Highlights of Points Made by Individual Speakers
- The federal government’s role in recovery is to support locally led recovery efforts to restore and improve the health care and social services networks in the affected communities.
- The health and the human services functions of the Department of Health and Human Services (HHS) need to work in tandem, educating each other about their respective disciples, and communicating better about available tools and resources.
- The goal of a children’s task force is to develop a common operating picture on children’s needs across the public, education, and early childhood sectors.
- A key aspect of the response to Hurricane Sandy was coalition building though the activation of existing resources and relationships.
- A barrier to response and recovery efforts for child care is that there are thousands of independent operators who are not part of organized networks, and are not reachable through standard communication mechanisms.
- An all-hazards approach to planning and training for child care providers includes chain of command, communications, emergency kits, evacuation and sheltering plans, and business recovery.
In the final chapter on recovery, panelists discussed examples of human services disaster recovery interventions that promote the social and economic well-being of children and families in the aftermath of disasters. The “recovery” phase begins almost as soon as the disaster and response end, but it continues for long after the rest of the country stops watching. Monitoring children and families during this recovery phase is critical and has often been overlooked. With the release of the Federal
Emergency Management Agency’s (FEMA’s) National Disaster Recovery Framework (NDRF), there is more focus and guidance for this important phase of rebuilding communities, and monitoring of social and economic determinants can give great insight to the process. During both the response and recovery phases, it is important to highlight the need for coordinated communication and action from the many players involved related to children. With a lack of power and communication options immediately after the storm, as well as jurisdictions responding differently based on their state or city protocols, streamlined activity and information gathering across child care providers can remain a difficult challenge. Representatives from state and federal level children and family agencies highlight their experiences during and after Hurricane Sandy hit the East Coast in October 2012.
Joyce Thomas, regional administrator for Administration for Children and Families (ACF) Region II,1 described the NDRF as the federal structure for how to best restore, redevelop, and revitalize the health, social, economic, natural, and environmental fabric of the community following a disaster. The NDRF defines the roles and responsibilities of the federal government in recovery, and provides guidance on coordinating structure, recovery planning, and building stronger, smarter, and safer communities.2
The NDRF established six recovery support functions (RSFs) that provide a structure to facilitate the identification, coordination, and delivery of federal assistance to supplement the state, local, private, and nonprofit efforts in affected communities. The RSFs are community planning and capacity building; economic; health and social services; housing; infrastructure systems; and natural and cultural resources. Each RSF has coordinating and primary federal agencies, and supporting organizations.
The coordinating agency for the health and social services RSF is the Department of Health and Human Services (HHS), with the Office of the
1Region II includes New Jersey, New York, Puerto Rico, and the U.S. Virgin Islands.
2The National Disaster Recovery Framework is available from FEMA at http://www.fema.gov/national-disaster-recovery-framework (accessed September 9, 2103).
Assistant Secretary for Preparedness and Response (ASPR) as the lead. The federal government role is to support locally led recovery efforts to restore and improve the health care and social services networks in the affected communities. Core mission areas include health care services impacts, social services impacts, referral to social services/disaster case management, public health, behavioral health impacts, environmental health impacts, food safety and regulated medical products, animal health, school impacts, and long-term health issues specific to responders.
ACF’s Role in Emergencies
ACF, through the Office of Human Services Emergency Preparedness and Response (OHSEPR) and in collaboration with each of 10 regional offices, provides national leadership in human services preparedness, response, and recovery. ACF is focused on child wellbeing, and Thomas said that ACF services touch the lives of every community and every tribal nation across the country.
In the event of any major disaster, ACF
- provides situational awareness on human services systems status and disaster-caused unmet needs;
- conducts outreach to Office of Child Care (OCC) and Office of Head Start (OHS) programs and grantees;
- coordinates federal support for children’s needs;
- conducts immediate disaster case management assessments and services;
- participates in the identification of the “problem set” for federal partners;
- defines the landscape of potential need for federal support and engagement across interagency in support of health and social services recovery, including new partners coming in to assist in response and recovery;
- focuses on establishing structure to support local long-term recovery operations at regional level; and
- identifies opportunities for building resilience (capacity, mitigation).
