Co
olora
ado Inte
egra
ated Foo
od
Safe
ety Cent
C ter o
of Ex
xcellenc
ce
Tra ining Needs
s Asse
essme
ent
Fina
al Repo
ort
ber 20
013
Octob
TABLE
E OF CON
NTENTS
Table
e of contents
s
Acknowledgemen
nts
PA
AGE
i
ii
1
Introd
duction
1
2
Methods
2
3
4
2.1
Interv
view guide
2
2.2
Key in
nformant rec
cruitment and
d interviewss
2
2.3
Data analysis
a
2
3
Resu
ults
3.1
Key in
nformant cha
aracteristics
3
3.2
Rankiing of trainin
ng needs
5
3.3
Trainiing delivery methods
m
8
3.4
Trainiing to addres
ss challenge
es during ou tbreak invesstigations
9
3.5
Barrie
ers to particip
pating in traiinings
12
3.6
Usefu
ul resources
12
3.7
Public
c health labo
oratory persp
pective
12
clusions
Conc
13
Appendix
x A: Interview
w Guide
14
Appendix
x B: Colorad
do’s urban/ru
ural/frontier county
c
desig
gnation
18
i
ACKNO
OWLEDG
GEMENTS
S
We would like to than
nk all of the key informants for takin g the time to
o participate
e in this need
ds
assessm
ment and for their
t
valuablle input. This
s training ne
eeds assessment was fu
unded by the
e
Colorado
o Integrated Food Safety
y Centers of Excellence (Epidemiolo
ogy and Laboratory Cap
pacity
for Infecttious Diseases (ELC), Cooperative Agreement
A
N
Number CDC
C-CI10-1012
204PPHF13
3
from CDC
C).
ii
1
IN
NTRODUCTION
The Colo
orado Integra
ated Food Safety
S
Center of Excellen
nce (CoE) iss a collabora
ation between the
Colorado
o Departmen
nt of Public Health
H
and Environment
E
t (CDPHE) a
and the Colo
orado School of
Public He
ealth (CSPH
H) which aim
ms to provide technical asssistance an
nd training o
on
epidemio
ological, labo
oratory, and environmen
ntal investiga
ations of foodborne illnesss outbreakss
and asso
ociated analy
yses. The Colorado CoE
E also intend
ds to identifyy and implem
ment best
practices
s in foodborn
ne diseases surveillance
e and serve a
as a resourcce for public health
professio
onals at state
e, local, and regional lev
vels. These a
activities are
e directed byy the Centerrs for
Disease Control and Prevention (CDC) as pa
art of the 20
012 Food Sa
afety Modern
nization Act.
To identify training ne
eeded in foo
odborne illne
ess surveilla nce and outtbreak respo
onse, the
Colorado
o CoE underrtook a training needs as
ssessment in
n Colorado 2
2013. This n
needs
assessm
ment will inforrm the devellopment of fu
uture trainin g.
1
2
METHODO
M
OLOGY
Key inforrmant interviews were us
sed to asses
ss the trainin
ng needs of public health personnel in
Colorado
o in the area of foodborn
ne illness surrveillance an
nd outbreak response.
2.1
In
nterview guide
Key inforrmant interviews were co
onducted with the aid off an interview
w guide (App
pendix A). T
The
interview
w guide includ
ded question
ns about the
e informant’ss position an
nd experiencce, including the
number of
o foodborne
e and enteric
c disease ou
utbreaks inve
estigated in the past yea
ar by the
informant and by the
eir team and the informant’s role in o
outbreak inve
estigations. The guide
ascertain
ned what if any
a training in outbreak investigation
n is provided
d at the informant’s agen
ncy
or instituttion and whe
ether the info
ormant participated in th
hese training
gs.
Informan
nts were pres
sented a num
mber of pote
ential training
g topics and
d asked to ra
ank these
potential trainings on
n a scale of 1-5
1 based on
n how usefu
ul the training
g would be tto them or th
heir
organization (with1 being
b
the mo
ost useful, 5 being the le
east useful). Informants w
were queried
d
about pre
eferred training delivery methods. In
nformants we
ere asked ab
bout the cha
allenges
encounte
ered when co
onducting ou
utbreak inve
estigations a
and the typess of trainingss that would help
overcome these challenges. Fina
ally, informants were as ked about potential challenges and
barriers to
t training. The
T interview
w guide was piloted priorr to initiating
g interviews w
with actual
informants.
2.2
Key
K informant recruitment and inte
erviews
Our goal was to interrview 30 key
y informants—
—epidemiol ogists, envirronmental he
ealth specia
alists,
and public health nurrses—from local
l
and sta
ate public he
ealth agencie
es in Colorado. Key
informants with differrent levels of experience
e, representiing different size health departmentss
from arou
und the state
e were selec
cted by CoE personnel a
at CDPHE. A
An introducto
ory email wa
as
nd
sent to in
nformants fro
om CDPHE explaining th
he purpose o
of the trainin
ng needs assessment an
informing
g them that a team mem
mber would contact
c
them
m to schedule
e an interview. Interview
ws
were con
nducted in-pe
erson or by telephone depending on
n the informa
ant’s location and
availability. All interviews were re
ecorded. In addition
a
to th
hese 30 inte
erviews, perssonnel from the
state pub
blic health la
aboratory we
ere interviewed about the
eir training n
needs.
