Developing a measure of local agency adaptation to emergencies: A metric

Local public health agencies often must respond to health-related emergencies or disasters, while continuing to fulfill all public health functions for which they are funded. This article reports the development and initial pilot test of a method for measuring the nature and degree of a public health agency's response to such an emergency or disaster. How the instrument was developed as well as the initial results from the pilot study of four local public health systems (LPHSs) are presented and discussed. The instrument measured the extent to which each function and division of each of the four LPHSs were affected and provided a metric that could be used across LPHSs to indicate the burden experienced by each due to the emergency. Results obtained from the pilot study indicate that size and complexity of an LPHS was not predictive of its ability to respond to the emergency. These results support the use of the framework and associated measurement procedures to provide valuable information to managers responsible for such LPHSs. Such information should provide a foundation for comparing variations in performance and outcomes to various types of emergencies that vary in their severity and focus.     

Public Complacency under Repeated Emergency Threats: Some Empirical Evidence

In the summer of 2004, the state of Florida was struck by fourmajor hurricanes consecutively. Using data collected from jurisdictionsexperiencing hurricanes, this study examines public complacencydefined as the tendency to ignore hurricane threat warnings.Results indicate that the public showed signs of complacencyunder repeated emergency threat warnings and there is a needto manage or reduce such tendency because a complacent publicis less prepared for emergencies. Importantly, the study findsthat the government plays a role in developing effective communicationstrategies to reduce public complacency and to enhance publicpreparedness in response to disasters.     

Preliminary study of the pilot's workload during emergency procedures in helicopters air operations

Military air operations and law enforcement operations in helicopters are examples of activities that require high performance of the operator. This article aimed at presenting a preliminary analysis of data obtained in the initial study in order to validate the instruments and the research protocol that focuses on the analysis of the workload imposed on helicopter pilots in emergency situations. The research was conducted in an environment of real flight training and used the NASA-TLX Scale to assess the workload and an interview guide to obtain reports on the main tasks performed. Preliminary data obtained is related to the participation of 10 (ten) volunteer pilots with experience in different types of helicopters. Four scenarios involving helicopter emergency procedures of HB-350 "Squirrel" were outlined. For this article, the analysis used only the data regarding the Physical and Mental Demands of the NASA-TLX Scale. Preliminarily, the results indicate that the "time pressure" as a factor contributing to increase mental requirement in emergency situations in flight, and that this increase was reflected in the request of mental processes such as: identification of the breakdown, attention and monitoring parameters. Future steps include extending the sample and adding physiological tools to better understand the effects of these types of emergencies on pilot performance and flight safety.     

Staff & client perceptions of unit quality: a pilot study

This pilot study compared psychiatric health care team members' perceptions of unit quality with discharged clients' perceptions of quality of care received on the unit. The staff members were from four different service units in one acute care psychiatric facility. The study used the Perceptions of Unit Quality (PUQ) scale, a valid and reliable outcome measurement instrument, developed by Cronenwett. Most quality assurance instruments that exist have focused on individual caregivers' or service-specific views of quality, but the PUQ scale allows quality assurance data that represent team performance to be described through team perceptions of quality. Results of this pilot study suggest that use of the PUQ scale, in conjunction with clients' perceptions of unit quality, may be a legitimate approach in continuous quality improvement efforts in psychiatric-mental health care centers.     

Disaster and response:science, systems and realities

The Indian Ocean Tsunami of December 2004 was one of the most significant natural disasters in modern history. The response that it drew was unprecedented at both local and international levels. While a range of specific impacts and losses may be predicted within the affected populations, there is substantial evidence that adverse impacts upon mental health may represent one of the most significant outcomes of such events. People from poorer countries are disproportionately exposed to such emergencies and may experience greater psychosocial burden in the aftermath, as well as a range of adaptations. This raises important questions regarding the current capacity of response agencies to mitigate negative impacts but also concerning the cultural context in which such mental health effects are defined. It also calls into question whether "indicated" interventions are both realistic and ecologically valid in non-Western settings. The science of Disaster Mental Health is a relatively new field, currently engaged in a number of such debates. However, there is some emerging consensus about what constitutes good public mental health practice throughout the phases of emergency response and across diverse cultural settings. Existing data and practice guidelines provide frameworks that may be adapted to allow health and recovery workers to identify and reduce mental health morbidity, support healing and harness the agency of those affected for the recovery process.     

