Richard Klomp

Richard W. Klomp

Q: This is Sam Robson here with Rick Klomp. Today's date is March 14th, 2016, I believe, and we're in the audio recording studio here at the CDC Roybal Campus in Atlanta, Georgia. I'm interviewing Rick as part of the CDC Ebola [Response] Oral History Project, and today we'll be discussing briefly his life and career and especially digging into his work supporting CDC's response to the 2014 Ebola epidemic. Rick, thank you for being here.

KLOMP: Looking forward to spending some time with you, Sam.

Q: Thank you. For the record, could you please state your full name and current position with CDC?

KLOMP: Yes, my name is Richard Wallace Klomp and I'm the deputy director for CDC's WorkLife Wellness Office, and I've been at CDC for just over fifteen years now.

Q: Great. Can you tell me where and when you were born?

KLOMP: I was born in La Grande, Oregon, in December of 1955. I'm the baby of five kids. My dad was a range research scientist for the US Department of 00:01:00Agriculture, and he got transferred about every seven years. I was born in Oregon, went to elementary school in Southern Idaho, and I grew up in Reno, Nevada. Reno is an excellent place to be a kid, a teenager.

Q: Tell me more about that, growing up in Reno, Nevada.

KLOMP: We moved from this little quiet town in Southern Idaho, where they kind of rolled up the street at six at night, to Reno, which is the biggest little city in the world; never, never stops, and it was just an amazing place. We're right at the foot of the Sierra Nevada Mountains, so I had amazing skiing about fifty minutes away up by Lake Tahoe. The locals tend to ski on Slide Mountain or on Mount Rose on the Nevada side. The Californians, whom we referred to as goat ropers, they would ski at Heavenly [Mountain Resort] and Incline [Village] on the Tahoe side. But it was a great place. Reno has about three hundred fifty days of sunshine a year, and it snows, but the snow doesn't stay very long. Reno and Denver are kind of sister cities, they're both mild, high kind of cities. My 00:02:00dad used to love to say, "Hey son, you better get out and shovel the driveway before the snow melts." We would get three or four inches and it would be gone usually in a day or two. Truckee River flows through the middle of town, so tubing and kayaking, amazing camping, Desolation Valley, El Capitan, all that kind of stuff was really close. Then the Bay Area is just over four hours away, so I spent a fair amount of time bouncing back and forth with Northern California. Reno was cool. It's more than you wanted, but--

Q: No, not at all. Please.

KLOMP: It was an awesome place to be a teenager.

Q: Not at all more than I wanted. It's really actually a vivid portrait. What kinds of things caught your interest as you were getting about high school age, say?

KLOMP: I did an awful lot of camping, also did a lot of dirt biking on motorcycles, spent a lot of time out in the woods. I'm an Eagle Scout, both of my brothers are Eagle Scouts. As an adult I've been a Scout master in four 00:03:00different states. So the outdoors was a really, really big thing. In fact, growing up in Oregon, Idaho, and Nevada, all are surrounded by mountains. My whole teenage life it was difficult for me to imagine living someplace where I wasn't surrounded by mountains. Then I had the opportunity after doing one year of college at the University of Nevada at Reno, I had the opportunity to spend a couple of years in Germany, which was very, very green and very, very wet and a completely different environment, kind of cloudy, more like the Pacific Northwest. I was able to say, wow, this German environment is completely different than what I'm used to, but different doesn't mean worse. It's amazing. I became enamored with Germany and all things German, so when I came back to the [United] States as a sophomore, I was able to become comfortable in different physical environments and different environments and more comfortable with 00:04:00diverse ways to live and diverse ways to speak. There's just lots and lots of ways to do things. It kind of shook me out of a pattern of rigidity, I think, living in Europe for a couple of years.

Q: You told me just a little bit about that before we got started. What does your last name mean again?

KLOMP: Klomp is a Dutch name. It means one wooden shoe. A pair of wooden shoes are called klompen. Sometimes when I'm doing some training, I'll say my last name means I'm half a pair, which explains a lot, as sometimes people say. My grandfather came from Holland when he was eleven years old, so it seems to me that everybody in America is an immigrant, it just depends on which boat or which plane or which whatever we're on. I'm a big supporter of having lots and lots of people come to America and have the same kind of opportunities that our grandparents and great-grandparents had.

Q: Well said. What did you major in, in college?

KLOMP: As the baby of five kids, I was very observant about my older brothers and sisters. One of my brothers is a doctor, one of my brothers is a dentist, my oldest sister loved chemistry, which I didn't, my other sister's a school teacher. I observed the kinds of things that they were doing, and instead of being more of a numbers guy like they were, I was more of a word guy. I wanted to write the great American novel. I didn't want to major in English though because I thought, well, you have to just teach if you major in English. I focused on communications with a print journalism emphasis because to me, that felt like a marketable skill. I graduated in communications with a print journalism emphasis and a minor in psychology, but about partway through my program I realized that it was hard to make a living as a journalist. My last semester of undergraduate work, I took an organizational behavior class in our 00:06:00graduate school of management, and I really, really liked it, and I did well in it. I rolled right into a graduate program in organizational behavior and graduated two years later with a master's degree in organizational behavior, and I wound up being the TA [teaching assistant] for that introductory class. I taught it three of my four semesters of graduate school. I don't think anybody else ever did that. I was able to help other people put structure into their graduate program, and it was just an amazing program focusing on introducing and managing change within systems with a heavy emphasis on management development, leadership training, those kinds of things.

Q: What did you like so much about it?

KLOMP: To me it mirrored reality. As an example, as a TA, people would come in to the class and say, I look on the syllabus and there are no tests and no assigned papers. It says you negotiate your grade. What is that all about? And I 00:07:00said, let me talk to you a little bit about that. They say, really, it's because that professor is lazy and doesn't want to grade papers, right? And I said, no. There's nothing easier than grading a multiple-choice test, even grading an essay test. But Dr. Richie believes, and I've come to believe, that life not only does not give you multiple-choice questions, it doesn't give you any questions. You have to formulate your own questions. We're trying to replicate life here. We've given you the syllabus, we've given you assigned readings, you know what the discussions are going to be about, so your assignment is to demonstrate subject matter mastery. Show us that you've learned the stuff that is being presented in class, and you can do that by doing one paper or by doing five papers. You can do that by doing a group project that's worth half of your grade along with the paper. You want to turn something in every week? You demonstrate to us--and that freaked out the accounting students. It was very, very difficult for them, but I was able to help them, having been through it 00:08:00myself. I had some street cred [credibility] for the class, and I was able to help them develop structure. I really feel like that was an amazing class, and I have the highest regard for this Dr. [J.] Bonner Ritchie who became my first mentor. I learned a lot from him about interactions with people.

Q: Can you tell me more about that?

KLOMP: Sure. One of the things that he said, and I think a lot of graduate students are told the same thing, that you should never say never and never say always because from a logical point of view, it only takes one fact to disprove what you're saying. Right after he said don't ever make exclusive statements, he said all interpersonal conflict is the result of violated expectations. I'm like, dude, you can't say that, you can't say that. You've told me numerous times don't make those exclusive, superlative kinds of statements. And I thought about it. I immediately tried to disprove that, and I said no, if I tell my wife 00:09:00I'm going to be home at six and I don't get home until eight, that's about punctua--oh no, no that would be her expecting me to do what I said. So yeah, that's about violated expectations. Wait a minute, there was this one person at work that I butted heads with and that wasn't because of violated expectations, that was because this person was a jerk. Oh, well wait a minute, I thought they were a jerk because they violated my expectations about how a human being should treat another human being. I've come to believe that all interpersonal conflict is the result of violated expectations. Either someone does something that you think they should not have, they don't do something you think they should, they say something you feel they should not have, or they don't say something you feel that they should. That is an example of a truism, or I think an important concept that I got from Dr. Bonner Ritchie.

Q: Got you. Thank you. What did you do after graduation?

KLOMP: After graduation, I spent quite a while looking for a job. I graduated 00:10:00the first time in 1980, then I graduated in 1982, and the economy was at a real low point. What I found was instead of getting a high-paying consultant job or working for IBM or one of the major tech [technology] companies or whatever, they were able to hire at the same rate somebody who had three or four years' experience who'd lost their job because the economy was so bad. The unemployment rate went up over eleven percent, so actually it was worse than in 2008. I wound up working construction for seven bucks an hour, and even back in the day that was lousy money. We wound up moving with two little kids--my wife and I moved to Dallas, Texas, and I worked construction for six months, and then I wound up playing volleyball with a guy who was the vice president for a company that owned eighty-five hospitals. They were looking for individuals who had graduate 00:11:00degrees and limited business experience so they could train them in human resource issues. I joined that company--it was called Humana, which now sells HMOs, but when I worked for them they owned eighty-five hospitals. I started working as an HR [human resources] professional in Dallas. The program was supposed to take about a year and a half or two years. Eight months into that--is this too much detail?

Q: No, not at all. Never too much detail.

