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Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
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8

Social Services

Disasters are profoundly discriminatory.

—MacDonald, 2005

As a result of preexisting conditions in communities, disasters have disproportionate effects on certain subpopulations, particularly those of low socioeconomic status and other marginalized groups. Loss of meager resources, exacerbation of preexisting health conditions, and higher rates of prior trauma can lead to poor health outcomes in impoverished groups, including increased incidence of substance abuse (Cepeda et al., 2010a) and mental distress (Cepeda et al., 2010b). Social services1 professionals act as advocates and service providers to underserved populations, enabling people to access critical goods and services and to become healthier and more self-sufficient. By ensuring access to needed resources, social services can help mitigate impacts of disasters on vulnerable populations.

Unfortunately, the social services sector has until only recently been largely excluded from preparedness and emergency management efforts (White, 2014). Events such as Hurricane Katrina that had devastating effects on vulnerable populations have demonstrated the importance of integrating social services into all other recovery activities, including but not limited to clinical care delivery, housing, economic and workforce development, and transportation. A RAND Corporation study on human services recovery 4 years after Hurricane Katrina found that nongovernmental organizations (NGOs) in Louisiana suffered from a lack of state and federal focus on human recovery and received little support for long-term case management. NGOs also reported that they were not integrated as partners in recovery planning and received little guidance on the implementation of human recovery plans (Chandra and Acosta, 2009). Yet successful human recovery depends on vertical integration and cross-sector coordination, collaboration, and communication—facilitated by technology and ongoing interagency relationships.

This chapter examines the impacts of disasters on the social services sector, the role the sector plays in advancing health in the community and reducing disparities, and the actions that various actors within the sector can take before and after disasters to ensure that the human needs of all community members,

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1 The terms “social services” and “human services” are used interchangeably in this chapter since both terms can be found throughout different reports, guidance materials, and other documents examined by the committee.

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

but especially the most vulnerable, are met. These activities, if undertaken, have the potential to yield significant positive impacts on recovery of community members and to make significant contributions to the creation of healthy communities. In developing its guidance, the committee identified the following key recovery strategies for the social services sector that should cut across all phases of the disaster cycle and that represent recurring themes throughout this chapter:

  • Build on existing relationships and establish comprehensive plans for collaboration among social service funders and providers, community- and faith-based organizations, and advocates to ensure coordinated social service delivery through all phases of disaster planning and recovery.
  • Integrate social services recovery plans into other disaster recovery services.
  • Create compatible structures, policies, and procedures to promote the flow of funding and information across federal, state, and local systems.
  • Provide support to reunite families and promote resilience through community programming designed to strengthen social support networks.
  • Focus on restoring normalcy through key community services/activities, such as child care, elder care, foster care, mental health services, schools, housing, jobs, and transportation.
  • Enhance efforts to increase accessibility and reach the most vulnerable populations to provide needed social services.
  • Promote ongoing evaluation and continuous learning to advance social services efforts in achieving health community goals.

The chapter concludes with a checklist of key activities that the social services sector needs to perform during each of the phases of recovery.

SOCIAL SERVICES IN THE CONTEXT OF A HEALTHY COMMUNITY

As discussed in Chapter 2, social factors are an important determinant of health. The social services sector has close contact with members of the community who have been most disadvantaged by these factors; therefore, social services are one of the main tools for addressing the social determinants of health (e.g., access to healthy food, safe and supportive environments for children) and ensuring health equity (White, 2014). The social services system directly assists individuals and families that have insufficient resources to meet their needs—often as a result of systemic inequalities—and advocates for structural and policy changes aimed at alleviating the underlying causes of such inequalities. There is clear evidence of disproportionate health risks associated with low socioeconomic status. Lower income is associated with shorter life expectancy, worse self-reported health status, and greater occurrence of chronic diseases such as diabetes and heart disease (RWJF, 2008). Social service supports are vital in mitigating these effects, and higher rates of spending on social services are linked to better health outcomes (Bradley and Taylor, 2013). The portfolio of social services programs in the United States is diverse and covers the entire life course, from pregnancy to aging services. These services impact health outcomes through a number of mechanisms, such as nutrition, health care access, and injury prevention (see Table 8-1).

In a healthy community, the social services sector provides accessible, equitable, and high-quality services that support the social and economic well-being of all people, particularly the most vulnerable, enabling self-sufficiency and thereby preserving the dignity and respect of individuals and the community. Service delivery is not reactive and crisis-driven; rather, it mirrors the proactive and prevention-based approach now taking hold in the health care sector. Consumer-centric systems built on a “no wrong door” policy offer a full range of services and supports and an assessment process that evaluates client needs comprehensively. Thus, in a healthy community, social services are integrated—strategically and operationally—within the sector but also with public health, clinical care, behavioral health, housing, and community development services so that resources are used as efficiently as possible to address the social factors that drive health outcomes.

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

TABLE 8-1 Mechanisms by Which Social Services Programs Influence Health Outcomes

Social Services Program Type Injury Risk Health Services Access Stress-Related Economic Determinants Behavioral Health Environmental Developmental
Economic Security (Cash Benefit) X images images X images
Child Support images X images X
Early Childhood images X images images images images
Family Violence images X images X images X
Child Welfare images images images images images images
Nutrition images images images
Energy X images images images
Aging Services images images images X images images
Vulnerable Population Services images images images images images images images

NOTE: “X”s denote committee additions to the original figure.

SOURCE: Adapted from White, 2014.

Agenda setting for and implementation of social services are optimally effective if private, nonprofit, philanthropic, faith-based, and neighborhood stakeholders are integrated into the process. Unfortunately, few communities in the United States benefit from an integrated and sustainable social support system. In most communities, social services capacity is strained by a number of complex challenges, including fragmentation, which impedes access; lack of coordination of funding streams and service providers (Smith, 2008); fluctuating levels of funding; chronic workforce shortages; and, relatedly, overburdened case workers (AECF, 2003). In addition, silos have resulted from the proliferation of social service programs designed to meet the specialized needs of specific vulnerable populations and from multiple separate funding streams. Considerable inefficiency results as isolated programs end up servicing the same clients in the absence of systems for collaboration, information sharing, and coordination of funding (Smith, 2008).

In recent years, economic recession has resulted simultaneously in increased demand for services and major budget cuts, posing significant challenges to local government agencies that fund and provide community services, including social services. These and a number of other forces (aging populations and an increasing understanding of the link between economic vitality and social conditions such as poverty and homelessness) are driving interest in new approaches and models for social service delivery. Some social service agencies are following the lead of the business community and offering clients complete solutions rather than discrete services (Smith, 2008). Despite the improved efficiency of integrated systems, however, lack of political will and fiscal resources may impede a major overhaul. To restate a central theme of this report, although disasters pose significant challenges to communities by further straining already fragile systems, they also provide an opportunity to create healthy communities—in the present context, to achieve more integrated and sustainable models of social service delivery—by building on disaster-related collaborations and creative uses of relief and recovery funds.

DISASTER-RELATED SOCIAL SERVICES CHALLENGES

Disasters generate increased demands on all social services because of impacts on vulnerable populations, the creation of newly vulnerable populations, interrupted service delivery, and displacement of both

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

providers and clients. Social service providers are called upon to mitigate the human impacts of disasters and fill the gaps in resources and capabilities. The same health determinants shown in Table 8-1 are relevant to the post-disaster context. For example, when schools and daycare centers are closed, children who have no safe place to play can be at increased risk of injury, and parents can experience added stress when there is no safe place to leave their child(ren) so they can return to work and begin restoring some normalcy to their lives (White, 2014). Post-disaster communities also experience increases in mental health and substance abuse issues (see Chapter 7), domestic violence, and child maltreatment (NJ DCF, 2013).

Disaster-related disruption of social services can impact health outcomes both directly and indirectly, and inadequate attention to the social service needs within a community will result in a greater postdisaster burden of poor health in the community. Depending on a disaster’s nature and scope, it may both cause a surge in social service needs within the community (and perhaps in the surrounding areas), due to trauma and resource-related vulnerabilities, and diminish the sector’s capacity to respond to those needs through loss of personnel and/or infrastructure. Service provision is further complicated in many disasters by damage to community infrastructure, including facilities of employers; schools; businesses essential to the fabric of the community, such as grocery stores and child care; and transit vehicles and routes. These losses have negative effects on food and job security for some disaster victims and tend to have disproportionate impacts on a community’s already-vulnerable populations.

The roles of social service professionals immediately after a disaster are largely an extension of their pre-disaster functions (although case loads are significantly increased). After a disaster, two priorities emerge: ensuring continuity of services in the face of disaster-related disruptions and addressing disaster-related unmet needs (HHS, 2014a). Specific roles include but are not limited to

  • reestablishing access to food, shelter, and clothing;
  • facilitating access to needed medical providers, medications, equipment, and auxiliary services (in concert with clinical care organizations);
  • reuniting displaced family members;
  • facilitating access to federal disaster benefits (following presidentially declared disasters) by collecting and/or re-creating needed documentation;
  • managing stress and behavioral health issues exacerbated by a disaster (in concert with NGOs and faith-based organizations); and
  • coordinating with Social Security, Medicaid, and other entitlement programs regarding survivors’ benefits.

It should be noted that many of these roles may begin during the response phase but continue into recovery, in some cases for years after the disaster. As the recovery progresses past the immediate crisis, opportunities exist for social services to evolve to incorporate holistic strategies targeted at achieving a healthy community.

Many barriers to access (e.g., physical impairment, location, hours of operation, language) need to be considered in planning for social services during the recovery period. For example, special attention is needed to ensure that messaging is culturally sensitive. Reaching the social service sector’s diverse constituencies can be particularly difficult, and multiple avenues of communication are required. Low literacy, low English fluency, lack of computer access, and confusion related to stress must be taken into account. Existing pre-disaster communication mechanisms, such as those established by immigrant-serving organizations, are important tools for reaching non-English-speaking populations. Using respected spokespeople to target subpopulations can increase receptivity to important messages. As recovery progresses, the community needs easily accessible information regarding resources for rebuilding; a clearinghouse website such as the New Orleans area’s GNOinfo.com provides a wide array of information in a centralized location to encourage self-help and resiliency.

Underpinning all of these considerations is the need to develop metrics for success and sustainable methods for measuring the effectiveness of chosen processes and interventions. Realistically, chronically

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

limited resources and the difficulty of measuring outcomes make this task difficult. Recovery organizations focused on fundraising, volunteer management, and other aspects of recovery but with limited staff expertise for assessments may use other organizations to assist with this task. For example, Habitat for Humanity, among other housing organizations, may have the capacity to conduct a housing needs assessment. Such collaboration depends on the relationships among organizations and illustrates the importance of establishing such relationships prior to a disaster and sharing information.

Also important is for those involved in recovery processes to assist with identifying sources of capital and financing for rebuilding in ways that support a healthy community, incorporate lessons learned, and continuously measure progress toward healthy community goals. Whenever possible, communities that have faced disasters can disseminate information valuable in improving social services and share lessons learned so that other jurisdictions can benefit from their recovery experiences.