Feasibility of bidirectional text messages in evaluating a text-based nutrition education program for low-income parents: Results from the Text2BHealthy program

Text messages are increasingly used in the delivery of health education programs. One appealing aspect of this approach is the possibility of remotely collecting participant data to use in program tailoring or evaluation. The purpose of the present study is to test the feasibility of using text messages to collect participant data. Using data from 33 texted evaluation questions sent through the Text2BHealthy nutrition education program for low-income parents (n = 108−1521) response rates under different incentive and prompting strategies were examined. Response rates are generally low across a pilot year and three program years, ranging from 10–55%. While incentives seemed to be ineffective at improving response rates, results indicate that prompting participants to respond may increase response rates. Individuals who respond to an initial question are highly likely to respond to a follow-up question (88–99%) and to report positive behaviors (68–100%). Responses received through text may be unrepresentative and positively biased. Text messages may be a supplemental data collection strategy in nutrition education programs, but low response rates and response bias undermine data quality.     

Disaster and Response

Abstract

The Indian Ocean Tsunami of December 2004 was one of the most significant natural disasters in modern history. The response that it drew was unprecedented at both local and international levels. While a range of specific impacts and losses may be predicted within the affected populations, there is substantial evidence that adverse impacts upon mental health may represent one of the most significant outcomes of such events. People from poorer countries are disproportionately exposed to such emergencies and may experience greater psychosocial burden in the aftermath, as well as a range of adaptations. This raises important questions regarding the current capacity of response agencies to mitigate negative impacts but also concerning the cultural context in which such mental health effects are defined. It also calls into question whether “indicated” interventions are both realistic and ecologically valid in non-Western settings. The science of Disaster Mental Health is a relatively new field, currently engaged in a number of such debates. However, there is some emerging consensus about what constitutes good public mental health practice throughout the phases of emergency response and across diverse cultural settings. Existing data and practice guidelines provide frameworks that may be adapted to allow health and recovery workers to identify and reduce mental health morbidity, support healing and harness the agency of those affected for the recovery process.     

Anticipating or Precipitating Crisis? Health Agencies May Not be Heeding Best Practice Advice in Avian Flu Press Releases

Precrisis information disseminated by public health information officers (PIOs) will play a critical role in preparing and safeguarding publics amidst a possible avian flu pandemic. This article analyzes avian flu press releases issued by leading health agencies, the Centers for Disease Control and Prevention, the National Institutes of Health, the Department of Health and Human Services and the World Health Organization, to reveal their purposes and the nature of organizational response constructed therein. Results of this analysis indicate important considerations for practitioners may not manifest in the press releases they issued: The threat was not localized; outlets for publics to contact for more information were not always present, and there was inconsistency in how avian flu was referenced. There was a steady increase in the volume of releases since 2004, and PIOs generally seemed to recognize the importance of partnerships and timeliness in pandemic preparedness. Examining the possible pandemic flu situation may yield a more thorough understanding of audience psychology and behavior during health crises as well as enhance the salience of crisis communication models for public health emergencies when public safety is of utmost concern.     

Is emergency preparedness a ‘disaster’ for people with disabilities in the US? Results from the 2006–2012 Behavioral Risk Factor Surveillance System (BRFSS)

This study compared emergency preparedness of people with activity limitations, with limitations who use specialized equipment, and with mental health conditions with that of people without these disabilities. Results of chi-square analysis and logistic regression analysis showed that people with activity limitations and/or mental health conditions were significantly less prepared for emergencies than people who used specialized equipment or persons without disabilities. Having an activity limitation and/or severe mental health conditions, and being non-white, uncoupled, female, and below the poverty line increases the likelihood of not being prepared. Suggestions for increasing preparedness related to training and policy development were discussed.     

Detecting suicide risk in adolescents and adults in an emergency department: a pilot study

The investigators conducted a pilot study to detect suicide risk in adolescents and adults seeking treatment in an emergency department, as well as to test the reliability and validity of the 4-item Risk of Suicide Questionnaire (RSQ). This study expanded the implementation of the RSQ beyond its initial use with children and adolescents with psychiatric symptoms who were seeking treatment in a pediatric emergency department to include adolescent and adult patients in a Level I trauma center. An advanced practice psychiatric nurse verbally administered the RSQ to a convenience sample of 104 emergency department patients ages 12 to 82. Psychometric analysis demonstrated an adequate degree of reliability and criterion-related validity for the RSQ. Approximately 30% of all patients who participated screened positive for suicide risk. The results support the continued use of the 4-item RSQ with all adolescents and use of a reduced 2-item form of the RSQ with adults exhibiting psychiatric chief complaints to determine imminent risk of suicide in patients who seek treatment in the emergency department. Nurses in all health care settings need to initiate suicide screening and implement nursing interventions directed toward suicide prevention.     

