The Florida County of Pinellas has a population of approximately 970,637 residents as of 2017, with 52% female and 82.7% White, 11.1% Black, and 9.7% Hispanic. Situated on 608 square miles, only 274 of which are land, Pinellas County is the most densely populated county in Florida, with a density of 3,292/sq. mi. The Florida Department of Health in Pinellas County (DOH-Pinellas) was established in 1936 and maintains public health jurisdiction over Pinellas County. DOH-Pinellas is one of 67 County Health Departments and operates under the auspices of Department of Health, Florida's state agency dedicated to protecting, promoting, and improving the health of all people in Florida. DOH-Pinellas serves Pinellas County with more than 700 employees in six health department locations throughout the county. DOH-Pinellas is divided into six divisions that provide a wide range of public health services including infectious disease control, health promotion, chronic disease prevention, environmental health monitoring, disaster preparedness and response, as well as personal health services.
Many of St. Petersburg's community members experience challenges that serve as barriers to optimal health. Recognizing that disparity in access to information is a significant barrier and social determinant of health, the DOH-Pinellas, the St. Petersburg Police Department (SPPD), the City of St. Petersburg's Healthy St. Pete initiative and the Foundation for a Healthy St. Petersburg collaborated and created the Community Resource Bus (CRB) program. The CRB program specifically addresses access to care by addressing inequities in access to information about healthcare and social services.
The CRB program originated from the City of St. Petersburg Police Department's goal of strengthening positive relationships between law enforcement and city residents. To build these relationships within the community, SPPD began dispatching their mobile command unit bus, staffed with a police officer, to various locations for one week each month. As the bus increased its presence in the neighborhoods of St. Petersburg, the need for information on healthcare and social services was realized. SPPD reached out to DOH-Pinellas for guidance to meet this need.
DOH-Pinellas initiated a formal partnership with SPPD, the City of St. Petersburg's Healthy St. Pete, and the Foundation for Healthy St. Petersburg to expand the use of the mobile command bus. The agency's collaboration involved remodeling the bus, transforming it into a neighborhood-friendly and approachable Community Resource Bus. The bus is staffed with volunteers and community health providers who provide various health screenings such as diabetes screening and HIV testing. To connect residents to local resources, the software Health Leads Reach was purchased through funds awarded by Florida Blue. Health Leads Reach is an integrated database that enables the CRB volunteers to quickly match residents to the best resources available, as well as easily manage and track referrals.
The overall goal of the CRB program is to improve community safety and access to care by connecting St. Petersburg residents to crucial resources via the CRB. The program combines public safety and public health to ensure that all residents have the resources they need to be healthy. The CRB program also involves a significant component of community policing, which has been documented to reduce crime rates and improve perception of officers.
CRB program objectives have already been met by implementing a sustainable program, connecting over 2,000 residents with health, municipal, social and safety information and resources at regular bus stops, and reaching hundreds more through participation in health fairs and events. Additionally, demographic and health/social needs data were collected from willing participants, allowing the opportunity for further analysis of community needs.
Partnerships and collaboration are some of the core factors that led to the ongoing success of the CRB project. By establishing partnerships with the City of St. Petersburg and SPPD, as well as local volunteers, DOH-Pinellas has expanded their reach and impact on community members who may not have otherwise encountered such information and/or resources through the CRB program. The CRB continues to reach thousands of residents and families in St. Petersburg, particularly those in high-crime, lower income areas where the bus is often stationed. Quality of life stands to be improved directly and quickly for these populations, via connection with medical and social resources. In addition, the data and insight we gain through the CRB program can inform future interventions down the road. The CRB has also impacted the population in some ways that are difficult to measure, but which are nonetheless important to quality of life, including greater trust of police officers and public servants, as well as overall gratitude and appreciation from neighborhood residents.
Pinellas County is resource-rich with organizations that address access to care in the target population of St. Petersburg. While many community organizations address access to care, only 211-Tampa Bay Cares locally aims to address this issue by improving access to information. Even so, 211 has no method of mobile outreach. The CRB program was thus designed to help promote local services and address disparities in access to care and information, serving the community while strengthening the existing service infrastructure. DOH-Pinellas, SPPD, the City of St. Petersburg collaborated to provide residents with crucial information about health and social services, and to foster positive relationships between at-risk communities and law enforcement via the CRB.
