West Virginia develops participatory, data-based health risk assessment

In Brief

The West Virginia Center for Threat Preparedness developed a county health risk assessment toolkit that gave local jurisdictions the resources they needed to involve communities in risk data collection and analysis.


In May 2011, the West Virginia Bureau for Public Health’s Center for Threat Preparedness (CTP) prioritized the CDC’s Public Health Preparedness Capabilities in order to plan activities for the upcoming 5-year (2011-2017) CDC grant period. Planners identified Capability 1 - Community Preparedness - as a high priority for the state, and the center proposed conducting a health risk assessment (HRA) that would fit the capacity and needs of West Virginia and other rural states interested in a community-based, participatory way of identifying and measuring risk.

Specific issues
  • Lack of risk assessment tools for rural states. In 2011, the one publicly available risk assessment tool, which was built by the University of California - Los Angeles, appeared targeted to large urban health agencies with access to significant resources and data.
  • Lack of historical data on risk. Risk assessment tools provided by CDC assume the availability of data from previous emergencies to measure hazard impact and probability. Data on hazard impact and risk in West Virginia is limited, due to lack of reporting systems and data integration.
  • Limited state resources. The CTP had only one staff person dedicated to the HRA project. The assessment had to be completed in 9 months, with 6 months to complete the data collection instrument.
The practice

The West Virginia Center for Threat Preparedness developed a county health risk assessment toolkit that gave local jurisdictions the resources they needed to involve communities in risk data collection and analysis.

The CTP engaged an advisory committee and a work group comprising representatives from six state agencies, seven local health departments, and two hospitals to create an HRA that would fit the unique capacity and needs of West Virginia communities. The CTP work group built the HRA and associated tools to collect baseline data from West Virginia's 49 local health jurisdictions, covering a 55-county area.

The HRA toolkit includes two instruments that local agencies can use to collect data from their communities using a participatory approach - the Workshop Participant Tool and the Public Health Narrative.

The Workshop Participant Tool consists of four sections:

  1. Hazard identification and ranking
  2. Impact discussion and planning
  3. Community mitigation assessment
  4. Agency mitigation assessment.

The workshop participant tools were tailored to the public health, behavioral health, primary care, and hospital sectors, and an additional tool was made for participating agencies that fell outside of these four groups.

The Public Health Narrative includes 10 open-ended questions on local health preparedness to give local agencies an opportunity to highlight challenges and resources not captured in the Workshop Participant Tool.

Materials to support health departments with completing the assessment include:

  • Template press releases
  • Lists of potential partner agencies in each county
  • Workshop checklists
  • Workshop facilitator guides
  • Participant guides

The CTP evaluated the HRA process throughout the development of the data collection tool, local implementation, and submission of the local assessments. Evaluation results were used to revise the data collection tool and instructions sent to local health departments. Evaluations from local health department facilitator training sessions were used to identify facilitators who may need additional technical assistance.

What made this practice possible?
  • Background information. The concept for the HRA was developed using a literature review of environmental health, hospital preparedness, and emergency management; informational interviews with other state health departments and academic institutions; and continuous feedback and evaluation at the state and local levels.
  • State-level work group partnerships. The subject matter expertise and partner support from the work group were critical to the HRA's development and implementation. The group met twice in person to develop the data collection instruments and also held conference calls to work on specific sections of the tools. Additional partners, such as the West Virginia Primary Care Association, the West Virginia Hospital Association, the West Virginia State Police, and West Virginia Homeland Security and Emergency Management, participated as reviewers throughout the HRA's development.
  • State-level communication efforts. Grant administrators responsible for preparedness funding to local behavioral health centers primary care centers, hospitals, and emergency management agencies sent e-mails to their grantees to encourage participation in the local assessment process. Administrators also assisted in developing language for template letters of invitation that local health departments sent to their partners to specify how the HRA would help local organizations meet grant requirements.
  • State-level data collection and analysis. The CTP developed a new partnership with the West Virginia Bureau for Public Health Office of Environmental Health Services to collect and analyze data from the 55 local assessments and map the highest-ranked hazards at the state and regional levels. The center also engaged the North Carolina Preparedness and Emergency Response Research Center to apply their vulnerable populations mapping tool to West Virginia. While the tool was not developed in time for the county-level assessments, it is now available for local health departments to use when applying their results.
  • Local support for the assessment. Despite limited time and familiarity with the assessment and a federally declared disaster affecting 47 out of 55 West Virginia counties (the June 2012 Derecho), all 49 local health departments completed the assessment with an average of 5.5 external partners within each county, highlighting overall partner support for and engagement in the process.
  • Technical assistance and communications. The HRA project manager delivered eight regional facilitator trainings to 99 local health agency staff across West Virginia. Each facilitator was given a binder and CD with supplementary materials (ie, a template press release, an FAQ, a list of data sources on hazard probability; a list of suggested workshop participants, a workshop planning checklist, a participant guide to the HRA, and a PowerPoint presentation) to assist with his/her process. The CTP also developed and distributed a report for each county using the county's assessment data, along with a resource and training guide for hazard planning and mitigation to complement the county report. This guide offered ideas for how to interpret assessment results and how to use the results in preparedness planning, exercise development, and partnership building. It also provided counties with hazard-specific and multi-hazard training resources, planning and exercise templates, and guidance.
  • Local engagement. More than 450 people participated in the local assessments. An average of eight people participated per county. Hospitals had the highest participation rate with 83% of counties reporting at least one hospital participating in their assessment process. Emergency management and 911 centers participated in 78% of counties; healthcare organizations participated in 53% of counties, and behavioral health centers were part of the process in 49% of counties.
  • Local benefit. During the evaluation process, 84% of local respondents (196 out of 233) agreed or strongly agreed that participation in the HRA process was valuable for their agencies, and 76% (168 out of 222) said that the HRA was useful for meeting and/or identifying new partners in their counties. Two local health departments stated that the HRA restarted their county Local Emergency Planning Committees, which had previously been inactive.
  • Informed planning recommendations. The CTP project manager created an aggregate report from the results gathered from the 55 West Virginia counties, and, in consultation with preparedness leadership, developed recommendations for critical findings from the risk assessments. These recommendations are currently being implemented at the state level and were used to inform the CTP's funding applications for the 2013-14 and 2014-15 grant periods.

Noted limitations of West Virginia's HRA process include lack of data regarding hazard probability/impact and the tool's subjective nature. Strengths include engaging preparedness and health system partners at multiple levels, developing a dataset for state and local planning, and communicating to the public the status and needs of state and local health preparedness.

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