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Final FY 2002 Performance Report, Final FY 2003 Performance Plan and Draft FY 2004 Performance Plan for the Agency for Toxic Substances and Disease Registry


Cover Page for the document

Dear colleagues,

We are very pleased to present the combined Final FY 2002 Performance Report, Final FY 2003 Performance Plan and Draft FY 2004 Performance Plan for the Agency for Toxic Substances and Disease Registry. The document provides a solid roadmap for where our Agency is going and how we will work to get there.

The Final FY 2002 Performance Report addresses the progress made during the past fiscal year. It represents a year of change as we implement a new strategic plan. We are happy to report that we have fully met or exceeded 91% of our performance measures. This achievement puts us well on our way to accomplish our mission to use the best science to prevent and treat harmful exposure and disease attributed to toxic substances in the environment. While we did not meet all of our performance measures, we are proud that the time and effort diverted from these tasks was well spent as our Agency played a vital role in the response to the September 11 terrorist attacks - fully one quarter of the ATSDR staff responded to this national emergency.

As we move to execute the FY 2003 and FY 2004 Performance Plans, our Agency will continue to examine how best to employ our resources - time, money and people - to achieve our five strategic goals to: Each of these goals is supported by our commitment to fulfill the President's Management Agenda and to address the needs of the American public. We are encouraged by the contributions of our colleagues to make ATSDR a better and more efficient public service agency.

In the year ahead, we look forward to working with each of our offices and divisions to steward our progress as an Agency. We look forward to using this document as a living guide to chart our success.

Sincerely,

Julie Louise Gerberding, M.D., M.P.H.
Administrator

Henry Falk, M.D., M.P.H.
Assistant Administrator
Rear Admiral, U.S.P.H.S. (Retired)



"Government should be results-oriented - guided not by process but guided by performance. There comes a time when every program must be judged whether a success or a failure. Where we find success, we should repeat it, share it, and make it the standard. And where we find failure, we must call it by its name. Government action that fails in its purpose must be reformed or ended."
Governor George W. Bush



TABLE OF CONTENTS

Executive Summary
I. Overview of Performance Measurement
II. Goal by Goal Performance Measurement
III. Appendices
APPENDIX 1: LINKAGE TO HHS AND AGENCY STRATEGIC PLANS
APPENDIX 2: CHANGES AND IMPROVEMENTS OVER PREVIOUS YEAR
APPENDIX 3: PARTNERSHIPS AND COORDINATION
APPENDIX 4: DATA VERIFICATION AND VALIDATION
APPENDIX 5: PERFORMANCE MEASUREMENT LINKAGES
APPENDIX 6: CHANGES TO GOALS AND OBJECTIVES



EXECUTIVE SUMMARY

PURPOSE

The Government Performance and Results Act of 1993 (GPRA) requires agencies to prepare an annual performance plan and report in support of a long-term strategic plan. This document provides the Final FY 2002 Performance Report, Final FY 2003 Performance Plan and Draft FY 2004 Performance Plan for the Agency for Toxic Substances and Disease Registry (ATSDR).

AGENCY MISSION

As the lead public health agency responsible for implementing the health-related provisions of Superfund (the Comprehensive Environmental Response, Compensation and Liability Act of 1980), ATSDR is charged with assessing health hazards at specific hazardous waste sites, helping to prevent or reduce exposure and the illnesses that result, and increasing knowledge and understanding of the health effects that may result from exposure to hazardous substances.

ATSDR's mission, as revised in the strategic plan for 2002-2007, is:

To serve the public by using the best science, taking responsive public health actions, and providing trusted health information to prevent harmful exposures and disease related to toxic substances.

The mission is supported by the Agency goals:

Goal 1. Evaluate human health risks from toxic sites and take action in a timely and responsive public health manner.

Goal 2. Ascertain the relationship between exposure to toxic substances and disease.

Goal 3. Develop and provide reliable, understandable information for affected communities, tribes, and stakeholders.

Goal 4. Build and enhance effective partnerships.

Goal 5. Foster a quality work environment at ATSDR.

 

To achieve the mission and goals, ATSDR works with its sister agency, the Centers for Disease Control and Prevention (CDC) and a host of partner organizations. With a shared vision, ATSDR works with these organizations to serve:

ATSDR's work with these customer groups and progress toward achieving these goals is presented under section II: Goal-By-Goal Performance Measurement.

OVERVIEW OF PERFORMANCE PLAN AND REPORT

This document represents ATSDR's Final FY 2002 Performance Report, Final FY 2003 Performance Plan and Draft FY 2004 Performance Plan. The content herein represents the Agency's efforts to challenge itself to protect America's health from toxic exposure. To do so, the Agency is working to integrate its performance planning and measurement with budget decision-making. Specifically for the FY 2002 Report, the Agency has: Figure A identifies how funding and full time equivalent (FTE) personnel are distributed to support ATSDR's operational goals and objectives (1-4). Funding and personnel associated with Goal 5, ATSDR's goal to improve the work place, contribute to the achievement of the other goals and are distributed proportionally across the other four goals.



Figure A. FY02 Distribution of ATSDR Funding and FTEs Across Agency Goals

In addition to creating strong ties between the Agency budget and its performance, ATSDR has taken the opportunity to refine its strategic objectives as originally crafted in the Agency's strategic plan for FY 2002-2007. Changes (noted in Appendix 6) reflect thoughtful consideration of how the Agency operates to achieve its mission. This document therefore reflects revised performance measures to support adjusted goals and objectives.

ATSDR's planning and evaluation accomplishments have allowed the Agency to develop a more concise and effective management tool in the Performance Plan. The approach has yielded an increased focus on performance outcomes rather than merely outputs and processes. Specifically, the plan provides a total of 23 measures, working toward 13 outcomes, six outputs and four process measurements.

More importantly, however, is the actual impact our Agency has made to the American public over the past year. In FY 2002, ATSDR's work has been in great demand. For several years, the number of toxic sites worked by the Agency has increased. In 2000, the number of sites rose to 707, over only 390 in 1996. Americans living within one mile of those sites also rose in the same period from just under 1 million to more than 2.5 million. To address these needs, the Agency employs three strategies which reflect ATSDR's unique expertise in environmental public health: In late FY 2001, the atrocity of the September 11 terrorist attacks and the anthrax attacks touched our entire country. Like many other federal agencies, ATSDR responded immediately. Fully one quarter of our 433 Agency staff has dedicated time to respond to the terrorist events during FY 2002. The rapid deployment of our people and expertise shifted resources from other programs to address our country's highest priority. ATSDR leveraged its three strategies to do this work. Our efforts here and throughout the year are highlighted below. The success demonstrated by these highlights as well as our other achievements to date in FY 2002 are reflected in the performance summary chart below.



Figure B. ATSDR Performance Summary

For questions regarding information in this document, please contact:

Peter McCumiskey
Deputy Assistant Administrator
ATSDR
1600 Clifton Rd NE
Mail Stop E28
Atlanta, GA 30333



I. OVERVIEW OF PERFORMANCE MEASUREMENT

With the development of the new strategic plan covering 2002 - 2007, ATSDR has renewed its commitment to the success and management of the Agency. This commitment includes not only planning and measuring our performance, but also making budget decisions based upon performance. Our approach will allow ATSDR to fund the most successful programs that truly make a difference to those exposed to toxic substances in the environment. The process we are undertaking represents just one of our Agency's efforts to address the President's Management Agenda by integrating budget and performance. Our other efforts will be described further.

This document, our Final FY 2002 Performance Report, Final FY 2003 Performance Plan and Draft FY 2004 Performance Plan, has utilized our efforts to link budget and performance. Specifically, in planning across our Agency, individuals linked ATSDR's extramural budget programs to strategic goals and objectives. Performance measures were then written to establish the outcome or output desired with each program. You will find these measures and supporting performance indicators under section II. Goal By Goal Performance Measurement. Figure 1 below outlines our process.



Figure 1. Integrated Budget and Performance Planning at ATSDR

In addition to our process of linking budget programs to our goals, objectives and performance measures, ATSDR has documented which employees work on what goals and objectives and estimated the amount of time spent to address each. This has allowed our Agency to attribute salary, benefits and other associated costs across our goals and objectives. Lastly, we have attributed other intramural costs and overhead to our goals and objectives. Collectively, these actions have enabled the Agency to calculate the cost of achieving each goal and objective. This cost, along with the FTEs associated with each goal and objective is provided under each goal in section II.

ATSDR continues to make other significant progress to address the President's Management Agenda. Highlights from the past year include: In FY 2003, our process to link budget and performance will be supported by a newly developed tool, the Project Profile system, which will be used across the Agency. The system and its relationship to Agency planning and evaluation is described in Appendix IV. Verification and Validation.

REPORT/PLAN ROAD MAP AND BUDGET LINKAGE

The following section describes each of ATSDR's five strategic goals and supporting objectives. As previously described in ATSDR's approach to performance planning and measurement, all of the Agency's budget programs, as well as FTEs, directly support the goals and objectives. Attribution to the Agency's operational goals (1-4) is shown in Figure 2 below. Funding and personnel associated with Goal 5, ATSDR's goal to improve the work place, contribute to the achievement of the other goals and are distributed proportionally across the other four goals.



Figure 2. FY02 Distribution of ATSDR Funding and FTEs Across Agency Goal

Below, budget programs are attributed to each goal and objective.

GOAL 1: EVALUATE HUMAN HEALTH RISK FROM TOXIC SITES AND TAKE ACTION IN A TIMELY AND RESPONSIVE MANNER.

GOAL 1, OBJECTIVE 1: Annually, enhance participation of communities, tribes, local and state governments, and other stakeholders in planning, assessment, and intervention at sites. GOAL 1, OBJECTIVE 2: Enhance effective and timely site-related actions. GOAL 1, OBJECTIVE 3: Develop and apply innovations in identifying and evaluating exposure to hazardous substances associated with human health risks. GOAL 1, OBJECTIVE 4: Enhance scientific quality of assessments, investigations, and interventions at all sites. GOAL 2: ASCERTAIN THE RELATIONSHIP BETWEEN EXPOSURE TO TOXIC SUBSTANCES AND DISEASE.

