6

Workshop Reflections

During the final session, workshop planning committee members shared their reflections on the workshop presentations and discussions. Topics included strengthening child care infrastructure, placing the needs of vulnerable populations in the center of disaster preparation efforts, resource and data accessibility, interdisciplinary collaboration, educating children about disaster preparedness, considerations of the effects of trauma, and monitoring and evaluating response and recovery efforts. Panelists included Heather Beal, founder and president of BLOCKS Inc.; Sherlita Amler, commissioner of the Westchester County, New York, Department of Health; Joelle Simpson, medical director of emergency preparedness at Children’s National Hospital; and Tarah Somers, regional director, Region 1 of the Agency for Toxic Substances and Disease Registry. The discussion was moderated by Roberta Lavin, professor at the University of New Mexico College of Nursing.

CLOSING REFLECTIONS ON THE WORKSHOP

In moderating the breakout session on the effect of disasters on parents and guardians, Beal said that themes surfaced related to the criticality of infrastructure that supports children. Availability of child care and schools after a disaster was highlighted, as this restores a routine for children, enables parents and guardians to return to work and rebuild their community, and gives families a sense of normalcy. The group also discussed the need for a return to stable housing as quickly as possible postdisaster, as unstable housing is a stressor for parents and guardians that in turn affects children and their ability to recover.

Amler reflected that a focus on children is the best approach to improving disaster preparation efforts. She noted that gaps in existing research, funding, support, and evidence-based interventions need to be addressed. Planning should occur at the local level—because disasters begin and end locally—but leadership is needed at all levels. Amler said that children can be empowered with an understanding of risks and protective actions that they can take, even if those actions are small. This knowledge enables children to remain calm, be less anxious, and participate actively and competently during an emergency (e.g., making their own go bag). She added that this knowledge may also encourage a lifelong interest in preparedness.

Furthermore, she suggested that the entire family should be considered in disaster preparation and response and that programs should work to build resiliency in both children and adults. This cannot be done in isolation and requires agencies to have a multigenerational approach. Professionals should integrate knowledge about the effect of childhood trauma into the development of policies and procedures. Lastly, she suggested enhancing mental health support through programs such as the psychological first aid program, which can help children learn to cope with the effects of trauma and enable them to successfully navigate difficult circumstances.¹

Simpson’s main lesson was the importance of interweaving services for children, including the education system, health care system, social services, and case management. Much good work is being done and many lessons have been learned since Hurricane Katrina, but there is a need to be more thoughtful about the data that inform services in order to avoid duplicative work and to enhance one another’s efforts to serve children and the adults caring for them. Somers emphasized the importance of groups with ongoing operations in communities having access to state and federal programs and services when disasters strike. Additionally, ongoing and continued collaboration across sectors is needed, as this connects the emergency response sector to the early care and education sector before a disaster. This connection then facilitates work on projects and solving problems after a disaster, enabling sectors to move forward together.

STRENGTHENING SUPPORT FOR CHILDREN AND YOUTH IN DISASTERS

Strengthening Critical Child Care Infrastructure

Lavin said that years ago, while working on critical infrastructure for public health and health care, she and colleagues conducted an exhaustive

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¹ More information about psychological first aid is available at https://www.nctsn.org/treatments-and-practices/psychological-first-aid-and-skills-for-psychological-recovery/about-pfa (accessed October 23, 2020).

survey of the existing infrastructure and its critical components. This type of exhaustive survey has not yet been conducted in human and social services, especially in terms of services for children. Thus, there is not a solid understanding of the infrastructure that exists. Given the lack of a critical infrastructure sector for human services, Lavin asked for suggestions to strengthen the infrastructure and build the knowledge base.

Simpson said she learned from this workshop that social services and educational services via the school system are the first areas that people think of for disaster response. Schools may be designated shelters or used as hubs for distributing food to families. However, these systems are already overtaxed, so when disaster strikes, they will have to implement continuity-of-operations plans. Therefore, the capabilities of other services in communities need to be built to support social and educational services. She stated that as a pediatrician, she is considering ways for her hospital system to conduct more targeted outreach to social services and to school systems in order to partner with the community to build the infrastructure needed to serve children.

Beal remarked that child care should be designated as critical infrastructure owing to its role in supporting recovery by simultaneously meeting the needs of children and enabling parents to work and rebuild. She added that currently, child care is often considered small business. She contended that as 60 percent of child care is for-profit, there is a large effect on communities when child care centers close. However, she remarked that there is no distinction between child care providers and other types of businesses in terms of grants, funding, and loan availability. Furthermore, there is no connection between child care and mental health support services. While these services are connected to schools, this access point is not available for younger children, she noted. Trauma and loss issues affect children of all ages, so greater support is needed for these services, whether or not they are classified as businesses.

