Author: Zara Hashmi, Research Assistant, Public Health Prepared



Emergency response and pandemic preparedness have both been on the forefront for multiple sectors within the field of public health, with many practitioners facing challenges they have not encountered before. Determining the proper and most efficient emergency response has provided room for discourse on effective frameworks in times of necessity. Assessing community needs specific to a group affected is an integral first step in carrying out an emergency response. Tools such as the Community Assessment for Public Health Emergency Response (CASPER) developed by the Centers for Disease Control and Prevention (CDC), provide an outline of how to properly evaluate the needs of a community while also organizing interventions that mitigate the magnitude of the emergency.


What Does CASPER Look Like

Source: Harris County Public Health, Pasadena, CA


What is CASPER?

The CASPER framework was originally derived from the epidemiologic approach used by professionals within the World Health Organization’s Expanded Program on Immunization, which was used to assess vaccine accessibility within Africa. It is a form of Rapid Needs Assessment (RNA) that delivers household information to professionals, which can be used in  disaster relief efforts and determining the allocation of  resources. The CASPER Toolkit provides guidelines across the board, providing applications of CASPER to federal, state, tribal, local, and territorial (STLT) public health departments.

It utilizes a cluster sampling design, in which a population is divided into clusters depending on location or district and are then randomly selected to be used within the study. Sampling is carried out in two stages, with the first stage being the selection of clusters of households based on size, and then around 25% of those households being interviewed within each cluster. This allows for the development of estimates that are representative of family needs within the overall population. 

The CDC outlines the overall methodology and steps in detail within the CASPER Toolkit, a 64-page document that describes in detail each phase of the framework, including how to effectively carry out preparation, data collection, interpretation of results, and more.


What is Included Within the CASPER Toolkit?

Source: Canva, Zara Hashmi


Why Should You Use CASPER?

  • To make informed decisions and produce effective response methods, outreach to the right people, at the right place, and at the right time is key
  • CASPER provides representative population estimates that are generalizable, time-effective, cost-effective, and flexible
  • Data from conducting CASPER allows for situational awareness, provides estimates for resources such as food, water, or medication, and establishes priorities for a public health response 


CASPER in Action: Use of CASPER in Michigan (2016 Report of the Flint Water Crisis)

  • In 2014, Flint changed their main water supply source from the Detroit-supplied Lake Huron water to the Flint River. This transition led to the corrosion of water distribution pipes which added lead and other contaminants into municipal drinking water.
  • In 2016, a CASPER was carried out to assess the following: 
    • Behavioral and physical health concerns for adults (21+ years old) and children (less than 21 years old) in each household
    • Household access to behavioral health services and barriers to access
    • Resources used for water-related needs and barriers to access
    • How community members were getting information about the crisis
  • Methodology:
    • 30 clusters were selected with a probability proportional to the number of housing units within the clusters from the predefined sampling frame using the Geographic Information Systems CASPER tool.
    • Interview teams used systematic random sampling to select 7 households from each of the 30 selected clusters, for a goal of 210 total interviews (30 clusters of 7 households each).
    • Two-person interview teams were assigned to two or three clusters, provided with detailed maps of their clusters, and instructed to go to every nth household (where “n” is the total number of housing units in the cluster divided by seven) to select the 7 households per cluster to interview. 
    • Teams made three attempts at each selected household before replacement of a household.
  • Results of CASPER:
    • 66% of households reported one or more adult members reported experiencing at least one behavioral health issue “more than usual”
    • 54% of households reported that at least one child experienced at least one behavioral health issue “more than usual”
    • 34% of individuals self-reported symptoms of anxiety and 29% self-reported symptoms of depression
    • 51% of households felt that the physical health of at least one member had worsened due to Flint water crisis
  • Conclusions:
    • Using the findings from CASPER, federal, state, and local government officials were able to focus their recovery efforts on behavioral health interventions and communication messages.
    • Data from the CASPER supported the need for continued mental health services along with five-year follow-up activities by the Substance Abuse and Mental Health Services Administration (SAMHSA) aimed to promote resilience in the Flint community.
    • These activities aim to support youth and their families, alleviate the impact of trauma, reduce behavioral health disparities, and increase opportunities and training for Flint’s youth through strong community engagement.


Previous Lessons Learned

  • Inform local officials (e.g., county judge, emergency management coordinator) about CASPER and solicit input on objectives.
  • For disaster-related CASPERs, engage emergency management and consider when it is safe to enter the affected disaster areas; the assessment may be timed when residents have been allowed back into their homes after an evacuation order or after disaster threats have ended. 
  • Visit selected clusters (“ground truthing”) prior to deploying field teams to identify potential sampling issues/obstacles (e.g., gated communities, apartment buildings, stray animals).
  • Develop the survey using appropriate level language and include versions in the languages prominent in the sampling area; pretest the survey on a focus group (e.g., coworkers or residents from a similar community) 
  • Pre-screen field volunteers for health and safety issues; fieldwork is not for everyone.
  • Assign experienced field teams to more challenging selected clusters (e.g., remote, potential safety issues, a large number of surveys needed).
  • Tailor the field report format (e.g., length, organization, and analyses) for intended audiences.