Graduate Student Internship Program

Alabama

Public Health Research Analyst Intern
Alabama Department of Public Health, Bureau of Family Health Services
Maternal and Child Health Epidemiology Branch, Montgomery, AL
Skill Area: Needs Assessment

Agency Information

The Bureau of Family Health Services (FHS) is located within the Alabama Department of Public Health (ADPH), the state department tasked with improving and protecting the health of resident and transient populations within its jurisdiction. The mission of FHS is to protect and promote the health and safety of women, infants, children, youth and their families through assessment of community status, development of health policy, and assurance that quality health services are available. This statement reflects the shift that FHS has experienced over the past decade away from direct health services to an increased emphasis on the core public health functions of assessment, assurance and policy development. The Maternal and Child Health (MCH) Epidemiology Branch (hereinafter the MCH Epi Branch) is located within a Consultants adjunct to the FHS’s Deputy Director, who serves as Alabama’s Title V MCH Director. The responsibilities of the MCH Epi Branch include surveillance of MCH indicators, including but not limited to most measures included in the MCH reports/applications; overall coordination and editing of the Title V MCH Services Block Grant reports/applications; 5-year needs assessments; and the State Systems Development Initiative. The intern will function within the MCH Epi Branch, focusing on data analysis to be included in the Alabama Fiscal Year (FY) 2009-10 MCH needs assessment.

Purpose, goals, and objectives of internship

Purpose: The purpose of the proposed internship is to analyze Alabama data from the 2007 National Survey of Children’s Health (NSCH) and compare key findings for Alabama in 2007 to those for the nation in 2007 and to those for Alabama in 2003. The 2003 NSCH data have been released, and the 2007 NSCH data are to be released in March 2009. The work completed during this internship will support the translation of the information from NSCH databases, along with other information from the needs assessment, into policies and programs that promote the health of children and youth residing in Alabama.

Goals: 1) produce salient information about Alabama children and youth from the 2007 NSCH database, for use in the FY 2009-10 MCH needs assessment, and 2) utilize the information in selection of priority needs, as the FY 2009-10 needs assessment process draws to a close. An overarching goal is to provide a work experience that enhances the intern’s professional growth. Achievement of the first goal will involve development of two products: a PowerPoint® graphics presentation and a final report that will include narrative and appropriate tables and figures.

Goal 1 objectives include the following, with all dates being for the year 2009:

1. By July 10, in consultation with the faculty advisor and the primary supervisor, identify any experiences that are not specified in this application but would benefit the intern and could be gained during the internship. These experiences need not be related to the goals and objectives stated in this application, but should not hinder achievement of the stated goals and objectives.
2. By July 17, prepare a preliminary, working PowerPoint® presentation showing how Alabama compared to the nation in 2007 on key indicators. For example, for the 2003 NSCH, the “National Chartbook Profile for Alabama vs. Nationwide” shows 26 indicators that fall into one of five areas: child’s health status, child’s health care, child’s school and activities, child’s family, and child and family’s neighborhood.
3. By July 24, add figures comparing key Alabama NSCH indicators in 2007 and corresponding indicators in 2003 to the working PowerPoint® presentation.
4. Also by July 24, based on findings shown in the PowerPoint® presentation and issues deemed of particular concern to FHS staff, select findings to focus on in subsequent, stratified analyses. (See Question 3 for details regarding stratified analyses.)
5. By August 14, basically complete the planned stratified analyses. (Because analysis and report writing often occur concurrently, some analyses may occur later.)
6. By September 4, submit a draft PowerPoint® presentation and a draft written report to the faculty advisor and the primary supervisor. Both the PowerPoint® presentation and the report may focus on salient findings, so need not include all figures shown in the earlier, working PowerPoint® presentation.
7. By September 30, submit the final PowerPoint® presentation and the final report to the faculty advisory and the primary supervisor.

Goal 2 objectives include the following, but the intern will not directly participate in these activities unless FHS’s Needs Assessment Advisory Group (Advisory Group) is convened in September 2009:

1. By November 27, 2009, FHS will convene the Advisory Group. Activities performed during the meeting will include the following:
1. FHS staff will present key findings from the needs assessment, including those from the intern’s work. If the intern is present, the intern may present findings from his or her work.
2. FHS staff will present about 12 potential priority MCH needs for consideration by the Advisory Group. These potential priority needs will have been selected based on needs assessment findings.
3. The Advisory Group’s input concerning priority needs will be obtained via a questionnaire to be completed by individual members, a questionnaire to be completed by breakout groups, and a plenary session in which breakout groups will present their views.
2. By January 31, 2010, FHS will select seven priority MCH needs: based on needs assessment findings, input from the Advisory Group, and whether ADPH has a role in addressing the need.

