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Gaps and Challenges in the Integration of                                    Public Health & Behavioral Health            ...
Presentation Snap-Shot   Presenter Disclosure   Disaster Behavioral Health   The Perfect Plan   Practice Integration   Wra...
Presentation Snap-Shot   Presenter Disclosure   Disaster Behavioral Health   The Perfect Plan   Practice Integration   Wra...
Presenter Disclosure   The following personal financial relationships with commercial    interests relevant to this prese...
Presentation Snap-Shot   Presenter Disclosure   Disaster Behavioral Health   The Perfect Plan   Practice Integration   Wra...
Disaster Behavioral Health: Defined             “… comprises the mental health issues related to             disasters and...
Disaster Behavioral Health: A Public Health Practice    A common challenge with the integration of public health and beha...
Presentation Snap-Shot   Presenter Disclosure   Disaster Behavioral Health   The Perfect Plan   Practice Integration   Wra...
The Perfect PlanOne major challenge is knowing what to use; when to use it; how to use it...                              ...
The Perfect Plan                   The information contained in this document is proprietary. Copyright © 2012 Capgemini. ...
The Perfect Plan: National Incident Management System (NIMS)     The National Incident Management System     (NIMS) define...
The Perfect Plan: Presidential Policy Directive (PPD) 8 – National   Preparedness         National Preparedness: The actio...
The Perfect Plan: Presidential Policy Directive (PPD) 8 – National   Preparedness          National Preparedness Goal     ...
The Perfect Plan: National Preparedness Mission Areas    Prevention                    Protection                         ...
The Perfect Plan: National Preparedness Mission Areas                                                               “Whole...
The Perfect Plan: National Preparedness Mission Areas & Key   Capabilities                                                ...
The Perfect Plan                   The information contained in this document is proprietary. Copyright © 2012 Capgemini. ...
The Perfect Plan                   The information contained in this document is proprietary. Copyright © 2012 Capgemini. ...
The Perfect Plan: Federal, State, Territorial, Tribal, and Local Plans                   Federal Plans                    ...
The Perfect Plan: Federal, State, Territorial, Tribal, and Local Plans                   Federal Plans                    ...
The Perfect Plan: CPG 101 V.2                                     State, Territorial, Tribal, and Local Plans             ...
The Perfect Plan: CPG 101 V.2                                     State, Territorial, Tribal, and Local Plans             ...
The Perfect Plan: CPG 101 V.2 Introduction and Overview 1. The Basics of Planning 2. Understanding the Planning Environ...
Presentation Snap-Shot   Presenter Disclosure   Disaster Behavioral Health   The Perfect Plan   Practice Integration   Wra...
Practice Integration• Public health and behavioral health disaster response lack consistantcollaboration and standardized ...
Practice Integration           Steps forward in the National Capital Region (NCR)  • Regional preparedness and coordinatio...
Practice Integration: Responder Focus        It’s time to take a second look at responders        Responders provide a u...
Practice Integration: Responder Focus           “Psychological first aid is one of the most important skills              ...
Practice Integration: Responder Focus        Disaster Behavioral Health (DBH) integration into         first/disaster res...
Practice Integration: Responder Focus    Time                          Operations                                         ...
Practice Integration: Responder Focus                                  ... filling gaps, overcoming challenges          O...
Practice Integration: Responder Focus                             Important considerations to accept, pre-disaster!      ...
Practice Integration: Responder Focus               “I personally havent saved a lot of lives in disasters...             ...
Practice Integration: “Whole Community”   Integrating Disaster Behavioral Health (DBH) Dynamically across    the “Whole C...
Practice Integration: Information Technology & Mobility Health Information Technology (HIT)                               ...
Practice Integration: HIE in Disaster Preparedness & Response:Five Recommendations for State HIEs  (1) Understand the Stat...
Practice Integration: Health Information Exchange                                                                         ...
Presentation Snap-Shot   Presenter Disclosure   Disaster Behavioral Health   The Perfect Plan   Practice Integration   Wra...
Wrap-up    Disaster Behavioral Health: a public health practice    The Perfect Plan: knowing what to use; when to use it; ...
Anthony A. Barone | M.P.H. | CHMM | CHS-V | FF/EMT-BSenior Consultant | Public SectorCapgemini Government Solutionsanthony...
About CapgeminiWith around 120,000 people in 40 countries, Capgemini isone of the worlds foremost providers of consulting,...
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Gaps and Challenges in the Integration of Public Health & Behavioral Health Disaster Response

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Abstract:

Gaps and challenges in the integration of public health and behavioral health disaster response

Emergency management and public health services have provided leadership in disaster response programs due to safety and injury as primary concerns. Over the past thirty years, with the federal crisis counseling program responding to devastating events with long lasting emotional repercussions, behavioral health concerns have become recognized as the second leading effect of these events. Public health emergency services have made significant gains in planning and preparedness efforts on a national level as well as on a state by state basis. Requirements that public health departments integrate behavioral health services into their preparedness and response plans has proved difficult despite a growing awareness of the need to progress in this area.

