Form 0920-1050 Needs Assessment

Attachment 1 – Needs Assessment Form approved
OMB No: 0920-1050
Expiration Date: 6/30/2019

Needs Assessment Survey

Thanks so much for taking this survey. This needs assessment survey is being conducted to identify the current areas of strength and needs in disaster and hurricane-related preparedness and response in your jurisdiction. Your participation is extremely important and completely voluntary. All information you provide will be kept confidential and only reported in summary form. Your responses will not be identifiable to the research team reviewing the data or anyone reading the summary report.

The first section asks questions about your current employment and role. This information will not be used to identify you, only to better understand the types of roles of the people who took the survey.

1. Which county do you work in? _______________________

2. About how many years have you worked in your field? __________

3. About how many years you have worked at your current agency/organization? ________

4. About how many years you have you worked in your current job? _______________

5. Which of the following best categorizes your job level?

   1. Front Line Staff/Entry Level: responsibilities include data collection and analysis, fieldwork, program planning, outreach, communications, customer service, and program support.

   2. Program Management/Supervisory Level: responsibilities include developing, implementing, and evaluating programs; supervising staff; establishing and maintaining community partnerships; managing timelines and work plans; making policy recommendations; and providing technical expertise.

   3. Senior Management/Executive Level: responsibilities include overseeing major programs or operations of the organization, setting a strategy and vision for the organization, creating a culture of quality within the organization, and working with the community to improve health.

CDC estimates the average public reporting burden for this collection of information as 20 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1050)

6. Which classification below best describes your work?

   1. Administration/Clerical

   2. Allied Health Professionals

   3. Environmental Health / Occupational Safety

   4. Management / Policy Analysis

   5. Laboratory

   6. Health Education

   7. Social Work / Mental Health

   8. Non-Health Professions

   9. Nursing

   10. Dentistry

   11. Epidemiology / Biostatistics

   12. Nutrition

   13. Physicians

   14. Community Health Workers

   15. Emergency Medical Services (EMS)

   16. Emergency Management Agency (EMA)

   17. Other ______________________

The next set of questions ask you about how confident you are in performing a variety of tasks as well as your level of need for training on that particular task.¹ Please answer both the first and second part of each question. Do not leave questions blank.

