Training Case Investigators and Contact Tracers

Knowledge and skills needed for case investigation & contact tracing staff

Case investigation and contact tracing are specialized skills. Training opportunities are available pdf icon[533 KB, 1 page].

Knowledge and skills that staff may need include:

• A keen understanding of the need for patient confidentiality and the ability to conduct case interviews with care in order to protect confidentiality and to conduct contact tracing without disclosing the identity of the patient (case).
• Understanding of, and ability to explain in plain language, the medical terms associated with COVID-19 and principles of exposure, infection, infectious period, potentially infectious interactions, symptoms of disease, pre-symptomatic and asymptomatic infection, types of tests used to diagnose infection, and available prevention and control interventions (e.g., isolation/quarantine, social distancing, environmental surface cleaning).
• Excellent and tactful interpersonal skills, cultural sensitivity, and language and interviewing skills that allow them to build and maintain trust with clients and contacts.
• Basic skills of crisis counseling and the ability to confidently refer clients and contacts for further care, if needed.
• Resourcefulness in locating and communicating with clients and contacts who may be difficult to reach or reluctant to engage in conversation.
• Awareness of the sensitivities surrounding immigration status and how this can be a barrier to case investigation and contact tracing activities.
• Understanding of when to refer individuals or situations to medical, social, or supervisory resources.
• Ability to help clients and contacts identify any needs they may have for social support during self-isolation/self-quarantine.
• Ability to collect basic standardized surveillance data per protocols.
• Understanding of when the use of public health legal authorities may be necessary and how to notify the appropriate public health officer for authorization.

The following cross-cutting knowledge, skills and abilities support the successful practice of case investigation and contact tracing. Recruitment for case investigators and contact tracers should focus on identifying people with these attributes:

• Ethical and professional conduct
• Active listening
• Open communication
• Critical thinking
• Negotiating skills
• Problem solving
• Cultural humility and competency
• Fluency in non-English languages for communities where English is not the primary language
• Emotional intelligence
• Flexibility and adaptability

Strong interpersonal skills are important, but the role of the case investigator also requires a higher level of acuity and training. The case investigator must be able to conduct a conversation-based investigation (as opposed to reading a script or data collection form) to obtain information on close contacts and to assess healthcare and support needs for people diagnosed with COVID-19.

Case investigation & contact tracing training

CDC has trained case investigators and contact tracers for over 40 years. Typically, training includes a blend of knowledge-based and skills-based coursework. Initial knowledge-based training covers disease-specific information, client-centered counseling and motivational interviewing techniques, assessment of risk and other social support needs, and approaches to facilitate confidential client communication. Initial skills-based training uses interview technique modeling, scripted language, case scenarios, and role-playing. These trainings are followed by on-the-job learning supported by experienced staff.

Similar techniques can be applied to the training of the COVID-19 surge workforce. All new staff mobilized to support case investigation and contact tracing will need a comprehensive overview of COVID-19 and the investigative process. Training for each of the case investigation and contact tracing roles should cover disease-specific information, interview guides, and protocols that include referral of high-risk individuals and complex cases to clinical staff, guidance on maintaining privacy/confidentiality, and referrals to support services, and should also include interactive skills-based training. CDC’s website provides COVID-19 Contact Tracing Training Guidance and Resources. Given the more nuanced work of the case investigator, staff conducting follow-up with clients with COVID-19 should be provided with a more intensive skills-based training. This should include special emphasis on enhancing their ability to navigate difficult conversations.

The urgency in standing-up the case investigation and contact tracing workforce requires that the training for COVID-19 be abbreviated. Therefore, we recommend supervisory structures in state, territorial, local, and tribal health jurisdictions to provide guidance and mentorship for new trainees to ensure quality of practice.

Identifying case investigation & contact tracing resources

Efforts are under way across the nation to recruit and train a case investigation and contact tracing workforce. This will take the coordination of federal, state, and local organizations as well as public-private partnerships where possible. Resources from each level will need to be woven together to create a blanket of support for case investigation and contact tracing within each community. Guidance and resources for state, tribal, local, and territorial health departments on staffing the public health workforce are available from CDC.

The estimated number of case investigators and contact tracers needed in each community may be large and will vary depending on a number of factors, including the number of COVID-19 cases reported each day, number of close contacts elicited per patient, languages spoken in the community, and the amount of time and resources needed to notify and monitor clients and contacts. Local jurisdictions can review the guidance in Appendix D to estimate the number of case investigators/contact tracers needed in their community.

The surge workforce may be drawn from a variety of sources:

• There may be local, state, and federal employees whose job can no longer be done due to COVID-19 who are available for redirection.
• Additionally, some local communities have identified volunteers who are willing and eager to support the COVID-19 response. Matching their knowledge, skills, and abilities with key roles in the COVID-19 response effort and providing relevant training can expand the workforce.
• Partnerships between public health and philanthropic entities can also expand the case investigation and contact tracing workforce by hiring and training individuals from local communities.
• Partnerships between public health and the technology sector can aid in the development of data management systems and innovations in communication.
• Finally, partnerships across all sectors can help support clients and contacts in need of housing and other support services during self-isolation and self-quarantine.

Alignment of case investigation & contact tracing staff with workflow

Combining large numbers of staff from different sources (e.g., local, state, federal) and varying categories (e.g., employees, contractors, temporary hires, volunteers) will be a challenge unique to the COVID-19 surge workforce. Consideration should be given to the alignment of staff assignments and supervision with workflow. For instance, those activities requiring knowledge of and access to public health surveillance systems (e.g., surveillance triage, case investigation) may be better integrated into the health department’s workflow. Some jurisdictions have found it useful to mobilize a cadre of state case investigators to bolster local efforts in the event of clusters or outbreaks.