Preparedness,
Response, and Recovery
Considerations for
Children and Families

Workshop Summary

Theresa Wizemann, Megan Reeve, and Bruce M. Altevogt,
Rapporteurs

Forum on Medical and Public Health Preparedness for
Catastrophic Events

Board on Health Sciences Policy

INSTITUTE OF MEDICINE
     OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

www.nap.edu



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Theresa Wizemann, Megan Reeve, and Bruce M. Altevogt, Rapporteurs Forum on Medical and Public Health Preparedness for Catastrophic Events Board on Health Sciences Policy

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THE NATIONAL ACADEMIES PRESS • 500 Fifth Street, NW • Washington, DC 20001 NOTICE: The workshop that is the subject of this workshop summary was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This activity was supported by contracts between the National Academy of Sciences and the American College of Emergency Physicians; American Hospital Association; Association of State and Territorial Health Officials; Centers for Disease Control and Prevention (Contract No. 200-2011-38807, TO #19); Department of Defense (Contract No. HT0011-11-P-0186); Department of Defense, Uniformed Services University of the Health Sciences (Contract No. HT9404-12-1-0022); Department of Health and Human Services’ National Institutes of Health: National Institute of Allergy and Infectious Diseases, National Institute of Environmental Sciences, National Library of Medicine (Contract No. HHSN26300007 [Under Base 1 #HHSN263201200074I]); Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response (Contract No. HHSO100201000021P); Department of Homeland Security’s Federal Emergency Management Agency (Contract No. HSFE20-13-P-0212); Department of Homeland Security, Office of Health Affairs (Contract No. HSHQDC-13-J-00384 [Under Base 1 #HSHQDC-11-D-00009]); Department of Transportation’s National Highway Traffic Safety Administration (Contract No. DTNH22-10- H-00287); Department of Veterans Affairs (Contract No. 101-G09041); Emergency Nurses Association; Food and Drug Administration (Contract No. HHSF22301027T [Under Base Contract DHHS-8598]); Infectious Diseases Society of America; Martin, Blanck & Associates; Mayo Clinic; Merck Research Laboratories (Contract No. 2391); National Association of Chain Drug Stores; National Association of County and City Health Officials; National Association of Emergency Medical Technicians; Pharmaceutical Research and Manufacturers of America; Target Corporation; Trauma Center Association of America; and United Health Foundation. The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for the activity. International Standard Book Number-13: 978-0-309-29458-4 International Standard Book Number-10: 0-309-29458-4 Additional copies of this workshop summary are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2014 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: IOM (Institute of Medicine). 2014. Preparedness, response, and recovery considerations for children and families: Workshop summary. Washington, DC: The National Academies Press.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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WORKSHOP PLANNING COMMITTEE1 MICHAEL ANDERSON (Chair), University Hospitals Case Medical Center and Rainbow Babies and Children’s Hospital, Cleveland, OH TERRY ADIRIM, Office of Special Health Affairs, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, MD WYNDOLYN BELL, UnitedHealthcare, Atlanta, GA BRUCE CLEMENTS, Community Preparedness Section, Texas Department of State Health Services, Austin DANIEL DODGEN, Office for At Risk Individuals, Behavioral Health, and Human Services Coordination, Office of the Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services, Washington, DC PATRICIA FROST, Emergency Medical Services, Contra Costa County Health Services, Contra Costa, CA ANDREW GARRETT, National Disaster Medical System, Office of the Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services, Washington, DC ANN MASTEN, Institute of Child Development, University of Minnesota, Minneapolis SCOTT NEEDLE, Healthcare Network of Southwest Florida, Naples GEORGINA PEACOCK, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA MARY RILEY, Office of Human Services Emergency Preparedness and Response, Administration for Children and Families, U.S. Department of Health and Human Services, Washington, DC ANDREW RUCKS, Department of Healthcare Organization and Policy, University of Alabama at Birmingham School of Public Health KENNETH W. SCHOR, National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD CHRISTINE TUCK, National Association of School Nurses, Topeka, KS 1 Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution. v

