2008 Model Practice Application (Public)

Pandemic Influenza Planning -- Partnership with County Emergency Management and Human Services

Hennepin County

BACKGROUND: The Hennepin County Human Services and Public Health Department (HSPHD) is a department of about 2700 staff whose focus is on both human service programs for county residents in need and also public health programs. In 2004 the County’s Human Services and Public Health Departments merged into one large department with 21 different service areas. Public Health service area has been planning a response to public health emergencies since 1998 and more formally since 2002 when the Centers for Disease Control and Prevention (CDC) funding for that purpose became available. With the introduction of public health emergency response planning into the larger department, the HSPHD Executive Team identified the need for a department wide plan to respond to an influenza pandemic and made this need a strategic initiative for the department. The department's Public Health Emergency Preparedness unit was identified to take the lead in this project. GOAL & OBJECTIVES: The goal was to increase the County's ability to respond to public health emergencies including an influenza pandemic. The objectives for the project included: 1) a HSPHD emergency response plan for a response to an influenza pandemic and adaptable for other emergencies would be completed; 2) HSPHD leadership and staff would be knowledgeable of their roles during a response; 3) targeted groups and organizations in the community would have a new awareness of the implications of a pandemic emergency, and receive information and resources to help themselves be prepared; and 4) the HSPHD pandemic influenza response plan would be compatible with the countywide pandemic response plan. The Public Health emergency response planning team recognized early in the planning process that in order to meet the health needs of the residents, the basic social service needs must also be met. Meeting these basic needs is better accomplished by those who do this work daily and have the expertise to navigate the systems – human service programs and providers. The opportunity to collaborate and plan with public health’s human service programs in the department would lead to a comprehensive response plan for the residents of the County. It would also tap the expertise needed to provide for the basic needs of the County residents and allow public health planning to focus on their area of expertise.

Public health must be prepared to lead the community through an influenza pandemic. For the community to be ready to respond to the guidance from public health during a pandemic the community members must also be able to meet their own basic needs, such as food, water, and shelter. The human service programs that assist with meeting these basic needs for the most vulnerable will also need to be ready to help those who because of the emergency find themselves unable to provide for themselves or their families. Our Public Health service area evaluated the work already done for an All Hazard Public Health Emergency Response Plan and recognized that while the infrastructure was in place particular concerns were raised when considering a protracted influenza pandemic in the community. It became clear that in order to respond PH would need the help of the entire department, that citizens would need help with social service needs; that the most vulnerable in the county would be at risk if their support network could not be maintained. In addition, as a result of the publicity of the threat of an influenza pandemic, the County Administration also began to ask whether the County was positioned well to respond to such a large diffuse event. The department also raised questions whose answers would impact all departments within the county and the need for consistency within the organization was recognized. While HSPHD public health service area began planning for a department wide response plan, the county administration took action by requesting all departments to relook at their business continuity plans but use 40% workforce reduction as the criteria to determine essential services. Since HSPHD had already begun pan flu planning, had the public health expertise on the topic and had identified work plan to accomplish the task, the County requested the HSPHD pan flu team assist in the development of the county plan. HSPHD influenced the format, content and subject matter that was needed at the county level in order for departments to be able to write plans consistent across the county. Public Health’s approach to the threat of an influenza pandemic was to evaluate the public health response plan and identify the gaps that would need to be addressed specific to this event. Being part of a large department that included human service programs, public health identified that a department wide approach would ensure public health would have the infrastructure to support the response but would also engage the human service providers in the planning to ensure basic needs of the residents were met. In addition, the opportunity to work with the county emergency preparedness program on both countywide business continuity and pandemic influenza planning allowed public health to influence the county pandemic influenza planning. What made this project innovative was the engagement of human service programs into public health emergency response planning. Most agencies in our metropolitan area have separate human service and public health departments. It has been difficult to engage the human service departments in emergency planning since there has been no funding for them to plan and the response needs for the community are not as well defined. By engaging our human service area programs, public health not only was able to get the right staff with the right expertise at the table to address some of the factors that contribute to unhealthy conditions during an emergency but public health was also able to help human service programs understand how their skills would be of help in any kind of a public health event. Public health service area needs to engage other areas that provide department wide support like information technology or human services or staff development to assist with other types public health emergencies. This project allowed public health and human service areas identify each others skills and expertise that will be needed to help t

Public Health emergency preparedness staff led the team to coordinate the planning and writing of the human services and public health department pandemic influenza response plan. This team identified the goals and objectives, outlined the project timeline, deliverables and steps need to achieve the objectives. There were six steering committee working meetings where problems and issues were brought to the group for input and guidance. Each member was given assignments through out the project to ensure program specific needs were being addressed. One particular example of the work was on the identification and prioritization of essential services for the their service areas. Since this project was part of the HSPHD’s strategic plan, the department’s executive team and service area managers were involved throughout the project development. There was a process established to take policy issues to the appropriate management team for discussion and decision making. Both administrative groups approved the incident command structure for the department, the essential services and priorities, workforce reassignment processes, and department wide training plans. The County emergency planning division requested the department’s pan flu team participate in the development of a countywide pan flu plan with a consultant. Based upon the work already in progress in the department and the broader issues that had been identified with HSPHD planning, the team was able to identify the issues a county plan needed to address. In doing so the county departments would have a consistent framework from which to make their decisions. The topics developed in the county functional annexes included employee health and safety, business continuity, human resources, information technology, direction and control, risk communication, workforce management, and property services. The pan flu team met with the county emergency planners and the hired consultant to work cooperatively on the county plan thus ensuring the HSPHD planning would be integrated into the county system and the county plan would address the issues identified at the department level. SPHD pandemic influenza planning team provided guidance and influenced the format, content and concept of the Countywide pandemic influenza response plan. The HSPHD pandemic influenza planning team identified the topic areas needed for the functional annexes. These annexes would define county policy and processes and would guide each county department to make consistent decisions within their areas. The HSPHD pandemic influenza planning team also worked with the consultants to use language that was consistent with the other county emergency plans and with the National Incident Management System. Outreach to community based organizations was started as part of the pandemic influenza planning for the department. Civic groups, faith based organizations and contracted vendors for the County have been targeted thus far. The focus of the outreach has been on awareness level training, providing tools to assist the agencies in developing their own pandemic influenza plan and to determine their ability to maintain or enhance their services to members and the community at large.

Two fulltime staff from the public health emergency preparedness team were assigned to lead the project in addition to their other duties. In addition, one supervisor from the human services part of the department accepted a mobility assignment and the fourth team member was hired to complete the team for a 2 year commitment. A steering committee comprised of representatives from the 21 service areas of the department was formed and met six times in 3 hour meetings over the course of 16 months. Front line supervisors and lead staff from 91 service area types each participated in one 2 hour meeting to gather data about the services and programs and to be introduced to the pandemic influenza topic and planning project. Once the project was underway, the pan flu team provided 63 awareness level trainings, 30 minute sessions, to 2003 employees in the department over a 6 month period. Contract vendor outreach and faith based outreach activities were also implemented. Public Health Pandemic Influenza response planning grant funds were used to support the pandemic influenza planning team. HSPHD provided in-kind staff time for committee work, individual service area planning time, and training time for all employees in the department.

