1152176.docx

Guidance Applicants are required to submit a work plan outlining planned activities and expected outcomes related to public health functions as described in CDC-RFA-TP18-1802. Work plans should not duplicate previously funded activities but rather expand upon such activities, such as augment scope or prolong duration.

Planning Scenario: For planning purposes, applicants should develop their work plans to address the public health preparedness and response capabilities required to respond to a scenario involving an emerging infectious disease outbreak. The work plan should address the initial response activities required for Component A, as well as the crisis-specific response activities required for Component B. Applicants should assume that their current public health infrastructure and staff are unaffected and at working capacity; and that the emerging infectious disease has multiple routes of transmission, a high attack and mortality rate, and either a countermeasure, pharmaceutical, vector control, or an oral prophylaxis component.

General Work Plan Guidance: Applicants must develop and submit a high level work plan that addresses the proposed scenario. The plans and activities related to Component A should be more developed and align with the activities addressed in the logic model. Applicants should be able to revise the plans and activities in the work plan related to Component B plan based on supplemental guidance issued by CDC for an identified public health emergency. The high level plan should reflect the strategies, activities, outcomes, evaluation, and performance measure described in the NOFO.

Applicants should review their existing public health emergency management program capabilities and capacities and identify the areas that would most likely require surge support. The domains, strategies, and activities within the logic model should be used as a basis for work plan development.

Applicants must provide at least one proposed output. The proposed output(s) should directly relate to the expected results of completing the planned response activity. Planned activities must be associated with functions or objectives related to the strategy.

Applicants must develop subrecipient contract plans, if applicable.

Component A Work Plan: The Component A work plan should address initial incident command capability and early crisis response activities for the emerging infectious disease planning scenario, including emergency operations center (EOC) activation, staffing contracts, needs assessment, accelerated planning, and call center activation. Identified activities should describe specific actions that support the completion of the domain activity. Applicants should explicitly identify what activity will be completed and in what timeframe. These activities should lead to measurable outputs that are linked to response activities and projected outcomes. Applicants are expected to aggregate and document activities that support subrecipients, such as state to local or tribal entities.

Applicants must include a high level object class budget for early EOC activation activities. Costs should be estimated using real, rather than budgeted, costs from previous responses such as H1N1, Ebola, or Zika. Domains specific to Component A:

· Domain 1: Strengthen Incident Management for Early Crisis Response

· Domain 2: Strengthen Jurisdictional Recovery

Component B Work Plan: The Component B work plan should be developed for the remaining four domains outlined below. Applicants should consider the budget required to plan for a significant increase in public health infrastructure and/or staff that would be required to address the emerging infectious disease scenario. Applicants must include a high level object class budget for crisis-specific response activities in each of the four logic model domains listed below. Costs should be estimated using real, rather than budgeted, costs from previous responses such as H1N1, Ebola, or Zika. Domains specific to Component B:

· Domain 3: Strengthen Biosurveillance

· Domain 4: Strengthen Information Management

· Domain 5: Strengthen Countermeasures and Mitigation

· Domain 6: Strengthen Surge Management

As awards are made, recipients will be required to update their work plans and submit them to CDC as part of quarterly progress reports along with quarterly budget summaries documenting the jurisdiction’s expenditures. CDC will provide the interim guidance document and budget summary form to applicants within seven days of the funding award.

Instructions Please provide the following information for each of the six (6) recipient activities as noted in this guidance.

1. Problem statement: Define what the problem or issue your jurisdiction seeks to resolve with these funds during the project period. Limitations or “root causes” that have led to the current problem/issue may be included.

2. Baseline Capacity: Specify the current baseline capacity in this area, such as number of staff available to conduct surveillance activities.

3. Outcomes: Define the expected outcomes that align to resolving the problem or closing the gaps. The outcomes should define what changes or improvements will occur to the public health system or to the community such as awareness, knowledge, attitudes, skills, opinion, behavior, policies, and health improvement. Ideally, outcomes should link to planned activities, quantify the targeted change, and include an estimated timeline for achieving the change. Applicants can insert as many outcomes as needed.

4. Planned activities: List the intermediate activities awardees will undertake, including tasks and estimated start and end dates that will lead to the associated outcome and contribute to resolving the identified issue or problems. Applicants can insert as many planned activities as needed.

Optional Work Plan Template Public Health Emergency Response: Cooperative Agreement for Emergency Response: Public Health Crisis Response

CDC-RFA-TP18-1802

5. Proposed outputs: List the proposed outputs that will be produced as a result of the planned activities, such as a plan, a training curriculum, or a tracking system database.

Work Plan Component A, Domain 1: Strengthen Incident Management for Early Crisis Response For additional guidance, please refer to CDC-RFA-TP18-1802.

