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Kent County Inclusive Preparedness Program

State: MI Type: Model Practice Year: 2018

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Kent County Health Department
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Kent County Inclusive Preparedness Program
The Kent County Health Department serves Kent County which is located in West Michigan and is the fourth largest population center in the state, with 642,173 residents estimated in 2016. The county is composed of 21 townships, five villages, and nine cities covering 864 square miles. There are urban, suburban, and rural communities contained within the county borders. Grand Rapids is the county seat and is located 30 miles from Lake Michigan. Approximately 6.1% of Michigan's population lives in Kent County and the population is growing at a rate almost twice as fast as Michigan and the United States. Approximately 19% of Kent County residents have a disability according to the 2014 Behavioral Risk Factor Survey. Nearly one fifth of the United States' population has a disability, but there are often not enough opportunities for people with disabilities to receive basic emergency preparedness training to help them be more resilient in times of crisis. The need for …adequate strategies for preparedness and response for individuals with disabilities” is identified as an emerging issue in the Healthy People 2020 Disability and Health topic area (https://www.healthypeople.gov/2020/topics-objectives/topic/disability-and-health). The Kent County Health Department's (KCHD, www.accesskent.com/health) Emergency Preparedness Program wanted to provide accessible emergency preparedness training to Kent County residents of all abilities. Based on input from Kent Regional Inclusive Community Coalition (RICC) officers and other Kent County response agencies including the American Red Cross, Salvation Army, Medical Reserve Corps, Kentwood Fire Department, and Kent County Emergency Management, a five-module program including: Introduction to Emergency Preparedness Basic First Aid Hands Only CPR Fire Safety Mass Care along with a final program celebration/hotwash was developed to provide people of all abilities the opportunity to learn basic emergency preparedness to promote resiliency in the community. The initial goals of the program were: 1. Develop an accessible series of preparedness training modules that is inclusive of Kent County residents of all abilities. 2. Partner with preparedness instructors in Kent County interested in broadening their teaching skills to teach a diverse group of students. 3. Based on feedback from students, revise the materials and offer the opportunity again. 4. Create incentive for participation with an award ceremony for graduates, and an opportunity for graduates to become peer trainers/instructor assistants. The pilot of the Kent County Inclusive Preparedness Program (KCIPP) began on May 9, 2016 with a cohort of fifteen people, of which thirteen have mobility and/or developmental disabilities, one is Deaf, and one without disabilities. Another participant, who is blind, attended one session. The five modules were approximately two hours a piece and were offered once over the course of two months. Each of the modules allowed interaction between the teachers and students, and four out of five modules had hands-on activities. Teachers were encouraged beforehand to ask students how they would perform an emergency function based on their abilities if the standard was not possible. During the final celebration/hotwash seven certificates of completion were awarded to participants who attended all five modules. Two additional students completed the remaining sessions during the next offerings. A discussion with participants and instructors provided feedback used to improve future courses, such as involvement of the National Weather Service and Law Enforcement. Graduates were given the opportunity to volunteer as assistant instructors for the next preparedness training series. All initial objectives for the program were achieved. The program was offered again twice in the spring and twice in the fall of 2017 with improvements based on the previous cohort's input. The program expanded to a six-module program with weather awareness being offered by the National Weather Service, and the Kent County Sheriff Department spoke on the role of law enforcement in the community during the final program hotwash, and KCHD implemented an inclusive learning evaluation tool for each module. The success of this program is primarily based on community partnerships. This program was designed in collaboration with members of Kent RICC to ensure that people with disabilities could be better prepared and understand the material that was presented. The program was executed with community response partners that donated their time and expertise. KCHD's partnerships with advocacy and human services agencies has made it possible to identify people that will benefit from the training. Thus far 52 people have participated in the training, with 29 of those completing the entire series of courses. Seven people have come back to be peer mentors in the following offerings of the program.
