HS315 Unit 10 Public Health Program Proposal Example

Thirteen Cases, Three Missed Chances, One Proposal: A Unit 10 Public Health Program Proposal for Street Wound Care in Drayton County

[Student Name]

Purdue University Global

HS315: Practices in Public Health

Unit 10 Public Health Program Proposal

[Instructor Name]

[Date]

The county, the funder, the budget and every bracketed figure are composite; the surveillance study, the outbreak report, the displacement study and the planning text cited are real.

Summary

Drayton County Health Department requests [$318,000] over two years to run Street Wound Care, a nurse-led wound care route that reaches people experiencing homelessness or injecting drugs at a syringe services van, a men's shelter and a river encampment. Of the [19] invasive group A strep infections reported in the county across 2023, 2024 and 2025, [13] occurred in this group, and [4] people died, every one of them under 60. Most began as a skin wound. The program aims to reduce cases in this group to no more than two a year by the end of 2029.

Statement of Need

Multistate surveillance traced a steep climb in invasive disease from this organism among adults who lack housing or inject drugs (Valenciano et al., 2021), and a single strain once circulated for months among unhoused adults in Anchorage before it was brought under control (Mosites et al., 2018). Drayton County fits that pattern. Its January point-in-time count recorded [312] people without housing, up by two thirds in five years, and its syringe services program served [410] people last year.

The county's community health profile found that overdose and injury, not heart disease, take the most years of life before age 75, and that the services reaching this group have no clinical staff. The health center sees about [5] percent of the group in a year. No agency offers wound care outside a clinic.

The [13] cases split by the chance each one missed. In seven, a wound went unexamined for days. In four, the wound was treated early, then reopened because there was no dry, clean place to care for it. In the last two, the infections began nineteen days apart in one shelter dormitory.

None of the three missed chances happened inside the hospital, so the response cannot happen there either: wound care where people are, conditions that let wounds heal, and a plan for the next cluster.

Population

The priority population is an estimated [600] adults, with a range of [450] to [750], in the county who either lack stable housing or inject drugs. The estimate combines the point-in-time count and syringe program enrollment, adjusted for overlap.

Goal and Objectives

Goal: a lasting drop in invasive group A strep within the priority population.

The program's nine objectives, set out in Unit 6, form four rungs. Reach: a baseline count in the first three months, at least [450] people with one wound check, and [40] percent seen at two or more sites. Care delivered: same-contact dressing for [90] percent of wounds found, a second dressing within three days for [60] percent, and shower access doubled at the day center. Timely escalation: same-day referral for [95] percent of people with spreading infection and [70] percent of health center referrals seen that day. Outcome: no more than two cases a year by 2029.

One objective has been revised since Unit 6. After the seminar on a shelter foot clinic that lost track of its patients, the second-dressing objective now counts dressings done by the person with kit supplies, recorded at the next contact, as well as those done by the nurse.

Intervention

Street Wound Care sends a health department nurse, paired with an outreach worker, along a five-day route: aboard the syringe services van three days a week at three stops, at the Fifth Street Shelter on two evenings, and on foot at the river camp on two mornings. The nurse offers wound checks, cleans and dresses wounds, gives kits with enough supplies for three changes, and follows a standing referral protocol for spreading or severe infection. The outreach worker records where each person expects to be in the coming days so the nurse can find them, and the program has asked the city for advance notice before any encampment is cleared, since involuntary displacement disrupts care for this population (Barocas et al., 2023).

The program also changes conditions: it funds two added shower and laundry mornings at the day center and buys socks and footwear in bulk. A cluster plan with three trigger levels, approved by the health officer, sets the department's response when cases are linked to a site.

Every kit carries a card asking for one action, getting a red, hot, spreading wound seen today, with a pen test for deciding when. The card was tested with eight readers and revised.

Partners

River Health Exchange, the Fifth Street Shelter, Fallon Springs Community Health Center, Open Door Day Center and Drayton Regional Medical Center have each signed a one-page agreement naming their roles. Letters of support are in Appendix B.

