Education and Training Opportunities in Long-Term Community Recovery: Preliminary Observations from the Field Kenneth Schor, DO MPH FAAFP Lauren Walsh, MPH National Center for Disaster Medicine and Public Health 4/29/14
Disclaimer The views expressed are those of the authors and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences, the Department of Defense, or the United States Government. 2
A Center of the http://ncdmph.usuhs.edu Vision A Nation of resilient communities with a competent health workforce prepared to respond and mitigate allhazards disasters. Mission The NCDMPH leads federal and coordinates national efforts to develop and propagate core curricula, education, training and research in all-hazards disaster health. Established in 2008 under Homeland Security Presidential Directive 21, paragraph 38 to be an academic center of excellence in disaster medicine and public health located at the Uniformed Services University of the Health Sciences. 3
Preliminary Research Data Please do not distribute, quote, or publish. Data may be subject to change. 4
Examining Long-Term Community Recovery to Identify Opportunities for Improved Education and Training: Case Studies from Hurricanes Irene and Sandy 5/7/2014 5
Study Objectives 1. Determine the level of education, training, and awareness participants had pre-disaster 2. Investigate how participants learned essential information and formed essential relationships in pre- and post-disaster phases 3. Examine how recovery-related training of the disaster health workforce can be improved Photo by Marilee Caliendo/FEMA 6
Study Background Federal advisory committee to NCDMPH recommended studying recovery phase education and training needs Aligns with the National Disaster Recovery Framework Anchored in the lived experience of leaders and decision makers in local communities affected by Hurricanes Irene and Sandy 7
Methods Primarily qualitative, mixed-methods study Semi-structured in-person interviews (n=90) Snowball sampling Quantitative material example: training competency checklist Data analyzed using QSR NVivo 10 5 case study locations (community-level) 2 Irene: NC, VT 3 Sandy: RI, NJ, and NY 8
Target Interview Population Leaders and decision makers involved in the recovery process including: Emergency manager Public health director Mental health director Hospital emergency operations leader Chiefs of fire and police Local political leader (i.e. mayor, town councilperson) Leaders of active grassroots/humanitarian organizations Faith based Community based Local chapters of national organizations Other active leaders in the recovery process Social Services 9
Research Timeline Completion Status Completion Date Field Research Completed January 2014 Data Analysis In Progress Late Summer 2014 Journal Article Draft Pending Fall 2014 Learning Tools & Products Pending Fall 2014 Photo by Sharon Karr/FEMA 10
Study Population Photo by Marilee Caliendo/FEMA 11
Interviewees State People Interviewed (n) Vermont 13 North Carolina 12 Rhode Island 14 New Jersey 16 New York 35 Total 90 Photo by Liz Roll/FEMA 12
Self-Assessment of Recovery NJ (13) NC (17), NY (15) VT (15) RI (12) National Disaster Recovery Framework (NDRF): Federal Register Volume 76, Issue 217 (November 9, 2011) 13
Observations from the Field and Preliminary Data Analysis Photo by Sharon Karr/FEMA 14
Prior to the disaster, were you trained on 1. Personal and family preparedness 2. Expected role(s) in organizational and community response plans 3. Situational awareness of actual/potential health hazards 4. Communicate effectively with others 5. Personal safety measures 6. Identification and use of surge capacity assets 7. Principles and practices for clinical management 8. Public health principles and practices 9. Ethical principles 10. Legal principles 11. Short- and long-term considerations for recovery *see handout 15
Competency Training Pre-Event Emergency Manager N = 5 Public Health Director N = 7 Mental Health Director N = 3 Fire Chief N = 7 Police Chief N = 3 Political Leader N = 6 Grassroots Org Leaders N = 11 Human Services N = 5 Hospital Emergency Manager N = 5 Personal family Preparedness Expected Role Situational Awareness Communication Personal Safety Surge Assets Clinical Management Public Health Ethical Legal Recovery Considerations Other N = 6 Total N = 58 Key: Red = <40%, Yellow = 40-74.9%, Green = >=75% 16
Job Roles with High Levels of Training (Pre-) Emergency Manager N = 5 Public Health Director N = 7 Mental Health Director N = 3 Fire Chief N = 7 Police Chief N = 3 Political Leader N = 6 Grassroots Org Leaders N = 11 Human Services N = 5 Hospital Emergency Manager N = 5 Personal family Preparedness Expected Role Situational Awareness Communication Personal Safety Surge Assets Clinical Management Public Health Ethical Legal Recovery Considerations Other N = 6 Total N = 58 Key: Red = <40%, Yellow = 40-74.9%, Green = >=75% 17
Job Roles with Low Levels of Training (Pre-) Emergency Manager N = 5 Public Health Director N = 7 Mental Health Director N = 3 Fire Chief N = 7 Police Chief N = 3 Political Leader N = 6 Grassroots Org Leaders N = 11 Human Services N = 5 Hospital Emergency Manager N = 5 Personal family Preparedness Expected Role Situational Awareness Communication Personal Safety Surge Assets Clinical Management Public Health Ethical Legal Recovery Considerations Other N = 6 Total N = 58 Key: Red = <40%, Yellow = 40-74.9%, Green = >=75% 18
