U.S. Department of Homeland Security Office for Civil Rights and Civil Liberties

1. U.S. Department of Homeland SecurityOffice for Civil Rights and Civil Liberties The Paradigm Shift in Planning for Special Needs Populations FEMA Higher Education Conference

2. Presentation Topics • Introduction • DHS Office for Civil Rights and Civil Liberties • Civil Rights and Emergency Management • Defining Special Needs – Synopsis of Published Definitions • Special Needs – Functional Based Definition • Assessments • Planning Considerations • The Implications for Emergency Management Curriculum • Q & A FEMA Higher Education Conference

3. DHS Office for Civil Rights and Civil Liberties Mission Among its core responsibilities: Provide proactive legal and policy advice to Department leadership. FEMA Higher Education Conference

4. DHS Office for Civil Rights and Civil Liberties Executive Order #13347: Individuals with Disabilities in Emergency Preparedness • Policy: To ensure that the Federal Government appropriately supports safety and security for individuals with disabilities in all hazard situations. • Consider the needs of agency employees with disabilities and those the agency serves; • Encourage the consideration of the needs of individuals with disabilities served by governmental and private sector organizations; and • Facilitate cooperation among government and private entities and individuals with disabilities. FEMA Higher Education Conference

5. DHS Office for Civil Rights and Civil Liberties Federal Collaboration • Leads “Special Needs” workgroup for NRP/NIMS revision • Provides Federal guidance on use of phrase “Special Needs” • Developed disability accommodation reference guide for disaster services. • Provide guidance to Emergency Support Functions 6 and 8 and Target Capability working groups. FEMA Higher Education Conference

6. DHS Office for Civil Rights and Civil Liberties Federal Collaboration (continued) • Drafted language for use in FEMA’s disaster victim intake form • Established Disaster Incident Management Team and Joint Field Office position • Participated in FEMA Hurricane Exercises • Participate in TOPOFF Exercises and Homeland Security and Exercise Program • Contribute to Homeland Security Grant Program criteria FEMA Higher Education Conference

7. DHS Office for Civil Rights and Civil Liberties Collaboration with State, Tribal, and Local Governments • Recommend special needs consideration to revision of Guide for All-Hazard Emergency Operations Planning (SLG 101) • Leading the development of special needs planning guide • Lead disability specific aspect of Nationwide Plan Review FEMA Higher Education Conference

8. DHS Office for Civil Rights and Civil Liberties Collaboration with Non-government Organizations • Liaison with Voluntary Organizations Active in Disasters (VOAD) • Provided content to American Red Cross volunteer training “Serving People with Disabilities” • Engage disability service, consumer, and advocacy organizations in departmental programs and activities • Engage university emergency management program leads to explore the addition of a special needs component to their curriculum FEMA Higher Education Conference

9. Civil Rights and Emergency Management Applicable Statutes for Disability Populations • Rehabilitation Act • Americans with Disabilities Act • Fair Housing Act • Architectural Barriers Act • Communications Act • Individuals with Disabilities Education Act FEMA Higher Education Conference

10. Civil Rights and Emergency Management Additional special needs civil rights considerations • Older Americans • Children • Cultural and minority populations status • Limited English proficiency FEMA Higher Education Conference

11. Civil Rights and Emergency Management Key Principles of Disability Law • Self-Determination – People with disabilities are the most knowledgeable about their own needs. • No “One Size Fits All“ – People with disabilities do not all require the same assistance and do not all have the same needs. • Equal Opportunity – People with disabilities must have the same opportunities to benefit from emergency programs, services, and activities as people without disabilities. FEMA Higher Education Conference

12. Civil Rights and Emergency Management Key Principles of Disability Law (continued) • Inclusion – People with disabilities have the right to participate in and receive the benefits of emergency programs, services, and activities provided by governments, private businesses, and nonprofit organizations . • Integration – Emergency programs, services, and activities typically must be provided in an integrated setting. • Physical Access – Emergency programs, services, and activities must be provided at locations that all people can access, including people with disabilities . • Equal Access – People with disabilities must be able to access and benefit from emergency programs, services, and activities equal to the general population. FEMA Higher Education Conference

