Designing and Implementing Surveillance Systems in Indian Country

1. Designing and Implementing Surveillance Systems in Indian Country Introduction

2. Introductions • Who are you? • Where are you from? • What do you do? • Do you have any experience in injury surveillance? Introduction

3. Course Learning Objectives • Review the concepts and framework of injury prevention • Learn to assess injury data sources and use data to describe the injury problem • Learn how to build partnerships or a coalition to support the injury surveillance system Introduction

4. Course Learning Objectives • Learn how to determine the appropriate methodology for the surveillance system • Learn how to define and develop an analysis plan for the surveillance data • Learn to use injury surveillance data to inform injury prevention • Learn how to define an evaluation plan for the surveillance system and monitor prevention activities Introduction

5. About the Course Manual • Pre-test on Page 3 • Post-test Page 107 • Larger versions of charts in Appendix 6 Introduction

6. What is an Injury Surveillance System? Introduction

7. What is an Injury Surveillance System? • Ongoing systematic collection, analysis and interpretation of injury data for use in planning, implementing and evaluating prevention activities • Injury prevention programs use the data to assess the need for new policies or programs and to evaluate the effectiveness of those that already exist Introduction

8. Questions for Class • Why do you want to develop an injury surveillance system? • What do you plan to do with the data you collect? Introduction

9. About the Course Exercise • Create a surveillance system • Goal to show how each step or concept could be applied • Choose a scenario • Work in groups • Complete worksheet after each section or at the end of the course • Share with group Introduction

10. Step 1: Understand the Concepts and Framework of Injury Prevention Section 1

11. Objectives for Section 1 • Review the concepts, definitions and classification of injuries • Review the burden and the cost of injury • Understand the conceptual models for understanding and preventing injuries • Introduce the steps to developing an injury surveillance system • Understand the ethical considerations associated with injury surveillance Section 1

12. Injury Problem in the United States • Unintentional & Intentional Injuries in 2010 • 3rd leading cause of death – all ages • Leading cause of death in ages 15-34 • Cost an estimated $403 billion annually in medical expenses and lost productivity Section 1

13. Injury Problem in Indian Country • Unintentional & Intentional Injuries in 2010 • 3rd Leading Cause of Death – all ages • Leading cause of death in ages 15-34 Section 1

14. Injury Definition Damage to the body caused by: • Exposure to an outside force or • Lack of something essential or • Uncontrolled release of mechanical energy Section 1

15. Injury Definition Injuries Are Not the Same As Disease Section 1

16. Injury DefinitionInjury vs. Disease Injury: Broken toe caused by a jackhammer Disease: Tendonitis of the elbow caused by years of exposure to the vibration of a jackhammer Section 1

17. Injury DefinitionInjury vs. Disease Section 1

18. Injury Definition Injuries Are Not Accidents Section 1

19. Injury Classification Unintentional Intentional Suicide Stabbing Gun Shot • Fall • Car Crash • Dog Bites • Burns • Drowning Section 1

20. Injury ClassificationUnintentional Injury • Occur without the intent of anyone involved • 5th leading cause of death in US -- all ages • In Indian Country • 3rd leading cause of death all ages • Leading cause of death under age 44 Section 1

21. Injury ClassificationUnintentional Injury • Physical damage to the body • Caused by • Excessive force or • Exposure to external agents, such as poison or • Deprivation of an essential elements, such as air or warmth • Damage is not done deliberately Section 1

22. Injury ClassificationUnintentional Injury • Can be inflicted by a number of mechanisms, including: • Mechanical • Radiant • Thermal • Electrical • Chemical Section 1

23. Injury ClassificationIntentional Injury • Deliberate harm to oneself or another • Includes • Domestic violence • Child or elder abuse • Suicide attempts Section 1

24. Injury ClassificationIntentional Injury • In US (2010) • 10thLeading Cause of Death – all ages • Leading Cause of Death – ages 15-34 • In Indian Country (2010) • 6th leading cause of death – all ages • Leading cause of death – ages 15-34 • Account for 28% of all injury deaths Section 1

25. Injury ClassificationIntentional Injury • World Health Organization divides intentional injuries in three categories • Self-directed • Interpersonal • Collective Section 1

26. Injury ClassificationIntentional Injury • Nature of Intentional Injuries • Physical violence • Sexual violence • Psychological violence • Deprivation or neglect Section 1