High Self-Rated Competency (Pre-) Emergency Manager N = 5 Public Health Director N = 7 Mental Health Director N = 3 Fire Chief N = 7 Police Chief N = 3 Political Leader N = 6 Grassroots Org Leaders N = 11 Human Services N = 5 Hospital Emergency Manager N = 5 Personal family Preparedness Expected Role Situational Awareness Communication Personal Safety Surge Assets Clinical Management Public Health Ethical Legal Recovery Considerations Other N = 6 Total N = 58 Key: Red = <40%, Yellow = 40-74.9%, Green = >=75% 19
Low Self-Rated Competency (Pre-) Emergency Manager N = 5 Public Health Director N = 7 Mental Health Director N = 3 Fire Chief N = 7 Police Chief N = 3 Political Leader N = 6 Grassroots Org Leaders N = 11 Human Services N = 5 Hospital Emergency Manager N = 5 Personal family Preparedness Expected Role Situational Awareness Communication Personal Safety Surge Assets Clinical Management Public Health Ethical Legal Recovery Considerations Other N = 6 Total N = 58 Key: Red = <40%, Yellow = 40-74.9%, Green = >=75% 20
Learning Priorities Thinking about where you currently stand on the recovery continuum, what training topics do you think would be useful for you, your organization, and community to reach full recovery? Photo by Marilee Caliendo/FEMA Photo by Marilee Caliendo/FEMA 21
Learning Priorities Self Organization Community Emergency Management Accessing FEMA Information Debris Management Communication with Private Sector Patient Tracking COOP Evacuation & Re-entry Public Health Planning Communication/ Social Media Community Planning Mental Health Patient Tracking Self-care & Preparedness for HCWs Psychological First Aid Building Resilience Recovery Stress in Employees Job Role Hospital Emergency Management Fire Drills Planning /H Management & Executive Training Self-care & Preparedness for HCWs Technical Training for Elected Officials Working with FEMA Caring for Vulnerable Populations for Elected Officials School-based Preparedness Police Technical Training Evacuation & Re-entry After Action Reports for Elected Officials Rebuilding Elected Official FEMA Basics Who To Know Prior Planning Financial/Public Assistance Programs Support Volunteer & Donations Management Grassroots Organizations CERT Training Rebuilding Applying for Assistance Working with FEMA Disaster Case Management Inter-org Relationships Working with Local, State, FEMA Personal Recovery Volunteer & Donations Management Human Services Inter-agency Cooperation - Working with State and Federal Other - for City Housing Asset/Money Allocation Personal Recovery 22
Incident Command System Self Organization Community Emergency Management Accessing FEMA Information Debris Management Communication with Private Sector Patient Tracking COOP Evacuation & Re-entry Public Health Planning Communication/ Social Media Personal preparedness Community Planning Mental Health Patient Tracking Self-care & Preparedness for HCWs Psychological First Aid Building Resilience Recovery Stress in Employees Job Role Hospital Emergency Management Fire Drills Planning /H Management & Executive Training Self-care & Preparedness for HCWs Technical Training for Elected Officials Working with FEMA Caring for Vulnerable Populations for Elected Officials School-based Preparedness Police Technical Training Evacuation & Re-entry After Action Reports for Elected Officials Rebuilding Elected Official FEMA Basics Who to Know Prior Planning Financial/Public Assistance Programs Support Volunteer & Donations Management Grassroots Organizations CERT Training Rebuilding Applying for Assistance Working with FEMA Disaster Case Management Inter-org Relationships Working with Local, State, FEMA Personal Recovery Volunteer & Donations Management Human Services Inter-agency Cooperation - Working with State and Federal Other - for City Housing Asset/Money Allocation Personal Recovery 23
FEMA Basics, Programs, and Assistance Self Organization Community Emergency Management Accessing FEMA Information Debris Management Communication with Private Sector Patient Tracking COOP Evacuation & Re-entry Public Health Planning Communication/ Social Media Community Planning Mental Health Patient Tracking Self-care & Preparedness for HCWs Psychological First Aid Building Resilience Recovery Stress in Employees Job Role Hospital Emergency Management Fire Drills Planning /H Management & Executive Training Self-care & Preparedness for HCWs Technical Training for Elected Officials Working with FEMA Caring for Vulnerable Populations for Elected Officials School-based Preparedness Police Technical Training Evacuation & Re-entry After Action Reports for Elected Officials Rebuilding Elected Official FEMA Basics Who to Know Prior Planning Financial/Public Assistance Programs Support Volunteer & Donations Management Grassroots Organizations CERT Training Rebuilding Applying for Assistance Working with FEMA Disaster Case Management Inter-org Relationships Working with Local, State, FEMA Personal Recovery Volunteer & Donations Management Human Services Inter-agency Cooperation - Working with State and Federal Other - for City Housing Asset/Money Allocation Personal Recovery 24
