Evidence-Based Practice for Public Health Emergency Preparedness and Response (2020) / Chapter Skim
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4 Engaging with and Training Community-Based Partners to Improve the Outcomes of At-Risk Populations
4 Engaging with and Training Community-Based Partners to Improve the Outcomes of At-Risk Populations
Pages 116-137
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From page 116... ...
knowledge of CBP represen tatives Culturally tailored preparedness training ; programs improve attitudes and beliefs of CBP representatives regarding their preparedness to meet needs of at-risk individuals ; Culturally tailored preparedness training programs increase CBP disaster planning ; Culturally tailored preparedness training programs improve the PHEPR knowledge of trained at-risk populations Culturally tailored preparedness training programs ; improve attitudes and beliefs of trained at-risk pop ulations regarding their preparedness 4 Culturally tailored preparedness training programs improve preparedness behaviors of trained at-risk ; populations CBP engagement in preparedness outreach activities improves the attitudes and beliefs of at-risk populations toward preparedness behaviors CBP engagement and training in coalitions addressing public health preparedness/resilience increases the diversity of coalitions, the coordination of CBPs with other response partners, or capacity to reach and edu cate at-risk populations before an emergency 116
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From page 117... ...
zations, and other and existing data sources that can be used to facilitate more community timely engagement of CBPs and to link at-risk populations based organizations. with needed services during an emergency ; Tailor the curriculum and format of CBP preparedness training programs to the learning needs and preferences of specific audiences, and ensure that they are culturally sensitive and appropriate Emergency Phase ; Consider soliciting stakeholder feedback in the evaluation Studies in this of training program materials and content evidence review focused on CBP engagement and training during the preparedness phase.
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From page 118... ...
in socially vulnerable groups. Although limitations of time and resources necessitated the committee's narrow focus on CBP engagement and training practices oriented specifically to public health emergency preparedness and response (PHEPR)
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From page 119... ...
Moreover, one must take care when drawing conclusions about the effectiveness of practices targeting at-risk groups because not everyone in a given demographic group is equally at risk. The term "at-risk population" is used in this review for consistency with the terminology used in CDC's 2018 Public Health Emergency Preparedness and Response Capabilities: National Standards for State, Local, Tribal, and Territorial Public Health (CDC, 2018a)
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From page 120... ...
Capability 2: Community Recovery -- the transition between response and recovery is rarely well defined, and in both phases community-based partners (CBPs) can provide critical services to mitigate the effects of public health emergencies on at-risk populations and to assist with their recovery.
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From page 121... ...
. OVERVIEW OF THE KEY REVIEW QUESTIONS AND ANALYTIC FRAMEWORK Defining the Key Review Questions The overarching review question that guided this review addresses the effectiveness of different strategies for engaging with and training CBPs to improve the outcomes of at-risk
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From page 122... ...
Recovery practices were outside the committee's scope of work, but separate key review sub-questions were formulated for the preparedness and response phases. The committee also posed sub-questions related to documented benefits and harms of CBP engagement and training strategies and the factors that create barriers to and facilitators of implementation of such strategies (see Box 4-3)
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From page 123... ...
» Increased capacity to reach Organizational level Organizational/system level » Increased capacity at-risk populations and (Community-Based Partners) » Increased participation in to reach and deliver services after public » Increased knowledge regarding and diversity of health care health emergency emergency preparedness and coalitions and other partner- educate at-risk response concepts and needs of ships; increased organizational populations » Improved reach/timeliness at-risk populations during/after networks before a public of risk communications public health emergencies health emergency targeting at-risk populations » Increased continuity of » Increased belief in ability to meet operations/disaster planning » Improved reach/ needs of at-risk populations timeliness of risk » Improved coordination with communications Individual level (at-risk population)
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From page 124... ...
At-risk individuals may be more recep tive to training on protective preparedness behaviors when it is delivered by trusted messengers, such as CBP representatives. OVERVIEW OF THE EVIDENCE SUPPORTING THE PRACTICE RECOMMENDATION1 This section summarizes the evidence from the mixed-method review examining strategies for engaging with and training CBPs to improve the outcomes of at-risk populations.
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From page 125... ...
