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Crandall Public Library has operated continuously since 1893. Located in Glens Falls, New York, about 50 miles north of Albany, the library is chartered to serve the City of Glens Falls and the Towns of Moreau and Queensbury as part of a special library tax district established in 1992. Its chartered population is 50,675 and the district covers over 109 square miles. The library was designated in 1959 as Central Reference Library for the Southern Adirondack Library System serving 34 member libraries in Warren, Washington, Saratoga and Hamilton Counties, part of which is within the "Blue Line" of the Adirondack Park. Combined, these four counties are about the size of the state of Connecticut. The population figure for the four counties is 330,359 and covers 4,238 square miles. The number of registered patrons on December 31, 2000 was 58,866 and the circulation total for 2000 was 525,808. The 2001 operating budget is slightly more than $2 million. Children's circulation is approximately 40% of the total. The library is a cultural hub with varied programming such as those of the Family Focus Center, Crandall's Film Festival, the Library's Center for Folklife, History and Cultural Programs, and The Langeloth Convalescent Education and Information Center. Designated as an NCLIS White House Millennium Council Sister Library in 1999 Crandall has been a Sister Library with the Saga City Municipal Library in Japan since 1995.
Crandall Public Library was the lead agency in establishing the Langeloth Convalescent Education and Information Center in 1999 to provide both specific consumer health information [convalescence] and a wide spectrum of health and medical information for patrons using two libraries: Crandall Public Library in Glens Falls, NY and Queens Borough Public Library in Jamaica, Queens. Crandall staff wrote the grant to provide funding for the new service. Crandall Public Library assessed the needs of the local community and established an advisory committee of health professionals from the community hospital staff, [public health nurses, physical therapists, other health care providers] to assist the library in planning the establishment of the service. Crandall then hired a professional medical librarian to design and implement the project. The medical librarian created a specialized collection at two sites by purchasing hundreds of books, videos, newsletters, and medical databases specific to this need, and she's provided medical reference training to other librarians in the Southern Adirondack Library System and Queens Central Library.
The medical librarian also performs specialized reference service. Currently, patients typically call or come into the library after consultation with their physicians. The patients ask the librarian questions about their disease or condition, and expect the librarian to find "the latest" information for them. The medical librarian points them in the right direction, or, if the patient is uncomfortable with using library resources, the librarian creates a customized packet of information for the consumer. This is done by going through books, journals, and databases and gathering information from a variety of sources. This information can be picked up at the library, delivered to the homebound (by our outreach librarian) or it can be mailed to the patient.
In recent years, staff noticed a trend in the type of reference questions being asked at Crandall Public Library. Library patrons were asking an increasing number of consumer health information questions. Staff could not answer many of these questions with the print and on-line resources in the collection. Reference staff members were not familiar with the resources that would best answer the questions. They were concerned that the language/vocabulary in medical texts in the collection might be too difficult to read/understand, and they were also uncomfortable because they feared giving the wrong answer or providing medical "advice". The library needed to develop print resources, find affordable consumer-health databases, and train staff in finding accurate information in print and on-line sources.
Anecdotal evidence gathered also indicated that area residents are in need of the program. "There is no information out there and you get nothing from the doctors, only that you'll be fine when it's done", reported Joe Vandy, one of the patients who requested information prior to his hip-replacement surgery. Janet Clark, describing her daughter's long battle with a psychiatric condition, said "Now I can have a more intelligent discussion with her psychiatrist and it allows me to better advocate for my daughter." Some claim that "the doctor didn't tell me anything", and several described the librarian as a "Godsend."
Recognizing the need for consumers and patients in both rural and inner-city areas to have access to accurate and understandable medical information, Director Christine McDonald applied to the Jacob and Valeria Langeloth Foundation in 1999 to establish education and information centers for convalescent and consumer medical information. The Langeloth Foundation showed great interest in the project. They also felt that the project would be strengthened if Crandall found an urban partner to test the premise of the grant, i.e., that the public library was a logical place for consumers to get medical information. Crandall found a willing partner in the Queens Borough Public Library. Since 1999, the Langeloth Foundation has awarded a total of $220,629 to Crandall Public Library as the lead agency for the establishment of the Langeloth Convalescent Education and Information Center at Crandall Public Library and the Queens Borough Public Library. Crandall hired the first Health Services Librarian who developed the print and on-line resource collections at both libraries. In the second year of the project, a Health Services Librarian was hired at Queens. Crandall was also able to obtain additional funding from the Friends of Crandall Public Library and from general operating funds. The Crandall Board wholeheartedly endorsed the project. By partnering with the Glens Falls Hospital, Crandall was able to gain support for the project from the medical community. In addition, area physicians agreed to distribute brochures about the project from their offices. The Glens Falls Hospital librarian generously offered free ILL services and faxes from journals Crandall does not subscribe to. The hospital librarian and Crandall's medical librarian have daily phone contact, enabling them to share resources and provide immediate responses to consumer health concerns. Crandall also partnered with Hudson Headwaters Health Network to expand the project to the underserved in a wider Adirondack area.
