CIFOR Toolkit: An Overview of Focus Area 3 – Communication New York Integrated Center of Food Safety Center of Excellence – August 23, 2016 Madhu Anand, DrPH Bureau of Communicable Disease Control New York State Department of Health

Background This is the fourth webinar in a series of monthly webinars from the New York Integrated Center of Food Safety Center of Excellence (NYCoE) Session will cover CIFOR Toolkit Focus Area 3: Communications Upcoming monthly sessions will work through the entire CIFOR Toolkit, Focus Areas 4-11

Background Additional sessions will focus on emerging issues in food safety including culture‐independent diagnostic testing, antimicrobial resistance, and advanced molecular detection/whole genome sequencing All webinars will be recorded and available through the NYSDOH Learning Management System (LMS) at: www.nylearnsph.com Slide decks/recordings for all webinars will post to the NYCoE website: http://nyfoodsafety.cals.cornell.edu/training/cifor-webinar-series

Objectives Describe how to use the CIFOR Toolkit (Worksheets) Explain Focus Area 3: Communications Review Goals Review “Keys to Success” and Recommendations Contact Lists Communication Practices Making Changes Image: http://www.dalecarnegiewayindy.com/2012/07/06/three-keys-to-success-in-sales/

How to Use the CIFOR Toolkit Determine Priority Focus Areas For each Focus Area (1-11) deemed as high priority, complete the corresponding worksheet regarding efforts to improve foodborne disease outbreak response in your agency/jurisdiction Complete the Worksheet as a Team (Workgroup) Epidemiology, Laboratory, Environmental Health and other agencies Describe your jurisdiction’s current activities/procedures for the Focus Area Refer to written protocols/procedures and materials related to ongoing efforts in capacity development or quality improvement Indicate any activities that, if modified, could improve your jurisdiction’s response to foodborne disease outbreaks

How to Use the CIFOR Toolkit Prioritize CIFOR Recommendations to Address Needed Improvements Based on needs identified in your jurisdiction, review the CIFOR recommendations related to the Focus Area of interest Rate the priority for implementing each recommendation based on its likely impact on foodborne outbreak response in your jurisdiction Some recommendations may already be in place at your agency, or not relevant to your agency, and can be marked as such Identify activities and procedures in need of improvement

Focus Area 3 Title: Communications Goal of the Focus Area: Agency/jurisdiction lays groundwork for good communication with key individuals, both internal and external to the agency, before an outbreak occurs

Toolkit Tracks and Focus Areas In developing the Toolkit, outbreak response activities have been divided into four major “tracks,” corresponding to the four main chapters of the CIFOR Guidelines Planning and Preparation brings the right expertise to the investigation, communicating quickly with all organizations that should be involved, and rapidly sharing investigation findings can accomplish the goal.

Keys to Success Activities, relationships, and resources that are critical to achieving success in a Focus Area Contact Lists Communication Practices Making Changes Determining whether your jurisdiction has a particular key to success in place can be subjective; use your best judgement in deciding whether an activity is partially or fully in place Applying metrics and measures can help you identify the success of your program or investigation process

Contact Lists 2 Keys to Success Agency/jurisdiction identifies key individuals and organizations related to outbreak response before an outbreak occurs including members of the outbreak response team, officials inside the agency, contacts at external agencies (i.e. other local, state, and federal agencies),and the media Agency/jurisdiction establishes and frequently updates contact lists for key individuals and organizations

Recommendations: Contact Lists Prepare contact information (including after-hours information) for: People in the agency who should be contacted in the event of an outbreak, including backups Contact people in external agencies (e.g., other local, state and federal agencies) Important food industry contacts, including trade associations Information to include: Phone numbers (primary, alternate, cellular, 24 hour contact, home) Pager numbers E-mail Fax number Address

Recommendations: Contact Lists Ensure that all contact lists are updated twice yearly and, when feasible, made available to all stakeholders on both electronic and hard copy formats Distribute a list of your agency’s contacts to other agencies, and obtain a list of their contacts. Provide the contact list in electronic and hard copy formats Develop a group electronic distribution list for rapidly sharing information with those who should be contacted in the event of an outbreak

