Building PartnershipsBuilding Partnerships

Azadeh Tasslimi, BA Research Specialist,

Department of Preventive Medicine & Community Health

UMDNJ-New Jersey Medical School

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Local implementation, Local implementation, coalition building, and coalition building, and partnerships with other partnerships with other local public health local public health agencies/organizationsagencies/organizations

Azadeh Tasslimi, BAPunam J. Parikh, MPHWilliam Bullock, BSEEDaniel M. Rosenblum, PhDDiana R. DeCosimo, MDStanley H. Weiss, MD

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Essex County Essex County Cancer Coalition (ECCC)Cancer Coalition (ECCC)

• One of 21 county cancer coalitions in NJ

• GOALS Implement the NJ Comprehensive Cancer

Control Plan (NJ‑CCCP) (www.state.nj.us/health/ccp/ccc_plan.htm)

Prioritize cancer control efforts at the local level

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Map of NJ – Highlighting Essex Map of NJ – Highlighting Essex CountyCounty

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BackgroundBackgroundEssex County Cancer Coalition: Addresses all 7 NJ-CCCP priority cancers:

Breast, cervical, colorectal, lung, melanoma, oral & prostate

County-wide focus: 4 contiguous inner-city municipalities with high

proportions of medically underserved Suburban areas with significant elderly

population

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MissionMission Increase cancer awareness & reduce its impact on

Essex residents through improved screening, access to treatment & follow-up

Promote awareness of and participation in cancer clinical trials

Support investigations that seek to find the causes of cancers, improve care, reduce health disparities, or increase access

Increase collaboration & communication among all stakeholders to maximize utilization/identification of resources

Examine and prioritize an expansion of cancer control efforts county-wide

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Diverse MembershipDiverse Membership Coalition’s major strength is its diverse

membership: Professional Background Geography (suburban & urban) Culture, race, ethnicity, & language

Membership reflects diversity of Essex residents -- many members live and/or work in Essex

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Diverse Membership Diverse Membership (cont.)(cont.) Members include:

Cancer Survivors Healthcare Providers Educators Outreach Workers Cancer Advocates Public Health

Workers & Researchers

People Personally Affected by Cancer

Organizations represented:

Community-based organizations

County & Local health departments

National & Local Cancer Organizations

Health Centers, Hospitals, & Clinics

Faith-based Organizations Corporations Academia Foundations

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Recruitment MethodsRecruitment Methods Word-of-Mouth Hospital Oncology Committees University Faculty Community Health Organizations Essex CEED Coalition Presentations by co-Coordinators Other County Coalition Coordinators NJDHSS - Office of Cancer Control &

Prevention

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Organizational Organizational StructureStructure

LeadershipCouncil

Development Committee

Education/OutreachCommittee

Clinical AdvisoryGroup

Essex County Cancer Coalition

NJDHSS – Office of Cancer

Control & Prevention

NJDHSS –

NJCEED

Essex CEEDCoalition

AdvocacyCommittee

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Leadership CouncilLeadership Council Membership:

co-Principal Investigators of Coalition Lead representatives from key organizations, businesses,

and government entities

Oversees and governs the Coalition & provides guidance to Committees

Formulated mission statement to encompass objectives and partnership plans

Identifies & prioritizes goals to be achieved and works with and mobilizes entire coalition to achieve these goals

Meets bi-monthly

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CommitteesCommittees Committees allow:

Members to accomplish specific goal-oriented tasks

Stakeholders to invest their efforts and expertise where they can be best utilized

Chairperson guides each committee Meet between quarterly Coalition meetings Coalition coordinators serve as staff to assist

committee

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Advocacy CommitteeAdvocacy Committee Provides a strong voice aiming to influence policy

decisions by:

Educating legislators about effective interventions and policies against cancer in Essex County

Notifying members of cancer-related campaigns through the Coalition list-serve

Sharing strategies to conduct effective advocacy

Earning respect and support from the community to represent groups of people concerned with cancer prevention and cancer-related health issues.

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Development Development CommitteeCommittee Coordinates efforts to obtain adequate funding

to implement priority cancer control activities

Examples: Identifying and informing members of

available resources Assisting members in obtaining resources

and funds Exploring vehicles for fundraising to meet

the goals of the Coalition

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Education/Outreach Education/Outreach CommitteeCommittee Enhance current public and professional education efforts

in Essex County aimed at increasing access to cancer prevention, detection, and treatment. Efforts include: Improving the public’s general knowledge about risk

factors, cancer symptoms, and screening resources Evaluating cancer literature currently distributed for

readability and cultural sensitivity Educating health professionals on cancer screening

guidelines, clinical trials focused on minority populations, health counseling

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Co-CoordinatorsCo-Coordinators Involved in C/NA process and knowledgeable of the

findings Facilitate communication & collaboration between

members Recruit new members and sustain membership Organize and facilitate quarterly coalition meetings Pro-active in developing initiatives and enlisting

active participants on committees Regularly communicate with Leadership Council &

Committee chairs Funding for 1 full time coordinator –

Split responsibilities between 2 people

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Co-Coordinators (cont.)Co-Coordinators (cont.)

