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Including Homeless Populations in Disaster Preparedness, Planning, and Response: A Toolkit for Practitioners

Gin, June L. PhD; Levine, Cheryl A. PhD; Canavan, David; Dobalian, Aram PhD, JD, MPH

Author Information
Journal of Public Health Management and Practice: January/February 2022 - Volume 28 - Issue 1 - p E62-E72
doi: 10.1097/PHH.0000000000001230
  • Open

Abstract

Recent emergencies and disasters demonstrate that people experiencing homelessness are often the first and most severely affected group during public health emergencies and disasters such as COVID-19, hurricanes, and wildfires. Their limited resources, social isolation, lack of access to housing and other material needs, and a high prevalence of disabilities, chronic physical conditions, and behavioral health needs create substantial barriers to undertaking individual disaster preparedness measures or to shelter in place during and after a disaster.1–7 These disaster-related challenges compound the daily stressors inherent to homelessness, such as social stigma and marginalization, and risk of violence.4–8

Historically, communities across the United States have often failed to adequately address the needs of homeless populations in disaster planning, response, and recovery activities, resulting in unintended consequences such as the denial of disaster services to people experiencing homelessness.6,9–11 Without plans that both anticipate their access and functional needs and establish protocols for addressing these needs in a disaster, communities risk prolonging the disaster response and recovery process, exacerbating the number of people adversely affected, multiplying the prevalence and frequency of traumatic experiences, and straining the capacity of existing safety net services such as emergency medical services.

The Federal Emergency Management Agency's (FEMA's) “whole community” approach12,13 calls for inclusive disaster planning that engages and empowers all sectors of the community, leveraging what works well in communities on a daily basis to address the disaster needs of all community members. In practice, implementing the vision of a “whole community” approach has been challenging and little operational guidance has been offered to support these changes at the local level.13,14 Consequently, emergency managers and homeless service providers often lack guidance about how to identify cross-sector partners for collaboration in disaster planning.

Homeless service providers and other community-based organizations (CBOs) are potential partners in implementing inclusive disaster planning. After a disaster, local CBOs remain in the community, playing a critical role in recovery for both preexisting homeless and newly homeless individuals.15 However, these CBOs are typically not connected with crucial emergency management partnerships, resources, and networks,10 creating challenges in identifying recovery resources, ensuring effective outreach, and delivering culturally competent services. Local emergency planners can enhance this process through establishing relationships with homeless-serving CBOs, identifying opportunities to partner, developing awareness of their capacity and limitations, and establishing agreements for CBOs to participate in addressing community needs during disasters.16

This article describes a toolkit designed to create a road map and a resource repository to help communities address collaboration between disaster professional and homeless service providers, preparedness among homeless service providers, and the ability to create and support a health care system capable of addressing the disaster health needs of people experiencing homelessness.

While communities often experience challenges in finding resources to support multisectoral collaboration,1,2,17,18 a few success stories offer a glimpse into how predisaster relationships can pay enormous dividends. After Hurricane Harvey in 2017, the city of Houston developed Housing for Harvey, which harnessed the city's existing homeless capabilities to rapidly rehouse more than 600 individuals and households remaining in disaster shelters after the storm with nowhere to go. Housing for Harvey was a collaborative of city and county organizations, the Coalition for the Homeless, affordable housing providers, and local foundations, with funding from FEMA and local partners. Similarly, North Carolina created the [email protected] initiative after Hurricane Florence in 2018 to rapidly rehouse hurricane survivors in disaster shelters. These efforts19,20 represent multisectoral collaboration efforts that deploy seasoned homeless service providers through a humane approach, reducing trauma and preventing postdisaster homelessness. Unfortunately, these cross-sector collaborations are not as common as they need to be in many communities because managers and homeless service providers are not always aware of each other's capabilities and limitations and may not know how to effectively partner.9