KLOMP: Okay. Eight months into this training experience, I got a call from my regional boss, the guy who'd hired me, and he said, "There's a guy in South Florida, a regional HR guy down there who wants to interview you because he's heard good things about you." But he says, "You don't really want to leave this region, do you?" And I said, "Well, Steve, my gosh, I'm only halfway through the training, it'll just be good experience for me. Let me just go down and visit with this guy." He said, "That's a good idea." I went down and interviewed, and 00:12:00they offered me the job to be the HR director at a 273-bed hospital in Pompano Beach, Florida, and I was ecstatic. I came back to the guy that hired me and said, "Sorry, but this is a great job." He said, "No, you need to do that." So I went down and started my career. I wound up working with Humana for about six years, had an opportunity to transition away from straight human resources, which was not my intention, into consulting. I wound up working for Hewitt Associates out of Lincolnshire, Illinois, for a couple of years and combined my writing background with my knowledge of human resources, as we were doing defined benefit pension plans and communicating 401K plans, that kind of thing, for different organizations. In the meantime, we had relocated to Chicago. We 00:13:00enjoyed downtown Chicago, but the cost of living was high and the weather is lousy and we had little kids. By that time, we'd had our fourth child, and sometimes it got to minus-fifty-five with wind chill in Chicago, and that's hard getting four little kids all bundled up. We said, is this really where we want to spend the rest of our lives, in Illinois? It was not. My wife grew up in Richmond, Virginia. We were looking for a career change and I came down to the Atlanta area--we had some good friends here that we'd gotten to know when we lived in Florida, which was where we moved after the Texas thing. I found that the job market was better down here and came down and got a human resources job down here. Then I said, you know what, long-term, this is not what we want to do. Long-term, I've always been interested in what makes people tick. That's why I had the minor in psychology as an undergrad [undergraduate], and so in 1996, looked at different graduate programs and went back to school at Georgia State, 00:14:00and was working full time and raising four kids and going to night classes. In 2000, I graduated with a second graduate degree focused on helping individuals change. After I had that degree, I was able to sit for the state licensure exam, and I became a licensed professional counselor. A few years later I became a board-certified professional counselor. In addition to my day job here at CDC, I also maintain a private counseling practice in Gwinnett County on one evening a week and part of Saturday.

Q: This seems off topic at first, but can you tell me a little bit about your wife and kids?

KLOMP: Sure. My wife is an amazing person. She grew up in Richmond, Virginia. She has been playing the piano for more years than she would like me to disclose right now. She started taking piano lessons, I think, when she was seven or 00:15:00eight. She was teaching piano when she was eighteen. She got into college a year early because she had started school early. She actually graduated before we got married, and she was just twenty-two, and I had just barely turned twenty-three when we got married, and we had our first child two days after our first anniversary. I used to joke around and say that I was so cheap, instead of giving her an anniversary present, I gave her a son for our first anniversary. She has felt that there was really nothing more important that she could do than to raise our children properly, so she's been a full-time mom the majority of our marriage. I say full-time because I'm focusing on the fact that she was in the home with the kids when they got home from school. She would say that she taught piano a good bit of the first twenty years when the kids were little, which is one hundred percent true. Right before we became empty nesters, she started up a music school and taught that for six years. She owned the music 00:16:00school, she got up to about one hundred ten students, and she taught a process called Harmony Road. Have you heard of Suzuki, where the kids play the--

Q: Yeah, I learned myself, the [Shinichi] Suzuki Method.

KLOMP: Okay, so Suzuki is very, very good. You know that it's designed by people who are really into detail, and finger position is a big deal. She came across this Harmony Road technique that was developed by someone who had started with the Suzuki Method but realized that American kids do a lot of other things, they don't just do music. They're playing baseball and they're playing basketball and they're playing soccer and they have other interests, and they're on swim teams, that kind of thing. The average American kid doesn't really in the second, third, fifth year of music instruction, is less inclined to be as focused as some children in other cultures. The Harmony Road approach incorporates the solfège method, which is do, re, mi. The kids are learning the basics that they 00:17:00are with the Suzuki or the Yamaha, and I'm not sure why they're all named after motorcycles, [laughter] but the kids are getting that solid instruction but they're also translating it more into music as they're singing. There's also group interaction, and in the Harmony Road approach, parents are also at each lesson, so then the parents can incorporate and reinforce what the children have learned in school. Their slogan was, "Bringing families to music step by step." You can tell I know a little bit about the approach that she had. I'm a huge proponent of that family focus on music. It's just very, very mutually reinforcing, and that the kids have the experience with Suzuki, that they can actually play songs. You're probably sick of "Twinkle, [Twinkle, Little Star]," but they can make music early on and it's a group, collective, social experience.

Q: Gotcha. And you said you're empty nesters now?

KLOMP: Yes, our four children range in age from our youngest, who just turned 00:18:00twenty-seven, to our oldest, who turned thirty-six right before Christmas. We had our thirty-seventh anniversary in December, and we wound up spending it in Aruba. It was just an amazing vacation. Four children, nine grandchildren, ranging in age from--Lily Marie is about four and a half weeks old, to our oldest, Kaylee, who is about nine and a half.

Q: Congratulations on the birth of your latest grandchild.

KLOMP: Thank you. Very fun.

Q: Getting back again to the career path side of things. As you're getting your second graduate degree and becoming a licensed professional counselor, what subjects start to really catch your interest?

KLOMP: That's a great question, Sam. I found that my GPA [grade point average] went up every time. I started off with a solid undergraduate GPA. I did well in my first graduate program, but actually I'm proud of the fact that I got a 4.0 in my second graduate program because literally every single class was relevant. 00:19:00As I'm taking a class on behavior change, it was relevant because I knew I was going to be sitting across, from chair to couch, with a client, and they were going to say, I've got this compulsive XYZ kind of behavior that I'm struggling with. That class was relevant. Talking about disciplining children, taking positive approaches and reinforcing good behaviors--that was very, very relevant. Every single class in my second graduate program, and that's not a cop-out answer, it really is true, I felt that the better I absorb this material and am able to digest it and implement it, the more effective I will be at helping somebody whose life is in a suboptimal state when they come to see me. You don't see a counselor because everything's rocking and rolling. You come in because you're stuck. In fact, that's actually my metaphor is that I don't work with ax murderers. That's not my population. I work with regular people who are stuck, and my experience in having lived in Reno and the Ft. Lauderdale area and 00:20:00Louisville and Dallas and the Atlanta area is our neighbors, people that we work with, people that we might share a faith-based experience with, virtually everybody's pretty good at solving problems, but my experience is at different points in our life everybody gets stuck. We run into something and we just don't know how to fix it. My job is to put tools in my clients' toolbox so that they can fix it. My job as a therapist is literally to work myself out of a job. The worst thing I could do would be to foster long-term dependence. I joke around when I'm talking to clients on a first visit and trying to give them a context, and everybody's nervous when they come in to a therapist. I tell them, first of all, that I only have a couple of rules. The first is that they don't have to answer any question that I might ask, and if they tell me no, then I will not twist their arm, that's fair. But I do need whatever comes out of their mouth to 00:21:00be true because if they're telling me something, they're going with the social desirability approach to something and they think it's what I want to hear, then everybody's wasting time because part of my job as a cognitive behavioral therapist is to help people achieve their goals, help them get where they want to go. Metaphorically speaking, if they're telling me they want to go to Denver because they think that's where I think they ought to go, but really they want to go to Chicago, then I'm going to be trying to help them make adjustments to get there and it's not really where they want to go. Those are my two basic rules, and then I talk to them about putting tools in their toolbox and then I joke around and say, you know what? You see me as long as you feel like I'm adding value, because that's a big question they have. How many times do I have to come in? I say it's not my call, it's your call, and I said I'm not kicking you out. My average client comes in nine to twelve times, but it's up to you. I said, because I'm not trying to get you to keep coming; we're not paying off my Lamborghini. I said, I drive a paid off Honda Accord, so you come in as much as 00:22:00it's helping you.

Q: Gotcha. At what point do you get to CDC?

KLOMP: I was doing my internship and practicum at a local social services location, and I started--because I was working full-time and going to school, I did my internship and practicum a couple of nights a week from six to nine after it was closed, and I was there on Saturdays. There was this other guy from a different school who already had a master's degree like me, and actually had a doctorate in epi [epidemiology], and he was working on some of the Saturdays that I was there. So I got to know him. It turns out he was a fairly senior communicator at CDC, and just a little over fifteen years ago I wound up having a little bit of extra bandwidth, and he said, "Are you interested in a project at CDC? We need somebody about twenty hours a week." I said, "That actually 00:23:00would work out perfectly for me." I started working in the Office of Communication as an ORISE [Oak Ridge Institute for Science and Education] fellow initially, and then that transitioned into a few years as contract work, and then I've been an FTE [full-time equivalent employee] for the last seven, eight years. A friend of a friend, basically.

Q: I have this idea of things in your professional life that are relevant leading up to Ebola--you recently helping respond to Hurricane Katrina, and I don't know, what else do I have? Other responses--Haiti, right?

KLOMP: Mm-hmm.

Q: And that might not be all of them. Can you just tell me briefly about some experiences that you think when you look back, yeah, that prepared me to do the work that I did in Ebola?