SOCIAL SERVICES SECTOR ORGANIZATION AND RESOURCES

Key stakeholders in the social services sector include agencies within the local, state, and federal levels of government, as well as nonprofit organizations, faith-based groups, and other private providers. A description of roles and responsibilities at each level and challenges related to integration of the social services provided follows in the sections below.

Federal Level2

Federal roles related to social services include funding, regulation, technical assistance, and coordination. Federal grant programs, primarily block grants, provide much of the day-to-day funding for state and local social service programs and can be leveraged after a disaster to support recovery efforts;3 in the current fiscally constrained environment, however, this funding has been diminishing. Block grants often go to the states, and those funds are then allocated to support governmental and/or nongovernmental programs. Funding for Head Start programs is different in that it goes directly from the federal level to the service provider (ACF, 2015c). Although a number of federal agencies support community social services programs, the three major contributors are (1) the Administration for Children and Families (ACF) and (2) the Administration on Community Living4 (both within the U.S. Department of Health and Human Services [HHS]), and (3) the Food and Nutrition Service within the U.S. Department of Agriculture, which funds the Special Supplemental Nutrition Program for Women, Infants, and Children (commonly known as WIC) and the Supplemental Nutrition Assistance Program (SNAP). One of the few federally funded

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2 A broader synopsis of legislation and federal policy related to disaster recovery and health security can be found in Appendix A.

3 Federal block grants to support social services include the following:

  • Community Development Block Grants (CDBGs), administered by the U.S. Department of Housing and Urban Development, are used to benefit low- or moderate-income people by ensuring affordable housing, providing services, and creating jobs (HUD, 2014).
  • Social Services Block Grants (SSBGs), administered by the Administration for Children and Families, provide funds for services such as daycare, case management, and protective services for adults and children (ACF, 2015b).
  • Community Services Block Grants (CSBGs), administered by the Administration for Children and Families, are intended to improve self-sufficiency and living conditions among low-income people by addressing such issues as employment, education, housing, nutrition, and health (ACF, 2015a).
  • The Child Care and Development Fund (CCDF), administered by the Administration for Children and Families, provides working families with child care subsidies and improves the quality of child care (ACF, 2012).
  • Community Mental Health Services Block Grants, administered by the Substance Abuse and Mental Health Services Administration, fund programs and centers that serve adults with serious mental illnesses and children with serious emotional disturbances (SAMHSA, 2015).
  • The Family Violence Prevention and Services Act Program, administered by the Administration for Children and Families, provides funds for “emergency shelter and related assistance for victims of domestic violence and their children” (FYSB, 2015).
  • Substance Abuse Prevention and Treatment Block Grants, administered by the Substance Abuse and Mental Health Services Administration, provide funds for substance abuse prevention and substance abuse disorder treatment and recovery for specific target populations (SAMHSA, 2015).

4 The Administration for Community Living works to “maximize the independence, well-being, and health of older adults, people with disabilities, and their families and caregivers” (HHS, 2014a, p. 13).

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

disaster-specific human services programs is the Disaster Supplemental Nutrition Assistance Program, D-SNAP (White, 2014).

In the aftermath of a disaster, block grant funds can be made available for disaster recovery through either the congressional appropriation of additional disaster-specific funds or the reprogramming of current funds. Congress has appropriated billions of additional dollars for recovery through the Community Development Block Grant for Disaster Recovery (CDBG-DR) vehicle, which has broad latitude in terms of eligible expenses (HUD, 2014). Communities also have been permitted to reprogram their annual CDBG funds for disaster relief activities, and the U.S. Department of Housing and Urban Development (HUD) is statutorily authorized to suspend almost all program requirements in disaster areas (CRS, 2014). Congress has also appropriated supplemental funds to the Social Services Block Grant (SSBG) program three times in the past to help with recovery from natural disasters (CRS, 2012). SSBG funds appropriated specifically for disaster recovery (SSBG-DR) have fewer limitations than funds appropriated under the general SSBG program. Activities specifically permitted under SSBG-DR include food cards, child care vouchers, temporary housing, and repair or rebuilding of damaged facilities (including mental health facilities, child care centers, and other social service facilities) (ACF, 2013a). Following Hurricane Sandy, additional funding was provided for Head Start programs to cover costs of services (including behavioral health services for affected children) and renovation/repair of damaged facilities (ACF, 2013b).

In addition to funding, agencies provide technical assistance to help communities use their block grant funds for disaster recovery. For example, ACF released guidance on how funds from the Child Care Development Fund (CCDF) can be used flexibly after a disaster (e.g., paying for child care for displaced families or making minor repairs to child care facilities) (ACF, 2005).

Under the National Disaster Recovery Framework (NDRF, described in more detail in Chapter 3), social services fall under the Health and Social Services Recovery Support Function, which is coordinated by the Assistant Secretary for Preparedness and Response (ASPR) on behalf of the Secretary of HHS (FEMA, 2011). The Health and Social Services Recovery Support Function encompasses three key social services activities: (1) social services impacts, (2) disaster case management5 and referral to social services, and (3) children’s needs in disaster recovery. In 2014, ASPR released the Disaster Human Services Concept of Operations (CONOPS), which provides the framework for coordination and guidance of HHS’s federal-level social services activities before, during, and after a disaster (HHS, 2014a). It describes several coordinating structures for HHS operations related to social services during the preparedness, response, and recovery phases. The committee finds these efforts to create a “one HHS” enterprise with integration of social services into departmental responsibilities related to public health and medical care, behavioral health, environmental health, and responder health and safety to be commendable. However, the CONOPS does not address needs for interdepartmental coordination of federal social services support. Importantly, under the National Response Framework (NRF), human services,6 temporary housing, and mass care fall under Emergency Support Function #6, which is led by the Federal Emergency Management Agency (FEMA) (FEMA, 2013). Thus, significant coordination between HHS and FEMA7 is required to ensure a smooth transition in human services operations from response to recovery, and the development of a broader framework for coordination of social services activities is critical.

One additional gap the committee identified at the federal level is a lack of comprehensive federal

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5 Disaster case management is described in more detail later in this chapter.

6 “Human services, for purposes of ESF #6, is defined as disaster assistance programs that help survivors address unmet disaster-caused needs and/or non-housing losses through loans and grants; also includes supplemental nutrition assistance, crisis counseling, disaster case management, disaster unemployment, disaster legal services, and other state and federal human services programs and benefits to survivors” (HHS, 2014a, p. 9).

7 Disaster case management is another area requiring significant coordination between HHS and FEMA. Following a presidentially declared disaster with authorization for individual assistance under the Stafford Act, FEMA may also play a major role in directly supporting social services by funding disaster case management (DCM) services. One option for DCM, the Immediate Disaster Case Management program, is administered by the Administration for Children and Families in HHS. A Concept of Operations for the Federal Immediate Disaster Case Management program was released by HHS in 2012 and is available at https://www.acf.hhs.gov/sites/default/files/ohsepr/immediate_dcm_concept_of_operations_conops_october_2012_508_compliant.pdf (accessed April 3, 2015).

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

guidance for state and local social service organizations. Although there is some topic-specific guidance, such as ACF’s guidance on developing task forces, general guidance (such as best practices) for these organizations is lacking.

State and Local Levels

All states have departments for social (or human) services, although multiple departments often share responsibility for these services. At the local level, many large cities, counties, and tribes have social service departments that cater to needs specific to their communities. Other communities have no social service department or are served by a higher level of government, and some social service departments offer only a limited range of services. Overall, these agencies provide regulation and enforcement, direct services, training, public awareness campaigns, and long-term planning for community social service needs.

State human service organizations provide oversight for local operations and are a prime funding source. Depending on the state, they impose various levels of regulation on local entities. Local operations depend highly on the state, but are nevertheless independent in developing creative solutions in times of disaster. In presidentially declared disasters, in which supplemental funding through Social Services Block Grants is available, those funds pass through the state to local operations (ACF, 2014).

Countless nonprofits and faith-based organizations operate around the country, focusing on separate areas of social services needs (GuideStar, 2014; Pipes and Ebaugh, 2002). These organizations often receive government funding to support their work, especially during and after disasters and other emergencies. Faith-based organizations and nonprofits play a critical role in social service delivery because they often fill gaps in government services. They also provide an outlet for the involvement of community volunteers and residents in social service delivery. Philanthropy plays a significant role in the social services sector as well. Donations to human services organizations made up 12 percent of all charitable giving in 2013, totaling more than $40 billion (National Philanthropic Trust, 2014).

Cross-Sector Collaboration

Leaders of all social service organizations can have positive impacts on the health of their community following a disaster through leadership, intraorganizational collaboration, and teamwork throughout the community. However, the fragmentation that exists during steady-state times poses significant challenges to coordination among social service providers after a disaster. And although many documents promoting improved disaster recovery stress the importance of cross-sector collaboration, such partnering often is difficult to achieve. Human services agencies and organizations are notoriously understaffed. As one human services provider in Pennsylvania stated, “Every day is an emergency for us” (Hipper et al., 2013, p. 14). In addition to limited staffing, most agencies are hampered by a general lack of sufficient resources, have differences in eligibility definitions, have different perspectives on strategies based on their focus, and receive no added funding for collaboration. They also may distrust other organizations and see the demands of collaboration as threatening to their organizational autonomy.

Communication among social service professionals (both intra- and interagency) during recovery planning and implementation needs to emphasize purposive, collaborative decision making and program implementation with the goal of building the community’s short- and long-term health and well-being. Regularly scheduled meetings of social service and other providers was important to the sharing of information and coordination of service delivery in post-Katrina New Orleans.8 Building a culture of teamwork and acceptance among collaborators is an ongoing process greatly aided by frequent multimodal communication.

Empowerment of vulnerable populations in recovery also is critical. Organizations should identify vulnerable populations and their potential needs before a disaster strikes and institutionalize meaningful

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8 Personal communication, J. Kelly, CEO Kingsley House, to L. Usdin, committee member, regarding post-Katrina recovery of social service, September 2013.

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

participation of these groups in planning efforts. Research investigating how early identification and support of vulnerable populations can reduce long-term needs and psychological consequences associated with disasters would be helpful in making the case for these identification and inclusion efforts. Social service professionals can act as advocates for vulnerable populations, working with key community partners to ensure that their needs are met both before and after disasters. Such community partners include but are not limited to planning, housing, community development, and public health departments; schools; employment agencies; health care organizations; and their respective partner organizations in the for-profit, nonprofit, and philanthropic sectors. Many of these organizations have goals in common (or at least compatible) with social service providers, as well as relevant experience and resources. Social service agencies seeking to form or enhance cross-sector partnerships are most effective when they understand and leverage preexisting administrative arrangements, processes, advisory bodies, and funding streams operating at the local level instead of attempting to create new structures that compete for scarce financial, time, and staff resources. One-off projects implemented outside of existing structures typically lack longevity as a result of insufficient buy-in.

