FEMA Higher Education Conference 1 The Paradigm Shift in Planning for Special Needs Populations U.S....

FEMA Higher Education Conference 1

The Paradigm Shift in Planning for Special Needs Populations

U.S. Department of Homeland SecurityOffice for Civil Rights and Civil Liberties


Presentation Topics

• Introduction• DHS Office for Civil Rights and Civil Liberties• Civil Rights and Emergency Management• Defining Special Needs – Synopsis of Published

Definitions• Special Needs – Functional Based Definition• Assessments• Planning Considerations• The Implications for Emergency Management

Curriculum• Q & A


DHS Office for Civil Rights and Civil Liberties

Mission

Among its core responsibilities:

Provide proactive legal and policy advice to Department leadership.



Executive Order #13347: Individuals with Disabilities in Emergency Preparedness• Policy: To ensure that the Federal Government

appropriately supports safety and security for individuals with disabilities in all hazard situations.– Consider the needs of agency employees with disabilities

and those the agency serves;– Encourage the consideration of the needs of individuals with

disabilities served by governmental and private sector organizations; and

– Facilitate cooperation among government and private entities and individuals with disabilities.



Federal Collaboration • Leads “Special Needs” workgroup for NRP/NIMS

revision• Provides Federal guidance on use of phrase “Special

Needs”• Developed disability accommodation reference guide

for disaster services.• Provide guidance to Emergency Support Functions 6

and 8 and Target Capability working groups.



Federal Collaboration (continued)

• Drafted language for use in FEMA’s disaster victim intake form

• Established Disaster Incident Management Team and Joint Field Office position

• Participated in FEMA Hurricane Exercises

• Participate in TOPOFF Exercises and Homeland Security and Exercise Program

• Contribute to Homeland Security Grant Program criteria



Collaboration with State, Tribal, and Local Governments

• Recommend special needs consideration to revision of Guide for All-Hazard Emergency Operations Planning (SLG 101)

• Leading the development of special needs planning guide

• Lead disability specific aspect of Nationwide Plan Review



Collaboration with Non-governmentOrganizations

• Liaison with Voluntary Organizations Active in Disasters (VOAD) • Provided content to American Red Cross volunteer training

“Serving People with Disabilities”• Engage disability service, consumer, and advocacy

organizations in departmental programs and activities• Engage university emergency management program leads to

explore the addition of a special needs component to their curriculum


Civil Rights and Emergency Management

Applicable Statutes for Disability Populations• Rehabilitation Act• Americans with Disabilities Act• Fair Housing Act• Architectural Barriers Act• Communications Act• Individuals with Disabilities Education Act



Additional special needs civil rights considerations

• Older Americans • Children• Cultural and minority populations status• Limited English proficiency



Key Principles of Disability Law

• Self-Determination – People with disabilities are the most knowledgeable about their own needs.

• No “One Size Fits All“ – People with disabilities do not all require the same assistance and do not all have the same needs.

• Equal Opportunity – People with disabilities must have the same opportunities to benefit from emergency programs, services, and activities as people without disabilities.



Key Principles of Disability Law (continued)• Inclusion – People with disabilities have the right to participate

in and receive the benefits of emergency programs, services, and activities provided by governments, private businesses, and nonprofit organizations .

• Integration – Emergency programs, services, and activities typically must be provided in an integrated setting.

• Physical Access – Emergency programs, services, and activities must be provided at locations that all people can access, including people with disabilities .

• Equal Access – People with disabilities must be able to access and benefit from emergency programs, services, and activities equal to the general population.



Key Principles of Disability Law (continued)

• Effective Communication – People with disabilities must be given information comparable in content and detail to that given to the general public, as well as accessible, understandable, and timely. .

• Program Modifications – People with disabilities must have equal access to emergency programs and services, which may entail modifications to rules, policies, practices, and procedures .

• No Charge – People with disabilities may not be charged to cover the costs of measures necessary to ensure equal access and nondiscriminatory treatment .