Based on the 2014 Behavioral Risk Factor Survey nearly 122,000 (19%) Kent County residents have a disability. This mirrors the projected one fifth of the United States population that has a disability. Often local public health emergency preparedness programs are stretched thin due to the lack of staffing, reduced funding, and time-consuming grant requirements. This does not allow for much effort to train the community itself, including people with disabilities, to enhance community resilience in response to disasters. In the past several years, Kent County has experienced heavy snow, flooding, tornadoes, straight line winds, and environmental issues that have forced evacuations of property and rendered water unsafe to drink. Previously, KCHD had worked with the Kent County Community Emergency Response Team (CERT) to try to make the program accessible for people with disabilities, but was unable to achieve this goal. Also, KCHD works heavily with advocacy and human services agencies to encourage emergency preparedness training for their clients, however most preparedness efforts stop at the agency being prepared and not the clients themselves. Therefore, KCHD wanted to develop a preparedness program that not only increased the resiliency of the community, but also helped responders understand the challenges that people with disabilities face during disasters. KCHD started discussions with three Kent Regional Inclusive Community Coalition (RICC) officers to determine what they thought would be most important for people with disabilities to learn to be better prepared in case of a disaster. Based on these discussions a framework was developed for a five-module program that included the following courses: Introduction to Emergency Preparedness Basic First Aid Hands Only CPR Fire Safety Mass Care with a final day for hotwash and celebration. KCHD reached out to community response partners including the American Red Cross, Salvation Army, Medical Reserve Corps, Kentwood Fire Department, and Kent County Emergency Management to see if they would be willing to teach a 2-hour class related to topics pertinent to their agency. Each of the agencies agreed and moved forward on developing materials for each module that were accessible for people with disabilities. This meant replacing most text with pictures on slides, ensuring that the text was written at an appropriate level, and removing jargon that most emergency preparedness professionals use. Once the instructors developed their materials they were vetted by members of Kent RICC and Disability Advocates of Kent County to ensure that the content was appropriate for people with a wide range of disabilities. Once the material was reviewed, it was used in the corresponding modules and participants were asked for feedback on the appropriateness of materials. Weather awareness was added as a sixth module after the pilot program based on participant feedback. After the first cohort of students completed the program, KCHD wanted a tool to evaluate learning in the program. Finding an appropriate tool to evaluate learning in a group of people that had a range of disabilities and reading levels was challenging. An appropriate tool was not found, so KCHD developed a pre-test and post-test system that relied on pictures and simple language to assess learning. This was vetted through the instructors, Kent RICC, Disability Advocates of Kent County, KCHD's Materials Review Committee, and a colleague through NACCHO's Health and Disability Workgroup. This evaluation tool was piloted during the spring 2017. Additionally, in the spring of 2017 Kent County Inclusive Preparedness Program (KCIPP) had two students who are blind. KCHD's Emergency Preparedness Specialist developed text for each of the slides and collaborated with the Kent District Library to have the material printed in Braille. KCHD received feedback from the participants that there was a shorthand Braille that could be used so that the amount of Braille printed was reduced. Overall, 52 people have participated in the training, with 29 of those completing the entire series of courses, which is only 0.04% of the targeted population in Kent County. While this is a small percent, impacts are far reaching. Many of the students live in group homes and have become the champions of preparedness for their homes, sharing what they have learned with their housemates. Additionally, twenty instructors, including eight Americorps workers, have taught the classes. The instructors have reported they have enjoyed teaching and have learned from teaching the courses. Based on the development of this program and feedback obtained from the students and instructors, the KCIPP has accessible emergency preparedness materials and evaluations developed for six different modules that can be shared across the nation to help people with disabilities be integrated into emergency preparedness. To KCHD's knowledge this is the only preparedness program for the whole community that was designed with the input of people with disabilities and advocacy agencies. KCHD feels that this practice of providing training directly to the public gives the opportunity for the public to meet responders from various agencies across the county and gives responders the chance to teach people of varying abilities. NACCHO has requested KCHD to upload the training package onto the NACCHO Toolbox and KCHD plans to do that at the beginning of 2018.