Disaster behavioral health’s entrance into the public health domain brings with it new skills to be added to an already overloaded curriculum. The emerging disaster behavioral health field has struggled with the lack of evidence based early interventions and this has significantly slowed the public health discipline from identifying and training their disaster response workforce in best practices.

In the wake of the last decade of catastrophic disasters, emergency management and public health responders are increasing their awareness of the stress they themselves experience in their work and learning how to mitigate its effects. This is allowing more responders to understand the concept of a public health application to disaster behavioral health response and is serving to move the integration process forward. More behavioral health disaster research is needed to build a solid evidence base to support staged disaster recovery interventions.

Learning Objective: Participants in this session will be able to describe three ways that disaster behavioral health interventions may be integrated into an overall public health response to an emergency.

Summary:
This session discusses how public health and emergency management staff plan for disaster preparedness and recovery response activities to meet the needs of trauma victims of large-scale and scope events such as catastrophic weather events, public health emergencies and terrorist attacks involving mass casualties as examples. It will include background information, key concepts in public health and behavioral health response stressing integrating health and behavioral health approaches to disaster response.

Published in: Health & Medicine
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Gaps and Challenges in the Integration of Public Health & Behavioral Health Disaster Response

  1. 1. Gaps and Challenges in the Integration of Public Health & Behavioral Health Disaster Response -A Responder’s Perspective Anthony A. Barone, M.P.H., CHMM, CHS-V, FF/EMT-BImage: FEMA Stock ID 54866 Wednesday, October 31, 2012
  2. 2. Presentation Snap-Shot Presenter Disclosure Disaster Behavioral Health The Perfect Plan Practice Integration Wrap-up The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 1
  3. 3. Presentation Snap-Shot Presenter Disclosure Disaster Behavioral Health The Perfect Plan Practice Integration Wrap-up The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 2
  4. 4. Presenter Disclosure The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: – No Relationships to Disclose Whereas today’s presenter is a member of a various organizations, both private and governmental, content provided herein is representative solely of the presenter’s perspective, experience, and lessons learned acquired throughout his career in the emergency preparedness arena. The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 4
  5. 5. Presentation Snap-Shot Presenter Disclosure Disaster Behavioral Health The Perfect Plan Practice Integration Wrap-up The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 5
  6. 6. Disaster Behavioral Health: Defined “… comprises the mental health issues related to disasters and the means of addressing them, including proactive methods to build resiliency and short- and long-term approaches to restoring and maintaining psychological and emotional health in the face of an emergency.” - PPHR “… the provision of mental health, substance abuse, and stress management to disaster survivors and responders.” - HHSProject Public Health Ready (PPHR) – 2012http://www.naccho.org/topics/emergency/PPHR/Criteria.cfm The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 6
  7. 7. Disaster Behavioral Health: A Public Health Practice A common challenge with the integration of public health and behavioral health disaster response is the recognition of behavioral health as a public health practice. Just like environmental health, epidemiology, and biostatistics, behavioral health is a public health practice. Disaster Behavioral Health (DBH) further applies behavioral health concepts in times of a disaster to survivors, responders, and other populations. What is unique about DBH is that it applies to everyone: – Survivors of the affected community, individuals and populations of surrounding communities, and at times others across the Nation (e.g. Hurricane Katrina) and throughout the world (e.g. September 11, 2011 terrorist attacks) – Responders (e.g. Police, fire, EMS, utilities, volunteers, crisis counselors, etc.) – Providers (e.g. First receivers, mental health professionals, etc.)Image: FEMA Stock ID 33425 The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 7
  8. 8. Presentation Snap-Shot Presenter Disclosure Disaster Behavioral Health The Perfect Plan Practice Integration Wrap-up The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 8
  9. 9. The Perfect PlanOne major challenge is knowing what to use; when to use it; how to use it... The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 9
  10. 10. The Perfect Plan The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 10
