ADAPs & Emergency Preparedness

1. ADAPs &Emergency Preparedness Richard Aleshire, Washington State Thelma Craig, Colorado State National ADAP TA Meeting Mandarin Hotel, Washington, DC July 17, 2009

2. Workshop Goal • The goal of this session is to provide participants with an overview, from two States’ perspectives, of the development of an Emergency Preparedness Plan for their ADAP. This will include the steps taken to develop a plan, the actions taken to implement a plan and lessons learned from the process.

3. Workshop Objectives • Participants will learn development ideas to begin or refine their own plans. • Participants will have a conceptual framework regarding where to begin or refine development of their plan. • Participants will learn the importance and essential need of a plan for the delivery of ADAP services.

4. WASHINGTON’S PLAN Richard Aleshire, Washington State Program Manager, HIV Client Services July 17, 2009

5. Phases of Disaster Management and Emergency Preparedness • Planning • Response • Recovery This session is focused on planning but in order to have a plan you need to consider how you would respond to an emergency and how you would recover.

6. Purpose – Why Have a Plan? • To ensure that your clients have access to their medications in the event of an emergency - no matter its duration

7. Terminology • Emergency Preparedness Plan • Business Continuity Plan • Continuity of Operations Plan • Contingency Plan

8. Development of an Emergency Preparedness Plan • Incident Command System Model (ICS) and Training • Have overall Program Emergency Response, written in plain talk, outlining: • Purpose • When to activate/deactivate emergency response • How staff will be contacted • Where they will report • Duties

9. Plan Development (con’t.) • ICS Positions and duties outlined • Operations Section • Logistics Section • Communication Section • Planning Section • Develop an individual Job Action Sheet for each Section Chief • Include emergency preparedness duties in everyone’s Position Descriptions

10. Plan Development (con’t.) • Need to plan for a short-term emergency and a long-term emergency • Is your building usable? • If not, what is the alternate location? • Coordinate with neighboring States if possible • Where is your database located? • Ensure a back-up location for the database

11. Plan Development (con’t.) • What partners should be at the planning table? • Have a copy of your partners’ plans that you may rely on in an emergency, such as your PBM • Outline and know your system and risk functions that may exist • Develop a Continuity of Operations Plan (COOP) • Be as specific as possible

12. Plan Development (con’t.) • Prioritize essential/critical functions • Complete a Technology Assessment • Cross train staff so that every position has a back-up or other options available • Develop forms

13. Execution of your Plan • Review for accuracy • Ensure the plan is updated regularly • Ensure assigned staff are updated as turnover occurs • Ensure Position Descriptions are updated • Ensure staff are regularly trained and know their role

14. Execution of your Plan (con’t.) • Conduct table-top exercises periodically • Larger scale exercises • Consider inviting partners to participate • Your program should be part of your State’s large scale exercise • Take advantage of opportunities such as H1N1 flu

15. Lessons Learned • Include clients in process • Prepare clients with an emergency resource guide to develop their personal emergency needs plan • Remember that the purpose of the plan is to ensure your clients can get their meds • Business operations may be different during an emergency – don’t get stuck on “doing business as usual”

16. Lessons Learned Examples • Western Washington Floods • Fact sheet developed for EOC about program • H1N1 • Having info for PLWH about H1N1 on web • Having info for clinicians about H1N1 on web • Process for distribution of anti-virals

17. Thank you for your interest and attention!!! Richard Aleshire, MSW Program Manager, HIV Client Services Washington State Department of Health HIV Client Services Programs P.O. Box 47841 Olympia, WA 98504-7841 360-236-3477 (voice) 360-664-2216 (fax) richard.aleshire@doh.wa.gov http://www.doh.wa.gov/cfh/hiv.htm

18. Development of Colorado’s ADAP Continuity of Operations Plan (COOP) Thelma Craig, ADAP Coordinator Colorado Department of Public Health and Environment July 17, 2009

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20. Overview • Purpose - Review our process and give you things to consider as you develop your Plan • Confirmed/Identified Need for Preparedness • Identified Participants for the Planning Process • Prioritized Essential Program Functions • Drafted Plan • Piloted/Planned/Executed • Lessons Learned

21. HRSA Recommendation Katrina example Administrators and Program Manager aware of extent to which disasters and emergencies can interrupt service delivery. Colorado ADAP realized just how vulnerable our program really is. Determined to develop a Continuity of Operations/Continuity of Government (COOP/COG)Plan Background and Need

22. Goals of COOP • Reduce consequences of disasters to a minimal level. • Assure a safety net . • Deliver excellent customer service even during a natural or manmade disaster.