Recipient Component A, Domain 1, Problem Statement (Please limit to 500 words)

Example MyDoH maintains a strong ability to activate and use its incident command system (ICS), emergency operations plan (EOP) and supporting plans, as well as its department operations center (DOC). Because much of the infrastructure of the DOC was developed during and/or immediately following the department’s response to the 2009-2010 H1N1 pandemic, much of the technology requires upgrading, as was identified during the Ebola response. Some examples of the technologies that need updating include, but are not limited to,: the development of a network shared drive; additional and/or new batteries for the cache of 800 MHz radios; upgraded laptops (with increased processor capability) for the DOC manager and incident manager (IM); and upgraded projectors and screens for all rooms in the DOC. Additionally, staff require additional training to continue to effectively respond to incidents. Training on updated operations plans, continuity of operations plans (CONOPS), and recovery plans is a consistent need.

Recipient Component A, Domain 1, Baseline Capacity (Please limit to 500 words)

As the governor required the development of an Ebola response plan over the course of one weekend when ICS was first activated for Ebola, it was noted that when outside of the MyDoH buildings and network, access to shared drives (where plans are stored) was unavailable, which was a barrier to accessing necessary plans, job action sheets, standard operating procedures (SOPs), and other pertinent documentation. Inquiry with the information technology division revealed that the type of space where the shared drive and limited staff file backup exists is not accessible outside of the network, and a significant server upgrade is required to allow for access and more comprehensive backup.

MyDoH maintains a robust cache of 800 MHz radios for internal staff and for communication with external partners, including all hospitals, health centers, critical care centers, hospice centers, and nursing homes at high risk of loss of communications and/or evacuation, which are on the same system and follow MyDoH’s protocols. These radios are used regularly by MyDoH staff for small operations, training, and exercises and for large incidents requiring ICS activation. During the Ebola response, it was noted that the original batteries for the in-house cache are failing and need replacement to ensure effective operation.

The computer used by the DOC manager during ICS activations requires significant processor capability because it can pull data from all of the databases throughout the department into its full geographic information system (GIS) capability and project that data in geospatial form through a Crestron to screens inside the DOC and to other rooms used for emergency operations, such as the emergency information line, and the health information center). Similarly, video and other types of presentations can be projected. The current computer that provides these services is failing, as it has been used regularly since it was first installed more than seven years ago, and requires replacement. In addition, the projector in the DOC, which is designed to receive signal from VGA plugs in several ports on the outside edges of the room needs to be upgraded to support the ability to wirelessly transmit data for ease of use by those in the room, especially as the DOC is designed to have command in the center for the room where there are no VGA ports.

Outcomes (Please limit to 500 characters)

MyDoH will have an expanded server that allows for additional redundancy in case of power outages.

MyDoH will have improved access to emergency plans and files for CEPR staff and other emergency responders.

MyDoH will have improved communication in the EOC.

Proposed Outputs Associated to Outcomes (250-character limit each; please add rows as needed)

Improved access to emergency plans and files for staff and other emergency responders.

Secure backup to CEPR staff and emergency response files.

Maintenance of primary radio communication capability.

Improved capability and ease of use of projecting data inside the DOC and to other rooms supporting emergency operations.

Component A, Domain 2: Strengthen Jurisdictional Recovery For additional guidance, please refer to CDC-RFA-TP18-1802.

Recipient Component A, Domain 2, Problem Statement (Please limit to 500 characters)

Example Although MyDoH has a standardized and widely exercised infectious disease plan, the plan does not include decontamination for highly infectious disease and the transport of materials that are to be and/or need to be decontaminated. Decontamination efforts will not only affect healthcare facilities but also all places where confirmed patients were, including, but not limited to, healthcare facilities, homes, schools, places of business, emergency medical services (EMS) ambulances, etc. MyDoH has to strengthen its partnerships with its community partners to identify opportunities for partnership, solidify gaps in decontamination planning, and develop joint contracts with applicable waste-management partners.

Recipient Component A, Domain 2, Baseline Capacity (Please limit to 500 characters)

MyDoH has identified 14 hospitals dispersed throughout the state that are working toward, or have achieved, the capability to be a treatment hospital. Each hospital has a distinct decontamination policy. MyDoH needs to coordinate with these hospitals to develop basic guidelines and protocols for highly infectious disease decontamination.

MyDoH has worked with some local health departments and EMS transport agencies to develop a plan to refer and transport persons under investigation (PUIs). The current transport plan includes a contractor to do decontamination and waste management. MyDoH will assist EMS in identifying and contracting secondary and tertiary contracting companies, in the event that one company is unavailable and/or unwilling to fulfill its contractual duties.

MyDoH will work with the board of education and the housing authority to ensure they develop a baseline plan that outlines basic guidelines and protocols for highly infectious disease decontamination.

Outcomes (Please limit to 500 characters)

Decontamination protocols will be developed and implemented as necessary.