2.3
Data
D
analysis
Interview
ws were trans
scribed by hand
h
and sum
mmarized in
n an Excel sp
preadsheet. Potential
trainings, ranked on a scale of 1--5, were weiighted and ssummed to g
give an overa
all score (i.e
e., 1
being the
e most usefu
ul was given a weight of 5; 5 being th
he least use
eful was give
en a weight o
of 1).
Qualitativ
ve data were
e analyzed using
u
a basic
c qualitative inductive ap
pproach (rea
ading, coding
g,
displaying, reducing, and interpre
eting). After these stepss were taken
n, common a
and emergen
nt
themes were
w
inferred
d from the da
ata. For the purpose of tthis analysiss, public hea
alth agenciess
were des
signated as urban
u
or rura
al, where rural included rural and fro
ontier countiies (Appendix B).
2
3
RESULTS
R
S
3.1
Key
K informant characte
eristics
Thirty key informant interviews were
w
completed from Ma
arch to May 2
2013. Most (n=21) were
e
conducte
ed by telepho
one; 9 were conducted in-person.
i
Key inforrmants held various positions within their instituttion, ranging
g from entry level to seniior
managerrial, and inclu
uded 14 epid
demiologists
s, 9 environm
mental healtth specialistss, and 7 pub
blic
health nu
urses (Table
e 1).
Eighteen
n informants were based
d in urban co
ounties, 15 w
were based in rural coun
nties, while 3
regional epidemiolog
gists covered
d both urban
n and rural c ountries. To
ogether the 3
30 key
informants representted 50 of the
e 64 counties
s in the state
e of Colorad
do (including Adams,
Alamosa, Arapahoe, Archuleta, Baca, Bentt, Boulder, C
Chaffee, Conejos, Costtilla, Crowleyy,
Delta, Denver, Dolo
ores, Dougla
as, Eagle El
E Paso, Garffield, Grand
d, Gunnison, Hinsdale,
Huerfano
n, Mesa, M
o, Jackson, Kiowa, La Plata, Larim
mer, Las An imas, Logan
Mineral, Mofffat,
Montezuma, Montro
ose, Morgan,, Otero, Oura
ay, Phillips, Pitkin, Prow
wers, Pueblo
o, Rio Blanco
o,
Rio Gran
nde, Routt, Saguache, San Juan, San
S Miguel, Sedgwick, Summit, Wa
ashington, a
and
Yuma).
Table 1: Key informa
ant characte
eristics
Characteristic
N=30
Occupa
ation
Epidemiologist
14
Reg
gional epidem
miologist
7
Statte/local epide
emiologist
7
Enviro
onmental hea
alth specialist
9
Public
c health nurs
se
7
†
Locatio
on/counties covered*
Urban
n
18
Rural
15
Type/siize of health
h department*
State health department
3
Multip
ple county he
ealth departm
ments
7
Single
e county hea
alth departme
ent
20
Sma
all
9
Med
dium
3
Larg
ge
8
*Regionall epidemiolog
gists cover mu
ultiple health departments;
d
3
cover hea
alth departments located in
n both urban and
a rural coun
nties.
3
All key in
nformants inv
vestigated at
a least one foodborne
f
orr enteric dise
ease outbreak in 2012; 43%
reported investigating
g 5 or more,, while 33% investigated
d 10 or more
e. In general, informants in
urban are
eas and thos
se in larger health
h
departments repo
orted investigating more
e outbreaks
compared to rural an
nd smaller he
ealth departments. The majority (80
0%) of inform
mants had
worked 5 years or more in a position where they
t
were ta
asked with re
esponding to
o outbreaks;;
43% had
d worked 10 years or mo
ore in such a position.
All inform
mants reporte
ed receiving
g some form of training in
n foodborne disease surrveillance an
nd
outbreak
k response. Informal train
nings within their organizzation and a
at state-wide
e meeting (e.g.,
the quartterly foodborrne illness “F
FITS” meetin
ng) were freq
quently men
ntioned. The most freque
ently
mentione
ed formal tra
aining was CDPHE’s
C
bas
sic communiicable disease course. S
Some inform
mants
reported attending tra
aining delive
ered by the CDC
C
and the
e Food and Drug Admin
nistration’s O
Office
of Regula
atory Affairs’ Online Univ
versity (ORA
AU).
Quotes from info
ormants ab
bout existing
g training o
opportunitie
es
“There
“
are [m
many] good trainings, bu
ut [they are] not always available orr [easy to
find whe
en needed]. To have something you
u can [quicklly] pull up to
o get
informatio
on or a training would be
e great.”- En
nvironmentall Health Spe
ecialist
“[I have don
ne the] basic
c communica
able disease
e training at CDPHE for 7 years.
