Emergency Response Research Centers Research Articles

Public Health Emergency Preparedness System Evaluation Criteria and Performance Metrics: A Review of Contributions of the CDC-Funded Preparedness and Emergency Response Research Centers.

The US Centers for Disease Control and Prevention (CDC)-funded Preparedness and Emergency Response Research Centers (PERRCs) conducted research from 2008 to 2015 aimed to improve the complex public health emergency preparedness and response (PHEPR) system. This paper summarizes PERRC studies that addressed the development and assessment of criteria for evaluating PHEPR and metrics for measuring their efficiency and effectiveness. We reviewed 171 PERRC publications indexed in PubMed between 2009 and 2016. These publications derived from 34 PERRC research projects. We identified publications that addressed the development or assessment of criteria and metrics pertaining to PHEPR systems and describe the evaluation methods used and tools developed, the system domains evaluated, and the metrics developed or assessed. We identified 29 publications from 12 of the 34 PERRC projects that addressed PHEPR system evaluation criteria and metrics. We grouped each study into 1 of 3 system domains, based on the metrics developed or assessed: (1) organizational characteristics (n = 9), (2) emergency response performance (n = 12), and (3) workforce capacity or capability (n = 8). These studies addressed PHEPR system activities including responses to the 2009 H1N1 pandemic and the 2011 tsunami, as well as emergency exercise performance, situational awareness, and workforce willingness to respond. Both PHEPR system process and outcome metrics were developed or assessed by PERRC studies. PERRC researchers developed and evaluated a range of PHEPR system evaluation criteria and metrics that should be considered by system partners interested in assessing the efficiency and effectiveness of their activities. Nonetheless, the monitoring and measurement problem in PHEPR is far from solved. Lack of standard measures that are readily obtained or computed at local levels remains a challenge for the public health preparedness field. (Disaster Med Public Health Preparedness. 2019;13:626-638).

Preparedness Emergency Response Research Centers (PERRCs): Addressing Public Health Preparedness Knowledge Gaps Using a Public Health Systems Perspective.

Preparedness Emergency Response Research Centers (PERRCs): Addressing Public Health Preparedness Knowledge Gaps Using a Public Health Systems Perspective.

Overview of the Translation, Dissemination, and Implementation of Public Health Preparedness and Response Research and Training Initiative.

We provide an overview of a Centers for Disease Control and Prevention-funded public health preparedness and response (PHPR) research and training initiative to improve public health practice. Our objectives were to accelerate the translation, dissemination, and implementation (TDI) of promising PHPR evidence-based tools and trainings developed by the Preparedness and Emergency Response Research Centers (PERRC) or the Preparedness and Emergency Response Learning Centers (PERLC) between 2008 and 2015. Nine competitive awards were made to seven academic centers to achieve predetermined TDI objectives. The outputs attained by the initiative included: user-friendly online repositories of PERRC and PERLC tools and trainings; training courses that addressed topics; a community resilience manual to synthesize, translate, and implement evidence-based programs; and Web applications that supported legal preparedness, exercise evaluation, and immunization education. The evaluation identified several best practices and potential barriers to implementation. As illustrated by the work in this supplement, the broader awareness and implementation of PERRC preparedness products and PERLC trainings and the continued evaluation of their impact could enhance the PHPR capacity and capability of the nation, which could lead to improved health security.

Preparedness and emergency response research centers: using a public health systems approach to improve all-hazards preparedness and response.

In 2008, at the request of the Centers for Disease Control and Prevention (CDC), the Institute of Medicine (IOM) prepared a report identifying knowledge gaps in public health systems preparedness and emergency response and recommending near-term priority research areas. In accordance with the Pandemic and All-Hazards Preparedness Act mandating new public health systems research for preparedness and emergency response, CDC provided competitive awards establishing nine Preparedness and Emergency Response Research Centers (PERRCs) in accredited U.S. schools of public health. The PERRCs conducted research in four IOM-recommended priority areas: (1) enhancing the usefulness of public health preparedness and response (PHPR) training, (2) creating and maintaining sustainable preparedness and response systems, (3) improving PHPR communications, and (4) identifying evaluation criteria and metrics to improve PHPR for all hazards. The PERRCs worked closely with state and local public health, community partners, and advisory committees to produce practice-relevant research findings. PERRC research has generated more than 130 peer-reviewed publications and nearly 80 practice and policy tools and recommendations with the potential to significantly enhance our nation's PHPR to all hazards and that highlight the need for further improvements in public health systems.

Contributions of academia to public health preparedness research.

