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PH-IST: Increasing the PHEP Workforce through Structured Cross Training & Exercises

State: TX Type: Promising Practice Year: 2021

Harris County, Texas, the third-largest county in the country, is located along the Gulf Coast where human health and well-being are continuously impacted by intricately intertwined man-made and natural events. Encompassing 1,777 square miles of sprawling urban and suburban landscape, Harris County is home to over 4.6 million residents and is continuing to grow at a rapid rate. With its size comes a great deal of diversity racially, ethnically, and socioeconomically Harris County is the most racially and ethnically diverse population in the country. As a result, there are quite a few vulnerable groups whose needs are not fully addressed by traditional providers or who feel they cannot comfortably or safely use the standard resources offered in preparedness, response, and recovery efforts.

On August 25, 2017, Hurricane Harvey made landfall on the Texas coast, then stalled out over southeast Houston causing widespread flooding in Harris County. The Harris County Flood Control District estimates that 70% of Harris County was flooded by at least 1.5 feet of water and that one trillion gallons of water rained on the county. Like many other federal, state, and regional agencies, Harris County Public Health sprang into action in order to respond to the disaster: enacting the Emergency Operations Plan and the Continuity of Operations Plan. The goals being to have regular essential functions up and running within 24 hours, and to begin responding to the emergent needs of the community as soon as possible, respectively. HCPH is the health department for Harris County, Texas, a jurisdiction that includes approximately 2.5 million people within Harris County's unincorporated areas and over 30 municipalities located within the county (not including the city of Houston). At HCPH, training and development is part of a comprehensive strategy toward agency quality improvement, but like many health departments, a major barrier in accomplishing these priorities is working with an extremely lean staff model.

As response and recovery activities from Hurricane Harvey began demobilizing, HCPH performed an agency-wide After Action Review (AAR) to look at the agency response. The evaluation revealed that while there was a core team of individuals trained in disaster response and the incident command system (ICS), there was a lack of depth in the number of highly trained and experienced public health professionals in disaster response at Harris County Public Health. To strengthen the HCPH workforce in disaster response, a year-long training and exercise program was created for a select group of HCPH employees to become a Public Health Incident Support Team (PH-IST). In order to build on an already strained workforce, the PH-IST program acts to provide training and exercise opportunities with minimal disruption to daily activities over a one-year period. The program is geared towards 12-15 mid-level full-time employees with basic incident command training and experience. The purpose of the program is to build the capacity of HCPH to scale up response activities while maintaining command and control with highly trained public health professionals. Once created, HCPH leadership reviewed and approved the program for implementation. Since January 2018, two teams of 13 full-time employees completed the yearlong program. Over the course of a year, employees completed in-depth in-person and online incident management courses, themed quarterly meetings with the Office of Public Health Preparedness and Response training team, exercise planning for a functional or full-scale exercise, and a final functional exercise to test and implement the skills and knowledge acquired over the year. Once completed, employees officially became part of the Public Health Incident Support Team. During a response, members of the PH-IST will hold a number of command roles within the department operations center (DOC) and the county's emergency operations center (EOC). Thereby, allowing PHEP funded staff to spread further across the response to ensure the communities' needs are met. Support from HCPH leadership, as well as our Executive Director, was crucial in the success of the program. The number of employees that are highly trained and experienced has tripled with an additional 13 employees identified for next year's program. It is only a matter of time before the next large scale emergency occurs in our community. Through lessons learned from Hurricane Harvey, HCPH has been able to advance the health department's capacity to respond to and recover from disasters in the future. Website: http://publichealth.harriscountytx.gov/

Although every public health emergency preparedness (PHEP) program should have a training and exercise program, many do not focus on small groups of existing health department employees or specialized public health disaster response training and experience. The Harris County Public Health – Incident Support Team (PH-IST) program is an innovative practice, created from an existing practice to build our agency's workforce capacity in disaster response. Following the agency's After-Action Review (AAR) from Hurricane Harvey, it was evident that the health department lacked depth in the number of highly trained and experienced public health professionals in disaster response. At HCPH, incident command system (ICS) training is required for all full-time employees, however, we found that basic ICS courses are not sufficient to respond to public health emergencies; additionally, many ICS courses focus on emergency management, not public health.

