The Light shines in the darkness, and the darkness did not comprehend it.

Background: The SafeCare model is a behaviorally-based parenting model used in the prevention of child maltreatment. SafeCare targets three proximal risk factors for child neglect and abuse: parent-child interactions, home safety, and child health. SafeCare is one of only a few evidence-based practices for preventing child neglect, the dominant problem in child welfare, accounting for over 75% of child maltreatment cases. SafeCare has been broadly implemented in several states in the US, including Georgia, and is disseminated by the National SafeCare Training and Research Center (NSTRC) at Georgia State University. The presentation will (1) describe SafeCare and associated data, (2) describe the SafeCare implementation. Methods: SafeCare has been implemented in Georgia since 2008 using a rigorous implementation model, which includes on-going quality assurance of SafeCare providers and skill acquisition evaluation in families. Providers of child welfare services have been trained to deliver SafeCare and have been coached by trainers from NSTRC. Evaluation data are regularly collected which include provider fidelity via observed sessions, family outcomes relating to completion of SafeCare, and skill acquisitions (i.e., changes in parenting behaviors, reductions in home hazards, and increases in knowledge and behaviors regarding child health care). Results: Recent evaluation data (2013-2015) indicate 115 families have been referred to a SafeCare provider and 100 families completed at least one session. Thirty-eight (38%) have completed the program in its entirety. Provider fidelity data collected monthly indicate high program fidelity (mean of 91% of desired behaviors performed). Family behavior data indicate excellent skill acquisition among families completing each SafeCare model. Parenting skills increased by 104%; home hazards were reduced by 85%, and child health care skills increased by 34%. Conclusions: The SafeCare model is an effective parenting program for reducing child maltreatment, and has been implemented successfully in Georgia. Broader impact of SafeCare will require increased implementation of the model to increase reach.

Background: In May 2015, Zika virus was detected in Brazil. The virus has since spread through several countries in the Americas. Knowledge of the major symptoms of Zika virus infection was based on historic data from two previous outbreaks in the Pacific Islands. Currently-known Zika-specific symptoms include rash, conjunctivitis, arthralgia, and fever. Epidemiologists at the Georgia Department of Public Health (GDPH) began surveillance for travel-related Zika virus infections in January 2016. Surveillance data from GDPH contributes to better characterization of the current Zika clinical picture and more efficient triage of suspect cases for laboratory testing and prevention measures. Methods: For each patient approved for Zika testing, GDPH epidemiologists created an entry in the Zika Active Monitoring System (ZAMS) within the State Electronic Notifiable Disease Surveillance System (SendSS). Patients are categorized as “asymptomatic” or “symptomatic” and reported symptoms are noted. For symptomatic patients, clinical data are compared to determine differences in the distribution of symptoms in Zika negative and positive patients. Results: GDPH has approved testing for 383 symptomatic suspect Zika patients as of October 19, 2016; 88 (23%) were confirmed Zika infections. Among symptomatic positive patients, the most common Zika-specific symptom was maculopapular rash (95%); other common symptoms were headache and myalgia (27%). Among symptomatic Zika-negative patients, the most common Zika specific symptom was fever (62%), and the most common non-Zika specific symptom was headache (19%). Conclusions: Maculopapular rash is the most suggestive symptom of a true Zika virus infection, with 95% of symptomatic Zika positive patients in Georgia exhibiting the symptom. These data can be taken into consideration when updating the testing criteria for Zika virus. GDPH currently does not approve a patient for testing based on fever or non-Zika specific symptoms alone, and that guideline is reaffirmed by these results.

Background: Georgia is experiencing a crisis of injection drug use and hepatitis C virus (HCV) infection. From 2002 to 2014, the statewide drug overdose mortality rate increased, with nearly every county experiencing a significant increase in drug overdose mortality. Especially concerning is the rising HCV infection rate in people younger than 30, many of whom inject drugs. HCV incidence in young people increased over 200% in Georgia from 2006 to 2012. CDC officials have suggested “…Georgia is experiencing an expanding epidemic of heroin use that is driving an increase in injection drug use, putting many more at risk for the spread of HIV and HCV infection.” Methods: Now in its second year, Imagine Hope is a Georgia-wide project that includes 20 agencies (8 methadone clinics, 12 abstinence based agencies) serving substance-using populations. It offers free routine HCV testing and linkage to care. Nearly all individuals served inject drugs. The agencies have implemented a novel combination of embedding routine HCV testing into services; tandem testing for HCV and HIV; linking individuals to HCV care and treatment; and providing access to two support groups. Results: Over 18 months, 6,136 consumers received HCV antibody testing. Of those, 677 (11%) were HCV antibody positive (Ab+), with 83% of them born outside the baby-boomer cohort. To confirm HCV status, clinics conducted RNA tests, completing 464 such tests that yielded 381 (82.1%) confirmed cases of HCV. Currently, the project has linked 102 (36.8%) confirmed HCV+ clients to care and treatment services, with 12 (11.8%) clients experiencing total remission. Conclusions: Among intravenous drug users, HCV prevalence is high, while infection awareness is low. Navigators and support groups enhance linkage. Connecting a population of mostly uninsured behavioral health clients to care is feasible. Providing HCV RNA confirmatory testing in the behavioral health setting greatly enhances the linkage to care process.

