<?xml version="1.0"?><Settings><answerBulletFormat>Numeric</answerBulletFormat><answerNowAutoInsert>No</answerNowAutoInsert><answerNowStyle>Explosion</answerNowStyle><answerNowText>Answer Now</answerNowText><chartColors>Use PowerPoint Color Scheme</chartColors><chartType>Horizontal</chartType><correctAnswerIndicator>Checkmark</correctAnswerIndicator><countdownAutoInsert>No</countdownAutoInsert><countdownSeconds>10</countdownSeconds><countdownSound>TicToc.wav</countdownSound><countdownStyle>Box</countdownStyle><gridAutoInsert>No</gridAutoInsert><gridFillStyle>Answered</gridFillStyle><gridFillColor>255,255,0</gridFillColor><gridOpacity>50%</gridOpacity><gridTextStyle>Keypad #</gridTextStyle><inputSource>Response Devices</inputSource><multipleResponseDivisor># of Responses</multipleResponseDivisor><participantsLeaderBoard>5</participantsLeaderBoard><percentageDecimalPlaces>0</percentageDecimalPlaces><responseCounterAutoInsert>No</responseCounterAutoInsert><responseCounterStyle>Oval</responseCounterStyle><responseCounterDisplayValue># of Votes Received</responseCounterDisplayValue><insertObjectUsingColor>Red</insertObjectUsingColor><showResults>Yes</showResults><teamColors>Use PowerPoint Color Scheme</teamColors><teamIdentificationType>None</teamIdentificationType><teamScoringType>Voting pads only</teamScoringType><teamScoringDecimalPlaces>1</teamScoringDecimalPlaces><teamIdentificationItem></teamIdentificationItem><teamsLeaderBoard>5</teamsLeaderBoard><teamName1></teamName1><teamName2></teamName2><teamName3></teamName3><teamName4></teamName4><teamName5></teamName5><teamName6></teamName6><teamName7></teamName7><teamName8></teamName8><teamName9></teamName9><teamName10></teamName10><showControlBar>All Slides</showControlBar><defaultCorrectPointValue>0</defaultCorrectPointValue><defaultIncorrectPointValue>0</defaultIncorrectPointValue><chartColor1>187,224,227</chartColor1><chartColor2>51,51,153</chartColor2><chartColor3>0,153,153</chartColor3><chartColor4>153,204,0</chartColor4><chartColor5>128,128,128</chartColor5><chartColor6>0,0,0</chartColor6><chartColor7>0,102,204</chartColor7><chartColor8>204,204,255</chartColor8><chartColor9>255,0,0</chartColor9><chartColor10>255,255,0</chartColor10><teamColor1>187,224,227</teamColor1><teamColor2>51,51,153</teamColor2><teamColor3>0,153,153</teamColor3><teamColor4>153,204,0</teamColor4><teamColor5>128,128,128</teamColor5><teamColor6>0,0,0</teamColor6><teamColor7>0,102,204</teamColor7><teamColor8>204,204,255</teamColor8><teamColor9>255,0,0</teamColor9><teamColor10>255,255,0</teamColor10><displayAnswerImagesDuringVote>Yes</displayAnswerImagesDuringVote><displayAnswerImagesWithResponses>Yes</displayAnswerImagesWithResponses><displayAnswerTextDuringVote>Yes</displayAnswerTextDuringVote><displayAnswerTextWithResponses>Yes</displayAnswerTextWithResponses><questionSlideID></questionSlideID><controlBarState>Expanded</controlBarState><isGridColorKnownColor>True</isGridColorKnownColor><gridColorName>Yellow</gridColorName></Settings> <?xml version="1.0"?><AllResponses /> <?xml version="1.0"?><AllQuestions /> <?xml version="1.0"?><AllAnswers /> Project Public Health Ready Texas Public Health Emergency Preparedness Quarterly Meeting Resham Patel, MPH July 23, 2014

