Frahm, Kathryn A. PhD, MSW; Gardner, Patrick J. RN, MPH, EMT; Brown, Lisa M. PhD; Rogoff, David P. MHA; Troutman, Adewale MD, MPH, MA, CPH
The mission of the University of South Florida Preparedness and Emergency Response Learning Center (USF-PERLC),* housed at the University of South Florida College of Public Health, is to improve Florida's and the nation's public health and medical preparedness and response capabilities for emergencies and disasters. This is done collaboratively through developing and delivering core competency-based training and education to the public health workforce, emphasizing essential public health security capabilities. One key activity of the USF-PERLC includes designing, developing, and delivering community preparedness and response and recovery system training to teams of Floridians. This was accomplished by initially working with Sarasota Community Organizations Active in Disaster, Florida Department of Health in Sarasota County, as well as other stakeholders and partners to refine and implement curriculum training that enhances community coalitions' ability to better prepare, respond, recover, and mitigate from emergency or disaster situations. Through building and enhancing community disaster coalitions, public health responders may effectively coordinate efforts to respond to events, preventing further negative outcomes.
In general, over the last several decades, building community coalition programs has become a more prevalent and structured practice, as it is increasingly used to address the complexity of community issues.1,2 Community coalitions are unique in that they bring varied and multiple types of organizations together to promote change or address community problems.3 Governmental as well as private organizations are also progressively supporting organizational collaboration and coalition formation to address larger community concerns.4 Furthermore, as organizations try to meet the needs of their communities with fewer available resources, coalition building is a potentially cost-saving method that enhances and builds individual and collective capacity.5
Research and evaluation of community coalitions suggest that shared decision making, leadership, and involvement of other organizations all influence coalition participation and satisfaction of partner members.6 To thrive and be successful, various characteristics have been identified for sustainable coalitions and include readiness, the capacity of its members, how they relate to one another, organizational abilities, overall resources, and level of programmatic functioning.7,8 In addition, there are several critical aspects that influence effectiveness of coalition collaboration to meet desired goals such as partner incentive, common interests, willingness to be involved, ability to participate, and capacity to contribute.9,10
However, coalitions can be challenging to not only form but also maintain or even grow over time. Reasons for this include loosely defined coalition structure and specific purpose (or original reason for forming), diversity and differences between the coalition and community, and multiple players in the decision-making process. Addressing these challenges at the onset can assist in preventing coalition tension or future ineffectiveness.11 There is also the challenge of sustaining mature coalitions over time to prevent decline, particularly if there is an extended period of time without the occurrence of a disaster. Although coalition success may be defined in multiple ways, a critical component appears to be the involvement of capable, dedicated, and knowledgeable leadership.4 Other elements associated with a successful coalition include involving multiple partners, recruiting diverse partners, and having comprehensive plans to address potential problems.12
Furthermore, although community coalitions or interorganizational collaborations are increasingly common, their results and effective goal attainment are mixed.13 Similar factors to those noted as critical for coalition success or sustainability are also recognized as key components for effectively attaining coalition goals such as clear procedures and leadership, as well as member diversity, cohesion, and participation.14 To successfully develop and sustain a community coalition, it is critical to evaluate several levels of coalition functioning, including if they are working toward and attaining target goals, if there are processes in place for retaining members or leadership succession, and if they are having an intended community impact.15 Research on the effectiveness and impact of coalitions must also address issues such as having a clear definition, reason for existence, and definition of success to better understand their functioning.16
Disaster coalition building
Specific to emergencies and disasters, coalitions may be particularly vital for communities or surrounding areas. Emergencies are common daily events that most communities are able to respond to with existing resources. It is well recognized that natural- and human-caused disasters routinely occur, effecting multiple organizations and community sectors. Given this, agencies need to form partnerships that enable them to collaborate in mitigation, planning, response, and recovery efforts, which can be effective in minimizing the mental and physical consequences of an event.17 Community disaster coalitions fall under the larger structure of the state for general emergency planning and response. When an emergency occurs, coalition coordination may enhance response without the need for outside assistance. In the event of a disaster, previous coordination and planning can help support a larger, statewide response and may assist in avoiding duplication of efforts across organizations. Findings suggest that coalition members need education and training on coalition building and sustaining efforts as well as ongoing reinforcement to be effective during adverse circumstances. Receiving technical assistance and ongoing support have also been noted as critical aspects for maintaining coalition cohesiveness and sustainment.8,18
Disaster coalition training
With this in mind, the Community-Based Disaster Coalition (CBDC) was designed to address the challenges of building and sustaining coalitions, emphasize methods to enhance their sustainability and effectiveness, and strengthen their purpose and community impact. The CBDC workforce development training program was focused on addressing the particular education and training needs of community disaster coalitions throughout Florida. Specifically, the CBDC program's goal is to improve Florida's disaster preparedness and emergency response and recovery capabilities by delivering public health preparedness and emergency response core competency-based training to program participants in county-specific teams representing each of Florida's 67 counties so that they can effectively support their own communities in the event of an emergency or disaster. This is of particular relevance for the state of Florida due to the frequent occurrence of disasters, such as major hurricanes, tornadoes, and oil spills.