Lavin quoted the statistic that of the 3,896,000 child care settings in the United States, 3,767,000 are in homes (Child Trends, 2020). Therefore, the child care facilities that most people envision only account for 129,000 settings across the country, making it all the more difficult to conceptualize child care as infrastructure. She contrasted this with banks, which are considered critical infrastructure. Somers noted that many times when people think of infrastructure, they think of physical space. For example, when people envision banks, they may think of physical locations and ATMs rather than of the services banks provide.

When considering the infrastructure needs of child care settings, early education, and schools, many people likely think of characteristics such as buildings having functioning water and electrical services. Somers noted that the services aspect of infrastructure is more abstract and should be

conceptualized more holistically to encompass both physical space and services. Amler added that the COVID-19 pandemic has severely affected the state of New York, with quarantines undercutting people’s ability to work and meet their own needs, and creating an increase in needs to be addressed by human services. Much can be learned from the pandemic and applied to other disaster-related events, she suggested. Lavin noted that programs discussed at this workshop, such as the children and youth task force in Puerto Rico, psychological first aid, and child care disaster planning requirements can be learned from and replicated.

Beal remarked that a human services sector needs to be built in which child care is defined as critical infrastructure. Child care includes tangible structures, such as child care centers and schools, in addition to the services it offers. She noted that the current critical infrastructure sectors do not cover child care buildings and services or mental health services. Amler suggested that sometimes the unmet needs of children seem so large that adequately addressing them is perceived as an impossible task. Improvements should be approached piece by piece, starting small and building up. Rather than attempting to overhaul the system all at once, addressing individual pieces can be successful and make the task less daunting, she added.

Simpson said she approaches issues through her health care system lens, where clinical conditions are addressed by examining the evidence base of data and research that applies to different populations in treating a particular illness. Referencing information on evidence gaps presented at this conference, Simpson noted that data are needed to measure the effectiveness of model programs being built at the local level. Many efforts to mitigate the effects of disasters on children are not yet present in the literature. Additional data would allow communities to learn from one another and would provide a benchmark of best practices for various situations and for different age groups of children and their adult supports.

Lori Peek, director of the Natural Hazards Center and professor at the University of Colorado Boulder, referenced a book, Palaces for the People: How Social Infrastructure Can Help Fight Inequality, Polarization, and the Decline of Civic Life, which argues that the physical infrastructure of schools, parks, libraries, and child care supports social infrastructure (Klinenberg, 2018). Lavin contended that first addressing the critical infrastructure of human services would likely enable other issues to be addressed, such as supporting service providers and building capacity of voluntary organizations active in disaster, and thus better meet the needs of children during a disaster.

Initiatives and Actions with Greatest Potential Effect

Lavin asked what initiatives or actionable items might have the most effect moving forward. Beal highlighted the value of using children and

youth task forces, but she noted that this particular structure may not be applicable to every area owing to a lack of resources to organize it. Furthermore, task forces would look different in various locations, as membership, design, and leadership will vary. However, Beal said that incorporating processes such as children’s task forces into standard emergency management planning efforts would place greater emphasis on children’s needs. Rather than considering children’s needs at the end of planning efforts, children’s needs and resources should be identified ahead of time so that gaps can be resolved before disasters take place.

Simpson pointed out that many programs currently exist that have been built on the lessons learned from Hurricane Katrina, but technical assistance may be needed in order for communities to access these programs. Thus, it is not only a matter of establishing services, but also of creating better systems of connecting programs and the people most in need. Programs also need to be operationalized so that the outcomes of services can be measured, thus enabling them to be built on each time new lessons are learned from a disaster, she added.

Responding to a participant’s comment that advocates should demand that emergency management systems in their local communities address the needs of children, Lavin said that access to resources will be required to scale up and integrate services for children. A single organization such as Save the Children (STC) cannot cover all child-related disaster needs. More engagement is needed, beginning with emergency management systems and establishing a larger leadership role for human services and agencies such as the Administration for Children and Families (ACF). Lavin said that in large-scale disasters, both bottom-up and top-down approaches are needed.

Amler emphasized that children should not be an afterthought: children are the future and should be the first population considered, not the last. The typical approach is planning for everyone else, and then making considerations for children and those with special needs—this paradigm should be flipped. She suggested that by addressing the most difficult considerations at the front end, populations with fewer needs would simultaneously be covered. Lavin added that a utilitarian approach of “the greatest good for the greatest number” results in serving “the wealthy and the healthy,” to the exclusion of everyone else.

In considering actions that might be most promising or have the greatest effect, Lavin said that a top priority is accessibility of data. A plethora of data has been generated, but the people who are able to take large amounts of data and distill them down into evidence generally lack access to data on disaster interventions. Another priority is addressing issues arising from school closings, such as the effect this has on food insecurity, she said. Additionally, she suggested effecting policy changes, such as the emergent electronic benefits transfer and advancing benefits before an imminent disaster.

Beal pointed out many providers of child care and child-related services lack a clear understanding of the Small Business Administration (SBA) loan process. In her dissertation research on Superstorm Sandy, she found that providers were not aware that they could apply for these loans. Although SBA makes this information available, it would be helpful if additional organizations assisted in making child care providers aware of their options regarding SBA loans before a disaster hits. For instance, child care professionalization organizations, state licensing groups, and ACF could offer more training and information on how to navigate the SBA system, she suggested.