KLOMP: Yeah, I appreciate that prompt, Sam. My start in mental health really was kind of a result of serendipity, I believe. I was working in the office of 00:24:00communication, working on some smallpox stuff like fourteen and a half years ago, and enjoyed what I was doing. I wasn't enthralled, but it was fine, and I was working with some really good people. There's so many training opportunities that come up at CDC, and I noticed that a speaker was coming from a nationally respected disaster mental health program. It was an hour, hour and a half presentation, so I said, let me go to that. It was over the lunch hour. I go to this presentation, and the guy was very engaging, and during the presentation he started talking about psychometrics. Someone in the audience said, "I just developed this assessment tool to measure XYZ." I don't even remember what the focus was at the time, but I made a mental note because that instrument sounded cool to me. The clinician in me said, that sounds cool. After that meeting was over, I went up to that person and said, "Hey, could I get a copy of that tool that you said you created? It's very interesting." And she said, "Yeah. Tell me 00:25:00a little bit about yourself." I said, "Well, I got an undergraduate degree in communications, so I write quickly and effectively, got a master's degree in organizational behavior, so it's all about being a change agent, and I have a graduate degree in counseling, so I maintain this private counseling practice. She made a mental note, emailed me the thing, and then three months later, Sam, I get this email from this person who it turns out is a psychiatrist who at that time was working in the injury center [NCIPC, National Center for Injury Prevention and Control]. She said, "I am working on a project here in the injury center, and our basic focus is to safeguard families and children. As I recall from talking to you, if you came and worked with me, it would be kind of like I was getting three different people: a communicator and a change person and the trainer as well as a clinician. Are you interested in that?" And I said, "You want to pay me to strengthen families and children? That's what I'm all about. This is important work." I transferred over to the injury center and started 00:26:00working with Dr. Dori [B]. Reissman, a psychiatrist who really was my second major mentor in my career. Dori and I had the opportunity to work on community resilience. Dori was very gracious with her Rolodex, and she introduced me to a ton of people and one of them was the woman who--Dr. Betty Pfefferbaum at the University of Oklahoma, who gained great expertise in resilience with the Oklahoma City bombing. Betty and her team were on scene shortly after the [Alfred P.] Murrah Federal Building was exploded by the terrorists, I guess, Timothy McVeigh. Dori and I worked with her. We developed some community reliance tools, we had an expert panel, we published with Betty and some of her colleagues, and they introduced us to other people. The whole concept of resilience, focusing on community resilience, was very uppermost in our mind.

Going back beyond Hurricane Katrina, in December of 2004, the tsunami hit 00:27:00Indonesia and Thailand, and as I recall over four hundred thousand people were killed by that tsunami. It was incredibly devastating. I also believe that CDC sent fifty to sixty people over there. We sent people from NCEH [National Center for Environmental Health] who were looking at environmental issues, we sent epidemiologists who were looking for cholera outbreaks and other vectors related to the hurricane, and then those people came back and went right back to their day jobs. Dori the psychiatrist and I scratched our heads and said, we wonder what CDC is doing about the mental health of those people who've seen bodies piled up like firewood out in front of buildings. When we looked into it, as far as we could tell, CDC wasn't doing anything. We were disappointed by that and we said, you know what? We've been doing this resilience work, maybe what we can do 00:28:00is connect with CDC's fledgling Emergency Operations Center--it was brand new in 2004. In fact, they were still installing the monitors in the sub-basement of Building 1, which no longer exists. We went over and were visiting with the folks, most of whom at least at that point, in emergency operations and the Division of Emergency Operations, were former military. We said we're mental health professionals and we want to help you with the people who you're deploying to the field. You would have thought that we were vampires at a blood bank because they were afraid that what we really were trying to do was to negatively impact their ability to deploy their human assets, because to them mental health really was synonymous with mental illness. They thought we were shrinks who were going to find problems with all of their team members, and we were not invited to come play in their sandbox. So Dori and I went out and recalibrated our message and came back a few weeks later and said, really, our 00:29:00job is to strengthen your workforce. We're about force protection, we're about making sure that you have readily deployable assets, and we would love to partner with you. They viewed it very differently then. Then there was an outbreak of hemorrhagic fever, Marburg hemorrhagic fever, in the spring of 2005, and they invited us to interview people who had come back so that we could share process improvement kinds of data with them about the flight and about the hotel and the accommodations and the logistics and the equipment that they took with them. Because Dori and I are clinicians, it's a little bit easier for us to establish rapport than maybe somebody who's come out of a military orientation. It's like, how was it? What the crap was wrong? Anyway, we became part of the team at that point, and over the next few years we became integrated into the pre-deployment process. The CDC ran a ninety-minute pre-deployment briefing for a lot of the outbreaks starting probably around 2005, 2006, and we had about 00:30:00nine to eleven minutes of the pre-deployment briefing process so we could talk about physiological, cognitive and behavioral symptoms of stress, so we could emphasize the importance of self-care and maintaining balance in your life. I can't tell you how many times, Sam, I've probably told people, probably over two hundred, that emergency response is much more like a marathon than a sprint. Even a world class gold medal sprinter can't sprint for twenty-nine days, which is our typical deployment length. You need to pace yourself appropriately and you need to dial it down a little bit because the goal is not to fall across the finish line like the first marathoner. Was that Pheidippides, who died at the end of their 26.2 mile marathon run taking the message about war? We want our people to cross the finish line and still have some gas in their tank from an emotional and mental perspective. So we did the pre-deployment briefing stuff.

Then you mentioned Haiti. Phil [Philip] Navin, who ran the Division of Emergency 00:31:00Operations for probably fourteen years, asked me personally if I would visit with individuals who had come back from a deployment to Haiti because at least for the first eight to ten months that we sent people down there, they were seeing some pretty nasty sights. The clean-up operations have gone on really, really slow in Haiti. Apparently, they don't have a lot of heavy equipment. Instead of like we do it around here with a front-end loader and huge pick-up, I mean huge dump trucks, apparently it's three guys with a shovel and a wheel barrow who are emptying bricks away. Our deployers were seeing hands stuck out from under a pile of bricks that a building had collapsed on them. I had the opportunity to visit with over two hundred people who'd deployed to Haiti and give them a chance to download some information. One of the things that's worked out pretty well on this is that even though I'm a clinician, that's not my 00:32:00primary role here at CDC. When I'm talking to somebody, I'm talking to them as Rick the wellness guy or Rick the guy from the injury center or Rick the guy from the Office of Health and Safety back in the day. There's very little stigma just talking to Rick because it's not a clinical visit. Now, CDC's Employee Assistance Program has qualified, licensed professionals. That is their job, is to talk to somebody, and they have confidential conversations and information doesn't get back to supervisors. Even though they report up through me, it's a different kind of a thing when somebody's talking to EAP as when they're talking to me or when they're talking to Crystal in the resilience side of our wellness office. I think it gives people a multi-dimensional response option when they get back. If somebody can't sleep and they can't get rid of the mental images that they have from a deployment, then boom, they need to talk to the EAP. They 00:33:00need some clinical support. But that's super, super rare. But there are lots of people who come back that might have a question, and lots of people might benefit from a listening ear and somebody who's not going to say, suck it up, or deal with it, or what did you expect? That's something a neighbor might say. That's something a family member might say if somebody was still kind of moping around after a certain amount of time. But that's not something that a trained professional would say. I've done what's called warm transfers. When I've had an informal conversation with somebody who is in distress and I could tell they're in distress, and I'm getting behavioral cues from that individual, I would say, "What I'm hearing you say is that you've got this thing going on in your personal life and you just can't get your arms around it and you're kind of coming unglued. I'm seeing some tears in your eyes right now and I'm guessing 00:34:00that a big, strong guy like you doesn't ordinarily do that, so I'm worried about you and I would think there would be value in you getting some clinical help in addition to this conversation that we're having. Is it okay with you if I reach out to one of our EAP professionals so that you can connect with them right now?" I'm not ratting anybody out, I'm not doing anything behind anybody's back, we're eyeball-to-eyeball. I've never had anybody say no, leave me alone. People appreciate it because they can tell that it's a genuine, sincere concern and it's a free service, it's a confidential service, and so I've done a few warm transfers. Not a lot because the vast majority of people around here are--I was going to say ridiculously resilient, I guess you can't be ridiculously resilient, but let's just say highly, highly resilient. This has been an amazing place to work.

That's some of the background going into that, up through the Marburg hemorrhagic fever outbreak. Then we get into the Hurricane Katrina thing and Dr. 00:35:00Reissman and I, Dori and I pulled together a virtual team of people who could get detailed to us for two weeks to address the needs of the individuals who were going through the whole Katrina thing. I never saw a final number of how many CDC people were deployed to Louisiana and surrounding areas for Hurricane Katrina, and I don't know if anybody actually knows. I know it was well over one thousand people. That marked, in my opinion, a huge transition between how CDC's been doing business. I believe that fifteen, twenty, forty years ago, CDC had a few small teams of very, very experienced people. Lots of epis [epidemiologists], lots of MD-MPHs [people with doctor of medicine and master of public health degrees] who would go out, like, under the direction of Dr. Pierre Rollin, who is as far as I know is the lead responder to outbreaks. Pierre and 00:36:00his teams, they've done it a zillion times. They had their support systems in place, they knew what to do, and they would go out and investigate the outbreak. I believe in the early days there was not a lot of collaboration with other international agencies. Then the WHO became involved and we had to worry about additional levels of collaboration, which made it a little bit more complicated, but even so I believe that CDC responded occasionally with small numbers of individuals. Then with Hurricane Katrina, completely different game. Everything got turned upside down. We had well over one thousand people, many of whom had never deployed before. You go from having a few highly trained, very seasoned people to having tons of less trained, and I'm not saying less qualified but less experienced, less trained individuals. Dr. Reissman and I looked at that and I said, "I'm not a statistician, but it seems to me that we have greatly 00:37:00increased the likelihood that somebody is going to have a problem, that somebody is going to have some kind of a spontaneous decompensation, somebody's going to have some kind of a meltdown just because the numbers have increased so much." Right about that time, Dr. Reissman transferred over to NIOSH [National Institute for Occupational Safety and Health] and went to [Washington], DC. I transferred from the injury center into the Office of Health and Safety, working with Dr. Casey [L.] Chosewood, and Casey was able to help me get some funding with OPHPR [Office of Public Health Preparedness and Response] for a project. PID6788, if we want to be technical, but the title of that project is "Safeguarding the Health, Safety and Resilience of Individuals that CDC Deploys to Dangerous Environments." That was about seven years ago that we got that funding, and that funding has enabled us to develop a program. Do you want me to go ahead and talk about that now?

