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					Progress in Public Health Workforce Development:
         Maine and Massachusetts


       A-CPHP reverse site visit presentation
                March 10, 2004
                     Overview
I.    HSPH-CPHP Strengths and Vision

II.   Challenges and Partnerships in Preparing the Public
      Health Workforce

III. Maine: HSPH-CPHP Contributions

IV. Massachusetts: HSPH-CPHP Contributions

V.    National and International HSPH-CPHP Contributions

VI. Evaluation and Future Directions for HSPH-CPHP


2
        HSPH-CPHP Investigators


          Howard Koh, MD, MPH, Director

      Leonard Marcus, PhD, Associate Director

    Paul Campbell, MPA, ScD, Rural Preparedness

        Jennifer Leaning, MD, SMH, Science

              Jon Burstein, MD, Science

       Gilbert Nick, Administration and Training
3
     HSPH-CPHP Investigators


      Robert Blendon, ScD, Public Health Polling

    Deborah Prothrow-Stith, MD, Founding Director

         Marcia Testa, PhD, MPH, Evaluation

     Christie Hager, JD, MPH, Public Health Law

         Gary Moore, PhD, Distance Learning

         Barry Dorn, MD, Local Public Health

             Paul Biddinger, MD, Science

4
                    State Partners


    MAINE:
       • Steven Trockman, MPH,CHES, Coordinator,
         Office of Public Health Emergency
         Preparedness, Maine Bureau of Health




    MASSACHUSETTS:
       • Suzanne Condon, MS, Associate
         Commissioner and Director, Center for
         Emergency Preparedness, Massachusetts
         Department of Public Health




5
        HSPH-CPHP Strengths and Vision


    State
    Responds to the needs of two very different states
    (Maine and Massachusetts)



    National and International
    Serves as a catalyst for national and international
    advances in preparedness

6
              HSPH-CPHP Responds to
                Different State Needs
         MAINE                        MASSACHUSETTS

    Provision of expertise       Coordination of education and training



                              Needs assessments
                              Educational curricula
                              Train-the-Trainer
                       Distance learning methodology
                           Web-based resources

             Coordination of Harvard-based scientific expertise

        Local coordination in the absence of regional health systems

7
      I. HSPH-CPHP Strengths and Vision
           International and National
    – International Disaster Management / International
      Relationships

    – National Preparedness Leadership Initiative

    – Connectivity and Conflict Resolution

    – Public Health Polling

    – Rural Preparedness

    – Public Health Law

    – Evaluation Methodologies


8
                        Overview
    I.    HSPH-CPHP Strengths and Vision

    II.   Challenges and Partnerships in Preparing the Public
          Health Workforce

    III. Maine: HSPH-CPHP Contributions

    IV. Massachusetts: HSPH-CPHP Contributions

    V.    National and International HSPH-CPHP Contributions

    VI. Evaluation and Future Directions for HSPH-CPHP


9
     II. 1. International Challenges in
                Preparedness




10
     International Challenges in Preparedness
                   Strategic Level

      – Vast differences in capacities across
        jurisdictions
      – No common analytic or operational
        approach
      – Political divides and suspicions
      – Familiarity with humanitarian model of
        assistance, not disaster model of Incident
        Command System and Mutual Aid

11
     International Challenges in Preparedness
                   Tactical Level

     – Familiarity with international expert teams
     – Threat assessment increasingly defined
       and communicated within shared analytic
       model
     – Military plays larger role in all hazard
       response as well as in mass catastrophes

Model of Israel offers instructive example

12
     International Challenges in Preparedness
           HSPH-CPHP Meetings in Israel




13
     International Challenges in Preparedness
           HSPH-CPHP Meetings in Israel
                       September 29-October 4, 2002
                         January 21-January 28, 2003
       Joseph M. Henderson                                                          Von E. Roebuck
     CDC Associate Director for Terrorism                              Director, Office of Health Communications, CDC
         Preparedness and Response



                       February 13-February 19, 2004
           Joseph M. Henderson                                                        Edgar Thompson
        CDC Associate Director for Terrorism                                           CDC Deputy Director,
            Preparedness and Response                                                  Office of the Director

                    Don Noah                                                                Dori Reissman
 Department of Defense Liaison to the CDC, OTPER                      CDC Special Advisor, Preparedness and Mental Health, OTPER