Organizations need to determine the level and type of integration most appropriate to their local circumstances. A universal need, however, is for agencies—and professionals within them—to build an understanding of partnering organizations and professions, including the rules and constraints under which they operate. Cross-training is one way to accomplish this goal. Social service leaders also should be attuned to opportunities to share their expertise and their sensitivity to diverse needs to inform recovery efforts in other sectors. For highly vulnerable populations, a greater degree of integration is warranted, while for less vulnerable populations, looser linkages between organizations may be more appropriate (Leutz, 1999).

Planning Departments, Community Development Entities, and Housing

City planners (also often called community planners or urban and regional planners) develop comprehensive plans that guide long-term private- and public-sector land development. These plans affect residential and business growth patterns and the associated infrastructure, all of which in turn affect the neighborhoods and services available to residents. Planning processes employed during steady-state times and after disasters typically provide for community participation (see the discussion in Chapter 3 on public engagement), which can be leveraged by social service organizations to discuss the needs of their client populations (Enarson and Fordham, 2001). Planning departments and community development entities are logical partners with social services departments in pre-disaster planning.

The community development sector shares goals with social services—both aim to help low-income populations improve self-sufficiency and access to services and amenities. Although there are important exceptions, community development generally uses “place-based” strategies (e.g., affordable housing, public transit systems; see Chapter 9) as opposed to the “people-based” approaches of the social services sector. The community development sector does its work to alleviate poverty and revitalize neighborhoods through planning processes that would (and in some communities already do) benefit from collaboration and coordination with health and human services agencies (Erickson and Andrews, 2011).

Housing service organizations work on such issues as homelessness, access to affordable housing, and eviction prevention. These organizations are closely linked to social services, as both aim to help low-income populations meet basic needs and maintain self-sufficiency. Clients of housing service organizations may be particularly vulnerable during and after a disaster as a result of closure of public housing or shelters, as well as a lack of resources to secure alternative housing. (Disaster-related housing issues are discussed in Chapter 10.)

Public Health, Behavioral Health, and Clinical Care Delivery

The client populations served by social services every day are the same populations that are at risk for adverse health outcomes after a disaster (i.e., the socially vulnerable). Public health and social service organizations have an interest in working collaboratively to find mechanisms for mitigating these adverse

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

outcomes. Likewise, the behavioral health and health care sectors need to work in tandem with social service organizations, as both mental and physical health issues can be exacerbated or caused by a disaster, and the populations served by social services are particularly at risk for these outcomes. Collaboration among social services, public health, behavioral health, and clinical care can markedly improve the health and well-being of individuals and communities affected by a disaster by coordinating care, improving the client experience, and reducing the burden on each individual organization. For example, The Jesse Tree, a social service organization in Galveston, Texas, partners with the public health department, clinical care providers, and mental health providers. Its clients can receive services as varied as classes in chronic disease management, referrals to federal assistance programs, glucose screening, and case management all under one roof. After Hurricane Ike, The Jesse Tree and its partners continued to work together to meet the emergent and ongoing needs of the community. Community health workers such as those at The Jesse Tree can provide “a community-based system of care and social support” that links social services with health care (CDC Division of Diabetes Translation, 2003) and promotes a healthy community approach to recovery. (The Jesse Tree is used as a case study later in this chapter.)

PRE-DISASTER SOCIAL SERVICES SECTOR PRIORITIES

In keeping with a key theme of this report, the committee emphasizes that the speed and success of social services recovery after a disaster depend heavily on pre-disaster planning both within the social services sector and collaboratively across sectors. The committee identified three key pre-disaster priorities in which the social services sector should be engaged to support pre-disaster recovery planning efforts:

  • Establishing Forums for Coordination and Collaboration Before and After Disasters
  • Establishing Mechanisms for Information Sharing After Disasters
  • Planning for Fluctuations in Social Services Workforce Needs

Establishing Forums for Coordination and Collaboration Before and After Disasters

Social service providers have limited resources to fulfill their missions even in non-disaster times. Thus, it is important to integrate pre-disaster planning into existing planning processes instead of creating additional processes. Organizations aiming to improve planning for social services recovery can build on existing community leadership and coordinating entities. These entities take many different forms, such as advisory groups and collaboratives. Often there are multiple coordinating entities in a community that work on specialized issues (e.g., child welfare, homelessness, domestic violence). If a community-level forum does not already exist, leaders should consider forming one to foster cross-sector coordination for purposes of (1) defining resources, roles, and responsibilities in recovery; (2) appropriately sharing client information among service providers; and (3) maximizing access to recovery resources, information, and activities. In addition, these forums provide a central clearinghouse and communication base for updated information on each organization’s key contacts and provide up-to-date information for all partners. Forums also are important arenas for the development of structures, policies, and procedures that facilitate a culture of collaboration and promote information sharing. Memorandums of understanding and mutual-aid agreements specifying disaster-related resources, roles, and responsibilities are useful mechanisms for formalizing these relationships. It is critical that all essential partners be identified and invited to participate in such forums.

Voluntary Organizations Active in Disaster (VOAD) and Community Organizations Active in Disaster (COAD) (described in Box 4-1 in Chapter 4) are common forums for collaborating on disaster issues related to human needs. Involvement of local health departments in COAD can help ensure that health considerations are better integrated into local planning efforts and that essential health and social services are prioritized in post disaster recovery. VOAD and COAD usually are involved in the formation of long-term recovery committees. These groups—which can go by a number of different names, including long-term recovery groups and unmet needs committees—link recovery resources to the unmet needs of

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

BOX 8-1
Considerations for Coordination of Long-Term Recovery Committee Activities

Coordination in the context of long-term recovery committees (LTRCs) is fundamentally different from the coordination that occurs among stakeholders involved in early recovery efforts (e.g., those conducting damage assessment, setting up response centers, and reestablishing vital services). First responder agencies are for the most part seasoned in disaster response, their roles are defined, and it is not unusual for many of these organizations to have previous experience working together. They also operate within the “honeymoon” phase of the recovery process, when optimism and good will prevail despite concerns over the magnitude of the task ahead. While conflicts are common among agencies, a process and institutional context for handling these matters are in place. LTRCs are being organized and/or activated during the initial recovery phase, but their work can extend to several years or more after the event, with a period of disillusionment arising from the inevitable delays associated with the recovery process.

The job of the LTRC entails a series of complex tasks such as recruiting and housing volunteer groups, assessing unmet needs, coordinating construction, establishing a case management strategy, and coordinating public and donated funds. The forum provided by the LTRC is a natural place for questions to be raised and concerns expressed by a cross section of stakeholders. In this context, and given the diversity of participants, spirited debate can be expected. It is often said that a disaster does not resolve underlying issues within a community, and such issues predictably emerge as the recovery process proceeds.

LTRC membership consists of funding agencies, faith-based groups, responder agencies, and many other interested organizations, including local community groups. Such diversity in membership and differing interests within the group pose unique challenges for LTRCs. Funding organizations frequently want assurances that the recovery is well organized and proceeding satisfactorily, while community groups are concerned with the changes in their community and the many unmet needs of residents. Additionally, constituencies have differing styles of debate, dialogue, and decision making, which adds to the challenges of long-term recovery efforts. When these issues are identified and handled, the long-term recovery process proceeds more smoothly in terms of both process and production. But when these issues go unresolved or are handled only partially, resulting problems with low trust levels and ongoing conflict can impede or even derail the recovery effort. Thus, special attention needs to be given to ensuring that a full voice and participation are afforded to a representative cross section of the community.

community members “in order to ensure that even the most vulnerable in the community recover from disaster” (National VOAD, 2012, p. 6). These important coordinating entities (discussed further in Box 8-1) are composed of members of nonprofits, governmental organizations, faith-based entities, and businesses, and they can be structured in many different ways depending on such factors as local needs, available resources, and community history.

Establishing Mechanisms to Facilitate Record and Information Sharing After Disasters

Development of an institutionalized cross-agency record-sharing arrangement before a disaster facilitates post-disaster social services recovery (see Box 8-2). Most social service clients are eligible for, and use, a wide variety of services; with proper attention to confidentiality and consent, information and documentation collected by one service provider can be shared with others.9 This allows service providers

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9 The American Red Cross has an exemption from requirements of the Health Insurance Portability and Accountability Act (HIPAA) during certain emergencies. This legal caveat enables them to provide family members of disaster victims with some basic information that generally would not be allowable (HHS, 2014b).

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

to see the full picture of community services and resources used by clients, thereby helping to reduce overlapping services and service gaps. It also frees up time that would otherwise be spent on intake interviews for other case management activities and reduces stress on disaster survivors associated with multiple intake processes. As noted earlier, moreover, disaster survivors often are mobile (i.e., they may relocate, temporarily or permanently, to other jurisdictions). Allowing documentation and case management notes collected by agencies in one jurisdiction to follow clients to sister agencies in different jurisdictions avoids the need for those agencies to start over with new intake and qualification processes, and it gives them a more comprehensive understanding of client needs and progress already made. Finally, because service providers typically change over time following a disaster—with national early responder organizations augmenting local organizations in early recovery, then transferring cases to local agencies for longer-term management—record sharing avoids the loss of data between organizations. Establishing such a system prior to a disaster is key in light of the chaos and emergent demands on time and resources following a disaster.

The first step in creating a shared system is to develop an understanding of existing social service data sources, reports, and relationships and to explore opportunities for access to electronic records. As mentioned above, strategies for dealing with challenges to the sharing of information/reports need to be explored and developed. During the pre-event stage, post-disaster data needs can be identified. Sharing an information plan with all partners makes it possible to develop a comprehensive system for meeting information demands after a disaster.

Planning for Fluctuations in Social Services Workforce Needs

One of the most difficult challenges prior to a disaster is anticipating social services resource needs after such an event. Disasters have differential impacts depending on the extent of infrastructure and housing damage, as well as the number of people impacted. Despite this uncertainty, communities need to consider before a disaster strikes the array of services that may be needed and how they can be provided. Pre-disaster planning requires clear articulation of who will recruit and train staff and volunteers so that public and private agencies and organizations will be familiar with their roles and responsibilities in advance of a crisis. The training needs to cover mental health needs, as well as special post-disaster issues, such as accessing benefits. Pre-disaster planning also should include memorandums of understanding among governmental and private agencies, local hospitals, NGOs, schools and child care centers, faith-based organizations, and other groups, specifying disaster-related roles, responsibilities, and duties. Continuity of operations plans can facilitate rapid recovery after a disaster, promote the concepts of a healthy communities approach, and provide guidance on social service impacts for medical service personnel and emergency management partners. More research is needed on how the social services sector can anticipate the impact of a disaster on the workforce, maintain a healthy workforce, and optimize functioning after a disaster.

When a disaster strikes, communities may need more intake workers, grief counselors, and other paraprofessionals. Not only must previously vulnerable populations be reached, but disasters create newly vulnerable populations that must be identified. Communities that have developed a rapid assessment capacity for identifying social service needs consistent with state and local emergency response and recovery plans are better situated to identify and serve the expanded pool of vulnerable populations.