As an example of ACF activities, Thomas highlighted the role of ACF in support of the health and social service RSF core mission area of referral to social services/disaster case management. ACF implements coordinated systems for rapid referral to appropriate social services, and strategic leveraging of federal service programs to mitigate social disruption and transition people back to self-sufficiency. ACF also facilitates the Federal Disaster Case Management program to address unmet recovery needs.
Hurricane Sandy and the NDRF
Hurricane Sandy was the first large-scale event that prompted NDRF implementation, Thomas said. The storm impacted 5 of the 10 ACF regional offices. About 70 staff members were deployed during the response phase, logging more than 16,000 staff hours. Three disaster case management assessments were conducted, which indicated that 86 Head Start centers and 697 child care centers were closed across Connecticut, New Jersey, and New York.
In the transition from response to the recovery phase, ACF provides recovery-related technical assistance for HHS and ACF programs by encouraging, facilitating, and supporting children’s task forces; providing support from OCC and OHS for early childhood center re-openings; providing early childhood programs and children’s issues subject matter expert teams; and providing linkages to human services networks. In addition, ACF provides financial recovery assistance through Social Services Block Grants, Head Start funding, and Family Violence Prevention Grants. Thomas noted that ACF provided $474 million in funding for Hurricane Sandy recovery, $2 million of which will go toward family violence prevention. An additional $95 million in recovery aid will be available for Head Start centers.
In closing, Thomas stressed that the health and human services pieces of HHS need to work in tandem, educating each other about their respective disciples, and communicating better about available tools and resources. Unlike a disaster event, recovery is a process and may take a very long time. Restoration of health and social services systems following a disaster requires coordination, communication, and collaboration among various levels of government, nongovernmental organizations (NGOs), and impacted communities. Situations such as Hurricane Sandy provide teachable moments, and Thomas reiterated the
need to seize those moments to make change and make the lessons learned become future actions. She urged participants not to become weary in doing good and important work.
Lieutenant Commander Jonathan White, deputy director of the Office of Human Services Emergency Preparedness and Response at ACF within HHS, stressed that responding to the needs of children in disasters is not about “pediatric populations” or “at-risk populations.” It is about children, youth, and families, and the world as children encounter it. It is vital, he said, to have a strategy that is multisectoral and multidisciplinary.
“As for-profit entities, the vast majority of America’s child care providers are ineligible for FEMA public assistance. Many are also ineligible for Small Business Administration disaster loans because their profit margins are too small to make them credit-worthy.”
White highlighted three key challenges to meeting the needs of children, youth, and families in a disaster. One of the foremost challenges is the limited interoperability of human services, public health and medical (including behavioral health), and emergency management systems. Of these three areas, White noted that human services is least connected to the other two. Second is the profound vulnerabilities of child care providers and the formidable financial barriers to child care recovery. White explained that a public hospital that suffers an uninsured loss looks to FEMA for public assistance. However, as for-profit entities, the vast majority of America’s child care providers are ineligible for FEMA public assistance. Many are also ineligible for Small Business Administration disaster loans because their profit margins are too small to make them credit-worthy. As noted earlier, child care workers are not well funded at baseline, with average earnings of about $21,000 per year. Third, disaster human services in the United States have historically focused on sheltered populations, not communities; however, the human services purview is the entire population.
Community-Level Task Forces
A key intervention, White said, is the community-level task force focused on children, youth, and families’ needs in recovery. The task force is a whole-community coordination forum that is multisectoral, multilevel, and multidisciplinary. It is often led by a state agency with equities in children’s services, convened by the state with support from ACF and Save the Children, and brings together a broad array of child-serving organizations (see Box 10-1).
The goal of the task force is to develop a common operating picture on children’s needs across the public, education, and early childhood sectors. A key feature of the task force is that it makes available to community-level leaders a ready channel to get technical assistance and subject-matter expertise from national organizations and federal agencies. The task force facilitates the integration of early childhood programs and the behavioral health mission. One of the most important places to be providing behavioral health services in the birth-to-5 age group is child care and Head Start, he said. The task force also enables resource pooling to address gaps. In Joplin, Missouri, for example, the tornado struck just after the Head Start centers in that community had closed in the summer. Head Start grantees had transportation and facilities that were child-suitable and were able to add these resources to the pool and help close the care gaps in the remainder of the community.