                                                      Shah Roohi
                                    CDC Special Advisor on International Relations, OTPER
14
     International Challenges in Preparedness
           HSPH-CPHP Meetings in Israel

                 REPORT ISSUED:

     “ISRAEL’S PREPAREDNESS FOR RESPONDING
          TO THE HEALTH REQUIREMENTS
            OF ITS CIVILIAN POPULATION
         IN THE EVENT OF DEPLOYMENT OF
       A NUCLEAR, BIOLOGICAL OR CHEMICAL
          WEAPON OF MASS DESTRUCTION”


                   October 28, 2002
15
     International Challenges in Preparedness
          HSPH-CPHP Meetings in Israel

                     ISRAEL 2002 IMPACT
                 REPORT EXECUTIVE SUMMARY

     “There is a fundamental distinction between
     preparedness in Israel and in the United States.
     Israelis approach the task in a pragmatic, results
     oriented manner. They apply current resources and
     time to assess current system capabilities and to
     determine whether those capabilities correspond to
     the current threat.

     By contrast, “preparedness” has a diffuse quality in
     the United States. Public health leaders are
     ambivalent if not resistant to responding to
     bioterrorism as a substantial threat.”
16
                  ISRAEL 2004: THE OUTCOMES

                       U.S. National Pharmaceutical Stockpile




   Decision                                 Transport                  In the Body   ?
                        Israel National Pharmaceutical Stockpile
                              Ashkelon         Decision to vaccinate
                            Shalom School
                               Class 7         Move to classrooms: 24 hrs
                                               Vaccinations: 7,500 per school
Pallette with smallpox vaccine
 17
                                               Whole country vaccinated: 4 days
        and equipment
             II. 2. National Challenges


     – Coordination between multiple federal
       agencies and state assets

     – Size and diversity of the U.S. population

     – Coordinating needs in workforce
       development and services for the public


18
      Professor Robert Blendon,
     HSPH-CPHP Co-Investigator




19
     Data to Address National Challenges:
       Public Opinion Polling/Surveying

• During an epidemic, public
  officials need to know
  peoples’ behavior, beliefs
  and information sources.

• Polling provides practical
  information of immediate
  importance (within 3-5
  days) to policymakers
  during an epidemic.


20
  Example of HSPH-CPHP Public Opinion Polling –
National Need to Educate the Public Health Workforce

• Public Attitudes About the Threat of a Smallpox
• Attack A survey of 3,011 adults <18 or older (2003)

     – Most Americans (84%) were confident that their
       doctors could recognize smallpox symptoms.

     – Most Americans (83%) would initially seek help from
       their own doctor or medical clinic.




21
     Anticipating Public Interest in Vaccination




22
     II. 3. State and Local Challenges and the
             New Public Health Workforce
     – Nascent national
       standards for
       preparedness

     – Counties/towns all at
       different stages of
       preparedness

     – Does the state have an
       existing county or
       regional health system?


23
      HSPH–CPHP Framework for Workforce
               Development
• Identify resources and partners

• Integrate evolving national standards into workforce development
     process


               – CDC and Columbia core competencies

               – Curriculum (according 9 core content areas as based on The
                 National Bioterrorism Training Plan)

               – ASPH - Academic Center Framework Document


• Select best-fit training modality for each target audience, based on
     needs assessment

• Deliver training and evaluate
24
     The “New” Public Health Workforce




             Police    Local      Local
                       Public     Government
                       Health
                                             Federal and
      Fire                                   State


                                  Academic
             EMS      Hospitals



25
     Partnerships in the New Public Health
                  Workforce
                               International
                               Tel Aviv University

                             Federal/National
               Association of State and Territorial Health Officials
                     Association of Schools of Public Health
                   Department of Health and Human Services
                     Centers for Disease Control and Prevention
           National Association of State and City and County Officials

                                 Regional
     American Society for Microbiology, Region I (Branches: Northeast, New
            York City, Eastern New York, Connecticut Valley, Eastern
                                  Pennsylvania)
                        Maine Center for Public Health
        New England Alliance for Public Health Workforce Development
      New England Coalition for Health Promotion and Disease Prevention

26
         HSPH-CPHP Partnerships in Action




     From left to right: Dr. Anita Barry, Boston Public Health Commission, Dr.
     Robert Blendon, Harvard School of Public Health, Dr. Dora Mills, Maine
27   Bureau of Health, Dean Barry Bloom, Harvard School of Public Health
     HSPH-CPHP Partnerships in Action




