ADAPs

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ADAPs Emergency Preparedness

• Richard Aleshire, Washington State Thelma Craig,
  Colorado State
• National ADAP TA Meeting
• Mandarin Hotel, Washington, DC
• July 17, 2009

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Workshop Goal

• The goal of this session is to provide
  participants with an overview, from two States
  perspectives, of the development of an Emergency
  Preparedness Plan for their ADAP. This will
  include the steps taken to develop a plan, the
  actions taken to implement a plan and lessons
  learned from the process.

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Workshop Objectives

• Participants will learn development ideas to
  begin or refine their own plans.
• Participants will have a conceptual framework
  regarding where to begin or refine development of
  their plan.
• Participants will learn the importance and
  essential need of a plan for the delivery of ADAP
  services.

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WASHINGTONS PLAN Richard Aleshire, Washington
State Program Manager, HIV Client Services July
17, 2009
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Phases of Disaster Management and Emergency
Preparedness

• Planning
• Response
• Recovery
• This session is focused on planning but in order
  to have
• a plan you need to consider how you would respond
  to
• an emergency and how you would recover.

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Purpose Why Have a Plan?

• To ensure that your clients have access to their
  medications in the event of an emergency - no
  matter its duration

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Terminology

• Emergency Preparedness Plan
• Business Continuity Plan
• Continuity of Operations Plan
• Contingency Plan

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Development of an Emergency Preparedness Plan

• Incident Command System Model (ICS) and Training
• Have overall Program Emergency Response, written
  in plain talk, outlining
• Purpose
• When to activate/deactivate emergency response
• How staff will be contacted
• Where they will report
• Duties

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Plan Development (cont.)

• ICS Positions and duties outlined
• Operations Section
• Logistics Section
• Communication Section
• Planning Section
• Develop an individual Job Action Sheet for each
  Section Chief
• Include emergency preparedness duties in
  everyones Position Descriptions

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Plan Development (cont.)

• Need to plan for a short-term emergency and a
  long-term emergency
• Is your building usable?
• If not, what is the alternate location?
• Coordinate with neighboring States if possible
• Where is your database located?
• Ensure a back-up location for the database

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Plan Development (cont.)

• What partners should be at the planning table?
• Have a copy of your partners plans that you may
  rely on in an emergency, such as your PBM
• Outline and know your system and risk functions
  that may exist
• Develop a Continuity of Operations Plan (COOP)
• Be as specific as possible

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Plan Development (cont.)

• Prioritize essential/critical functions
• Complete a Technology Assessment
• Cross train staff so that every position has a
  back-up or other options available
• Develop forms

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Execution of your Plan

• Review for accuracy
• Ensure the plan is updated regularly
• Ensure assigned staff are updated as turnover
  occurs
• Ensure Position Descriptions are updated
• Ensure staff are regularly trained and know their
  role

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Execution of your Plan (cont.)

• Conduct table-top exercises periodically
• Larger scale exercises
• Consider inviting partners to participate
• Your program should be part of your States large
  scale exercise
• Take advantage of opportunities such as H1N1 flu

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Lessons Learned

• Include clients in process
• Prepare clients with an emergency resource guide
  to develop their personal emergency needs plan
• Remember that the purpose of the plan is to
  ensure your clients can get their meds
• Business operations may be different during an
  emergency dont get stuck on doing business as
  usual

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Lessons Learned Examples

• Western Washington Floods
• Fact sheet developed for EOC about program
• H1N1
• Having info for PLWH about H1N1 on web
• Having info for clinicians about H1N1 on web
• Process for distribution of anti-virals

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Thank you for your interest and attention!!!

• Richard Aleshire, MSW
• Program Manager, HIV Client Services
• Washington State Department of Health
• HIV Client Services Programs
• P.O. Box 47841
• Olympia, WA 98504-7841
• 360-236-3477 (voice)
• 360-664-2216 (fax)
• richard.aleshire_at_doh.wa.gov
• http//www.doh.wa.gov/cfh/hiv.htm

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Development of Colorados ADAP Continuity of
Operations Plan (COOP)

• Thelma Craig, ADAP Coordinator
• Colorado Department of Public Health and
  Environment
• July 17, 2009

19

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Overview

• Purpose - Review our process and give you things
  to consider as you develop your Plan
• Confirmed/Identified Need for Preparedness
• Identified Participants for the Planning Process
• Prioritized Essential Program Functions
• Drafted Plan
• Piloted/Planned/Executed
• Lessons Learned

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Background and Need

• Colorado ADAP realized just how vulnerable our
  program really is.
• Determined to develop a Continuity of
  Operations/Continuity of Government
  (COOP/COG)Plan

• HRSA Recommendation
• Katrina example
• Administrators and Program Manager aware of
  extent to which disasters and emergencies can
  interrupt service delivery.