Because of the particular vulnerabilities of child care, White said it is often helpful to have a child care workgroup within the larger children’s task force. Participants would include the lead state agency for child care (in some states there may be multiple lead state agencies for child care), ACF, the child care resource and referral agency, Save the Children, child care providers, affected families, FEMA, and others.
The role for national organizations and federal agencies in recovery is to support the state leadership, empower communities, and provide them every resource and tool that will help them achieve recovery. The community needs ownership of the process, White concluded.
Examples of Individuals and Organizations That Participate as Task Force Members
- State agencies with children’s services equities
- Affected parents and youth
- Child care providers
- Child care resource and referral agencies
- Child welfare agencies
- Behavioral health agencies
- Individual pediatricians, pediatric nurses, social workers, child psychologists, child life specialists
- After-school care providers
- Recreational services programs
- Runaway and homeless youth providers
- Family violence prevention and services agencies
- Agencies serving children with disabilities
- Public health and environmental health authorities
- Schools (principals, teachers, counselors, social workers)
- Local religious leaders
- Community action agencies
- Head Start providers
- National Voluntary Organizations Active in Disasters (VOAD) focused on children (e.g., Save the Children, Southern Baptists, Church of the Brethren Children’s Disaster Services)
- Child advocate organizations
- Federal partners including ACF, ASPR, FEMA, others as needed (e.g., Small Business Association, HUD, EPA)
NOTE: ACF = Administration for Children and Families, ASPR = Office of the Assistant Secretary for Preparedness and Response, EPA = Environmental Protection Agency, FEMA = Federal Emergency Management Agency, HUD = Department of Housing and Urban Development.
SOURCE: White presentation, June 11, 2013.
Allison Blake, commissioner of the New Jersey Department of Children and Families (DCF), discussed preparedness and response before, during, and after Hurricane Sandy. In the state of New Jersey, DCF is responsible for Child Protective Services, all of children’s behavioral health care, and services for children with intellectual and
developmental disabilities. DCF operates a network of special education schools for pregnant and parenting teens and children with profound physical impairments, and a very large network of community-based family-strengthening child abuse prevention programs. Blake noted that DCF has no responsibility or authority for sheltering or decision making around mass care. Each of the 21 counties in New Jersey has a county department of human services that is responsible for emergency sheltering and for local homeless sheltering and boarding homes; a county department of health; and an office of emergency management. In each county, there is also a board of social services (formerly called the county welfare agency) that provides temporary assistance for needy families, emergency assistance, and housing assistance. In some counties, the head of Social Services reports to the Department of Human Services, while in others it operates independently. This inconsistency across counties became one of the most complicated parts of the disaster response to Hurricane Sandy, Blake noted.
Hurricane Sandy touched down in New Jersey on October 29, 2012. Blake said that the magnitude of the approaching storm was not fully appreciated until 4 or 5 days before that. In preparation, DCF looked to other jurisdictions for lessons about child welfare. For example, when Hurricane Katrina hit Louisiana in 2005, many state offices were impacted. At that time, Louisiana did not have a client tracking system or a robust system of electronic records, and numerous paper records were destroyed or lost. As a result, foster children who moved out of state with their displaced foster parents were essentially missing, for 2 years in some cases. Medications and prescriptions were lost for children in foster care (and many of the children in the welfare system are taking psychotropic medications which should not be discontinued abruptly).
In fall 2012, New Jersey already had a robust electronic record system in place for case management. In preparation for the storm, DCF established the existing child abuse hotline as the hub or central point of communications for contact with DCF on any issue. All children’s and women’s service providers and all foster parents were notified of this central contact hub via blast e-mails, phone calls, and alerts on the DCF website. Staff were sent to coastal areas to retrieve state vehicles used to
transport children and move them to higher ground so they would be serviceable after the storm.
After the Storm
Devastating flooding and widespread power outages meant that many people did not have television or Internet access to obtain news. The DCF central operations, where the hotline is based, did not flood or lose power, and it became the central point of communications and operations. DCF was able to put in calls to every foster parent in the state within the first 5 days after the storm. There were also daily conference calls with FEMA and the Red Cross.