13. Civil Rights and Emergency Management Key Principles of Disability Law (continued) • Effective Communication – People with disabilities must be given information comparable in content and detail to that given to the general public, as well as accessible, understandable, and timely. . • Program Modifications – People with disabilities must have equal access to emergency programs and services, which may entail modifications to rules, policies, practices, and procedures . • No Charge – People with disabilities may not be charged to cover the costs of measures necessary to ensure equal access and nondiscriminatory treatment . FEMA Higher Education Conference

14. Defining Special Needs - Synopsis of Published Definitions No singular definition of the term “special needs” exists although “special needs” is a widely used term within the disaster services and emergency management world. FEMA Higher Education Conference

15. Defining Special Needs – Synopsis of Published Definitions Federal Government Sources “…The situation section may include relative probability and impact of the hazards, geographic areas likely to be affected by particular hazards, vulnerable critical facilities, population distribution, characteristics and locations of special populations (institutionalized persons, the elderly and disabled, those who speak languages other than English, etc.), critical resource dependencies on other jurisdictions, and more.” FEMA State and Local Guide (SLG) 101 - Guide for All-Hazard Emergency Operations Planning, 1996. FEMA Higher Education Conference

16. Defining Special Needs – Synopsis of Published Definitions Federal Government Sources In practice, the term also includes people who live in poverty or on public assistance; people without private transportation or who rely on public transportation; and people who rely on caregivers for assistance in daily living and would need similar assistance in an emergency and those who live independently or with the caregiver(s) in their homes, assisted living housing, nursing homes, supervised group homes, hospitals, and other health care facilities. Nationwide Plan Review Phase 2 Report, U.S. Department of Homeland Security in cooperation with the US Department of Transportation, June 16, 2006.Page 41. FEMA Higher Education Conference

17. Defining Special Needs – Synopsis of Published Definitions DHS Nationwide Plan Review revealed major inconsistencies in definition of the term special needs or similar term among State and urban areas. A few examples: • "the disabled, elderly and those traveling with pets or livestock" • The term “vulnerable populations” was used for hazard mitigation, people younger than 19 or older than 65 with incomes less than $20K, and those living in 100+ year old dwellings (does not include people with disabilities) • Seniors and people with disabilities, non-English speakers, people who are culturally or geographically isolated, people with substance abuse issues, homeless, marginally housed or shelter-dependent, children with special circumstances (unattended minors, foster care or residential living situations), single parent households, people living in poverty FEMA Higher Education Conference

18. Defining Special NeedsSynopsis of Published Definitions Other Sources Among this small “city” of students, faculty, staff, and visitors on the University of Washington Seattle Campus are people who may require more individualized assistance in the case of an emergency. Often called special needs populations, the terms “vulnerable populations” or “specific needs” are also used. These special needs populations include: • Minors under the age of 18 • Physically, psychologically, cognitively, and sensory impaired persons • Hospitalized patients and others with medical conditions • Frail elderly • Non-English speaking persons • Companion, service, and research animals University of Washington Seattle Campus Report on Emergency Preparedness for Special Needs Populations, April 2006 FEMA Higher Education Conference

19. Special Needs -Functional Based Definition Establishes a flexible framework to address a broad set of common function-based needs irrespective of specific diagnosis, status, or label (e.g., children, the elderly, transportation disadvantaged). FEMA Higher Education Conference

20. Special Needs – Functional Based Definition As proposed for the NRP and NIMS drafts: Before, during and after an incident members of the special needs population may have additional needs in one or more of the following functional areas: • maintaining independence • Communication, • transportation, • supervision, and • medical care. Individuals in need of additional response assistance may include those: who have disabilities; who live in institutionalized settings; who are elderly; who are children; who are from diverse cultures; who have limited English proficiency or who are non-English speaking; and who are transportation disadvantaged FEMA Higher Education Conference

21. Special Needs – Functional Based Definition Maintaining Independence Supports for independence in daily activities may be lost. This may include lost or damaged durable medical equipment (wheelchairs, walkers, scooters, and essential supplies catheters, ostomy supplies, etc.). By supplying needed support/ devices independence is preserved. FEMA Higher Education Conference

22. Special Needs –A Functional Based Definition Communication Limitations that interfere with the receipt of and response to information will need that information provided in methods they can understand and use. They may not be able to hear verbal announcement, see directional signage, or understand how to get assistance all because of hearing, vision, speech, cognitive or intellectual limitations, and limited English proficiency FEMA Higher Education Conference

