Running head: PRACTICUM FINAL PAPER 1 MPH Practicum Final...

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Running head: PRACTICUM FINAL PAPER 1 MPH Practicum Final Paper Erika McKenzie Texas Department of State Health Services- Region 8 7430 Louis Pasteur San Antonio, TX 78229 Dr. Katherine Velasquez

Transcript of Running head: PRACTICUM FINAL PAPER 1 MPH Practicum Final...

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Running head: PRACTICUM FINAL PAPER 1

MPH Practicum Final Paper

Erika McKenzie

Texas Department of State Health Services- Region 8

7430 Louis Pasteur

San Antonio, TX 78229

Dr. Katherine Velasquez

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Abstract

I spent my practicum hours at the Texas State Department of Health Services (DSHS) working

on their work place wellness program. During my time there I worked to improve several aspects

of their wellness program including connecting DSHS to other wellness resources in the

community, addressing employee health needs through informational centers, and conducting a

lunch and learn as well as coaching employees regarding their health goals. I employed

knowledge and skills gained from various courses taken for the Master of Public Health program

at Concordia University to further my understanding of public health practice and reach my

practicum goals.

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MPH Practicum Final Paper

Wellness is a growing area of public health. Many workplaces are developing work place

wellness programs in order to address the health needs of their employees. Employees spend so

many waking hours in the work place that it presents a great opportunity to encourage healthy

behaviors and promote wellness. I spent 75 hours over three weeks working at the Texas State

Department of Health Services (DSHS) in the region eight headquarters helping to improve and

build their work place wellness program. I reviewed health assessments to identify employee

demographics, health needs, and barriers to healthy changes to tailor program components and

health promotions to those needs through developing various educational resources, facilitating a

lunch and learn, and coaching employees as needed to assist them in reaching their health goals.

The mission of DSHS is to improve health and well-being in Region eight of Texas

(Department of State Health Services- Health Service Region 8, 2015). This region covers 28

counties, includes seven local public health departments, and fifteen region eight offices in south

central Texas serving a combined population of three million people (Department of State Health

Services- Health Service Region 8, 2015). Their headquarters are located in San Antonio, TX

where I spent my hours. Most offices within region eight provide services to include

immunizations, tuberculosis treatment and contact investigation, health and community

education, HIV and STD testing and treatment, and communicable disease investigation and case

management. Other services and programs offered throughout region eight pertain to birth

defects epidemiology and surveillance, border health, cancer epidemiology and surveillance,

consumer safety, emergency medical service compliance, environmental groups, family health

services, food establishment groups, food safety, meat safety assurance, oral health, sanitation,

emergency preparedness, radiation control, spinal screening, tobacco prevention and control,

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vision and hearing screening, zoonosis control, and specialized health and social work services

(Department of State Health Services- Health Service Region 8, 2015).

I worked with the Specialized Health Care and Social Work Services Department

manager, Dr. Katherine Velasquez. Dr. Velasquez founded the Wellness Committee and the

Employee Wellness Program out of sheer love for wellness and on a volunteer basis.

DSHS is federally funded, but they do not have a paid position for workplace wellness.

Since DSHS works to serve the community and their health needs in various ways, Dr.

Velasquez thought it was important to provide wellness resources and programs for their

employees in order to practice what they preach as well as to put their best self into their work

and the services they provide. The development of the wellness program and committee aligns

with the organization’s mission of improving health and well-being in region eight by starting

with themselves. The wellness program serves all counties and employees in region eight.

Although DSHS receives federal funding for their programs to support health efforts in the

community, they do not have funding to support wellness in the workplace. Therefore, all

wellness efforts are financially supported by fundraising, donations, and volunteer efforts in this

region.