The goal of the project was to increase the County's ability to respond to public health emergencies specifically pandemic influenza. The objectives for the project included: 1) A HSPHD emergency response plan for a response to influenza pandemic and adaptable for other emergencies would be completed by December 2007. Steps included: a) Develop and write the components for the HPHD emergency response plan that will include the basic plan, overview of response functions and procedures for activation and implementation of a response planunctional annexes, 8 topic specific annexes that will provide consistent direction for each service area in the department to follow. Example: direction and control; employee health and safety, human resourcesService Areas annexes – 21 service area specific plans that outline essential services and priorities, resources, response functions and other service area specific information needed in the emergency, b) Determine the Essential Services for each service area when an emergency response is needed & how they will be delivered differently during Pandemic, c) Identify changes needed in laws, rules, contracts or policies in order to respond during a Pandemic Influenza emergency, d) Provide outreach training on pandemic influenza planning to contracted vendors. 2) HSPHD leadership and staff would be knowledgeable of their roles during a response, a) Develop and deliver awareness level training on emergency preparedness and response to all HSPHD Staff, b) Provide Incident Command training to all HSPHD staff identified in leadership positions during an emergency response, c) Exercise HSPHD operational response plan at least once, d) Test service area specific operational plans or components of the plan at least once. Develop at least a tabletop exercise, e) Test activation of workforce. 3) Targeted groups and organizations in the community would have a new awareness of the implications of a pandemic emergency and receive information, resources to help themselves be prepared, a) Provide education, resources and assistance to targeted community groups in suburban Hennepin County that could assist their community, membership or vulnerable populations during a pandemic including: Faith Community, Civic groups, Family Service Collaborative, b) Gather baseline information on community providers or potential partners in response such as numbers, locations, current emergency preparedness status for Schools, Group Homes, and others, c) Gather data on location of vulnerable populations in suburban Hennepin County such as senior housing, group homes, homeless shelters, battered women’s shelters, day cares, 4) The HSPHD pandemic influenza response plan would be compatible with the countywide pandemic response plan, a) Provide guidance to the Countywide pandemic influenza planning activities to ensure coordination of plans, b) Identify specific topic areas departments will need addressed to ensure countywide consistency during a pandemic influenza response.

The HSPHD pandemic influenza response plan is part of the countywide pan flu plan. The County recognizes the need for regular updates, trainings and exercises to keep these plans alive. The County will be prompting departments for updates, training and exercise information at least annually after the initial training and testing occurs. There is a software system that will assist in monitoring compliance to the updates. The HSPHD pan flu plan is part of the department’s strategic initiative and the department has committed significant support to the development of this plan. The basic premise of the project was to engage the department at the service area and program levels recognizing that any response has to be practical and based in reality. By engaging the front line supervisors in the planning process, there is already an understanding of the need for such a plan and the basic components of the plan that they will have to implement. By offering initial training for all leadership staff and then service area training those needing to implement the plan will have the information they need to start. A department emergency planning committee will be responsible for coordinating and sustaining all the emergency plans that the departments have.

Currently, 16 months into the 24 month project the HSPHD Pandemic Influenza response plan is written including the basic plan and functional annexes. HSPHD leadership has an incident command organizational structure that will be used during a large-scale public health emergency, including a pandemic. All 21 service areas have their essential services identified and prioritized into 4 categories. HSPHD leadership will use these lists to decide which services will be continued when staff shortage requires the department to adjust from business as usual. The service area plans also identify lines of succession to maintain management of areas when certain leadership staff are not available. These plans identify where contact information for all employees is located and who has access to the information. It outlines backups for human resource functions such as timecard approval. It also identifies which staff may be at risk for exposure during their normal work day and thus identifies which staff may need personal protective equipment and under what circumstances. As the planning was taking place, there also was an effort to provide education to all department employees about pandemic influenza, emergency preparedness and personal preparedness planning. Seventy-five percent of HSPHD staff attended awareness level training. Most importantly, HSPHD as a department has an emergency response plan that can be adapted to different types of emergencies. The human service program areas recognize their need to have emergency response plans and have identified both the day to day work that needs to continue but also the new work that may be required during an emergency. Some examples of new work include behavioral health response plans for the community and response plans for those adults or children who may loose caregivers during a pandemic or other emergency. Finally, HSPHD is part of the larger countywide pandemic influenza plan that ties all the departments together with common leadership structure and consistent county policy decisions for specific topic areas.