Lack of disaster preparedness planning among homeless service providers frequently hinders their ability to partner with emergency managements before disasters. Even in the absence of disaster, these organizations are often economically fragile and typically face constraints preventing them from doing comprehensive disaster planning.9,10,21–23 They frequently lack technical expertise for disaster planning and need guidance for continuity of operations planning to enable them to restore services and avoid service disruptions. Organizations that have not done internal disaster planning are less likely to be familiar with the community's disaster response and recovery networks and less likely to be informed about their county's emergency plans or role in a disaster.2 There is a lack of guidance materials specifically tailored to their disaster planning needs.6,9,10,21 Organizations at the beginning stages of developing preparedness plans often find it difficult to start the process without professional technical assistance.9 Homeless service providers often describe the resources they find online as overwhelming, difficult to implement, and not adequately tailored to their needs and challenges.10

A social determinants of health perspective encourages providers to account for the conditions of homelessness that lead to an elevated risk of chronic health problems.24,25 These vulnerabilities place people experiencing homelessness at a greater risk of adverse health impacts following a public health emergency such as COVID-19 or disaster. For example, homelessness is a major risk factor for contracting hepatitis A, and liver disease can exacerbate its severity.26 As such, health care providers who are experienced in providing care to homeless populations will be vital in disaster response. People experiencing homelessness often have a heavy burden of medical and behavioral health disorders, placing them at a greater risk of morbidity, mortality, and disaster-related needs for behavioral health services.27 Health care organizations can ensure that people experiencing homelessness can receive needed care during disasters by developing relationships with providers experienced in treating this population. Health care providers can also integrate a trauma-informed approach for delivering culturally competent care by ensuring that assessment and diagnosis include housing status as well as health status and social service needs. This toolkit compiles guidance documents for different health care sectors to provide resources for health care systems and individual providers in using these approaches for disaster planning for homelessness.

Emergency managers, public health officials, homeless service providers, and their funders all cite constraints in funding, staffing, and lack of specific guidance as barriers to improving their communities' ability to adequately plan for a disaster. A resource repository and a road map are needed to guide how to address the community coordination effort involved in addressing the disaster needs of people experiencing homelessness. This involves (1) creating strong, networked linkages in advance of a disaster to ensure coordination, messaging, and information sharing during disasters; (2) increasing the disaster readiness of nonprofit homeless service providers; and (3) planning to ensure adequate, culturally competent health care.

The Veterans Emergency Management Evaluation Center (VEMEC) of the US Department of Veterans Affairs (VA), the US Department of Health and Human Services Office of the Assistant Secretary of Preparedness and Response (HHS ASPR), and the US Department of Housing and Urban Development Office of Special Needs Assistance Programs (HUD SNAPs) launched a process to identify a set of resources to guide communities through addressing the disaster needs of people experiencing homelessness. For this relatively uncharted arena, our objective was to define systemic barriers and find replicable best practices that would inform a road map for other communities to address these challenges. A toolkit—Disaster Preparedness to Promote Community Resilience—was developed as a first step toward building this road map and the resource repository.

Methods

The need for a systematic effort to improve how communities plan and respond to the needs of people experiencing homelessness was identified in a joint effort by the ASPR's Division for At-Risk Individuals, Behavioral Health & Community Resilience (ABC) and VEMEC to identify strategic gaps. Through a consensus process, subject matter experts identified 3 priority areas as critical to communities addressing the disaster needs of homeless populations:

  1. Communications and coordination: How can communities ensure that emergency management organizations and homeless services establish predisaster relationships to ensure that people experiencing homelessness receive timely disaster warnings beforehand and meet their response and housing recovery needs afterwards?
  2. Training and technical assistance for CBOs: How can CBOs serving homeless populations receive training to ensure disaster readiness and to plan for continuity of service delivery in disasters?
  3. Guidance for health care providers: How can health care providers and health systems ensure continuity of care for homeless populations and develop the capacity to provide culturally competent and trauma-informed care?

A workshop, “Incorporating Homeless Populations Into Disaster Preparedness, Planning, and Response,” was organized around these questions to develop tools and strategies for communities to include considerations of homeless populations in disaster planning. The workshop was organized into 3 sessions corresponding to the priority areas, each including discussions of suggested policy, research, and practice steps needed to develop community capabilities in each area. Sessions were audio-recorded and transcribed. An audience response system was used to survey attendees before each session, eliciting recorded opinions (agree/disagree) about statements on relevant policy issues regarding the disaster needs of people experiencing homelessness. The results of the audience survey were displayed on a screen in real time, encouraging participants to react to policy questions such as: “Homeless people need a telephone hotline number to access disaster outreach information.”