That’s the
e only one offfered every year. Other [trainings are held] on [[an as]
needed
d [and] request basis.”- Epidemiolog
gist
“[I wish] CDPHE's
C
training were more
m
in-depth
h, [they are] too basic fo
or us.”Environmen
ntal Health S
Specialist
“[[We send] out staff here at CDPHE really on casse by case b
basis, [we do
on’t have]
much funding
f
to se
end staff outt to external trainings.”- Epidemiolog
gist
“[A] new arrea of interes
st is [the] ele
ectronic systtem (Epi Info
o.) and using
g those
templates. Also
A
[we wou
uld like] to le
earn how to transfer to a Google tem
mplate.”Public
c Health Nurs
rse
4
3.2
Ranking
R
of training nee
eds
Training on ‘Environm
mental assessments’ rec
ceived the h
highest overa
all score follo
owed by traiining
in ‘Legal issues in su
nked
urveillance and outbreak
k investigatio
ons’; both of these trainin
ngs were ran
as 1 or 2 (where 1 was the most useful) by 22
2 of 30 info rmants when asked how
w useful the
trainings would be to
o them or the
eir organization (Table 2
2).
n
as ran
nked by inforrmants
Table 2. Importance of training needs
Training
Environmental asse
essments
Legal is
ssues in surv
veillance and
d outbreak in
nvestigationss
Interview
wing skills
Overvie
ew of outbrea
ak investigattion
Control of secondarry spread
Writing after action reports
Questio
onnaire desig
gn
Analytic
cal epidemio
ological meth
hods
Foodborne disease surveillance
e
Descriptive epidemiological methods
Commu
unicating with
h the media and the pub
blic
Overall
score
123
120
113
112
111
110
107
99
97
95
92
Number of
informan
nts
ranking
g
training as
1 or 2**
22
22
19
18
18
18
18
16
12
11
13
*How use
eful do you thiink these train
nings would be
b to you and your organizzation (where 1 is the mostt
useful)?
Informan
nts in urban counties
c
gav
ve their highest rankingss to trainingss on ‘Environ
nmental
assessm
ments’, ‘Legal issues in surveillance and
a outbrea k investigations’, and ‘Q
Questionnaire
e
design’, while
w
rural in
nformants ga
ave training in ‘Control o
of secondaryy spread’ and
d ‘Interviewing
skills’ a higher
h
rankin
ng (Table 3).. Informants located in ru
ural countiess ranked bassic courses such
as ‘Interv
viewing skills
s’, ‘Overview
w of outbreak
k investigatio
ons’, and ‘Fo
oodborne dissease
surveillan
nce’ higher than
t
those in
n urban coun
nties.
5
Table 3. Importance of training needs
n
as ran
nked by inforrmant locatio
on (urban ve
ersus rural)**
Training
(overalll score; num
mber of info
ormants ran
nking trainin
ng as 1 [mo
ost useful] o
or 2)
Urban (n=17)
(
Rurall ( n=13)
Environmental asse
essments
(score=69; n=12)
Contro
ol of second
dary spread
(score
e=57; n=11)
Legal is
ssues in surv
veillance/outtbreaks
(score=65; n=12)
Intervviewing skillss
e=56; n=12)
(score
Questio
onnaire desig
gn
(score=62; n=12)
Overvview of outbrreak investig
gations
(score
e=55; n=10)
Writing after action reports
(score=61; n=9)
Legal issues in su
urveillance/o
outbreaks
e=55; n=10)
(score
Analytic
cal epidemio
ological meth
hods
(score=58; n=11)
Foodb
borne diseasse surveillan
nce
(score
e=54; n=10)
Overvie
ew of outbrea
ak investigattions
(score=57; n=8)
Enviro
onmental Asssessment
(score
e=54; n=10)
Interview
wing skills
(score=57; n=7)
Writin
ng after actio
on reports
e=49; n=9)
(score
Control of secondarry spread
(score=54; n=7)
Descrriptive epidemiological m
methods
(score
e=45; n=7)
Descriptive epidemiological method
(score=50; n=4)
Questtionnaire dessign
(score
e=45; n=6)
Commu
unicating with
h media/the public
(score=48; n=6)
Comm
municating w
with media/ tthe public
(score
e=44; n=7)
Foodborne disease surveillance
e
(score=43; n=2)
Analyytical epidem
miological me
ethods
(score
e=41; n=5)
*For the purpose
p
of this
s analysis reg
gional epidem
miologists werre classified a
as urban or ru
ural based on the
county wh
here they werre located, no
ot the territory covered.
Rankings
s differed by
y occupation (Table 4). Environment
E
tal health specialists gavve their highest
rankings to training on
o ‘Environm
mental asses
ssments’ and
d ‘Control off secondary spread’. Tra
aining
on ‘Envirronmental as
ssessments’’ was also ra
anked highlyy by epidemiologists (botth regional a
and
local/statte epidemiologists). Epid
demiologists
s at the state
e and local le
evel gave the
eir highest
ranking to training on
n “Analytical epidemiolog
gical method
ds’, while reg
gional epide
emiologists g
gave
highest ranking
r
to ‘Le
egal issues in surveillance and outb
break investig
gations’. The
e highest ranked
training among
a
public health nurses were ‘Overview of o
outbreak inve
estigations’ and ‘Legal
issues in surveillance
e and outbre
eak investiga
ations’.
