Lynn Steele

1
CDC Terrorism Preparedness and Emergency
Response Education Strategy and the CPHP Program

September 22, 2004
Lynn Steele Senior Advisor, Education and
Training Centers for Disease Control and
Prevention Office of Terrorism Preparedness and
Emergency Response
2
Today

• Briefly summarize CDC efforts to coordinate
  education and training activities for terrorism
  preparedness and emergency response current
  status
• Briefly describe needs and education focus of
  State / local terrorism preparedness grantees
• Discuss the Centers for Public Health
  Preparedness program as key asset to contribute
  to education of public health / health workforce
  development

3
Education and Training IncludesAll Hazards
Public Health Preparedness

• Biological Terrorism
• Chemical Terrorism
• Choking agents (phosgene / chlorine)
• Blood agents (cyanides)
• Blister agents (mustard gas)
• Nerve agents (sarin, soman, tabun, etc.)
• Radiation Terrorism
• Dirty bombs
• Food / water supply contamination
• Power plants

4
Terrorism Preparedness / Emergency Response
Education Strategy and Programs

• Improve quality and quantity of public health
  preparedness and response workforce
• Drive toward standards-based programs
• Assure ongoing funding based on performance,
  efficiently applied to avoid duplicative efforts,
  and support for long-term sustainable programs
• Build strong relationships between academic and
  practice partners
• Build on excellent work already complete or
  underway
• Support and nurture flexibility

5
JAMA 2002287898
6
Golden Triangle of Local Health Preparedness
and Response
Local Public Health Agencies
Clinicians and Laboratorians
Healthcare Organizations
JAMA, January, 2002
7
CustomersPeople whose health we can improve
Alliances
Channels
Partners
Stakeholders
Public Health Systems and Communities
Business
Health Care Delivery
FederalAgencies
Education
Coordinating Center for Health Information and
Services
National Center for Health Marketing
National Center for Public Health Informatics
National Center for Health Statistics
Coordinating Center for Environmental Health,
Injury Prevention and Occupational
Health NCEH/ATSDR, NCIPC, NIOSH
Coordinating Center for Infectious
Diseases NCID, NCHSTP, NIP
Coordinating Center for Health
Promotion NCCDPHP, NCBDDD, Genomics
Office of Global Health
Office of Terrorism Preparedness Emergency
Response
Executive Leadership Team
Management Council
Executive Board
Office of Strategy and Innovation
Office of the Chief of Science
Office of the Chief of Public Health Improvement
Office of Workforce and Career Development
Office of the Chief of Staff
Director
Office of the Chief Operating Officer
CDC Washington Office
8
CDC Information Development and Dissemination
Critical Health Information
Communication
Education
Development and dissemination of critical health
information is on a continuum ranging from
delivery of communication messages to delivery of
formal professional education
9

Centers for Disease Control and Prevention
Office of the CDC Director Office of Terrorism
Preparedness Emergency Response

• Initiated Fall 2002 as model coordinating Office
  for all CDC
• Goals
• Provide strategic direction for CDC to support
  preparedness and emergency response efforts
• Distribute resources to support activities
• Ensure systems are in place to monitor
  performance and manage accountability
• Coordinate communication with other federal
  agencies (DHHS, DHS, GAO, etc.)

10
CDC Terrorism Preparedness and Emergency Response
Need for coordination of all CDC programs with
science and/or service of terrorism preparedness
/ emergency response all had education
activities
OC CDC Directors Office of Communication ATSD
R Agency for Toxic Substances Disease
Registry NIOSH National Center for Occupational
Safety Health NCIPC National Center for
Injury Prevention Control NCID National
Center for Infectious Diseases NCEH National
Center for Environmental Health EPO
Epidemiology Program Office NIP National
Immunization Program PHPPO Public Health
Program Practice Office
OTPER
11
CDC Terrorism Preparedness and Emergency Response
Strategic Position
12
Strategic Imperative Support Education Strategy
for Ensuring Competent and Sustainable
Preparedness Workforce

• Critical Objectives Include
• Increase number and types of professionals that
  comprise a preparedness and response workforce
• Deliver certification- and competency-based
  training and education
• Recruit and retain the highest quality workforce
• Evaluate impact of training to assure learning
  has occurred

13
CDC Terrorism Preparedness / Emergency Response
Education

• CDC CDC emergency response
• EIS, emergency deployment, field staff, project
  officers, others developed 22 competencies in 11
  domains for CDC responders for targeted
  education/training
• 2. CDC external partners/organizations
• CDC programs and staff provide education to
  State/local health departments and public health,
  clinician, laboratory audiences
• 3. CDC-funded partners external
  partners / organizations
• State/local BT grantees, Centers for Public
  Health Preparedness, others