     From left to right: Drs. Deborah Prothrow-Stith and Leonard Marcus,
     Harvard School of Public of Health Center for Public Health Preparedness,
28   Dr. Alfred DeMaria, Massachusetts Department of Public Health
     Partnerships in the New Public Health
                   Workforce
                                State
                       Maine Bureau of Health
              Massachusetts Department of Public Health
             Massachusetts Emergency Management Agency
               Massachusetts Health Officers Association
                Massachusetts Public Health Association
                                Local
                    Boston Public Health Commission
               Massachusetts Association of Health Boards
        Needham Health Department – Project Public Health Ready
        Wellesley Health Department – Project Public Health Ready
                             Academic
                           Columbia University
                 John F. Kennedy School of Government
                        Louisiana State University
                  University of California at Los Angeles
                 University of Massachusetts at Amherst
29
                      University of Texas-Houston
       Local Challenges
     Massachusetts & Maine




30
                      Massachusetts & Maine:
                      Demographic Differences

                          Massachusetts                      Maine
      Population                 6.4M                          1.3M

      Population       Land Area: 8,000 sq. miles   Land Area: 31,000 sq. miles
       density
                       810 persons per sq. mile       41 persons per sq. mile
      Cities and                  351                          492
        towns
        Regional                 None                          None
         health
     Infrastructure
     Demography        More diverse: 84% White,     Less diverse: 97% White, 3%
                       5% Black, 4 % Asian, 7%         Black, Asian, Latino,
                                Latino,                      and other
                               6% other
31
               Massachusetts and Maine
                Workforce Differences
               Massachusetts   Maine
Health Dept.       3,000        365
Staff



MD, PA,           122,000      25,500
Nurses             (est.)       (est.)




Acute Care          74           44
Hospitals




32
          Massachusetts & Maine:
             Different Needs


                     MAINE
             Provision of expertise


              MASSACHUSETTS
     Coordination of education and training




33
                     Overview
I.    HSPH-CPHP Strengths and Vision

II.   Challenges and Partnerships in Preparing the Public
      Health Workforce

III. Maine: HSPH-CPHP Contributions

IV. Massachusetts: HSPH-CPHP Contributions

V.    National and International HSPH-CPHP Contributions

VI. Evaluation and Future Directions for HSPH-CPHP


34
     III. Maine




35
     III. Maine: HSPH-CPHP Contributions

1.   Strategic Planning and Partnership Building

2.   Training Needs Assessment and Evaluation

3.   Curriculum Development and Provision of Training

4.   Satellite Broadcast Development

5.   Train-the-Trainer Program and Evaluation

6.   Web-based Treatment Protocols

7.   Impact on Maine


36
      III. 1. Strategic Planning and
            Partnership Building




     HSPH-CPHP                 Maine




37
      III. 1. HSPH – CPHP Partnership




            Harvard
                                      Maine
     School of Public Health
                                  Bureau of Health


                          Maine
                        Center for
                       Public Health




38
     III. 1. Examples of Maine Partnership
                    Projects
• Prevention Research Center
  (CDC, Tobacco Settlement)

• Public Health Preparedness
  (CDC, HRSA)

• Public Health Training Center
  (HRSA)




39
     III. 2. Training Needs Assessment and
                     Evaluation

            Columbia SPH Competency Criteria



     Needs Assessment for Core Bureau of Health Staff



         Needs Assessments for Other Audiences




40
      III. 2. Training Needs Assessment and
                      Evaluation
• Logic Model Development:

     – Overall Emergency Preparedness

     – Response

     – Detection

     – Communication

     – Training

• Needs Assessment for other audiences (all public health workers,
  hospital workforce, primary care workforce, first responders, key
  community individuals and organizations)

41
           III. 3. Curriculum Development

• Surveillance                   • Incident Command System
• Smallpox
                                 • Training Facilitation
• Public Health Law and Policy
                                 • Syndromic Surveillance
• Risk Communication
                                 • Biological Toxins as Weapons
• Connectivity & Leadership




42
     III. 3. Curriculum Development and
              Provision of Training
• Video Conference
  Maine Bureau of Health
  Core Team



• Face-to-Face
   – Maine Osteopathic
     Association
   – Maine Primary Care
     Association