Emergency management communication: The paradox of the positive in public communication for preparedness

Government emergency management agencies use public communication to inform and educate around risks such as floods, fires, storms, and earthquakes with the aim to help communities understand how to prepare for these emergency events. This study of government communication relating to emergency management preparedness examines an Australian context to understand the types of messages preparing community members for natural hazards. Findings suggest that agencies employ a two-track approach combining warranting and engagement messages. Yet a deeper look at the messages suggests a “paradox of the positive” that overemphasizes the capacity of local agencies to respond to crises and underemphasizes citizen shared responsibility. Implications for the paradox of the positive in other national contexts and public relations theory building are also discussed.     

Youth tobacco sales-to-minors and possession-use-purchase laws: a public health controversy

Tobacco use among youth remains one of our nation's most significant public health problems, and yet available evidence from prevention and cessation person-centered approaches has been mixed. Given these disappointing outcomes, some have recommended more public health approaches, and these include tobacco sales-to-minors and possession-use-purchase laws. While community members and police officials have endorsed these types of public health initiatives, many within the public health community have been either guarded or even oppositional to such approaches. The primary reasons for this controversy are reviewed in this article. Outcome studies indicate that sales-to-minors laws can be an effective step toward the reduction of youth access to commercial sources of tobacco. However, even with these laws in place, many youth indicate that they continue to have easy access to tobacco, often by means of social sources. Advocates of these approaches have argued that more comprehensive public health interventions are needed, such as programs that combine youth access and possession-use-purchase laws. This article reviews the ongoing debate behind these types of public health efforts, and examines the evidence of such programs to reduce youth tobacco use.     

Initial Validation of the Open Adoption Scale: Measuring the Influence of Adoption Myths on Attitudes Toward Open Adoption

All adoptions, including those facilitated by public agencies, should be evaluated for openness. Although there are no national figures related to openness in public welfare, there are indications that it is not considered in all cases. Adoption myths may be one of the reasons that adoption workers do not always assess a family's ability to maintain a more open adoption arrangement. The following study is the initial validation of a multidimensional psychometric instrument developed to measure myths as they relate to open adoption. Based on a sample of 547 university students, the results indicate very good reliability and acceptable factorial and construct validity. The instrument was designed as a training and research tool to inform child welfare personnel and policy makers of the influence of adoption-related myths on child welfare adoption practice.     

Racial inequality and the implementation of emergency management laws in economically distressed urban areas

This study examines the use of emergency management laws as a policy response to fiscal emergencies in urban areas. Focusing on one Midwestern Rust Belt state, we use a mixed methods approach – integrating chronology of legislative history, analysis of Census data, and an ethnographic case study – to examine the dynamics of emergency management laws from a social justice perspective. Analysis of Census data showed that emergency management policies disproportionately affected African Americans and poor families. Analysis indicated that in one state, 51% of African American residents and 16.6% of Hispanic or Latinos residents had lived in cities that were under the governance of an emergency manager at some time during 2008–2013, whereas only 2.4% of the White population similarly had lived in cities under emergency management. An ethnographic case study highlights the mechanisms by which an emergency manager hindered the ability of residents in one urban neighborhood, expected to host a large public works project, to obtain a Community Benefits Agreement intended to provide assistance to residents, most of whom were poor families with young children. We conclude with a discussion of how emergency management laws may impact social service practice and policy practice in urban communities, framed from a social justice perspective. We argue that these are not race neutral policies, given clear evidence of race and ethnic disparities in their implementation.     

Child Sexual Abuse Cases: Implementing a Specialist Judicial List

The damage done to children who are subjected to sexual abuse and the often lengthy delays in the resolution of these matters by the child welfare and legal systems is well documented. With this in mind, the Children's Court in Victoria established for 12 months in 2013 a pilot specialised judicial list (the “D” List) as an intensive case-management approach to more effectively respond to child sexual abuse concerns. The evaluation of the pilot aimed both to review the effectiveness of the list in terms of court functioning, and to provide information about the nature of such cases coming to court, the ages and family circumstances of subject children, decisions made and factors associated with these decisions, and the challenges related to management of and decision-making about such cases. The success of the specialist list has seen it extended to regional courts, because it is a more effective approach to managing and deciding this complex class of cases.     

