Community Health Capstone Paper

Running head: COMMUNITY HEALTH CAPSTONE – BURNETT COUNTY
Community Health Capstone – Burnett County
Katelyn Duncan
University of Wisconsin – Eau Claire

COMMUNITY HEALTH CAPSTONE – BURNETT COUNTY 2
Introduction
Community health nurses face many challenges to improve health outcomes and monitor
and manage various health conditions. Burnett County is a rural area filled with small
communities. These communities have many positive attributes, including beautiful landscapes,
friendly people, and small town charm, but there are many struggles as well. Burnett County
struggles with a high rate of poverty, unemployment, and decreased access to health care.
Community stakeholders are currently working to reduce these issues through an initiative called
Healthy Burnett, which is part of the Healthiest Wisconsin 2020 state plan. Initiatives target
individuals, communities, and systems to improve the overall health of the population. In order
to define and manage health issues, data collection is vital. The UWEC nursing students helped
this community by collecting data, and adding visibility to the issues and the current efforts to fix
them. This project helped our group gain a better understanding of the multifaceted role of the
public health nurse.
Epidemiology and Data Significance
Burnett County Characteristics
Burnett County is a small community in northwestern Wisconsin near the Wisconsin-
Minnesota border. It covers approximately 821.52 square miles (All About Wisconsin, Inc.,
2005b). The most recent population estimate of Burnett County comes from the year 2013 found
on the Wisconsin Department of Health Services website (2014a). According to this data, the
estimated population of Burnett County in 2013 was 15,426 people. There are many rivers in
Burnett County, including the St. Croix, Clam, Namekagon, Trade, Upper Tamarack, Wood, and
Yellow Rivers. Burnett County is home to over 500 lakes and located in the central plains
geographical region (All About Wisconsin, Inc., 2005b).

Recreation
There are many recreational activities available to Burnett County residents and visitors.
Some of these activities include orchards, wildlife areas, Burnett County Fair, Central Burnett
County Fair, a casino, bingo, arts and crafts, museums, and Governor Knowles State Forest (All
About Wisconsin, Inc., 2005a). Other recreational activities available for the adventurous spirit
include the Gandy Dancer trail, ATV trails, snowmobile trails, camping, boating, hiking,
hunting, and fishing. Burnett County offers many amenities to its inhabitants, including airports,
churches, educational opportunities, health care, long-term care facilities, pharmacies, public
libraries, recycling centers and waste disposal centers, and transportation services (Burnett
County, WI, 2015).
Comparison to Other Areas of the State
Wisconsin is definitely a geographically beautiful state, so it is no surprise that there are
so many adventurous outdoor recreational activities. This holds true throughout not just Burnett
County but in all of Wisconsin. Wildlife, state forests, casino going, hunting, and fishing are
common recreational activities throughout all of Wisconsin. Burnett County is a part of Western
Wisconsin, of which the population in 2013 was 781,379 people (Wisconsin Department of
Health Services, 2015b). The population of the entire state of Wisconsin in 2013 was 5,730,937
people (Wisconsin Department of Health Services, 2014b). These values show that Burnett
County only takes up approximately 1.97% of the population of western Wisconsin and only
approximately 0.27% of the entire population of the state of Wisconsin. These statistics show
how truly small a community Burnett County really is when compared to the rest of state.
Population Data and its Impact on Different Population Groups

According to census data (2013), 91.5% of Burnett County’s inhabitants are white. This
tells us that racial diversity is not very prominent in Burnett County’s population (United States
Census Bureau, 2013b). Those in the population who are under 18 years old make up 18.6% of
the population and those over 65 years old make up 25.6% of the population. This determines
that the majority of Burnett County inhabitants, 55.8%, are between the ages of 18 and 65. Only
16.7% of the population in Burnett County holds a Bachelor’s Degree or higher, but 89.2% of
the population are high school graduates or higher. The median household income of the county
is significantly lower than that of the state, coming in at only 39,564 dollars. The median income
of the state is 52,413 dollars. People living below the poverty level amount to 17.1% of the
population in the county and 13.0% in the state (United States Census Bureau, 2013b). The
county unemployment rate in 2013 was 11.0% in comparison to the Wisconsin unemployment
rate of 7.8% (United States Census Bureau, 2013a). This statistic shows that there is a high
occurrence of poverty in Burnett County. This raises a concern for healthcare because it is likely
that these residents in poverty do not have access to healthcare. Some people below poverty level
may not have access to any form of health insurance. This also raises health concerns because
living below the poverty level can be living in close quarters and in unsanitary conditions. Both
of these qualities can often cause sickness and illnesses.
Private businesses in Burnett County are not very high in numbers. As of 2012, there
were 399 private non-farm establishments in Burnett County, and 3,230 private non-farm
employees. These numbers are low as compared with the rest of the state (United States Census
Bureau, 2013b). Having low numbers of privately owned businesses does not suggest a very
‘booming’ economy. Low numbers of business causes low numbers of employees, decreasing