The day after the storm, the governor’s office began holding conference calls twice daily and providing reports on the number of people in shelters. Although they had data on the number of adults, senior citizens, and even pets, there were no data on children in shelters. As a result, DCF sent “well-being teams” to the shelters to meet with the Red Cross and the county staff and check on the children and families. Blake explained that the name of the teams was intentionally chosen because many people hear “State Department of Children and Families” but think “Child Protective Services.” Blake noted that although many individuals and families who stayed in longer-term shelters were not known to the public systems, they had been living on the edge and were in need of public services. DCF had public health nurses and social workers talking with these people to understand why they were still in the shelter after they were able to return to their communities or other housing options.
A key aspect of the response to Hurricane Sandy was coalition building though the activation of existing resources and relationships. Immediately after the storm, DCF contacted the human services directors in the impacted counties. DCF also reached out to the FEMA-operated disaster recovery centers to provide information about available local social services and community support. The State-Led Child Task Force was also created, focused on identifying a short-term recovery plan for children and families, and long-term recovery needs around trauma, resilience, and other issues. In addition to DCF and the New Jersey Departments of Health, Human Services, and Education, task force members included FEMA, ACF, AAP, New Jersey Volunteer Organizations
New Jersey DCF Long-Term Recovery Plan Target Areas of Focus
Strengthening families and preventing incidence of child abuse that would be exacerbated by the storm
- Strategically bolster DCF’s network of Family Success Centers to enable the centers to continue to be a resource to families during the long-term recovery phase.
- Provide direct assistance to foster/resource homes displaced by the storm to maintain stable home environments for children under the care of the Department of Child Protection and Permanency.
- Ensure child protection worker caseload sizes remain at appropriate levels to be able to effectively and efficiently respond to allegations of abuse or neglect.
- Expand respite services for families with children with special needs.
- Engage pediatric primary health care practices in a partnership to assess, identify, and intervene in a coordinated manner to mitigate the potential negative impacts of this disaster.
Preventing violence and exploitation exacerbated by the storm’s impact
- Broaden existing domestic violence prevention programming.
- Prepare the domestic violence intervention system for the expected increase in incidents of domestic violence.
- Strengthen programs for homeless youth and victims of human trafficking.
Building resiliency and supporting recovery
- Expand access to mental health services for children.
- Provide evidence-based psychosocial disaster recovery programming in schools.
- Provide psychosocial programming for child care centers and other early childhood centers to promote positive early childhood development and build resilience.
SOURCE: Blake presentation, June 10, 2013.
Active in Disaster (VOAD), Montclair State University, Save the Children, and others. Blake stressed the importance of recognizing the unique needs of the local jurisdictions. DCF worked with the county long-term recovery committees to understand the greatest need and gaps in their communities. In January 2013, DCF issued a report on the state’s long-term recovery plan, which is focused on keeping families strong, preventing the potential negative impacts of the disaster on children and
families, and providing swift support and intervention (see Box 10-2).3 Next steps for the state include gathering additional stakeholder feedback, tracking and adjusting in coordination with coalitions, and preparing for the upcoming hurricane season with the new working group and coalition in place.
The New York State Office of Children and Family Services (OCFS) is the child welfare agency, the juvenile justice agency, and regulates all modalities of child care (with the exception of child care centers in New York City). Janice Molnar, deputy commissioner of the Division of Child Care Services at the New York State OCFS, described the office’s preparation and response to Hurricane Sandy.
There are more than 4 million children in New York State, and almost 400,000 live in the Hurricane Sandy surge areas.4 In the days before the storm, OCFS staff prepared geographic information system (GIS) maps of all of the child care providers in the vulnerable coastal areas of the Rockaways and Long Beach. In the days immediately following the storm, the initial focus of OCFS was identifying child care programs that were open and possibly able to take in children from affected areas. She pointed out that this was different from the early federal data collection focus, which was on identifying programs that were closed (to make the case for resources before Congress). There are numerous challenges to collecting data from child care facilities. There are thousands of independent operators who are not part of organized networks, and often not reachable through standard communication strategies and mechanisms. Because many home-based providers are not technology-savvy or do not have e-mail, OCFS still sends out important communications by regular mail, resulting in delays in response. Staff also went door to door to conduct operational assessments of providers. The numbers of open and impacted centers was continuously refined as more information became available. Ultimately, about 11,500 licensed and registered child care programs were impacted by the storm in the 13
3Available at http://www.state.nj.us/dcf/home/HurricaneSandyRecoveryPlan.pdf (accessed September 9, 2013).
counties for which President Obama issued a major disaster declaration (more than half of the 21,000 regulated programs in the state as a whole).
