Children and Emergencies Briefing

1. Children and Emergencies Briefing Mother Nature and Children – A Recipe for Disaster Guidance and Resources for Addressing the Unique Needs of Children

2. OBJECTIVES

3. Workshop Objectives • Share recommendations from the National Commission on Children and Disasters • Explore successful implementation activities at the child, school and community levels • Discuss maximizing limited resources • Present various ways to connect with child-focused stakeholders in the community • Provide information on best practices and planning tools

4. Children in Emergencies

5. Framing the Topic In the U.S., children under 18 represent 25% of the total population Estimated 27.8% or 7,149,062 children under 18 years old in Texas Estimated 24%or1.5 million of children under 18 are in poverty in Texas

6. Where are children on a “normal” day? • School • Child Care • Out of school program • Before/after school, camp • At home • Informal care • Foster care • Juvenile justice facility

7. Those most vulnerable Vulnerable children and families are most likely to end up in mass care shelters Few resources and social networks Low socioeconomic status (SES) makes children and families more vulnerable to a variety of disaster consequences

8. Children’s Unique Needs in Emergencies Children are not just “little adults.” They have unique areas of need that must be addressed to ensure their safety and well-being: • Physical needs for protection vary greatly by age group • At higher risk for long-term mental health consequences • Dependent on guardians for protection, food, clothing, shelter, learning/development

9. National Progress for Children

10. National Commission on Children and Disasters (NCCD) • Independent: Authorized by Congress in 2007 under Federal law; not tied to any agency • Bipartisan: 10 members appointed by President, Senate and House leaders • Diverse: Expertise drawn from several disciplines: pediatrics, state and local emergency management, non-governmental organizations, and state elected office

11. NCCD Final Reportwww.childrenanddisasters.acf.hhs.gov

12. NCCD: Overarching Findings Children = 25% of the population, but… • Placed into broad categories: “at-risk” “vulnerable” or “special needs” populations; annexes • Unique needs unaddressed or misunderstood • Homeland Security Grant $$: training, exercising, equipment directed to child-focused projects limited • Recovery $$: rebuilding infrastructure, not lives

13. NCCD Core Planning Principles • Integrate children across all phases of emergency management • Designate a lead agency and individual for coordinating children’s needs • Build on existing capabilities and requirements • Adopt “whole community” approach: Federal, state, local, non-profit, private sector, parents, children • Encourage relationship building and cooperation prior to incidents • Require accountability: institute goals and monitor progress • monitoring measures

14. Mass Care - Recommendations • National Standards and Indicators for Children in Mass Care Emergency Shelters • Children sheltered with families or caregivers • Designate area for families • Temporary respite care for children • Shelter Supply List for Infants and Toddlers • Identifies basic supplies necessary to sustain and support 10 infants and children <4 years of age for a 24 hour period • Formula, baby food, diapers, feeding bottles, cribs

15. Child Physical Health and Trauma - Recommendations • Access to/distribution of pediatric MCM • Build pediatric medical capabilities of response teams through specific training, supplies, personnel • Provide pediatric disaster clinical training for health care professionals who may treat children during an emergency • Ensure hospital Emergency Departments provide effective care for children • Expedite recovery of pediatric health and mental health care delivery systems in disaster-affected areas

16. NCCD: Mental and Behavioral Health • Integrate mental and behavioral health for children into emergency plans • Enhance pediatric disaster mental and behavioral health training for professionals and paraprofessionals • Support long-term disaster-related mental health treatment for children

17. National Commission on Children and Disasters Publications Includes Appendix E: “Supplies for Infants and Toddlers in Mass Care Shelters and Emergency Congregate Care Facilities” Recommendations to Governors Federal Emergency Management Agency (FEMA) Children’s Working Group CPG 101 Version 2.0 2012 HSGP Supplemental Guidance on Children National Progress for Children

