Injury Control and Emergency Health Services; Integrative, Complementary and Traditional Health Practices; Maternal and Child Health; Mental Health; Oral Health; Physical Activity; Public Health Education and Health Promotion; Sexual and Reproductive Health; and Vision Care. The seeds have been planted; it’s now up to all of us to work together to close the gap and ensure it stays closed. Finally, at the research level, there are opportunities for epidemiologists and other public health researchers to harness the power of public libraries by examining how we identify public health issues. In communities across the country, public libraries are on the frontlines of virtually all emerging health issues. In today’s information rich environments, citizens do not necessarily turn first to medical providers when faced with illness. Flaherty found in her study of information practices of those with a newly discovered meat allergy that people often learn about their condition from someone other than their primary care physicians.51 Based on these shifts in information gathering and sharing, we can study public libraries as venues for not only the dissemination of timely public health information on emerging health issues, but also as venues for the collection of public health information. This work is already underway in the context of the 2020 Census, in which the U.S. Census Bureau has worked closely with American public libraries to ensure citizens have information about the census,52 and the technological means to complete it. Similar efforts have begun to emerge through the National Institutes of Health’s All of Us initiative.53 As these national and local partnerships emerge and flourish, we also need to keep emphasizing the importance of evaluation. So often in public libraries, the focus is on doing. Librarians are people who get things done. Nonetheless, given the idiosyncratically local nature of public librarianship, more often than not after one initiative ends, there is no time to evaluate it before moving on to the next one. The field of public health could assist public librarians by better supporting efforts to evaluate the impacts of past, present, and future health promotion efforts. Technical assistance in evaluation could in turn begin to fill the

need of building an evidence base for the effectiveness of working with public librarians to promote public health. Establishing such an evidence base could, in turn, facilitate the integration of public librarianship into both the MPH curricula and the public health research funding apparatus. Much remains to be done, but we are already on the way to closing the gap between public libraries and public health.

REFERENCES 1. St. Jean, B., Jindal, G., Liao, Y., & Jaeger, P. T. (2019). The central roles of information in health justice, part 2: Consumer health information justice and the connections between health, ability, and literacy. The International Journal of Information, Diversity, and Inclusion, 3(4). https://doi.org/10.33137/ijidi.v3i4.33057 2. St. Jean, B., Jindal, G., Liao, Y., & Jaeger, P. (2019). The central roles of information in health justice, part 1: Toward a new field of consumer health information justice. The International Journal of Information, Diversity, and Inclusion, 3(3). https://doi.org/10.33137/ijidi.v3i3.32961 3. Jean, B. S., Jindal, G., Liao, Y., & Jaeger, P. (Eds.). (2020). Roles and responsibilities of libraries in increasing consumer health literacy and reducing health disparities. Emerald Publishing Limited Advances in Librarianship Series. https://books.emeraldinsight.com/page/detail/Roles-andResponsibilities-of-Libraries-in-Increasing-Consumer-HealthLiteracy-and-Reducing-Health-Disparities/?K=9781839093418 4. Iowa Department of Public Health. (2020). IDPH project pairs public health and libraries. Retrieved from: https://idph.iowa.gov/News/ArtMID/646/ArticleID/158290/IDPHProject-Pairs-Public-Health-and-Libraries-12120 5. MacFayden, G. (2020, April 7). How the Toronto public library turned its branches into food banks. Toronto Life. Retrieved from: https://torontolife.com/city/we-can-pack-850-food-hampers-in-twohours-how-the-toronto-public-library-turned-its-branches-into-foodbanks 6. D’Orio, W. (2020, May 1). When librarians become disaster workers. School Library Journal. Retrieved from: https://www.schoollibraryjournal.com/?detailStory=WhenLibrarians-Become-Disaster-Service-Workers-COVID-19coronavirus 7. DeCock, L., & Wagner, A. (2020, June 7). Unknown phone number? Don’t hang up. It might be an NC COVID-19 contact tracer. The News & Observer (Raleigh). Retrieved from: https://www.newsobserver.com/news/coronavirus/article243350901. html 8. Zemple, M. (2020, March 30). Rochester Public Library staff can now answer your COVID-19 questions on new hotline. KTTC. Retrieved from: https://kttc.com/2020/03/30/rochester-public-library-staff-can-nowanswer-your-covid-19-questions-on-new-hotline/ 9. Flaherty, M. G., & Miller, D. (2016). Rural public libraries as community change agents: Opportunities for health promotion. Journal of Education for Library and Information Science, 57(2), 143–150. https://doi.org/10.3138/jelis.57.2.143 10. Lenstra, N. (2020). Think outside the library with a sidewalk obstacle course. OCLC/WebJunction. Retrieved from: https://www.webjunction.org/news/webjunction/sidewalk-obstaclecourse.html 43

11. Rubenstein, E. (2012). From social hygiene to consumer health: Libraries, health information, and the American public from the late nineteenth century to the 1980s. Library & Information History, 28(3), 202–219. https://doi.org/10.1179/1758348912Z.00000000016 12. Philbin, M. M., Parker, C. M., Flaherty, M. G., & Hirsch, J. S. (2019, February). Public libraries: A community-level resource to advance population health. Journal of Community Health, 44(1), 192–199. https://doi.org/10.1007/s10900-018-0547-4

24. American Library Association. (2020). State of America’s Libraries Report 2020. Retrieved from: http://www.ala.org/news/state-americas-libraries-report-2020 25. Lenstra, N., & Carlos, J. (2019, May 20). Public libraries and walkable neighborhoods. International Journal of Environmental Research and Public Health, 16(10), 1780. https://doi.org/10.3390/ijerph16101780 26. University of Pennsylvania. (2020). Healthy Library Initiative. Retrieved from: http://www.healthylibrary.org/

13. Libraries Ireland. (2020). Healthy Ireland at Your Library. Retrieved from: https://www.librariesireland.ie/services/healthy-ireland-at-your-library/

27. American Public Health Association. (2019). Annual Meeting and Expo Program. Retrieved from: https://apha.confex.com/apha/2019/meetingapp.cgi/ Search/0?sort=Relevance&size=10&page=1&searchterm=library

14. Institute of Museum and Library Services (US). (2019). Public Libraries in the United States Survey: Fiscal Year 2016. Institute of Museum and Library Services. Retrieved from: https://www.imls.gov/sites/default/files//publications/documents/ public-libraries-united-states-survey-fiscal-year-2016.pdf

28. Plough, A., & Chandra, A. (2015). From vision to action: measures to mobilize a culture of health. Princeton (NJ): Robert Wood Johnson Foundation. Retrieved from: https://www.ruralcenter.org/resource-library/from-vision-to-actionmeasures-to-mobilize-a-culture-of-health

15. Institute of Museum and Library Services (US). (2019). Public Libraries in the United States Survey: Fiscal Year 2016: Data File Documentation. Institute of Museum and Library Services. Retrieved from: https://www.imls.gov/sites/default/files/ fy2016_pls_data_file_documentation.pdf

29. Robert Wood Johnson Foundation. (2017, June 13). Fun and fitness in a library parking lot. Retrieved from: https://www.youtube.com/watch?v=ES5tQCRCyeI

16. Flaherty, M. G. (2013). Consumer health information provision in rural public libraries: A comparison of two library systems. The Library Quarterly, 83(2), 155–165. https://doi.org/10.1086/669548 17. Luo, L. (2019). INFO 287-17 Seminar in information science topic - health literacy and public libraries summer 2019 syllabus. San Jose State University. School of Information. Retrieved from: https://ischoolapps.sjsu.edu/gss/ajax/showSheet.php?id=8479 18. University of Missouri School of Information Science & Learning Technologies. (2019). Librarians as Catalysts for Healthy Communities. Institute of Museum and Library Services. Retrieved from: https://www.imls.gov/grants/awarded/re-17-19-0022-19 19. University of Tennessee. Knoxville. (2017). Rural Library Professionals’ Role in Community Engagement in the Southern and Central Appalachian Region. Retrieved from: https://scholar.cci.utk.edu/ca2ca-sca-rl/about-ca2casca-rl/ 20. Flaherty, M. G. (2018). Promoting individual and community health at the library. American Library Association. Retrieved from: https://www.alastore.ala.org/content/promoting-individual-andcommunity-health-library 21. OCLC/WebJunction. (2020). Health Happens in Libraries. Retrieved from: https://www.webjunction.org/explore-topics/ehealth.html 22. OCLC/WebJunction. (2016). Library Heroes Make Health Happen. Retrieved from: https://www.webjunction.org/news/webjunction/library-heroesmake-health-happen.html 23. OCLC & American Library Association. (2018). From awareness to funding: voter perceptions and support of public libraries in 2018. Dublin: OCLC Research. Retrieved from: https://www.oclc.org/content/dam/oclc/reports/awareness-tofunding-2018/2018_From_Awareness_to_Funding_Report.pdf 44 Delaware Journal of Public Health – September 2020

30. Miller, C. E., & Chandra, A. (2018). Measuring progress toward a culture of health... at the library. Health Affairs, 20, •••. Retrieved from https://www.healthaffairs.org/do/10.1377/hblog20181119.551788/full/ 31. Jarzombek, S. C. (2019, November 18). Twitter post. Retrieved from: https://twitter.com/SCJarzombek/status/1196464587626954752?s=20 32. Ghorbanzadeh, M., Ozguven, E. E., Tenney, C. S., Leonarczyk, Z., Jones, F. R., & Mardis, M. A. (2020). Natural disaster accessibility of small and rural libraries in northwest Florida. Public Library Quarterly, •••, 1–20. https://doi.org/10.1080/01616846.2020.1772027 33. Wrigley, J., Kennedy, C., Flaherty, M. G., Ponder, M., Foster, M., & Akman, J. (2020). A statewide analysis of North Carolina public libraries and their response to the opioid epidemic. Public Library Quarterly, •••, 1–13. 34. Lowenstein, M., Feuerstein-Simon, R., Sheni, R., Dupuis, R., Kinsey, E. W., Luna Marti, X., & Cannuscio, C. (2019, December 18). Public libraries as partners in confronting the overdose crisis: A qualitative analysis. Substance Abuse, •••, 1–8. https://doi.org/10.1080/08897077.2019.1691129 35. OCLC/WebJunction. (2019). Public Libraries Respond to the Opioid Crisis with Their Communities, p. 16. Retrieved from: https://www.oclc.org/research/publications/2019/oclcresearch-publiclibraries-respond-to-opioid-crisis.html 36. Freeman, L. M., & Blomley, N. (2019). Enacting property: Making space for the public in the municipal library. Environment and Planning C. Politics and Space, 37(2), 199–218. 37. Wahler, E. A., Provence, M. A., Helling, J., & Williams, M. A. (2020). The changing role of libraries: How social workers can help. Families in Society, 101(1), 34–43. https://doi.org/10.1177/1044389419850707 38. Luo, L. (2018). Health information programming in public libraries: A content analysis. Public Library Quarterly, 37(3), 233–247. https://doi.org/10.1080/01616846.2018.1498704

39. Lenstra, N., & D’Arpa, C. (2019). Food Justice in the Public Library: Information, Resources, and Meals. The International Journal of Information, Diversity, & Inclusion (IJIDI), 3(4).

47. American Library Association. Public Library Association. (2020). Social Worker Task Force. Retrieved from: http://www.ala.org/pla/about/people/committees/pla-tfsocwork

40. Klinenberg, E. (2018). Palaces for the people: How social infrastructure can help fight inequality, polarization, and the decline of civic life. Broadway Books.

48. Pima County Public Library. (2020). Library Nurse. Retrieved from: https://www.library.pima.gov/public-health-nurse/

41. Boise Public Library. (2018). Boise library campus health impact assessment: library site visit & the 7 dimensions of health. Retrieved from: https://www.cityofboise.org/programs/new-main-library/architectsand-design-concept/

49. Free Library of Philadelphia. (2017). Culinary Literacy: A Toolkit for Public Libraries. Retrieved from: https://libwww.freelibrary.org/assets/pdf/programs/culinary/freelibrary-culinary-literacy-toolkit.pdf

42. Lesneski, T. R. (2020). Sensory library design: responding to a pandemic’s impact on built environments. MSR Design. Retrieved from: https://msrdesign.com/2020/06/12/sensory-library-designresponding-to-a-pandemics-impact-on-built-environments/ 43. APHA. (2019). Most-read public health news stories of the year, 2018. The Nation’s Health. Retrieved from: http:// thenationshealth.aphapublications.org/content/most-read-publichealth-news-stories-year-2018 44. APHA. (2020) Member sections. Retrieved from: https://www.apha.org/apha-communities/member-sections 45. Orosco, E. (2019, Jan. 23). Kansas City Public Library offers classes to boost community health and wellness. Northeast News. Retrieved from: http://northeastnews.net/pages/kansas-city-public-library-offersclasses-boost-community-health-wellness/ 46. Johnson, S. C. (2020). Social Work Students & Public Libraries. Retrieved from: https://swlibraryinterns.com/

50. De La Cruz, M. M., Phan, K., & Bruce, J. S. (2020, August). More to offer than books: Stakeholder perceptions of a public library-based meal programme. Public Health Nutrition, 23(12), 2179–2188. https://doi.org/10.1017/S1368980019004336 51. Flaherty, M. G., Kaplan, S. J., & Jerath, M. R. (2017, October). Diagnosis of life-threatening alpha-gal food allergy appears to be patient driven. Journal of Primary Care & Community Health, 8(4), 345–348. https://doi.org/10.1177/2150131917705714 52. American Library Association. (2020). Librarian’s Guide to the 2020 Census. Retrieved from: http://www.ala.org/advocacy/sites/ala.org.advocacy/files/content/ govinfo/Census%20Guide%20Update_Jan2020.pdf 53. National Institutes of Health. (2017, November 19). NIH’s All of Us Research Program partners with the National Library of Medicine to reach communities through local libraries. NIH News Releases. Retrieved from: https://www.nih.gov/news-events/news-releases/nihs-all-us-researchprogram-partners-national-library-medicine-reach-communitiesthrough-local-libraries

Developing a Model Policy for Public Libraries to Address Homelessness & Mental Illness Mariekie Barone Stacie Fifelski Alexandra Stocker Thomas Worm

Ashley Patterson Jessica Braamse Robert S. Lathers, M.S.W., L.M.S.W. Senior Adjunct Professor, Grand Valley State University Graduate School of Social Work

INTRODUCTION

COVID-19

Public Libraries across the United States have become places of respite and sanctuary for increasing numbers of people who are homeless and/or struggling with mental health issues. The issue has been highlighted in the past few years in popular literature, especially in Susan Orlean’s recent New York Time’s Best Seller, “The Library Book,” as well as in Emilio Estevez’s 2019 Movie, “The Public,” which was filmed at the Cincinnati Public Library. State Library Associations, including that of Michigan, have developed active workgroups to address these populations in an inclusive fashion. Many libraries across the country have begun to hire social workers to be on their staff. Addressing homelessness and mental illness, from a local library perspective, is a relatively new and emerging practice area for both libraries and community agencies. Best practices to address these issues have not yet been systematically developed. Only one book, Whole Person Librarianship: A Social Work Approach to Patron Services is currently available in print that addresses the issue.1

The first several weeks of class in January through March 2020 were productive for most of the workgroups. Each group was required to interface with other workgroups and adjust their work accordingly. The project showed promise and students were engaged in its success. Each class period focused on understanding key elements of how to make good policy and applying the concepts to the “Library project.”

METHODOLOGY In early 2020, a Grand Valley State University (GVSU) Graduate School of Social Work class, Introduction to Social Policy, committed to spend an entire semester researching and examining the issue of Michigan public libraries’ response to patrons who were homeless and/or mentally ill. The goal was to develop a comprehensive draft model policy for libraries to consider in order to enhance community collaborations, especially with local homeless and public community mental health organizations. The project was intended to be a nontraditional, interactive, educational experience for first year graduate policy students. To that end the Michigan Library Association and the Community Mental Health Association of Michigan committed resources to the project and proactively scheduled workshop presentations at their annual spring conferences that would feature student presenters from the class project. In addition, a Michigan state senator who had pending legislation regarding library safety agreed to work with the class. Contact was also made with the Niles Public Library which had received a $200,000 Federal grant to develop outreach services regarding rural homelessness. The class of thirty students was divided into ten workgroups. Each workgroup was assigned a specific area of policy analysis to focus on. These included: identifying draft policy language and articulating the purpose of the policy; definitions of policy words and concepts; a literature review; survey current attempts to address the issues of homelessness and mental health issues in libraries from across the United States; identifying the benefits and consequences of developing and implementing a comprehensive library policy; a political analysis comparing conservative vs. liberal support for the policy; a cost-benefit analysis of implementing vs. not implementing the policy; a policy feasibility assessment; and finally an ethical analysis of the draft policy utilizing the American Library Association and the National Association of Social Work Code of Ethics respectively. 46 Delaware Journal of Public Health – September 2020

Then in March, Covid-19 shut down GVSU classrooms, Michigan’s Public Libraries, and in-person services of Community Mental Health Centers. Staff of public libraries as well as community mental health were furloughed or laid off. GVSU shifted all classes online, a technology that was new to many faculty who were fundamentally unprepared. Consequently, students in the Policy class were offered an alternate unrelated assignment to meet the goals of the course. Eighty percent of the students (24) who were enrolled in the course accepted the alternate assignment. However, the six remaining students (co-authors of this article) were determined to follow the project to its conclusion and declined the alternate assignment. However, by the end of the semester the library project had not been completed. The students all received a final grade of “A” for the course due to evidence that they understood the fundamental concepts of social policy. Surprisingly, they requested to extend their work on a volunteer basis in order to complete the project. A literature review had been completed, work on surveying libraries across the country had received positive results, a survey of Michigan mental health agencies was still being pursued and recommendations for a model policy were emerging. This article summarizes an abbreviated version of the final information and qualitative data that was collected, as well as recommendations of the essential elements that should be considered in the development of a Model Policy for Public Libraries to Address Homelessness and Mental Illness.

NATIONAL SURVEY OF LIBRARY POLICIES AND SERVICES REGARDING PATRONS WHO ARE HOMELESS At the beginning of this project, it was clear that it would be important to connect with libraries across the country in an effort to learn more about what programs and services were in place to serve those experiencing homelessness and/or mental illness. Initially, the focus was to be on about twelve metropolitan library systems, however, it was decided that an effort to connect with a library from every state in the country would be valuable. This group reached out to 106 library systems in all fifty (50) states and in Washington D.C. Each library was asked: • What specific policies were in place that pertain directly to individuals experiencing homelessness?

• What was the general experience of front line staff with the homeless population? • What type of training did they receive in this area? • Did their branch(es) had a social worker on site and what community collaborations were in place to better serve the homeless population? Of the one-hundred-six (106) inquiries, sixty (60) libraries responded. Every library reported that all their policies must be equitable for all people. Many said that there were some policies in place that affected those experiencing homelessness more so than others, e.g. policies regarding body odor, the size and storage of personal items, “no sleeping” rules, and “no bathing/shaving/ washing clothes in public restrooms.” Many libraries shared information on programs and collaborations in place to serve those experiencing homelessness. However, there were several library systems that stood out as leaders in this area of practice. The exemplary efforts of library systems in four of these states are described below.

Delaware

The Delaware Division of Libraries’ Social Innovation mantra is ‘help people take the next step.’ Several Delaware Libraries staff have taken both the Mental Health First Aid and Ryan Dowd’s Librarian’s Guide to Homelessness training in addition to library trainings offered to both the public and staff in regards to NARCAN intervention and drug use, along with various programs around Trauma Informed Care. Social workers and social work interns serve in twenty-one (21) libraries so far across the state through the Department of Health and Social Services’ (DHSS) Community Partner Support Unit, operated within the Division of Social Services. These social workers establish collaborations with hospitals, mobile medical testing units, employment services, veteran services, and community mental health organizations in the community as well as the programming already established in the library system, utilizing the AmeriCorps VISTA program and local ties. The public libraries utilize Unite Delaware, a coordinated care network of health and social care providers, which keeps data on how a person has been helped and what else they might need. Additionally, the newest library being built will have showers for use by patrons that may need this service.