The 2006 Pandemic and All-Hazards Preparedness Act (PAHPA) resulted in the development of several major program areas designed to respond to its legislation, “to improve the nation's public health and medical preparedness and response capabilities for emergencies, whether deliberate, accidental, or natural.”1 In 2008, the Centers for Disease Control and Prevention (CDC) Office of Public Health Preparedness and Response (OPHPR) created seven Preparedness and Emergency Response Research Centers (PERRCs) in an effort to support the goals of PAHPA. The program expanded to nine centers in 2009. PERRCs, located at Council on Education for Public Health (CEPH)-accredited schools of public health, were tasked to improve “public health practice for preparedness and emergency response planning and policies at the local, state, federal, and tribal level.”2 CEPH is an independent agency certified by the U.S. Department of Education that accredits schools and programs of public health to assure compliance with well-defined standards. CDC established a cooperative agreement in 2008 with the Association of Schools of Public Health (ASPH), now known as the Association of Schools and Programs of Public Health (ASPPH), to provide programmatic support to the PERRCs (“Year Four: ASPH Continuation Application,” application by CDC, June 2008). As the voice of accredited public health education, ASPPH works to transform public health by strengthening and promoting the education, research, service, and practice activities of CEPH-accredited schools and programs of public health and by advocating for the investments in science that will advance population health. A commitment to advocating for evidence-based public health policies and programs lies at the core of the ASPPH mission (Unpublished document, ASPPH Strategic Framework, ASPPH, 2013). PERRCs conduct research that can be used to enhance public health preparedness (PHP) policies, planning, and response.2 Most health departments lack the resources to test new theories or concepts, but the federal funding allocated for these centers allows researchers to be more innovative in their work.3 The PERRCs have formed numerous collaborations with community partners and performed extensive outreach, including to disciplines not traditionally engaged in public health activities, such as engineering, law, and public policy. Involving stakeholders is a crucial component of translational research.4 As a result, those working with communities can feel confident that their activities and trainings are rooted in evidence.

Institutional Facilitators and Barriers to Local Public Health Preparedness Planning for Vulnerable and At-Risk Populations

Numerous institutional facilitators and barriers to preparedness planning exist at the local level for vulnerable and at-risk populations. Findings of this evaluation study contribute to ongoing practice-based efforts to improve response services and address public health preparedness planning and training as they relate to vulnerable and at-risk populations. From January 2012 through June 2013, we conducted a multilevel, mixed-methods evaluation study of the North Carolina Preparedness and Emergency Response Research Center's Vulnerable & At-Risk Populations Resource Guide, an online tool to aid local health departments' (LHDs') preparedness planning efforts. We examined planning practices across multiple local, regional, and state jurisdictions utilizing user data, follow-up surveys, and secondary data. To identify potential incongruities in planning, we compared respondents' reported populations of interest with corresponding census data to determine whether or not there were differences in planning priorities. We used data collected from evaluation surveys to identify key institutional facilitators and barriers associated with planning for at-risk populations, including challenges to conducting assessments and lack of resources. Results identified both barriers within institutional culture and disconnects between planning priorities and evidence-based identification of vulnerable and at-risk populations, including variation in the planning process, partnerships, and perceptions. Our results highlight the important role of LHDs in preparedness planning and the potential implications associated with organizational and bureaucratic impediments to planning implementation. A more in-depth understanding of the relationships among public institutions and the levels of preparedness that contribute to the conditions and processes that generate vulnerability is needed.

An academic-government-faith partnership to build disaster mental health preparedness and community resilience.

Faculty and affiliates of the Johns Hopkins Preparedness and Emergency Response Research Center partnered with local health departments and faith-based organizations to develop a dual-intervention model of capacity-building for public mental health preparedness and community resilience. Project objectives included (1) determining the feasibility of the tri-partite collaborative concept; (2) designing, delivering, and evaluating psychological first aid (PFA) training and guided preparedness planning (GPP); and (3) documenting preliminary evidence of the sustainability and impact of the model. We evaluated intervention effectiveness by analyzing pre- and post-training changes in participant responses on knowledge-acquisition tests administered to three urban and four rural community cohorts. Changes in percent of correct items and mean total correct items were evaluated. Criteria for model sustainability and impact were, respectively, observations of nonacademic partners engaging in efforts to advance post-project preparedness alliances, and project-attributable changes in preparedness-related practices of local or state governments. The majority (11 of 14) test items addressing technical or practical PFA content showed significant improvement; we observed comparable testing results for GPP training. Government and faith partners developed ideas and tools for sustaining preparedness activities, and numerous project-driven changes in local and state government policies were documented. Results suggest that the model could be an effective approach to promoting public health preparedness and community resilience.

Accelerating preparedness: leveraging the UNC PERLC to improve other projects related to public health surveillance, assessment, and regionalization.

