1. Public health nurses work in a variety of settings. Today’s simulation is for the year 2000. While
we might have expected updated resources for the Butte County, CA to have been updated, the
granularity of data for the 2010 and 2020 U.S. census is more limited than that provided for 2000.
Nonetheless, we’ll suspend a bit of reality and assume things did not change much from the turn
of the century thru the November 2018 Paradise Township Camp Fire.

fire started because of mismanagement of resources (PGAE). Lot of people died, fire started
in northeast and then hit an electric line. Wind was 100 mph so the flames went up and out
and started spreading to the North and West.

What nursing has to do with this: the nurse in charge to have emergency contact information
with laminated photo of the child and the parent or guardians on it.

public health nurse to prevent death and destruction: assess to make sure to be ready for a
disaster and to make sure to prevent disaster.
2. The Frontline documentary (first few minutes shows the bucolic beauty of the community
3. Is this a one-off? Click here

it is NOT a one-off – research done after Paradise stated it is not a one-off

looked at 526 communities and got a heat map – color coded all the areas that will be
hazardous (deep red and orange). There is disproportional risk.

they mapped at an 18-acre level and looked at if fire risk is a problem. One mile out
parameter around Paradise would determine how much the fire would fly out.

On 1-5 scale- they did predictors and concluded that Paradise is a 3.81 on the scale.

They were looking at the map to see the major escape routes outside of the county. At the
upper part of the county (the mobile homes area; top of “triangle”). They were trying to get
1800 households out of that county in an hour with only 2 routes outside of the region.
o
Nurses, firefighters, etc work with the community to show how to get out of the county.
Nurses should teach people and how to practice getting out of buildings or areas
because of disasters.
o
The nurses, doctors, and firefighters were not prepared for the evacuation because
they never actually practiced it. The deaths at paradise would have been prevented if
they were prepared to do this.

