After Action Review/ Improvement Plan

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AfterActionReview/ImprovementPlanStrategicPlanningToolkit

InterTribalCouncilofArizonaInc.

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TableofContentsFIGURES...............................................................................................................................................................................4TABLES................................................................................................................................................................................4ACKNOWLEDGMENTS......................................................................................................................................................5INTERTRIBALCOUNCILOFARIZONAINC.TRIBALEPIDEMIOLOGYCENTER.....................................................................................5Background.........................................................................................................................................................................................................5

ABBREVIATIONSANDACRONYMS...............................................................................................................................7INTRODUCTIONTOTHEAFTERACTIONREVIEW(ARR)TOOLKIT....................................................................8PURPOSEOFTHEAARTOOLKIT..........................................................................................................................................................8WHOISTHISTOOLKITFOR?.................................................................................................................................................................8HOWTOUSETHISTOOLKIT.................................................................................................................................................................8

COVID-19VIRUSINFORMATION.................................................................................................................................10INTRODUCTIONTOANAAR.........................................................................................................................................12WHATISANAAR?.............................................................................................................................................................................12WHATARETHEOBJECTIVESOFANAAR?........................................................................................................................................13WHATARETHEBENEFITSOFCONDUCTINGANAAR?....................................................................................................................13WHENSHOULDANAARBECARRIEDOUT?.....................................................................................................................................14

TRIBALSPECIFICCONSIDERATIONS.........................................................................................................................15TRIBALPRIORITIES............................................................................................................................................................................15TRIBALLEADERSHIPCONSULTATION..............................................................................................................................................16TRIBALCAPABILITYCONSIDERATIONS............................................................................................................................................16

BEFOREANAAR..............................................................................................................................................................17DESIGNINGANAARWORKINGGROUP............................................................................................................................................17BUILDINGTHEAARTEAM................................................................................................................................................................18DEVELOPINGABUDGET.....................................................................................................................................................................19DEVELOPINGACHECKLISTANDAGENDA.........................................................................................................................................19INFORMINGSTAKEHOLDERS,PARTICIPANTS,ANDFACILITATORS................................................................................................19VIRTUALVENUESDURINGCOVID-19PANDEMIC.........................................................................................................................20

PREPARINGFORTHEAAREXERCISE........................................................................................................................21COLLECTANDREVIEWRELEVANTBACKGROUNDDOCUMENTATION...........................................................................................21REFINETRIGGERQUESTIONSANDEXERCISES................................................................................................................................21TIMELINELEADINGUPTOANAARWORKINGGROUP..................................................................................................................22

DURINGANAAR..............................................................................................................................................................23CONDUCTINGANAAR.......................................................................................................................................................................23ActivitiesduringanAAR............................................................................................................................................................................23

USINGCAPABILITYSTANDARDSFORANAAR.................................................................................................................................23CREATEANINVENTORYOFCORECAPABILITIES.............................................................................................................................29SELECTAFOCUSFORTHEAAR........................................................................................................................................................30KEYMILESTONESOFANINCIDENT...................................................................................................................................................31IDENTIFICATION,EVALUATIONANDRATINGOFSTRENGTHS,CHALLENGES,ANDNEWCAPACITIESDEVELOPED....................32RatingPerformanceforEachCapacity.............................................................................................................................................32HowtouseyourEvaluationforImprovementPlanning..........................................................................................................35

BUILDINGCONSENSUSAMONGPARTICIPANTS................................................................................................................................35PRESENTINGRESULTSANDFOLLOW-UPACTIONS...............................................................................................36

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INTER-TRIBALDEBRIEFING..............................................................................................................................................................36EXTERNALDEBRIEFING.....................................................................................................................................................................36AARFINALREPORT..........................................................................................................................................................................36AFTERTHEAAR:DOCUMENTINGPROGRESS.................................................................................................................................37LESSONSLEARNEDDATABASE.........................................................................................................................................................37

IMPROVEMENTPLANNING...........................................................................................................................................38IMPROVEMENTPLANAUTHORITY....................................................................................................................................................38TribalImprovementPlanLeadership.................................................................................................................................................38

TRIBALTIMELINES.............................................................................................................................................................................39AFTERACTIONIMPROVEMENTPLAN.......................................................................................................................39IMPROVEMENTPLAN(IP)DEVELOPMENT:.....................................................................................................................................39GatheringStakeholderObservations..................................................................................................................................................39SMARTCorrectiveActions........................................................................................................................................................................40

IMPLEMENTATIONFUNDING.............................................................................................................................................................43DirectRequestsforAssistance................................................................................................................................................................43Partnerships.....................................................................................................................................................................................................43PostDisasterGrantsandAssistance...................................................................................................................................................44

IMPLEMENTATIONSTAFFING............................................................................................................................................................44InternalStaffing............................................................................................................................................................................................44ExternalStaffingResources.....................................................................................................................................................................45

IMPROVEMENTPLANNINGTOSUPPORTCONTINUOUSIMPROVEMENT.........................................................................................45ContinuousImprovement:........................................................................................................................................................................45CorrectiveActionTrackingandImplementation.........................................................................................................................46

APPENDICES.....................................................................................................................................................................47APPENDIXA.PERFORMANCERATINGOFCAPABILITIES.................................................................................................................48APPENDIXB.IMPROVEMENTPLANMATRIX...................................................................................................................................49APPENDIXC.AFTERACTIONREPORTANDIMPROVEMENTPLANTEMPLATE..............................................................................50

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FiguresFigure1.TECServiceAreas.....................................................................................................................................6Figure2:AARPlanningRoadmap........................................................................................................................9Figure3:CDCNewCasesbyDay........................................................................................................................11

TablesTable1:COVID19CasesbyIHSArea.................................................................................................................10Table2:AdditionalTribal/RegionalSpecificConsiderations..............................................................16Table3:WorkingGroupDesign.........................................................................................................................17Table4:AARTeamMembersandRoles...........................................................................................................18Table5:ExampleItemstoBuildintoaBudgetforAARActivities........................................................19Table6:ExampleRelevantBackgroundDocuments..................................................................................21Table7:ExampleTimelinePriortoWorkingGroup...................................................................................22Table8:CapabilityDefinitionsandFunctions...............................................................................................24Table11:ExampleEvaluationforCapability#1-CommunityPreparedness.................................33Table12:ExampleEvaluationforCapability#2–CommunityRecovery.........................................33Table13:ExampleEvaluationforCapability#3-EmergencyOperations.......................................34Table14:ExampleEvaluationforCapability#8-MedicalCountermeasure..................................34Table15:SMARTCorrectiveActions...............................................................................................................40Table16:ImprovementPlanMatrix................................................................................................................42

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AcknowledgmentsThistoolkitwascommissionedbytheInterTribalCouncilofArizona:TribalEpidemiologyCenter.ThetoolkitwasdevelopedandcompiledbyBlueStoneStrategyGroup.InterTribalCouncilofArizonaInc.TribalEpidemiologyCenter

BackgroundInterTribalCouncilofArizonaInc.

The Inter Tribal Council of Arizona was established in1952toprovideaunitedvoiceforTribalgovernmentsinthe state of Arizona to address common issues ofconcerns. On July 9, 1975, the Council established aprivate, non-profit corporation, Inter Tribal Council ofArizona,Inc.(ITCA),underthelawsoftheStateofArizonatopromoteAmericanIndianself-reliancethroughpublicpolicy development. ITCA provides an independentcapacitytoobtain,analyze,anddisseminateinformationvital to American Indian community self-development.ThemissionofITCAistoprovideitsMemberTribeswithaunited voice and themeans for unitedactiononmattersthataffectthemcollectivelyorindividually.

TribalEpidemiologyCenter

The Inter Tribal Council of Arizona, Inc. Tribal Epidemiology Center values trust, service, andintegrity above all else. We provide responsive, confidential, reliable, practical, high-qualityprofessional epidemiologic services and products that address current and future public healthchallengesamongtribalnations.Wedothisbypromotingtribalself-determination,partnerships,innovation, resourcefulness, accountability, and sustainability. Our goal is to eliminate healthinequitiesamongAmericanIndianNationswithinthreegenerations.

OurmissionistobuildTribally-drivenpublichealthandepidemiologiccapacityamongTribesinthePhoenix and Tucson Indian Health Service Areas by assisting Tribes with health surveillance,research,prevention,andprogramevaluationforplanningandpolicydecisionmakinginordertoimprovecommunityhealthandwellness.

Weenvisionourgrouptobeastrong,interwovengroupofcentersworkingtogethertodevelopaNationalTribalEpidemiologyCenternarrative;enhanceddataaccessandstewardship;respectedmulti-directionalpublic health collaborations; and adiverse sustainable funding base. WeworktogetherforthebettermentofthehealthofAmericanIndianandAlaskaNativepeoplelivinginavarietyofsettingsintheUnitedStates.

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OurmissionistobuildTribally-drivenpublichealthandepidemiologiccapacityamongTribesinthePhoenix and Tucson Indian Health Service Areas by assisting Tribes with health surveillance,research,prevention,andprogramevaluationforplanningandpolicydecisionmakinginordertoimprovecommunityhealthandwellness.Thegoalof the ITCATEC istobuild independenttribalcapacities to collect and use community health information in directing programs, managingresources,andbuildingrelationswithlocal,state,andfederalpublichealthsystems.

TheITCATECprovidestechnicalassistanceinthefollowingareas:n Improvingdiseasesurveillancecapabilitiesthroughdataanalyses,interpretation,and

disseminationofinformation;n Providingcommunicationandeducationfordiseaseoutbreakinvestigationandresponse;n Developingepidemiologicstudies;andn Assistingwithdiseasepreventionandhealthpromotionactivities.

Figure1.TECServiceAreas

CoverPagePhoto:Sauber,W. (2008, April 20). Philbrook - Navajo Satteldecke [PhilbrookMuseum in Tulsa, Oklahoma.Navajo single saddle blanket ( 1880s ).]. Retrieved August 05, 2020, fromhttps://commons.wikimedia.org/wiki/File:Philbrook_-_Navajo_Satteldecke.jpg

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AbbreviationsandAcronymsAAR AfterActionReviewBIA BureauofIndianAffairsCDC CentersforDiseaseControlandPreventionCNC CorporationforNationalandCommunityFEMA FederalEmergencyManagementAgencyHICS HospitalIncidentCommandSystemICS IncidentCommandTeamIHS IndianHealthServicesIP ImprovementPlanMOA MemorandumofAgreementMOU MemorandumofUnderstandingNDRF NationalDisasterRecoveryFrameworkNIMS NationalIncidentManagementSystemNRF NationalResponseFrameworkPPE PersonalProtectiveEquipmentUSACE UnitedStatesArmyCorpsofEngineersWHO WorldHealthOrganization

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IntroductiontotheAfterActionReview(ARR)Toolkit

PurposeoftheAARToolkitThis toolkit serves as a planning tool outlining the After Action Reviewprocess(i.e.designing,planning,preparing,andconducting)completewithtools that can be found in the appendices. Each step in the toolkit can betailored to fit your Tribe’s needs todevelop and improve your operationsafterapublichealthresponse.

WhoisthisToolkitfor?Theguidanceforafteractionreview(AAR)andtheAARtoolkitismeantforTribal government leaders, public health practitioners, and otherstakeholderswhoareplanningforanAARtoreviewactionstakeninresponseto an incident of public health concern within Tribal communities. ThesestakeholdersmayincludeTribalexecutivestaffandgovernmentemployees,suchas:planners,emergencymanagers,andhealthcareprofessionals.

PlannersofAARshouldbearinmindthateachTribe,agencyandorganizationisdifferent.Theprinciplesinthisguideshouldbeadaptedtothetraditionaland institutional culture, practice and needs around which the review istakingplace.

HowtoUsethisToolkitThistoolkitisdesignedtobereadintheorderthatismosthelpfultoyoubyfirstprovidinganintroductiontotheAAR.Throughoutthetoolkit,youwillseekeyhighlightsonthesidepanelsforeasyreadingandconceptabsorption.

Atthecoreofthistoolkit,therearethreeprocessphasestotheAAR(planning,conducting,andfollowingup)andafinalsectiononimprovementplanning:

● Part1:Pre-AAR● Part2:DuringanAAR● Part3:Post-AAR● Part4:ImprovementPlanning

EachstepinthistoolkitcanbetailoredtofityourTribe’s

needstodevelopandimprove

youroperationsafterapublic

healthresponse.