GOAL 2, OBJECTIVE 1: Conduct descriptive investigations to track disease and other health conditions and ascertain links to environmental exposures. GOAL 2, OBJECTIVE 2: Enhance environmental exposure tracking by the use of exposure registries. GOAL 2, OBJECTIVE 3: Conduct analytic studies to increase our knowledge about the effects of toxic substances on human health. GOAL 2, OBJECTIVE 4: Implement the Agency's research agenda to enhance the quality and quantity of ATSDR research and public health practices. GOAL 3: DEVELOP AND PROVIDE RELIABLE, UNDERSTANDABLE INFORMATION FOR AFFECTED COMMUNITIES, TRIBES AND STAKEHOLDERS.

GOAL 3, OBJECTIVE 1: Improve capabilities of health professionals to recognize, diagnose, and treat exposure related illness in their communities. GOAL 3, OBJECTIVE 2: Improve public understanding of health risks from exposures in their communities. GOAL 3, OBJECTIVE 3: Improve the Agency's ability to identify and reach target audiences. GOAL 3, OBJECTIVE 4: Enhance the development, scientific quality, and accessibility of Agency products and services. GOAL 4: BUILD AND ENHANCE EFFECTIVE PARTNERSHIPS.

GOAL 4, OBJECTIVE 1: Build and enhance the capability of state and tribal partners to evaluate, prevent or mitigate human health risks posed by toxic sites and releases. GOAL 4, OBJECTIVE 2: Collaborate with both domestic and international partners to address shared priorities and achieve common goals. GOAL 4, OBJECTIVE 3: Enhance ATSDR's internal and external identity for more effective partnerships. GOAL 5: FOSTER A QUALITY WORK ENVIRONMENT AT ATSDR.

GOAL 5, OBJECTIVE 1: Create an agency culture promoting collaboration, growth, and development opportunities. GOAL 5, OBJECTIVE 2: Promote a culture of effective leadership and management. GOAL 5, OBJECTIVE 3: Review workforce diversity and targeted recruitment and hiring practices. GOAL 5, OBJECTIVE 4: Promote improved facilities and services for Agency staff.

II. GOAL-BY-GOAL PERFORMANCE MEASURMENT

Introduction

This section highlights ATSDR's efforts to achieve its mission across each of ATSDR's five strategic goals. This section is dedicated to the efforts undertaken in FY 2002 and those that will continue in future years.

In a number of instances, objectives and performance measures have been revised through ATSDR's iterative planning process. Changes to goals and objectives (highlighted in Appendix VI) reflect refinements in our strategy and the way in which ATSDR works in support of customers and stakeholders. Revised performance measures are provided as well in order to support the adjustments. These changes are the result of thoughtful planning and evaluation in the Agency's first year using its new strategic plan.

Achieving the ATSDR Mission

Under the Superfund legislation, ATSDR was given the mission to protect the public's health as it is related to exposure to toxic substances from hazardous waste sites or uncontrolled releases of hazardous substances in the environment. In 1980, CERCLA mandated that ATSDR (1) establish a National Exposure and Disease Registry; (2) create an inventory of health information on hazardous substances; (3) create a list of closed and restricted-access sites; (4) provide medical assistance during hazardous substance emergencies; and (5) determine the relationship between hazardous substance exposure and adverse human health effects.

Over the years, this mandate has been expanded by legislation to broaden the volume, scope and type of work performed by ATSDR. This increased responsibility helps ATSDR address concerns at an expanding variety of sites and the growing number of persons living within a mile of the sites.



Figure 3. People Living Within 1 Mile of Site; Sites Worked by ATSDR


In order to meet the growing demand to address environmental public health concerns related to exposure to hazardous substances, ATSDR employs three broad strategy groups. Each of these strategies, as well as the Agency's management approach, allow ATSDR to make its impact upon the Americans threatened by health risks from toxic exposure. The strategies are described below.

Public Health Assessments, Health Consultations, and Site Specific Public Health Activities

Public health assessments, health consultations, and other site specific activities result in evaluations, assessments and recommendations on specific public health issues related to actual or potential human exposure to a hazardous material. ATSDR's recommendations result in additional characterization of sites, remediation activities or relocation of populations, fish advisories, alternate water sources, and other measures. In addition, these activities can initiate other activities within ATSDR such as exposure investigations, health studies, and health education.

In recent years, ATSDR has directly dispersed as much as $37 million (approximately 53%) of the Agency's total budget through contracts, grants, cooperative agreements, and interagency agreements to support environmental health programs in state and local health departments, educational institutions, and other organizations serving public health to address public health issues from hazardous waste sites in communities.

A number of ATSDR's findings from its health studies and other activities have pointed to the very real health threat of adverse health effects that people who live near hazardous waste sites face when they drink contaminated water, eat contaminated fish, breath toxic fumes, or are otherwise exposed to hazardous substances. Our approach to responsive public health actions includes identifying a need for health education in a community, health studies to be conducted, or for the issuance of a public health advisory to recommend immediate actions to prevent exposure.

Surveillance, Epidemiology, Health Studies, and Registries

Surveillance provides follow-up of the people at risk of adverse health effects from exposure to hazardous substances released from Superfund sites. Epidemiologic and other health studies further define the association between exposure and adverse health effects and provide vital information for determining public health actions in site-specific communities. Those identified by the Agency as priority health conditions include: Registries of persons exposed to select hazardous substances offer the best resource for clearly explaining health effects of long-term exposure to low concentrations of toxicants. They also provide personal health information to the registrants and create databases that facilitate epidemiologic research.

This strategy is often used to address priority health conditions linked to toxic exposure, such as asthma. CDC's programs, as well as reports from other governmental agencies, including the Pew Environmental Health Commission's Attack Asthma report, show asthma has reached epidemic proportions in the United Studies. While 15 million people are affected, these indicate a growing number of children with asthma. The largest increases are cases in children under the age of five. African Americans and Hispanics have higher rates of asthma emergency room visits, hospitalizations, and death than do non-Hispanic whites.

In seeking to address community concerns about hazardous air pollution and asthma, ATSDR health studies provide additional research data to fill in gaps in our scientific knowledge and identify areas for epidemiologic investigations. Our collaborations with partners have been very successful in identifying children with asthma through the use of both school health records and hospital discharge data. This information helps to build capacities at the state and local level by offering an opportunity for additional states or local public health agencies to explore the relationship between childhood asthma and specific hazardous air pollutants.

Scientific Assessment, Research, and Information Dissemination

The implementation of a program of applied research seeks to answer priority questions about exposure to hazardous substances and subsequent health outcomes. ATSDR supports programs that evaluate and interpret existing data on substances found at sites on the National Priorities List (NPL), and considers priority data needs for high-ranking substances in toxicological profiles research.

The toxicological profiles continue to support the mission of ATSDR by developing and implementing a comprehensive toxicological program. Toxicological profiles are used as the authoritative source of up-to-date information on the health guidance values for estimating potential human health risk that may result from exposure to toxic substances. The profiles are also utilized to support the development of other Agency documents such as, Chemical Specific Fact Sheets, Case Studies in Environmental Medicine, and Medical Management Guidelines.

ATSDR's Emergency Response section provided consultations in response to 54 acute release events and 496 time critical consultation requests. Of these events, approximately 1 in 3 were repeat users of the Emergency Response services and another 1 in 5 were requesters who found out about our program from the Internet. The extremely popular Managing Hazardous Materials Incidents guidance document series continues to be a major focus of the preparedness activities of the Agency. Either in print or in compact disc (CD/ROM) format, ATSDR has distributed approximately 500,000 copies of the three documents. ATSDR also supports community wide simulations and exercises, and technology exchanges through national and regional conferences.

ATSDR calls upon its resources in health education, risk communication, environmental medicine, and health promotion to prevent or reduce the harmful health effects of exposure to hazardous substances in communities. Events following the September 11th terrorist attacks on New York and Washington, D.C., have emphasized the need to strengthen the ATSDR's health and risk communication program. New emphasis is being placed on developing health and risk communication strategies to enhance capacity to provide technical support for site-specific work as well as for emergencies resulting from unplanned chemical releases which have international impact.

The Agency's Agenda for Public Health Environmental Research (APHER) 2002 - 2010 is underway. Six projects were funded. APHER helps direct applied research activities into 6 focus areas: Exposure Assessment, Chemical Mixtures, Susceptible Populations, Communities and Tribal Involvement, Evaluation and Surveillance of Health Effects, and Health Promotion and Intervention.



Performance associated with Goal 1 and its objectives is summarized in the figure below. References provided (1A, 1B, etc.) link individual performance indicators to written descriptions. Page numbers note where descriptions may be found. Instances of the building symbol identify indicators associated with the President's Management Agenda. The referencing scheme applies to all goal discussions.







Figure 4. Performance Summary Chart for Strategic Goal 1


Program Description and Context

The purpose of Goal 1, its objectives and supporting programs is to respond to releases of toxic substances, when they occur or as they are discovered, and to evaluate and prevent possible health risks associated with exposure at sites.

Each year, ATSDR responds to hundreds of sites, including those on the National Priorities List established by Superfund. It is critical to respond to these events as quickly as possible to identify health risks and communicate them to the surrounding community to prevent or reduce harmful exposures. When left unidentified and untreated, continued exposure to hazardous substances may cause a number of health problems, including those identified by the Agency as priority health conditions: Understanding the link between exposure and disease and knowing the cost of treatment, the need to evaluate health risks associated with toxic sites is easily substantiated. If ATSDR activities were to result in a reduction in the incidence rate of chronic disease by even one-hundredth of one percent, the entire Agency budget could be offset by the health care cost savings alone.¹

Program Performance Analysis

Specific indications of ATSDR's success are highlighted below.

Participation At Sites To Address Concerns

(1A) Fostering Participation of Affected Communities - Each year, ATSDR faces the significant challenge to engage community members to learn about, understand and take action to mitigate or prevent health effects due to toxic exposure. Not only must ATSDR reach more people and increase participation, the Agency must improve the quality of the participation to make an impact upon the health of those at sites. ATSDR is undertaking a campaign to measure participation at sites and the resulting impact upon health. In FY 2002, the Agency initiated development of a survey tool to measure participation. The survey will be submitted to OMB for approval prior to the close of the fiscal year.

(1B) Increasing Participation of Agency Partners - ATSDR works with the Agency's cooperative agreement partners to build their capacity and increase their involvement in site related activities. In FY 2002, ATSDR deployed the Agency's State Tracking And Reporting System (STARS), which allows the Agency's state (1043) cooperative agreement partners to submit annual plans of work (APOW) to identify their work. Technical project officers at ATSDR work with the partners to enhance plans to improve site actions. Through the use of the system, ATSDR is able to track the progress of cooperative agreement partners, noting that 70% of the partners completed both health study and health education activities at 80% of applicable sites by the end of FY 2002.