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The Kent County Health Department (KCHD) works with mental health and human services agencies that serve those that are most vulnerable to disasters get prepared through their Disaster Mental Health and Human Services Committee, which has been in existence for ten years. Through this committee KCHD has forged strong partnerships with agencies fire, emergency management, community mental health, disability advocacy agencies, long term care, hospice, and others to ensure preparedness efforts are occurring in these underserved areas. Through these partnerships KCHD has become a trusted community partner in the disability community and therefore KCHD had an avenue to pursue an appropriate preparedness training for people of all abilities in Kent County with the following objectives: 1. Develop an accessible series of preparedness training modules that is inclusive of Kent County residents of all abilities. 2. Partner with preparedness instructors in Kent County interested in broadening their teaching skills to teach a diverse group of students. 3. Based on feedback from students, revise the materials and offer the opportunity again. 4. Create incentive for participation with an award ceremony for graduates, and an opportunity for graduates to become peer trainers/instructor assistants. KCHD worked with three of the Kent Regional Inclusive Community Coalition (RICC) officers to determine what types of training would be beneficial to people with disabilities in the community. The main topics that were highlighted were: Introduction to Emergency Preparedness Basic First Aid Hands Only CPR Fire Safety Mass Care Based on the subjects chosen, KCHD partnered with Kent County Emergency Management, the American Red Cross, the Kentwood Fire Department, Kent County Medical Reserve Corps, and the Salvation Army to provide the training. The planning committee designed this to be a six-session program and hot wash over the course of approximately three months in various response agency buildings so that participants could become familiar with the location with the following topics presented and taught by the following agencies: Preparedness Overview: KCHD & Kent County Emergency Management Hands Only CPR: American Red Cross Fire Safety: Kentwood Fire Basic First Aid: Kent County Medical Reserve Corps Shelters: American Red Cross & Salvation Army Program Hot wash: All Materials were developed by each of the presenting agencies and then vetted by members of the Kent RICC and Disability Advocates of Kent County to ensure accessibility for the program participants. The KCIPP was announced through various avenues including the Disaster Mental Health and Human Services list and many of the people that participated in the first offering were affiliated with either the Kent RICC or Hope Network, an agency that is an advocate for people with disabilities. The pilot started with a cohort of fifteen people, of which thirteen have mobility and/or developmental disabilities, one is Deaf, and one without disabilities. Another participant, who is blind, attended one session. Each of the modules allowed interaction between the teachers and students, and four out of five modules had hands-on activities. After the pilot program, Weather Awareness was added to the curriculum and is taught by the National Weather Service. During later offerings of the program the Association for the Blind and Visually Impaired and the Kent District Library worked with KCHD's Emergency Preparedness Specialist to develop materials in Braille. The result was a set of training materials that are suitable for both participants with cognitive challenges and those who are college-educated. Additionally, twenty instructors, including eight AmeriCorps workers, have taught the classes and has increased the awareness of the responder community in working with people with disabilities during disasters. Although the KCIPP is meant for the whole community the majority of the people who were involved in the first three offerings were associated with KCHD's preparedness partners. Also, the classes were offered over two months during normal work hours and thus excluding people who work. To try to reach people that are not available during work hours, KCHD worked with the instructors to schedule and condense the material down into a one day offering on a Saturday held at the Kentwood Fire Station. Nine people attended all of the trainings for the day and achieved a certificate of completion. KCHD is working with partners on offering further one day sessions and sessions spread out over the course of two months as well. In terms of budget for this program most of it has been funded through KCHD's Emergency Preparedness Program and in-kind costs through KCHD's partner agencies. During the pilot, the costs were limited to staff time and printing. After the pilot, KCHD utilized preparedness funds to stockpile bus passes, CPR aids, weather radios, and folders for the participants for less than $3000. KCHD still has many of these supplies on hand and will continue to offer these until they are gone or if more funding is available through the Public Health Emergency Preparedness Grant to buy more.