The CRB targets citizens of St. Petersburg and rotates between the city's three police districts. St. Petersburg is in Pinellas County and is the county's most highly populated city with 248,429 citizens. St. Petersburg's population is more diverse than the county as 69% are white, 23.9% are black and 6.9% are Hispanic (by comparison, Pinellas County is 82.9% white, 11% black, and 9.1% Hispanic).
Several regions within St. Petersburg experience issues that serve as barriers to optimal health. Overall, approximately 17.2% of St. Petersburg residents live below the poverty level and 6.5% are unemployed (US Census). As stated in the 2013 Economic Impact of Poverty Report, there are five At-Risk Zones within Pinellas County that have higher concentrations of poverty than the County overall, one of which is South St. Petersburg: one of the CRB's key target areas. Pinellas has 15 census tracts where =30% of residents live below the Federal Poverty Line. In nine tracts, over a quarter of adults have less than a high school education. According to the report, six of these are in St. Petersburg. The city of St. Petersburg also struggles with crime and access to health care. The violent crime rate is 6.62 per 1,000 residents, much higher than the Florida rate of 4.3 per 1,000 (Neighborhood Scout). In terms of access to care, 14.8% of adult residents in Pinellas were uninsured in 2016 with 17.2% saying they had not seen a doctor in the past year due to cost (BRFSS).
In 2012, 59.4% of Pinellas County Community Health Survey respondents cited access to care as the most important factor for a healthy community (DOH-Pinellas). Healthy People 2020 cites the link between disparities in access to care and health information and disparities in health outcomes. A community with greater access to care and health information will have a higher quality and quantity of life. In 2016, the Foundation for a Healthy St. Petersburg also solicited community input for how to make St. Petersburg healthier. Responses included: safer neighborhoods, a publicity campaign to let the public know about services, and funding partnerships with the local government.
The CRB program has aimed to fulfill the following objectives: By fostering positive relations between police and residents we can help create safer neighborhoods. Further, the overall goal of the CRB was to directly deliver information about services. Finally, the CRB is a collaboration of three local government agencies, DOH-Pinellas, SPPD, and the City of St. Petersburg.
The CRB took a comprehensive approach to health and wellbeing by expanding the idea of public safety to include health and municipal elements and enhanced the capacity of all three individual agencies by serving as a low-cost intervention with the capacity to serve thousands of residents. The innovative partnership also allowed for the opportunity to receive funding for full time staff dedicated to the CRB, and bus improvements such as Wi-Fi, a shade awning, and a space for health screenings – all of which allowed the program to be more effectively and efficiently implemented within the community.
The CRB worked to build upon the practice of Community Policing, a strategy of policing focused on building ties and working closely with community members, and interventions highlighting the importance of access to information. The CRB worked to innovatively combine and expand upon these practices, and a literature review has yielded no documentation of any similar mobile resource bus projects. The close collaboration between the city, the police force, and the health department is unique because of the way it demonstrates an understanding of the relationship between law enforcement and health, thereby joining public health and public safety. The CRB model is cost-effective and has reached thousands of residents throughout St. Petersburg. In Pinellas, we are fortunate to have several social services and healthcare resources, but citizens often lack awareness and ability to access them. The main goal of the CRB was to bridge that gap, allowing for the potential to become a new model of best practice.
The impact of access to information and in-person resource navigation on health has already been documented in other cities through interventions such as Health Leads, which similarly recruits volunteers to serve as resource connectors. However, while the underlying principle of the CRB is evidence-based and has precedent, the CRB intervention itself is innovative.
Community Policing is also cited in George Mason University's Center for Evidence-Based Crime Policy as a promising policing strategy that can be combined with other interventions in ways that may increase their overall effectiveness.
Goal: Improve community safety and access to care by connecting St. Petersburg residents to crucial resources via the Community Resource Bus.
Objective A: Implement a sustainable Community Resource Bus (CRB) Program.