During this first year of implementation of the STARS tracking system, a 97% participation rate was achieved with 32 of the 33 state partners successfully uploading their data into ATSDR's main database system. In-house training was developed and provided on-site for 16 state partners and over 50 staff members. In March, training was provided at ATSDR's partners' meeting in Cincinnati, OH. The STARS Guidance Manual was developed, peer reviewed, and distributed.

The STARS system is one of the ways ATSDR has complied with the President's Management Agenda, as it leverages principles of electronic government for its customers by allowing electronic submission of the APOW and to comply with reporting requirements. This minimizes the time and effort partners must use for program administration.

In FY 2002, ATSDR has also used training as a means to involve its partners. This year, ATSDR's Tribal Affairs program worked with Alaska Native tribes to develop an environmental public health training needs assessment. The assessment was provided to all 235 federally recognized Alaska Native tribes to determine the most needed and applicable training. In FY 2003, the Agency will work to develop a targeted training program.

(1C) Providing Information To Agency Stakeholders - Specifically cited throughout this document, ATSDR develops and distributes many definitive resources for those dedicated to the environmental public health mission. In FY 2002, the Agency distributed 78,300 informational items to stakeholders.

Improved Emergency Preparedness and Response

(1D) ATSDR Staff - In FY 2002, one quarter of the Agency's staff helped to respond to the World Trade Center and Anthrax terrorist attacks. In order to support the Agency's need to respond, a significant amount of training has been provided. Initially, only five ATSDR staff members were trained to be ready responders for emergency events. In FY 2002, ATSDR was able to raise that number to 30 staff members, approximately 7% of the Agency staff.

Each of ATSDR's regional offices has developed a Continuity of Operations Plan (COOP) to help maintain continuous, uninterrupted operations in the event of an emergency that prevents use of ATSDR's regional federal buildings. In regions 1, 8 and 10 ATSDR staff will collocate with EPA and PHS staff in the event of an emergency. More than 25% of ORO staff have already completed advanced emergency response training such as scene coordinator readiness, emergency augmentee training, as well as training for radiological disasters and biological agents.

(1E) Health Professionals - In FY 2002, ATSDR has also sought to improve the preparedness and response capabilities of health professionals. In FY 2002, ATSDR established a target to train 10-12 emergency medicine professionals, as determined by partnering schools. To date, 14 medical residents have participated in the rotation program. Nine from Howard University Hospital Emergency Medicine, two from Meharry Medical College of Occupational Medicine, two from Drew Medical College of Emergency Medicine, and one from Emory University.

In order to target the Agency's time and resources most effectively, the ATSDR has initiated an assessment of the level of preparedness that currently exists. In FY 2003 and in future years, health professionals preparedness and response training will be targeted to the needs identified.

(1F) Responding To Emergencies: The World Trade Center - ATSDR assisted in the public health response to the attack on the World Trade Center. Response included site investigation, development of fact sheets on the health effects from the asbestos and other hazardous substances released from the site, as well as the initiation of a registry to track the health effects of 100,000 to 200,000 individuals who may have been impacted by substances from the site.

(1G) Foreign Disaster Assistance - Each year, ATSDR's Office of Federal Programs (OFP) works with other federal agencies to respond at toxic sites. In FY 2002, OFP partnered with the Discretionary Foreign Disaster Assistance Program at the Agency for International Development (AID) most recently to respond to chromated cooper arsenate (CCA) spills in the Port of Djibouti, thereby opening the port to US food aid programs and US forces conducting Operation Enduring Freedom. Work with the program is supported by the cache of supplies and equipment that ATSDR supports at Dobbins Air Reserve Base. This cache provides health information, radiation meters, protective clothing and equipment, chemical detection kits, tents, generators, costs, sleeping bags, etc.

Other FY 2002 partnerships with AID supported training in Ecuador to respond to petroleum refinery and drug lab disasters; training to help Argentina identify and mitigate hazards posed by chemical fuels transported through Buenos Aires during civil unrest; as well as assistance to the Republic of Georgia to identify radiation; chemical and explosive hazards at former Soviet military bases, also in support of Operation Enduring Freedom.

(1H) Other Emergency Responses - Within quarters 1 and 2 of FY 2002, ATSDR responded to 7 fires and explosions, 21 Superfund cleanups, 85 exposures, 36 spills or releases, and 15 worker health and safety issues.

(1I) Improving Timely Response - In FY 2002, the Agency re-committed itself to provide the most timely and effective site related actions. The need for fast and coordinated emergency response was made clear by the events of September 11. ATSDR is conducting research and data analysis to establish indicators to measure and help us improve timely actions.

Determining Status of At-Risk Populations

(1J) Conducting Public Health Assessments - In FY 2002, ATSDR's Division of Health Assessment and Consultation (DHAC) worked to complete assessments for ASTDR sites. Of those planned, the Agency expects to complete 69 health assessments for initial release, exceeding target by 27 assessments, 58 for public comment to exceed the planned target by 17, and 51 for final release to exceed the planned target by 18. Health consultations and technical assists for FY 2002 are expected to total 1,811, exceeding the target of 1,746. Finally, the Agency also expects to exceed the planned target of 12 exposure investigations by completing 19 by close of the fiscal year.

Based on health assessments conducted, the Agency has determined that 1.7 million people live within one mile of toxic sites worked by ATSDR. In order to take responsive public health action, the Agency expects to provide 18,800 recommendations for site characterization, 6,300 recommendations to cease and reduce exposures, as well as 4,300 for health follow-up by the close of FY 2002. Since FY 1995 and through quarter two of FY 2002, approximately 70% of the Agency's health assessment recommendations have been adopted.

(1K) Conducting Health Studies - Additionally, ATSDR's Division of Health Studies (DHS) has initiated a study on Vasquez Boulevard and Interstate 70 (VBI-70) soil pica and completed a study on the effects of lead upon exposed children in Kansas in FY 2002.

The VBI-70 site in northeast Denver encompasses five residential neighborhoods, 5,000 houses, and over 15,000 people. ATSDR worked closely with community representatives, local, state, and federal agencies for more than three years, meeting monthly so that community representatives could be involved with all aspects of the public health assessment process. ATSDR evaluated data from 3,000 residential properties, identified 650 residential properties that are a concern for children because of high levels of arsenic in soil, and over 1,300 properties as a concern for lead contamination in soil.

In response to the health issues identified, ATSDR informed residents of the health concerns for arsenic and lead contamination in residential yards. ATSDR funded the Colorado Department of Health and Environment (CDPHE) to conduct a health study in FY 2002 to identify children who might have arsenic poisoning because of soil-pica behavior and to collect urine and hair samples for arsenic to verify exposure. ATSDR also funded CDPHE to collect blood lead samples as part of the health study and awarded a grant to Toxicology Associates, an AOEC (Association of Occupational and Environmental Clinics) clinic in Denver, to conduct public health intervention at the site including health care provider education and community education concerning arsenic and lead poisoning.

Developing Analysis Tools

(1L) Use of Biomarkers - In FY 2002, ATSDR developed a database of biomarkers and filed applications to measure exposure. ATSDR plans to develop a compendium for exposure investigations by FY 2004.

(1M) Exposure Dose Reconstruction - In FY 2002, ATSDR established a baseline to leverage exposure dose reconstruction in 6 health assessments. This target will be met at the close of the fiscal year. Specifically, exposure dose reconstruction was used as an innovative tool at the Dover Township of Tom's River, New Jersey site. DHAC used historical reconstruction of the water distribution system to estimate the percentage of water a study subject might have received from contaminated well fields for use in a study conducted by the New Jersey Department of Health and Social Services.

The goal of Exposure Dose Reconstruction (EDR) is to enhance the Agency's capacity to assess exposure and dose, with special emphasis on characterizing past exposures, to better support health assessments, consultations, health studies, and exposure registries. The EDR placed 100 percent of its resources and research efforts into documenting and completing the historical reconstruction of the water-distribution system serving Toms River. This effort assisted the New Jersey Department of Health and Senior Services' (NJDHSS) epidemiological investigation of childhood cancer. EDR efforts lead to development of new optimization techniques to assist with epidemiological investigations of water-distribution systems. These techniques assisted the NJDHSS in completing its epidemiological investigation, which resulted in associating pre-natal exposures to contaminated groundwater supplies with leukemia in female children.

ATSDR's development and use of tools includes publicizing their availability for use in the scientific community. In FY 2002, ATSDR expects to complete two published articles and one presentation of the analysis tools, exceeding its original target.

(1N) Computer-Assisted Methods - Computer-assisted models are used for chemical-specific consultations that are found at many sites, including those involved in emergency situations. In FY 2002, ATSDR's Division of Toxicology (DT) targeted an increase in the use of computer-assisted methods provide models for 33% of the Agency's health assessments, consultations and other activities. The Agency is currently exceeding this target. Already, 25 physiologically based pharmacokinetic (PBPK) models have been developed to analyze exposures to toxic substances in Anniston, Alabama. By year-end, an interaction physiologically based model was developed for assessing toxicity of two common pesticides and models for four site-related chemicals will be used.

Computer-assisted models support the Agency's mandates for chemical specific consultations and health assessments. Two new projects with major universities were recently initiated: interaction thresholds for low level waste site contaminants are being studied at Colorado State and University of Georgia, and innovative SAR models are being developed at University of Minnesota that will improve the Agency's ability to predict the effects of poorly studied substances.

Improving Quality of Site-Related Actions

(1O) Development of Quality Indicators - In order to improve the quality of actions at sites, ATSDR has initiated a program to develop indicators of quality in actions. The Agency is currently working to develop baseline data, identify improvement needs and target changes to address the needs.

(1P) Health Assessor Certification - ATSDR's Division of Health Assessment and Consultation has initiated the development of a certification program for those who conduct assessments at sites. The certification program, to be piloted in FY 2003 and implemented in FY 2004, will provide minimum training requirements and certification testing. ATSDR expects that better trained professionals will provide better, and higher quality site assessments.

The health assessor certification protocol, which is intended to standardize the basic skills for health assessors, is currently under management review. The protocol has a three-tier program starting at Health Assessor In training, to Health Assessor, and completing as a Designated Reviewer. Continuing education requirements are being established to ensure that staff remain current with existing science.

