Lou Ann Carter, Mike Chappell, Vicki Green, Myra Reece
Edisto Health District, SC
Executive Summary | Definition
of Project | Industry Analysis | Target
Market
Marketing Strategy | Project
Operations and Management | Implementation Plan and
Timeline
Potential Risks and Regulatory Issues
| Financial Projections and Statements
The Business: In 1998, 50% of the children in South Carolina who died from asthma-related complications were from Orangeburg County. Between 1996-1998, SC spent $63 million treating asthma and its related illnesses. (1999, SC Division of Epidemiology) Research has shown that poor indoor air quality (IAQ) has a significant impact on the health of asthmatics. Based on increasing numbers of complaints from schools, Safeguarding Air in Schools (SAS) has chosen to target the K thru 12 school environment to help solve this problem for one of our most sensitive populations. SAS will promote IAQ in schools, increase public awareness and identify resources to address IAQ problems. By promoting good IAQ management, schools will be able to prevent IAQ problems and provide healthier learning environments.
Target Market: Safeguarding Air in Schools (SAS) is a campaign which will target the administrators, facility managers and nurses of schools K through 12th grade in the following South Carolina counties: Aiken, Allendale, Bamberg, Barnwell, Calhoun and Orangeburg. These counties were chosen as the pilot counties due to their location as contingent South Carolina Department of Health and Environmental Control (SCDHEC) health districts with similar demographics. Research indicates that schools in these counties have not participated in any formal training related to indoor air quality in schools.
Financial: The secured funding of $10,000 provided by national, state, and local partners will be adequate to cover expenditures for the SAS Project. This funding includes a $4,500.00 grant from National Association of County and City Health Officials (NACCHO), $3,000.00 from SCDHEC Health Services and $2,500.00 generated from registration fees.
Long-term Goals: The long-term goals for this campaign are: 1) to reduce the number of IAQ complaints in local schools; 2) to assist schools in developing individualized IAQ management plans; 3) to increase collaboration among all stakeholders to address IAQ issues in schools within the six counties, & 4) to strengthen the linkage between SC DHEC and SC Dept. of Education.
Product: Safeguarding Air in Schools Campaign (SAS) demonstrates how poor indoor air quality affects the health of school-aged children. According to Dr. Daniel Daggett of the Wisconsin Department of Health and Family Services, asthma is the leading cause of school absenteeism. Dr. Daggett also proposes one-in-10 school-aged children have asthma. To encourage schools to begin to manage their IAQ issues and therefore impact their absentee rates, a training program will be offered to present the latest information and support systems in place for managing IAQ in the school environment.
This campaign centers on EPA's "Indoor Air Quality Tools for Schools" kits. The kits assist participants with developing practical plans of action: to prevent and resolve indoor air problems at little or no cost, through the use of straight-forward activities and the identification of school staff or students as IAQ Coordinators. This product is co-sponsored and endorsed by the National PTA, National Education Association, the Council for American Private Education, Association of School Business Officials, American Federation of Teachers, American Lung Association and National Association of City and County Health Officials (NACHO). "IAQ Tools for Schools" kits offer sound guidance that give school officials the ability to improve indoor air quality and create a healthier, favorable learning environment for children and better productivity for teachers and staff. (EPA, 1995). Technical assistance and monitoring of changes (in recorded measurements and amount of IAQ- related complaints) over the 2000-2001 school year will be provided to a pilot school. An annual evaluation tool will be developed and implemented.
Customer/Geographic Focus: Primary customers are school administrators, facility managers and nurses in SCDHEC Edisto and Lower Savannah Health Districts. Other health and environmental professionals within the districts will participate in the training as well.
Objective: The major objectives are: 1) schools will develop their own IAQ management plans and 2) SC DHEC will establish policies and procedures for effectively responding to school IAQ concerns, decreasing health, financial and educational impacts of poor IAQ.
Measures of Performance: Currently, no IAQ Standards have been established. However, for the purposes of this project, good IAQ management will include: control of indoor airborne pollutants; introduction and distribution of adequate outdoor air and maintenance of acceptable temperatures and relative humidity. Four measurements will be necessary for monitoring school environments - temperature, relative humidity, air movement and airflow volume. Information will be provided to schools on how to obtain measurements equipment and how to begin measuring these four indicators. However, IAQ-related complaints will be monitored and compared. In addition, evaluation tools will be administered after the initial training and after the first year of implementation of the pilot school. Other measurements to be considered include: absenteeism in schools due to Acute Respiratory Illness (ARI)/asthma, number of ER visits and hospital admissions for school-aged children with asthma, changes in awareness and utilization of prevention strategies concerning IAQ within the school environment, and development of individual school indoor air management plans/policies.