6
Table 4. Importance of training needs
n
as ran
nked by inforrmants, by o
occupation
Training (overall score;
s
number of inforrmants rank
king training
g as 1 [mos
st useful] orr 2)
Environ
nmental
Epidemiologist
Regio
onal
Public health nu
urse
health specialist
s
(n=7)
epide
emiologist
(n=7))
(n=9)
(n=7)
Environmental
assessm
ments
(score=43; n=9)
Analyttical
Epidem
miological
Metho
ods
(score
e=32; n=7)
Enviro
onmental
assess
sments
(score
e=32; n=6)
Legal issues in
surve illance/
outbre
eak
(score
e=34; n=7)
Enviro
onmental
assesssments
(score
e=29; n=5)
Interview
wing skills
(score=38; n=8)
Writing
g after action
n
reports
s
(score
e=28; n=5)
Intervviewing skillss
(score
e=29, n=5)
Legal is
ssues in
surveilla
ance/
outbreaks
(score=35; n=7)
Overvie
ew of outbrea
ak
investigations
(score=35; n=6)
Questionnaire des
sign
e=27; n=6)
(score
Overvview of outbrreak
investtigations
(score
e=27; n=5)
Contrrol of second
dary
sprea
ad
(scorre=27; n=5)
Legal issues in
surveillance/
outbre
eaks
(score
e=25; n=4)
Comm
municating with
w
the me
edia/public
(score
e= 23; n=4)
Interviewing skills
e=22; n=2)
(score
Writin
ng after actio
on
reportt
(score
e=26, n=4)
Intervviewing skillss
(scorre=26; n=4)
Questtionnaire dessign
(score
e=25; n=5)
Quesstionnaire de
esign
(scorre=26; n=3)
Foodb
borne diseasse
surve illance
(score
e=24; n=3)
Descrriptive
epide miological
metho
ods
(score
e=24; n=3)
Analyytical
Epide
emiological
Metho
ods
(score
e=23; n=4)
Comm
municating w
with
the m edia/public
e=22; n=3)
(score
Food
dborne disea
ase
surve
eillance
(scorre=25; n=4)
Analyytical
Epide
emiological
Methods
(scorre=25; n=4)
Writin
ng after actio
on
reporrt
(scorre=23; n=4)
Envirronmental
assesssments
(scorre=19; n=2)
Contro
ol of second
dary
sprea d
e=22; n=3)
(score
Comm
municating w
with
the m
media/public
(scorre=15; n=1)
Control of secondarry
spread
(score=41; n=8)
Writing after action
report
(score=33; n=5)
Commu
unicating with
h
the med
dia/public
(score=32; n=5)
Questio
onnaire desig
gn
(score=29, n=4)
Contro
ol of seconda
ary
spread
d
(score
e=21; n=2)
Foodborne disease
surveilla
ance
(score=27; n=4)
Foodb
borne diseas
se
surveillance
e=21; n=1)
(score
Descriptive
epidemiiological
methods
(score=25; n=2)
Analytic
cal
Epidemiological
Methods
(score=19; n=1)
Overview of outbre
eak
investiigations
(score
e=20; n=2)
Descriiptive
epidem
miological
metho
ods
(score
e=18; n=1)
Overvview of outb
break
invesstigations
(scorre=30; n=5)
Legal issues in
surve
eillance/
outbrreaks
(scorre=29; n=5)
Desccriptive
epide
emiological
methods
(scorre=28; n=5)
7
3.3
Training
T
deliivery metho
ods
The majo
ority of inform
mants said they would prefer
p
in-persson trainingss for training
gs on
‘Interview
wing skills’, ‘Environmen
ntal assessm
ments’, and ‘C
Communicatting with the
e media and the
public’ (T
Table 5). The
e reason giv
ven was the “hands-on”
“
n
nature of the
e content an
nd training
materials
s. Both online and in-perrson were co
onsidered op
ptions for tra
ainings on ‘Q
Questionnairre
design’, ‘Legal
‘
issues
s in surveilla
ance in outbreak investig
gation’, ‘Ove
erview of outtbreak
investiga
ation’, and ‘C
Control of sec
condary spre
ead’. While many inform
mants said th
hey preferred
d inperson trrainings, facttors such as
s time and money
m
made online trainiings appealiing.
Table 5: Preference for in-person versus online training for ranked ttrainings (am
mong informa
ants
ranking training as 1 [most usefu
ul] or 2)
Training
(numberr of informants
s ranking train
ning as 1 [mo
ost useful] or 2
2)
Interview
wing skills (n
n=19)
Environmental asse
essments (n=
=22)
Commu
unicating with
h the media and the pub
blic (n=13)
Analytic
cal epidemio
ological meth
hods (n=16)
Questio
onnaire desig
gn (n=18)
Legal is
ssues in surv
veillance/outtbreaks (n=2
22)
Overvie
ew of outbrea
ak investigattions (n=18)
Control of secondarry spread (n=18)
Descriptive epidemiological methods (n=11)
Foodborne disease surveillance
e (n=12)
Writing after action reports (n=18)
In-person
N (%)
18 (95)
18 (82)
11 (85)
10 (63)
10 (56)
9 (41)
8 (44)
7 (41)
7 (64)
6 (50)
5 (28)
Onlin
ne
N (%)
1 (5)
4 (18)
2 (15)
6 (38)
8 (44)
13 (59)
10 (54)
10 (59)
4 (36)
6 (50)
13 (72)
Most info
ormants also
o had a prefe
erence for te
eam training (as opposed individual learning). A
couple off informants stated that it was imporrtant to learn
n the materia
al together a
and train toge
ether
as outbre
eak investiga
ations rely on group worrk. Although most expresssed a prefe
erence for te
eam
training, individual tra
ainings were
e seen as filling an impo
ortant need fo
or the follow
wing reasonss: all
staff mem
mbers may not
n be able to
t leave the office at the same time due to small staff and th
he
need for coverage in the office, individuals might
m
feel un comfortable
e asking questions in a g
group
setting, and
a it might be
b easier to find a time to
t do training
g for one pe
erson than a whole group
p.
8
3.4
Training
T
to address
a
cha
allenges during outbre
eak investig
gations
Challeng
ges faced during outbrea
ak investigations include
ed a lack of kknowledge a
about roles a
and
responsibilities, a lac
ck of complia
ance with sp
pecimen colle
ection, problems in dealling with difficult
people, and
a a lack off resources.
d during outbreak investtigations, byy occupation*
Table 6. Challenges experienced
Environ
nmental
health specialists
s
Epidem
miologists
Region
nal
epidem
miologists
Public health
nurse
es
Lack of resources
Lack off training
Lack o
of compliance
e
with sp
pecimen
collection
Lack of
understanding off
roles and
respo
onsibilities
Lack of
understanding of
roles an
nd
respons
sibilities
Comple
eting after
action reports
r
Dealing
g with difficu
ult
people
e
Lack of experiencce
Lack of interviewing
g
skills
Data co
ollection
Lack o
of
time/tim
meliness
Comm
munication
Being able to meet
face-to--face with the
e
public given
g
work
schedulle/hours
Lack off resources
Freque
ent turnover in
public health field a
and
with lo ng term care
e
facilitie
es
Dealiing with difficcult
people
Commu
unication
Lack off compliance
e
for spec
cimen testing
Lack o
of well-trained
staff
Lack of skills for
desig
gning
questtionnaires
Language barriers
Commu
unication
Lack o
of resources
Lack of staff
Dealing with difficult
people
Dealing
g with difficult
people
Accesss to
questio
onnaires
Lack of complian
nce
with sspecimen
collecction
Isolation
n of health
departm
ment
Lack off interviewing
g
skills
Comm
munication
*Ranked in
i order of mo
ost frequently
y mentioned
9
All inform
mants empha
asized the im
mportance of good comm
munication d
during outbre
eak
investiga
ations and the need for clearly
c
define
ed roles and
d responsibilities. Some informants ccited
the succe
ess of implementing an incident com
mmand struccture during outbreak invvestigations.
Good communication
n with extern
nal partners was also me
entioned. Th
his was seen
n as especia
ally
important during multi-jurisdiction
nal outbreak
ks or when a
additional ressources or a
assistance w
was
required.. Partners in other health
h departmen
nts can often
n be of assisstance by sharing existin
ng
questionnaires or oth
her resource
es, which sav
ve time and can often exxpedite the o
outbreak
investiga
ation. In orde
er to build strronger relationships betw
ween person
nnel in differrent
organizations, inform
mants sugges
sted the nee
ed for more m
multi-agencyy meeting (e
e.g., the quarterly
foodborn
ne illness “FITS” meeting
g) and table--top exercise
es (Table 7)..
Table 7. Trainings ke
ey informantt said would help addresss challenge
es experiencced during
outbreak
k investigatio
ons, by occupation*
Environ
nmental
health specialists
s
Two-day
y long
quarterly foodborne
e
illness “FITS” meeting
Epidemiologists
Regio
onal
Epide
emiologists
s
Intervview techniqu
ues
Public
c Health
Nurse
es
Refressher course on
epidem
miology and
questiionnaire dessign
Foodborne and ente
eric Table--top exercise
es
pathoge
ens
Dealin
ng with difficcult
people
e
Yearlyy refresher
course
e on outbrea
ak
investtigations
Refresh
her courses
How tto explain the
value of specimen
n
testing
g
Table
etop exercise
es
Just-in
n-time trainings
d
Incident command
structu
ure
Leade
ership skills
Tabletop exercises
Commu
unicating with
h
owners//operators
Dealing with difficult
people
Legal is
ssues
Team building
*Ranked in
i order of mo
ost frequently
y mentioned
10
Quotes from
f
inform
mants aboutt specific ch
hallenges w
when doing outbreak
inve
estigation w
work
“Communica
ation is alwa
ays a big dea
al, particularrly if it’s multtijurisdictiona
al [outbreak]].
Knowing wh
ho the playerrs are and finding out wh
ho you need
d to talk to ab
bout product,
distribution, and industrry.”- Environ mental Health Specialisst
“[Having a]
a good relattionship with
h all facilitiess lends itselff to early dettection and
reportin
ng, and helps
s reduce seccondary exp
posures.”
- Public Health N
Nurse
“Need an infrastructurre set up, no
o real system
m in place.”
- Env
vironmental H
Health
“How to deal with thos
se difficult people, upsett people, ma
anagers at fa
acilities, so
ma
aybe some conflict
c
reso
olution trainin
ng.”
-E
Epidemiolog
gist
t challeng
ge is making ourselves u
understood b
by the people
“A lot of the
e who are
affected
a
in outbreak
o
inve
estigations and
a the reas on behind th
he guidance that we give
e.
People sometimes think we are
e giving them
m unnecessary grief.”- R
Regional
Epidemiologi
E
ist
“Obtaining the samples
s to validate the outbrea k, it's hard to
o obtain from
m facilities.”-Pub
blic Health N
Nurse
mebody) to provide a sto
ool sample. Main reason
n
“Getting testing (doctor,, person, som
people do
on't do it is because of co
ost, state wi ll only pay fo
or it at certaiin times.” –
Regio
onal Epidemiiologist
11
3.5
Barriers
B
to participating
p
g in training
gs
Funding was cited as
s the main barrier
b
to parrticipating in trainings. O
Only two of th
he 30 key
informants interviewe
ed said that funding for training
t
wass not an issue at their he
ealth departm
ment.
As a solu
ution, many health departments had adopted a ““train-the-tra
ainer” approa
ach to trainin
ng,
sending one
o staff me
ember to a trraining with the
t expectattion that theyy would train
n other staff on
their retu
urn.
The seco
ond most important barriier was time
e. Several infformants, pa
articularly tho
ose in smaller
health de
epartments, mentioned having
h
a limited numberr of staff and
d the fact tha
at people ofte
en
need to wear
w
multiple
e ‘hats’, mak
ke trainings burdensome
e to attend in
n-person.
Travel wa
as also men
ntioned as a barrier, partticularly by in
nformants lo
ocated in rura
al counties. Most
trainings are offered in Denver which
w
can me
ean 2-5 hou rs of driving each way fo
or some pub
blic
health pe
ersonnel. Other barriers included: av
vailability of trainings, aw
wareness off trainings, ca
aps
on number of particip
pants allowe
ed to attend a given train
ning, travellin
ng during incclement wea
ather,
and fulfillling differentt training nee
eds among staff.
s
3.6
Useful
U
resou
urces
Resource
es mentione
ed by informa
ants that would be helpfful during ou
utbreak invesstigations
included questionnaires (for spec
cific pathoge
ens or differe
ence outbreak settings),, checklists o
or
step by step
s
guides for
f handling outbreak inv
vestigations , contact info
ormation sheets for key
personne
el, fact sheetts, assistanc
ce using Epi Info, and bi lingual serviices.
3.7
Public
P
health
h laboratory
y perspectiv
ve
Staff at th
he State Pub
blic Health Laboratory
L
cited the nee
ed for training
g on the late
est laboratorry
technique
es and training on Coun
ncil to Improv
ve Foodborn
ne Outbreakk Response ((CIFOR)
guideline
es. The main
n challenges faced by the laboratoryy included the implementation of new
w
diting the invvestigation p
technolog
gies; mainte
enance of ex
xisting capab
bilities; exped
process to
identify th
he source more
m
rapidly; improving th
he speed of the courier service during outbreakk
investiga
ations; and educating
e
epidemiologistts on the sco
ope and utilitty of locally available
laboratorry tests.
The main
n barrier to participating
p
in trainings was limited funding. Restricted fund
ding levels fo
or
training were
w
seen as
s not only im
mpacting affe
ecting local e
efforts to devvelop new a
and innovativve
approach
hes to labora
atory testing, but also the ability of th
he laboratorry to participa
ate in nation
nal
initiatives
s (e.g., whole
e genome sequencing). The opportu
unity to participate in tra
ainings and
meetings
s at both the local and na
ational level was seen a
as crucial to a broad-bassed sharing o
of
challenge
es, barriers, and solution
ns that could
d lead to a u
unified impro
ovement of la
aboratory
response
e. Frequent meetings
m
tha
at include ep
pidemiology and laborattory staff, wh
hile sometim
mes
time-consuming, werre seen as im
mperative fo
or advance p
planning and
d good comm
munication w
which
resulted in more succ
cessful outb
break investig
gations and response.
12
4
CONCLUS
C
SIONS
This asse
essment highlighted the need for mo
ore training o
opportunitie
es for public health perso
onnel
ak response
in Colora
ado in foodbo
orne illness surveillance
e and outbrea
e. A number of trainings
were ranked highly in
ncluding training on ‘Env
vironmental assessmentts’, ‘Legal issues in
surveillan
nce and outb
break investtigations’, ‘In
nterviewing sskills’, ‘Overvview of outbreak
investiga
ations’, ’Conttrol of secon
ndary spread
d’, ‘Writing affter action re
eports’, and ‘Questionna
aire
design’.
