Translation, Dissemination, and Implementation of Public Health Preparedness Research and Training: Introduction and Contents of the Volume

Natural and anthropogenic disasters are a major public health threat in the United States and throughout the world. The cost of disasters, both in terms of the lives lost and direct and indirect costs of rebuilding communities, can be immense. For example, 16 separate weather-related disasters occurred in the United States in 2017, resulting in a record total cost of more than $300 billion and more than 1000 lives lost.¹ Public health preparedness and response can help mitigate the impact of disasters on the public’s health and its associated costs.² The importance of preparedness and response has been recognized by the US Federal Government and codified in the 2006 Pandemic and All-Hazards Preparedness Act.³ Between 2008 and 2015, the Centers for Disease Control and Prevention (CDC) invested more than $90 million in developing nine Preparedness and Emergency Response Research Centers (PERRCs) and 14 Preparedness and Emergency Response Learning Centers (PERLCs).^4,5 During this period, these centers have published numerous articles and a wide range of learning materials. One of the ongoing challenges in the field is the translation, dissemination, and use of evidence-based articles and learning resources. In phase three of their funding for preparedness and response, CDC created the Translation, Dissemination, and Implementation of Public Health Preparedness and Response Research and Training Initiative to maximize the dissemination and use of the most promising materials (p. S348).

This supplemental issue of AJPH explores the overall programmatic goals of this initiative, the role of science as the basis of preparedness and response, and the role of schools of public health in conducting research and developing training strategies. The issue contains a variety of editorials, commentaries, and public health practice vignettes that provide an overview of various channels and populations.

In the opening editorial, Erwin (p. S351) examines who will fund public health preparedness and response. A second editorial, written by the staff at the Association of Schools and Programs of Public Health (ASPPH), focuses on how the engagement of Schools of Public Health served as a foundation for a three-pronged approach to building an effective public health system, involving academic centers as well as state and local health departments (p. S353).

Qari et al. then provide a comprehensive overview of the Translation, Dissemination, and Implementation Initiative, including its history, objectives, and goals (p. S355). The CDC chose ASPPH as its coordinating center and provided funding for seven sites involved in three distinct types of activities. These activities include synthesizing and disseminating either research or training outcomes and translating these outcomes into practice and policy.

In their editorial, Carbone and Thomas (p. S383) explore the development of the science base in public health emergency and response. They note that much of the development of evidence-based practice in this field has occurred in the past 20 years.

Translation and implementation research is quite different from foundational research. One of the biggest challenges with this type of research is determining how the results actually impact the public health field. Savoia et al. conduct an evaluation of nine PERRCs (p. S363). Using both quantitative and qualitative methods, they assess both the direct and indirect effects of the research done by these centers, and they conclude that these centers played a substantial role in the knowledge production used in more than half the research produced in the field.

One of the barriers to widespread dissemination of information about evidence-based programs and research to the public health workforce is the passive nature of the provision of most currently available materials. The onus is on the employee to search for and identify programs that will be effective in the settings in which they work. To address this, Testa et al. develop a social media-based platform to encourage collaborative learning (p. S375). An e-learning community allows practitioners to work together to submit questions and exchange ideas and insights about online courses, toolkits, and assessments. Revere et al. (p. S369) examine mechanisms that support implementation of emergency and response communication tools in public health agencies. They find 12 primary areas related to adoption of products including costs, leadership buy-in, and involving nonpublic health partners. In a second editorial, Baseman et al. examine the structural, organizational, and stakeholder factors that affect innovation in public health agencies (p. S369).

Furthermore, access to online learning materials can be essential in training the workforce. In two articles, Documet et al. (p. S394) and Van Nostrand et al. (p. S387) discuss the Emergency Law Inventory, a searchable online tool for the emergency response volunteer workforce. Developed with extensive stakeholder input, the Web site provides an easy-to-use portal through which laws are searchable by profession and jurisdiction. This inventory helps volunteers find and understand employment laws and address legal issues pertaining to training and deployment, including seniority, vacation, sick leave, and overtime. Similarly, Blake et al. develop a Web site to enhance emergency preparedness in long-term care facilities (p. S399). The Web site (https://www.ltcprepare.org) includes links to state and local Twitter feeds, as well as responses to questions within 48 hours.

Although virtual learning communities are valuable for teaching many types of skills, some programs require in-person hands-on approaches. Arora et al. describe an experiential adult learning approach for medical countermeasures (p. S378). These trainings are complex and require the involvement of numerous agencies to be effective.

There are approximately 2800 local health departments in the United States. They are part of the core public health workforce, and including and reaching these health departments is essential. The Getting to Outcomes program was used by Eisenman et al. to increase use of evidence-based programs in three local health departments (p. S396). The program, which combines in-person training with a guidebook, was found to be effective in improving skills. Reaching diverse communities is also essential for preparedness. Chico-Jarillo et al. used root cause analysis to identify approaches for emergency response planning with American Indian and Alaska Native communities (p. S366). They created a guidebook to improve working with these communities that included improving face-to-face interaction with partners, knowledge about how tribal governments work, and improving the preparedness infrastructure within the community.

Acute mental health conditions often occur as a result of disasters, and early intervention is often helpful in preventing long-term negative consequences. Birkhead and Vermeulen have developed a set of tools called Psychological First Aid to help first responders address mental distress in survivors (p. S381). The program is based on six competency domains:

1. initial contact, rapport building, and stabilization;

2. brief assessment and triage;

3. intervention;

4. triage;

5. referral, liaison, and advocacy; and

6. self-awareness and self-care.

This supplement demonstrates the diversity of both the channels of dissemination (e.g., online, guidebooks, experiential learning) and the populations to be addressed (e.g., local health departments, long-term care facilities, volunteers) in programs related to the Translation, Dissemination, and Implementation Initiative. Significant strides have been made in improving the translation, dissemination, and implementation of evidence-based programs involving disaster training and response; however, more work will be needed to ensure that we are ready for the next disaster.