Defining Special Needs - Synopsis of Published Definitions

No singular definition of the term “special

needs” exists although “special needs” is

a widely used term within the disaster

services and emergency management

world.


Defining Special Needs – Synopsis of Published Definitions

Federal Government Sources

“…The situation section may include relative probability and impact of the hazards, geographic areas likely to be affected by particular hazards, vulnerable critical facilities, population distribution, characteristics and locations of special populations (institutionalized persons, the elderly and disabled, those who speak languages other than English, etc.), critical resource dependencies on other jurisdictions, and more.”

FEMA State and Local Guide (SLG) 101 - Guide for All-Hazard Emergency Operations Planning, 1996.



Federal Government Sources

In practice, the term also includes people who live in poverty or on public assistance; people without private transportation or who rely on public transportation; and people who rely on

caregivers for assistance in daily living and would need similar assistance in an emergency and those who live independently or with the caregiver(s) in their homes, assisted living housing, nursing homes, supervised

group homes, hospitals, and other health care facilities.

Nationwide Plan Review Phase 2 Report, U.S. Department of Homeland Security in cooperation with the US Department of Transportation, June 16, 2006. Page 41.



DHS Nationwide Plan Review revealed major inconsistencies in definition of the term special needs or similar term among State and urban areas. A few examples:

• "the disabled, elderly and those traveling with pets or livestock" • The term “vulnerable populations” was used for hazard mitigation, people

younger than 19 or older than 65 with incomes less than $20K, and those living in 100+ year old dwellings (does not include people with disabilities)

• Seniors and people with disabilities, non-English speakers, people who are

culturally or geographically isolated, people with substance abuse issues, homeless, marginally housed or shelter-dependent, children with special circumstances (unattended minors, foster care or residential living situations), single parent households, people living in poverty


Defining Special NeedsSynopsis of Published Definitions

Other SourcesAmong this small “city” of students, faculty, staff, and visitors on theUniversity of Washington Seattle Campus are people who may require more individualized assistance in the case of an emergency. Often called special needs populations, the terms “vulnerable populations” or “specific needs” are also used. These special needs populations include:

– Minors under the age of 18– Physically, psychologically, cognitively, and sensory impaired persons– Hospitalized patients and others with medical conditions– Frail elderly– Non-English speaking persons– Companion, service, and research animals

University of Washington Seattle Campus Report on Emergency Preparedness for Special Needs Populations, April 2006


Special Needs -Functional Based Definition

Establishes a flexible framework to address a broad set of common function-based needs irrespective of specific diagnosis, status, or label (e.g., children, the elderly, transportation disadvantaged).


Special Needs – Functional Based Definition

As proposed for the NRP and NIMS drafts:

Before, during and after an incident members of the special needs population may have additional needs in one or more of the following functional areas:

• maintaining independence• Communication,• transportation, • supervision, and • medical care.

Individuals in need of additional response assistance may include those: who have disabilities; who live in institutionalized settings; who are elderly; who are children; who are from diverse cultures; who have limited English proficiency or who are non-English speaking; and who are transportation disadvantaged


Special Needs – Functional Based Definition

Maintaining Independence

Supports for independence in daily activities may be lost. This may include lost or damaged durable medical equipment (wheelchairs, walkers, scooters, and essential supplies catheters, ostomy supplies, etc.). By supplying needed support/ devices independence is preserved.


Special Needs –A Functional Based Definition

Communication

Limitations that interfere with the receipt of and response to information will need that information provided in methods they can understand and use. They may not be able to hear verbal announcement, see directional signage, or understand how to get assistance all because of hearing, vision, speech, cognitive or intellectual limitations, and limited English proficiency


Special Needs – A Functional Based Definition

Transportation

Individuals who cannot drive due to the presence of a disability or who do not have a vehicle will require transportation support for successful evacuation such as the availability accessible vehicles (e.g., lift equipped or vehicle suitable for transporting individuals who uses oxygen) or knowledge of how/where to access mass transportation used to assist in evacuation.



