Recovery

How to Include Diverse, Vulnerable Populations in Emergency Preparedness

All-inclusive preparedness can be challenging for governments, but examples of resources and successful programs can help.

by / April 11, 2011
Photo courtesy of www.123rf.com.

The United States is home to more than 308 million people, comprising many cultures and subpopulations — such as diverse and vulnerable groups of people — who may interpret messages differently or distrust the government. Perhaps no disaster has illustrated the need for emergency planning and preparedness with these communities to the extent that

Hurricane Katrina did. Almost six years ago, the nation watched as more than 1,800 perished, 80 percent of New Orleans flooded and nearly 100,000 citizens remained in the water-ravaged city rather than evacuating.

A study of 1,089 people affected by the hurricane in Louisiana, Mississippi and Alabama found that 28 percent of those who didn’t evacuate couldn’t leave because of limited means, according to the nonprofit Fritz Institute. Of those who couldn’t evacuate for this reason, 71 percent said they had nowhere else to go, 37 percent didn’t have a car, and 36 percent couldn’t leave their homes without assistance. What’s more, 84 percent of those with limited means had household incomes of less than $50,000; 58 percent were African-American; 66 percent were women; 57 percent said their highest level of education was a high school diploma or less; and 32 percent had a physical disability.

When preparing residents for disasters, officials must think not only about the different cultures within their community, but also about the vulnerable populations — the disabled, very young, elderly, homeless and people who speak limited or no English. Emergency managers and public health officials have wrestled with developing relationships with these groups for decades, and it’s still a challenge for many.

Luckily there are resources for officials to use; examples of successful initiatives can assist state and local agencies with their plans, helping them to reach as many people as possible in ways that create positive relationships and changes.

The following three examples demonstrate how governments have worked with diverse and vulnerable populations and the organizations that serve them.


Philadelphia Reaches Out


One of the easiest and possibly most effective ways to educate and connect with diverse and vulnerable populations is to partner with organizations that already interact with them. This was one way the Philadelphia Department of Public Health communicated with these populations — officials reached out to human service agencies, and community- and faith-based organizations to take advantage of what it believed was an existing information structure, said Dr. Esther Chernak, who led the department’s Public Health Emergency Preparedness Program from 1999 to 2008. “We knew they would be trusted partners in the community to the people who had special needs,” she said. “During an emergency, they would look to the trusted partners for assistance.”

The department’s goal was to build relationships with community organizations before there was an emergency. The Public Health Department created a database of the different community organizations that included information like their size and phone number. “Even though they might not necessarily have a mission directly related to public health or emergency management functions, we wanted to get a sense of who was out there working with the most vulnerable communities in our city,” said Chernak, who is now the director of the Center of Public Health Readiness and Communication at the Drexel University School of Public Health.


Photo: A FEMA representative provides a Fargo, N.D., resident information translated into Arabic in June 2009. Photo courtesy of Samir Valeja/FEMA.


Then the department developed a plan to reach out to those organizations, informing them of what they could to do to help their clients — or the population they serve during an emergency. Chernak said a one- to two-hour briefing was developed that discussed the types of public health emergencies that could happen in Philadelphia and how they might affect community organizations. Department representatives explained how the organizations could support their clients’ needs if an emergency occurred. Representatives also explained that the most important thing the organizations could do during and after an emergency is to stay open. The briefing also included a basic tutorial of the city’s emergency response plan.

From Chernak’s experience with including community organizations in emergency planning to reach vulnerable and diverse populations, she identified recommendations for other agencies to consider before embarking on their own project.

  • Work with large organizations — like the American Red Cross, United Way and Voluntary Organizations Active in Disaster — because they have a good roster of which agencies in the community are doing what.
  • Conduct a needs assessment of who in the community has functional needs; this helps prioritize who to work with first.
  • Ensure that outreach efforts include bidirectional communication. “When you meet with folks who work in communities, the message is more than, ‘Here’s what the government plans to do during an emergency,’” Chernak said, “but it’s a two-way conversation in which the community agencies have the ability to provide government planners with what they believe the most pressing needs are or will be in their community during an emergency.”
  • Understand that planning and relationship building will take a long time and require patience.


