Program Details

Practice Type:	Promising
Program Name:	Intra-Interagency Collaboration in Preparing Homeless Populations for All Hazards
Organization:	Tarrant County Public Health Department
Web site:
Overview:	Tarrant County currently has an estimated 2,000+ homeless persons. A large number of whom stay in an area east of downtown Ft. Worth, Texas, where several shelters happen to be colocated. The primary means of transportation for this group is the city bus system or no transportation of any kind. “The lack of healthful food, adequate medical care, and the facilities needed for routine hygiene, as well as the enormous emotional difficulties many homeless people experience in choosing between (a) the close quarters living space provided by the shelter community; and (b) living outdoors in all types of weather put the homeless community at increased risk for naturally occurring diseases. Not incidentally, these same conditions make the nation’s homeless community an ideal target for bioterrorists seeking to spread disease quickly and easily throughout the entire country.” (Cahill, 2008. Domestic Preparedness Journal.) It is this lack of resources, comingling, cohabitation, and use of mass transportation or lack of transportation that leads Tarrant County Public Health to identify this vulnerable population as at-risk. Our goals were to collaborate with leaders of homeless organizations and shelter directors, and to coordinate an effective response to meet the needs of this identified at-risk population residing in Tarrant County while using existing infrastructure and programs. Regarding Prevention, we sought to educate and prepare shelter staff and homeless persons in Tarrant County regarding pandemic and seasonal flu prevention and response; to educate this at-risk group to be alert for clinical symptoms consistent with the attack agent, for this scenario cold vs. flu vs. pandemic flu; and to identify a location for the dispensing of medical countermeasures within the area of Tarrant County where this population is concentrated. Regarding Response, we sought to provide medical countermeasures to this at-risk population while evaluating existing Strategic National Stockpile standard operating guidelines; and to collaborate with shelter directors and organizations to meet the needs of this population during a public health emergency. Medical countermeasures were successfully provided and key partners in homeless population preparedness and response were identified. After action reviews of the exercise and subsequent meetings with the Salvation Army Director and Homeless Coalition Committee Chair have taken place. Alternative locations for mass dispensing have been discussed for future consideration. A large facility in this area that houses MHMR services is under consideration and a walk thru is scheduled. It is without doubt that prior involvement with this community and regular visits to the area by public health staff are important to build a trusting relationship and improve compliance not only for medical countermeasure but fostering good health habits in general.
Year Submitted:	2009
Responsiveness and Innovation:	Tarrant County Public Health views the homeless population at risk for ease of disease transmission and vulnerable to not only naturally occurring disease but possibly as a bioterrorist target due largely to their use of mass transportation, cohabitation, and comingling combined with lack of adequate medical care, nutrition, and health hygiene. This practice uses existing programs within the public health department that focus on this group to prevent tuberculosis transmission and enhances that program for use as a response tool should a biological or terrorist incident occur. Based on subject matter literature, research, and existing staff knowledge on the health of the homeless in Tarrant County, as referenced previously, this local health department determined this group to be at-risk. Successful delivery of medical countermeasures was completed at minimal cost using existing programs within public health.
Agency and Community Roles:	Tarrant County Public Health performs community outreach on a broad spectrum and has the responsibility to safeguard our community’s health before, during, and after a public health emergency. Preparedness staff recognized an opportunity to work with interagency divisions and optimize their relationships with intra-agency organizations, such as the shelter directors and the homeless coalition, to combine resources and provide medical countermeasures while evaluating response plans to meet the needs of this vulnerable population. All hazards planning, prevention, and response involves multiple stakeholders; participating agencies for this exercise were staff from three divisions of public health: immunizations, tuberculosis, and preparedness; staff from Tarrant County administration (EOC); Tarrant County Constables provided security for staff and pharmaceutical cache; Salvation Army; MRC Ham Radio operators. Additional partner agencies have become involved postevent to assist Tarrant County Public Health in our endeavors to identify the best site for mass dispensing operations.
Costs and Expenditures:	Tarrant County Public Health Immunization Outreach, Tuberculosis Outreach, and Preparedness divisions worked in collaboration with Salvation Army Shelter Directors to implement this model. The practice is scalable and would allow for any public health staff, shelter staff, and/or MRC volunteers to support operations to meet the population need that might show up in this area of Ft. Worth. Section 8 public housing and low-income housing located in this area could also be served at this site. Tarrant County tuberculosis teams screen twice monthly in the homeless shelters located in this east Ft. Worth area and have developed a long standing trustful relationship with the patrons of the shelters. Approximately 200 PPDs and chest x-rays were provided during this exercise, covering approximately 10 percent of what shelter directors consider their core population. In addition, 73 seasonal flu vaccinations were provided free to consenting patrons, including children who resided at the shelter. The pre-existing relationship with public health staff fostered this vaccination process to a population typically noncompliant with any vaccination and at high risk for seasonal flu. Costs for the project were staff time and transportation of equipment and supplies. Because all three divisions were engaged in performing their normal daily functions, no additional costs were incurred by the divisions over and above normal operating costs, which makes the practice sustainable as part of routine screening and vaccination programs.
Implementation:	Tarrant County Public Health views the homeless population at risk for ease of disease transmission and vulnerable to not only naturally occurring disease but possibly as a bioterrorist target due largely to their use of mass transportation, cohabitation, and comingling combined with lack of adequate medical care, nutrition, and health hygiene. This practice uses existing programs within the public health department that focus on this group to prevent tuberculosis transmission and enhances that program for use as a response tool should a biological or terrorist incident occur. Based on subject matter literature, research, and existing staff knowledge on the health of the homeless in Tarrant County, as referenced previously, this local health department determined this group to be at-risk. Successful delivery of medical countermeasures was completed at minimal cost using existing programs within public health.
Sustainability:	This exercise was completed at no additional costs to the agencies involved. Comic books were donated by the APC, staff from all agencies willingly committed resources with all functions being part of normal daily activities. It is the goal of Tarrant County Public Health to develop practices that are sustainable and flexible, we as an agency provide many services and work with many community partners, our goal is to maximize our resources and force multiply in new and innovative ways so that we may be better and faster in a response.
Lessons Learned:	Information was not provided in 2009

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