  11. 11. The Perfect Plan: National Incident Management System (NIMS) The National Incident Management System (NIMS) defines preparedness as "a continuous cycle of planning, organizing, training, equipping, exercising, evaluating, and taking corrective action in an effort to ensure effective coordination during incident response." This preparedness cycle is one element of a broader National Preparedness System to prevent, respond to, recover from, and mitigate against natural disasters, acts of terrorism, and other man-made disasters. http://www.fema.gov/preparedness-1Image: FEMA Stock ID 58278 The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 11
  12. 12. The Perfect Plan: Presidential Policy Directive (PPD) 8 – National Preparedness National Preparedness: The actions taken to plan, organize, equip, train, and exercise to build and sustain the capabilities necessary to… … prevent, … protect against, … mitigate the effects of, … respond to, and … recover from… … those threats that pose the greatest risk to the security of the Nation.Image: FEMA Stock ID 58278 The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 12
  13. 13. The Perfect Plan: Presidential Policy Directive (PPD) 8 – National Preparedness National Preparedness Goal National Preparedness SystemImage: FEMA Stock ID 54866 The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 13
  14. 14. The Perfect Plan: National Preparedness Mission Areas Prevention Protection Mitigation Response RecoveryImage: FEMA Stock ID 54866 The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 14
  15. 15. The Perfect Plan: National Preparedness Mission Areas “Whole Community” Prevention Protection Mitigation Response RecoveryImage: FEMA Stock ID 54866 The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 15
  16. 16. The Perfect Plan: National Preparedness Mission Areas & Key Capabilities “Whole Community” Prevention Protection Mitigation Response 1.Community Recovery Resilience Mass Care 1. Planning Operational Public Information 2. Risk &Services Disaster 2. Public Health Resilience Medical Health and and 1. Coordination & Warning Services Social Services AssessmentImage: FEMA Stock ID 54866 The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 16
  17. 17. The Perfect Plan The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 17
  18. 18. The Perfect Plan The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 18
  19. 19. The Perfect Plan: Federal, State, Territorial, Tribal, and Local Plans Federal Plans State, Territorial, Tribal, and Local Plans The Integrated Planning System (IPS) Comprehensive Planning Guide (CPG) 101 V.2  Describes planning doctrine and the  Describes the fundamentals of planning Federal plan development process and developing emergency plans  Provides structure for:  Provides guidance for: – Federal Strategic Plan – Strategic Plan – Federal Concept Plan – Operational Plan – Federal Operations Plan – Tactical Plan  Plans described:  Plans described: – Contingency (pre-incident/event) – Emergency Operations Plan (EOP) – Crisis Action (post-incident/event) – Standard Operating Procedure / Guideline (SOP / SOG) – Field Operations Guide (FOG) or handbook The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 20
  20. 20. The Perfect Plan: Federal, State, Territorial, Tribal, and Local Plans Federal Plans State, Territorial, Tribal, and Local Plans The Integrated Planning System (IPS) Comprehensive Planning Guide (CPG) 101 V.2  Describes planning doctrine and the  Describes the fundamentals of planning Federal plan development process and developing emergency plans  Provides structure for:  Provides guidance for: – Federal Strategic Plan – Strategic Plan – Federal Concept Plan – Operational Plan – Federal Operations Plan – Tactical Plan  Plans described:  Plans described: – Contingency (pre-incident/event) – Emergency Operations Plan (EOP) – Crisis Action (post-incident/event) – Standard Operating Procedure / Guideline (SOP / SOG) – Field Operations Guide (FOG) or handbook The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 21
  21. 21. The Perfect Plan: CPG 101 V.2 State, Territorial, Tribal, and Local Plans Comprehensive Planning Guide (CPG) 101 V.2  Describes the fundamentals of planning and developing emergency plans  Provides guidance for: – Strategic Plan – Operational Plan – Tactical Plan  Plans described: – Emergency Operations Plan (EOP) – Standard Operating Procedure / Guideline (SOP / SOG) – Field Operations Guide (FOG) or handbook The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 22
  22. 22. The Perfect Plan: CPG 101 V.2 State, Territorial, Tribal, and Local Plans Comprehensive Planning Guide (CPG) 101 V.2  Describes the fundamentals of planning and developing emergency plans  Provides guidance for: – Strategic Plan – Operational Plan – Tactical Plan  Plans described: – Emergency Operations Plan (EOP) – Standard Operating Procedure / Guideline (SOP / SOG) – Field Operations Guide (FOG) or handbook The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 23
  23. 23. The Perfect Plan: CPG 101 V.2 Introduction and Overview 1. The Basics of Planning 2. Understanding the Planning Environment: Federal, State, and Local Plans 3. Format and Function: Identifying the Right Plan for the Job 4. The Planning Process – Step 1: Form a Collaborative Planning Team – Step 2: Understand the Situation – Step 3: Determine Goals and Objectives – Step 4: Plan Development – Step 5: Plan Preparation, Review, and Approval – Step 6: Plan Implementation and Maintenance The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 24
