Designing and Delivering Relevant Public Health Preparedness Training:  Title: Adapting Tier I Training

Although the Mountain West Preparedness Education  and Response Learning Center’s (MWPERLC) program focuses on designing competency-based training for mid-level workers, the need still exists to offer basic public health preparedness training, due partly to turnover in the public health workforce. 
Adaptation is the process through which curricula are made more geographically and culturally appropriate by incorporating case studies, learning activities, and examples with which the target audience can identify. The MWPERLC has had much success in adaptation of curriculum, particularly for tribal partners.  In the past, the MWPERLC has collaborated with Tribal Community Colleges to adapt and deliver training to local Community Health Representatives.  Local case studies highlight tribal government and response infrastructure.

 As a part of our standard curriculum development procedures, the MWPERLC team systematically maps all courses and modules to Public Health Preparedness and Response Core Competencies (PHPRC), Target Capabilities (TC) and the Public Health Preparedness and Response Competencies (PHPR).  One challenge faced by MWPERLC curriculum design staff is maintaining the original integrity of the content and not rewriting it entirely while meeting the needs of our partners.  A system had to be developed to ensure that the PHPRCs, TCs and PHPR competencies were still addressed. 

Quickly adapting existing modules ensures our responsiveness to our partners, as well as content relevance. We use one entry level module builder (eXe Software) in which the Curriculum Designer is able to organize and review the content.  The Instructional Technologist then uses a more advanced module building software to design, animate, and publish the content. Breaking free from the usual work flow and traditional assignments is critical.  For example, the Curriculum Designer must be willing and able to learn some technical skills to use entry level module building software. To further improve the process, the MWPERLC is working on a web-based content collection system which will be used for subsequent partner-requested course adaptation.

One of the benefits adaptation offers for partners throughout the United States is the creation of training materials relevant to their respective region and or jurisdiction.  Additional benefits for the end user include: an increased sense of ownership of and resulting improved participation in the training; an online experience to which they can relate; and sustainability.  MWPERLC is currently working to make the adapted modules available through the TRAIN network to facilitate access for the broader public health audience.

The MWPERLC is currently engaged in adapting the Epidemiology of Chemical, Biological, and Radiological module for the Utah Department of Health and the Special Needs Populations module for the Colorado State Health Department.

When H1N1 flu broke in spring 2009, Texas was one of the first states with deaths from this disease. Pandemic flu caused 240 deaths in Texas between April 2009 and April 2010, and an estimated 2,316 people were hospitalized; 108 school campuses were closed to prevent further spread. The Rural Pandemic Influenza Public Engagement (R-PIPE) Project built community capacity by organizing local resources to create local solutions to improving community health.

In rural areas, it is especially important to engage the broader community, since these communities lack resources often found in urban and suburban communities and are frequently dependent on non-traditional partners and volunteers in planning and response. The R-PIPE Project was successful in engaging a wide range of stakeholders in planning meetings, an educational conference, a series of work group meetings, town hall meetings and community education. Between the two rural counties involved in this project, 129 stakeholders representing 74 different organizations, agencies or stakeholder groups:

• identified local priority issues and concerns
• identified concrete solutions and next steps to address these issues
• identified additional stakeholders to attend work group meetings
• planned town hall meetings and community-wide education activities

While the project goal was planning for local pandemic flu issues, one of the primary outcomes was the development of a stronger communication and resource-sharing network between stakeholders and the public. Three years after the project, this network still operates. Should any other type of local issue or concern arise in which communication and collaborative problem-solving are necessary, there is already a strong network of engaged community members in place.

The Training and Education Collaborative System Preparedness and Emergency Response Learning Center (TECS-PERLC) is a collaboration among the Texas A&M School of Rural Public Health, the University Of Texas School Of Public Health, and the University Of North Texas Health Science Center School Of Public Health. For more information about TECS-PERLC go to http://www.rural-preparedness.org/

The month of March 2012 was an enormous learning opportunity for CDC staff interested in and working with Emergency Preparedness Learning products. Throughout the month, grantees from 12 accredited schools of public health that receive funding supported by CDC Preparedness and Emergency Response Learning Centers (PERLC), visited CDC OPHPR for the Reverse Site Visits (RSV). Despite their busy schedules PERLC grantees from as far west as University of Washington and our partners in the east, Columbia, John’s Hopkins and Harvard University, for example, descended on the Roybal campus to highlight their activities and premier products. The visits provided an opportunity for both the PERLC Grantee and the Learning Office Project Officers to review their approaches outlined for Year 2, identify gaps or barriers in achieving the workplan activities, and evaluate productivity. In addition, the RSV were designed enhance relationships with PHEP partners, and highlight the PERLC’s work to key OPHPR staff.

