Three Rivers District Health 

Department Sets Example by 

Splashing into Health:

 Case Study 

National Center for Chronic Disease Prevention and Health Promotion 

Division of Population Health

Organization Background 

Three Rivers District Health 

Department 

« Established in 2010 

« Government agency

« Industry sector: Health care and 

social assistance

« Locations: Carrollton, Falmouth, 

Owenton, and Warsaw counties, 

Kentucky

« 66 Employees

« 91% women, 9% men

The Three Rivers District Health 

Department (TRDHD) is working to 

deliver essential public health services 

in the best way possible through 

employee training, an “All One Team” 

attitude, and a multifaceted public 

health effort that includes programs, 

policies, and preventive services. 

TRDHD serves four Kentucky counties 

in the northern part of the state: 

Carroll, Gallatin, Owen, and Pendleton. 

Each county has its own health center 

and local board of health. TRDHD 

serves a large geographical area of 

mainly small, rural communities. 

With training and effort, 

employers of all sizes and 

types can plan and implement 

a workplace health program. 

Employers can learn from the 

experiences of employers like 

TRDHD how to plan strategies 

and anticipate implementation 

challenges. 

Participating in CDC’s Work@Health® Program

Before TRDHD participated 

in the Centers for Disease 

Control and Prevention’s 

(CDC’s) Work@Health® 

program, it had only a 

few policies in place to 

support employee health 

and wellness, including 

smoke-free vehicles and 

facilities. It did not have 

a dedicated person to 

coordinate worksite health 

promotion, which made it challenging to implement employee 

health promotion efforts. One advantage that TRDHD did have was 

its ongoing involvement in community health activities in the four 

counties it serves. These activities included a 5K run and weight loss 

challenges that TRDHD employees could participate in at no cost.

In early 2014, TRDHD 

Community Health Planner 

Dianne Coleman received 

an e-mail from a colleague 

about the Work@Health® 

program. The free training 

and potential seed funding 

to support worksite 

health promotion sparked 

Coleman’s interest, and 

she decided to apply for 

the chance to jump-start 

TRDHD’s program.

The Work@Health® Program is designed to teach employers how to 

improve the health of their workers (and workers’ families) by using 

prevention and wellness strategies that focus on chronic health 

conditions. Well-designed, science-based, and comprehensive 

workplace wellness programs can improve the health of

 individuals and companies, lower health care costs, and increase 

worker productivity.

CS257190H

TRDHD employees in front of the main office.

Photo provided by TRDHD. 
TRDHD was selected to participate in the online version of the Work@Health® training program, which allowed 

Coleman the flexibility to move through the eight training modules at her own pace at the times most convenient 

to her. The training was held in June 2014 and followed by 6-10 months of personalized technical assistance from 

a trained Work@Health® provider. 

Program Overview

Creating a Committee and Assessing Needs

After the Work@Health® training, Coleman set up 

several activities and environmental changes to 

support a worksite health program at TRDHD. First, 

she changed TRDHD’s community planning team, 

which had representatives from each of the four 

county health centers, to a 

wellness committee. That 

way, each health center 

had a wellness champion 

for its local community. The 

committee used TRDHD’s 

logo of three interconnected 

rivers and its water droplet 

mascot, Splash, to create the 

motto “Splash Into Health.”

The wellness committee used methods from the 

Work@Health® module, Assessing Your Worksite, 

to collect information about employee needs and 

interests before planning its program. The committee 

surveyed employees about the amount of time 

they spent sitting during the work day, their overall 

physical and mental health, and how TRDHD could 

help them improve their quality of life. It used the 

results to select several strategies that focused on 

improving nutrition and weight management and 

increasing physical activity. 

Standing Up and Moving More

The survey data showed that many employees spent 

6 or more hours each day sitting at their desks and 

that employees had a strong interest in having more 

ways to be physically active at work. To meet this 

need, TRDHD used seed funding from 

Work@Health® to buy 10 standing desks for 

employees who indicated a strong interest in using 

one and who spent at least 6 hours sitting. These 

employees also had to agree to complete a threemonth evaluation tool about the work stations. The 

wellness committee has received positive feedback 

from those employees who completed the standing 

work station assessment tool. The majority reported 

that the standing desk has made a difference in their 

ability to focus and that they feel better.

The wellness committee also bought copies of 

WELCOA’s Walking 4 Wellness book for employees and 

persuaded its 

health insurance 

carrier to donate 

wearable 

tracking 

devices for 20 

employees who 

participated in a 

TRDHD weight 

loss challenge. 

TRDHD has 

always encouraged 

employees to participate in 5Ks in their communities. 

