The 2003 State Homeland Assessment and Strategy Program, administered by the Office for Domestic Preparedness (ODP) in the Department of Homeland Security, is a national program designed to assess emergency preparedness at the state and local level, and to provide funding to address gaps in preparedness. The 2003 program is an update and refinement of the 1999 statewide emergency preparedness grants program, developed and administered by ODP, as part of the Department of Justice (DOJ) http://www.ojp.usdoj.gov/odp/assessments/definition.htm. For a complete description of the 2003 Homeland Security Statewide Grants Program, see http://www.ojp.usdoj.gov/odp/assessments/definition.htm or for a copy of the handbooks (jurisdiction, state, reference), see http://www.shsasresources.com.

Beginning in 1999, CDC worked with the Office for Domestic Preparedness (ODP), Department of Justice (DOJ), in coordinating an assessment of emergency preparedness of local public health jurisdictions, as part of a larger statewide emergency preparedness grants program developed and administered by DOJ http://www.ojp.usdoj.gov/odp/assessments/definition.htm. After September 11, 2001, Congress directed ODP to update the needs assessment to document progress made, as well as to identify remaining areas in need of improvement. CDC is again working with ODP in developing a comprehensive, integrated assessment of public health`s ability to rapidly and effectively detect and respond to biological and chemical agents, as well as other acute public health emergencies. CDC and its partners that represent public health agencies at the local and state levels (the National Association of County and City Health Officials (NACCHO) and the Association of State and Territorial Health Officials (ASTHO)) had two major goals in developing the 2003 assessment strategy.

• 1. to improve integration with other emergency response disciplines;
• 2. to integrate assessment process with CDC Terrorism Grant activities and evaluation strategies; and
• 3. to improve the utility of the assessment, including making access to the data easier.

Participation by public health in the updated 2003 grants program differs considerably from the previous 1999 program. Though much was learned about the state of public health preparedness from the 1999 experience, CDC and ODP, as well as public health and emergency management partners, felt that a more integrated approach to assessment would be even more valuable. The 1999 Grants Program included Public Health, but only through a separate assessment process from the overall program. As such, there was less than optimum opportunity to work together with other emergency response partners at both the local and state levels in assessing preparedness needs and capabilities and for sharing in the possible funding from DOJ to the states. The principal difference between the two grant programs is that the 2003 program includes Public health as one of 10 disciplines included in an integrated assessment (with Law Enforcement, Emergency Medical Services, Emergency Management, Fire Services, Hazardous Materials, Public Works, Governmental Administration, Public Safety Communication, and Health Care). Officials from each discipline will have the opportunity to highlight areas of need in planning, organization, equipment, training, and exercises.

The 2003 Homeland Security Statewide Grants Program began on July 1, 2003, with the implementation of the on-line assessment capabilities. It is expected that states will complete and submit assessments for all local jurisdictions, as well as state assessments and an overall State Homeland Security Strategy by December 31, 2003. States will set their own internal deadlines for completion of local assessments.

A Public Health representative (to be appointed by the State Health Official) will participate in a 10-discipline working group that will assess vulnerabilities, as well as needs and capabilities of the public health agency. The State Health Official (SHO) should contact the State Administrative Agency (SAA) director, who is charged with convening the State workgroup, to ensure that Public Health is included in the process. The Public Health representative for the local jurisdiction (usually the director or the Preparedness and Response coordinator of the local public health agency) should contact the SHO to ensure their participation in the local process. The process for Local and State jurisdictions are outlined in the following flowchart:

• 2003 Homeland Security_state / local processes PDF

The State Administrative Agency (SAA) director is the person responsible for the overall conduct of the state`s or territory`s activities related to the 2003 Homeland Security Grants Program. A complete list of the SAAs is available:

• SAA List PDF

The Public Health Preparedness and Response coordinator, in most cases, will be responsible for the Public Health participation in the 2003 Homeland Security Grants Program within a given state. To identify the Public Health Coordinator in your state, you may contact the CDC State and Local Preparedness Program (SLPP) (404-498-2200). The CDC project officer for your state will provide the name and contact information of your Preparedness and Response coordinator.

