Technical Assistance Review Assignment, Documentation, and Tracking Tool & Documentation Organization Process

State: KS Type: Model Practice Year: 2012

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The Johnson County Health Department has been a part of the Cities Readiness Initiative (CRI) Program since 2006. The CRI is a federally funded program designed to enhance preparedness in the nation’s largest cities and metropolitan statistical areas where more than 50% of the U.S. population resides. Through CRI, state and large metropolitan public health departments have developed plans to respond to a large-scale bio-terrorist event by dispensing antibiotics to the entire population of an identified MSA within 48 hours. For Johnson County, this would mean emergency plans would need to be vigorous and comprehensive to uphold a mass dispensing campaign for prophylaxis of all 545,000 citizens and visitors. To ensure continued readiness, the CDC and state public health personnel conduct annual Technical Assistance Reviews (TAR) to assess the plans for each local jurisdiction within their CRI region and measure capacity for functions considered critical. The TAR scores (reviewed on scale from zero to 100) for each local jurisdiction are combined to compute an average TAR score for the CRI MSA.

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Johnson County Department of Health & Environment
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Technical Assistance Review Assignment, Documentation, and Tracking Tool & Documentation Organization Process
The Johnson County Health Department has been a part of the Cities Readiness Initiative (CRI) Program since 2006. The CRI is a federally funded program designed to enhance preparedness in the nation’s largest cities and metropolitan statistical areas where more than 50% of the U.S. population resides. Through CRI, state and large metropolitan public health departments have developed plans to respond to a large-scale bio-terrorist event by dispensing antibiotics to the entire population of an identified MSA within 48 hours. For Johnson County, this would mean emergency plans would need to be vigorous and comprehensive to uphold a mass dispensing campaign for prophylaxis of all 545,000 citizens and visitors. To ensure continued readiness, the CDC and state public health personnel conduct annual Technical Assistance Reviews (TAR) to assess the plans for each local jurisdiction within their CRI region and measure capacity for functions considered critical. The TAR scores (reviewed on scale from zero to 100) for each local jurisdiction are combined to compute an average TAR score for the CRI MSA. A score of 69 or higher indicates a CRI location is performing in an acceptable range in its plans to receive, distribute, and store Strategic National Stockpile medical assets. The TAR tool is consists of a baseline “cover page” and 12 subsequent sections and has a total of approximately 110 tasks to assign. The preparation for gathering extensive documentation for a TAR review can take months and several personnel to complete. In 2008, JCHD developed a systematic approach to assign, manage, and document completion of each TAR task and has continued to perfect this approach in the following years. JCHD was awarded a perfect score of 100% for their 2010 review. As this system was created within JCHD, there has been no associated cost for this tool. The tool is merely a well-formatted, easy-to-use spreadsheet created by an Emergency Planner with the capability to share assignments, status updates, and document locations among the other members of the Emergency Preparedness Program. JCHD is looking to share this approach with other LHDs who are interested in improving their TAR score and their overall ability to document preparedness efforts.
Health Issues Each local health department within a CRI county must undergo an annual Technical Assistance Review conducted by the CDC. To maintain emergency preparedness and funding for such functions, LHDs are required to score a 69% or higher. The issue of sustainment of preparedness funding and overall preparedness response can be addressed by targeting a system to achieve scores to meet requirements of the TAR. Unlike other public health campaigns, emergency preparedness is a federally funded and mandated program and therefore, the process to determine the relevancy is eliminated. The relevancy of such actions has already been determined by our government making it the responsibility of the local jurisdiction to perform necessary actions to ensure progressive efforts. If public health and identified stakeholders do not continue to advance their relationships to progress emergency preparedness efforts, our community as a whole will suffer. Preparedness efforts are essential to effective emergency response during a public health emergency. This practice allows an organized approach to managing the large undertaking of a successful TAR review including the engagement of LHD Preparedness personnel, county agencies, local law enforcement, community partners and businesses, etc.  Innovation After the initial Technical Assistance Reviews for JCHD in 2006, PHEP staff has been collaborating systematic approaches to completing and organizing TAR documentation. In 2010, JCHD PHEP staff created a systematic approach by re-creating the TAR tasks in an excel spreadsheets including detailed information, such as who the task is assigned to, an area to track the level of completion for the task as progress is made, a target completion date, an area to input status updates and flag support staff for follow-up, the final date of completion, and notes regarding the location to find the completed documents for review. Examples of other approaches to completion of a TAR review have not been shared. Other practices surely exist but have not been reviewed at this time.     