Discussion

Throughout my time at DSHS I worked on several projects and was involved in various

activities. The first week of my practicum was spent getting acquainted with my surroundings

and coworkers, as well as learning the background and starting point of the wellness program by

reviewing various materials to bring myself up to speed with where the current program was at. I

ran into several barriers this first week as I was not able to have a workspace and computer set

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up until the last day of the week due to technology issues. This was a real drawback when I had

limited time to work on projects, so I worked from home two days and thoroughly reviewed

every single material that the wellness program had previously used, as well as brainstormed

potential projects and ideas to discuss with my supervisor. Once getting back in the office my

supervisor and I set forth an action plan and narrowed down some goals with regards to the time

constraints I had. I also developed flyers and a schedule for the Farm to Work program during

my first week which they had just put in place.

The Farm to Work Program is a program that allows employees to order fresh produce

twice a month from local farmers markets that gets delivered to the office. Dr. Velasquez had

made it a priority to get this program rolling right when I started, so I helped raise awareness and

promote the program by developing the flyers. The flyers can be found in the appendices of this

paper. These flyers informed employees of the correct week to place orders, as well as the days

each month that their orders would be delivered. I also added reminders for this program to the

Wellness Outlook Calendar which could be accessed by employees. We also discussed where to

strategically distribute the flyers so that they would easily be seen and noticed by employees in

order to utilize the program.

Another initiative that Dr. Velasquez and I agreed I would work on was their

informational centers. The informational centers included Bits and Tips and wellness bulletin

board materials. The Bits and Tips were once-a-month informational posters that were to be

hung up in the bathroom stalls of each health department location. Since I did not have adequate

time to run an assessment of employee health issues and challenges, I reviewed the previous

assessment that had been done nearly two years ago. I studied the results of this assessment to

develop a theme for each month that would address employees’ relevant health needs. The needs

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assessment told me that employees at DSHS primarily struggled with their weight, healthy

eating, and exercise. Employees had indicated that they would be more receptive to

informational centers as opposed to coaching/mentoring. They had also disclosed that they

struggled with accountability and staying motivated. They listed relevant barriers to changing

their habits as time, money, lack of energy and sleep, and stress.

Based on these results I developed four months of informational centers. I set themes for

each month to include motivation, emotional eating and portion control, stress management, and

sleep. Each month had one of the aforementioned themes. I developed my own Bits and Tips for

each theme, and found relevant credible information on each subject to be printed off each month

for the bulletin boards. Each Bits and Tips can be found in the appendices. I also compiled

multiple resources on other subjects from credible sources for future use. I organized each of the

months and materials into folders to be easily printed off and distributed for each month. After

previously reviewing the older Bits and Tips that had already been used, I decided that ‘less was

more’ and to try to make them less wordy, more succinct, and more visually appealing. I varied

the style on each Bits and Tips with the intention of being able to grab people’s attention with a

new visual appeal. I tried to make it less wordy than before so that people wouldn’t feel

overwhelmed with reading and could more easily read an article quickly. I worked on the

informational centers throughout the entire span of my practicum.

Another main project I worked on was developing a Lunch and Learn. For this project I

developed marketing materials, facilitated the lunch and learn, and evaluated it with Dr.

Velasquez. In my previous job as a Health Coach I had found that it was difficult for people to

focus on making long term sustainable changes. The benefits of making a lifestyle change versus

a quick fix (regardless of the goal) are vast, so I planned my Lunch and Learn on making

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sustainable changes and named it “Make it a Way of Life.” I discussed with some coworkers and

my supervisor their thoughts on this subject and they confirmed that it would interest them and

seemed relevant. The promotional materials I developed to market the lunch and learn are

attached in the appendices as well as the PowerPoint used and two handouts given. I tried to

make all of these materials visually appealing and attention-grabbing to garner interest,

attendance, and participation for my lunch and learn. My turn out was high, the presentation

interactive, and the participants engaged. My supervisor and I evaluated the lunch and learn

afterwards, and she told me she had heard good feedback about it and thought it went well. We

also discussed some areas for slight improvement if given another similar opportunity down the

road.

