A Regional Model for Public Health Practice:

Transcription

1 A Regional Model for Public Health Practice: Colorado Emergency Preparedness and Response Presented by: Walter Snip Young, Lisa VanRaemdonck and Jeff Zayach NACCHO Conference 2009

2 Today s Presentation History of the Regional EPR System in Colorado Background on System Review System Review Findings Regional EPR System in Action Future use of Regional EPR System Discussion and Questions

3 Introductions Jeff Zayach, MA, Executive Director Boulder County Public Health Walter Snip Young, Ph.D., Consultant Advanced Health Directions Lisa VanRaemdonck, MPH, MSW, Project Manager Colorado Association of Local Public Health Officials

4 CALPHO Role CALPHO manages Local Advisory Committee (LAC) for state EPR division State contract to provide additional assistance

5 History of the Regional EPR System in Colorado Developed in 2003 Funded with CDC EPR funds for local public health Used All Hazards region map Added a minimum of 3 staff positions per region Epidemiologist, Planner, Trainer Currently, 42 total regional staff Staff employed by and housed at local public health Work under contract deliverables directed by state

6 Regional EPR System Map

7 Funding for Regional EPR Model CDC $$ Host Agency $$$ $ State $ $ Regional Staff Non-host Agency Non-host Agency Non-host Agency

8 System Review

9 Background Study was contracted by EPR division, completed by CALPHO and approved by EPR Local Advisory Committee Study Objective: Assess local, state and regional program staff perspectives on functioning and success of the Regional EPR Program Model in preparing Colorado communities for responses to public health emergencies.

10 Methods Formative Methods Focus Group of Local Health directors Interviews with CDPHE EPR Staff Study Participants Local Health Directors (Host and Non-host) Regional & Local EPR Staff Data Collection Methods Online survey of study participants In-depth face-to-face & telephone interviews Analysis Processing and Review of Survey Data Integration of Interview Data

11 Logic Model - Colorado Emergency Preparedness Response Program Inputs Outcomes EPR Staff and Partners Activities Outputs Short-term Intermediate Long-term Regional Planning Workshops Training Workshops Emergency Preparedness Plans Opportunities to Network Prepared Staff and Community Partners Regional & Community Awareness Community Consciousness of Risk Broad Community Participation Community Participation in Drills Ongoing Planning & Preparation Prevention and Response Policies Implemented Reduced Risk to Lives Epidemiology/ Data Analysis Emergency Drills Targeted to Colorado Communities Data to Assess Risk Reports on Community Risks Community Partnerships Regional Staff Services Increase in Prepared County Health Department Staff Local Health Depts and Partners Cooperate Increase in Emergency Response Teams Increased Social Acceptance of Preparedness Communications systems in place Resource Sustainability Secure & Protected Communities

12 Online Survey ed to 137 individuals Regional Staff Agency Directors EPR Supervisors/Managers Forwarded to local EPR staff by agency directors Respondents 104 completed surveys 83 ed (61% response rate) 21 forwarded

13 Online Survey Respondents 25 EPR Region Reported in Survey

14 Online Survey Respondents Positions Reported in Survey Local EPR Staff (Secondary Respondents) 18% Other 11% Regional Staff 34% Regional Planner 14% Regional Epid 12% Regional Trainer 8% Agency Director 37%

15 Interviewees Face-to-Face and Telephone Interviews Total of 83 interviews completed Regional EPR Staff Host Agency Directors Non-host Agency Directors Local EPR Staff

16 Findings

17 Findings REGIONAL STAFF Regional staff experience and education Responsibilities Who is your customer? Opinions of Agency Directors and Local Staff HOW IS THE SYSTEM WORKING? Overall opinions Concerns/Challenges COMMUNICATION AND FEEDBACK

18 Regional Staff: Experience/Education Most common backgrounds were in: General Public Health (15) Including communicable disease, prevention and programmatic work Training/Education (10) Environmental Health (9) Disaster planning (6) Red Cross, International, MRC Nursing (5) EMS/Fire/Police (4) Others included Military, MD, social services/social work, emergency management

19 Regional Staff: General Responsibilities Most frequently mentioned responsibilities Coordination with non-public health partners Deliverables Coordination with public health partners Serve counties in region Least frequently mentioned responsibilities Leadership Liaison between state and local Technical support Site visits

20 Regional Staff: Who is your customer? 1. Public 2. Non-public health partner agencies (not including first responders or emergency management) 3. Non-host agency directors/staff 4. Host agency directors/staff 5. First responders 6. State/CDPHE 7. Emergency Managers 8. Public health workforce/general public health

21 Regional Staff: Agency Director and Local Staff opinions Regional EPR staff : Are available during working hours. Are good ambassadors for the EPR program in our region. Travel when necessary to accomplish the job. Use technology to improve accessibility. Can be easily reached during working hours. Share important information. Are accessible. Are strong leaders of Emergency Response Teams in our region.

