PHEP 102 - Overview of the Capabilities-Based Approach

Welcome to the Overview of the Capabilities-Based
Approach to Public Health Preparedness.
My name is Christine Kosmos, I'm the Division Director
for the Division of State and Local Readiness at CDC
within the Office of Public Health Preparedness
and Response, and in this unit we’re going
to take a little bit of a closer look at the
capabilities based approach.
One of the nation's key preparedness challenges
has been determining appropriate state and local
public health preparedness priorities.
To assist state and local public health departments
in their strategic planning, CDC implemented
a systematic process to define a set of public health
preparedness capabilities.
This process incorporated a comprehensive review
of evidence-informed documents and relevant
preparedness literature, along with subject matter expertise
gathered from across the federal government
and the state and local practice community.
The resulting body of work,
Public Health Preparedness Capabilities:
National Standards for State and Local Planning,
outlines a capabilities-based approach that will assist
state and local planners to identify gaps
in preparedness and develop plans for both building
and sustaining their capabilities.
The approach also provides structure and focus
for CDC’s Public Health Emergency Preparedness
—PHEP—cooperative agreement:
it clarifies expectations for PHEP-funded states,
localities, territories and freely associated states,
and helps CDC measure progress toward achieving
public health preparedness.
Introduction to the Public Health Preparedness Capabilities
discussed how and why the capabilities
were developed and details some of the benefits
to this capabilities-based approach. In this overview,
we will provide background information
on the development of the approach,
discuss how the public health preparedness capabilities
are structured and, using one capability as an example,
demonstrate how its component parts relate to one another.
The capabilities-based approach identifies
15 public health preparedness capabilities
each of which represents an essential and critical
aspect of preparedness.
Here they are in alphabetical order:
These capabilities can be used broadly to prepare for
any type of public health emergency and hazard
whether a result of man-made threats, biological agents,
natural disasters, environmental exposures,
chemical and radiological incidents, or explosions.
Let’s take a closer look at the overall structure
of state and local public health capabilities,
including the capability definition, associated functions,
tasks and resource elements, and performance measures.
The Capability definition defines the capability
as it applies to state, local, tribal, and territorial public health.
Each capability is composed of 3 to 5 functions.
Functions are critical elements that need to occur
in order to achieve the capability.
Each function in turn is supported by both
preparedness and response tasks
—these tasks detail the kinds of actions that need
to occur to complete the function.
They can be observed and evaluated
during a response or under exercise conditions.
Performance measures defined by CDC
may be associated with some of the functions.
These measures monitor the extent to which
jurisdictions are able to demonstrate their performance
on specific preparedness and response capabilities.
Finally to be able to do any or all functions and tasks,
one needs resources.
These are what a jurisdiction should have
or have access to in order to successfully perform
a function and the associated tasks.
There are 3 types of resource elements:
Planning,
Skills and Training,
and Equipment and Technology.
Planning: These include having standard
operating procedures and emergency operations plans in place.
They may include memoranda of understanding
with partner agencies or language which describes
a public health agency’s legal authority and role
under a variety of emergency conditions.
Skills and Training: These refer to the baseline competencies
and skills necessary for personnel and teams
to competently deliver a capability.
Equipment and Technology: These specify
what kinds of equipment—including information technology—
jurisdictions should have, or have access to
in order to carry out a capability.
Among the resource elements, CDC has designated
some as “priority” resource elements
which should be considered to be the most critical
and a minimum standard for state and local preparedness.
Jurisdictions are encouraged to consider having
the other recommended resource elements in place.
Let’s apply the capabilities-based approach
in the context of a public health preparedness capability
using Emergency Operations Coordination as an example.
Emergency Operations Coordination is defined
as the “ability to direct and support an event or incident
with public health or medical implications
by establishing a standardized, scalable system
of oversight, organization, and supervision consistent
with jurisdictional standards and practices
and with the National Incident Management System or NIMS.”
In other words effective and orderly management
of a response to an incident with public health implications
must be systematic, sensitive and responsive
to changing conditions, and consistent with procedures
used by other emergency management agencies.
There are five functions that need to occur in order
to achieve this capability and for each function,
various tasks should be carried out to operationalize it.
In addition, the capability includes several
performance measures and priority resource elements.
We’re going to talk about three of these functions
in order to get a sense of the types of activities that
should be considered to perform each of them.
Next, we’ll take a closer look at one of the functions
to discuss performance measures
and some of the priority resource elements that support it.