(1Q) Peer Review - ATSDR recently developed a new process to provide a peer review panel for all Agency research. In FY 2002, the process is to be reviewed and finalized. The Agency anticipates use of the panel process in FY 2003. Within FY 2002, 100% of Agency protocols and research findings were peer reviewed.

(1R) Providing Useful Information for Site-Related Actions - Annually, ATSDR works to provide information that will be timely and relevant to site-related work. A few examples of the information provided in FY 2002 includes publication of Thermal Treatment and Landfill Gas Primer guidance, public comment for the Public Health Assessment Guidance manual, the Public Health Assessment basic course and 36 advanced courses, an intranet based Health Assessment Resource Center. A new case study was developed for the Basic Health Assessor Course, as well as a web based training course on "Protocols For Conducting Exposure Investigations."



Performance associated with Goal 2 and its objectives is summarized in the figure below. References provided link performance measures to written discussion, while use of the building symbol denotes measures that support the President's Management Agenda.





Figure 5. Performance Summary Chart for Strategic Goal 2

Program Description and Context

Goal 2 encompasses ATSDR's work to determine the relationship between toxic exposure and disease through health studies, toxicological research, disease tracking and surveillance studies. Through the efforts within objective four, the Agency continually seeks to improve the quality and quantity of this work to increase ATSDR's impact upon environmental public health and individuals at sites.

ATSDR's work toward this goal includes study of toxic chemicals, 480 of which are already profiled by the Agency; an estimated 75,000 remain to be studied. In addition, the Environmental Protection Agency (EPA) has identified more than 1,500 sites critical for study and clean up on its National Priorities List for Uncontrolled Hazardous Substances (NPL). More than 11,000 additional sites have been identified by Superfund as potential hazards to human health.

Each year, ATSDR provides toxicological reference materials, health studies (both site specific and general), and works to expand the National Exposure Registry (NER) to track the short and long-term health effects of individuals exposed to long-term low-level toxic substances.

Program Performance Analysis

Specific indications of ATSDR's success are highlighted below.

Conducting Investigations

(2A) Site-Specific: Libby, Montana - ATSDR is reviewing locations that received shipments of vermiculite from a mining operation in Libby, Montana. The vermiculite was shipped to approximately 244 locations around the U.S. for processing and packaging. ATSDR selected 30 sites for initial review. To date, ATSDR has completed site visits for 27 of the 30 priority sites and is currently developing site-specific health consultations for each priority sites; conducting additional research to support site exposure pathway analyses and coordinating the overall efforts of state partners and other ATSDR divisions as they relate to the site evaluations.

Since 1999, ATSDR has worked to evaluate health concerns in Libby related to vermiculite ore contaminated by asbestos. In FY 2002, ATSDR conducted studies related to the Libby site and funded other activities undertaken by the state of Montana. Investigation activities at the Libby site include a mortality review of the area for the past 20 years, an asbestos-related disease registry, a study of the usefulness of compute tomography (CT) in identifying lung problems associated with asbestos exposure, a tremolite asbestos Toxicological Profile, and a case series involving a review of medical records associated with asbestos-related illness in the area. A total of 7,307 individuals participated in two rounds of asbestos medical testing, and 353 individuals took part in CT testing and studies.

From the work done, ATSDR was able to determine that the mortality resulting from malignant and non-malignant respiratory diseases was significantly elevated. In fact, the associated mortality rate was 20 to 40 percent higher in comparison to others in Montana and across the US from 1979 to 1998. Specifically, asbestosis mortality in Libby was 40 to 80 times higher than expected and lung cancer mortality was 1.2 to 1.3 times higher when compared to Montana and the US. X-ray findings established that 18% of study participants were found to have abnormalities in the lining of their lungs (pleural abnormalities). CT scans detested pleural abnormalities in 28% of those tested whose chest x-rays had been classified as indeterminate. A large majority (70%) of these persons were vermiculite mine/mill workers or their household contacts.

(2B) Site-Specific: Knollwood Community, Montgomery, Alabama - In FY 2002, ATSDR worked with the Center for Computational Epidemiology at Tuskegee University's college of Veterinary Medicine, Nursing, and Allied Health to investigate if there is an increase in cancer in the community. This year, university investigators and community residents re-created a cohort of all households since 1964 to establish a baseline of cancer incidence. The study is expected to be completed on schedule by close of the fiscal year.

(2C) Site-Specific: Calcasieu, Louisiana - Residents of Calcasieu are concerned about exposure to neighboring chemical manufacturing plants. In order identify possible health impacts, ATSDR worked in FY 2002 to collect data that will allow the Agency to assess the link between dixoin exposure associated with the chemical plants and adverse health outcomes. In FY 2003, ATSDR expects to complete data collection for the dioxin study and results in FY 2004.

Other site-specific investigations include: Anniston, Alabama; North Carolina; Kelly Air Force Base, Texas; Mattel-Tyco, Oregon; Dakota Respiratory, South Dakota; Hanford Birth Cohort, Washington; Conrail Rail Yard, Indiana. This effort is a follow-up to an initial exposure investigation conducted by ATSDR in Mossville, Louisiana.

(2D) Childhood Asthma and Hazardous Substances - The link between asthma and hazardous air pollutants remains a priority area of study for ATSDR. In FY 2002, the Agency continued two ongoing asthma studies with Massachusetts and Utah. A new program announcement has been posted for future work and an objective review panel was conducted to award funding to the proposed studies thought to provide the most valuable information.

(2E) Multiple Sclerosis and Hazardous Substances - In cooperation with state and local health partners, ATSDR is developing a capacity to respond to community concerns about Multiple Sclerosis (MS) and to more fully understand the epidemiology of MS. By close of FY 2002, ATSDR expects to complete an expert panel to assess the feasibility of tracking a high priority disease, such as MS. The panel will determine which diseases may be most successfully tracked and will make a recommendation to direct the Agency's work to determine how high priority diseases like MS are linked to toxic exposure.

Currently, the Agency is working on three ongoing studies related to MS. To date, abstraction of medical records for the studies are complete and reports are being compiled. However, the Agency has missed its target to complete the three studies as the project initiation was delayed due to the development of a partner agreement to use a single protocol. Development of an acceptable protocol and data collection instruments has required extensive time.

(2F) National Environmental Disease Tracking System - In FY 2002, ATSDR began supporting the creation of a national system to track disease and other health effects to ascertain their link to exposure to hazardous substances by holding workgroups to discuss issues related to surveillance. Specific diseases studied include: (2G) Hazardous Substances Emergency Events Surveillance (HSEES) - Each year, ATSDR's HSEES system collects and analyzes information on approximately 5,000 toxic releases in order to reduce the morbidity and mortality at sites. Information on acute hazardous substances in emergency events is collected, including the substance(s) released, number of victims, number and types of injuries, and number of evacuations. In FY 2002, ATSDR provided information about acute releases by publishing the biannual HSEES report, holding four national meetings and publishing multiple journal articles. In FY 2002, ATSDR maintained cooperative agreements with 16 states to participate in HSEES: Alabama, Colorado, Iowa, Louisiana, Minnesota, Mississippi, Missouri, New Jersey, New York, North Carolina, Oregon, Rhode Island, Texas, Utah, Washington, and Wisconsin.

Enhancing Exposure Tracking

(2H) Developing and Updating Exposure Registries - ATSDR uses exposure registries as a tool to track the short and long-term health impact of toxic exposures on individuals. In FY 2002, ATSDR was awarded $20 million in funding from the Federal Emergency Management Agency (FEMA) to develop a registry of 100,000 - 200,000 individuals exposed to contaminants released at the collapse of the World Trade Center. ATSDR will work with the New York City Health Department to develop the registry.

Additionally, In FY 2002, ATSDR has worked to further develop a registry of individuals exposed to vermiculite ore contaminated by asbestos. This is done to address health concerns related to the Libby, Montana site. In FY 2002, ATSDR worked with six states to analyze cancer and mortality data related to exposure. In FY 2003 and FY 2004, ATSDR expects to support this analysis with additional states impacted by asbestos contaminated vermiculite.

ATSDR has also updated five additional registries in FY 2002.

(2I) Prioritizing Disease Study and Tracking - In FY 2002, ATSDR has used expert scientific panels and workshops to enhance and design outcomes of future studies regarding tremolite asbestos as well as PCBs found in Anniston, Alabama. By the close of FY 2002, ATSDR expects to complete four additional panels.

Increasing Our Knowledge About Toxic Substances

(2J) Effects of Toxic Substances on Children's Health - In FY 2002, ATSDR has worked to develop and demonstrate sensitivity of a test method to detect abnormalities in neurodevelopment among children exposed to toxic substances. ATSDR's Division of Toxicology (DT) has assembled a battery of test methods to assess 4 neurodevelopmental functions. In FY 2003, the methods will be applied to a population of 300 at risk children. Study results are expected to be released in FY 2004. The test battery will provide quantitative assessments of learning and memory function, visual functioning, auditory functioning, and fine motor skills.

In FY 2002, ATSDR also focused its child studies on determining the risk of birth defects and cancer in children exposed in utero to trichloroethylene (TCE) and tetrachloroethylene (PCE). ATSDR is examining more than 12,500 surveys from women who were pregnant while living in base housing at Camp Lejeune (North Carolina) between 1968 and 1985. Some drinking water wells in operation at Camp Lejeune before 1985 were found to be contaminated with TCE and PCE, chemicals used as degreasers and dry cleaning solvents. The survey was conducted to determine the frequency of birth defects and childhood cancers among children who were in utero during this time and who might have been exposed to the chemicals. The survey phase of the project ended in January 2002 and the Agency expects to release the medically confirmed survey findings and final report in the summer of 2003.

Other studies included determining risk of adverse neurobehavioral development on children exposed to methylparathion and identifying risk of childhood brain tumors associated with exposure to hazardous substances. Findings on risk of getting Wilms Tumor from exposure to toxic substances were also published and did not support the hypothesis that Wilms tumor is associated with residing near a National Priorities List (NPL) site.