43
     III. 4. Satellite Broadcast - May 2003

                 Augusta Studio



          11 Downlink Sites across Maine




            Over 200 Total Participants
                (Multidisciplinary)

44
         III. 5. Train-the-Trainer Program and
                         Evaluation
• HSPH-CPHP developing curriculum for 12 modules:
     –   Emergency Preparedness
     –   Hospital Emergency Incident Command System
     –   Surveillance & Epidemiology
     –   Communications Equipment
     –   Legal Issues
     –   Risk Communication
     –   Personal Protective Equipment
     –   Population Movement
     –   Introduction to Weapons of Mass Destruction (WMD)
     –   Advanced WMD: Biological
     –   Advanced WMD: Chemical
     –   Advanced WMD: Nuclear & Bombs


45
     III. 5. Train-the-Trainer Program and
                     Evaluation


                Feedback Loop
                    Trainer


     Managers                   Trainees


                  Evaluators


46
             III. 6. HPSH-CPHP Web-Based
                    Treatment Protocols
     Purpose: Provide up-to-date,
     accurate information on
     Category A and B Agent
     Treatment Protocols to Maine
     clinicians

• HSPH-CPHP Contributions
   – Identification
   – Access
   – Quality Assurance




47
         III. 7. Examples of IMPACT in Maine:
           Systems Change & Infrastructure
     •    Conceptualization and assistance in hiring public health
          emergency preparedness staff
         – Regional Epidemiologists
         – Laboratory personnel
         – Medical Toxicologist (Medical Director)

     •    Identification and development of resources
         – Logic modeling

     •    Education and training
         – Needs assessments
         – Training delivery and evaluation

     •   Academic and technical expertise

48
49
          III. 7. Examples of IMPACT in Maine:
           New Sweden Arsenic Poisoning, 2003


     •   Connectivity
     •   Catch
     •   Contain
     •   Control
     •   Communication


50
      III. 7. Examples of IMPACT in Maine:
     New Sweden Arsenic Poisoning, 2003




51
                        Overview
     I.    HSPH-CPHP Strengths and Vision

     II.   Challenges and Partnerships in Preparing the Public
           Health Workforce

     III. Maine: HSPH-CPHP Contributions

     IV. Massachusetts: HSPH-CPHP Contributions

     V.    National and International HSPH-CPHP Contributions

     VI. Evaluation and Future Directions for HSPH-CPHP


52
     IV. Massachusetts




53
         IV. Massachusetts: HSPH-CPHP
                  Contributions
 1.   Needs Assessment and Strategic Planning

 2.   Statewide Coordination

 3.   Curriculum Development

 4.   Training Products

 5.   Targeted Trainings

 6.   Public Health Ready

 7.
54    Impact on Massachusetts
         IV. 1. Needs Assessment and
                 Strategic Planning
• Assisted in accelerating the needs assessment
  process

• Supported the Massachusetts Department of Public
  Health in determining appropriate evaluation
  strategies

• Provided consultation in determining criteria for
  needs


55
        IV. 1. Needs Assessment and
                Strategic Planning
• Support
  Regionalization

• Promote Connectivity

• Coordination of
  Education and Training
  (statewide advisory
  group)


56
     IV. 1. Support Regionalization




57
             IV. 1. Promoting Connectivity


                “CONNECTIVITY”
A seamless web of
      people, organizations, resources, & information
                      that can best
     catch, contain, and control
                              a bioterrorist incident

58
               IV. 1. Promoting Connectivity


            “CONNECTIVITY”
A seamless web of     Linkages
      people, organizations, resources, & information
     Operations       that can best
                                     Assets
     catch, contain, and control
          Decisions           a bioterrorist incident

59
      IV. 1. Promoting Connectivity


          “CONNECTIVITY”
Symptoms of         Linkages
conflict         not in place
  Operations          Assets
    impeded         not ready
      Decisions   Lousy
60
                IV. 2. Statewide Coordination

     •   Help establish statewide workgroups:
          – Curriculum Workgroup
          – Bioterrorism Advisory Group
          – Needs Assessment

     •   Links to :
          – Conference of Boston Teaching Hospitals (especially on Surge
            Capacities)
          – Boston Public Health Commission
          – Massachusetts Public Health Association
          – Education and training for Massachusetts Association of Health
            Boards

