cdc/hrsa/asph meeting preparedness education and training:
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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
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