Communication Practices 3 Keys to Success Agency/jurisdiction has procedures for communicating with key individuals and organizations Agency/jurisdiction has staff trained in communicating with the media and risk communication Agency/jurisdiction identifies a person(s) responsible for external communication on behalf of the agency/jurisdiction during each outbreak response

Recommendations: Communication Practices Internal Ensure the members of the outbreak response team know each other before an outbreak occurs Establish and use routine procedures for communicating among outbreak response team members and their units and agencies before an outbreak occurs Define a formal communication process for agencies of the outbreak response team for use during outbreaks. Options include daily phone calls and routine e-mail alerts

Recommendations: Communication Practices Internal (Prior) Decide who will be notified when an outbreak is suspected on the basis of roles, including any changes in notification according to the nature of the outbreak (e.g. pathogen type, involvement of commercial product) and timing (weekends and holidays versus weekdays) Determine whether and how confidential information (e.g. from forms and questionnaires) can be shared within the outbreak response team before an outbreak occurs Serves as a form of quality assurance Can be a point of discussion during an after action report

Recommendations: Communication Practices Internal (During) During an outbreak response, maintain close communication and coordination among outbreak response team members (Epi, Lab, EH) During an outbreak response, identify persons who will be responsible for external communication on behalf of their organizational unit and for the outbreak response team During an outbreak response, communicate actions taken and new outbreak information to all members in the outbreak response team. Make sure public information officer is routinely updated to ensure appropriate messaging to the public and media During an outbreak response, arrange for the outbreak response team to meet daily to update the entire team in a timely manner

Recommendations: Communication Practices External (Prior) Develop standardized processes (including notification triggers and timelines) for sharing information with other local, state, and federal agencies, including who will notify the next level of public health, environmental health, or food regulatory agencies. Commit to notifying collaborating agencies as soon as possible in the outbreak investigation process. Identify an agency lead on interactions with other agencies, ideally the lead investigator. Establish procedures for coordinating communication with these entities to provide consistent messaging and accurate information flow.

Recommendations: Communication Practices External (Prior) Foster working relationships with other agencies, holding joint meetings and planning sessions before an outbreak occurs Establish processes for participating in multiagency, multijurisdictional conference calls and train staff in conference call etiquette Determine whether and how confidential information can be shared with other local, state and federal agencies Identify and regularly communicate with agencies or organizations that receive possible foodborne illness complaints (e.g. Agriculture agencies, facility licensing agencies, poison control centers) and ensure that they have current contact information for your staff

Recommendations: Communication Practices External (During and After) Rapidly post subtyping results to PulseNet and report newly detected clusters to PulseNet and Fodoborne Outbreak Listserves Document every outbreak investigation using a standard form to facilitate inclusion in state and national outbreak databases NORS Summary Report Background Methods Results Conclusion Recommendation Epi-Curve with timeline

Recommendations: Communication Practices Public Establish standard channels of communication with the public before an outbreak occurs and use those same channels each time a public health issues arises about which the public may seek information Identify an agency lead on interactions with the public, ideally someone trained in communication. Establish procedures for coordination communication with the public to provide consistent messaging and accurate information flow. Create templates for communication with the public (e.g. fact sheets), focusing on the most common foodborne diseases before an outbreak occurs Refer to CIFOR clearinghouse for templates

Recommendations: Communication Practices Public Establish relationships with consumer groups that might be helpful in disseminating information about foodborne disease outbreaks and prevention messages Periodically issue foodborne disease prevention messages or press releases to ensure that the public knows with whom to communicate and from where information ill come during an outbreak Since the public obtains news from multiple sources, us all available sources to disseminate information (e.g. the Internet, television, radio, newspapers, and social media If there is a void, public may fill sought information with unreliable sources

Recommendations: Communication Practices Public Create and test web-based tools for communication with the public (e.g., blast emails, survey instruments) Adopt a standard format for reporting risk information to the public. Decide in advance how to communicate the naming of implicated establishments based on local legal guidelines and whether risk of transmission is ongoing Adopt a standard scripts for reporting complex procedural or technical information to the public