     •   Integration of Project Public Health Ready into Massachusetts
         communities (Needham, Wellesley)

     •   Integration of Harvard University resources
          – New England Regional Center for Excellence for Biodefense and
             Emerging Infectious Disease Research
61        – Scientific Advisory Council and other faculty
         IV. 3. Curriculum Development

• Provide materials and resources
• Develop education and training to match standards based
  on national models
• Help identify core competencies and the organization of a
  training framework
   – CDC and Columbia model shared by HSPH-CPHP
   – HSPH-CPHP works with MDPH to tie competencies to
      overall training
   – ACEP NBC Taskforce interpreted by HSPH-CPHP


62
         IV. 4. Training Products – Satellite
                      Broadcasts
• Responded to direct request from the Massachusetts Department of
  Public Health

• Development of satellite broadcasts (script, production, staffing,
  education materials, facilitator training and re-purposing)

     – National (“Lessons Learned from SARS, Anthrax and West Nile
       Virus”, May 2003)

     – Massachusetts (“Connectivity and Incident Command System”, July
       2003)

     – Massachusetts (“Isolation and Quarantine”, March 2004)


63
        IV. 4. Rationale for Locally-Led
          Satellite Broadcast Training
• Methodology successfully used to train over 15,000
  people in violence prevention across the U.S.

• Local leaders trained to provide expertise & leadership
  to public health workforce within their communities and
  become a resource for:

         – Training needs assessments

         – Developing an action plan

         – Local activities and projects

         – Evaluation of broadcasts
64
               Liz Walker
     HSPH-CPHP Satellite Broadcast Host




65
     Locally-led Satellite Broadcast Training
           Massachusetts - July, 2003

      – ICS, Emergency Preparedness and Connectivity for about 700
        Massachusetts public health workforce

      – Facilitated exercise on Plague

      – Each board of health (351) received a copy of the broadcast for
        training purposes




66
     Evaluation of Massachusetts Satellite
         Broadcast July, 2003 (N=615)

      • Overall impression is positive (72%)

      • Respondents felt objectives were
        somewhat or fully achieved (95%)


      • I learned something new (64%)


      • Interested in future broadcasts (75%)

67
                 IV. 5. Targeted Trainings

     – Smallpox for First Responders

     – Key issues in All-Hazards Approach
       to Weapons of Mass Destruction
       agents for Medical Providers

     – Emergency Preparedness for Local
       Public Health Providers

     – Incident Command System for
       Hospitals and Public Health

       Audiences: Massachusetts
       Association of Health Boards,
       Massachusetts Public Health
       Nurses Association, Department of
       Fire Services
68
         IV. 6. Project Public Health Ready

• Massachusetts represents two of the first twelve pilot sites in the
  country (Needham and Wellesley)

• Future expansion with National Association of County and City Health
  Officials




69
            IV. 7. Impact on Massachusetts
                     Surge Capacity


                                                      Local with
                    Police with                       Regional
                    Nat’l Guard
                                     Local            Government


                                     Public
     Fire with Mutual Aid                                   State, Federal &
                                     Health                 Int’l Assets




                                     Hospitals with   Local
                                       DMAT and
               EMS with                               Academic
                                  NDMS and Promoted
               MMRS                 and Rejuvenated
                                                      Assets with
                                      Caregivers      (A-CPHP)


70
        IV. 7. Impact on Massachusetts
                 Surge Capacity
• Metropolitan Boston region has convened 2 “summits” in
  the past year regarding surge capacity

• Participants included MDPH, Boston Public Health
  Commission, Boston EMS, local hospital and community
  health center representatives

• Unprecedented communication and cooperation among
  players

• HSPH-CPHP members played important roles in
  facilitating these summits


71
       IV. 7. Impact on Massachusetts
           Syndromic Surveillance

• Nationally innovative
  development of the
  syndromic
  surveillance system
  in Boston EMS and
  emergency
  departments



72
                     Overview
I.    HSPH-CPHP Strengths and Vision

II.   Challenges and Partnerships in Preparing the Public
      Health Workforce

III. Maine: HSPH-CPHP Contributions

IV. Massachusetts: HSPH-CPHP Contributions

V.    National and International HSPH-CPHP Contributions

VI. Evaluation and Future Directions for HSPH-CPHP


73
V. 1. National and International HSPH-CPHP
                Contributions

1.   Connectivity Trainings
2.   National Preparedness Leadership Initiative
3.   HSPH-CPHP CDC Conference
4.   HSPH Academic Courses
5.   Publications
6.   Distance Education
7.   HSPH-CPHP Website



