The Kansas City metropolitan area is a single media market with approximately 2 million residents in two states. Of those two million residents, 1,886,302 (according to the 2010 census) are served by ten local health departments (City of Kansas City, Mo., Health Department, City of Independence, Mo., Health Department, Cass County Health Department, Clay County Health Department, Jackson County Health Department, Platte County Health Department and Ray County Health Department in Missouri and Johnson County Health Department, Wyandotte County/Unified Government Health Department and Leavenworth County Health Department in Kansas). The local health departments work with an organization call the Mid America Regional Council (MARC) to coordinate and facilitate cooperation across the ten local jurisdictions.
Kansas City Health Department
Joint Metropolitan Regional News Release Protocol
The Kansas City metropolitan area is a single media market with approximately 2 million residents in two states. Of those two million residents, 1,886,302 (according to the 2010 census) are served by ten local health departments (City of Kansas City, Mo., Health Department, City of Independence, Mo., Health Department, Cass County Health Department, Clay County Health Department, Jackson County Health Department, Platte County Health Department and Ray County Health Department in Missouri and Johnson County Health Department, Wyandotte County/Unified Government Health Department and Leavenworth County Health Department in Kansas). The local health departments work with an organization call the Mid America Regional Council (MARC) to coordinate and facilitate cooperation across the ten local jurisdictions. The market includes a Fox Affiliate (WDAF 4), CBS affiliate (KCTV 5 and KSMO 62), NBC affiliate (KSHB 41 and 38 the Spot), ABC affiliate (KMBC 9 and KCWE 29), PBS affiliate (PBS 19), and Univision affiliate, as well as 24 broadcast radio stations and numerous print and web news outlets. It is currently the #31 television market according to the Nielsen Local Television Market Universe Estimates. One of the greatest challenges during any public health emergency is communicating information to the public, and news media is the single most efficient means of reaching the largest number of people. Metropolitan areas face a challenge within that challenge: those 10 health departments must work together to push messages out with a single voice or risk the messages being lost in confusion. In April of 2006, the health departments collaborated to develop a protocol by which news releases could be sent to the media and represent all the health departments. This protocol also allows a work-around for more controversial public health topics that might be held up in the approval process if representing a single agency, as elected officials tend to be more comfortable if something controversial comes out from the region rather than from their specific local health agency. The protocol does not replace individual releases for information specific to jurisdictions or take power or authority away from individual departments and how they address public information issues specific to their jurisdiction.The goal of this practice is to create a single, unified voice for public health in a metropolitan area that ranges from urban to rural and across the full range of socioeconomic status populations.
Communicating with the public is a major challenge during any public health emergency or event. If ten separate messages from ten different health departments – even if they are similar or only slightly different – hit the media from ten different health departments, there is going to be confusion and incomplete or even inaccurate coverage by the media.Communications and Public Information have been determined by CDC, FEMA and DHS (among others) to be of vital importance, relevant in any public health discussion, whether it is emergency communication or day to day communication of public health messages.The regional news release protocol enhances the communication pathway between the local health departments and creates a means of communicating with the media using a single public health voice.
There are only a limited number of large metropolitan areas crossing multiple jurisdictions, including a state line, and while the Kansas City metropolitan area has been utilizing and updating this protocol since 2006, metropolitan areas around the nation are contacting health departments in the Kansas City metropolitan area for advice on developing similar protocols. In February of 2008 it was selected for a roundtable break-out session for the NACCHO Public Health Preparedness Summit.This differs from most current practices in that most metropolitan areas have a single dominant health department that receives the majority of media attention or several health departments that act independently, even if they communicate with each other before sending out information. With this regional protocol in place, any of the health departments may request a regional release, and if they do not have the staff available to write the release, they may request that their subject matter expert work with a public information officer (PIO) at one of the larger departments to craft a draft release for review and approval by the different departments.
The primary stakeholders are the ten local health departments
MARC and members of the media.
Role of Stakeholders/Partners
A representative of each health department participates in a group called the Risk Communication Task Force, under the Regional Homeland Security Coordinating Committee’s Public Health Subcommittee. Though the group does not meet on a regular basis, there is regular communication among group members. This group is responsible for reviewing and updating the protocol when needed, and the protocol must then be approved by the 10 health directors. Often, it is this group that actually writes the draft release based on information provided by the subject matter experts.
With the regional release protocol, there are three roles a local health department can take: they can request and author the regional release, suggest edits and approve, or refuse approval of the release.Directors of the 10 health departments meet bi-monthly in a group called the Metropolitan Official Health Agencies of the Kansas City Area (MOHAKCA), and other department representatives meet monthly with the Public Health Subcommittee. Communications between departments is encouraged and fostered through a variety of regional committees and work groups, because diseases and other public health events do not stop at jurisdictional lines.
