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The Centers for Disease Control and Prevention (CDC) and the Council of State and Territorial Epidemiologists have identified a deficit in the resources and infrastructure for epidemiologic capacity in the United States.1 This deficit is particularly evident during public health emergencies, such as infectious disease outbreaks and natural disasters, which require an acute surge in the number of public health responders. Disruptions in daily health department operations due to the need to reorganize personnel during public health emergencies have prompted interest in developing and maintaining a dependable source of surge capacity.2
In response to this identified need, graduate student epidemiology response programs (GSERPs) have been created at numerous schools of public health around the U.S. GSERPs provide an innovative solution to the need for skilled public health labor while simultaneously offering students the benefit of hands-on experience working with public health practitioners to complement their academic training. Numerous GSERPs operate as programs supported through CDC-funded Centers for Public Health Preparedness (CPHPs) or other similarly funded support mechanisms; a growing number operate as independent student organizations.3
The Student Epidemic Intelligence Society (SEIS) at The University of Texas School of Public Health (UTSPH) is a GSERP that has operated as both a CPHP-funded program and an independent student organization. Under both support structures, the SEIS has fostered an ongoing and mutually beneficial relationship that links trained student volunteers with opportunities afforded by local health departments (LHDs). This article details the structure and response operations of the SEIS. Drawing on feedback from program participants after a preliminary evaluation, we illustrate the organization's ability to facilitate service-learning opportunities for students while fulfilling LHDs' surge capacity needs. We also highlight the challenges of integrating the resources offered by a student volunteer group into the infrastructure of public health preparedness and response and provide perspective on maintaining a sustainable student-run organization.
The SEIS was created in 2003 in response to the need for both increased public health surge capacity and opportunities for hands-on field training of future public health professionals. The SEIS is modeled after CDC's Epidemic Intelligence Service, and its action plan encompasses education, response, and training activities. The objectives of the SEIS are to (1) provide emergency assistance to health departments during infectious disease outbreaks and other public health emergencies, (2) offer students didactic training and hands-on field experience in outbreak and disaster preparedness and response, and (3) develop competency in emergency operations management.4 Training activities were recently organized into a more formal Public Health Preparedness Training Program (PHPTP) that was developed and launched by SEIS student officers in 2008. The PHPTP's 11 training modules reflect practical skills that may be requested of volunteers during response activities, including outbreak investigation, rapid assessment methods, and risk communication.
The SEIS has core partnerships with the Houston Department of Health and Human Services, Harris County Public Health and Environmental Services, and the Texas Department of State Health Services. Additional partnerships have been established with local emergency medical personnel, the Texas Medical Rangers, and a student readiness initiative paralleling the inactive reserve corps of the U.S. Public Health Service.
SEIS membership is open to faculty, students, alumni, and staff from the various institutions within the Texas Medical Center, where UTSPH is located. The majority of its members are graduate students of public health, although a number of student members are in the biomedical sciences, medical, and nursing fields. There are 328 members registered on an electronic membership database maintained by the SEIS; of these, approximately 93 are currently active members who have participated in at least one SEIS event in the past year. The organization follows a set of bylaws registered with the university, which are available on the SEIS website.4 The SEIS is led by eight student officers who are elected annually by student members enrolled at UTSPH. The organization's faculty advisor and founder provide guidance on the organization's operation and continuance. Two officers serve as health department liaisons to maintain active communication and relay expressed needs from the health departments to the student group.
Membership records are maintained by the SEIS in an electronic database that is updated each semester with information on each member's pertinent training and skills, interests, and affiliation (e.g., student, faculty, or other). In the event of a need for public health surge capacity, health department personnel contact SEIS officers to request assistance. SEIS officers responsible for coordinating response activities solicit volunteers by sending out a mass e-mail to all members in the database or by activating a telephone contact system to organize volunteers according to the immediate needs identified by the health department. The SEIS recently implemented a “volunteer reserve” system for imminent public health response needs, such as impending hurricanes or suspected epidemic situations. Through this new system, these reserve volunteers inform officers of their anticipated availability prior to the event and are contacted if and when the need arises.
Since its inception, SEIS members have assisted the LHDs in several infectious disease outbreak responses and community and disaster needs assessments (Table). Recent infectious disease responses have included interviewing cases for the local response to the H1N1 epidemic, interviewing cases and controls for a multistate Salmonella outbreak (in coordination with CDC officials), case finding and contact tracing for a Shigella outbreak at a local daycare, exposure screening for a meningococcal outbreak at a local university, screening and crowd control for a hepatitis A virus outbreak at a large restaurant chain, and manning telephone hotlines for a citywide syphilis outbreak. Students have also provided pretouch contacting and interviewing for multiple community needs assessments.
