# Presentation: 851557

## Epi-Ready Team Training Workshop

**USDA FSIS Strategies for Improved Coordination during Foodborne Outbreaks**
**                       ****Elizabeth Bugden, NEHA   May 15, 2008**

## Epi-Ready

**A team-based training program on how to**
**effectively respond to a  foodborne**
**disease outbreak.**
***NSF 2008 Food Safety Leadership***
***Award for Food Safety Education***** **

## Program Overview

**Team Approach**
- Epidemiologists, Environmental
- Health Professionals,
- Laboratorians, Public Health
- Nurses, Industry QA
**Didactic Lectures, Group Exercises, Q&A Sessions**
**Best Practices and Local Requirements **

**Notes:**
Who the source targets and what training styles are implemented.  Group exercises are extremely important and beneficial. 

## Epi-Ready Table of Contents

- Module 1: Passive Surveillance
- Module 2: Outbreak Investigation
- Module 3: Environmental Assessment
- Module 4: Epidemiologic Investigation
- Module 5: Laboratory Guidance
- Module 6: Outbreak concluding Actions and Case Study

## History

**Centers for Disease Control and Prevention – Food Safety Office**
**October 2003 – Atlanta, GA**

**Notes:**
Include that CDC funds approximately four 2 day workshops and two TtT workshops per funding year.  However we do contract with state and local health depts to provide non CDC funded, “for fee” workshops as well.

## Partnerships

_***Federal***_**    – CDC, FDA, USDA/FSIS             ****	**
**	****	****             ****US Coast Guard, US Navy, US Army**
_***State***_***        *****–  MI, MA, SC, WV, VA, TX**
_***County***_***    *****–  San Diego, Knoxville,**
**                         ****San Francisco**
_***Academia***_** – Michigan State, Tulane,**
**                         ****Southern Illinois, St. Louis University,**
**                         ****University of Minnesota**

**Notes:**
Partnerships represent a combination of support capacities:
CDC- funding agent
FDA - contributed greatly in the development of the Epi-Ready curriculum and continues to promote  Epi-Ready and support the identification of potential funding sources.  We also have 2 FDA instructors for Epi-Ready. 
USDA, FSIS - contributed greatly in the development of the Epi-Ready curriculum and continues to explore potential funding avenues to promote and support Epi-Ready in the future. 
Tulane-used their facility to make an Epi-Ready video
All others are a mix of either departments we’ve worked with to bring Epi-Ready (CDC funded and non CDC funded) or departments/universities where are instructors are located.

## Workshop Statistics

**2003 – 1 workshop – 36 students **
**2004 – 6 workshops – 242 students**
**2005 – 7/2 workshops – 262 students; 52 trainers**
**2006 – 6/1 workshops – 276 students; 22 trainers**
**2007 – 6/1 workshops – 275 students; 24 trainers**
**2008 – 6/3 workshops – 320 Students; 90 trainers**
**	****	****	****	****	****  **

**Notes:**
-first number represents how many of the 2 day workshops we have and the second number represents how many TtT. 

-Students is how many attended the 2 day workshop for the year and Trainers is how many attended the Train the Trainer.  Combined numbers of 2 day workshop attendees and TtT is the number on the previous slide.

-We do workshops based off of each funding year, however this slide is based on a calendar year, not the fiscal year.

-2008 numbers are approximate since we still have 4 workshops to be completed. 

## Epi-Ready Workshops

**Notes:**
Workshop total includes Train the Trainer workshops.  2009 workshops already have 5 workshops scheduled with a possible 3 more pending their funding, which would total 8 workshops in 2009.  Epi-Ready has started to train more instructors based on the increasing interest level and requests from local and state health depts.   