Throughoutthetoolkit,youwill

seekeyhighlightsonthesidepanelsforeasyreadingand

conceptabsorption.

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See Figure 2 (below) to view the four process phases and the estimatedtimelinesforstartingandcompletingeachphase.

Figure2:AARPlanningRoadmap

Pre-AAR

Design• DesigninganAAR• BuildingtheAARTeam• DevelopingaBudget• Developingachecklistand

agenda• Informingstakeholders,

participants,andfacilitators• Keyinformantinterviews• Virtualvenuesduring

COVID-19PreparingfortheAARExercise• Collectandreviewrelevant

backgroundinformation• Refinetriggerquestionsand

exercises• Identifyandbrieffacilitators

andinterviewers• SettingupanAAR

DuringanAAR

Conduct• Conduct

AnalyticalComponentofAAR

• Identificationofcorecapabilities

• Timelineofkeymilestones

• Identificationofstrengths,challenges,andnewcapacitiesdeveloped

• Evaluationofcorecapabilities

• Buildingconsensusamongparticipations

Post-AAR

Results• Conducting

AARdebriefings

• AARFinalReport

Follow-up

• DocumentingProgress:Post-AARFollow-up

• LessonsLearnedDatabase

ImprovementPlanning

• Tribal

Priorities• Tribal

Timelines• AfterAction

ImprovementPlan

• RoutineCheck-Ins

• SharingAARLessonsLearned

3-4weeksbeforeAAR1-3Days:AARSetup

1-3Days:ConductAAR

Immediately&overthenext2weeks

Continuousasneeded

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COVID-19VirusInformationAswith previous health crises, Tribes andNative communities have beendisproportionately affected by the COVID-19 pandemic, often facingchallenges such as lack of testing and shortages of personal protectiveequipment (PPE). As of July 18, 2020, the Indian Health Services (IHS)reported132,955positivecasesofcoronavirusbasedonvoluntaryreportingfromIHS,tribal,andurbanIndianorganizationfacilities(seeTable1).AcrossIndianCountry,Tribesare imposingstay-at-homeorders, socialdistancingregulations,curfews,andmandatorymaskorderstohelpmitigatethespreadofCOVID-19totheircommunities.Inadditiontothehealthimpact,multipleindustriesacrossthecountryarefacing extreme disruptions in operations ultimately affecting Tribalgovernment systems and economies. Tribes are now faced with aligningvarious departments (i.e. health, crisis management, communications,finance,etc.)withbusinesscontinuitystrategiesinhopestoflattenthecurveofcoronaviruscasesandsimultaneouslyworktostabilizetheireconomies.Table1:COVID19CasesbyIHSAreaIHSArea Tested Positive Negative

Alaska 98,912 606 83,136

Albuquerque 33,320 1,563 22,313

Bemidji 29,072 760 26,490

Billings 37,493 819 29,988

California 7,281 447 5,951

GreatPlains 38,785 1,661 36,618

Nashville 18,622 1,657 15,990

Navajo 66,913 10,570 50,590

OklahomaCity 96,332 4,943 88,691

Phoenix 44,746 7,891 36,371

Portland 19,972 1,538 17,685

Tucson 5,372 500 4,763

TOTAL 496,820 32,955 418,586*DatareflectcasesreportedtotheIHSthrough11:59pmonAugust2,2020.

1IndianHealthServices.(August3,2020).COVID-19CasesbyIHSArea.RetrievedAugust04,2020,fromhttps://www.ihs.gov/coronavirus/

Thenovelcoronavirushastheabilitytoincurmultipleoutbreaksoveralongperiodof

time.

Theunfoldingofthewidespreadresponseallowsforunique

organizationalopportunitiesandcontinuousimprovement.

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Nationally, as ofAugust 4, 2020, a total of 4,649,102 positive cases of thecoronavirus have been reported to the Centers for Disease Control andPrevention(CDC)sincethebeginningoftheoutbreak(seenewcasesbydayinFigure2).Accordingto thesamedatabase,onAugust3,2020,atotalof47,576newcaseswerereportedinasingleday.Asthetotalnumberofcasescontinuetoincreaseathighrates,governments,localagencies,andorganizationsareencouragedtotakethetimetoassessresponses to the COVID-19 pandemic. As shown in Figure 2, this novelcoronavirushastheabilitytoincurmultipleoutbreaksoveralongperiodoftime. The unfolding of the widespread response allows for uniqueorganizational opportunities and continuous improvement; and the AfterActionReviewistheexacttoolforTribestousetobetterprepareforglobalpandemicsandtostrengthenoverallresiliency.Figure3:CDCNewCasesbyDay2

2 CentersforDiseaseControlandPrevention.(August3,2020).CasesintheU.S.RetrievedAugust04,2020,fromhttps://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html

TheAfterActionReviewistheexacttoolforTribestousetobetterprepareforglobal

pandemicsandtostrengthen

overallresiliency.

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IntroductiontoanAAR

WhatisanAAR?AnAfterActionReview(AAR)isastructured,qualitativereviewofactionstakeninresponsetoanincidentofpublichealthconcern.Generally,anAARis a simple, powerful tool used to assess performance, document lessonslearned,andidentifyareasforimprovement.

AnAARseekstoidentify:

● actions thatneed tobe implemented immediately, toensurebetterpreparationforthenextincident;and

● medium- and long-term actions needed to strengthen andinstitutionalizethenecessarycapabilitiesofthepublichealthsystem3.

Designed to be flexible, an AAR can be adapted to fit the incident underreview, as well as the organization and systems involved. StakeholdersinvolvedinpreparednessactivitiesrelevanttotheincidentunderreviewareencouragedtobeinvitedtoanAARtoassesstheimpactofpreparednessontheresponse.

AnAARfeatures:

● Anopenandhonestprofessionaldialogue,● Participationbyallrelevantstakeholders,● Afocusontheresultsofanincident,and● Recommendationstoimproveperformance.

ThesuccessofanAARiscontingentontheabilitytobringrelevantresponsestakeholders together in an environment where they can analyze actionstakenduringtheresponseinacriticalandsystematicmanner.AARsarenotintended to assess individual performances or competences, but rather toidentifyfunctionalchallengesthatmustbeaddressed,andbestpracticestobemaintained4.

AnAARisNOT:

● Acritiqueorlecture,● Judgeofperformance,● Ameanstoembarrass,or● Atooltoblame.

AnAARoffersparticipantsanopportunitytotranslatetheirexperiencesfromtheresponseintoactionableroadmapsorplanssotheycandobetterthenexttime. The added value of an AAR is its focus on collective learning andexperience sharing,with emphasis on theknowledgeof stakeholders.Oneway in which an AAR can add value is by turning tacit knowledge intolearning, and building trust and confidence among teammembers. In thisway,AARscanbecomeakeyaspectofanorganization’sinternalsystemof

3Guidanceforafteractionreview(AAR).Geneva,Switzerland:WorldHealthOrganization;2019(WHO/WHE/CPI/2019.4).Licence:CCBY-NC-SA3.0IGO4Ibid.

AnAARisasimple,powerfultoolusedtoassess

performance,document

lessonslearned,andidentifyareasfor

improvement.

TheaddedvalueofanAARisits

focusoncollective

learningandexperiencesharing,withemphasisontheknowledgeofstakeholders.

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learningandqualityimprovement,andcancontributetostrengtheningthecapacityattheorganizationandTriballevels5.

AARs should ideallybe conductedas soonaspossible after an incidentoroutbreakisdeclaredoverbytheTribeorotherauthorizedentity(orwithinthreemonths).Forprolongedcrises,multipleAARscanbeconductedaftereachmajorphase.Similarly, for large-scaleemergencies that involvemanydifferent capacities, separate AARs can be conducted for each majorcomponentoftheresponse6.

WhataretheobjectivesofanAAR?AnAARaimstoidentify(1)capacitiesinplacebeforetheresponse,(2)anychallengesthatcametolightduringit,(3)thelessonsidentified,and(4)anybestpracticesobservedduring theresponse, including thedevelopmentofnewcapacities7.

AnAARanswersthefollowingquestions:

1. Whatwasexpectedtohappen?2. Whatactuallyoccurred?3. Whyweretheredifferences?4. Whatwentwellandwhy?5. Whatdidn'tworkandwhy?6. Whatcanbeimprovedandhow?8

As a form of group reflection, AARs are designed to foster organizationallearningandtofacilitatecontinuousimprovementsofperformance.

AARsseektogatherthefollowing:

● Unbiasedobservations: in retrospect, establishhowactionswereactually implemented, rather than how they would ideally havehappenedaccordingtoexistingplansandprocedures.

● Analysisofgaps,bestpractices,andcontributingfactors:identifygapsbetweenplanningandpractice;analyzewhatworkedandwhatdidnotwork,andwhy.

● Identification of areas for improvement: identify actions tostrengthenorimproveperformance,anddeterminehowtofollowuponthem9.

WhatarethebenefitsofconductinganAAR?AARsarepowerfultoolsofassessmentthatproducequickresults.Infact,theU.S.ArmyisoneoffeworganizationsthathaveimplementedAARprocessestoreviewtheirmostrecentmissionsandtoidentifypossibleimprovements105Ibid,12.6Ibid.,12.7Ibid.,12.8Salem-Schatz,S.,Ordin,D.,&Mittman,B.(2010).GuidetotheAfterActionReview[PDF].Nashville:VanderbiltUniversity.9Ibid.,410DavidAGarvin,“LearningInAction,AGuidetoPuttingtheLearningOrganizationtoWork”(Boston:HarvardBusinessSchoolPress,2000),106-116.

AnAARaimstoidentify:

1. capacitiesinplacebeforetheresponse,

2. challengesthatcametolightduringit,

3. lessonsidentified,and

4. bestpracticesobservedduringtheresponse,includingthedevelopmentofnewcapacities

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Thephrase“leaveyourrankatthedoor”positivelyoutlinesamajorbenefittoconductingAARs: itallows teamstoshare theirviewsandideas tohelpdevelopcollective,organizationalsolutions.

Additionalbenefitsinclude:

● Intentionalcritical thinkingaroundan incident.AARs foster anenvironmentfortheteamtouserootcauseanalysis.Thishelpsassessthe underlying factors that led to any failures and successesencounteredduringtheresponse.

● Teamconsensus.AsteammembersworktogetherduringtheAARtoassessperformanceandidentifylessonslearned,theyalsodevelopstrategiestoimprove.

● Documentationof lessons learned.AARsallowdocumentationtobeusedforfutureincidents.

● Cross-sectoral learning.As responses tomany complex incidents(for example, the COVID-19 pandemic) involve more stakeholdersthanjustthoseinthehealthsector,participantsintheAARcancomefrommultiplesectorsinvolvedintheresponse.Thesemightincludeanimal health departments, hospital management boards, securityauthorities,andStateandTribalgovernmentdepartments.Thiscanresultinadditionallessonsbeingidentifiedacrosssectors,bringingtogether new perspectives and strengthening relationships andcoordinationacrosssectors.

● Builds capacity for preparedness and response. Gaps and bestpractices identified in the AAR can be respectively addressed forimprovement,anddocumentedandinstitutionalized11.

WhenshouldanAARbecarriedout?Ideally, AARs should be considered immediately after a response to anyincidentwithpublichealthsignificance.AnAARisusuallyconductedwithinthreemonthsoftheofficialdeclarationoftheendoftheincidentbytheTribe.Thereasonforimmediacyistoensureresponsestakeholdersarestillpresentandhaveclearmemoriesofwhathappened.

Thesamemethodologycanbeappliedwhileanincidentisstillcontinuing;forexample, an AAR during the COVID-19 pandemic is a form of real-timeanalysis,coveringaspecificperiodorphaseoftheresponse.

11Ibd,12.

AARBenefitsInclude:

1. Quickresults2. Collective,organizationalsolutions

3. Intentionalcriticalthinking

4. Teamconsensus

5. Documentationoflessonslearned

6. Cross-sectorallearning

7. Helpsbuildcapacityforthenextincident

AnAARisusuallyconductedwithinthreemonthsoftheofficial

declarationoftheendoftheincident

bytheTribe.

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TribalSpecificConsiderations

TribalPriorities

Each American Indian and Alaska Native Tribe has immeasurableresponsibilities to theirTribalmembers, to their Tribal culture, theTribalhistory,andthefutureoftheirTribe.Tribalgovernmentsareentrustedwithauthority for all aspects of Tribal matters, including self-governance,provisionofsocialservices,health,education,energy,andlandmanagement,whileupholdingandexercisingTribalsovereignty.