The number of available providers fluctuates during different phases of disaster recovery. In the immediate post-disaster period, communities may experience a loss of providers because providers themselves are affected by the disaster and are either displaced or incapable of offering their usual services. The surge of untrained volunteers can further drain professional resources because providers must spend time supervising and training them. As the recovery progresses, providers may experience burnout and need breaks, and volunteer support will diminish. This oscillation in workforce capacity should be planned for in advance. Potential ways to preserve or expand the social service workforce capacity after a disaster include

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

BOX 8-2
Information Systems in Social Services Recovery

Coordinated Assistance Network

The Coordinated Assistance Network (CAN) is a multiorganizational partnership among many disaster relief organizations in the United States, including the Red Cross and United Way (CAN, 2014a). CAN was founded following the September 11, 2001, terror attacks to allow for information sharing across disaster relief organizations, thereby improving the quality, efficiency, and management of response to a disaster. The network was piloted during the 2004 Florida hurricanes and has played a role in the response to other major disasters, including Hurricane Sandy (2012), the Oklahoma City tornadoes (2013), and the Deepwater Horizon oil spill (2010) (CAN, 2014c). CAN’s website (www.can.org) features an extensive cloud-based database system that is used to collect data on the experiences of clients in the wake of a disaster (CAN, 2014b). The database is open to any relief organization operating in the United States that chooses to use it, but CAN’s client data must remain confidential within the user network. For more information about CAN, see http://www.can.org/images/CommunityIntro.pdf (accessed April 4, 2015).

Efforts to Outcomes™

Efforts to Outcomes™ is software designed to help nonprofits collaborate and share data across organizations. The software can track and analyze demographic data, manage referrals, assess needs and progress, identify and track trends, and monitor and assess program and staff effectiveness (Social Solutions, 2014). Boulder County, a user of Efforts to Outcomes, finds that it allows multiple divisions in the county government to share data and coordinate services. For example, when individuals seek service, their data need be entered into the system only once, and providers across the collaborative are informed (Microsoft Case Studies, 2010).

Parkland Center for Clinical Innovation (PCCI) Pieces™

There is increasing focus on incorporating sociodemographic information (e.g., education, employment, and financial resource strain) into electronic health records (IOM, 2014) to support both individual- and population-level health interventions. Such information also has value in the planning for and response to disasters, particularly with respect to identifying and serving at-risk populations. PCCI, a nonprofit organization in Dallas specializing in the development of real-time predictive and surveillance analytics for health care, has created Pieces™, software designed to identify patients at high risk for experiencing an adverse event by detecting clinical and social risk factors in the electronic health record system. PCCI also has developed an information exchange portal that captures social health components important to public health preparedness and response. The aim is to include more than 400 community organizations that provide a range of social services, including food and nutrition assistance, shelter, transportation assistance, housing assistance, and financial support. The information exchange portal uses technology to provide coordination of care for patients moving throughout the various health and social sectors. Connie Chan, project director at PCCI, reports that many of the benefits of health information technology, including information exchange portals, not only are useful during daily operations but also can provide extra benefit during disasters or emergencies (Chan, 2013).

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×
  • preventing burnout by rotating workers through difficult assignments, assisting caseworkers with child care or other services that may have been disrupted, or offering peer support;
  • recruiting professionals from other communities and states, which may require emergency licensure of professionals10;
  • integrating providers from relief groups such as the American Red Cross, the Salvation Army, Church of the Brethren, and other National Voluntary Organizations Active in Disaster (National VOAD) members;
  • integrating staff and volunteers from existing community groups, including clergy/faith leaders and other community leaders;
  • exploiting cross-cutting opportunities for accreditation;
  • developing systems for including spontaneous volunteers;
  • maintaining up-to-date lists of translators and bilingual providers to help reach non-English-speaking vulnerable populations; and
  • engaging providers from retired professional groups.

As noted above, organizations may be inundated with volunteers who need to be trained to support the provision of social services; the use of untrained spontaneous volunteers is not a viable option since it raises liability issues (Sauer et al., 2014). Pre-disaster training programs can reduce the burden associated with post-disaster “just-in-time” training needs. More research is needed, however, to elucidate the training needed to support the social services system in a disaster and to clarify which tasks are appropriate for volunteers and how NGOs and faith-based organizations can be mobilized in planning efforts. Some communities have found it helpful for a single local organization to register and coordinate volunteer workers. A clearinghouse for volunteers also can help during the chaos following a disaster. Hands On, for example, is a national group that establishes procedures and systems for coordinating untrained volunteer efforts. Such clearinghouses require clear standards covering issues that include

  • the need for volunteers to have a basic background check;
  • how volunteer hours can be tracked for possible credit against FEMA’s local match requirement for public assistance funds;
  • issues of training and liability for spontaneous untrained volunteers to minimize safety risks; and
  • the need for regular, coordinated communication with volunteers (e.g., training opportunities, updates, news).

Several resources can help in addressing the need for increased social services workforce capacity after a disaster. These resources include but are not limited to

  • FEMA Crisis Counseling Assistance and Training Program funding for counselor training (for psychosocial support services),
  • SSBG-DR-funded education and training programs,
  • hotlines such as the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Disaster Distress Helpline and the National Domestic Violence Hotline that provide around-the-clock access to skilled counselors,
  • local and national philanthropic foundations committed to employment initiatives, and
  • businesses seeking to invest in community workforce development.

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10 For more information on state licensure requirements for disaster volunteer social workers, see http://www.socialworkers.org/ldf/legal_issue/200509.asp?back=yes (accessed April 2, 2015).

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

THE CONTINUUM OF POST-DISASTER SOCIAL SERVICES INTERVENTIONS

Social service organizations have key roles to play throughout the post-disaster recovery process. Immediately after a disaster, these organizations, particularly if they are already embedded in the community, can meet individuals’ basic needs, provide psychosocial support, and initiate case management to connect people with resources available to meet their myriad recovery needs. As recovery efforts continue into the intermediate and long terms, social service organizations can continue case management, offer ongoing psychosocial support, and help people manage their chronic conditions.

As discussed previously, ensuring access to services is a critical part of meeting the post-disaster needs of low-income and other vulnerable populations. Access has many dimensions, including physical location and accessibility to those with handicaps, hours of operation, and availability of materials and services in needed languages (SAMHSA, 2012). Since disaster victims often have multiple needs following a disaster—including food, housing, medical care, medical prescriptions and equipment, behavioral health support, cash assistance, transportation, and child care—efficiency in providing those services is paramount in enabling communities to begin recovery quickly. Early coordination through a joint recovery information system staffed by representatives of all engaged sectors can facilitate access to needed services. In particular, people are more likely to access food and auxiliary services before seeking behavioral health care because of the stigma associated with the latter and the perceived urgency of other matters. Providing disaster victims with a “one-stop shop” for social service, behavioral health, and other needs decreases the time required to travel between offices; eases the difficulty of transport and the stress of visiting multiple sites; and minimizes stigma related to seeking services, particularly for behavioral health.

FEMA and the Red Cross often establish multipurpose centers after disasters to help survivors access disaster benefits and a range of services (see Box 8-3). Another approach is to bring the services to survivors. Residents of temporary housing, for example, may require several kinds of assistance. The Human Services Campus developed in Joplin, Missouri, after the 2011 tornado illustrates the benefits of collocating these services and reaching people where they are. This community center, located at a FEMA temporary housing site, housed 40 local agencies, including legal aid and crisis counseling. It helped survivors access services, especially those who had lost vehicles in the storm and would have had difficulty traveling to multiple sites for services (Missouri Department of Mental Health, 2013; Rodriguez, 2013).

The committee identified three early critical services that represent priorities for the social services sector in the early recovery period, including

  • meeting basic human needs (e.g., food shelter);
  • initiating disaster case management; and
  • providing psychosocial/behavioral health support for survivors.

In the intermediate- and long-term recovery periods, social services efforts should focus on providing ongoing social support and building client self-sufficiency. Each of these priority areas are discussed in the following sections.

EARLY POST-DISASTER SOCIAL SERVICES RECOVERY PRIORITIES

Meeting Basic Human Needs

An early priority for social service organizations is to coordinate with mass recovery sites to provide victims with basic needs: food, shelter, clothing, and medical prescriptions and supplies, as well as social services. To the extent possible in the context of a crisis, it is important to attend to special needs, such as meals with appropriate nutritional content for individuals with medical conditions (e.g., diabetes).

Although mass care is considered a response phase function, needs for assistance in obtaining basic resources can extend well into the recovery phase, depending on survivors’ personal assets and the scope

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

BOX 8-3
Example of Collocation: Multi-Agency Resource/Relief Center

On May 29, 2011—just seven days after the tornado in Joplin, Missouri—the American Red Cross opened the doors to a Multi-Agency Resource/Relief Center where more than 30 partner agencies joined to provide services. Together, these local, state, and federal agencies partnered with the Red Cross to listen to survivor stories, verify each family’s damage and needs, and record the documentation necessary to open more than 1,500 recovery cases.

Over the course of 15 days, the Multi-Agency Resource/Relief Center became the one-stop shop for survivor assistance: agencies coming to the survivor rather than the survivor needing to navigate to the varied locations of multiple agencies. Working together, these agencies helped more than 5,000 people, not only by offering financial assistance, legal services, and replacement driver’s licenses and social security cards, but also by providing hot meals and moments of comfort. For those families that lost loved ones, the center facilitated access to an integrated care team made up of a caseworker, nurse, behavioral health professional, and chaplain, who met separately with each family to offer condolence, guide them compassionately through the assistance process, and ensure that they obtained additional assistance for funeral related expenses. There were specific services for veterans, children, seniors and those with disabilities. The Department of Family Services replaced food stamps and provided Disaster-Supplemental Nutrition Assistance Program (D-SNAP) assistance. Faith-based organizations provided shuttle services using church vans. Medical and mental health personnel listened, assisted, and counseled. Federal Emergency Management Agency (FEMA) specialists helped families submit applications for federal assistance and explained the opportunity to receive benefits and the necessary application processes.

Beyond the provision of these critical services, the Multi-Agency Resource/Relief Center became a gathering place for survivors. It was where neighbors reconnected with neighbors, and where families could get respite from the tragedy.

SOURCE: Meeds, 2013.

of the disaster. Experience with past disasters has shown that survivors’ families, neighbors, and other members of personal support networks play critical roles in helping to meet basic human needs (Aldrich, 2012). It is when these capabilities and resources are overwhelmed (e.g., when members of personal support networks themselves require assistance) that auxiliary assistance is especially needed. The first and most critical step in supporting social networks is to reunite families, neighbors, and those with social ties who have been separated. At the community level, this work typically occurs in congregate settings, and it is important for a wide range of social service and other providers to develop a basic knowledge of mass care services. State emergency management agencies offer Community Mass Care/Emergency Assistance G108 courses periodically to build this knowledge base (National Mass Care Strategy, 2014).

Responsibilities of the social services sector in helping to meet basic human needs immediately following a disaster include an effective communication system that provides accurate mapping of available resources; multimodal, multi-language communications for both those in need of and those who wish to provide services and supplies; and a tracking system that monitors increases in mental health disorders, domestic violence, and other disaster-impacted issues. Messages about available resources and services can be integrated into general emergency management messages. It is also during this early phase that social service providers can begin to help individuals and families access disaster benefits by helping them compile needed portfolios of information.

