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Education and Training Opportunities in Long-Term Community Recovery:
Preliminary Observations from the Field
Kenneth Schor, DO MPH FAAFP Lauren Walsh, MPH
National Center for Disaster Medicine and Public Health 4/29/14
Disclaimer
The views expressed are those of the authors and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences, the Department of Defense, or the United States Government.
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Vision A Nation of resilient
communities with a competent health workforce prepared to
respond and mitigate all-hazards disasters.
Mission The NCDMPH leads federal and coordinates national efforts to
develop and propagate core curricula, education, training and research in all-hazards
disaster health.
Established in 2008 under Homeland Security Presidential Directive 21, paragraph 38 to be an “academic center of excellence in disaster medicine and public health” located at
the Uniformed Services University of the Health Sciences.
http://ncdmph.usuhs.edu
A Center of the
Preliminary Research Data
Please do not distribute, quote, or publish. Data may be subject to change.
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Examining Long-Term Community Recovery to Identify Opportunities
for Improved Education and Training: Case Studies from Hurricanes Irene
and Sandy
5/7/2014 5
Study Objectives 1. Determine the level of education, training, and
awareness participants had pre-disaster
2. Investigate how participants learned essential information and formed essential relationships in pre- and post-disaster phases
3. Examine how recovery-related training of the disaster health workforce can be improved
© Photo by Marilee Caliendo/FEMA 6
Study Background
• Federal advisory committee to NCDMPH recommended studying recovery phase education and training needs
• Aligns with the National Disaster Recovery Framework
• Anchored in the lived experience of leaders and decision makers in local communities affected by Hurricanes Irene and Sandy
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Methods • Primarily qualitative, mixed-methods study
– Semi-structured in-person interviews (n=90) – Snowball sampling – Quantitative material example: training
competency checklist
• Data analyzed using QSR NVivo 10 • 5 case study locations (community-level)
– 2 Irene: NC, VT – 3 Sandy: RI, NJ, and NY
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Target Interview Population Leaders and decision makers involved in the recovery process including:
• Emergency manager • Public health director • Mental health director • Hospital emergency operations leader • Chiefs of fire and police • Local political leader (i.e. mayor, town councilperson) • Leaders of active grassroots/humanitarian organizations
• Faith based
• Community based
• Local chapters of national organizations
• Other active leaders in the recovery process • Social Services
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Research Timeline Completion Status Completion Date
Field Research Completed January 2014
Data Analysis In Progress Late Summer 2014
Journal Article Draft Pending Fall 2014
Learning Tools & Products Pending Fall 2014
© Photo by Sharon Karr/FEMA 10
Interviewees State People Interviewed (n)
Vermont 13
North Carolina 12
Rhode Island 14
New Jersey 16
New York 35
Total 90
© Photo by Liz Roll/FEMA 12
Self-Assessment of Recovery
NJ (13)
NC (17), NY (15)
VT (15) RI (12)
13 National Disaster Recovery Framework (NDRF): Federal Register Volume 76, Issue 217 (November 9, 2011)
Prior to the disaster, were you trained on…
1. Personal and family preparedness 2. Expected role(s) in organizational and community response
