The public health workforce is diverse and encompasses a wide range of professions. For tribal communities, the Community Health Representative (CHR) is a public health paraprofessional whose role as a community health educator and health advocate has expanded to become an integral part of the health delivery system of most tribes. CHRs possess a unique set of skills and cultural awareness that make them an essential first responder on tribal land. As a result of their distinctive qualities they have the capability of effectively mobilizing communities during times of crisis and can have a significant impact on the communities' response to a local incident. Although public health emergency preparedness training is a priority of federal, state, local and tribal public health agencies, much of the training currently available is not tailored to meet the unique traits of CHRs. Much of the emergency preparedness training is standardized, such as the Federal Emergency Management Agency (FEMA) Training Programs, and does not take into account the inherent cultural traditions of some of the intended target audience. This paper reports on the use of the Native American Talking Circle format as a culturally appropriate method to teach the Incident Command System (ICS). The results of the evaluation suggest the talking format circle is well received and can significantly improve the understanding of ICS roles. The limitations of the assessment instrument and the cultural adaptations at producing changes in the understanding of ICS history and concepts are discussed. Possible solutions to these limitations are provided.
This study describes the development and evaluation of online Public Health Emergency Preparedness (PHEP) training adapted to the learning styles and needs of tribal Community Health Representatives (CHRs). Working through a university-tribal community college partnership, the Arizona Center for Public Health Preparedness at the University of Arizona and Diné College of the Navajo Nation delivered a blended online and face-to-face public health preparedness certificate program based on core public health emergency preparedness competencies. This program was carefully adapted to meet the environmental and learning needs of the tribal CHRs. The certificate program was subsequently evaluated via a scenario-based decision-making methodology. Significant improvements in five of six competency areas were documented by comparison of pre- and post-certificate training testing. Based on statistical support for this pedagogical approach the cultural adaptations utilized in delivery of the certificate program appear to be effective for PHEP American Indian education.
Abstract:Background:Since the tragic events experienced on September 11, 2001, and other recent events such as the hurricane devastation in the southeastern parts of the country and the emergent H1N1season, the need for a competent public health workforce has become vitally important for securing and protecting the greater population.Objective: The primary objective of the study was to assess the training needs of the U.S. Mexico border states public health workforce.Methods:The Arizona Center for Public Health Preparedness of the Mel and Enid Zuckerman College of Public Health at The University of Arizona implemented a border-wide needs assessment. The online survey was designed to assess and prioritize core public health competencies as well as bioterrorism, infectious disease, and border/binational training needs.Results:Approximately 80% of the respondents were employed by agencies that serve both rural and urban communities. Respondents listed 23 different functional roles that best describe their positions. Approximately 35% of the respondents were primarily employed by state health departments, twenty-seven percent (30%) of the survey participants reported working at the local level, and 19% indicated they worked in other government settings (e.g. community health centers and other non-governmental organizations). Of the 163 survey participants, a minority reported that they felt they were well prepared in the Core Bioterrorism competencies. The sections on Border Competency, Surveillance/Epidemiology, Communications/Media Relations and Cultural Responsiveness, did not generate a rating of 70% or greater on the importance level of survey participants.Conclusions:The study provided the opportunity to examine the issues of public health emergency preparedness within the framework of the border as a region addressing both unique needs and context. The most salient findings highlight the need to enhance the border competency skills of individuals whose roles include a special focus on emergency preparedness and response along the US-Mexico border.
Eight lessons learned are shared including the need to design training courses to align to an operation-based exercise, and not vice versa, the need to rely on qualitative approaches, and the need for an a priori evaluation rubric.
Root cause analysis (RCA) is methodology recommended by the Homeland Security Exercise and Evaluation Program (HSEEP) for examining why exercise objectives were not met and providing specific recommendations for corrective action. The consequence of not completing the RCA as required by HSEEP is significant. In the absence of a RCA arriving at the best corrective action is less likely. Despite its importance, there is research evidence from a Centers for Disease Control and Prevention study that the RCA is seldom completed. Several reasons are presented as to why the RCA is not completed including a lack of guidance as to how to conduct a RCA. An example of how to complete a RCA is provided followed by a discussion of the benefits of using the approach over traditional exercise debriefing methods. Reasons why there may be continued resistance to using RCA despite having the necessary facilitation skills and dedicated time are also discussed.
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