18. National Progress for Children and the Child Care Community • Save the Children 4th Annual Report • Focuses on the ability of schools and child care facilities to protect the 67 million kids in their care on any given day across the nation • Only 17 states meet our four minimal requirements • Save the Children / NACCRRA • Protecting Children in Child Care During Emergencies: Recommended State and National Regulatory and Accreditation Standards for Family Child Care Homes and Child Care Centers • Administration for Children and Families • Guidance to assist Child Care and Development Fund (CCDF) Lead Agencies in developing, exercising, and maintaining written child care emergency preparedness and response plans pursuant to submission of the CCDF Plan. • Federal Emergency Management Agency • Public Assistance Fact Sheet 9580.107 identifies child care services eligible under Category B, Emergency Protective Measures • Emergency Sheltering Costs, Temporary Relocation, Repair, Restoration or Replacement

19. Additional National Change National Standards & Indicators for Mass Care • Standards and Indicators for Disaster Shelter Care for Children (ARC) • Temporary Respite Care for Children • Shelter Guidance (STC) • Low Cost and No Cost Guidance to mitigate risks • Counting Children • Family dormitory areas • Private breastfeeding area for women • Mega Shelter Planning Guide (IAVM and ARC)

20. The Assessment Process: Strengths, Gaps and Opportunities

21. State Assessment Example • Assess the needs of children across all four phases of the emergency management • Evaluate policies, programs, and regulations • Identify gaps and lessons learned • Compile a comprehensive report for the governor • Gap analysis – process, findings, critical risks • Low Cost / No-Cost Opportunities

22. State Assessment Example Based on NCCD Report and Best Practice Guidance • Three Working Groups • Pediatric Medical Group • Human Services • Emergency Management • 65 Planning gaps • Prioritized top 3 and identified cost

23. Pediatric Medical CareWorking Group Stakeholders • State Level, Hospital and Pre-hospital • Leadership group: • Dept. of Public Health • Children’s Hospitals • American Academy of Pediatrics • Focus group • Local emergency management • University School of Public Health • Emergency Medical Services

24. Pediatric Medical CareWorking Group Efforts • State, regional and local plans for pediatric surge (including transport) • Inventory of pediatric health care specialists • Stockpile with pediatric counter measures • Children included in MA emergency operations base plans • Mapping and inventory of pediatric resources in the state. GIS location of children • Critical care Transport: altered standards of care

25. PRE-HOSPITAL • Followed EMSC requirements – most were in place • Gaps: • off-line medical direction • No pediatric designation • Pediatric education not required • MCI plan to include children • EMS pediatric triage • EMS tracking and reunification capabilities • Regional pediatric coordinator

26. HOSPITALS • Major gap- State capabilities for pediatric medical care for disasters as well as day to day care unknown • Areas to explore: pediatric ICU/floor beds; hospital pediatric subspecialty capabilities; tracking and reunification

27. Pediatric Medical Care(4 of 36) • Mechanism to request and share medical records for reunification. Cost - No Cost • Mandating pediatrics education for pre-hospital providers. Cost – Minimal Cost • Conduct analysis of pediatric capabilities for each hospital. Cost - Minimal cost • Regional Pediatric Coordinator. Cost - Considerable Cost

28. Human Services(3 of 11) • Basic pediatric disaster mental and behavioral healthtraining required for health care professionals, school personnel, child care, and early education providers. • No mechanisms exist currently to share records among federal, state or local partners. • Require specific activities for identifying children in the event of a disaster, and to require that foster homes have an emergency plan.

29. Emergency Management (3 of 19) • Identify all local child-serving environments. No Cost • Provide training, guidance and Exercise opportunities at the local level, with focus on child-serving environments (including shelters). Moderate cost • Hire Child Services CoordinatorConsiderable Cost

30. PREPAREDNESS – RESPONSE - RECOVERY: Changing the Way Communities Protect Children in Disasters

31. San Antonio: Targeted RRC Who: San Antonio Office of Emergency Management What: Children in Emergencies Appendix to Annex C (Mass Care) How: Created a Children in Emergencies Working Group comprised of partners from the public, private, and non-governmental sectors to strategize and implement best practices during sheltering operations in the San Antonio urban area.