The Continuing Guidance for the CDC Cooperative Agreement on Public Health Preparedness and Response for Bioterrorism http://www.bt.cdc.gov/planning/continuationguidance requires that each state conduct an assessment of its emergency preparedness and response capabilities and progress made on activities funded by grant. Assessment is required, but no specific tool is mandated. The specific tasks listed in the Homeland Security assessment that relate to Public Health were chosen to relate to items outlined in the State and Local Public Health Preparedness and Response Capacity Inventory http://www.phppo.cdc.gov/od/inventory. The Inventory was developed by CDC to assist state and local public health agencies in self-assessing progress on activities described in the Bioterrorism Supplemental Funding Cooperative Agreement. The Inventory can also be used as a guide for determining capacities that ought to be in place in the Focus Areas according to current expert opinion. As of June 2003, 20 states have used, are using, or plan to use the State Inventory or a state-specific modification of it to assess their emergency preparedness and response capacities. More than 1000 local jurisdictions in 24 states have used or are planning to use the Local Inventory. State and local health departments that have used the Inventory can refer to the table that pairs public health tasks from the Homeland Security Assessment with the corresponding Inventory questions.

• Task List for Public Health Responder Capabilities PDF

Note that, in most cases, the Inventory questions are more specific than the task list, and more than one question may relate. Responses to the Inventory questions may be used as a guide to responding to the Homeland Security assessment. Clearly, if State and local health agencies have conducted assessments using other tools, they may also relate to the specific task items, and could be used to help complete the Homeland Security assessment.

There are several ways in which the current assessment differs from the one in which local public health jurisdictions participated previously, all of them designed to improve the utility of the assessment.

• Integration of Public Health with Other Emergency Response Partners: The 2003 Public Health component is well integrated with assessments conducted by the other emergency response disciplines (Law Enforcement, Emergency Medical Services, Emergency Management, Fire Services, Hazardous Materials, Public Works, Governmental Administration, Public Safety Communication, and Health Care). Rather than conducting its own separate assessment, Public Health will be represented on the 10-discipline workgroup convened by each local jurisdiction and by each state.
• More funding resources available to Public Health: In most cases, the 1999 DOJ assessment process did not result in funding or other resources being targeted to Public Health at the State or local level. The 2003 process allows more ability for states to direct funding to Public Health, as an emergency response partner integrated in the assessment process. States and locals are able to identify desired equipment from a wider range of lists, with more applicability to Public Health.
• Definition of Jurisdiction: Jurisdictions need to be defined in conjunction with emergency management. Because the previous public health assessment was conducted separately, public health was able to define its local jurisdiction in whatever way it deemed appropriate (e.g., municipality, county, district, state), regardless of how the emergency management local jurisdiction was defined. The current assessment strategy requires a unified approach, and therefore emergency management and public health must define and assess local jurisdictions defined in the same manner.
• Focus on Public Health Agency: The 1999 tool assessed the capabilities of the `local public health system` (i.e., the public health agency and other agencies and organizations with public health roles and responsibilities). The 2003 assessment seeks information about the `local public health agency.`
• Question Framework: The 1999 assessment was an extensive set of questions based on the 10 Essential Services of Public Health (link to reference: Harrell, J.A. and Baker, E.L. The essential services of public health. Leadership in Public Health 3(3):27-31, 1994.). The elements of the 2003 assessment specific to public health are derived from the capacities assessed in the State and Local Public Health Preparedness and Response Capacity Inventory http://www.phppo.cdc.gov/od/inventory. Rather than the 10 Essential Services, the Inventory structures its questions on the 6 funded Focus Areas of the CDC Terrorism Grant. The table (link to `Attach 3_Homeland Security Assessment_PH task list.doc`) cross-references the specific items in the Homeland Security task list with the questions in the state and local Inventory that relate to them.
• Broader Allowable Responses: The 1999 assessment tool allowed only `yes` or `no` (or `not applicable` in some cases) as valid responses. The 2003 assessment allows a broader range of responses: `yes,` `no', `partial`, `not applicable`,`no, the task is a state-designated responsibility.` (The response alternative `no, the task is a state-designated responsibility` is allowed only for the Public Health component of the ODP assessment.)
• Inclusion of State Agency: The 1999 grants program only involved assessment of local jurisdictions. The 2003 program will also include an assessment of state agencies.
• Emergency Scenario Development: The 1999 assessment asked about general capacities, without tying them to a specific emergency or scenario. To make responses more relevant and meaningful, the 2003 Grants Program requires that members of the 10-discipline workgroup in each local jurisdiction or state develop real-world possible scenarios for their jurisdiction, involving a response to chemical, biological, radiological, nuclear, or explosive (CBRNE) events. The assessment is then completed with regard to current and desired capabilities to respond to those scenarios.
• Easier Access to Data: The 2003 program has been redesigned to allow better, more immediate access to raw data and data summaries to local, state, and federal agencies. The 1999 assessment did not allow sufficient data access to local and state agencies in a timely manner. The current assessment will allow a local jurisdiction access to its own data in electronic form as soon as they are submitted to the State Administrative Agency. A state will have electronic access data submitted by its local jurisdictions as soon as they are received by the state. The state will have electronic access to its own assessment as soon as it is submitted to Homeland Security.