National Association of County and City Health Officials (NACCHO) The National Association of County and City Health Officials (NACCHO) represents the nation's 2,600 local health departments (LHDs). These city, county, metropolitan, district, and tribal departments work everyday to protect and promote health and well-being for all people in their communities. NACCHO’s Mission: To be a leader, partner, catalyst, and voice for local health departments in order to ensure the conditions that promote health and equity, combat disease, and improve the quality and length of all lives. 2

Project Public Health Ready Project Public Health Ready (PPHR) is a collaborative activity between the National Association of County and City Health Officials (NACCHO) and the Centers for Disease Control and Prevention (CDC). Vision Local health departments (LHDs) will be fully integrated into the response community and prepared to respond to any emergency. Mission To protect the public’s health and increase the public health infrastructure by building local health department preparedness capacity and capability. With assistance from state health departments, LHDs will use sustainable tools to plan, train, and exercise using a continuous improvement model.

Project Public Health Ready Project Public Health Ready (PPHR) is a competency- based training and recognition program that assesses preparedness and assists local health departments to respond to emergencies. 396 public health agencies from 27 states have been PPHR recognized individually or as part of a region.

History of PPHR Piloting began in 2003 Collaborative activity between NACCHO and CDC Committee developed criteria, led by local public health practitioners National standards for local public health preparedness

Importance of Standards and Performance Measures in Preparedness Measures progress on preparedness capabilities and capacities Demonstrates return on investment of federal and state funding Informs state and local public health, policy makers, key preparedness partners and other stakeholders Provides a framework to ensure that public health preparedness is meeting national standards Knowing that there is: Increased pressure to demonstrate overall agency capacity and public health preparedness capability. Demands on state and local health departments to address mandatory and voluntary requirements are increasingly difficult. Demands to demonstrate return on investment to external decision-makers and stakeholders are increasing nationwide Decreased federal funding. Increased budget constraints and limited resources directed toward public health preparedness. Evidence-based national standards and performance measures are critical. BUT, we also know that federal and national standards and performance measures need to be developed in collaboration with local and state practitioners, and specifically need to balance their value against the administrative burden of evaluating progress, especially with decreased resources

PPHR Criteria, CDC preparedness capabilities, and PHAB standards: An Overview Set a standard of achievement for performance for local health departments NACCHO’s Project Public Health Ready (PPHR) criteria address preparedness and response, specifically in planning, training, and demonstration of readiness. CDC’s Public Health Preparedness capabilities assist state and local planners in identifying gaps, determining priorities, and developing plans for building and sustaining capabilities. Public Health Accreditation Board’s (PHAB) standards address global organizational and system-wide agency capacity and capability.

PPHR Criteria, CDC preparedness capabilities, and PHAB standards: A Shared History PPHR criteria and CDC preparedness capabilities focus on building public health preparedness capacity/capability at the state and local level PPHR informed the CDC preparedness capabilities; they both informed development of PHAB standards PPHR updated regularly with special attention to continued alignment with these two Since the early 2000’s, Project Public Health Ready (PPHR) and the Centers for Disease Control and Prevention (CDC) Public Health Emergency Preparedness Program, have maintained a specific focus and relevance on building public health preparedness capacity and capability at the state and local level. Both PPHR and PHEP initially targeted agency capacities, and have also incorporated a stronger emphasis on a capability-based view with an eye toward demonstration of planning. While both PPHR and PHEP provide the state and local structure for public health preparedness, each tackles unique aspects of the equation. PPHR has taken the lead on detailed preparedness planning with a local focus, while PHEP has maintained a strategic, state-focused approach to preparedness priorities and resources. As both programs continue to serve their unique and critical purposes, NACCHO and the CDC have recently increased efforts to collaborate and inform one another, and now both programs are more closely aligned. 2011 PPHR criteria was used as a source document in developing the PHEP capabilities. In fact, PPHR is cited over 100 times throughout the PHEP capabilities, predominantly within the planning resource elements. There were PPHR folks on the PHAB S/M workgroup. PHAB has held a think tank on preparedness and another is planned