Q: Please do.

KLOMP: Okay. Because I'd spent the first sixteen years of my career in industry, 00:38:00it is horrible to me to think about the right hand not knowing what the left hand's doing or reinventing wheels that have already been invented. In other words, wasting federal resources feels terrible to me. As we were trying to fill this gap--what do we do for people that we're sending out into the field? How do we help them address their emotional well-being, their resilience? I thought it would be irresponsible if I didn't see what other federal agencies are doing. I reached out to other agencies that routinely put people in harm's way, and that's NASA [National Aeronautics and Space Administration], that's the FBI [Federal Bureau of Investigation], that's the Coast Guard, that's the Department of Defense, [Bureau of] Alcohol, Tobacco, Firearms, [and Explosives], other agencies like that that have people who can wind up being put in a dangerous situation. It probably won't surprise you that I did not see any consistency between their particular approaches. I did, however, find a couple of common 00:39:00elements, and what virtually all of these different agencies had were two things. They had some kind of a psychological model, and they also had some kind of peer support component to their approach.

I did some research, and the primary psychological model that had been implemented up until that time, and so we're talking about eight years ago, is called critical incident stress management. I don't know if you've heard of that, Sam. It was a program that was developed by a couple of very intelligent guys, Dr. George [S.] Everly [Jr.] and Dr. Jeff [Jeffrey T.] Mitchell. My recollection is that they developed it primarily for firefighters. Think about it. You're on a firefighting crew and the wind blows the wrong way and two of your crewmembers are killed in a very unpleasant way to do it. Critical incident stress management was designed to pull everybody together on the team, which 00:40:00makes sense, right, keep your team intact. And then give them the opportunity to share their story. What happened? What did they see? What role did they play? When CISM [critical incident stress management] was originally developed, it was very structured, it was very clear on the training for the people who did it, and I believe it was a very, very impactful program. The trouble is, that happens sometimes, is it was adopted and applied to a lot of things for which it was never intended. People said, wow, we've got this really good program for treating people who've been through this traumatic fire, let me apply that to people who've been in a motor vehicle accident. Let me apply that to victims of sexual assault, let me apply that to victims of domestic abuse. It started being applied--I don't want to say willy-nilly, I'm sure everybody who did it thought that they were reaching for a ladder to help these people come up from the depths of pain that they were experiencing, but the uniformity and the 00:41:00consistency went away. the studies that I looked at said that while people generally tend to feel good about having gone through a critical incident stress management program, the results were equivocal at best, and in fact there were data to indicate that in certain situations participation in a critical incident stress debriefing, which is a key component of critical incident stress management, is actually contraindicated. I'll give you a quick little example if I may, Sam, and then we can move on.

Q: Please do.

KLOMP: Let's say that you and I had both been working in New Orleans when Hurricane Katrina hit, but you had been out wading around chest deep going from house to house, and you'd been painting the X on the door of the building to show that it had been investigated. In one part of the X you put how many dead bodies you found, in another part if there's any toxicity. You'd been doing that day in and day out, seeing dead bodies. I'd been back in the hotel room entering data, which is a very important part of that role. Under the critical incident 00:42:00stress management model, you and I would've been brought to the same meeting and you would've been encouraged to spill your guts, metaphorically speaking. As you're talking about these dead bodies, I very easily could've been vicariously traumatized. I knew that I could not, as a behavioral scientist at CDC, promote a psychological approach that had some negative baggage attributed to it, and ironically, I'd taken a training course, a two-day training course, from Dr. George Everly, one of the co-founders of the program. I don't have anything against the program as it was instituted, and I have the utmost regard for its founding fathers, but I knew that it wouldn't fly here at CDC.

Dr. Reissman had introduced me to Dr. Bob [Robert J.] Ursano, and Bob is a psychiatrist. He has run the Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Sciences for probably twenty or twenty-five years. Bob is a rocket scientist. He's an amazing individual, and 00:43:00because Dori had introduced me to Dr. Bob, I was able to visit with him and said, here's our dilemma. We want to set up this program to safeguard the health, safety and resilience of our deployees. However, I don't know of a psychological model that I can use that I won't get beat up by my colleagues. He said, there's this fairly new thing that's been developed by some folks for the National Child Traumatic Stress Network and some of our colleagues, and it's called psychological first aid. It's designed for non-clinicians. It totally does no harm. You're not going to hurt anybody by applying it, and it incorporates some very powerful principles, some very simple principles. Pretty much everybody who sees it says that it has face validity. For example, the first step is contact and engagement. If you drive past a car accident and you see somebody staggering around and they're dazed and confused and you stop, the first step is going up and saying, excuse me, my name is Rick, are you okay 00:44:00because you look like you're in distress. That's the first step. That's not real risky, it's what most of us would do anyway, but it's a very simple model to give people a format to address other people's distress. We said, wow, that sounds great, and we looked into.

We then worked very closely with his deputy, Dr. Dave [David M.] Benedek, and wound up developing a three-day course that incorporates these basic principles of psychological first aid and principles of peer support that I mentioned was the other common element that was existent in the federal agency programs that we looked at. We also built in some conflict resolution, some coping skills, because you can't always fix everything, you can't always change everything. Frequently, you can't change everything, so coping skills.

Then we also did something that initially might appear a little bit unusual. We wanted this program that we were developing to be sustainable. We didn't want it 00:45:00to just be a one-shot and then it fades away. But we knew that if we just had this little touchy-feely, mental health thing that was independently hanging out by itself, it was likely to be forgotten very easily. So we asked, what is the language of emergency response? It's the incident command system. The incident command system says who's in charge. If there's a plane crash, the incident command system says, is it going to be the fire chief who responds, who's calling the shots, or the police department or the Army or the Navy? It's a standardized approach, and the incident commander is responsible for finance, logistics, operations, and plans, but that incident commander also has a safety officer reporting to her or him. To us it made perfect sense to integrate our approach, our resiliency approach, with the safety officer because to us it was ludicrous to try and separate physical health from mental health. For example, 00:46:00Sam, if you break your leg and it's very, very painful and you can't work and you can't ski, you can't snowboard or whatever, it's going to affect you mentally. It would be unusual for you not to be bummed out by that. The flip side of that is, if you have something happen and it negatively impacts you mentally or emotionally--let's say your favorite aunt dies of cancer and you didn't have a chance to see her before she died or whatever, and you're troubled, that puts you at greater risk of accidents because your concentration is disrupted. To us, mental health and physical health are interconnected. The safety officer should not only say, don't drink that water, we don't know where that's come from, but that safety officer also should be able to say, how are you feeling today? Did you get enough rest? How's your nutrition going? So we wound up developing this three-day course. The first two days focus on resilience, third day focuses on basic disaster site safety issues. Once again, a one-day training course does not make somebody a safety officer, but it gives 00:47:00them the basics of confined spaces and fall protection and off-gassing of generators and blood-borne pathogens. They are at least conversant with the kinds of issues that a safety officer is going to be concerned about.

Just to recap, the goal of this three-day training course is to create a cadre of individuals who can function like a medic in a military unit so they can assess and address the emotional well-being of themselves and their colleagues during a deployment. We've viewed that, Sam, as the gap that existed because we had done training before people deployed and we would visit people when they got back from deployment, but there were no resources available for somebody when they were in the field, when they most needed the resources. This OPHPR-funded project gave us the ability to develop this cadre of individuals who could provide real-time support in the field. Does that make sense?

Q: Yeah, I think it does. There are individuals who would be sent out alongside 00:48:00safety officers?

KLOMP: Yeah. Great question. In a perfect world, we would love to have somebody who could focus just exclusively on this mental health and safety related role. The reality is that all of our colleagues in the Division of Emergency Operations said, our teams have to be as small as possible. We can't give up one of our spots for somebody just to do this mental health thing. So it's additional training. It's a second hat that somebody wears. We've had over three hundred fifty people who've gone through our training in the last handful of years. We've had epidemiologists, we've had public health analysts, we've had management program analysts, we've had veterinarians, we've had logisticians, we've had communicators. Basically, anybody who's likely to be deployed can participate in this training, and then they can, when they're deployed--right 00:49:00now it still is not one hundred percent formalized.

Q: Oh, looks like something happened on my--

[interruption]

Q: We just had an interruption, but I had asked Rick to explain further what this cadre of individuals is, who it's made up of, and what they're doing when they go out on responses.