plans 3. Situational awareness of actual/potential health hazards 4. Communicate effectively with others 5. Personal safety measures 6. Identification and use of surge capacity assets 7. Principles and practices for clinical management 8. Public health principles and practices 9. Ethical principles 10. Legal principles 11. Short- and long-term considerations for recovery
*see handout
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Competency Training Pre-Event Emergency Manager N = 5
Public Health Director N = 7
Mental Health Director N = 3
Fire Chief N = 7
Police Chief N = 3
Political Leader N = 6
Grassroots Org Leaders N = 11
Human Services N = 5
Hospital Emergency Manager N = 5
Other N = 6
Total N = 58
Personal family Preparedness ● ● ● ● ● ● ● ● ● ● ● Expected Role ● ● ● ● ● ● ● ● ● ● ● Situational Awareness ● ● ● ● ● ● ● ● ● ● ● Communication ● ● ● ● ● ● ● ● ● ● ● Personal Safety ● ● ● ● ● ● ● ● ● ● ● Surge Assets ● ● ● ● ● ● ● ● ● ● ● Clinical Management ● ● ● ● ● ● ● ● ● ● ● Public Health ● ● ● ● ● ● ● ● ● ● ● Ethical ● ● ● ● ● ● ● ● ● ● ● Legal ● ● ● ● ● ● ● ● ● ● ● Recovery Considerations ● ● ● ● ● ● ● ● ● ● ●
Key: Red = <40%, Yellow = 40-74.9%, Green = >=75% 16
Job Roles with High Levels of Training (Pre-) Emergency Manager N = 5
Public Health Director N = 7
Mental Health Director N = 3
Fire Chief N = 7
Police Chief N = 3
Political Leader N = 6
Grassroots Org Leaders N = 11
Human Services N = 5
Hospital Emergency Manager N = 5
Other N = 6
Total N = 58
Personal family Preparedness ● ● ● ● ● ● ● ● ● ● ● Expected Role ● ● ● ● ● ● ● ● ● ● ● Situational Awareness ● ● ● ● ● ● ● ● ● ● ● Communication ● ● ● ● ● ● ● ● ● ● ● Personal Safety ● ● ● ● ● ● ● ● ● ● ● Surge Assets ● ● ● ● ● ● ● ● ● ● ● Clinical Management ● ● ● ● ● ● ● ● ● ● ● Public Health ● ● ● ● ● ● ● ● ● ● ● Ethical ● ● ● ● ● ● ● ● ● ● ● Legal ● ● ● ● ● ● ● ● ● ● ● Recovery Considerations ● ● ● ● ● ● ● ● ● ● ●
Key: Red = <40%, Yellow = 40-74.9%, Green = >=75% 17
Emergency Manager N = 5
Public Health Director N = 7
Mental Health Director N = 3
Fire Chief N = 7
Police Chief N = 3
Political Leader N = 6
Grassroots Org Leaders N = 11
Human Services N = 5
Hospital Emergency Manager N = 5
Other N = 6
Total N = 58
Personal family Preparedness ● ● ● ● ● ● ● ● ● ● ● Expected Role ● ● ● ● ● ● ● ● ● ● ● Situational Awareness ● ● ● ● ● ● ● ● ● ● ● Communication ● ● ● ● ● ● ● ● ● ● ● Personal Safety ● ● ● ● ● ● ● ● ● ● ● Surge Assets ● ● ● ● ● ● ● ● ● ● ● Clinical Management ● ● ● ● ● ● ● ● ● ● ● Public Health ● ● ● ● ● ● ● ● ● ● ● Ethical ● ● ● ● ● ● ● ● ● ● ● Legal ● ● ● ● ● ● ● ● ● ● ● Recovery Considerations ● ● ● ● ● ● ● ● ● ● ●
Key: Red = <40%, Yellow = 40-74.9%, Green = >=75% 18
Job Roles with Low Levels of Training (Pre-)
High Self-Rated Competency (Pre-) Emergency Manager N = 5
Public Health Director N = 7
Mental Health Director N = 3
Fire Chief N = 7
Police Chief N = 3
Political Leader N = 6
Grassroots Org Leaders N = 11
Human Services N = 5
Hospital Emergency Manager N = 5
Other N = 6
Total N = 58
Personal family Preparedness ● ● ● ● ● ● ● ● ● ● ● Expected Role ● ● ● ● ● ● ● ● ● ● ● Situational Awareness ● ● ● ● ● ● ● ● ● ● ● Communication ● ● ● ● ● ● ● ● ● ● ● Personal Safety ● ● ● ● ● ● ● ● ● ● ● Surge Assets ● ● ● ● ● ● ● ● ● ● ● Clinical Management ● ● ● ● ● ● ● ● ● ● ● Public Health ● ● ● ● ● ● ● ● ● ● ● Ethical ● ● ● ● ● ● ● ● ● ● ● Legal ● ● ● ● ● ● ● ● ● ● ● Recovery Considerations ● ● ● ● ● ● ● ● ● ● ●
Key: Red = <40%, Yellow = 40-74.9%, Green = >=75% 19
Low Self-Rated Competency (Pre-) Emergency Manager N = 5
Public Health Director N = 7
Mental Health Director N = 3
Fire Chief N = 7
Police Chief N = 3
Political Leader N = 6
Grassroots Org Leaders N = 11
Human Services N = 5
Hospital Emergency Manager N = 5
Other N = 6
Total N = 58