14
CDC-Supported TPER Education Programs

• Distance learning offerings
• gt5 million cumulative viewers for terrorism
  preparedness / emergency topics
• Forensic Epidemiology Course
• Model curriculum (developed to be tailored for
  local use) community-based programs educated
  gt5000 since Aug 03
• State and Local Public Health Support
• Education coordination, Focus Area G)
• Centers for Public Health Preparedness
• 23 Schools of Public Health and 19 other
  university-based / academic programs
• Project Public Health Ready
• Pilot projects in local health departments
  emphasis on planning, education, drills/exercises

15
CDC-delivered Preparedness Education and
TrainingPriorities for FY2005

• Support CDC competency-based emergency response
  training
• Identify and fill gaps in web-based preparedness
  information for critical audiences (1 focus on
  clinicians)
• Project and implement national preparedness
  Distance-learning calendar based on S/L grantee
  education needs
• Support CPHP Network activities for development
  and marketing of preparedness education /
  informational compendia (toolkits)

16
CDC Cooperative Agreement for BT Preparedness
and Planning

• Goal
• To upgrade state and local public health
  jurisdictions preparedness for and response to
  bioterrorism, other outbreaks of infectious
  disease, and other public health threats and
  emergencies

17
Education and Training (Focus Area G) 2004
Continuation Guidance

• Critical Capacity
• Ensure delivery of appropriate education to key
  PH professionals, infectious disease specialists,
  emergency department personnel, other health care
  providers
• Benchmark
• Implement training plan that ensures priority
  preparedness education provided across all Focus
  areas to PH workforce, healthcare professionals,
  laboratorians
• Enhanced Capacity
• Provide ongoing systematic evaluation of
  effectiveness of training, and incorporation of
  lessons learned during exercises/drills

18
Education and Training (Focus Area G) Priorities

• Education, appropriately planned and delivered,
  is critical to help demonstrate progress in
  Grantees overall preparedness
• Priorities for Coordination
• 1. Know educational needs and plans across
  content (focus) areas
• 2. Provide assistance with planning based on
  identified needs, priority goals, input from
  other content/focus area leads, and (soon)
  national public health preparedness indicators /
  performance goals
• 3. Ensure progress is being made and planned
  educational programs carried out

19
Summary of Proposed State and Local Grantee
Education and Training, 2003

• Each grantee proposed many training/education
  programs and activities, spread throughout grant
  applications
• Range 10-67
• Mean median 39
• 73 grantees proposed educational activities in
  all content and support areas (Focus areas)
• MANY educational topics proposed based on needed
  competencies of workforce for emergency response

20

• Terrorism Preparedness / Emergency Response
  EducationState and Local Grantee Progress
• Training Needs Assessments Completed
• (May 2004)

21

• Terrorism Preparedness / Emergency Response
  EducationState and Local Grantee Progress
• Developed Training Plans Based on Needs
  Assessments
• (May 2004)

22

• Terrorism Preparedness / Emergency Response
  EducationState and Local Grantee Progress
• Provided Training in All Focus Areas
• (May 2004)

23
Terrorism Preparedness / Emergency Response
EducationState and Local Grantee Progress

• 98 grantees have systems in place to provide
  education and training to medical doctors,
  front-line clinicians and nurses on diagnostic
  information for anthrax, smallpox, plague
• 76 grantees provided front-line clinicians with
  diagnostic information for chemical,
  radiological, nuclear

Thousands of Public Health workers being trained
annually for emergency response gt2000 programs
developed and delivered
24
State and Local Grantee Education and Training
Next Steps

• Coordinate educational planning and programs ---
  a cross-cutting function across all focus areas
• Implement programs based on identified needs
• Maximize use of available local / regional
  educational resources

25

Includes 34 Performance Goals, 46 Measures, 214
References Added Proofs of Performance
(evaluative criteria for each measure) Next
Develop a readiness rating scale based on
26
CDC Next Steps for Measuring Preparedness

• Refine Evidence-based performance goals
• Refine Proofs of Performance, prioritize and
  weight
• Develop CDC-level companion to EBPG
• Self-assessment for grantees
• Develop public health plug-in-play injects for
  universal use in exercises
• Field evaluations of performance starting in 2005
• Continue to clarify roles with DHHS and DHS
• Write new S/L terrorism grant guidance based on
  EBPG new cooperative agreement in July 2005

27
CDC Centers for Public Health Preparedness

• Funded initially in 2000 (n4 Now 35 M annual
  investment)
• Over 250 education programs delivered in 2003
• Success dependent on linkage with state and local
  health agencies
• New 2004 CPHP Program incorporate related
  programs
• Academic Centers for Public Health Preparedness
  (A-CPHP) 23 accredited Schools of
  Public Health
• Specialty Centers for Public Health Preparedness
  (S-CPHP) 19 university-based
  Schools of Medicine, Veterinary Sciences, Nursing
  Schools, etc. funded via congressional earmarks