  24. 24. Presentation Snap-Shot Presenter Disclosure Disaster Behavioral Health The Perfect Plan Practice Integration Wrap-up The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 25
  25. 25. Practice Integration• Public health and behavioral health disaster response lack consistantcollaboration and standardized integration with preparedness partners• The concept of the “Whole Comminity” calls for theleveraging, collaboration, and cooperation of all key players andstakeholders• Public Healh, as the lead for Emergency Support Function (ESF) 8:Public Health and Medical Services, is expected by the public to providehealth and medical direction, guidance, support, and services toindividuals, families, and communities during disasters•Disaster Behavioral Health services are an expectation of the public, anda critical need for responders The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 26
  26. 26. Practice Integration Steps forward in the National Capital Region (NCR) • Regional preparedness and coordination efforts • Regional health and medical planning • Public health and behavioral health at the table with emergency management, public safety, hospitals, and others The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 27
  27. 27. Practice Integration: Responder Focus  It’s time to take a second look at responders  Responders provide a unique challenge for public health and behavioral health disaster response: – Provide initial contact with survivors – Expected to triage and treat patients according to scope and protocol, maintain incident safety and security, and/or conduct other emergency operations – Subjected to continuous exposure to a disaster scene and traumatic incidents – Are often survivors themeslves – Lack standardized training, guidance, procedures, and protocols for application in the field • While many resources do exist, police/fire academies and EMS schools do not incorporate sufficient training, education, or competencies for respondersImage: FEMA Stock ID 54866 The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 28
  28. 28. Practice Integration: Responder Focus “Psychological first aid is one of the most important skills my team can have in the field.” Christina Catlett, MD, FACEP Medical Officer, MD-1 DMAT Director, Johns Hokpins Go Team MRCImage: FEMA Stock ID 54866 The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 29
  29. 29. Practice Integration: Responder Focus  Disaster Behavioral Health (DBH) integration into first/disaster responder training, education, and certification process would help bridge the DBH gaps during the initial interactions of the survivor and responder.  Standardized core DBH competencies for responders, in conjunction with requirements for skill demonstration (e.g. CPR, ACLS, etc.) would help bring DBH to life in practice, in training, and subsequently the field.  Standardized guidance for survivors provides an opportunity for unaffected survivors to actually care for responders. – For example, encouraging survivors to demonstrate appreciation to responders for their duties is a powerful tool in refreshing and refueling responders.Image: FEMA Stock ID 54866 The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 30
  30. 30. Practice Integration: Responder Focus Time Operations You 0  Rotate On-call  Prepare, train, and exercise 12hr  Alerted and placed on standby  Check your gear, notify work, secure 24hr  Activated and provided family and property... and you wait... 48hr providers orders  Report to ralley-point  Deploy  Begin your journey 72hr  Travel by land, air, sea, land  While excited, you are weatherd by again, prior to arrival exhausting travel modalities  Mission assignment pending  You wait...  Relocated to an alternate  Just when you’ve begun to settle, 96hr location the journey continues  Mission begins  Faced with limited resources, long Week 1 hours, tough decisions, you work  Mission changes time again Week 2  Exhausted, dazed, and longing for a  Mission endsImage: FEMA Stock ID 54866 shower (hot or cold!) The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 31
  31. 31. Practice Integration: Responder Focus ... filling gaps, overcoming challenges  On every deployment I encourage my team to focus on “controling the controlables”  This is accomplished by: • Taking care of one’s self, first “ cura te ipsum” • Next, taking care of one another • Lastly,taking care of our patients through difficult decision making on when, and when not, to advance care “ primum non nocere” • While not always overtly apparent, more often than not it’s not medical care we’re providing, but rather behavioral • Consequently, this is also an area where many responders are not familiarImage: FEMA Stock ID 54866 The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 32
  32. 32. Practice Integration: Responder Focus Important considerations to accept, pre-disaster!  Team unity and support is critical to mission success  All disasters are different, and something new is learned on every deployment  You will be required to improvise, adjust, and operate outside of your comfort zone  Disasters require personnel to wear many diffferent hats  ”While I may be a physician in my day-to-day practice, when my boots hit the ground I will be a shoulder to cry on, a pharmacist, a nurse, a tech, a transporter, and a grunt moving resources.”– DMAT NJ-1 Medical Officer  Disaster responders and providers are forced to make difficult decisions  Knowing, deciding, and accpeting when to provide care (e.g. Haiti)  Disasters are physically, socially, mentally, psychologically, and spirtually draining  Down-time reading a book or listening to some tunes is a must  What can go wrong, will go wrongImage: FEMA Stock ID 54866 The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 33
