1. Capability Cliff Notes Series PHEP Capability 11—Non- Pharmaceutical Interventions What Is It And How Will We Measure It?

2. Learning Objectives Become familiar with Capability Functions Become familiar with Tasks that complete the Functions Understand how these Functions and Tasks are measured or may be measured in the future (Performance Measures)

3. Non-Pharmaceutical Interventions Non-pharmaceutical interventions (NPI) involves the ability to recommend to the applicable lead agency (if not public health) and implement strategies for disease, injury, and exposure control that do not include the use of medication or vaccine. Measures can include interventions such as: – Isolation and quarantine – Restrictions on movement and travel advisory/warnings – Social distancing – External decontamination – Hygiene – Precautionary protective behaviors How can health departments assist in finding appropriate non- pharmaceutical interventions for incidents?

4. Non-Pharmaceutical Intervention Functions How Should Health Departments Recommend Non- Pharmaceutical Interventions? 1.Engage partners and identify factors that impact non- pharmaceutical interventions 2.Determine non-pharmaceutical interventions 3.Implement non-pharmaceutical interventions 4.Monitor non-pharmaceutical interventions

5. Capabilities and Measures Resources The presentation will be an overview of what the functions and tasks mean, linked to the performance measures. Please note that since the capabilities PDF document has come out, more performance measures have been developed. If performance measures have come out since the creation of the capabilities document below, they have been included in these tutorials following their function slide, even if the PDF lists that there are no measures for that function. For functions that still have no measures, questions for health departments to begin thinking about measures have been included instead. For exact lists of the capabilities and performance measures, and data collected for the measures, documents can be found at these links: For Capabilities, Functions, and Tasks: http://www.cdc.gov/phpr/capabilities/DSLR_capabilities_July.pdf For Performance Measures: http://www.colorado.gov/cs/Satellite/CDPHE-EPR/CBON/1251643573938

6. Function 1: Engage partners and identify factors that impact non-pharmaceutical interventions Tasks: How can health departments identify partners and determine what will be a barrier to non-pharmaceutical interventions? Before an incident, identify legal, policy, and regulatory authorities that enable or limit the ability to recommend and implement non- pharmaceutical interventions, in both routine and incident-specific situations. Before an incident, engage healthcare organizations, government agencies, and community sectors in determining their roles and responsibilities in non-pharmaceutical interventions.

7. Function 1 Measurement How does CDC measure if health departments or other responsible organizations are engaging partners and identifying situations that could interfere with Non- Pharmaceutical Interventions? Have the following criteria been met?: Legal Identification of legal authorities for NPI implementation (hazard-specific) Identification of legal barriers to NPI implementation Identification of authorities able to alter legal statutes as needed Scientific Identification of subject matter experts (SMEs) needed to assess the severity of exposure and transmission Identification of triggers for needing an NPI Development of NPI recommendations before incidents Agreement to participate in recommending or adjusting NPIs at the time of an incident Criteria continued on next slide:

8. Function 1 Measurement How does CDC measure if health departments or other responsible organizations are engaging partners and identifying situations that could interfere with Non- Pharmaceutical Interventions? Have the following criteria been met? Criteria cont’d: Community Identification of community organizations needed for NPI implementation (hazard-specific) Up-To-Date contact information for each identified key community organization Development of letters of agreement, MOUs, or jointly developed operational plans Identification of secondary factors (e.g., those based on intended and unintended consequences) that affect the use of an NPI Specific data measures that went into calculating this measure can be found in PHEP Performance Measures on pgs 56-57: http://www.colorado.gov/cs/Satellite/CDPHE-EPR/CBON/1251643573938 http://www.colorado.gov/cs/Satellite/CDPHE-EPR/CBON/1251643573938

9. Function 2: Determine non- pharmaceutical interventions Tasks: What do health departments need to do to determine the appropriate non-pharmaceutical interventions for an incident? 1.At the time of the incident, consult with subject matter experts to assess the severity of exposure and transmission within their jurisdictions, in order to develop recommendations for non-pharmaceutical interventions.

10. Function 2 Measurement How does the CDC measure whether health departments or other responsible organizations have assisted appropriately in developing non-pharmaceutical interventions? Proportion of key partners identified to have an incident-specific role that participated in the development or implementation of NPI during an incident. Numerator: Number of key partners that participated in the development/implementation of NPI (for a specific hazard) at the time of the incident Denominator: Total number of key partners identified (pre-incident and at the time of the incident) to have a role in developing/implementing NPI for a specific hazard Specific data elements that went into forming this measure can be found in PHEP Performance Measures on pgs 58-60: http://www.colorado.gov/cs/Satellite/CDPHE-EPR/CBON/1251643573938 http://www.colorado.gov/cs/Satellite/CDPHE-EPR/CBON/1251643573938

11. Function 3: Implement non-pharmaceutical interventions Tasks: What steps will ensure that health departments can assist in implementing non-pharmaceutical interventions? 1.At the time of an incident, activate non-pharmaceutical intervention locations (e.g., isolation or quarantine sites) through coordination with officials. 2.At the time of an incident, assist community partners with coordinating support services for individuals affected by non-pharmaceutical interventions, such as quarantine. 3.At the time of an incident, provide recommendations, if needed, for closure of events and places where people gather, for officials and stakeholders, such as business owners. Tasks continued on next slide:

12. Function 3: Implement non-pharmaceutical interventions Tasks Cont’d: What steps will ensure that health departments can assist in implementing non-pharmaceutical interventions? 1.At the time of an incident, provide recommendations to officials for restrictions on population movement, if needed. 2.Upon request, activate processes for managing and detaining passengers at ports of entry through coordination with CDC’s Division of Global Migration and Quarantine, port authorities, and jurisdictional officials. 3.At the time of an incident, assure ability to decontaminate potentially contaminated and contaminated individuals. 4.At the time of an incident, educate the public, response agencies and other partners about the recommended interventions.

13. Function 3 Measurement How does the CDC measure whether health departments or other responsible organizations have assisted appropriately in developing non-pharmaceutical interventions? Proportion of key partners identified to have an incident-specific role that participated in the development or implementation of NPI during an incident. Numerator: Number of key partners that participated in the development/implementation of NPI (for a specific hazard) at the time of the incident Denominator: Total number of key partners identified (pre-incident and at the time of the incident) to have a role in developing/implementing NPI for a specific hazard Specific data elements that went into forming this measure can be found in PHEP Performance Measures on pgs 58-60: http://www.colorado.gov/cs/Satellite/CDPHE-EPR/CBON/1251643573938 http://www.colorado.gov/cs/Satellite/CDPHE-EPR/CBON/1251643573938

14. Function 4: Monitor non-pharmaceutical interventions Tasks: What are the steps health departments should take to monitor non-pharmaceutical interventions? Assess the degree of transmission, contamination, infection and severity of exposure of the population in the incident. Share situational awareness reports about the impact of the intervention with all agencies involved in the interventions. Revise recommendations for non-pharmaceutical interventions as needed for the incident, including whether to increase or decrease the intervention. Document the intervention actions taken by local jurisdictions, and document the feedback from community partners assisting in the interventions, as part of the incident After Action Report.

15. Function 4 Measurement How does the CDC measure whether health departments or other responsible organizations have assisted appropriately in developing non-pharmaceutical interventions? Proportion of key partners identified to have an incident-specific role that participated in the development or implementation of NPI during an incident. Numerator: Number of key partners that participated in the development/implementation of NPI (for a specific hazard) at the time of the incident Denominator: Total number of key partners identified (pre-incident and at the time of the incident) to have a role in developing/implementing NPI for a specific hazard Specific data elements that went into forming this measure can be found in PHEP Performance Measures on pgs 58-60:

16. Questions? Please contact: Rachel Coles Program Evaluator--CDPHE 303-692-2764 rachel.coles@state.co.us