As the SEIS has progressed in establishing its role within the local public health infrastructure, its response and training activities have steadily increased (Figure). The SEIS's response requests increased markedly following its collaboration with LHDs in conducting syndromic surveillance in evacuation centers for Hurricane Katrina evacuees in 2005. The Hurricane Katrina rapid assessment was by far the largest and most prominent response in which SEIS members have been involved. When more than 25,000 New Orleans residents were evacuated to Houston and temporarily placed in the Houston Astrodome/Reliant Park Complex and the George R. Brown Convention Center, the SEIS was requested by the city and county health departments to design and implement a rapid “cot survey” assessment. The cot survey, which included a checklist of symptoms administered to each occupied cot at the shelter, proved critical in detecting and monitoring the course of a norovirus outbreak and identifying preventive measures for stopping its spread.5
The Hurricane Katrina response demonstrated the SEIS's ability to serve as a reliable resource for emergency public health surge capacity. As shown in the Figure, requests for SEIS assistance have steadily increased since 2005. More recently, following Hurricane Ike, student volunteers used the expanded program on immunization cluster sampling method to assess the health needs of Houston residents and conducted syndromic surveillance activities in area evacuation centers. During the 2008–2009 academic year, SEIS members volunteered more than 750 hours of service with the health departments. Recognizing this growing demand for response assistance, the SEIS initiated its PHPTP in 2008 to ensure a prepared and skilled volunteer base. This initiative led to an increased number of training opportunities offered in the 2008–2009 academic year. Skills-based training events have increasingly replaced the SEIS's educational guest lecture activities.
In the fall of 2008, the SEIS conducted a preliminary evaluation of its education, training, and response activities. Using SurveyMonkey™ Pro,6 SEIS sent an electronic invitation to participate in an online questionnaire to the 328 student and faculty members registered in the electronic database and nine health department personnel who have worked directly with SEIS officers during response activities. Both open- and closed-ended questions were included in the questionnaire. SEIS members were asked questions that assessed their utilization and satisfaction with SEIS response opportunities (hereafter referred to as the SEIS Member Survey). Health department personnel were asked questions that assessed their perceptions of the SEIS's ability to fulfill their surge capacity needs and challenges to SEIS volunteer utilization (hereafter referred to as the Health Department Personnel Survey). The results of the pilot evaluation are summarized in the next section of this article.
A convenience sample of 64 participants completed the SEIS Member Survey, yielding a 69% response rate among the 93 members who have participated in one or more SEIS activities in the past year. Ninety-five percent of the participants were students affiliated with UTSPH. Among SEIS member participants, 58% indicated that they had attended at least one SEIS educational guest lecture or social networking activity, 53% had participated in at least one training activity, and 44% had volunteered in at least one response activity.
Among SEIS members, the most common theme that emerged from the open-ended questions was the positive role of the SEIS in supplementing classroom education. One participant said, “SEIS field response activities created a hands-on approach to learning public health skills … [which] compliments the classroom experience.” Participants also reported that volunteering in SEIS response activities gave them practical experience: “Volunteering at the health department gave me real-world experience I would have not have had otherwise through my education at [UTSPH].”
These findings were supported by quantitative results indicating that 65% of participants agreed or strongly agreed that they gained practical experience in public health through SEIS activities, and 64% agreed or strongly agreed that programs sponsored by the SEIS increased their knowledge of procedures used to address infectious disease outbreaks and public health emergencies. Among SEIS member participants, 78% agreed or strongly agreed that the SEIS provided students the opportunity to get involved in public health responses conducted in the local area. As one participant stated, “[The SEIS] provides a nice platform for students to work [with] health department officials and better serve the community.” Overall, the survey results indicated positive attitudes toward the SEIS, with 83% of participants indicating that they agreed or strongly agreed that they would recommend membership to fellow students, faculty, and/or staff.
A convenience sample of five of the nine health department personnel who have worked directly with SEIS officers completed the online Health Department Personnel Survey. Results showed general satisfaction in working with SEIS volunteers. Health department participants cited surge capacity as the most helpful service offered by SEIS volunteers. All participants indicated that they agreed or strongly agreed that SEIS volunteers improved their health department's capacity for responding to infectious disease outbreaks and emergency situations. One health department participant stated that SEIS volunteers “increase our capacity to provide quality public health,” while another reported that SEIS participation in responses “enables us to more thoroughly complete outbreak investigations and follow-ups as necessary.”