Over the past 40 to 50 years, exposure to indoor air pollutants has increased. Exposures are due to a variety of factors, including construction of more tightly sealed buildings, reduced ventilation rates to save energy, delays in building maintenance to save money, the increased use of synthetic building materials and furnishings, and the use of chemically formulated housekeeping supplies. Comparative risk studies performed by the Environmental Protection Agency (EPA) and its Science Advisory Board have ranked indoor air pollution among the top five environmental risks to public health. Indoor air levels of pollutants may be 2-5 times, and occasionally 100 times, higher than outdoor levels. Elevated levels of indoor air pollutants in schools are of particular concern because children spend a great deal of time inside school buildings and children are especially susceptible to the effects of air pollution. Symptoms such as eye, nose, and throat irritation, dizziness, headache, nausea and asthma have been linked to elevated levels of indoor air pollutants.
In February 1995, the United States Government Accounting Office (GAO) released a report based on a survey indicating that 15,000 of our nationð's schools have IAQ problems which affect 8.4 million students. Problems are particularly pronounced in the Southeast where humidity levels are high. Deferred maintenance, which frequently occurs when schools have limited maintenance budgets, and inadequate ventilation are often cited as primary causes of poor indoor air quality. In 1999, 150 schools in South Carolina requested assistance from the South Carolina Department of Health and Environmental Control (SCDHEC) to assist in identifying and solving indoor air quality problems. However, limited assistance was provided because SCDHEC has no regulatory or enforcement authority regarding indoor air quality in schools.
The South Carolina Occupational, Safety and Health Administration (OSHA) may provide some help to schools; however, before OSHA will become involved, formal complaints of workplace exposure must be registered by at least three school employees. Schools are reluctant to contact OSHA because their assistance consists of a ðAcomplianceð@ inspection, civil penalties imposed for noncompliance and limited hands-on assistance in providing recommendations for solving problems.
The Medical University of South Carolina's program known as the Environmental Health Education Partnership (EHEP) provides indoor air quality distance learning and telephone consultation to schools for an annual enrollment fee of $100. This program provides a cost-effective alternative to traditional training and consultative support services; however, the program only has 100 schools state wide participating of which none are in our target area.
Environmental consulting firms offer assistance to schools but at a high price. Average cost of investigating individual air quality complaints at schools, including minimal air sampling, is $1000. Needless to say, most schools do not have the ðAluxuryð@ of spending money on air sampling and consulting fees, and as a result, schools are usually faced with solving indoor air problems ðAon their ownð@ and hoping for the best.
Indoor air quality is a very complex field with many challenges or barriers. Indoor air quality standards have not been developed by EPA that would define the much-needed ðAacceptable exposure levels.ð@ More research is needed to identify and rank the health risks from exposure to individual indoor air pollutants and mixtures of pollutants. Methods for diagnosing and correcting the causes of indoor air quality problems need to be improved. At this time, ensuring safe air in schools is a voluntary action and many times is haphazardly addressed by schools to avoid potential liability problems.
For schools, the key success factor in addressing indoor air quality problems is prevention. Many indoor air quality problems can be prevented by school staff and students using ðAcommon-senseð@ activities, i.e., painting classrooms and repairing roofs during summer vacations. The expense and effort required to prevent most indoor air quality problems is much less than the expense and effort required to solve problems once they develop. The development of indoor air quality education and awareness campaigns and the development of community partnerships between the Department of Education, American Lung Association, and state governments will enable schools to take a proactive approach in dealing with the challenging field of indoor air quality.
Safeguarding Air in Schools (SAS) targets administrators, facility managers, and school nurses in 97 public schools pre-K through 12th grade in the following South Carolina counties: Aiken, Allendale, Bamberg, Barnwell, Calhoun and Orangeburg. (see Appendix ) These counties were chosen as the pilot counties due to their location as contingent SC DHEC health districts, having the same Medical Director and also Director of Environmental Quality Control. Research indicates that schools in these counties have not participated in a formal training session related to indoor air quality in schools.
