CDC/HRSA/ASPH Meeting Preparedness Education and Training:

CDC/HRSA/ASPH MeetingPreparedness Education and Training:

Where We Are

September 20, 2004

Lynn Rothberg Wegman, M.P.A.Director, Division of State, Community, & Public Health

(DSCPH)

Bureau of Health Professions (BHPr)Health Resources and Services Administration (HRSA)

Department of Health and Human Services (DHHS)

HRSA’s Bioterrorism Training and Curriculum

Development Program (BTCDP)

Education and Training Activities at the State and Local Levels

Public Health Security and Bioterrorism Preparedness and Response Act of 2002

Public Law 107-188, Section 319F (g) Signed June 12, 2002 for FY 2003-2006 Bioterrorism Training and Curriculum

Development Program (BTCDP)

Bioterrorism Training and Curriculum Development Program

Recognize

Alert

Treat

Participate

Purpose

Development of a health care workforce that possesses the Knowledge Skills, and Abilities (KSAs) to:– Recognize indications of a terrorist event

– Treat patients and communities in a safe and appropriate manner

– Participate in a coordinated multi-disciplinary community response

– Alert the public health system rapidly and effectively

Two Separate BTCDP Components

Provision of Continuing Education for Practicing Providers

Curricular Development/Enhancement in Health Professions Schools

Courses/Training Offered Number of CE Awardees: 19 Number of CE Respondents: 14 Most Popular Topics (Descending order) Basic Preparedness Bioterrorism Chemical Radiological Nuclear Incendiary NIMS Infrastructure Stockpile Hospital Emergency Communications

BTCDP FY 2003 Available funds: $26.5 M

– Total CE: $22.2– Total CD: $4.3

Awards: 32– Total CE: 19 Avg. Award: $1.2 M– Total CD: 13 Avg. Award: $351, 000

Estimated Trainees*: 193,314– Total CE: 173,786– Total CD: 19,528*Estimates are from entire two-year project period

CE = Continuing EducationCD = Curriculum Development

Continuing Education Linkages

Linkage with: Number:HRSA Hospital Preparedness Program 17

CDC Public Health Preparedness 17

Major Metropolitan Response System 16

Area Health Education Centers 7

Community Health Centers 5

Public Health Training Centers 5

Indian Health Service Sites 4

National Health Service Corps Sites 3

BTCDP FY 2003/04 AwardeesBTCDP FY 2003/04 Awardees

CE AwardeesCE Awardees

CD AwardeesCD Awardees

States with both CE States with both CE and CD Awardeesand CD Awardees

PRTXTX

ARARTNTN

VAVA

OHOH

NYNY

NENE

MTMTWAWA

CACA

ILIL

HIHI

NJNJ

NMNM

COCOKSKS

OKOK

NDND

SCSC

PAPA CTCT

WVWVKYKY

Needs Assessment

Funded programs are refining the initial needs assessment by carrying out the following:– Collaborate with other DHHS Programs

• Centers for Disease Control and Prevention (CDC) Public Health Preparedness and Response for Bioterrorism Program

• HRSA Bioterrorism Hospital Preparedness Program

– Utilize BHPr data sources regarding licensed health professionals in state

– Identify gaps: • Disciplines/trainees that have not received CE• Disciplines which have not developed core competencies for

bioterrorism preparedness training

Evaluation

Tied explicitly to project objectives

Will specify what data will be collected and the method for collection

Utilize existing discipline-specific competencies for bioterrorism preparedness training to:– Measure and evaluate the objectives and outcomes presented in

curricula and training courses– Measure and evaluate the demonstrated knowledge, skills, and

abilities of trainees in response simulations/drills/exercises

Topics/Subjects Most Frequently Offered by CE Awardees

Basic Emergency Preparedness Biological Emergencies/Infectious Diseases Chemical Emergencies Nuclear/Radiation Emergencies Incendiary/Explosive Events NIMS Infrastructure Stockpile Hospital Emergency/Mass Care Communications Psychological Response

Mode/Method of Delivery

Face-to-Face Self-Paced Web-Based Tabletop Drills and Exercises

TOTAL CE/CD PARTICIPANTS

Target ProfessionsEstimate of Total

CE TraineesEstimate of Total

CD Trainees

Health Center Administrators 624 

0

Allied Health Providers 11,887 6,731

Nursing 68,660 3,385

Medicine 36,375 4,818

Nurse Practitioners 7,508 593

Physician Assistants 2,773 574

Dentists 3,317 693

Pharmacists 5,982 1,624

Mental Health Providers 7,392 0

Public Health Providers 2,091 430

EMS 16,043 285

Veterinarians 508 0

Others 10,626 395

Total 173,786 19,528

Total Trainees 193,314

Bioterrorism and Emergency Preparedness Training in Aging

(BTEPA)Curriculum Development Projects

HRSA’s Geriatric Education Centers Initiative on Bioterrorism

Bureau of Health ProfessionsDivision of State, Community

and Public Health

Geriatric Education Centers

Geriatric Education Centers strengthen interdisciplinary training of health professionals to diagnose, treat, and prevent disease and other health problems that older people face