74
     V. 1. Statewide Connectivity Trainings

     CDC – State coordinators   Missouri
     Massachusetts              Iowa
     Maine                      Nebraska
     Pennsylvania
     California – Kern County
     Los Angeles County
     Oklahoma
     Arizona
     Tennessee
     Kansas
     Virginia
75   Alaska
                             The National Preparedness
                               Leadership Initiative

     Harvard School of            HARVARD UNIVERSITY             Kennedy School of
       Public Health                                               Government



                             A collaborative initiative of

                    The Centers for Disease Control and Prevention
                    US Department of Health and Human Services

                                Health Force Protection
                               US Department of Defense


                          Federal Emergency Management Agency
                           US Department of Homeland Security

76
                                 The National Preparedness
                                   Leadership Initiative

     Harvard School of                  HARVARD UNIVERSITY               Kennedy School of
       Public Health                                                       Government
                                      Inaugural Meeting
                                   November 23 – 24, 2004
                       Harvard Faculty Club – Cambridge, Massachusetts




                                                                    David Gergen
                                                             Kennedy School of Government



                 Michael Brown
 Undersecretary Department of Homeland Security
                     FEMA
77
                                  The National Preparedness
                                    Leadership Initiative

     Harvard School of                HARVARD UNIVERSITY                   Kennedy School of
       Public Health                                                         Government
                                       Inaugural Meeting
                                    November 23 – 24, 2004
                        Harvard Faculty Club – Cambridge, Massachusetts




                                                                         Ellen Embry
                                                                    Health Force Protection
      Julie Gerberding, CDC and
                                                                   US Department of Defense
       Barry Bloom, Dean HSPH
                                          Richard Danzig
78                                  Former Secretary US Navy and
                                            CDC Advisor
     V. 3. HSPH-CPHP CDC Conference

         “A Conversation with the CDC"




                         Mr. Joseph Henderson,
                         Associate Director for Terrorism
                         Preparedness and Response
                         speaks at the Harvard School of
                         Public Health, May, 2002.
79
       V. 4. HSPH Academic Courses
• HSPH course ID 287 –
  Bioterrorism: Public Health
  Preparedness and Response
   – Key agents and response
   – Risk assessment and
     communication
   – Technical aspects of
     surveillance and modeling
   – Table-top drills

• HSPH course ID 205 – Societal
   Response to Disaster
    – Natural and technological
      disasters
    – Decision-making under
      stress
80  – ICS system
         V. 4. HSPH Academic Courses

     HSPH course ID 265 - Practice
       of Quantitative Methods

     – Mentored “Practice”
       Internship Program with new
       attention to Preparedness
       Evaluation

     – Practice Project in Evaluation
       and Quantitative Science
       required for MPH degree in
       Quantitative Methods




81
           V. 5. HSPH-CPHP Publications

• National publications on topics
  ranging from Public Health
  Polling, Disaster Management,
  Connectivity, Public Awareness
  (See Supplemental Materials)

• Newly released textbook,
  Disaster Medicine, by David
  Hogan and Jonathan Burstein




82
V. 6. Distance Education: A HYBRID Model




           From the classroom to the
           home/office, a field-tested
           hybrid approach using
           face-to-face and Web-         •Incident Command and
           based instruction to teach    Management System
           public health professionals   •PubHl10-Biotraining
           about emergency
                                         •Agents of Environmental
           preparedness. Developed       Illness
           from focus groups and
                                         •PH Emergency
           surveys in Rhode Island_G.    Preparedness
           Moore
     V. 6. Multimedia Course Development

                       Emergency Preparedness 101 for all
                       PH workforce (Web-based )


                       Emergency Preparedness for Nursing
                       instructors (Train-the-trainer)


                       Emergency Preparedness for PH
                       Nurses (Web-based )


                       Risk Communication for Health
                       Officers, Sanitarians and Pubic Health
                       Nurses (Train-the-trainer)


                       Epidemiology Refresher for Local
                       Health Practitioners (Train-the-trainer)


                       ICS and the Disaster Field Manual for
                       Local Health (Train-the-trainer)