Background: Academic institutions provide consistency and routine to children. When disasters damage schools, students often suffer in a variety of ways, and racial minority students are often impacted disproportionately. However, minimal research exists exploring these discrepancies. This presentation examines racial disparities in school systems affected by Hurricane Ike (2008). Methods: This study, funded by the National Science Foundation, uses publicly available Texas Education Agency data from approximately 600 schools affected by Hurricane Ike. Schools were included in the study based on two criteria: if they were declared “disaster areas” by FEMA and if they were closed for at least 10 school days after Hurricane Ike. Results: Descriptive analyses were conducted comparing school characteristics and pass rates for all students in grades 3-11 on the Texas Assessment of Knowledge and Skills (TAKS) standardized test during pre- and post-hurricane school years (i.e., 2003 – 2011). Mean pass rates on the TAKS varied greatly by race/ethnicity and other factors. Of African American students, 60.7% (SD=17.4) passed the TAKS in 2004 compared to 69.9% in 2011 (SD=15.0); 68.0% (SD=15.7) of Hispanic students passed in 2004 as opposed to 76.23% (SD=12.2) in 2011; 78.8% (SD=14.8) of White students passed in 2004 versus 83.1% in 2011. Further analyses will explore various other determinants influencing academic performance. Conclusions: Preliminary findings show discrepancies at baseline in academic outcomes between racial/ethnic groups. These discrepancies persisted post-hurricane, though all groups saw an increase in pass-rates. Further research utilizing advanced statistical approaches and geographic information system (GIS) analysis could yield insights on variation of academic performance between schools and school districts, as well as physical exposure and risk factors. These insights can inform strategies for improving schools’ academic trajectories after disasters and optimizing community recovery as a whole.

Background: Children in Flint, Michigan were exposed to lead at unsafe levels in drinking water bringing renewed interest and national attention to an old public health problem. In Georgia, thousands of children are exposed annually to lead at unsafe levels primarily from paint in homes built before 1978. With lead poisoning typically viewed as an urban problem, rural areas are often considered lower-risk in light of similar lead poisoning risk factors, albeit on a smaller scale. The purpose of this preliminary study was to examine the prevalence of elevated blood lead levels in children <6 years of age tested in rural Ben Hill County, Georgia, a county designated as lower risk. Methods: Lead surveillance data from the Georgia Department of Public Health (DPH) were analyzed using SAS®v-9.3 to calculate the prevalence of elevated blood lead levels (≥5ug/dL) among those children in Ben Hill County who had been tested for lead; the results were compared to state and national data. Results: A preliminary analysis of 2010-2015 screening data for Ben Hill County indicates that 8.73% (95%- CI: 7.4%-10.1%) of children who were tested for lead exceeded the Centers for Disease Control reference level (≥5ug/dL). This is approximately 3.5 and 2.4 times higher, respectively, when compared to national (2.5%) and state (3.64%) percentages of children exposed to lead ≥5ug/dL. Analysis also indicated low screening rates, which limits interpretation of population prevalence. Conclusions: Lead poisoning is often viewed as an urban, inner-city problem due to a higher percentage of older homes clustered together, exposing more children, compared to rural areas with homes geographically dispersed. While these data are preliminary and more analysis is planned to understand the problem, it highlights lead poisoning risks rural communities face that are often overlooked in population-based risk analysis and research on lead exposure in children.

Background: Cobb & Douglas Public Health (CDPH) was the first health district in Georgia to achieve accreditation by the Public Health Accreditation Board (PHAB) (accredited on May 12, 2015). Since then, two additional health districts, DeKalb (3-5) and Gwinnett, Newton, and Rockdale County Health Departments (3-4), have achieved accreditation. Efforts are underway among health districts statewide to become accredited, yet, little is known about life after accreditation. This presentation will highlight CDPH’s approach to submitting the PHAB Annual Report, which is required of health departments in order to maintain their accreditation status. Methods: CDPH will provide an overview of the PHAB Annual Report process and requirements. We will also share the process we used to construct a one-year timeline to prepare for the submission of the Annual Report and organize the Accreditation Team. CDPH will also provide a preview of the electronic submission process using ePHAB. Finally, CDPH will share tips, including lessons learned while preparing and submitting the Annual Report during July-August 2016. We will also discuss our experiences since submission and feedback received from PHAB’s Evaluation and Quality Improvement Committee. Results: CDPH will share knowledge and experiences related to the submission and feedback received of its first PHAB Annual Report, which was submitted August 2016. Conclusions: Health departments devote a tremendous amount of time, money, and energy to become accredited; however, the journey continues through the submission of PHAB Annual Progress Reports and reaccreditation planning.

