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The Paradigm Shift in Planning for Special Needs Populations


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Title: The Paradigm Shift in Planning for Special Needs Populations

U.S. Department of Homeland SecurityOffice for
Civil Rights and Civil Liberties
  • The Paradigm Shift in Planning for Special Needs

Presentation Topics
  • Introduction
  • DHS Office for Civil Rights and Civil Liberties
  • Civil Rights and Emergency Management
  • Defining Special Needs Synopsis of Published
  • Special Needs Functional Based Definition
  • Assessments
  • Planning Considerations
  • The Implications for Emergency Management
  • Q A

DHS Office for Civil Rights and Civil Liberties
  • Mission
  • Among its core responsibilities
  • Provide proactive legal and policy advice to
    Department leadership.

DHS Office for Civil Rights and Civil Liberties
  • 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
  • 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
  • Facilitate cooperation among government and
    private entities and individuals with

DHS Office for Civil Rights and Civil Liberties
  • Federal Collaboration
  • Leads Special Needs workgroup for NRP/NIMS
  • 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.

DHS Office for Civil Rights and Civil Liberties
  • Federal Collaboration (continued)
  • Drafted language for use in FEMAs 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

DHS Office for Civil Rights and Civil Liberties
  • 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
  • Lead disability specific aspect of Nationwide
    Plan Review

DHS Office for Civil Rights and Civil Liberties
  • Collaboration with Non-government
  • Organizations
  • 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
  • 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

Civil Rights and Emergency Management
  • Additional special needs civil rights
  • Older Americans
  • Children
  • Cultural and minority populations status
  • Limited English proficiency

Civil Rights and Emergency Management
  • 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.

Civil Rights and Emergency Management
  • 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.

Civil Rights and Emergency Management
  • 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
  • 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
  • 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.

Defining Special Needs Synopsis of Published
  • 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
  • independently or with the caregiver(s) in their
  • assisted living housing, nursing homes,
  • group homes, hospitals, and other health care
  • 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.

Defining Special Needs Synopsis of Published
  • 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
  • Other Sources
  • Among this small city of students, faculty,
    staff, and visitors on the
  • University 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
  • 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
  • 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

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

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.

Special Needs A Functional Based Definition
  • 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, Alzheimers and psychiatric conditions
    (schizophrenia, intense anxiety) and
    unaccompanied children will require supervision
    to make decisions affecting their welfare.

Special Needs A Functional Based Definition
  • 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

  • Assessments
  • Registries
  • Geographic information system (GIS)

  • 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
  • Utility providers (for electricity dependent
  • Job Access Services

  • 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
  • Nursing homes
  • Places of worship

  • 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
  • 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- 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 - Other Community Trends
  • Diversity of language and culture
  • Single parent households and use of daycare
  • Transient populations (i.e. tourists, migrant
    workers, etc.)
  • Homeless individuals

  • Sample Special Need City Population Assessment
  • Portland (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
  • 13 live below the poverty level

  • 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
  • 38 nursing homes
  • School enrollment is approximately 130,000

  • 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.

  • 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.

  • Registries are voluntary. People may choose not
  • 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.

  • Registries (continued)
  • The establishment of a registry creates an
    expectation among participants that may not be
  • Needs and location of people are constantly
    changing keeping a registry updated with
    accurate information is both costly and time
  • Must reach the entire special needs population
    during, or prior to, an emergency registered or
  • There might not be a way to access the registry
    if there is no electricity.

  • Understanding implications of population data
  • Resource identification, coordination, and
  • Key community partners

  • 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
  • Include information on availability of guidance
    to create appropriate personal plans.

Planning Considerations
  • 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
  • Braille
  • Large print type
  • Door-to-door warnings

Planning Considerations
  • 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

Planning Considerations
  • 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

Planning Considerations
  • 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
  • Evacuate medically fragile prior to the general
    population when time permits
  • Sustain people over the course of an evacuation

Planning Considerations
  • Transportation
  • Adequate provision identification of appropriate
    transportation for general population and nursing
    homes, group homes, assistive living facilities,
  • Awareness of plans for nursing homes and
  • Returning people back to the community

Planning Considerations
  • Human Services and Medical Management
  • Identification of medical and human service
    personnel, pharmaceuticals, and durable medical
    goods for immediate community and surge
  • Credentialing systems for identification of
    appropriate health service staff
  • Consideration of individuals who are physically
    or psychologically harmed as a result of the
  • Interstate issues related to medical personnel.

Planning Considerations
  • 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.

Planning Considerations
  • 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
  • Train spontaneous volunteers with special needs

Planning Considerations
  • 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
  • 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.

Planning Considerations
  • Summary
  • Demographics and grouping of populations
  • Identification of functional areas that may need
  • 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
  • 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 Councils
    Disability Preparedness Resource Center
  • Speaker Contact Info
  • Brian S. Parsons, Senior Policy Advisor
  • Phone 202-357-8344
  • Debbie Fulmer, Emergency Management Planning
  • Phone 202-357-8329