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

Initiating Disaster Case Management

Although providing for short-term survival needs such as food, shelter, and clothing is often accomplished in congregate settings, concurrent with and after this process, one-on-one case management is the primary strategy for determining and addressing the myriad recovery needs of individuals and families. Disaster case managers provide clients with access to the resources and programs of multiple relief agencies, as well as financial assistance depending on the resources available to the individual, including existing savings, level of family income, and homeowner’s and other insurance. The disaster case management process entails:

  • identifying disaster survivors’ needs using metrics developed in the pre-disaster phase;
  • developing viable individual or family recovery plans that allow for long-term recovery even after the disaster case management program expires in the disaster area (FEMA, 2014);
  • reconnecting survivors to essential services (including legal assistance, if needed);
  • identifying new services needed and newly vulnerable populations resulting from the disaster; and • helping survivors move toward a healthier lifestyle.

Individuals and families with minimal financial resources and insurance require more assistance and support. The elderly (particularly the frail elderly); people with disabilities; those who are underinsured, uninsured, and financially fragile; children in foster care or under the care of protective services; those who are medically vulnerable, such as those with acute or chronic illnesses; homeless families; and the mentally ill all have special needs that require additional casework coordination and attention. Case management for vulnerable populations frequently involves additional efforts at outreach; coordination with a wide range of agencies and organizations so these individuals can achieve stable living arrangements; and restoration and improvement of services tailored to ensuring that they can live as independently as possible. Many socially vulnerable people are enrolled in government assistance programs prior to a disaster; as a result of this ready access to their information, social service providers can more easily furnish them with information on special disaster benefits. On the other hand, many clients may require special assistance to re-create documentation lost as a result of the disaster.

In the event of a presidential disaster declaration, the Stafford Act authorizes FEMA to fund the Disaster Case Management Program. This program provides assistance in accessing disaster-specific federal benefits and works with the local long-term recovery committee to address needs not met by other programs. In the absence of this federally funded program, a similar disaster case management program can be run by a local entity, such as a VOAD, and can help identify sources of additional funding for social services. Additional resources with further information on disaster case management can be found in Appendix C.

Case managers often work for an organization that is contracted by the state to provide case management services and may not be linked to the community or work in concert with local social services agencies. Further, case managers change over time, which complicates recovery and adds to frustrations for many disaster survivors, who must relate the facts of their case repeatedly and produce documentation for different service providers. Therefore, as discussed earlier, strategies for facilitating the collection and sharing of case information are essential, as is working closely with strong community supports, such as schools, neighborhood associations, community centers, civic groups, and faith-based organizations.

Providing Psychosocial/Behavioral Health Support for Survivors

Early psychosocial support interventions, such as psychological first aid (discussed in more detail in Chapter 7), can be provided by a number of professional and trained individuals, including mental health and social service professionals, volunteers (retired professionals and trained volunteers), representatives of faith-based groups, and community members (e.g., teachers). Social service organizations can play a key role in several ways: providing psychosocial support directly; making referrals; or reaching out to individu-

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

als in community settings, such as schools and community centers. As discussed above, after a disaster, people are likely to visit a social service organization to meet basic needs such as food or shelter. When these organizations take that opportunity to offer psychosocial support, they can mitigate the behavioral health effects of disasters and facilitate individual and community recovery. Faith-based organizations also can play a role in providing early support, particularly when they are already integrated into the community. (See Chapter 7 for more discussion of psychosocial support, including emotional and spiritual care.)

INTERMEDIATE- TO LONG-TERM RECOVERY PRIORITIES

As community-level early needs are addressed—which may take months depending on the scope of loss—the social service sector begins working toward reestablishing normalcy, although often with sorely depleted resources and increased needs among clients. The majority of national disaster relief funds are focused on meeting short-term needs, with few notable exceptions following extreme disasters.11 Long-term recovery needs must be met primarily through local resources or reprogramming of existing federal funds (e.g., SSBG funds), although supplemental appropriations through the SSBG-DR program have been used to support mental health and social services.12 Social service departments can help communities identify how needs will be met once external resources have diminished. This includes efforts to move the social service delivery model to one that embraces a healthy community approach.

Although most individuals require social service supports for only a short time following a disaster, many unmet needs remain; in some cases, survivors may be subject to long-term displacement, job loss, and loss of family or other social supports. These needs are the focus of longer-term case management, which continues from the early recovery period and aims to assist individuals and families in achieving the fullest possible recovery. The emphasis during the long-term recovery phase is on helping to replace losses; adjust to changes in life circumstances; restore suitable permanent housing that is safe, sanitary, and secure; and support self-sufficiency and a healthy lifestyle. When gaps exist between an individual’s resources and recovery needs, work is directed toward documenting those needs, assessing costs, and applying for assistance. Issues that can arise during the long-term recovery period that require a case manager’s attention include financial problems, health issues, job loss, stress-related domestic issues, and emotional problems. For individuals and families that continue to need support after exhausting funds from FEMA’s individual assistance grants13 (when authorized) and other federal and state disaster resources, their cases are referred to the local long-term recovery committee, which reviews cases and distributes funds according to need and availability. However, these committees are often not permanent and may dissolve when donated funds are exhausted.

Providing Ongoing Psychosocial Support

Management of chronic post-disaster stress is of central concern in the months—and often years—following a disaster. The stress caused by evacuation, relocation, and disruption of routines continues to affect people even if their homes and the community’s physical infrastructure are restored to normal quickly. This post-disaster stress, along with the grief associated with catastrophic loss, is a normal response that

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11 Following the September 11, 2001, terrorist attacks and Hurricane Sandy, the American Red Cross allocated a portion of the donations it received for a recovery grant program (ARC, 2014; The Urban Institute, 2006).

12 After Hurricane Sandy, Congress enacted a nearly $475 million supplemental appropriation for the Social Services Block Grant to be devoted to social, health, and mental health services for individuals and to repair, renovate, and rebuild health care facilities, mental hygiene facilities, and child care and other types of social service facilities. Additional post-Sandy supplemental funds were made available through the Family Violence Prevention and Services program and Head Start, as well as a SAMHSA Emergency Response Grant (ACF, 2013b; HHS, 2012).

13 Individual assistance funds from FEMA may be made available after a presidential disaster declaration and have a broad range of eligible uses, including but not limited to housing repair, temporary housing costs, medical and dental costs not covered by insurance, and child care costs. These grants are capped at approximately $30,000 per individual or household and generally are limited to a period of 18 months (CRS, 2012) (see also Chapter 4).

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

requires psychosocial support. As mentioned earlier, an early warning tracking system can aid in monitoring increases in behavioral health problems. Chapter 7 addresses in detail behavioral health issues that may be exacerbated by post-disaster stress, as well as clinical and nonclinical interventions for dealing with these issues.

The community may benefit from a public messaging campaign that normalizes the stress of a disaster and helps overcome fears of stigma associated with help-seeking behavior. The “All Right?” campaign in New Zealand (see Box 7-3 in Chapter 7) is an example of success with this type of messaging. Psychosocial support also can be provided by family, neighbors, faith communities, and other nonprofessional volunteers. Use of these sources of support strengthens social networks and community cohesion and alleviates the burden on a behavioral health system that may be sorely taxed following a disaster.

Building Client Self-Sufficiency and Managing Chronic Medical Conditions

Long-term goals for recovery should include interventions to build clients’ capacity for resilience and self-care (and thus reduce future strain on resources). Through partnerships between community or neighborhood groups and social service providers, communities can develop plans for self-help support groups facilitated by professionals or appropriately trained lay volunteers. These groups can assist in the exchange of information about recovery resources and encourage individual recovery and resilience.

Job loss resulting from closure or relocation of businesses is a major barrier to individual and community recovery following a disaster. However, the recovery process itself may require a large number of workers, which presents an opportunity to address unemployment and assist low-income populations in the community. Partnerships between workforce development and social services agencies can promote both training that includes recognition of the social determinants of health and local hiring to fill recovery-related positions and help support client self-sufficiency. Academic institutions may also be key partners. After Hurricane Katrina, for example, Dillard University’s Minority Worker Training Program14 worked with United Steelworkers to launch the initiative “A Safe Way Back Home,” which was designed to train local low-income and minority neighborhood residents to dispose of waste and replace soil on properties in New Orleans (NIEHS, 2014). Similar training was provided through the Minority Worker Training Program after the Deepwater Horizon oil spill and Hurricane Sandy. Providing valuable environmental cleanup skills represents a sustainable approach to helping those in underserved and disadvantaged communities.

As discussed in Chapter 1, chronic conditions such as diabetes, hypertension, asthma, and many others are increasingly common in U.S. communities. Disaster-related disruption of care routines can lead to health crises, even among people whose chronic conditions were previously well controlled (Kessler, 2007). Thus, another important area for capacity building interventions is chronic disease self-management. The committee heard testimony that, both in non-disaster times and following a disaster, many social service clients experience repeated flare-ups of chronic conditions. Complicating this pattern is a behavioral health component: people with other chronic diseases are more likely to suffer from depression (Chapman et al., 2005), and depression is closely linked with substance abuse (Regier et al., 1990). These health issues complicate many aspects of employment and family life, so building clients’ capacity to manage their chronic conditions—while traditionally understood as a health care responsibility—is a function that social service organizations can undertake in partnership with health care professionals and organizations to help reduce reliance on the social safety net in the long term. Outside of the disaster context, chronic disease self-management classes have shown great promise for improving patient outcomes, although only anecdotal evidence is available regarding these interventions during disaster recovery (see Box 8-4).

Community health workers (CHWs) can play a critical role in helping to manage chronic disease after a disaster (see the discussion of CHWs in Box 6-3 in Chapter 6). CHWs are laypersons—not trained

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14 The Minority Worker Training Program is a program funded by the National Institute of Environmental Health Sciences at the National Institutes of Health. The program is designed to recruit and train young minority individuals who live in communities with contaminated properties to work in construction and environmental remediation.

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

BOX 8-4
Chronic Disease Management Assistance from The Jesse Tree, Galveston, Texas

The Jesse Tree is a faith-based organization that connects Galveston, Texas, residents with basic necessities (food, medications) and essential services (medical and social services). One way in which The Jesse Tree serves the community is by offering chronic disease self-management classes. These classes use a Chronic Disease Self-Management Program developed by the Patient Education Research Center at Stanford University School of Medicine, which is designed to help patients manage their chronic health problems and control their symptoms (Stanford School of Medicine, 2014). The classes cover conditions including diabetes, hypertension, and chronic diseases generally, as well as stress management and relaxation training. In addition to these classes, The Jesse Tree offers such services as blood pressure screenings and glucose checks, and helps people apply for food stamps, Medicare, and the Children’s Health Insurance Program.

The Chronic Disease Self-Management Program designed by Stanford and offered by The Jesse Tree has been found to result in better self-management skills, improved health outcomes, more appropriate health care utilization, and reduced costs and hospitalizations (CDC and National Council on Aging, 2008). For example, a review of studies on the program found that it results in

  • better quality of life,
  • better psychological well-being,
  • less fatigue,
  • more exercise and healthier eating,
  • better communication with physicians,
  • improved self-reported health, and
  • slightly fewer visits to hospitals and physicians (CDC and National Council on Aging, 2008).