TASK	LEVEL OF CONFIDENCE	NEED FOR TRAINING
	6. How confident are you in your ability to perform this task?	7. Please rate your level of need for training in this task.
	Very Not very Not at all Confident Confident Confident Confident 1 2 3 4	No Low Moderate High Need Need Need Need 1 2 3 4
a. Prepare a personal/family disaster plan	1 2 3 4	1 2 3 4
b. Gather disaster supplies/equipment consistent with personal/family plan	1 2 3 4	1 2 3 4
c. Practice one’s personal/family disaster plan annually	1 2 3 4	1 2 3 4
d. Describe methods for enhancing personal resilience, including physical and mental health and well-being, as part of disaster preparation and planning	1 2 3 4	1 2 3 4
e. Explain one’s role within the incident management hierarchy and chain of command established within one’s organization/agency in a disaster or public health emergency	1 2 3 4	1 2 3 4
f. Prepare a personal professional disaster plan consistent with one’s overall organization/agency plan	1 2 3 4	1 2 3 4
g. Explain mechanisms for reporting actual and potential health threats through the chain of command/authority established in a disaster or public health emergency	1 2 3 4	1 2 3 4
h. Practice one’s personal professional disaster plan in regular exercises and drills	1 2 3 4	1 2 3 4
i. Identify the functional role(s) of a health department during an emergency situation	1 2 3 4	1 2 3 4
j. Identify and locate the agency all hazards emergency response plan	1 2 3 4	1 2 3 4
k. Summarize the incident command system in your community	1 2 3 4	1 2 3 4
l. Find resources that will help you carry out your responsibilities during an emergency	1 2 3 4	1 2 3 4
m. Identify general indicators and epidemiological clues that may signal the onset or exacerbation of a disaster or public health emergency	1 2 3 4	1 2 3 4
n. Describe measures to maintain situational awareness before, during, and after a disaster or public health emergency	1 2 3 4	1 2 3 4
o. Identify authoritative sources for information in a disaster or public health emergency	1 2 3 4	1 2 3 4
p. Explain principles of crisis and emergency risk communication to meet the needs of all ages and populations in a disaster or public health emergency	1 2 3 4	1 2 3 4
q. Identify strategies for appropriate sharing of information in a disaster or public health emergency	1 2 3 4	1 2 3 4
r. Identify cultural issues and challenges in the development and dissemination of risk communication in a disaster or public health emergency	1 2 3 4	1 2 3 4
s. Perform your communication role(s) in an emergency response	1 2 3 4	1 2 3 4
t. Demonstrate the use of all communication equipment used by your organization during emergencies	1 2 3 4	1 2 3 4
u. Explain general health, safety, and security risks associated with disasters and public health emergencies	1 2 3 4	1 2 3 4
v. Describe risk reduction measures that can be implemented to mitigate or prevent hazardous exposures in a disaster or public health emergency	1 2 3 4	1 2 3 4
w. Assess situations that require an emergency response	1 2 3 4	1 2 3 4
x. Describe the potential impact of a mass casualty incident on access to and availability of clinical and public health resources in a disaster or public health emergency	1 2 3 4	1 2 3 4
y. Identify existing surge capacity assets which could be deployed in a disaster or public health emergency	1 2 3 4	1 2 3 4
z. Discuss common physical and mental health consequences for all ages and populations affected by a disaster or public health emergency	1 2 3 4	1 2 3 4
aa. Explain the role of triage as a basis for prioritizing or rationing health care services for all ages and populations affected by a disaster or public health emergency	1 2 3 4	1 2 3 4
bb. Discuss basic lifesaving and support principles and procedures that can be utilized at a disaster scene	1 2 3 4	1 2 3 4
cc. Discuss public health consequences frequently seen in disasters and public health emergencies	1 2 3 4	1 2 3 4
dd. Identify all ages and populations with functional and access needs who may be more vulnerable to adverse health effects in a disaster or public health emergency	1 2 3 4	1 2 3 4
ee. Identify strategies to address functional and access needs to mitigate adverse health effects of disasters and public health emergencies	1 2 3 4	1 2 3 4
ff. Describe common public health interventions to protect the health of all ages and populations affected by a disaster or public health emergency	1 2 3 4	1 2 3 4
gg. Describe the public health role in emergency response for a range of all hazards emergencies that might arise	1 2 3 4	1 2 3 4
hh. Identify ethical issues likely to be encountered in disasters and public health emergencies	1 2 3 4	1 2 3 4
ii. Describe the Community Assessment for Public Health Emergency Response (CASPER) methodology	1 2 3 4	1 2 3 4
jj. Implement CASPER after a disaster	1 2 3 4	1 2 3 4
kk. Use results of CASPER to plan for future emergency response	1 2 3 4	1 2 3 4
ll. Discuss public health considerations for the recovery of all ages and populations affected by a disaster or public health emergency	1 2 3 4	1 2 3 4
mm. Identify strategies for increasing the resilience of individuals and communities affected by a disaster or public health emergency	1 2 3 4	1 2 3 4
nn. Identify and implement protocols for environmental remediation in a public health emergency	1 2 3 4	1 2 3 4
oo. Identify and implement protocols for risk assessment related to emergency environmental responses	1 2 3 4	1 2 3 4
pp. Identify and prioritize the potential medical, environmental, and mental/behavioral health risks responders may encounter during an incident with public health consequences based on jurisdictional risk assessment findings	1 2 3 4	1 2 3 4
qq. Identify, prioritize, and recommend protection and control measures, medical services, and mental/behavioral health support services for responders	1 2 3 4	1 2 3 4
rr. Use identified safety and health recommendations to develop or refine incident safety plan.	1 2 3 4	1 2 3 4
ss. Provide recommendations and guidance to support pre-incident screening and verification of responder credentials, training, and health status to ensure sustainability for deployment role	1 2 3 4	1 2 3 4
tt. Conduct safety monitoring and health surveillance for responders based on identified risks, jurisdictional responder roles, and subject matter expert recommendations	1 2 3 4	1 2 3 4
uu. Identify potential responder safety and health risks based on responder monitoring and surveillance findings.	1 2 3 4	1 2 3 4
vv. Update and revise the incident safety plan, as needed, based on responder monitoring and surveillance findings	1 2 3 4	1 2 3 4

The final section of the survey asks about your training preferences.

8. Which of the following training formats would you be likely to participate in? (Select all that apply)

1. In-person lecture

2. In-person skills based workshop

3. Live webinar

4. Self-paced distance course

5. Online interactive

6. Other (please specify)_______________________________

9. How important is each of the following issues to you when participating in training courses?

	Very important	Important	Not very important	Not at all important
a. Opportunity to interact with instructor
b. Opportunity to interact with other participants
c. Being part of a group that is taking the same course at the same time
d. Opportunity to start at any time
e. Opportunity to complete at your own pace
f. Opportunity to receive feedback
g. Being able to measure comprehension through pre-post tests
h. Being able to access an online training on your mobile device?
i. Being able to access an online training on your laptop/desktop?
j. Being able to access an online training on your tablet?

10. Please specify any additional training needs related to emergency preparedness and response that you may have:

Thank you again for completing this survey! We really appreciate your time and input.

1 Tasks were selected from Walsh L, Subbarao I, Gebbie K, et al. Core competencies for disaster medicine and public health. Disaster Med Public Health Prep. 2012;6: 44-52.; Gebbie, K and Merrill, J. Public Health Worker Competencies for Emergency Response. J Public Health Management Practice, 2002, 8(3), 73–81.; and North Carolina Public Health State Accreditation. Public Health Workforce Assessment Report. 2007. https://sph.unc.edu/files/2013/12/nciph-wf-assess-2007.pdf. As well as Reischl, T. M., Sarigiannis, A. N., & Tilden Jr, J. (2008). Assessing emergency response training needs of local environmental health professionals. Journal of environmental health, 71(2), 14-19 and Centers for Disease Control and Prevention (CDC). (2018). Public health emergency preparedness and response capabilities. Atlanta, GA: U.S. Department of Health and Human Services.