Tools and Best Practices
The day after Hurricane Sandy, OCFS developed and implemented an assessment tool for the licensing staff to use when determining the level of impact on child care programs (via phone if possible, or on foot through onsite inspections). One of the goals of outreach, Molnar explained, was to help open programs stay open, even those without heat, running water, or light. Children’s circumstances were so dire that most would not have fared any better staying at home, and for many it would have been even worse. It was also important to maintain the continuity of care for children to preserve some sense of normalcy in their lives, and to support parents who were struggling with significant issues and for whom the provision of child care was a relief. The GIS maps of facilities created before the storm were overlaid against FEMA maps of flood and surge zones so that OCFS could triage outreach to programs that had the greatest potential of being impacted on the storm. Assessors looked for very basic health and safety procedures (e.g., bottled water, safe food storage, sufficient clothing and blankets, sanitation, working smoke detectors, a way to contact emergency services, and sufficient staff/adequate child supervision). Molnar noted that OCFS waived staff-to-child ratio and group-size requirements on a case-by-case basis to keep as many programs open as possible. She added, as noted by others, that many of the staff helping in the recovery effort were themselves impacted by the storm.
Working to Stay Open
The New York government is a state-supervised, county-administered system, which means that the 62 counties have a considerable authority in determining how they run their child care subsidy systems and other social services. Because there was no time for counties to do plan amendments, OCFS created a simple checklist that counties could submit (by e-mail or by phone) for on-the-spot approval by the state of expanded services to affected families. Districts could be allowed, for example, to extend the eligibility period for services, expand the definition of a child needing protective services, or expand the amount of time a district can
pay for child care for families seeking employment. Molnar stressed the importance of daily communication with the commissioners of the departments of Social Services in the affected counties, representatives of the governor’s office, and representatives of all applicable state agencies.
In addition to outreach, OCFS co-chairs the Children’s Issues Task Force with ACF Region II (discussed by Thomas, above), and Molnar noted that they continue to meet monthly. Meeting agendas included topics such as review of time sensitive deadlines, update on temporary shelters and assistance, updates on housing, or mental health supports. Subcommittees concentrate on specific topical areas such as outreach to immigrant populations, disaster-related food loss, and behavioral and mental health.
OCFS made resources for providers and families available on its website in both English and Spanish, issued waivers to programs to allow them to temporarily relocate, and OCFS staff provided onsite case management at the seven FEMA disaster recovery centers on Long Island. In addition, Governor Cuomo issued an executive order that allowed for temporary suspension of certain statutory provisions related to programs under the jurisdiction of OCFS (for example, child care subsidy eligibility predetermination could be processed in the absence of a family’s supporting documents, which were likely destroyed in the storm).
Molnar described current OCFS activities to improve child care provider emergency preparedness. Existing regulations are very basic and require providers to have a written plan for evacuation and to have evacuation drills once per month. OCFS is proposing new regulations to ensure that each program has onsite supplies sufficient for an overnight stay, including nonperishable food, water, first aid, and other safety equipment in the event parents are unable to pick up children due to a local disaster. There is also a focus on all-hazards planning and training for providers, including chain of command, communications, emergency kits, evacuation and sheltering plans, and business recovery. Online videos are available for providers on emergency scenarios such as what
to pack in a “to go” bag or emergency kit.5 It can take a while for actual on-the-ground practice to catch up with best practice, Molnar concluded, and in New York “we’ve had no choice but to catch up as best we can.”
As national guidelines and support at the federal level are beginning to include the “recovery” phase more and more in documents and agendas, these children and family agencies affected by Hurricane Sandy are important examples of the work and outreach that need to be done after the incident occurs. This also presents an opportunity to engage child care providers and agencies across the country to share lessons and work collectively through ACF on improving plans and preparedness for future incidents.
5The video library is available at http://www.ecetp.albany.edu/videolibrary.shtm#emergencyvids (accessed September 9, 2013).