Subsequently, VA VEMEC, ASPR ABC, and HUD SNAPs convened 40 subject matter experts, divided into workgroups corresponding to the 3 priority areas, to develop a toolkit, to collect resources, and to serve as a road map to help communities plan for the disaster needs of people experiencing homelessness. It intended to focus on preparedness actions that communities can establish in advance to enhance their homeless-serving capabilities during an event. It was to be a “living document,” combining lessons learned with new experiences during disasters and public health emergencies, to inspire dialogue and conversation.

The Figure below illustrates the process for producing the toolkit.

F1
FIGURE:
Process for Developing Toolkit for Including Homeless Populations Into Disaster Preparedness, Planning, and ResponseAbbreviations: CBO, community-based organization; HHS-ASPR/ABC, US Department of Health and Human Services Office of the Assistant Secretary of Preparedness and Response, Division for At-Risk Individuals, Behavioral Health & Community Resilience; VA/VEMEC, Veterans Emergency Management Evaluation Center of the US Department of Veterans Affairs.

All activities conducted to gather information for the toolkit were deemed nonhuman subjects research by the institutional review board at the VA Greater Los Angeles Health Care System and therefore exempt from human subjects review. All informants identified earlier consist exclusively of government officials and other subject matter experts providing information, opinions, and perspectives about existing governmental policies and other matters related to the topic of homelessness and other disasters.

Overview: Problem Definition and Policy Road Map

The toolkit28 consists of 2 documents and an infographic. Documents can be found at the following Web site: https://www.va.gov/HOMELESS/nchav/education/VEMEC-Toolkit.asp. Given the inherent barriers to addressing homeless needs in disasters, the authors elected to create 2 distinct documents: (1) an introduction to the larger systemic policy barriers hindering communities' ability to help their homeless populations prepare, respond, and recover from disasters; and (2) the resource toolkit, which would offer communities concrete tools and guidance about how to improve their homeless service capabilities.

Identifying Systemic Policy Barriers

Many of the challenges to improving communities' ability to address homeless disaster needs are rooted in policy, the structure of disaster relief and recovery assistance, and the culture of the local organizations tasked with addressing such challenges during and after disasters. Inherent limitations in funding and resources, and the resulting inability to undertake disaster preparedness planning, particularly within the nonprofit sector, were identified as barriers to the full participation of nonprofit homeless service providers in disaster response and recovery. The Introduction document presents an overview of these systemic policy barriers.

Homeless service providers are among the most knowledgeable and skilled organizations regarding how to best address the needs of people experiencing homelessness. However, they often lack a formal role in emergency response and recovery. Unlike professional disaster response organizations, they do not have access to resources for disaster activities. They lack formal mechanism to ensure reimbursement for any mass care and shelter services provided during disaster response and recovery, even for disaster-related expenses well above normal operating costs. Moreover, the reimbursement process can be complicated, bureaucratic, and difficult for CBOs to navigate. As the Housing for Harvey and [email protected] examples illustrate, these organizations are positioned to play a significant role in supporting the long-term recovery of individuals experiencing homelessness, such as addressing postdisaster housing and sheltering needs. The ability of homeless service providers to recoup disaster-related expenses and stay financially solvent is vital to ensuring their continued viability as community resources. However, structural barriers hinder collaboration between homeless service providers and emergency management and disaster professionals. In many communities, collaboration between human service providers and emergency managers, disaster relief organizations, and other governmental entities often does not exist or is ineffective. Some of this disconnect reflects the absence of formal avenues for CBOs such as homeless service providers to engage in disaster response and recovery processes.

Communities also face challenges because homeless service providers are often inadequately prepared for the challenges of responding to disasters. Guidance about continuity of operations planning is often unavailable to homeless service providers and not well targeted to their unique needs. Homeless service providers also have diverse funding streams, all with differing requirements for organizational preparedness and how funds can be spent on disaster planning. Despite this challenge, communities such as San Francisco, California, and Seattle-King County, Washington, have established a consensus-based set of performance measures to evaluate CBO preparedness.29,30 Additional incentives from CBO funders and partners organizations, coupled with guidance and resources, would motivate homeless servicing organizations to engage in disaster preparedness planning.9,10

Finally, providing trauma-informed health and behavioral health services during disaster is vital to ensuring that people experiencing homelessness have access to care. People experiencing homelessness have high rates of past trauma and as such providing trauma-informed health care and addressing behavioral health needs are vital to helping disaster responders effectively serve homeless individuals and families.