the population’s access to health insurance. Lack of health insurance often decreases the
accessibility to health care.
Significance of Data-BasedPublic Health Practice
All this data combined affects public health programs. Mental health problems are very
common in those below the poverty line. Public health programs in Burnett County are highly
focused on many things, including decreasing mental health stigmas and increasing the quality of
mental health. The small size of the county and the isolated demographics contribute to the high
rate of suicides that have occurred. According to Clay (2014), rural areas tend to have higher
suicide rates due to greater access to firearms, high rates of drug and alcohol use, and limited
health care access.
Burnett County is indeed a small county. It is not surprising that they have a focus on
mental health, considering the businesses and demographics. The multiple statistics within
Burnett County add to the factors that place mental health as a high priority.
Individual, Community, and system Level Interventions
Public Health Intervention Levels and Wheel
The public health wheel is a highly developed tool used by public health nurses that
evaluates areas of health concerns across individual, community, and system levels (Minnesota
Department of Health, 2001). The public health wheel includes 17 interventions which include:
surveillance, disease and health threat investigation, outreach, screening, case-finding, referral
and follow-up, case management, delegated functions, health teaching, counseling, consultation,
collaboration, coalition building, community organizing, advocacy, social marketing, and policy
development and enforcement (Minnesota Department of Health, 2001). Each of these topic
areas act as a model in assessing and analyzing different population-based health needs. All of

these interventions may further utilize primary, secondary, and tertiary prevention methods to
address these needs.
Defining Public Health Intervention Levels
There are three levels to the Public Health Wheel. These levels include individual,
community, and systems. The individual level is defined as focusing on the individual person
and how the interventions affect that person. The community level is defined as focusing on the
community population and how the interventions affect the community as a whole. The systems
level is defined as a system that affects the health of a population. These systems may include
organizations and different structures (Minnesota Department of Health, 2001).
Interventions Relatedto Community Health
Information and data gathered from the Burnett County Public Health Department
addressed several different categories ranging from nutrition and development to tobacco and
drug-use. Each of these categories could be further evaluated to discover a plethora of
interventions formulated by the health wheel. Applying public health wheel interventions to
census data is a vital component within the career of public health nurses. In fact, when
discussing information with public health nurses, all departments and their nurses are required to
analyze their census data at least every five years in order to ensure the organization is meeting
the needs of the community.
Such data can then be evaluated by comparing other information from state and
nationwide data. When examining this data researchers and health professionals can gain a
wealth of knowledge about a variety of issues that seem to be reoccurring within the given
population. In addition to this, another beneficial idea encouraged by the public health wheel is
collaborating between county health departments and individuals within the community. Burnett

County Health Department has developed a team of individuals which gather on a monthly basis
and communicate on current health developments and needs throughout areas within the
community. It is one of many resource teams that Burnett utilizes to promote better health
outcomes for the county.
Interventions by level. Individual-focused interventions for Burnett County include
examples such as vaccinations and Women Infant and Children (WIC) appointments. These
interventions are part of the public health wheel. They are grouped into the categories of
consultation, counseling, and health teaching. Examples of community-focused interventions
include mental health support groups, suicide training sessions (such as Question, Persuade, and
Refer [QPR]), and community health clinics. When applying these issues to the public health
wheel they fall under the categories of counseling, health teaching, and screening. System-
focused interventions include the “Healthy Burnett” website and Facebook page which act under
the health wheel’s advocacy, outreach, and social marketing areas. These interventions are in
place so Burnett County can be informed of different health resources and teachings offered
within the community. Also under the system-focused interventions is the Community Health
Improvement Practice Plan (CHIPP) data collection system that acts as a surveillance tool for
policy development and enforcement.
Application of the Healthiest Wisconsin 2020 plan. The Healthiest Wisconsin 2020
plan includes twelve health focus areas pertaining to the state (Wisconsin Department of Health
Services, 2015a). Out of these twelve focus areas, the area that relates to a primary intervention
elicited within our data and Burnett County is mental health. To further investigate interventions
for rural communities each member of our group researched the literature to find an original
document analyzing the use of a mental health intervention. All together we were able to study