During my practicum I also had the opportunity to attend the New Employee Orientation.

This was an all-day event where speakers from each department came and talked to us and

explained their role within DSHS. I learned more about emergency preparedness, vaccinations,

infectious diseases, social services, and children and pregnant women with regard to their

various respective programs offered through DSHS. This was very interesting to me to learn how

each department helps to address different but important health issues, and also how they all

work together to achieve the mission of DSHS.

I also spent several hours completing required trainings of new employees. These

trainings were on subjects including harassment in the workplace, HIPAA, computer usage,

workplace violence awareness, and civil rights. While I had previously completed much similar

training for other employment opportunities in the past, it was interesting to see how DSHS

tailored these trainings to their specific workplace and responsibilities.

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Additionally, I had the opportunity to attend a meeting with members of the United States

Air force collaborating with members of DSHS on emergency preparedness issues. This meeting

was enlightening in several ways. I learned about the importance of collaboration between

parties during the event of an emergency, and also the importance of having a plan in place and

anticipating potential challenges as much as possible. It was also interesting to learn how each

department of DSHS has a role in responding to an emergency.

Furthermore, I filled out the application for DSHS to join the Veg Out SA competition

put on by the City of San Antonio. This competition was designed to promote healthy

workplaces through incorporating more fruits and vegetables into employees’ healthy eating

plans. I had to review what DSHS was already doing along these lines to see if we would be

eligible to participate, and explain why we wanted to join. This application was submitted right

before I finished my hours.

Throughout my practicum I also updated the Wellness Outlook Calendar with reminders

and activities. I attended a group work out with some colleagues, and provided healthy recipes

and health coaching to those who were interested.

My initial proposal goals included revising and executing a new wellness program

assessment to develop a wellness room, wellness bulletin board materials, Bits and Tips, lending

library, and wellness calendar. Due to time constraints I was unable to revise and execute a new

wellness program assessment but overcame this challenge in the best way I could by using the

results from the previous one. I also was not able to develop the wellness room as Dr. Velasquez

had found a sponsor to do this for her instead who would provide equipment, paint the room, fix

it up and fund these changes. The remaining proposal goals stayed the same throughout the

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course of my practicum, with the addition of the lunch and learn and other activities and

initiatives like trainings, orientation, Farm to Work, and Veg out SA. The goals of my practicum

were appropriate in addressing the employee health problems at DSHS. The projects I worked on

aimed to make healthy living easier and more convenient, as well as inform and educate

employees about health issues and ways to overcome barriers and stay motivated while changing

the environment in the workplace to be one that is conducive to and supportive of healthy living.

Throughout my practicum I encountered several barriers and challenges. The main

challenge I faced was that I completed all my hours in such a short period of time. While the

number of hours completed was the same as my peers in the program, three weeks was fairly

limiting for what I could accomplish since other contingent things needed more time (ie:

employees to fill out a health and program assessment). Initially my practicum was intended to

be spanned over four weeks which would have allowed for slightly more time, but then I ran into

other challenges regarding paperwork and technology. Once I did begin my hours, there were

several hours that my computer either wasn’t set up or working, or I had some other

technological problem that sometimes limited my productivity. Barriers related to time and

technology were addressed by changing some of my goals to account for less time, and using an

old health assessment’s results instead of creating and distributing a new one. While this is not

ideal, my supervisor and I agreed that this was the best option given the circumstances.

Other challenges I encountered included a lack of resources for work place wellness from

DSHS. As previously mentioned, DSHS does not fund an actual wellness program, and therefore

all initiatives and efforts are volunteer-based and funded through donations and fundraising. This

was severely limiting as to what I could do and what initiatives for wellness were realistic. This

also affected program stability and consistency, as employees had other job responsibilities that

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often restricted their ability to put time and effort toward employee wellness initiatives. The

wellness committee was also voluntary, which made it difficult to know how serious employees

were about contributing to the wellness program and how reliable they would be. These barriers

were addressed by simply trying to be realistic with the situation and what I had to work with. In

three weeks I did not have time to plan fundraisers or raise money, so I researched wellness

program ideas and reviewed options that were less dependent on time, money, or resources and

tried to fit those ideas into my time constraints. I also discussed these challenges with Dr.