32. San Antonio Mass Care Sheltering of Children Captain Frank Xiques Captain Eric Jones Lt Jim Reidy Lt Dean Watson Engineer Brandon Murray

33. Pre-planning • Site Acquisition • Shelter Operations

34. Pre-planning • Shelter Branch Team begins with meetings to identify lessons learned and objectives for current season • Usually begin this planning in February • Here we discuss and develop plans to implement in our shelters that will allow us to meet the needs of the children entrusted to us • Push-Packs are developed, inventoried and placed at-the-ready in our warehousing space • Extensive inventory lists are readied for immediate ordering • Local child-care agencies and stakeholders groups are consulted or invited to assist us in our planning and preparations

35. Site Acquisition • Here you must consider the potential needs of the children that will be in your shelters • Ability to provide security in areas that children will occupy • Adequate indoor and outdoor recreation areas available on site • Ability to provide “quiet” areas that will be needed to help deal with the stresses that accompany an evacuation of one’s home • Easy access for families and children between service areas

36. Typical floor plan

37. Shelter Operations • Considerations: • Separate play and respite areas • Indoor and outdoor • Family shower time scheduled • Child-friendly entertainment provided • Adequate, and easily accessible, restrooms for children and families to use with an abundance of hand washing stations • Pre-identifying, and early ordering, of anticipated equipment and supplies that will be needed • Key here is to forecast and stay ahead of the curve on what will be needed

38. Supplies needed for infants, toddlers and children • Assembled into our push-packs our warehouse space • Immediately available upon opening of any shelter

39. Shelter Operations (Cont.) • Considerations: • Staffing of child-friendly play and respite areas • These areas must be monitored while in use • Develop a plan early to address the medical, psychological, emotional and dental needs of the children • Coordinate closely with partnering agencies and local Health Department to ensure this is provided for • Anticipate and plan for different dietary needs of infants, toddlers and children • Again, coordinate closely with partnering agencies to ensure this

40. Shelter Operations (Cont.) • Considerations: • Safety and security • Work closely with partnering agencies and local law enforcement to ensure access control of shelter is in place and monitoring of children-occupied areas is ongoing

41. Shelter Operations (Cont.) • Considerations: • Professional, certified and credentialed formal child-care program • As the population of the shelter grows, so will your need for extended and diverse child-care equipment, supplies and services • This may exceed your local capabilities • Anticipate the need for this early • Utilize ordering process (STAR – State of Texas Assistance Request) and identify your needs • Be very specific as to what it is you want to accomplish and how many children are under your care

42. Resources • Save the Children Organization • www.savethechildren.org • CHILDREN IN DISASTERS GUIDANCE – FEMA • www.fema.gov/pdf/government/grant/2012/fy12_hsgp_children.pdf

43. Translating National Standards and Best Practices to Reality at the Local Level. Policy Change and PracticeState of Connecticut • Child Care Preparedness Training • Trained more than 350 providers (7,000 children) Governor of Connecticut Signing Emergency Preparedness Bill (SB 983) Championed by Save the Children • Advisory Council and Policy Change • Moved CT from an “F” to an “A”

44. Fostering life long partnerships – Beginning, Building, Sustaining. Building Community CapacityThe Gulf Coast • TA & Trainings - Coastal Mississippi • Partnerships with the American Red Cross leverages resources and expands reach • Community Meeting – New Orleans • Initiated dialogue and strengthened networks around child-focused issues

45. Impacting Children, Caregivers and Communities through training and implementations. Training and Implementation Houston, Texas • Child-Friendly Space Training • Training with Texas State Guard • Resilient and Ready Workshop • More than 1,000 children in 2011

46. Response Journey of Hope – SC New Zealand Child-Friendly Spaces - AmeriCorps NCCC in American Samoa

47. What You Can Do

48. Suggested Child-Focused Checklist Emergency Planning and Training • Include needs of children across emergency planning, training and exercises • Designate individual as children’s needs coordinator • Provide staff with briefings on children’s unique needs and how they can protect and support children in their role

49. Steps Forward • Make it a priority to improve emergency planning/response to meet the needs of children • Review and share guiding documents – CIE Resource List • Contact Save the Children to set up briefings or trainings for your organization’s personnel and volunteers

50. Get Children Involved!