  33. 33. Practice Integration: Responder Focus “I personally havent saved a lot of lives in disasters... … but Ive given a lot of hugs and held a lot of hands.” Christina Catlett, MD, FACEP Medical Officer, MD-1 DMAT Director, Johns Hokpins Go Team MRCImage: FEMA Stock ID 54866 The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 34
  34. 34. Practice Integration: “Whole Community” Integrating Disaster Behavioral Health (DBH) Dynamically across the “Whole Community” – Survivors – Responders – Providers – Animals Survivors Responders Providers Animals Survivors S-S R-S P-S A-S Responders S-R R-R P-R A-R Providers S-P R-P P-P A-P Animals S-A R-A P-A A-A The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 35
  35. 35. Practice Integration: Information Technology & Mobility Health Information Technology (HIT) Health Information Exchange (HIE) The use information technology and mobility in the disaster response is here. The time for Public Health and Behavioral Health Disaster Response to get involved is now. Southeast Regional HIT-HIE Collaboration (SEARCH): Final Report, ONC State Health Policy Consortium Project: Health Information Exchange in Disaster Preparedness and Response, July 2012 http://www.healthit.gov/sites/default/files/pdf/SERCH-White-Paper.pdf The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 36
  36. 36. Practice Integration: HIE in Disaster Preparedness & Response:Five Recommendations for State HIEs (1) Understand the State’s disaster response policies and align with the State agency designated for Emergency Support Function #8 (Public Health and Medical Services) before a disaster occurs. (2) Develop standard procedures approved by relevant public and private stakeholders to share electronic health information across State lines before a disaster occurs. (3) Consider enacting the Mutual Aid Memorandum of Understanding to establish a waiver of liability for the release of records when an emergency is declared and to default state privacy and security laws to existing Health Insurance Portability and Accountability Act (HIPAA) rules in a disaster. States should also consider using the Data Use and Reciprocal Support Agreement (DURSA) in order to address and/or expedite patient privacy, security, and health data-sharing concerns. (4) Assess the State’s availability of public and private health information sources and the ability to electronically share the data using HIE(s) and other health data- sharing entities. (5) Consider a phased approach to establishing interstate electronic health information- sharing capabilities. Source: Southeast Regional HIT-HIE Collaboration (SEARCH): Final Report, ONC State Health Policy Consortium Project: Health Information Exchange in Disaster Preparedness and Response, July 2012, http://www.healthit.gov/sites/default/files/pdf/SERCH-White-Paper.pdf The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 37
  37. 37. Practice Integration: Health Information Exchange • Patient Admission • Patient Discharge Notification Examples • New Laboratory Result • New Radiology Result • Final Microbiology • ER Admission The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 38
  38. 38. Presentation Snap-Shot Presenter Disclosure Disaster Behavioral Health The Perfect Plan Practice Integration Wrap-up The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 39
  39. 39. Wrap-up Disaster Behavioral Health: a public health practice The Perfect Plan: knowing what to use; when to use it; how to use it Practice Integration: responder focus Practice Integration: the “whole community” Practice Integration: Health Information Technology (HIT) and Health Information Exchange (HIE)Image: FEMA Stock ID 33425 The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 40
  40. 40. Anthony A. Barone | M.P.H. | CHMM | CHS-V | FF/EMT-BSenior Consultant | Public SectorCapgemini Government Solutionsanthony.barone@capgemini-gs.com www.capgemini-gs.com The information contained in this presentation is proprietary. © 2012 Capgemini. All rights reserved.
  41. 41. About CapgeminiWith around 120,000 people in 40 countries, Capgemini isone of the worlds foremost providers of consulting,technology and outsourcing services. The Group reported2011 global revenues of EUR 9.7 billion (approximately$13.5 billion USD).Together with its clients, Capgemini creates and deliversbusiness and technology solutions that fit their needs anddrive the results they want. A deeply multiculturalorganization, Capgemini has developed its own way ofworking, the Collaborative Business ExperienceTM, anddraws on Rightshore ®, its worldwide delivery model.Rightshore® is a trademark belonging to Capgemini www.capgemini-gs.com The information contained in this presentation is proprietary. © 2012 Capgemini. All rights reserved.

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