After the terrorist attacks of September 11,2001, increased funding was provided to federal, state, and local health departments to improve their capacities for terrorism preparedness and emergency response. To evaluate the effect of this funding and to identify priority program areas in Kansas, the Kansas Association of Local Health Departments (KALHD) contracted with the Kansas Health Institute (KHI) to perform an independent assessment of local health department (LHD) preparedness capacity using a CDC assessment tool. This report summarizes the results of two surveys of LHDs and changes in preparedness capacity from 2002 to 2003. The findings indicated a substantial increase in local preparedness capacity, although increases among counties varied widely. Repeated assessments of preparedness using standardized tools can provide useful information to help guide federal, state, and local public health policies and investments.
In 2002, CDC developed the Public Health Preparedness and Response Capacity Inventory (1) to provide rapid assessment of a local public health agency's capacity to respond to public health threats and emergencies. The assessment tool is organized into six sections, which correspond to six focus areas (FAs) (i.e., planning and assessment [FA A], surveillance and epidemiology [FA B], laboratory capacity [FA C], communication and information technology [FA El, risk communication and health information dissemination [FA F], and education and training [FA G]), as defined in the CDC cooperative agreement that funds many state terrorism preparedness activities. The six FAs include a total of 15 critical capacities targeted for achievement. The assessment tool was field-tested, revised, and made available for national distribution in August 2002. Its validity has been described elsewhere (2).
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The assessment tool includes 79 questions and approximately 700 subquestions. Thirty additional questions were added to target Kansas-specific preparedness capacities not fully addressed by the assessment tool (e.g., adoption of Kansas-specific disease intervention protocols or computer security standard procedures). The printed questionnaire was converted to electronic form to support data submission from LHDs via a secure, Internet-based, communication system. Answers were submitted electronically during the second half of 2002 and the second half of 2003, leaving approximately 1 year between the two assessments. LHDs representing 103 of 105 (98%) Kansas counties (i.e., one LHD per county) responded to both surveys.

Most questions in the assessment tool have a limited number of multiple-choice answers and are qualitative in nature; for example, respondents were asked to specify the extent to which a certain activity had been completed. To calculate measures of LHD capacity, the KHI project team, in consultation with representatives from LHDs, developed a method for aggregating responses from multiple questions into summary scores. Each question was assigned to one or more of the 15 critical capacities. Representatives from KALHD and KHI developed a method for converting responses to each survey question to dichotomous, "achieved" or "not achieved" classifications. These criteria were included in a computerized algorithm used to analyze all the answers from all LHDs. Through the computerized analysis, a preparedness index was calculated for each LHD for every critical capacity. FA preparedness indexes were computed by calculating the unweighted average of the critical capacities indexes included in that FA. Finally, an overall, county-level preparedness capacity index was computed as the average of the indexes for all the FAs for each LHD.

To summarize local preparedness capacity in Kansas, state averages of the critical capacities and FAs indexes were computed as the unweighted averages of the corresponding county-level indexes. State overall preparedness indexes were calculated as the average of all county overall preparedness indexes.

From 2002 to 2003, a total of 89 (86.4%) of the 103 participating counties improved their county preparedness capacity indexes (median change = 27%). The state average for the overall local preparedness capacity index increased by 27.7%, from 33.9% to 43.3%. Improvement was observed for each FA index, with the largest increase (48.3%) in FAG (education and training) and the smallest (10.4%) in FA C (laboratory capacity) (Table).