AtRisk Populations and Pandemic Influenza: Planning Guidance for State, Territorial, Tribal, and Loc

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At-Risk Populations and Pandemic Influenza
Planning Guidance for State, Territorial, Tribal,
and Local Health Departments

• Natalie Vestin, MPH, Grant Program Associate
• Center for Infectious Disease Research Policy
• Katie Gruner, MPH, Grant Program Associate
• Center for Infectious Disease Research Policy

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Todays presentation

• Overview
• Project methods
• Definition of at-risk populations
• 5 work group topic areas
• Key recommendations
• Public comment period

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What is the At-Risk Populations Project?

• The Centers for Disease Control and Prevention
  (CDC) funded The Association of State and
  Territorial Health Officials (ASTHO) to develop
  planning guidance on at-risk populations and
  pandemic influenza
• ASTHO worked with CIDRAP, The National
  Association of County and City Health Officials
  (NACCHO), and the Keystone Center to develop the
  guidance
• Audience state, territorial, tribal, and local
  health departments

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What Makes this Project Unique?

• The project represents the first time
  national-level guidance has been developed
  outside of CDC
• A factors-based definition for at-risk
  populations was used, rather than traditional
  labels
• During the drafting process, input was sought
  from at-risk populations and the providers who
  serve them

Photo from http//www.onekcvoice.org
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Project Methods

• A literature review assessed federal, state, and
  local plans and promising practices
• An Advisory Panel oversaw the process and created
  a factors-based definition for at-risk populations

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Project Methods Work Groups and Topics

• Subject-matter expert work groups - 67 experts
  provided guidance and expertise on the individual
  sections of the document
• Collaboration with and engagement of at-risk
  populations
• Identifying at-risk populations
• Communications with and education of at-risk
  populations
• Provision of services (clinical and non-clinical)
• How to test, exercise, measure, and improve
  preparedness

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Project Methods Community Engagement

• Two public engagements Boston, MA and Kansas
  City, MO to gain input from members of at-risk
  populations
• National Stakeholders Meeting (21 ppl) to gain
  input from organizations that work regularly with
  these populations
• Public comment period under way through May 15 to
  ensure a wide range of input is received

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Public Engagement Meetings

• Boston, MA 57 participants
• Strong representation from people who are deaf
  and those who rely on wheelchairs
• Kansas City, MO 66 participants
• Strong representation from people who are
  homeless and/or people with brain injuries or
  other cognitive or behavioral health issues
• Course of the day
• Education on influenza, pandemics, and the unique
  situation of at-risk populations
• Small-group discussions

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Public Engagement MeetingKansas City, Missouri
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Public Engagement Meetings Participant and
Observer Comments

• The participants were very representative of
  the community. You do not usually see this kind
  of diverse representation at most
  local/state/federal meetings of public health
  issues.
• - Feedback from a participant at the Boston
  public engagement meeting

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Public Engagement Meetings Participant and
Observer Comments

• Boston 82 of participants who responded agreed
  that the city should conduct transportation
  drills (e.g., evacuation, food delivery) that
  include people with disabilities
• Staff incorporated a step-by-step
  discussion-based exercise scenario into the
  guidance that addressed transportation
  infrastructure changes

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Public Engagement Meetings Participant and
Observer Comments

• Kansas City 77 of participants who responded
  agreed that they would be better prepared for a
  pandemic if their faith-based communities were
  more involved in preparedness activities
• Staff incorporated information on outreach to
  faith-based organizations and establishments into
  the guidance
• Additions included noting that
• Specific messages may need to be developed in
  light of certain religious practices
• Trusted or primary messengers may include
  pastors, priests, chaplains, rabbis, and imams
  (among other religious leaders)

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The Guidance OverviewAt-Risk Populations and
Pandemic Influenza Planning Guidance for State,
Territorial, Tribal, and Local Health
Departments

• The guidance contains
• Factors-based definition of at-risk populations
• Discussion of legal and ethical considerations in
  planning for at-risk populations
• 5 chapters that correspond to each subject-matter
  work group
• Proposed timeline for enacting recommendations
  based on pandemic phase and severity

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Definition of At-Risk Populations

• Certain factors will increase a persons risk of
  negative outcomes on essential health, safety,
  and well-being
• Individuals may experience significant barriers
  and need help maintaining medical care, food, and
  shelter
• People are more likely to experience these
  effects when the systems on which they usually
  rely are overloaded

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What Factors Put People at Greater Risk?