San Francisco

The San Francisco Public Library is the first library in the United States to have an on-site social worker. Library staff were seeing a lot of patrons experiencing mental health issues, substance use disorders, poverty, and chronic health issues and determined that libraries were not trained to work with these vulnerable populations. They reached out to the Department of Public Health and ultimately decided to recruit a social worker to provide direct service to library patrons, support the front line staff with building relationships, direct patrons to the support services they needed, and to develop a program of peer outreach workers. A trauma-informed approach to working with patrons was implemented that has proven very effective and has since funneled into other parts of the library. The San Francisco Public Library system has numerous collaborative relationships within the community. Onsite social workers are able to connect individuals to a variety of services including medical, mental health, food, housing, and employment. Onsite showering

facilities and a pop-up care village, which brings in about thirty (30) community organizations on a bi-monthly basis, serves patrons needs thereby reducing the need for patrons to travel great distances to obtain services.

Houston

The Houston Public Library in Texas created the Senior Library Service Specialist position in lieu of a social worker position. This person works to develop programs to serve individuals experiencing homelessness, arranges for staff training on relevant topics, and works with community partners to get resources and direct services to the library. Programs include housing assessments and services, partnering with Mental Health America to receive Mental Health First Aid training, and trauma-informed training for library staff. The library has also established a partnership with a Workforce Solutions Homelessness Specialist. This specialist visits the library regularly to assist individuals experiencing homelessness and/or unstable housing with a goal of obtaining employment. The specialist provides connections to necessary employment services like bus passes, clothing for interviews, and vocational training. Finally, the library has also created a Social Services Guide Binder.

Maryland

The Charles County Public Library-Waldorf West in Maryland partners with Lifestyles of Maryland, an organization that supports people in crisis by providing emergency services. The library has public showers available for use by individuals who are experiencing homelessness. They also host a program called “Safe Night” where patrons can call and reserve a place to sleep, especially in the winter months. The Waldorf West library provides free non-perishable lunches in the summer primarily for school-aged children, but makes them available to anyone who needs them. The Waldorf West library has a JobSource Mobile Career Center and a Mobile Veteran’s Center that visit the library once per month to offer job seeking assistance and other resources.

Community Mental Health Centers and Libraries

Libraries throughout the country are seeing needs that are oftentimes overlooked by other organizations and mental health professionals. Many libraries that responded to this project shared that in their experience, mental health organizations did not understand what libraries had to do and how they dealt with homelessness and mental health. However, once invited to come to the library to observe, nearly all mental health professionals understood the gravity of the situation libraries are facing and readily collaborated with the library to provide services to these patrons in need. A list of all the collaborations and services that libraries in this country are providing or working to create exceeds the scope of this article. However, this project did focus on Michigan and how libraries across the state work with all forty-six (46) Community Mental Health Service Programs that collectively cover the eighty-three (83) Michigan counties. Libraries are generally left to their own resources to address the issues of their most vulnerable patrons. Public libraries are not usually included in discussions about improving population health, let alone mental health. However, public libraries are extremely common areas in which individuals experiencing mental illness or homelessness may use to seek shelter. “Public libraries are trusted institutions that have broad 47

population reach and untapped potential to improve population health.”2 During research of community mental health service programs (CMHSPs) interactions with libraries, only twenty-two out of forty-six Michigan CMHSPs responded. Several efforts were made to contact the twenty-four (24) non-respondents. It is important to note that due to Covid-19 stay-at-home orders, many CMHSP staff were not available to respond to the survey. While researching the roles that some of Michigan CMHSPs play with libraries, several commonalities were found including training for library staff as well as providing information and resources to library patrons including Mental Health First Aid, NARCAN training and kits, as well as crisis line services. Eight (8) of the forty-six (46) Michigan CMHSPs reported that they provide Mental Health First Aid (MHFA) to library staff. “MHFA is a standardized, psychoeducational program developed to empower the public to approach, support and refer individuals in distress by improving course participants’ knowledge, attitudes and behaviours related to mental ill-health.”3 Four (4) CMHSPs reported that they provide Narcan training and/or kits. This is a tool that is not widely used in libraries at this time. “Naloxone (Narcan) is a fast-acting opioid antagonist that can be used to reverse the agonist effects of opioids to stop an overdose. In the past decade, there have been increasing efforts to equip non-medical persons with naloxone and train them in its administration to reverse an opioid overdose.”4 Four (4) CMHSPs indicated that they do not have any interactions with the public libraries in their county. While these CMHSPs reported that they do not provide any services or information to their public libraries, they did indicate interest in beginning to implement services after hearing what other CMHSPs are doing. Collaborations currently in place between CMHSPs and Public Libraries in Michigan: • Provides information to libraries about CMH (Berrien County, Genesee Health Services, Ionia County, Lapeer County, Lifeways CMH, Calhoun, West MI CMH, Montcalm, Ottawa, St. Clair) • Host events at libraries (Berrien County, Lifeways CMH, Livingston CMH, Calhoun, Ottawa, St. Clair, Washtenaw) • Outreach at libraries (Berrien County, Saginaw) • Drop-In Center (Lapeer County) • Community collaboration including library staff (Ionia County, West MI CMH, Montcalm, Saginaw, St. Clair) • Case management (Allegan, Central MI, Berrien County, SW MI Behavioral Health) • Meet individuals at library (Allegan, SW MI Behavioral Health, Detroit/Wayne?, West MI CMH, Saginaw, Washtenaw) • Street Outreach Programs (Kalamazoo CMH, Ottawa, Saginaw, Berrien County) • Shelter (Kalamazoo CMH, Livingston CMH) • Naloxone/Narcan training to library staff (SW MI Behavioral Health, Montcalm, Available in Saginaw, St. Clair) • Offer MHFA training to libraries (Lifeways CMH, Livingston CMH, Pathways CMH), Calhoun (in community, but libraries can access), Network 180 (library can access), Montcalm, Ottawa, St. Clair, Washtenaw) 48 Delaware Journal of Public Health – September 2020

• HAP is with all CMH – Transitional housing (Cass, Central MI, Kalamazoo CMH, Northern Lakes, Macomb) – Screening and referral (Allegan, Central MI, SW MI Behavioral Health, Kalamazoo CMH, North Country CMH, Northern Lakes, Macomb, Newaygo) – Information (Allegan, Cass, Clinton-Eaton-Ingham, Southwest MI Behavioral Health, Kalamazoo CMH, Lapeer County, Hiawatha Behavioral Health, North Country CMH, Northern Lakes, Macomb, Newaygo, Oakland) • Strategic planning around homelessness (Central MI, Detroit/ Wayne, St. Clair) • Would like to do more with library (Central MI, Network 180)

RECOMMENDED ESSENTIAL ELEMENTS OF A MODEL POLICY The following are recommended essential elements of a model policy to address patrons who may be experiencing homelessness and/or mental illness based on communication with libraries across the United States, a review of the literature, and additional research of the project authors.

Purpose of Policy

A statement focused on how the specific policy will address the interface of libraries, homelessness and mental health. Specifically identifying areas of service needs, existing programming, collaboration opportunities, and deficits in current services for the marginalized homeless community.

Authority of Policy

Libraries develop their policies as individual agencies, separate from the American Library Association (ALA) and state library associations. Therefore, libraries can and should develop policies that are relevant to concerns that impact their individual functioning, one of which is the issue of homelessness and how it interfaces with the library’s system. Policies should adhere to reasonableness, non-discrimination, equity, current legal practices, and measurable enforcement. Implications of Policy Enclosed herein are well-researched and well-intentioned policy initiatives. This tool is meant to be used as a guide for future initiatives and policy implementations engaged as the library sees fit and is able. This is also meant to be a measure against which the library can compare their current policies.

Definitions

The following definitions of homelessness, mental illness and library depict the basis of conversation for the rest of the article. Homelessness. An individual or family with a primary nighttime residence in a place not meant for human habitation, living in temporary or emergency shelters designed to provide temporary living arrangements, or living in a place where they have resided for ninety (90) days or less and who has resided in a place not meant for human habitation or emergency shelter immediately prior to this living arrangement; individual or family who will lose their primary nighttime residence within fourteen (14) days, with no identified subsequent residence, and lacks supports to obtain other permanent housing (HUD definitions of Category 1 and 2 homelessness).

Mental Illness. The American Library Association uses definitions from Mental Health America, National Alliance of Mental Health, National Institute of Mental Health and Substance Abuse, and Mental Health Administration to develop an overview of mental health and a tip sheet, accessible on the American Library Association’s webpage, for how to interact with those experiencing a mental illness episode in the library. Generally, it is assumed that people who live with mental illness are patrons of the library and it is the responsibility of the library staff to ensure professional interaction and provide reliable information for those experiencing mental illness and their families. Library. As defined by the American Library Association: A public library is established under state enabling laws or regulations to serve a community, district, or region, and provides at least the following:

ensuring equity of access to information and knowledge of community resources. Libraries are encouraged • To provide day passes to patrons who are not able to prove permanent residence. This day pass may include internet accessibility. In lieu of day pass, the library may develop a library card program allowing patrons to identify temporary residence locations; • To develop a document of community resources/sources of information for patrons to access in both physical and electronic methods.

• An organized collection of printed or other library materials, or a combination thereof; • Paid staff; • An established schedule in which services of the staff are available to the public; • The facilities necessary to support such a collection, staff, and schedule; and • Is supported in whole or in part with public funds.

ETHICAL AND PROFESSIONAL STANDARDS The ALA has developed a Professional Ethics Guideline that is similar to the National Association of Social Workers Code of Ethics. The Committee on Professional Ethics is encouraged to develop a more concrete Code of Ethics. The following are tenets of both guidelines that may be incorporated or encouraged within the library. All-Inclusive. The library is encouraged to support creating responsible and all-inclusive spaces that serve and represent the entire community, by decentering power and privilege and facilitating conversations around access and identity as they impact patrons and professionals. Confidentiality. A basic tenet of the library is privacy. To uphold their privacy standards is abiding by confidentiality principles. Confidentiality is when a library has possession of personally identifiable information about its users and keeps that information private on their behalf in line with current confidentiality practices. Anti-Stigma. The library is responsible for presenting factual representation to correct misinformation about stigmatized groups or topics, and correct misperceptions about those groups or topics. Library as Sanctuary. Many people perceive libraries as a sanctuary and as a respite during their daily experiences, especially from interpersonal and environmental dangers experienced by people experiencing homelessness. It must be recognized that the role of the library is a resource and a sanctuary for all people.

Informational Resources

Libraries may ensure the right of all citizens to participate to the best of their ability in a fully democratic society through

Collaboration

Libraries already work with other organizations to bring information about the community within one hub of information. Libraries are encouraged to: 49

• Work in tandem with existing community programs and services to enhance access to these services and programs for library patrons;

If individuals are found to be sleeping, the library could offer multiple warnings to the patron before taking next remedial steps;

• Collaborate with local community mental health agencies to serve as a point of access for emergent mental and behavioral health needs;

• Assume a non-threatening stance (open body language, facing slightly away) in approaching patrons.

• Identify local partners who provide no-cost showering locations for patrons who may not otherwise have access to showering facilities (for example, the YMCA); • Identify community partners that offer laundry facilities for reduced or no cost; • Bring community resources to the library to present to patrons on relevant topics (for example, the VA and an adult GED program); • Collaborate with local Graduate Schools of Social Work to request Masters of Social Work (MSW) interns to be placed in the library to provide support and develop services for patrons.; • Develop written memorandums of understanding with community organizations, including local law enforcement and community mental health agencies.

Training Opportunities

To ensure equitable practices and a positive experience for patrons and staff, the following list offers suggestions for training opportunities. A library is encouraged to train staff in: Drug overdose intervention, specifically opioid overdose – this may include training in Narcan/Naloxone administration; Trauma-informed interventions; Topics such as crisis intervention, verbal de-escalation, emergency response, all-inclusive practices, gender identity, homelessness, community resources, etc; Mental Health First Aid, which can be accessed through local Community Mental Health Organizations; Training for administrative staff regarding managing staff who interact with disadvantaged and high-risk populations; Compassion fatigue, burnout, and vocational awe for librarians.

Interface with Individuals

Recognizing the role of the library in serving the needs of a diverse patron population, the library may develop all-inclusive practices that utilize library resources and facilities to ensure appropriate and responsible interactions with individuals of all life experiences that utilize library resources and facilities. The following suggestions are attributed to the training developed by Ryan Dowd.5 Libraries are encouraged to: • Maintain or develop identified courses of action for library patrons whose behavior impacts the experience of the library environment for others. These behaviors include but are not limited to: direct confrontations with other patrons, excessive noise, or preventing others from using space in the library; • Verbally interact with patrons who appear to be sleeping no less than every fifteen minutes, and to contact emergency services if the patron is unresponsive to verbal interaction. 50 Delaware Journal of Public Health – September 2020

The following are not attributed to Ryan Dowd’s training. Libraries are encouraged to: • Provide a sanitized or single-use set of headphones to patrons free of charge or through a rental process to discourage noise complaints; • Maintain policies that prohibit panhandling on library property, the library should not infringe upon the right of individuals to panhandle in the vicinity of the library; • Address a patron who presents with overwhelming odor (perfume, cologne, body odor) that impedes the experience of other patrons. Library staff may ask the patron to return after addressing the odor and refer the patron to community resources that provide hygiene facilities if the patron identifies a need for this resource. – This recourse shall only be utilized if a patron specifically identifies a concern with overwhelming odors.

Infrastructure

Ideally, library spaces are physically structured so as to meet the needs of the diverse populations that they serve, while meeting the needs of patron confidentiality and patron safety to the best of the library’s ability. Libraries are encouraged to: • Have spaces identified for use by only children/teens and to clearly identify that this space is not to be used by adults without children; • Have at least one single-stall, unisex bathroom. If no such bathroom exists, one may be installed for patron use if the library undergoes remodeling or building modification. Sharp item disposal containers should be placed in all restrooms; • Identify possible points of physical contact between patrons and between patrons/staff, and place antibacterial/sanitizer in those places for both staff and patron use; • Identify local public transportation methods and routes, and be able to identify stops nearest the library for patrons use; • Identify space for patrons to store and secure belongings upon arrival to the library dependent on community and patron need and available spatial resources. Signage shall be posted with regard to the length of time that items may be stored for and what will happen to items that are stored beyond the identified length of time; • Direct patrons to store belongings that exceed the size of a traditional backpack in storage space provided in order to ensure that belongings do not infringe on the library experience of other patrons; • Provide charging stations that are available for patron use; • Library is encouraged to have identified resources for the LGBTQ+ community.

Staff Accommodations and Requests

Policies regarding staff activities should ensure safety and professionalism of library staff, while recognizing staff abilities and the limits of staff training. Activities that request a staff member to operate beyond the scope of their training and beyond their comfort should be referred to other library staff.

CONCLUSION People experiencing homelessness may use the library as a safe haven as well as a resource. It would be an incredible opportunity for the population of people experiencing homelessness to find everything they need for a safe, clean, and informational life within the place they already come. The services that may be provided within the library are an excellent example of how a society may care for their vulnerable populations.

2. Morgan, A. U., D’Alonzo, B. A., Dupuis, R., Whiteman, E. D., Kallem, S., McClintock, A., . . . Cannuscio, C. C. (2018, May). Public library staff as community health partners: Training program design and evaluation. Health Promotion Practice, 19(3), 361–368. https://doi.org/10.1177/1524839917735304 3. Hadlaczky, G., Hökby, S., Mkrtchian, A., Carli, V., & Wasserman, D. (2014, August). Mental Health First Aid is an effective public health intervention for improving knowledge, attitudes, and behaviour: A meta-analysis. International Review of Psychiatry (Abingdon, England), 26(4), 467–475. https://doi.org/10.3109/09540261.2014.924910

REFERENCES

4. Dunn, K. E., Barrett, F. S., & Bigelow, G. E. (2018, November). Naloxone formulation for overdose reversal preference among patients receiving opioids for pain management. Addictive Behaviors, 86, 56–60. https://doi.org/10.1016/j.addbeh.2018.03.011

1. Zettervall, S., & Nienow, M. (2019). Whole person librarianship: A social work approach to services. Libraries Unlimited: Santa Barbara, CA

5. Dowd, R. (2016). Practical skills for working with patrons experiencing homelessness. Retrieved from: http://library.ifla.org/id/eprint/1493

52 Delaware Journal of Public Health – September 2020

FEATURING: COVID-19: Immunity & Vaccine Potential

Join us for a virtual summit! Due to COVID-19 gathering restrictions, the 2020 Communicable Diseases Summit will be held virtually this year. Join us from the comfort of your own screen!

Marci Drees, MD ChristianaCare

MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN Neil Rellosa, MD

WHEN Monday, November 9 8:20 am – 12:30 pm WHERE Online:

https://delamed.org/CD2020

Nemours/AI duPont Hospital for Children

UPDATE ON DE HEALTH Karyl Rattay, MD

Director, Division of Public Health

THE COVID-19 GLOBAL RESPONSE

David Henderson, MD

President, SHEA

The Medical Society of Delaware designates this live activity for a maximum of 3.75 AMA PRA Category 1 Credits ᵀᴹ CME credit conversion is 1 to 1 for Nursing and Pharmacy.

COVID-19 PANEL DISCUSSION

Partnerships for Health: NNLM MAR and Delaware Partners Make a Lasting Impact Kate Flewelling, M.L.I.S. Executive Director, Network of the National Library of Medicine, Middle Atlantic Region Erin Seger, M.P.H. Health Professions Coordinator, Network of the National Library of Medicine Tess Wilson, M.F.A, M.L.I.S. Engagement Coordinator, All of Us, Network of the National Library of Medicine, Middle Atlantic Region

INTRODUCTION What began in 1836 as a collection of medical publications overseen by the United States Army Surgeon General would eventually become the institution known as the National Library of Medicine (NLM). Now located in Bethesda, Maryland, as part of the National Institutes of Health (NIH) campus, NLM is regarded as the largest biomedical library in the world. As well as providing an impressive collection of electronic and print resources, NLM also supports highly utilized health information resources like MedlinePlus, ClinicalTrials.gov, PubMed, and approximately 250 others.1 These resources are invaluable tools for libraries and organizations across the country, and NLM remains a trusted entity in the health information community. Though these resources are freely available to any individual or organization, it became necessary in 1965 to establish an outreach and engagement arm of NLM. The Network of the National Library of Medicine (NNLM) exists as the conduit between trusted health resources and users from a wide variety of libraries and organizations. Eight NNLM Regional Medical Libraries (RMLs) serve the different regions of the United States, with each providing services to their respective states. Membership is completely free at both individual and organizational levels. NNLM support includes delivering virtual (and in-person, when feasible) introductions to health information resources and granting funding to network members to provide health programming in their communities. Because of the nature of network-based support, strong partnerships are essential to the work NNLM does. Leveraging existing networks and connections within any given region is not only an effective way to maximize reach, but also a way to ensure NNLM addresses, amplifies, and advocates for a region’s unique needs. NNLM Middle Atlantic Region (MAR) serves libraries and organizations in Pennsylvania, New York, New Jersey, and Delaware. Throughout this organizational relationship, countless meaningful partnerships have been formed, resulting in many successful projects. Three specific collaborations are highlighted here, each of which promoted health information in creative and effective ways, with lasting impact throughout the health resources community.