Learning Office Project Officer, Liane Hostler welcomes Ms. Laurie Walkner, Director of Training and Education and Dr. Tanya M. Uden-Holman, Principal Investigator for the Upper Midwest Preparedness and Emergency Response Learning Center.

Time is of the Essence-

This engagement was timely for several reasons. The OPHPR Division of State and Local Readiness had recently launched the Hospital Preparedness Program (HPP) and Public Health Emergency Preparedness (PHEP) Program Grant Alignment which was published on Grants.gov in March 2012. In previous years, the Public Health Emergency Preparedness (PHEP) and HPP Capabilities have been separate; however, in 2012 these capabilities will be aligned. HPP-PHEP Applicants were in the midst of drafting their responses for the HPP-PHEP Capabilities Planning Guide (CPG) which further outlined the new alignment and relationship. And finally, the DSLR Project Officers were preparing to meet their respective HPP-PHEP Applicants March 21-23 for the 2012 Joint Preparedness Conference. Therefore, PERLC grantees presentations were important to highlight opportunities to support emergency preparedness training and collaborations.

Learning Office Associate Director, Dr. Joan Cioffi and Project Officer, Gregg Leeman welcome Dr. Barbara Quiram (right), TECS-PERLC Principal Investigator and Kay Carpender (2nd left), TECS-PERLC Director.

What did we learn?

Each PERLC has a special niche in the emergency preparedness learning environment. Among their unique features, several PERLCs work to develop trainings and learning products for rural public health, tribal communities and vulnerable populations. For example, the University of Arizona-Mountain West PERLC created two workshops geared toward public health professionals at the Cochise County Health Department, a small rural health department on the US Mexico border. These workshops coupled with online modules provided participants with key information on the roles and importance of collaboration during public health emergencies. The University of Oklahoma-Southwest PERLC, with their long established relationship with 39 sovereign tribal nations in Oklahoma, continues to play an integral role in the success of the Inter-Tribal Emergency Management Coalition.

April 16th, U.S. Sen. Tom Harkin and Centers for Disease Control and Prevention Director Thomas Frieden were guests at the University of Iowa College of Public Health for the dedication ceremony for the new building. Dr. Frieden gave a presentation prior to the CPH building dedication titled, “Supporting Health, Productive Lives, and Communities.” Harkin, who serves as chairman of the Senate Committee on Health, Education, Labor and Pensions, delivered the keynote address during the building dedication which stressed the importance of public health. The new $47.7 million 142,000-square-foot building opened to faculty and students this semester.

One of the CDC funded programs at the University of Iowa College of Public Health is the Upper Midwest Preparedness and Emergency Response Learning Center (UMPERLC.)  UMPERLC serves the predominantly-rural states of Iowa and Nebraska with their emergency preparedness response training efforts. UMPERLC has learning projects and resources designed to support the states’ capacity in building a strong, prepared public health workforce. UMPERLC has  produced 37 innovative, online training and education programs that are accessible at no-cost to a diverse, public health workforce, including online courses (e.g., Lab Biosafety: Avoiding Laboratory Acquired Infections), and toolkits (e.g., Shelter Management, PIO/JIC). 
The UMPERLC partners with several state agencies and non-profit organizations within Iowa and Nebraska to address the states’ preparedness training needs. Examples of these partnerships include: 

• Community Health Centers-Provided training and resources to the Primary Care Association of Iowa, and its affiliated community health centers (CHC) to build their capacity for preparedness and emergency response. CHCs serve as an important resource for local and state health departments in a disaster.
• Laboratorians-Partnered with the State Hygienic Laboratory at The University of Iowa to provide interactive, virtual Just-In-Time trainings (e.g., Anatomy of a Foodborne Outbreak, Electronic Bioterrorism Workshop for Sentinel Labs). 
• Veterinarians-Partnered with Iowa State University, College of Veterinary Medicine, Center for Food Security and Public Health to develop the “Public Health Emergency Preparedness” course for practicing veterinarians completing their MPH at the University of Iowa, College of Public Health.
• Public Health Workforce-Developed a series of competency –based scenarios- to assess knowledge and skills and provide training where gaps exist.  The scenarios allow the worker to demonstrate proficiency through practical exercise.
• Prevention of Disabilities Policy Council-On February, 27th UMPERLC participated in Iowa’s first ever State Strategic Planning for emergency preparedness and response for Iowans with disabilities.
• Iowa Homeland Security and Emergency Management-UMPERLC combined the HSEEP and Exercise Design courses from a 4 day into a 2 ½ day training course. The Iowa Homeland Security and Emergency Management training officer will be requesting this course to be added to the national catalog of courses.
  For more information on the UMPERLC, please visit their website at http://cph.uiowa.edu/umperlc/

On the Front Lines of a Response: PERLC Support During Hurricane Sandy
During the last days of October 2012, mid-Atlantic area officials began advising residents on the barrier islands to evacuate in preparation for Hurricane Sandy. Among many states, New Jersey, Pennsylvania, New York and those in New England were bracing for what had already surged as a tropical storm in the Caribbean, Bermuda and the southeastern states. Preparedness teams at the regional, state and local levels were geared up for response and recovery efforts. The Centers for Disease Control and Prevention wanted to make sure Americans in the storm’s path were prepared to reduce the risk of any health hazards. Cities identified under a hurricane watch or warnings were encouraged to learn about their local community emergency plans, including the location of emergency shelter and evacuation routes. Two of CDC-funded Preparedness and Emergency Response Learning Centers (PERLC) mobilized to support state and local public health agencies with Hurricane Sandy relief efforts. There are 14 funded PERLCs serving 39 states nationally since 2010.

