The Northeast Texas Public Health District (NTPHD) has experienced its share of disasters. After Hurricane Katrina, NTPHD preparedness staff noticed that educational resources were not available to members of the deaf community. In response, they created a series of informational preparedness videos to be used in Point of Dispensing (POD) settings. The information in the videos is communicated using American Sign Language (ASL), closed captioning, and an audible component in English and Spanish. The POD video project was founded on the principle that all languages and communities should be equally represented when information is given in any setting, but especially in a POD setting. Each POD video provides information about the relevant disease, how to complete forms, the medication being administered, as well as information about adverse effects of medicines, where to report adverse reactions, and how to crush pills. This multifaceted tool is available to any health department or organization.
Below, Kendall Leser, NACCHO Health and Disability fellow, and Stephanie Walker, assistant director for the Public Health Emergency Preparedness Program at NTPHD, discuss the program’s development, execution, and successes.
Kendall: How and when did you start your program? What was the catalyst?
Stephanie: During after-action sessions for Hurricane Katrina, I saw a need to reach out to deaf communities in our preparedness efforts. Many non-English reading deaf communities were not being communicated emergency information properly and I wanted to assure that any public health response would provide information to those audiences in the future. I began searching for preparedness resources specific to the deaf community. That search taught me that ASL is a language in and of itself, without written form: the syntax is different from English, the words themselves have gestures, and not all words are gestured. Some words are explained through a series of gestures, and simple fingerspelling for information may not close that gap. I thought that everyone who grew up in the United States could read simple English, and I was wrong. For a whole community, written English didn’t make sense. We needed to get the information in ASL to support inclusion. As I searched for resources I also found that many deaf organizations create videos, but they do not include written English on screen, which prevents those people who don’t read and speak ASL from using them as a resource. My original vision for the resources we created was to support both the emergency manager and deaf audiences. With print on screen, emergency responders know what’s being signed in ASL and what information is being relayed. I get feedback from the deaf community, both good and bad, concerning resources that have been developed, and with each new set of resources, I try to close additional gaps.
Kendall: So all people can benefit from your video tool?
Stephanie: Yes, exactly. Since creating the first set I’ve learned that deaf, low literacy, blind, limited sight, hard of hearing, cognitively delayed groups and English groups all can benefit from the one resource. Additionally, organizations such as our local ARC chapter have taught me that receiving the information repeatedly helps people with developmental disabilities better grasp it; so, they can play the videos continuously on a loop.
Kendall: So on these videos you’re showing audiences what to do?
Stephanie: In a way, yes. The videos allow the audience to make an informed decision. We present the information about the drug, possible side effects, how to complete screening forms, how to crush a pill and so on. By providing basic information to the public we allow them a choice in determining what’s best for themselves and their families. Another great aspect of the video material is that when played in a clinic setting, they also teach hearing audiences; simple exposure to a video while standing in a screening line helps more than you realize. It may generate a line of questions the audience had not thought to ask and alleviate callbacks after POD operations.
Kendall: What have been the benefits of including people with disabilities in your programming/planning efforts?
Stephanie: They are truly vested in assuring their group is accommodated, and many of the members are happy to teach us how to best serve that community.
Kendall: What challenges did your local health department experience when trying to include people with disabilities?
Stephanie: Some deaf community members are skeptical of outsiders, but fortunately I was able to use a hearing group that was closely related to a deaf group and overcame that challenge.
Kendall: For this video project, did your local health department include any people with disabilities on any committees or workgroups? If so, in what ways did their inclusion help to guide your efforts?
Stephanie: The company I contracted with to create the videos is deeply involved with deaf communities. This provided me access to resource specialists with deaf employees who provided feedback during the video creation process. I also coordinated with deaf resource specialists locally to look at the information and critique the videos and then incorporated their feedback. During the development, the deaf organizations would lend feedback on the ASL portion and I assured inclusion of low literacy, blind, and hearing groups. I feel overall there’s a good mixture in the video material. This project reaches beyond deaf groups; it’s an inclusive approach to planning for public health POD operations.
Kendall: How did your local health department measure the outcomes of your video project? Were they different than you had expected?
Stephanie: The only outcome I’ve been able to measure outwardly is the uptake from the emergency management community. I think once they’ve seen the video, they realize there’s a gap that they may not have known could be filled. I would hope as others use the resources, they share experiences and feedback to show outcomes locally for them. The resources have been adopted by so many diverse groups, it would be invaluable to ascertain their outcomes.
Kendall: What advice do you have for other local health departments interested in including people with disabilities in their public health programming/planning efforts?
Stephanie: I think partnership is crucial. If the contractors I used didn’t value the importance of the project like they did, I wouldn’t have been able to complete as much as I have so far. I think educating ourselves to search for multifaceted approaches to problem solving is important; you need to understand that when you create something with so many sides, it’s easier to use. It doesn’t single anybody out, and it doesn’t seem like anyone is getting any special treatment. I truly believe in working smarter and faster to solve problems, and I believe in a clinic setting these videos do just that. Like many other resources, these videos are a tool in the kit; they will not solve all the issues with POD operations, but will help to bridge an information gap for many.
Kendall: What would have made it easier for your local health department to create this video?
Stephanie: Well, if there had been an example or blueprint to use, it would have been easier. But somebody always has to be the first somebody. I have some behavioral health videos in production now, and as long as I can find a funding opportunity, I will continue to create and ask others to join me. I am also acutely aware that it’s often difficult to use a resource someone else created, due to branding. That’s another area we ensured would not be a problem. The reference to the organizations involved is on the back, it’s not branded with Texas or my local health department, so anyone can confidently use the material without much modification. It’s just the information. If you want to put your logo on the front, you can and if you don’t want to, you don’t have to. There’s not a lot of funding around, so if I can make something and everybody can use it, then I’m just getting more bang for the buck.