Getting to Outcomes^®

Getting to Outcomes at a Glance

• Step: 01. Needs and Resources Assessment

  This step helps you identify and document the need for a program and related existing community resources.

• Step: 02. Goals and Desired Outcomes

  This step prompts you to develop a goal, specific desired outcomes, relevant program activities to reach the goal, and a logic model that displays all these elements.

• Step: 03. Best Practices

  This step guides you through the best available research evidence on building CEP to help you select an EBPH approach.

• Step: 04. Fit

  This step provides a structure to determine whether the program you identified during GTO Step 3 is appropriate for your target, community, and organization.

• Step: 05. Capacities

  This step provides a structure to determine whether the program(s) you identified during GTO Step 3 can be carried out effectively with the knowledge, skills, and resources of your organization and its partners.

• Step: 06. Plan

  This step helps you make a detailed work plan for delivering and evaluating the program you identified in Step 3 and selected at the end of Steps 4 and 5.

• Step: 07. Process Evaluation

  This step provides guidance on what to include in, and how to gather data for, a process evaluation, which tells you how well you delivered the program.

• Step: 08. Outcome Evaluation

  This step helps with planning an outcome evaluation and using the results from it. An outcome evaluation reveals how well you met the goals and desired outcomes you set for the program in Step 2.

• Step: 09. Continuous Quality Improvement (CQI)

  This step provides a framework for using process and outcome evaluation data to make program improvements.

• Step: 10. Sustainability

  This step guides you through some questions to consider when making decisions about whether your organization should continue a program.

Preface

Getting To Outcomes® (GTO) is a user-friendly process for comprehensive planning, implementation guidance, and evaluation of programs and community initiatives. It is designed to help organizations run programs well and get desired outcomes. This guide is designed to lead the user through the ten steps of GTO and provide supplemental information and resources to improve planning, implementation, evaluation, improvement, and sustainability of a community emergency preparedness (CEP) program. This guide is a streamlined sequence of overviews, tools, and additional resources for each GTO step. Other GTO manuals for drug prevention, underage drinking prevention, positive youth development, homelessness services, home visiting, and teenage pregnancy prevention are available at www.rand.org/gto .

This guide is designed for individuals who are considering and/or planning for the implementation (and evaluation) of a CEP program. Emergency planners, personnel from community-based organizations, state and local health department staff responsible for CEP programs, and individuals assessing or evaluating CEP programs may also be interested in this guide.

This publication was supported under a cooperative agreement: CDC’s Collaboration with Academia to Strengthen Public Health Workforce Capacity, grant number 3 U36 OE000002-04 S05, funded by CDC Office of Public Health Preparedness and Response through the Association of Schools and Programs of Public Health (ASPPH). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC, the U.S. Department of Health and Human Services, or ASPPH.

The UCLA Center for Public Health and Disasters promotes efforts to improve community resilience and to reduce the health impacts of disasters and global climate change. For more information on the center, see www.cphd.ucla.edu.

RAND Health is a division of the RAND Corporation, a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest. For more information on RAND Health, see www.rand.org/health or contact the director at RAND_Health@rand.org.

Purpose of the Guide

This guide is designed to lead the user through the ten steps of GTO and provide supplemental information and resources to improve planning, implementation, evaluation, improvement, and sustainability of a community emergency preparedness (CEP) program. This guide is a streamlined sequence of overviews, tools, and additional resources for each GTO step. Other GTO manuals for drug prevention, underage drinking prevention, positive youth development, homelessness services, home-visiting, and teenage pregnancy prevention are also available. .

This guide is designed for individuals who are considering and/or planning for the implementation (and evaluation) of a CEP program. Emergency planners, personnel from community based organizations, state and local health department staff responsible for CEP programs, and individuals assessing or evaluating CEP programs may also be interested in this guide.

Why Use GTO?

Research has shown that organizations that use GTO improve their programs and get better outcomes than organizations that do not use GTO (Chinman et al., 2016; Acosta, et al., 2013; Chinman et al., 2008).

Why Use GTO to Improve CEP

The number and severity of disasters is increasing. When a disaster hits, affected populations often seek help through emergency response systems, public health systems, and acute care hospitals. This surge of people seeking help can disrupt services and overwhelm systems. Having a 7-day supply of food, water, and medication and a written household evacuation plan – simple ways to improve household preparedness – can help prepare the population to cope with service disruption, thereby lessening the burden on systems and hospitals.

Traditional CEP programs have focused on (1) increasing awareness about the importance of being prepared; and (2) educating community members about simple ways that they can make themselves and their neighbors better prepared for disaster. CEP programs are often focused on:

• educating or training households to create a family or personal preparedness plan (how to evacuate, where to meet up, how to cover medication needs) and a preparedness kit (food, water, batteries, radio, flashlight, etc.)
• improving neighbor-to-neighbor outreach to talk about preparedness and identify how neighbors may be able to help each other during a disaster
• educating or training individuals about how to maintain psychological health during a disaster (e.g., psychological first aid program, including a stuffed animal or bar of chocolate in a household preparedness kit for comfort)
• coordinating volunteer efforts (Citizen Corps, Medical Reserve Corps, or a local neighborhood group that shovels during snow storms, etc.)
• organizational networking and preparedness planning (to build capability among community- and faith-based organizations that don’t traditionally get involved in preparedness activities).

Preparedness efforts can also be tailored to specific populations that have certain needs that make them especially vulnerable to disasters. For example, older adults tend to have more health and functional needs than others and preparedness efforts may need to take specific steps for that population.

The intended outcomes of CEP programs are two-fold:

1. Improve individuals’ and households’:

• awareness that a disaster can happen in their community
• awareness of skills that they can use during a disaster
• development of personal/household preparedness plan or kit
• awareness of the importance of/inclusion of psychological health items in plans and kits
• awareness of a neighbor or organization they can count on during a disaster
• willingness to volunteer for coordinated preparedness efforts in their community.

2. Improve community organizations’:

• awareness that a disaster can happen in their community
• awareness of emergency plans in the community (the role their organization plays in a coordinated response and where they can get help, if needed)
• use of preparedness planning
• willingness to participate in disaster planning efforts, or community disaster exercises or drills.

Despite continued investment FEMA’s national preparedness survey shows that only about half of individuals report making a plan (2007) or having emergency supplies on hand (2009).

Research has suggested that some of the reasons that these numbers have remained constant is because CEP programs were not culturally appropriate or making a disaster kit was not feasible because not all families could afford to store extra food and water. In addition, research has found that community preparedness programs were lacking an emphasis on mental health. Not only is it important to prepare plans to ensure physical health and safety, but mental health effects of disasters can persist and exacerbate chronic health issues and substance use disorders.

GTO can help your organization assess the need for and the fit of a CEP program, identify a specific goal, and specify desired outcomes that relate to the goal. After that, GTO can help you choose an evidence-based public health (EBPH) approach and a plan for successful implementation. Furthermore, GTO will help you plan and collect process and outcome evaluation data to improve and sustain the program. Conducting these activities will help you meet the needs of your community and demonstrate your effectiveness to funders, community members, and other stakeholders.

In this guide, we define community preparedness as the ability of communities (organizations and households in the community) to prepare for, withstand, and recover — in both the short and long terms — from manmade or natural disasters. To prepare communities for disaster, public health agencies, in partnership with emergency management, healthcare organizations (private and community-based), mental/behavioral health providers, and community and faith-based partners can conduct CEP programs.

Organization of the GTO CEP Guide

This guide contains 10 chapters – one for each GTO step. Each chapter contains:

• an overview of the GTO step—what it is, why it is important, and how to do it
• an introduction to the tools contained within each step that explains why using the tools is important
• detailed instructions for completing each tool within the step
• a completed example of each tool
  The examples throughout this guide relate to a fictional location. The place is Townville, USA located along the banks of a river that experiences frequent seasonal flooding. The town has a large population of older adults living throughout the community. In recent years, the floods have left many neighborhoods cut off for several days. Lack of access to shops and pharmacies has impacted older adults, many of whom require daily medications for chronic medical conditions, disproportionately. Hospitalizations and emergency medical assistance has resulted due to lack of compliance with medication regimes during the periods when older adults were cut off by the flooding. In addition, several severely dehydrated older adults were seen in emergency rooms during the disaster events. A public health team from the local health department (LHD) was working to try to understand more about the problems and figure out if there was some preparedness work that could be done to better educate and prepare this population for disasters that might leave them cut off from medical and retail services. The team includes the (LHD) staff (a program manager, program coordinator and a trainer) and managers of several older adult community centers, also referred to as senior centers, with which the LHD has collaborated in the past on older adult wellness interventions. The examples in this guide follow the LHD team’s work of using GTO to consider and then select, plan, and evaluate ROAD-MAP, a real CEP program developed by the UCLA Center for Public Health and Disasters. ROAD-MAP was selected for implementation in Townville after assessment of other options concluded that they were not appropriate. Only the ROAD-MAP assessment tools are included here as examples.
  
  ROAD-MAP is a CEP program that educates older adults in how to prepare emergency supplies, including an extra 7-day supply of medications and household supplies, and a disaster plan. The program is delivered as an in-person workshop with trained peer facilitators leading the 75 minute long session. Resources are distributed to workshop participants to help them obtain extra medication and emergency household supplies after the workshop. For more information about ROAD-MAP, including the ROAD-MAP resource package, see the tools and resources section at www.cphd.ucla.edu.
• Blank tools for you to complete in each chapter. Microsoft Word versions of each tool and the complete Guide can also be downloaded without charge from the RAND website.
• Tips and resources for use in completing each step
• A summary checklist for doing each step and a summary of next steps
• The guide also includes an appendix containing ROAD-MAP process evaluation materials, a list of abbreviations, and a Glossary section at the front to help you better understand terms used throughout the chapters.

Tips for Using the GTO CEP Guide

• Completing the tools for each step takes time, thought, and consideration. When time and attention are put into completing these tools, they will help improve the quality of your program.
• The ten GTO steps and corresponding tools outlined in this guide are designed to be completed sequentially. The GTO process is most beneficial when program facilitators and program managers/directors collaborate on their completion to ensure that key details are not missed.  
•  It is especially important to complete GTO Steps 1–6 before implementing your program. GTO Steps 7 and 8—the evaluation steps—also have parts that are important to complete before you start running your program.  Set aside a regular time for your program facilitators and program manager to address the steps leading up to, during, and immediately following implementation.
•  If you plan to deliver your program more than once, possibly once a year you will want to use your evaluation results in Step 9—quality improvement—and revisit GTO Steps 1–6 before any subsequent implementation to see whether changes should be made to improve the process and/or outcomes of the next implementation. You would then continue the evaluation and quality improvement steps (Steps 7–9) with each implementation of the program. GTO prescribes this ongoing cycle for all future program implementations. Step 10 is also important to complete whenever ongoing implementation is planned.

Acknowledgments

The authors wish to express our thanks to Mary Leinhos, Ph.D., M.S., our project officer from the Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention (CDC), for her support of this project. We appreciate the participation of the staff from the Public Health Emergency Department at the City of Long Beach Department of Health and Human Services, the Health Disaster Management Department at the Orange County Health Care Agency, and the Preparedness and Response Program at the San Bernardino County Department of Public Health. We would also like to acknowledge Plymouth Village, an older-adult residential community, in Redlands, California. We appreciate the input of our RAND and University of California, Los Angeles colleagues who provided insights and experiences for this work—in particular, Michael Prelip, Alina Dorian, Cathy Lang, Deborah Glik, and Andrea Martel. We thank Jeffrey Chappelle for administrative support. We would also like to thank Melinda Moore and Paul Koegel for their reviews and comments on the manual.