Beyond manpower, all health department participants also indicated that they agreed or strongly agreed that SEIS volunteers were well prepared with the public health skills required for their work with the health departments. Comments indicated that SEIS officers “demonstrated excellent temperament and skills appropriate for tasks required,” and volunteers “were professional, have strong knowledge of public health, and greatly assist in outbreak monitoring.” Cited challenges to SEIS participation in response activities included difficulties in communicating and coordinating response logistics. One participant said, “There is occasional miscommunication in setting up times for students.” Regarding this challenge, it was suggested by the participant that “a more formalized method of contacting someone” would be helpful.
Through numerous response activities during the past six years, the SEIS has developed and maintained ongoing partnerships with LHDs. The result is a system that allows for the integration of student volunteers within the public health preparedness and response infrastructure. Beyond the foremost need for surge capacity manpower, LHDs benefit from trained volunteers who offer specific skills needed for community assessments and outbreak and natural disaster response. Students receive such training through their classes and participation in the SEIS PHPTP.
Feedback from program participants indicates that students appreciate the complimentary hands-on learning opportunities offered by SEIS response activities. Health departments benefit from the availability of skilled student volunteers, although there are barriers to integrating the SEIS within the LHDs' operations. One of the cited barriers was difficulty in communicating with SEIS officers and coordinating logistics during response operations. This difficulty may be due to the fact that, although there is an established protocol for communicating with the health departments regarding response activities, the proximity and convenience of preexisting contacts often cause deviations from the procedures. The survey has drawn attention to the need for stricter adherence to the established procedures by SEIS officers and the need to periodically review the procedures with health department personnel.
In the SEIS's experience, communication during response activities is greatly improved by maintaining an ongoing relationship with the health departments. Accordingly, SEIS officers designated as health department liaisons serve as valuable links between the needs of the health department partners and the resource base offered by the SEIS. Health department personnel are regularly invited to instruct and participate in trainings and to attend and deliver educational events and guest lectures. Additionally, the SEIS hosts semiannual socials in which students, faculty, and health department personnel can network and discuss possible collaboration, including student internships and practica. These events provide opportunities to share successes and concerns while strengthening professional relationships. By maintaining ongoing visibility and interaction with the health departments, the SEIS is able to reinforce its position as a go-to organization for emergency surge capacity needs.
Ongoing visibility is likewise needed to build SEIS membership, maintain interest during nonemergency periods, and strengthen institutional support for the organization. The SEIS works to build its core membership by actively recruiting students at its semiannual orientation and networking events. The SEIS maintains student involvement by hosting regular guest lectures, conducting PHPTP training events, and hosting and promoting special annual events, such as World AIDS Day and World Rabies Day. Communication with its members is accomplished by sending out e-mail messages alerting members of upcoming PHPTP events, member meetings, and other activities of interest and by providing monthly electronic newsletters and outbreak reports. The SEIS logo is incorporated into all promotional materials and SEIS T-shirts, which serve the dual function of fundraising and strengthening organizational identity.
Institutional support for the SEIS has been garnered over the years by encompassing the broader UTSPH community in SEIS activities. The SEIS hosts the Annual Public Health Field Day, a day of family-oriented fun focused on physical activity, which the UTSPH administration enthusiastically supports as a community-building event. Partnerships have been established with the school administration and other UTSPH entities (e.g., the Global Health Concentration and student government) to cohost other events such as World AIDS Day and receptions for distinguished speakers. Another way in which the SEIS has garnered institutional support has been by opening activities to the entire Texas Medical Center, which augments UTSPH's presence in the local health science community.
Institutional support, in combination with an engaged member base, allows the SEIS to operate as a cohesive functioning system. This enables the SEIS to dependably fulfill the needs of LHDs for sudden and temporary increases in public health workforce resources. Graduate student epidemiology response groups are an ideal volunteer base in that they provide dependable, flexible, and skilled public health labor that can be readily mobilized to respond to public health emergencies. While establishing a successful and independent student organization is a challenging endeavor, the lessons described in this article provide insight on how to overcome some of the most common obstacles. As the nation continues to build its public health preparedness infrastructure, local GSERP initiatives may be an attractive resource that health departments can call on to fulfill their surge capacity needs.
The authors thank all of the past and present members of the Student Epidemic Intelligence Society (SEIS), as well as other University of Texas School of Public Health students, staff, faculty, and administration who have volunteered time and effort in helping make the SEIS a successful organization. The authors also thank the staff at the City of Houston Department of Health and Human Services and Harris County Public Health and Environmental Services for their continued support. The SEIS has been supported in part by Centers for Disease Control and Prevention grant #5U90TP624246.