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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.

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Vision A Nation of resilient

communities with a competent health workforce prepared to

respond and mitigate all-hazards 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.

http://ncdmph.usuhs.edu

A Center of the

http://ncdmph.usuhs.edu/

Preliminary Research Data

Please do not distribute, quote, or publish. Data may be subject to change.

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Examining Long-Term Community Recovery to Identify Opportunities

for Improved Education and Training: Case Studies from Hurricanes Irene

and Sandy

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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

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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

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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

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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

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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)

13 National Disaster Recovery Framework (NDRF): Federal Register Volume 76, Issue 217 (November 9, 2011)

Observations from the Field and Preliminary Data Analysis

©Photo by Sharon Karr/FEMA

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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

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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

Other N = 6

Total N = 58

Personal family Preparedness ● ● ● ● ● ● ● ● ● ● ● Expected Role ● ● ● ● ● ● ● ● ● ● ● Situational Awareness ● ● ● ● ● ● ● ● ● ● ● Communication ● ● ● ● ● ● ● ● ● ● ● Personal Safety ● ● ● ● ● ● ● ● ● ● ● Surge Assets ● ● ● ● ● ● ● ● ● ● ● Clinical Management ● ● ● ● ● ● ● ● ● ● ● Public Health ● ● ● ● ● ● ● ● ● ● ● Ethical ● ● ● ● ● ● ● ● ● ● ● Legal ● ● ● ● ● ● ● ● ● ● ● Recovery Considerations ● ● ● ● ● ● ● ● ● ● ●

Key: Red = <40%, Yellow = 40-74.9%, Green = >=75% 16

Job Roles with High Levels of Training (Pre-) Emergency Manager N = 5



Fire Chief N = 7

Police Chief N = 3





Other N = 6

Total N = 58



Emergency Manager N = 5



Fire Chief N = 7

Police Chief N = 3





Other N = 6

Total N = 58



Job Roles with Low Levels of Training (Pre-)

High Self-Rated Competency (Pre-) Emergency Manager N = 5



Fire Chief N = 7

Police Chief N = 3





Other N = 6

Total N = 58



Low Self-Rated Competency (Pre-) Emergency Manager N = 5



Fire Chief N = 7

Police Chief N = 3





Other N = 6

Total N = 58



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/ICS Social Media

Personal Preparedness Community Planning

Mental Health Patient Tracking ICS Self-care & Preparedness for HCWs Psychological First Aid

Building Resilience Recovery Stress in Employees

Hospital Emergency Management

ICS ICS/HICS Management & Executive Training Self-care & Preparedness for HCWs

ICS for Elected Officials Working with FEMA Caring for Vulnerable Populations

Fire Drills Planning Technical Training

Personal Preparedness ICS for Elected Officials School-based Preparedness

Police Technical Training Evacuation & Re-entry After Action Reports ICS

ICS 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 Personal Preparedness Inter-org Relationships Working with Local, State, FEMA

Personal Preparedness Personal Recovery Volunteer & Donations Management

Human Services Inter-agency Cooperation - Personal Preparedness Working with State and Federal

Other - ICS for City Housing Asset/Money Allocation

Personal Preparedness Personal Recovery

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Job

Role

Incident Command System Self Organization Community






Personal preparedness Community Planning










Elected Official FEMA Basics Who to Know Prior Planning









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Job

Role

FEMA – Basics, Programs, and Assistance Self Organization Community

























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Job

Role

Preparedness – Personal, Community, and Workplace Self Organization Community

























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Job

Role

Rebuilding and Recovery Self Organization Community

























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Job

Role

Inter-Agency and Private Sector Cooperation Self Organization Community

























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Job

Role

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

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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.

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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

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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

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For further information please contact:

Dr. Kenneth Schor, Acting Director Phone: 240-833-4444 Email: [email protected]

Follow Us: Facebook.com/NCDMPH @NCDMPH LinkedIn ncdmph.usuhs.edu

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