Themes:
1) access to health insurance, primary care and other important service for our patients;
2) the opportunities in the clinical setting to screen, counseling and educate patients on broader health and prevention issues; particularly at discharge;
3) needs for staff development and training;
4) importance of assessing community needs, going out to the community with programs and involving the community in the process;
5) cultural competence/diversity training;
6) maintaining a comprehensive data base- tracking, monitoring and surveillance of injury, substance abuse and other preventable conditions;
7) staff wellness.

Five work groups have been formed:
Group 1--Carol Harris, RN and Chris Hill, RN are inviting staff to join in developing a plan to go to the schools--private and public, mid and high school. Possible issues include drinking & driving, "good touch," chronic disease awareness, dating violence. Group 2--Ludy Young, Rene Siquieros and Luis Alvernaz invite ED staff to join in planning together with Project ASSERT an event to raise substance abuse awareness and highlight the need for treatment resources. This activity will be entitled,"One Step at a Time." People can call 534-4388 for more information. Group 3--The Pediatric ED, represented by Dr. Amy Arnett, would like to develop a comprehensive health needs assessment and health promotion program for teenaged ED patients to address issues such as drugs, safe sex, violence prevention and injury and integrate Project ASSERT into the Pediatric ED. Group 4--Nancy Connors and Pat Dowd, RN are inviting staff to join them to develop an outreach program at Old Colony Public Housing Community in South Boston. Michael Kinneavy, EAPdirector for the mayor's office, volunteered to work on this project. Group 5--Niels Rathlev MD and Luis Alvernaz will be working to establish health forums for the patients we serve, and finding new educational materials for the waiting room television. Group 6--Thea James MD will be working with the residents to organize next year's health fair.

It was recommended by Dr. Brinsfield that every project build in an evaluation component, and that we develop a tracking and surveillance system for all public health issues related to Emergency Medical Services. Finally, John Auerbach, Executive Director of the Boston Public Health Commission, pledged to work collaboratively with us on our projects, as did Dr. Ralph Hingson, Chairman of the Dept. of Social and Behavioral Sciences at the School of Public Health.

The particular public health issues that BMC ED staff is currently addressing and would like to address in a more systematic and collaborative manner include: 1) HIV; 2) sexual assault and HIV prophylaxis; 3) domestic violence/ elder and partner abuse; 4) teen violence, date rape and violence; 5) linkages to pre-natal care; 6) child abuse and role of DSS; 7) tobacco, alcohol and other drugs of abuse/ binge drinking in college students; 8) unintentional injury (safety restraints, bicycle safety, motorcycle helmet use, window falls, falls in the elderly, pedestrian); 9) teen suicide; 10) asthma education; 11) sexually transmitted infections; 12) over and under nutrition/hunger; 13) environmental safety; 14) cancer prevention: prostate, breast and cervical cancer.

Suggested Projects:
1) crisis center for children;
2) outreach/ community programs;
   a) mid & high school health education programs (private and public)
   b) Project ASSERT for Old Colony Project in South Boston (collaboration          with South Boston Neighborhood Health Center);
   c) Project ASSERT at Suffolk County Detention Center: pre-release;        
   d) Health Fair in Franklin Park (BMC ED residents' project--Vince Hayes)
   e) Training BU Dormitory Resident's Life Assistants in Brief Intervention to          address Binge Drinking;
    f) BMC Health WALK, Project ASSERT WALK
3) Staff Wellness
4) Staff Development Program (cultural diversity training; community                resources; incorporation of prevention into discharge planning).

Suggestion for Resources:
Dr. Ralph Hingson, Chairperson of Social and Behavioral Sciences at BUSPH, said he would recruit his faculty for staff development. He also suggested that work teams are formed around areas of individual interest and BU SPH students could provide support staff on project in exchange forfield placement credits.