To reduce silos and broaden perspectives, Somers suggested that entities and organizations should reach out across sectors and professions. In her work around environmental health at the Agency for Toxic Substances and Disease Registry, Somers has collaborated with ACF regarding children’s exposures to environmental contaminants after disasters. Such collaborations lead to thinking about problems and issues in a new way. Once working relationships are established across professions, organizations become information resources for one another. For example, in her work in environmental health, Somers can reach out to colleagues in early child care and education when she is approaching an issue involving children. Child care, education, environmental health, and mental health are all important needs, so breaking down the barriers between silos to share data and best practices with one another improves the work of each profession.

Supporting Children and Youth in School Settings

Given that children spend much of their day in school settings, Lavin asked how schools can be better used to provide disaster-related education of teachers and students—and perhaps of community members and volunteers as well. Amler suggested that regular education around disaster preparedness be taught in schools, beginning in kindergarten. Children should be taught what to do in disaster situations and take an active part in disaster-related drills, for example. She added that in public health, much time is spent drilling on processes (e.g., points of distribution), but the pediatric population is rarely included in the actual drills. She suggested that children’s active participation in a variety of disaster-related drills would decrease their anxiety should an event occur; it would also provide them with the knowledge of what to do in such situations. For example, teaching children cardiopulmonary resuscitation (CPR) or how to dial 911 enables them to know what to do in an emergency.

Given that children in the child welfare system have predisaster vulnerability, Lavin asked how predisaster conditions can be accounted for in disaster response and recovery. Amler commented that adverse child-

hood experiences (ACEs) are relevant in this context. That is, the trauma experienced by many children in the child welfare system puts them at a greater risk for both health-related and mental health conditions, which can decrease their ability to cope in a disaster-related event. She suggested that foster parents and people sponsoring children should be trained to have a fundamental understanding of disaster preparedness and a basic plan in place for managing an emergency event while the child is in their care. Simpson added that a community understanding of the natural grief reaction is lacking in the general population. Regardless of ACEs or predisposing conditions, Simpson said there is a need to learn “the ‘CPR’ for the grief response of tragedy and coping,” because this would help people to cope before their needs rise to the level of requiring specialized mental health services or behavioral health specialists. The capacity of adults to understand and support children in an evidence-based way can be expanded through psychological first aid and other systems that are known to work in communities, Simpson suggested. Somers remarked that at this unique time in history of heightened discussion of equity and justice, the timing may be right to better understand the specific vulnerabilities of communities and populations, especially those of children.

Monitoring and Evaluation of Support Efforts

Lavin asked about strategies to monitor and evaluate the performance of disaster response and recovery efforts as they relate to human and social services. One strategy would be to fund disaster research specific to human services and encourage researchers to use available ACF data for assessment. Citing the need for holistic approaches that include government agencies, she asked the panel how interventions can be monitored and evaluated in order to generate evidence and in turn have evidence-based programs and responses. Amler said that it is best to look at lessons learned after events have occurred to determine what worked and what did not work. She noted that this approach is not theoretical, and that data are often readily available. Although it is not a hurricane or natural disaster, COVID-19 presents similar issues and provides an opportunity to learn how systems function and whether the most vulnerable families can be supported. In examining the response to any type of disaster, it becomes evident where the holes are, Amler stated.

Simpson said there are benefits to community-based participatory research. Noting that many organizations are developing systems and resources serving the same populations, she suggested that organizations share experiences and collect data from families experiencing multiple parts of the system simultaneously. Breaking down silos allows health care, social services, and other community programs to work together not

only to develop programs but also to share in the evaluation process. Data building and collection can enable organizations to learn lessons together in real time, she added. For example, when she has a project in the emergency room, she can extend this to talking to school systems, case management systems, and so forth as she builds out her projects.

Lavin asked how government agencies could approach the evaluation of evidence collected about prevention interventions designed for children in schools. Somers responded by saying that federal agencies could aggregate the best practices they have observed and make them available to the public, which would empower local community members with knowledge about how to rebuild their communities. Organizations such as ACF, STC, and the American Red Cross can be sources of good information for community members, she added.

Lavin stated that while many people of higher socioeconomic status think of child care as private, for-profit facilities, the majority of providers that ACF helps to support are not-for-profit and serve some of the most financially disadvantaged people in the country, as is the case with many other social supports and human services organizations. Indeed, many of these not-for-profit organizations rely on volunteers. Lavin pointed out that data collection and evaluation efforts are far more feasible for large corporations than for small, not-for-profit organizations who do not have the staff capacity to conduct these activities.

Closing reflections called for strengthening child care infrastructure, placing the needs of children in the center of disaster preparation efforts, increasing resource and data accessibility, supporting interdisciplinary collaboration including considerations of the impact of trauma, better educating children about disaster preparedness, and monitoring and evaluating response and recovery efforts.