The goal of the CBDC is to train program participants to develop the essential knowledge, skills, and abilities to organize a CBDC or strengthen an existing CBDC that integrates public health, human services, and emergency management systems into their respective county's disaster preparedness, response, and recovery structure. Program participants are provided with knowledge of current best practices, collaborative approaches, practical tools, and technical assistance that will enable them to organize or strengthen a CBDC in their counties. In addition, lessons learned, experiences, and practices utilized in the creation of the Sarasota Community Organizations Active in Disaster as well as other CBDC are shared.
Program participants can actively participate in 2 consecutive years of training. In year 1, participants engage in 3 days of facilitator-led instruction. The training sessions include lectures, hands-on activities, tabletop exercises, and breakout groups to help participants work on techniques to strengthen their coalition. Trainings are tailored to the needs of the participating coalitions, and adjustments are made to ensure the program addressing their individual challenges and concerns. On-site group training is augmented with distance learning training opportunities and periodic webinars. In addition, participants are provided with follow-up assistance and coaching as needed. In year 2, participants engage in additional individual training through course refreshers, distance learning opportunities, and webinars. This support is provided to enhance sustainability. Following year 2, further training opportunities are available in general through the USF-PERLC, and all materials from the year 1 training are available online for participant reference and review. Participants in the year 1 training are grouped by county or region and include between 6 and 9 individuals from a wide range of background and professions, volunteers to emergency management technicians to county emergency managers, as well as other agencies or organizations that deliver disaster recovery services. Recommended team composition includes staff from local emergency management, health department, human services, and nongovernmental organizations to include a diverse group of potential disaster responders. However, groups comprised already formed coalitions with varying membership or interested professionals who are available to attend the 3-day training.
Five first year on-site trainings were delivered in 2012, project year 1. Table 1 provides an example of the course agenda for each training day. Pretest and posttest data were collected via a CBDC assessment instrument consisting of 30 multiple choice items and a course evaluation. The assessment instrument consisted of items related to the coalition training, such as critical elements of a coalition, assessing community capacity, and aspects of an effective disaster response system. The pretest was designed to serve as a baseline measure to which the posttest scores could be compared. Participants completed the pretest at the onset of the training delivery and the posttest and course evaluation at the conclusion of the final training day. Gain in knowledge was calculated for participants who completed both pretest and posttest. A within subjects t test was used to analyze participant scores. This was the chosen method for comparison, as no other variables were controlled for and only a simple comparison of each participant gain was calculated. The course evaluation included Likert-type items asking about course satisfaction, relevance to daily job, if participants felt it increased their knowledge, opened questions about course strengths, and suggestions for improvement as well as other items.
Over the five 2012 CBDC trainings, 184 preparedness and emergency response professionals attended the program. The 2012 three-day program was provided in March, May, June, July, and November. Across trainings, performance data indicate that participants significantly improved their scores, showing a gain in knowledge among respondents. The course evaluations showed that program participants were satisfied with the course content, the facilitators, and the overall course. The March CBDC program offering was used to refine and tailor the course curriculum as well as determine the best methods to collect pretest and posttest data from participants for analysis purposes. Based on information gained from the March training, data collection methods were implemented using a clicker system to gather pretest and posttest data for the remainder of the trainings. Of the 184 total participants across trainings, 130 completed both the pretest and the posttest for analysis.