Tribes are free to coordinate and collaboratewith any outside partner tofurther the resilience and safetyof their citizens.During timesof disaster,Tribescanlooktopartnersinhealth,wildlandfire,structuralfire,emergencymanagement,and lawenforcement, tobolster the inherentabilitytoservetheirTribalmembers,afteranincident,emergencyordisaster.

Tribal governments may consider the adoption of nationally acceptedincidentmanagementconcepts,toenhanceinternalandexternalemergencyresponse and recovery capabilities and resources. This toolkit utilizesconcepts from theWorldHealth Organization (WHO), Centers for DiseaseControl and Prevention (CDC), and the Federal Emergency ManagementAgency(FEMA)forAfterActionReportandImprovementPlanning.

Additional planning resources would include the National ResponseFramework(NRF)andthe IncidentCommandSystem(ICS).TheNRF isanever-improving guide as to how governments within the United Statesrespond to all types of disasters and emergencies; It is built on scalable,flexible, and adaptable concepts identified in the National IncidentManagementSystem(NIMS)toalignkeyrolesandresponsibilitiesacrosstheNation.

In the hospital and clinical settings, Tribes should consider the HospitalIncidentCommandSystem(HICS).HICSisanincidentmanagementsystembased on principles of the ICS which assists hospitals and healthcareorganizationsinimprovingtheiremergencymanagementplanning,response,and recovery capabilities for unplanned and planned incidents. HICS isconsistentwithICSandNIMSprinciples.

ThechiefbeneficiariesofHICSwillbeanyonewitharesponseroleduringacrisisincludingclinicalandhospitalphysicians,nurses,andadministrators,focusing on the understanding healthcare response issues and incidentcommand practices and tools used during various incidents with healthimpacts.

Tribalgovernmentsmayconsidertheadoptionofnationally

acceptedincidentmanagementconcepts,to

enhanceinternalandexternalemergencyresponseandrecovery

capabilitiesandresources.

Thistoolkitutilizesconceptsfromthefollowingorganizationsandincludestribal

specificconsiderations:

1. WHO2. CDC3. FEMA4. NRF5. ICS6. NIMS7. HICS

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TribalLeadershipConsultation

Inordertoensureapplicability,thetermTribalLeadershipwillrefertotheTribe’sgoverningauthoritiessuchasaTribalCouncil,ExecutiveCommittee,orBusinessCommittee.

ItisapossibilitythattheAfterActionReportTeammayhavelimitedTribalLeadershipparticipation;however,itmaybenecessaryfortheAARTeamtopresent findings andprogress along theway inorder to gain support andprovideupdates.ItwouldbeidealtopresenttheAfterActionReportonceadraftisdevelopedpriortomovingintotheImprovementPlan.Itwouldlikelybe necessary to present the final draft Implementation Plan to the TribalLeadership to garner support and approval to finalize and beginimplementationofimprovements.

TribalCapabilityConsiderationsCapabilitystandardsareaguidetolookingatoverallresponsetoemergencieswithinanorganization.ThereareadditionalfactorsthatshouldbeaddedperthespecificTribalcommunity’scustomandtraditionalcomponentsaswellasspecific regional components. Examples of other areas to consider inreviewingresponseandplanningforimprovementsarelistedinthefollowingtable.

Table2:AdditionalTribal/RegionalSpecificConsiderations

● Tribalculturalandtraditionalmedicine● ScheduledTribalceremonial/gatheringevents● Ceremonial,custom,andculturalritualsrelatedtoburials● Tribalcommunityclosurestothepublic/visitorswithbarriers,

checkpoints,signage,notifications● Accesstoinfrastructureneedsinrural/underservedareasfor

TribalMembers(water,electricity,etc.)● Multi-generationalandmulti-familyhomes

TheAfterActionReportTeam

maynotincludealloftheTribalLeadership;it

maybenecessaryfortheAARTeamto

presentfindingsandprogress

alongthewayinordertogainsupportand

provideupdates.

Capabilitystandardsareaguidetolooking

atoverallresponsetoemergencieswithinan

organization.

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BeforeanAAR

DesigninganAARWorkingGroupHavinganAARWorkingGroupinvolveshavingworksessionswithadiversegroupofindividualswhoworkinvariouscapacitieswithintheTriberelatedtohealthservices,emergencyservices,humanresources,planning,utilitiesandmaintenance, social services, education, housing, elders’ services, andTribalLeadership.

There may be others involved who work in different departments andprograms.Invitationstolocalmunicipalitiesandgovernmentsmayalsobeaconsiderationiftherearepartnerships,MOAsorMOUs,andothercontractedservicesestablished.

Thedesignofaworkinggroupistoprovideaforumfortheparticipantstospeak openly regarding the focus areas, experiences, and to provideopportunities for collective learning. The following table shows furtherpointsofaWorkingGroupdesign.

Table3:WorkingGroupDesign12

WhentoUse PlanningConsiderations Outcomes

• Withlargergroupsofdiversestakeholderswheretherearemorethanthreefocusareas

• Whenthoseinvolvedintheresponsecanbebroughttogetherforaface-to-facemeeting

• Whenparticipantsarewillingtospeakfreelyandhonestlyabouttheirexperiencesinagroupsettingandsharetheirexperienceforcollectivelearning

• Morethanthreepillarsforreview

• Caninvolveupto50individuals

• Preparationsshouldbegin4-6weeksprior

• Takes2-3daystoconduct

• Foreachworkinggroup,onefacilitatorandnotetakerproficientinthefunctionsassignedtothegroup

• Requiresmoreresourcesthanadebrief

• Sharedlearningbetweenpillarsandbetweenstakeholdersparticipatinginthereview

• Sharedexperienceandspacefordiscussion

• Reportdraftedthatwillincludethefindingsfromthereview

12Guidanceforafteractionreview(AAR).Geneva,Switzerland:WorldHealthOrganization;2019(WHO/WHE/CPI/2019.4).Licence:CCBY-NC-SA3.0IGO

HavinganAARWorkingGroupinvolveshavingworksessionswithadiversegroupof

individualswhoworkinvariouscapacitieswithin

theTribe.

Thedesignofaworkinggroupistoprovideaforumfortheparticipantstospeakopenlyregardingthefocusareas,

experiences,andtoprovide

opportunitiesforcollectivelearning.

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BuildingtheAARTeamTheAARTeamwillbetheassignedteamtoassistinplanningtheworkinggroup,facilitatingtheworkinggroup,anddevelopingtheafteractionreportand improvement plan. Depending upon the size of the Tribe and thestakeholders involved, the AAR Team size could vary, but overall shouldincludethefollowingroles(seeTable4).

Table4:AARTeamMembersandRolesTeamMember RoleAARLead ● InitiatoroftheAAR

● Developsthescopeandobjectivesofthereview● Ensurescoordinationandsupport● Preparesanddisseminatesrelevantbackgroundinformation● IdentifiesAARteammembersandparticipants● Supervisesteamlogistics● Reviewsfinaldraftsofplanandapprovals● PresentsfinalreporttoTribalLeadershipandotherkeystakeholders

LeadFacilitator ● LeadfacilitationofAARasanunbiasedparty● Developstriggerquestions● Informsotherfacilitationteammembersofprocess,activities,and

exercises● Providessupporttofacilitators● Conductsdebriefingsasrequired

Facilitators ● Supportsinfacilitationcapacitiesinanunbiasedmanner● Guidesdiscussionswithexcellentinterpersonalandcommunication

skills● Facilitatesquestionsandseeksresponseswhichareaddressingthe

objectivesandscopeoftheAAR● SummarizesresponsesandprovidessupporttoNoteTakersandthe

ReportWriterasnecessarytodevelopthefinalwrittenAAR● ForTribalcommunities,itmaybenecessarytohaveteammembers

familiarwiththecommunity,language,andtraditionsNoteTakers ● Takesnotesonworkinggroupparticipantsinattendance

● Takesnotesofgroupdiscussions● Takesnotesregardingidentifiedexercises

ReportWriter ● PreparesdraftsandfinalwrittenAfterActionReportTribalImprovementPlanLeader

● IsanindividualfromwithintheTribalgovernmenttooverseetheimprovementplanprocess

● Hastheauthority,ordelegatedauthority,toplan,implement,andcompleteallidentifiedcorrectiveactionitemsintheimprovementplan

● Issolelyfocusedontheimprovementplan● Avoidsaddingtotheresponsibilitiesofimplementationonanalready

taskedindividual● Assumestheresponsibilityfortheidentifiedissuesduringdevelopment

oftheimprovementplant,whilealsomakingdecisionsabouttheinitiallistofappropriatecorrectiveactionstoresolvetheidentifiedissues

19

DevelopingaBudgetOnce you have decided how to structure the AAR process and team, it isimportanttooutlineabudgetforactivitiesplanningwhichcaninclude,butnotlimitedtotheitemslistedinthefollowingtable.

Table5:ExampleItemstoBuildintoaBudgetforAARActivities

● Teammemberwages● Translatorservices● Materials/Supplies(e.g.flipboards,markers,notepads,sticky

notes,pens)● Food/Snacks/Beverages● Printing● Communicationaids(projectors,A/Vequipment,recording

equipment)● Usagefeesofmeetingspaces● Virtualmeetingplatforms● Travelexpenses/perdiemamounts● Lodging

Itmaybepossible tooutlineabudget for implementationofimprovementplanactionableitemsaheadofcompletionoftheplan.Informationonfundingopportunities is available in the section regarding developing theImprovementPlan.

DevelopingaChecklistandAgendaAs a best practice, having a checklist of materials and logistics for eachmeetinghelpstostreamlineplanning.Thechecklistshouldincludesuppliesandequipment,meetingroom/virtualmeetinglogistics,assignmentsofteammembers, participant information (invitations, notes, reminders), specialaccommodationsneeded foraccessibility,meals/cateringdetails if needed,andanymaterialstobehandedout.

AnagendafortheWorkingGroupshouldbedevelopedtoprovidedetailsonlocation,dates,startandendtimesoftheday,topicstobecoveredandlengthoftimeforeach.TopicsmayincludeWelcomeandIntroductions,ReviewoftheAARProcess,ExpectationsoftheWorkingGroup,Capabilities,Exercises,etc.

InformingStakeholders,Participants,andFacilitatorsWhen informingstakeholders,participants,and facilitators,havinganAARLaunchmemooremailcontaininginformationofwhatanAARis,theprocess,logisticalmeeting information,expected timelines tocompletion,andwhatyou are asking of the participants, tailoring information for each specificgroupofstakeholdersasneeded.

Asabestpractice,havingachecklistofmaterialsandlogisticsforeachmeetinghelpsto

limitanyunnecessaryhassle.

20

TheAARLeadshould at thispointdevelop anddistribute thebackgroundinformation to help ensure all stakeholders have a similar level ofunderstanding.

VirtualVenuesDuringCOVID-19PandemicDuringtheCOVID-19pandemic,therehavebeenvarioussafetyprecautionsrecommendedbytheWorldHealthOrganization,CenterforDiseaseControl,andotherhealthagencies thatlimitgatheringsand interactions. Since thevirusishighlycontagiousandtransmittedthroughdirect,indirect,andclosecontactwithinfectedindividuals,oneoftheprecautionsissocialdistancing,stayingataminimum6feetawayfromothers.

For thesafetyof those involved, itmaybebeneficialtoallparties toavoidlargegatheringsandoptforvirtualmeetingspaces.TherearemanyvirtualmeetingplatformsavailablesuchasZoom,GoogleHangouts,AdobeConnect,etc.Itmaybenecessarytoresearchtheseplatformsandselectthebestoptionbasedontime limitations,activities(whiteboards,polls,etc.), security,andcompatibilitywithtechnicalsystems.

Forthesafetyofthoseinvolved,it

maybebeneficialtoallpartiestoavoidlargegatheringsandoptfor

virtualmeetingspaces

21

PreparingfortheAARExercise

CollectandReviewRelevantBackgroundDocumentationBefore beginning the AAR Working Group, all AAR facilitators andinterviewersofkeyinformantsshouldhaveacommonunderstandingofthenecessary background information that will allow focus on the responseactionsthathavebeenimplemented. AbestpracticewouldbetohavetheAARTeamandparticipantsreviewtherelevantdocumentation inorder tobeginwiththesamelevelofunderstandingforreviewanddevelopmentofimprovementplans. TheAAR facilitatorsshouldbecome familiarwith theinformation in order to adequately guide the trigger questions anddiscussionswithintheAARWorkingGroup.