Emergency Risk Communication via Web and Social Media
The Columbia Regional Learning Center (CRLC) http://www.cdc.gov/phpr/documents/perlcPDFS/ColumbiaPERLC-FinalCOcomments.pdf
played an active role throughout each phase of Hurricane Sandy, timely communicating important preparedness information during the preparedness (72 hours prior to landfall), response, and recovery phases. Successful communication of this information was achieved through the National Center for Disaster Preparedness (NCDP) website updates and providing links to credible resources, as well as social media postings on Facebook and Twitter.  Key information made available focused on personal protective measures during all phases and addressed public health preparedness, response, and recovery issues specific to the event.  Messaging was communicated to a wider audience by making information available in both English and Spanish. The center also published additional guidance and recommendations on heating and shelter protective measures in regards to the Nor’easter storm that followed Hurricane Sandy.

Media Outlets
CRLC faculty members were actively sought by local and major media outlets for their expertise. Dr. Irwin Redlener, Director, National Center for Disaster Preparedness, appeared on MSNBC, CNN, and CBS News and was quoted in USA Today, Bloomberg BusinessWeek, The Economist, and The Village Voice, to name a few. Dr. Michael Reilly, Director of Planning and Response was also featured on ABC 7 and in The Washington Post, The Atlantic, The NY Post and Remapping Debate. Dr. Redlener and Dr. Reilly wrote an editorial in the New England Journal of Medicine, ‘Lessons from Sandy—Preparing Health Systems for Future Disasters’. Dr. Redlener and Deputy Director Dr. David Abramson also published an editorial, ‘Hurricane Sandy: Lessons Learned Again’ in the Disaster Medicine & Public Health Preparedness journal (Dec 2012).

Hands-on Deployment
A team comprising Drs. Redlener, Abramson, and Reilly accompanied the Children’s Health Fund mobile medical unit team to conduct health care needs assessments in the affected areas. Dr. Reilly was deployed to staff the hospital desk at the Westchester County Emergency Operations Center (EOC) for three days, providing monumental support before, during and after the storm.

Dr. Irwin Redlener, Professor at the Columbia University’s Mailman School of Public Health and Director of the National Center for Disaster Preparedness.

After Action Response
Dr. George DiFerdinando, Co-Director of the NY•NJ PERLC, has been actively involved in Hurricane Sandy response and recovery efforts in New Jersey.  Initial response activities included assisting the local board of health with sheltering and reception center activities.  Since then, various partners have requested his assistance with post-Sandy After Action reviews and analysis to help identify areas of improvement.  Recent participation in “hot washes” at the state and local level include the following:

• New Jersey Local Board of Health Association -  After Action of Sheltering/Reception Center activities of several Boards of Health
• New Jersey Department of Health and Senior Services (NJDHSS) hot wash of the actions of their Health Command Center (HCC).  The NJDHSS HCC focuses on coordination with standing health facilities, either direct care or residential, during an event.
• Mercer County Hot Wash - 13 municipalities reviewed storm related issues, including the sustained power loss (greater than 96 hours) for a majority of the population.

Ongoing activities include collaboration with the New Jersey Public Health Training Center and the New Jersey Learning Management System to identify mid-term and long term trainings suggested by the Sandy and post-Sandy events and project planning sessions with partners at the New Jersey Climate Adaptation Alliance to develop grant proposals for post-Sandy projects.
Efforts Continue….
The National Center for Disaster Preparedness (NCDP) and the New York City-Long Island-Lower Tri-County Public Health Training Center (NYC-LI-LTC PHTC), at Columbia University’s Mailman School of Public Health co-sponsored a live web-conference on January 17, 2013, the “Hurricane Sandy Roundtable: A Conversation Among Local Public Health Leaders.”

This event brought together the public health commissioners from New York City, Suffolk, Nassau, Putnam, Rockland, and Westchester counties along with their respective emergency preparedness planners and response coordinators. These local health department panelists shared experiences, highlighted their challenges, and discussed critical decision-making prior to, during, and following Hurricane Sandy.   To view the original broadcasts go to http://ncdp.mailman.columbia.edu/hurricane_sandy.html.