FY 2004 $19 million

47 Geriatric Education Centers

Geriatric Education CentersStatutory Purposes Improve the training of health professionals in

geriatrics Develop and disseminate curricula on the

treatment of health problems in elderly individuals Train and re-train faculty to provide instruction in

geriatrics Support continuing education for health

professionals who provide geriatric care Provide clinical geriatrics training in nursing

homes, chronic and acute care hospitals, ambulatory care centers, and senior centers

Need for Education and Training of Health Professionals in Bioterrorism and Aging

9/11/01, anthrax scare, and IOM report on BT Internet search produced 314,000 references on bioterrorism Citations focused almost solely on the 6 Class A Agents

identified by CDC Few mentioned the special needs of frail elders living alone or

in long-term care facilities <50% HCPs have had BTP training, only 1 in 10 have

geriatrics-related BTP HCPs, administrators, 1st responders and ED staff need

training in treatment and geroethics of triage 

Physiological changes in older people = increased risk of illness / injury with attention to down-regulation of immune system

Altered presentation of illness – e.g., infection, myocardial infarction, and temperature regulation

Public health principles such as herd immunity, vectors of disease, spread and containment

Environmental settings in which older persons reside – weaponized flu and SARS

Key Principles and Components to BTEPA Approach

Surveyed older adults as to their levels of concern and knowledge

What they would do if they felt ill or heard of an attack

Whether they have ever discussed this with their health care providers

What they want from their health care providers to prepare

Needs Assessment: Bioterrorism and Emergency Preparedness in Aging

N = 55, average age 71 High level of concern and knew about anthrax and

smallpox 75% would go to hospital or ED or see MD if they

felt ill None had discussed this with their HCP’s Majority would rely on HCP’s to give them the

information they need on bioterrorism preparedness

Results of Needs Assessments of Older People

Surveyed health care providers as to:

Adequacy of profession’s/community’s preparedness to care for older people in times of bioterrorism and natural disasters

Their formal training in bioterrorism and whether there was aging-specific content

Education/training they need

Who they would call for help

Needs Assessment: Bioterrorism and Emergency Preparedness

N = 50 Profession’s/community’s preparedness for

bioterroism

-- 3.53 (1=inadequate, 9=fully adequate) Profession’s/community’s preparedness for a

natural disaster -- 5.41 (1=inadequate, 9=fully adequate)

Formal training in bioterrorism -- 58% No Geriatric specific content -- 90% No

Results of Needs Assessments of HCP’s

Training needed -- information on toxins (35%), information about the elderly (21%), services available (17%)

Where to go for help for older adults in the event of exposure -- emergency services (37%), public health agencies (26%), physician (13%)

Results of Needs Assessments of HCP’s (cont.)

Health care professionals do not feel prepared to respond to or treat older people exposed to biological, chemical or nuclear weapons

Over 50% of those surveyed have had no training on bioterrorism

Only one in ten had received information on bioterrorism and aging

Health care professionals want information on biological weapons and their elderly patients are relying on them

Lessons Learned from Needs Assessments

Recognizing the potential threats

Defining roles in crisis management

Basic geriatrics considerations

Mobilizing available resources

Communicating effectively

Mental and behavioral health

Geroethical issues

* Meeting of six HRSA-funded GEC’s held January 2004.

Consensus Conference Curricular Content*

Set the stage: an elderly person as the sentinel event

Immune system changes that come with aging

The 6 Class A agents – anthrax, tularemia, smallpox, plague, botulin toxin, VHF-- plus weaponized flu and other emerging infections

Diagnosis and treatment of the elderly in the event of exposure

Containment

Psychosocial, ethnographic & ethical issues

Overview of Approaches

New York University Consortium of New York Geriatric Education Centers

St. Louis University Missouri Gateway Geriatric Education Center of Missouri and Illinois

University of Kentucky Ohio Valley Appalachia Regional Geriatric Education Center Stanford University Stanford Geriatric Education Center

Baylor College of Medicine Texas Consortium of Geriatric Education Centers

Case Western Reserve University Western Reserve Geriatric Education Center

Summary of Six HRSA-Sponsored BTEPA Grantees

Clinical Training Exercises

CME Programs

Grand Rounds

Speakers Bureau

CD-ROM’s

Web-based Content

Newsletter and Journal Articles

Summary: BTEPA Learning Opportunities

Public Health Training Centers

Health Resources and Services Administration Bureau of Health Professions

Division of State, Community and Public Health

PHTC are collaborative partnerships between accredited schools of public health and public

health practice organizations

Provide foundational competency-based training opportunities that prepare public health workers

to pursue specialized training in areas such as

leadership development and emergency

preparedness.