Twenty-two participants in the May training completed both the pretest and the posttest for a completion rate of 96% (restricted sample). Participants, on average, scored 23.82 out of 30 on the pretest (79.4%) and 24.41 out of 30 on the posttest (81.4%). While the average increase in scores was small, the findings indicate that participants did fairly well on the pretest, so large improvements in scores were difficult and the difference in scores was not significant (t = 1.183, df = 21, P = .250). In addition, it should be noted that the number of participants was small, and this may indicate their level of coalition development prior to training.
Reviewing the June training, 17 participants completed both the pretest and the posttest for a completion rate of 53% of those who took the pretest and the posttest. For this training, participants, on average, scored 23.59 out of 30 on the pretest (78.6%) and 26.82 out of 30 on the posttest (89.4%). Again, the findings indicated that participants performed well on the pretest and showed significant improvement in scores (t = 3.840, df = 16, P = .001), although this should be viewed with caution because of the small number of reporting participants.
The July training was larger in size, and 57 participants out of 58 (98%) completed both the pretest and the posttest for comparison purposes and are included in this report. Participants, on average, scored 24.45 out of 30 on the pretest (81.5%) and 27.14 out of 30 on the posttest (90.5%). The findings revealed that while participants did well on the pretest, they showed significant improvement in scores (t = 6.430, df = 56, P < .001).
Finally, 34 participants out of 41 (83%) in the November session fully completed both the pretest and the posttest for comparison purposes. For this training, participants, on average, scored 23.65 out of 30 on the pretest (78.8%) and 27.21 out of 30 on the posttest (90.7%). The findings indicate that participants again showed significant improvement in scores (t = 6.995, df = 33, P < .001). Table 2 provides a summary of the findings across trainings.
Information provided in the training evaluation was consistent with posttest findings. Across trainings, 94% of participants endorsed that they were satisfied with the program overall, 95% agreed the course enhanced their knowledge of the subject matter, and 96% would recommend the course to others. Some of the participant feedback from the evaluation on strengths of the program training curriculum included the following:
* Bringing groups together, giving them time to coordinate, share best practices, and move forward.
* Relatively comprehensive; abundant information about all emergency management functions.
* Provides lots of information and multiple samples of how to get started.
* Content made awareness of needs and strengths apparent.
* Brought coalition together—a better understanding of where we are at.
* Activities were engaging and sparked good conversation.
* It was an excellent opportunity to get to know the emergency management/state contacts and build lasting relationships!
* Great curriculum—well thought out!
* Addresses issues that are not often discussed.
* Our facilitator was fantastic because she did a great job of meeting our needs by meeting with us individually and making sure we could with confidence walk away with a tangible plan.
* A great facilitator. He made the exercises understandable and fun.
Some of the follow-up feedback received regarding examples of how participants have changed their behavior or applied the CBDC training in the community included the following:
* Have become more proactive about partnering with other agencies.
* The course made me more aware of the organizations that can be used after a disaster and how to better communicate to them through the new coalition.
* What is different is my way of thinking about disasters, and I walked away with a better understanding of how to assess what needs to be done.
* More clearly defined both our mission/role and the timeline at which we would fully activate.
* I have changed the way I do my disaster preparedness trainings.
The CDBC training was provided to teams from 31 counties, which represent close to 13 million people or nearly three-fourths of Florida residents. The Figure provides a visual depiction of the counties represented across the CBDC trainings. Participants indicated that the information they gained from the CBDC course increased their knowledge and skills related to developing and sustaining successful community disaster coalitions. These trainings are especially important, considering the frequent nature of emergency and disaster occurrences and the need for community organizations to effectively and efficiently respond. Over the course of the CBDC trainings, it also became apparent that the trainings need to be tailored to the current developmental state of the individual county coalitions and modified accordingly to best meet their unique needs. While many coalitions have already begun their development and need assistance to continue, others may be grappling with how to just begin the developmental stage of identifying leadership and members.