PPHR Criteria & CDC preparedness capabilities Project Public Health Ready Criteria Public health preparedness capabilities Focus on local health departments State health department focus Detailed operational plans, training, and exercise Strategic priorities, assess resources, and identify gaps

Crosswalk: PPHR criteria and CDC preparedness capabilities This tool highlights PPHR Criteria that correlate to the CDC public health preparedness capabilities released in 2011. Available online at: http://naccho.org/topics/emergency/PPHR/national-alignment.cfm

NACCHO’s Document Selection Tool: PPHR and accreditation

Examples The continued alignment between PPHR’s criteria, PHEP’s capabilities, and PHAB’s standards allows for a more streamlined approach to addressing state and local public health preparedness, and meeting relevant requirements with limited resources. Particularly, participating in PPHR can be used to inform a strategy for meeting PHEP and PHAB requirements. Together, these programs help to demonstrate the impact of state and local public health preparedness funding and initiatives in a measureable manner.

PPHR Roles Applicants - LHDs or regional agencies submitting plans and other documentation for peer review to achieve national recognition State Lead – A coordinator at the state level that oversees application development for applicants within a state and acts as point of contact for NACCHO Reviewers – Local subject matter experts selected by NACCHO to score applications against the criteria and provide feedback NACCHO – Provides technical assistance to applicants and reviewers and coordinates application review process

PPHR Process Overview Part 1: Application Development Orientation Content Development Technical Review Submission

PPHR Process Overview (cont.) Part 2: Application Review Peer reviewer selection and training Three-person team review of applications (independently and at in-person review meeting) Additional evidence request and review Final review call to determine recognition status Written notification and feedback Recognition ceremony

PPHR Participation

State-Supported Model Implements PPHR in larger numbers of LHDs Creates a network of collaboration within an entire preparedness community. Partnerships: first responders, local emergency management, medical staff, volunteer organizations, etc. Ensures state health department meets local needs State-Supported Implementation: Florida, Colorado, Virginia, Arizona, Pennsylvania, Oregon, Connecticut, Michigan, Tennessee, Georgia, Texas, Louisiana

PPHR Program Value Preparedness is a genuine need Provides a framework Aligns with federal plans and guidance National recognition of efforts has real value Assists in identifying resources from partners and neighboring jurisdictions; develops community partnerships Utilizes a continuous quality improvement process

Benefits and Incentives of Participating in PPHR Staff team building Access to knowledgeable peers for review and comment on performance Increased visibility and recognition Increased credibility and accountability Clear expectations Potential access to new funds Potential streamlined reporting

PPHR Program Evaluation A 2012 survey of the 2011 and 2012 PPHR participants (92 total) yielded responses from 67 (73%). 80% of respondents agreed that PPHR helped them to improve their all-hazards preparedness plans (e.g., emergency and risk communication and continuity of operations). Approximately two-thirds of respondents agreed that PPHR helped them improve their ability to respond to an event and expanded staff knowledge of response roles. Other benefits perceived by more than 60% of participants include: Improvements in how they organized their documentation; Identification of gaps in workforce training and competency; and Identification of future planning priorities.  

PPHR Criteria Project Public Health Ready (PPHR) a criteria-based program that assesses local health department capacity and capability to plan for, respond to, and recover from public health emergencies  NACCHO and CDC program, around since 2003 Development included local practitioners, updated every year Like PHAB: peer reviewed, standards based program Informed PHAB’s development +300 LHDs recognized individually or as part of a region

PPHR Criteria PPHR Criteria is comprised of 3 goals: Goal I: All-hazards preparedness planning Goal II: Workforce capacity development Goal III: Demonstration of readiness through exercise or real event Updated regularly and aligned with federal guidelines and national initiatives, including: National Health Security Strategy (NHSS) CDC Public Health Preparedness Capabilities Public Health Accreditation Board (PHAB) Standards Project Public Health Ready (PPHR) a criteria-based program that assesses local health department capacity and capability to plan for, respond to, and recover from public health emergencies  NACCHO and CDC program, around since 2003 Development included local practitioners, updated every year Like PHAB: peer reviewed, standards based program Informed PHAB’s development +300 LHDs recognized individually or as part of a region