Preparedness Personal, Community, and Workplace Self Organization Community Emergency Management Accessing FEMA Information Debris Management Communication with Private Sector Patient Tracking COOP Evacuation & Re-entry Public Health Planning Communication/ Social Media Community Planning Mental Health Patient Tracking Self-care & Preparedness for HCWs Psychological First Aid Building Resilience Recovery Stress in Employees Job Role Hospital Emergency Management Fire Drills Planning /H Management & Executive Training Self-care & Preparedness for HCWs Technical Training for Elected Officials Working with FEMA Caring for Vulnerable Populations for Elected Officials School-based Preparedness Police Technical Training Evacuation & Re-entry After Action Reports for Elected Officials Rebuilding Elected Official FEMA Basics Who to Know Prior Planning Financial/Public Assistance Programs Support Volunteer & Donations Management Grassroots Organizations CERT Training Rebuilding Applying for Assistance Working with FEMA Disaster Case Management Inter-org Relationships Working with Local, State, FEMA Personal Recovery Volunteer & Donations Management Human Services Inter-agency Cooperation - Working with State and Federal Other - for City Housing Asset/Money Allocation Personal Recovery 25
Rebuilding and Recovery Self Organization Community Emergency Management Accessing FEMA Information Debris Management Communication with Private Sector Patient Tracking COOP Evacuation & Re-entry Public Health Planning Communication/ Social Media Community Planning Mental Health Patient Tracking Self-care & Preparedness for HCWs Psychological First Aid Building Resilience Recovery Stress in Employees Job Role Hospital Emergency Management Fire Drills Planning /H Management & Executive Training Self-care & Preparedness for HCWs Technical Training for Elected Officials Working with FEMA Caring for Vulnerable Populations for Elected Officials School-based Preparedness Police Technical Training Evacuation & Re-entry After Action Reports for Elected Officials Rebuilding Elected Official FEMA Basics Who to Know Prior Planning Financial/Public Assistance Programs Support Volunteer & Donations Management Grassroots Organizations CERT Training Rebuilding Applying for Assistance Working with FEMA Disaster Case Management Inter-org Relationships Working with Local, State, FEMA Personal Recovery Volunteer & Donations Management Human Services Inter-agency Cooperation - Working with State and Federal Other - for City Housing Asset/Money Allocation Personal Recovery 26
Job Role Inter-Agency and Private Sector Cooperation Emergency Management Public Health Mental Health Hospital Emergency Management Fire Police Elected Official Grassroots Organizations Self Organization Community Accessing FEMA Information Debris Management Planning Patient Tracking Drills Planning Technical Training FEMA Basics Who to Know CERT Training Rebuilding Applying for Assistance Working with FEMA Human Services Inter-agency Cooperation - Other - Communication with Private Sector Patient Tracking Communication/ Social Media Self-care & Preparedness for HCWs Psychological First Aid /H Management & Executive Training Self-care & Preparedness for HCWs Technical Training Evacuation & Re-entry After Action Reports Prior Planning Disaster Case Management Inter-org Relationships Working with Local, State, FEMA for City Housing Asset/Money Allocation COOP Evacuation & Re-entry Community Planning Building Resilience Recovery Stress in Employees for Elected Officials Working with FEMA Caring for Vulnerable Populations for Elected Officials School-based Preparedness for Elected Officials Rebuilding Financial/Public Assistance Programs Support Volunteer & Donations Management Personal Recovery Volunteer & Donations Management Working with State and Federal Personal Recovery 27
Summary Workforce Competency is Inconsistent Of 11 core competencies, only Expected Role and Communication were attained by >75% of interviewees Large discrepancies in training among job roles Additional Training Needs Topic trends include: Incident Command System/Hospital Incident Command System FEMA Basics, Programs, and Assistance Preparedness Personal, community, and organization Rebuilding and Recovery Cooperation Inter-agency and private sector Many other training needs identified 5/7/2014 28
Value of the Research 1. Rooted in the lived experience of leaders currently in the recovery phase; 2. Focused on leaders currently active in recovery, yet identifies multiple learning gaps; 3. Snowball sampling identified only 13-19 people in each community, suggesting that recovery is driven by a small number of people. 5/7/2014 29
Limitations Case Study Design Cannot generalize to the rest of the population Includes two different disasters Difference in chronology between sites Sites that experienced Sandy also experienced Irene Do not have competency data for all 90 respondents NDRF released after Hurricane Irene (Sept. 2011) May have been progress in capacity and recognition of recovery needs from Irene to Sandy 5/7/2014 30
Potential Secondary Analyses Considerations for rural vs. urban areas Relationships and roles of organizations involved in response and recovery Coordination among federal, state, and local agencies Awareness and application of National Disaster Recovery Framework Short- and long-term recovery training Community recovery planning 31
For further information please contact: Dr. Kenneth Schor, Acting Director Phone: 240-833-4444 Email: kenneth.schor@usuhs.edu Follow Us: Facebook.com/NCDMPH LinkedIn @NCDMPH ncdmph.usuhs.edu 32