Resource toolkit

The Homeless Toolkit is divided into 3 sections: section 1—creating an inclusive emergency management system; section 2—guidance for homeless service providers: planning for service continuity; and section 3—guidance for health care providers. These sections offer solutions, step-by-step guidance, and best practices to create systems—in emergency management, public health emergency preparedness, homeless service provider organizations, and health care providers, that can address the access and functional needs of homeless individuals during disasters.

Sections 1 and 2 take readers through 7 consecutive steps toward achieving the section's respective identified goal, that is, creating an inclusive emergency management system or helping homeless service providers plan for service continuity. Section 3 proffers 5 guidelines for health care providers and health systems to assess health needs of people experiencing homelessness, create plans for addressing their health care needs, and avoid being overwhelmed with health care demands that strain their capabilities during disaster. The 3 sections are described, followed by a table detailing the recommended activities in each section.

Section 1

Section 1 provides guidance to homeless service providers, public health departments, and emergency managers in identifying partners in advance of a disaster for these entities to collaborate to address the disaster needs of homeless populations. Homeless service providers' ability to partner with each other and partnerships between homeless service providers and local government emergency managers are particularly important. The section identifies the necessary community partners with skills and strengths needed to expand a community's ability to address homeless individuals' needs during disasters. These include local government emergency managers, homeless service organizations, disaster coalitions, local agencies in charge of public health emergency preparedness and human services, nongovernmental disaster professionals such as the American Red Cross or Salvation Army, and private sector funders. Table 1 outlines recommended activities for section 1.

TABLE 1 - Section 1: Build an Inclusive Emergency Management System
Section 1 Steps Build an Inclusive Emergency Management System
Prepare
Step 1: Get to know the community Become familiar with key homeless service providers in the community.
Understand the homeless populations in the community.
Identify ways to connect with existing preparedness coalitions in the community.
Step 2: Design a strategy for collaboration Identify opportunities to collaborate with other sectors within their community for disaster
planning.
Work with partners to identify clear roles, responsibilities, and expectations.
Determine decision-making, collaboration, and communication processes.
Step 3: Establish or strengthen relationships with potential partners Expand nondisaster partnerships to include collaboration for disaster preparedness and
response.
Step 4: Meet and discuss common concerns Discuss with other disaster coalition members:
  • Disaster response;

  • Community capabilities; and

  • Opportunities to collaborate and the form that collaborations should take (eg, structure).

Step 5: Maintain relationships Disaster coalitions are encouraged to do the following to keep partners engaged:
  • Bring something valuable to the table, such as relationships with key officials;

  • Have a strategic plan and focus on small steps. Set realistic expectations;

  • Start working on homeless service provider disaster plans; and

  • Ensure that key government and funding stakeholders are present at meetings.

Respond
Step 6: Use/test the system Agree on clear roles and responsibilities in disaster response plans.
Government and CBOs should ensure that they are connected with each other during
emergencies through the EOC, through a designated representative in the EOC.
Develop plans to ensure communications with partners during and after disasters.
Recover
Step 7: Sustain an inclusive system Ensure that homeless service providers participate in the long-term recovery group.
Establish agreements and contracts with homeless service providers in advance of a
disaster so they can be included in reimbursement applications after disaster.
Abbreviations: CBO, community-based organization; EOC, Emergency Operations Center.

Section 2

Section 2 provides guidance to homeless service providers in planning to be able to continue vital client services during and after disaster, that is, continuity of service operations. Homeless service providers often have robust plans to ensure life safety, that is, evacuation, but lack protocols for disaster service operations or avoiding service disruption.9 Section 2 underscores the importance of CBOs in addressing their internal preparedness planning so that they are equipped to participate in collaborative community partnerships. Continuity of operations planning is time- and labor-intensive and requires specialized guidance, preventing many providers from achieving their ideal level of preparedness. However, any continuity planning steps taken will increase an organization's ability to respond and restore services after a disaster.22,29 These steps ensure that homeless service provider organizations are equipped both to collaborate with partners and to contribute their experience and skills toward supporting their community's disaster recovery. These steps will also enable organizations to create a plan to recover after a localized disruption. Table 2 illustrates the steps in section 2.