Jewish Community Alert System


The Jewish community in Boston is an example of a well prepared society. Created in 2006 as a program of the Combined Jewish Philanthropies organization, the Greater Boston Jewish Emergency Management System (JEMS) keeps the more than 200 Jewish agencies — from synagogues to preschools to social service agencies — updated about possible emergencies and public safety concerns. Working closely with the Boston Police Department, the Boston Regional Intelligence Center (BRIC) and local communities — while tracking information from FEMA, the U.S. Department of Homeland Security and the Secure Community Network — JEMS Director Elyse Hyman e-mails safety and emergency notifications to about 250 community leaders.

“A lot of our issues and themes revolve around Israel, which is a very emotional topic, and we just had an incident where suspicious people were giving out information in front of synagogues,” she said. “So I sent a notice that you need to be a little bit more aware and make sure people notice what’s going on around them, and if there’s an emergency or something looks
suspicious, call 911 immediately.”

From local issues to emergencies that garner national attention, Hyman works with the
police to address issues that could possibly affect the Jewish community. For example, in 2010 when there were reports of printer cartridges packed with explosives directed at Jewish entities in Chicago, Hyman called her contacts at BRIC to find out if there were any threats to Boston’s Jewish community. “We have representatives from the FBI and Department of Homeland Security assigned to our office,” said Boston Police Department Detective Bill Dickinson. “We get the information quickly and can assure her that she can put out something saying there’s no nexus to Boston and everybody can relax a little.”

JEMS not only provides an avenue for Hyman to reach community leaders, but it also allows BRIC to reach them consistently and quickly, Dickinson said.

When a major incident happens — whether locally, nationally or worldwide — JEMS follows protocols to determine what action to take. When the system was created, representatives from 10 organizations created a checklist that they go through on a conference call to decide how to handle the threat or problem.

JEMS’ relationship with the Boston Police Department also increases public safety. Hyman
will bring possible public safety issues to Dickinson’s attention. For example, last year someone called a Jewish organization and spoke only in Arabic. “We weren’t sure if it was a threat or somebody got the wrong number and it just happened to come to us,” she said. The call was taped and sent to Dickinson to determine what the person said. “It’s a really nice relationship that we’ve built: a trusting relationship,” she said.

Being honest with each other and establishing a relationship before an emergency happens is key, Dickinson said. “A lot of what we do is diffuse situations, things of concern to the community.”


Mentoring Community Organizations


Simply telling an individual or an organization that they must prepare because something terrible will eventually happen doesn’t usually elicit the response officials hope for. So in 2009, Lane County, Ore., public health officials took a different approach to working with community organizations: They mentored them through workshops and one-on-one sessions to develop action plans.

Selene Jaramillo, a community health analyst and assistant preparedness coordinator for the county’s Public Health Department, said 36 agencies that provided a service to at least one homeless person and lacked the resources for emergency planning were recruited to participate.


Photo: American Sign Language interpreters are an example of FEMA utilizing a diverse work force to serve the wide range of needs of a community after a disaster. Photo courtesy of Mike Moore/FEMA.


Before the workshops began, participants evaluated the resources the department was interested in using, which included tools from the nonprofit organization Collaborating Agencies Responding to Disasters (CARD). Jaramillo said the department asked questions including: Would this meet your need? Is it something you find interesting? Is it outside your scope?

“Having the opportunity to pre-sample those things in a small setting and hearing their feedback generates lots of buy-in,” she said. “They took ownership of the project.”

To determine the program’s effectiveness, participants were surveyed beforehand to find out if they had an emergency plan in place and if they felt confident that they could execute it. Jaramillo said most of them were starting from scratch and some acknowledged that their plans needed improvement — others didn’t know if their organization had an emergency plan.

Three workshops were held over seven months and covered different objectives and ideas. Examples were given of emergencies that other local agencies had faced, like a blood bank that caught on fire in the middle of the night. “When we talk about emergencies and disasters, we’re not talking about apocalyptic events that you may not think are ever going to happen to you,” Jaramillo said. “We’re talking about day-to-day things that happen to us in every organization.”

Twenty-six of the organizations then received individual mentoring in which a department representative helped draft an action plan where they identified steps to take toward preparedness, like hanging evacuation maps in the building or compiling an after-hours contact list. The mentors took notes and created a plan with the steps needed to complete the actions. They also tracked the organizations’ progress. “Having someone follow up really motivated them,” she said.