Goal I All-Hazards Preparedness Planning Measure 1: Possession and Maintenance of a Written All-Hazards Response Plan Concept of Operations Community Preparedness Epidemiology & Lab Data and Sample Testing Medical Countermeasure Dispensing Mass Care Environmental Health Response Disaster Behavioral Health Surge Capacity Continuity of Operations Mutual Aid & External Resources

Goal II Workforce Capacity Development Measure 2: Conduct of Regular Training Needs Assessment Measure 3: Completion and Maintenance of a Workforce Development Plan & Staff Competencies Workforce Development Plan Just-in-Time Training

Goal III Quality Improvement through Exercises and Responses and a Comprehensive Exercise Plan Measure 4: Learning and Improving Through Exercises or Responses Participation in Exercises (After Action Reports/Improvement Plans) Participation in Real Events (Incident Action Plans and AAR/IP) Measure 5: Comprehensive Exercise Plan Future Exercise Planning

PPHR Criteria Crosswalk Sub-measures vs. elements. Mention criteria guidance, glossary.

PPHR Quality Improvement Process Training needs assessment based on all-hazards plan Workforce development plan and exercise plan based on results of training needs assessment All plans updated based on after action reports from exercises and real events

PPHR Quality Improvement Process Plan Train Demon-strate Evaluate

Executive Summary The executive summary is the applicant’s opportunity to give local context to national reviewers. In general, the summary should include: Introduction Organizational Structure of the Agency Employee Demographic Information Jurisdictional Area Description Connection/Coordination Type of Regional Collaboration (for regional applications) Full Executive Summary guidance can be found at the end of the Criteria Not scored, just to help reviewers

Application Guidelines Application Guideline #1: If the applicant is not the lead agency for a particular task (evidence element and/or sub-measure), the applicant must provide a description that includes the following: Identification of the lead agency Description of the roles and responsibilities of the lead agency Description of the roles and responsibilities of the applicant Description of how the applicant partners with the lead agency to plan for, and prepare to deliver, the emergency service addressed in the evidence element Description of the applicant’s coordination and communication process for supporting the work of the lead agency Description of how the applicant will work with the lead agency during and/or following an emergency response An example of how this has worked in the past, how it was exercised, or how it is addressed in your training plan If available, agreements between the applicant and the lead agency

Application Guidelines Application Guideline #2: If there is an evidence element and/or sub-measure that the applicant has not yet addressed, or for which documentation is not yet available, the applicant must provide a description that includes the following: Explanation of why the specific item has not been addressed Steps/milestones of a plan to address the item Timeline for steps/milestones Listing of partners and description of their responsibilities to address the item

Regional Applications If the regional agency is the lead, provide evidence to meet the criteria as usual. If the regional agency is not the lead, meet the requirements of Application Guideline #1 If the regional applicant is “not the lead” because it is playing a support role to LHDs within the region, then the applicant must include a single local plan to indicate what their agency is coordinating. For more information, please see the “Guidance for Regional PPHR Applicants and Reviewers” document.

Re-recognition Process New re-recognition process beginning fall 2013 Focus is on changes and lessons learned since previous PPHR recognition and on quality improvement processes in place. Four sections: Section A: Documents Section B: Key criteria elements added since previous recognition Section C: Plan Revision Matrix Section D: Narrative Questions

Questions to Consider Do you have “buy-in” at the department? Do you have a PPHR planning team? What challenges do you foresee? Have you identified collaborating partners (both within the department and the community?) Existing resources and gaps Who’s responsible? Individual or Team?

Initial self-assessment is important Steps to Success Initial self-assessment is important Envision the process as a series of realistic steps Designate individual(s) as process lead Designate individuals as leads for sections Set deadlines (early) Identify partners and various roles in collaboration Gap analysis is the best form of assessment: What do you have? What do you need to work on? Is there a lead in place? Who will you collaborating partners be? Have they been established? Who do you need to reach out to?

Key PPHR documents all-hazards plan and its annexes (revised within 12 months) training needs assessment (conducted within 36 months) workforce development plan (revised within 12 months) documentation (AAR, IAP, etc) for an exercise or event response (24 months) a comprehensive exercise plan (revised within 12 months) include a description of at least one planned exercise to take place no later than 12 months after the PPHR application submission date Gap Analysis Tool – the gap analysis tool that applicants use to assess significant gaps and areas of strength in planning and documentation. While this document details specific criteria elements that applicants should asses as they prepare their applications, applicants should first complete a brief gap analysis before committing to PPHR. In particular, applicants should ensure that they have, or are on track to complete, the following: an all-hazards plan and its annexes that have been reviewed or revised within one year of the PPHR application submission date. a training needs assessment no earlier than 36 months prior to the PPHR application submission date. The results of this assessment must inform the workforce development plan, which must be reviewed or revised within one year of the PPHR application submission date. documentation (AAR, IAP, etc) for an exercise or event response that must have taken place within the 24 months prior to the PPHR application submission date. a comprehensive exercise plan that has been reviewed or revised within one year of PPHR submission (it must include a detailed description of at least one planned exercise to take place no later than 12 months after the PPHR application submission date).

Select PPHR Resources PPHR Gap Analysis Highlights for each agency which areas they should focus on as they begin application development. PPHR Process Guide (http://www.naccho.org/topics/emergency/PPHR/pphr-overview.cfm) Provides a full overview of the PPHR application development process, including roles, responsibilities, and timelines. PPHR Toolkit (www.naccho.org/pphrtoolkit) Contains example local public health preparedness practices. FAQs page (http://www.naccho.org/topics/emergency/PPHR/faqs.cfm) Contains Frequently Asked Questions about each goal of the PPHR criteria. Many of these questions were asked by technical reviewers.

