1. A Multi-State Survey on Public Health Emergency Preparedness Paul Kuehnert, MS, RN Acting Deputy Director Bureau of Health Maine Department of Health and Human Services

2. Acknowledgements Paul Campbell Joshua Frances Hugh Tilson Harvard Ctr for Public Health Preparedness The Maine PHEP Policy Research Group RWJ Executive Nurse Fellows Program

3. Why Maine? Maine is: Large, poor rural state No county or regional health departments 2 municipal health departments 39 private hospitals Primary care shortage areas across state EMS services largely volunteer staffed No School of Public Health

4. Key Strategy: Collaboration Multiple public and private partners in all strategic areas: –Maine Center for Public Health –Harvard Center for PHP –University of Southern Maine –State agency and private partners

5. Research Who: –Maine Center for Public Health –Harvard Center for PHP –Office of Public Health Emergency Preparedness –Regional Resource Centers –University of Southern Maine Why: –Increase our learning –Inform our policy decisions/advocacy –Share our successes and our challenges –Threat of redirection of funding from rural states

6. 2004 Multi-State Survey Descriptive Largely qualitative Two questions: –What are the current perceptions of state capacity for response to public health emergencies? –What are the differences (if any) of perceptions of capacity for public health emergencies between rural and non-rural states?

7. Sample TFAH score used to select sample of states All states that fell into either the highest (scores of 6-7) or lowest (scores of 2-3) scoring groups of states (N=26) “Rural state” defined as > 25% of its population living outside of SMSAs as defined by the US Census Bureau (N=18)

8. Methods Phone and email-based semi-structured interview of state PHEP Directors 17 questions in each of 3 sections: 1.Current capacity --- Y/N Comments 2.Barriers --- Ranking 1 - 5 Comments 3.Enabling factors --- Ranking 1 – 5 Comments

9. Methods (cont’d) Questions grouped into 5 subject areas: 1.Public policy (4 questions) 2.Health care system (2 questions) 3.Public health system (4 questions) 4.Public health workforce (4 questions) 5.Connectivity (3 questions) Comments and explanations encouraged throughout the interview

10. Sample Questions Do you have the following in your state: “ Current state (vs. solely federal) financial support for PHEP?” [Public policy] “Well-equipped and staffed hospital emergency rooms statewide? [Health care system] “Electronic communication system linking state and local public health departments 24/7 statewide? [Public health system]

11. Sample Questions (cont’d) Does your state have: 4. “Strong training support in public health emergency preparedness from academic {preparedness} center?” [Public health workforce] 5. “Effective connectivity with other (non- PH) state bodies involved in emergency preparedness?” [Connectivity]

12. Results: Respondents 96% response rate (25/26 states) 17 Rural states, 8 Urban 3/17 (18%) of Rural states TFAH score > 6 5/8 (63%) of Urban states TFAH score > 6 6/8 (75%) Urban states received CRI funds 1/17 (6%) Rural states received CRI funds

13. Results: Current Capacity Score

14. Results: Current Capacity Urban: more likely to describe health care and public health systems as strong

15. Results: Barriers All: – Lack of state general fund support – Status of regional/statewide health care system – Inadequately staffed/equipped ERs Urban: –Lack of local elected official support –Lack of support among legislators Rural: –Lack of strong local health departments –Lack of 24/7 electronic communications system linking state and local health departments

16. Results: Enabling Factors All: – Training support from academic preparedness centers – Electronic communications systems 24/7 linking state and local health departments Urban: –Strong local health departments statewide –Planning/evaluation framework using logic models –Graduate PH degree program in state –Well equipped/staffed ERs Rural: –Effective connectivity with other state agencies –Support of the Governor –Recent experience with a public health emergency

17. Summary: Rural-Urban Comparisons Political support:Strong local and state legislative support less likely in rural states Health care system: Adequate health care systems less common in rural states Public health system: Urban states more likely to have adequate public health infrastructure Public health workforce: Urban states more likely to have adequately trained workforce Connectivity: Rural states more likely to have strong working relationships with non-public health state agencies

18. Implications PHEP capacity still lags in most states Rural states face common challenges in building PHEP capacity Further research needed to better describe rural states’ needs and identify successful strategies Financial and human resources need to be targeted to rural states

19. Paul Kuehnert Maine Dept. of Health & Human Services 207-287-5179 paul.kuehnert@maine.gov