DISASTER RELIEF EFFORTS In 2017, The Disaster Research Center at the University of Delaware, NNLM MAR, and the Delaware Division of Libraries sponsored Disaster Recovery for Delaware: Exploring Potential 54 Delaware Journal of Public Health – September 2020

Partnerships Among Emergency Planners, First Responders, Librarians and Others. This summit brought together Delaware public, health sciences, and academic librarians, emergency management directors, operation planners from Delaware Emergency Management Agency, the Medical Reserve Corps, healthcare professionals, and other agencies involved with disaster planning, response, and recovery. This statewide event was intended to “connect library staff with emergency planners to help communities bounce back more quickly following a natural or man-made disaster.”2 There was a deliberate focus on developing partnerships and strategies before an emergency happens, as a way to strengthen these essential relationships over time. Emergency responders spoke to the myriad ways libraries can assist them in mitigation and preparedness, response, and recovery. Libraries are often considered to be “second responders” in these circumstances, and the summit provided practical advice, ready-to-use toolkits, and volunteer opportunities throughout. Presenters also promoted the Disaster Information Specialization, a professional opportunity through the Medical Library Association (MLA) and NLM. Open not just to library staff, but to other interested professionals as well, this curriculum “trains individuals in providing access to information for disaster and emergency preparedness, response, and recovery supporting their institutions and communities throughout the disaster/emergency cycle.”3 Since then, the Medical Reserve Corps and library partners have continued to meet quarterly to continue these discussions and maintain the momentum sparked by the summit. The resources shared by presenters remain relevant today, and crucial to libraries that hope to support their communities in crisis. The Disaster Planning and Recovery LibGuide remains on the Delaware Division of Libraries website. Resources including emergency contacts, related guides, health information sources, and links to relevant mobile applications are all available on this page.4

LIBRARIES AND PUBLIC HEALTH Over the years, the Delaware Department of Health and Social Services (DHSS) Library has been an important NNLM partner. The library’s mission to “empower employees to provide quality services to Delawareans and assist the public with health- and social service-related questions…[and] provide access to current print and electronic research materials, timesaving tools and training, and skilled specialists to support... information needs” aligns well with NLM’s mission to promote reliable health resources, which makes this partnership highly beneficial for the populations served by both entities.5 Two

library directors from this institution have served on NNLM MAR’s Health Professionals Special Advisory Group at various times and the library has partnered with NNLM MAR on several valuable projects. In 2018, an escape room initiative at the DHSS Library was highlighted in a workshop titled “Developing Escape Rooms at Libraries” that was part of NNLM MAR’s monthly guest speaker series within the region. These escape rooms took a creative approach to introducing library services to health department employees. This kind of collaboration is a prime example of how partnerships between libraries and health departments can open up opportunities for out-of-the-box programming and innovative collaborative projects that impact audiences across disciplines. In 2019, a representative from the DHSS Library partnered with NNLM MAR’s Health Professions Coordinator, Erin Seger, to present at the American Public Health Association Annual Conference as part of a session titled “Improving Health through Collaboration: Libraries and Public Health.”6 This session focused on a variety of library and public health partnerships, including collaborative efforts between the Delaware DHSS and public libraries throughout the state. The session also promoted practical NLM resources like the Disaster Information Management Research Center, a hub for disaster preparedness information that “connect[s] people to quality disaster health information and foster a culture of community resiliency.”7

OPIOID EPIDEMIC RESPONSE Opioid overdoses have increased dramatically in recent years. Millions of people in the United States suffer from substance use disorders. NLM and NNLM have responded accordingly with increased online health information resources and training. Many of NNLM MAR’s members—especially public libraries—have responded to the crisis with public events and staff training. For example, the Reading Public Library in Pennsylvania hosted a panel discussion that included the PA Physician General, first responders, and a mother who lost a child to the epidemic. After the public event, Lydia Collins, former NNLM MAR staff member, provided a training for library staff about how to navigate relevant health information resources. In addition, NNLM MAR Education and Health Literacy Coordinator Michelle Burda created a one-hour workshop focused on finding and using authoritative health information about opioid abuse, overdose prevention, and treatment options. This training, “Understanding the Opioid Crisis: Where Do I Begin,” was piloted with Medical Reserve Corps members from across Delaware.8

CONCLUSION The nature of the outreach and education provided by NNLM makes it crucial to forge and maintain meaningful partnerships with public health institutions, libraries of various types, and community-serving organizations. Forming lasting relationships across disciplines serves to amplify the missions of all parties involved. This, in turn, gives the communities served by these institutions an even stronger foundation of knowledge to build on and draw from. NNLM is always excited to work with its Delaware partners, and the future is undoubtedly full of more collaborations to come.

REFERENCES 1. National Library of Medicine. (2019, March 20). A brief history of NLM. National Library of Medicine. Retrieved from: https://www.nlm.nih.gov/about/briefhistory.html 2. Burda, M. (2017, March 1). Disaster recovery for Delaware: exploring potential partnerships among emergency planners, first responders, librarians and others. University of Delaware. Retrieved from: https://www.drc.udel.edu/news/Pages/DE-Library-Summit.aspx 3. Medical Library Association. (n.d.). Disaster information specialization. Retrieved from: https://www.mlanet.org/education/dis/ 4. Delaware Division of Libraries. (2020, May 12). Disaster planning and recovery. Delaware Division of Libraries LibGuides. Retrieved from: https://guides.lib.de.us/DisasterRecovery 5. Department of Health and Social Services. (n.d.). DHSS Library. Delaware.org. Retrieved from: https://dhss.delaware.gov/dhss/library.html 6. Seger, E. (2019, December 2). Public health and library partnerships at APHA. The MARquee. Retrieved from: https://news.nnlm.gov/mar/2019/12/02/public-health-and-librarypartnerships-at-apha/ 7. Disaster Information Management Research Center. (n.d.). About the Disaster Information Management Research Center (DIMRC). National Library of Medicine. Retrieved from: https://disasterinfo.nlm.nih.gov/about-dimrc 8. Flewelling, K. (2018, September 28). The National Library of Medicine and national network of libraries of medicine respond to the opioid epidemic. The MAReport. Retrieved from: https://news.nnlm.gov/mar-newsletter/2018/09/the-nationallibrary-of-medicine-and-national-network-of-libraries-of-medicinerespond-to-opioid-epidemic/

COVID-19 is the illness caused by a novel, or new, coronavirus first identified in Wuhan, China, in late 2019. The virus is SARS-Co-V-2, and the disease the virus causes, coronavirus disease 2019, is abbreviated as COVID-19. Public health officials are monitoring the COVID-19 outbreak, which is a public health emergency and on March 11 was declared a pandemic by the World Health Organization. Misinformation, rumors and the rapidly changing nature of the outbreak are big problems, so APHA and the entire public health community are working overtime to ensure you have the facts.

What is APHA Doing? We are urging the public health community to share science-based information with the public and are speaking out for outbreak response funding and support. •

Rethinking US policies and practices at 200,000 COVID-19 deaths (APHA news release)

•

New COVID-19 testing advice could endanger lives (APHA news release)

•

On the ground in battle against COVID-19 (The Nation's Health)

•

Essential workers facing higher risks during COVID-19 outbreak (The Nation's Health)

•

Letter to Vice President Pence requesting a reversal of the change in CDC testing guidelines for asymptomatic individuals who were exposed to COVID-19

•

Assessing Legal Responses to COVID-19 (APHA-sponsored report)

•

Help find a vaccine for COVID-19 (Public Health Newswire)

•

Tell your members of Congress to prioritize public health in legislation to combat COVID-19 (APHA action alert)

•

COVID-19 Conversations: An APHA/National Academy of Medicine webinar series

•

Letter in support of AHRQ funding for COVID-19 response

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COVID-19 in Corrections Data Transparency Act (APHA-endorsed legislation)

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Stop the spread and show you care: Wear a mask to protect others from COVID-19 (APHA news release)

•

Essential information for US state and counties to publicly report (joint COVID-19 indicators report)

•

Letter to House and Senate leaders urging investments in public health infrastructure and clean energy and clean transportation initiatives in future COVID-19 recovery stimulus legislation

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Public health professionals are heroes who deserve our support and gratitude, not intimidation and threats (APHA, American College of Preventive Medicine, American Association of Public Health Physicians)

•

American Journal of Public Health July issue: COVID-19: WE'RE NOT ALL IN THIS TOGETHER!

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"Everybody should recognize that their second job is public health" (TED Talk with APHA Executive Director Georges Benjamin)

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Ensuring health equity during the COVID-19 pandemic: the role of public health infrastructure (Georges Benjamin in Pan American Journal of Public Health)

•

Get Ready Mailbag: Can we go back outside already?!

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Coronavirus: How to protect yourself from COVID-19 (tips and resources to share with your friends, family and community)

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Public Health Newswire post series

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COVID-19 and Equity (new APHA webpage)

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American Journal of Public Health COVID-19 resource page

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Statement on physical distancing guidelines (PDF)

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Legislative Response to COVID-19 (PDF, APHA summary)

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Letter from more than 1,000 organizations and individuals urging the Trump administration to reverse course and continue funding the World Health Organization

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Countering the "infodemic" of misinformation (highlights of APHA media coverage)

56 Delaware Journal of Public Health – September 2020

2020 John Scholz Stroke Education Conference WHEN

Saturday, October 10 8am – 12:00pm

FEATURING: Treating Tobacco Dependance Sarah Mullins, MD Driving After Stroke Jeff Vari, PT Patient Perspective

WHERE

Bill Funk, MD

Online

Endovascular Intervention Sudhakar Satti, MD

Register Online: https://tinyurl.com/DSIStroke2020 The Medical Society of Delaware designates this live activity for a maximum of 3.75 AMA PRA Category 1 Credits ᵀᴹ CME credit conversion is 1 to 1 for Nursing and Pharmacy. CE credits for Physical Therapy,, Occupational Therapy, and Speech Language Pathology have been requested.

PA Optics

ToriAnn Yetter, PA-C Elizabeth Masten, PA-C Theresa Rohrs, PA-C

Racial Disparities and Stroke

Mary Cushman, MD

How Data from the Institute of Museum and Library Services Describe Ways Public Libraries Provide Health and Wellness Information Services Lisa M. Frehill, Ph.D., M.A., B.S. Senior Statistician, US Institute of Museum and Library Services; Energetics Technology Center, George Mason University

ABSTRACT Objective: This article describes how funding from the Institute of Museum and Library Services (IMLS) provided resources for state and public libraries to deliver health information to their patrons. Methods: Three IMLS publicly available data collections were used: State Library Administrative Agency Survey data; State Program Report system; and the Awarded Grants Search portal. Data about health related projects from these two administrative data sources for 36 competitive award projects since 2015 and 143 projects supported via the formula-funded Grants to States Program between 2015-2018 (inclusive) were included. Descriptive statistics about projects with a health and wellness focus were presented within the context of others supported by Grants to States. Results: Competitive projects supported public libraries’ health resources and built librarians’ skills to facilitate patron access to health information. The Grants to States program supported 143 projects associated with health undertaken by 29 states plus Puerto Rico between 2015 and 2018. The IMLS $14.4 million investment during this period leveraged an additional $5 million from state and local sources to support health information projects in public libraries. Finally, data from the State Library Administrative Agency Survey showed that in addition to projects that relied on IMLS Grants to States funds, 29 state libraries provided program assistance in health literacy to the public libraries in their jurisdictions in 2018. Conclusions: The findings point to a need to determine whether there are ways to collect additional information via IMLS’s data systems to further support state and public libraries in meeting patron health information needs. The lessons learned in the analyses in this article offer useful food-for-thought about how IMLS might work with our data stakeholders to continue to modify each of these data sources to describe the role of libraries in an increasingly complex information landscape.

INTRODUCTION As community anchor institutions, libraries are trusted sources of information.1 Libraries provide access to both online and print resources, technology to access information, and library professionals trained to assist patrons in navigating the sea of information. In addition to answering individual questions posed by patrons, libraries also offer programs to facilitate patrons’ lifelong learning and access to quality information about many topics, including health and wellness. Currently, during the coronavirus pandemic, it is even more important for library patrons to access high quality health information from trusted sources. Internet access, information literacy, and digital literacy are common themes in the research about the public’s access to valid and reliable health information, which has been exacerbated during the recent pandemic according to panelists in a Roundtable on Health Literacy hosted by the National Academies in August 2020. Research has shown persistent disparities in how different groups of people seek health information, with the elderly, people, those in rural areas, and those who are economically disadvantaged less likely than others to access health information online.2–4 Libraries can serve an important role in bridging this digital divide by facilitating public access 58 Delaware Journal of Public Health – September 2020

to the Internet. For example, across the country, public libraries make more than 300,000 computers available for patron use and provide WiFi access for those using their own devices. In 2018 more than 240 million sessions were logged on public-access Internet computers and over 426 million WiFi sessions were provided by public libraries.5 The Institute of Museum and Library Services (IMLS) has supported grant programs to expand library computer resources to address the persistent digital divide,6,7 to enable libraries to provide health-related programing,8 and to build information resources to facilitate libraries’ support for community health.9 Since March 2020, during the coronavirus pandemic, IMLS has also provided broad support to address the health-related concerns of libraries and museums to continue to meet public needs via the REopening Archives, Libraries and Museums project.

INSTITUTE of

Museum and Library SERVICES

Using IMLS’s Library Services and Technology Act (LSTA, also known as Grants to States) funds, three state libraries (Arizona, Oklahoma, and Pennsylvania) have specific Five-Year Plan goals to improve health literacy in their states via projects at public libraries. The diverse projects reflect each state’s specific needs. For example, Oklahoma cited troubling state public health statistics to motivate resource development, capacity building, and educational projects for libraries to provide Oklahomans tools to improve their health. A project in Arizona purchased a mobile cooking cart and curriculum to educate children and teens about preparing healthy meals, which is consistent with that state’s five-year plan goal of supporting libraries to engage with their communities for health literacy, among other learning goals. Finally, PA Forward is a Pennsylvania state library project that provides training to library staff to learn how to apply five literacy types (including health) to their programs and resources offered to local patrons. In this article, we describe IMLS mechanisms that have supported libraries’ health programming via formula-based grants made to state library agencies (i.e., the Grants to States program) and through various discretionary grant programs since 2015. Then we describe IMLS publicly available data to provide both a general description of health programming and to demonstrate the capabilities of these data as a resource to libraries and health care professionals interested in learning about health programs at libraries. Finally, we close with a short discussion of IMLS’s on-going role in facilitating health-related programming at public libraries and additional data that could be useful in understanding how public libraries serve patrons’ health information needs, with reference to the coronavirus pandemic.

IMLS GRANT PROGRAMS THAT SUPPORT HEALTH INFORMATION ACCESS AT LIBRARIES Grants to States Program

Using a population-based formula, more than $150 million is distributed among the State Library Administrative Agencies (hereafter, called state libraries) every year. State libraries are official agencies charged by law with the extension and development of library services located in each of the 50 states and the District of Columbia; the Territories (Guam, American Samoa, the Commonwealth of Puerto Rico, the Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands); and the Freely Associated States (Federated States of Micronesia, Republic of Palau, and the Republic of the Marshall Islands). Each year, about 1,500 Grants to States projects support the purposes and priorities outlined in the LSTA. State libraries may use the funds to support statewide initiatives and services, and they may also distribute them through competitive subawards to, or cooperative agreements with, public, academic, research, school, or special libraries or consortia. Matching funds required of the states reflect that libraries are a shared investment. Each state submits a five-year library plan with various projects supported by a combination of LSTA funds and state/local matching funds. Since 2015, $14.4 million in LSTA funds leveraged an additional $5 million from state and local sources to support health projects at libraries. Since that time, these projects have added health resources to America’s libraries including nearly 42,000 print items and over 600 electronic or audio-visual

materials. These funds also supported more than 4,100 program sessions, almost 45,000 consultations, and the completion of three program evaluations so that libraries can learn how to improve health programming for their patrons.

Nationally Competitive Award Programs for Libraries

In addition to the Grants to States program, IMLS has offered a host of nationally competitive funding opportunities. Awardees have used these funds to provide support for libraries’ healthrelated programming at various points in time. These include: • Accelerating Promising Practices for Small Libraries, started in 2019, supports projects that strengthen the ability of small and rural libraries and archives to serve their communities. • The Laura Bush 21st Century Librarian Program, launched in 2003, supports the development of a diverse workforce of library professionals to better meet the changing learning and information needs of the American public.10 • National Leadership Grants for Libraries support projects that enhance the quality of library and archive services nationwide by advancing theory and practice. • Native American Basic Grants support existing library operations and maintain core library services for tribal communities, while projects supported by Native American /Native Hawaiian Enhancement Grants may improve existing library services or implement new library services for tribal communities. • Sparks! Ignition Grants for Libraries, awarded from 2011 to 2016, were small grants that supported the deployment, testing, and evaluation of promising and groundbreaking new tools, products, services, or organizational practices of libraries and archives.

IMLS DATA RESOURCES We used survey data collected by IMLS to provide contextual information about public libraries and the role of state libraries in supporting health literacy programming at the libraries in their states. More detailed information about programs supported by IMLS funds that address health-related issues was obtained from two IMLS administrative data systems available to the public, which support search and download capabilities.

SURVEY DATA IMLS conducts two surveys of libraries: the Public Libraries Survey; and the State Library Administrative Agency (SLAA) survey. For this article, we performed analyses about state library program assistance for health literacy programs (among several other types of literacy) using the SLAA survey data. The Public Libraries Survey does not provide information about the topics of programs offered by public libraries. Starting in 1994, the SLAA survey gathers data about the official agency responsible for extension and development of public library services in each state and the District of Columbia (often referred to as the state library). In addition to their critical role in assessing, planning, and coordinating library services and resources, SLAAs may provide important reference and information services to the state government; administer the state library or serve as the state archives; operate libraries for the blind and physically handicapped; and support the State Center for the 59

Book. Data about the SLAA services provided to libraries within its jurisdiction are included in the survey along with information such as staffing, income, expenditures, and governance.11

ADMINISTRATIVE DATA The IMLS Awarded Grants Search provides a way for the public to access general information about projects funded by IMLS. For example, for this article, we merely entered the search term “health” as a keyword to generate a list of projects. While this is not meant to be a comprehensive look at all projects related to the full range of health issues, it provides a useful first set of projects to gain an understanding of the approaches taken by libraries and library researchers and how health information programming is supported by IMLS. Other users could search on a larger number of health-related terms to cast a wider net or on specific terms or within a specific program area to limit their search. Finally, the IMLS State Program Report (SPR) system is a comprehensive, highly detailed collection of data provided annually by the state libraries that administer the LSTA funds awarded via the IMLS Grants to States program (described in more detail, below).12 Each LSTA coordinator enters data about how LSTA funds support programming that meets needs as defined by the state library. Data includes information about the purposes of the programming, its intended audience, the types of expenditures necessary to support the program, program outputs and, as appropriate, evaluation findings. Since the majority of data we present is from the complex SPR system, additional explanation is necessary to understand how one may extract and understand its information. The system was developed as a collaborative project between state LSTA coordinators and IMLS to facilitate information access needed to assess progress of states in meeting state library five-year plan goals and inform conversations about how LSTA funds produced outcomes important to the state. Every year LSTA coordinators enter data about each project and its associated activities in the SPR system by selecting one of 14 choices for the project intent, which are aggregated within six “focal area” categories associated with more general library goals (see Figure 1 for a crosswalk of intents and focal areas). The system also provides flexibility to “drill down” into each intent to better understand the subjects of each project. LSTA coordinators can select up to two of 38 possible subjects for each intent (see Figure 2 for a list of subjects). In other words, the SPR system retains the common narrative grant reporting features, while providing state LSTA coordinators with ways to “tag” content to facilitate later retrieval and analysis. As such, the SPR system provides both a high level of transparency about state programming supported by LSTA funds awarded by IMLS and a way to explore projects in other states to benchmark, share resources, etc. For this article, SPR projects were identified as being associated with health and wellness in two ways. First, if any subjects for the project were either “Health & Wellness” or “Personal/Family health & wellness” the project was flagged as related to health. Second, projects were also flagged if any of the project intents included “Improve users’ ability to apply information that furthers their personal or family health & wellness.” This latter method was also used to flag activities as related to health and wellness. 60 Delaware Journal of Public Health – September 2020

Once the LSTA coordinator enters data about a project in the SPR, they can enter more detailed information about activities associated with the project. Most projects (70 percent) have one or two activities, with 25 percent reporting on three to five and 5 percent reporting more than six activities. Activity details include information about the intent of the activity (Figure 2), the intended audience, outputs (e.g., number of program sessions, number of items purchased), and optional information about the partners involved in the activity.