(2K) Preventing Exposure to Toxic Substances in the Great Lakes - Great Lakes research demonstrated the neurological effects in newborns and adults from exposure to contaminated Great Lakes fish. ATSDR, in partnership with a consortium of five Great Lakes states - Wisconsin, Illinois, Indiana, Michigan, and Ohio, has released fish consumption warnings about the contaminated fish in the Great Lakes. These fish advisories target at-risk populations such as the elderly, Native Americans, African-American infants, sports anglers, pregnant women, children, fetuses, and nursing infants. They explain how to safely consume fish from the lakes.

The program also published 10 articles in peer-reviewed journals. Key findings indicate a population of Lake Michigan fish-eating men who had higher levels of PCBs were more likely to father boys. Another finding included, children born to mothers who ate more than the median number (116) of fish meals before pregnancy were 5.4 times more likely to have low birth weight (5.4 oz. Lighter). Presentations were made at two international meetings including the 22nd International Symposium on Halogenated Environmental Organic Pollutants in Spain.

(2L) Alaska Native and Native American Environmental Health Concerns - With the exception of the Indian Health Service, ATSDR spends a greater percentage of its budgeted funding (2%) on the health of Alaska Natives and Native Americans than any other federal agency. In FY 2002, ATSDR continued its Alaska Native Diet Project. The project operates in response to the Congressional mandate to study and identify contaminants in the environment that may impact subsistence resources and to influence dietary decisions to prevent adverse health outcomes in Alaska Native and Native American people.

Over 600,000 people call Alaska home and about one-sixth are Alaska natives whose traditional diets can make up to 90% of their diet. Providing assurance that their subsistence foods are safe to eat is critical to their cultural practices. Dietary assessments are now complete for over 660 participants in 13 communities.

(2M) Refining Health Guidance Values - The Agency makes it a priority to refine health guidance values following acute releases in order to improve the information available for public health decision making. Acute releases that generate the need for the guidance include both biological and chemical terrorist events. In FY 2002, the Agency undertook a number of activities to help refine guidance, including quantitative environmental sampling of the Anthrax contaminated AMI building in Florida and reporting on lessons learned from the World Trade Center and Anthrax responses. Additionally, ATSDR has identified applicable health-based guidance values for minimum risk levels (MRLs), no-observed-adverse-effect levels (NOAELs), and lowest-observed-adverse-effect levels (LOAELs).

Implementing the Agency's Agenda for Public Health Environmental Research

(2N) Conducting Studies In Support of the Agenda - Annually, ATSDR's Office of the Associate Administrator for Science prioritizes and focuses proposed research across the six focus areas of the Agency's Agenda for Public Health Environmental Research (APHER). In FY 2002, the Agency met its goal to support six APHER projects across six focus areas: Exposure Assessment, Chemical Mixtures, Susceptible Populations, Communities and Tribal Involvement, Evaluation and Surveillance of Health Effects, and Health Promotion and Intervention. Cumulatively, the projects helped meet the FY 2002 target to leverage 17.5% of the Agency budget for research, with a total of $13,117,000.

(2O) Evaluating Research Compliance and Quality - By close of FY 2002, ATSDR completed its plan to evaluate the quality and impact of peer review journals in which ATSDR authors have published in 2000 and 2001. This plan will identify the number of times ATSDR-authored articles are cited by other researchers. The baseline established for citations in FY 2002 is 20.

(2P) Improving Compliance With Human Subjects and Research Requirements - Based on findings about human subjects requirements in FY 2001, the Agency renewed its commitment to improve awareness and compliance with requirements. In FY 2002, ATSDR sponsored two training courses on human subjects requirements and plans to continue refresh training in future years to provide 100% compliance. The Agency also conducted human subjects and technical review for six exposure investigations, four new research protocols, seven amendments, ten continuations, and three terminations to existing protocols.

In FY 2002, the Agency's Office of the Associate Administrator For Science facilitated clearance on approximately 150 articles, reports, fact sheets, response to reviewer documents and other ATSDR publications.



Performance associated with Goal 3 and its objectives is summarized in the figure below. References provided link performance measures to written discussion.







Figure 6. Performance Summary Chart for Strategic Goal 3

Program Description and Context ATSDR's Goal 3 seeks to provide information and educational resources to promote the understanding of risk, prevent exposure and enable health professionals to identify, diagnose and treat health impacts due to toxic exposures. The Agency provides information and educational resources in a variety of ways: These communication channels allow ATSDR to continually expand its reach to improve awareness of environmental public health issues.

Program Performance Analysis

Specific indications of ATSDR's success are highlighted below.

Improving Capabilities of Health Professionals

(3A) Health Professional Education - ATSDR constantly works to increase the number of health professionals that can recognize, diagnose and treat exposure related illness. In FY 2002, the Agency has worked to develop a strategy to identify these professionals so that their level of expertise can be measured and improved. Additionally, ATSDR expects to develop a national measurement protocol to evaluate the level of expertise.

In FY 2002, ATSDR's Division of Health Education and Promotion has worked to improve means to accredit health professionals over the Internet. Accreditation programs are to award health professionals working internationally to complete case studies in environmental medicine. Upon implementation, ATSDR plans to aggressively target educational accreditation over the Internet. This initiative helps the Agency to address the President's Management Agenda initiative to use e-government to better serve ATSDR's customers.

Additionally, ATSDR is able to train health professionals across the country through its 1043 Cooperative Agreement program. Through the cooperative agreements 10,213 professionals were trained. In support of health education and training, participants in the Cooperative Agreement program developed 140 different education materials which were distributed to 67,847 individuals.

(3B) Using Pediatric Environmental Health Specialty Units (PEHSUs) to Assist Health Professionals - ATSDR funds pediatric environmental health specialty units (PEHSUs) to assist parents, health care providers, local communities and others across the country. During this fiscal year the PEHSUs staff have clinically evaluated over 1,916 children, conducted over 28,500 telephone consultations, and provided education and training activities to over 18,700 health care and public health professionals. Additionally, ATSDR's Office of Regional Operations has conducted three rotational assignments to detail specialists in the Agency's regional offices.

(3C) Developing Guidance for Managing Hazardous Materials Incidents - Through its three volume Managing Hazardous Materials Incidents series, ATSDR has provided guidance to first responders, hospitals, and treating physicians on how to manage and treat chemically contaminated patients. ATSDR has either updated or developed new Medical Management Guidelines for 51 chemicals in Volume III of the series. These Medical Management Guidelines have been developed in a CD-ROM format and distributed to more than 3,600 Local Emergency Planning Committees, as well as all State Emergency Response Planning Commissions and health departments. The American Chemistry Council provided partial funding to support this effort. ATSDR plans to develop a user survey to evaluate the utility of the Managing Hazardous Materials Incidents series and revise it accordingly.

(3D) Improving Environmental Public Health Curricula - In FY 2002, ATSDR worked to assess curricula used to teach nurses about environmental health. Specifically, ATSDR's Office of Urban Affairs is assessing the utility of the Environmental Health and Nursing curriculum developed by Howard University for use by other health professionals beyond nurses. This assessment will assist ATSDR in developing a strategy to enhance environmental medical care for low income and minority populations.

Within the Division of Health Assessment and Consultation, the Tribal Affairs program has also worked to develop curricula for environmental public health study at tribal colleges and universities. In FY 2002, the curricula are being developed for four schools, College of Menominee Nation, Dine College, Northwest Indian College, and Turtle Mountain Community College.

(3E) Environmental Public Health Professionals Who Reflect the Communities They Serve - In FY 2002, the Office of Urban Affairs (OUA) participated in the planning and development of the Minority Health Professionals Foundation's (MHPF) Annual Symposium on Career Opportunities in Biomedical Sciences. The symposium was targeted to expose at least 500 minority students to the environmental public health mission. OUA exceeded this target by exposing 652 minority students to health professions through the MHPF biomedical symposium, in addition to nine students who were exposed through the MHPF cooperative agreement, Historically Black Colleges and Universities (HBCUs), and Minority Institutions (MI). Additionally, 98 Hispanic students were exposed to health professions through the Inter-American College Program.

Additionally, ATSDR's Office of Regional Operations facilitated the development of a Memorandum of Understanding (MOU) with the University of Texas Health Science Center. The agreement provides $200,000 in funding to build a bridge between federal and state partners that will provide environmental health education. This is the first initiative in HHS developed to train and recruit Hispanic medical students into environmental health.

(3F) Access to Healthcare at Affected Sites - In fourth quarter of FY 2002, ATSDR initiated a new project to analyze the barriers to health care at sites. ATSDR understands that access is critical to implementing the recommendations made at sites and to leveraging community health professionals to mitigate exposure to toxic substances.

(3G) Health Resources Services Administration (HRSA) Public Health Training Centers (PHTCs) - In FY 2002, ATSDR awarded the 14 PHTCs approximately $9,400 each to begin the integration of opportunities related to environmental health nursing into their training activities. Using ATSDR materials and various approaches directed toward the nursing workforce, the PHTCs reached approximately 5,500 health care professionals. Approximately 2,700 health care professionals participated in training programs, and of those 1,900 were nurses.

In addition to the number of health care professionals reached, the PHTCs efforts have resulted in other significant outcomes. For example, the Midwest Center for Life-Long-Learning has established a demo version of "Introduction to Environmental Health and Nursing," an on-line, stand alone training module (see attachment). Usability testing of the alpha version of the module was conducted and revisions incorporated into the beta version. The Michigan PHTC conducted a training program that involved a panel of nurse leader advocates. The training was taped and produced into a video titled, "Stepping Out of the Box." This video is being used in subsequent training programs. The South Central PHTC developed a satellite broadcast based out of Alabama, which reached 1153 participants across 20 states. The PHTC in Texas conducted 3 training sessions through the statewide tele-health network.

Participants of these training sessions will become a part of an environmental health nursing network for capacity building within the state. The Mid-America PHTC formed a partnership with the regional American Association of Occupational Health Nurses to conduct the Core Curriculum in Environmental Health workshop. The greatest capacity building outcome of the PHTCs efforts is evidenced in the new partnerships and collaborations that have formed and are continuing as a result of this support.

(3H) National Institute of Environmental Health Sciences (NIEHS)/National Institute of Nursing Research (NINR) Collaborations - Leaders in environmental health and nursing were invited to attend the August 2002 Nursing and Environmental Health Roundtable in Research Triangle Park, North Carolina, which was a jointly sponsored effort between NIEHS, NINR and ATSDR. Priority recommendations for advancing environmental health nursing were discussed and included: setting a research agenda, improving coordination, publishing, and dissemination of environmental health research and information, and targeting funding of multi-institutional and multidisciplinary efforts on all fronts. Establishing a clearinghouse to compile environmental health nursing research and information and to help set an agenda was also identified as a high priority.