Training needs differred between rural and urrban health departmentss and by occcupation.
Generally
y, informants
s in smaller rural health departmentts who often had less exxperience
investiga
ating outbrea
aks, emphas
sized the nee
ed for more basic trainin
ngs on “Overrview of outb
break
investiga
ations’, ‘Interrviewing skillls’, and ‘Foo
odborne Dise
ease Surveillance’. While
e there were
e
some diffferences in trainings
t
nee
eds by occupation, ‘Envvironmental a
assessmentss’ and ‘Lega
al
issues in surveillance
e in outbreak
k investigatio
ons’ were ra
anked highlyy by multiple groups.
Barriers to
t training in
ncluded reso
ources and tiime. Therefo
ore, while ma
any informants said theyy
preferred
d in-person trainings, lim
mited time an
nd resourcess often made
e online train
nings more
feasible option.
o
This information will be used by the
t Colorado
o CoE to gu ide future pllanning and training
developm
ment.
13
APPEN
NDIX A
Interview
w Guide: Inttegrated Fo
ood Safety Center
C
of Ex
xcellence
Needs Assessment
A
t
ction:
Introduc
Thank yo
ou for being willing to tallk with me. I am intereste
ed in learnin
ng about you
ur training ne
eeds
in the are
ea of foodbo
orne illness surveillance
s
and outbrea
ak response.. This inform
mation will be
e
used for future plann
ning and train
ning develop
pment as pa
art of the new
w Colorado IIntegrated F
Food
Safety Center of Exc
cellence.
As we talk, please ke
eep in mind that there arre no “right” or “wrong” a
answers to a
any of the
questions
s I ask you — The inform
mation you provide
p
is a valuable parrt of this train
ining needs
assessm
ment, I am sim
mply interested in learnin
ng about yo ur current trraining needs
ds so that you
u
and yourr team are be
etter equipped when res
sponding to foodborne illlness outbre
eaks. Just to
o
clarify wh
hen I say foo
odborne outb
break investtigations, I am
m speaking broadly abo
out foodborn
ne
and ente
eric infections
s transmitted
d by food an
nd other routtes (so I am interested in
n a variety o
of
things ranging from person-to-pe
p
erson noroviirus outbreakks to E. coli O157 outbre
eaks due to
contact with
w animals at a petting zoo).
This interrview will tak
ke about 30--45 minutes.. All the thing
gs you share
re with me to
oday will be kkept
confidential, but I willl be recordin
ng this interv
view, so thatt I won’t misss anything yyou say. Afte
er our
interview
w, the recordiing of our co
onversation will be summ
marized. How
wever, no na
ames or
identifyin
ng informatio
on will be inc
cluded in the
e summary. C
Can I confirm
m that you a
are okay talkking
with me today?
t
(Waiit for verbal consent.)
c
Interview
wer: By check
king this box
x
[turn on digital
d
record
der]
the perso
on consentss to this interrview.
I’d like to
o start by ask
king you som
me basic que
estions abou
ut your posittion and experience.
Section 1 Questions: Position and Experiience
i your curre
ent position?
?
1. What is
Probe- Name
N
of posiition?
Probe- What
W
is your role in an ou
utbreak inve
estigation? (O
Overall coorrdination, inte
erviewing,
environm
mental asses
ssments, ana
alysis of data
a?)
ong have you been in this position?
2. How lo
Probe- Years?
Y
Month
hs?
3. How lo
ong have you worked in a position where
w
you re
espond to ou
utbreaks?
Probe forr clarity- only
y enteric/foo
odborne illne
esses
4. Over the past year, how many
y outbreaks have you invvestigated? How many o
outbreaks did
your team
m investigate
e?
Probe- Iff no outbreak
ks in the pas
st year, the most
m
recent?
?
14
5. Where
e any of thes
se outbreak’s
s multijurisdictional?
gists only:)
5A. (For epidemiolog
c
a ca
ase-control or
o cohort stu
udy during an
ny of your in
nvestigationss?
Did you conduct
Were the
ese outbreak
k mostly dete
ected from complaints
c
to
o the health departmentt or through
disease surveillance
s
?
6. Does your
y
organiz
zation offer any
a training in foodborne
e disease su
urveillance o
or outbreak
response
e?
Probe- In
n house? Ex
xternal? Wha
at types of trrainings are offered? Ple
ease list.
y taken an
ny trainings or courses on
o foodborne
e disease su
urveillance o
or outbreak
7. Have you
response
e?
Probe- Name
N
of train
ning? Who gave
g
it? Whe
ere? When? Helpful?
Section 2 Questions: Training needs
Please consider som
me of the outtbreaks that your team in
nvestigated in 2012, if not, prior yea
ars:
8. What types
t
of cha
allenges did you
y or your team encou nter when in
nvestigating these
outbreak
ks?
Probe- Specific
S
exam
mple? Why a challenge?
