ASTHO s At-Risk Populations Project

1. ASTHO�s At-Risk Populations Project Anna Buchanan, MPH Senior Director, Immunization and Infectious Disease ASTHO

2. About ASTHO The national, non-profit association representing the 57 state and territorial health agencies in the United States, including the District of Columbia Members are the person holding the executive position in any state or territorial health department ASTHO provides policy guidance and advocacy, based on members� priorities

3. The Stark Facts: Hurricane Katrina �73 percent of Hurricane Katrina-related deaths in New Orleans area were among persons age 60 and over, although they comprised only 15 percent of the population in New Orleans. Most of those individuals had medical conditions and functional or sensory disabilities that made them more vulnerable.�

4. The 1995 Chicago Heat Wave �over seven hundred people had perished...twenty times the number of those struck by Hurricane Andrew in 1992�in the great Chicago heat wave, one of the deadliest in American history�the literal and social isolation of seniors, the institutional abandonment of poor neighborhoods, and the retrenchment of public assistance programs�contributed to the high fatality rates.�

5. What is the At-Risk Populations Project? The Centers for Disease Control and Prevention (CDC) funded ASTHO to develop planning guidance on at-risk populations and pandemic influenza To develop it, ASTHO worked with: The University of Minnesota�s Center for Infectious Disease Research & Policy (CIDRAP) The National Association of County and City Health Officials (NACCHO) The Keystone Center Audience: state, territorial, tribal, and local health departments

6. Creating a Unique National Guidance: Background and Process

7. Purpose of the Guidance What it is: Useful information, model practices, tools and recommendations about how to address the needs of at-risk populations in emergency situations What it isn�t: It is NOT a mandatory directive with a set of new, required activities as a condition of funding

8. What makes this project unique? The project represents the first time national guidance has been developed outside of CDC A factors-based definition for at-risk populations was developed, rather than using traditional labels During the drafting process, input was sought from at-risk populations and the providers who serve them

9. Project Methods A literature review assessed federal, state, and local plans and promising practices An Advisory Panel oversaw the process and created a factors-based definition for at-risk populations 19 members from federal, state, local, and tribal agencies and national-level agencies Work groups with subject matter expertise: 66 experts from all levels of government, private business, academics, associations, and others provided guidance and expertise Engagement meetings: Two public engagements � Boston, MA and Kansas City, MO One national stakeholders meeting � Washington, DC Public comment period

10. Definition of At-Risk Populations At risk of consequences from pandemic influenza, NOT at risk of infection. �Factors� may increase a person�s risk of impacts - including societal, economic, and health-related impacts. Individuals may experience significant barriers and need help maintaining medical care, food, and shelter More likely to experience these effects when the systems on which people usually rely are overloaded

11. What Factors Put People at Greater Risk? Economic disadvantage People may have too little money to stockpile supplies, or to stay home from work Absence of a support network e.g., some children; homeless; travelers; and the socially, culturally, or geographically isolated

12. What Factors Put People at Greater Risk? Needing support to be independent in daily activities because of: Physical disability Developmental disability Mental illness or substance abuse/dependence Difficulty seeing or hearing Medical conditions Difficulty reading, speaking, or understanding English

13. Prioritizing Health DepartmentActivities: Key Recommendations

14. Overview The guidance contains: Factors-based definition of at-risk populations Ethical and legal considerations in planning for at-risk populations 5 chapters that correspond to each subject-matter Work Group Sample tools and practices for each chapter Proposed timeline for enacting recommendations based on pandemic phase and severity

15. The Guidance: A User�s Guide Identifying partnerships Engaging, strengthening, and contributing to community networks Including at-risk populations in policy development

16. Chapter 1: Recommendations Chapter 1 contains 15 recommendations, such as: Identify and reach out to non-traditional leaders who may not occupy obvious or formal roles in their community (e.g. tribal elders, hairdressers) Designate a staff member to build and maintain collaborations Involve at-risk individuals and their service providers during all phases of policy development Identify partners and link to existing networks

17. Chapter 1: Key Recommendation For each chapter, this longer list of recommendations has been distilled into 1-3 key recommendations. That recommendation in Chapter 1 is: Join an existing network or create a network with representation from at-risk individuals, faith-based organizations, CBOs, and key partners, such as media outlets

18. Sample Tools and Practices Each chapter contains a table with sample tools and practices specific to the chapter�s topic area.

19. The Guidance: A User�s Guide Purpose, tools, and approaches Sources and limits of public data Managing and mapping public data Prioritizing at-risk groups National, state, and local data sources and practices

20. The Guidance: A User�s Guide Chapter 2: Identifying at-risk populations Many tools available to assist this work Chapter 2 includes many resources to identify at-risk populations, including online data sources for: Demographics relevant to factors that put people at risk Children and the elderly Language Special healthcare needs Mapping and geographic information system resources

21. Chapter 2: Key Recommendations Find and use data sources that identify at-risk populations in the jurisdiction Prioritize planning for populations at economic disadvantage Identify where the greatest needs are in order to effectively allocate funds

22. The Guidance: A User�s Guide Chapter 3: Communications with and education of at-risk populations Trusted messages, messengers, and methods Timing Evaluating effectiveness

23. Chapter 3: Key Recommendations Use appropriate risk communication techniques; trusted messengers; and appropriate technologies, media, and formats to reach at-risk populations Establish and follow a protocol for evaluating risk communication messages for at-risk populations, which may include: Conducting pre- and post-tests at public meetings Evaluating channels used for messages Evaluating the ability of collaborative partners to disseminate emergency messages Measuring the impact of messages on preparedness

24. The Guidance: A User�s Guide Chapter 4: Provision of services (clinical andnon-clinical) Essential clinical services and challenges Lack of access to the healthcare system Chronic physical conditions Equipment/resources for independent living Behavioral health conditions Non-clinical essential services Providers and responsibilities

25. Chapter 4: Key Recommendation Convene the appropriate service provision agencies and provide the framework for necessary planning activities

26. The Guidance: A User�s Guide Chapter 5: How to test, exercise, measure, and improve preparedness of at-risk populations Barriers to evaluation Methods for evaluation Tailoring Homeland Security Exercise and Evaluation Program (HSEEP) to at-risk populations Sample discussion- and operations-based exercise objectives and scenarios

27. Chapter 5: Key Recommendations Include at-risk populations in evaluation as planners, participants, and part of scenario development in exercise design, implementation, and evaluation Implement a quality assurance program that tests, evaluates, exercises, and improves the process of providing services for at-risk populations

28. Guidance Supplement: �Proposed Timeline for Enacting Recommendations� As a supplement to the document, 7 �grids� describe specific pandemic planning and response activities (identified in the guidance) based on pandemic phase and severity. The grids should be used as a complement to the guidance to help planners enact recommendations at appropriate times. Details of the activities suggested in the grids can be found in the guidance chapter with the same title.

29. Read the Guidance and View Tools Online ASTHO: www.astho.org CIDRAP: www.cidrap.umn.edu Click on link under �At-Risk Populations Project� at either site