FINDINGS Nationally Competitive Awards by IMLS Support Health-Related Programming in Various Ways

Consistent with the themes raised in the August 2020 National Academies Roundtable on Health Literacy, IMLS competitive awards that referenced health in their online short descriptions since 2015 have taken various approaches to enhancing libraries’ capacity to provide health information. Table 1 provides general information about the themes/approaches of 36 IMLS competitive awards to libraries and library researchers for health-related programs, assessment, or research. The health-related projects in Table 1 represented 2.3 percent of the 1,575 competitive awards for libraries in the Awarded Grants Search portal since 2015. Over the past decade the number of programs of any type offered by public libraries has increased from 3.4 million offered in 2008 to 5.4 million in 2017.13 This transition to more programming, combined with the proliferation of electronic resources has sparked interest in professional development for librarians to meet the public’s changing information needs, including in health areas. Grants awarded within the Laura Bush 21st Century Librarian program, National Leadership Grants, and Sparks! Ignition Grants for Libraries all funded projects that included professional development for library professionals to deliver health-related programming. In some cases, funding was for projects to enhance connections between library professionals and medical researchers or providers’ use of more advanced library health literature resources. Table 1 also shows that several of the 12 grants in the Native American Basic and Native American/Native Hawaiian Enhancement programs have sought to develop collections, resources, and programming to serve tribal communities’ health needs. Other IMLS competitive grant programs funded projects that facilitated library partnerships with health providers and/or community health advocates, connected health issues to disaster preparedness, or focused on issues specific to the health needs of patrons in rural areas.

The IMLS Grants to States Program Stimulated Public Library Health Programming

This section focuses on information about the 143 SPR projects and their associated 230 activities for which either an intent or, in the case of projects, a subject associated with health and wellness was specified by the jurisdiction’s LSTA coordinator. Overall, since 2015, 29 states and Puerto Rico have used a portion of their LSTA funds to support health projects in their jurisdictions. As shown in Table 2, the number of projects and activities focused on health and wellness was relatively small, representing 2.5 percent of all projects included in the SPR. Proportionately more health and wellness projects supported with LSTA funds were flagged by LSTA coordinators as “exemplary”,

Figure 1. Crosswalk: SPR Intents to Focal Areas

Figure 2. 38 SPR System Subject Choices

Grant Program National Leadership Grants

Awards made 2015-2020

Number of Themes / Approaches health projects

259

Varied: Training for librarians (including medical librarians) to provide programming for patrons, including medical professionals (7 projects); Development of patron resources (7 projects, 3 of which focused on medical/health workers); Health partners (4 projects); Health issues in rural areas (3 projects); Disaster preparedness (2 projects)

1,235

Increase resources and services at libraries to provide health information to communities. Two projects connected digital and health literacy themes.

Laura Bush 21st Century Librarian Grants

178

Professional development for library staff to deliver health literacy programming or to provide information services to medical/health professionals (6 projects). Two projects also included research about library health programming to inform practice.

Sparks! Ignition Grants for Libraries

Curriculum/resource development for medical librarians and patrons

Accelerating Promising Practices for Small Libraries

Digital literacy and health literacy as connected themes (1 project); Oral history collection development to destigmatize mental health treatment (1 project)

TOTAL

1,575

Native American Basic and Native American/ Native Hawaiian Enhancement Grants

Table 1. Competitive Awards that Referenced “Health” in Project Abstracts, 2015-2020

Source: Analysis of information using the IMLS Awarded Grants Search tool: https://www.imls.gov/grants/awarded-grants. with this gap becoming more pronounced in 2018 when 41 percent of health and wellness versus nine percent of all others were identified as exemplary by the state, making it easier for others to locate promising practices in health programming. Budget information is reported in the next two panels of Table 2. The overall yearly investment in health and wellness projects increased from $3.6 million in 2015 to $4.6 million in 2018, with health and wellness projects representing just over one percent of the total IMLS Grants to States allotments during this period. The total IMLS $14.4 million investment during this fouryear period leveraged an additional $5 million from state and local sources to support health information projects in public libraries. Median budgets for health and wellness projects as compared to all others from 2015-2018 are shown in the next panel of Table 2. Budgets for health and wellness projects increased more rapidly (185 percent) during the period from 2015 to 2018 than did those for all LSTA-supported projects (52 percent). The final panel of Table 2, shows that most (62 percent) of health and wellness projects supported with IMLS LSTA funds provided to the state were carried out at public libraries with just over one-fourth implemented by the state library. In contrast, nonhealth projects were nearly equally likely to be implemented at a public library (42 percent) as at the state library (40 percent). Turning now to look at the details about 230 activities (combining all four years) with a health and wellness intent, Figure 3 compares the mix of activity types for health and wellness intents compared to all other activities. Just over half of health and wellness activities were instructional programs compared to 27 percent of all other activities. Health and wellness activities were also less likely than others to be associated with content (e.g., acquisition, lending collection items, description of digital items, or preservation). Finally, health and wellness programs were less likely to involve individual or other forms of instruction than were all other programs. 62 Delaware Journal of Public Health – September 2020

STATE LIBRARIES SUPPORT HEALTH LITERACY PROGRAMS: SLAA DATA Besides LSTA funds, state libraries invest their own dollars to support programs, including those in the areas of health, information, and digital literacy. As noted earlier, researchers have indicated these three types of literacy are inter-related. The SLAA survey asks whether the state library provides program assistance for various types of literacy programming at public libraries. Table 3 shows that at least two-thirds of state libraries reported they supported literacy programming in public libraries since 2014. Over this period, there was also increased prevalence of state library support for health, digital, and information literacy. In particular, the number of state libraries that provided support for health literacy programming at public libraries increased from 23 to 25 in 2016 and finally to 29 in 2018. There were also more state libraries supporting digital and information literacy programs during the same period.

SUMMARY IMLS funded projects that focus on health-related topics represented about 2.3 percent of IMLS competitive awards and 2.5 percent of Grants to States projects since 2015. This article has provided an overview of how library stakeholders interested in health topics might use the IMLS SPR and Awarded Grants Search systems to learn about these efforts to facilitate libraries’ role in serving the public’s need for high quality and reliable health information. As described here, IMLS has supported efforts aimed at developing library professionals’ skills in delivering programming and curating information resources about health for patrons, including those with more specialized medical knowledge needs. Support provided by the Grants to States program leverages state and local funds to deliver health programming to patrons and to develop the capacity of libraries to meet the diverse health needs of their communities. The SPR system also facilitates

2015 20*

2016 20*

2017 19

2018 13

Tota l 30

1,557 42 2.7%

1,459 37 2.5%

1,369 37 2.7%

1,339 27 2.0%

5,724 143 2.5%

3,283 73 2.2%

3,179 59 1.9%

3,040 75 2.5%

2,936 23 0.8%

12,438 230 1.8%

$23,273 Total $11,575 LSTA $11,698 State/ Local 49.7% % LSTA Type of libra ry tha t a dminis tered projects 44.8% Public library 39.6% Non-hea lth & State library 15.6% All other* wellnes s 69.0% Public library Hea lth & 23.8% State library wellnes s 7.1% All other*

$50,919 $34,540 $16,379 67.8%

$38,070 $20,000 $18,070 52.5%

$66,226 $34,291 $31,935 51.8%

$35,947 $24,613 $11,334 68.5%

43.2% 39.1% 17.7% 54.1% 29.7% 16.2%

40.3% 40.0% 19.7% 59.5% 21.6% 18.9%

40.9% 42.2% 16.9% 63.0% 29.6% 7.4%

42.4% 40.2% 17.4% 61.5% 25.9% 12.6%

Number of s ta tes tha t reported a hea lth & wellnes s project All projects Projects Health & wellness (# ) Health & wellness (%) All activities Activities

Health & wellness (# ) Health & wellness (%) E xempla ry 7.9% 9.4% 8.0% 6.3% 8.0% All other projects (%) 26.6% 40.7% 21.6% 24.3% 23.8% Health & wellness B udgets (in $ 1 ,0 0 0 )* * $385,221 $397,484 $406,871 $418,001 $1,607,578 All projects Tota l $19,421 $4,600 Health & wellness $3,627 $5,935 $5,259 $606,406 $149,356 $150,142 $151,061 $155,847 All projects LS TA Funds $14,417 $3,430 $3,789 $4,524 $2,674 Health & wellness Percent of budgets s pent on hea lth & wellnes s projects 1.2% 1.1% 1.3% 1.5% 0.9% Total Budget 2.4% 2.2% 2.5% 1.8% 3.0% LSTA Media n Project B udgets * * $42,322 $35,000 $35,130 $36,298 $27,930 Total Non-Hea lth & LSTA $23,560 $27,333 $24,079 $25,000 $18,708 wellnes s $11,440 $14,989 State/ Local $9,222 $11,298 $11,051 67.3% 64.6% 68.5% 68.9% 67.0% % LSTA Hea lth & wellnes s

* Includes Puerto Rico. * * These financial data have not been adjusted for inflation and are as-reported in the SPR system. To put this in perspective, the U.S. Bureau of Labor Statistics online inflation calculator indicates that $1 in 2015 is equivalent to $1.06 in 2018. (https:/ / www.bls.gov/ data/ inflation_calculator.htm)

Table 2. Overview Health & Wellness Projects Reported in SPR, 2015-2018 Source: State Program Report (SPR) system: https://imls-spr.imls.gov/Public/Projects https://imls-spr.imls.gov/Public/Projects

2014

2016

2018

Literacy programming of any type

Digital

Information

Health

Table 3. Number of State Libraries that Supported Each Type of Literacy Program, 2014-2018 SLAA survey respondents include the 50 states and the District of Columbia.

Figure 3. Mix of Activity Types, All Activities Combined (2015-2018) by Activity Intent Note: Other includes planning, evaluation, and procurement activities.

national information sharing to enable health and wellness project development to build upon a background of context-specific knowledge. The findings in this article also point to a need to determine whether there are ways to collect additional information via IMLS’s data systems to further support state and public libraries in meeting patron health information needs. For example, while the SPR system provides some insights into the types of partners libraries collaborate with to deliver programming, the Public Libraries Survey does not collect information on partnerships. Such partnerships, especially with local health provider organizations and advocacy groups, are likely to be more important in understanding how libraries serve as community anchors to meet public health needs. Additionally, the SLAA survey asks whether state libraries provide health literacy program assistance to libraries (among other types of literacies) but does not include details about the nature of that support nor the extent to which the state library might partner with state departments of health. At the current time, in the midst of the coronavirus pandemic, many public libraries have had to restrict access to their physical facilities, but have taken steps to provide phone and email support for patrons, curbside pick-up of physical materials, expanded electronic resources, and increased Internet access for patrons.1 IMLS CARES Act funding provided special additional allotments in the Grants to States program totaling $30 million. Over the next two reporting cycles, the SPR system will provide transparency about these expenditures and a means to determine if, as a result of these circumstances, more health and wellness 64 Delaware Journal of Public Health – September 2020

projects and activities are reported in the coming years. Additional IMLS CARES Act funds were made available via competitive grant programs, including one focused on providing resources to Native American and Native Hawaiian institutions. Reporting about the use of these funds over the coming years will provide additional information about how libraries collaborated with other organizations in their communities to mitigate the impacts of the current health crisis. It should be noted that we found the competitive awards projects in this article using only “health” as a search term. Those interested in more specific health topics can use additional terms to cast a wider net to identify potential ideas via the IMLS Awarded Grants Search. Additionally, new pandemic-related questions added to the 2020 SLAA survey (to be fielded in 2021), we will have other data points to understand how the pandemic affected state libraries. Finally, this article integrated information separately from three different data sources to paint a picture of how federal funds from IMLS support state and public libraries in developing and delivering health information to their patrons. The public library role in serving as a reliable source of health information and as an access point for telehealth may be an emerging area of focus for public libraries in the midst of the coronavirus pandemic. The lessons learned in the topical analyses, such as those about health described in this article, offer useful food-for-thought about how IMLS might work with our data stakeholders to continue to modify each of these data sources, plus the Public Libraries Survey, to describe the role of libraries in an increasingly complex health information landscape.

ACKNOWLEDGEMENTS The author is grateful to the comments and suggestions made by Amanda Bakale, Matt Birnbaum, Madison Bolls, Marvin Carr, Teri DeVoe, Michele Farrell, Sarah Fuller, Cyndee Landrum, Dennis Nangle, and Marisa Pelczar. Any remaining errors or omissions are the author’s alone. Correspondence should be directed to: Lisa M. Frehill, lfrehill@imls.gov

REFERENCES 1. Geiger, A. W. (2017, August). Most Americans – especially millennials – say libraries can help them find reliable trustworthy information. Pew Research Center. Retrieved from: https://www.pewresearch.org/fact-tank/2017/08/30/mostamericans-especially-millennials-say-libraries-can-help-them-findreliable-trustworthy-information/ 2. Powe, B. D. (2015, September). Health information seeking among rural African Americans, Caucasians, and Hispanics: It is built, did they come? The Nursing Clinics of North America, 50(3), 531–543. https://doi.org/10.1016/j.cnur.2015.05.007 3. Din, H. N., McDaniels-Davidson, C., Nodora, J., & Madanat, H. (2019, May 14). Profiles of a health information-seeking population and the current digital divide: Cross-sectional analysis of the 2015-2016 california health interview survey. Journal of Medical Internet Research, 21(5), e11931. https://doi.org/10.2196/11931 4. Hesse, B. W., Nelson, D. E., Kreps, G. L., Croyle, R. T., Arora, N. K., Rimer, B. K., & Viswanath, K. (2005, December 12-26). Trust and sources of health information: the impact of the Internet and its implications for health care providers: findings from the first Health Information National Trends Survey. Archives of Internal Medicine, 165(22), 2618–2624. https://doi.org/10.1001/archinte.165.22.2618 5. Pelczar, M., Frehill, L. M., Nielsen, E., & Hasanbasri, A. (2020). Supplementary tables: public libraries in the United States fiscal year 2018. Institute of Museum and Library Services: Washington, D.C. 6. Martin, M. J. R. (2019). Deconstructing the digital divide: identifying the supply and demand factors that drive internet

subscription rates. U.S. Census Bureau SEHSD Working Paper #2019-15. Retrieved from: https://www.census.gov/library/working-papers/2019/demo/SEHSDWP2019-15.html 7. Owens, T., Sands, A. E., Reynolds, E., Neal, J., & Mayeaux, S. (2017). The first three years of IMLS investments to enhance the national digital platform for libraries. Washington, D.C.: Institute of Museum and Library. Retrieved from: https://www.imls.gov/publications/ndp-three-report Services, Office of Library Services 8. Allen, S. G., Clark, L., Coleman, M., Silipigni Connaway, L., Cyr, C., Morgan, K., & Procaccini, M. (2019). Libraries respond to the opioid crisis with their communities: summary report. Dublin, OH: OCLC. Retrieved from: https://doi.org/10.25333/qgrn-hj36 9. Online Computer Library Catelog. “Health happens at libraries” (portal) online at: https://www.webjunction.org/explore-topics/ehealth. html#:~:text=A%20recent%20IMLS%20study%20showed,and%20 assessing%20health%20insurance%20options 10. International, I. C. F. (2013, July) “Laura Bush 21st century grant program evaluation (grant years 2003-2009). Retrieved from: https://www.imls.gov/sites/default/files/legacy/assets/1/AssetManager/ LB21%20Evaluation%20Report.pdf 11. Pelczar, M., Frehill, L. M., Robbins, E., & Karr, A. (2020). Data file documentation: state library administrative agency survey: fiscal year 2018. Institute of Museum and Library Services: Washington, DC. Retrieved from: https://www.imls.gov/sites/default/files/slaadatadoc2018.pdf 12. Frehill, L. M. (2020, May). The grants to states portfolio: FY 2015-FY 2018. 2020 LSTA Annual All States Conference. Retrieved from: https://www.imls.gov/sites/default/files/day1_state_of_the_nation_ g2s_2020.pdf 13. The Institute of Museum and Library Services. (2020). Public libraries in the United States: fiscal year 2017, volume I. Washington, DC: The Institute. Retrieved from: https://www.imls.gov/sites/default/files//publications/documents/ publiclibrariesintheunitedstatessurveyfiscalyear2017volume1.pdf

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GLOBAL GLOBAL HEALTH GLOBAL HEALTH M AT TERS HEALTH M M AT AT TERS TERS

Inside this issue Inside this issue Former Fogarty Inside thisFellow’s issue JULY/AUGUST 2020 JULY/AUGUST 2020

FOGARTY INTERNATIONAL CENTER • NATIONAL INSTITUTES OF HEALTH JULY/AUGUST 2020•

Former Fogarty TB training usefulFellow’s in Former Fogarty Fellow’s TB training useful in COVID response . . . p. 4 TB training useful in COVID response . . . p. 4 DEPARTMENT HEALTH COVIDOF response . . .AND p. 71 4 HUMAN SERVICES

FOGARTY INTERNATIONAL CENTER • NATIONAL INSTITUTES OF HEALTH • DEPARTMENT OF HEALTH AND HUMAN SERVICES FOGARTY INTERNATIONAL CENTER • NATIONAL INSTITUTES OF HEALTH • DEPARTMENT OF HEALTH AND HUMAN SERVICES