Median age of people that died was 72. There was 85 people total that died, and 62 of them
were over age 65. Public health workers and nurses are responsible to make a disaster plan
with these people and how to prepare to get out.
4. Simple examples of things that went wrong, and could have prevented community danger from
the Frontline
a. Communication breakdown (Reveal podcast)
b. Resources The Guardian newspaper coverage (Posted in Resources page for Week 1)
1. We knew and didn’t act long before Paradise burned. North-south differences in evacuation
notices
•
“Last October, more than 170 wildfires ripped across Northern California, burning more than
9,000 buildings, causing millions in damage and killing 44 people. It was the deadliest fire
incident in the state’s history. This week’s episode is a partnership with KQED in San
Francisco. KQED reporters Marisa Lagos, Sukey Lewis and Lisa Pickoff-White obtained
thousands of 911 calls and dispatch recordings, and together we reconstruct the first hours
of those fires. Starting from the night of Oct. 8, 2017, we examine the decisions that were
made and the delays in evacuation warnings that may have contributed to more deaths.”
5. Program-based PHNs may cover an entire county or may be one of a number that are assigned
to deliver program activities in prescribed areas. District Office based PHNs, such as those
located in Los Angeles County SPAs, may cover specific health department Program needs,
such as case finding for the Tuberculosis Control Program, by executing program activities in
“their assigned areas”. These assigned areas may be assigned by census tracts.
a. Listen to the brief history of U.S. Census tracts and their meaning.
(https://www.youtube.com/watch?v=DOe4alPmjss) [2:20 minutes]
b. Navigate to the U.S. Census tract map for Butte County, California
(http://www.bcag.org/documents/demographics/2000_census/U.S._Census_2000_Tracts
_Butte_County.pdf)
1. Evaluate the maps that shows Butte County entirely. Describe the characteristics
of Census tracts on this map. Enter the characteristics you note below
Map name: Butte County Census Tracts, 2000 U.S. Census
Characteristics
c. Zoom in on Paradise, CA. What Census tracts include residents of Paradise, CA.
Census Tract
d. In many public health departments, a district public health nurse would be assigned to census
tracts. The total target population for each PHN is approximately 5000 people, nationally. Some
communities may budget for a higher ratio.
From the video presentation describing census tracts, roughly how many people are included
in the census tracts comprising Paradise, California. (hint: remember the video discussed a range of
population estimates for each census tract and the upper end of the range is the cut-point for
dividing a census tracts into subunits, e.g., “17.01” and “17.02” that you see in the census tracts
north of Paradise, CA.
Your estimate:
e. Some data provided by the Census Bureau may be helpful in disaster planning. Evaluate the County
to County commute patterns map for Butte County. Summarize your findings about important factors
that may affect disaster planning for the area Be sure to address:
1. Describe commuting destination pattern for most Butte County residents?
2. How can this pattern benefit disaster preparedness? Give examples.
3. How can this pattern pose challenges? Give examples. (hint: think about what
more you need to know.)
4. What additional information is needed that is not provided on this map, were you
f.
g.
planning for Paradise CA?
Other resources: RWJF Rankings and Roadmap project
Butte County Public Health Community Assessment and Organizational Chart
Assessment:
Answer the following questions (boxes expand):
1. Answer the following questions (boxes expand):
In week 1 and 2 Lectures and Readings, four videos and the Minnesota Wheel manual
are posted for your review
Resources: 1) Minnesota Wheel Nursing Interventions Manual, posted resource
module for week 1: advocacy, social marketing, and policy development and
enforcement (Also posted in the week 1 course website “resources”)
In our wee1 and 2, the concepts of
advocacy, social marketing, and
policy development and
enforcement are grouped together
on the Minnesota Wheel. How are
these public health activities
related?
If the individual or family is unable
to respond, the PHN works with
them to resolve the barriers by
advocacy. What are the basic ways
we view nurse advocacy?
Describe a systems-level intervention
that PHNs might employ, develop, and
enforce policies for families displaced
by the Paradise Camp Fire. (See
Manual pp 206, 221, 238, and 239 for
examples)
Describe a community-level
intervention that PHNs might employ
social marketing to that ensure safe
and dependable housing for families
receiving Section 8 housing assistance
and affected by the Camp Fire. (See
Manual pp 206, 221, 238, and 239 for
examples)
Describe a family-level intervention that
PHNs might employ as advocacy for a
kinship foster family caring for an
8-year old grandchild that requires
durable medical equipment that was
destroyed in the (Paradise, CA) Camp
Fire.(See Manual pp 206, 221, 238,
and 239 for examples)
2. To describe factors that might affect a wildfire natural disaster in Paradise, CA, we can explore
characteristics that affect the resilience of the community.
We reviewed many of the characteristics that are community assets that foster resilience in adverse conditions.
Some characteristics make resilience more difficult. Review the Community Assessment and characterize five
community assets of Butte County, CA and five features that may predict challenges in coping with a natural
disaster like the Paradise CA CAMP FIRE. (See Butte County Public Health. Community Health Assessment,
2019-22 (Butte County). Oraville, CA: County of Butte, 2019.
Asset
Health Care Assets- Mental health
providers, free clinics, EMS
Food System Assets – agriculture, food
pantry/bank/commodities
Housing Assets - affordable housing
programs/subsidized housing, assisted
Challenge
living facilities, foster care homes, homeless
coalitions/shelters, weatherization/home