As part of its expanded activities after participating 

in the Work@Health® program, TRDHD offered 

employees the chance to win an extra vacation day as 

an incentive to participate in local 5Ks. In spring 2015, 

the wellness committee also organized a 5K walk/

run in which 18 employees participated and held a 

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TRDHD logo and mascot, Splash. 

 Graphic provided by TRDHD. 

TRDHD employee using a standing desk.

Photo provided by TRDHD. 

Employers selected to participate in 

Work@Health® were assigned to one of three 

models, all of which delivered the same 

comprehensive workplace health curriculum. 

1. The hands-on model was an on-site, 

instructor-led one-day training workshop 

held in one of six regional locations. 

2. The online model allowed employers 

to move through the curriculum 

independently over several weeks using a 

web-based learning platform.

3. The blended model included a 

combination of hands-on and online 

learning strategies.
drawing for a wearable fitness tracking device—an 

incentive that proved to be more popular than the 

extra vacation day.

The committee 

also used 

environmental 

supports 

and activities 

to promote 

better nutrition 

and weight 

management, 

adopting a more 

comprehensive 

approach to 

worksite wellness. It bought water coolers for each 

health center and gave employees a tool that can 

be placed on a food plate to measure portion 

size. In 2014, the committee organized a weight 

loss challenge that was so popular, it spurred 

another challenge for 13 weeks in early 2015. 

Twenty employees—nearly one-third of the staff—

participated in the challenge. 

In addition, the wellness committee put some of the 

materials it received from the Work@Health® training 

into practice by improving communications about its 

program and adding nutrition and physical activity 

tips in its monthly newsletter for employees. 

Integrating Employee Health into 

Organizational Objectives

The employee interests survey data also helped 

the committee get a commitment from TRDHD’s 

leadership to integrate worksite wellness into the 

health department’s strategic plan. The strategic 

planning team, which represents employees from 

different TRDHD locations, created a map that 

showed what resources and support employees 

needed to effectively deliver public health services 

to their communities. Developing internal wellness 

programs emerged as a key way to make the health 

department more credible in the community and 

more effective in its mission to improve the overall 

health of the district.

According to Coleman, the wellness committee 

also realized that TRDHD employees needed to be 

role models for their communities. Making worksite 

wellness part of the organization’s strategic plan was 

a huge step toward creating a sustainable culture 

of health.

Applying what Coleman learned from the “Assessing 

Your Worksite” module, TRDHD worked with its health 

insurance carrier to offer employees free biometric 

screenings at one of its on-site, all-day staff trainings. 

About 20% of employees took advantage of the 

screening, and the results were submitted to the 

employees and the insurance carrier. The wellness 

committee also plans to use the results to design 

future worksite wellness activities. 

Kentucky Counties Served by the Three Rivers District Health Department.

THDHD employee participating in the organization’s 

5K walk/run. Photo provided by TRDHD. 

“If we’re not healthy, how can we expect the community 

to listen to us?”

—Diane Coleman, Community Health Planner

Program Success

Coleman said she believes that TRDHD’s most 

significant achievement is learning how to develop 

a worksite wellness program and making that 

program part of the organization’s strategic plan. She 

also believes that the director’s commitment to the 

program has been key to its success, and that this 

support will make it more likely that other agency 

leaders will get on board. Another achievement was 

the wellness committee’s efforts to assess employees’ 

health status and interests. Partnering with TRDHD’s 

insurance carrier has allowed the committee to 

collect biometric data that will guide the committee’s 

wellness plan and promote future collaborations.

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Like all of the employers participating in the 

Work@Health® program, TRDHD used the 

CDC Worksite Health ScoreCard to assess the extent 

to which it had evidence-based health promotion 

strategies in place before they started the program 

in 2014 and again at the end of the program in 2015. 

The ScoreCard is a free tool that employers can use to 

assess their health promotion and disease prevention 

programs, identify gaps, and set priorities across 

health topics. Strategies assessed by the ScoreCard 

include health promoting counseling services, 

environmental supports, policies, health plan 

benefits, and other worksite interventions shown to 

be effective in preventing heart disease, stroke, and 

related health conditions.

TRDHD increased its total ScoreCard score from 

90 to 167 out of a possible 264 points. It tripled its 

score in the area of Organizational Supports, which 

includes key elements for building the foundation for 

a healthy worksite, like strong leadership support. The 

Work@Health® curriculum stressed the importance 

of establishing organizational support for health 

promotion to build an infrastructure and support 

a sustainable program. TRDHD’s improvements 

included its assessment of employee needs and 

interests, which was used to plan health 

promotion activities and setting up a health 

promotion committee. 