The state infectious disease plan will be updated to reflect partner considerations and new decontamination plans.

MyDoH staff, partners, and stakeholders will be trained on infectious disease environmental cleanup, disinfection, and disposal standards.

2. MyDoH will work alongside LHDs, EMS, Board of Education, Housing Authority, and other pertinent partners to develop decontamination guidelines for homes/facilities/schools/etc. that housed persons affected by the disease

3. A notification system for identifying will be developed and implemented End of Q1

Proposed Outputs Associated to Outcomes (250-character limit each; please add rows as needed)

1. Appropriate staff will be notified of a potential infectious disease case within jurisdiction.

2. Ensure 100% of appropriate environmental health staff receive training on infectious diseases, environmental cleaning, disinfection, and disposal.

3. Increase the number staff by at least one per region that can identify potentially contaminated items in other settings.

4. Cleaning companies identified to provide cleanup and waste removal if needed.

Component B, Domain 3: Strengthen Biosurveillance

Recipient Component B, Domain 1, Problem Statement (Please limit to 500 characters)

Example MyDoH needs to update the Communicable Disease Electronic Surveillance System (CDESS) for emerging disease cases and enhance modules designed to track persons exposed to highly infectious disease. MyDoH needs to continue preparing for emerging infectious diseases, such as highly pathogenic avian influenza (HPAI) and EVD, along with other agencies and local stakeholders, and also educate livestock producers, local health departments, the public, etc.

Recipient Component B, Domain 1, Baseline Capacity (Please limit to 500 characters)

CDESS is able to collect and communicate disease surveillance and health monitoring data between MyDoH and local health departments and generate status reports. Protocols are in place for airport screening, traveler (or exposed person) monitoring, hospital assessments, quarantine, and critical transport of specimens, both for infectious diseases. MyDoH has excellent relationships with other agencies to plan for a response to novel and emerging diseases.

Outcomes (Please limit to 500 characters)

1. Rapidly identify a person under investigation (PUI) and facilitate early diagnosis and treatment.

2. Standardize/communicate protocols for risk assessment/monitoring of exposed persons, ill PUI isolation, assessment, specimen collection and testing, case identification, and investigation and contact tracing / monitoring.

3. Engage federal, state, and local agencies, medical providers, and community stakeholders about the health response to an emerging disease outbreak.

1. Purchase additional personal protective equipment (PPE) and thermometers for responder health monitoring.

End of Q1

2. Improve CDESS by adding modules for emerging diseases and for tracing exposed persons for health monitoring including expanded access.

End of Q2

3. Hold regional/local meetings to engage local agencies, including local health departments, and others, such as healthcare facilities, poultry producers, medical providers, to enhance existing policy and protocol coordination in preparation for an novel emerging disease outbreak, such as HPAI, Zika virus, EVD).

Continuous

Proposed Outputs Associated to Outcomes (250-character limit each; please add rows as needed)

1. Update CDESS for emerging disease cases and for contact monitoring.

2. Healthcare workers and outbreak responders who have been exposed to a concerning infectious disease are appropriately monitored and managed.

3. Effective communication of multiple agency and partner response plans for emerging disease risks.

Component B, Domain 4: Strengthen Information Management

Recipient Component B, Domain 2, Problem Statement (Please limit to 500 characters)

Example Due to limited resources, adequate risk communication materials for infectious diseases have not been produced consistently. Materials require plain language adaptation, low-literacy adaptation, and translations; in some cases, materials must be printed and distributed. Additional production and distribution are needed to help raise knowledge and awareness among the community and stakeholders including local health department and healthcare providers.

Additionally, the Nationwide Emergency Department Sample (NEDS) database that analyzes information from all local and state hospital and lab information needs an upgrade to better analyze HL7 codes to provide better data analysis across all hospital types, (including long-term care centers and nursing homes.

Lastly, to continue an already successful public information campaign, MyDoH requires the means to:

· Ensure that its current messages, communication plan, web content, and other resources are aligned with the evolving guidance and situation,

· Develop new messaging and ensure that messages successfully reach the appropriate populations,

· Formalize many of the processes that occurred within its Joint Information Center (JIC), including an operating manual and job action sheets, and

· Further develop a clear set of standard operating procedures and a toolkit of messages to be shared with hospital public information officers (PIOs) to ensure coordinated messaging in the event of a case of a new emerging infectious disease.

Recipient Component B, Domain 2, Baseline Capacity (Please limit to 500 characters)

MyDoH maintains a robust public website with infectious diseases information, uses social media channels, has an extensive notification system, and works with statewide media to share important health and safety messages. As technology has evolved, the MyDoH has built its ability to disseminate messaging quickly through electronic means.