Background: Chronic hepatitis C virus (HCV) affects more than 3 million people in the United States. Current HCV treatment offers a shorter treatment interval with fewer adverse reactions as well as improved cure rates of 96%. The increasing rates of hepatitis C infections in adults have been accompanied by multifaceted adverse health outcomes. The purpose of this screening program is to identify HCV-infected individuals, which will lead to clinical interventions and treatment that will improve health outcomes compared to no screening. Methods: The Centers for Disease Control and Prevention guidelines recommend that anyone with risk factors should be screened for HCV infection. In addition, all persons born between 1945 and 1965 should be screened once in their lifetime. Screening at Curtis V. Cooper Primary HealthCare Inc. (CVCPHC) includes individuals 18 and over for HCV and HIV. Results: CVCPHC’s screening program was implemented in January 2016. As of October 1, 2016, 4054 individuals had been screened for HCV with 187 antibody-positive. Of the individuals with positive antibody tests, 179 were RNA tested, and of these, 122 tested positive. Seventy four percent of those with a positive RNA test were linked to care. Eighty five percent of individuals with a positive RNA test were born between 1945 and 1965. The current case reports consist of 57 active HCV patients on medication and/or have completed therapy; 10 have a viral load not detected (ND) > 4-6 weeks after starting medication; 15 completed therapy with a ND viral load resulting in a 100% cure rate; 12 are currently on medication < 4 weeks; 15 were referred to GI; and five deferred treatment. Conclusions: Screening for HCV and HIV lead to the appropriate interventions and treatments for persons infected, preventing the progression of liver disease and reducing morbidity and possibly mortality.

Background: Modern day slavery is a $150 billion industry and the second largest criminal enterprise, behind drug trafficking.1 Approximately 21-30 million men, women, and children are modern day slaves worldwide, and over 200 cases of human trafficking were confirmed in GA in 2016 alone.2, 3 In 2006 Georgia incorporated a statute against trafficking of persons for labor or sexual servitude into its criminal code (see O.C.G.A. § 16-5-46). The penalties for this crime are stiff, and those convicted face a minimum of 10 years in state prison and up to a $100,000 fine. This is not enough, however. There is a need to identify this as a public health issue and work to create Georgia’s “Freedom Ecosystem,” a network of key players, including state government, businesses, consumers, and non-profit organizations. Together, these players can make strides in ending and preventing modern day slavery. Methods: Human trafficking is prevalent across our state, partly due to factors related to supply, demand, and facilitation. By applying a public health lens to human trafficking, we may deconstruct the issue across the socio-ecological model to identify the root causes and the most strategic approaches to overcoming systemic barriers, identifying and aiding victims, and empowering survivors. To do so, the Freedom Ecosystem can be used as a framework for harnessing change. Results: Through external interviews and research, we identified nine ways that organizations play a role in the Freedom Ecosystem. Conclusions: Members of Georgia’s private sector, civil society, government, funding communities, academia, and the broader public can use a collective-action framework with a public health lens to promote prevention and advance freedom from modern-day slavery.

Georgia enjoys a wealth of public health capacity ranging from governmental public health to academic programs as well as local, state, and internationally acclaimed organizations. Leadership is evident across public health policy, practice and research. In the closing plenary of the 2017 Annual Meeting-Faces of Public Health, GPHA engages leaders in our field in a spirited conversation on the public health workforce. The esteemed panel representing state, national, and international public health organizations will reflect on the needs of a 21st Century workforce: prepared to respond beyond emergencies and identified threats; able to adapt to an increasing complex technological, political and economic environment; committed to affecting the economic and social determinants of health inequities; and collaborating to advance the knowledge base aligned with core public health functions and essential services. Are professional standards, qualifications and credentials appropriately calibrated for the needs and opportunities ahead? How has the underlying science base for public health practice, leadership and research changed? As stewards of population health, is the workforce equipped to provide thought leadership on health policy and legislation? What’s working and what’s not working in the recruitment, preparation, and retention of Georgia’s large and diverse public health workforce? The audience will be invited to join the panel in this engaging dialogue.