28
Shared Vision for Centers of Public Health
PreparednessFall 2003

• Define role and contribution to workforce
  readiness focus on preparedness education and
  training
• CPHP work should focus on
• 1) meeting pre-determined community needs
• 2) contributing to national preparedness agenda
  (network)
• All CPHP activities
• Performance-based
• Support public health performance goals /
  indicators
• Contribute to life-long learning
• Option A Readiness training for existing
  workforce
• Option B Graduating students with readiness
  skills

29
Centers for Public Health PreparednessReverse
Site Visits, Feb-Mar 2004

• Scheduled to Inform CDC of Program/Progress
• 21 CPHPs (faculty from Schools of Public Health)
  presented in half-day formats in Atlanta
  accompanied by 93 government public health
  practice partners
• Goals
• 1) Describe progress to date
• 2) Identify common themes, successes, challenges,
  
• 3) Provide input to CDC for future program
  direction inform RFA being developed

30
Centers for Public Health PreparednessReverse
Site Visits, Feb-Mar 2004

• Major Findings
• Ties between state / local public health agencies
  CPHPs strong
• Wide range of specialty areas evolving (e.g.
  mental health preparedness, education evaluation,
  rural preparedness)
• BT/ER Core competencies used as starting point,
  but modification needed
• Standards-based curriculum is needed
  (discipline-specific)
• Credentialing programs being investigated (e.g.
  Public Health Ready Project)
• Certificate programs MPH emphasis on emergency
  preparedness offered

31
Centers of Public Health Preparedness Program2004

• 5-year Program Goals
• Strengthen workforce readiness through programs
  of lifelong learning
• Strengthen capacity at State/local levels for
  terrorism preparedness, emergency response
• Develop network of academic-based programs
  contributing to national TPER strategy by sharing
  resources and expertise
• Program priorities for FY2005
• Maximize outreach of existing educational
  materials
• Build evidence base for effective preparedness
  education

32
Centers of Public Health Preparedness
ProgramParticipants, 2004
Schools of Public Health (n23)

• Pittsburgh
• U South Carolina
• St Louis U
• Tulane
• U AlabamaBirmingham
• UCLA
• U Illinois-Chicago
• UMD New Jersey
• U South Florida
• U North Carolina
• U Texas Houston
• Washington

• SUNY Albany
• UC Berkeley
• Columbia
• Emory
• Harvard
• Iowa
• Johns Hopkins
• Michigan
• Minnesota
• Ohio State
• Oklahoma

33
Centers of Public Health Preparedness
ProgramParticipants, 2004
Other University-based Preparedness Programs
(n19)

• U Miami, Medical School
• Emory, Health Sciences Center
• New York U, School of Medicine
• Iowa State, Veterinary Medicine / Public Health
• N Arizona U, Laboratory / Biological Sciences
• U Findley
• U Georgia, Pharmacy / Medicine
• U Louisville, Public Health
• U Louisville, Law / Medicine
• Georgetown / Johns Hopkins, Law Public Health

Funded by congressional earmark or via other CDC
programs
34
Centers of Public Health Preparedness
ProgramParticipants, 2004

Other University-based Programs - continued

• Kent State, Health Sciences
• Oklahoma, Health Sciences Center
• U Nebraska, Medical Center
• U Pittsburgh, Medical Center
• Burlington Community College
• Monterey Institute International Studies
• Thomas Jefferson University Hospital
• St Louis University, School Public Health
• Vanderbilt University (no CPHP funding)

Funded by congressional earmark or via other CDC
programs
35
Centers of Public Health Preparedness Program2004

• Core Activities
• Develop (if does not exist), deliver, evaluate
  education programs based on needs of community
  public health / heath workforce
• Work with ANY jurisdiction, maximal collaboration
  S/L
• Implement programs for learning, including
• Preparing students, academic programs with
  preparedness focus
• Training current PH / Health workforce for
  preparedness and response, including response
  competencies, skill-building and leadership
• For SPH, core activities to account for 80
  program funds

36
Centers of Public Health Preparedness Program2004

• Network Activities
• Contribute to Resource Center all
  educational/informational materials developed or
  utilized in program activities (minimally)
• Course/ program title
• Learning objectives /or targeted competencies
• Evaluation results
• Ongoing use or delivery of course / materials
• Participate in Exemplar groups other
  collaborative activities to create national
  preparedness resources from existing CPHP
  materials
• For SPH, Network activities to account for 20
  program funds