and briefly explain seven different interventions that provided original research data within the
last four years. Beyond finding statistics and research related to mental health, we worked to
provide information to the community through listing mental health resources via the Healthy
Burnett Facebook webpage.
ResearchApplication: Mental Health in Rural Communities
Mental health has many barriers for treatment, but rural communities face additional
barriers including fewer mental health specialists, long distances to access specialties, and
increased waiting time for mental health (Colon-Gonzalez et al., 2013). These barriers are
compounded with existing stigmas and barriers related to mental illness, creating even more
difficulties for treating these individuals. Because rural communities are facing these obstacles,
interventions have to be tailored to their needs.
As mentioned, one of the barriers facing mental health in rural communities is access to
care. There are simply not enough mental health specialties in rural areas. One solution to this
problem is to provide rural communities with more mental health providers. Unfortunately, this
is much more complex than simply moving providers to rural areas. One proposed solution to
this problem is using technology to deliver mental health care to the rural communities.
According to the American Telemedicine Association (ATA), telehealth can connect providers
and patients via video conferencing. This alleviates the problem by enabling providers to store
and forward digital images and clinical data, monitor patients’ progress in the home, and enhance
staff education (Benavides-Vaello, Strode, & Sheeran, 2013). This article demonstrates that
telehealth can be successfully implemented in rural communities to enhance mental health care.
The researchers include benefits such as a reduction in the time and money spent on travel,
reduced family separation, and a decreased number of missed appointments. This study

conducted a systematic review of 38 articles analyzing telehealth as a resource for mental health
patients. It stated telehealth has been successfully utilized to improve mental health in rural
communities (Benavides-Vaello, Strode, & Sheeran, 2013).
Burnett County Health Department could successfully implement telehealth as a resource
for mental health patients. According to Colon-Gonzalez (2013), primary care providers may not
be as skilled in diagnosing and treating mental health disorders, which can result in suboptimal
care for the patient. By using telehealth, primary care providers do not have to focus on mental
health issues if that is not their specialty or they do not feel comfortable. Burnett County can
relieve this burden on primary care providers by providing this resource to patients. Primary care
providers can also benefit through training via telehealth communication or talking with a mental
health professional if they have any specific questions. By connecting these patients and
providers, mental health patients can have more resources available to them.
Mental health is associated with many stigmas, decreasing patients’ likelihood to seek
treatment. According to Bischoff et al. (2013), stigmas in rural communities can be even greater
than in urban areas. These researchers conclude that in order to reduce stigmas facing mental
health in rural communities, the medical community must pay attention to not only availability
but also acceptability of that care. They describe accessibility as the degree to which patients
have reasonable access to mental health services. Acceptability is how the consumers see care as
adequate or appropriate to their needs. One example of acceptability is a patient not feeling they
can see their local mental health providers because they know them in their personal life.
Without addressing both of these issues, rural community member will not feel as though they
have adequate mental health services available to them. This study proved that both acceptability
and accessibility need to be addressed in order to increase access to mental health services in the

rural community. The participants of this study universally agreed that the foundation of mental
health care acceptability is appropriate diagnostic and clinical skills (Bischoff et al., 2014).
Reflection and Application to Nursing Practice
Presence of the Agency
The Government building in Siren is very important to Burnett County. It houses many
different departments and serves as the County jail. Many different services can be accessed at
this one location. This is important for the residents of Burnett County because it is a rural
county. The Burnett County Public Health department is located in the Government building.
This central location allows the public easy access to their services.
The Public Health Department of Burnett County has a small clinic where vaccinations
and WIC appointments occur. This is where the community comes to access these services and
many more. All of the Public Health offices are located next to each other allowing for easy
information sharing and providing an environment conducive to teamwork. The Public Health
Department also holds their meetings at the Government building. They encourage the public to
take part in these monthly meetings. Our group was privileged enough to be able to participate in
the April meeting.
Nursing Care Provided by the Public Health Department
During our participation at the monthly meeting, it was apparent that the Public Health
Department is involved with a variety of undertakings in addition to vaccinations. There was a
focus on mental health with the discussion of creating more group therapies and recruiting more
members of the community to become certified to lead these sessions. Another mental health
intervention focused on the QPR training for suicide prevention.

In addition to a mental health focus, they also discussed other community health issues.
One of these issues is lack of access to healthy foods. To address this concern, they discussed a
program designed to use recycled tires as gardens for members of the community. This would
allow them to grow their own fresh vegetables and encourage a healthier diet. Another topic
discussed was the issue of lower socioeconomic members of the community not having adequate
transportation. It was noted that some members of the community do not own a car, lack the
funds to pay for gas, or cannot afford to pay for insurance.
Experiential Journal and Reflection
Some of the experiences elicited by this project included the following work
accomplishments; arranging an email list project list for public health leaders to communicate
with UWEC public health students; communicating back and forth with Burnett County public
health staff to gain access to CHIPP database, PowerPoints, and guidelines; adding/revising a
column within the CHIPP data spreadsheet with location data for data found and moving
columns around for the specific PowerPoint slide associated with the specific slide; downloads
of numerous PDF files with data pertaining to the topics of Growth/Development
and Reproductive Health; searching through online websites, databases, and PDFs for valuable
up to date information for each sub category topic under Growth/Development and Reproductive
Health; formatting a Microsoft word document chart to enclose mental health rural interventions;
Searching the literature for a rural county mental health intervention research article; making a
quick analysis of main points within a mental health research article to be applied to the
Microsoft Word document chart; and communicating with group members and sending out
reminders to accumulate and then compile mental health intervention research synopses with the
Microsoft Word document table