Harris County Public Health provides comprehensive health services through a workforce of about 700 public health professionals to a jurisdiction that includes approximately 2.5 million people within Harris County's unincorporated areas and over 30 municipalities located within the county (not including the city of Houston). The PH-IST program focuses on 12-15 full-time employees on an annual basis to fill high-level incident support roles at the HCPH Department Operations Center (DOC) and Harris County Emergency Operations Center (EOC). Training and exercise opportunities are offered to all HCPH employees and volunteers, however, through PH-IST, 12-15 employees receive additional specialized training and exercise experience. Prior to the PH-IST program, command staff roles within the DOC and EOC were filled by the Office of Public Health Preparedness and Response (OPHPR) team of 7 full-time employees. After the first year of implementing the PH-IST program, 12 full-time employees can now fill those roles. This current practice is innovative in the structure, and design, as well as an emphasis on public health emergencies. The PH-IST program utilized the NIMS Training Program, to guide necessary core training, but expanded on traditional courses by adding an emphasis on public health. Exercise scenarios were based on a public health response to the top 3 hazards for our jurisdiction.

The goal of the Public Health – Incident Support Team (PH-IST) program was to strengthen the agency's capacity to respond to public health emergencies by increasing the number of highly trained and experienced public health professionals in disaster response. Our objective was to implement specialized training and experience in public health disaster response. With the support from the HCPH Executive Director, each Division and Office provided a list of possible program participants based on initial qualifications. Each participant had to be a mid-level, full-time employee with 4 core National Incident Management System (NIMS) courses completed, as well as some disaster response experience. After reviewing each employees training and experience, the OPHPR selected the final 13 participants for 2018. The structure and design of the program, ensured that each requirement focused on building their knowledge and skills to staff the DOC or EOC. Participants dedicated 2 hours every 3 months to learning 1 of 4 subjects: emergency operations, plans, partners, and communications. During the partner course, participants met with various county, regional and state partners to learn about the department's collaboration and coordination in disaster response. All partner agencies were part of the planning process. Throughout the year, over five ICS-300 and 400 courses were offered locally, for participants to choose from. Lastly, four functional or full-scale exercises were conducted for participants to gain experience in disaster response. Exercise scenarios were based on the top 3 hazards for our jurisdiction. The success of the program was measured through the evaluation of a functional exercise using PH-IST participants. All training and exercises were local and did not require additional funding for the PH-IST program.

The goal of the Public Health Incident Support Team (PH-IST) program was to strengthen the agency's capacity to respond to public health emergencies by increasing the number of highly trained and experienced public health professionals in disaster response. Our objective was to implement specialized training and experience in public health disaster response. With a workforce of approximately 700 public health professionals, it is not always possible to meet their training and exercise needs. By focusing on a small group of HCPH employees, we were able to provide the training and attention needed to be successful. Feedback was provided by participants at all trainings, events, and exercises; exercises were also evaluated by internal and external partners. Feedback and evaluations were analyzed in an After-Action Report (AAR). Based on the most recent training, participants enjoyed the small groups and interactive learning but would like to exercise more often. As a result of this training, participants were invited to respond to recent public health emergencies in the county. Over the past two years, PH-IST members have acquired over 12 months of response experience by holding command and general staff roles during several public health disasters such as the ITC Chemical Fire, 2019 Measles, Hurricane Laura, and COVID-19 along with several local activations for planned and special events. Overall, participants enjoyed the learning and skills building, as well as the interaction between divisions and offices.  

The Public Health – Incident Support Team (PH-IST) program is sustainable if your agency supports the goal. All divisions and offices provided full-time employees to participate in a year-long program. Also, following completion of the program, PH-IST members are more likely to respond to public health emergencies. Due to the demographics, as well as the frequency of disasters in Harris County, HCPH leadership, largely supports training and exercise opportunities. County partners also support our program due to the reinforcement it provides during emergencies. Lastly, since the program components were created within the Office of Public Health Preparedness and Response, funds to conduct training and exercise opportunities did not exceed regular budget allocations.