The KCIPP objectives were: 1. Develop an accessible series of preparedness training modules that is inclusive of Kent County residents of all abilities. 2. Partner with preparedness instructors in Kent County interested in broadening their teaching skills to teach a diverse group of students. 3. Based on feedback from students, revise the materials and offer the opportunity again. 4. Create incentive for participation with an award ceremony for graduates, and an opportunity for graduates to become peer trainers/instructor assistants. The planning process for the KCIPP trainings began with meetings between KCHD and officers of the Kent RICC, 18 months prior to the first pilot series. The Kent RICC helped identify barriers to preparedness in Kent County's residents with disabilities, and established priority topics of interest in preparedness. These meetings provided a solid base on which to build the module concepts, materials, and delivery. Presentation slides, handouts, locations, and instruction language were assessed and modified as necessary to meet the learning needs of people with visual, hearing, cognitive, and mobility disabilities. Feedback from participants on accessibility of the trainings has been overwhelmingly positive, with occasionally constructive criticism for program improvement. Instructors for the pilot modules were found readily among KCHD's community partners. The modules were: Introduction to Emergency Preparedness: KCHD & Kent County Emergency Management Hands Only CPR: American Red Cross/AmeriCorps Fire Safety: Kentwood Fire Basic First Aid: Kent County Medical Reserve Corps Shelters: American Red Cross & Salvation Army Weather: National Weather Service (added in second pilot) Community/Responder Forum (Program Hot wash): All The instructors met prior to the first pilot to review the Kent RICC's recommendations and to discuss disability etiquette. With the help of KCHD, each of the presenters developed the materials for their modules, which were then vetted by Kent RICC and Disability advocates of Kent County to ensure accessibility for the program participants. Additional changes were made to the materials because of program participant feedback. During the first Community/Responder Forum, the instructors all expressed great interest in providing this training again. Some instructors stated it was helpful for them to learn the particular needs of their audience, and that they were impressed by the questions and responses from the students. All expressed that they enjoyed and learned from this teaching experience and would participate again. As of the submission of this application, 20 instructors have participated in the project, eight of whom were AmeriCorps staff, and many supporting staffs from the hosting agencies. Each iteration of the program was revised after feedback from course participants and participating instructors. All strengths and improvement areas were used to improve the program, with the goal of continually improving accessibility for program participants. The result was a set of training materials that are suitable for participants with cognitive, mobility, and sensory disabilities, or with no disabilities. As an incentive for completion, of all the KCIPP modules, participants were awarded a certificate of completion during the Community/Responder Forum in the presence of their peers, instructors, and community leaders. These program graduates were then offered the opportunity to attend future modules as peer mentors, offering help to new students ranging from passing out materials, to helping with paperwork, to teaching a portion of the class. The opportunity to return serves the dual purpose of refreshing the program content for peer mentors while inviting them into an active role in promoting preparedness. KCHD conducted a hot wash of participants and instructors at the end of the first pilot. Verbal feedback regarding concepts learned and accessibility of the courses was positive. To better determine whether the program was making a difference in the understanding of preparedness concepts, KCHD developed a learning assessment tool for each of the modules. The tool consisted of three printed pages. The first page was a brief demographic questionnaire asking if the participant had a disability; the functional needs of the participant; and, if someone was helping the participant complete the form. The second and third pages contained five module-specific questions; the second for completing before the module, and the third at the end of the module, to assess learning. The question pages were titled Survey 1” and Survey 2” respectively, rather than using the anxiety-inducing terms pre-test” and post-test.” The pages were in 16 point sans serif font, using simple, concise language, and pictures when possible. The tool was vetted through local disability advocates, a colleague from the NACCHO Health and Disability Work Group, and the KCHD Materials Review Committee. The Learning Assessment Tools were implemented during the second pilot in Spring 2017. KCHD explained to the participants that the purpose of the form was to make sure our instructors were effective, and that no names were needed on the forms. Peer mentors and instructors assisted participants who needed help with reading or writing. The forms were numbered so they could be grouped by participant later. After each module, all forms were collected and an opportunity for verbal feedback was offered. The data collected were compiled into a spreadsheet, and participant responses to questions on Surveys 1 and 2 were compared. After the Spring 2017 courses, the data showed that participants' correct answers improved by an average of 30% among the modules overall, and ranging from 18% to 64% among the individual modules. The results of each module were shared with the instructors, as well as participant feedback on the module. Some questions on the learning assessment tools were changed or improved for clarity as a result. While the data from the learning assessment showed improved participant understanding of the preparedness topics, there were several instances in which individual participants gave more incorrect answers on Survey 2. In these cases, the participants had cognitive disabilities and needed help completing the form. It was observed that they were trying to read the helpers' faces for the best answers. Moving forward, KCHD will continue to work with disability advocacy partners on effective delivery of the learning assessment tool, while balancing the need for program evaluation with the ultimate objective of instilling preparedness concepts in an accessible manner.