Activity 1: Hire a CRB Coordinator with the City of St. Petersburg and Community Health Educator through DOH-Pinellas to staff and manage the bus. Activity 2: Formalize the volunteer program, including recruitment and training of at least 12 new volunteers. Activity 3: Ensure the CRB was active at least two weeks per month beginning in the first month of the project period. Activity 4: Market the CRB program to St. Petersburg residents via a minimum of three methods (print, radio, in-person outreach at events, etc.) during the first 6 months of the project period.
Objective B: The CRB will connect 2,000 St. Petersburg residents with social and healthcare resources during the project period.
Activity 1: Host a minimum of four health screenings at the CRB during the project period. Activity 2: Provide a minimum of 2,000 residents with resources at the CRB and outreach events (including brochures, screenings, and referrals to 211-Tampa Bay Cares and partner agencies).
Objective C: Collect data on health and social resource needs from St. Petersburg residents.
Activity 1: Create a demographics and needs paper survey to be administered through the CRB.
Activity 2: Administer surveys to 1,000 residents through the CRB and outreach events.
As a collaboration with the City of St. Petersburg and St. Petersburg Police Department (SPPD), only those in St. Petersburg were recipients of the practice. The SPPD was responsible for choosing the bus location within its three police districts each month based on assessment of neighborhood needs for the designated district. Anyone who walks up to the bus is eligible to speak with a police officer or bus staff, as well as receive information, resources, giveaways, screenings, etc.
Since the beginning, the CRB program embodied collaboration among a variety of stakeholders. The program was born after the St. Petersburg Police Department reached out to Florida Department of Health in Pinellas (DOH-Pinellas) for help when its mobile command bus began receiving requests from citizens for social service and health information. Ultimately, DOH-Pinellas, SPPD, and the City of St. Petersburg formally collaborated to establish the CRB program. Additionally, local organizations became involved providing volunteers, screenings, information, resources and incentives, while the community members themselves were an important group of stakeholders through their feedback and participation since the inception of the program. The project initially took place over a period of 15 months, January 2017 to April 2018, measured by its grant funding period. The partners, however, have committed staff and resources to continue the CRB program beyond its grant funding.
DOH-Pinellas served as the lead agency for the grant application that allowed for the implementation and expansion of the CRB program with the partner agencies. As the convener of the project, DOH-Pinellas also managed the grant budget, and oversaw all written agreements formalizing the partnership with SPPD and the City of St. Petersburg. DOH-Pinellas also employed the CRB's Community Health Educator, provided health-related literature from DOH and various community partners, and continued to foster collaboration with external partners such as BayCare Health System and Help Us Help U, Inc. to provide health screenings, and organizations including Community Health Centers of Pinellas, Pinellas County Human Services, Healthy Start Coalition, Utica College of Nursing and many others to provide volunteers and information. DOH-Pinellas also presented information about the CRB project to various groups including the Pinellas Community Health Action Team, Council of Neighborhood Associations and Churches United for Healthy Congregations to continue to foster community access, involvement and collaboration.
The SPPD took responsibility for the costs involved with CRB maintenance, as well as scheduling bus locations. SPPD led the major internal and external improvements to the mobile command unit, while working closely with the partners to determine what renovations would be needed to transform the bus into a CRB that would be welcoming to community members. SPPD staffed the bus with officers at all times who were available to speak with citizens, answer questions and give tours of the CRB, as well as provided public safety information, resources and giveaways.
The City of. St Petersburg Parks & Recreation Department employed the CRB Coordinator within the city's Healthy St. Pete team. This ensured that the Coordinator had easy access to City events and updates for CRB outreach, volunteer opportunities and municipal information and resources to provide to citizens. The City's Coordinator was also responsible for marketing the CRB through various forms of media, as well as confirming the CRB's monthly location with SPPD and updating the location on the Healthy St. Pete website.