NIH launches $58M Africa data science program NIH launches $58M Africa data science program NIH launches $58M Africa data science program The NIH has unveiled a $58 million initiative to advance data science, catalyze innovation and spur health The NIH has unveiled a $58 million initiative to advance discoveries across Africa. The new program, Harnessing The has unveiled $58 million initiative to advance dataNIH science, catalyze a innovation and spur health Data Science for Health Discovery and Innovation in data science, catalyze innovation spur health discoveries across Africa. The newand program, Harnessing Africa (DS-I Africa), will leverage data and technologies discoveries across Africa.Discovery The new and program, Harnessing Data Science for Health Innovation in to develop solutions for the continent’s most pressing Data for Health Discovery andand Innovation in AfricaScience (DS-I Africa), will leverage data technologies clinical and public health problems. Africa (DS-Isolutions Africa), will leverage data and technologies to develop for the continent’s most pressing to develop for theproblems. continent’s most pressing clinical andsolutions public health “Data science drives scientific discovery and data sets clinical and public health problems. are the currency of the future,” said NIH Director Dr. “Data science drives scientific discovery and data sets Francis S. Collins. “Many years of investment in research “Data drives scientific data sets are thescience currency of the future,”discovery said NIHand Director Dr. infrastructure by NIH and other organizations in Africa are the currency of “Many the future,” NIH Director Dr. Francis S. Collins. years said of investment in research have produced an opportunity for substantial technical Francis S. Collins. “Many investment in infrastructure by NIH andyears other of organizations in research Africa innovation. By forming a robust network of public and infrastructure and otherfor organizations in Africa have producedby anNIH opportunity substantial technical private partners, we believe this initiative can transform have produced an opportunity fornetwork substantial technical innovation. By forming a robust of public and the field and pay huge dividends—such as deploying lowinnovation. By forming a robust network of public and private partners, we believe this initiative can transform cost technologies to improve health care in remote areas, private believe this initiative transform the fieldpartners, and pay we huge dividends—such ascan deploying lowand developing skilled scientists who can mine vast data the and pay huge dividends—such lowcostfield technologies to improve health careas in deploying remote areas, collections to make discoveries that improve health for cost technologies to improve health care remote and developing skilled scientists who caninmine vastareas, data us all.” and developing skilled scientiststhat whoimprove can mine vast for data collections to make discoveries health collections to make discoveries that improve health for us all.” In four funding announcements, NIH is calling for us all.” applications to establish an open data science platform In four funding announcements, NIH is calling for and coordinating center; research hubs; research In four funding announcements, calling platform for applications to establish an open NIH dataisscience training programs; and ethical, legal and social applications to establish open data science platform and coordinating center; an research hubs; research implications (ELSI) research. The open data science and coordinating center; research hubs; training programs; and ethical, legal andresearch social platform will develop and maintain a data-sharing training programs; ethical, legal and social implications (ELSI) and research. The open data science gateway for existing resources and new data generated implications research. The open data science platform will (ELSI) develop and maintain a data-sharing by the DS-I Africa research hubs. The coordinating platform willexisting developresources and maintain a data-sharing gateway for and new data generated center will provide the organizational framework for the gateway for existing resources andThe newcoordinating data generated by the DS-I Africa research hubs. direction and management of the initiative’s common by the DS-I Africa research hubs. Theframework coordinating center will provide the organizational for the activities. The research hubs are intended to become center willand provide the organizational framework for the direction management of the initiative’s common recognized centers of excellence in data science fields direction of are the intended initiative’s activities.and The management research hubs tocommon become and will advance population-relevant, affordable, activities. research hubs arein intended to become recognizedThe centers of excellence data science fields acceptable and scalable data science solutions that will recognized centers of excellence in data science fields and will advance population-relevant, affordable, improve health in Africa. Research training programs and will advance population-relevant, affordable, acceptable and scalable data science solutions that will will include a strong foundation in rigorous research acceptable and in scalable science solutions that will improve health Africa.data Research training programs design, methods and analytic techniques, provide improve health in Africa. Research training programs will include a strong foundation in rigorous research will include a strong in rigorous research design, methods and foundation analytic techniques, provide design, methods and analytic techniques, provide

interdisciplinary research experience and enhance trainees’ ability to develop novel data science solutions. interdisciplinary research experience and enhance Finally, the program will support research into key interdisciplinary enhance trainees’ ability toresearch develop experience novel data and science solutions. ELSI issues such as data privacy and ownership, trainees’ ability to develop novel data science solutions. Finally, the program will support research into key cybersecurity and sensitivities concerning the use of Finally, the program will support into key ELSI issues such as data privacy research and ownership, geospatial information for research or public health ELSI issues such data privacy and ownership, cybersecurity andas sensitivities concerning the use of surveillance. cybersecurity and sensitivities concerning thehealth use of geospatial information for research or public geospatial information for research or public health surveillance. DS-I Africa is intended to encourage partnerships surveillance. across sectors and engage private, government, DS-I Africa is intended to encourage partnerships nongovernmental organizations and other stakeholders DS-I Africa is intended to encourage partnerships across sectors and engage private, government, in applications. In addition, interdisciplinary across sectors andorganizations engage private, nongovernmental andgovernment, other stakeholders collaborations will bring together data specialists, nongovernmental and other stakeholders in applications. Inorganizations addition, interdisciplinary computer scientists and engineers with biomedical in applications.will In addition, interdisciplinary collaborations bring together data specialists, researchers, clinicians and other health experts. The collaborations will bring computer scientists and together engineersdata withspecialists, biomedical program aims to foster a culture of innovation and computer scientists and engineers with researchers, clinicians and other health biomedical experts. The entrepreneurship that will result in new software researchers, other of health experts. The program aimsclinicians to foster and a culture innovation and solutions and technologies, produce start-ups and program aims to foster a culture and entrepreneurship that will result of in innovation new software spinoff companies, and partner with governments and entrepreneurship that will result in new software solutions and technologies, produce start-ups and businesses to reach scale and impact. solutions and technologies, produce and and spinoff companies, and partner with start-ups governments spinoff companies, partner with governments and businesses to reachand scale and impact. “Our colleagues in Africa have identified data science businesses to reach scale and impact. expertise as a key priority for capacity building support,” “Our colleagues in Africa have identified data science “Our colleagues in priority Africa have identified data science expertise as a key for capacity building support,” expertise as a key priority for building support,” Data Science incapacity Africa virtual

platform Datasymposium Science in Africa virtual Datasymposium Science in Africa virtual platform symposium platform Keynote presentation videos

Keynote presentation videos Interactive panel discussions Keynote presentation videos Interactive panel discussions Virtual networking forum Interactive panel discussions Virtual networking Technical advice on forum grant applications Virtual networking forum advice on grant applications Visit:Technical https://commonfund.nih.gov/africadatasymposium Technical advice on grant applications Visit: https://commonfund.nih.gov/africadatasymposium Visit: https://commonfund.nih.gov/africadatasymposium

Fogarty community engaged in combatting COVID-19

FOCUS FOCUS FOCUS

• Researchers study new syndemicinon US-Mexico border Fogarty community engaged combatting COVID-19 • Grantees examine intersection of COVID-19 andCOVID-19 HIV Fogarty community engaged in combatting • Researchers study new syndemic on US-Mexico border • Fogarty fellow captures ‘lived experiences’ of pandemic • Researchers study new syndemic US-Mexico Grantees examine intersection of on COVID-19 andborder HIV Read More more on pages pages 73-76 6–9 on • Grantees examine intersection of COVID-19 and HIV Fogarty fellow captures ‘lived experiences’ of pandemic

• Fogarty fellow captures ‘lived experiences’ pandemic Read of more on pages 6 – 9 68 Delaware Journal of Public Health – September 2020 Read more on pages 6 – 9

JULY/AUGUST 2020 JULY/AUGUST 2020 JULY/AUGUST 2020

NIH launches $58M Africa data science program NIH launches . . . continued from p.1$58M Africa data science program NIH launches . . . continued from p.1 $58M Africa data science program We believe this initiative can transform the field and pay Fogarty Director .continued continued from p.1 Dr. . ...said from previous pageRoger I. Glass. “Through this

initiative hope toDr. create a cadre of African scientists said Fogartywe Director Roger I. Glass. “Through this and nurture multidisciplinary, multisector partnerships initiative we hope to create a cadre of African scientists said Fogarty Director Dr. Roger I. Glass. “Through this to nurture advancemultidisciplinary, discoveries that will improve health.” and multisector partnerships initiative we hope to create a cadre of African scientists to advance that willmultisector improve health.” and nurturediscoveries multidisciplinary, partnerships Potential research topics could include development to advance discoveries that will improve health.” of artificial intelligence tools to advance decision Potential research topics could include development support for mobile and other point of care technologies, of artificial intelligence tools to advance decision Potential research topics could include development establishment and use of shared platforms to leverage support for mobile and other point of care technologies, of artificial intelligence tools to advance decision large health datasets to shared reveal disease patterns and establishment and use of platforms to leverage support for mobile and other point of care technologies, risks, and computational approaches and data sharing to large health datasets toof reveal disease patterns and establishment and use shared platforms to leverage accelerate discovery of new diagnostics, treatments and risks,health and computational approaches data sharing to large datasets to reveal diseaseand patterns and vaccines.discovery of new diagnostics, treatments and accelerate risks, and computational approaches and data sharing to vaccines. accelerate discovery of new diagnostics, treatments and The program is targeting African academic and other vaccines. non-profit to apply in partnership with The programorganizations is targeting African academic and other private sector, government and in other research with partners. non-profit organizations to apply partnership The program is targeting African academic and other Applications are due in late 2020 with projects slated to private sector, government other research partners. non-profit organizations to and apply in partnership with begin in September 2021. Applications are due in lateand 2020 withresearch projects partners. slated to private sector, government other begin in September Applications are due2021. in late 2020 with projects slated to NIH is hosting a virtual symposium platform with begin in September 2021. networking and online eventsplatform continuing NIH is hostingtools a virtual symposium withthrough November.tools These opportunities willcontinuing communicate the networking and online events through NIH is hosting a virtual symposium platform with program’sThese key priorities and engage participantsthe in robust November. opportunities will communicate networking tools and online events continuing through scientific discussions on state participants of data science robust in program’s priorities andthe engage November. key These opportunities will communicatein the Africa. The platformon is the designed to data encourage networking scientific discussions state of science in program’s key priorities and engage participants in robust across disciplines, sectors andtogeographies to foster Africa. The platform is designed encourage networking scientific discussions on the state of data science in collaborations that will produce high quality applications. across disciplines, and geographies to networking foster Africa. The platformsectors is designed to encourage collaborations that sectors will produce high qualitytoapplications. across disciplines, and geographies foster collaborations that will produce high quality applications.

“We believe this initiative can transform the field and pay

“ Wehuge dividends—such as deploying low-cost technologies believe this initiative can transform the field and pay dividends—such as deploying low-cost technologies “ huge to improve health care in remote areas, and developing huge dividends—such as deploying low-cost technologies to improve health care in remote areas, and developing skilled scientists who can mine vast data collections to to improve health care in remote areas, and developing skilled scientists who can mine vast data collections to make discoveries that improve health for us all. skilled scientists who can mine vast data collections to make discoveries that improve health for us all. — NIH DIRECTOR DR. FRANCIS S. COLLINS make discoveries that improve health for us all.

” ”

”

— NIH DIRECTOR DR. FRANCIS S. COLLINS The African-led initiative is intended to build on previous — NIH DIRECTOR DR. FRANCIS S. COLLINS large-scale NIH collaborations on the continent including The African-led initiative is intended to build on previous the Human Heredity and Health in Africa (H3Africa) large-scale NIH collaborations on theto continent The African-led initiative is intended build onincluding previous consortium, the Medical Education Partnership Initiative the Human Heredity and Health in Africa (H3Africa) large-scale NIH collaborations on the continent including (MEPI) and the Health-Professional Education Partnership consortium, the Medical Partnership Initiative the Human Heredity andEducation Health in Africa (H3Africa) Initiative (HEPI). H3Africa advanced genomics capacity and (MEPI) and the Health-Professional Education Partnership consortium, the Medical Education Partnership Initiative research partnerships, while MEPIgenomics and HEPIcapacity strengthened Initiative (HEPI). H3Africa advanced and (MEPI) and the Health-Professional Education Partnership and expanded training for doctors andHEPI health care research partnerships, while MEPI and strengthened Initiative (HEPI). H3Africa advanced genomics capacity and professionals. and expanded training for doctors care research partnerships, while MEPIand andhealth HEPI strengthened professionals. and expanded training for doctors and health care DS-I Africa is an NIH Common Fund program guided by a professionals. working led by the Office of the Director, the Fogarty DS-I Africagroup is an NIH Common Fund program guided by a International Center, the National Institute ofthe Biomedical working group led by the Office of the Director, Fogarty DS-I Africa is an NIH Common Fund program guided by a Imaging and Bioengineering, theInstitute Nationalof Institute of International working groupCenter, led by the the National Office of the Director,Biomedical the Fogarty Mentaland Health and the National Library Institute of Medicine. Imaging Bioengineering, the National of International Center, the National Institute of Biomedical Mental Health and the National Library of Medicine. Imaging and Bioengineering, the National Institute of For more information, please visit https://commonfund. Mental Health and the National Library of Medicine. nih.gov/AfricaData. For more information, please visit https://commonfund. nih.gov/AfricaData. For more information, please visit https://commonfund. nih.gov/AfricaData.

Essence establishes funding coordination mechanism Essence establishes funding coordination mechanism Essence establishes funding coordination mechanism A framework for reviewing and coordinating capacity building in for lowand middle-income countries (LMICs) A framework reviewing and coordinating capacity has been established by the Essence Health Research building in lowmiddle-income countries (LMICs) A framework for and reviewing and coordinating capacity initiative, a collaboration ofEssence 40 funding agencies. has been established by the Health Research building in low- and middle-income countries (LMICs) The review mechanism is initiative, a collaboration of intended 40 funding agencies. has been established by the Essence Health Research to increase efficiency and equity in The review mechanism is intended initiative, a collaboration of 40 funding agencies. health research capacity strengthening to increase efficiency and equity in The review mechanism is intended activities, and decrease duplication of health research capacity strengthening to increase efficiency and equity in efforts, according to a recent article activities, and decrease of health research capacityduplication strengthening by Essence partners published in the efforts, according to a recent article activities, and decrease duplication of Annals of partners Global Health. by Essence in the efforts, according to apublished recent article Annals of Global Health. by Essence partners published in the The mechanism includes three independent Annals of Global Health. workstreams, WHO-developed The mechanism including includes three independentstandardized metrics to characterize the status of health research workstreams, including standardized The mechanism includesWHO-developed three independent capacity, use of NIH World Report global funding metrics to characterize status of health research workstreams, includingthe WHO-developed standardized capacity, use of NIH World Report global funding metrics to characterize the status of health research capacity, use of NIH World Report global funding

data to monitor current activities, and periodic meetings of global funders and stakeholders data to monitor current activities, and periodic to review investments, identify gaps, and enhance coordination meetings of global funders and stakeholders to review data to monitor current activities, and periodic and collaboration on grantmaking. investments, identify gaps, and enhance coordination meetings of global funders and stakeholders to review and collaboration on grantmaking. investments, identify gaps, and enhance coordination The overall goals are to increase and collaboration on grantmaking. support research national The overallofgoals are toonincrease health priorities, improve pandemic support of research The overall goals areon to national increase preparedness in LMICs and reduce health improve pandemic supportpriorities, of research on national the number of countries operating preparedness in LMICs and reduce health priorities, improve pandemic with very limited research capacity, the number of countries operating preparedness in LMICs and reduce the authors stated. with very limited research capacity, the number of countries operating the authors stated. with very limited research capacity, Fogarty is an Essence partner and several of its staff the authors stated. contributed to the publication. Fogarty is an Essence partner and several of its staff contributed the publication. Fogarty is antoEssence partner and several of its staff contributed to the publication. RESOURCES http://bit.ly/EssenceMech RESOURCES

http://bit.ly/EssenceMech RESOURCES

http://bit.ly/EssenceMech

JULY/AUGUST 2020 JULY/AUGUST 2020 JULY/AUGUST 2020

NIEHS explores environmental change and health NIEHS NIEHS explores explores environmental environmental change change and and health health By Susan Scutti

By Susan Scutti By Scutti TheSusan Diama Dam is just 18 meters high, yet its 1986

70 Delaware Journal of Public Health – September 2020

http://bit.ly/GEHday2020

Images Images courtesy Images courtesy ofcourtesy Upstream of Upstream of Upstream Alliance Alliance Alliance

construction changed Senegal The Diama Dam is justthe 18local meters high, River yet itsecology 1986 into Diama a fresh-water for snails. Proliferation of The Dam ishabitat justthe 18local meters high, yet itsecology 1986 construction changed Senegal River the gastropods ledhabitat to an outbreak of construction changed theunanticipated local Senegal River ecology into a fresh-water for snails. Proliferation of schistosomiasis, a habitat parasitic disease. Fogartyinto a fresh-water forworm snails. Proliferation of the gastropods led to an unanticipated outbreak of supported research a simple solution of the gastropods led tosuggested an unanticipated outbreak ofstocking schistosomiasis, a parasitic worm disease. Fogartythe river with prawns, a natural snail predator. The result? schistosomiasis, a parasitic worm disease. Fogartysupported research suggested a simple solution of stocking Reduced incidence of schistosomiasis and improved health supported research suggested a simple solution of stocking the river with prawns, a natural snail predator. The result? within the community, notsnail onlypredator. gained a The dietary the river with prawns, awhich natural result? Reduced incidence of schistosomiasis and improved health proteinthe source but also a new not cash crop. “Aimproved key lesson Reduced incidence of schistosomiasis and health within community, which only gained a dietary in planetary health thinking that hazards are often within the community, which only gained a dietary protein source but also a newisnot cash crop. “A key lesson accompanied by opportunities,” saidcrop. Dr. Howard Frumkin protein source but also a newiscash “A key lesson in planetary health thinking that hazards are often his keynote address for theisfourth annual Global in planetary health thinking that are often accompanied by opportunities,” saidhazards Dr. Howard Frumkin Environmental changes can have unintended health consequences. In Senegal, Environmental Health Day, hosted byDr. theHoward NIH’s National accompanied opportunities,” said Frumkin in his keynoteby address for the fourth annual Global researchers introduced prawns to prey on disease-carrying snails, which Environmental changes can have unintended health consequences. In Senegal, Institute of Environmental Health Sciences (NIEHS). proliferated after a dam was built. in his keynote address for the fourth Global Environmental Health Day, hosted byannual the NIH’s National researchers introduced to unintended prey on disease-carrying snails, which Environmental changes prawns can have health consequences. In Senegal, Environmental Health Day,Health hostedSciences by the NIH’s National Institute of Environmental (NIEHS). proliferated after a damprawns was built. researchers introduced to prey on disease-carrying snails, which In settingofthe agenda for global environmental health building and Institute Environmental Health Sciences (NIEHS). proliferated structures after a dam was built.demographics, explained Bell. research, says need to address As climates alter, Alaska can anticipate explained an increase in In setting Frumkin the agenda forscientists global environmental health building structures and demographics, Bell. overarching change, wildfire smoke, yetAlaska exposure healthexplained effects will not In setting Frumkin thechallenges—climate agenda forscientists global environmental health loss building structures and demographics, Bell. research, says need tobiodiversity address As climates alter, can and anticipate an increase in and others—not just in terms of characterizing the issues be distributed uniformly. Some indigenous populations research, Frumkin says scientists need tobiodiversity address As climates alter, can anticipate increase in overarching challenges—climate change, loss wildfire smoke, yetAlaska exposure and health an effects will not but also in seeking solutions for biodiversity each. the “We issues need willdistributed likely suffer theexposure most,Some sheand said, based on research overarching challenges—climate change, loss wildfire smoke, yet health effects will not and others—not justmultiple in terms of characterizing be uniformly. indigenous populations to doalso thisinwork urgently because thesefor problems are very supported by the National Institute on Minority Health and others—not justmultiple in terms of characterizing issues be distributed uniformly. indigenous populations but seeking solutions each. the “We need will likely suffer the most,Some she said, based on research pressing,” Frumkin observed, “and thefor time we have to and likely Health Disparities. A current project, funded by but seeking multiple solutions each. “We will suffer most, she said, based on research to doalso thisinwork urgently because these problems areneed very supported by thethe National Institute on Minority Health solve is limited.” He “and alsothese encouraged Wellcome Trust, study air pollution exposure in to do problems this work urgently because problems are to very supported by thewill National Institute on Minority Health pressing,” Frumkin observed, the time we researchers have and Health Disparities. A current project, funded by to collaborate across multiple sectors Brazil and how itproject, will change over pressing,” Frumkin observed, theincluding time we researchers have to and Health Disparities. A current funded bytime. solve problems is limited.” He “and also encouraged Wellcome Trust, willestimate study air pollution exposure in health, energy,across agriculture andsectors transportation, “We can’t understand how climate change solve problems is limited.” He also encouraged WellcomeBrazil Trust, will study air pollution exposure inwill to collaborate multiple includingresearchers and estimate how it will change over time. and to stay focused on the world’s most impact health in thehow future until we understand to collaborate across multiple including Brazil and estimate it will change overwill time. health, energy, agriculture andsectors transportation, “We can’t understand how climate change vulnerable populations. how can’t those exposures affect health in the present health, energy, agriculture and transportation, “We understand how climate change will and to stay focused on the world’s most impact health in the future until we understand day,”those said Bell. and to staypopulations. focused on the world’s most impact health in the future until we vulnerable how exposures affect health inunderstand the present Each of thepopulations. United Nations’ sustainable vulnerable how those exposures affect health in the present day,” said Bell. development goals either directly or indirectly This year’s Global Environmental Health Day, day,” said Bell. Each of the United Nations’ sustainable impact health, Frumkin noted. The goal a virtual forum dueEnvironmental to the pandemic, provided Each ofhuman the United Nations’ sustainable development goals either directly or indirectly This year’s Global Health Day, of “affordable and clean energy,” for example, opportunities fordue attendees to explore areas of development goals either directlynoted. or indirectly This year’s Global Environmental Health Day, impact human health, Frumkin The goal a virtual forum to the pandemic, provided may be human satisfied byclean hydroelectric power today, common interest, discuss ideas and partner impact health, Frumkin The goal Snails can cause a a virtual forum due to the new pandemic, provided of “affordable and energy,”noted. for example, opportunities for attendees to explore areas of parasitic worm disease. Snails can cause a yet“affordable policymakers must consider for futureinterest, collaborations. theand occasion, of andby clean energy,”whether for example, opportunities for attendees tomark explore areas of may be satisfied hydroelectric power today, common discussTo new ideas partner parasitic Snails canworm causedisease. a tomorrow’s droughts and reduced snowmelt caused the NIEHS updated its climate change and human health may be satisfied by hydroelectric power today, common discuss new ideas and partner yet policymakers must consider whether for futureinterest, collaborations. To mark the occasion, parasitic worm disease. by climate change willand decrease water flow and render literature database, said the Institute’s newthe director, yet policymakers must consider whether for future collaborations. To mark occasion, tomorrow’s droughts reduced snowmelt caused the NIEHS updated its climate change and human health thisclimate energychange source unsustainable, saidflow the and University Dr. Rick Woychik. portal, which more health than tomorrow’s droughts and reduced snowmelt caused the NIEHS updated“The its climate changecurates and by will decrease water render of literature database, said the Institute’s newhuman director, Washington Professor Emeritus. Dams typically alter river 10,000 publications, is which our effort at NIEHS by climate will decrease water render literature database, saidportal, the Institute’s new director, this energychange source unsustainable, saidflow the and University of Dr. Rickunique Woychik. “The curates more to than hydrology, may increase risks of typically schistosomiasis, helpRick many of you get answers questions haveto this energywhich source unsustainable, said the University of Dr. Woychik. “The portal, which curates more than Washington Professor Emeritus. Dams alter river 10,000 unique publications, isto our effort atyou NIEHS malaria andwhich vector-borne illnesses. “Energy policy is health aboutmany climate change and itsiseffects on human health.” Washington Professor Dams alter river 10,000 unique publications, our effort atyou NIEHS to hydrology, may Emeritus. increase risks of typically schistosomiasis, help of you get answers to questions have policy,” stated themay former Fogarty grantee. hydrology, increase risks of schistosomiasis, help many of you get answers to questions you have malaria andwhich vector-borne illnesses. “Energy policy is health about climate change and its effects on human health.” The NIEHS enjoys a longstanding partnership malaria stated and vector-borne illnesses. “Energy policy is health about climate change and its effects on humanwith health.” policy,” the former Fogarty grantee. Weavingstated a related her presentation, Dr. Michelle Fogarty, which includes the Globalpartnership Environmental policy,” the theme formerinto Fogarty grantee. The NIEHS enjoys a longstanding with and Bell discussed smoke waves by wildfires. “Under Occupational Health program andpartnership joint efforts with to combat The NIEHS enjoys a longstanding Weaving a related theme intocaused her presentation, Dr. Michelle Fogarty, which includes the Global Environmental and climate change, wildfires are caused anticipated to occur more indoor airwhich pollution. Weaving a related theme into her presentation, Dr. Michelle Fogarty, includes the Global Environmental and Bell discussed smoke waves by wildfires. “Under Occupational Health program and joint efforts to combat frequently and smoke burn more intensely,” explained the Yale Bell discussed waves caused by wildfires. “Under Occupational Health program and joint efforts to combat climate change, wildfires are anticipated to occur more indoor air pollution. University professor. Her are NIEHS-funded research estimated Woychik climate change, wildfires anticipated to occur more indoor airconcluded pollution.his remarks with a simple wish: “I frequently and burn more intensely,” explained the Yale a 7.2% higher risk ofmore respiratory hospital admission among hope everyone signshis off remarks with an increased motivation frequently and burn intensely,” explained the Yale University professor. Her NIEHS-funded research estimated Woychik concluded with a simple wish: “I Western U.S. residents exposed tohospital smokeresearch waves between to do everyone all they can to his address theincreased challenges posed by“I University professor. NIEHS-funded estimated Woychik concluded with a simple wish: a 7.2% higher risk of Her respiratory admission among hope signs off remarks with an motivation 2004 and 2009. Interactions of weather health are climate global environmental dangers.” a 7.2% higher risk of respiratory admission among hope signs off with an motivation Western U.S. residents exposed tohospital smokeand waves between to do everyone alland theyother can to address theincreased challenges posed by complex and depend onexposed manyoffactors, including geography, Western residents to smoke waves between to do alland theyother can to address the challenges posed by 2004 andU.S. 2009. Interactions weather and health are climate global environmental dangers.” 2004 andand 2009. Interactions weatherincluding and health are climate and other global environmental dangers.” complex depend on manyoffactors, geography, RESOURCES complex and depend on many factors, including geography, 3 RESOURCES http://bit.ly/GEHday2020 RESOURCES 3 http://bit.ly/GEHday2020