Table6:ExampleRelevantBackgroundDocuments● Strategicplansdevelopedinresponsetotheincident● StatusreportsfromkeyLeadership,IncidentCommandTeams,

andotherEmergencyManagementTeams● OperationsAssessments● Statisticalreportsofoutbreakinformation● PublicHealthinformationissuedbyCDC,WHO,FEMAonstart

datesofinfections,keymilestones,clinicalsymptoms,demographicvulnerabilities,treatmentdevelopments

● Mediareports● TribalEmergencyResponseresolutionsoraddresses● TribalCommunitycommunicationmaterials● Tribalhealthclinic/medicalcenterdataasnecessary

RefineTriggerQuestionsandExercisesPrior to the AARWorking Group, the LeadFacilitator shoulddevelop andrefine trigger questions to guide the session. Trigger questions are open-endedquestionsusedtoguidediscussionthroughtheAARWorkingGroupbasedupontheobjective,capabilities,andareasoffocus.Thesequestionscanbe refined after meeting with the AAR Team. Below are examples ofadditional questions for specificareasbasedon theWHO’sworking grouptemplates.

● Whatwasinplacebeforetheresponse?○ Aplan,capabilities,procedures,resources,etc.

● Whathappenedduringtheresponse?○ Timeline,keymilestones,etc.?

● Whatwentwell?Whatwentlesswell?Why?○ Whatwerethestrengthsandchallenges?Fundsorresources

related?Processgaps?● Whatcanwedotoimprovefornexttime?

○ Addressingchallenges?Implementationforbestpractice?

AbestpracticewouldbetohavetheAARTeamandparticipants

reviewtherelevant

documentationinordertobeginwiththesame

levelofunderstandingforreviewanddevelopmentofimprovement

plans.

Triggerquestionsareopen-ended

questionsusedtoguidediscussion

throughtheAARWorkingGroupbasedupontheobjective,

capabilities,andareasoffocus.

22

TimelineLeadingUptoanAARWorkingGroupTable7:ExampleTimelinePriortoWorkingGroupTask TimelineSendoutinvitationstoWorkingGroupparticipants

10-20DaysPriortoAARWorkingGroup

DistributeRelevantBackgroundDocumentation


CoordinationmeetingwithAARLead,LeadFacilitator,facilitators,andnotetakerstoreviewroles,objectivesofmeeting,meetingpreparation,lastminutepreparations/adjustments


Distributefinalizedmaterials(e.g.agenda,etc.)


Reviewchecklistandconfirmlogistics


Tip:TheAARLeadshould

coordinatewiththeLead

Facilitatortoensure

alignmentintimelineandcontent.

23

DuringanAAR

ConductinganAARConductingaworkinggroupAARwilllikelytaketwotothreedays.DuringthistimeAARparticipantsconductathoroughreviewoftheresponse.Theworkinggroupwillidentifyachievements,challengesandactionsneededtoimplementbestpractices.Theobjectiveistodevelopmethodstostrengthenfuturecapacity. Priortoconductingtheanalysis,thegroupshouldidentifyspecific areas of focus for the review. The analysis itself should includeobjective observation, gap analysis and identification of areas forimprovement.

ActivitiesduringanAARDuringtheAAR,participantswillengageinanumberofexercisesincluding:

1. Creatinganinventoryofcapabilities2. Agreeinguponatimelineofkeyeventsduringtheincident3. SelectingafocusfortheAAR4. Conductinganevaluationofresponse5. Creatingaperformanceimprovementplan

UsingCapabilityStandardsforanAARState, local, tribal, and territorial public health agencies exist within alandscapeofdiversegovernance,organizationalstructures,legalauthorities,partnerships,stakeholders,risks,demographics,andresourcesthatinfluencejurisdiction-to-jurisdictionpublichealthemergencypreparednesspriorities.CDC’s Public Health Emergency Preparedness and Response Capabilitiesprovideaninterrelatedframeworkforcommunitiestopreparefor,respondto,andrecoverfromthreatsandemergencies.Thecapabilitystandardsserveas a resource to assess, build, and sustain Tribal public health agencypreparedness and response capacity by further defining the Tribal publichealthagencyESF#8role13whileguidingprogramimprovementinitiativesto addresspreparednessand responseplanning gaps. It is important thatTribalpublichealthagenciesmustremainawareofnewandemergingpublichealththreats.Thedefinitionsdescribedwithin thecapabilitystandardsarebroad.Tribalhealthagenciesarenotexpectedtosimultaneouslyandcompletelyaddressallidentifiedissues,gaps,andneedsacrossallcapabilitiesintheshortterm.Instead,Tribesshouldperiodicallyreprioritizethecapabilitystandardstheypursue based on regularly updated jurisdictional inputs, including riskassessmentfindings.

13EmergencySupportFunction(ESF)#8-PublicHealthandMedicalServicesprovidesthemechanismforcoordinatedFederalassistancetosupplementTribalresourcesinresponsetoapublichealthandmedicaldisaster,potentialoractualincidentsrequiringacoordinatedFederalresponse,and/orduringadevelopingpotentialhealthandmedicalemergency.

Theworkinggroupwillidentify

achievements,challengesandactionsneededtoimplementbestpractices.Theobjectiveistodevelopmethodstostrengthen

futurecapacity.

Tribesshouldperiodically

reprioritizethecapability

standardstheypursuebasedon

regularlyupdated

jurisdictionalinputs,includingriskassessment

findings.

24

The resources and functions described within each capability are notintended to be all inclusive. It is important to identify any additionalresources, specific to your Tribe and your community, which may benecessarytoachievecapabilitytasks.Identifyingtheseadditionalresourceswillallowforcustomizationoftheplan.Yourstakeholderscanassistindoingthis.In Table 8 (see below) find the CDC’s fifteen Public Health EmergencyPreparedness and Response Capabilities along with definitions andcorrespondingfunctions.Thisisimportantforthenextsection:CreatinganInventoryofCapabilitiesforyourAARWorkingGroup.Table8:CapabilityDefinitionsandFunctions14Capability

Definition Functions

Capability#1:CommunityPreparedness

Communitypreparednessistheabilityofcommunitiestopreparefor,withstand,andrecoverfrompublichealthincidentsinboththeshortandlongterm.Throughengagementandcoordinationwithacross-sectionofstate,local,tribal,andterritorialpartnersandstakeholders,thepublichealthroleincommunitypreparednessisto:• Supportthedevelopmentofpublichealth,healthcare,humanservices,mental/behavioralhealth,andenvironmentalhealthsystemsthatsupportcommunitypreparedness

• Participateinawarenesstrainingonhowtoprevent,respondto,andrecoverfromincidentsthatadverselyaffectpublichealth

• Identifyat-riskindividualswithaccessandfunctionalneedsthatmaybedisproportionatelyimpactedbyanincidentorevent

• Promoteawarenessofandaccesstopublichealth,healthcare,humanservices,mental/behavioralhealth,andenvironmentalhealthresourcesthathelpprotectthecommunity’shealthandaddresstheaccessandfunctionalneedsofat-riskindividualsEngageinpreparednessactivitiesthataddresstheaccessandfunctionalneedsofthewholecommunityaswellascultural,socioeconomic,anddemographicfactors

• Function1:Determineriskstothehealthofthejurisdiction

• Function2:Strengthencommunitypartnershipstosupportpublichealthpreparedness

• Function3:Coordinatewithpartnersandshareinformationthroughcommunitysocialnetworks

• Function4:Coordinatetrainingandprovideguidancetosupportcommunityinvolvementwithpreparednessefforts

14Redd,S.,M.D.,Kosmost,C.,R.N.,B.S.N.,M.S.,&Talbert,T.,M.A.(2019).Publichealthemergencypreparednessandresponsecapabilities:Nationalstandardsforstate,local,tribal,andterritorialpublichealth.Atlanta,GA:CentersforDiseaseControlandPrevention,CenterforPreparednessandResponse.

Tip:Identifyallcapabilityresources

specifictoyourcommunitytocustomizeyour

plan.

25

• Conveneorparticipatewithcommunitypartnerstoidentifyandimplementadditionalwaystostrengthencommunityresilience

• Plantoaddressthehealthneedsofpopulationsthathavebeendisplacedbecauseofincidentsthathaveoccurredintheirownordistantcommunities,suchasafteraradiologicalornuclearincidentornaturaldisaster

Capability#2:CommunityRecovery

Communityrecoveryistheabilityofcommunitiestoidentifycriticalassets,facilities,andotherserviceswithinpublichealth,emergencymanagement,healthcare,humanservices,mental/behavioralhealth,andenvironmentalhealthsectorsthatcanguideandprioritizerecoveryoperations.Communitiesshouldconsidercollaboratingwithjurisdictionalpartnersandstakeholderstoplan,advocate,facilitate,monitor,andimplementtherestorationofpublichealth,healthcare,humanservices,mental/behavioralhealth,andenvironmentalhealthsectorstoatleastaday-to-dayleveloffunctioningcomparabletopre-incidentlevelsandtoimprovedlevels,wherepossible.

• Function1:Identifyandmonitorcommunityrecoveryneeds

• Function2:Supportrecoveryoperationsforpublichealthandrelatedsystemsforthecommunity

• Function3:Implementcorrectiveactionstomitigatedamagefromfutureincidents

Capability#3:EmergencyOperationsCoordination

Emergencyoperationscoordinationistheabilitytocoordinatewithemergencymanagementandtodirectandsupportanincidentoreventwithpublichealthorhealthcareimplicationsbyestablishingastandardized,scalablesystemofoversight,organization,andsupervisionthatisconsistentwithjurisdictionalstandardsandpracticesandtheNationalIncidentManagementSystem(NIMS)

• Function1:Conductpreliminaryassessmenttodeterminetheneedforactivationofpublichealthemergencyoperations

• Function2:Activatepublichealthemergencyoperations

• Function3:Developandmaintainanincidentresponsestrategy

• Function4:Manageandsustainthepublichealthresponse

• Function5:Demobilizeandevaluatepublichealthemergencyoperations

Capability#4:EmergencyPublicInformationandWarning

Emergencypublicinformationandwarningistheabilitytodevelop,coordinate,anddisseminateinformation,alerts,warnings,andnotificationstothepublicandincidentmanagementpersonnel.

• Function1:Activatetheemergencypublicinformationsystem

• Function2:DeterminetheneedforaJointInformationSystem

26

• Function3:Establishandparticipateininformationsystemoperations

• Function4:Establishavenuesforpublicinteractionandinformationexchange

• Function5:Issuepublicinformation,alerts,warnings,andnotifications

Capability#5:FatalityManagement

Fatalitymanagementistheabilitytocoordinatewithpartnerorganizationsandagenciestoprovidefatalitymanagementservices.Thepublichealthagencyroleinfatalitymanagementactivitiesmayincludesupporting• Recoveryandpreservationofremains• Identificationofthedeceased• Determinationofcauseandmannerofdeath• Releaseofremainstoanauthorizedindividual• Provisionofmental/behavioralhealthassistanceforthegrieving

Therolealsomayincludesupportingactivitiesfortheidentification,collection,documentation,retrieval,andtransportationofhumanremains,personaleffects,andevidencetotheexaminationlocationorincidentmorgue.

• Function1:Determinethepublichealthagencyroleinfatalitymanagement

• Function2:Identifyandfacilitateaccesstopublichealthresourcestosupportfatalitymanagementoperations

• Function3:Assistinthecollectionanddisseminationofantemortemdata

• Function4:Supporttheprovisionofsurvivormental/behavioralhealthservices

• Function5:Supportfatalityprocessingandstorageoperations

Capability#6:InformationSharing

Informationsharingistheabilitytoconductmultijurisdictionalandmultidisciplinaryexchangeofhealth-relatedinformationandsituationalawarenessdataamongfederal,state,local,tribal,andterritoriallevelsofgovernmentandtheprivatesector.Thiscapabilityincludestheroutinesharingofinformationaswellasissuingpublichealthalertstoalllevelsofgovernmentandtheprivatesectorinpreparationforandinresponsetoeventsorincidentsofpublichealthsignificance.