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IOM Staff BRUCE M. ALTEVOGT, Project Director MEGAN REEVE, Associate Program Officer KATE KELLEY, Research Associate (through August 2013) BRADLEY ECKERT, Research Associate (from October 2013) ALEX REPACE, Senior Program Assistant vi

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FORUM ON MEDICAL AND PUBLIC HEALTH PREPAREDNESS FOR CATASTROPHIC EVENTS1 ROBERT P. KADLEC (Co-Chair), RPK Consulting, LLC, Alexandria, VA LYNNE R. KIDDER (Co-Chair), Consultant, Boulder, CO ALEX J. ADAMS, National Association of Chain Drug Stores, Alexandria, VA ROY L. ALSON, American College of Emergency Physicians, Winston-Salem, NC WYNDOLYN BELL, UnitedHealthcare, Atlanta, GA (from September 2013) GEORGES C. BENJAMIN, American Public Health Association, Washington, DC (until September 2013) DAVID R. BIBO, The White House, Washington, DC (from September 2013) KATHRYN BRINSFIELD, Office of Health Affairs, Department of Homeland Security, Washington, DC (from September 2013) CAPT. D.W. CHEN, Office of the Assistant Secretary of Defense for Health Affairs, Department of Defense, Washington, DC SUSAN COOPER, Regional Medical Center, Memphis, TN BROOKE COURTNEY, Office of Counterterrorism and Emerging Threats, U.S. Food and Drug Administration, Washington, DC JEFFREY S. DUCHIN, University of Washington School of Medicine, Seattle (until September 2013) BRUCE EVANS, National Association of Emergency Medical Technicians, Upper Pine River Fire Protection District, Bayfield, CO ALEXANDER G. GARZA, Office of Health Affairs, Department of Homeland Security, Washington, DC (until September 2013) JULIE L. GERBERDING, Merck Vaccines, Merck & Co., Inc., West Point, PA LEWIS R. GOLDFRANK, New York University School of Medicine, New York DAN HANFLING, INOVA Health System, Falls Church, VA JACK HERRMANN, National Association of County and City Health Officials, Washington, DC 1 Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution. vii

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JAMES J. JAMES, Disaster Medicine and Public Health Preparedness, Onancock, VA (until September 2013) PAUL E. JARRIS, Association of State and Territorial Health Officials, Arlington, VA BRIAN KAMOIE, The White House, Washington, DC (until September 2013) LISA G. KAPLOWITZ, Office of the Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services, Washington, DC ALI S. KHAN, Centers for Disease Control and Prevention, Atlanta, GA MICHAEL G. KURILLA, National Institute of Allergy and Infectious Diseases, Washington, DC JAYNE LUX, National Business Group on Health, Washington, DC LINDA M. MACINTYRE, American Red Cross, San Rafael, CA (from September 2013) SUZET M. MCKINNEY, Chicago Department of Public Health, IL NICOLE MCKOIN, Target Corporation, Furlong, PA MARGARET M. MCMAHON, Emergency Nurses Association, Williamstown, NJ AUBREY K. MILLER, National Institute of Environmental Health Sciences, Bethesda, MD MATTHEW MINSON, Texas A&M University, College Station ERIN MULLEN, Pharmaceutical Research and Manufacturers of America, Washington, DC JOHN OSBORN, Mayo Clinic, Rochester, MN ANDREW T. PAVIA, Infectious Disease Society of America, Salt Lake City, UT STEVEN J. PHILLIPS, National Library of Medicine, Bethesda, MD LEWIS J. RADONOVICH, Department of Veterans Affairs, Washington, DC KENNETH W. SCHOR, Uniformed Services University of the Health Sciences, Bethesda, MD (from November 2012) ROSLYNE SCHULMAN, American Hospital Association, Washington, DC RICHARD SERINO, Federal Emergency Management Agency, Department of Homeland Security, Washington, DC SHARON A. R. STANLEY, American Red Cross, Circleville, OH (until September 2013) ERIC S. TONER, UPMC Center for Health Security, Baltimore, MD (until September 2013) viii