Supervision

Individuals may lose the support of caregivers, family, or friends or may be unable to cope in a new environment; have conditions such as dementia, Alzheimer’s and psychiatric conditions (schizophrenia, intense anxiety); and unaccompanied children will require supervision to make decisions affecting their welfare.



Medical Care Includes individuals who do not have or have lost support from caregivers, family, or friends and need assistance with: managing unstable, terminal or contagious conditions that require observation and ongoing treatment; managing intravenous (IV) therapy, tube feeding, and vital signs; receiving dialysis, oxygen, and suction administration; managing wounds; and operating power-dependent equipment to sustain life. These individuals require support of trained medical professionals.


Assessments

• Assessments• Registries• Geographic information system (GIS)


Assessments

• An informed estimate of the number and type of special needs individuals within the population based on lists and information collected from multiple sources including:– U.S. Census data– Social services listings (dialysis centers, Meals on Wheels,

etc.)– Para transit providers – Health departments (State, tribal, or local as applicable)– Utility providers (for electricity dependent individuals)– Job Access Services


Assessments

Assessments (continued)

– Large-scale senior housing developments– Congregate care facilities– Schools (especially those with significant proportion of

students with disabilities or with limited English proficiency)– County emergency alert list serves– Medicaid– Hospitals– Day care centers (for children or senior citizens)– Nursing homes– Places of worship


Assessments

Assessments – Aging Population Trends

• In 2000, there were an estimated 35 million people age 65 or older in the United States, accounting for almost 13 percent of the total population.

• In 2011, the “baby boom” generation will begin to turn 65. • By 2030, it is projected that one in five people will be age 65 or

older. • The size of the older population is projected to double over the

next 30 years, growing to 70 million by 2030. • The population age 85 and older is the fastest growing segment

of the older population.


Assessments

Assessments- Community Residential Trends• Individuals with disabilities living independently in the

community.

• Individuals who require personal assistance in their own homes.

• Individuals requiring acute and hospice care are receive it through home health agencies

• Naturally occurring senior, cultural, or language based communities.


Assessments

Assessments - Other Community Trends

• Diversity of language and culture

• Single parent households and use of daycare settings

• Transient populations (i.e. tourists, migrant workers, etc.)

• Homeless individuals


Assessments

Sample Special Need City Population AssessmentPortland (city proper, U.S. Census 2000)

• Total population - 530,000+• Established Vietnamese community of 11,000+• 64,600 people (11% of the population) are over the age of 65• 172,000+ people (or more than 30%) self-identify as having a

disability • 25% of households have children under the age of 18 • 13% live below the poverty level


Assessments

Portland Assessment (city proper) (continued)

• 45,000 people speak English less than “very well” (U.S. Census 2000)

• Approximately 11 mosques or Islamic centers in the greater Portland region, and at least one Sufi center that brings together members of several Sufi orders.

• Center for the Deaf and Hard of Hearing (Public School)• 38+ nursing homes• School enrollment is approximately 130,000


Assessments

Assessments provide an overview of community population clusters and their general locations. Registries identify the location of specific individuals who need additional assistance during an emergency.


Assessments

Registry• A database of individuals who meet the eligibility for

receiving emergency response services based on having special needs (the criteria for which should be established by the State, local, or tribal jurisdiction as applicable) and who voluntarily sign up.


Assessments

Registries are voluntary. People may choose not to

sign up for the following reasons• They fear their financial assets will be taken;

• They fear legal consequences (in the case of undocumented workers);

• They think their medical information will not be protected, making them targets of crime and fraud; and

• They do not believe they have special needs.


Assessments

Registries (continued)

• The establishment of a registry creates an expectation among participants that may not be valid.

• Needs and location of people are constantly changing; keeping a registry updated with accurate information is both costly and time consuming.

• Must reach the entire special needs population during, or prior to, an emergency registered or not.

• There might not be a way to access the registry if there is no

electricity.


Assessments

Understanding implications of population data

• Resource identification, coordination, and allocation• Key community partners


Assessments

Geographic Information Systems (GIS)

• Demographic and registry information is entered into a database management program.

• Map communities, facilities, and households where persons with special needs reside relative to response assets and hazards.