Velasquez for ideas and guidance regarding overcoming them.

Personal Assessment

My practicum experience has greatly contributed to an understanding of public health

practice. I began my hours wanting to completely redo the wellness program at DSHS and make

it the best it could be, but I quickly realized that I had to work within the confines of time and

resources and be realistic. I think this was a good representation of reality and how often times

when working in public health the circumstances are less than ideal. This experience helped me

to understand that public health programs often have limited resources and time, and one must do

the best one can with what there is to work with. Public health situations are rarely if ever ideal,

and it was helpful for me to be able to problem solve and try and work with the barriers I faced,

as opposed to fighting them in a situation that wasn’t realistic to do so.

I also had the opportunity to use many skills I learned in various classes. I employed

strategies learned in my Marketing in Public Health, Principles of Health Behavior, Community

Health, and Program Planning and Evaluation courses. I combined this knowledge with skills I

developed in my previous job as a Health Coach working on employee wellness programs to

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work on each of my initiatives for my practicum. My marketing class taught me how to develop

promotional pieces to a specific target audience, and I used this information when developing

promotional materials for the Farm to Work Program as well as my Lunch and Learn. I also used

some concepts from marketing when developing the Bits and Tips to keep them visually

appealing and succinct for my colleagues for whom they were intended. I also used various

models and theories of behavior change that I learned about from my health behavior course

when developing materials to try to influence healthy behaviors. I used constructs from the trans-

theoretical model of change, social learning theory, social cognitive theory, and theory of

planned behavior. I used strategies to increase self-efficacy with my health coaching at DSHS

and also during my lunch and learn. My community health and program planning classes gave

me the foundation to know how to gear program pieces to a specific audience as well as evaluate

their efficacy. Each of these classes paired with my previous employment experience guided me

throughout my practicum experience.

Several of the public health competencies were applied during my practicum experience.

I aimed to protect and promote the health of individuals within the DSHS employee community

through encouraging healthy behaviors and making sustainable lifestyle changes. I evaluated my

lunch and learn as well as previous wellness program efforts and designed and implemented

appropriate initiatives to address employee’s health needs. I also critically reviewed and

analyzed medical and public health literature and research findings for appropriateness in

addressing DSHS employee’s relevant health problems and barriers to change through the Bits

and Tips and wellness bulletin board materials. I also had to frequently consider ethical issues in

the work place pertaining to employee wellness and demonstrated an understanding of ethical

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reasoning to guide my decisions in not overstepping personal boundaries and rights within the

workplace.

My practicum experience greatly contributed to my understanding of public health

practice. I had to apply the information I had learned and develop skills to put my knowledge

into practice. I also had to problem-solve and overcome typical barriers in public health while

still working to make a positive change in the DSHS work place. I believe my experience offered

me a hands-on, real-life opportunity to understand what public health work looks like in the real

world. I had to learn how to balance ideals with realism and budget and time restrictions which I

believe is crucial in learning how to practice public health outside of an educational setting.

Conclusions and Recommendations

I have several suggestions and recommendations for improving the work site wellness

program at DSHS in Texas. Since my practicum time was limited I was limited in how much I

could do in such a short period of time, but I left Dr. Velasquez with various other ideas that she

or a future intern could move forward with as well as laid the groundwork for the Farm to Work

Program and Veg Out SA competition.

After receiving feedback from my colleagues at DSHS I suggested to Dr. Velasquez that

the Bits and Tips continue on with themed months after I left. I left her with a theme for each

month for the remainder of the year, based off of health needs and barriers reported in the health

assessment. I also prepared various print outs for those themes to be displayed on the wellness

bulletin boards.