23. Stakeholders Perspectives • Contracted with subject matter expert - International Security Solutions, Inc (ISSI). • Program Administrators and Staff. • Clients • ADAP Contractors, including Pharmacies and ID Clinics

24. Stakeholderscon”t • ADAP Advisory Committee • ADAP Medical Advisory Committee • AIDS Service Organizations • CDPHE Emergency Preparedness Response Staff

25. Focus groups Key informant interviews Large group meetings Reviewed State and Federal guidelines Information Gathered/Facilitated by Contractor

26. Asked clients what “Continuity of Operation Planning” meant to them. What would happen to services in the event of a catastrophe? What could be done to ensure a seamless delivery of service in the event of a catastrophe? Asked administrators how confident are we in current state of preparedness. Reviewed contract Pharmacies COOPs. Buy-in from ASO’s. How they might be willing to help? Volunteer commitment from the community if needed. Commitment from former/retired staff to volunteer service if needed. Areas explored

27. Clients wanted to feel safe Clients wanted to know how to respond or how ADAP would assist them in the event of a catastrophe. Administrators wanted to have a system in place – Clear guidance on how to be prepared and respond. Concerns about communcation breakdowns. Access to resources. Appreciated being asked to participate in this process. Need to keep this issue in the forefront. Ideas for enhancements to the COOP and the program. Findings

28. Reviewed structure of Program and listed components – Org Chart Examined operations and functions that could be performed during an emergency. Attempted to establish policy of mission essential policy functions. Sought clarification on how to direct personnel and resources to alternate facilities capable of supporting operations. Prioritized Essential Functions

29. Colorado’s Essential ADAP Functions • Intake- Enrollment • Support of Database • Procurement • Ordering /Purchasing Process • Receiving • Pharmacy Dispensing • Shipping Function

30. Prepared in accordance with direction from Presidential Decision Directive 67 and subsequent implementing guidance in Federal Preparedness Circular 65 dated June 2004. Comprehensive and effective COOP Memoranda of Agreement Document includes references and resources needed Incident Command System Overview Developed Plan- Document

31. Plan- Document con’t • Published bound hard copy and CD that could be changed or modified for essential personnel. • Included Statewide and Nationwide Resources, including health care providers, administrators and clients. • Maps to ADAP Pharmacies (Directions). • Contact Cards • References • Developed Readiness Checklist

32. Contractor conducted a table top exercise. Included all ADAP administrators, staff and contractors. Conducted at all ADAP Facilities. Major gaps in plan and program were highlighted. Scenariosdesigned to challenge program staff. Unknowns uncovered. Execution of Plan Practice/Exercise/Pilot

33. Vulnerability System Disconnect Gaps in communication with CDPHE fiscal and IT Need for better coordination with CDPHE Emergency Preparedness & Response Program ADAP pharmacies COOPs not in place or inconsistent. Need regular trainings to keep staff prepared. Identified untapped resources and opportunities for collaborations. Identified limitations of authority. Lessons Learned

34. Need to be respectful, considerate and responsive to the varied circumstances of our diverse clientele. Need to be inclusive in redevelopment and planning process. Consider all recommendations for enhancements to plan and program/update plan every 6 months. Continue more in-depth training. Communication mechanism need to be strengthened. Need to include guidelines about plan in program contracts and new employee orientation. Respectful of contractors and stakeholders. Fear of judgment. Lessons Learnedcon’t

35. Contact Information Thelma Craig, ADAP Coordinator Colorado Department of Public Health and Environment Thelma.Craig@state.co.us 303-692-2748 Contractor: Oz Hill, CEO International Security Solutions, INC ozhill@issisecuritysolutions.com  678-360-7885

36. Check List and Discussion

37. Resources • NASTAD’s ADAP Emergency Preparedness Guide http://nastad.org/Programs/ADAP/ • Washington State’s Emergency Resource Guide (for general public) http://www.doh.wa.gov/phepr/default.htm

38. Thank you!!!Questions????