A final summary report is currently being prepared for wide distribution. The three federal agencies plan to have a briefing to determine strategies for putting the report priority recommendations into action and identifying the essential partners that also need to be "at the table". A follow-up meeting with the identified partners is planned for Spring 2003.

Improving Public Understanding of Risk

(3I) Community Based Planning For Environmental Public Health - ATSDR's Division of Health Education and Promotion is working to increase the percentage of people in affected communities who are aware of and understand the risks associated with their exposure to toxic substances. In FY 2002, ATSDR developed a tool to measure results in communities. The tool will be pilot tested in FY 2003 and should be able to help affected communities take action to reduce their health risks. A quality assurance plan to develop a mechanism to measure public health impacts is underway and expected to be implemented in FY 2003.

Also in FY 2002, ATSDR initiated the development of risk communication software with CDC. The software is being designed to take health professionals through a series of decision models to identify each of the appropriate risk communications steps and strategies that should be used in a given situation.

(3J) Working With Media to Convey Risk - Each month, ATSDR responds to approximately 80 calls from the media. Responsiveness to these calls is important for the Agency to take advantage of earned media opportunities to convey information about toxic exposure to those in affected communities. In FY 2002, ATSDR's Office of Policy and External Affairs responded to 100% of media calls within 24 hours of receipt. In FY 2003 and 2004, the Agency will use coordinated marketing campaigns in sites. Additionally, ATSDR has provided 54 press releases and numerous talking points regarding health effects at the World Trade Center site, the anthrax investigations and the study of the human health impact of dioxins in Louisiana.

Other communications include fact sheets for use by the media. In FY 2002, ATSDR completed updates to fact sheets for each of the 50 states that are more than two years old. ATSDR expects to complete four new fact sheets on cross-cutting programs: (1) ATSDR's Response to Bioterrorism, (2) ATSDR's Cooperative Agreement Program, (3) ATSDR's Global Health Activities, and (4) ATSDR's Health Studies.

(3K) Training Others To Convey Risk in Crisis Situations - Generally, public health leaders at sites are the most trusted and most effective individuals to convey risk associated with toxic exposure. ATSDR has made it a priority to provide two media relations training sessions in FY 2002. Additionally, the Agency developed a Crisis Communications and Training Strategy to reach state and local partners. Future years will allow ATSDR to provide more advanced media and communications training.

(3L) Creating Awareness of Environmental Justice Issues - In FY 2002, ATSDR developed a lecture series as well as other forums and workshops on environmental justice. In FY 2003, ATSDR plans to continue the program to organize partnerships between the Agency and the Environmental Resource Center in Clark Atlanta and in underserved, low income and minority communities.

Reaching Target Audiences

(3M) Leveraging the Internet to Reach ATSDR Audiences - For years, ATSDR has taken advantage of the Internet as a means to reach its customer and stakeholder groups, from those affected by sites to the health professionals who treat them. In FY 2002, ATSDR has expanded its reach by publishing its website in Spanish. Additionally, ATSDR has conducted an Internet usability benchmark and tailored the information provided to the audiences using the website. Overall, hits to the website are up from 11.7 million in 2000, to 16 million in 2001. Total hits for FY 2002 reached over 21 million.

In order to make the ATSDR website more valuable to those who use it, ATSDR plans to conduct a usability benchmark of the website in FY 2003. The project was initially targeted for, but was not funded in FY 2002.

In FY 2002, ATSDR also worked to make the National Exposure Registry more available to the public. This year, ATSDR has made one data set available on the Internet.

ATSDR's use of the Internet to reach and support customers contributes to the e-government initiative from the President's Management Agenda.

(3N) Other Publications - In FY 2002, ATSDR's Division of Health Education and Promotion reformatted the Agency newsletter to better reach audiences. Other efforts by the division include increasing web site content and producing satellite broadcasts.

Improving Quality of Agency Products and Services

(3O) ATSDR As the Definitive Source For Toxicology Expertise - ATSDR's Toxicological Profiles and associated ToxFAQs fact sheets remain the definitive source on the effects of toxic substances found in the environment. In FY 2002, ATSDR's Division of Toxicology completed 12 new profiles. These profiles have been distributed to more than 3,000 stakeholders in 47 countries.

In FY 2002, an update of the profile for pesticide DDT was also published. Associated with increased risk for cancer, DDT was one of twelve persistent organic chemicals (POPs) considered for worldwide ban.

Also in the past year, the Division of Toxicology has produced 12 fact sheets on already released Tox Profiles. The fact sheets provide important chemical-specific information to the general public and are a quick and easy-to-read reference guide. By close of FY 2002, the Agency expects to raise the total to 24.

ATSDR's fact sheets will be distributed to over 13,000 stakeholders in 59 countries and produced in 27 different languages in FY 2002. Fact sheets translated into other languages serve specific communities living near hazardous waste sites by providing health information in native languages and assisting health assessors and educators in relating accurate information to exposed individuals. One example of such a fact sheet is for chromated copper arsenate (CCA). The CCA fact sheet was provided in response to USAID to support their request for health input regarding releases in Djibouti, Africa.



Performance associated with Goal 4 and its objectives is summarized in the figure below. References provided link performance measures to written discussion.





Figure 7. Performance Summary Chart for Strategic Goal 4


Program Description and Context

Goal 4 challenges the Agency to work through partnerships to build environmental public health capacity outside the Agency as a means to protect a greater number of people from exposure to hazardous substances in the environment. Ultimately, the use of partnerships allows ATSDR to reach more people than it ever could on its own.

Although Goal 4 is new to ATSDR (as of the revised strategic plan, 2002-2007), the partnership concept is not. Over the years, ATSDR has adapted its partnership model and achieved substantial success. Partnerships include capacity building cooperative agreements, work with health professional associations, relationships with academic institutions, and various government institutions.

Program Performance Analysis

Specific indications of ATSDR's success are highlighted below.

Improving Capacity of States and Tribes

(4A) ATSDR's 1043 Cooperative Agreement Program - At more than $10 million, the 1043 Cooperative Agreement Program continued to be ATSDR's largest funded item in FY 2002. The program, designed to build the capacity of governments to work with toxic sites, was expanded to 33 jurisdictions (states, commonwealths, territories, tribes), an increase of five awards over FY 2001. 1043 Cooperative Agreement Funding allowed these jurisdictions to reach more than 1.7 million residents in 591 communities. Additionally, through the program funded health studies in seven states to determine health effects caused by toxic sites. Studies included California (2), Florida (1), Illinois (1), New York (2), Missouri (1), Wisconsin (2) and Texas (1).

This year ATSDR has developed a means to evaluate its own efforts on behalf of the 1043 cooperative agreement partners. This evaluation effort has lead to the development of ATSDR's "360 degree" evaluation tool. In FY 2003, ATSDR will make the tool available to the 1043 partners to provide critical, constructive input on the Technical Project Team provided by ATSDR. The 360 degree evaluation will ultimately yield insight about the performance of each team member and the overall effectiveness and proficiency of the team. Ultimately, ATSDR expects to use evaluation results to design a more effective capacity building program.

ATSDR's 1043 cooperative agreement partners interact directly with the Agency through the STARS system. The system allows cooperative agreement partners to report progress, including lessons learned on the effectiveness of actions taken at sites. In FY 2002, 70% of the Agency's 1043 cooperative agreement partners completed 80% of their productivity goals. Information in the STARS system helps ATSDR direct its actions and guidance to continually build capacity of its partners.

(4B) Tribal Cooperative Agreements - ATSDR's Tribal Affairs program facilitates cooperative agreements with American Indian and Alaska Native tribes. Cooperative agreements are maintained for various purposes, including the development of environmental public health curricula at tribal colleges, as previously discussed. The Tribal Affairs program also sponsors cooperative agreements with tribes in proximity to the Hanford Nuclear Reservation in Washington, a Department of Energy facility used to produce plutonium for the Manhattan Project. Funding from the agreements allows seven tribes impacted by the release of radiation at the Hanford site to develop a needs assessment of health needs and impacts in FY 2002.

Tribes supported by the Hanford cooperative agreement program include Coeur d'Alene, Nez Perce, Confederated Tribes of the Umatilla, Confederated Tribes of Warm Springs, Colville Confederated Tribes, Kalispel, Kootenai, Spokane, and Yakama Indian Nation. These seven American Indian tribes around the Hanford Nuclear Reservation continued to update their training needs assessment. Under the ATSDR, the National Center for Environmental Health (NCEH) and the Department of Energy (DOE) project, the data from the needs assessments will be used in the development of an environmental health plan as it relates to Hanford.

ATSDR has several partnerships with Native Americans that aid in building environmental public health capacity within the various tribes and tribal organizations. For example, in the past year the Office Of Tribal Affairs and the ATSDR training program developed a Training Needs Assessment and distributed it to the 235 federal recognized Alaskan Native Tribes to determine the most appropriate training to be offered. In addition, six presentations and information exchange sessions were held to identify the environmental public health training needs for tribal clinicians. Currently, the identified needs are being compared with existing training materials to determine which materials need modification and what materials need to be developed. The results will be incorporated into a tribal clinicians training program.

ATSDR has agreements with three tribal colleges and universities to assist in development of environmental health curriculum. Representatives from Dineh College came to ATSDR and discussed their current environmental health curriculum and areas for potential collaborations. Planning is currently underway with the other two tribal colleges to arrange discussions with ATSDR concerning their curriculum and how ATSDR may contribute.

Improving Capacity in Minority Communities

(4C) Minority Health Professions Foundation - ATSDR's cooperative agreement with the Minority Health Professions Foundation works to provide a broad range of public health activities targeted to minority and low-income communities. In FY 2002, the Agency worked to identify shared priorities and common goals with the organization in order to improve capacity in communities. A program of environmental health, toxicology, and public health research to investigate the role of environmental health disparities is under development.

Working With Domestic Partners

(4D) Board of Scientific Counselors - ATSDR leverages the Board of Scientific Counselors (BSC) to bring in outside perspectives from scientific and lay public to identify ways to better serve communities. In FY 2002, ATSDR used the BSC as a new forum to solicit input and address concerns of state and local health departments. In FY 2002, ATSDR was able to form the Health Department Subcommittee under the BSC. Additionally, ATSDR is working to evaluate the effectiveness of the existing Community Tribal Subcommittee with results expected in FY 2003.

