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Integrating All-Hazards Preparedness with Public Health

May 24, 2007

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Emerging Issues in MCH:Integrating MCH into Public Health Preparedness Plans

Using Integrated Public Health Methods to Identify

and Effectively Provide All-Hazards Preparedness

Education to Underserved and High Risk Populations

NACCHO Tele-Conference Conference – 24 May 2007Witold Migala PhD, MPH – Chief Epidemiologist City of Fort Worth Public Health Department

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BACKGROUND

� Health Department is divided into 5 Divisions, including Outreach and Epidemiology/Assessment

� Massive Community Needs Assessment conducted every five years; provides reliable, detailed data

� Diverse metropolitan municipality of over 620,000

� Fertile environment for integrating all hazards and public health by identifying and targeting high risk and/or underserved populations

History of Community Linkage

� Optimize effectiveness of interventions through community collaborations

� Cooperative and supportive relationship with other city departments

� Partnerships with external organizations, including community centers and clinics

� Proven record of effective community integration and cooperation through department’s Outreach Division

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Data Driven Programming

� Mobilizing for Action through Planning and Partnership (MAPP) / NACCHO High Risk Workbook

� GIS Capabilities of Community Needs Assessment Data allows for identification of un-served and underserved high-risk groups (inc. geo-spatial ID)

� Proven Bioterrorism and Health Emergency Preparedness Program (BHEP)

� Culturally and linguistically appropriate service and information modalities

Project Description

� Target Population Reliably Identified Via Community Needs Assessment (3,361 face-to-face surveys conducted in 2003)

� Target Population Identified Geo-Spatially

� Target Population Predominantly Served at Community Clinics; Specifically, the Galvan (“Northside”) Clinic

� Long-term Relationship with Galvan Clinic Established

� Support of Clinic Secured; Central to Target Population

� Outreach Presence and Rapport Established in the Clinic and within the Target Population Area and Community

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Description of Program Development Activities

� Planning Session with Key Partners (05 Oct 06)

� Organizational Focus Group Coordination and Project Development Meeting (16 Nov 06)

� Focus Groups with Community Members Representative of the TargetPopulation conducted to Identify Issues and Preferred Programs (13-28 Dec 06)

� Data used to incorporate providers to represent identified health and social service issues at a “Kickoff Community Luncheon” (08 Feb 07); 289 / 57

� Follow-up Telephone survey with representative sample of participants held (24-27 Apr 07)

� Developed Preferred Modalities for Service Delivery (Preparedness/Health Education)

� Pre/Post-Evaluation Planned for final “Community Appreciation” event (19 May 07)

Supporting Activities

� Analyses Conducted by Grantee Epidemiologists to Design, Direct and Redirect Program

� Clinical Personnel Training

� Outreach Assisted Liaison and Linkage to Secure Other Services as Needed by Participants

� Kick-Off and Culmination / Summit Events

� Quarterly and Final Reports

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Results of Community Service Needs Survey

� Health insurance 42.6% 66% Cannot Afford / 27% Not Aware of Availability

� English as a second language34.7% 70% Not Aware of Availability

� Children health care 29.7% 60% Cannot Afford

� Employment 20.8% 60% Not Aware of Availability

� Children immunizations 17.8% 44% Cannot Find Service / 39% Cannot Afford Service

� Physical fitness resources 17.8% 88% Not Aware of Availability

� Children Edu. programs 16.8% 86% Not Aware of Availability

� Care for chronic cond. 15.8% 46% Cannot Afford / 46% Not Aware of Availability

� Activities for children 15.8% 77% Not Aware of Availability

� Banking services 13.9% 64% Not Aware of Availability

� Prenatal care 12.9% 55% Cannot Find Service / 36% Cannot Afford Service

� Maternal care 11.9% 64% Are Not Aware of Availability

� Other: Dental services, flu shots, mental health services, and transportation services

Follow-Up Phone Survey to Kick-Off Event

� 88.5 percent were administered in Spanish and 11.5 percent were in English

� 100% of respondents reported enjoying the event.

� 92.0 % expressed information received in the event was useful for them or for their family members

� 84.3 % reported they received the services they needed.

� 76.0 % of the respondents indicated they received information about services they did not know were available or existed.

� 67.3 % of respondents stated having received information on emergency preparedness.