Additionally, I prepared a list of other wellness program ideas for Dr. Velasquez to

consider with more time and resources to act on the various ideas. I suggested further utilization

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of the Wellness Outlook Calendar to plan employee workouts, events, and reminders for other

initiatives that employees could have easy access to. I believe the wellness calendar is something

that has immense potential but was not properly utilized. I think that this calendar could even be

used for motivation or reminders for healthy living in addition to wellness activities.

I also suggested that DSHS run more fundraising campaigns. It is difficult to do much

more with the wellness program than what already exists with such limited funding. Raising

funds for wellness could be put toward pedometers for all employees, wellness challenges with

rewards, participation in group 5k’s or other fitness events, or more fitness equipment to go in

the wellness room once it is developed.

I also suggested that a future intern look into government sponsorships for gym

memberships, as many employees had mentioned the cost of membership to a gym as a barrier to

exercising. Developing a partnership with various local gyms could be helpful in terms of

reducing costs for membership (ie: offering group or discounted membership rates) as well as

having stakeholders in the community that support healthy living at DSHS.

During my time at DSHS I developed wellness bulletin board materials pertaining to

employee assistance program benefits. Many employees were not aware of the benefits they had

access to at no charge through the employee assistance program. Because many employees had

reported stress as a barrier to healthy living and the employee assistance program offers free

counseling from qualified therapists, I thought this could be a good option to help manage and

reduce the stress that employees experience and thereby improve wellness in the workplace.

One of the biggest recommendations I had for Dr. Velasquez was to develop and

distribute a new health assessment to give to employees that would quantify their health issues

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and barriers as well as satisfaction with current program initiatives to gauge efficacy. It is

difficult to gear program initiatives and activities toward the health needs of current employees

with a dated assessment. Dr. Velasquez said that there had been a good amount of turnover since

the last assessment was executed, although she suspected that new employees probably had

similar health issues to the older employees who were still at DSHS. Regardless, conducting a

new health assessment would provide very valuable insight as to how the current program is

working. Even if the health needs of the employee population has not drastically changed, an

assessment could measure what to put valuable time and resources into as opposed to what

initiatives may not be worth continuing.

I believe that moving forward the work site wellness program at DSHS in Texas will only

continue to improve. With a new assessment will come more clarity about where to spend

wellness efforts as well as how to address current employee health needs. When I began my

practicum the work site wellness program had just begun, but with continued development of

some of my ideas presented in conjunction with more time for employees to respond to wellness

efforts I believe that the health of employees at DSHS can be improved even more. I am thankful

for my time spent and learning experience gained through DSHS, and am happy to have been a

part of supporting employee health through their work site wellness program.

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Reference

Department of State Health Services- Health Service Region 8. (2015, June 11). Retrieved from

Texas Department of State Health Services:

http://www.dshs.state.tx.us/region8/default.shtm

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Appendix A

Farm to Work Flyers

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Appendix B

Farm to Work Schedule

Farm to Work Schedule 2015

Order Delivery (every first and third Wednesday between 2-4pm)

June 3

June 17

July 1

July 15

August 5

August 19

September 2

September 16

October 7

October 21

November 4

November 18

December 2

December 16

Order Submission (every 2nd and 4th week Mon-Fri)

May 25-20

June 8-12

June 22-26

July 6-10

July 27-31

August 10-14

August 24-28

September 7-11

September 28th-October 2

October 12-16

October 26-30

November 9-13

November 23-27

December 7-11

December 28-January 1

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Appendix C

Lunch and Learn Promotional Flyers

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Appendix D

Lunch and Learn Tips Sheet

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Appendix E

Bits and Tips June-September (see attachments in submission for better clarity)

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Appendix F

Evaluation (see attachments in assignment submission for a more clear document and included

comments from supervisor)

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