(4E) Regional Partners - In FY 2002, ATSDR's Office of Regional Operations worked to provide three regional retreats to build capacity within ATSDR's 10 regions. Participants included state and local health departments. Training was provided to approximately 70 individuals.

Working With International Partners

(4F) Responding to International Environmental Public Health Events - In FY 2002, ATSDR worked to initiate a partnership with the government of India to conduct a joint research project. The project is designed to facilitate technology transfer to Indian researchers through work with US scientists. Political tensions between India and Pakistan and the events of September 11 resulting in staff reallocation have forced the Agency to delay the project for FY 2002. However, the Agency plans to continue pursuit of the partnership.

Working With Other Federal Agencies

(4G) Protecting American From Toxic Exposure At Federal Facilities - ATSDR's Office of Federal Programs provides fee-for-service (reimbursable) work to manage toxic exposures on federal properties. In FY 2002, ATSDR forged a number of partnerships, including the Departments of Defense, Energy, Agriculture, Interior (Bureau of Indian Affairs), and Transportation (Coast Guard), as well as NASA.

Improving ATSDR Visibility and Identity

(4H) Revisiting Partnership Priorities and Goals - In FY 2002 ATSDR has worked to take inventory of the activities undertaken with partners and to evaluate partnership priorities and goals. Strengthening of partnership activities in FY 2002 continues with joint efforts such as risk communication training with SOPHE, fellowship training with ACMT, workshop planning sessions between NIEHS centers and PEHSUs. A biennial partners meeting is currently being planned for FY 2003, with plans underway to increase the frequency of the meetings to yearly. ATSDR will continue facilitating collaborative efforts between PEHSU and NIEHS Centers and the fellowship training program with ACMT will result in expanded health professional training and development with regards to environmental health.



Program Description and Context

Goal 5 is new to ATSDR, recently added under the Agency's strategic plan for 2002 -2007. ATSDR recognizes the importance of developing and maintaining a quality work environment in order to remain a viable organization in service to the American public. As well, Goal 5 plays a significant role in how ATSDR has worked to support the President's Management Agenda.

Under the Agency's Office of Program Operations and Management (OPOM) , Quality of Work Life Committee and in partnership with CDC's Human Resource Management Office, ATSDR is able to provide a quality work environment for its employees. As an internal goal for the Agency, individual performance measures are not provided for the performance plan and report.

In 1996, HHS launched its Quality of Work Life Initiative to annually measure employee satisfaction. Since 1997, the Human Resource Management Index has provided a summary of employee perceptions of the work environment, showing a steady improvement in how ATSDR employees view the Agency.

The following section details progress made to foster a quality work environment at ATSDR.

Program Performance Analysis

Progress Implementing the President's Management Agenda - In FY 2002, ATSDR used its efforts under Goal 5 to address each of the five areas of the PMA. Promoting Collaboration, Growth and Development Opportunities - In FY 2002, ATSDR provided a number of means to promote collaboration, growth and development of its employees. Training opportunities include: Professional development opportunities are also fostered by encouraging ATSDR employees to participate in conferences or other meetings of professional associations, Agency partners and other forums. Participation allows ATSDR employees to share ideas with their scientific colleagues and promotes the sharing of ideas across government and private sector groups. ATSDR also provides for rotational assignments in ATSDR's regional offices.

In the future, ATSDR will be able to target its training and development activities to address any identified skill gaps, including those identified by succession planning to comply with the PMA initiative to provide strategic management of human capital.

Promoting Effective Leadership and Management - Our commitment to implementing the President's Management Agenda has strengthened our commitment to this objective. Examples of how ATSDR promoted effective leadership and management in FY 2002 include: ATSDR recognizes the individual milestones and accomplishments of our organization, and presents these awards on an annual basis: In addition to internal awards presented to staff, a number of individual and group awards have been given to ATSDR employees from outside sources: Promoting Workforce Diversity, Targeted Recruitment and Hiring - In FY 2002, ATSDR has leveraged a number of means to maintain a diverse workforce. For example: Promoting Improved Facilities and Services - Annually, ATSDR works with CDC to provide improved facilities and services such as: Additionally, ATSDR is on target to consolidate many of its facilities at the beginning of FY 2003. This consolidation will allow more ATSDR employees to work co-located. We expect the consolidation to promote workplace collaboration and improve communication and relations among staff.



III. APPENDICES

APPENDIX 1:
LINKAGE TO HHS AND AGENCY STRATEGIC PLANS


This appendix demonstrates, in chart form, how ATSDR's work supports the HHS strategic plan and its sister agency, CDC.



Figure 8. Linkage to HHS and CDC Goals
Specifically, ATSDR supports its stakeholders in the following ways:

HHS Goal 1: ATSDR reduces the major threats to the health and well being of Americans by evaluating health risks from toxic sites, determining the relationship between toxic exposure and disease and by providing information about risks to the public.

HHS Goal 2: ATSDR's work prepares environmental health professionals to respond to chemical and biological emergencies, including incidents of terrorism. ATSDR not only provides training and planning expertise, but also advances the science of how chemical agents impact public health.

HHS Goal 3: ATSDR improves access to healthcare in communities affected by toxic exposure.

HHS Goal 4: ATSDR continually enhances the capacity and productivity of science through the health studies, consultations and assessments it performs each year. Agency research is prioritized and focused across the Agency's Agenda for Public Health Environmental Research (APHER).

HHS Goal 5: ATSDR strives to improve the quality and quantity of all its health services. While the APHER enhances the focus of research, ATSDR provides training, education and information resources to continually improve science, whether it is practiced inside the doors of the Agency or among its partners.

HHS Goal 6: ATSDR's work in communities affected by toxic sites and releases is often targeted to underserved communities. Through many programs and by work done through the Office of Urban Affairs, ATSDR is able to reach those most in need.

HHS Goal 7: ATSDR's Office of Child Health is dedicated to ensuring that the Agency's work addresses the needs of children, who are often more vulnerable to toxic exposure. Each year, ATSDR targets studies and assessments to determine the effects of toxic substances on children.

HHS Goal 8: ATDSR is committed to working with HHS to respond to the President's Management Agenda. ATSDR's Goal 5 addresses a number of management initiatives that directly support improved management within HHS and in compliance with the Agenda.

CDC Goal 1: ATSDR works to protect health and safety by evaluating health risks from toxic sites, determining the relationship between toxic exposure and disease and by providing information about risks to the public.

CDC Goal 2: ATSDR provides training, education and information resources through various means to support health decisions. The Agency's Toxicological Profiles are just one example of how ATSDR's expertise is shared and used for environmental public health decision-making.

CDC Goal 3: ATSDR has dedicated Goal 4 to building and maintaining strong partnerships. Through these partnerships, the Agency is able to reach more people at risk from exposure to hazardous substances.

APPENDIX 2:
CHANGES AND IMPROVEMENTS OVER PREVIOUS YEAR

ATSDR is proud to have developed a new long-term strategy and supporting performance documents for FY 2002. This new performance plan is the result of an effort to plan continuous improvement and to regularly evaluate the progress of the Agency. These efforts have yielded a number of enhancements to the performance plan, some of which are highlighted below.

New approach - As noted in the Overview of Performance Measurement, ATSDR has re-focused its efforts to provide a more integrated process to link strategy, performance and budgeting. This approach will allow ATSDR to make more informed management decisions about the focus of the organization and the use of resources.

New vision, mission, goals and objectives - As previously mentioned, ATSDR has developed a new vision, mission, goals and objectives to better protect America's health from toxic exposures (see Appendix VI for changes to objectives). These goals capture our flexibility to respond to a constantly changing environment, developments in technology, emerging site-based needs, a renewed commitment to our people, and the ongoing war for talent.

Improved performance measures - Based upon feedback from stakeholders and oversight groups, ATSDR has made an effort to develop more meaningful and more measurable performance measures that challenge the Agency to improve its operations year-to-year. ATSDR has minimized the total number of measures while increasing the number of outcomes and decreasing the number of measures that demonstrate outputs and process. This is an ongoing effort that will yield additional improvements in ATSDR's FY 2003 and future performance plans.

Changes or improvements to form and content - As part of the Agency's effort to develop easy-to-read and effective materials (see Goal 4, Objective 2), ATSDR has worked to develop a more reader-friendly performance plan. In this document and in ATSDR's new strategic plan, the Agency has improved its explanation of ATSDR's services and why they are critically important to Americans. Descriptive language is provided for each strategic goal and objective to demonstrate their linkages and to make the performance measures more meaningful to the readers.

This year's performance plan also provides an increased level of detail over previous years. Multiple appendices include supplemental information to create a more complete picture of ATSDR's work and performance. For example, Appendix 3 highlights ATSDR's partnerships and crosscutting programs. These programs, which partner ATSDR with other Federal agencies and public health organizations, demonstrate the Agency's outreach and work with stakeholders as well as the significant amount of program work funded through reimbursable monies not included in the Agency's CERCLA budget.

APPENDIX 3:
PARTNERSHIPS AND COORDINATION


FEMA/New York City Health Department for WTC Registry - The Federal Emergency Management Agency (FEMA) has provide $20 million in funding to ATSDR to develop a registry to track the health of 100,000-200,000 people who may have been exposed to substances emanating from the collapse of the World Trade Center after the September 11 terrorist attacks. ATSDR will work with the New York City Department of Health in creating the registry.

EPA (headquarters and regional offices) - ATSDR must continue to work closely with EPA to ensure that the Agency meets EPA remediation timelines. Close cooperation with EPA will ensure the maximum value of ATSDR's analysis. A particularly effective way to coordinate with EPA has been achieved by posting ATSDR staff members in each EPA regional office.

Affected citizens - Examples of effective partnering with affected citizens is exemplified by the work in Libby, Montana; Brick Township, New Jersey, Autism Public Health Assessment, etc. ATSDR emphasized the need for community involvement and outreach, and the cooperation of the citizens greatly enhanced public health activities. ATSDR coordinated all activities to ensure that a consistent message was conveyed to the community members.

Government researchers - ATSDR must continue to leverage the scientific advances of CDC, the National Institutes of Health, and others to ensure that the Agency remains at the forefront of applied toxicology and epidemiology. For example, important studies have been published by CDC and the National Institute for Occupational Safety and Health to document asbestos exposure and related health effects. These studies continue to provide the framework for assessing asbestos exposure in affected communities.