PPRROOFFII LL EE Fogartyfellow’s fellow’s TB TB training training Fogarty usefulinincombatting combatting COVID COVID useful By January W. Payne By January W. Payne

When COVID-19 reached the U.S., former Fogarty Fellow When COVID-19 theup U.S., former Dr. Mark Brady reached was called by the NavyFogarty reserve Fellow to help Dr. Mark was response called upat bythe thenow-infamous Navy reserve Elmhurst to help with theBrady pandemic hospital in New York. His Fogarty studying with the pandemic response at the experience now-infamous Elmhurst tuberculosis in aHis biosafety lab in studying Peru had hospital in New(TB) York. Fogartylevel-3 experience given him a(TB) foundation in infectious research tuberculosis in a biosafety level-3disease lab in Peru had and howhim to teach others safety procedures to avoid infection. given a foundation in infectious disease research and how to teach others safety procedures to avoid infection. “The fellowship was excellent preparation for my career. I can't think of anything better,” said Brady. investigated “The fellowship was excellent preparation forHe my career. I a liquid-based culture better,” for TB diagnosis as aHe participant in can't think of anything said Brady. investigated Fogarty’s Fellows andfor Scholars program, providesina a liquid-based culture TB diagnosis as which a participant year-long mentored research training Fogarty’s Fellows andclinical Scholars program, whichexperience provides a in a low-resource setting. It gave him the opportunity to year-long mentored clinical research training experience conduct a variety of research projects with numerous in a low-resource setting. It gave him the opportunity to collaborators, gaining field experience, learning project conduct a variety of research projects with numerous management and going through the publication process. collaborators, gaining field experience, learning project management and going through the publication process. While working at Lima’s Cayetano Heredia University, Brady watched residents perform manual ventilation While working at Lima’s Cayetano Heredia University, on patients when ventilators were in short supply. More Brady watched residents perform manual ventilation recently, he has been studying the effectiveness of a on patients when ventilators were in short supply. More simple, inexpensive device to help regulate correct airflow recently, he has been studying the effectiveness of a during manual ventilation, which could be helpful in simple, inexpensive device to help regulate correct airflow the U.S. or wherever ventilators are in short supply or during manual“It ventilation, couldhas be ahelpful unavailable. costs next which to nothing, stable in shelf the U.S. or wherever ventilators are in short supply life for years and helps fill a critical need when thereoraren’t unavailable. “It costs ventilators,” next to nothing, has Brady a stable shelf enough mechanical he said. previously lifehelped for years and helps fill a critical need when there aren’t test an electricity-free incubator with a team from enough mechanical ventilators,” he said. Brady previously MIT during his fellowship. “I like helping people and I like helped test an electricity-free with a he team from solving problems—that’s justincubator how I’m wired,” observed. MIT during his fellowship. “I like helping people and I like solving problems—that’s just howworld I’m wired,” he observed. His early work in the developing gave him valuable exposure to pathogens encountered in his later military His early workBrady’s in the infectious developingdisease world gave him valuable experience. expertise was also exposure pathogens encountered in deployments his later military called ontoduring his previous military when experience. Brady’s infectious disease was also he was confronted with cholera in Iraqexpertise and a vaccinederived outbreak in Syria. called on polio during his previous military deployments when he was confronted with cholera in Iraq and a vaccineHis fellowship traininginhas made him “kind of the de facto derived polio outbreak Syria. content expert on airborne disease transmission,” he explained. His fellowship training has made him “kind of the de facto content expert on airborne disease transmission,” he It’s no surprise then that Brady was selected as the chief explained.

It’s no surprise then that Brady was selected as the chief

Mark Brady, MD, MPH Mark Fellow: Brady, MD, Fogarty 2007 MPH Fogarty Fellow: US Institution:

2007 Alpert Medical School at Brown University Warren US Institution: Warren Medical School Lima, at Brown Foreign Institution: UniversityAlpert of Cayetano Heredia, PeruUniversity Foreign Institution: Universityand of Cayetano Heredia, Lima, Peru Research area: detection of tuberculosis Diagnosis Research area:

Diagnosis and detection of tuberculosis

operating officer for a 400-bed COVID-19 field hospital in Memphis, where helped start the region’s operating officer forhe a 400-bed COVID-19 field first hospital emergency medicine (EM) residency andfirst is EM in Memphis, where he helped start program the region’s research director at the University of Tennessee. “I emergency medicine (EM) residency program and just is EM happeneddirector to have at thethe right training of at Tennessee. the right time,” he research University “I just said. “During an airborne pandemic, being able to say, happened to have the right training at the right time,” he we've “During got a physician who did a research fellowship an said. an airborne pandemic, being able to on say, airborne infectious disease” makes him a good asset in we've got a physician who did a research fellowship on an Memphis. airborne infectious disease” makes him a good asset in Memphis. As everywhere, the pandemic has forced hard choices on Brady. His ability to squeeze every cent and every bit As everywhere, the pandemic has forced hard choices of efficiency from the available resources is grounded in on Brady. His ability to squeeze every cent and every bit his Fogarty experience. “When you have novel situations, of efficiency from the available resources is grounded in what you need most are problem solvers,” Brady his Fogarty experience. “When you have novel situations, suggested. “That’s something that Fogarty really shines what you need most are problem solvers,” Brady in, with a focus on translational research.” suggested. “That’s something that Fogarty really shines in, with a focus on translational research.” All of these experiences have allowed Brady to continue doing what led him to do a Fogarty fellowship years ago: All thesetoexperiences have allowed Brady continue his of desire help underserved populations atto home and doing what led him to do a Fogarty fellowship years ago: abroad. “That's ultimately how I ended up in emergency his desire to help underserved populations at home and medicine. I thought about infectious diseases, but I just abroad. “That's ultimately how I ended up in emergency like the very, very fast pace in the emergency department medicine. thought about infectious but I just where you Isee very, very sick people,” diseases, he said. “You like the very, very fast pace in the emergency department see really underserved populations in the emergency where you see very, very sickyou're people,” heurban said. “You department, especially when in an area.” see really underserved populations in the emergency For Brady, the Fogarty fellowship is what path department, especially when you're in anstarted urban his area.” toward being ready to take a leadership role in addressing the pandemic both Memphis andisNew York. “I'm his justpath For Brady, theinFogarty fellowship what started gratefulbeing for theready experience,” heleadership said. “The role fellowship toward to take a in addressing punches aboveinits weight class in terms impact.” the pandemic both Memphis and NewofYork. “I'm just grateful for the experience,” he said. “The fellowship punches above its weight class in terms of impact.” RESOURCES http://bit.ly/BradyPeru RE S OURC E S

http://bit.ly/BradyPeru

Q&A

WILLIAM DUKE, MD, MPH

Dr. William Duke, a physician and epidemiologist, is dean of health sciences and epidemiology at the Universidad Nacional Pedro Henriquez Urena (UNPHU) in the Dominican Republic. Early in his career, he received infectious disease research training through a Fogarty grant to the University of California, Berkeley. Since then, Duke has served as a scientific advisor to the Dominican Government’s Ministry of Public Health and provided leadership for PEPFAR-supported HIV/AIDS projects. He earned his black belt in Jujitsu and is a certified chief medical officer for Paralympic Sport. Recently, Duke was named a member and advisor to his country’s COVID-19 Prevention and Control National Commission.

What Fogarty-funded training did you receive?

While a Fogarty trainee in 1990, I was able to improve my research skills—including use of biostatistics—and learned to critically analyze epidemiological data and publish the findings. I also designed and conducted serosurveillance research among the general population and high-risk groups. I received this training at UC Berkeley through Fogarty’s AIDS International Training and Research Program (AITRP) under the mentorship of its principal investigator, Dr. Art Reingold, who spearheaded their Center for AIDS Prevention Studies (CAPS) program there. I was representing the Dominican Republic as part of a consortium of LatinAmerican health ministries with the goal of improving my nation’s HIV/AIDS National Program.

How did that experience impact your career?

My mentor Dr. Reingold influenced me in my decision to continue with an academic focus on HIV, in addition to tuberculosis. I recognize now, after nearly three decades in this field, that without Fogarty I would never have achieved my current professional life and career successes. For these reasons, I must express my deepest gratitude to Dr. Reingold. The San Francisco HIV/AIDS Program and the UC Berkeley program were also instrumental during my Fogarty fellowship because they provided unique opportunities. I gained a great deal by collaborating with other trainees, conducting community epidemiology surveys, updating interventions for the San Francisco region, working with NGOs on HIV/AIDS prevention and control, and even treating patients. Each of these experiences shaped my future. Since 2009, I have served as the Coinfection TB/HIV national advisor in the Dominican Republic’s Ministry of Health.

How were you able to apply what you learned? After my training I used my expertise to improve the research interventions in my country’s national program for HIV/AIDS/STDs, including establishing 72 Delaware Journal of Public Health – September 2020

a new methodology and best practices for both the general population and high-risk populations. Having influenced the National Health Plan and the health system in this way, I spent the next 30 or so years working to save lives and mitigate risk among LGBTQ populations, pregnant women with HIV, children living with HIV, Haitian immigrants and inmates to prevent, control and treat HIV/AIDS.

How did Fogarty training prepare you for this?

Fogarty’s most significant message was the need to cooperate and influence all levels of the health system as well as all stakeholders, both national and international. Because of Fogarty, I understood I would need to integrate all existing professionals and systems if I wanted to create a new and effective model of intervention for people living with HIV. Collaboration, then, is what led to the opening of new treatment sites that provided antiretroviral therapy and follow-up medical care throughout the Dominican Republic.

How are you involved in the COVID response?

In February 2020, the Ministry of Health selected me to act as National Epidemiology Advisor and member of the COVID-19 Prevention and Control National Commission. In March, the National Health Science and Dominican School of Medicine Association asked me to provide a COVID-19 epidemiology data analysis and intervention plan and protocol for medical students during their training. The goal is to improve the control and prevention of the pandemic disease using contact tracing with COVID patients and people they have interacted with in poor provinces. Specifically, we use the “triple T” method—tracing, testing and treatment— when patients test positive for the coronavirus. During the quarantine period, we not only re-test patients and their contacts, we also provide training in physical distancing and psychological support for a population of 500,000 people. RESOURCES http://bit.ly/DR-covid-response

FOCUS

COVID-19 creates new syndemic on US-Mexico border

Photo by Bob Ross, courtesy of UCSD

order regions tend to be a “no man’s land,” where countries don’t pay the same level of attention and infectious diseases—including coronavirus—can run rampant, says NIH grantee Dr. Steffanie Strathdee. She recently received funding to study SARS-CoV-2 along the US-Mexico border, where the University of California, San Diego professor has been conducting research since 2004. If you were to conceptualize this area as a state, “it would be the poorest in every indicator of poverty and socioeconomic status,” said Strathdee. Not surprisingly the region experiences elevated rates of HIV, sexually transmitted infections and latent tuberculosis. With California a COVID-19 hotspot, pandemic monitoring along the border is critical.

of the samples collected on the border with those in global databases, her team will be able to tell if different strains are circulating, which is important for the vaccine effort.

Strathdee and her interdisciplinary team will collect pilot data to inform future research on pandemic transmission in the border zone, with a two-year grant supplement from the National Institute on Drug Abuse (NIDA). A study of viral shedding that involves testing nasal swabs and fecal smears for SARS-CoV-2 will be led by Dr. Jack Gilbert. This work will inform whether wastewater can be used for COVID-19 surveillance and whether harmful bacteria are hitching a ride with the pandemic virus. Meanwhile, Dr. Antoine Chaillon, a molecular virologist on the team, will sequence SARS-CoV-2 isolates to establish a molecular clock. “By comparing sequences, you can establish timing and that will tell us the directionality of the infection—whether it’s going from north to south or south to north,” explained Strathdee. Understanding directionality would provide needed context for immigration, drug and health policies, she said. In addition, by comparing the genetic sequencing

Her NIDA parent grant is funding an investigation of how drug policies influence behavior and health, particularly HIV transmission. The team includes Rangel and Dr. Annick Borquez, a Mexican researcher who recently received NIDA’s Avenir award. In recent years, Mexico has become more permissive with drug possession laws, while the U.S. has become more stringent. As a result, San Diego users travel to Tijuana to buy and use drugs where drugs are cheaper and used more openly. “And, when you have a border closure like we’re experiencing now, there’s a backup of drugs in Tijuana and that also changes the drug market,” said Strathdee.

Former Fogarty grantee Dr. Steffanie Strathdee plans to use a binational network built over years of conducting research along the US-Mexico border to study COVID-19 transmission in the area.

Fogarty funding for her earlier research training projects helped her build a binational network with longtime Mexican partners Drs. Gudelia Rangel and Carlos MagisRodriguez. This laid the foundation for her new research, said Strathdee, who is currently a member of Fogarty’s advisory board. By watching successful Fogarty grantees, she learned that establishing trust meant her Mexican collaborators inform decisions about which research questions will most effectively influence policies and programs south of the border.

Such macrolevel political and economic factors often influence individual behavior, which in turn affects disease transmission, she explained. And so it’s an “open question” whether addiction predisposes people who inject drugs (PWID) to COVID-19. For example, they may not practice social distancing when seeking a fix. PWID who earn their living through sex work may be more willing to accept higher pay for unprotected sex because they have fewer clients with the decline in tourists to Mexico. Other behaviors documented when drugs are in short supply include non-injecting users turning to cost-effective injection or pooling money to purchase and then sharing needles. It’s possible the PWID border community may be a sentinel population for COVID-19 risk, noted Strathdee. Uncovering social, political and economic drivers of infectious disease has long been a hallmark of Strathdee’s research. “We’ve been misplacing HIV prevention efforts by blaming individuals for their behavior—not using condoms or sharing needles, for example—when it’s really

Stories on these pages by Susan Scutti Resources: http://bit.ly/FogartyCOVID19-research 73

FOCUS ON THE FOGARTY COMMUNITY’S RESPONSE TO COVID-19

Researcher collaborates to solve pandemic inequities at home and abroad

SARS-CoV-2

Some people find opportunity within adversity. Professor Gene Morse of University at Buffalo, State University of New York, is among them. When the March 2020 lockdown suspended his HIV-related work, Morse pivoted his team toward COVID-19 research and looked to Fogarty for inspiration to remedy a stateside problem.