• Function1:Identifystakeholdersthatshouldbeincorporatedintoinformationflowanddefineinformationsharingneeds

• Function2:Identifyanddevelopguidance,standards,andsystemsforinformationexchange

• Function3:Exchangeinformationtodetermineacommonoperatingpicture

Capability#7:MassCare

Masscareistheabilityofpublichealthagenciestocoordinatewithandsupportpartneragenciestoaddress,withinacongregatelocation(excludingshelter-in-placelocations),thepublichealth,healthcare,mental/behavioralhealth,andhumanservicesneedsofthoseimpactedbyanincident.Thiscapabilityincludescoordinatingongoingsurveillanceandpublichealthassessmentsto

• Function1:Determinepublichealthroleinmasscareoperations

• Function2:Determinemasscarehealthneedsoftheimpactedpopulation

• Function3:Coordinatepublichealth,healthcare,andmental/behavioral

27

ensurethathealthneedscontinuetobemetastheincidentevolves.

healthservices• Function4:Monitormasscarepopulationhealth

Capability#8:MedicalCounter-measureDispensingandAdministration

Medicalcountermeasuredispensingandadministrationistheabilitytoprovidemedicalcountermeasurestotargetedpopulation(s)toprevent,mitigate,ortreattheadversehealtheffectsofapublichealthincident,accordingtopublichealthguidelines.Thiscapabilityfocusesondispensingandadministeringmedicalcountermeasures,suchasvaccines,antiviraldrugs,antibiotics,andantitoxins.

• Function1:Determinemedicalcountermeasuredispensing/administrationstrategies

• Function2:Receivemedicalcountermeasurestobedispensed/administered

• Function3:Activatemedicalcountermeasuredispensing/administrationoperations

• Function4:Dispense/administermedicalcountermeasurestotargetedpopulation(s)

• Function5:Reportadverseevents

Capability#9:MedicalMaterielManagementandDistribution

Medicalmaterielmanagementanddistributionistheabilitytoacquire,manage,transport,andtrackmedicalmaterielduringapublichealthincidentoreventandtheabilitytorecoverandaccountforunusedmedicalmateriel,suchaspharmaceuticals,vaccines,gloves,masks,ventilators,ormedicalequipmentafteranincident.

• Function1:Directandactivatemedicalmaterielmanagementanddistribution

• Function2:Acquiremedicalmaterielfromnationalstockpilesorothersupplysources

• Function3:Distributemedicalmateriel

• Function4:Monitormedicalmaterielinventoriesandmedicalmaterieldistributionoperations

• Function5:Recovermedicalmaterielanddemobilizedistributionoperations

Capability#10:MedicalSurge

Medicalsurgeistheabilitytoprovideadequatemedicalevaluationandcareduringeventsthatexceedthelimitsofthenormalmedicalinfrastructureofanaffectedcommunity.Itencompassestheabilityofthehealthcaresystemtoendureahazardimpact,maintainorrapidlyrecoveroperationsthatwerecompromised,andsupportthedeliveryofmedicalcareandassociatedpublichealthservices,includingdisease

• Function1:Assessthenatureandscopeoftheincident

• Function2:Supportactivationofmedicalsurge

• Function3:Supportjurisdictionalmedicalsurgeoperations

• Function4:Supportdemobilizationofmedical

28

surveillance,epidemiologicalinquiry,laboratorydiagnosticservices,andenvironmentalhealthassessments.

surgeoperations

Capability#11:Non-pharmaceuticalInterventions

Nonpharmaceuticalinterventionsareactionsthatpeopleandcommunitiescantaketohelpslowthespreadofillnessorreducetheadverseimpactofpublichealthemergencies.Thiscapabilityfocusesoncommunities,communitypartners,andstakeholdersrecommendingandimplementingnonpharmaceuticalinterventionsinresponsetotheneedsofanincident,event,orthreat.Nonpharmaceuticalinterventionsmayinclude• Isolation• Quarantine• Restrictionsonmovementandtraveladvisoriesorwarnings

• Socialdistancing• Externaldecontamination• Hygiene• Precautionaryprotectivebehaviors

• Function1:Engagepartnersandidentifyfactorsthatimpactnonpharmaceuticalinterventions

• Function2:Determinenonpharmaceuticalinterventions

• Function3:Implementnonpharmaceuticalinterventions

• Function4:Monitornonpharmaceuticalinterventions

Capability#12:PublicHealthLaboratoryTesting

Publichealthlaboratorytestingistheabilitytoimplementandperformmethodstodetect,characterize,andconfirmpublichealththreats.Italsoincludestheabilitytoreporttimelydata,provideinvestigativesupport,andusepartnershipstoaddressactualorpotentialexposuretothreatagentsinmultiplematrices,includingclinicalspecimensandfood,water,andotherenvironmentalsamples.Thiscapabilitysupportspassiveandactivesurveillancewhenpreparingfor,respondingto,andrecoveringfrombiological,chemical,andradiological(ifaRadiologicalLaboratoryResponseNetworkisestablished)publichealththreatsandemergencies.

• Function1:Conductlaboratorytestingandreportresults

• Function2:Enhancelaboratorycommunicationsandcoordination

• Function3:Supporttrainingandoutreach

Capability#13:PublicHealthSurveillanceandEpidemiologicalInvestigation

Publichealthsurveillanceandepidemiologicalinvestigationistheabilitytocreate,maintain,support,andstrengthenroutinesurveillanceanddetectionsystemsandepidemiologicalinvestigationprocesses.Italsoincludestheabilitytoexpandthesesystemsandprocessesinresponsetoincidentsofpublichealthsignificance.

• Function1:Conductorsupportpublichealthsurveillance

• Function2:Conductpublichealthandepidemiologicalinvestigations

• Function3:Recommend,monitor,andanalyzemitigationactions

29

• Function4:Improvepublichealthsurveillanceandepidemiologicalinvestigationsystems

Capability#14:ResponderSafetyandHealth

Respondersafetyandhealthistheabilitytoprotectpublichealthandotheremergencyrespondersduringpre-deployment,deployment,andpost-deployment.

• Function1:Identifyrespondersafetyandhealthrisks

• Function2:Identifyandsupportrisk-specificrespondersafetyandhealthtraining

• Function3:Monitorrespondersafetyandhealthduringandafterincidentresponse

Capability#15:VolunteerManagement

Volunteermanagementistheabilitytocoordinatewithemergencymanagementandpartneragenciestoidentify,recruit,register,verify,train,andengagevolunteerstosupportthejurisdictionalpublichealthagency’spreparedness,response,andrecoveryactivitiesduringpre-deployment,deployment,andpost-deployment.

• Function1:Recruit,coordinate,andtrainvolunteers

• Function2:Notify,organize,assemble,anddeployvolunteers

• Function3:Conductorsupportvolunteersafetyandhealthmonitoringandsurveillance

• Function4:Demobilizevolunteers

CreateanInventoryofCoreCapabilitiesTheinventoryofthecapabilitiesthatexistedpriortotheincident,andwhichcould have been used to support the response, should be established.IdentificationofcorecapabilitieswillhelpinformthefocusfortheAAR.

Thecapabilitiesaretypicallygroupedinthefollowingcapabilityelements:

1. PlansandPolicies:Reviewtheplanforamultisectorresponsea. Leadership, partner coordination, information management,

healthoperations,operationssupportandlogistics(supplychainmanagement),financialmanagement,IT

2. Resources: Availability of sufficient resources (human, material andfinancial)availableformultisectoralcoordinationatalllevels?

3. CoordinationMechanisms: Collaborationwith local, stateand federalpartners

4. Preparednessactivities:includingpreventionmeasuressuchastestingandimmunization(ifavailable)

5. Others:Communications,IT,Broadband,Education

Identificationofcore

capabilitieswillhelpinformthefocusforthe

AAR.

30

SelectaFocusfortheAARPrior to conducting the review, the group should identify specific areasoffocus.SelectingareasoffocusisnecessarytostructuretheAARandmakeitmorecustomizedandmeaningfultoyourTribalNation.Inordertodeterminethe focus of the AAR, Tribes should select from the capabilities outlinedearlieronpages24-29.Notallcapabilitystandardsneedtobeincludedinthe AAR; only those which are most relevant and important to yourcommunity.Subsequently,notallfunctionswithineachcapabilityneedtobeevaluated. In addition, some functionsmay fallwithin andacrossdifferentcapabilitiesdependingonhowyouremergencyresponseeffortisstructured.

Table9(seebelow)isanexampleoffocusingoncapabilitiesrelevanttotheincidentandtheresponsebytheTribe.

Table9.ExampleAARSelectedCapabilityandFunctionSelectedCapabilities Functions/ActivitiesforReviewCapability#1:CommunityPreparedness

● Function2:Strengthencommunitypartnershipstosupportpublichealthpreparedness

● Function3:Coordinatewithpartnersandshareinformationthroughcommunitysocialnetworks

● Function4:Coordinatetrainingandprovideguidancetosupportcommunityinvolvementwithpreparednessefforts

Capability#2:CommunityRecovery

● Function1:Identifyandmonitorcommunityrecoveryneeds● Function3:Implementcorrectiveactionstomitigatedamage

fromfutureincidentsCapability#3:EmergencyOperationsCoordination(SincetheactualemergencyoperationscoordinationisthecoreofanAAR,typicallyallassociatedfunctionsareincludedinthereview.)

● Function1:Conductpreliminaryassessmenttodeterminetheneedforactivationofpublichealthemergencyoperations

● Function2:Activatepublichealthemergencyoperations● Function3:Developandmaintainanincidentresponsestrategy● Function4:Manageandsustainthepublichealthresponse● Function5:Demobilizeandevaluatepublichealthemergency

operations

Capability#4:EmergencyPublicInformationandWarning

● Function2:DeterminetheneedforaJointInformationSystem● Function4:Establishavenuesforpublicinteractionand

informationexchange● Function5:Issuepublicinformation,alerts,warnings,and

notificationsCapability#8:MedicalCountermeasure

● Function1:Determinemedicalcountermeasuredispensing/administrationstrategies

● Function2:Receivemedicalcountermeasurestobedispensed/administered

● Function3:Activatemedicalcountermeasuredispensing/administrationoperations

● Function4:Dispense/administermedicalcountermeasurestotargetedpopulation(s)

SelectingareasoffocusisnecessarytostructuretheAARandmakeitmorecustomizedandmeaningfulto

yourTribalNation.

31

● Function5:ReportadverseincidentsCapability#10:MedicalSurge

● Function1:Assessthenatureandscopeoftheincident● Function2:Supportactivationofmedicalsurge● Function3:Supportjurisdictionalmedicalsurgeoperations● Function4:Supportdemobilizationofmedicalsurgeoperations

Capability#11:Non-pharmaceuticalInterventions

● Function1:Engagepartnersandidentifyfactorsthatimpactnonpharmaceuticalinterventions

● Function2:Determinenonpharmaceuticalinterventions● Function3:Implementnonpharmaceuticalinterventions● Function4:Monitornonpharmaceuticalinterventions

Capability#14:ResponderSafetyandHealth

● Function1:Identifyrespondersafetyandhealthrisks● Function2:Identifyandsupportrisk-specificrespondersafety

andhealthtraining● Function3:Monitorrespondersafetyandhealthduringand

afterincidentresponse

KeyMilestonesofanIncidentAttheoutsetoftheAAR,thefacilitatorwillworkwiththegrouptoidentifykeymilestonesfortheincident.Thetimelineisimportanttotheanalysisinorder todetermine ifelementsof theresponseeffortoccurred timely.TheTribalmilestonetimelineshouldbecomparedtotheepicurveofthediseasetoevaluatetheimpactofinterventionsoncontrollingtheoutbreak.Typicalkeymilestonesandtheirdefinitionscanbefoundbelow.

Table10:KeyMilestonesDefinitionsKeyMilestone DefinitionStartoftheOutbreak/Event

Dateofsymptomonsetinthefirstcaseasdefinedbytheepidemiologydefinitionofacase

DetectionoftheOutbreakontheReservation

Datetheoutbreakisfirstrecordedbyanysource

DeclarationofEmergency

DateTribalLeadershipofficiallyannounceddeclarationofemergency

EmergencyOperationsCenteractivated

EOCactivated

DateofTribalcommunitycommunication

Dateoffirstofficialreleaseofinformationtothecommunity

Dateofoutbreakintervention

Earliestdateofpublichealthinterventiontocontroltheoutbreak

Dateoutbreakisundercontrolorended

Dateoutbreakisdeclaredundercontroloroverbypublichealthauthority

TheTribalmilestone

timelineshouldbecomparedtotheepicurveofthediseasetoevaluatetheimpactof

interventionsoncontrollingtheoutbreak.