Personal family Preparedness ● ● ● ● ● ● ● ● ● ● ● Expected Role ● ● ● ● ● ● ● ● ● ● ● Situational Awareness ● ● ● ● ● ● ● ● ● ● ● Communication ● ● ● ● ● ● ● ● ● ● ● Personal Safety ● ● ● ● ● ● ● ● ● ● ● Surge Assets ● ● ● ● ● ● ● ● ● ● ● Clinical Management ● ● ● ● ● ● ● ● ● ● ● Public Health ● ● ● ● ● ● ● ● ● ● ● Ethical ● ● ● ● ● ● ● ● ● ● ● Legal ● ● ● ● ● ● ● ● ● ● ● Recovery Considerations ● ● ● ● ● ● ● ● ● ● ●
Key: Red = <40%, Yellow = 40-74.9%, Green = >=75% 20
Learning Priorities Thinking about where you currently stand on
the recovery continuum, what training topics do you think would be useful for you, your organization, and community to reach “full recovery”?
© Photo by Marilee Caliendo/FEMA © Photo by Marilee Caliendo/FEMA 21
Learning Priorities Self Organization Community
Emergency Management
Accessing FEMA Information Debris Management
Communication with Private Sector Patient Tracking
COOP Evacuation & Re-entry
Public Health Planning Communication/ICS Social Media
Personal Preparedness Community Planning
Mental Health Patient Tracking ICS Self-care & Preparedness for HCWs Psychological First Aid
Building Resilience Recovery Stress in Employees
Hospital Emergency Management
ICS ICS/HICS Management & Executive Training Self-care & Preparedness for HCWs
ICS for Elected Officials Working with FEMA Caring for Vulnerable Populations
Fire Drills Planning Technical Training
Personal Preparedness ICS for Elected Officials School-based Preparedness
Police Technical Training Evacuation & Re-entry After Action Reports ICS
ICS for Elected Officials Rebuilding
Elected Official FEMA Basics Who To Know Prior Planning
Financial/Public Assistance Programs Support Volunteer & Donations Management
Grassroots Organizations
CERT Training Rebuilding Applying for Assistance Working with FEMA
Disaster Case Management Personal Preparedness Inter-org Relationships Working with Local, State, FEMA
Personal Preparedness Personal Recovery Volunteer & Donations Management
Human Services Inter-agency Cooperation - Personal Preparedness Working with State and Federal
Other - ICS for City Housing Asset/Money Allocation
Personal Preparedness Personal Recovery
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Job
Role
Incident Command System Self Organization Community
Emergency Management
Accessing FEMA Information Debris Management
Communication with Private Sector Patient Tracking
COOP Evacuation & Re-entry
Public Health Planning Communication/ICS Social Media
Personal preparedness Community Planning
Mental Health Patient Tracking ICS Self-care & Preparedness for HCWs Psychological First Aid
Building Resilience Recovery Stress in Employees
Hospital Emergency Management
ICS ICS/HICS Management & Executive Training Self-care & Preparedness for HCWs
ICS for Elected Officials Working with FEMA Caring for Vulnerable Populations
Fire Drills Planning Technical Training
Personal Preparedness ICS for Elected Officials School-based Preparedness
Police Technical Training Evacuation & Re-entry After Action Reports ICS
ICS for Elected Officials Rebuilding
Elected Official FEMA Basics Who to Know Prior Planning
Financial/Public Assistance Programs Support Volunteer & Donations Management
Grassroots Organizations
CERT Training Rebuilding Applying for Assistance Working with FEMA
Disaster Case Management Personal Preparedness Inter-org Relationships Working with Local, State, FEMA
Personal Preparedness Personal Recovery Volunteer & Donations Management
Human Services Inter-agency Cooperation - Personal Preparedness Working with State and Federal
Other - ICS for City Housing Asset/Money Allocation
Personal Preparedness Personal Recovery
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Job
Role
FEMA – Basics, Programs, and Assistance Self Organization Community
Emergency Management
Accessing FEMA Information Debris Management
Communication with Private Sector Patient Tracking
COOP Evacuation & Re-entry
Public Health Planning Communication/ICS Social Media
Personal Preparedness Community Planning