Conduct presentations to lay community and professional organizations on Essex C/NA findings, cancer prevention, and local screening & educational resources

Attend regular state-wide meetings to share with and learn from other county coalition coordinators

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Effective Effective Communication Communication MethodsMethods Quarterly ECCC Meetings Email list-serve (free using Yahoo!

Groups) for Entire Coalition Leadership Council and Each Committee

Monthly Community Health Calendar Coalition Website:

www.umdnj.edu/EssCaWeb

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Effective Communication Effective Communication Methods – Quarterly Methods – Quarterly Coalition MeetingsCoalition Meetings Updates from:

Coalition Co-coordinators Committee chairs & Leadership Council OCCP representative Member Agencies

Presentations: 1-2 speakers invited to present their

research and/or activities Facilitates sharing of resources, activities

and research finding

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Effective Communication Effective Communication Methods – Methods – Quarterly Coalition Quarterly Coalition MeetingsMeetings (cont)(cont) Examples of presentations:

NCI Cancer Information Services The Prostate Net’s Barbershop Initiative NJ Cancer Trials Connect Website Role of Health Care Professionals in the

Prevention and Early Detection of Oral Cancer An Evaluation of Cancer Educational Materials

Distributed by NJ Local Health Departments Colorectal Cancer Disparities

Presentations often spur new Coalition priorities and initiatives

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Effective Communication Effective Communication Methods – Coalition List-Methods – Coalition List-ServeServe Facilitates the sharing of information

with the entire Coalition on: Cancer-related health fairs & screenings Advocacy alerts Cancer-related news/research findings

Communications initiated both by co-coordinators & Coalition members

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Effective Communication Effective Communication Methods – Community Methods – Community Health CalendarHealth Calendar Monthly calendar of cancer-related

screenings and events (initiated in June 2005)

Members notify co-Coordinators of events by 15th of preceding month

Online version is continuously updated Maintained by co-Coordinators Available through list-serve, Coalition

website, & local libraries

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Effective Communication Effective Communication Methods – OtherMethods – Other Coalition Website: www.umdnj.edu/EssCaWeb Coalition website is referenced on other state

health websites: OCCP - www.state.nj.us/health/ccp/ Healthy NJ – www.healthynj.org

Coalition Brochure & Profile OCCP Comp Quarterly Newsletter Newark Cancer Initiative Newsletter

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Coalition PrioritiesCoalition Priorities

• Findings from the C/NA serve as the empirical basis for prioritizing local cancer control efforts• County demographic profile was

created • Cancer issues not historically

recognized as priorities in Essex emerged from the C/NA process

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Composition of Essex County, Composition of Essex County, 20002000

(source: U.S. Census 2000)(source: U.S. Census 2000)

56% Minority population in Essex vs. only 27% in New Jersey

1/3 of State’s total Black population lives in EssexWhite

44%

Asian4%

Black41%

Other11%

Substantial Hispanic/Latino population - 16% of Essex vs.13% of NJ

Other special populations (race, ethnicity, or language) exceeding 3% of county include:

• Asians (29,429) • French- /French-Creole-speaking (24,874; incl. Haitians)• Portuguese (23,744)• Spanish-speaking, comprise 1/2 of linguistically isolated households

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Key Health and Economic Key Health and Economic IndicatorsIndicators

(source: U.S. Census 2000)(source: U.S. Census 2000)Essex County New Jersey

Population Density (people per square mile)

6,285.4 1,134.4

Median Age (years) 34.7 36.7

% Adults ≥25 years without high school diploma

24.4 17.9

% Linguistically Isolated Households 7.5 6.3

% Unemployed 9.3 5.8

% Estimated Uninsured 17.0 13.0

% Population Below Poverty Level

Individuals (all ages) 15.6 8.5

Children (<18 years) 22.1 11.1

Single, female householders 28.3 19.4

Elderly (65 years and older) 12.2 7.8

Median Household Income

1989 $34,518 $40,927

1999 $44,944 $55.146

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Among women, rates in Essex were over 10% higher than NJ for: Breast mortality Cervical incidence Cervical mortality Oral mortality

Among men, rates in Essex were over 10% higher than NJ for: Oral incidence Oral mortality Prostate incidence Prostate mortality

Essex C/NA FindingsEssex C/NA Findings

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Essex C/NA FindingsEssex C/NA FindingsEssex County had the highest Essex County had the highest cancer mortality rates of anycancer mortality rates of anycounty in NJ for:county in NJ for:

CervicalCervicalOral Oral ProstateProstate

Oral and prostate cancers emerged as new priorities

Cervical cancer screening & treatment remains a priority, as it is preventable and highly treatable. High cervical cancer mortality rates indicate a need for increased education and detection.