Government websites and social media's influence on government-public relationships

Recent years have witnessed the increasing use of online media, such as websites, blogs, and social networking sites, by the government for various public relations purposes. These government communication channels are often regarded to promote democratic values and public trust in government by helping the government provide the public with information and respond to citizen inquires. Further, such channels help the public provide the government with feedback. This study questions whether individuals’ experience with government websites and social media do, in fact, influence their perception of the government-public relationship (represented by public trust in government). The results, which are based on a nationwide survey of more than 2000 American citizens, showed support for a positive relationship between this online experience and public trust in government. In particular, experiences with informational online services and social media were associated with greater trust in government at the local and state levels, while those with transactional online services conveyed greater trust in the federal government. However, successful experience with the channels was more important than the experience itself, and an unsuccessful experience could even backfire in terms of trust in government.     

The use of Facebook for information seeking,decision support,and self-organization following a significant disaster

The wide-spread proliferation of the Internet has revolutionized the ways that individuals obtain, interpret, and respond to information in the aftermath of disaster. An F3 tornado that impacted the community of Goderich, Ontario, on 21 August 2011 provided the opportunity to examine how people utilized Facebook and Facebook groups to seek out information, self-organize, and provide support. This mixed-methods project was conducted in two phases. First, semi-structured interviews (n?=?35) were conducted with Goderich area residents on their experiences using social media after the tornado. Next, all of the publicly available posts and replies on the Goderich Ontario Tornado Victims and Support (GOTVS) Facebook group were gathered and analysed using computer-assisted content analysis. The results demonstrate that Facebook was a highly influential source of information and support, particularly in the immediate aftermath of the disaster. Although misinformation and gossip occurred, the tendency was for the group to self-moderate inaccurate information. Public engagement by local officials may further reduce misinformation and encourage public confidence. The results also show that GOTVS activity significantly declined after two weeks. This abrupt decrease in public attention suggests that the window for engagement by public officials is narrow. As such, officials should have a social media plan in place so that they may engage with the public during the critical response phase when their participation may yield the greatest benefit. Finally, this research underscores the potential for analysing Facebook content using computer-assisted content analysis, a method that may be of interest across the social sciences.     

The influences of relationship quality with external partners and required levels of approval of messaging on crisis preparedness

As funding for public health promotion is increasingly limited in the U.S., public relations research informing management of crises that threaten public health is especially critical. Crisis planning models such as Reynolds and Seeger’s (2005, 2014) crisis and emergency risk communication model offer comprehensive directives for crisis managers and present opportunities to extend the utility of best practice recommendations. A survey of public information officers (PIOs) (n=208) at local public health departments across the U.S. examines the quality of their relationships with partners in public health crisis management, including first responders, media, law enforcement, and hospitals, and reveals that relationships with key publics in crisis management are lacking. Further, PIOs at state governed health departments may face critical delays in releasing crisis messages, as their messages are required to clear more levels of approval than locally (city/county) governed departments. Implications and future research for these key variables extending public relations crisis communication research with a focus on inter-organizational relationships are discussed.     

Interactive Health Communication Technologies in the Public Health Sector: Positive Perceptions Still Outpace Actual Utilization

ABSTRACT

Effective population-based and patient-centered public health care is highly dependent on timely and reliable health-related information. The continuous growth and availability of health-related information brought about by the emergence of a new digital communications environment offers a range of opportunities that facilitate access to useful health information for the public health sector–for providers as well as patients. Such advancements, however, can only be realized if public health professionals are knowledgeable about existing sources of online health information, have the ability to successfully judge the reliability of online health information, and are able to acquire the information in a timely and efficient manner. This research follows on the heels of a survey of public health professionals in New York State that concluded that limited access and knowledge negatively impacted utilization of interactive health communication technologies. In this study, a survey was administered to providers at a large county health department located in central Michigan. Results indicate that perceptions regarding the advantages of online health information still far outweigh actual utilization. Barriers to actual utilization include lack of easy access to computers with high-speed connections, trusted and timely online information, training and staff development issues, and organizational policies concerning computer access and usage.     

Emergency Saving and Household Hardship

Households with limited income and wealth often struggle to access the financial liquidity needed to address unexpected expenses or income drops. Emergency savings can act as form of insurance against such economic shocks and reduce the risk of hardships that influence family wellbeing. Prior research has established that threshold amounts of liquid assets can reduce the risk of economic hardship. This study used a measure of self-reported emergency saving behavior to examine whether households who reported saving for emergencies were less likely to experience subsequent economic hardships in a longitudinal sample of households in disadvantaged neighborhoods from the Annie E. Casey Foundation’s Making Connections project. Results across a range of regression models suggest that households who saved for emergencies experienced slightly less overall hardship and were less likely to report several specific hardships, such as food insecurity and having a phone disconnected, three years later. This study supports the idea that small, unrestricted savings may play a protective role for low-income households.