Marketing Goal: The goal of SAS marketing efforts is to increase the awareness of school administrators, facility managers, nurses and other health and environmental professionals of good indoor air quality management and its relationship to the health of children -especially asthmatic children. Poor health affects learning capabilities. Good indoor air quality management includes: "control of airborne pollutants, introduction and distribution of adequate outdoor air, and maintenance of acceptable temperature and relative humidity." (EPA, 1995)
This goal will be reached by offering a one-day Indoor Air Quality Education for Schools (for up to 250 participants), identifying and monitoring a pilot school during an entire school year, and assisting the state to develop an indoor air quality program. This training/conference will be offered in May, 2000.
Marketing message: Good indoor air quality contributes to a favorable learning environment for students, productivity for teachers and staff, and a sense of comfort, health and well-being for all school occupants. These combine to assist a school in its core mission - educating children.
Competition: There is no agency or community organization offering a comparable initiative. Environmental consultant firms are available (e.g. Davis and Floyd). However acceptance, affordability and accessibility are barriers to utilization by our school districts.
The SAS Team will market this training directly to the target market (public and private school principals, budget and facility managers). In effectively planning this training the following strategies will be implemented:
1) A grant proposal will be written to NACCHO (National Association of County and City Health Officials) for Indoor air Quality Training Tools for Schools training. (see Appendix)
2) A meeting with SCDHEC's Deputy Commissioner of Health Services will be held to discuss plan, receive input for state level participation on the Planning Committee and secure additional funds to conduct the training (to be held in May 2000).
3) A meeting with SC DHEC's Environmental Quality Control Bureau Chief will be held to discuss the plan, receive input for state level participation on the Planning Committee and secure additional funds to conduct the training.
4) SC Dept. of Education will be approached to assure a "top-down" internal communication effort within the school systems.
5) A Planning Committee will be determined. Letters will be sent from District Health Director encouraging their participation, citing the importance of partnerships between South Carolina's health officials and education professionals in developing action plans to ensure healthy schools (See appendix).
6) Planning Committee members will meet with superintendents, one-on-one, prior to the training to stress importance of having staff attend.
7) Flyers will be developed for distribution to school district administrators announcing the training. Registration forms will be developed and distributed to target audience. A $10 fee will be charged to encourage "buy-in" to the importance of the training.
8) Local newspaper coverage prior to the training will be conducted. Linkages to good indoor air quality and improved health status of our children will be the message. Media will cover the training event and will do a follow up article at the beginning of the 2000-2001 school year.
9) An IAQ reference manual will be developed for distribution to training participants. Incentives such as 2/$100 memberships to EHEP and monitoring/assistance to a pilot school will be offered.
IAQ Tools for School Training will be conducted. Each participant will receive kits to take back to their school. The indoor air quality guidance in this kit can be divided into two basic categories: background information and specific activities. Once the participant understands the basic principles and factors that influence indoor air quality in the school, they will note that the specific activities involve two major actions -- the management of pollutant sources, and the use of ventilation for pollutant control.
This guidance is organized around the use of an IAQ team, with the IAQ coordinator fulfilling leadership and administrative roles, and with the team members each performing specific activities.
Action packets are designed to help team members: "understand the importance of good IAQ; understand basic concepts of IAQ; identify and solve basic IAQ problems and prevent future problems." (EPA,1995)
In addition to kits being available, resources will be identified and reference materials will be distributed. Networking among the agencies/organizations represented will also be encouraged.
Human Resources: Project developers are the core group of Lou Ann Carter, Michael Chappell, Myra Reece and Vicki Green. Michael Chappell functions as the Environmental Health Director for the three-county area. He has extensive expertise in bridging environment and health issues. Myra Reece is the Director of Environmental Quality Control for a six-county area. Her knowledge of the regulatory processes related to air and water quality are a major asset to this project. Lou Ann Carter is a Systems Developer for the three-county health district. She has major strengths in developing collaborations and partnerships between agencies and the community. She has worked diligently with the local schools and hospitals to explore partnership opportunities and obtain grants for funding new initiatives. Vicki Green is the Director of Nursing and Professional Offices for the three-county health district. As supervisor of school nursing activities and as a Family Nurse Practitioner, she offers expertise in the health and medical field - specifically for this effort, health indicators for the school environment.