?
9. Can yo
ou think of trrainings thatt would have
e better prep
pared you orr your team tto deal with
these cha
allenges?
Probe- Specific
S
trainiing? Specific
c skills? What would be the best forrmat for this training (inperson or
o online)?
10. Can you
y think of things that went
w
well wh
hen respond
ding to these
e outbreaks?
?
Probe- Specific
S
exam
mple?
Probe- Why
W did it go well? Trainiing/preparattion?
11. I am going to go through partticular trainin
ngs in the arrea of foodb
borne illness surveillance
e and
outbreak
k response?
Probe- On
O a scale off 1-5 (1 being the most useful,
u
5 bein
ng the least useful) how
w useful do yyou
think thes
se trainings would be to
o you and your organizattion?
A. Foodb
borne diseas
se surveillance
(Probe fo
or clarity- usiing CEDRS surveillance
e system, orr surveillance
e and how it works
nationally
y)
B. Overv
view of an ou
utbreak inves
stigation
(Probe fo
or clarity- ste
eps in an outtbreak inves
stigation, the
e relationship
ps, roles and
d responsibillities
of local, state,
s
and fe
ederal agenc
cies)
C. Descrriptive epidem
miological methods
m
(Probe fo
or clarity- ma
aking line lists and epi cu
urves)
D. Analyttic epidemio
ological meth
hods
(Probe fo
or clarity- designing case
e-control, co
ohort studiess, analyzing data)
15
E. Questtionnaire des
sign
(Probe fo
or clarity- designing ques
stionnaires for
f use in ca
ase-control a
and cohort sttudies)
F. Interviewing skills
(Probe fo
or clarity- hyp
ypothesis gen
neration inte
erviews or ro
outine case iinterviews)
G. Enviro
onmental assessments/iinvestigation
ns
(Probe fo
or clarity- rettail food esta
ablishments, recreationa
al water settiings, and cchild care
settings)
H. Contro
ol of secondary spread
(Probe fo
or clarity- inffection contro
ol measures
s, e.g., during
g a noroviru
us outbreak)
I. Commu
unicating witth the media
a/public
(Probe fo
or clarity- wri
riting press re
eleases, doiing interview
ws with the m
media)
nd outbreak investigatio ns
J. Legal issues in surveillance an
or clarity- wh
hat public he
ealth personn
nel are legallly able to do
o/what inform
mation can b
be
(Probe fo
collected
d and shared
d)
G. Writing after actio
on reports
(Probe fo
or clarity- how to assess
s what went well
w and wha
at did not go
o well after a
an outbreak
investiga
ations)
12. Interv
viewer- for all
a trainings liisted above that were ra
anked a 1 orr 2, ask abou
ut the best
format? In-person
I
orr on-line?
13. Are there any tra
ainings or courses related to foodborrne disease surveillance
e or outbreakk
response
e that you arre aware of that
t
you or your
y
team wo
ould benefit from?
Probe-Lo
ocal, regiona
al, national
Probe- Best
B
format? (in-person or
o online)
14. For th
he trainings that you me
entioned abo
ove, are therre any that yyou would prrefer your gro
oup
to do as a team?
W
one/s?
?
Probe- Which
15. Are there other re
esources tha
at could help
p you investiigate an outbreak?
ch as, but no
ot limited to: questionnair
ires, check liists, etc?
Probe forr clarity- suc
16. Whatt are three ways
w
in which
h you would like to impro
rove your org
ganizations ffood outbrea
ak
investiga
ation and res
sponse work
k?
Ok, in thiis last sectio
on I want to ask
a you about potential challenges tto and preference for
training.
Section 3 Questions: Challeng
ges and preferences
17. Whatt challenges do you or your
y
team fac
ce in taking advantage o
of or particip
pating in
trainings?
?
Probe- Funding,
F
lack
k of staff, lac
ck of knowled
dge, lack of communica
ation with oth
her health
departme
ents/outside resources, etc.?
16
18. Woulld you or oth
hers from your organizattion be able to travel for in-person trrainings or
workshop
ps?
Probe- Yes/No?
Y
How
w far? How many
m
from your
y
organiza
ation?
19. Does
s your organization have
e the funding
g available to
o pay for traiinings or for travel to inperson trraining?
Probe- Yes/No?Parti
Y
ial?
20. Beforre we end is
s there anyth
hing that I ha
ave not touch
hed on that yyou think is important fo
or me
to know as
a far as imp
proving yourr organizatio
ons response
e to outbreak investigations?
21. Is the
ere anybody else that yo
ou can think of that woul d be good fo
or me to spe
eak to about
training related
r
to foo
odborne dise
ease surveillance and ou
utbreak resp
ponse?
Probe- Another
A
person in your ro
ole at your agency?
a
Or ssomeone fro
om another a
agency?
Well, that concludes our interview
w. If you thin
nk of anythin
ng else that yyou would like to share with
me pleas
se don’t hesiitate to conta
act me. Thank you so m
much for sharring all that iinformation w
with
me.
TURN OFF RECORD
DER.
17
APPEN
NDIX B
18