1. Using Qualitative Methods to Identify Public Health Competencies Kristine Gebbie, RN, DrPH, Jacqueline Merrill, MPH, RN,C Center for Health Policy Columbia University School of Nursing

2. October 23, 2001 Center for Health Policy Columbia University School of Nursing Project Goals Aim 1--Identify competencies most needed by the the individual public health worker responding to an emergency situation, including bio-terrorism Aim 2--Assess the identified competencies with local and state public health agency representatives.

3. October 23, 2001 Center for Health Policy Columbia University School of Nursing Importance 448,254 public health workers are a key first response to emergencies of all kinds

4. October 23, 2001 Center for Health Policy Columbia University School of Nursing Why qualitative methods? No documented knowledge base on individual competencies in this practice area Delphi Panel is an iterative technique to create opinion consensus in a topic area in which empirical information is limited Focus group with experienced but non-expert practitioners to assess utility of expert findings

5. October 23, 2001 Center for Health Policy Columbia University School of Nursing Delphi panel composition 80 identified through organizations and publications 72 invited based on geography, expertise & level of practice 56 accepted 3 clerical/support experts added during Round I

6. October 23, 2001 Center for Health Policy Columbia University School of Nursing Round I instrument based on: State public health system: Draft performance assessment instrument. CDC /PHPPO (9/99) Local public health performance assessment: Pilot instrument. CDC /PHPPO (3/99) The public health workforce: An agenda for the 21st century. U.S. DHHS (1997) Current literature on emergencies and emergency response.

7. October 23, 2001 Center for Health Policy Columbia University School of Nursing Instrument 1 Organized by: Essential Services of Public Health for consistency with infrastructure thinking Levels of staff consistent with enumeration and workforce studies Leader/administrator Professional Technical Support/clerical

8. October 23, 2001 Center for Health Policy Columbia University School of Nursing Items scored by: Scale of importance: Very important Somewhat important A little important Not important at all Pilot tested with 4 individuals

9. October 23, 2001 Center for Health Policy Columbia University School of Nursing Round I results Response rate 98% All items were deemed important or very important for leaders and professionals About half of items were deemed important for technicians No items were deemed important for support staff One new item suggested by several comments

10. October 23, 2001 Center for Health Policy Columbia University School of Nursing Panel Expansion Experience suggested support staff are important 3 persons with support staff experience added to panel

11. October 23, 2001 Center for Health Policy Columbia University School of Nursing Round II instrument development Feedback Percentage score Comments from Round I Forced choice Yes or No on each item for each category of worker Question format again tested with pre-test panel

12. October 23, 2001 Center for Health Policy Columbia University School of Nursing Round II results Response rate 85% Competencies that were identified as very important by 75% of respondents were retained 43 of 43 for administrators 43 of 43 for professionals 28 of 43 for technicians 7 of 43 for clerical support – for clerical support 21 of 43 scored higher than 75% as NOT necessary

13. October 23, 2001 Center for Health Policy Columbia University School of Nursing Assessment of identified competencies At CDC Two groups of local, state, and fed reps Approximately 15 people in each group With and without recent ER training At two BT training exercise sites Colorado and New Hampshire Two groups each: leadership/professionals and technical/support

14. October 23, 2001 Center for Health Policy Columbia University School of Nursing Focus group questions Do staff of federal, state and local health agencies generally agree that the identified competency statements are an appropriate statement of what staff should be able to do in the area of emergency preparedness? To what degree can the existing staff of state and local public health agencies perform the identified competencies? To the extent that staff cannot now meet the identified competencies, what should be the priority for staff development and training?

15. October 23, 2001 Center for Health Policy Columbia University School of Nursing Focus group findings Competencies identified are appropriate, but poorly organized for use Many public health workers do not now have the needed competencies Competencies in planning and communicating are the most critical gaps

16. October 23, 2001 Center for Health Policy Columbia University School of Nursing 9 Core competencies that apply for ALL WORKERS 1. DESCRIBE the public health role in emergency response in a range of emergencies that might arise. 2. DESCRIBE the chain of command in emergency response. 3. IDENTIFY & LOCATE the agency emergency response plan (or the pertinent portion of the plan).

17. October 23, 2001 Center for Health Policy Columbia University School of Nursing Core competencies for ALL WORKERS (cont’d) 4. DESCRIBE his/her functional role(s) in emergency response and DEMONSTRATE his/her role(s) in regular drills. 5. DEMONSTRATE correct use of all communication equipment used for emergency communication (phone, fax, radio, etc.).

18. October 23, 2001 Center for Health Policy Columbia University School of Nursing Core competencies for ALL WORKERS (cont’d) 6.DESCRIBE communication role(s) in emergency response: Within agency Media General Public Personal (family, neighbors) 7.IDENTIFY limits to own knowledge/skill/authority and IDENTIFY key system resources for referring matters that exceed these limits.

19. October 23, 2001 Center for Health Policy Columbia University School of Nursing Core competencies for ALL WORKERS (cont’d) 8. APPLY creative problem solving and flexible thinking to unusual challenges within his/her functional responsibilities and EVALUATE effectiveness of all actions taken. 9.RECOGNIZE deviations from the norm that might indicate an emergency and DESCRIBE appropriate action (e.g. communicate clearly within the chain of command).

20. October 23, 2001 Center for Health Policy Columbia University School of Nursing Additional competencies 7 additional competencies specific to leaders 3 additional competencies specific to professionals 2 additional competencies specific to support/clerical staff

21. October 23, 2001 Center for Health Policy Columbia University School of Nursing Assessment of process and project The product has immediate utility in public health practice The process is an effective approach to competency development

22. October 23, 2001 Center for Health Policy Columbia University School of Nursing Columbia University School of Nursing Center for Health Policy http://cpmcnet.columbia.edu/dept/nursing/ institute-centers/chphsr/index.html