One barrier encountered was that even when the majority or all of the local health departments agree on a message, the influence of two separate state health departments can interfere with the release. During a mumps exposure, information from the two states differed on how long children should stay home from school. During H1N1, the states differed on how they identified suspect and confirmed cases because while there was federal guidance, there was no federal mandate on how that terminology was to be used; one of the states created the classification “presumptively confirmed”. When that happens, the conflicting information is omitted from the regional release, and the individual jurisdictions work with their doctors and clinics as best fits their needs.
The protocol recommends a certain amount of lead team before routine releases, but allows for urgent and emergency releases as well. Any department may suggest a regional release. An initial contact is made with all departments, either by phone or e-mail, that a release is being suggested. A draft release is written, either by the suggesting agency or by the PIO of another agency in cooperation with them, and is sent to the PIO and director of every department for feedback, with a set time limit for edits to be suggested. Each department can either suggest an amendment or approve. The intent is to reach a consensus among all departments, but due to time constraints this often is not possible. If and when a consensus is not possible due to either technical or other unforeseen circumstances, the release is considered approved when at least five of the 10 head directors or designees representing at least 67% of the population agree to issue it. The release is then sent to MARC’s office of public information, which puts it into a regional letterhead that was developed with the protocol and sends to the metro area media market. The regional letterhead includes contact information for all ten health departments.
When lead time is allowed, the process can take a day or two, depending on the needs of the situation. When an urgent release is needed, the process has been completed – from initial notification to authoring, editing, approving and sending – in as little as three hours with the consensus of all 10 health directors.
Process & Outcome
Objective 1: Demonstrate that the protocol has been tested regularly:
Since it was developed in April 2006, the regional news release protocol has been exercised 9 times in 2006, 8 times in 2007, 5 times in 2008, 9 times in 2009, 3 times in 2010 and 5 times so far in 2011.
Objective 2: Demonstrate that the protocol can be used in both time sensitive and everyday situations:
Three examples of 2011 exercises of the regional news release protocol:
On Monday, 1/31/11 at 5:16 p.m. notification was sent to directors and PIOs that a regional release on extreme cold weather safety be developed for the following morning. On 2/1 at 10:11 a.m. a draft release was sent to the directors and PIOs; by 10:46 a.m., approval had been received from 7 departments representing 84.7% of the population and the release was sent to MARC public information staff for publication. There were several last minute edits received after that e-mail, but they were included and the release reached the media at 11:32 a.m. on 2/1, 1 hour and 21 minutes after the initial rough draft was submitted for approval.
On Wednesday, 8/31/11 at 10:57, the director of the Cass County Health Department contacted the PIO of the Kansas City, Mo., Health Department requesting a regional release on cryptosporidiosis prevention, due to increased activity in several jurisdictions. After communications between PIOs and subject matter experts, an initial draft was sent to directors and PIOs for review and suggested amendments at 4:04 p.m. on 8/31. By close of business on 9/1, six departments representing 84.7% of the population had approved, and the release was sent to MARC public information staff at 5:57 p.m. for publication the following morning. The release reached the media at 9:38 a.m. on 9/2.
On Friday, 9/9/11 at 1:46 a request was sent to the area health directors and PIO, including the initial draft of a regional release on the movie, “Contagion”, based on information received from the National Public Health Information Coalition and CDC. The request was for a release to be sent the following Monday morning, pending a review of the movie by department directors. By close of business that day, approvals had been received from three directors representing 66.7% of the metro population. At 1:15 p.m. on Monday, 9/12, the area directors agreed during their bimonthly MOHACKA meeting to approve the draft release, which immediately sent to MARC public information staff. The regional release entitled “New movie ‘Contagion’ illustrates importance of public health” reached the media at 3:53 p.m. on Monday, 9/12/11.
Objective 3: Demonstrate that the protocol allows ten health departments to speak with one voice to the public through the media:
In each case mentioned in Objective 2, a sufficient number of directors and public information officers provided input to assure a unified message representing most or all the local health departments was sent to the media on a health topic of interest. Depending on the topic, information from the releases appeared in television and radio broadcast and in internet news stories.
Each of the ten local health departments is committed to sustaining the practice as it allows all to have a say in the overall message reaching the community, and a unified message results in less confusion and decreased calls from the community requesting clarification. There is also a financial incentive for smaller departments who cannot afford to staff a PIO position, in that they can work with the PIOs from other departments to draft these releases. MARC likewise is committed to a sustained regional cooperation as that is their primary goal.
The departments, which have been operating under this protocol for five years, do plan to sustain the practice over time by maintaining regional interagency relationships and continued partnership with MARC. There is no additional cost involved as most of the staff members involved in this process are salaried employees and the primary method of communication and publication are tools that are already in place at each department.
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