Editor's Note: CIDRAP's Promising Practices: Pandemic Influenza Preparedness Tools (www.pandemicpractices.org) online database showcases peer-reviewed practices, including useful tools to help others with their planning. This article is one of a biweekly series exploring the development of these practices. We hope that describing the process and context of these practices enhances pandemic planning.
Mar 10, 2008 (CIDRAP News) Public health officials in Kansas recently took a key step toward incorporating vulnerable populations into pandemic readiness efforts: They launched an online toolkit that streamlines the needs assessments across diverse parts of the state.
Intensified efforts to assess pandemic readiness needs, even down to the individual household level for vulnerable groups such as older people and those who have disabilities, happened to occur as natural disasters hit Kansas hard.
Edie Snethen is executive director for the Kansas Association of Local Health Departments (KALHD), the Topeka-based group that is offering the toolkit as a component of its vulnerable populations outreach. KALHD provides services, including technical assistance, to 100 health departments across the state. "In Kansas," Snethen said, "we have had an incredible number of natural disasters, so that brings the vulnerable populations issue to the forefront."
In 2007, nearly 100 of the 105 counties in Kansas had some type of declared natural disaster, Snethen said. In May, deadly tornadoes killed 11 people and destroyed the town of Greensburg. Soon after, the same weather patterns produced massive flooding across parts of Kansas, followed by another round of flooding in June. And in December, icy winter storms immobilized some counties and led to prolonged power outages for thousands of residents.
"This helped create an awareness about what worked and what didn't work," Snethen said.
In some states, such as Kansas, threats like bioterrorism aren't very real to residents, she said. "But in a rural community, these other threats are very real," she said, adding that the weather events can create teachable moments about preparedness, not only for government and public health officials, but also for the populations they serve.
A look inside the toolkit
The Special Needs Populations Assessment Toolkit is connected to broader efforts at KALHD that use geographic information system (GIS) mapping to assist with pandemic influenza response. Snethen said the GIS maps initially included just licensed facilities, such as nursing homes, that house vulnerable population groups. However, ongoing efforts will involve adding information to the GIS mapping that is gleaned from special needs assessments of communities and households.
"So often public health workers spend so much time gathering information that they don't have time to use it," Snethen said. "In this instance, time is spent using the information."
The assessment toolkit is a four-tiered grouping that includes forms for communities, agencies, and households. The kit includes two versions of the household needs assessment, one of which is an abridged survey in a brochure format. (The kit also includes Spanish translations of the assessment tools.)
The community needs tool helps localities identify their unique populations and existing resources and then determine their capabilities, gaps, and educational needs. The agency form is designed to promote partnerships with other groups that serve special needs population. Local planners can use the household tool to assess the needs and gaps of those they serve.
The assessment tools were developed for KALHD by Sherry Angell, RN, as a Capstone Project for a public health fellowship she is working on through the Kansas Public Health Leadership Institute. Angell is regional coordinator at the North Central Kansas Public Health Initiative in Beloit, Kan., an organization that provides support services to 13 area public health departments.
Angell, in a report she wrote for her project, said combining GIS technology with assessments, surveys, and registriesthrough partnerships with other state public health groupscan help officials identify the resources, needs, and gaps to improve overall emergency preparedness planning and response for vulnerable populations.
Angell told CIDRAP that the special needs toolkit is based on materials developed by Connecticut officials, but is broader and focused more on an all-hazards approach. "My goal was that I wanted something easy to use and adaptable," she said. The documents in the toolkit are available in Microsoft Word format so that other groups can customize them to meet their own needs. "The tool isn't finished yet. It's a work in progress," she said.
Some local public health departments in Kansas are small and don't have the resources to develop their own assessment tools, Angell said. "There's no reason to reinvent the wheel."
Tools raise challenges, new issues
Defining the vulnerable populations was one of the first challenges in designing the toolkit, Angell said. "The definition of special needs varies from place to place in emergency response. And sometimes people will become special needs after a disaster," she said.
Snethen said that Kansas has become more diverse in the last 10 or 15 years, but that one vulnerable group is at the forefront: the "very old" population, defined as those older than age 85. Of 80 counties in the United States with the greatest population of "very old" people, 23 (29%) are in Kansas, she said. "We are chronologically gifted," she quipped.
A concern that Angell, Snethen, and public health officials in Kansas have about the vulnerable population needs assessment is that it might raise people's expectations about what responders can realistically do in the event of an emergency such as an influenza pandemic.
Recognizing the impact such a pandemic would have on resources, planners are emphasizing the importance of individual preparedness. Angell said the toolkit instructions address how important it is to teach vulnerable populations about what they can do to individually prepare. "This will help them have realistic expectations about what the community can and can't do," she said.
Angell said it's too early to tell what impact the tools are having on preparedness for vulnerable populations. "But we have had good response from public health workers," she said.
View tools and reviewers' comments from the "Kansas Vulnerable Populations Outreach" practice