In the earliest days of the pandemic, regional hospitals in Western New York were not equipped to conduct clinical studies and so lacked access to investigational coronavirus treatments for their patients. “To address this, I collaborated with my colleagues at UB and Roswell Park Comprehensive Cancer Center to complete a needs assessment, which is how you start a Fogarty project,” said Morse. Following the appraisal, the team established the Western New York COVID-19 Research Collaborative, which included some care-based hospitals, so they could participate in studies funded by pharmaceutical companies and offer experimental COVID-19 drugs to their patients. “All of the foundation-building approaches that I learned for

developing countries I used right here at home,” said Morse. Because the pandemic shines a spotlight on virology, it has increased innovation and capacity building, observed Morse. “Previous UB Fogarty trainees have focused on developing research questions to address complex health issues related to virology.” Today these former fellows and Morse’s current team—funded by Fogarty’s global infectious diseases and HIV research training programs— are continuing to collaborate, applying lessons learned to COVID-19. For example, Morse’s group, which includes scientists at University of the West Indies in Jamaica and University of Zimbabwe, had planned a biorepository to examine biomarkers related to disease outcomes resulting from arbovirus infections in Jamaica and HIV in Zimbabwe. “When COVID-19 occurred, we adapted these projects to focus on genomics, proteomics and meta-omics to identify biomarkers that might predict patients that would progress to more severe disease from SARS-CoV-2,” said Morse. He also is investigating a new approach to point-of-care antibody testing for use in low-resource countries and, in collaboration with the University of Maryland’s Institute of Human Virology project, he is exploring the possibility of activating the immune system with oral polio vaccine to protect against COVID-19 illness. Even after it subsides, the pandemic will change how scientists collaborate and innovate, Morse believes. “It has created new expectations of what can be planned and implemented in a short period of time, while pointing out inefficiencies in our old system. We have learned how to move things along more quickly.”

COVID-19 creates new syndemic on US-Mexico border . . . continued from p. 6 the underlying societal drivers that we create that put people at risk,” she said. Disrupting macrolevel factors could reduce rates of HIV, COVID-19 and multiple other diseases with similar root causes, she said. “It’s really about considering these infectious diseases as syndemics.” Conducting research amid a pandemic poses challenges, including an indefinitely closed border, and the need for additional safety protocols and supplies. Also, ethics committees on both sides of the border must review and ensure appropriate reporting compliance, adding “a layer of complexity in the midst of an epidemic,” said Strathdee. Still, her team is on track to begin collecting data in August 2020. Personal as well as professional experience guide Strathdee on this new project. In 2015, her husband,

74 Delaware Journal of Public Health – September 2020

Dr. Tom Patterson, a psychiatry professor at UCSD, was dying from a multidrug-resistant bacterial infection. After numerous treatment failures, a desperate Strathdee pored over the scientific literature and discovered a forgotten cure, 100-year old bacteriophage therapy. With the help of a global village of researchers who donated phage, Patterson’s doctors transformed this into an experimental treatment and saved his life. “Sometimes when your back is against the wall and you think you’ve run out of solutions, that is when your best creative moments arise,” said Strathdee. The silver lining of COVID-19 is that the challenge has driven researchers from different disciplines and multiple countries to work together. “When you do that, it’s an incubator for innovation,” said Strathdee. “And that gives us all hope we’ll end this pandemic.”

FOCUS ON THE FOGARTY COMMUNITY’S RESPONSE TO COVID-19

Scientists study intersection of COVID-19 and HIV is that one type of antiretroviral seems to offer more Although studies in high-income countries don’t indicate protection against COVID death than others. Coronavirus greater health risks for people with HIV who develop FOCUS ON THE FOGARTY COMMUNITY’S RESPONSE TO COVID-19 patients with HIV who were taking tenofovir disoproxil COVID-19, there is not enough information to know fumarate (TDF) fared better than those on different whether that holds true in low- and middle-income versions of ART, concurring with similar findings from a countries. In Kenya—where coronavirus transmission has study in Spain. been light—hypertension and diabetes are much more frequently associated with COVID deaths than HIV/AIDS, is that one type of antiretroviral studies in high-income don’tearly indicate Learning from people withseems HIV to offer more accordingAlthough to health ministry reports. countries Meanwhile, against COVID death than others. Coronavirus health risks for people with HIV who develop As the research community plans its response to data fromgreater one region in South Africa where COVID is more protection patients with HIV who were taking tenofovir disoproxil COVID-19, there is not enough information to know COVID-19 in sub-Saharan Africa, common suggests people fumarate (TDF) fared better than those on different whether that holds true in low- and middle-income should begin by from listening to with HIV countries. (PWH) may have versions of ART, concurring it with similar findings a In Kenya—where coronavirus transmission has PWH, according to a recent double the risk of dying from study in Spain. been light—hypertension and diabetes are much more frequently associated with COVID deaths than HIV/AIDS, AIDS and Behavior paper by coronavirus. Additionally, Learning from people with several HIV according to health ministry reports. Meanwhile, early NIH-supported authors. current and previous As the research community plans its response to data from one region in South Africa where COVID is more “COVID-19 is new; but the fear, tuberculosis (TB) infection COVID-19 in sub-Saharan Africa, common suggests people stigma and poverty that determine also seems to increase COVID it should begin by listening to with HIV (PWH) may have for to much of the world, are mortality.double the risk of dying from PWH,health according a recent not,” they noted. have likely AIDS and Behavior paperPWH by coronavirus. Additionally, several NIH-supported authors. before current andour previous faced similar challenges “What’s new from “COVID-19 is new; but the fear, tuberculosis (TB) infection and “have solutions that are more data is that we’ve been stigma and poverty that determine also seems to increase COVID likely to be successful in their able to quantify the effect health for much of the world, are mortality. context than global mandates of HIV and tuberculosis, not,” they noted. PWH have likely for different which until now we haven’t faceddesigned similar challenges beforesettings, “What’s new from our cultures and resources.” known,” said University of and “have solutions that are more data is that we’ve been likely to be successful in their ableresearcher to quantify the Cape Town Dr.effect context than global mandatesanxiety and of Davies, HIV and tuberculosis, COVID-19 generates Mary-Ann during designed for different settings, which until now we haven’t fatalism in many people, but a recent webinar. “We cultures and resources.” known,” said University of especially among PWH. “The lack might’ve Cape expected that effect Town researcher Dr. of understanding of coronavirus to really be very large, but COVID-19 generates anxiety and Mary-Ann Davies, during fatalism many people, a recent webinar. “We andinits effects on but HIV leads people in fact what we are seeing especially PWH.to “The might’ve expected a that effect livingamong with HIV be lack more fearful, is very modest—around of understanding of coronavirus really be very large, but given what they know about their 2.5 timestoincreased risk of and its effects on HIV leads people in fact what we are seeing condition. This stress and sense COVID death—with these living with HIV to be more fearful, is very modest—around a Rapid testing for COVID-19 is available at the CAPRISA clinic in impending doom conditions.” In Davies’ givenofwhat they know aboutcan theirlead to a 2.5 times increased risk of South Africa, where patients testing positive often have comorbidities, fatalism that is reminiscent of the NIH-supported analysis of condition. This stress and sense COVID death—with these such as diabetes, HIV and TB. Rapid testing for COVID-19 is available at the CAPRISA clinic in of impending doom to a conditions.” In Davies’ advent of thecan HIVlead epidemic,” said COVID deaths, published South Africa, where patients testing positive often have comorbidities, fatalism thataisFogarty reminiscent of the at Weill NIH-supported analysis co-author Dr. Robert N. Peck, grantee as a preprint by medRxiv, sheofalso noted “that HIV risk such as diabetes, andmight TB. advent of the HIV epidemic,” said COVID deaths, published Cornell Medical College. “‘If God wills it, I will die from the be overestimated if we haven’t fully disentangled all of co-author Dr. Robert N. Peck, a Fogarty grantee at Weill as a preprint by medRxiv, she also noted “that risk might coronavirus,’ we were told by more than one person living the comorbidities and risks that drive COVID death.” For Cornell Medical College. “‘If God wills it, I will die from the be overestimated if we haven’t fully disentangled all of with HIV.” instance,the diabetes was a factor in 52% of COVID deaths in coronavirus,’ we were told by more than one person living comorbidities and risks that drive COVID death.” For the study. with HIV.” instance, diabetes was a factor in 52% of COVID deaths in the study. Stigma is another concern that has arisen anew during Stigma is another concern that afraid has arisen anew during COVID, with many people of being tested. “They're “The small contribution of HIV and TB to COVID-19 COVID, with many people afraid of being tested. “They're “The small contribution of HIV and TB to COVID-19 fearful that if they are infected, or known to be infected mortality is mainly due to these deaths occurring in older fearful that if they are infected, or known to be infected mortality is mainly due to these deaths occurring in older publicly, they'll be stigmatized or ostracized we people, inpeople, whominHIV and TB are notnot common,” publicly, they'll be stigmatized or ostracized because because we whom HIVactive and active TB are common,” have made it sound like a death sentence. We’ve made it observed observed FogartyFogarty grantees Drs. Quarraisha Abdool Karim have made it sound like a death sentence. We’ve made it grantees Drs. Quarraisha Abdool Karim sound a cause of quarantine and isolation, and not and not and S. Abdool in a Science article. Integrated soundlike like a cause of quarantine and isolation, and Salim S.Salim Abdool KarimKarim in a Science article. Integrated like disease,” said co-author Dr. MarkDr. J. Mark J. medical for three these three conditions important likeaamanageable manageable disease,” said co-author medical care for care these conditions willwill be be important an NIH grantee at Harvard Medical School. “We COVID patients with comorbidities begin seeking health Siedner, an NIH grantee at Harvard Medical School. “We as COVIDaspatients with comorbidities begin seeking health Siedner, need to focus on communicating about this disease in care services in greater numbers, they added. need to focus on communicating about this disease in care services in greater numbers, they added. a way that’s not terrifying and does not stigmatize the a waywho that’s terrifying and does not stigmatize the are not infected.” Another interesting finding from Davies‘ South Africa study people Another interesting finding from Davies‘ South Africa study people who are infected.”

Scientists study intersection of COVID-19 and HIV

Photo courtesy of CAPRISA

Stories on these pages by January W. Payne Resources: Stories onhttp://bit.ly/FogartyCOVID19-research these pages by January W. Payne

Resources: http://bit.ly/FogartyCOVID19-research

Photo courtesy of Themba Nxumalo

Fogarty fellow captures ‘lived experiences’ of pandemic in South Africa

ealth care workers are the heroes of COVID-19, but little attention has been paid to their perceptions of serving on the frontlines in Africa. A Fogarty fellow is launching a study to capture their ‘lived experiences’— and those of their patients—to better understand their observations of the outbreak, innovative approaches taken to address it, gaps observed in the health system, and the mental and psychological effects they are feeling. Gathering this evidence quickly is important, according to Themba Nxumalo, a nurse at a rural community health center in South Africa who is conducting the research. “How health care workers are responding right now is shaped by how the virus is spreading at the moment,” he said. “My findings could have public health implications for the quality of patient care provided, as well as for training, preparation and care of health care workers during this outbreak and those that may occur in the future.” A Ph.D. candidate in nursing at the University of KwaZuluNatal (UKZN), Nxumalo is a fellow in the Medical Education Partnership Initiative (MEPI) junior faculty research training program. The UKZN grant to strengthen the research culture in South Africa is funded by the NIH Office of the Director and the NIH’s National Institute of Mental Health. Nxumalo is interviewing about 20 primary care health workers—including nurses, doctors, facility managers, and allied health professionals such as pharmacists and physiotherapists—working in one rural and one urban community health clinic. His exploratory, descriptive study is designed to capture their first impression of the pandemic’s arrival in their country, as well as their fears, stigma witnessed and achievements made while diagnosing and treating COVID-19 patients. “I'm working in a low-income, rural setting. When the pandemic first started, basic things like personal protective equipment were not available,” said Nxumalo. Some PPE arrived as the pandemic progressed, which has been reassuring for workers at his clinic, he said. Another local issue was difficulty complying with the South African government’s policy that those testing positive had to be isolated—difficult in his community. Previously published research has shown that health care workers endure physical and mental health repercussions when dealing with disease outbreaks. Concerns for personal safety are to be expected. Additionally, hearing reports of

76 Delaware Journal of Public Health – September 2020

MEPI junior faculty fellow Themba Nxumalo is studying the ‘lived experiences’ of frontline health care workers, COVID-19 patients and their families in South Africa.

fellow health care workers getting infected and/or dying from COVID-19 can lead to fear and distress, Nxumalo said. His research aims to document these experiences in real time while his colleagues are still in the midst of the pandemic. He also plans to conduct interviews with people who contracted COVID-19, as well as their families, to study the impact on them. “Something that affects one member will affect the entire family,” he noted. The outbreak caused suffering due to separation during patient quarantine, financial difficulties and psychological problems, all of which could be better understood through anecdotal evidence, he said. Nxumalo suggested his Fogarty fellowship helped position him to make these kinds of observations and connections in the midst of a global pandemic that could help guide future public health response. Prior to participation in the MEPI program, he was not exposed to scientific and academic writing—something he craved. “The fellowship gave me the skills to write effective articles, publish and network,” he explained. His training opened his eyes to the issues he and his colleagues face providing primary care and gave him the research skills necessary to uncover the root causes of these problems, Nxumalo said. “The first step is collecting evidence, then looking at it from a scientific research perspective and finally marrying the two to find a solution.” He said he views research as a craft—one that he’s become very comfortable practicing. “I know what I’m doing but there’s still a lot to learn because learning never stops.”

OPINION OPINION OPINION

ByBy Dr.Dr. Roger Roger I. I. Glass, Glass, Director, Director, Fogarty Fogarty International International Center Center By Dr. Roger I. Glass, Director, Fogarty International Center

Decolonizing Decolonizingglobal globalhealth healthresearch researchisisdifficult, difficult,but butvital vital Decolonizing global health research is difficult, but vital AA renewed renewed effort effort toto decolonize decolonize and and democratize democratize global global health health A renewed effort to decolonize has has recently recently been been gathering gathering and democratize global health steam, steam, especially especially among among college college has recently been gathering students, students, who who are are questioning questioning steam, especially among college the the fairness fairness of of the the existing existing students, who are questioning framework framework and and are are calling calling forfor aa the fairness of the existing shift shift inin leadership leadership and and broader broader framework and are calling for a knowledge knowledge sharing. sharing. What What does does shift in leadership and broader this this mean mean forfor the the research research knowledge sharing. What does community? community? this mean for the research community? AtAt Fogarty, Fogarty, wewe believe believe health health equity equity and and open open access access toto knowledge knowledge are are atat the the very very heart heart of of our our mission—to mission—to build build At Fogarty, we believe health equity and open access to scientific scientific capacity capacity inin lowlowand and middle-income middle-income countries countries knowledge are at the very heart of our mission—to build (LMICs) (LMICs) toto help help develop develop equitable equitable research research partnerships, partnerships, scientific capacity in low- and middle-income countries ensure ensure studies studies are are locally locally relevant relevant and and that that participating participating (LMICs) to help develop equitable research partnerships, communities communities benefit benefit from from the the knowledge knowledge gained. gained. Informing Informing ensure studies are locally relevant and that participating allall our our activities activities is is the the Fogarty Fogarty vision vision of of “a“a world world inin which which communities benefit from the knowledge gained. Informing the the frontiers frontiers of of health health research research extend extend across across the the globe globe and and all our activities is the Fogarty vision of “a world in which advances advances inin science science are are implemented implemented toto reduce reduce the the burden burden the frontiers of health research extend across the globe and of of disease, disease, promote promote health, health, and and extend extend longevity longevity forfor allall advances in science are implemented to reduce the burden people.” people.” of disease, promote health, and extend longevity for all people.” It It is is obvious obvious toto usus that that the the historical historical approach approach of of taking taking solutions solutions developed developed inin high-income high-income countries countries (HIC) (HIC) It is obvious to us that the historical approach of taking and and trying trying toto make make them them fitfit inin LMICs LMICs is is not not anan effective effective solutions developed in high-income countries (HIC) approach approach oror respectful respectful of of the the local local circumstances, circumstances, cultural cultural and trying to make them fit in LMICs is not an effective practices practices oror available available resources. resources. Ideally, Ideally, local local scientists scientists approach or respectful of the local circumstances, cultural with with anan understanding understanding of of the the local local context context and and resources resources practices or available resources. Ideally, local scientists will will develop develop and and study study the the effectiveness effectiveness of of interventions interventions with an understanding of the local context and resources tailormade tailormade forfor the the setting. setting. will develop and study the effectiveness of interventions tailormade for the setting. InIn the the 1980s, 1980s, when when Fogarty Fogarty began began itsits first first research research training training program program toto build build capacity capacity inin LMICs, LMICs, inin most most cases cases trainees trainees In the 1980s, when Fogarty began its first research training traveled traveled toto a HIC a HIC forfor their their studies. studies. Since Since then, then, the the Center Center program to build capacity in LMICs, in most cases trainees has has supported supported significant significant training training forfor more more than than 6,000 6,000 traveled to a HIC for their studies. Since then, the Center scientists scientists worldwide. worldwide. AsAs a cadre a cadre of of highly highly knowledgeable knowledgeable has supported significant training for more than 6,000 faculty faculty developed developed inin numerous numerous LMICs, LMICs, a transition a transition began began scientists worldwide. As a cadre of highly knowledgeable toward toward creation creation of of local local advanced advanced degree degree programs programs inin faculty developed in numerous LMICs, a transition began disciplines disciplines such such asas infectious infectious diseases, diseases, epidemiology epidemiology and and toward creation of local advanced degree programs in public public health. health. There There are are now now 9191 LMIC LMIC institutions institutions that that disciplines such as infectious diseases, epidemiology and award award degrees degrees with with Fogarty Fogarty support, support, including including more more than than public health. There are now 91 LMIC institutions that 1,338 1,338 master’s master’s degrees degrees and and 452 452 Ph.Ds. Ph.Ds. award degrees with Fogarty support, including more than 1,338 master’s degrees and 452 Ph.Ds. This This is is significant significant because, because, not not only only is is it it more more economical economical soso allows allows more more students students toto bebe trained, trained, LMIC LMIC curricula curricula This is significant because, not only is it more economical are are farfar more more relevant relevant toto the the local local disease disease priorities priorities and and so allows more students to be trained, LMIC curricula are far more relevant to the local disease priorities and