22 Regional Staff: Agency Director and Local Staff opinions Regional EPR staff are less likely to: visit non-host agencies regularly in some regions. use a customer feedback system. offer suggestions to improve operations. anticipate the needs of the counties being served.

23 Highlights: How well is the system working? Regional staff report that generally the system is working well. Host directors report that the model is working well (near consensus) and there has been great progress since the program began. Non-host staff agreed less that the system was working well, but many say it is working pretty well and without it they wouldn t get many of their deliverables completed. Host directors acknowledge that the program forced successful collaboration.

24 Highlights: How well is the system working? Some Concerns/Challenges: Regional staff lack the time to understand outlying communities. Lack of clear sanctioned authority creates confusion when multiple agencies are involved. Ambiguity in chain of command can be problematic. Evaluations and standards are needed to measure host agency performance. Sustainability of the program and staff turnover are concerns. Priorities of regional staff tend to favor host agencies. Unequal and inconsistent service is a concern.

25 Highlights: How well is the system working? Concerns/Challenges continued: Communication Geography Defining roles within the system and with non-public health partners. Non-host agency directors have concerns about host agencies seeking regular feedback, and host agencies seeking input on how to deploy the regional staff.

26 Highlights: Communication and Feedback Communication is one of the common contributors to issues and success within the system. Few respondents/interviewees recognize a formal communication and feedback system. Most communication is considered informal. Regular face-to-face meetings, s and conference calls are reported in successful relationships.

27 Conclusions System Variations The regional preparedness system is implemented in different ways across the state. There are clear rural/urban variations and variations based on the strength of key local public health agencies in a region. Geography Matters Geography and distance make significant impacts on regional services. Communication, Communication, Communication Regions where communications occur regularly and systematically are more likely to be more satisfied with the Regional EPR system. Customer Feedback There is no discernable systematic, formal feedback process within the regional EPR system.

28 Conclusions Funding and Long-term Sustainability The regional EPR system has experienced flat-funding and rising costs over time. Deliverables versus Regional Priorities Contract deliverables don t always represent the needs of a community or region. Beyond Deliverables- Anticipating Needs of the Customer and Enhancing the System Regional EPR staff should be anticipating the needs of local public health agencies and partners in addition to responding to requests and completing contract deliverables.

29 Questions/Comments?

30 Regional EPR System in Action Alamosa Salmonella Outbreak 2008

31 Alamosa in the San Luis Valley

32 Environmental Health in Colorado

33 Regional EPR Staff in Alamosa Alamosa is a host agency Two part-time epidemiologists Planner Trainer County also has Homeland Security staff (in offices next to planner and trainer) EOC down the hall

34 The Beginning Friday, March 7, 2008 First resident becomes ill Wednesday, March 12, 2008 First case of Salmonella reported Case investigation Friday, March 14, cases Salmonella severe diarrhea Normally 1 to 2 Salmonella cases per year in the county Saturday, March 15, 2008 Alamosa public health agency establishes EOC Consultation between county public health, state and EM

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36 Early Cases (March 7-17) 46 cases, 18 culture confirmed 37 reside in Alamosa City At least 3 of the remaining 5 have recently been to Alamosa No common sources Several infants consume formula only Monday March 17, 2008 Water testing begins

37 It s in the Water! March 19, 2008 State health department issues bottled water order Alamosa declares city/county emergency

38 March 21, 2008 Governor declares state public health emergency Colorado National Guard arrives IMTs from other areas rotate to provide help

39 March 23, 2008 April 11, 2008 Water distribution, community education and system flushing

40 Regional Staff Involvement Both Alamosa regional epidemiologists worked overtime (benefit of having job share) Alamosa Regional staff opened/led EOC Regional staff from across the state travelled to Alamosa to assist including as a part of Incident Management Teams Regional epidemiologists travelled to Alamosa to assist in case investigation and assisted from their own offices

41 Benefits of Regional System Many response professionals in the local community trained in ICS so there was a common language (Regional trainer) Regional staff across state know each other and have worked together at various levels relationships already existed Local and regional deliverables are the same so regional staff coming in to help knew what plans were there and where some issues might be State employees working with regional system were deployed as well Personnel could come from other host agencies without much change in their host agency s daily work

42 Future of Regional EPR: Project Public Health Ready Project Public Health Ready Colorado is embarking on an effort to get every local public health agency in the state recognized through PPHR over the next two years. Local public health agencies have PPHR as the primary part of their contract for this year. Each agency will apply for recognition individually but many are planning to work together within their regions.

43 Future of Regional EPR: Project Public Health Ready Most regional staff will act as the point of contact between local public health and state public health staff coordinating the PPHR program. Regional staff providing technical assistance to individual counties. Contract deliverable for regional staff = Providing technical assistance, convening regional partners, and evaluating county and regional PPHR application information. Some regional staff are organizing efforts in their region by convening meetings, evaluating needs, etc.

44 Informative Links CALPHO Report NACCHO PPHR Program NACCHO Regionalization Information

45 Discussion and Questions