Data or analytic tasks and activities

As indicated under Question 2, the intern will perform stratified analysis of salient indicators, which will be selected based on findings shown in the working PowerPoint® presentation, issues deemed of particular concern to FHS staff, and feasibility. Based on limited review of 2003 NSCH findings and current concerns of FHS staff, salient indicators are likely to pertain to such issues as the following: moderate or severe health problems in general, asthma, absence from school, socio-emotional difficulties, breastfeeding, mental health care, medical home, repetition of grade, household smoking, and obesity. For the salient indicators, Alabama findings for 2007 will be sequentially stratified according to age, race/ethnicity, household income, and insurance type. If indicated, other variables that may be available for stratification include sex of the child, whether the child has special health care needs, and family structure. According to the NSCH web site, more complicated queries, such as concurrent stratification by two variables, can be completed by emailing NSCH staff with the topic and subgroups of interest. Further, the full NSCH dataset is offered in both SPSS© and SAS® formats.

The methods and extent of the intern’s analysis of NSCH data will depend on the intern’s interests and capabilities, as well as the form in which the 2007 data are available. If the NSCH web site allows the intern to query the 2007 data and direct analysis is not deemed necessary, the intern’s analysis could consist solely of queries of the NSCH web site, which currently provides point estimates and confidence intervals for 2003 data. Whether the intern will directly analyze the database, using SAS® software, will depend on several factors: such as what information can be obtained by querying the 2007 database, accessibility of the NSCH 2007 database and necessary documentation for direct analysis, and the intern’s interests and capabilities. The primary supervisor is skilled in using SAS® software, though she is not experienced in analyzing NSCH data.

Further, should the intern wish to do so, he or she would have the opportunity to analyze several years of vital statistics data using SAS®, as long as performing such analysis did not hinder achievement of the internship goals. Specifically, the MCH Epi Branch periodically produces maternal and infant profiles for the state and each of its five perinatal regions. In late 2007, under an agreement with the University of Alabama at Birmingham, a masters-level epidemiology intern updated these profiles—based on SAS® analyses performed by the intern under the primary supervisor’s oversight. SAS® programs used to produce the profiles include complex macros defining new variables. The intern secured through this application could help the MCH Epi Unit again update these profiles, using macros previously written by the primary supervisor and/or independently writing his or her own macros.

Data or analytic skills required

In order to achieve the stated goals, the intern will need to bring the following skills and knowledge to the assignment:

1. Competence in performing basic calculations (percentages, rates, and relative risks) via a calculator and a spreadsheet, such as IBM® Lotus® 1-2-3® or Microsoft® Excel.
2. The ability to interpret confidence intervals, p-values, and relative risks, for the purpose of comparing one population to another.
3. Skills and initiative required to familiarize oneself with the NSCH web site, take the analytical tutorials offered on the web site, and interpret the findings available by querying the web site.
4. Basic skills in preparing presentations using PowerPoint® or similar graphics software.
5. Excellent word-processing skills, preferably with Microsoft® Word.
6. Excellent writing skills.

Optimally, the intern would come with basic skills in performing analysis using SAS® software. Given basic skills, more advanced skills could be learned during the assignment. At a minimum, the intern would need to have the ability and initiative to learn basic and intermediate SAS® skills under the primary supervisor’s oversight.

Preferably, the intern would have demonstrated some skill in identifying and describing salient findings from research studies. Such skill would provide a foundation for identifying salient findings from the NSCH and describing potential implications of these findings for MCH policies and programs.

Supervisors

Primary: Anita Cowden, MPH, DrPH, Director of the MCH Epi Branch within FHS. Dr. Cowden has been located at ADPH since 1989 (including 2 years as a Centers for Disease Control and Prevention assignee). She joined FHS in 1998 and, since then, coordinated MCH reports/applications and needs assessment activities, including the FY 1999-2000 and FY 2004-05 MCH needs assessments. Her masters-level studies concentrated in MCH; and her doctoral-level studies concentrated in epidemiology first, statistics second, and MCH third.

Secondary: Dawn Ellis, MPH, Assistant Director of the MCH Epi Branch. Mrs. Ellis has over 30 years of experience in pediatric nursing and administration, including grants management. Mrs. Ellis was employed with the Alabama Department of Rehabilitation Services’ Division of Children’s Rehabilitation Service (CRS), which is the State Title V Program for Children with Special Health Care Needs (CSHCN), for 17 of those years. She recently joined the ADPH/FHS staff and has an undergraduate degree in nursing and a graduate degree in public health-MCH. She coordinated CRS’s component of the FY 1999-2000 and FY 2004-05 MCH-CSHCN needs assessments, including the collection and interpretation of both primary and secondary data.

Internship begins

The most suitable time for the 3-month internship to begin is in July 2009. This time frame also is conducive to the timely development of a presentation to report the findings at a state-level Needs Assessment Advisory Group by November 27, 2009.

Housing

General referrals are available.

Transportation

The work site is accessible via public transportation.

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