At the end of the project, the department collected the completed plans and surveyed the
accomplishments. “When you’re going from zero, even just putting two or three things in place is a humongous change,” Jaramillo said. But, she added, about 65 percent of the participants accomplished at least 10 activities toward preparedness.

Though the program isn’t ongoing, Lane County has been helping other governments in the region start similar programs to expand the idea of mentoring toward community preparedness.

The following three examples demonstrate resources governments and nonprofits can use when working with diverse and cultural populations.


Community Advocates


When the Emergency Operations Center (EOC) is activated in Alameda County, Calif., government officials have a direct link to community- and faith-based organizations in the area through representatives from CARD. They have a seat in the EOC during emergencies and advocate for the community agencies and clients they serve. “If the San Bruno fire had happened in Alameda County, if our EOC activated, we would be the ones looking at a map and pulling up our county database and saying, ‘Look, there’s a senior center here,’ or ‘This is a deaf resource agency,’” said Ana-Marie Jones, executive director of CARD.

The organization identifies communities that will be the most adversely impacted by an emergency and acts as their advocates. Created during the Loma Prieta earthquake in 1989, CARD
attempts to ensure that vulnerable people aren’t overlooked during disaster response. “We’ve always been earthquake prone, but [during the earthquake] we fell flat on our faces in terms of serving people with disabilities, anyone who didn’t speak English,” Jones said. “We were
really unprepared for the people who live here.”

Following the ’89 quake, nonprofits and community-based organizations in the Bay Area formed CARD “to address the preparedness and response needs of service providers,” according to its website. Since a majority of the time, the area isn’t in disaster mode, CARD works on making preparedness easy, fun and sustainable, Jones said. “We create tools for agencies so they can embrace preparedness inside their budgets, inside their cultures,” she said. Many resources are available on its website, http://cardcanhelp.org, and require only a printer and a piece of tape — Potty Posters inform a captive audience and safety signage uses images to instruct where emergency tools are located and how to evacuate.

CARD conducts emergency preparedness training with community- and faith-based organizations using divergent learning. “In convergent learning, which is the norm, it’s all about teaching you the right answer,” Jones said. Using the divergent model, CARD encourages people to be creative — to think of how they can be resourceful during an emergency instead of telling them to buy certain resources. “We focus on teaching people a million and one things they could do with a fork or a Ziploc bag,” she said.

The organization also focuses on not using fear to make people prepare. Jones said telling people that they should prepare for disasters because horrible things will happen to them doesn’t elicit positive responses. “If you look over the course of the last 100 years, it has not actually worked. We are still a grossly unprepared nation.” Instead of using threats or disaster imagery to encourage preparedness, CARD seeks to empower community-based organizations to be prepared to prosper because staying open during and after an emergency is the best way they can help the people they serve.


A Wealth of Information


The imagery from Hurricane Katrina and the storm’s disproportionate impact on blacks raised questions for many in the emergency management and public health realms; it led some to wonder what information was available for connecting with different cultures and groups of people in a community. Jonathan Purtle, a program manager and health policy analyst at Drexel

University’s Center for Health Equality, said the resources around this topic were fragmented across different fields and sectors because it’s a complex issue that spans multiple domains.

“It’s not just language, culture or income — it’s all these things working together that contribute to these disparities that we see again and again,” he said.

After surveying literature that focused on emergency preparedness and diverse communities, Purtle’s colleagues determined that there was a decent amount of information available, but that it was fragmented. “What was concluded was if someone did want to engage diverse communities and really kind of move this issue forward, they would have to look in a lot of different places,” Purtle said. “And there was really no central source of information.”

After coming to that conclusion, they continued locating resources that covered any phase of an emergency and diverse populations, such as translated materials. Then they organized the resources by type and topic, and created the National Resource Center on Advancing Emergency Preparedness for Culturally Diverse Communities. “It’s a Web-based clearinghouse of resources that are focused on emergency preparedness and diverse communities,” said Purtle, the center’s program manager.

Anyone looking for information can browse the website, www.diversitypreparedness.org, or search by resource type, topic, community, state or language. For example, Purtle said, a search for “Vietnamese” would bring back translated materials in that language, planning guides and people’s experiences with working with Vietnamese communities.