Primary Stakeholders LHD – Johnson County Health Department (JCHD) Role of Stakeholders/Partners Stakeholders include: County Agencies – Facilities, County Manager’s Office, Risk Management, Sheriff Office and Corrections, Emergency Management, Treasury and Financial Management, Information Technology Services, Emergency Communications, Transit, Mental Health, Developmental Support, Human Services, Med-Act, Legal, etc. Local Law Enforcement (Johnson County Sheriff Office, Olathe Police Department, Overland Park Police Department, and Shawnee Police Department) City Government Jurisdictions – City of Overland Park Community At-Risk Populations – Deaf community, home-bound and low-limited mobility citizens, nursing homes and assisted living, incarcerated citizens, Mental Health and Developmental Support clients, etc. Hospitals (Overland Park Regional Medical Center, Olathe Medical Center, Shawnee Mission Medical Center, St. Luke’s South, Menorah Medical Center, and Children’s Mercy Hospital) All stakeholders’ role during preparedness efforts is that of a supporting agency and varies in complexity based on which preparedness functions are being addressed. For example, county agencies would be called upon to assist with lending staff for non-essential positions during the event of a public health emergency to aid with staffing dispensing sites, volunteer reception, call centers, etc. They would also be asked to assist with specialized services, such as calling upon facilities staff that complete warehouse functions on a day to day basis to manage receipt, storage, and distribution of SNS materials. LHD Role JCHD acts as the lead agency regarding collaboration and organization of gathering and documenting materials for review. PHEP staff continues to strengthen their relationships with stakeholders by participating in a wide-range of relationship-building exercises such as face-to-face or phone conference discussions of public health preparedness topics, training of concept of operations and emergency response protocols, and exercising of emergency response and notification systems.  Lessons Learned There have been many barriers and lessons learned during the course of the last 7 years. For example, JCHD had previously managed warehouse operations during receipt and management of federal materials with PBH staff. After several exercises of this methodology, it became apparent PBH staff was not capable of such undertakings due to the complexity of such actions in an emergency. After brain-storming alternate approaches, PHEP staff looked to county resources to support such functions. After research, JCHD determined Facilities staff completed warehouse operations in county owned and operated buildings throughout the county on a day-to-day basis. Following initial discussions, Facilities considered testing the capacity of managing warehousing operations under JCHD direction. Several small-scale events and trainings clearly demonstrated the validity of utilizing county resources in such a manner. Since those initial discussions and exercises, JCHD and Facilities have persistently developed a detailed Local Distribution Site (LDS) Standard Operating Guide (SOG), quarterly meetings to train and refresh Facilities staff on preparedness operations, and a number of real-life and pre-planned events to practice procedures and protocols. Implementation Strategy Create excel spreadsheet for TAR sections and tasks. (See attached document labeled “2011 TAR Assignments”) Assign each task to appropriate JCHD personnel. Determine level of completion and completion date for each task. Track tasks by level of completion and projected completion dates and determine actions to take to complete each task. Updating status notes for other JCHD staff to access can assist with completion. Once tasks are completed, documentation must be recorded for the CDC reviewer. This can be done in two ways. One way would be as a tagged comment for review in the JCHD BIA or attached Tabs. (See attached documented labeled “JCHD Planning Documents Tabbed”) The second way would be making a PDF version of any loose documents not contained within JCHD plans. For example, Job Action Sheets, Sign-in sheets and agendas for meetings and trainings, After Action Reports, etc. Once these documents are converted to PDFs, they can be placed within the appropriately labeled folder for each section. (See attached document labeled “JCHD TAR Folder Structure”) After all documentation is completed for each task, the PHEP staff will update the TAR Tool notes section of each task, specifically outlining where each piece of documentation can be found. (See attached document labeled “2010 JCHD TAR Final”) Once the TAR is updated with locations of documentation, the information can be uploaded to a USB drive and sent to the CDC prior to the scheduled review.      
Process & Outcome 1. Clear and concise system of assigning tasks to be completed among LHD staff and determining practical completion dates. 2. Efficient information gathering throughout completed tasks and systematic approach for organization of such documents to be presented for review. Objective 1: PERFORMANCE MEASURES USED TO EVALUATE THE PRACTICE: CDC Conducted Technical Assistance Review (See attached document labeled “2010 JCHD TAR”) DATA: JCHD 2010 TAR Scoring (See attached document labeled “2010 JCHD TAR Score”) EVALUATION RESULTS: 100% FEEDBACK: See attached document labeled “2010 JCHD TAR Report” Objective 2: PERFORMANCE MEASURES USED TO EVALUATE THE PRACTICE: CDC Conducted Technical Assistance Review (See attached document labeled “2010 JCHD TAR”) • DATA: o JCHD 2010 TAR Scoring (See attached document labeled “2010 JCHD TAR Score”) • EVALUATION RESULTS: o 100% • FEEDBACK: o See attached document labeled “2010 JCHD TAR Report”  
Sustainment of this practice is nothing more than maintaining relationships with stakeholders and continuing to complete discussions, trainings and exercises to progress emergency preparedness efforts each year. Updating of documentation for reviews must be maintained, as well. There are no direct monies needed to support such actions. As long as there is a need for LHDs to continue to undergo a Technical Assistance Review each year, there will be a need for an organized system to assist with the evaluation. JCHD’s process will support LHDs’ efforts to manage and document emergency preparedness accomplishments to achieve an accurately reflective TAR score. Sustainment of this process is solely dependent upon staffing resources, making sustainment reliant on personnel availability rather than financial resources.
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