When Hurricane Ike struck Galveston, The Jesse Tree lost $2.5 million in facilities and supplies. With the help of donors, it reopened and responded to the needs of the Galveston residents, providing food, medical supplies, and help with applications for disaster assistance benefits (The Jesse Tree, 2015). Chronic disease management classes were offered to help those whose medical conditions had been exacerbated by the disaster get them under control.

medical professionals—who are members of the community and usually share ethnicity, language, culture, and socioeconomic status with those they serve (HRSA, 2011). They can help manage chronic disease in many ways: educating patients on self-management; administering health screenings, such as blood pressure tests; facilitating and coordinating care by primary care providers; providing social support to patients and caregivers; and helping patients follow a self-management plan (CDC, 2011). After a disaster, CHWs are especially vital because they are present and integrated into the community, and they can help support chronic disease management while primary care providers are occupied with treating more acute medical needs. Their use to manage chronic disease has been shown to increase patients’ knowledge of their disease and ability to self-manage, improve individual health outcomes, decrease mortality, and reduce visits to emergency departments and hospitalizations (CDC, 2011).

SPECIAL CONSIDERATIONS FOR CHILDREN AND THE ELDERLY

Although the social services sector routinely addresses the needs of vulnerable populations, children and the elderly are especially vulnerable groups that require special consideration during pre-disaster planning and after an event.

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
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Children and Youth

Part of the challenge of addressing the needs of children and youth relates to the diffuse nature of the systems that service this population—comprising a number of sectors, including education/child care, pediatrics, child welfare authorities, social services, family violence prevention and services, and community- and faith-based groups (ACF, 2013a). After a disaster, it is critical for community leaders to focus on children’s needs, working with school districts, Head Start, and other child-focused organizations to help them return to normal routines as soon as possible (DHS, 2012). A children and youth task force can be used to bring together all relevant agencies, organizations, and professionals to pool resources and jointly develop a strategic approach to meeting the needs of this vulnerable population. Such a task force can develop strategies for identifying children most likely to be vulnerable following a disaster by working with existing public assistance programs, and it can serve as a source of information about child-related services after a disaster. If a children and youth task force is in place, it can be used to coordinate efforts to meet the needs of these groups. Where such a task force is not already in place, leaders should consider forming one, as it has been shown to be a successful model for meeting children’s post-disaster needs15 (White, 2014).

In addition to the recovery needs of children themselves, quick return of school programs and child care is vital to community recovery overall (see Box 8-5). The committee heard from speakers at the federal and community levels that the lack of child care following a disaster poses significant challenges to individual and community recovery; as noted earlier, parents who are unable to find child care cannot return to work or meet other daily needs, and children may be exposed to unsafe environments (Nolen, 2014; White, 2014). As discussed in Chapter 7, schools also are important in enabling children to have access to behavioral health interventions after a disaster. Yet while significant progress has been made in integrating behavioral health services into schools, this is not the case for early childhood programs such as Head Start (White, 2014), although supplemental funding for Head Start programs made available after Hurricane Sandy was used to fund behavioral health services for affected children (ACF, 2013b). Better integration of behavioral health and social services is needed to ensure that interventions reach the youngest and most vulnerable children. Mitigation measures (e.g., structural hardening) that minimize the duration of school closures are critical to ensuring that children have safe places to be and access to needed services after a disaster. Although such measures are best carried out in advance, post-disaster reconstruction may be an important opportunity to build safer and stronger schools.

Despite the availability of small business loan programs at the federal and state levels, child care businesses often struggle to recover because of high start-up costs and a lack of licensed providers. Long-term lack of affordable child care was noted more than a decade following the Grand Forks flood (Gerber, 2006). Moreover, child care providers often have low incomes and may be in need of assistance themselves after a disaster. Further, licensing requirements for child care facilities are complex, and compliance requires time and resources, both of which are in short supply following a disaster. Thus, disaster pre-planning might include the development of mechanisms for post-disaster rapid assessment of the status of child care centers; temporary waivers of requirements, such as those for vaccination; processes for assisting centers in attracting resources and rebuilding; and strategies for recruiting and training new staff. A child care recovery group can be formed under a children and youth task force to address this critical need. This group can work with child care advocates to set priorities for ensuring the most inclusive response to a disaster and for making infrastructure investments that strengthen safety and resilience at schools and child care sites.

________________

15 Guidelines on developing children and youth task forces are available at www.acf.hhs.gov/sites/default/files/ohsepr/childrens_task_force_development_web.pdf (accessed July 2, 2014).

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

BOX 8-5
The Role of School Systems in Recovery: Case Study of Joplin, Missouri

In the event of a disaster, schools play a vital role in contributing to the overall recovery of a community. The quick return of school programs, as well as schools’ role in promoting the mental and behavioral health of children following disasters, facilitates a community’s resilience and efforts to rebuild.

The tornado that struck Joplin, Missouri, a rural community with a population of approximately 50,000, in May 2011 occurred at the close of the school year. The tornado directly affected 18,000 residents and severely damaged nine of the city’s 18 schools. Less than 48 hours after the disaster, however, city officials publicly declared a commitment to starting the 2011-2012 school year on time. The city made a concerted effort to locate and contact all children associated with the school system, both to offer assistance and to coordinate future school activities. Summer school enrollment was expanded, and for the first time, transportation to summer school was provided, allowing parents to address post-disaster concerns with their children safely under the protection of schools. Joplin’s post-disaster interventions, as part of this effort to restore school services as soon as possible, spurred on the overall recovery of the community. The early decision to reopen on time may have encouraged families to stay in the community; despite the displacement of 30 percent of Joplin residents, few ultimately left the community. The city achieved a 95 percent retention rate in student re-enrollment for the 2011-2012 academic year, only slightly below average.

Beyond encouraging families to remain in the community, schools played a vital role in promoting children’s behavioral health. Joplin’s summer school program emphasized both children’s safety and emotional well-being. Following the disaster, school staff were trained on behavioral health issues. Counseling sessions took place at schools in the following year, with as many as 25 percent of students at some schools participating, an intervention that also facilitated the referral of children to community providers if needed. Further discussion of school-based behavioral health programs can be found in Chapter 7.

Joplin’s post-disaster school-based interventions demonstrate the extent to which schools can promote the recovery and resilience of their community. Furthermore, school-based programs encourage a community to engage in its own recovery, and schools themselves can offer visible recovery milestones, reopening on schedule, for example. Consequently, incorporating school systems into preparedness, response, and recovery planning and activities is critically important.

SOURCE: Kanter and Abramson, 2014; NCDP, 2013.

The Elderly

Many challenges are unique to the elderly during disaster recovery. First, they encompass a diverse range of circumstances—from those living in nursing homes needing comprehensive supportive services to active, able older adults who live independently but in some cases are isolated from their communities. The impacts of disasters on different subpopulations of the elderly are varied and require different strategies. A comprehensive plan of support for the elderly does not exist in part because of a lack of supportive networks. The geriatric education centers that once existed lost their funding and have disappeared (Brown, 2014), so there are no logical hubs for the provision of information and services for the elderly that are especially needed during disaster recovery.

In addition to the lack of infrastructure support, it is rare for relief workers or crisis counselors to receive specialized training for working with the elderly after a disaster (Brown, 2014). This gap is exacerbated by special issues that arise from the unique vulnerabilities of older adults (e.g., being prey to unscrupulous contractors and scammers, limited mobility leading to service access issues).

To better meet the disaster-related needs of older adults, social service departments can develop specialized materials and training for emergency and other disaster recovery workers. The previously

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

mentioned strategy of collocation or centralized disaster recovery services will be especially effective for the elderly, as will all strategies designed to promote stronger social networking within communities. As communities change over the years, many elderly who have aged in place no longer know their neighbors, so strategies that strengthen neighbor-to-neighbor communications and social bonds not only diminish this isolation in normal times but also can provide lifelines to help the elderly prepare for and deal with disasters. Further, if communities develop disaster recovery forums/coordinating bodies, these entities can promote pre-disaster programming that identifies opportunities for elderly people to provide their varied expertise as volunteers during recovery.

BUILDING A MORE RESILIENT AND SUSTAINABLE SOCIAL SERVICES SECTOR

The recovery process itself can provide a foundation for building a stronger social services system by leveraging new resources, lessons learned, and partnerships developed in the aftermath of a disaster to achieve greater capacity and interoperability. The recovery period may present opportunities to restructure service provision within the community, particularly in the case of major disasters that have destroyed significant portions of local infrastructure. If infrastructure must be rebuilt, collocation of agency offices can be used to facilitate client access and cross-agency collaboration. Regardless of infrastructure conditions, however, social service providers should use all available opportunities to advocate for decisions that facilitate integration of services and a healthy community approach to recovery. Integration of social services with other community services is a powerful tool for building local partnerships aimed at improving the community’s health.

Long-term recovery committees, although traditionally focused on case management, are diverse in makeup and focus, and they may serve as a natural platform for integration at the local level. Communities may identify other, more viable structures for their context. As discussed earlier in this chapter, integration can take many forms; local social service agencies are in the best position to determine what level and type of integration is both helpful for the clients they serve and attainable within the community’s existing administrative arrangements.

Consistent with the traditional view of social services, this chapter has focused heavily on people-oriented strategies for improving social well-being. However, the committee recognizes that long-term strategies for achieving lasting transformation must also target the physical, social, and economic environments associated with defined geographic areas that contribute to social vulnerability. These “place-based strategies,” which often fall in the realm of community development, are discussed in Chapter 9.

RESEARCH NEEDS

In the process of developing its guidance and recommendation specific to social services, the committee noted that further research is needed to address the following questions:

  • How does early identification of and support for vulnerable populations reduce long-term psychological consequences or long-term recovery needs?
  • How can the social services system maintain a healthy workforce and optimize its utilization after disaster? What percentage of workers can an agency expect to lose as a result of trauma, loss, burnout, or family needs?
  • What training do event-based volunteers need to be able to support the social services system? What types of tasks are appropriate for volunteers? How can faith-based and other NGOs be mobilized in pre-disaster recovery planning?
  • What strategies can be promoted to facilitate information sharing during and after disasters?
  • What are the long-term impacts to beneficiaries of government assistance and their families when a disaster causes disruptions in benefits?
Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

SUMMARY OF FINDINGS AND RECOMMENDATION

The current provision of post-disaster social services is fragmented and episodic and lacks flexibility, with components of the system too often working in isolation. Further, social services are not adequately integrated with other sectors, such as emergency management and public health, at the state and local levels. This fragmented structure creates a lack of continuity of care and reduces the ability of governmental and nongovernmental organizations at all levels to provide effective services, resulting in inefficiency and suboptimal health outcomes. Although HHS’s Human Services CONOPS is a commendable step forward in terms of coordination at the federal level, the lack of federal guidance for coordination of activities and resources at the state and local levels remains a critical gap. The committee concludes that an integrated social services recovery framework is needed to enable intra- and intersector coordination that can meet post-disaster human recovery needs and link effective practices to funding sources.