One of the first challenges to be met was to convince the healthier community that such a program is needed since there is an assumption that "everything is on the Internet", Although there is a plethora of health-related information on the Internet, it is often inaccurate, out of date, and incomplete, or it is at a reading level that is too difficult for most consumers. In fact, a recent article in JAMA revealed that less than one-quarter of a search engine's first pages of links led to relevant content, and that most relevant content was at a collegiate reading level. Additionally, when rating coverage and accuracy, only 45% of relevant English sites had good coverage and accurate information. (Berland, GK, Elliott, MN, Morales, LS et al. "Health Information on the Internet: Accessibility, Quality, and Readability in English and Spanish". JAMA. 2001; 285:2612-2621.) The advisory committee was made aware of Crandall's medical librarian' s ability to weed through the morass of medical information on the web and to provide users with accurate medical information. They were also convinced that this service is needed since local hospitals were unable to provide the in-depth reference service provided by the library.
Using the public library to provide accurate information to answer medical questions was another major challenge met. Library customers in the Crandall service area now think of calling the library to get medical information. Since Queens just hired a medical librarian this year, more time is needed for them to make this assessment. A new group of customers now come to use Crandall Public Library for medical reference and tell their friends about the services offered. [Attached is a sample of questions handled by Crandall's medical librarian. Also attached is a sample of publicity about the service.]
The geographic distance between Crandall Public Library and Queens Borough Public Library became a barrier to optimal service. It was increasing difficult to manage the program at two libraries. Fortunately, the Langeloth Foundation recognized the difficulties and provided funding to hire a librarian at the Queens Borough Public Library.
Another challenge was to provide the best available medical information when the medical librarian was unavailable. Crandall recognized the need to train more librarians in the techniques of medical reference service. First, staff at Crandall received in-depth training from the medical librarian. Then, with the assistance of the Southern Adirondack Library System's LSTA grant, 14 libraries sent 30 people (library directors and key staff members) to a four-session hands-on training series on electronic information resources for medical and consumer health questions using Crandall's medical librarian as the trainer. Crandall Public Library has received positive feedback about the value of such a training program:
"I learned 10 times more in the training session than 1 could have learned in a month of searching the Internet" --Mary Ann Hunter, Saratoga Springs Public Library.
This will be extremely helpful and valuable for our patrons -- Nancy Sheahan, Round Lake (population 11,709).
This has been one of the BEST trainings offered. ...There is such a need to keep up- to-date in reference, but nothing is more timely than medical issues. Having taken a medical practicum in library school 20 years ago, 1 am so impressed with how much more information is available IF you know how to find it. My library is next door to the health center, and it is the first stop people make after their appointments. I have increased the amount of reference service I provide in the last several months just by knowing 1 can provide it. Thank you! -- Nancy Berkowitz, Indian Lake (pop. 1,481)
Additionally, every Friday for 14 weeks, participating SALS librarians shared their most interesting medical reference question with each other through an e-mail distribution list. The medical librarian at Crandall Library monitored the list, gave suggestions for further information, and alerted members of the list to medical site changes or added resources.
The impact this project had on library customers was that access to reliable information on health concerns has allowed people to more fully participate in their care because they have more choices because of information received at the library. Both Crandall Public Library and the Queens Borough Public Library have evidence that public libraries are a logical place to provide medical reference to their communities. Being able to access information about a loved ones' condition allows families to participate in a meaningful way by getting needed information at Crandall and Queens.
Equally important is the ability of public librarians in the far comers of the Southern Adirondack Library System to have the confidence to tackle complex medical reference questions and also know that there is a Health Services Librarian available to them for assistance at Crandall Public Library.
Generally, the medical librarian at Crandall receives between 15-25 requests per week for in-depth medical information. It takes between one to two hours to find the materials that pertain to these information questions. The reference staff also answer medical reference questions. They tend to answer the questions that take less than 15 minutes to answer. Approximately 20-25% of questions are related to health issues.
The community of librarians in Crandall's Central Library service area have also expressed satisfaction with the project at Crandall:
I am much more confident in giving the patron information and web sites for their medical requests. I feel 1 have a wonderful set of tools to use in answering their questions, and I am able to give pretty complete and CURRENT information. -- Cindy Robertson, Shenendehowa (population of 30,117)