Public health preparedness and response competency model methodology.

OBJECTIVE: The Pandemic and All-Hazards Preparedness Act calls for establishing a competency-based training program to train public health practitioners. To inform such training, the Centers for Disease Control and Prevention and the Association of Schools of Public Health managed groups of experts to produce a competency model which could function as a national standard of behaviorally based, observable skills for the public health workforce to prevent, protect against, respond to, and recover from all hazards. DESIGN: A systematic review of existing competency models generated a competency model of proposed domains and competencies. PARTICIPANTS: National stakeholders were engaged to obtain consensus through a three-stage Delphi-like process. RESULTS: The Delphi-like process achieved 84 percent, 82 percent, and 79 percent response rates in its three stages. Three hundred sixty six unique individuals responded to the three-round process, with 45 percent (n = 166) responding to all three rounds. The resulting competency model features 18 competencies within four core learning domains targeted at midlevel public health workers. CONCLUSIONS: Practitioners and academics have adopted the Public Health Preparedness and Response Core Competency Model, some of whom have formed workgroups to develop curricula based on the model. Efforts will be needed to develop evaluation materials for training and education programs to refine the model as well as for future training and education initiatives.

Core competency model for the family planning public health nurse.

OBJECTIVES: A core competency model for family planning public health nurses has been developed, using a three stage Delphi Method with an expert panel of 40 family planning senior administrators, community/public health nursing faculty and seasoned family planning public health nurses. DESIGN AND SAMPLE: The initial survey was developed from the 2011 Title X Family Planning program priorities. The 32-item survey was distributed electronically via SurveyMonkey(®). RESULTS: Panelist attrition was low, and participation robust resulting in the final 28-item model, suggesting that the Delphi Method was a successful technique through which to achieve consensus. CONCLUSIONS: Competencies with at least 75% consensus were included in the model and those competencies were primarily related to education/counseling and administration of medications and contraceptives. The competencies identified have implications for education/training, certification and workplace performance.

Public health preparedness and response competency model methodology.

OBJECTIVE: The Pandemic and All-Hazards Preparedness Act calls for establishing a competency-based training program to train public health practitioners. To inform such training, the Centers for Disease Control and Prevention and the Association of Schools of Public Health managed groups of experts to produce a competency model which could function as a national standard of behaviorally based, observable skills for the public health workforce to prevent, protect against, respond to, and recover from all hazards. DESIGN: A systematic review of existing competency models generated a competency model of proposed domains and competencies. PARTICIPANTS: National stakeholders were engaged to obtain consensus through a three-stage Delphi-like process. RESULTS: The Delphi-like process achieved 84 percent, 82 percent, and 79 percent response rates in its three stages. Three hundred sixty six unique individuals responded to the three-round process, with 45 percent (n = 166) responding to all three rounds. The resulting competency model features 18 competencies within four core learning domains targeted at midlevel public health workers. CONCLUSIONS: Practitioners and academics have adopted the Public Health Preparedness and Response Core Competency Model, some of whom have formed workgroups to develop curricula based on the model. Efforts will be needed to develop evaluation materials for training and education programs to refine the model as well as for future training and education initiatives.

Implications of preparedness and response core competencies for public health.

Public health care practitioners and organizations are a part of community readiness for, response to, and recovery from emergencies and disasters of all kinds. Although response to health threats, particularly communicable disease outbreaks, have long been a part of public health practice, 2 advancements in preparedness, including the integration of public health into the broader community emergency response system and the clarification of exactly what knowledge, skills, and attitudes a public health professional brings to the response, have been made since 2001. This article presents the newly affirmed core competencies to be attained and maintained by the majority of the public health workforce and discusses some of the many ways in which these competencies influence practice, research, and education.

Update on competencies and education.