Recommended Resources for Select PPHR Criteria Hazard Risk Assessment Instrument (Developed by the UCLA Center for Public Health and Disasters). Available online at http://www.cphd.ucla.edu/npdfs/HRAI_Workbook.pdf Risk Communication and Public Education Tool Kit. Available through the APC website at www.apc.naccho.org Emergency Risk Communication for Public Health Professionals. Available through the APC website at www.apc.naccho.org Incident Command System Job Action Sheets (Developed by Tarrant County (TX) Public Health Department). Available through the PPHR Toolkit at http://www.naccho.org/toolbox/tool.cfm?id=5 Managing Mass Fatalities: A Toolkit for Planning. Available through the APC website at www.apc.naccho.org Disclaimers: Use of these resources does not guarantee meeting PPHR requirements. This list represents a sample of the resources available to address PPHR criteria; it is not an exhaustive list. Additional resources are available through the PPHR Toolkit (www.naccho.org/pphrtoolkit) and the APC website (www.apc.naccho.org) 1.L.l2. Crises and Emergency Risk Communication Plan Emergency Risk Communication for Public Health Professionals Effective communication with the public during an emergency is vital to protect the community's health. This module provides an overview of how to plan for an emergency, create effective messages, and interact with the media and community in times of crisis. Available through the APC website at www.apc.naccho.org List some common reactions exhibited by the public during public health emergencies Identify some effective communication strategies that can be used during public health emergencies Communicate with the news media more effectively during public health emergencies Work with the community more effectively during periods of heightened emotion Participate in planning processes that can help your organization be better prepared for communicating during an emergency   1.E.e2. The plan demonstrates performance of a hazard analysis of threats (e.g., chemical/nuclear facilities, hurricanes, floods) and unique jurisdictional characteristics/vulnerabilities that may affect a public health response to an emergency event. Hazard Risk Assessment Instrument The Hazard Risk Assessment Instrument (HRAI) workbook is intended to be used as a guide to enable state and local public health agencies to conduct a risk assessment of their community. The tool is designed for use as a standard approach to hazard risk assessment that is adapted to the public health impacts of hazards. HRAI will allow public health agencies to assess the probability of hazards for a particular geographic area and the magnitude of impact given the local resources, allowing for prioritization of response and mitigation options. As such, this workbook will guide public health agencies in determining the likelihood of a hazard occurring, assessing their community’s vulnerabilities and current resources, and prioritizing resources in planning for disasters. Developed by the UCLA Center for Public Health and Disasters. Available online at http://www.cphd.ucla.edu/npdfs/HRAI_Workbook.pdf 1.I.i3. The plan contains copies of Job Aids or Job Action Sheets detailing specific functions of each role indicated as necessary in measure 1.I.i1. Incident Command System Job Action Sheets This PowerPoint presentation contains a series of slides functioning as sample job action sheets for incident command positions and others with roles in a BT emergency. These job action sheets provide examples of how to assign functional roles to public health staff and thereby ensure that staff are better prepared to face an emergency. The job action sheets presented in this tool are relatively basic but provide a sound foundation for the development of more advanced job action sheets. As LHDs work to develop their own job actions sheets for PPHR recognition or to improve their preparedness plans, they should use these as a place to start, but also seek out other resources as examples as well. Good job action sheets will always be specific to the jurisdiction and to the jurisdiction's emergency response plan.  Developed by Tarrant County (TX) Public Health Department. Available through the PPHR Toolkit at http://www.naccho.org/toolbox/tool.cfm?id=5 Some of the jobs contained in this presentation include: Incident Commander Logistics Section Chief Planning Section Chief Public Information Officer Safety Officer SNS Coordinator Field Health Threats Investigator 1.Q. Mass Fatality Management Plan   Managing Mass Fatalities: A Toolkit for Planning This comprehensive toolkit evolved from recognition of the need for communities to increase their preparedness for managing mass fatalities. Its focus—the care and management of the dead—is one of the most difficult aspects of disaster response and recovery operations. Toolkit materials are based on lessons learned from actual events, including the Oklahoma City bombing, 9/11, and Hurricane Katrina. The toolkit provides scalable, operational direction and tools to guide jurisdictions in creating a local plan. Highlights include: Identification of stakeholders involved in mass fatality management and recommendations for a planning process that is co-led by public health and the medical examiner/coroner’s office; Specific guidelines for all medical examiner/coroner responsibilities at the incident site, morgue, and family assistance center Guidance on infection and other health and safety threats; and Requirements and recommendations for managing mass fatalities during a worst-case scenario pandemic influenza. Available through the APC website at www.apc.naccho.org Identification of stakeholders involved in mass fatality management and recommendations for a planning process that is co-led by public health and the medical examiner/coroner’s office Specific guidelines for all medical examiner/coroner responsibilities at the incident site, morgue, and family assistance center Guidance on infection and other health and safety threats Requirements and recommendations for managing mass fatalities during a worst-case scenario pandemic influenza. Risk Communication and Public Education Tool Kit This tool kit identifies techniques for conducting pre-event public education activities, as well as strategies for pre-event and event risk communication planning. The tool kit is organized into three sections: Plan, Prepare and Perform. Each section includes Santa Clara County Public Health Department insights, key tactics, lessons learned and tools when communicating to the public during a health or medical emergency event. Available through the APC website at www.apc.naccho.org RISK COMMUNICATION PLAN: The purpose of the plan. Scope and responsibilities. Pre-event preparation activities. Public information Officer event actions (checklist). Operational and logistical considerations. Media management and message development. Interagency coordination. Plans for post-event wrap up and assessment

PPHR References State lead Fellow applicants NACCHO staff Recognized agencies Past national reviewers

PPHR Staff Contacts Scott Fisher, MPH Senior Director 202-507-4218 sfisher@naccho.org Rachel Schulman, MSPH, CPH Program Analyst 202-507-4203 rschulman@naccho.org Resham Patel, MPH Senior Program Analyst 202-507-4233 rpatel@naccho.org