37
Centers of Public Health Preparedness Program
Network Coordination

• Network Coordinator --- Association of Schools of
  Public Health (ASPH)
• Vital role in helping CDC manage CPHP Network
• Maintain educational Resource Center (ongoing
  updates of programs and utilization)
• Key convener of collaborative (exemplar) groups
  
• Broker for CPHP expertise and services
• Convene representative Consultation Committee
  comprised of CPHP members / Deans

38
Centers of Public Health Preparedness Program
Network Collaboration Activities

• Network Exemplar groups (19 proposed)
• Charge To compile educational toolkits around
  common curricula, courses, informational
  materials
• Convened by Topic areas, key Audiences,
  educational Methods
• Additional short-term Collaboration Activities
  (18 identified)
• Toolkits - compilations comprised of
  comparative descriptions of national preparedness
  resources this year, to be developed from
  existing CPHP materials and programs

39
Centers of Public Health Preparedness
NetworkProposed Exemplar Groups

• Mental preparedness
• Legal preparedness
• Cross-border prepness
• Rural preparedness
• Field Epidemiology
• Environmental prepness
• Incident Command
• Occupational prepness
• Standard discipline-specific prepness educ

• University preparedness
• Leadership preparedness
• Clinician preparedness
• Local PH preparedness tools
• Grad student EIS programs
• Prepness educn evaluation
• PH prep exercises/drills
• PH certification
• Distance-learning prep educ
• Train-trainer for prep educ

40
Centers of Public Health Preparedness Program
Critical Input Needed!

• Exemplar groups process, outputs, timelines
• Standards for discipline-specific preparedness
  curricula
• Clinician preparedness curricula
• Resource Center structure, format, data
  elements to access/assess course materials
• Linking training opportunities to other
  clearinghouses / LMS systems
• Determining need, defining expertise, and
  brokering CPHP
• CPHP contribution to building the pipeline
• Reporting progress, communications, program
  success

41
Terrorism Preparedness Emergency Response
Education Next Steps

• Issue new grant guidance (2005) to state and
  local health agencies -
• Ensure education and training continues to be
  supported
• Plans based on measures, identification of
  training needs, implementation of programs to
  fill gaps
• Institutionalize CPHP program
• Make important resource for CDC and strong
  contributor for implementation of national
  preparedness education strategy

42
Terrorism Preparedness and Emergency Response
EducationStrategic Implementation

• Improve coordination with HHS/ HRSA and DHS
  education and training efforts
• Develop standard-based training guidance and
  program
• Measure / demonstrate impact of training (!)
• Determine long-term funding needed to sustain
  preparedness and response education and training
  programs
• Assure workforce is maintained in state of
  readiness to respond to, contain, and recover
  from public health emergencies (CDC responders
  and external workforce)

43
To contact me LSteele_at_cdc.gov
44
Centers of Public Health Preparedness
NetworkProposed Short-term Collaborations

• Chem / Radiological prep
• GIS for preparedness
• Veterinary prepness
• Inf Dis / BT preparedness
• Cultural competence
• Isolation / quarantine
• SNS / Pharm prepness
• Food / water safety
• Informatics for prepness response

• Clinical lab preparedness
• Nurse preparedness
• 1st responder preparedness
• Media / journalist prepness
• Tribal nations preparedness
• Lessons learned, Israel
• Pediatric preparedness
• Geriatric preparedness
• Measuring cost-effectiveness of preparedness
  education

45
CDC Terrorism Preparedness / Emergency Response
Information and Education Considerations

• Just in case Information needed by frontline
  PH professionals and clinicians to recognize
  illness caused by terrorist agents
• Delivery Ongoing rollout didactic,
  interactive, web-based formats distance learning
• Just in time Information that can be
  immediately accessed by PH professionals and
  clinicians when presented with suspect or known
  persons affected by terrorism events
• Delivery Real-time continuous updates quick
  communication

46
Clinician Preparedness Just in Case
D Content / coordination
Level D
C Educators
Level C
B Clinical Specialists
Level B
A Frontline Clinicians
Level A
47
Just in Time Information
In the event of terrorist act or public health
emergency, information provided by CDC includes

• Guidance for first responders
• Immediate clinical guidance, medical management
• Public health response
• Clinical and reference laboratory protocols
• Basic information for public

48
CDC Emergency Communication System
Teams
6. Community Education 7. Public
Health Workforce 8. Clinicians 9.
Policymakers 10. Research

• 1. Leadership
• 2. Information Mgmt
• 3. Media
• 4. Web
• 5. Hotlines

• Coordination of emergency information ensures
• CDC speaking, responding in one voice in concert
  with DHHS
• Information shared, coordinated, for critical
  stakeholders and channels
• Diverse target audiences served during
  emergency
• Information checked for consistency between
  audiences, over time