Function 1 is: Conduct a preliminary assessment
to determine the need for public activation,
which involves three tasks:
For whatever emergency that arises –a multi-car crash
on the interstate, a chlorine leak at Metro Chemical–
we’ll need to determine the public health impact
of the event that’s unfolding.
We’ll work with local Public Safety and other
local response partners to decide our role
in the response—are we going to be a lead
or supporting organization?
We’ll need to decide at what level the public health
incident command system should be activated
in order to carry out our role.
Function two is: Activate public health emergency operations,
which involves six tasks:
Who has the authority to activate the EOC?
Who is trained and available take on incident command
lead roles over an extended period?
We’ll need continuous staffing for as long as
emergency operations are activated.
Do we have potential emergency operations center
locations identified? We may be sharing a site
with other agencies.
Functions three and four involve developing
the incident response strategy, managing it,
and maintaining it.
Let’s jump to function five: Demobilize and evaluate
public health emergency operations, which involves five tasks:
Getting back to normal has its own challenges.
How will we gradually step-down the response
and how will we provide for the needs
of our public health responders?
We’ll need to pack away all of the supplies
such as cots, screens and equipment,
making sure they are in good condition
and in the right locations for use next time.
We’ll also need to inventory supplies like gloves
and masks for replenishing.
And here’s a big question: What systems are in place
to assure that we can learn from the response experience
and make improvements for the future?
While it is not mandatory that every jurisdiction
perform every task that was just discussed,
as we can see many tasks would be performed
to carry out the function.
Let’s take a closer look at the performance measure
and resource elements that are associated with
Function 2: Activating Public Health Emergency Operations.
There is one performance measure associated
with Function Two: It is Staff Assembly,
the time it takes for pre-identified staff covering
activated public health agency incident management
lead roles (or equivalent lead roles) to report
for immediate duty.
Assembly can occur at a physical location
—for example the EOC, a virtual location
—for example a web-based interface
such as Web EOC, or a combination of both.
While all awardees report their best demonstration
of staff assembly, this measure has special importance
for the 50 states as it has been designated a
Priority Goal by the U.S. Department of Health
and Human Services and the Office of Management
and Budget.
The Priority Goal specifies a target of 60 minutes
for state public health agencies to convene a team
of trained staff that can make decisions
about appropriate response and interaction with partners.
We need to fill incident command lead roles quickly,
so we’ll need to have accurate contact lists
and redundant means of making contact.
If we can notify key staff by cell phone, e-mail, landline,
and pagers, we have a better chance of quickly making contact
than if we just call cell phones.
The quicker we notify, the quicker we can assemble.
Function 2 has at least one of each of 3 types
of resource elements described earlier: planning,
skills and training and equipment and technology.
Having written standard operating procedures
for the management, operation and staffing
of the emergency operations center is one of five
planning resource elements and it is a ‘priority’
resource element.
Thus, at a minimum these written procedures should be in place.
There is one resource element under ‘skills and training’
for this function and it too is a ‘priority’
resource element. It is: Staff involved in incident response
should be competent in the incident command
and emergency management responsibilities
that they may be called upon to fulfill in an emergency.
There are three resource elements under
‘Equipment and Technology,’ they are:
Have or have access to back up equipment in the event
of system failure or power loss in the public health
emergency operations center, communications equipment
to allow information to be transmitted inside
and outside the EOC, and information technology equipment
sufficient to meet the event or incident objectives.
While none of the Equipment and Technology
resource elements is a priority resource element,
all of them can help build and maintain the ability
to perform the function of activating public health
emergency operations.
Public Health Preparedness Capabilities:
National Standards for State and Local Planning
includes a public health preparedness capabilities
planning model which offers a series of suggested
activities for preparedness planning.
As a first step, jurisdictions are encouraged to self-assess
their ability to address the priority planning
resource elements of each capability, followed by
an assessment of their ability to demonstrate
the functions and tasks within each capability.
Jurisdictions may follow different strategies
to operationalize them or they may address
the capabilities in different order, informed by their own
risk assessments, forms of government,
and population characteristics.
Preparing for public health emergencies requires
continual and coordinated efforts involving every level
of government, the private sector, non-governmental
organizations and individuals.
Public Health Preparedness Capabilities:
National Standards for State and Local Planning
are designed to excelerate state and local preparedness
planning and, ultimately, assure safer, more resilient,
and better prepared communities.
We now conclude this Overview of the
Capabilities-Based Approach to Public Health Preparedness.
For more information, visit the Office of Preparedness
and Response website at www.cdc.gov/phpr.
Thank you for your time, your attention and for all that
you do on behalf of our communities and our country.