23. Special Needs – A Functional Based Definition Transportation Individuals who cannot drive due to the presence of a disability or who do not have a vehicle will require transportation support for successful evacuation such as the availability accessible vehicles (e.g., lift equipped or vehicle suitable for transporting individuals who uses oxygen) or knowledge of how/where to access mass transportation used to assist in evacuation. FEMA Higher Education Conference

24. Special Needs – A Functional Based Definition Supervision Individuals may lose the support of caregivers, family, or friends or may be unable to cope in a new environment; have conditions such as dementia, Alzheimer’s and psychiatric conditions (schizophrenia, intense anxiety); and unaccompanied children will require supervision to make decisions affecting their welfare. FEMA Higher Education Conference

25. Special Needs – A Functional Based Definition Medical Care Includes individuals who do not have or have lost support from caregivers, family, or friends and need assistance with: managing unstable, terminal or contagious conditions that require observation and ongoing treatment; managing intravenous (IV) therapy, tube feeding, and vital signs; receiving dialysis, oxygen, and suction administration; managing wounds; and operating power-dependent equipment to sustain life. These individuals require support of trained medical professionals. FEMA Higher Education Conference

26. Assessments • Assessments • Registries • Geographic information system (GIS) FEMA Higher Education Conference

27. Assessments • An informed estimate of the number and type of special needs individuals within the population based on lists and information collected from multiple sources including: • U.S. Census data • Social services listings (dialysis centers, Meals on Wheels, etc.) • Para transit providers • Health departments (State, tribal, or local as applicable) • Utility providers (for electricity dependent individuals) • Job Access Services FEMA Higher Education Conference

28. Assessments Assessments (continued) • Large-scale senior housing developments • Congregate care facilities • Schools (especially those with significant proportion of students with disabilities or with limited English proficiency) • County emergency alert list serves • Medicaid • Hospitals • Day care centers (for children or senior citizens) • Nursing homes • Places of worship FEMA Higher Education Conference

29. Assessments Assessments – Aging Population Trends • In 2000, there were an estimated 35 million people age 65 or older in the United States, accounting for almost 13 percent of the total population. • In 2011, the “baby boom” generation will begin to turn 65. • By 2030, it is projected that one in five people will be age 65 or older. • The size of the older population is projected to double over the next 30 years, growing to 70 million by 2030. • The population age 85 and older is the fastest growing segment of the older population. FEMA Higher Education Conference

30. Assessments Assessments- Community Residential Trends • Individuals with disabilities living independently in the community. • Individuals who require personal assistance in their own homes. • Individuals requiring acute and hospice care are receive it through home health agencies • Naturally occurring senior, cultural, or language based communities. FEMA Higher Education Conference

31. Assessments Assessments - Other Community Trends • Diversity of language and culture • Single parent households and use of daycare settings • Transient populations (i.e. tourists, migrant workers, etc.) • Homeless individuals FEMA Higher Education Conference

32. Assessments Sample Special Need City Population Assessment Portland (city proper, U.S. Census 2000) • Total population - 530,000+ • Established Vietnamese community of 11,000+ • 64,600 people (11% of the population) are over the age of 65 • 172,000+ people (or more than 30%) self-identify as having a disability • 25% of households have children under the age of 18 • 13% live below the poverty level FEMA Higher Education Conference

33. Assessments Portland Assessment (city proper)(continued) • 45,000 people speak English less than “very well” (U.S. Census 2000) • Approximately 11 mosques or Islamic centers in the greater Portland region, and at least one Sufi center that brings together members of several Sufi orders. • Center for the Deaf and Hard of Hearing (Public School) • 38+ nursing homes • School enrollment is approximately 130,000 FEMA Higher Education Conference

34. Assessments Assessments provide an overview of community population clusters and their general locations. Registries identify the location of specific individuals who need additional assistance during an emergency. FEMA Higher Education Conference

35. Assessments Registry • A database of individuals who meet the eligibility for receiving emergency response services based on having special needs (the criteria for which should be established by the State, local, or tribal jurisdiction as applicable) and who voluntarily sign up. FEMA Higher Education Conference

36. Assessments Registries are voluntary. People may choose not to sign up for the following reasons • They fear their financial assets will be taken; • They fear legal consequences (in the case of undocumented workers); • They think their medical information will not be protected, making them targets of crime and fraud; and • They do not believe they have special needs. FEMA Higher Education Conference