TRDHD also increased the number of evidence-based 

strategies it offered to increase physical activity and 

improve nutrition. Examples of evidence-based 

strategies TRDHD put in place during their Work@

Health® training using the ScoreCard that it did not 

have in place in 2014, included:

• Offering or promoting an on-site or nearby 

farmers’ market where fresh fruits and 

vegetables are sold.

• Providing educational seminars, workshops, or 

classes on nutrition.

• Providing free or subsidized lifestyle selfmanagement programs that include advice on 

physical activity.

• Providing other environmental supports 

for recreation or physical activity, such as 

standing desks.

Looking back on her experience with the

 Work@Health® program, Coleman attributes much of 

the positive change at TRDHD to the knowledge she 

gained through training, as well as the seed funding 

she received because it “allowed us to explore 

something we could offer to staff. It was the spark 

that started things.” Coleman said the training taught 

her how to make the business case for worksite health 

promotion and frame the message about return on 

investment in terms of the value of having happier 

employees, not just the dollar amount saved. 

Coleman said she also found that going through the 

curriculum “opened your eyes to things you needed 

to be more aware of.” As a result, TRDHD’s wellness 

committee is looking beyond weight management 

and physical activity to identify the effect that 

health can have on employee productivity. An 

employee survey conducted in January 2015 had 

several questions from CDC’s Behavioral Risk Factor 

Surveillance System survey. Employees rated both 

their physical and mental health as “not good” on 

about 8 days of the previous month. 

This information served as an indicator of the level of 

presenteeism, the problem of workers’ being on the 

job but, because of health issues, not working at full 

potential. This in turn could have a costly negative 

effect on productivity. The committee would not 

have had this information to start working with if it 

had not included these questions in the survey. Now 

that leadership is aware of these results, TRDHD plans 

to conduct this survey every year, with the hope of 

seeing improvements in employees’ physical and 

mental health over time. Changes will be tracked and 

used to improve TRDHD’s wellness program 

as needed.

0 5 10 15 20 25 30

Organzational Supports

Nutrition

Physical Activity

2015 Score 2014 Score

 CDC Worksite Health ScoreCard Overall Score 

in Wellness Programming, 2014-2015

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In addition to the curriculum, Coleman said she 

found the support of the Work@Health® technical 

assistance provider (TAP) crucial to keeping her 

efforts going, especially because of her competing 

job responsibilities. She was comfortable contacting 

the provider at any time, and the provider sent her 

information about several resources, including links 

to tools and books.

Learning from Work@Health®

After the online Work@Health® training, all 

participants were asked to complete a survey, and 

most rated the training favorably in their responses to 

the following statements:

• I understand how to apply what I learned at the 

training at my job (86% agreed).

• I will be able to use what I learned in this training 

at my job (87% agreed).

• I would recommend this online training to others 

in my position (81% agreed).

Participants were also asked to share the lessons they 

had learned. Coleman said she had learned that, “It is 

not always important to focus on the financial return 

on investments but to look at return on value with 

employees.” She also said that she particularly liked 

the presentations and the resources provided as part 

of the training.

About 6 months later, participants were asked to 

complete surveys about what they had done since 

the training. All participants reported that they had 

used the information they had learned to develop a 

worksite health plan and collect the data they needed 

to set up worksite health programs. In addition, 

about 75% of participants said they had shared the 

information they had learned with others in their 

organization and used it to get leadership support. 

Challenges

One challenge for TRDHD’s worksite wellness 

program is that its health centers are spread across 

four rural counties, with one of the centers located 

nearly 1 hour away from the others. Coleman 

works to overcome this problem by giving all of the 

locations a voice, including all representatives from 

all centers on the wellness committee, and making 

sure that employees at all locations have the same 

opportunities to fill out interest and satisfaction 

surveys about worksite wellness. The committee also 

sent the standing desks and water coolers to all of the 

centers so that employees at all locations could take 

advantage of these new resources made possible by 

the Work@Health® program. 

What’s Next?

Over the next 12 months, TRDHDC plans the following activities for worksite health promotion: 

• Finish an evaluation of the standing desk initiative.

• Present data from the standing desk evaluation and other sources to the health department director and the 

board of health.

• Use results from the biometric screening in its worksite wellness plan for next year.

• Use data on employee health interests to develop lunch and learn sessions and other activities that are low 

cost and easy to set up.

The Work@Health® employer-training program is an initiative of the U.S. Centers for Disease 

Control and Prevention (CDC) to promote workplace wellness through employer education, 

training, and technical assistance. Work@Health® training provides employers with knowledge 

and tools through a comprehensive curricula to promote good health in their work places to 

prevent or reduce chronic illness and disability, and improve productivity.

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