Recommendations: Communication Practices Public In communicating with the public during an outbreak provide technical practical measures that the public can take to decrease risk for illness (e.g., avoidance of known high-risk foods or special instructions for their preparation), as well as basic food-safety messaged and information about how to contact public health authorities to report suspected related illnesses Test messages to the public with representatives of the target population before releasing them

Recommendations: Communication Practices Public Guide staff on how to respond to and communicate with upset members of the public Make copies of summary reports from each outbreak response available to members of the public who request them.

Recommendations: Communication Practices Media Identify an agency lead on media interactions, ideally someone trained as a public information officer Obtain media training for primary agency spokespersons

Recommendations: Communication Practices Media Establish standard channels of communication with the media (e.g.; website, telephone number), and use those same channels each time a public health issues arises about which the public might seek information. Identify primary contact persons from major local media outlets. Know routine deadlines and time frames for reporting news through major local media outlets (e.g. the deadline for having news from a press release appear in the evening paper) Periodically hold a media education event to teach new media professionals in the community’s media market about public health and response to foodborne disease outbreaks

Making Changes 2 Keys to Success Agency/jurisdiction conducts a debriefing among investigators following each outbreak response and refines outbreak response planning based on lessons learned Agency/jurisdiction has performance indicators related to communication and routinely evaluates its performance in this Focus Area

Recommendations: Making Changes Conduct a debriefing following each outbreak response with all members of the outbreak response team to identify lessons learned Complexity and how formal depends on size of event Formal Identify contributing factors and environmental antecedents Measures to prevent additional outbreaks Identify long-term and structural control measures, and plan for implementation Assess effectiveness and difficulties in implementing outbreak control measures Assess whether further scientific studies should be conducted Clarify resource needs, structural changes, or training needs for future Identify factors that compromised the investigation and seek solutions Identify necessary changes to current investigation and control guidelines and development of new guidelines or protocols as required Discuss legal issues that may have arisen

Recommendations: Making Changes Prepare summary reports for all outbreaks consistent with the size and complexity of the response. Use the reports as a continuous quality improvement opportunity NORS Annual summaries Make copies of summary reports available to all members of the outbreak response team and their units and agencies and persons responsible for implementing control measures

Helpful Tips for Using the Toolkit Don’t get distracted by the volume Be clear on the process Keep moving – don’t get caught up in too much detail Focus on a few realistic changes End with specific action plans Include time frames and responsible persons Appoint a facilitator and a recorder for each discussion Emphasis on realistic changes than can actually occur. Facilitator and recorder can be within the group or from an outside party. Also doesn’t all have to be done at once, but gradually over the span of months, year, etc.

Why Should My State Use the Toolkit? Improve foodborne outbreak investigation and response Enhance partnerships with agencies/partners in foodborne outbreak investigations Identify areas needing improvement that may have otherwise gone unrecognized Comment on what other states are doing or have done – Examples from the field section. Ask if any states on the call would like to share an experience? Maybe mention the use in NY so far – needs assessment via Survey Monkey and setting up regional trainings, to then extend to counties?

Where to Find the CIFOR Products Online at: www.cifor.us Paper copies are also available from CSTE Contact Dhara Shah at dshah@cste.org Examples of CIFOR product use by other states: http://www.coefoodsafetytools.org/

Next Scheduled NY CoE CIFOR Webinars Wednesday, September 28, 2016 @ 2-3 PM Focus Area 4: Complaint Systems Course announcement and link to register is posted on the NY CoE website, as well as, the DOH Learning Management System (LMS): www.nylearnsph.com

Resources Comments or questions for NY CoE can be directed to: Paula Huth, NY CoE Program Coordinator 518-473-4439 or paula.pennell-huth@health.ny.gov Integrated Food Safety CoE Websites: NY CoE: http://nyfoodsafety.cals.cornell.edu/ CDC: http://www.cdc.gov/foodsafety/centers/