Mental Health Patient Tracking ICS Self-care & Preparedness for HCWs Psychological First Aid
Building Resilience Recovery Stress in Employees
Hospital Emergency Management
ICS ICS/HICS Management & Executive Training Self-care & Preparedness for HCWs
ICS for Elected Officials Working with FEMA Caring for Vulnerable Populations
Fire Drills Planning Technical Training
Personal Preparedness ICS for Elected Officials School-based Preparedness
Police Technical Training Evacuation & Re-entry After Action Reports ICS
ICS for Elected Officials Rebuilding
Elected Official FEMA Basics Who to Know Prior Planning
Financial/Public Assistance Programs Support Volunteer & Donations Management
Grassroots Organizations
CERT Training Rebuilding Applying for Assistance Working with FEMA
Disaster Case Management Personal Preparedness Inter-org Relationships Working with Local, State, FEMA
Personal Preparedness Personal Recovery Volunteer & Donations Management
Human Services Inter-agency Cooperation - Personal Preparedness Working with State and Federal
Other - ICS for City Housing Asset/Money Allocation
Personal Preparedness Personal Recovery
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Job
Role
Preparedness – Personal, Community, and Workplace Self Organization Community
Emergency Management
Accessing FEMA Information Debris Management
Communication with Private Sector Patient Tracking
COOP Evacuation & Re-entry
Public Health Planning Communication/ICS Social Media
Personal Preparedness Community Planning
Mental Health Patient Tracking ICS Self-care & Preparedness for HCWs Psychological First Aid
Building Resilience Recovery Stress in Employees
Hospital Emergency Management
ICS ICS/HICS Management & Executive Training Self-care & Preparedness for HCWs
ICS for Elected Officials Working with FEMA Caring for Vulnerable Populations
Fire Drills Planning Technical Training
Personal Preparedness ICS for Elected Officials School-based Preparedness
Police Technical Training Evacuation & Re-entry After Action Reports ICS
ICS for Elected Officials Rebuilding
Elected Official FEMA Basics Who to Know Prior Planning
Financial/Public Assistance Programs Support Volunteer & Donations Management
Grassroots Organizations
CERT Training Rebuilding Applying for Assistance Working with FEMA
Disaster Case Management Personal Preparedness Inter-org Relationships Working with Local, State, FEMA
Personal Preparedness Personal Recovery Volunteer & Donations Management
Human Services Inter-agency Cooperation - Personal Preparedness Working with State and Federal
Other - ICS for City Housing Asset/Money Allocation
Personal Preparedness Personal Recovery
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Job
Role
Rebuilding and Recovery Self Organization Community
Emergency Management
Accessing FEMA Information Debris Management
Communication with Private Sector Patient Tracking
COOP Evacuation & Re-entry
Public Health Planning Communication/ICS Social Media
Personal Preparedness Community Planning
Mental Health Patient Tracking ICS Self-care & Preparedness for HCWs Psychological First Aid
Building Resilience Recovery Stress in Employees
Hospital Emergency Management
ICS ICS/HICS Management & Executive Training Self-care & Preparedness for HCWs
ICS for Elected Officials Working with FEMA Caring for Vulnerable Populations
Fire Drills Planning Technical Training
Personal Preparedness ICS for Elected Officials School-based Preparedness
Police Technical Training Evacuation & Re-entry After Action Reports ICS
ICS for Elected Officials Rebuilding
Elected Official FEMA Basics Who to Know Prior Planning
Financial/Public Assistance Programs Support Volunteer & Donations Management
Grassroots Organizations
CERT Training Rebuilding Applying for Assistance Working with FEMA
Disaster Case Management Personal Preparedness Inter-org Relationships Working with Local, State, FEMA