32

Identification,EvaluationandRatingofStrengths,Challenges,andNewCapacitiesDevelopedIdentifying,evaluating,andratingthestrengthsandchallengesofyourrecentresponseeffortsisthefirstmajorstepinatwo-stepprocessfordevelopingandupdatinganinfectiousdiseaseresponseplan.Thesecondstepiscreatingaperformanceimprovementplan.Withineachcapabilityarea,participantsshould work together to identify key strengths, challenges and newcapabilitiesdevelopedthroughtheresponsetotheoutbreak.ThisevaluationwillserveasthebasisoftheperformanceimprovementplanforAAR.Createatemplatetotrackeachfunctionwithinaparticularcapability.

RatingPerformanceforEachCapacityAspartoftheevaluationprocess,performanceforeachcapacityshouldberated. The typical rating scale recommended by FEMA and associateddefinitionsareasfollows:

• Performed without challenges (P): The targets and critical tasksassociated with the core capability were completed in a manner thatachievedtheobjective(s)anddidnotnegativelyimpacttheperformanceof other activities. Performance of this activity did not contribute toadditionalhealthand/orsafetyrisksforthecommunityorforemergencyworkers, and it was conducted in accordance with applicable plans,policies,procedures,regulations,andTribalandFederallaws.

• Performed with Some Challenges (S): The targets and critical tasksassociated with the core capability were completed in a manner thatachievedtheobjective(s)anddidnotnegativelyimpacttheperformanceof other activities. Performance of this activity did not contribute toadditional health and/or safety risks for the public or for emergencyworkers, and it was conducted in accordance with applicable plans,policies, procedures, regulations, and laws. However, opportunities toenhanceeffectivenessand/orefficiencywereidentified.

• PerformedwithMajor Challenges (M): The targets and critical tasksassociated with the core capability were completed in a manner thatachievedtheobjective(s),butsomeorallofthefollowingwereobserved:demonstratedperformancehadanegativeimpactontheperformanceofotheractivities;contributedtoadditionalhealthand/orsafetyrisksforthe public or for emergency workers; and/or was not conducted inaccordancewithapplicableplans,policies,procedures,regulations,andlaws.

• Unable tobePerformed (U): The targetsand critical tasks associatedwiththecorecapabilitywerenotperformedinamannerthatachievedtheobjective(s)

Foreachcapability, thegroupshouldagreeuponadescription includingashort narrative of key issues, milestones, and challenges which will helpidentifythefunctionandactivitiesincludedforreviewandframesubsequentareas for the evaluation. Below is a selected, non-all-inclusive exampleevaluationtemplate.

Identifying,evaluating,andratingthe

strengthsandchallengesofyourrecent

responseeffortsisthefirstmajorstepinatwo-stepprocessfordevelopingandupdatinganinfectious

diseaseresponseplan.

33

Table9:ExampleEvaluationforCapability#1-CommunityPreparedness

Function PerformanceRating

(P,S,M,U)

Strength Challenge NewCapability

Strengthencommunitypartnershipstosupportpublichealthpreparedness

S Internalpartnershipswerealreadystrongandseveralexternalpartnershipsinplace

Somekeyexternalpartnershipsweren’testablished

N/A

Function3:Coordinatewithpartnersandshareinformationthroughcommunitysocialnetworks

M Coordinationhelpedwithconsistencyofresponseefforts

Missingpartnershipsweredifficulttoobtaininthemiddleofacrisis

N/A

Function4:Coordinatetrainingandprovideguidancetosupportcommunityinvolvementwithpreparednessefforts

S Internalpartnershipsallowedforeaseofcoordinationfortrainingwithinthecommunity

N/A N/A

Table10:ExampleEvaluationforCapability#2–CommunityRecovery


(P,S,M,U)


Function1:Identifyandmonitorcommunityrecoveryneeds

M Internalinventoryofassetsexisted

Jurisdictionalpartnerinformationwaseithermissingoroutofdate

Knowledgeofjurisdictionalpartnersandserviceswasupdated

Function3:Implementcorrectiveactionstomitigatedamagefromfutureincidents

M Overtime,thevariousstakeholdersbecamemoreagileinrespondingtofrequentlychanginginformationandstandards

Communicationandcoordinationwasattimeschallenging

Developedmoreformalchannelsofcommunicationandestablisheddailybriefings.

34

Table11:ExampleEvaluationforCapability#3-EmergencyOperations


(P,S,M,U)


Function1:Conductpreliminaryassessmenttodeterminetheneedforactivationofpublichealthemergencyoperations

P TeamengagedquicklyandgainedLeadershipsupportswiftly.

NA NA

Function2:Activatepublichealthemergencyoperations

P TeamengagedquicklyandgainedLeadershipsupportswiftly.

NA NA

Function4:Manageandsustainthepublichealthresponse

M Overtime,theresponseeffortstabilizedandadaptedtochangingconditions.

Understandingallcomponentsandidentifyingappropriatepartnerswaschallengingattimes

FormalMOA’ssignedwithmultiplepartners.

Table12:ExampleEvaluationforCapability#8-MedicalCountermeasure


(P,S,M,U)

Strength Challenge Newcapability

Function1:Determinemedicalcountermeasuredispensing/administrationstrategies(forapandemicthiscanincludetesting)

M N/A Notestingsuppliesimmediatelyavailable

Suppliersidentified,contractssigned,securestorageidentified,stockpilecreated

35

Function2:Receivemedicalcountermeasurestobedispensed/administered

M IdentifiedLocalandstatelevelpartnerswithassistancefromFederalagenciesincludingIHSandCDC

Notestingsuppliesimmediatelyavailable

Suppliersidentified,contractssigned,securestorageidentified,stockpilecreated

Function3:Activatemedicalcountermeasuredispensing/administrationoperations

S Coordinatedwithlocalpartnersoncetestingequipmentbecameavailable

Timelineinestablishingagreementwithlocalpartners

Creatednewpoliciesandprocedureswhichmaybeappliedinfuturesituations

HowtouseyourEvaluationforImprovementPlanningCreatinganidentificationandevaluationofyourresponseactivityisthefirststepinupdatingyourplan. Theevaluationshouldthenbeusedtodevelopyour performance improvement plan. There is no prescribed way todetermine which capacities and functions should be included in theperformanceimprovementplan. Youmaychoose toincludeeachcapacity,onlythoserated“performedwithsomeormajorchallenges”orahybrid.

BuildingConsensusAmongParticipantsUponcompletionoftheidentificationandevaluationofstrengths,challenges,andnewcapacitiesthegroupshouldconductafinalreviewofeachandreachagreement.Thisreviewisimportanttobuildconsensusandgeneratebuyin.Thiscreatesresponsibilitywithinthegroupandincreasesthelikelihoodthattheperformanceimprovementplanwillbecompletedandimplemented.

Afinalreviewcreates

responsibilitywithinthegroupandincreasesthelikelihoodthatthe

performanceimprovementplanwillbe

completedandimplemented.

36

PresentingResultsandFollow-UpActions

Inter-TribalDebriefingTheAARdebriefingshareswithLeadership,stakeholders,andpartnerstheoverall planning, preparation, and conduct of the AAR. If desired, thedebriefing can also share the roles, responsibilities, and timelines forcompletion of the AAR reports and other deliverables. Ideally, the AARdebriefingshouldoccurwithinoneweekof completing theAAR.TheAARdebrieftypicallytakestheformofacombinationofaformalpresentationanddiscussion.ThedebriefcanbeledbytheAARfacilitator,someoneappointedbythegroup,oracombinationofgroupparticipantsdependingonareasofexpertise.Thefocusshouldbeonlessonslearnedandbestpractices.TheAARdebriefmayalsoincludeadiscussiononhowtoimprovetheAARprocessinthefuture.

WhenpresentinganAARdebrieftoTribalLeadership,inadditiontosharinginformation andbestpractices, this is anopportunity to gain support andapprovalfortheresourcesneededtoimplementtheAARimprovementplan.ItmayalsobeanopportunitytogainsupporttosharetheAARfindingswithothers including external partners and the Tribal community. Thismorewidespread sharing of results can garner greater cooperation andunderstandingforactionsduringfutureincidents.

ExternalDebriefingIn response to most emergency incidents, particularly public healthemergencies,Tribalgovernmentscollaboratewithotherexternalpartners:local, state, federalandNGO’s tocoordinate theresponse. Forthisreason,whenappropriate, it isoftenabestpractice toconductanAARwith theseexternalpartners.Thisisparticularlyimportantwhentherearesegmentsofthe action plan which include and rely on external partners forimplementation. This helps strengthen partnerships and futurecollaborations.ThesameformatusedfortheinternalTribaldebriefingmaybeusedwithminoradjustmentsforthisexternaldebrief.

AARFinalReportAnauthorforthefinalreportshouldbetheassignedReportWriterfromtheAARTeam.TheReportWritershouldgatherallnotesandtheaction/workplandevelopedduringtheAARforintegrationintothereport.Oncetheinitialdraftiscompleted,itshouldbecirculatedtoareviewcommitteetoreviewforaccuracyandcompleteness.ThemostcriticalcomponentoftheAARistheaction plan for key activities and recommendations including timelines,budget information and assigned staff/departments/individuals. Activitiesshouldbeseparatedintothosewhichcanbecompletedwithinashortamountoftimeandthosewhicharelongerterm.(e.g.buildingalternatehousingforthosewhomustbequarantined.)

WhenpresentinganAARdebriefto

TribalLeadership,thisisanopportunitytogainsupportandapprovalfortheresourcesneededto

implementtheAAR

improvementplan.

Externaldebriefinghelpsstrengthenpartnershipsandfuture

collaborations.

37

At a minimum, the final report for the AAR should include the followingsections:

I. ExecutivesummaryII. BackgroundanddescriptionoftheincidentunderreviewIII. Scope/focusofthereviewIV. Findings/Evaluation/ActionplanV. NextStepsVI. Conclusions

The plans for disseminating the final AAR report should be agreed uponduringtheAARplanningprocess.Itisadvisabletoconsideranabbreviatedreportwithclassifiedand/orsensitiveinformationremoved.Forexample,iftheactionplanassignsspecificindividuals,thismaynotbeallowedaccordingtohumanresourcepolicies.Oncethereportisfinalized,itshouldbesharedwitheveryoneintheAARplanninggroup,TribalLeadershipandanyoneelseTribalLeadershipdetermines.

AftertheAAR:DocumentingProgressIt is important tokeep inmindthat theactionplan for theAAR isa livingdocument and should be followed and amended as the action plan isimplemented.NotuntiltheimprovementplanisfinalizedhastheAARcometo completion. A best practice is to assign a coordinator to oversee theongoingimplementationoftheimprovementplan.Thisisdifferentfromtheteam members responsible for implementing the plan. The role of thecoordinatoristwofold:

1. Actasaconvenerofthegroup,whetherthatmeansweekly,monthlyorquarterly gatherings depending on the activities and availability ofmembers.

2. Facilitationofaccesstoresourcesneededtogettheworkdonei.e.supportfromprocurementandfinancetoseekvendorsforPPE’sandfundingtopurchase

LessonsLearnedDatabaseTheAARTeamshoulddocumenttheirworkandnotesprovidedbytheNoteTakertocreateadatabaseof“lessonslearned”.ThepurposeofthisdatabaseistorecordandshareinformationgainedduringtheemergencyandtheAARprocess with others. As stated previously, keeping a record of theperformanceratingsforeachcapabilitywillbeimportantwhenitcomestothenextphaseofImprovementPlanning.

ItisimportanttokeepinmindthattheactionplanfortheAAR

isalivingdocumentandshouldbe

followedandamendedastheactionplanisimplemented.

38

ImprovementPlanningImprovement planning is the essential next step, once the AAR has beencompleted. The identification of strengths, areas for improvement, andcorrectiveactionsthatresultfromincidentshelpTribalorganizationsbuildcapabilitiesaspartofalargercontinuousimprovementprocess.Aneffectivecorrective action program develops improvement plans that are dynamicdocuments,whicharecontinuallymonitoredandimplementedaspartofthelargersystemofimprovingTribalresponsetoincidents.

ImprovementPlanningisaprocessbywhichtheareasforimprovementfromanincidentareturnedintotangibleandquantifiablecorrectiveactionsthatstrengthen capabilities. Improvement planning activities can help shapepreparedness priorities and support continuous improvement in Tribalorganizations

ImprovementPlanAuthority

ThecompletionofanAARandthesubsequentImprovementPlan(IP)byaTribeshouldhavethefullbackingofalllevelsofTribalLeadership,astherearepersonnel,financial,policy,legal,andattimes,sovereigntyissuesrelatedtotheadoptionandimplementationoftheIP.