27. Burden of Injury Injury Severity Pyramid US 2010 Section 1

28. The Burden of Injury in Indian Country • 2,523 deaths in 2010 • 66,612 years of potential life lost in 2010 • Cost an Estimated $2.1 billion • Medical care • Rehabilitation cost • Lost wages and productivity Section 1

29. Burden of InjuryLifetime Cost of AI/AN Injuries Section 1

30. Financial Benefits of Injury Prevention Interventions that Save Money in Indian Country • DUI Laws • Personal Flotation Devices • Smoke Detectors • Bike Helmets • Primary Seat Belt Laws • Livestock Control • Child Car Seat Program Section 1

31. Financial Benefits of Injury PreventionCost Outcome Analysis Section 1

32. Conceptual Models for Understanding and Preventing InjuryPublic Health Approach Section 1

33. Conceptual Models for Understanding and Preventing InjuryEPI Triad Host Environment Agent Section 1

34. Conceptual Models for Understanding and Preventing InjuryEPI Triad • Offers three opportunities for intervention • Host: Injured Person • Agent: Mechanism that inflicted the injury • Environment: Physical and social environment in which the injury occurred Section 1

35. Conceptual Models for Understanding and Preventing InjuryHaddon Matrix Section 1

36. Conceptual Models for Understanding and Preventing InjuryEcological Model for Understanding Violence Community Relationship Individual Societal Section 1

37. Conceptual Models for Understanding and Preventing InjuryEcological Model for Understanding Violence • Interaction of biology, behavior and environment • Changes over the course of life • Violence prevention a continuum of activities Section 1

38. Conceptual Models for Understanding and Preventing InjuryEcological Model for Understanding Violence • Looks at factors on four levels • Individual • Relationship • Community • Societal Section 1

39. Conceptual Models for Understanding and Preventing InjuryEcological Model for Understanding Violence • Individual Level • Biological and personal factors, such as age, education, income, substance abuse, history of abuse • Prevention strategies would promote attitudes, behaviors or beliefs to prevent violence Section 1

40. Conceptual Models for Understanding and Preventing InjuryEcological Model for Understanding Violence • Relationship Level • Includes peers, partners and family members • Prevention strategies would promote healthy relationships Section 1

41. Conceptual Models for Understanding and Preventing InjuryEcological Model for Understanding Violence • Community Level • Includes settings, such as schools, workplace and neighborhood • Prevention strategies designed to impact system could include marketing campaigns to promote healthy relationships Section 1

42. Conceptual Models for Understanding and Preventing InjuryEcological Model for Understanding Violence • Societal Level • Include societal or cultural norms, policies that maintain economic or social inequalities • Prevention strategies aimed at policy Section 1

43. Conceptual Models for Understanding and Preventing InjuryFor More Information • Energy damage and the 10 countermeasures strategies by Dr. William Haddon, Jr. • The Social Ecological Model: A Framework for Prevention Centers for Disease Control and Prevention • The Ecological Model and Risk Protection Factors Centers for Disease Control and Prevention Section 1

44. 1. Review the concepts and framework of injury prevention 7. Define an evaluation plan for the surveillance system and monitor prevention activities 2. Assess injury data sources and define the injury problem Steps to Developing an Injury Surveillance System 6. Use injury surveillance data to inform injury prevention 3. Build a partnership or coalition to support the injury surveillance system and prevention activities 5. Define and develop an analysis plan for the surveillance data 4. Determine the appropriate methodology for the surveillance system Section 1

45. Steps to Developing a Surveillance SystemImportant Things to Remember • These steps are a guide • Not every step will be achievable or feasible • Implement as much as you can • Modify steps as need be • Seek the help of experts Section 1

46. Steps to Developing a Surveillance SystemEthical and Cultural Considerations • Privacy • Confidentiality • Privacy Act of 1974 • HIPAA Section 1

47. Steps to Developing a Surveillance SystemEthical and Cultural Considerations • Institutional Review Boards • Cultural Concerns Section 1

48. Summary of Section 1 • Questions? • What did you already know? • What did you learn that was new? • Complete Question 1 on Final Exercise Section 1

49. Step 2: Assess Injury Data Sources and Describe Injury Problem Section 2

50. Objectives for Section 2 • Identify injury data sources and the strengths and weaknesses of each • Identify available data sources that can provide information to your surveillance system • Use data to describe the size of the injury problem Section 2