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Appreciation Luncheon Service Providers

19 May 2007 – Rosen Heights Baptist Church� Albert Galvan Health Clinic (Major partner)

� Rosen Heights Baptist Church (Provided facilities for events)� Fort Worth Public Health Bioterrorism and Health emergency Preparedness Program� Fort Worth Public Health Public Health Outreach (including “Hotshots” program)

� University of North Texas Health Science Center – School of Public Health� Communities in Schools

� Sam Rosen Elementary School (Distributed Announcements to students for parents)� All Saint’s Catholic Church (Distributed Announcements to Parishioners)

� Northside Inter-Church Agency, (NICA) � Fort Worth Police Crime Prevention

� Fort Worth Code Compliance� Fort Worth Public Libraries

� Wells Fargo Bank � State Farm Insurance

� “Coming Up Club” (to assist people to get out of gangs)� Neighborhood Housing Services of North Texas

� Aetna (Insurance services)� Safe Haven

� Prevent Blindness� Nurse Finders (for diabetic home health care)

� Early Childhood Matters� The Welcome Table (distributes flyers and information on other services)

� South Texas Dental� Unity One Federal Credit Union

� Harris Hospital� Casa Del Inmigrante Fort Worth

� Boys & Girls Club� The T (Fort Worth Public Transportation)

� Latin Arts Association of Fort Worth� Child Care Associates

� Pan Flu, Chronic Disease and ACT (Tarrant County Public Health)� United Community Centers

� Workforce Solutions

Conclusions� Results Suggest Data Driven Project Specifically Identifies and

Targets Appropriate Participants

� Multi-Disciplinary Planning, Development and Implementation Integral to Success

� Multi-Dimensional Modes of Presentation / Incentives and Trusted Rapport with Health and Social Service Providers Promote Success

� Synergistic Benefit (Overall Health / Emergency Preparedness)

� Pilot Program Can Be Replicated Based on Practices as Demonstrated by Program and Supported by Evaluation Process

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Contact Information

Witold Migala PhD, MPH Chief Epidemiologist, City of Fort Worth

1800 University Drive, Suite 217Fort Worth, Texas 76107

Ofc: 817-871-6209Cell: 817-991-0652

Fax: 817-871-6240

E-mail: witold.migala@fortworthgov.org

Thank you!

Public Health Preparedness and Epidemiology

Montgomery County Health Department

Leisa Prasser R.N.Public Health Preparedness Coordinator

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Background

� Unusual outbreak of Campylobacteriosis in small Montgomery County town February/March 2006

� Need for more knowledge within Health Department about Epidemiology

� Realization that small understaffed Health Department could not do it all!

� Lessons Learned—NACCHO grant allowed implementation of improvements

Timeline2006 5/31 Start of Grant

6/28,29 First Epi Training for Health Dept. Staff

7/11,12 First Epi Training for Health Dept. Staff

7/18 Partner Meeting8/16 Start of Course for Certificate in Field Epi

11/14 TTX Initial Planning Conference (IPC)

12/7 TTX Final Planning Conference (FPC)

12/11 TTX Invitations sent out

20072/13 Original TTX Date—cancelled due to blizzard!

3/19 TTX Happens!

4/13 After Action Conference (AAC)

4/30 After Action Report (AAR) released

5/31 Community Brochure scheduled to come out by this date

11/1 Second Epi Training for Health Dept. Staff

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� July 18, 2006� Agencies present:

� Montgomery County Health Department� Indiana State Department of Health� Montgomery County Board of Health� St. Clare Medical Center� Crawfordsville Fire Department� Crawfordsville Police Department� Montgomery County Sheriff� County Crisis Team� Crawfordsville School Corporation� South Montgomery School Corporation� Wabash College� Christian Nursing Service� Red Cross� Local Emergency Planning Committee (LEPC)� Emergency Management Agency (EMA)*

Health Department Partner Meeting

� Health Department Staff� Epi-Ready Foodborne Illness Response Strategies Workshop by ISDH

� June 28-29 and July 11-12, 2006� Improvement measured by pre- and post-test

� Outbreak Investigation Presentation by Steve Allen, ISDH Field Epidemiologist on November 1, 2006

� Public Health Preparedness Coordinator� Certificate in Field Epidemiology from the UNC School of Public Health (measured by course grade)

� Focus on Field Epidemiology, Volumes 1 – 4 (issue 2) from UNC School of Public Health

Epidemiology Training

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� Using HSEEP (Homeland Security Exercise and Evaluation Program)

� Initial Planning Conference on November 14, 2006� Agencies Represented:

� Crawfordsville Fire Department (Chief)� Crawfordsville Police Department (Assistant Chief)

� St. Clare Infection Control Nurse� Montgomery County Health Department (Public Health Preparedness Coordinator)

� Local Emergency Planning Committee (LEPC Chair)

Tabletop Exercise

Tabletop Exercise

� Final Planning Conference on December 7, 2006� Agencies Represented:

� Crawfordsville Fire Department (Chief)

� Crawfordsville Police Department (Assistant Chief)

� St. Clare Infection Control Nurse

� Montgomery County Health Department (Public Health Preparedness Coordinator)

� Local Emergency Planning Committee

(LEPC Chair)

� Crawfordsville School Corp. (Superintendent)

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Initial and Final Planning Conferences

Shari Harrington, Sanitarian for Health Dept.and LEPC Chairperson

Leisa Prasser R.N., Public Health Preparednessfor Health Dept.