KCHD's community partners have routinely provided preparedness education to the public. However, these training opportunities have not always been accessible for people with disabilities. The need for accessible preparedness training in particular subject areas was expressed by the officers of the Kent RICC. A training program for people with disabilities first, but that would be open to everyone, had not been implemented in Kent County before the KCIPP. Although the KCIPP was spearheaded by KCHD, each partner agency donated their time and resources to make this endeavor a success. Most of the cost for this program was related to printing; however, participants paid for their own transportation during the 2016 offering. In the 2017 iterations of the program KCHD purchased bus passes for those needing them, and the Salvation Army and Red Cross provided preparedness kits to participants. Interpretation and adaptive communication equipment costs are anticipated as ongoing needs as people with sensory disabilities participate in the training. Lessons Learned in Relation to Practice All the instructors expressed increased knowledge regarding the communication needs of their participants, and were receptive to feedback from them. Over all the course offerings, 60% of the participants relied on transportation from the GoBus (Kent County's public paratransit entity), community living support services, group home supervisors, or friends/family. KCHD invested in GoBus passes in 2017, but eligibility criteria limit those who can ride the bus. The community living support services van is staffed by volunteers who may or may not be available to transport participants in their program. Some participants living in group homes missed sessions because the group home supervisor was unavailable to transport them. About 50% of registrants in the Fall 2017 cohort attended any of the classes. Interest is high, but transportation will continue as a potential barrier to participation for those who cannot drive. Mode of transportation has been added as a question on the course registration form. All six modules were offered on a Saturday in 2017. Nine of 14 registrants attended the entire day, which allowed them to graduate the course. The Saturday option was given to allow people who work during the day to be able to attend; other options were Monday or Thursday afternoons between 1:30 and 3:30. Although the afternoon classes drew more registrants, they yielded fewer graduates. KCHD will work with the course partners to coordinate Saturday classes as an option in the future. Marketing for the program is limited to email correspondence and Facebook due to budget constraints. However, the contacts KCHD has accumulated through community partnerships have yielded interest from partner affiliates in support groups, adult foster homes, and schools beyond KCHD's network. One school was interested in bringing some of the modules to their classrooms. In future planning sessions, KCHD will work with course partners to modify the program materials and delivery to accommodate new environments. Lessons Learned in Relation to Partner Collaboration Since the first pilot course, partner investment has been high. The KCIPP partner agencies are: o Kent County Health Department – Program Coordination, Intro to Preparedness Module o Kent County Emergency Management – Intro to Preparedness Module, Community/Responder Forum Host o National Weather Service – Weather Awareness Module o Kent County Medical Reserve Corps – Basic First Aid o Salvation Army Emergency Disaster Services – Mass Care Module o American Red Cross – Mass Care Module, Hands-Only CPR Module o Kentwood Fire Department – Fire Safety Module o Kent Regional Inclusive Community Coalition (RICC) – Disability Advocacy Expert o Disability Advocates of Kent County – Disability Advocacy Expert o Association for the Blind and Visually Impaired – Disability Advocacy Expert, Braille resource As of the submission of this application, 20 instructors have participated in the project, eight of whom were AmeriCorps staffs, and many supporting staffs from the hosting agencies. Five subject matter experts from KCHD's advocacy partners have advised in course development, vetted materials, and evaluated module delivery. All have expressed commitment to continuing the program. Because the preparedness educators in the program are all in response professions, the hurricane outbreak of 2017 presented challenges in scheduling instructors for the courses. Three instructors were deployed and one was on standby. However, in the end, all the modules were staffed and none were rescheduled. Some participants expected a certificate for CPR and First Aid, required for some jobs such as babysitting. This level of expertise was not the goal of the course. However, this expressed need opens an opportunity for coordinating with the same partners to make their certification courses more accessible for people with disabilities. KCHD will continue to work with community partners on accessible training practices. Stakeholder Commitment Feedback from participants has been consistently positive. Most participants who graduated expressed interest in returning as a peer mentor. Rewarding achievement with recognition and responsibility supports continued interest in and understanding of preparedness.
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