An Impact Evaluation of the Disability and Preparedness Specialist Program

July 24, 2024 | Margaret Nilz

From January 2021–July 2022, ASTHO and the National Association of County and City Health Officials (NACCHO), supported by CDC’s National Center on Birth Defects and Developmental Disabilities, launched an innovative preparedness and disability specialist program. This initiative embedded specialists in state, territorial, and local health agencies to enhance emergency response, planning, mitigation, and recovery efforts for individuals with disabilities. Specialists received extensive training, resources, and support from ASTHO, NACCHO, and CDC, ensuring they were well-equipped to fulfill their roles. Throughout the program, ASTHO and NACCHO conducted separate impact evaluations to assess the effectiveness of the specialist work within each health agency.

Two Years Later: Evaluating the Impact

Nearly two years after funding for this group of specialists concluded, ASTHO, NACCHO, and CDC have conducted a comprehensive evaluation to understand the program's long-term impact. Using a mixed methods approach that included surveys and focus group interviews, the evaluation captured quantitative and qualitative data on the program's sustainability and effectiveness. On-site health agency supervisors and specialists from the ASTHO and NACCHO specialist programs were engaged to respond to the survey and participate in focus group interviews. Due to the program ending in July 2022, both specialists and their on-site supervisors have scattered. Several specialists and supervisors have moved to new roles outside the health agency while others remained in their health agency in similar roles.

Key Findings

Increased Capacity and Knowledge

The specialist program significantly enhanced the capacity of participating jurisdictions to address the needs of people with disabilities. According to survey respondents, 84% agreed that the program improved their ability to implement or adjust programs and policies to be more inclusive. All participants affirmed the value of their work to the disability community, highlighting the specialist role of consistently advocating for people with disabilities within health agencies.

“[Our jurisdiction] has been making progress anyway. That's the big P policy. The smaller P policy, how we implement those bigger things, is really what [the program] helped with and helped us think differently.”

Strengthened Partnerships

The program also fostered stronger partnerships between health agencies, cross-sector organizations, government agencies, and other internal departments. Key external partnerships that were built include partnerships with tribal nations, Ability 360, Special Olympics, and more. These collaborations extended efforts to include people with disabilities in COVID-19 response initiatives and beyond, continuing today. With the groundwork laid by the specialist program, jurisdictions have continued to build on these cross-sector partnerships through new projects and working together to achieve common goals.

“We now have ongoing and I would say strengthened connections with our director of communications for the state, which is important, because this is not something that's housed within our [emergency preparedness] program… those relationships still continue, to now we have ongoing projects such as our Crisis Emergency Risk Communication plan.”

Sustained Efforts and Leadership Support

The evaluation revealed that most health agencies (87%) have continued the programs and policies initiated during the specialist program. Agencies increasingly prioritize equity and inclusion, which further supports implementing disability-inclusive policies and programs. Most respondents (67%) noted continued changes in key policies and communication processes to ensure resources effectively reach people with disabilities. Support from agency leadership and funding has been crucial in sustaining these efforts.

Challenges and Future Needs

Despite these successes, some agencies have faced challenges in sustaining their efforts. Limited staff capacity, funding, leadership support, and lack of disability expertise were cited as barriers. Most participants (78%) voiced hopes that the program would be re-funded in the future, observing that gains would likely be lost without additional funding, support, and recruitment and retention support for the preparedness and disability specialist role. Respondents emphasized the need for additional funding, resources, technical assistance and training to better plan and implement inclusive practices.

“I never realized that we weren't doing enough. We thought we were.”

Conclusion

Although the disability and preparedness specialist program has ended, ASTHO, NACCHO, and CDC continue to assist jurisdictions and build the capacity to plan for and respond to the needs of people with disabilities during emergencies. The specialist program left a lasting impact on participating jurisdictions, enhancing their ability to support people with disabilities in emergency preparedness and response. Ongoing support, training, and resources for disability preparedness will be vital to maintain and expand inclusive practices in health agencies in future public health emergencies. This program has shown that dedicated staffing with disability experts can help health agencies succeed in supporting the disability community.