Collaboration Aims to Improve Public Health in Rural Areas

HealthStreet brochures rest on the bumper of a firetruck at the Melrose Fire DepartmentUF HealthStreet has entered into a unique collaboration with the Melrose Volunteer Fire Department to train off-duty firefighters as certified community health workers, or CHWs.

Serving as part-time CHWs, the firefighters will become familiar with the resources available through UF HealthStreet and can then connect community members to those resources while attending community events or answering 911 calls through the fire department.

“The goals of this initiative are to provide education, assist with better health care and decrease the number of serious emergencies by leading the citizens to preventive care,” said Capt. Kevin Mobley, of the Melrose Volunteer Fire Department.

Kayvon Yazdanbakhsh, a driver/EMT with the Melrose Volunteer Fire Department and a Master of Public Health student at the University of Florida, helped launch a community resource paramedicine, or CRP, program at the fire department in June of 2018.

One of the big concerns the fire department faces is with people calling 911 for rides to the hospital for primary care concerns, Yazdanbakhsh explained. “It’s not necessarily an emergency issue,” he said, “but they may need medical treatment and have no other way to get there.”

This type of call can be a real issue for a small fire department because it can tie up limited resources and delay response time. With a low budget and high 911 call volumes, the department has to be innovative to meet the needs of the community, which covers parts of four counties, Yazdanbakhsh said.

“We don’t have the resources to have a paramedic come off of a truck five days a week to go out into the community as a CRP officer and take blood pressures, meet with people and find out what the needs of the community are,” he said.

That’s where UF HealthStreet comes in.

The program’s CHWs meet people in the community every day and engage them in conversations about their health needs and concerns. CHWs perform blood pressure screenings, provide health education and give personalized referrals to local health resources through UF HealthStreet’s vast referral database.

CHWs also administer a health needs assessment that helps to determine a community member’s eligibility to participate in current research studies at the University of Florida. In aggregate, these health needs assessments also help to highlight which community needs are going unmet and to show trends in substance use and disease prevalence.

So, how did this collaboration get started?

UF HealthStreet founder Linda Cottler, Ph.D., MPH, is the associate dean for research in the UF College of Public Health and Health Professions and was Yazdanbakhsh’s adviser in the M.P.H. program. Cottler learned of the CRP program at Melrose and of the interest in helping connect people to UF HealthStreet.

“The goals of the CRP program aligned so well with HealthStreet CHW model that it seemed serendipitous to have Kayvon as my advisee,” Cottler said. “A match was made!”

Kelly Likos, another M.P.H. student at UF, is also a volunteer firefighter at Melrose. Likos and Yazdanbakhsh will be the first firefighters certified as UF HealthStreet CHWs.

Likos said that when explaining CHW work, participants often use blood pressure as an analogy because it’s common for people to have been told that they need to monitor their blood pressure but no one explained why or what the numbers mean.

“Through UF HealthStreet, we can help educate them about blood pressure, we can take their blood pressure … right there in the community, and then we can provide printed materials to teach them more about it,” Yazdanbakhsh said. “So, we’re really trying to improve not only the health literacy of the person but their self-efficacy to deal with that issue so that later down the road they feel empowered to do that themselves.”

HealthStreet's first Volunteer Firefighter CHWs stand in front of the HealthStreet sign
Kelly Likos, left, and Kayvon Yazdanbakhsh, both students at UF and volunteers with the Melrose Volunteer Fire Department, will be the first firefighters certified as UF HealthStreet Community Health Workers. Credit: Tamara Lowrey

Yazdanbakhsh said many existing CRP programs seek to reduce hospital readmissions, but the CRP program at Melrose is focused more on resources that help improve people’s daily lives and socioeconomic status.

“Reducing hospital readmissions is great; it saves people money, it saves your agency time and money and keeps the ambulances available,” he said. “But what happened years ago, before it turned into a 911 call and a hospital admission? Was it food assistance for Ensure shakes for (keeping) diabetes under control, was it simply telling someone that the pharmacy in Palatka will deliver your medication for free? Simple things like that that are completely nonmedical, total public health resources and take minimal to no effort for a fire department to implement into their daily activities.”

Yazdanbakhsh and Likos plan to share the knowledge they gain as CHWs with their fellow firefighters so their colleagues will also be able to educate community members about the available resources, whether on a 911 call or at a community event.

“It’s going to have to be departmentwide because we can’t be everywhere at once,” said Yazdanbakhsh.

This collaboration will build on the strengths of the Melrose Volunteer Fire Department, which already has a strong presence in the community, and empower them to bridge the gap between the resources in Gainesville and the citizens of Melrose who need them. The collaboration will also help UF HealthStreet further its mission to reduce disparities in health care and health research by expanding its reach into the rural communities the Melrose Volunteer Fire Department serves.

“We’re excited to be in collaboration with HealthStreet,” Yazdanbakhsh said. “To our knowledge, this is the first time a department in Central Florida has put certified CHWs on their roster to act for the department in conjunction with a program like UF HealthStreet. Being the first ones to do that is very exciting.”