## Epi-Ready Students

_**1387-Trained to Date / 1599-Trained by end of 2008**_

**Notes:**
Total trained to date and by end of 2008 include train the trainers.
2008 increased due to the new remote site feature (explain under Additional Projects slide)

## 2008  Workshops

**Feb 5-6****	****	****  Washington, DC **
**May 6-8****	****	****  Columbia, MO- ****TtT workshop**
**                                              ****(1****st**** workshop with Remote Sites)**
**June 20-21****	****  Tucson, AZ **
**                                              ****(NEHA Annual Education Pre-Conference)**
**August 5-7****	****  Tampa, FL ****(non CDC funded)**
**August 26-28****	****  Jackson, MS- ****TtT workshop**
**October 21-23****	****  Bloomington, IL- ****TtT workshop**

**Notes:**
Remind that even though we use a fiscal year when talking about when to do a workshop, CDC funded or non CDC funded, this slide is based on a calendar year.  

## 	2009 Workshops (to date)

**Jan 13-14****	****Sacramento, CA**
**April 28-30****	****Casper, WY- ****TtT workshop**
**June 19-20****	****Atlanta, GA**
**	****	****	****	****(NEHA Annual Education Pre-Conference)**
**Sept 15-16****	****Portland, ME**

**Notes:**
The above referenced workshops are pending receipt of FY09 CDC Food Safety funds.

2 other states interested in a non CDC funded or “for fee” based workshop in 2009.

## Products Offered

**Epi-Ready Team Training **
**2 days**
**Epi-Ready Team Training: ****Food Defense Module**
**2 1⁄2 days**
**Epi-Ready Team Training: ****Train-the-Trainer**
**3 day**
**Epi-Ready workbook and supplies**
**Epi-Ready Distance Learning  **

**Notes:**
-These are for CDC funded and non CDC funded workshops.

-Explain purpose behind TtT: teams wishing to become Epi-Ready Trainers should ensure their team is composed of an EH professional, a laboratorian, and an epidemiologist who together possess the desire and abilities to teach large groups of students.  Upon satisfactory completion of the training each team will receive a generic instructor’s version of the Epi-Ready course curriculum and agree to (a) at their cost, conduct a workshop in their local jurisdiction within one year and (b) potentially be called upon to assist NEHA at a future, expense paid Epi-Ready workshop.

-Workbook and supplies-we provide the following:
Epi-Ready Foodborne Illness Response Strategies Course Manual  
Control of Communicable Diseases Manual
Procedures to Investigate Foodborne Illness book
Diagnosis & Management of Foodborne Illnesses, A Primer for Physicians & other Health Care Professionals packet

-Epi-Ready Distance Learning-see next slide.

## 	Follow Up Feedback 

**1.***  ****Do you have examples of how you’ve applied the teamwork training?***
- 	Our district is _restructuring our epi response team_ to include a dedicated foodborne outbreak “sub-team” and will construct district policies and procedures specific to this team.
**2.***  ****Have you been able to provide information received from the training to others in your place of work?  ***
- 	Yes.  Ongoing conversation and _collaboration between the epidemiologist and environmental health_ professionals has resulted directly from the workshop.

**Notes:**
Questionnaire format - response from a standard 2 day workshop.  
These are responses received 2 months after the initial workshop.

## 	Follow Up Feedback 

**3.***  ****Do you have examples of putting new procedures in place (for example, surveillance activities or investigation protocols) or getting rid of old ones?   ***
- 	As district epidemiologist, I am in the process of working with our EH manager and EH specialists to create a _database for passive surveillance_ by collecting and entering consistent data on all potential foodborne illness complaints.  Our goal, specifically, is to collect quality data that can be readily analyzed.  Such data does not currently exist for our district unless a foodborne illness is laboratory confirmed.

**Notes:**
Questionnaire format - response from a standard 2 day workshop.  
These are responses received 2 months after the initial workshop.

## 	Follow Up Feedback

- The workshop was excellent and the class helped the _sanitarians_ that attended have a _better working relationship with nurses_ and the different roles each would have in an outbreak of a foodborne disease.  As a nurse it helped me have a better understanding how sanitarians felt and their responsibilities and roles.

**Notes:**
Open response format – various responses from a standard 2 day workshop.  
These are responses received 2 months after the initial workshop.