Recommendation 9: Develop an Integrated Social Services Recovery Framework.

The U.S. Department of Health and Human Services should lead the development of an integrated post-disaster social services framework that more effectively meets human services needs during recovery.

The following steps should be taken to enable the development of the framework:

  • ASPR should commission a study to analyze federal programs related to disaster recovery social services and to generate recommendations for decreasing duplication and fragmentation, streamlining processes, and optimally meeting the needs of the affected populations.
  • Based on the results of this study, ASPR should work with federal and nonfederal partners—including but not limited to FEMA, HHS (including ACF, SAMHSA, and the Health Resources and Services Administration), HUD, the U.S. Department of Agriculture, the U.S. Department of Education, the U.S. Department of Veterans Affairs, the American Red Cross, and other appropriate nongovernmental organizations—to create a framework linking current and future funding sources, policies, and regulations to the recommended strategies for optimizing social services after disasters.
  • The multiple federal agencies and nongovernmental organizations that provide day-to-day funding for human services and funding to support social services during recovery (including those agencies cited above) should condition funding on the creation by each state or municipality (in cases where large municipalities receive funding directly) of an integrated strategy for social service delivery. This strategy should be designed to facilitate the accessibility of these services through such means as collocation of services and data portability for disaster survivors.
  • Departments responsible for human/social services within states and municipalities should serve as the coordinators for operationalizing the above strategy and coordinating faith-based and other nongovernmental organizations, and related state agencies implementing the post-disaster social services framework.

SOCIAL SERVICES SECTOR RECOVERY CHECKLIST

The committee has identified three pre-event and five post-disaster critical recovery priorities for the social services sector that are inextricably linked to strengthening the health, resilience, and sustainability, of a community. Action steps for each of these priorities are provided in the following checklist. Although social services leaders will need to adapt these actions to the local context, this guidance provides an indicative set of concerns to be considered during recovery. Although the committee has suggested a primary actor for each priority area, it is recognized that individual circumstances in each community will

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

influence the actual choice of a lead entity. The checklist illustrates how the following seven key recovery strategies, identified as recurring themes at the beginning of this chapter, apply to individual priority areas:

  • Build on existing relationships and establish comprehensive plans for collaboration among social service funders and providers, community- and faith-based organizations, and advocates to ensure coordinated social service delivery through all phases of disaster planning and recovery.
  • Integrate social services recovery plans into other disaster recovery services.
  • Create compatible structures, policies, and procedures to promote the flow of funding and information across federal, state, and local systems.
  • Provide support to reunite families and promote resilience through community programming designed to strengthen social support networks.
  • Focus on restoring normalcy through key community services/activities, such as child care, elder care, foster care, mental health services, schools, housing, jobs, and transportation.
  • Enhance efforts to increase accessibility and reach the most vulnerable populations to provide needed social services.
  • Promote ongoing evaluation and continuous learning to advance social services efforts in achieving health community goals.
Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

Pre-Event

Priority: Establish Forums for Coordination and Collaboration for Disaster Planning and Recovery

Primary Actors1: Social Services Agencies

Key Partners: Disaster Relief Organizations, Education System, State/Local Health Departments,2 Community Development Organizations, Housing Agencies, Transportation Agencies, Health and Medical System Partners, Emergency Management Agencies, Community- and Faith-Based Organizations, Private Sector

Key Recovery Strategies:

  • Build on existing relationships and establish comprehensive plans for collaboration among social service funders and providers, community- and faith-based organizations, and advocates to ensure coordinated social service delivery through all phases of disaster planning and recovery.
  • Integrate social services recovery plans into other disaster recovery services.
  • Create compatible structures, policies, and procedures to promote the flow of funding and information across federal, state, and local systems.

Activities include but are not limited to:

img Identify program areas within social services where alignments and relationships exist.

img Identify existing cross-sector, cross-agency collaborations that can be leveraged for recovery planning.

img Identify essential partners that are not yet but need to be collaborating and work to engage them.

img Establish relationship with urban and regional planning and community development organizations to integrate disaster recovery planning into ongoing planning efforts.

img Identify/update key contacts within each partner organization and develop a communication system (based on the above four activities).

img Integrate representatives of vulnerable populations and elected officials and community leaders in collaborative efforts.

img Educate elected officials and community leaders, in conjunction with urban and regional planners, on the elements of a healthy and resilient community and the important opportunity to use recovery efforts to achieve healthy community goals.

img Integrate forums into the National Disaster Recovery Framework to leverage activities/ resources/contacts.

img Develop structures, policies, and procedures to facilitate collaborative efforts, promote information sharing, and foster compatible cultures within partner organizations (including the development of memorandums of understanding [MOUs] and mutual-aid agreements, where appropriate).

img Enhance regulatory and accreditation requirements for more intensive pre-event recovery planning by local and state social services agencies, health and medical system partners, behavioral health authorities, public health agencies, and local and state emergency management agencies using standard criteria.

________________

1 See Appendix F for further description of terms used to describe Primary Actors and Key Partners in this checklist.

2 Throughout this checklist, “State/Local” is used for the purposes of brevity but should be inferred to include tribal and territorial as well.

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

Pre-Event

img Pre-identify priority essential services to be provided during recovery and areas in which recovery resources can be used to develop new programs for improving social services.

--------------------------

Priority: Establish Mechanisms to Facilitate Record and Information Sharing After Disasters

Primary Actors: Social Services Agencies

Key Partners: Health and Medical System Partners, Behavioral Health Authorities, Community Development Organizations, Housing Agencies, Community- and Faith-Based Organizations, Community Data Centers

Key Recovery Strategies:

  • Build on existing relationships and establish comprehensive plans for collaboration among social service funders and providers, community- and faith-based organizations, and advocates to ensure coordinated social service delivery through all phases of disaster planning and recovery.
  • Integrate social services recovery plans into other disaster recovery services.
  • Create compatible structures, policies, and procedures to promote the flow of funding and information across federal, state, and local systems.

Activities include but are not limited to:

img Review all existing social services data sources and relationships.

img Examine opportunities for access by social services agencies to electronic records from clinical and other relevant service agencies and organizations, community- and faith-based organizations, and providers.

img Develop strategies for addressing current challenges to sharing information in post-disaster scenarios.

img Determine key metrics to be used after a disaster to measure social services needs and resources required to move toward a healthy community model.

img Develop disaster social services data needs related to metrics in the pre-disaster environment.

img Proactively engage in planning for information technology infrastructure to connect data sets relevant to social services, and develop data-sharing policies across agencies and organizations.

img Define how current analyses and reports can support recovery planning, and develop new reports to inform recovery planning if needed.

img Share data with disaster recovery planners, elected officials and community leaders, governmental agencies, community- and faith-based organizations, and the community.

--------------------------

Priority: Plan for Fluctuations in Social Services Workforce Needs

Primary Actors: Social Services Agencies

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

Pre-Event

Key Partners: Disaster Relief Organizations (including American Red Cross), Community- and Faith-Based Organizations, Community Development Organizations, Behavioral Health Authorities, Education System

Key Recovery Strategies:

  • Build on existing relationships and establish comprehensive plans for collaboration among social service funders and providers, community- and faith-based organizations, and advocates to ensure coordinated social service delivery through all phases of disaster planning and recovery.
  • Enhance efforts to increase accessibility and reach the most vulnerable populations to provide needed social services.
  • Integrate social services recovery plans into other disaster recovery services.
  • Promote ongoing evaluation and continuous learning to advance social services efforts in achieving health community goals.

Activities include but are not limited to:

img Provide caseworker training on special post-disaster issues (e.g., insurance and mortgage issues, loss of documentation), as well as typical social services needs (which will be amplified after a disaster).

img Provide cross-training for multiorganizational staff, volunteers, and partners.

img Create policies and systems to support the social services workforce during/after disasters to mitigate strain on these workers.

img Promote disaster mental health training and psychological first aid to help staff identify stressors in themselves and coworkers.

img Create guidance and training materials addressing disaster impacts on social services, as well as the value of a healthy community approach.

img Exercise and train for recovery activities.

img Exploit cross-cutting activities for accreditation and social services emergency planning.

img Develop social services department continuity of operations plans that enable impacted jurisdictions to rapidly overcome damage and engage in recovery efforts by using social services department staff or social services staff from other jurisdictions and volunteers.

img Identify sources that can supplement the social services workforce, and develop MOUs with community- and faith-based organizations with relevant social services skills.

img Identify sources for post-disaster financial support for social services, including businesses seeking to invest in community workforce development.

img Identify potential new vulnerable populations based on experience with past disasters.

img Promote and develop capacity for rapid assessment of social services consistent with local and state emergency response and recovery plans, and provide training on post-disaster community assessments.

img Train health and medical system partners and emergency management agencies regarding social services assessments during recovery efforts, with special consideration for vulnerable and difficult-to-reach populations, such as the elderly and immigrants.

img Routinely include social services personnel in local, regional, state, and national disaster exercises.

img Develop standards for communication with and vetting, coordination, and tracking of volunteers, and develop plans for preventing post-disaster burnout.

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

Short-Term Recovery

Priority: Conduct Impact Assessments and Establish Critical Social Services to Meet Basic Human Needs

Primary Actors: Social Services Agencies

Key Partners: State/Local Health Departments, Housing Agencies, Private Sector, Community- and Faith-Based Organizations

Key Recovery Strategies:

  • Build on existing relationships and establish comprehensive plans for collaboration among social services funders and providers, community- and faith-based organizations, and advocates to ensure coordinated social service delivery through all phases of disaster planning and recovery.
  • Integrate social services recovery plans into other disaster recovery services.
  • Provide support to reunite families and promote resilience through community programming designed to strengthen social support networks.
  • Focus on restoring normalcy through key community services/activities, such as child care, elder care, foster care, mental health services, schools, housing, jobs, and transportation. • Enhance efforts to increase accessibility and reach the most vulnerable populations to provide needed social services.
  • Promote ongoing evaluation and continuous learning to advance social services efforts in achieving health community goals.

Activities include but are not limited to:

img Participate in a recovery joint information system staffed by representatives from all engaged sectors.

img Assess the impact of the disaster on social services and resources needed using metrics developed in the planning phase.

img Coordinate with mass recovery sites to provide social services that meet survivors’ basic needs (food, shelter, clothing, and medical prescriptions and supplies).

img Maintain early warning tracking systems to monitor increases in mental health, domestic violence, and other disaster-impacted issues.

img Establish guidelines for promoting accessibility of social services for all residents.

img Develop multimodal communication strategies for people in need of services and people who want to donate or volunteer (in multiple languages).

img Map available resources for:

  • – shelter and housing,
  • – food and water distribution,
  • – medical care,
  • – medical supplies and medications,
  • – basic living supplies, and
  • – behavioral health support.

img Develop a communication system to provide information on these resources.

img Identify opportunities for generating additional resources.

img Coordinate with other disaster-related activities and resources (e.g., housing coalition, medical providers/advocates, schools, transportation).

img Focus on reuniting families, neighbors, and those with social ties who have been separated.

img Provide ongoing training for social services providers on post-disaster mass care services.