From these two categories, three strategies for training and/or engaging CBPs were identified and evaluated separately: • implementation of culturally tailored2 preparedness training programs for CBPs and at-risk populations they serve, • engagement of CBPs in preparedness outreach activities targeting at-risk populations, and • engagement and training of CBPs in coalitions addressing public health preparedness/ resilience. Consistent with the methods described in Chapter 3, in making its final judgment on the evidence of effectiveness for strategies for engaging with and training CBPs to improve the outcomes of at-risk populations, the committee considered other types of evidence that could inform a determination of what works for whom and in which contexts, ultimately coming to 2 The committee uses the term "culturally tailored" to describe an intervention that is targeted and/or tailored to ensure that it meets the unique needs of the target group by incorporating its experiences and norms and values.
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From page 126... ...
The parallel evidence was considered recognizing that the engagement and training of CBPs to better reach and improve outcomes for individuals with social vulnerabilities has much broader application in public health beyond the PHEPR context, and the committee believed that this broader body of evidence may have some applicability to the PHEPR activities evaluated in this review. Implementation of Culturally Tailored Preparedness Training Programs for CBPs and At-Risk Populations They Serve The evidence suggests that culturally tailored preparedness training may be effective in improving outcomes for at-risk populations following a public health emergency, although there is little evidence linking preparedness phase outcomes (e.g., improved knowledge and preparedness behaviors)
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From page 127... ...
Engagement and Training of CBPs in Coalitions Addressing Public Health Preparedness/Resilience The committee found limited evidence on the effects of engaging and training CBPs in coalitions addressing public health preparedness/resilience. There is very low COE based on a single quantitative study that CBP engagement and training in such coalitions increases the diversity of coalitions, the coordination of CBPs with other response partners, or capacity to reach and educate at-risk populations before an emergency.
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From page 128... ...
Reframing public health emergency preparedness activities to include a commitment to leveraging existing community health activities, along with a strong emphasis on health equity, can facilitate this organizational shift toward collaborative strategies and community preparedness. (Evidence source: case report evidence synthesis.
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From page 129... ...
As discussed further in the section below on evidence gaps and future research priorities, equity outcomes need to be measured in future studies to better capture the opportunities to embrace a health equity framing and community asset approach to CBP engagement and preparedness training. Careful attention is needed to ensure that participants in CBP engagement and training efforts are representative of the populations intended to be served.
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From page 130... ...
(Evidence source: qualitative evidence synthesis, case report evidence synthesis.) Engaging umbrella organizations that often serve at-risk populations (e.g., American Red Cross, United Way)
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From page 131... ...
serving at-risk populations is recom ended as part of state, local, tribal, and territorial public health agencies' community m preparedness efforts so that those CBPs are better able to assist at-risk populations they serve in preparing for and recovering from public health emergencies. Recommended CBP training strategies include • he use of materials, curricula, and training formats targeted and/or tailored to the indi t vidual CBPs and the at-risk populations they serve; and • train-the-trainer approaches that utilize peer or other trusted trainers to train at-risk populations.
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From page 132... ...
Although there is insufficient evidence to recommend specific strategies for engaging CBPs in PHEPR outreach activities targeting at-risk populations or for engaging CBPs in community coalitions, the qualitative evidence suggests numerous benefits of CBP engagement in public health preparedness and response. CBPs appear to support and value engagement and train ing, particularly when implemented using a participatory approach, but capacity limitations for both CBPs and public health organizations should be considered when selecting specific strategies.
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From page 133... ...
Although this evidence gap is challenging to address through prospective research studies given uncertainty as to the location and timing of future emergencies, communities that have made investments in CBP engagement in preparedness activities and training need to consider how the effect of those investments can be rigorously evaluated in the event of a public health emergency. While it is encouraging that engagement and training strategies have been evaluated for multiple types of CBPs (e.g., nongovernmental social services organizations, faith-based organizations, community health workers)
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From page 134... ...
The PROGRESS (place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status, and social capital) framework is a tool that may facilitate the application of an equity lens to the conduct and reporting of research focused on improving outcomes for at-risk populations after disasters and public health emergencies (O'Neill et al., 2014)
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From page 135... ...
2018a. Public health emergency preparedness and response capabilities: National standards for state, local, tribal, and territorial public health.
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From page 136... ...
2011. Guidance for integrating culturally diverse commu nities into planning for and responding to emergencies: A toolkit: Recommendations of the national consen sus panel on emergency preparedness and cultural diversity.
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