Community/consumer engagement was also an important element of the CRB program. The idea for the project began by listening to the community: the St. Petersburg police chief noted that residents were asking officers for health and social service information. Additionally, DOH-Pinellas took into account several community surveys, including the Pinellas County Community Health Assessment and the Foundation for a Healthy St. Petersburg's 2016 listening sessions, which yielded similar feedback. Suggestions for a healthy community safer neighborhoods, a publicity campaign to let the public know about services, and partnerships between local government entities. Once the CRB was implemented and citizens became more familiar with the sight of the CRB around their neighborhoods, staff received a multitude of statements of appreciation and gratitude from local residents.
These relationships and formal collaborations across sectors and the community have allowed for the expansion of the community policing model and successful dissemination of health, safety and social information, supporting a healthier and safer community with increased access to crucial resources.
Yes, implementation and expansion of the CRB program was made possible through a grant from the Foundation for a Healthy St. Petersburg which funded the CRB program, as well as the enhancement of DOH-Pinellas' Community Health Needs Assessment. $259,562 of the grant was budgeted for the CRB program for:
Personnel, including the Community Health Educator position ($45,024), and in-kind contributions for CRB-related duties of the Contract Manager ($17,469), Director of Community Health & Performance Management ($10,872) and Planning & Partnerships Manager ($37,023), totaling $110,388.
Direct costs, including office operations/supplies for the CRB ($2,300), communications/marketing ($1,000), travel ($1,000), equipment/promotional items ($900), and other items such as the Human Resources Assessment ($1,305) and a cell phone for the Community Health Educator ($346), totaling $6,851.
Purchase services, including contracts with SPPD for bus renovations and staffing ($76, 223), with the City of St. Pete for the Community Resource Bus Coordinator position ($58,100) and external marketing costs ($8,000), totaling $142, 323.
Objective A: Implement a sustainable Community Resource Bus (CRB) Program.
Activity 1: Hire a CRB Coordinator and Community Health Worker within 60 days of the grant award.
Activity 2: The Coordinator will formalize the volunteer program, including recruitment of at least 12 new volunteers and holding at least one formal training during the 12-month project period.
The project coordinator established a communication flow with Police to relay information regarding bus location, usage, events, etc. They also engaged about 40 volunteers during the project period, including regulars from the County, Community Health Centers of Pinellas and Utica College of Nursing, as well as nurses from BayCare, and several community members.
Activity 3: The CRB will be active at least two weeks per month beginning in the second month of the project period.
This activity was met. In addition, SPPD and Healthy St. Pete have continued to commit staff so that the bus is out in the community the first week of each month. This schedule will continue beyond the project period.
Activity 4: The CRB program will be marketed to St. Petersburg residents via a minimum of three methods (print, radio, in-person outreach at events, etc.) during the first 6 months of the project period.
The Resource Bus was marketed via flyer distribution in nearby neighborhoods and outreach events, via SPPD Radio, through several local newsletters and to clients of DOH-Pinellas community partners. The Bus also received media coverage and is promoted on the DOH-Pinellas and Healthy St. Pete websites.
DOH-Pinellas also presented about the bus to various community groups including the Diabetes Collaborative, the Community Health Action Team, Suncoast United Way, Community Health Centers- Johnnie Ruth Clarke, Boley Centers, JWB South County Community Council, St. Petersburg Free Clinic, the Tampa Bay Healthcare Collaborative, Churches United for Healthy Congregations, and various health and wellness fairs locally. The Resource Bus was also featured in the 2018 Community Health Needs Assessment, which has been distributed to a range of community partners in Pinellas County.
Objective B. The CRB will connect 2,000 St. Petersburg residents with social and healthcare resources.
Activity 1: Host a minimum of four health screenings at the CRB during the project period.
We exceeded this goal. The Community Resource Bus partnered with BayCare to offer health diabetes screenings as well as general screenings at the Community Resource Bus, including a paper risk quiz, blood pressure, glucose, cholesterol and A1Cs. BayCare staff came out for a total of 12 weeks, at which they screened 113 individuals. Another 167 screenings came from events and other organizations; so far, over 200 community members have received health screenings at the bus.
Activity 2: The CRB coordinator will provide a minimum of 2,000 residents with social and healthcare resources at the CRB and outreach events (including brochures, screenings, and referrals to 211-Tampa Bay Cares and partner agencies).