KLOMP: They have their specific assignment. They're going out to do contact tracing or epi or data management or whatever, but because they've had this training--and we're talking about epis or MDs or psychologists or data folks or logisticians or whatever, they go out with their primary responsibility. But our expectation is that they tag up with their team leader. We view the team leader, the CDC deployment team leader, basically as a mini incident commander because 00:50:00she or he is responsible for everything that goes on on their teams. But the reality is that we have huge expectations for the team leaders that we deploy to the field because they typically have significant technical expertise, but then they also are responsible to make sure that everybody has good accommodations and proper nutrition and exercise and safety. They also are being polled by CDC Atlanta to give data. They're wanting to have the data so that that can be shared with our different partners around the world. My perspective from having watched multiple deployments is that our team leaders have way more than they can say grace over, so we don't want anything to fall off of their plate. My operating assumption is that if you're a team leader and you're running ninety miles an hour and I come up to you as a newly deployed person and I say, by the way team lead, looking forward to working with you, wanted you to know that I've had some specialized training, I've been through this three-day training about 00:51:00resilience, and if it's okay with you I'd like to keep my eyes open and be a resource for you, and if I see anything that is disconcerting or that you would need to know about, is it okay if I just run it up the flagpole to you? To me that's a win-win kind of a thing. That has been the basic focus. We're still working to have it become more and more organized.

One thing that we found out during Ebola is that there was a strong need for country safety officers, and I had the opportunity to share some of these principles with some of the safety officers that went out. But that is, I believe, part of what we will be working on for Zika with the Deployment Risk Mitigation Unit is getting more of this training available to people who go out and fill the role of country safety officers. As recently as I believe it was Wednesday of last week, I reached out to some of the folks who were running the GRRT, the Global Rapid Response Team, and said we've got this three-day training 00:52:00and I think it would be ideal for your team members that you are deploying around the world on relatively short notice. They said, oh my goodness, yes, we'd heard about it, but we hadn't had a chance to close the loop yet. So I anticipate that we're going to be working much more closely with the Global Rapid Response Team members, giving them this training.

Where we're coming from, Sam, is that this really is analogous to regular first aid. And first aid is something that you have, it's a little bit like insurance. You hope that you don't need it. When you go hiking, hopefully you've got some Band-Aids, you've got some antiseptic or whatever in your backpack. You want to carry it and not use it. We would love for people to not have to use these psychological first aid techniques, but the reality is that stuff does happen. People do get stretched real thin. Fatigue is a clear and present danger and we want for people to be prepared. We want for people to have these skills and not 00:53:00need them. When I am trying to get people to enroll in my three-day training, I send an announcement out through all of the ECs, the emergency coordinators, and each CIO [centers, institutes, and offices] at CDC has an emergency coordinator, and different levels, different offices have their own emergency coordinators. When I'm kind of marketing that to them, I say, this training will be great if people are deployed to the field, but it also will be great for you on your team when they come back for the training. For example, several years ago we had an employee whose mother was dying. They had quit taking their antidepressant medication, the employee had quit taking their antidepressant medications, and I think they'd had some family squabbles, and they decided that they didn't really want to live anymore, and they went to the top of a five or six story building and spent a couple of hours contemplating whether or not they were going to jump 00:54:00off the building. Dr. Chosewood and some of DeKalb's finest [police officers] were up on the roof talking to them and eventually got them talked down, but there was a period of multiple hours when this person's coworkers thought that they were going to commit suicide. They were very, very distressed. The principles that we teach--if we'd had somebody who had completed the deployment safety resilience team member training who had been in that branch, they would've been able to have applied these principles so it would've helped the supervisor. Not only does it help in a deployment, but it helps in a day-to-day situation.

I had lunch last year with an EIS [Epidemic Intelligence Service] officer who'd been through the training, and I was expecting him to tell me how helpful it was in the field. He said, "Rick, it was helpful in the field. I talked to my team leader and told him I had this training, and we kept our eyes open and didn't really need to use it because everybody was doing fine." But he said, "I did use 00:55:00the training before I went on deployment because one of my friends had an ugly family situation and it was just killing him, and I was able to do the contact and engagement. I was able to offer them some safety and I was able to listen." They basically had applied several of the key steps for psychological first aid. To me it's great for CDC, it's great for deployments, but it's also great for organizational units and for individuals and their families and the community. They're just solid principles.

Q: Was the three-day training, was Ebola the first time that it was really tried out, or were there deployments before Ebola?

KLOMP: A great question. We have been doing the training for the last six years. So it preceded. There's been a cadre of individuals who've gone out. Because this is a training intervention and not a research project, we've collected data 00:56:00on pre-training safety knowledge, post-training safety knowledge, and we show a significant increase. We're able to raise the needle. We see an increase between pre-training resilience knowledge and post-training resilience knowledge. I've got the graphs on that. We also do a self-efficacy assessment before the training and after the training and people's self-efficacy has increased. Once again, we're not doing research, these are just program evaluation assessments that we're doing. We have not done longitudinal stuff and collected data from people when they've returned from deployment who said, I was able to apply it X number of times or in these kinds of circumstances. I anticipate doing those kinds of evaluation projects within the next two years, as we've got additional resources to do that. I'm looking forward to answering some of those kinds of questions. Short answer is no, Ebola was not the first time, and we're still 00:57:00ruling things out.

One of the things that I didn't mention to you, Sam, that's one of the sexier features of this three-day training is related to a conference that I attended eight or nine years ago. I went to a meeting, a conference, for the International Society for Traumatic Stress Studies, and I saw a presentation that was conducted by a professor and a couple of senior military psychologists. What they showed was the use of a virtual reality environment that was accessed via a head mounted display and earphones that simulated a couple of different military deployment environments. They had created a virtual Vietnam and a virtual Iraq. The simulation that I saw from virtual Iraq showed the scenery as if you were in a Humvee, going down the road in the desert with camels on the side of the road, and as you're driving down the road it simulates that you've 00:58:00run over an IED [improvised explosive device] and that it explodes, and there's smoke and there's noise and you hear somebody screaming. This was designed as an actual clinical treatment for post-traumatic stress disorder. That's what I saw, was a demonstration of a clinical treatment for PTSD using this virtual reality. As a clinician and as a former training professional and as a behavioral scientist, I thought about that and I said, why can't we use this same technology to prevent the onset of PTSD? Why can't we use it prophylactically to do the equivalent of stress inoculation, basically to give people an emotional vaccination so that their brain is prepared so that they have the equivalent of mental antibodies? I don't want to push that analogy too far but that's what we were going for.

When I got back, I looked into it a little bit further. We got this funding for this project we developed with the Center for the Study of Traumatic Stress when 00:59:00we had the funding. The individual who had been at that presentation at the conference that I attended runs part of the psychiatry department at Emory [University]; her name is Dr. Barbara [O.] Rothbaum, and it turns out that she had pioneered a PTSD treatment called prolonged exposure therapy. She also had started a company that makes these virtual reality environments. For the last six years, we've been working with that contractor, and we have developed fifty-to-sixty-minute VREs, virtual reality environments, that simulate a deployment. One of the VREs simulates deployment to a primitive African village. One simulates a town that has been rocked by a hurricane. Another simulates a village, a city that has been hit by an earthquake, and pretty much decimated by an earthquake. Another simulates an RDD explosion, radiological dispersal device, also known as a dirty bomb. Another one simulates a bio scenario that 01:00:00winds up being a pandemic flu, but you don't know that for a while. Another simulates a deliberate anthrax attack. At the end of the three days of training, literally the last hour of the three days of training, we run our trainees through this simulation in a dark room where they're standing up in a U shape and they're watching on one of the large screens here in Building 19 and they're interacting with the characters on the screen. We've designed it so they're answering questions and asking questions, and on the newer trainings, the newer VREs, we've developed triads, so groups of three people are holding an iPad Mini and they're answering questions on the iPad Mini and their scores are being tabulated on the screen as they're interacting, as they're going through the scenario. We're cutting edge on the application of that technology to the 01:01:00training environment, and our basic rubric is forewarned is forearmed, that we believe that by showing people what they're likely to encounter we're helping them get their brain ready. We're helping them get their confidence up. We believe that we're increasing their competence and confidence, which will decrease their distress or anxiety when they encounter some of those kinds of things in the real environment.

Q: What feedback have you heard from them, the people who have gone through the training so far?

KLOMP: It's universally positive. They feel that it's part of the reason why their self-efficacy scores are increased is they feel better prepared for it.

Q: And it's something that they do--it's not one individual who's locked into a little box, a virtual reality camera, but with large groups?

KLOMP: Correct.

Q: Or smaller, or even you said small groups, like three people?

KLOMP: Correct. You're hitting on a good point there, Sam. The first two that we developed the technology only allowed us to do two people at a time because they were, in fact, wearing the head mounted displays, basically two little TV 01:02:00screens and the earphones, and that was twice as many as other people did. When we first started, everybody else could only train one person at a time, and our contractor was able to train two at a time. We were doing twice as many as anybody else. Then Dr. Isaac Ashkenazi from the Israel Defense Forces came and we showed it to him and he said, "My goodness, this is an amazing training, absolutely phenomenal. If only you could do groups, because in a group training then you could look at issues of conflict and communication and leadership, and you could delegate and you could have discussions and people could do group processing of information." So I went back to my contractors and said, "Is there any way we can do more than two people?" They said, not if we keep the head mounted display, because the head mounted display allowed people to look around 360 degrees in front, below, behind them, and obviously you can't have twenty-seven people looking in different directions and have each one see that 01:03:00when you're doing it together. So we went with a unified perspective. We gave up a little bit of the realism, but we picked up the whole group dynamic component. I'm leading it. I've got an iPad and I can stop, start, emphasize, I can bring in different audio sounds like a baby crying or a generator or a helicopter flying overhead to complicate things. If I see anybody who is looking confused, I can stop things and we can address any concerns that they might have, and so we pick up a whole synergy thing that we didn't have on the first two iterations of this element of the training.

Q: Is it something that you have used in conjunction with the Ebola response at all?