The `Public Health Security and Bioterrorism Preparedness Response Act of 2002` (Public Law 107-188) signed into law on June 12, 2002, requires that individuals possessing, using, or transferring agents or toxins deemed a threat to public, animal, or plant health, or to animal or plant products, notify either the Secretary of the Department of Health and Human Services (DHHS) or the Secretary of the Department of Agriculture (USDA). CDC has been given the responsibility for collecting this information from each site. CDC has provided to ODP a list of the number of sites by zip code. ODP will provide to each SAA the state-specific list.

State and local Public Health agencies, as well as agencies representing the other nine disciplines involved in the emergency preparedness, will be required by their states to participate in the 2003 Homeland Security grants program, so that Homeland Security funding can be received by the State. There are numerous benefits to the agencies themselves, as well as the communities they serve, in participating in the process and developing a unified approach to emergency preparedness. Specifically, they include:

• The 2003 Homeland Security grants program provides coordinated initiative to states, reducing duplication across disciplines.
• It mirrors the Administration`s strategy for federal coordination of domestic preparedness.
• This process provides valuable assessment and strategy information to emergency response partners.
• The process and assessment focus on needs rather than capacity, allowing better targeting of resources.
• The unified assessment process improves synergy between public health and other emergency responder partners.
• Because Public Health is well integrated into the process and because the authorized equipment lists are more comprehensive and relevant to Public Health, the program improves funding opportunities for state and local public health agencies.
• The current assessment, by relating to assessment of activities supported by the CDC Terrorism Grant, attempts to avoid duplication with other existing public health assessments.
• Because the same process and assessment will be used by all states and territories and all local jurisdictions, the results will provide standardized national reporting. (Note: Summary reports of findings will be generated by CDC and ODP; however, no reports will be publicly available in a manner that identifies the needs and capabilities of specific state or local jurisdictions.)

Beginning in 1999, CDC worked with the Office for Domestic Preparedness (ODP), within the Department of Justice (DOJ) in coordinating an assessment of emergency preparedness of local public health jurisdictions, as part of a larger statewide emergency preparedness grants program developed and administered by DOJ http://www.ojp.usdoj.gov/odp/assessments/definition.htm. Local jurisdictions in all states and territories conducted assessments of risks (threats and vulnerabilities) and emergency response capabilities. A separate assessment was conducted of public health capabilities in local jurisdictions. The public health assessment tool

• Public Health Performance Assessment - Emergency Preparedness PDF

was developed in collaboration with the Centers for Disease Control and Prevention (CDC) and its public health partners, the National Association of County and City Health Officials (NACCHO) http://www.naccho.org , Association of State and Territorial Health Officials (ASTHO) http://www.astho.org, and Council of State and Territorial Epidemiologists (CSTE) http://www.cste.org. The public health assessment sought in-depth information about the capabilities of the local public health system (agency and other organizations with public health roles and responsibilities). It was structured on the 10 Essential Services of Public Health, similar in format to the local and state tools developed by the CDC`s National Public Health Performance Standards Program http://www.phppo.cdc.gov/nphpsp/index.asp. The tool focused on activities related to emergency preparedness, including health monitoring for rapid detection, laboratory and epidemiologic capacity for investigating potential emergencies, development of emergency plans and protocols, communication systems and protocols, ensuring adequate health care in emergencies, and assessment and training of public health work force. Between July 2000 and March 2003, more than 2000 local public health agencies in all 56 states and territories completed and submitted assessments. (Most were completed by March 2002.) Public Health assessment data received by DOJ from a state were provided to CDC for analysis and reporting back to that state. CDC summarized each state`s data, displaying strengths and weaknesses across capacities reflecting preparedness for emergencies. Each state and territory has received an overall summary report, as well as individual reports for each participating jurisdiction.

• DOJ/CDC Public Health Performance Assessment for Emergency Preparedness (LOCAL) PDF
• DOJ/CDC Public Health Performance Assessment for Emergency Preparedness (STATE) PDF

CDC provided a summary report of the strengths and weaknesses of each participating jurisdiction and for each State overall to the State Health Official (SHO) for each State and territory. Due to the obviously sensitive nature of those reports, it is up to the SHO to determine to whom and the manner in which they may be released. You should contact your SHO to request a copy.

For questions about Public Health participation in the grants program, contact: