1. Rebuilding Communicable Disease Investigation: A Two Year Training Program for Disease Intervention Specialists (DIS) 2008 National STD Prevention Conference Confronting Challenges, Applying Solutions Chicago, Illinois, March 10-13, 2008 Romni A. Neiman 1, 2 Joe Sanchez, Edwin Lopez 1 Gail Bolan, MD 1 1 STD Control Branch California Department of Health Services 2 Division of STD Prevention, NCHHSTP, CDC

2. Overview Background Objectives Core Competencies Fellowship Program Overview The Model Monitoring Progress Outcomes Implications/Next Steps

3. CDPH, DCDC, STD Control Branch Disease Intervention Section Regional Field Offices Northern CA Region Central CA Region Southern CA Region Field Offices BakersfieldFresno Long Beach OrangeRichmondSacramento San Joaquin San Diego (newly forming) Independent Assignments Current Regional Structure

4. Background Public health infrastructure crisis at state and local levels in California Late1980s: more than 60 DIS positions (CPA) 40 DIS 6 DIS Supervisors 6 Area Managers 2 Special Projects Coordinators 2 Assistant Regional Managers 4 Regional Managers 1 Program Manager 1 Senior Program Manager Currently: only 32 DIS positions (CPA) 21 DIS 1 Surveillance Specialist 7 Communicable Disease Managers 2 Regional Managers 1 Senior Program Manager

5. Background Local health jurisdictions (LHJs) struggling to conduct enhanced surveillance, case management and disease intervention activities Our ability (state) to provide safety net support for disease intervention activities & simultaneously mobilize rapid response teams to address outbreaks and emergency response, has been limited “On-the job” training methods for new staff burdensome in already strained environment Training of new DIS in LHJs inconsistent as structural and supervisory support varies

6. DIS Fellowship Program Objectives Rebuild capacity for disease intervention Improve program performance STD case management Partner services Enhanced surveillance activities Improve ability to mobilize rapid response to outbreaks and public health emergencies

7. Building DIS Expertise … Core Competencies Field Investigation Enhanced Surveillance Client Interview Partner Services (Partner Elicitation and Notification) Collaboration with Medical Providers and Laboratories Case-based Community Outreach and Screening

8. DIS Fellowship Program Overview Two year hands-on training program to recruit and prepare new DIS 8 Week Intensive Assignment to a local health jurisdiction for front- line public health experience Skill-building in client interview, partner services, provider and lab visits, collecting data and conducting surveys Outbreak investigation Bioterrorism cross-training New opportunities every year!

9. The Model 8 Week Intensive Housed in Bay Area Complete the CDC self study Employee Development Guide (EDG) Onsite manager facilitates module discussion and monitors chapter and comprehensive test taking Attend related lectures, interactive workshops and local health jurisdiction site visits for observation

10. The Model 8 Week Intensive New Employee Paperwork & Orientation Disease Intervention Specialist Orientation STD Prevention & Control Overview Meet the Chief: STD Program Overview Organizational Structure & Communication Confidentiality CDC STD Program Performance Measures STD Surveillance GC Surveillance Syphilis Surveillance Clinical Overview of GC,CT, PID Clinical Overview of Syphilis Clinical Overview of HIV/AIDS Clinical Overview of Viral STDs Overview of Hepatitis Syphilis Elimination Effort Syphilis Overview-DIS Activities Syphilis Case Management Process/Forms Reactor Workshop Syphilis Performance Measures for DIS Syphilis Visual Case Analysis Field Investigation Process/Forms Internet Partner Notification Office of AIDS Overview HIV PCRS Enhanced Gonorrhea Surveillance-DIS Activities PDPT Guidelines Clamydia Screening Project (CLaSP)- Ct Screening in Juvenile Hall Binational Border Health Wrap up and Expectations for Field Assignments

11. The Model Field Practicum 3-5 days conducting observation of STD clinical, laboratory and disease intervention activities in a comprehensive, well-staffed LHJ Assigned to high morbidity local health jurisdiction for skill- building for the duration of their two year assignment

12. The Model Formal Training Courses CDC STD/HIV PTC Part III Introduction to STD Intervention HIV Basic I & II (CA CDPH OA funded/certified course) HIV PCRS (CA CDPH OA funded/CA HIV PCRS course) STD Overview for Non- Clinicians (CA STD/HIV PTC course) Domestic Violence Assessment (CA STD/HIV PTC course) Integrated Partner Services- Incorporating HIV PCRS into Syphilis Interviews (CDPH course) Internet Partner Notification (CDPH course) Top Safe-Field Safety (CA STD/HIV PTC course) California Phlebotomy Training/Certification Principles of Harm Reduction (CA Harm Reduction Institute) Bioterrorism and Emergency Preparedness for Field Investigators (CDPH/UCB course) Introduction to Tuberculosis (CDC Module Study)

13. DIS Fellowship Program Monitoring Progress DIS Fellowship Program Evaluation Tool DIS Fellowship Program Evaluation Tool Completed by Trainees, Mentors and Managers Completed by Trainees, Mentors and Managers DIS Fellowship Program Debrief (Year 1) DIS Fellowship Program Debrief (Year 1) Open dialogue on what is working and what is not Open dialogue on what is working and what is not DIS Fellowship Checklist DIS Fellowship Checklist Master guide for supervisors and DIS Master guide for supervisors and DIS Core competencies for skills development Core competencies for skills development Topic areas include: record search, field preparation, in the field, encountering the client, documentation, internal systems, field record closure, communication, problem solving, safety, ICCR, pre-interview analysis, interview, re-interview, cluster interview, contacting medical providers, contacting laboratories Topic areas include: record search, field preparation, in the field, encountering the client, documentation, internal systems, field record closure, communication, problem solving, safety, ICCR, pre-interview analysis, interview, re-interview, cluster interview, contacting medical providers, contacting laboratories

14. DIS Fellowship Program Outcomes Two cohorts of trainees 2006* (2 Richmond, 1 Orange County) 2007 (2 Long Beach, 2 Orange County) Augmented local capacity for syphilis case management & STD/HIV partner services Enhanced ability to respond to outbreaks Syphilis increases TB outbreaks Food borne illness * One trainee left the program to pursue a career in public health

15. DIS Fellowship Program Implications and Next Steps DIS Fellows are trained core of personnel to support front line public health work at the local level To pursue funding for sustainability of the CDPH DIS Fellowship Program