Planning Considerations

Emergency Public Information

• Public Awareness– Personal preparedness and planning focus.– Disseminate in coordinate with community based

organizations.– Include information on availability of guidance to create

appropriate personal plans.



Emergency Public Information

• Delivery Mechanisms– Phone tree– Teletypewriters (TTY), video relay– Text messaging – Automated dialing programs– Closed captioning– Accessible websites– Sign language interpreters and foreign language translators– Braille – Large print type– Door-to-door warnings



Emergency Public Information (continued)

• Messaging– Timely delivery of complete information.– Appropriate for diverse populations (schools, nursing

homes, ethnic communities, home health care providers, single parents, etc.)

– Compose skeletal messages in advance in collaboration with community based organizations



Sheltering and Mass Care

• Life safety issues are first priority• Provision of appropriate level of care based on functional need• Shelter intake assessment process• Resource management• Laws related to admission of service animals• Shelter-in-place planning for congregate settings • Shelter-in-place planning for individuals living at home requiring

home health care and/or personal care assistance



Evacuation

• Transportation resources identified, coordinated, and incorporated at all levels of government with consideration of mobility limitations.

• Established policies for evacuation of special needs populations from high-rise buildings.

• Keep individuals with disabilities who have mobility devices, other durable medical goods, and service animals together

• Establish a system to evacuate pre-identified individuals• Evacuate medically fragile prior to the general population when

time permits• Sustain people over the course of an evacuation



Transportation

• Adequate provision identification of appropriate transportation for general population and nursing homes, group homes, assistive living facilities, etc.

• Awareness of plans for nursing homes and hospitals• Returning people back to the community



Human Services and Medical Management

• Identification of medical and human service personnel, pharmaceuticals, and durable medical goods for immediate community and surge populations

• Credentialing systems for identification of appropriate health service staff

• Consideration of individuals who are physically or psychologically harmed as a result of the disaster.

• Interstate issues related to medical personnel.• HIPPA



Congregate settings

• Awareness of congregate facilities’ emergency plans (i.e., nursing homes, assistive living, group homes, residential schools, etc.).

• Prioritization of power restoration to facilities where individuals are dependent on life-sustaining equipment.



Training and Exercises• Cross-train on evacuation, sheltering, assistive care,

long-term recovery, etc. • Include special needs community based and

volunteer organizations• Include persons with special needs into all phases of

training (development through exercise delivery.• Train spontaneous volunteers with special needs

expertise.



Recovery

• Include consideration of restoration of personal care givers, service providers, rehabilitation, service animals, child care providers, etc.

• Identify the impact on special needs communities of an interruption in utility or transportation services.

• Identify appropriate and accessible long term shelters and temporary housing.

• Involve representatives of special needs communities in after action assessments to capture the impact of the disaster.

• Improve future community sustainability by implementing universal design and hazard mitigation concepts into the long term recovery planning process.



Summary • Demographics and grouping of populations• Identification of functional areas that may need support• Identification of community partners• Collaboration with multiple stakeholders• Public education stressing personal responsibility as key

element in readiness


Implications for Higher Education

Curriculum development• Planning for the whole community will naturally

include special needs populations.• Utilize the functional needs approach to planning.• Proactively engage the special needs community.• Actively recruit individuals who have special needs

experience (formal or informal).


Implications for Higher Education

Curriculum development (continued)• Eliminate labeling and a medical-only focus• Apply functional needs planning to every phase of

emergency management; weave throughout curriculum and not just in a separate special needs course.

• Recruit instructors and curriculum designers with an appropriate knowledge base.


For Further Information

To read about the work of DHS/CRCL, and to access the Interagency Coordinating Council’s “Disability Preparedness

Resource Center:”www.disabilitypreparedness.gov

Speaker Contact Info:Brian S. Parsons, Senior Policy Advisor

Phone: [email protected]

Debbie Fulmer, Emergency Management Planning Specialist

Phone: [email protected]

http://www.disabilitypreparedness.gov/

mailto:[email protected]

mailto:[email protected]

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