Each Tribe that completes an IP should consider the internal businesspracticesoftheTribe,includingtheroleandauthoritiesofTribalLeadership,toassurethateachofthecorrectiveactionscanbeaddressedattheproperlocationwithintheorganization,toassurecompletionofthecorrectiveactionitems.

Tribal Leadership andTribal governmentofficialsmustbe included in thelifespanoftheIPandthecompletionofthecorrectiveactionitems.Theycanprovide strategicdirection for the IPprogramaswellas specific guidancenecessaryforachievingthedesiredoutcomesoftheIP.RoutineengagementduringtheIPprocesswithTribalLeadershipandTribalgovernmentofficialscan bolster internal and external supportnecessary for the success of theproject.

TribalImprovementPlanLeadership

It is essential to have an assigned individual from within the TribalgovernmenttooverseetheIPprocess,throughtocompletion.Thisindividualshouldhavetheauthority,oradelegatedauthority,toplan,implement,andcompletealltheidentifiedcorrectiveactionitemsintheIP.It ispreferablethat this individual is solely focused on the IP, avoiding adding theresponsibilities of the IP implementation on an already tasked individual.DuringtheIPimplementationperiodthedevelopmentofcorrectiveactions,the Tribal IP Leader, as the Tribal IP project manager, will assume theresponsibilityfortheidentifiedissues,whilealsomakingdecisionsabouttheinitiallistofappropriatecorrectiveactionstoresolvetheidentifiedissues.

ImprovementPlanningisa

processbywhichtheareasforimprovement

fromanincidentareturnedintotangibleandquantifiable

correctiveactionsthatstrengthencapabilities.

ThecompletionofanAARandthesubsequentImprovementPlan(IP)byaTribeshouldhavethefullbackingofalllevelsofTribalLeadership.

39

TribalTimelines

Therearenumerousfactorsthatimpactthetimelinefortheimplementationof theTribal IP.Once the IP hasbeenapprovedat the final reporting, theproper internal Tribal Leadership approvals and resolutions have beenobtained, and the Tribal IP Leader is identified, the project managementaspectsoftheIPprocessarenowofgreatestconcern.Theseissuesincludefinancial/fundingmattersandstaffingtocompletethecorrectiveactionitemsfortheIP.

AfterActionImprovementPlan

ImprovementPlan(IP)Development:TheImprovementPlan(IP)isadocumentthatgenerallyincludesanoverviewof the event or incident that is being evaluated, including an analysis ofcapabilities, and a list of accepted and approved corrective actions. Thelength,format,anddevelopmenttimeframeoftheIPdependontheincidenttypeandscopeoftheinvolvementofeachparticipatingentity.TheIPshouldincludeanoverviewofperformancerelated toeach incidentobjectiveandassociatedcapabilitiesrequired.

The ability to communicate exercise evaluation results to stakeholders iscrucialtotheimprovementplanningprocess.

GatheringStakeholderObservationsTime spent planning for data collection, the actual collection of data, andconducting analysis supports the development of clear observations andrecommendationsforinclusionintheImprovementplan.

It is recommended the database information be provided to additionalstakeholderswhodidnotparticipateintheAARWorkingGrouptoidentifyareas for further improvement, provide feedback on improvementimplementation activities, and provide their recommended resources andtimelinesforimplementation.

AftertheAfterActionReviewworkinggroupiscompleted,itisrecommendedthatthecapabilitiesrankedas“UnabletoPerform”or“PerformedwithMajorChallenges”beatthetopoftheprioritylisttobeincludedintheimprovementplan. The capabilities ranked as “Performed with Some Challenges” and“PerformedwithoutChallenges”donotneedtobeaddedbutmaybeincludedatthediscretionoftheTribalIPLeader.

The observations developed for the capabilities should be categorized aseitherstrengthsorareasforimprovementandcanbefoundinthedatabaseof lessons learned from the AAR Working Group. Additionalrecommendationsforimprovementcanbegatheredfromotherstakeholderstogainmoreinsightintospecificimprovementactions.

TheImprovementPlan(IP)isadocumentthatgenerallyincludesan

overviewoftheeventorincidentthatisbeingevaluated,includingananalysisof

capabilities,andalistofacceptedandapprovedcorrectiveactions.

40

Mechanismstodiscoverobservationsfromstakeholdersinclude:

• WrittenObservations• VerbalInterviews• Written/Onlinesurveys• GroupDiscussions

Feedbackshouldinclude:

• Clearanddirectstatementoftheissueidentified• Abriefdescriptionoftheanalysis• Theimpactorresultoftheissue

ObservationStrengthsandWeaknesses:

• Actionsthatwentexceptionallywellgiventhecircumstances• Theimpactofpositiveperformanceondesiredorexpectedoutcomes• Activitiesthatyieldedbetterresultsthancouldhavebeenexpected• Outcomesdidnotmeetexpectationsorintent• Thenegative impact of actual performanceondesiredor expected

outcomes• The factors that contributed to the inability tomeet critical tasks,

capabilitytargets,ordesiredoutcomes

Other areas of emphasis when organizing observations into theImprovementPlan:

• Focus on issues that are critical to the success of a mission orrepresentatrend

• Observationshelpguidecorrectiveactionplanningbyfocusingtimeandresourcesonissuesthathavethegreatestimpact

• Include data on consequences and likelihood of reoccurrences orwhatwouldhappenifnoactionistaken

SMARTCorrectiveActions

The Homeland Security Exercise and Evaluation Program (HSEEP) Guidefrom January 2020 recommends the use of SMART Corrective Actions.Specific, measurable, achievable, relevant, and time-bound (SMART)corrective actions are steps intended to resolve capability gaps andshortcomingsidentifiedpriorto,during,andafteranincident.

Table13:SMARTCorrectiveActions

SMARTGuidelinesforCorrectiveActions

Specific ObjectivesshouldaddressthefiveWs:who,what,when,where,andwhy.Theobjectivespecifieswhatneedstobedonewithatimelineforcompletion.

ItisrecommendedthedatabaseinformationbeprovidedtoadditionalstakeholderswhodidnotparticipateintheAAR

WorkingGrouptoidentifyareasforfurther

improvement.

41

Measurable Objectivesshouldincludenumericordescriptivemeasuresthatdefinequantity,quality,cost,etc.Theirfocusshouldbeonobservableactionsandoutcomes.

Achievable Objectivesshouldbewithinthecontrol,influence,andresourcesofexerciseplayandparticipantactions.

Relevant Objectivesshouldbeinstrumentaltothemissionoftheorganizationandlinktoitsgoalsorstrategicintent.

Time-Bound Aspecifiedandreasonabletimeframeshouldbeincorporatedintoallobjectives.

After reviewing the AAR database and reviewing the improvementrecommendations, the Tribal IP Leader should begin inputting theinformationintotheImprovementPlanMatrix.

The Improvement Plan Matrix will show the steps to implement theimprovementplanforeachcorecapability,theissuetoberesolved,theactionto be taken, responsibilities, and timelines. Below is an exampleImprovementPlanMatrix.

42

Table14:ImprovementPlanMatrix

Core

Capability

Issue/Area

for

Improvem

ent

Corrective

Action

Capability

Elem

ent

Primary

Responsible

Organization

Organization

POC

StartDate

Completion

Date

Core

Capability1:

Operational

Coordination

1.Delayin

situational

statusreporting

fromindivid

ual

Triba

lclinics

1.Provide

situational

status

reporting

education

to

Triba

lclinic

departm

ent

heads

Train

ing

Education

Joh

nDoe

10/21/20

11/04/20

43

ImplementationFunding

Fundingof the IP is an essential aspect of theTribal IPLeader and the IPprocess. The AAR, including the IP, is a flexible process, allowing formanagementofincidents,emergencies,anddisastersofallsizes.Thesizeofthe incident will normally influence the size and cost of the IP process.Although many incidents that impact Tribes may be handled internally,withoutafinancialimpacttotheTribe,fundingforcorrectiveactionsduetolarge incidents can overwhelm a Tribe. After large incidents, Tribes canstrugglewiththecostsoftheresponseandrecoveryphasesoftheincidents.WhenaTribestruggleswiththecostofresponseandrecovery,theremaynotbeadditionalinternalfundingavailablefortheimplementationoftheIP.Thefollowing sections will review potential sources of funding if internalresourceshavebeenexhausted.

DirectRequestsforAssistance

TheUnitedStateshasatrustresponsibilitywithfederallyrecognizedTribesand recognizes their right to self-government. This “Government toGovernment”relationshiprequirestheUnitedStatesFederalGovernmenttoprotect Tribal treaty rights, lands, assets, and resources while providingsupportthroughstatutoryauthorityandotherprograms.UndertheRobertT.Stafford Disaster Relief and Emergency Assistance Act (Stafford Act),federallyrecognizedTribesimpactedbyanincident,emergency,ordisaster,maydirectlyrequesttheirownemergencyand/ormajordeclarationfromtheUnited States Federal Government or they may request for assistance incoordinationwithastate.

As outlined in the National Response Framework (NRF) and the NationalDisaster Recovery Framework (NDRF) federally recognized Tribes canrequest federal assistance for incidents that impact the Tribe, but do notresultinaStaffordActdeclaration.Tribescanelecttorequestassistancefroma singular federal department or agency acting under their own federalauthorities.TribescanalsorequestFederalEmergencyManagementAgency(FEMA) assistance to coordinate federal governmental assistance frommultiplefederalsources.

Partnerships

AlthoughtherearenumerousTriballyrelatedgroupsthatareassociatedwithemergenciesanddisasters,TheTribalAssistanceCoordinationGroup(TAC-G) is recognized in the National Response Framework (NRF) as theMultiAgency Coordination (MAC) group that assists federally recognized Tribesduring emergencies and disasters and provides information and technicalassistanceforTribalemergencymanagementprogramsincoordinationwithfederalpartners.

Thesizeoftheincidentwillnormally

influencethesizeandcostoftheIPprocess.

WhenaTribestruggleswiththecostof

responseandrecovery,theremaynotbeadditional

internalfundingavailablefortheimplementation

oftheIP.

Externalfundingresourcesinclude:

1. DirectRequestsforAssistance

2. Partnerships3. PostDisasterGrantsandAssistance

44

The TAC-G is led and managed by the Bureau of Indian Affairs (BIA)EmergencyManagementProgram.TheTAC-Gconsistsofpartners fromalllevels of government(local, state,Tribal, territorial, insular, or federal), aswellasnonprofitaidorganizationsandtheprivatesector.InadditiontotheBIA,othermajorcontributors totheTAC-G include theFederalEmergencyManagementAgency(FEMA),theIndianHealthService(IHS),andtheUnitedStatesArmyCorpsofEngineers(USACE).

PostDisasterGrantsandAssistance

ThemostfamiliartypeofassistancethatTribesutilize,afteranoverwhelmingincident,ismanagedbytheFederalEmergencyManagementAgency(FEMA)asdelegatedbythePresidentoftheUnitedStates,insupportoftheRobertT.Stafford Disaster Relief and Emergency Assistance Act (Stafford Act). TheStaffordActauthorizesthePresidenttoprovidefederalassistancewhenthemagnitudeofanincidentorthreatofanincidentexceedstheaffectedstate,territorial,Tribal,andlocalgovernments’capabilitytorespondorrecover.

WhenaTribe is approved for an emergencyormajordisasterdeclarationfrom the President through the Federal Emergency Management Agency(FEMA),TribesmayreceiveassistanceintheformofgrantsorcooperativeagreementsthroughFEMAPublicAssistance(PA),IndividualAssistance(IA),andtheHazardMitigationGrantPrograms(HMGP).MostTriballydeclareddisasterfinancialassistancedoesrequireaTribalcostsharewiththefederalgovernment.

States,ontheirownforstatelevelincidents,orinpartnershipwithFEMAandotherfederalentities,alsohavetheabilitytoassistTribeswithgrants.Non-GovernmentOrganizations(NGO)alsohaveinternalgrantmakingabilities.

ImplementationStaffing

Afterthefinancialsolutionshavebeenidentified,theTribalIPLeaderneedstoaddressstaffingissuesfortheIPprocess.OnlargerIPscenarios,theTribalIPLeaderwillneedtoformnumerousteamstocompletetheIP.Theseteamscan includemanagement, safety, design, operations, logistics, financial andconstructionteams.