Personal Preparedness Personal Recovery Volunteer & Donations Management
Human Services Inter-agency Cooperation - Personal Preparedness Working with State and Federal
Other - ICS for City Housing Asset/Money Allocation
Personal Preparedness Personal Recovery
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Job
Role
Inter-Agency and Private Sector Cooperation Self Organization Community
Emergency Management
Accessing FEMA Information Debris Management
Communication with Private Sector Patient Tracking
COOP Evacuation & Re-entry
Public Health Planning Communication/ICS Social Media
Personal Preparedness Community Planning
Mental Health Patient Tracking ICS Self-care & Preparedness for HCWs Psychological First Aid
Building Resilience Recovery Stress in Employees
Hospital Emergency Management
ICS ICS/HICS Management & Executive Training Self-care & Preparedness for HCWs
ICS for Elected Officials Working with FEMA Caring for Vulnerable Populations
Fire Drills Planning Technical Training
Personal Preparedness ICS for Elected Officials School-based Preparedness
Police Technical Training Evacuation & Re-entry After Action Reports ICS
ICS for Elected Officials Rebuilding
Elected Official FEMA Basics Who to Know Prior Planning
Financial/Public Assistance Programs Support Volunteer & Donations Management
Grassroots Organizations
CERT Training Rebuilding Applying for Assistance Working with FEMA
Disaster Case Management Personal Preparedness Inter-org Relationships Working with Local, State, FEMA
Personal Preparedness Personal Recovery Volunteer & Donations Management
Human Services Inter-agency Cooperation - Personal Preparedness Working with State and Federal
Other - ICS for City Housing Asset/Money Allocation
Personal Preparedness Personal Recovery
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Job
Role
Summary • Workforce Competency is Inconsistent
– Of 11 core competencies, only Expected Role and Communication were attained by >75% of interviewees
– Large discrepancies in training among job roles • Additional Training Needs
– Topic trends include: • Incident Command System/Hospital Incident Command System • FEMA – Basics, Programs, and Assistance • Preparedness – Personal, community, and organization • Rebuilding and Recovery • Cooperation – Inter-agency and private sector
– Many other training needs identified
5/7/2014 28
Value of the Research
1. Rooted in the lived experience of leaders currently in the recovery phase;
2. Focused on leaders currently active in recovery, yet identifies multiple learning gaps;
3. Snowball sampling identified only 13-19 people in each community, suggesting that recovery is driven by a small number of people.
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Limitations • Case Study Design
– Cannot generalize to the rest of the population • Includes two different disasters
– Difference in chronology between sites – Sites that experienced Sandy also experienced Irene
• Do not have competency data for all 90 respondents
• NDRF released after Hurricane Irene (Sept. 2011) – May have been progress in capacity and recognition of
recovery needs from Irene to Sandy
5/7/2014 30
Potential Secondary Analyses
• Considerations for rural vs. urban areas • Relationships and roles of organizations
involved in response and recovery • Coordination among federal, state, and local
agencies • Awareness and application of National
Disaster Recovery Framework • Short- and long-term recovery training • Community recovery planning
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For further information please contact:
Dr. Kenneth Schor, Acting Director Phone: 240-833-4444 Email: [email protected]
Follow Us: Facebook.com/NCDMPH @NCDMPH LinkedIn ncdmph.usuhs.edu
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