Public Health Training Centers

PHTC Offer Trainings Based on Public Health Core Competencies

Public Health

Core Competencies

Emergency Preparedness

Leadership Competencies

Nursing Competencies

Environmental Health Skills

Health Resources and Services Administration

Bureau of Health ProfessionsBureau of Health Professions

Public Health Training CentersPublic Health Training Centers

Boston UniversityBoston, MA

Columbia UniversityNew York, NY

University of PittsburghPittsburgh. PA

Johns Hopkins UniversityBaltimore, MD

University of North CarolinaChapel Hill, NC

University of MichiganAnn Arbor, MI

University of IllinoisChicago, IL

Tulane UniversityNew Orleans, LA

University of MinnesotaMinneapolis, MN

University of IowaIowa City, IA

St. Louis UniversitySt. Louis, MOUniversity of Texas-HSCHouston, TX

University of WashingtonSeattle, WA

UCLALos Angeles, CA

States Not Covered

Academic Partners

HawaiiAlaska

PHTC Network Status

14 PHTCs cover 42 states and D.C.

Involve all but 8 accredited schools of public health and over 90 academic partners

Collaborate with over 270 public health practice organizations

Needs Assessments

PHTC Needs Assessments are ongoing and include:– Education and training needs of the public health

workforce – Educational assets and resources in service area

Assessment results inform the development of training initiatives

PHTC Trainings

Target audience- all public health workers, including those working in:– Health Departments

– Community Based Organizations

– Hospitals/Health Care Organizations

Training based on: – 10 Essential Public Health Services

– Council on Linkages Core Competencies for Public Health Professionals

PHTC Accomplishments

Over 100,000 public health workers have

been trained by PHTCs

40,000 workers trained at a distance

13048

37889

55428

0

10000

2000030000

40000

50000

60000

2001 2002 2003

Number of Public Health Workers Trained by PHTC: 2001-2003

Num

ber

Tra

ined

6296

13685

20278

0

5000

10000

15000

20000

25000

2001 2002 2003

Number of PHTC Distance Learning Participants: 2001-2003

PHTC Accomplishments

Over 4,100 trainings delivered to date

Over 2,400 distance learning trainings

268137

636376

795

1910

0

400

800

1200

1600

2000

2400

Number of

Trainings

2001 2002 2003

Face-to-Face and Distance Learning Training Provided by PHTC: 2001-2003

Face-to-Face Trainings DL Trainings

405

1012

2705

0

500

1000

1500

2000

2500

3000

2001 2002 2003

Number of PHTC Trainings Offered: 2001-2003

Num

ber

of T

rain

ings

PHTC Accomplishments

Over 700 different trainings/courses have been developed or are in development

– 90% of trainings co-sponsored with other organizations

– 77% of trainings are competency-based

PHTC Trainings

Delivery Mode

Face to Face 63%

Distance Learning 23%

Hybrid 14%

PHTC/ACPHP Collaboration

13 ACPHP are co-located at universities that have PHTC

PHTC & ACPHP are often structured as components of an umbrella entity, sharing resources among multiple academic/practice training programs

Shared efforts include:– Management: PIs, Co-PIs

– Governance: Advisory boards, committees

– Personnel: staff, faculty, consultants

– Training technology

PHTC/ACPHP Collaboration

All PHTCs partner with ACPHP by co-sponsoring public health workforce trainings

As of June 2004, 90% of all PHTC trainings

were co-sponsored; 12% of all PHTC trainings were co-sponsored with an ACPHP

PHTCs focus on foundational skills while ACPHP focus on specialized bioterrorism and emergency preparedness skills

Future Directions

National PHTC Network Recently Formed

Improve quality and outcomes of public health training

Increase efficiency of PHTCs’ operations and training delivery

Expand the coverage of PHTCs and the National PHTC Network

Evaluate the impact of training

Advocate for broadened support for public health workforce training in general and the PHTCs in particular

PHTCs will partner with YOU to provide foundational population-based education and training programs

Contact:

Heartland Public Health Education and Training Centerwww.slu.edu/centers/heartland

Michigan Public Health Training Centerwww.mitrainingcenter.org

Mid-America Public Health Training Centerwww.uic.edu/sph/maphtc

Mid-Atlantic Public Health Training Center maphtc.jhsph.edu

Midwest Center for Life Long Learning in Public Healthwww.publichealthplanet.org

New England Public Health Workforce DevelopmentAlliancewww.bu.edu/publichealthworkforce/index.html

New York and New Jersey Public Health Training Centerwww.nynj-phtc.org

Northwest Center for Public Health Practicehealthlinks.washington.edu/nwcphp/hrsa/

Pacific Public Health Training Centerwww.pphtc.org

Pennsylvania and Ohio Public Health Training Centerwww.pophtc.pitt.edu/

South Central Public Health Training Centerscphp.sph.tulane.edu/scphtc/

Southeast Public Health Training Centerwww.sphtc.org

Texas Public Health Training Centerwww.txphtrainingcenter.org/

Upper Midwest Public Health Training Centerwww.public-health.uiowa.edu/UMPHTC/

Health Resources and Services AdministrationBureau of Health Professions

http://bhpr.hrsa.gov/publichealth/phtc.htm

Thank You

Contact Information:

Lynn Rothberg Wegman, M.P.A.Director, Division of State, Community, & Public

Health (DSCPH), HRSA, BHPr301-443-1648

lwegman@hrsa.gov