InternalStaffing

Theuseofaninternalstaffingmaybesufficientforsmallerincidents.Internalstaffmembers, includingfulltime,part-time,andvolunteers,alreadyknowtheTribalsystemsandcanbeefficientwithassistingwithmanyaspectsoftheIP.TribalLeadership,includingmanagersandsupervisors,canassignexistingstafftoassistintheirspecificareasofexpertise.Workloadbalanceissuescanarisewhentheprioritiesofastaffmember’snormaldutiesareusurpedbytheIPassignmentsandduties.

Afterthefinancial

solutionshavebeenidentified,theTribalIP

LeaderneedstoaddressstaffingissuesfortheIP

process.

45

ExternalStaffingResources

ThroughouttheTribalenterprise,thereisagroupofknowncontractorsthatassisttheTribewithtasksandassignments.TheTribemayelecttoobtaintheservicesoftheknowncontractors,aswiththeinternalstaff,arefamiliarwithcollaboratingwiththeTribe,theTribalLeadership,andareculturallyaware.

One of the most active post disaster organizations from the federalgovernmentistheCorporationforNationalandCommunityService(CNCS).CNCS is the federal agency that encompasses four main program areas:AmeriCorps, Senior Corps, the Social Innovation Fund, and the VolunteerGenerationFund.

Thousands of citizens from around the country serve in an AmeriCorpsprogramincommunitiesacrossthecountryeachyear.AmeriCorpsstateandnational members serve to meet education, public safety, health andenvironmental needs of the community. The AmeriCorps VISTA programcollaborates with faith-based and community organizations and publicagencies, focusing on issues of poverty. Members of AmeriCorps NationalCivilianCommunityCorps(NCCC)canworkinpartnershipwithnonprofits,faith-basedorganizations,localmunicipalities,stategovernments,Tribesandschools on a variety of service projects. AmeriCorps NCCC-FEMA Corpsspecifically partners with FEMA to address emergency management anddisasterreliefprojects.

Voluntary Organizations Active in Disaster (VOAD) are another resourceavailable to the Tribal IP Leader. VOADmember agencies can support avariety of needs including individual and community needs assessments,accessible construction (repair/rebuild) support and coordination, debrisremoval from Tribal, public, and private property, and assistance withobtaininggrants.

ImprovementPlanningtoSupportContinuousImprovement

ContinuousImprovement:

Continuousimprovementisamethodinwhichcapabilitiesareperiodicallyexaminedtomakesuretheyaresufficient,accurate,andeffectivetohandlethethreats,hazards,andrisksaTribemayface.Identifyingstrengths,areasforimprovement,andcorrectiveactionsthatresultfromincidentscanassista Tribe to build, sustain, and deliver capabilities as part of a continuousimprovementprocess.

CorrectiveActionTrackingandImplementationCorrectiveactionscapturedintheIPshouldbetrackedandcontinuallyreportedonuntilcompletionbythe Tribal IP Leader. These efforts are part of a more comprehensivecontinuous improvement process that applies before, during, andafter an

ExternalStaffingResources:

1. Trustedcontractors

2. CNCS(AmeriCorps,SeniorCorps,theSocialInnovationFund,andtheVolunteerGenerationFund)

CorrectiveActionTracking

andImplementation

CorrectiveactionscapturedintheIPshouldbetrackedandcontinually

reportedonuntilcompletionbytheTribalIPLeader.

46

incident. Stakeholders should also ensure a system is in place to validatepreviouscorrectiveactionsthatweresuccessfullyimplemented.

CorrectiveActionTrackingandImplementation

Corrective Action Tracking and Implementation captured in the AAR/IPshould be tracked and continually reported on until completion. Tribesshouldassignpointsofcontactresponsiblefortrackingandreportingontheirprogressinimplementingcorrectiveactions.Bytrackingcorrectiveactionstocompletion,Tribesandtheirstakeholderpartnerscandemonstratethatthecapture,identification,andreviewofAARrelatedcorrectiveactionissuesandsolutionscanyieldtangibleimprovements.Tribesshouldalsoensurethereisa system in place to validate previous corrective actions that have beensuccessfullyimplemented.Theseeffortsshouldbeconsideredpartofawidercontinuousimprovementprocessthatappliespriorto,during,andafteranincident.

Bytrackingcorrectiveactionstocompletion,

Tribesandtheirstakeholderpartnerscandemonstrate

thatthecapture,identification,andreviewofAARrelated

correctiveactionissuesandsolutionscanyieldtangibleimprovements.

47

Appendices

48

PerformanceRatingofCapabilities

Capability

Function Performance

Rating (P, S, M, U)

Strength Challenge New Capability

Capability


Rating (P, S, M, U)


Capability


Rating (P, S, M, U)


AppendixA.PerformanceRatingofCapabilities

49

Improvem

entPlanMatrix

This

IP h

as b

een

deve

lope

d sp

ecifi

cally

for [

Trib

e or

Trib

al O

rgan

izat

ion

as a

resu

lt of

the

[Wor

king

Gro

up N

ame]

con

duct

ed o

n [d

ate

of w

orki

ng g

roup

].

15CapabilityElementsare:Planning

,Organization,Equip

ment,Training,orExercise.

Core

Ca

pabi

litie

s Ar

ea fo

r Im

prov

emen

t Co

rrec

tive

Actio

n Ca

pabi

lity

Elem

ent15

Pr

imar

y Re

spon

sibl

e O

rgan

izat

ion

Org

aniz

atio

n PO

C St

art D

ate

Com

plet

ion

Date

Cap

abilit

y 1:

[C

apab

ility

Nam

e]

1. [A

rea

for

Impr

ovem

ent]

[Cor

rect

ive

Actio

n 1]

Cap

abilit

y 1:

[C

apab

ility

Nam

e]

1. [A

rea

for

Impr

ovem

ent]

[Cor

rect

ive

Actio

n 2]

Cap

abilit

y 1:

[C

apab

ility

Nam

e]

2. [A

rea

for

Impr

ovem

ent]

[Cor

rect

ive

Actio

n 1]

Cap

abilit

y 1:

[C

apab

ility

Nam

e]

2. [A

rea

for

Impr

ovem

ent]

[Cor

rect

ive

Actio

n 2]

Cap

abilit

y 2:

[C

apab

ility

Nam

e]

1. [A

rea

for

Impr

ovem

ent]

[Cor

rect

ive

Actio

n 1]

Cap

abilit

y 2:

[C

apab

ility

Nam

e]

1. [A

rea

for

Impr

ovem

ent]

[Cor

rect

ive

Actio

n 2]

Cap

abilit

y 2:

[C

apab

ility

Nam

e]

2. [A

rea

for

Impr

ovem

ent]

[Cor

rect

ive

Actio

n 1]

AppendixB.Improvem

entPlanMatrix

50

[Working Group Name] After-Action Report/Improvement Plan

[Date]

AppendixC.AfterActionReportandImprovementPlanTemplate

51

WorkingGroupExecutiveSummary

Working Group Name

[Insert the formal name of working group, which should match the name in the document header]

Date & Location This working group was conducted on [date] over [duration] at [location].

Incident/Event Under Review

[List the incident/event being responded to (e.g. natural/hurricane, health emergency technological/radiological release)]

Scope of Review [Details of the reason for providing a response to the recent incident or event]

Key Milestones of Incident/Event

[Details/dates of the incident/event such as start, detection, verifications, testing, public communications, vaccine development, declared over]

Core Capabilities

[List the capabilities being focused on and reviewed identified in creation of an inventory of core capabilities]

52

Key Takeaways from Evaluations

[List the key takeaways from the working group and evaluations completed around the capabilities and functions.]

Sponsor [Insert the name of the sponsor organization, as well as any grant programs being utilized, if applicable]

Participating Departments/ Programs

[Insert a brief summary of the total number of participants and participation level (i.e., Federal, State, local, Tribal, non-governmental organizations (NGOs), and/or international agencies).]

After Action Review Team

[Insert the name, title, agency, phone number, and email address of the AAR Lead, Lead Facilitator, Facilitators, Note Takers, Report Writer, Tribal Improvement Plan Leader]

53

FindingsandEvaluationsThe following sections provide an overview of the performance related to each capability and function focused on during the working group, highlighting strengths and areas for improvement to address identified challenges. (The completed Performance Rating of Capabilities Charts may be attached in addition to the summary information below)

[Capability1]The strengths and areas for improvement for each core capability aligned to this objective are described in this section.

[Function1]Descriptionofthefunctionunderthiscapabilitybeingreviewed.

StrengthsThe [full or partial] capability level can be attributed to the following strengths:

Strength 1: [Observation statement]



ChallengesThe following areas require improvement to achieve the full capability level:

Challenge 1: [Observation statement. This should clearly state the problem or gap; it should not include a recommendation or corrective action, as those will be documented in the Improvement Plan.]

Reference: [List any relevant plans, policies, procedures, regulations, or laws.]

Analysis of Root Cause: [Provide a root cause analysis or summary of why the full capability level was not achieved.]

Challenge 2: [Observation statement]



[Function2]



54










[Capability2]The strengths and areas for improvement for each core capability aligned to this objective are described in this section.









55





56

EvaluationConclusionsThis section describes the primary conclusions drawn from the evaluations of each focus capability and function. This section will not include recommended improvements as that will be in the next phase of Improvement Plan.

NextStepsThis section describes the next steps after completion of the working group AAR such as:

• Communication of drafts with internal Tribal Leadership review

• Any communication to be provided to Tribe or other stakeholders

• Process for Improvement Plan pre-planning steps such as team organization, review of documents, outreach to additional stakeholders for observations.

• Using the capabilities rated as “Unable to Perform” or “Performed with Major Challenges” will be the focus of the Improvement Plan areas.

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ImprovementPlanReport

Method for Stakeholder Observations

[Method of collecting additional stakeholder observations outside of the AAR Working Group. (Written observations, verbal interviews, written/online surveys, group discussions.)]

Stakeholders Involved This working group was conducted on [date] over [duration] at [location].

Key Stakeholder Observations

[List the incident/event being responded to (e.g. natural/hurricane, health emergency technological/radiological release)]

Core Capabilities

[List the capabilities being focused on and included in the improvement plan. It is suggested to focus on those which were rated “Unable to Perform” or “Performed with Some Challenges” for the improvement plan.]

Overview of Corrective Actions

[High-level list of corrective actions to be implemented to accomplish improvement plan]

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Timeline to Completion of Implementation

[Estimated timeline to complete improvement implementations recommended]

Implementation Funding Options

[Insert the name of the sponsor organization, as well as any grant programs being utilized, if applicable]

Implementation Staffing Needs

[Insert a brief summary of the total number of participants and participation level (i.e., Federal, State, local, Tribal, non-governmental organizations (NGOs), and/or international agencies).]

Stakeholder Communication

[Insert the name, title, agency, phone number, and email address of the AAR Lead, Lead Facilitator, Facilitators, Note Takers, Report Writer, Tribal Improvement Plan Leader]

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FindingsandEvaluationsThe following sections provide an overview of the improvement plan matrix with a focus on the core capability and area for improvement, the corrective action, responsibilities, and timeline. (The completed Performance Rating of Capabilities Charts may be attached in addition to the summary information below)

[Capability1]The capability under the function is related to.


AreaforImprovementThe [full or partial] description of the specific issue or area for improvement in the Tribe’s ability to perform the function.

Issue/Area for Improvement 1: [Observation statement]



CorrectiveActionsThe following corrective actions are recommended for implementation to be able to perform the function.

Corrective Action 1: [SMART Corrective Action]

Responsible Party: [Who will be the responsible party to carry out this corrective action?]

Timeline: [What are the anticipated start and completion dates for implementation of this corrective action?]





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[Capability2]The capability under the function is related to.







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ImplementationFundingThis section will include any required funding details for implementation such as grant assistance, direct requests for assistance, and partnerships. Details of process to obtain funding should be included as well.

ImplementationStaffingThis section should consider the staffing needs necessary for implementation of the corrective actions. This would include:

• Teams to complete implementation

• Specific external staffing resources necessary

• New positions or modified positions, responsibilities, reporting.

ContinuousImprovementTrackingThis section provides details on how the implementation of corrective actions will be tracked and progress check-ins and the assigned individual responsible for tracking. This section will also include details of how to make modifications to the corrective actions should changes need to be made during implementation. The method for tracking and recording when corrective actions have successfully been implemented will also be included in this section.