2011 Model Practice Application (Public)

FACILITY USE ASSESSMENTS: A MULTI-AGENCY COOPERATIVE EFFORT

Stanislaus County Public Health Department

FACILITY USE ASSESSMENTS: A MULTI-AGENCY COOPERATIVE EFFORT

This project addressed multiple public health issues within Public Health emergency preparedness, planning, and response related to the essential service of enforcing health and safety regulations. The project involved developing policies and strategies for action, and established functional standards for data collection. The importance of health equity was respected by special attention to the needs of the individuals with disabilities (the “functional needs” population) and complying with ADA standards. Successful identification of appropriate locations for PODs, ACS sites, general population emergency shelters, medical shelters, and alternative spaces for health department operations will facilitate the ability of Stanislaus County Health Services Agency to perform its core functions during an emergency. Successful completion of the project required community mobilization, project evaluation and training to assure a competent workforce.

The Stanislaus County Public Health Department (SCPHD) served in two major roles in this project. First, it was the project instigator. SCPHD identified the need, solicited partners, and initiated the project at the Operational Area level. Second, SCPHD served in a leadership and coordination role. For example, SCPHD facilitated and participated in the planning meetings, maintained minutes, distributed/compiled assessment questionnaires, scheduled assessments, and organized and trained the site assessment teams. When the assessments were completed, copies were compiled into binders and distributed to stakeholder agencies. The SCPHD contributed staff and equipment (camera/measuring devices) to the assessment teams and provided administrative support.

Public Health plays an integral role in disaster response. Some of these disaster responses include the ability to receive, store, and distribute Strategic National Stockpile assets and establish Points of Distribution (PODs), government authorized Alternate Care Sites (ACS), and medical and general population shelters. But how and where does one begin to find appropriate facilities that meet Americans with Disabilities Act (ADA) guidelines? How do you assure compliance and meet expectations of persons with functional needs? What are the associated roles and responsibilities for coordinating agencies? This project entailed a collaborative approach in developing a standardized assessment tool, training staff to assess facilities, and formalized roles and responsibilities through a Memorandum of Understanding (MOU). In an emergency, facilities such as schools, churches, or meeting halls may be needed to use as shelters, cooling/heating centers, government-operated ACS, or mass prophylaxis distribution. Establishing these sites requires a multi-agency response. Though the CDC developed a Shelter Assessment Tool to rapidly assess shelter facilities for use DURING an emergency or disaster, in October 2008, Stanislaus County Public Health initiated a collaborative approach to evaluate sites for multiple uses PRIOR to a disaster. The Operational Area Council was chosen as the venue to begin the process because participants from municipalities, government agencies, community organizations, and all public safety are represented, and once approved by this group, participation in the project by member agencies was guaranteed. This project involved a three-pronged collaborative effort with American Red Cross, Community Services Agency, Animal Services, Department of Environmental Resources, Office of Education, Office of Emergency Services and Public Health to evaluate sites as possible locations for use in an emergency. This effort provides a systematic approach to facility evaluations that addresses participating agency needs; streamlines and maximizes efficiencies with non-duplication of effort; furnishes and centralizes information and access; and enhances partnerships and collaboration. The objectives of the project were to a) Develop an ADA compliant assessment tool that evaluates facilities for multiple uses and can be maintained electronically, b) Develop a MOU between American Red Cross and County departments that defines roles and responsibilities, and c) Train teams to utilize the assessment tool to evaluate sites and introduce them to resources to assist in compliance with ADA requirements e.g. County Registrar warehouse inventory(ramps, low tables, etc). In order to ensure ADA compliance, the Disability Resource Agency for Independent Living (DRAIL) contributed a certified ADA evaluator who reviewed and supplied assistance in the development of the assessment tool. The workgroup collected samples of survey tools and MOUs from many sources, and a final survey tool was constructed by March 2009. In the same month, approximately 30 staff from all agencies underwent training in the utilization of the tool. Three-member teams were formed to perform scheduled assessments. Schools were first selected, and over 90 sites were evaluated from June-August 2009. Pre-assessment questionnaires were distributed to school principles to gather contact and baseline information. Site evaluations consisted of completing the tool, taking digital photos, gathering Google satellite pictures, and drawing schematics to reflect location of doors, outlets, etc. The tool was converted into a form-fill PDF with drop-down boxes and all evaluations were data entered. The schematics were electronically captured utilizing Visio. The Stanislaus County Office of Emergency Services provided access to ETEAM, a web-based emergency management data system, and site information was entered. The completed PDF assessment, digital

The first objective was to develop an ADA compliant assessment tool that evaluates facilities for multiple uses and can be maintained electronically. Process evaluation: Drafts of the assessment tool were reviewed by all members of the planning group for a) ADA compliance, b) utility for specific purposes, and c)user friendliness. The assessment tool was not adopted until unanimous agreement was achieved. Outcome evaluation: Objective 1 involved the completion of a tangible product (multipurpose site assessment form. This objective was considered successfully completed upon adoption of the standard form after approval by all stakeholders. The second objective was to develop a Memorandum of Understanding (MOU) between American Red Cross and Stanislaus County departments that defines roles and responsibilities. Process evaluation: Drafts of the MOU were reviewed by all members of the planning group and Stanislaus County and National American Red Cross legal departments. Once MOU language was agreed upon, the MOU was adopted by the Stanislaus County Board of Supervisors and executed by all department heads of the signatory agencies. Outcome evaluation: Objective 2 involved the completion of a tangible product (MOU). This objective was considered successfully completed upon execution of the MOU. The final objective was to train teams to utilize the assessment tool and evaluate sites. Process evaluation: To ensure that assessments were completed in a standard manner and all forms were appropriately and thoroughly completed, the Project Lead attended and oversaw all site evaluations (i.e. fidelity to the model). Through direct observation and immediate informal feedback, practice deficiencies were corrected. Outcome evaluation: Completed activities (‘outputs”) included the training of over 30 staff on site assessment and ADA compliance, and the completed assessment of over 90 school-based sites. Results: All activities were implemented as planned and objectives accomplished. The sites evaluated were assessed for potential uses in emergency and disaster response and information is electronically maintained and accessible via web-enabled data management system. The assessment tool can be used for any building for pre-designation of use. Feedback: CSA reported that entering the paper assessment forms into the on-line database took too many staff hours. The group decided that future evaluations should be completed via direct data entry with a laptop to save valuable staff time. The development of training muli-disciplinary staff from agencies with various response assignments to be a function site assessment team is a Promising Practice. The willingess to be an instigator and provide leadership and coordination to a project and turn over the responsibility for the project data input, management and sustainment may also be a practice of collaboartion for future review.