TABLE 2 - Section 2: Preparedness for Homeless Service Providers
Section 2 Steps Preparedness for Homeless Service Providers
Step 1: Identify an internal champion and preparedness team Internal champion(s):
Own the process within the organization;
Engage and motivate leadership and staff for organizational preparedness.
The disaster committee develops the disaster plan and establishes buy-in for preparedness.
Step 2: Identify technical assistance resources to initiate the planning process Homeless service providers can take the lead in identifying resources to help with planning.
Potential sources of assistance include:
  • Local emergency management, police, fire, and public health departments;

  • Voluntary Organizations Active in Disaster and American Red Cross chapters.

Step 3: Build organizational buy-in The Disaster Mission Statement and Launch Meeting are 2 strategies to develop buy-in.
The Disaster Mission Statement is the foundational component of a disaster plan. It:
  • Is drafted by the disaster committee;

  • Given limited resources in a disaster, identifies which services are most critical; and

  • Helps the organization set priorities and identify the role it will play in a disaster.

The Launch Meeting convenes staff to consider how a disaster will affect the organization. It
seeks to accomplish the following:
  • Present a disaster scenario;

  • Engage in an exercise to explore how the organization would respond to disaster scenario;

  • Review the Disaster Mission Statement and obtain feedback;

  • Secure buy-in from key participants and identify expectations; and

  • Generate momentum and convert skepticism into motivation for disaster planning.

Step 4: Prepare staff Staff preparedness includes disaster preparedness training for staff and key volunteers,
disaster personnel policies, and inventorying the disaster response skills of current staff.
Disaster preparedness training for staff includes:
  • Personal preparedness training;

  • Search and rescue, CPR, First Aid.

Disaster personnel policies and procedures should clarify staff roles and responsibilities
following a disaster and which staff should automatically deploy in a disaster.
Step 5: Meet client and staff needs during and after a disaster Organizations providing residential services need to plan for clients' disaster needs, including:
  • On-site service delivery—meeting the needs of on-site clients and staff;

  • Off-site service delivery—addressing the needs of clients living off-site, eg, outreach;

  • Clients' personal preparedness—ensuring clients have resources to prepare for disaster; and

  • Plan for the possibility of delivering services at an alternate location.

Step 6: Back up unique documents Documents essential to organization's functioning and recovery should be backed up,
including:
  • Financial records;

  • Personnel records;

  • Client records;

  • Legal documents (eg, property leases and deeds);

  • MOUs and other contracts; and

  • State and local permits, credentials, and licenses.

Step 7: Maintain financial operations Homeless service providers should consider how they will:
  • Maintain existing funding after a disaster and access new funds for disaster operations;

  • Staff compensation policies after a disaster should be written out in the disaster plan.

Abbreviations: CPR, cardiopulmonary resuscitation; MOU, Memorandum of Understanding.

Section 3

Section 3 provides guidance to health care settings and providers working with individuals and families experiencing homelessness about facilitating predisaster coordination and planning, disaster response, and recovery to meet their needs. Resources in this section are organized around needs identification, prevention of hospital system surge and coordination of care, and developing medical capacity available to rapidly mobilize in disasters.

The section offers guidance about (1) assessing the medical and behavioral health needs of individuals experiencing homelessness; (2) raising awareness of predisaster planning and coordination needs for health care service providers to address the access and functional needs of individuals experiencing homelessness; and (3) enhancing the capacity of health care settings with providers experienced in serving people experiencing homelessness and to expand care following a disaster or public health emergency. It catalogues promising practices and models in this area, as outlined in Table 3.

TABLE 3 - Section 3: Guidance for Health Care Providers
Section 3 Steps/Priorities Guidance for Health Care Providers
Approach For providers:
  • Integrate a trauma-informed approach;

  • Integrate cultural and linguistic competency;

  • Recognize strengths, skills, and resilience; and

  • Colocate mental health with medical services; bring services to people who are homeless.