These four individual comprise the steering committee and are the top decision -makers for SAS. Mr. Chappell has strengths in sales and marketing and makes persuasive presentations. He has presented environmental issues on the national level. Mrs. Reece has an extensive scientific background and is recognized as an excellent manager and expert in her field across the state. Ms. Carter has excellent negotiation skills, has a science, nutrition and health education background and is able to tailor information for appropriate presentations to diverse audiences. Mrs. Green offers excellent organization, management, conflict negotiation, and people skills. All are articulate presenters and have presented health and/or environmental issues on the state level. As members of the state public health system, no compensation for this business venture will be in the form of salaries or bonuses. Monies obtained for the operation of the business will be put back into operations.
In addition to the steering committee, a planning committee has been identified. This planning committee is comprised of the steering committee and representatives from: the local school district; the Hospital Board of Trustees (this representative is also with the local Department of Public Utilities and Chamber of Commerce); the local University; state-level agencies; School Administrator Association, and American Lung Association. The group will assist with planning logistics of the education offerings, exploring opportunities and identifying additional community needs related to the business proposal.
Methods: The campaign's name, Safeguarding Air in Schools (SAS), will be utilized in all correspondence for better recognition. Existing staff meetings within Health Services and EQC will be used to inform staff of the project goals, objectives and timelines. Statistics regarding IAQ and asthma related illnesses will be shared with all stakeholders to heighten awareness of this children's environmental health issue. These updates will serve to gain support, identify and plan to utilize local employees as resources. By sharing information, the linkage between HS and EQC will be strengthened through increased collaboration between experts in Air Quality and health services in addressing health-related indicators. The collaboration will result in marketing efforts to institutions, businesses and private citizens supporting the need for monitoring IAQ to help prevent illnesses. As a result of these linkages, policy and procedures will be developed to address public concerns around this emerging health care issue.
An elementary school will be selected for a pilot project to begin after the training, (most likely starting in 2001). Intense monitoring and consultation will be provided during the school year. Statistics including benchmarking will be collected and utilized to show the improved health benefit from implementing IAQ management plans within the school environment.
Consultants: Consultants will be utilized from the Environmental Protection Agency; the SC DHEC central offices of Environmental Quality Control, Health Services, and Epidemiology; the American Lung Association of SC and MUSC's EHEP. EPA is the expert organization for Indoor Air Quality education and training. The education and tool kits have been developed in collaboration with the American Lung Association and utilized for schools in other states. EQC has expertise in risk management as well as air quality policies and regulation. Epidemiology has expertise in collection and utilization of information resources, data and trends relative to health indicators for the local health district. EHEP has systems in place to provide assistance on a continuing basis to schools for a fee of $100/school. Compensation for consultation for this project will not be required by these agencies.
Quality Management: As a result of SAS, the quality of SC DHEC's planning process will be improved. Linkages between EQC and HS will be strengthened. CQI teams will become more outcome-focused. School staff and employees will be empowered to identify problems and solutions. Teamwork between agencies will be emphasized for common objectives. Proactive management will be encouraged. Final decision-making for SAS will be the responsibility of the steering committee.
Benchmarks toward adopting a school IAQ management plan [such as absentee rates, IAQ monitoring systems (e.g. humidity, temperature, etc) and complaints by staff and students] will be established. People involved with the project will realize the parallel with other goals and objectives. IAQ will be established for CQI measurement and will reflect "quality of life" and economic impact outcomes.
Acknowledging that no IAQ standards currently exist, good indoor air quality management must be defined to assist in determining how an educational program (to increase knowledge and awareness of school officials regarding IAQ) will affect the overall result of improved indoor air quality in school environments. For the purposes of this project, good IAQ management will include: control of indoor airborne pollutants; introduction and distribution of adequate outdoor air; and maintenance of acceptable temperature and relative humidity. Thus, four measurements will be necessary for monitoring school environments - temperature, relative humidity, air movement, and airflow volume. (EPA, 1995) Information will be give to schools on how to obtain measurement equipment and how to begin measuring these four indicators. However, no baseline data exists to compare measurements of current school environments to how environments will improve after the IAQ educational program. In addition, an evaluation tool will be developed to monitor absentee rates - specific to asthma-related illnesses - for the pilot school.