Dr. Kathy Steele, Crawfordsville School Corporation,Superintendent

Hal Utterback, Crawfordsville Police, Assistant Chief

Tabletop Exercise

� Scenario

The exercise scenario involved two different components:

� Chemical Spill of Anhydrous Ammonia (to satisfy LEPC and EMA requirements)

� Intentional Contamination of Water Source for Small Town by Local Area High School Students

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Tabletop Exercise

Agencies Playing� Montgomery County Health

Department

� Indiana State Department of Health

� Montgomery County Board of Health

� St. Clare Medical Center

� EMS

� Crawfordsville Fire Department

� Volunteer Fire Departments

� Crawfordsville Police

� Montgomery County Sheriff

� County Crisis Team

� Crawfordsville School Corporation

� North Montgomery School Corporation

� Wabash College

� Montgomery County EMA

� Montgomery County LEPC

� Red Cross

Media was present!

Tabletop Exercise

Controllers

� Dr. Pat Badt, Cass County Health Department

� Pat Boardman R.N., Infection Control, Greater Lafayette Health Services

� Gordon Cochran, White County EMA Director

� Rodney Wann, Clinton County Health Department

� Tilara Treece, Tippecanoe County Health Department

Evaluators

� Ken Woodall, Indiana Department of Homeland Security

� Linda Pagels R.N., White County Health Department

� Vicky Snipes, Logansport Memorial Hospital

� Justin Darling, Carroll County EMA Director

� Fred Martin DVM, Fountain-Warren County Health Department

� Greg Robison, Fountain-Warren County Health Department

Controllers and Evaluators were brought in from out of county.

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Tabletop Exercise

Tabletop Exercise

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Tabletop After Action Conference

� Held on April 13, 2007

� Draft After Action Report

� Discussed Lessons Learned

� Talked about Improvement Plan

� Representative present from:

County Crisis Team, Crawfordsville School Corporation, Wabash College, Montgomery County Health Department, Board of Health, Indiana State Department of Health, Sheriff, EMA, LEPC, Crawfordsville Fire, EMS, St. Clare Medical Center, Indiana Department of Homeland Security

Tabletop After Action Report

Homeland SecurityExercise and Evaluation Program

Montgomery County Health DepartmentTabletopAFTER ACTION REPORTApril 30, 2007

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BrochureMontgomery County

Health Department

Preparing for a Healthy Community

Due out by end of May 2007

Great Quote!

“Public Health was and is where the largest numbers of lives are saved, usually by understanding the epidemiology of a disease—its patterns, where and how it emerges and spreads—and attacking it at its weak points.”

John BarryThe Great Influenza

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Using GIS Technology to Integrate Preparedness and Core Public Health Functions

Kathy Colville, MSW, MSPHCarl Carroll, RS, MBA

Alamance County Health DepartmentBurlington, NC

Think of each point as a light bulb that will “light up” when you query your map.

GIS is somewhat like a thumbtack map.

You can link each point on your GIS map to a database that contains information about that point.

Then you can “query” your map just like you would query a database, and look for points that match the criteria you seek.

GIS (Geographic Information System) allows us to visually display multiple layers of data and analyze trends in those data.

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Preterm Births, Alamance County, NC,

2005-2006

Which of these……are Health Department patients?

GIS is also like an overhead projector with multiple transparencies.

You can analyze the relationships and distances between objects in different layers to see how they are related to each other.

In GIS, multiple layers come together to form one map.

Lung Cancer Mortality Map from GIS Tutorial for Health, Kurland K and Gorr W

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Lung Cancer Mortality Maps from GIS Tutorial for Health, Kurland K and Gorr W

Mobile GIS allows you to take GIS into the field with you.

Using a GPS-card in a

handheld computer

equipped with GIS software,

you can link data collected in the field to the exact location where you collected them.

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Why Do a Rapid Needs Assessment?

• Provide objective data from a random sample– rumor control, squeaky wheel

• Augment/confirm information from other sources– trees are down, power’s out

• Identify unanticipated needs and risks– food, water, access to medical care, carbon monoxide

• Define the magnitude of the need– population estimates

• Provide information to influence response– The “R” in RNA

Hurricane Wilma Response November 2005

Hurricane Wilma Response November 2005

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Preparing the handhelds for deployment

Interviewing

Downloading the data

210 Surveys Collected in Northeastern Broward Count y

• Approximately forty-five thousand (12.3%) household s reported not having access to a 3-days supply of food.