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Among women in Essex, Cervical cancer incidence & mortality rates:

over 2 times higher in Blacks vs. whites Oral and breast cancer mortality:

higher in Blacks than whites despite similar incidence rates

Among men in Essex, Oral cancer incidence:

over 2 times higher in Blacks than whites Prostate cancer incidence:

about 50% higher in Blacks than whites Oral and prostate cancer mortality:

over 2-3 times higher in Blacks than whites

Essex C/NA FindingsEssex C/NA FindingsRacial Disparities: Blacks vs. whites

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Implementation of Implementation of Essex C/NA by CoalitionEssex C/NA by Coalition

The Coalition is now partnering with the following organizations to address these three cancers: The Prostate Net Oral Cancer Consortium Essex “Communities Against Tobacco”

(CAT) Coalition Essex CEED Coalition

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Partnership with Partnership with The Prostate Net The Prostate Net ((www.prostate-online.orgwww.prostate-online.org)) Barbershop Initiative:

National program to increase prostate cancer awareness among minority men by training barbers to deliver health messages and involving local medical centers to provide free prostate cancer screenings & treatment.

Coalition members facilitated expansion of the Barbershop Initiative to include several Essex County hospitals

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Partnership with Partnership with Oral Cancer Consortium Oral Cancer Consortium ((www.oral-cancer.orgwww.oral-cancer.org))

Recruited an oral cancer specialist from the regional Oral Cancer Consortium to promote oral cancer awareness & education efforts

Presentation on role of primary care providers in oral cancer screening to Coalition

Promoted Oral Cancer Screening Day (April 7, 2005)

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Partnership with Partnership with The Essex Communities The Essex Communities Against Tobacco (CAT) Against Tobacco (CAT) CoalitionCoalition Supports tobacco prevention education

programs and participates in anti-tobacco advocacy efforts/activities Advocate for passage of

“Clean Indoor Air” Bill in NJ

NJ Breathes “Picture This” Campaign

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Partnership with Partnership with Essex CEED Coalition Essex CEED Coalition Provides cancer education & screening

to county residents Publicize cervical cancer education

and screening events Refer women to Essex CEED for

cervical cancer screenings

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Committee ActivitiesCommittee Activities

Advocacy: Promotes breast cancer education and

screening at local shopping centers

Development: Seeking support and funding for a new

mobile cancer screening van

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Committee ActivitiesCommittee ActivitiesEducation/Outreach Committee: Identified need to evaluate cancer

education materials for readability & cultural sensitivity

Evaluation of cancer education materials distributed by NJ local health departments

Supported summer medical student Coalition’s partnership with the NJ

Medical School facilitated obtaining funding from the Research Programs Office.

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Strengths of CoalitionStrengths of Coalition

Activities are driven by local cancer data Dedication to reduce community’s

cancer burden Diverse Membership Wide range of expertise

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Obstacles to Obstacles to ImplementationImplementation Current Funding

Support for infrastructure, with little allotted for Coalition activities and programs

Obstacles to Expansion of Funding Funding agencies look for an applicant’s

proven track record Limited funding impairs development of track record

Hard to fully document the CoalitionExample: Coalition submitted a letter of intent for a education

project but was not invited to submit a full proposal, in part owing to inadequate delineation of cancer survivors among the ECCC membership (privacy issues)

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Obstacles to Obstacles to Implementation Implementation (cont.)(cont.)

Maintenance of membership/interest in committee work Coalition is largely volunteer-driven Members volunteer their valuable expertise and

time Ongoing interest needs to be sustained through

progress & creativity

Solutions: Insure that the Coalition is productive Respond to ongoing feedback from members

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Obstacles to Obstacles to Implementation Implementation (cont.)(cont.) Implementing effective interventions

Ethical Dilemma: Screening and Treatment Issue

Many Essex residents are under-/uninsured and do not qualify for Medicaid

Those with abnormal findings or a cancer diagnosis may have no means of obtaining treatment & follow-up

Treatment money available for only certain types of cancer (breast & cervical)

Rising charity care costs

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SUMMARYSUMMARY

Essential elements for effective local implementation of cancer control activities: Well-defined organizational structure Diverse and dedicated membership Clear mission statement Effective communication channels Data at the local level Funded Staff

SUPPLEMENTSUPPLEMENTAL AL

INFORMATIOINFORMATIONN

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Coalition BackgroundCoalition Background

The Essex County Cancer Education & Early Detection (CEED) community coalition served as the foundation of ECCC

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Coalition Background Coalition Background Essex County CEED Coalition Comprised of grassroots community and civic leaders Builds and maintains local partnerships to promote cancer

education and screening services for the medically underserved

Primary focus is the greater Newark area, which has a large medically underserved population

focus is on 4 cancers: Breast Cervical Colorectal Prostate

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Coalition BackgroundCoalition Background Overlap in objectives and stakeholder

interests Holding joint meetings was approved to

maximize utility and avoid duplication of efforts:

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Obstacles to Obstacles to Implementation Implementation

Recruiting Corporate / Insurance representation Coalition is not incorporated, therefore

lacks liability insurance Corporate representatives hesitate to join

because of potential liability issues Incorporation is expensive Insurance would be expensive