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REED V. TUCKSON, UnitedHealth Group, Minnetonka, MN (until September 2013) MARGARET VANAMRINGE, The Joint Commission, Washington, DC W. CRAIG VANDERWAGEN, Martin, Blanck & Associates, Alexandria, VA (from February 2013) JENNIFER WARD, Trauma Center Association of America, Las Cruces, NM (from February 2013) JOHN M. WIESMAN, Washington State Department of Health, Tumwater (from September 2013) GAMUNU WIJETUNGE, National Highway Traffic Safety Administration, Washington, DC IOM Staff BRUCE M. ALTEVOGT, Forum Director MEGAN REEVE, Associate Program Officer KATE KELLEY, Research Associate (until August 2013) BRADLEY ECKERT, Research Associate (from October 2013) ALEX REPACE, Senior Program Assistant ANDREW M. POPE, Director, Board on Health Sciences Policy ix

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Reviewers This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary: ARTHUR COOPER, Harlem Hospital Center MARY HILFIKER, University of California, San Diego TALA HOOBAN, U.S. Department of Health and Human Services ROBERT KANTER, SUNY Upstate Medical University ANDREW C. RUCKS, University of Alabama at Birmingham Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by KRISTINE GEBBIE, Flinders University School of Nursing and Midwifery. Appointed by the Institute of Medicine, she was responsible for making certain that an independent examination of this workshop summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the xi

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xii REVIEWERS final content of this workshop summary rests entirely with the rapporteurs and the institution.

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Contents 1 INTRODUCTION AND OVERVIEW 1 Background, 1 About This Summary, 3 Highlighted Topics, 3 2 CHILDREN AND DISASTERS 9 Needed Focus on Children and Families, 9 2010 National Commission on Children and Disasters Recommendations, 14 HHS Progress in Addressing Children’s Disaster Health Needs, 21 3 LEVERAGING HEALTH CARE COALITIONS 27 Federal Perspective: The Hospital Preparedness Program, 28 Local Perspective: The California Neonatal/Pediatric Disaster Coalition, 30 Hospital Perspective: New York City Pediatric Disaster Coalition, 32 4 AUGMENTING STATE AND LOCAL EMERGENCY PLANS 37 Provider Perspective: Integrating Community Pediatric Practices into Disaster Preparedness, 38 Evidence-Informed Guidelines for Child-Focused Pandemic Planning and Response, 42 Development of a State Pediatric and Neonatal Surge Annex, 45 xiii

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xiv CONTENTS 5 FINANCING HEALTH CARE FOR CHILDREN IN EMERGENCIES 49 Health Care System Policy, 50 Private Insurers, 52 Hospital Association, 54 Independent Private Practice Providers, 55 6 BROADENING STAKEHOLDERS INVESTED IN CHILDREN 59 Preparedness Issues for Child Care, 60 Community Engagement, 61 7 PLANNING FOR CHILDREN AND FAMILIES DURING DISASTER RESPONSE 67 Child and Family Needs During Mass Care and Sheltering Operations, 68 Best Practices and Potential Strategies During Response, 75 8 MONITORING CHILDREN’S MENTAL HEALTH AFTER DISASTERS 85 Ensuring That Children Are Coping, 86 Triaging High-Risk Children, 89 9 FOSTERING RECOVERY THROUGH COMMUNITY RESILIENCE 91 The Foundations of Research on Resilience in Children and Youth, 93 The Science and Practice of Resilience Interventions for Children Exposed to Disasters, 95 Promising Practices of Child-Serving Partners, 102 10 HURRICANE SANDY EXPERIENCE: DISASTER RECOVERY FOCUSED ON CHILDREN AND FAMILIES 109 National Disaster Recovery Framework: Health and Social Services Recovery Support Function, 110 Children, Youth, and Families Task Forces for Recovery, 113 State Perspective: New Jersey Child Task Force, 115 New York State Child Care Response, 119

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CONTENTS xv 11 FINAL REMARKS 123 APPENDIXES A References 125 B Abbreviations and Acronyms 129 C Statement of Task 131 D Agenda 133 E Biographical Sketches of Invited Speakers and Panelists 147 F Resource List: Tools for Planning for Children and Families 173 G The Science and Practice of Resilience Interventions for Children Exposed to Disasters 177 H Recommendations from the National Commission on Children and Disasters 203

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