• Of the estimated 66,038 households with no electric ity, 30.9% were using generators. Of these households, 88.1% had no working carbon monox ide monitor.

• Of those households with a child under two years of age, 43.0% did not have access to a 3-day supply of diapers and/or formula.

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Community Health Assessment

Mobile GIS application

2-Step Randomization Process

7 randomly chosen sites within

30 randomly chosen census blocks

210 surveys provide a representative sample of county population of 140,000

Preparedness exercise combined with core public health function of assessment

Community Health Assessment

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Community Health Assessment

Top Five Health Priorities

Diabetes HIV/AIDSTop Five Social Issues

Not Enough Money to Pay Bills Youth Violence Access to Legal System

Preparedness Applications of GIS

Risk Assessment for Schools and Child Care Centers

Within 1 mile of TRI Sites Within 1 mile of Railroad tracks

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Preparedness Applications of GIS

Population Assessment for SNS PODs

Population DensityLatino Population Density

Elderly Population Density

Preparedness Applications of GIS

Orthophotography Assists in POD Planning

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Maternal and Infant Health and GIS

African American population density

Maternal and Infant Health and GIS

Community Assets—Places of Worship

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Environmental Health AssessmentDiagnose and investigate health problems and health hazards in the community

AssuranceEnforce Environmental Laws and Protect Public Health

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Next Steps

Integrate use of Mobile GIS into everyday Health Department activities

- Environmental Health Inspection forms on handhelds and mapping of inspected facilities

- Mapping of wells, onsite wastewater systems

- Communicable Disease forms for rapid deployment in an outbreak

Special Mapping Projects– Disparities analysis such as

multi-county prostate cancer mortality mapping

– Mapping of all birth and death records

NACCHO Public Health Preparedness Integration Project

Project 516 from NC Public Health Regional Surveillance Team 5

Children’s Environmental Health Initiative, Nicholas School of the Environment at Duke University

Center for GIScience and Health, University of North Carolina at Greensboro

Thank You…

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Zerlyn Ladua, RN, FNP, MSN,Bioterrorism/Public Health Emergency Preparedness Coordinator

When: May 24, 2007

Where: NACCHO Webinar

WHACK

the

Flu

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WHACK THE FLU

� Community Outreach/Education

� Focus on Schools and Families

� Reduce transmission of communicable diseases

by teaching hand washing

� Recruit Community Volunteers

� Originally the focus on Children K-2

“WHACK” the Flu

� 5 basic CDC prescribed hygiene tips can help

� W – wash your hands often

� H – home is where you stay when sick

� A – avoid touching nose, mouth or eyes

� C – cover your coughs and sneezes

� K – keep your distance from people

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Phases of the WHACK the Flu

Program

� Phase 1: Presentation to school superintendents.

� Phase 2: Material preparation completed in

English only.

� Phase 3: Recruited and trained volunteers.

� Phase 4: Classroom and site visits

� Phase 5: Evaluation; data collection ongoing

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Community Outreach

First Community Outreach

Program

was a Health Fair

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Partners

� Partnered with Albany Unified School District >1000 flyers went out in the school information packets

� Partnered with the Albany High School

Advanced Placement Chemistry Club who

served as volunteers

� Partnered with local business for donations

� Partnered with Albany Police Department

� Partnered with Albany Fire Department

Albany Unified School District Event

School Health Faire 9-30-06

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Challenges

� Scheduling: Initially, we planned on classroom demonstrations

� Our second school district had a city population of >210,000.

� We were told by the district superintendent to contact the elementary school principals directly

� The elementary school principals told us to contact the teachers directly

� Things went back and forth

� We decided to offer hand washing instructions during lunch.

Challenges

� Lunch time demonstrations worked well, for the elementary school, but not for the Advanced Placement Chemistry student volunteers.

� We were able to do >2000 students with lunchtime presentations and a part-time staff of 3

� We tried to roll out the program to another large school district. This time offering both lunch time presentations and classrooms presentations. Right before the roll out, the teachers went on strike for the first time in over a decade.

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Adaptations to the Program

� Scheduling: We are beginning scheduling now.

� Volunteers: We are negotiating with nursing

schools to become our volunteers.

� Contracts: 5 of our school districts have

applied for emergency preparedness grants.

We added 3 components1. Absentee data

2. Communication

3. Implementation of WHACK the Flu

Expansion of the Program

� I have been contacted by 2 different counties who would like to duplicate the program

� Many counties are working on similar projects with funding from their pandemic influenza grants

� We are looking into producing a video for schools aged children to be shown at school assemblies.

� We are looking into translating our materials

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THANKS

Type your question into the “Questions” boxlocated on the lower left side of your screen. Be

sure to click “send” to submit your question.

Questions & Answers

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