## 	Follow Up Feedback

- I have approached complaints differently.  I had a food complaint about 6 weeks ago, that I used the 72 hour food history, but the person did not go to the ER for diagnosis, the person also called the food inspector and we collaborated on the issue which did not go any where.  Without the training I would not have collaborated with the food inspector, and we _approached the situation jointly_.  The training was exceptional and I now always focus on the 72 hour food history versus what was your last meal.

**Notes:**
Open response format – various responses from a standard 2 day workshop.  
These are responses received 2 months after the initial workshop.

## Distance Learning - Remote Site feature
Primary site / 50 attendees
Remote site / 2-3 sites / minimum of 25 attendees each
Volunteer past Epi-Ready graduate at each site

Recruit Additional Epi-Ready instructors

Continue to Integrate CDC EIS Officers into workshops

Offer support for Train the Trainer graduates

Share SUCCESS STORIES of Epi-Ready graduates

**Primary site / 50 attendees**
**Remote site / 2-3 sites / minimum of 25 attendees each**
**Volunteer past Epi-Ready graduate at each site**
**Recruit Additional Epi-Ready instructors**
**Continue to Integrate CDC EIS Officers into workshops**
**Offer support for Train the Trainer graduates**
**Share SUCCESS STORIES of Epi-Ready graduates**

**Additional Projects**

**Notes:**
-To help deliver the Epi-Ready Team Training workshops to an even broader audience, NEHA and NEHA-CERT are working together to offer Web casts in conjunction with in-person training. At our Columbia, MO workshop on May 6-7, we conducted a pilot to offer an accompanying live Web cast to three additional remote location sites.  The three remote sites where St. Louis, Kansas City and Richardson, TX, with approximately 25 attendees at each remote site, for a total of 125 participants between all four sites (an increase of 75 people).  A past Epi-Ready graduate will be placed at each remote site as a facilitator to maintain structure, answer questions and to ensure attendees are fully engaged and interactive during group exercises.  This is essential to our goal of having all participants feel as though the remote site workshop is as good as the live, in-person workshop.  After evaluations have been reviewed and it is found to be a success, this feature may be utilized at future workshops pending adequate funding. 

-We are currently in the process of actively recruiting additional instructors.  With more workshops being performed, we do not want our instructors to feel overwhelmed or over “volunteered.”  Many of our instructors take vacation time from work in order to instruct and therefore we must respect their time and professional priorities.  In order to prepare for this growth we will be adding a few new instructors to each category (epi, EA, lab).  Ex. CSTE has assisted with this effort and we have received many interested members who would like to be instructors. 

-CDC EISO’s cover the final case study exercise.  They do a great job and we receive good responses from attendees.  It also always us to use the “teamwork” approach by incorporating fed, state and local people as our instructors which is very beneficial for attendees. 

-Graduates enjoy TtT workshop and people have done great things with it.  Ex. A team in South Carolina has performed a modified version of Epi-Ready throughout their state and a team from Maryland is doing something similar.  There are some who really want tp do a workshop, however run into obstacles with putting on a workshop, such as funding issues like finding money for workshop materials, venue, etc.  They also may like more one-on-one support and communication from us which would help them feel more comfortable and motivated to do a workshop of their own.  We are exploring how we can further help and assist these TtT graduates. 

-Regarding out current course evaluation process, we have started implementing follow up evaluations (via email) 2 months and 9 months after each workshop.  Gathering significant meaningful data beyond the initial evaluation on both standard and TtT workshops is vital for funding, growth and success of the program and therefore a priority to us.  With this information we will learn how the training has effected the participants long term and/or how the training is being applied and implemented.  We have complied a list of follow up feedback received thus far (see next slide).  

## Epi-Ready Team Training Workshop

**NEHA Epi – Ready Contact: **
**                 ****Elizabeth Ostertag ****303-756-9090 ext. 346**

*** ******Thank you for your attention and your questions are welcomed.***