KLOMP: The short answer is we do the training about twice a year, so yes, we've had some Ebola deployers who've gone through the training. We didn't do a session just for them because it's quite involved because there are about eight people who teach the third day, the safety training, and there are five of us 01:04:00that teach the first two days. It's difficult to just flip a switch and say yeah, we're going to do that for you next week. Plus, it's very difficult to get a training room for three days in a row any place at CDC. I pretty much have to go out six months. I booked three different training times this year the first day that the training reservation system opened up this year.

Q: The individuals who went through it, were they aware that they were going to go through the training that length of time ahead?

KLOMP: No. What the deal is, usually about two months before the training is scheduled, I send out an email with details and a description out to the emergency coordinators. The emergency coordinators flow that down to supervisors and managers, and then what I get back is a one-page nomination form from the supervisor or manager so I know that an employee's supervisor knows and recommends that they attend the training. The supervisor is never surprised, saying what the heck, why is my person gone for three days? The supervisor 01:05:00completes an assessment looking at about fourteen different characteristics, because if you think about it, you have people that you trust, that you would be comfortable talking to if you were distressed about something, but you also know people that you wouldn't tell them jack because you don't trust them or you don't have confidence in them or you don't respect them. The people who get nominated for this program have received basically an endorsement from their supervisor that they have good listening skills, that they are respected within their work unit, that they're decisive, that they have technical competence, that they are a hearty, robust kind of a person who's not likely to freak out if they have to sleep in a sleeping bag. We're looking at some of those kinds of variables, because to me the credibility of this three-day training rests on each individual who graduates from the training and goes out and says yeah, I completed that resiliency stuff, let me try and help.

Q: Now I'm wondering if we can take ourselves to just before the Ebola epidemic. 01:06:00Think about what you were doing around then, what you were thinking around then, and then march from there, loosely chronologically, through your experience of helping support that response.

KLOMP: It had been about a year and a half since we had started up a new office from scratch, this Worklife Wellness Office. I was integrating the Employee Assistance Program and this resilience training and some other mental health related concerns into work-life wellness, which also gets into physical activity. Our office runs all of the lifestyle fitness centers around. We also look at the nutrition side of things, so the cafeterias report up through us. This new Café 16 in Building 16, we designed the layout on that. We did the contract with the organization that does the from-scratch cooking. All of those 01:07:00kinds of things. Nutrition, physical activity, and mental and emotional stuff. That's what we were doing.

Q: What was the impetus for all of this coming together?

KLOMP: The Office of Safety, Security, and Asset Management realized that there were probably five different subsets of CDC who were responsible for different aspects of wellness. The HR organization was responsible for certain things, certain benefits, obviously. Another group was responsible for the cafeterias--I believe it's primarily the financial group. They knew a lot about contracts but they didn't know much about nutrition. The Lifestyle Fitness Center was up under the clinic, but the clinic folks weren't really focused on exercise, they were focused on giving people vaccinations and making sure deployers got out the door. CDC had many of the components of a good wellness program, but they were 01:08:00not at all organized. So Tina [J.] Lankford, the director, and I were given the mandate to pull all of these different pieces of the wellness puzzle together, identify any gaps, and then try and address the gaps and integrate the resources that exist. That's a long answer to your question, but that's what we're doing. It was less about starting from scratch than it was to pull together and integrate these things. We brought on some management program analysts who were focusing on the nutrition and the cafeteria and the vending side of things. We've actually reduced the number of vending machines I think by about forty percent because if you think about it, most vending machines are not full of yogurt and vanilla and fresh fruit. It's more a Coke and a Snickers. We started with just the two of us and wound up having fifteen people in this wellness office.

I got an email about probably three months into the Ebola response from Dr. 01:09:00Ileana Arias, who was Dr. Frieden's chief deputy for five or six years. She was basically his right-hand man. By the way, Sam, it cracks me up to say that Dr. Frieden's right-hand man was a woman. I love to say that. Dr. Arias had been the director of the injury center when Dr. Reissman and I worked over there, so we knew Ileana. Ileana shot me an email and said, "It looks like we are getting the first couple of waves of Ebola responders coming back and some people think maybe they have PTSD symptoms, and Dr. Frieden wants to make sure that we are not sending anybody out to the field who shouldn't be deployed. Can you look into maybe setting up some kind of a screening process for that?" Now, I know that the clinical case definition for PTSD would not allow that definition to be applied when somebody had just gotten back from a traumatic event. There's a duration thing, but I'm not going to quibble with the deputy and a clinical 01:10:00psychologist, and what I heard her saying was senior leadership is very, very worried that people are being damaged by their deployment. I pulled together a group of nineteen individuals, subject matter experts, from a variety of disciplines. I had psychometricians, I had clinical psychologists, I had ethicists, attorneys, people who had deployed, and we tackled literally three dozen obstacles to setting up a screening process. This question had been raised before, Sam, but never by anybody in leadership. Typically, it was somebody in the lower levels of the emergency response organization, and they'd say, how come we're not screening everybody, because the Army screens people. They have to take a 105-item assessment tool. The reality is that CDC is very different from the Army. We can't mandate things. In fact, if you've been around very long, you've heard that the word "mandatory" usually has air quotes around it at CDC because there's so many exceptions to mandatory kinds of things. But having 01:11:00senior leadership say, can you please look into this and hopefully set something up, allowed us to pull together this team, and this team met four different times and we worked through each of the obstacles. By obstacles, I mean things that could have some very negative outcomes. For example, you can never just administer a single assessment tool. In mental health, that's considered irresponsible because the results of one tool are the results of one tool. You have to have some kind of a battery. But it's very difficult as you can imagine to have a bunch of different professionals say oh, we need to use A, B and C because some people are going to say, I really like J, K, L. That's a challenge. What do you do with these records? Because these records are potentially damaging to someone's reputation if somebody's viewed as not eligible for deployment. It also can negatively impact somebody's career. Also, there's a whole chain of custody thing. If you do an assessment and for some reason it has 01:12:00a score that you don't want everybody to know about, and that's sitting on my desk, and somebody walks by, there can be potential embarrassment. Obviously, we don't want any PII, any personally identifiable information, to get out. These were the kinds of issues that we addressed, and by the time we got done with our fourth meeting, we had identified three assessment tools. We had identified a way that we could have this information be as confidential as humanly possible, and we wound up integrating it with the same electronic medical record that the clinic uses when you have a clinic visit. It's called Medgate. Medgate has your health history, that your grandpa had a heart condition or that your grandma had cancer or whatever, and it also now houses this information. It took us a while to pull that information together. We floated a trial balloon back up to senior management. They said, yeah, let's make it happen. We had to develop a standard 01:13:00operating procedure. We had to develop a policy. We wanted to get input from other individuals besides just the group that we got. We were looking at ethical issues, so we put a disclaimer in this thing. We sat down with our colleagues in the clinic in terms of using the electronic medical record.

On November 19th, 2015, we started prescreening individuals, and the way that that worked is they got an email from the deployment coordination folks in the Emergency Operations Center, and it tells them, you need to go to the clinic and get your shots, blah, blah, blah, and here's the URL [Uniform Resource Locator] to fill out your health history for the clinic. And by the way, here's a URL that you need to complete a brief resiliency assessment. They would click on that, they would complete these three different assessments, then we had it set up so that a PhD-level clinician would review their scores. We, of course, knew 01:14:00what the norms were for those scores, what the cut scores were, what was--we called it a yellow flag and a red flag, and if the scores were within the standard norms, then we just okayed that and then the clinician in the clinic would say, okay, we've done their physical stuff, they've got their mental health stuff done. Boom, they sign their letter that says they're deployment eligible. Let's say that your mother was dying from stage-4 cancer, and that is reflected in your score, and you're showing some unease as you're completing the score. Well, then one of my colleagues would call you and say, hey Sam, I noticed there were a couple of little surprises on your assessment, was wondering if we could talk to you just a little bit about that. Then you explain what's going on. She's able to tell as she's talking to you that you're a normal, healthy person, but you've got this outlier condition, and you're okay, you've made arrangements, and your family is all watching out for your mom, 01:15:00blah, blah, blah, so she marks down that you're okay to go. We also realize that a lot of people are under pressure to deploy, that there are high expectations, or that maybe they have a unique skill set or some linguistic expertise or whatever, and we view ourselves as employee advocates. We didn't set this up that we were like Emperor Nero saying thumbs-up, thumbs-down, you go, you don't go--the mental health people say no, no soup for you, no deployment for you. We didn't want it to be like that at all. We want to be employee advocates, and so if somebody's score is atypical, if it's a yellow flag and we have a conversation with them and they say, you know what, I want to deploy, but I've deployed twice in the last year and my two-year-old doesn't recognize me, blah, blah, blah, then we want to be able to advocate for that individual and say you know what, this is not a good time for them to deploy. We can do that by consulting with the clinic, and what it says is "not deploying at this time." It 01:16:00doesn't say your brain is broken, it doesn't say you failed the mental portion. It comes back from the CDC clinic saying, "not eligible for deployment right now." We feel pretty good about that process. We have so far had over 2,400 people who've completed these assessments and that's times three, right, so we're talking almost 7,500 assessments that we've reviewed and responded to. We've also had conversations with over 140 individuals whose scores were outside of the normal range, and we feel good about that. To be honest with you, I'm actually really proud of the fact that I have not gotten a single complaint from any one of the over 140 people that my colleague has spoken to, and think about that. Think about what a tightrope she's walking when she calls and basically 01:17:00she's calling because your score is abnormal. But she's doing everything she can to be professional, to be courteous, to be discrete, to be confidential. People are in a hurry, people are anxious, and I've never had anybody say, I can't believe that you people are invading my privacy, you're being intrusive, you're being disrespectful. To me, that really speaks to her sensitivity and her finesse and the concern that she's able to convey, because this really is about protecting our workforce, it really is about doing everything we can to be responsible and reduce risks and not deploy somebody when it's not a good time for them. This is not a permanent thing, this is not a black mark. As I say, it doesn't go back to their supervisor, hey, you failed the mental health portion, because they haven't. We just had a conversation, and to be honest with you, out of this 2,400 you can count on one hand the number of times that we felt 01:18:00somebody shouldn't go. That speaks to the resilience of our folks. Every once in a while there have been a few people that we said, hey, you may want to talk to our clinicians, you may want to get a little bit of confidential professional help here, but percentage-wise we're talking virtually everybody is coming through with flying colors. Now, may I share a nuance with you that we discovered?

