Jennifer A. Horney

Adaptive Planning for Disaster Recovery and Resiliency: An Evaluation of 87 Local Recovery Plans in Eight States

Problem, research strategy and findings: A pre-disaster recovery plan that considers how a community should be redeveloped is a logical first step to support resiliency during high uncertainty and rapid change, yet limited attention has been given to recovery plans. In this study, we evaluate local disaster recovery planning in eight southeastern states and find that such planning receives limited public support: Less than one-third of vulnerable local jurisdictions had a recovery plan, and those plans received low plan quality scores. Unfunded state mandates produce weaker plans than plans in other states without mandates. We find that a collaborative network of stakeholders initially intent on reordering priorities results in stronger plans. Takeaway for practice: Local recovery planning should be designed to operate under conditions of high uncertainty. Local jurisdictions can choose plan design options that reflect how they build capability for recovery planning: 1) standalone community-wide recovery plan; 2) comprehensive land use plan; 3) emergency management plan; and 4) small area recovery plan. Because recovery planning lacks a public constituency, and is new to most local jurisdictions, the stand-alone community-wide recovery plan design option is the most effective at building local commitment. This option involves a plan-making process that concentrates time, effort, and resources focused on a building a network of stakeholders who likely have the greatest responsibility in rebuilding efforts because they care most about the impacts of a disaster.

The role of applied epidemiology methods in the disaster management cycle

Disaster epidemiology (i.e., applied epidemiology in disaster settings) presents a source of reliable and actionable information for decision-makers and stakeholders in the disaster management cycle. However, epidemiological methods have yet to be routinely integrated into disaster response and fully communicated to response leaders. We present a framework consisting of rapid needs assessments, health surveillance, tracking and registries, and epidemiological investigations, including risk factor and health outcome studies and evaluation of interventions, which can be practiced throughout the cycle. Applying each method can result in actionable information for planners and decision-makers responsible for preparedness, response, and recovery. Disaster epidemiology, once integrated into the disaster management cycle, can provide the evidence base to inform and enhance response capability within the public health infrastructure.

Partnering to Meet Training Needs: A Communicable-Disease Continuing Education Course for Public Health Nurses in North Carolina

In 2004, the General Communicable Disease Control Branch of the North Carolina Division of Public Health and the North Carolina Center for Public Health Preparedness partnered to create a free continuing education course in communicable-disease surveillance and outbreak investigations for public health nurses. The course was a competency-based curriculum with 14 weeks of Internet-based instruction, culminating in a two-day classroom-based skills demonstration. In spring 2006, the course became mandatory for all public health nurses who spend at least three-fourths of their time on tasks related to communicable diseases. As of December 2006, 177 nurses specializing in communicable diseases from 74 North Carolina counties had completed the course. Evaluations indicated that participants showed statistically significant improvements in self-perceived confidence to perform competencies addressed by the course. This course has become a successful model that combines academic expertise in curriculum development and teaching technologies with practical expertise in course content and audience needs. Through a combination of Internet and classroom instruction, this course has delivered competency-based training to the public health professionals who perform as frontline epidemiologists throughout North Carolina.

Social Factors as Modifiers of Hurricane Irene Evacuation Behavior in Beaufort County, NC.

Encouraging residents in high-risk areas to evacuate before a hurricane makes landfall is one of the few ways to reduce hurricane-related morbidity and mortality. However, demographic factors associated with evacuation in at-risk groups have not been consistent across studies. To determine if social factors (social control, social cohesion, and social capital) modified the relationship between demographic groups and failure to evacuate from Hurricane Irene, the authors conducted a cross-sectional stratified two-stage cluster sample among residents of Beaufort County, NC. Of 226 attempted rapid response interviews, 205 were completed (response rate = 90.7%). Data were analyzed using generalized linear modeling, which produced crude risk differences to estimate the association between failure to evacuate from Hurricane Irene and a number of demographic and social factors; effect measure modification (EMM) was assessed on the additive scale through stratified analyses of key social factors. There were no significant associations between demographic or social factors and evacuation in the bivariate analysis. However, EMM was present for households with high social capital or social cohesion among special needs residents, those over age 65, males, and non-whites. In Beaufort County, NC, future hazard mitigation plans should include evacuation messages tailored for households with high social capital or social cohesion.

Assessing the Quality of Rural Hazard Mitigation Plans in the Southeastern United States

High-quality hazard mitigation plans may improve postdisaster outcomes in many ways, including establishing a community fact base and providing rationales for protective policies and actions. Hazard mitigation plans in eighty-four rural counties in the Southeastern United States were scored using an established protocol. To supplement quantitative data, twenty-one key informant interviews were conducted in a subsample of seven counties. While overall plan quality was poor, informants identified areas for improvement. Understanding potential shortcomings of rural hazard mitigation plans can help communities identify areas to direct limited resources to improve plans, particularly in communities that self-identify as highly vulnerable to disasters.