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Goals of COOP

• Reduce consequences of disasters to a minimal
  level.
• Assure a safety net .
• Deliver excellent customer service even during a
  natural or manmade disaster.

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Stakeholders Perspectives

• Contracted with subject matter expert -
  International Security Solutions, Inc (ISSI).
• Program Administrators and Staff.
• Clients
• ADAP Contractors, including Pharmacies and ID
  Clinics

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Stakeholders cont

• ADAP Advisory Committee
• ADAP Medical Advisory Committee
• AIDS Service Organizations
• CDPHE Emergency Preparedness Response Staff

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Information Gathered/Facilitated by Contractor

• Focus groups
• Key informant interviews

• Large group meetings
• Reviewed State and Federal guidelines

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Areas explored

• Asked clients what Continuity of Operation
  Planning meant to them. What would happen to
  services in the event of a catastrophe?
• What could be done to ensure a seamless delivery
  of service in the event of a catastrophe?
• Asked administrators how confident are we in
  current state of preparedness.

• Reviewed contract Pharmacies COOPs.
• Buy-in from ASOs. How they might be willing to
  help?
• Volunteer commitment from the community if
  needed.
• Commitment from former/retired staff to volunteer
  service if needed.

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Findings

• Clients wanted to feel safe
• Clients wanted to know how to respond or how ADAP
  would assist them in the event of a catastrophe.
• Administrators wanted to have a system in place
  Clear guidance on how to be prepared and respond.
• Concerns about communcation breakdowns.

• Access to resources.
• Appreciated being asked to participate in this
  process.
• Need to keep this issue in the forefront.
• Ideas for enhancements to the COOP and the
  program.

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Prioritized Essential Functions

• Attempted to establish policy of mission
  essential policy functions.
• Sought clarification on how to direct personnel
  and resources to alternate facilities capable of
  supporting operations.

• Reviewed structure of Program and listed
  components Org Chart
• Examined operations and functions that could be
  performed during an emergency.

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Colorados Essential ADAP Functions

• Intake- Enrollment
• Support of Database
• Procurement
• Ordering /Purchasing Process
• Receiving
• Pharmacy Dispensing
• Shipping Function

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Developed Plan- Document

• Prepared in accordance with direction from
  Presidential Decision Directive 67 and
  subsequent implementing guidance in Federal
  Preparedness Circular 65 dated June 2004.

• Comprehensive and effective COOP
• Memoranda of Agreement
• Document includes references and resources needed
• Incident Command System Overview

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Plan- Document cont

• Published bound hard copy and CD that could be
  changed or modified for essential personnel.
• Included Statewide and Nationwide Resources,
  including health care providers, administrators
  and clients.
• Maps to ADAP Pharmacies (Directions).
• Contact Cards
• References
• Developed Readiness Checklist

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Execution of Plan Practice/Exercise/Pilot

• Contractor conducted a table top exercise.
• Included all ADAP administrators, staff and
  contractors.
• Conducted at all ADAP Facilities.
• Major gaps in plan and program were highlighted.

• Scenarios designed to challenge program staff.
• Unknowns uncovered.

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Lessons Learned

• Vulnerability
• System Disconnect
• Gaps in communication with CDPHE fiscal and IT
• Need for better coordination with CDPHE
  Emergency Preparedness Response Program

• ADAP pharmacies COOPs not in place or
  inconsistent.
• Need regular trainings to keep staff prepared.
• Identified untapped resources and opportunities
  for collaborations.
• Identified limitations of authority.

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Lessons Learned cont

• Need to be respectful, considerate and
  responsive to the varied circumstances of our
  diverse clientele.
• Need to be inclusive in redevelopment and
  planning process.
• Consider all recommendations for enhancements to
  plan and program/update plan every 6 months.

• Continue more in-depth training.
• Communication mechanism need to be strengthened.
• Need to include guidelines about plan in program
  contracts and new employee orientation.
• Respectful of contractors and stakeholders. Fear
  of judgment.

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Contact Information
Thelma Craig, ADAP Coordinator Colorado
Department of Public Health and
Environment Thelma.Craig_at_state.co.us 303-692-2748

Contractor Oz Hill, CEO International Security
Solutions, INC ozhill_at_issisecuritysolutions.com 
678-360-7885
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Check List and Discussion
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Resources

• NASTADs ADAP Emergency Preparedness Guide
• http//nastad.org/Programs/ADAP/
• Washington States Emergency Resource Guide (for
  general public)
• http//www.doh.wa.gov/phepr/default.htm

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Thank you!!!Questions????