But no matter how much research an individual or agency does, Purtle said it’s important to have an open mind and understand that there’s diversity even within different communities. “For example, in cities, African immigrants often live in a general area and they may be considered a distinct community in their own right, but within the community there’s significant cultural and tribal diversity. So one thing that may work with Nigerians may not work with Ugandans — it could be completely the opposite and actually harmful.”


Tools Based on Experience


The National Association of County and City Health Officials’ Advanced Practice Centers are a network of eight local health departments that develop free resources and toolkits on a variety of topics. Each center focuses on addressing specific public health challenges, and one of the topics the Seattle and King County Public Health Department concentrates on is vulnerable populations. The department’s center has been funded since 2004 and seeks to build resiliency in vulnerable populations through partnerships with key community stakeholders, said Carina Elsenboss, the center’s program manager.

“As an Advanced Practice Center, our goal is to align solutions with the local health departments’ needs and the preparedness challenges that they face, as well as using evaluation and analysis tools to drive that product development,” she said.

The toolkits developed by the center are based on planning that’s under way in King County, lessons learned with input from the National Association of County and City Health Officials, and questions from other local health departments, according to Elsenboss. Many of the tools are Web-based and located at www.apctoolkits.com.

Although the tools are developed by public health departments, the information can benefit emergency managers, community organizations and other agencies that work with the public.

The Equity in Emergency Response kit is broken down into different tools including an action plan template, message development and training. “It talks about how you can begin to plan around this in your health department; how you would begin to engage community-based organizations; how you can begin to identify and define vulnerable populations in your community,” Elsenboss said. “It also has a draft agenda for meetings we have done with community organizations, trainings and resources we’ve offered. And also how to develop messages that are inclusive and meet the needs of vulnerable and at-risk populations, including audience research we’ve done.”


Increasing Preparedness, Creating Relationships


Examples of initiatives that aim to increase emergency preparedness in vulnerable and
diverse communities can provide ideas and help establish best practices for governments and emergency management organizations. But for those that haven’t started building these relationships yet, the task can seem daunting. Here are seven recommendations for how to reach all the citizens in a community, despite their background, culture or socioeconomic status:

  1. Partner with community- and faith-based organizations. They already work with the people you’re trying to reach and are viewed as a trusted source of information by their members. “Have them be a liaison and co-presenter in education forums,” Purtle said.
     
  2. Partner with the ethnic media — loop them into your information chain. Purtle said they’re viewed as a trusted information source by the community they serve. The audiences may not speak English, so they’re not receiving many of the messages already being disseminated by a government or agency. Purtle said New American Media, an association of ethnic media organizations, is a good resource for determining which media outlets reach certain populations.
     
  3. Help organizations find funding to keep preparedness programs going. Elsenboss said it’s important to think through how programs and relationships will be maintained long term. Some philanthropic organizations offer grants to nonprofits, and helping community partners find and apply for funding will keep preparedness efforts ongoing.
     
  4. Don’t tell people what to do. “You can’t go into poor communities and tell people that the earthquake that may happen in 30 years is something they should pay attention to,” Jones said. “They don’t have food for tonight’s dinner, they don’t have money to put shoes on their kids’ feet — why would the earthquake be looked at as the crisis?” She recommended starting a conversation with people and discussing what items they can use in an emergency that they already own.
     
  5. Give organizations a role in the government or agency’s emergency plan. By including community- and faith-based organizations in disaster training and response plans, they will better understand their roles and know how important they are to preparedness and recovery. Chernak said joint-planning exercises can be beneficial, and getting organizations’ feedback on how useful materials are and how well information was translated can be invaluable for governments.
     
  6. Don’t use disaster imagery in preparedness messages. Jones referred to a Red Cross research paper that said using images of disasters during preparedness presentations diminished their purpose. “If you see the pictures of the floating dead bodies of Hurricane Katrina and all the devastation, and those types of pictures, that’s exactly the type of thing that will cause you to not take action,” she said. “But that’s what most preparedness stuff looks like.”
     
  7. Know the audience you’re trying to reach. When going into new communities, research their cultures and keep an open mind. Also keep the audience in mind when developing presentations.

By rethinking the conversation and developing relationships, little steps can go a long way toward including more people in the emergency management conversation, and increasing preparedness for a community — and the nation as a whole.

Elaine Pittman Former Managing Editor

Elaine Pittman worked for Emergency Management from 2008 to 2017.