improvement/home safety programs
Cultural Assets - agencies that provide
cultural support, education and advocacy,
family and cultural centers, public spaces
Public Safety Assets - Anti-Bullying
Programs, Domestic Violence & Crisis
Response Organizations, Emergency
Operations Centers, Emergency Operations
Centers, Jail, Probation and Fire
Departments
Organizational Assets- Crisis intervention,
Emergency operations center, Police & Fire
department
6. Helpful resources for the exercise can be found at: Module 4 Resource materials for class
activities: 1) Butte County Community Health Assessment and 2) Minnesota Wheel (Public
Health Nursing Interventions) Manual.
CA?
How does the foster care
placement rate in Butte County,
CA compare to other CA
counties?
Navigate to the “First Entries
into Foster Care, by Reason for
Removal” chart by County.
What proportion of child
residents of Butte County are
placed in foster care due to
neglect, physical abuse, sexual
abuse, and other reasons?
How does the prevalence of
neglect as a reason for
placement compare to California
prevalence, overall?
...to other California Counties?
Diagnosis:
1. To promise improvement in care for foster children, we need to state our
expectation in for children who are cared for in foster care by Public Health Nurses,
Social Workers and Probation Officers, and population.
State your community diagnosis for children entering foster care.
Identifying an Overall Outcome Objective:
Format Outcome Objective
By (date)
, {what will change?} {in what target group?} will be {reduced or
increased?} {by how much? }. (Sources)
EXAMPLE Objective for a problem identified in 2004,
By January 2014, the risk for death from falls among seniors 50 years and older in SPA 4 will be
reduced by 72 per 100,000, from SPA 4 baseline of 625 per 100,000 per year, to 553 per 100,000 in
2014.
Formulate two possible Outcome Objectives from the assessment you conducted:
Outcome objective 1: (remember, format matters)
Outcome objective 2:
Discuss your group’s rationale for selecting this Overall Outcome Objective:
Identifying Intermediate Objectives:
Intermediate objectives link the outcome objectives to the process objectives. They describe the
changes that will occur that ultimately result in or produce the desired outcome. They are
precursors to attaining the outcome. Intermediate objectives have shorter time frames and clearly
reflect what can be accomplished and measured within the time period of the program plan.
Intermediate objectives assess measures, which have a high probability of reducing a health
problem or increasing resiliency/capacity. These objectives measure the impact of specific
interventions designed to achieve the outcome. Intermediate objectives measure changes in
organizations, laws, policies, and power structures at the systems level, changes in community
norms, attitudes, awareness, beliefs, practices, and behavior at the community level, and
knowledge, attitude, beliefs, values, skills, circumstances, behaviors, and practices at the
individual/family level.
Intermediate objectives stair-step toward your Overall Outcome Goal. State objectives that together
will achieve the goal. For example, if the overall goal is to paint the office, we would: assess
resources, gather resources, prepare office, paint, finalize project.
Format for Intermediate Objectives
By [date? Month, year, sometimes day], [What will change?] [Where or which population?] will be
[direction: reduced or increased] by [amount: quantity, % change, fold change] as evidenced by
[how will you know you reached this piece of the plan to achieving your overall goal.
EXAMPLE Objective for a problem identified in January 2004,
By March 2004, identify >8 stakeholders as an executive advisory committee that will meet monthly
to assist project personnel to develop, pilot test, evaluate, revise and implement evidence-based
approaches to decrease the incidence of falls in adults >55 years of age.
NOTE: A series of process objectives focused on achieving the intermediate objective would
immediately follow.
Write three Intermediate Objectives toward achieving the overall goal:
Intermediate Objective #1
Intermediate Objective #2
Intermediate Objective #3
Identifying Process Objectives:
DEFINITION: Process objectives are the methods of the intervention. They detail the specific tasks
that will be carried out within a specified time frame. Process objectives describes the input; the
means by which the intervention or strategy will be implemented. They include inputs, participation,
and reactions.
Simple EXAMPLE of : The overall approach, not including the formal language, to painting my
office at Factor 4-242 by September 28, 2020, we would want to
1) assess resources for the paint project by February 28, 2020
a) who is able and willing to help paint,
b) type of paint needed,
c) environment- and work-related restrictions to paint,
2) gather resources for the project by June 2020
a) save money;
b) interview,
c) select, hire and schedule the painters,
d) buy paint,
e) transport to the office,
3) prepare office by August 15, 2020
a) move furniture,
b) air and ventilate the room,
c) meet the painters in the lobby for them to prepare the walls,
d) tape off trim,
e) prepare walls with TSP,
4) paint the room by August 20, 2020
a) pour paint in trays,
b) apply paint methodically,
c) apply second coat,
5) finalize project by September 15 2020.
a) allow to dry (have a vacation away planned for 2 weeks),
b) replace furniture,
c) smile.
The formal approach to stating Process Objectives is:
Process Objective 1
By
, PHNs will
Process Objective 2:
By
, PHNs will
.
.
Synthesize five or more process objectives toward achieving each of two or more intermediate
objectives.
Intermediate Objective #
Process Objectives:
Discuss the rationale for these choices:
.
Intermediate Objective #2
Process Objectives:
Discuss the rationale for these choices:
The Camp Fire, centered in Paradise, California, began on November 8, 2018 and destroyed
18,804 buildings, killed 85 civilians, and displaced 52,000 people, overall (https://g.co/kgs/ufh8G9).