available available resources resources than than inin programs programs developed developed forfor HIC HIC consumption. consumption. Our Our goal goal is is toto empower empower LMIC LMIC scientists scientists soso available resources than in programs developed for HIC they they can can enter enter into into equitable equitable partnerships partnerships where where they they setset consumption. Our goal is to empower LMIC scientists so the the research research agenda, agenda, based based onon national national priorities, priorities, and and they can enter into equitable partnerships where they set direct direct studies studies that that will will produce produce data data soso that that policymakers policymakers the research agenda, based on national priorities, and can can make make evidence-based evidence-based decisions. decisions. WeWe believe believe these these direct studies that will produce data so that policymakers equitable equitable research research partnerships partnerships should should bebe reflected reflected inin can make evidence-based decisions. We believe these the the authorship authorship of of the the resulting resulting publications. publications. WeWe were were equitable research partnerships should be reflected in encouraged encouraged toto discover discover promising promising trends trends inin a study a study done done the authorship of the resulting publications. We were with with the the NIH NIH Library Library of of Fogarty-supported Fogarty-supported publications publications encouraged to discover promising trends in a study done had had LMIC LMIC senior senior (last) (last) authors authors and and approximately approximately 85% 85% with the NIH Library of Fogarty-supported publications had had U.S. U.S. senior senior authors. authors. ByBy 2019, 2019, LMIC LMIC senior senior authorship authorship had LMIC senior (last) authors and approximately 85% had had increased increased toto about about 44%. 44%. had U.S. senior authors. By 2019, LMIC senior authorship had increased to about 44%. This This shift shift has has also also been been reflected reflected inin our our grantmaking. grantmaking. InIn 2015, 2015, 18% 18% of of our our grants grants went went toto LMIC LMIC institutions. institutions. ByBy This shift has also been reflected in our grantmaking. In 2019, 2019, that that had had risen risen toto 31%. 31%. The The NIH NIH policy policy decision decision inin 2015, 18% of our grants went to LMIC institutions. By 2006 2006 toto allow allow multiple multiple Principal Principal Investigators Investigators onon grants grants 2019, that had risen to 31%. The NIH policy decision in has has allowed allowed more more equitable equitable recognition recognition of of research research 2006 to allow multiple Principal Investigators on grants partnerships. partnerships. Since Since 1988, 1988, Fogarty Fogarty has has awarded awarded grants grants toto has allowed more equitable recognition of research 408 408 LMIC LMIC PIs, PIs, oror about about 20% 20% overall. overall. partnerships. Since 1988, Fogarty has awarded grants to 408 LMIC PIs, or about 20% overall. InIn recent recent conferences conferences and and other other venues, venues, some some have have called called forfor the the decolonization decolonization of of the the mind mind and and democratization democratization In recent conferences and other venues, some have called of of information. information. They They propose propose shifting shifting the the paradigm paradigm inin for the decolonization of the mind and democratization global global health health education education away away from from Eurocentric Eurocentric thought thought of information. They propose shifting the paradigm in toto a more a more inclusive inclusive approach. approach. WeWe hope hope wewe have have made made aa global health education away from Eurocentric thought contribution contribution toto that that effort, effort, through through our our Medical Medical Education Education to a more inclusive approach. We hope we have made a Partnership Partnership Initiative Initiative (MEPI), (MEPI), which which was was anan African-led African-led contribution to that effort, through our Medical Education effort effort toto strengthen strengthen and and expand expand medical medical curricula curricula across across Partnership Initiative (MEPI), which was an African-led the the continent. continent. MEPI MEPI also also supported supported improved improved internet internet effort to strengthen and expand medical curricula across connectivity, connectivity, provided provided tablet tablet computers computers toto medical medical the continent. MEPI also supported improved internet students students and and enabled enabled access access toto up-to-date up-to-date electronic electronic connectivity, provided tablet computers to medical medical medical texts texts and and journal journal articles. articles. Through Through the the Human Human students and enabled access to up-to-date electronic Heredity Heredity and and Health Health inin Africa Africa program, program, NIH NIH and and Wellcome Wellcome medical texts and journal articles. Through the Human Trust Trust have have supported supported genomic genomic training training and and established established aa Heredity and Health in Africa program, NIH and Wellcome biorepository, biorepository, soso African African data data and and samples samples will will remain remain inin Trust have supported genomic training and established a Africa, Africa, where where they they can can bebe studied studied byby African African scientists. scientists. biorepository, so African data and samples will remain in Africa, where they can be studied by African scientists. Building Building equitable equitable partnerships partnerships inin global global health health and and pushing pushing forfor wider wider access access toto knowledge knowledge soso that that people people Building equitable partnerships in global health and everywhere everywhere benefit benefit from from discoveries discoveries will will require require sustained sustained pushing for wider access to knowledge so that people effort effort and and are are onon ongoing ongoing process process that that is is central central toto our our everywhere benefit from discoveries will require sustained mission. mission. WeWe measure measure progress progress made made over over decades decades and and effort and are on ongoing process that is central to our understand understand that that this this is is a marathon a marathon and and not not a sprint. a sprint. AtAt mission. We measure progress made over decades and Fogarty, Fogarty, wewe are are inin it it forfor the the long long haul. haul. understand that this is a marathon and not a sprint. At Fogarty, we are in it for the long haul. RESOURCES RESOURCES

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http://bit.ly/DemocratizeGH http://bit.ly/DemocratizeGH RESOURCES

http://bit.ly/DemocratizeGH

PEOPLE Collins wins Templeton Prize NIH Director Dr. Francis S. Collins is the recipient of the 2020 Templeton Prize, awarded in recognition of his scientific leadership, public speaking and writing, including his 2006 book, The Language of God. His work has demonstrated how religious faith can inspire and motivate scientific research, according to Templeton philanthropies.

NIH selects Woychik to direct environmental sciences Dr. Rick Woychik is the new director of the NIH’s National Institute of Environmental Health Sciences. He served as deputy director since 2010 and was appointed acting director in late 2019. Previously he spent a decade running the Jackson Laboratory in Maine, where he established the genetics science division.

Zenk to lead NIH nursing research institute Dr. Shannon N. Zenk was recently tapped to become director of the National Institute of Nursing Research. Zenk has been a visiting scholar in Rwanda and Australia and was inducted into the International Nurse Researchers Hall of Fame in 2019. She is currently a professor at the University of Illinois at Chicago.

Global community mourns Dr. Kirk R. Smith Former Fogarty grantee Dr. Kirk R. Smith died in June. He was a professor at the University of California, Berkeley and director of the Collaborative Clean Air Policy Centre in New Delhi. He shared the 2007 Nobel Peace Prize and served on numerous national and international scientific advisory committees.

Senate confirms Panchanathan as NSF director Dr. Sethuraman Panchanathan was recently confirmed by the U.S. Senate as director of the National Science Foundation (NSF). He previously was executive vice president of Arizona State University’s (ASU) Knowledge Enterprise, and ASU’s chief research and information officer. During his time at ASU, he helped elevate the university’s research profile.

Virologist known for first HIV cloning dies Molecular virologist Dr. Flossie Wong-Staal, formerly a Fogarty grantee, died in July. In 1973, Wong-Staal became a fellow at the NIH’s National Cancer Institute. She was best known as the first person to clone HIV. In 1990, she joined the University of California San Diego to launch its AIDS research center.

78 Delaware Journal of Public Health – September 2020

Global HEALTH Briefs NIH issues plan for COVID-19 research

NIH has developed a framework for accelerating the development of therapeutic interventions, vaccines and diagnostics for SARS-CoV-2. The NIH-Wide Strategic Plan for COVID-19 Research includes five cross-cutting strategies that draw upon the agency’s unique position to coordinate a swift research response to the pandemic. Full plan: https://bit.ly/NIH_Covid_Plan

WHO releases COVID infodemic advice

Strategies on how to effectively manage the COVID-19 infodemic were explored during a recent online consultation organized by the WHO. The goal was to crowdsource ideas from an interdisciplinary group of global experts and the 1,300 participants. Video presentations, a meeting summary and other materials are available online. Website: https://bit.ly/WHO_infodemic

FNIH launches global malaria effort

A new initiative will advance the safe and responsible exploration of genetic biocontrol technologies, a set of tools with the potential to save lives particularly among those afflicted with malaria. The GeneConvene Global Collaborative was announced by the Foundation for the NIH. News release: https://bit.ly/FNIH_GeneConvene

New research ethics guidance released

Ethics guidance has been produced by an international working group to advance responsible HIV co-infection research in pregnant women. This population is commonly excluded from research and the resulting evidence gaps have put them and their children in harm's way. The NIH’s National Institute of Allergy and Infectious Diseases funded the project, with technical assistance from Fogarty. Website: http://www.hivpregnancyethics.org/

Gender toolkit for health workers released

A package of materials—including modules on unconscious biases, mentorship and sexual harassment—has been developed to offer health workers and organizations the skills and strategies needed to respond to gender disparities in health leadership. The participatory toolkit was developed by Jhpiego, an affiliate of Johns Hopkins University. Website: https://bit.ly/Gender_toolkit

JULY/AUGUST 2020

Funding Opportunity Announcement

Details

Deadline

Mobile Health: Technology and Outcomes in LMICs non-AIDS applications

http://bit.ly/NIHmhealth

Sep 24, 2020

Fulbright-Fogarty Fellows and Scholars in Public Health

http://bit.ly/Fulbright-Fogarty

Oct 13, 2020

Global Infectious Disease (GID) Research Training Program

http://bit.ly/IDtraining

Oct 28, 2020

Emerging Global Leader Award

http://bit.ly/NIHGlobalLeader

Nov 4, 2020

Global Brain and Nervous System Disorders Research Across the Lifespan

http://bit.ly/NIHGlobalBrain

Nov 6, 2020

Reducing Stigma to Improve HIV/AIDS Prevention, Treatment and Care in LMICs

http://bit.ly/NIHstigmahiv

Nov 12, 2020

Chronic, Noncommunicable Diseases and Disorders Research Training

http://bit.ly/NCDtrain

Nov 13, 2020

Ecology and Evolution of Infectious Diseases

http://bit.ly/EEIDNIH

Nov 18, 2020

Harnessing Data Science for Health Discovery and Innovation in Africa U2R Research Training Program U01 Ethical, Legal, and Social Implications Research U2C Open Data Science Platform and Coordinating Center U54 Research Hubs

https://bit.ly/nih-dsiafrica-funding

Nov 24, 2020 Dec 1, 2020 Dec 3, 2020 Dec 8, 2020

Mobile Health: Technology and Outcomes in LMICs - AIDS

http://bit.ly/NIHmhealth

Dec 3, 2020

HIV-associated Noncommunicable Diseases Research at LMIC Institutions

http://bit.ly/FogartyHIVNCD

Dec 3, 2020

For more information, visit www.fic.nih.gov/funding

Global Health Matters

NIH director encourages 2020 Fogarty Fellows & Scholars

July/August 2020 Volume 19, No. 4 ISSN: 1938-5935 Fogarty International Center National Institutes of Health Department of Health and Human Services Managing editor: Ann Puderbaugh Ann.Puderbaugh@nih.gov Web manager: Anna Pruett Ellis Anna.Ellis@nih.gov Writer/editor: January W. Payne January.Payne@nih.gov Writer/editor: Susan Scutti Susan.Scutti@nih.gov Designer: Carla Conway

All text produced in Global Health Matters is in the public domain and may be reprinted. Please credit Fogarty International Center. Images must be cleared for use with the individual source, as indicated.

SUBSCRIBE: www.fic.nih.gov/subscribe

For the first time, the 2020 Fogarty Fellows and Scholars orientation program was held via teleconference. NIH Director Dr. Francis S. Collins made his annual appearance from his home office to offer advice and words of encouragement. Fogarty’s Global Health Program for Fellows and Scholars provides year-long mentored research experiences in low- and middle-income countries. Collins suggested the new program participants keep their horizons wide open during the next year and that they not become too narrowly focused. He welcomed them to the Fogarty network that extends around the world and said he counts on Fogarty alumni to develop into significant global health leaders. “You will be changed by the experience and that’s good; you will be positioned to take on leadership roles,” he said. “We are a family and we like to support each other. And now you are part of it.” R ESOURCES http://bit.ly/FellowsScholars2020 79

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Delaware Journal of

Public Health

Submission Guidelines

updated April, 2020

About the Journal Established in 2015, The Delaware Journal of Public Health is a bi-monthly, peer-reviewed electronic publication, created by the Delaware Academy of Medicine/Delaware Public Health Association. The publication acts as a repository of news for the medical, dental, and public health communities, and is comprised of upcoming event announcements, past conference synopses, local resources, peer-reviewed content ranging from manuscripts and research papers to opinion editorials and personal interest pieces, relating to the public health sector. Each issue is largely devoted to an overarching theme or current issue in public health. The content in the Journal is informed by the interest of our readers and contributors. If you have an event coming up, would like to contribute an Op-Ed, would like to share a job posting, or have a topic in public health you would like to see covered in an upcoming issue, please let us know. If you are interested in submitting an article to the Delaware Journal of Public Health, or have any additional inquiries regarding the publication, please contact DJPH Deputy Editor Elizabeth Healy at ehealy@delamed.org, or the Executive Director of The Delaware Academy of Medicine and Delaware Public Health Association, Timothy Gibbs, at tgibbs@delamed.org

Information for Authors Submission Requirements The DJPH accepts a wide variety of submission formats including brief essays, opinion editorials pieces, research articles and findings, analytic essays, news pieces, historical pieces, images, advertisements pertaining to relevant, upcoming public health events, and presentation reviews. If there is an additional type of submission not previously mentioned that you would like to submit, please contact a staff member.

Cover Letters must address the following four article requirements: 1. A description of what the paper adds to current knowledge, in particular with respect to material previously published in DJPH, and if systematic reviews exist on the topic. 2. The public health importance of the paper. 3. One sentence summarizing the main message(s) of the paper, which may be used to disseminate the paper on social media.

The initial submission should be clean and complete, without edits or markups, and contain both the title and author(s) fulls name(s). Submissions should be 1.5 or 4. For individual or group randomized trials, provide the double spaced with a font size of 12. Initial submissions date of trial registration and the NCT number from must also contain a cover letter with concise text www.Clinicaltrials.gov or other approved registry. (maximum 150 words). Once completed, articles In the cover letter only, not in the paper. Do NOT should be submitted via email to Elizabeth Healy at include the trial registration or NCT number in the ehealy@delamed.org as an attachment. Graphics, images, abstract or the body of the manuscript during the info-graphics, tables, and charts, are welcome and initial submission. encouraged to be included in articles. Please ensure that all pieces are in their final format, and all edits and track All manuscripts must be submitted via email to Elizabeth Healy at ehealy@delamed.org. changes have been implemented prior to submission. 84 Delaware Journal of Public Health – September 2020

To view additional information for online submission requirements, please refer to the website for the Delaware Journal of Public Health: https://djph.org/sample-page/submit-an-article/. Submission Length While there is no prescribed word length, full articles will generally be in the 2500-4000-word range, and editorials or brief reports will be in the 1500-2500-word range. If you have any questions regarding the length of a submission, or APA guidelines, please contact a staff member. Copyright Opinions expressed by contributors and authors do not necessarily reflect the opinions of the DJPH or affiliated institutions of authors. Copying for uses other than personal reference or interest without the consent of the DJPH is prohibited. All material submitted alongside written work, including graphics, charts, tables, diagrams, etc., must be referenced properly in accordance with APA formatting. Conflicts of Interest Any conflicts of interest, including political, financial, personal, or academic conflicts, must be declared prior to the submission of the article, or in conjunction with a submission. Conflicts of interest are any competing interests that may leave readers feeling misled or deceived, and/or alter their perception of subject matter. Declared conflicts of interest may be published alongside articles in the final electronic publication.

Additional Documents and Information for Authors Please Note: All authors and contributors are asked to submit a brief personal biography (3 sentences maximum) and a headshot along submissions. These will be published alongside final submissions in the final electronic publication. For pieces with multiple authors, these additional documents are requested for all contributors. Abstracts Authors must submit a structured or unstructured abstract along with their article. The word limit is 200 words, including headings. A title page should be submitted with this abstract as well. Structured abstracts should employ 4-5 headings: Objectives (begins with “To…”) Methods Results Conclusions A fifth heading, Policy Implications, may be used if relevant to the article. Trial Registration information is required for clinical trials and must be included in the final version abstract All abstracts should provide the dates(s) and location(s) of the study is applicable. Note: There is no Background heading.

Nondiscriminatory Language Use of nondiscriminatory language is required in all DJPH submissions. The DJPH reserves the right to reject any submission found to be using sexist, racist, or heterosexist language, as well as unethical or defamatory statements.

The DPH Bulletin – Special flu edition From the Delaware Division of Public Health

September 2020

Underlying conditions elevate flu risk

Flu season is nearly here; get vaccinated The Division of Public Health (DPH) asks Delawareans 6 months of age and older to get their annual flu shot. Flu vaccination reduces the chances of getting the flu and becoming sick. DPH Director Dr. Karyl Rattay recommends getting flu vaccinations by the end of October, since the state usually experiences its first flu case that month.

“It is even more critical for everyone to get their flu vaccine this year as flu and COVID-19 will be circulating at the same time, and those with underlying health conditions are at greater risk from developing COVID-related complications if their immune system is already weakened from also having the flu,” Dr. Rattay said. Individuals at high risk from the flu are adults 65 years and older, children younger than 5 years old (especially infants and children younger than 2 years old), pregnant women and women up to two weeks after the end of pregnancy, American Indians and Alaska Natives, and residents of nursing homes and other long-term care facilities. Delawareans with chronic conditions are also at risk. For more information, visit CDC.gov.

Where to get your flu vaccine Delawareans should first seek a flu vaccine from their primary care provider (PCP), pharmacy, or grocery store. Uninsured people and those whose insurance does not cover the flu vaccine may be vaccinated at DPH clinics. Individuals with insurance, but who do not have a PCP, should select a PCP. Clinics accept donations, Medicaid, or Medicare Part B. For the flu clinic schedule, visit flu.delaware.gov or call 1-800-282-8672, or use www.flu.gov to find flu clinics in your ZIP code.

86 Delaware Journal of Public Health – September 2020

Delawareans with chronic health conditions should closely manage their health to avoid unnecessary medical visits and hospitalizations during flu season. Fewer flu cases help providers recognize COVID-19. Also, DPH wants to avoid having people become ill with the flu and COVID-19 at the same time. According to the Centers for Disease Control and Prevention (CDC), people who have these underlying conditions have a greater risk of having serious flu complications: asthma, blood disorders, chronic lung disease, diabetes, heart disease, neurologic conditions, obesity, and weakened immune systems. For the CDC’s full list, click here.

Prevent respiratory diseases

• Get a flu vaccine every year. Keep immunizations up to date to prevent respiratory diseases such as influenza, pertussis, pneumonia, and shingles. • Wash hands often with soap and water for 20 seconds or use hand sanitizer. • Wear masks in public that cover your face and nose. • Avoid touching your eyes, nose, and mouth. • Social distance (be at least six feet apart from those outside the household). • Cover your nose and mouth with a tissue when coughing or sneezing, or cough or sneeze into your inner elbow. • Clean and sanitize frequently touched surfaces. • If sick with flu-like illness, stay home from work, school, and other gatherings. Do not return until you are fever free (100 degrees Fahrenheit, or 37.8 degrees Celsius or higher) without feverreducing medication for at least 24 hours. If flu symptoms worsen, call your doctor.

Index of Advertisers 2020 APHA Virtual Annual Meeting & Expo. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 American Public Health Association Get a Delaware Library Card! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Delaware Library The DPH Bulletin August 2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Division of Public Health, Department of Health and Social Services Dolly Parton's Imagination Library . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Delaware Library Library Card Sign Up Online . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Delaware Library Wilmington Community Flu Vaccine Clinic - West 4th Street. . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Westside Family Healthcare Hoopla at Delaware Libraries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Delaware Library 2020 APA Delaware Fall Conference. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 American Planning Association - Delaware Chapter The DPH Bulletin - Vector-borne Illnesses Issue - August 2020 . . . . . . . . . . . . . . . . . . . . . . . . . 27 Division of Public Health, Department of Health and Social Services CUGH 2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Consortium of Universities for Global Health Delaware PrEP, 2020 PrEP Conference. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Delaware HIV Consortium Health Ready!. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Delaware Library Appointments at Delaware Libraries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Delaware Library Communicable Dieseases Health Summit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Delaware Academy of Medicine APHA Press . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 American Public Health Association 2020 John Scholz Stroke Education Conference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Delaware Stroke Initiative Wilmington Community Flu Vaccine Clinic - Bear, DE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Westside Family Healthcare DJPH Submission Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Delaware Journal of Public Health The DPH Bulletin - Special Flu Edition - September 2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Division of Public Health, Department of Health and Social Services 87

Delaware Academy of Medicine / DPHA 4765 Ogletown-Stanton Road Suite L10 Newark, DE 19713

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The Delaware Academy of Medicine is a private, nonprofit organization founded in 1930. Our mission is to enhance the well being of our community through medical education and the promotion ofpublic health. Our educational initiatives span the spectrum from consumer health education tocontinuing medical education conferences and symposia. The Delaware Public Health Association was officially reborn at the 141st Annual Meeting of the American Public Health Association (AHPA) held in Boston, MA in November, 2013. At this meeting, affiliation of the DPHA was transferred to the Delaware Academy of Medicine officially on November 5, 2013 by action of the APHA Governing Council. The Delaware Academy of Medicine, who’s mission statement is “to promote the well-being of our community through education and the promotion of public health,” is honored to take on this responsibility in the First State.

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