84
             V. 7. HSPH-CPHP Website

• Newly updated HSPH-CPHP Website is a public site
  available worldwide: www.hsph.harvard.edu/hcphp

• Vast library of links with categories of Emergency
  Response, Biohazards, Chemical Hazards, Radiation
  Hazards

• Devoted page listing national Key Contacts in a Disaster

• Direct links to up-to-date, universal Treatment Protocols for
  clinicians

85
                     Overview
I.    HSPH-CPHP Strengths and Vision

II.   Challenges and Partnerships in Preparing the Public
      Health Workforce

III. Maine: HSPH-CPHP Contributions

IV. Massachusetts: HSPH-CPHP Contributions

V.    National and International HSPH-CPHP Contributions

VI. Evaluation and Future Directions for HSPH-CPHP

86
     VI. Evaluation and Future Directions
               for HSPH-CPHP
     From July 2002 through February 2004, HSPH-CPHP has:

          provided training to over 11,050 professionals including
      physicians, nurses, administrators, first-responders and local public
           health professionals in Maine and Massachusetts


           provided over 30,500 hours of face-to-face training,
                  lectures and/ or distance learning.




87
      VI. 1. Evaluating Local Preparedness:
      Western Massachusetts Pilot Project

     1. Massachusetts Department of Public Health has
        requested information from each of the 351 cities and
        towns with respect to several hundred preparedness
        variables such as staffing, resources and
        connectivity.

     2. HSPH-CPHP will develop an overall validated
        scorecard system that summarizes levels of
        preparedness (starting with 15 towns in Western
        Massachusetts)

     3. THE GOAL IS TO DEVELOP A “CONSUMER
        REPORT” – LIKE SCORECARD.

88
 VI. 2. Exercises and Drills in the Evaluation
           of National Preparedness
• Few large-scale exercises
  post-9/11
   – Top-Off 1&2
   – Dark Winter
   – FEMA has extended the
     Comprehensive HAZMAT
     Emergency Response -
     Capability Assessment
     Program (CHER-CAP)
     throughout the nation.

• Significant costs
   – $16 million for TopOff2


89
           VI. 2. Exercises and Drills in the
         Evaluation of National Preparedness
• Dependent on significant planning, coordination, and expertise

     – Dept. of Homeland Security, Agency for Toxic Substances and
       Disease Registry , Centers for Disease Control and Prevention,
       Federal Emergency Management Agency involvement

     – Delays in executing CHER-CAP exercise in Boston

• Hospitals required to perform exercises every 4-8 months by Joint
  Commission on Accreditation of Healthcare Organizations (JCAHO)

• Operation Prometheus (Boston dirty bomb scenario) integrated hospital,
  public safety and public health providers over 2 days, but required
  significant federal and state involvement

• Often poorly coordinated with surrounding community

90
 VI. 2. Exercises and Drills in the Evaluation
           of National Preparedness

• Costs of large-scale exercises often beyond the means of
  smaller communities

• Local expertise in planning/evaluating exercises often
  lacking

• CONCLUSION: Need more accessible, less expensive,
  and scientifically valid tools for evaluating local public
  health preparedness


91
        VI. 3. Future HSPH-CPHP National
                 Evaluation Efforts


     1. Systematic review of the literature with evidence
        matrix for evaluation methodology

     2. Semi-structured telephone survey of 21 ACPHP in
        US regarding evaluation expertise, capacity and
        quantitative practice applications




92
               VI. 4. Public Health Law:
               HSPH-CPHP Pilot Project
     – Needs assessment for public health education of local
       and district-level judiciary and non-public health legal
       professionals

     – Topics for future trainings may include:
        • Scope of state and federal authority
        • Local code enforcement
        • Liability and compensation issues (for both the
          workforce and the public)
        • State law and rule revision


93
               VI. 4. Future Directions

Training
   –Satellite Broadcast 2004: Isolation and Quarantine: A
   Massachusetts Satellite Training Broadcast
   –Expand Train-the-Trainer model

Coordination/Outreach
  –Project Public Health Ready
  –New England Alliance for Public Health Workforce
  Development
  –Community Forum on Equity in Preparedness


94
              VI. 4. Future Directions

Evaluation/Measurement and Research
   – Exercises and drills in preparedness for Maine and
     Massachusetts
   – Harvard School of Public Health drill/exercise in early
     spring
   – Measurement tool to evaluate local preparedness and
     connectivity
   – Create evaluation framework for measuring the success
     of our trainings