Review of the UNC Team Epi-Aid Graduate Student Epidemiology Response Program six years after implementation

Service learning is one way that academia can contribute to assuring the publics health. The University of North Carolinas Team Epi-Aid service-learning program started in 2003. Since then, 145 graduate student volunteers have contributed 4,275 hours working with the state and local health departments during 57 activities, including outbreak investigations, community health assessments, and emergency preparedness and response. Survey data from student participants and public health partners indicates that the program is successful in meeting its goal of creating effective partnerships among the university, the North Carolina Center for Public Health Preparedness, and state and local health departments; supplying needed surge capacity to health departments; and providing students with applied public health experience and training. In this article, we discuss the programmatic lessons learned around administration, maintaining student interest, program sustainability, and challenges since program implementation.

Developing indicators to measure post-disaster community recovery in the United States.

Disaster recovery is a key capability of federal, state, and local government. To support this capability effectively practitioners need useful and validated metrics to document how well a community is recovering from a particular disaster. This study developed and categorised recovery indicators according to the Federal Emergency Management Agency (FEMA)s Recovery Support Functions and Recovery Mission Area Core Capabilities through a literature review, an evaluation of the pre-disaster recovery plans for 87 coastal jurisdictions, and a case study of two communities (New Hanover County, North Carolina, and the City of Hoboken, New Jersey). Metrics identified in the literature were validated through the recovery plan review and the case study. The research team also identified sources for both baseline and current status data. Based on these findings, a user-friendly checklist for practitioners was established, which will be piloted with practice partners during a future disaster recovery initiative.

Support and services provided by public health regional surveillance teams to Local Health Departments in North Carolina.

Since 2001, many states have created regional structures in an effort to better coordinate/public health preparedness and response efforts, consolidate services, and supplement local government capacity. While several studies have identified specific benefits to regionalization, including enhanced networking, coordination, and communication, little research has examined the effect of regionalization on specific preparedness and response activities. To better understand the impact of regionalizing public health workforce assets in North Carolina, a survey aimed at documenting specific support and services that Public Health Regional Surveillance Teams(PHRSTs) provide to local health departments (LHDs) was developed and administered by the North Carolina Preparedness and Emergency Response Research Center, located at the North Carolina Institute for Public Health. Of80 potential types of assistance, 26 (33%) were received by 75% or more LHDs, including 9 related to communication and 7 related to exercises. There was significant variation by PHRST region in both the quantity and quality of support and services reported by LHDs. This variation could not be explained by county- or LHD-level variables. PHRST assistance to LHDs is largely focused on communication and liaison activities, regional exercises, and planning. On the basis of these findings, regionalization may provide North Carolina with benefits consistent with those found in other studies such as improved networking and coordination. However, further research is needed to identify whether regional variation is the result of varying capacity or priorities of the PHRSTs or LHDs and to determine how much variation is acceptable.

10 Guiding Principles of a Comprehensive Internet-Based Public Health Preparedness Training and Education Program

Distance learning is an effective strategy to address the many barriers to continuing education faced by the public health workforce. With the proliferation of online learning programs focused on public health, there is a need to develop and adopt a common set of principles and practices for distance learning. In this article, we discuss the 10 principles that guide the development, design, and delivery of the various training modules and courses offered by the North Carolina Center for Public Health Preparedness (NCCPHP). These principles are the result of 10 years of experience in Internet-based public health preparedness educational programming. In this article, we focus on three representative components of NCCPHPs overall training and education program to illustrate how the principles are implemented and help others in the field plan and develop similar programs.

Validating indicators of disaster recovery with qualitative research.

Introduction: Recovery from disasters is a critical function of federal, state, and local governments, yet measurable, validated indicators of community recovery remain unidentified. A list of potential recovery indicators was developed by the authors through a literature review, recovery plan review, and case study of two disaster impacted communities. Methods: To validate the indicators, qualitative data was collected from experts on disaster recovery. Twenty-one key informant interviews and two focus groups were conducted between January and April of 2014 to solicit feedback from disaster recovery practitioners and academics. Results: Five major themes emerged from the qualitative data. These included: the flexibility of the indicators to serve multiple purposes for communities and individuals both pre- and post- disaster; the focus areas are comprehensive, but content and organization can be improved; the importance of seeing the indicators as a self-assessment, rather than a tool for comparing communities; the potential challenges of collecting data for some indicators; and the identification of potential measurement issues with the indicators. Discussion: The proposed recovery indicators can be utilized by both practitioners and researchers to effectively track post-disaster recovery. They capture many of the complexities of community disaster recovery and provide potential opportunities for linkages to the development of disaster recovery plans and other activities that could increase community resilience in the future.