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

Short-Term Recovery

img Integrate social services messages with general emergency management messages related to ongoing recovery efforts, focusing on accessibility for items/services that meet basic human needs.

--------------------------

Priority: Facilitate Access to Disaster Assistance Resources and Provide Disaster Case Management

Primary Actors: Social Services Agencies

Key Partners: State/Local Health Departments, Health and Medical System Partners, Emergency Management Agencies, Community- and Faith-Based Organizations

Key Recovery Strategies:

  • Build on existing relationships and establish comprehensive plans for collaboration among social service funders and providers, community- and faith-based organizations, and advocates to ensure coordinated social service delivery through all phases of disaster planning and recovery.
  • Integrate social services recovery plans into other disaster recovery services.
  • Create compatible structures, policies, and procedures to promote the flow of funding and information across federal, state, and local systems.
  • Provide support to reunite families and promote resilience through community programming designed to strengthen social support networks.
  • Focus on restoring normalcy through key community services/activities, such as child care, elder care, foster care, mental health services, schools, housing, jobs, and transportation. • Enhance efforts to increase accessibility and reach the most vulnerable populations to provide needed social services.
  • Promote ongoing evaluation and continuous learning to advance social services efforts in achieving health community goals.

Activities include but are not limited to:

img Activate or consider forming a long-term recovery committee to assist in decision making on the allocation of funding for meeting the unmet needs of individuals and families.

img Reach out to vulnerable and low-income families with information on disaster benefits and services using client contact information from governmental assistance programs such as Temporary Assistance for Needy Families, Head Start, and the local housing authority.

img Develop strategies for reaching the expanded population of vulnerable people created by the disaster.

img Work closely with community supports such as schools, neighborhood associations, community centers, civic groups, and faith-based organizations, all of which play a major role in creating an environment in which problems are readily identified and access to services is facilitated.

img Contact legal services organizations and private legal practitioners with appropriate expertise to assist with benefit eligibility issues.

img Identify and provide local resources to assist people with difficulty in producing the documents required to qualify for governmental and nongovernmental relief programs.

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

Short-Term Recovery

    (Documentation often is destroyed or unavailable because of such issues as relocation, and federal disaster relief programs do not allow funds to be used for obtaining new copies of documents.)

img Work with immigrant support groups to assist immigrant populations that may not seek assistance because of fear of deportation. Undocumented families are ineligible for Federal Emergency Management Agency (FEMA) Individual Assistance, so they are susceptible to especially difficult recovery.

img Recruit bilingual volunteers, have signage in all languages represented in the community, and provide telephone translation/interpreter services.

img As the recovery process continues, intake workers and disaster case managers identify those households with unmet needs to be referred to the long-term recovery committee.

img Implement special measures to help clients overcome barriers to access to disaster assistance resources.

img Tap community- and faith-based organizations to disseminate information about available resources.

img Create a website to serve as a clearinghouse for community resources, information, and key contacts for assistance.

img Collocate service providers in the same facility, if possible.

img Collect and compile service restoration timelines from key social services and health and medical system partners.

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

Intermediate- to Long-Term Recovery

Priority: Promote Social Services Strategies That Can Help Clients Manage Chronic Health Conditions and Build Self-Sufficiency

Primary Actors: Social Services Agencies

Key Partners: State/Local Health Departments, Housing Agencies, Behavioral Health Authorities, Health and Medical System Partners, Federal Agencies (including SAMHSA and ACF), Community- and Faith-Based Organizations

Key Recovery Strategies:

  • Build on existing relationships and establish comprehensive plans for collaboration among social service funders and providers, community- and faith-based organizations, and advocates to ensure coordinated social service delivery through all phases of disaster planning and recovery.
  • Create compatible structures, policies, and procedures to promote the flow of funding and information across federal, state, and local systems.
  • Provide support to reunite families and promote resilience through community programming designed to strengthen social support networks.
  • Focus on restoring normalcy through key community services/activities, such as child care, elder care, foster care, mental health services, schools, housing, jobs, and transportation. • Enhance efforts to increase accessibility and reach the most vulnerable populations to provide needed social services.
  • Promote ongoing evaluation and continuous learning to advance social services efforts in achieving health community goals.

Activities include but are not limited to:

img As external resources leave the community, identify how the community will meet needs internally, including building secondary surge capacity.

img Identify sustainable strategies for moving people toward independence.

img Maintain early warning and tracking systems to monitor increases in mental health disorders, domestic violence, and other disaster-impacted issues.

img Provide psychosocial and behavioral screening and support through community institutions such as schools, child care centers, elder day care, and health centers.

img Identify new funding sources—either those that are recovery related or those that are general and can be used to meet recovery goals.

img Institute strategies designed to strengthen social networks in the community.

img Develop a community messaging campaign that helps people identify early warning signs of psychosocial/mental health problems and overcome stigma associated with help-seeking behaviors.

img Build, strengthen, and seek funding for community health worker training programs.

img Provide support for initiating and sustaining self-help support groups through partnerships between community groups and social services agencies.

img Develop partnerships among workforce development programs, community colleges, universities, and social services to train and promote hiring of local people to fill recovery-related positions, including community health workers who can assist in chronic disease self-management.

img Coordinate with health care programs to help reduce reliance on safety-net programs through chronic disease self-management.

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

Intermediate- to Long-Term Recovery

img Develop greater social services workforce capacity in the community to address the social determinants of health and move toward a healthy community model.

img Build resiliency by regularly updating organizational and community plans.

--------------------------

Priority: Address the Unique Needs of Children and the Elderly

Primary Actors: Social Services Agencies

Key Partners: State/Local Health Departments, Child Care Organizations, Foster Care and Elder Care Organizations, Urban and Regional Planning Agencies, Education System, Transportation Agencies, Housing Agencies, Community- and Faith-Based Organizations, Health and Medical System Partners (including Nursing Homes)

Key Recovery Strategies:

  • Create compatible structures, policies, and procedures to promote the flow of funding and information across federal, state, and local systems.
  • Provide support to reunite families and promote resilience through community programming designed to strengthen social support networks.
  • Focus on restoring normalcy through key community services/activities, such as child care, elder care, foster care, mental health services, schools, housing, jobs, and transportation. • Enhance efforts to increase accessibility and reach the most vulnerable populations to provide needed social services.
  • Promote ongoing evaluation and continuous learning to advance social services efforts in achieving health community goals.

Activities include but are not limited to (for each care system [child care, foster care, elder care]):

img Bring together partner organizations for needs assessment, planning, and implementation, including

  • – social services agencies that ensure the availability of resources;
  • – state agencies responsible for licensing and administration of subsidy programs for low-income families;
  • – local providers of care, including faith-based institutions;
  • – local and national funders (e.g., United Way, private foundations, community foundations);
  • – local resource and referral agencies;
  • – behavioral health professionals to work with sites to deal with disaster-related trauma in staff and clients;
  • – community volunteers; and
  • – private-sector organizations that need child care services to get the workforce back.

In conjunction with other post-disaster planning efforts and partner organizations:

img Determine the status of existing centers and service sites; needs based on the postdisaster environment; and community assets that can be used to support sites in the short term.

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

Intermediate- to Long-Term Recovery

img Consider temporarily waiving some requirements for facilities to enable their reopening.

img Identify a process for seeking and applying public and private funding to restore damaged sites or build new ones.

img Establish a process for selecting sites that need to be rebuilt.

img Use existing information from government assistance programs to follow up with displaced residents and notify them about services.

img Work with disaster recovery communication networks to disseminate information about services, job opportunities, and training.

img Design/provide training to facilitate the recruitment of new staff and volunteers for sites (based on post-disaster criteria established by state agencies).

img Identify priorities needing immediate advocacy to ensure the most inclusive response to the disaster, and identify advocacy allies.

img Inform about and advocate for infrastructure investments that will strengthen safety and resilience, such as improved construction standards and energy-efficient standards/ construction.

--------------------------

Priority: Reorganize the Social Services System Toward a Healthy Community Model by Integrating New Strategies and Lessons Learned

Primary Actors: Social Services Agencies

Key Partners: State/Local Health Departments, Housing Agencies, Behavioral Health Authorities, Health and Medical System Partners, Federal Agencies (including SAMHSA and ACF), Community- and Faith-Based Organizations

Key Recovery Strategies:

  • Integrate social services recovery plans into other disaster recovery services.
  • Enhance efforts to increase accessibility and reach the most vulnerable populations to provide needed social services.
  • Promote ongoing evaluation and continuous learning to advance social services efforts in achieving health community goals.

Activities include but are not limited to:

img Assist with identifying sources of capital and financing for rebuilding in ways that promote meeting the social service needs of a healthy community.

img Participate in an after-action process, including analysis of lessons learned and identification of opportunities for improvement.

img Continuously measure progress toward healthy community goals and adapt recovery plans accordingly.

img Use state, regional, and national conferences, workshops, and discipline-specific professional meetings to share lessons learned and opportunities for improvement so that other jurisdictions can benefit from recovery experiences.

img Disseminate information regarding opportunities for improved social services to the social services sector and other groups, such as the council of mayors, city managers, city councilors, emergency management agencies, and urban and regional planning agencies.

Suggested Citation:"8 Social Services." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

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×
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×
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In the devastation that follows a major disaster, there is a need for multiple sectors to unite and devote new resources to support the rebuilding of infrastructure, the provision of health and social services, the restoration of care delivery systems, and other critical recovery needs. In some cases, billions of dollars from public, private and charitable sources are invested to help communities recover. National rhetoric often characterizes these efforts as a "return to normal." But for many American communities, pre-disaster conditions are far from optimal. Large segments of the U.S. population suffer from preventable health problems, experience inequitable access to services, and rely on overburdened health systems. A return to pre-event conditions in such cases may be short-sighted given the high costs - both economic and social - of poor health. Instead, it is important to understand that the disaster recovery process offers a series of unique and valuable opportunities to improve on the status quo. Capitalizing on these opportunities can advance the long-term health, resilience, and sustainability of communities - thereby better preparing them for future challenges.

Healthy, Resilient, and Sustainable Communities After Disasters identifies and recommends recovery practices and novel programs most likely to impact overall community public health and contribute to resiliency for future incidents. This book makes the case that disaster recovery should be guided by a healthy community vision, where health considerations are integrated into all aspects of recovery planning before and after a disaster, and funding streams are leveraged in a coordinated manner and applied to health improvement priorities in order to meet human recovery needs and create healthy built and natural environments. The conceptual framework presented in Healthy, Resilient, and Sustainable Communities After Disasters lays the groundwork to achieve this goal and provides operational guidance for multiple sectors involved in community planning and disaster recovery.

Healthy, Resilient, and Sustainable Communities After Disasters calls for actions at multiple levels to facilitate recovery strategies that optimize community health. With a shared healthy community vision, strategic planning that prioritizes health, and coordinated implementation, disaster recovery can result in a communities that are healthier, more livable places for current and future generations to grow and thrive - communities that are better prepared for future adversities.

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