Overview of CASPER

About

CASPER is a type of rapid needs assessment (RNA) that provides household-level information to public health leaders and emergency managers. CASPER can provide accurate and timely data for decision makers through precise analysis and interpretation. CASPER is a cross-sectional epidemiologic design; it is not surveillance.

Information from CASPERs can help public health and emergency managers:

• Initiate public health action
• Identify information gaps
• Facilitate disaster planning, response, and recovery activities
• Allocate resources
• Collect and assess new or changing needs in the community

The CASPER methodology is an adaptation of epidemiologic techniques used by scientists in the World Health Organization's (WHO's) Expanded Program on Immunization (EPI) who estimate vaccine coverage in Africa.

CASPER's cluster sampling design involves two stages. The first stage includes 30 clusters selected probability proportional to size. The second stage includes seven households interviewed within each cluster. This design provides estimates for the population.

There may be situations in which this design is not feasible or ideal. Modifications are acceptable. For additional information, read the CASPER Overview fact sheet.

There are many opportunities for CASPERs to influence public health. A CASPER can be used in both a disaster and non-disaster setting.

For example, CASPER methodology has been used to do the following:

• Analyze public health perceptions
• Estimate needs of a community
• Assist in planning for emergency response

Benefits of CASPER

Information is key for decision-making. Information sent to the right people, at the right place, at the right time, is optimal for any successful response. CASPER addresses this by providing valid information rapidly about the general and health needs of a community to decision-makers. CASPER is generalizable (providing population estimates), timely, relatively low cost, reported in a simple format, and flexible.

CASPER was originally designed to provide information during a disaster response. It can also be used when population-representative data are needed during other disaster phases (preparedness, recovery, mitigation). Additionally, it can be used in situations unrelated to a disaster. For example, public health departments have used CASPER to:

• Identify household-level information about community health status
• Learn more about emerging infectious diseases, such as Zika virus and H1N1
• Assess community awareness/opinions/concerns on subjects such as the following:
  • Environmental justice
  • Climate change
  • Opioid use
  • Healthy homes
  • Radiation emergency preparedness

Goals

The primary goals of the CASPER are to rapidly obtain information about the needs of an affected community and to assess changes in needs during the response or recovery period. CASPER also produces household-based population estimates of needs for decision makers.

Examples of CASPER objectives include the following:

• Determine the critical health needs
• Assess the impact of a disaster on the community
• Characterize the population residing in the area including any ongoing health effects
• Evaluate the effectiveness of recovery efforts using a follow-up CASPER

CASPER is not intended to deliver food, medicine, medical services or other resources to the affected area or to provide direct services to residents such as cleanup or home repair.

CASPER toolkit

In the early 2000s, the two-stage cluster method became an increasingly widespread method for disaster response. CDC’s National Center for Environmental Health developed the CASPER Toolkit to outline and standardize the assessment methodology. CDC coined the term CASPER to distinguish it from other rapid needs assessments.

The CASPER toolkit provides guidelines to assist personnel from any federal, state, tribal, local, or territorial (STLT) public health department or other emergency response agencies in conducting CASPER. The toolkit is focused on United States disaster response. However, it may also be adapted for use in a non-disaster or international setting.

The toolkit provides a standardized, step-by-step guide for conducting a CASPER, including:

• Preparing a checklist
• Questionnaire development
• Sample selection
• Training
• Data collection
• Analysis
• Report writing
• Templates and examples

Public health personnel, emergency management officials, academics, or others who wish to assess household-level public health needs will find the toolkit useful for rapid data collection for actionable decision-making during disaster or non-emergency situations.

Using CASPER data

Data from CASPERs are used for the following:

• Provide situational awareness
• Confirm (or contradict) rumors or anecdotal reports
• Identify and provide estimates of needs in the community, such as food, water, medication
• Establish priorities
• Tailor interventions and communication messaging

Other potential benefits of CASPER data include the following:

• Monitor changes in community needs
• Raise visibility of emergency management and public health in the community
• Justify requests for outside assistance or funding
• Evaluate the effectiveness of response activities
• Serve as field exercise to build capacity and prepare the workforce for emergency situations

CASPER data have been useful to support resource allocation, fund projects or services, tailor messages, and inform future planning.

Getting started

During a disaster, the local, state, or regional emergency managers or health department officers may decide to initiate a CASPER when at least one of the following conditions occurs:

• The effect of the disaster on the population is unknown
• The health status and basic needs of those affected are unknown
• Response and recovery efforts need to be evaluated

CASPER methodology can be used in both a disaster and non-disaster setting. CASPERs have been conducted to assess public health perceptions and to estimate needs of a community during a non-disaster setting. Regardless of the setting and objectives, once the decision to conduct the CASPER has been made, it should be initiated as soon as possible. CDC is available for technical assistance for any CASPER, regardless of type (preparedness, response, recovery, non-disaster, etc.).

Considerations

Prior to conducting a CASPER, consider whether CASPER provides an appropriate sampling methodology based on your:

• Objectives
• Timeframe
• Available resources

A clear understanding of how CASPER information will be used, who the relevant partners are, and needed and available resources is important prior to moving forward with your CASPER.

Remember, a CASPER will be descriptive of the entire sampling frame (geographic area from which your sample is drawn). It will not provide detailed information on subpopulations or specific groups. For example, if you want to determine the needs or status of pregnant people or persons experiencing homelessness, you should not conduct a CASPER.

CASPER phases

There are four phases in a CASPER: prepare for the CASPER; conduct the CASPER in the field; analyze the data; and write the report.

Phase 1: Prepare for CASPER

As you prepare to conduct a CASPER, there are many planning questions that should be addressed.

Work with leadership, key partners, and CASPER subject matter experts (SMEs) within your state or CDC to help plan and prepare. Keep in mind that preparing for a CASPER can take several hours (e.g., during a response) or, if time allows, several months (e.g., in a non-disaster setting).

Phase 2: Conduct the CASPER in the field

CASPER is conducted through face-to-face interviews in the field. There are several advantages to conducting face-to-face interviews. These include a high response rate and the ability to distribute health information or other materials to the community.

Face-to-face interviews have the additional benefit of directly connecting the community to local staff, increasing the visibility of and trust in the health department. Interview teams can also provide anecdotal information (e.g., direct visual inspection of a disaster-affected area, common concerns overheard in the community not captured in the questionnaire) that can help guide response and recovery efforts, implementation of any recommendations, and future plans.

Phases 3 and 4: Analyze and report CASPER data

Data from the questionnaire can be entered into any statistical software package that allows for multistage sample design weighting. CDC recommends using Epi Info™, which is user-friendly, does not require computer permissions for download, and is available free of charge. Access tutorials and guidance on Epi Info™. Data from the tracking form can be entered into any spreadsheet such as Microsoft Excel.

Disseminating findings is a vital component of a CASPER. The information from the CASPER will help partners better understand the needs and health status of the community.

Technical assistance

Contact CASPER@cdc.gov if you are interested in conducting a CASPER.

CDC provides scientific consultation, technical assistance, and disaster epidemiology training to the following organizations:

• State, regional, tribal, local, territorial, or foreign health departments
• Federal agencies
• Non-governmental organizations
• Professional interest groups
• International organizations
• Academic institutions
• Foreign governments

Visit the Disaster Epidemiology and Response Training and Technical Assistance webpage to learn more. You can also check out the CASPER eLearning for an overview of the following:

• Methodology
• Uses
• Local capabilities required to conduct a CASPER