• Economic disadvantage
• People may have too little money to stockpile
  supplies, or to stay home from work
• Absence of a support network
• E.g., children homeless travelers and the
  socially, culturally, or geographically isolated

Photo by Ken Hammond, USDA copied on Nov. 16,
2007 from http//www.ers.usda.gov/amberwaves/Febr
uary04/Findings/HowMany.htm
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What Factors Put People at Greater Risk?

• Needing support to be independent in daily
  activities because of
• Physical disability
• Developmental disability
• Mental illness or substance abuse/dependence
• Difficulty seeing or hearing
• Medical conditions
• Trouble reading, speaking, or understanding
  English

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The Guidance A Users Guide

• Topic Collaboration with and engagement of
  at-risk populations
• Challenges for public health, CBOs, and at-risk
  people
• Identifying partnerships
• How public health can engage and contribute to
  community networks
• Including at-risk populations in policy
  development

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The Guidance A Users Guide

• Topic Identifying at-risk populations
• Purpose, tools, and approaches
• Sources and limits of public data
• Managing and mapping public data
• Prioritizing at-risk groups
• National, state, and local data sources and
  practices

Photo from http//www.esri.com
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The Guidance A Users Guide

• Topic Communications with and education of
  at-risk populations
• Trusted messages, messengers, and methods
• Timing
• Evaluating effectiveness

Photo from http//www.echominnesota.org
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The Guidance A Users Guide

• Topic Provision of services (clinical and
  non-clinical)
• Essential clinical services and challenges
• Lack of access to healthcare
• Chronic physical conditions
• Essentials for independent living
• Behavioral health conditions
• Non-clinical services
• Providers and responsibilities

Photo from Encyclopedia Britannica's Advocacy for
Animals Working Animals page. Retrieved Feb. 12,
2008 from http//advocacy.britannica.com/blog/advo
cacy/category/features/working-animals/
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The Guidance A Users Guide

• Topic How to test, exercise, measure, and
  improve preparedness of at-risk populations
• Barriers to evaluation
• Methods for evaluation
• Tailoring Homeland Security Exercise and
  Evaluation Program (HSEEP) to at-risk populations
• Sample discussion- and operation-based exercise
  objectives and scenarios

Photo from http//www.nursing.columbia.edu/pdf/Pub
licHealthBooklet_060803.pdf
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Key Recommendations

• Join an existing network or create a network with
  representation from at-risk individuals, FBOs,
  CBOs, and key partners, such as media outlets
• Find and use data sources that identify at-risk
  populations in the jurisdiction
• Prioritize planning for populations at economic
  disadvantage
• Identify where the greatest needs are in order to
  effectively allocate funds

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Key Recommendations

• Use appropriate risk-communication techniques
  trusted messengers and appropriate technologies,
  media, and formats to reach at-risk populations
• Establish and follow a protocol for evaluating
  risk communication messages for at-risk
  populations, which may include
• Conducting pre- and post-tests at public meetings
  
• Evaluating channels used for messages
• Evaluating partners ability to share emergency
  messages
• Measuring the impact of messages on preparedness

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Key Recommendations

• Convene the appropriate service provision
  agencies and provide the framework for necessary
  planning activities
• Include at-risk populations in evaluation as
  planners, participants, and part of scenario
  development in exercise design, implementation,
  and evaluation
• Implement a quality assurance program that tests,
  evaluates, exercises, and improves the process of
  providing services for at-risk populations

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Review the Guidance Online

• CIDRAP www.cidrap.umn.edu
• ASTHO www.astho.org

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Providing Comments on the Guidance

• The Public Comment Period is open until May 15
• Please provide feedback via
• E-mail (preferred) ARPP_at_astho.org
• Phone, Fax, or Mail
• Caroline Barnhill, MPH
• Senior Analyst, Infectious Disease
• ASTHO
• 2231 Crystal Drive, Suite 450
• Arlington, VA 22202
• Phone [phone]
• Fax [phone]

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• Questions?
• Thank you!