FIGURE . Florida Cou...Image Tools
Based on the training results, it appears that participants significantly increased their knowledge overall about the course of disasters, process of emergency preparedness, and roles as well as understanding of the importance of community coalitions in addressing disaster or emergency events. Participants also indicated an overall high level of satisfaction with the CBDC course. Another finding is that coalitions felt that the training enhanced their knowledge and felt that they would recommend it as a resource to others. Through open-ended feedback, participants reported that the CBDC course helped to keep them motivated as well as to continue strengthening their efforts toward attaining their goals. Training feedback supports previous findings regarding key coalition elements for development and sustainment, such as clear coalition purpose and goals. Providing the opportunity for county coalition members to meet for an extended 3-day period during the first year of the program gives them the opportunity and time to truly identify their purpose, mission, and goals; delve into the challenges they face; and brainstorm steps they need to further their effectiveness and community impact. Year 2 program support enables coalitions to reassess their current state and receive any assistance they need to move forward and provides needed education and resources.
The CBDC training and education program provides county coalitions the opportunity to bring key stakeholders in the community together to focus solely on how they can work together to meet, mitigate, prevent, respond, and recover from an event. Through the sharing of resources, information, and capabilities of the individual coalition members, they are better able to respond collectively than they would be as individual responders. In addition, they are able to plan in advance, preparing for events in order to mitigate their impact, making response and recovery efforts more effective. As resources become more limited, community organizational cooperation through the formation of coalitions will continue to be a critical aspect of addressing needs in an emergency or disaster situation.
Several limitations to this study should be noted. First, it is challenging to get participants to attend a 3-day training at a location that may be hours away from their community. Because of this, those who attended may have been a selective group and not accurately representative of those most directly involved in, and responsible for, disaster response. Second, the trainings were relatively small and regional in nature. These findings may not generalize to other areas. In addition, not all participants completed the pretest, posttest, and evaluation. It is unknown whether those who did not would have impacted the study findings. Finally, while follow-up efforts are ongoing, it is challenging to assess true community impact, with or without a disaster occurrence.
Lesson Learned/Next Steps
Through the process of delivering the CBDC training, it became apparent that this program is a valuable and much needed resource for county coalitions trying to develop, strengthen, or sustain their efforts to address organizational cooperation within their community, with the focus on disaster preparedness and recovery efforts. Several lessons are evident that inform current and future CBDC efforts as well as other entities developing programs to educate and train community coalitions focused on emergency and disaster events. These include the following:
* Adapt: Each county coalition is different. All coalitions have a unique organization as well as different state of development. Ensuring that training is tailored to the coalition needs is imperative to ensure that it is as beneficial as possible.
* Support: Encourage the process of coalition building; ensuring they are in the right direction are critical aspects for CBDC trainings, so they continue the process, even when it is difficult or members become complacent. In addition, provide the necessary resources and information coalitions need to further their efforts; guide them in the process.
* Follow-up: Ensure that extended training opportunities and educational resources are available for coalitions as ongoing refreshers and support outlets. Sustaining coalition efforts after CBDC training is important and can be done by both checking in with the coalitions and safeguarding against them falling back to their prior operational state.
* Continue: Provide trainings to counties that have not yet participated. While the CDBC trainings that have been offered to professionals cover a significant portion of the Florida population, it is some of the rural counties that have not had the opportunity to participate that may be the most vulnerable. While the coalition trainings have reached counties representing the majority of Florida residents, more outreach can occur. As rural areas have fewer resources and staff in general, creating ways to maximize what is available in an emergency or disaster event or incident is critical.
* Expand: Deliver the CBDC training in other states, regions of the country, territories, and internationally. Disasters happen everywhere and no one is immune. Adequately preparing every county to face such events is crucial for addressing the preparedness, response, and recovery of communities. While not all disasters are the same, each requires significant resources and response efforts to regain some sort of equilibrium or even the potential to improve the state of the community postevent or incident.
Strengthening CBDCs improves the capacity of communities to coordinate local resources and services and, importantly, enhances their ability to effectively plan, prepare, respond, and recover from a variety of potential emergency and disaster situations. As Florida experiences disasters on a frequent basis, ensuring each county is prepared, regardless of the type of disaster, is crucial. This program may also be adaptable for providing training to other community coalitions addressing a variety of other important issues. Through providing education and support to community coalitions, USF-PERLC has reached a significant number of Florida counties and the residents they serve to enhance and build their disaster capability and capacity.
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