To meet a broad variety of public information needs during an infectious disease-based response, communications staff developed an online repository of messages, press releases, guidance (for a variety of audiences, including clinicians), a communication plan, web content, and other resources that can be rapidly retrieved, edited, adapted, translated, and disseminated to appropriate parties. Most, if not all, of these materials have been developed in such a fashion that, in the event of an outbreak of another type of infectious disease, they can easily be manipulated to convey information appropriate for that particular disease.

During the peak of Ebola-related activity in our state, MyDoH (with participation from the emergency management agency and the governor’s office) activated and operated a JIC for the purpose of analyzing situational information and guidance, developing and vetting public messaging, and disseminating those messages to the appropriate audiences. Many of these processes were informed by previous responses, such as H1N1, and were re-evaluated both in practice during the Ebola response and through a tabletop exercise of the JIC. MyDoH also began collaborating with hospital PIOs, through conference calls, to discuss communication protocols and to clarify roles in the event of a confirmed case in the state.

Outcomes (Please limit to 500 characters)

Infectious disease risk communication materials for infectious diseases will be developed, distributed, translated and distributed in a variety of languages and formats to reach all intended audiences to educate and mitigate potential infectious disease transmission.

Formalized processes and plans for the JIC, including an operating manual and job action sheets.

An SOP and a toolkit of messages to be shared with hospital PIOs to ensure coordinated messaging in the event of a case of a new emerging infectious disease.

Proposed Outputs Associated to Outcomes (250-character limit each; please add rows as needed)

1. Translations of standardized messages for infectious disease risk communication materials in the top five languages in the state.

2. Materials produced and distributed to stakeholders.

Component B, Domain 5: Strengthen Countermeasures and Mitigation For additional guidance, please refer to CDC-RFA-TP18-1803.

Recipient Component B, Domain 3, Problem Statement (Please limit to 500 characters)

Example MyDoH has very limited state and local environmental health staff available to coordinate environmental assessments and recommendations for highly infectious (or other infectious) disease cleaning and waste management in nonhealthcare settings. Inasmuch, additional trained staff resources are needed to provide property inspection and proper cleaning of nonhealthcare settings where PUIs or those with probable or confirmed emergent virus(es) or other infectious diseases have been located.

Recipient Component B, Domain 3, Baseline Capacity (Please limit to 500 characters)

MyDoH has only two trained, qualified state and local environmental health staff available to coordinate environmental assessments and recommendations for EVD or other infectious disease cleaning and waste management in other settings. Additional staff and/or contracted staff are needed.

Outcomes (Please limit to 500 characters)

Increase trained state and/or local staff to provide recommendations on proper cleaning protocols, inspect property in nonhealthcare setting for evidence of bodily fluids, and provide technical support and guidance in EVD and other infectious disease clean-up efforts.

Proposed Outputs Associated to Outcomes (250-character limit each; please add rows as needed)

1. Appropriate staff will be notified of a potential infectious disease case within jurisdiction.

2. Ensure 100% of appropriate environmental health staff receive training on Ebola environmental cleanup, disinfection, and disposal.

3. Increase the number staff by at least one per region that can identify potentially contaminated items in nonhealthcare settings.

4. Cleaning companies identified to provide cleanup and waste removal if needed.

Component B, Domain 6: Strengthen Surge Management

Recipient Component B, Domain 4, Problem Statement (Please limit to 500 characters)

Example MyDoH will collaborate with healthcare system partners to implement a tiered network of hospitals within the state capable of providing affected patient care and a plan to refer and transport PUIs to the appropriate location. This will include state selection of hospitals to serve as highly infectious disease treatment centers, assessment hospitals, and frontline hospitals. EMS has patient transport matrix that identifies “Dry/Wet” EMS agency transport capabilities.

Recipient Component B, Domain 4, Baseline Capacity (Please limit to 500 characters)

MyDoH has identified nine hospitals that are working toward capability to be an assessment facility, and another five hospitals that are working toward, or have achieved, the capability to be a treatment hospital. These 14hospitals are geographically dispersed throughout the state to best serve the entire population. MyDoH will support these hospitals to enhance their capability based on the intent of each hospital administration. MyDoH has worked with some local health departments and EMS transport agencies to develop a plan to refer and transport PUIs. EMS has a baseline capability for a patient transport matrix that identifies “Dry/Wet” EMS agency transport guidelines.

Outcomes (Please limit to 500 characters)

1. By April 2018, all identified hospitals will have achieved their respective assessment hospital tier status to enhance statewide ability to care for suspect or actual cases of said highly infectious disease.

2. The DOH EMS office will have and maintain a current list/matrix of EMS agencies, with contact information, that are capable of transporting “Dry/Wet” patients to allow for quick transport.

Proposed Outputs Associated to Outcomes (250-character limit each; please add rows as needed)

1 Tiered network of hospitals to provide patient care is complete

2. Statewide plan for local health departments and EMS to respond to PUIs, with local health department and EMS agency (including tribal) input

3. An updated patient transport matrix