95
              VI. 4. Future Directions

Distance Learning
   – Partners Telemedicine
   – Rural Preparedness Conference
   – Expansion throughout New England

Expanding Capacities
   – Harvard University-wide symposium on Bioterrorism and
     Public Health Preparedness for Fall 2004
   – Continue to advance strategy and vision on national and
     international fronts


96
                ISRAEL 2003: IMPACT




Von Roebuck, Col Isaak Ashkenazi, Lenny Marcus & Joe Henderson
 97
      at the Tel Hashomer base of the Israeli Defense Forces
                   ISRAEL 2003: IMPACT




Joe Henderson views infant protective gear kits at gas mask distribution
98
      center in a Jerusalem mall prior to the 2003 Iraq offensive
                 ISRAEL 2004: PLANS

1. Meet with government communicable disease experts to
   discuss science and policy issues involving critical agents such
   as anthrax and botulinum toxin.

2. Meet with government officials to understand plans
   for community wide distribution of vaccine and antibiotics.

3. Discuss community preparedness with community leaders
   to determine how stakeholders engage in local response.

4. Explore venues and opportunities to advance concrete and
   systematic cooperation on matters of preparedness between
   Israel and the United States.

99
             ISRAEL 2004: THE MEETINGS



Edgar Thompson, CDC Deputy              Israel Center for Disease Control
Director, Office of the Director
                                        Israel Ministry of Health
Joseph M. Henderson, CDC Associate
Director, OTPER                         Israel Defense Forces –
                                        Home Front Command
Don Noah, DOD Liaison to the CDC        Israel Institute for Biological Research

Dori Reissman, CDC Special Advisor,     Medical Simulation Center, Tel
Preparedness and Mental Health, OTPER   Hashomer Hospital

Shah Roohi, CDC Special Advisor on      Chemical Drill at Barzelai Hospital,
International Relations, OTPER          Ashkelon
                                        Hadassah Hospital, Ichilov Hospital,
 Leonard Marcus, HSPH Center for        and the Magen David Adom
 Public Health Preparedness
100
           ISRAEL 2004: THE MEETINGS




      The CDC-HSPH delegation observes a chemical drill at
101             Barzelai Hospital, Ashkelon
      Chemical Drill in Israel




102
           DEFINING AND RAISING THE BAR
                 ON PREPAREDNESS
                         Strategy and Activities

      We focus future efforts - working with our partners - to
                                address:
       • Old, new, and emerging threats
       • Problems/possibilities for surveillance/detection
       • Connectivity w/ state, local, federal, int’l agencies
        • Translating what is learned into what is taught
       • Enhanced workforce development
       • Leadership on a local, state, federal, and global
            scale to enhance preparedness impact
103
                                        DEFINING AND RAISING THE BAR
                                              ON PREPAREDNESS
                                                                                      Strategy and Activities

                                                                                ADVANCED PREPAREDNESS
                                        CENTER FOR PUBLIC HEALTH PREPAREDNESS




                                                                                   LEADERSHIP DEVELOPMENT       Build Direction
      HARVARD SCHOOL OF PUBLIC HEALTH




                                                                                   EVALUATION                   Refine Strategy

                                                                                   DRILLS AND EXERCISES         Test Capacity

                                                                                   CURRICULUM & TRAINING        Build Capacity

                                                                                   NEEDS ASSESSMENT             Find Gaps

                                                                                   CONSULTATION                 System Change
                                                                                   INQUIRY AND “CURIOSITY”      New Knowledge


104
                                                                                STARTING POINT
       DEFINING AND RAISING THE BAR
             ON PREPAREDNESS
                Strategy and Activities




             HARVARD SCHOOL OF PUBLIC HEALTH

             CENTER FOR PUBLIC HEALTH PREPAREDNESS




      2002    2003                2004               2005
                              BUILD UPON OUR
                                EXPERIENCE -
                             CONTRIBUTIONS TO
                          STATE, LOCAL, NATIONAL
                            AND INTERNATIONAL
105
                               PREPAREDNESS
      DEFINING AND RAISING THE BAR
            ON PREPAREDNESS
              Strategy and Activities




               Thank you


        Questions & Discussion



106

				
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