Embedding Equity in a Local Government's Response to COVID-19.

The COVID-19 pandemic has dramatically impacted life across the world and amplified inequities experienced by communities of color within the United States. Washington County was the first jurisdiction in the state of Oregon to have a confirmed COVID-19 case. To center equity within the County Emergency Operations Center (EOC), new positions were created within the EOC including an Equity Officer and an Equity Technical Advisor position, an Equity Team, and a Language Access Coordinator. This team engaged stakeholders and community partners in addition to developing an equity framework to guide decision making within the EOC. Implementation of the framework resulted in better identification of urgent community needs, especially for groups most impacted by inequities. This integration also supports government leaders and communities in creating programs, policies, and procedures to equitably address community needs.

Evaluation of a Novel Medicolegal Death Investigator-Based Suicide Surveillance System to the National Violent Death Reporting System.

The abundance of actionable information available in a medicolegal suicide investigation is often inaccessible and underutilized in public health to the detriment of prevention efforts. Epidemiologists obtained the Washington County subset of the Oregon Violent Death Reporting System (OR-VDRS). To determine if additional information beyond the OR-VDRS was available through a standard death investigation, an epidemiologist shadowed medicolegal death investigators (MDIs) for nearly 2 years. The MDIs and epidemiologist developed a novel, real-time, MDI-entered surveillance system, the Suicide Risk Factor Surveillance System (SRFSS), to capture suicide risk factor data with greater timeliness and accuracy than available through the OR-VDRS. To evaluate the performance of each surveillance system, differences in the prevalence of suicide risk factor data from SRFSS were compared with the county OR-VDRS subset for the same 133 suicides occurring in 2014-2015. Across 27 suicide risk factors and circumstances, the median difference in prevalence was 10.5 percentage points between the OR-VDRS and the SRFSS, with the higher prevalence in SRFSS. The prevalence was significantly different between the 2 surveillance systems for 21 (78%) of 27 variables. This study demonstrates the truly exceptional data quality and timeliness of MDI information over traditional sources.

Lessons Learned From an Epidemiologist-Led Countywide Community Assessment for Public Health Emergency Response (CASPER) in Oregon.

CONTEXT: Conducting a large-scale Community Assessment for Public Health Emergency Response (CASPER) in a geographically and linguistically diverse county presents significant methodological challenges that require advance planning. PROGRAM: The Centers for Disease Control and Prevention (CDC) has adapted methodology and provided a toolkit for a rapid needs assessment after a disaster. The assessment provides representative data of the sampling frame to help guide effective distribution of resources. IMPLEMENTATION: This article describes methodological considerations and lessons learned from a CASPER exercise conducted by Washington County Public Health in June 2016 to assess community emergency preparedness. The CDC's CASPER toolkit provides detailed guidance for exercises in urban areas where city blocks are well defined with many single family homes. Converting the exercise to include rural areas with challenging geographical terrain, including accessing homes without public roads, required considerable adjustments in planning. Adequate preparations for vulnerable populations with English linguistic barriers required additional significant resources. Lessons learned are presented from the first countywide CASPER exercise in Oregon. EVALUATION: Approximately 61% of interviews were completed, and 85% of volunteers reported they would participate in another CASPER exercise. Results from the emergency preparedness survey will be presented elsewhere. DISCUSSION: This experience indicates the most important considerations for conducting a CASPER exercise are oversampling clusters, overrecruiting volunteers, anticipating the actual cost of staff time, and ensuring timely language services are available during the event.

Disparities in Access to Easy-to-Use Services for Children with Special Health Care Needs.

OBJECTIVES: Families, clinicians and policymakers desire improved delivery of health and related services for children with special health care needs (CSHCN). We analyzed factors associated with ease of use in obtaining such services. We also explored what were specific difficulties or delays in receiving services. By examining data from the National Survey of Children with Special Health Care Needs (NS-CSHCN 2009-2010) and using the revised criteria for "ease of use," we were able to assess the percentage of parents who reported that their experiences seeking services for their children met those criteria. METHODS: We performed Chi square tests to examine associations between the independent variables and their relationship to the difficulties or delays assessed in the survey; including: eligibility, availability of services, waiting lists, cost, and access to information. We used logistic regression to determine the association of meeting the "ease of use" criteria with socio-demographic, complexity of need, and access variables. RESULTS: Overall, a third of families of CSHCN (35.3 %) encounter difficulties, delays, or frustrations in obtaining health and related services. The lack of access to health and community services in this study fell most heavily on children from racial/ethnic minority backgrounds, those in poverty, and those with complex emotional/behavioral or developmental needs and functional limitations. CONCLUSIONS: for Practice CSHCN require services from a broad array of providers across multiple systems. Unfortunately, there are certain difficulties that hamper the accessibility of these systems. These findings underscore the need for both practice-level response and systems-level reform to ensure equitable distribution of health and community resources.

Adverse childhood experiences: assessing the impact on health and school engagement and the mitigating role of resilience.

The ongoing longitudinal Adverse Childhood Experiences Study of adults has found significant associations between chronic conditions; quality of life and life expectancy in adulthood; and the trauma and stress associated with adverse childhood experiences, including physical or emotional abuse or neglect, deprivation, or exposure to violence. Less is known about the population-based epidemiology of adverse childhood experiences among US children. Using the 2011-12 National Survey of Children's Health, we assessed the prevalence of adverse childhood experiences and associations between them and factors affecting children's development and lifelong health. After we adjusted for confounding factors, we found lower rates of school engagement and higher rates of chronic disease among children with adverse childhood experiences. Our findings suggest that building resilience-defined in the survey as "staying calm and in control when faced with a challenge," for children ages 6-17-can ameliorate the negative impact of adverse childhood experiences. We found higher rates of school engagement among children with adverse childhood experiences who demonstrated resilience, as well as higher rates of resilience among children with such experiences who received care in a family-centered medical home. We recommend a coordinated effort to fill knowledge gaps and translate existing knowledge about adverse childhood experiences and resilience into national, state, and local policies, with a focus on addressing childhood trauma in health systems as they evolve during ongoing reform.