We provided almost exactly 2,000 residents with information and/or resource referrals at regular bus postings. The bus also participated in various health fairs and events with community partners such as St. Petersburg College, Tampa Bay Health Collaborative and YMCA, at which hundreds more residents stopped by to receive services; because of the volume of participants/walk-bys at these special events, we don't have exact figures.
Objective C. Collect data on health and social resource needs from St. Petersburg residents.
Activity 1: Create a demographics and needs paper survey to be administered through the CRB.
A CRB survey was created in English and Spanish to capture basic demographics and needs/reason for stopping by the CRB, as well as what type of resources were received.
Activity 2: Administer surveys to 1,000 residents through the CRB and outreach events.
We collected as many surveys as possible from residents, but ended up focusing on our Community Health Needs Assessment phone survey to collect robust, specific data. Resource bus coordinators administered surveys to as many willing participants as possible who came up to the bus, and we did end up collecting 834 paper surveys during the project period.
Primary data was collected from nearly 1,000 residents during the project period, and will be analyzed for demographics, needs/reason for visit to the bus and type of resources that were provided, all linked to zip codes where the bus was stationed. This data will be used to inform the partners of the most prevalent needs for each location, as well as the most commonly used resources to help tailor content to the needs of the community.
Numbers of community members reached with resource information and provided with health screenings were used as process measures for the project, as well as number of media outlets used for marketing and number of community groups presented with information regarding the CRB.
There were many lessons learned in implementing the Community Resource Bus (CRB) project and in the close collaboration with our primary community partners, the St. Petersburg Police Department (SPPD) and the City of St. Petersburg. In the process of formalizing the collaboration through written agreements, making purchases and bus improvements, among other startup measures, we learned that working with three government agencies with individual/differing policies, procedures, etc. can lead to various bottlenecks in the setup process, delaying the time it takes to get the ball rolling on implementation of the program.
In relation to the practice, we learned that it is necessary to market near a CRB stop ahead of time to local businesses, organizations and the neighborhood in general, as soon as police determine location. Sergeants don't tend to determine the CRB location until about two weeks before the CRB week, so having marketing materials ready to update with the location is extremely helpful. Even so, it is helpful to have large flags/banners, preferably emphasizing free health-related services, that can attract the attention of neighbors as well as those passing by.
We also learned that it takes residents and other passersby a little while to get used to seeing the bus in their neighborhood. Additionally, some areas are notably slower in terms of walk-ups than others. Usually by the end of the week neighbors are much more receptive and willing to interact with the CRB. Giveaways are extremely helpful in incentivizing citizens to stop by the CRB, fill out a survey, etc. Residents have shown tremendous gratitude for health and safety related giveaways such as sunscreen, bike lights, condoms, toothbrushes, stickers and other child-friendly incentives, etc.
It is also helpful to stock up on resources based on demand of locations. For example, we began to realize in some locations, partly due to the times of the CRB stops, that we would encounter many older, retired citizens or parents of infants and toddlers and, therefore, would ensure we stocked up on relevant resources based on populations we encountered at different locations and/or time of your (e.g. summer and school-aged youth).
Lastly, it is helpful to broaden the reach of the CRB by branching out beyond regular station stops. We were able to connect hundreds of residents to resources by going out to events, fairs, recreation centers, nursing and mobile homes, etc.
All three partner agencies have committed staff and resources to continue the CRB program. With the communication flow established and initial setup costs such as bus renovations out of the way, the foundational work of the CRB project has allowed for the sustainability of the program.
The City of St. Petersburg has integrated the CRB Coordinator position within staff of their Healthy St. Pete initiative and DOH-Pinellas has similarly integrated the duties of the DOH Community Health Educator/bus coordinator into a full-time position. The SPPD continue to station the mobile command bus throughout St. Pete and agreed to continue working with the City and DOH-Pinellas to provide resources and services through the CRB the first week of each month.
By requesting funds to renovate the bus, the vehicle can serve the dual function of the police mobile command bus and the CRB for years to come. Additionally, the continued marketing and publicity, growing network with community partners to expand bus capacity and organization of the volunteer program have allowed the CRB to continue engaging with its most valuable stakeholder, the community.