The beginning of the 21st century has been marked by an increase in attention to the quality of emergency and disaster response, particularly the preparedness of health workers of all kinds. The increase in natural disasters, civil unrest, and dislocation of populations has seen health workers mobilized. These workers are moving, both within countries and across borders, as members of long- organized teams such as the National Disaster Medical System (NDMS), volunteers joining through a nongovernmental organization (NGO) such as a Red Cross/Red Crescent unit, or individuals self-deploying to the scene of the emergency. Postevent evaluations have consistently identified the need for those responding to be able to join in an organized response that includes taking on assigned roles, communication through established channels and minimization of the number of "SUVs" or "spontaneous unrequested volunteers." Although bystanders and self-deployed helpers (some with professional qualifications) are the first at any disastrous event, the subsequent response efforts are expected to be organized, efficient, and effective. This requires advance training of the responders.

Emergency preparedness training and response among community health centers and local health departments: results from a multi-state survey.

Due to their access to medically underserved and vulnerable populations, community health centers (CHCs) can play an essential role in emergency response. CHCs often fill this role in partnership with other local health resources, such as local health departments (LHD). Little research has been done to understand the success of these partnerships as it relates to emergency planning and emergency response. This study compares CHC and LHD personnel regarding past, present, and future collaborative preparedness and response activities. Surveys were distributed electronically to 1,265 clinical and clerical staff at LHDs and CHCs in 23 states who met the study criteria. Of the 522 respondents, 287 (55%) reported having engaged in collaborative preparedness activities in general, with CHCs more likely to report partnering than LHDs. LHDs were more likely than CHCs to report taking part in specific preparedness activities, such as planning activities (91, 79%), (chi(2)(1, N = 280) = 7.395, P < 0.05), mass dispensing drill/exercises (65, 42%), (chi(2)(1, N = 279) = 14.019, P < 0.001), and communication drill/exercises (69, 47%), (chi(2)(1, N = 280) = 13.059, P < 0.001). This study suggests that collaborations between CHCs and LHDs in general are occurring, but these general collaboration are not being translated into participation in functional drills or exercises. Additional efforts to ensure a more comprehensive partnership between CHCs and LHDs in emergency preparedness are warranted.

A large-scale points-of-dispensing exercise for first responders and first receivers in Nassau County, New York.

Points of dispensing (PODs) are vital for responding to events that require mass chemoprophylaxis, such as bioterrorist attacks or pandemic influenza. This article evaluates the operational success of a large-scale dispensing drill for first responders and first receivers, focusing on differences in functioning of PODs by practice discipline and POD model. PODs were operated by either first responders (EMS, fire, or police) or first receivers (hospitals). Facilities could operate a centralized POD model, a decentralized POD model, or a combination, or "hybrid," model. Evaluation consisted of having evaluators at every POD, conducting a survey of POD individuals, and reviewing retrospectively the medications dispensed during the drill. Throughput counts, satisfaction with POD functioning, and errors in medication dispensing at each site are reported by practice discipline and facility model. During the drill, 23 PODs successfully processed more than 4,000 individuals. Centralized PODs and first responder facilities had faster throughput times than hybrid and hospital facilities, but hospital facilities had a lower incidence of medication error. Nominal differences in patient satisfaction were found. Assessing a combination of throughput, medical errors, and patient satisfaction with first responders and first receivers as points of dispensing can provide valuable insight into the feasibility of providing chemoprophylaxis to first responders and first receivers in advance of POD operations for the general public.

Public health certification.

In 2003, the Institute of Medicine (IOM) recommended voluntary certification of graduates achieving the Master of Public Health degree. The Association of Schools of Public Health (ASPH), the American Public Health Association, the Association of State and Territorial Health Officials, the National Association of County and City Health Officials, and the Association for Prevention Teaching and Research joined together to establish the National Board of Public Health Examiners (5). This new body will certify graduates of accredited schools and programs of public health who successfully pass their examination. If this certification becomes common, the debate will move to other questions such as (a) can those who lack a degree from a school of public health be certified through the same examination, or a similar one; (b) how will this general certificate relate to specialized areas of public health practice which are also learned elsewhere; and (c) how will we assess the public health competence of public health workers who do not have a professional education?

Care provided in visits coded for intimate partner violence in a national survey of emergency departments.