Goals: To establish policies and procedures for effectively responding to school IAQ concerns, decreasing health, financial and educational impacts of poor IAQ. Strategies: The training will provide a recommended plan to address IAQ within the school. IAQ Management Plan checklists and action packets will be distributed for use. Once schools begin utilizing the plan and action packets, complaints relative to IAQ factors should increase. Once the plan has been in effect long enough for actions to be taken for prevention, complaints should decrease. A pilot school will be selected for school year 2000-2001. This school will be provided closer technical assistance and monitored for changes in measurements (temperature, relative humidity, air movement, and airflow volume) and amount of IAQ- related complaints. Additional information will be relayed and internal systems will continue to be developed. An annual evaluation tool will be developed and implemented. Once the community is informed of the potential health risks relative to poor IAQ, it is anticipated the campaign will expand to address the home and work environments.
Priorities: Education will be limited to schools, grades K-12, within the Edisto and Lower Savannah Health Districts of DHEC. Space permitting, the training will be open to environmental health workers who work closely with school inspections and to other members of the health care/EQC teams.
Timetable: The planning committee for the IAQ educational program will meet immediately. The training date will be determined by the planning committee - anticipating May, 2000. A pilot school will be identified after the educational program is conducted. The implementation of recommendations and initiation of IAQ programs in the schools will begin within three months after the training and will allow for school staff to obtain measurement equipment while schools are being serviced/improved during that time. Actual monitoring of the pilot school will begin in the 2000-2001 school year. It is anticipated that each school committed to improve IAQ will develop their own policies and procedures to address IAQ on an ongoing basis. An evaluation tool will be developed by December 2000.
Exit Strategy: In the event that this project becomes too large for the group to continue, the responsibility for continuing education re: IAQ will be assumed by programs existing within SCDHEC. Policies and procedures will be developed to assure continuation of monitoring and responding appropriately to IAQ complaints by appropriate staff members within the health districts. Ongoing consultation can be provided by EHEP with schools enrolling for membership and paying the $100 fee. Annual evaluations will be continued through developed programs within SCDHEC and the State Department of Education.
Although The Indoor Air Act of 1993 gives EPA the authority to set voluntary indoor air standards, standards have not been developed. Any regulatory influence or requirements in the indoor air quality field have been indirect. Federal government regulates products associated with indoor air pollution while building codes, fire ordinances, chemical and pesticide use, and other safety rules that affect indoor air quality are enforced by state, and local governments. The Clean Air Act (CAA) which focuses on ðAambientð@ or outdoor air impacts the quality of air indoors as well. Legislation requiring schools to develop indoor air quality policies is currently being debated and may be just around the corner. Schools, therefore, that participate in SAS training will be ahead of the game and will be adequately prepared for this new requirement. The development of the SAS campaign will certainly pose potential risks to SCDHEC, and the Department of Education. For the Department of Education, as in any education and awareness campaign, contacts and requests from ðAcustomersð@ (students, parents) could drastically increase in the initial phases of the campaign. This potential response could be overwhelming for schools who do not have a formal indoor air policy which describes how they will effectively respond to questions from parents/students and how they will address any future indoor air quality problems which may occur. Additionally, SCDHEC could see a substantial increase of requests for indoor air quality assistance from schools and an increased expectation from the public for SCDHEC to develop a formal indoor air quality program with sufficient resources and personnel.
Through the SAS campaign, each school will be encouraged to develop an indoor air quality management plan and to identify a current staff member as the indoor air quality coordinator. This will assure that all indoor air requests or concerns from parents will be handled by one person. The indoor air quality coordinator will attend the training and will receive an EPA "Indoor Air Quality Tools for Schools" kit which provides sample memos and policies, and a recommended IAQ management plan. SCDHEC will aggressively explore funding opportunities to develop a formal indoor air quality assistance program. Meanwhile, existing resources/personnel within and outside the organization will be identified to adequately address increased requests for assistance.
Secured funding of $10,000 provided by National, State, and local partners will be adequate to cover expenditures for the SAS Project. This funding includes a $4,500 grant from National Association of County and City Health Officials (NACCHO), $3,000 from SCDHEC Health Services and $2,500 from registration fees.
As a result of this funding, the project will be fully covered during the first year; the costs of the training will be covered by the grants as well as the admission fee. (See Statement of Cash Flow, Appendix E) After the first year, however, the on-going technical assistance will be provided at the expense of the government (in other words, via the health department's staff salaries). The annual cost to the Edisto health district of maintaining this project will be $2,423.
Revenues:
The training is expected to draw 250 attendees at $10 admission fee each.
Expenses:
[ Operations budget | Annual Cash Flow | Annual Balance Sheet ]