Q: Please do.

KLOMP: When we convened these four meetings with our panel of subject matter experts, these nineteen people plus me, we looked at the assessment tools that the Department of Defense uses. They have a ten-page item, and they use another tool that has a couple of hundred items. One of those is one hundred percent confidential and it says on it, the results of this are strictly for you and your family. You take it before you deploy and you take it when you get back, and it's just for you to see how you adjusted. The other one says, everybody and 01:19:00their dog that has anything to do with deployment is going to see the results of this because we need to make these decisions. That was one of the dilemmas, that was one of the obstacles that we addressed when we were trying to decide how to implement this screening process, and it was a big dilemma, and some people said you know what, it needs to be one hundred percent confidential. I'm picturing in my mind that we implement this thing and Dr. Frieden says, how are we doing? And I say, wow, we're doing great, 98.5% of people are just passing this with flying colors. And he says, what did we do to the other 1.5%? I would have to say, I don't know, it's confidential, we don't have any names. To me that's unacceptable. Can you imagine the clinic screening one hundred people and two of them have major heart problems and the physicians don't know which those two people are? So we put in disclaimer language saying this information will inform 01:20:00deployment decisions, so we're one hundred percent transparent about what's going on so everybody knows what's going on.

We came up with the three best assessment instruments that we could come up with. One is a four-item PTSD screener, and that is a very condensed version. The PCL-C, the Posttraumatic Stress Disorder Checklist [Civilian version], is a couple of dozen items. We're only taking four items because we're not pathologizing people, we're not presuming ill health, we're not presuming weakness or imbalance. We're presuming people are in good shape, but we do want to ask, so we ask four questions about that. We ask ten questions related to some anxiety issues on the Kessler 10 [Psychological Distress Scale, K10]. These are well-known instruments. The other one that we really were focusing on, because we're focusing on people's assets, not liabilities, was an instrument called the CD-RISC. That's the Connor-Davidson Resilience [Scale] instrument. It 01:21:00has twenty-five items. It came strongly recommended, normed, valid, reliable instrument, and each of these twenty-five items has been positively correlated with resilience in the general population. We say, hey, we want to see how resilient they are, right?

As we've been administering this since November 19th, 2014, the individual who does the primary reviews said, you know what, I'm getting some false positives. I'm getting people whose scores are outside of the norms but when I call them, they're just fine. She started collecting information that said there were really a couple of questions that tended to come up most often. One of the questions said, in the absence of adequate information, I'm comfortable making a hunch. Now, we have epidemiologists around here, and the words "epidemiology" and "hunch" rarely are used in the same sentence. That's anathema to them, 01:22:00right? So we said for our population, even though the ability to make a decision with limited information is positively correlated with resilience, it's an outlier. It creates false positives in our environment. Another question that has been directly correlated with resilience basically says, when things aren't working out, I accept that fate or a higher power is involved. Now, that's not a God test. There is no litmus test. We aren't asking anybody if they believe in God. But that question that we didn't develop--it's part of this normed, valid, and reliable instrument--asks about faith in a higher power. That also apparently is anathema to some of our employees because some people who are absolutely fine, if they said I'm not going to make a hunch and God's got nothing to do with my work, that was potentially enough to generate a 01:23:00conversation. So before anybody complained, before anybody said wait a minute, what are you doing here, we did additional research and we found a ten-item version of this CD-RISC that doesn't have those questions that had any baggage with them. Early this year, we substituted the new instrument. Some people said, why didn't you just take out those questions? That's completely unscientific, completely inappropriate to just pick and choose the questions that you're going to use from a validated, reliable instrument, but we found a valid and reliable instrument that didn't have those questions that was a more distilled version that has basically the same efficacy. We self-diagnosed the potential limitation in one of the tools that we've used, so we viewed that as evolutionary progress.

Q: Was that a change you made after having used the tool, or was it one before the tool was implemented?

KLOMP: We didn't have any data to go one way or the other, so that's an 01:24:00evolution. We took the very best swing that we could at the time, and it took us six to eight months to start collecting information that that was why we were getting some of these false positives.

Q: That makes sense.

KLOMP: It doesn't account for all of the false positives, but the majority it does. We put in this alternative, reduced approach. It also is more efficient for individuals because we now have twenty-four items instead of thirty-nine items in the assessment. We have equal validity and reliability, so our ability to anticipate people, or identify individuals who are in a sub-optimal condition in their lives, is the same as it was before, but we're not having anybody have the dilemma of saying, if I answer it--I mean, everybody that takes these instruments is a smart person and they can say, I pretty much have a sense of what the socially acceptable answer is here, so if I answer it honestly and say 01:25:00no, God's got nothing to do with it--well it doesn't say God--a higher power of faith has nothing to do with it, or I'm not going to do a hunch, then we've eliminated that dilemma for people by going with the more simplified version of the assessment tool that has also been factor analyzed and is viewed as solid.

Q: Was the CD-RISC tool part of that initial screening in November?

KLOMP: Yes.

Q: The one you click on the link, and they--

KLOMP: Yes. That was one of the three, and so now the distilled version is one of the three. We have research professionals who have helped us as we are going to be looking back on this. They have calibrated that, so that we can do some valid comparisons, because the ten items are a subset of the twenty-five, so we 01:26:00can actually do one-to-one correlation, we don't have to extrapolate. Everybody that answered the twenty-five answered the ten, so we can do an apples-to-apples comparison.

Q: Just to review, there was this initial battery of questions. That's probably not the best word to use.

KLOMP: That's fine.

Q: And what were the other two assessments?

KLOMP: It was the Kessler 10 and the PTSD quick assessment.

Q: Something that just flashes through my mind when I hear that is, you're testing people for PTSD previous to the deployment, if they have any existing PTSD from anything else?

KLOMP: Yes. It's basically trying to get some baseline measures, and if we were doing a thorough screen for PTSD, if we assumed that they had it, we would've used the twenty-five-item posttraumatic stress disorder checklist. It was kind 01:27:00of like saying, we're not going to have a whole taco, we're just going to have two little pieces of cheese. We were just kind of testing the water. If somebody was absolutely coming unglued, it would show up on the four-item, but we were not presuming that we were going to have it. One of the things that we didn't want to have happen is we didn't want for people to take it and say, oh my gosh, they think I'm damaged, they think I'm broken. We didn't want to insult anybody's intelligence and we wanted to be very careful that we weren't part of the nanny state where anybody thought holy crap, I've deployed fifteen times and now they implement this new policy and I've got to take this thing and jump through all these hoops, and this is insulting to me that they're presuming that I'm broken. It's the lowest possible level that we could introduce to catch 01:28:00serious problems without insulting anybody else. Four questions, they look at it, nah, nah, nah, good--they're on to the next one.

Q: Another follow-up question. You mentioned one member of your team was the one who fielded the conversations with over 140 people following up about a little--I suppose you'd say yellow flag maybe that showed up in the data. Would you mind identifying that person?

KLOMP: Yeah, her name is Dr. Crystal Frazier, and Crystal has been at CDC I think about the same amount of time as I have, around fifteen years. She worked in OSSAM OD [Office of Safety, Security, and Asset Management, Office of the Director], and she went back to school and picked up her doctorate. She finished that work I believe a year and a half ago and sat for her licensure exam within the last six months. I'm real proud of the contributions that she makes because 01:29:00there again, she is a licensed mental health professional. She's not providing clinical services to anybody, but they're getting the benefit of somebody that has that sensitivity, has that expertise, has that background, and to me that's a real win-win. In fact, since you asked that, I can tell you that when we were developing the policy on who was going to make those follow-up calls, we initially thought that it made sense for our Employee Assistance Program professionals to make those calls. The first draft of our standard operating procedure said that people go in the system, they go in the Medgate system, they click the URL, they complete the three assessments, and it's in this electronic medical record. And then we initially thought we would have our Employee Assistance Program licensed professional counselors review that information, and then they would make the reports, they would call or whatever. Dr. Gordon Hughes, who runs our Employee Assistance Program, talked to me and he said, 01:30:00"Rick, we want to be team players, and we want to help the deployment process, but this makes us really uncomfortable because everything we do in the Employee Assistance Program is confidential, and we are like an escalation point. If somebody has a problem with their supervisor or whatever, and they come to talk to us about it, they know it's not going to go anyplace. But if you have us be the ones who look in the electronic medical record and review somebody's scores, then all of a sudden that's not confidential anymore and that feels like an ethical gray area to us." When he expressed that reservation, I said, "Gordon, you're exactly right. Hadn't even thought about that." So before we even launched we said, you know what? We are not going to have EAP be the people who review those documents, we're going to have somebody else who has parallel knowledge, parallel insight, expertise, finesse, sensitivity and compassion, but 01:31:00we're not going to have them. Then if anybody has a problem, anybody has a concern, then they still have a full clinical avenue to address any concerns that they have. I'm very, very proud of that feature because we have preserved the confidentiality, we have given people multiple touchpoints. If they have a care or concern, they can talk to Crystal or now they can talk to a clinical person or they can talk to me. I feel good that we've gotten additional input and we've tweaked our standard operating procedure to not put our EAP professionals in any kind of a gray area where they felt uncomfortable.