PURPOSE: This article describes the health status of and care provided to patients in visits coded to intimate partner violence (IPV) victims in a national survey of emergency departments (EDs). Visits coded for IPV were defined by International Classification of Diseases, 8th edition-Clinical Modification (ICD-9-CM) codes. METHODS: Data from the National Hospital Ambulatory Medical Care Survey for 1997-2001 were analyzed. The sample consisted of 111 ED visits with ICD codes for IPV (or 12 IPV visits per 10,000 ED visits, and 21 female IPV visits per 10,000 female ED visits). FINDINGS: The majority of visits coded to IPV were for patients who presented with mild to moderate pain (86%), physical or sexual violence (50%), and injuries to the body (38%). The majority of patients in visits coded to IPV received radiologic testing, wound care, and pain medications (odds ratios [ORs], 1.6, 3.3, and 2.3 respectively). Disposition was mostly referral to another physician or clinic (42%) or return to the ED when needed (20%), but much less to nonphysician services such as social services, support services, and shelters (14%). Uninsured IPV patients were more likely to receive radiologic testing and pain medications (ORs 5.1 and 3, respectively). Patients seen by nurses were 9 times more likely to receive wound care. CONCLUSION: Caution should be exercised when interpreting the study results because they reflect only coded IPV visits in the ED and these might be the most obvious IPV cases. The results signal the need for further studies to evaluate access to and the quality of care for IPV patients and to improve screening, documentation, coding, and management practices.

Modernizing state public health enabling statutes to reflect the mission and essential services of public health.

It is unclear whether efforts of the past decade to modernize state public health statutes have succeeded in codifying into state law the currently understood mission and essential services of public health. Although many state health agencies may be operating in a manner consistent with these principles, their codification in state law is crucial for the sustainability of agency efforts in disease prevention and health promotion. This research examines the 50 state public health enabling statutes for their correspondence with the 6 mission statements and the 10 essential services of public health described in Public Health in America. This analysis finds that modernization efforts have not been universally effective in ensuring that the legislative basis of public health is commensurate with the accepted scope of authority necessary to support health agency performance. Given current imperatives for law modernization in public health, this analysis highlights the importance of model statutory language in facilitating the codification of the mission and essential services of public health in state law. As a result, this research provides the practice community with a research base to facilitate statutory reform and develops a framework for future scholarship on the role of law as a determinant of the public's health.

Examination of the relationship between public health statute modernization and local public health system performance.

OBJECTIVES: Wide variation in performance of public health (PH) systems, coupled with national interest in improving PH system quality, makes it a priority to identify factors associated with performance. One factor may be congruence between a state's PH enabling statutes and the obligations outlined in Public Health in America-the collaboratively developed framework that defines the mission and essential services (ESs) of PH. SUBJECTS: This research examined the relationship between (1) the degree to which language in a state's PH enabling statutes reflects PH's mission and ESs and (2) the performance of local public health systems in delivering ESs, measured by National Public Health Performance Standards scores in 207 local jurisdictions. METHODS: Binary logistic regression demonstrated that a high degree of congruence between statutory language and public health's mission increased the odds of above-average system performance for 5 of 10 ESs. RESULTS: High levels of congruence between statutory language and the ESs themselves increased odds of above-average system performance for 6 of 10 ESs. Results yielded modest odds ratios (<2.0). CONCLUSIONS: Limitations of the data make it impossible to draw firm conclusions; however, these modest results suggest that statutory language may account for little of the variation in local public health system performance.

Assessment of emergency preparedness of veterinarians in New York.

Veterinarians have unique skills and abilities that could be useful in preparing for and responding to disasters and emergencies. However, veterinarians are often absent from emergency preparedness planning and exercises, and little is known about veterinarians' perceptions of emergency preparedness. A focus group was conducted among veterinarians to explore issues such as previous emergency-preparedness education, types of training needed, barriers to participation in training, and future steps to overcome identified barriers. Focus-group participants reported that they had had little to no emergency-preparedness training and had no clear understanding of what their specific role should be in an emergency. Participants also reported several barriers to participation in training and expressed significant concerns about their ability to respond in an emergency. The concerns reported include limited knowledge of zoonotic diseases, confusion about providing care for animals displaced during natural disasters, and poor relationships with other health professions. In order to respond to disasters, veterinarians require training tailored to their concerns and needs. Furthermore, partnerships between veterinarians and health care workers need to be further developed and strengthened.