37. Assessments Registries (continued) • The establishment of a registry creates an expectation among participants that may not be valid. • Needs and location of people are constantly changing; keeping a registry updated with accurate information is both costly and time consuming. • Must reach the entire special needs population during, or prior to, an emergency registered or not. • There might not be a way to access the registry if there is no electricity. FEMA Higher Education Conference

38. Assessments Understanding implications of population data • Resource identification, coordination, and allocation • Key community partners FEMA Higher Education Conference

39. Assessments Geographic Information Systems (GIS) • Demographic and registry information is entered into a database management program. • Map communities, facilities, and households where persons with special needs reside relative to response assets and hazards. FEMA Higher Education Conference

40. Planning Considerations Emergency Public Information • Public Awareness • Personal preparedness and planning focus. • Disseminate in coordinate with community based organizations. • Include information on availability of guidance to create appropriate personal plans. FEMA Higher Education Conference

41. Planning Considerations Emergency Public Information • Delivery Mechanisms • Phone tree • Teletypewriters (TTY), video relay • Text messaging • Automated dialing programs • Closed captioning • Accessible websites • Sign language interpreters and foreign language translators • Braille • Large print type • Door-to-door warnings FEMA Higher Education Conference

42. Planning Considerations Emergency Public Information (continued) • Messaging • Timely delivery of complete information. • Appropriate for diverse populations (schools, nursing homes, ethnic communities, home health care providers, single parents, etc.) • Compose skeletal messages in advance in collaboration with community based organizations FEMA Higher Education Conference

43. Planning Considerations Sheltering and Mass Care • Life safety issues are first priority • Provision of appropriate level of care based on functional need • Shelter intake assessment process • Resource management • Laws related to admission of service animals • Shelter-in-place planning for congregate settings • Shelter-in-place planning for individuals living at home requiring home health care and/or personal care assistance FEMA Higher Education Conference

44. Planning Considerations Evacuation • Transportation resources identified, coordinated, and incorporated at all levels of government with consideration of mobility limitations. • Established policies for evacuation of special needs populations from high-rise buildings. • Keep individuals with disabilities who have mobility devices, other durable medical goods, and service animals together • Establish a system to evacuate pre-identified individuals • Evacuate medically fragile prior to the general population when time permits • Sustain people over the course of an evacuation FEMA Higher Education Conference

45. Planning Considerations Transportation • Adequate provision identification of appropriate transportation for general population and nursing homes, group homes, assistive living facilities, etc. • Awareness of plans for nursing homes and hospitals • Returning people back to the community FEMA Higher Education Conference

46. Planning Considerations Human Services and Medical Management • Identification of medical and human service personnel, pharmaceuticals, and durable medical goods for immediate community and surge populations • Credentialing systems for identification of appropriate health service staff • Consideration of individuals who are physically or psychologically harmed as a result of the disaster. • Interstate issues related to medical personnel. • HIPPA FEMA Higher Education Conference

47. Planning Considerations Congregate settings • Awareness of congregate facilities’ emergency plans (i.e., nursing homes, assistive living, group homes, residential schools, etc.). • Prioritization of power restoration to facilities where individuals are dependent on life-sustaining equipment. FEMA Higher Education Conference

48. Planning Considerations Training and Exercises • Cross-train on evacuation, sheltering, assistive care, long-term recovery, etc. • Include special needs community based and volunteer organizations • Include persons with special needs into all phases of training (development through exercise delivery. • Train spontaneous volunteers with special needs expertise. FEMA Higher Education Conference

49. Planning Considerations Recovery • Include consideration of restoration of personal care givers, service providers, rehabilitation, service animals, child care providers, etc. • Identify the impact on special needs communities of an interruption in utility or transportation services. • Identify appropriate and accessible long term shelters and temporary housing. • Involve representatives of special needs communities in after action assessments to capture the impact of the disaster. • Improve future community sustainability by implementing universal design and hazard mitigation concepts into the long term recovery planning process. FEMA Higher Education Conference

50. Planning Considerations Summary • Demographics and grouping of populations • Identification of functional areas that may need support • Identification of community partners • Collaboration with multiple stakeholders • Public education stressing personal responsibility as key element in readiness FEMA Higher Education Conference