Q: Thank you for that. Would you mind describing some of the other team members?

KLOMP: Yeah. There's really only one other full-time team member and that is Laurie [A.] Jones, and this may be our concluding point here, as the concluding 01:32:00team member. Laurie has a diverse background. She's been working in laboratory services in Building 23 for much of the last few years, but she also has been interested in what makes people tick and went to school, got a relevant graduate degree, and is a licensed associate professional counselor right now. She does a lot of volunteer work in the evenings with disadvantaged children. She loves dance, and so she teaches children how to feel an improved body image and greater control by doing dance. She does that on her own. Anyway, Laurie was detailed to us a little bit over a year ago and she has single handedly done the vast majority of the outreach. You can see that we're trying to be as comprehensive as we can. Before somebody deploys, they get a mental health component of their pre-deployment briefing, then we hope to have everybody have access to one of these Deployment Safety Resilience Team members. We haven't 01:33:00quite gotten that integrated one hundred percent into deployment, so everybody doesn't have a DSRT, but some teams do. When they get back, everybody who returns from an EOC deployment, we get that list. Laurie, or one of her colleagues when she's not available, sends them a welcome back email, and that's basically what it says, I understand you've returned from West Africa and we appreciate the job that you've done, I hope it was a productive experience for you; if you would like to have a confidential conversation about your experience, things you felt good about, questions or concerns you might have, non-clinical confidential conversation, be happy to visit with you, my calendar is up to date so feel free to go online and block out a half an hour visit if you want. So far, she has sent emails to right around 2,400 individuals and 01:34:00thirty-three percent of those, about seventy-five individuals, have said yeah, I would love to have that conversation. She's done the vast majority of those seven hundred fifty or so conversations. Once again, we've not received complaints about that. It's not viewed as intrusive. It's viewed as one more symbol of the fact that CDC really cares about their employees. It gives people the opportunity to get a sense of closure, and it also gives them a chance to focus on the meaningfulness of what they've done and to kind of put a bow on their deployment. We also have--for over a year we had a weekly post-deployment group debriefing, and I facilitated those, and we had about [seven hundred fifty individuals] who participated in that ninety-minute group debriefing. Once again, voluntary. It was anonymous. We weren't tracking whose names, we just 01:35:00tracked the number of people who participated, and it was a chance to collect information.

It's all about improving the process, its all about saying thanks, it's all about expressing gratitude because when you think about it, people have really put their lives on hold. They have experienced support system deprivation which is, coincidentally, what I wrote my thesis on for my first graduate program. They have gone without their family members, they've gone without their pets, kids, whatever, their nutrition has been thrown off, their exercise pattern has been thrown off, and they've put themselves in a place where if they sat in a cab that had just transported somebody to an Ebola treatment unit and there were body fluids there, that they risked potential exposure with Ebola, so their lives were literally in some danger. We wanted to make it crystal clear that we appreciated what they'd been doing. I assume you know that people who got back from West Africa also did twenty-one days of active monitoring. They were 01:36:00checking their temperature a couple of times a day. That wasn't us. The clinic had folks who were doing that, but we were kind of doing something similar on the emotional side. We wanted to make sure there were plenty of touchpoints. In the demobilization email they got, my contact information was there so they could talk to me, Laurie pinged them, and at any point in this process they were free to reach out to the Employee Assistance Program professionals for confidential clinical consultation with them.

Q: Thank you for that. I don't want to keep you talking forever, and I know I've kept you in here for quite a long time, but one concluding question I have is what you see potentially taking forward from the Ebola response to future responses like Zika, and as you mentioned, not all of this necessarily is just response-specific, it's about everyday operations here at CDC.

KLOMP: There are two or three main things that come to mind as we're wrapping up. The first is that early on in the Ebola response we realized that there were lots of people at CDC who were specialized in different parts of the deployment process. There were people who actually select the individuals who go out. There are logisticians who track, there are travel preparers. There are people who fill a wide variety of roles, people who fill the different desks in the EOC with all kinds of planning and geo-coding and all kinds of things, but there wasn't really any group that was focused specifically on being advocates for the deployees as they were going through that process. So CDC stood up--I should say OPHPR stood up the DRMU, the Deployment Risk Mitigation Unit, and Dr. Jeff [Jeffrey B.] Nemhauser and Dr. Sachi [Sachiko] Kuwabara have headed up that DRMU 01:38:00for well over a year and a half now and I am incredibly impressed with the work they've done in terms of creating checklists so people would know, here are the twenty-seven things that I need to do before I go out the door. They were instrumental in setting up family outreach calls when it became clear early on in the process that family members just didn't know what the heck to expect. What were their family members being exposed to, could they come to Christmas parties, all those kinds of things, and a million other details Jeff and Sachi have taken care of. They also were the ones that stood up and trained country safety officers, which should've been part of the process for a long time, but sometimes our lessons learned in one activation don't get transferred to others. My understanding is that the Deployment Risk Mitigation Unit is being hardwired into future deployments. I think that's a huge, huge plus, and we very much enjoy collaborating with them. We are in parallel lanes but different lanes. The 01:39:00DRMU is a big thing. Also, the after-action reporting group and the evaluation team was collecting data from people via an anonymous Zoomerang survey, and they also were doing some interviews. In addition to that, they had somebody who participated in the group debriefs, but they were collecting ongoing information so that they wouldn't just wait until everything was over to do an after-action report. What we found was that they were kind of doing audibles at the line every once in a while, coming up with different questions. We have had meetings with the AAR [after-action report] evaluation team about creating a list of questions that we could draw from so that we can do some more specific comparisons between activations, between disasters, so that each time we're not 01:40:00starting from scratch. We're getting more consistency, more uniformity, so it doesn't take us six months to come up with a certain internal survey. We say we learned this from the last one, just like we modified our assessment process so we're now shorter and fewer false positives. They are doing the same kinds of things on their data collection process, and that information goes directly to senior leadership and the incident commander. That to me is an additional big plus. Then we also are transitioning to work even more closely with the clinic within the next couple of months. We've had a reorganization in OSSAM, and I made a proposal about thirteen months ago for us to specialize and focus a little bit more directly just on resilience, not resilience and wellness, and so we're in the process of setting the stage so that we can focus our efforts just a little bit more, which will include a little bit more dissemination than has happened in the past as we've been balancing between well-being issues, wellness 01:41:00and resilience.

Q: Great. Thank you. I don't want to keep you too long and I know I just said that that was my concluding question. Do you have another five minutes, or do you really have to go?

KLOMP: I've got two, so how's that? I can split the difference.

Q: I hear you. Okay, this has been fantastic and I really appreciate you being here. Is there any concluding thing that you want to make sure that we have on the record?

KLOMP: Yeah. I appreciate that opportunity. A couple of things occur to me. One is that I cannot think of a single person with whom I've spoken, and we're talking about four hundred fifty individuals who participated in group debriefings, and I've reviewed conversations from the seven hundred fifty-ish individual conversations. I can't think of a specific person as we're sitting here talking right now that I'm aware of who deployed to Guinea, Sierra Leone, and Liberia who didn't say this was one of the most productive, valuable, 01:42:00personal and professional experiences I've had in my life. Now, that doesn't minimize how challenging it was. They didn't say this was the easiest thing, but they said this was one of the most meaningful things I've ever done in my life. People, as we said a couple of minutes ago, put their lives on hold, they subject themselves to some potential risks and some guaranteed deprivations to benefit people that they've never even met before. To me, this really is kind of the crux of why people get into public health. It has been an honor for me to interact with them and to see that. It's very, very encouraging to see the level of dedication and commitment for people that do that. Lots of organizations around the world don't do that. We're not military, we don't march in under orders, we're not under armed guard. In fact, one of the individuals who trains in our resiliency training, this three-day DSRT training, is Scott Drexler. 01:43:00Scott works in the Strategic National Stockpile, and Scott is a former Navy SEAL, and he has said in several different trainings, and he's not kidding, he's totally serious, he said to me, it's kind of crazy that the public health professionals go into some really dangerous locations where I would've been leery to go as a Navy SEAL with my whole SEAL team behind me, fully locked and loaded. He says, you guys go in there with a clipboard or an iPad and no weaponry, no body armor. It really is a tribute to the dedication of people around here, and I feel personally fortunate as a mental health professional to be able to apply my skills directly to a very clear and tangible need, and none of what we've been talking about should be construed in any way, shape, or form as any kind of fear that we have weak people around here or that we have people who can't deal with trauma or stressors. This is not about propping up weak 01:44:00people. This is about saying we've got really, really strong people and we want to do everything we can to help them. I guess it's like football players have trainers and nobody says they're a sissy because they have a trainer. We're just a trainer for well-being. That's kind of how I look at it.

Q: Thank you so much for your time.

KLOMP: Thank you, Sam. Really enjoyed it.

END