Academic institutions - The Agency must continue to facilitate coordination with academic institutions. Knowledge gained from academic research can be successfully applied by Agency professionals. An excellent example of this would be exposure and dose assessment research that has been particularly helpful in correlating high consumption of Great Lakes fish with symptoms of the local populations.

State and tribal governments and associations - Local groups will continue to be the best source of information for local understanding of environmental impact. Any toxic exposure and surveillance program depends on the awareness and cooperation of local groups. Most Agency success stories begin with the involvement of a local community or local organizations in a community (for example, the request for an investigation of sheep vats from the Bureau of Indian Affairs via the Navajo, Zuni, and Pueblo reservations).

Other federal agencies - ATSDR is working with an increasing number of federal facilities and other federal agencies and will continue to work with these other federal groups as ATSDR continues to receive requests for assistance.

The following table identifies crosscutting programs conducted with ATSDR's partners in FY 2002. Included in the table is the funding source.
NO STAKEHOLDER PROGRAM FUNDING SOURCE
      Direct Reimbursable Funded by ATSDR
1 Agency for International Development Assess, evaluate, manage, plan and formulate emergency and disaster response Information on toxic substances   X  
2 American Academy of Pediatrics (AAP) Train Health Care Professionals     X
3 American Association of Occupational Health Nurses (AAOHN) Train Health Care Professionals     X
4 American College of Medical Toxicologists (ACMT) Provide Environmental Health Education     X
5 American College of Preventive Medicine (ACPM) Information on Toxic Substances
Train Health Care Professionals
    X
6 Association of Occupational and Environmental Clinics (AOEC) Train Health Care Professionals
Provide Environmental Health Education
Community-Based Health Intervention
Children's Health
    X
7 Association of Occupational and Environmental Clinics (AOEC) PEHSU clinics     X
8 Association of State and Territorial Health Officials (ASTHO) Provide Environmental Health Training     X
9 City of Dallas, TX Brownfield     X
10 City of Denver, CO Brownfield     X
11 City of Stamford, CT Brownfield     X
12 Colleges:
Boston University
Tulane University
Children's Health
Community-Based Health Intervention
    X
13 Department of Defense Information on toxic substance
Community Involvement
  X  
14 Department of Energy Information on toxic substances
Community Involvement
  X  
15 Department of Interior (BIA) Information on Toxic Substances
Community Involvement
Public Health Assessment
Information Dissemination
Health Studies
Health Education & Promotion
  X  
16 Environmental Protection Agency Superfund sites
Brownfields
RCRA
Community Assistance/Involvement
Information/testing/ research on toxic substances
Neurobehavioral test methods
X    
17 Federal Emergency Management Agency (FEMA) Development of registry of health impacts due to World Trade Center terrorist attacks   X  
18 Food and Drug Administration Neurobehavioral test methods   X  
19 Health Resources and Services Administration (HRSA) Train Health Care Professionals
Community-Based Health Intervention
    X
20 Institute of Medicine (IOM) Information on toxic substances     X
21 Migrant Clinicians Network) Provide Environmental Health Education     X
22 NASA Interactive Profiles   X  
23 National Association of City and County Health Officials (NACCHO) Bioterrorism
Brownfields
Information on Toxic Substances
Provide Environmental Health Training
    X
24 National Environmental Health Association Bioterrorism
Information on Toxic Substances
    X
25 National Institute of Environmental Health Sciences Information/ testing/ research on toxic substances Proposed    
26 Oak Ridge Institute for Science and Education (ORISE) Train Health Care Professionals
Environmental Health Training
    X
27 The National Alliance for Hispanic Health (NAHH) Provide Environmental Health Education     X
28 Tribal Affairs:
Indian Health Council
Ely Shoshone Tribe
St. Regis Mohawk Tribe
Eight Northern Indian Pueblos Council
Community-Based Health Education     X


APPENDIX 4:
DATA VERIFICATION AND VALIDATION


In FY 2002, ATSDR has made significant progress to develop and maintain useful data and statistics to support the Agency's scientific work as well as its strategic planning, performance measurement and reporting needs. This information is collected and managed at various levels and from various sources to provide the Agency with a comprehensive view of its performance. The different levels and sources are captured in three separate, but complimentary systems:

Project Profile - ATSDR's newest effort to track how Agency programs support the strategic goals and objectives of the Agency. Project Profile is being developed to establish and maintain a strong management link between the Agency budget, strategy and performance, in compliance with GPRA guidance and the President's Management Agenda. The Project Profile system is scheduled for implementation by the beginning of FY 2003.

HazDat - The Agency's long-standing system to maintain information on all aspects of ATSDR's work.

STARS - The Agency's newly developed system to collect information on the progress of the 1043 Cooperative Agreement program, typically the Agency's single largest budget program. The STARS system interfaces directly with the grantee to collect information over the Internet.

Collectively, the three systems will work together to provide information in support of ATSDR's performance planning, reporting and internal management. Specifically, the Project Profile system will allow ATSDR employees to align programs to the Agency's goals and objectives. The system also allows employees to establish performance measures and indicators, reflective of those in this document. Progress toward achieving the individual indicators and all higher-level components may be tracked using quarterly activities and milestones.

While Project Profile manages information provided by ATSDR employees, the STARS system collects and manages information provided by ATSDR's 1043 State Cooperative Agreement partners. Using the STARS system, grantees in the individual states may provide their Annual Plan of Work (APOW) which demonstrates how they will use the awarded cooperative agreement monies. Within the APOW, the grantees establish their performance goals through milestones and activities. On a quarterly basis, grantees provide performance reports through the STARS system. In order to provide a comprehensive view of progress made by Agency partners and the Agency itself, ATSDR is working to feed information from the STARS system into the HazDat system.

HazDat is a robust scientific and administrative data management system that contains information on all aspects of the Agency's work. ATSDR developed HazDat to provide information on the release of hazardous substances from Superfund waste sites or from emergency events and on the effects of these substances on the health of human populations. This Agency-wide database was developed to provide ready access to reliable scientific and administrative information that is accurate and consistent with the Agency documents serving as the source of the data. Results of the Agency's activities maintained in HazDat are assessed each year to determine the best course of action for meeting the public's evolving environmental health needs. The identified course of action then becomes the Agency's Annual Plan of Work, from which the Agency develops program plans and priorities. Information from HazDat is also used to determine how best to work with Agency partners and stakeholders to assure that mutual goals are met.

HazDat permits the tracking of Agency activities and important site information and contains environmental and health data found in Agency public health assessments and consultations, health studies, educational materials, and toxicological profiles, as described below.

Public Health Assessments and Consultations

Data collected from public health assessments and consultations include: identification of potential exposure pathways, contaminants of concern, affected populations, community health concerns, public health hazard categories, and site-specific recommendations. These data permit identification of populations within potential and completed exposure pathways and are vital for development of the mandated Priority List of Hazardous Substances (to be the subject of toxicological profiles) based on the frequency of occurrence of substances at Superfund sites and the potential for human exposure.

Health Studies

Data collected from epidemiologic studies, health investigations, health statistics reviews, exposure registries, and surveillance activities include: objectives, population data, and health effects and substances of concern. Health studies are conducted to assess the relationship of hazardous waste at Superfund sites to adverse human health effects focusing on the seven priority health conditions (birth defects and reproductive disorders, cancer, immune function disorders, kidney dysfunction, liver dysfunction, lung and respiratory diseases, and neurotoxic disorders).

Educational Materials and Training

Health education and communication materials are developed for health care providers and communities to increase awareness and knowledge and promote behavioral change to eliminate exposures and mitigate adverse human health outcomes relate to hazardous substances in the environment. Data collected from these materials include: target audience, material distribution, related substances, related sites, needs assessment method, promotional method, and evaluation method.

Toxicological Profiles

Toxicological profiles provide essential information for health professionals about relationships between exposure to hazardous substances and adverse effects on human health. Data collected from these profiles include: adverse health effects associated with routes and durations of exposure, interactions of substances, health-based guidelines, susceptible populations, and biomarkers of exposure and effect. Data are also collected regarding priority data needs identified through development of the profiles.

Data necessary to operate ATSDR's public health programs within the Superfund program include time and cost of services rendered. These data are required by Superfund and are useful to public health officials in assessing the effectiveness of the programs and maintaining accountability for dollars spent.

APPENDIX 5:
PERFORMANCE MEASUREMENT LINKAGES


Clinger-Cohen Act

ATSDR is currently implementing the requirements under the Clinger-Cohen Act of 1996 (CCA) for information technology (IT) capital investment planning, monitoring, and performance measurement. The Information Technology Investment Review Board (ITIRB) process has been established and was released CDC-wide, including ATSDR, on January 5, 1999 via the Intranet. CCA compliance became a component of the CDC/ATSDR budget planning process for the FY 2001 budget. Major IT investments in support of the Agency's mission are subject to OMB's Capital Asset Plan and Business Case, support of the President's Management Agenda and, as applicable, completion of exhibits 300 and 53.

Also in compliance with CCA, CDC/ATSDR has developed several components of the Agency's information technology architecture, such as certain health data standards, networking and telecommunications architecture, information security, and the majority of the Agency's administrative procedures. More extensive work on other core business processes, information flows, process and data models is ongoing.

In addition to efforts in the implementation of CCA, CDC/ATSDR has a well integrated GPRA and IRM Strategic Plan that aligns IT products and services with ATSDR's ever-changing mission needs and directions. The IRM strategic goals, strategies and performance measures support the mission, mission goals, and CDC's and ATSDR's GPRA performance plans.

APPENDIX 6:
CHANGES TO GOALS AND OBJECTIVES


This appendix demonstrates the changes in ATSDR goals introduced in the Agency's strategic plan for 2002-2007. Additionally, the appendix also illustrates changes to the strategic objectives since they were developed for the new strategic plan. Changes demonstrate considerable thought about how they impact the direction of the Agency and the accuracy with which they depict ATSDR's work.















¹ATSDR's FY 2002 direct appropriation budget is approximately $78 million, which is approximately equivalent to costs associated with 8,035 chronic cases (.01% of the total) with an average annual cost of $9,314 each where $1.4 trillion is total HCFA health care cost and chronic disease represents 60% of cost.

This page updated January 10, 2003
R. Searfoss / ATSDR-OpeaMail@cdc.gov


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