Evaluation

The evaluation uses the program planning approach of measuring process before impact and impact before outcome (McKenzie et al., 2022). Process measures come from the contact log and the nurse's encounter record: people reached, sites used, wounds dressed and referrals made. Impact measures are second dressings within three days, shower vouchers used and same-day referrals completed, matched to the health center's slot log. The outcome, county cases in the priority population, comes from the department's reportable disease records and is reported as a three-year rolling count, because a single cluster can swing a yearly figure. A short interview with ten program users in month eighteen will ask what makes the route easy to use and what puts people off.

No causal claim about cases will be possible, since there is no comparison county and the numbers are small. It will show whether the program reached people and delivered care as planned, which is the precondition for any effect.

Budget Summary

Year 1: [$152,000]. Year 2: [$166,000], including a second outreach worker at half time. Two-year total: [$318,000]. Personnel make up about [72] percent. Detailed budget and justification are in Appendix C.

Sustainability

The health department will seek to bill Medicaid for nurse visits where state rules allow, and the hospital has agreed to discuss funding part of the nurse's time in year three if emergency visits for skin infection fall.

The cluster plan and the shelter agreements cost nothing to keep once written, and the department will fold them into its standing communicable disease procedures in year one so they outlast the grant. The kit card and its Spanish version will be posted on the department's website for other counties to adapt, and the evaluation report will be shared with the state program so that a similar county could judge whether the route model fits its own shelters and camps.

Crosswalk

1. Missed chance: wounds no one examined. Component: wound checks on the route. Objective: 2, 3, 4. Record: contact log, encounter record.

2. Missed chance: nowhere to keep a wound clean. Component: kits, showers, laundry. Objective: 5, 6. Record: encounter record, day center sign-in.

3. Missed chance: two cases under one roof. Component: cluster trigger plan and shelter evening visits. Objective: 7, 9. Record: cluster log, reportable disease records.

References

Barocas, J. A., Nall, S. K., Axelrath, S., Pladsen, C., Boyer, A., Kral, A. H., Meehan, A. A., Savinkina, A., Peery, D., Bien, M., Agnew-Brune, C., Goldshear, J., Chiang, J., Linas, B. P., Gonsalves, G., Bluthenthal, R. N., Mosites, E., NHBS Study Group, Wortley, P., . . . Xia, M. (2023). Population-level health effects of involuntary displacement of people experiencing unsheltered homelessness who inject drugs in US cities. JAMA, 329(17), 1478-1486. https://doi.org/10.1001/jama.2023.4800

McKenzie, J. F., Neiger, B. L., & Thackeray, R. (2022). Planning, implementing, and evaluating health promotion programs: A primer (8th ed.). Pearson.

Mosites, E., Frick, A., Gounder, P., Castrodale, L., Li, Y., Rudolph, K., Hurlburt, D., Lecy, K. D., Zulz, T., Adebanjo, T., Onukwube, J., Beall, B., Van Beneden, C. A., Hennessy, T., McLaughlin, J., & Bruce, M. G. (2018). Outbreak of invasive infections from subtype emm26.3 group A Streptococcus among homeless adults, Anchorage, Alaska, 2016-2017. Clinical Infectious Diseases, 66(7), 1068-1074. https://doi.org/10.1093/cid/cix921

Valenciano, S. J., Onukwube, J., Spiller, M. W., Thomas, A., Como-Sabetti, K., Schaffner, W., Farley, M., Petit, S., Watt, J. P., Spina, N., Harrison, L. H., Alden, N. B., Torres, S., Arvay, M. L., Beall, B., & Van Beneden, C. A. (2021). Invasive group A streptococcal infections among people who inject drugs and people experiencing homelessness in the United States, 2010-2017. Clinical Infectious Diseases, 73(11), e3718-e3726. https://doi.org/10.1093/cid/ciaa787