The co-location of the University of North Carolina at Chapel Hill (UNC) Preparedness and Emergency Response Learning Center (PERLC) and the UNC Preparedness and Emergency Response Research Center (PERRC) and other smaller projects within the North Carolina Institute for Public Health, a public health practice-oriented unit of the UNC Gillings School of Global Public Health, facilitated many successful collaborations. By sharing personnel, space, and other resources, the UNC PERLC and PERRC and other projects were able to meet the needs of the public health workforce by developing evidence-based training programs and tools around topics including epidemiology, surveillance, and vulnerable populations.

Academic-community partnerships for sustainable preparedness and response systems.

Academic institutions possess tremendous resources that could be important for community disaster response and preparedness activities. In-depth exploration of the role of academic institutions in community disaster response has elicited information about particular academic resources leveraged for and essential to community preparedness and response; factors that contribute to the decision-making process for partner engagement; and facilitators of and barriers to sustainable collaborations from the perspectives of academic institutions, public health and emergency management agencies, and national association and agency leaders. The Academic-Community Partnership Project of the Emory University Preparedness and Emergency Response Research Center in collaboration with the Association of Schools of Public Health convened an invitational summit which included leadership from the National Association of County and City Health Officials, Association of State and Territorial Health Officials, Directors of Public Health Preparedness, Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response, CDC Office of Public Health Preparedness and Response, Association of Schools of Public Health, Association of American Medical Colleges, Association of Academic Health Centers, American Association of Colleges of Nursing, Council of State and Territorial Epidemiologists, and American Association of Poison Control Centers. From this convention, emerged recommendations for building and sustaining academic-public health-community collaborations for preparedness locally and regionally.

Data for Preparedness Metrics

Tracking progress toward the goal of preparedness for public health emergencies requires a foundation in evidence derived both from scientific inquiry and from preparedness officials and professionals. Proposed in this article is a conceptual model for this task from the perspective of the Centers for Disease Control and Prevention-funded Preparedness and Emergency Response Research Centers. The necessary data capture the areas of responsibility of not only preparedness professionals but also legislative and executive branch officials. It meets the criteria of geographic specificity, availability in standardized and reliable measures, parameterization as quantitative values or qualitative distinction, and content validity. The technical challenges inherent in preparedness tracking are best resolved through consultation with the jurisdictions and communities whose preparedness is at issue.

Advancing the Science of Delivery

Advancing the Science of Delivery

Lessons Learned from North Carolina Public Health Regional Surveillance Teams’ Regional Exercises

All-hazards exercises bring together emergency response partners at the local, regional, state, and federal levels for the primary purposes of testing response plans, defining roles and responsibilities, assessing capabilities, and making necessary improvements prior to an actual incident. To better understand the benefits and challenges of conducting regional (ie, multicounty) exercises, a study was carried out by the North Carolina Preparedness and Emergency Response Research Center at the University of North Carolina Gillings School of Global Public Health. This article describes 5 all-hazards regional exercises conducted by Public Health Regional Surveillance Teams (PHRSTs) in North Carolina in 2009 and highlights 4 unique benefits that resulted from the exercises beyond meeting explicit objectives to test plans and identify areas for improvement: (1) building relationships among response partners, (2) promoting public health assets, (3) testing multiple communications systems, and (4) training exercise evaluators. Challenges of planning and conducting regional exercises also are addressed, followed by recommendations for maximizing the effectiveness of regional public health exercises.

Support and Services Provided by Public Health Regional Surveillance Teams to Local Health Departments in North Carolina

Since 2001, many states have created regional structures in an effort to better coordinate/public health preparedness and response efforts, consolidate services, and supplement local government capacity. While several studies have identified specific benefits to regionalization, including enhanced networking, coordination, and communication, little research has examined the effect of regionalization on specific preparedness and response activities. To better understand the impact of regionalizing public health workforce assets in North Carolina, a survey aimed at documenting specific support and services that Public Health Regional Surveillance Teams(PHRSTs) provide to local health departments (LHDs) was developed and administered by the North Carolina Preparedness and Emergency Response Research Center, located at the North Carolina Institute for Public Health. Of80 potential types of assistance, 26 (33%) were received by 75% or more LHDs, including 9 related to communication and 7 related to exercises. There was significant variation by PHRST region in both the quantity and quality of support and services reported by LHDs. This variation could not be explained by county- or LHD-level variables. PHRST assistance to LHDs is largely focused on communication and liaison activities, regional exercises, and planning. On the basis of these findings, regionalization may provide North Carolina with benefits consistent with those found in other studies such as improved networking and coordination. However, further research is needed to identify whether regional variation is the result of varying capacity or priorities of the PHRSTs or LHDs and to determine how much variation is acceptable.

Opportunity Knocks but Twice for Public Health Preparedness Centers

Opportunity Knocks but Twice for Public Health Preparedness Centers