The overall experience working with Burnett County Public Health Department was
unique compared to every other clinical experience we have had. It was really nice to be able to
meet with the leaders of the project in Burnett County initially and I feel that meeting face to
face was very valuable. Although, I am very self-motivated I found that with other clinical
experiences taking up the first portion of the semester it was difficult to start the project before
the end of that clinical. Also, at first I did have some struggles with accessing google documents
and had to do a lot of distance communicating with Burnett Staff to gain access and move the
project along. Once all of this was in place I was finally able to sit down and go to town with the
project. There were several documents to search through and the original google document
although it initially looked like it would be very helpful didn't seem to have a lot of direct links
to the sources where data should be found. I found myself downloading numerous PDF files and
searching the literature continuously only to find portions of data for either the county,
Wisconsin, or U.S.A. Because of the inconsistency with data found some areas did not have
enough information to make a comparison with other charts already within the PowerPoint so I
didn't make a large effort to update PowerPoint data because it would not have been consistent
with other data where they gave a broader range of data.
My favorite part about this project was probably traveling to Burnett County and sitting
in on their team meeting for Healthy Burnett. Although communication was difficult with several
members within the meeting I thought that our presentation went well as we continue to research
information for the project and seeing these interactions with the members will be important
information to utilize in future meetings. The meeting showed me the importance of
incorporating multiple disciplines in order to make a difference within a county. Also I learned

that although it is always rewarding to see immediate change some of the greatest outcomes from
projects such as Healthy Burnett are formulated through numerous little changes.
Conclusion
All together I can see a great need for public health and through studying more about
Burnett County I have been able to further recognize that Public Health can influence numerous
dimensions within a community. I have learned that through community team integrations much
work can be accomplished and hope to apply this in and throughout the future of my nursing
career.

References
All About Wisconsin, Inc. (2005a). Attractions in Burnett County. Retrieved from
https://www.wisconline.com/cgi-bin/find_attractions.pl?typ=cou&county=Burnett
All About Wisconsin, Inc. (2005b). Burnett County, Wisconsin. Retrieved from
https://www.wisconline.com/counties/burnett/index.html
Benavides-Vaello, S., Strode, A., & Sheeran, B. (2013). Using technology in the delivery of
mental health and substance abuse treatment in rural communities: a review. Journal of
Behavioral Health Services & Research, 40(1), 111-120. doi:10.1007/s11414-012-9299-6
Bischoff, R., Reisbig, A., Springer, P., Schultz, S., Robinson, W., & Olson, M. (2014).
Succeeding in Rural Mental Health Practice: Being Sensitive to Culture by Fitting in and
Collaborating.Contemporary Family Therapy: An International Journal, 36(1), 1-16.
doi:10.1007/s10591-013-9287-x
Burnett County, WI. (2015). Our community. Retrieved from
http://burnettcounty.com/index.aspx?NID=31
Clay, R.A. (2014). Reducing rural suicide. American Psychological Association, 45(4), 36.
Retrieved from http://www.apa.org/monitor/2014/04/rural-suicide.aspx
Colon-Gonzalez, M. C., McCall-Hosenfeld, J. S., Weisman, C. S., Hillemeier, M. M., Perry, A.
N., & Chuang, C. H. (2013). 'Someone's got to do it' - Primary care providers (PCPs)
describe caring for rural women with mental health problems. Mental Health In Family
Medicine, 10(4), 191-202.
Minnesota Department of Health. (2001). Public health interventions: Applications for public
health nursing practice. Retrieved from
http://www.health.state.mn.us/divs/opi/cd/phn/wheel.html

United States Census Bureau. (2013a). Employment status: 2009-2013 American community
survey 5-year estimates. Retrieved from
http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_1
3_5YR_S2301&prodType=table
United States Census Bureau. (2013b). State & county quickfacts: Burnett County, Wisconsin.
Retrieved from http://quickfacts.census.gov/qfd/states/55/55013.html
Wisconsin Department of Health Services. (2014a). Burnett County population. Retrieved from
https://www.dhs.wisconsin.gov/population/burnett.htm
Wisconsin Department of Health Services. (2014b). State of Wisconsin population. Retrieved
from https://www.dhs.wisconsin.gov/population/wisconsin.htm
Wisconsin Department of Health Services. (2015a). Healthiest Wisconsin 2020: Focus area
profiles. Retrieved from https://www.dhs.wisconsin.gov/hw2020/profiles.htm
Wisconsin Department of Health Services. (2015b). Western region population. Retrieved from
https://www.dhs.wisconsin.gov/population/western.htm

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