Assessment and diagnosis Providers are encouraged to assess for:
  • Housing status and risk of homelessness;

  • Health status and social service needs;

  • Clinical needs for a range of medical issues, eg, chronic and acute conditions; and

  • A range of medical and behavioral health needs, eg, history of trauma.

Planning Providers and health care coalitions can plan for the health needs of people who are homeless:
  • Map community assets predisaster including resources and data to anticipate and plan.

  • Develop relationships with providers who treat people experiencing homelessness.

  • Get to know community health centers, which serve people experiencing homelessness.

  • Recruit disaster workers who represent people experiencing homelessness.

  • Maintain and monitor the inventory of community health care resources.

  • Integrate access and functional needs into plans and exercises.

Prevention of hospital surge Health care providers and health care coalitions can help ensure that emergency departments
and hospitals are not overwhelmed, by redirecting people who are homeless to alternate
sources of care:
  • Implement in-reach strategies at emergency departments and hospitals to redirect people experiencing homelessness to a “medical home” providing primary and preventive care.

  • Develop health and hygiene protocols at emergency shelters to minimize secondary exposure risk.

  • Assess disaster behavioral health capacity to facilitate effective collaboration and communication across agencies and strengthen identified weaknesses.

  • Posthospitalization management must address the needs of people who lack housing but require effective discharge planning.

Coordination/continuity of care Health service organizations can ensure service availability during disasters using the following
strategies:
  • Health services organizations should develop continuity of operations plans.

  • Develop disaster behavioral health coalitions to facilitate communication across provider groups, coordinate behavioral health care efforts, and needs.

  • Mobilize teams to find, locate, and treat people and families experiencing homelessness.

  • Ensure coordination and communication between disaster relief agencies and people experiencing homelessness to support recovery.


Discussion and Next Steps

In the absence of clear, systematic, written guidance on methods of improving communities' inclusion of the needs of people who are homeless into disaster planning, this toolkit offers a broad road map for tackling 3 major systemic gaps: (1) coordination, (2) preparedness among service providers, and (3) disaster health care delivery. The compendium of best practices adopted by communities that have successfully built collaboration, enhanced service provider preparedness, and built a well-prepared health care sector continues to expand. This continual process of adding to the body of knowledge is vital as new disasters and health emergencies, such as COVID-19, arise to challenge existing preparedness capabilities.

The COVID-19 crisis has disproportionately affected people experiencing homelessness. An epidemiological study of residents in a Boston homeless shelter in April 2020, shortly after identification of a case cluster, found a 36% positivity rate for COVID-19 (147/408 shelter residents tested positive). The majority (88.5%) of the COVID-19–positive individuals in the shelter were asymptomatic, raising concerns of further spread, given the fact that symptom screening in homeless shelters may not adequately identify individuals who need to be physically isolated.31 Similar testing conducted by public health authorities in April 2020 in homeless shelters found as many as 17% testing positive in a Seattle shelter and 66% testing positive at a shelter in San Francisco.32 Given the heavy burden of comorbidities, reliance on congregate shelter, and the transient nature of homeless living, plans to address a surge of COVID-19 within homeless populations are urgently needed for communities and homeless service providers. The steps outlined in this toolkit can be adapted to the challenge of COVID-19 to formulate best practices, such as homeless service provider readiness to pivot to social distancing in congregate sleeping quarters, inclusion of homeless service providers in COVID-19 tracking and tracing, and health system readiness for testing and treating homeless populations.

VEMEC is pursuing next steps toward ensuring that the toolkit's key audiences—homeless service providers and emergency managers—can efficiently and effectively achieve its goals of enhancing preparedness in homeless provider organizations and strengthening these organizations' connectedness to emergency management structures. First, every effort is being made to disseminate the toolkit through as many avenues as possible. For example, it is included as a resource in the Centers for Disease Control and Prevention's guidance to homeless service providers to plan and respond to COVID-19.33 It is also hosted on the Web sites of HHS ASPR (ASPR TRACIE), the National Veterans Technical Assistance Center, and the United Nations Office of Disaster Risk Reduction. We have also encouraged those who partner with homeless service providers, including government and philanthropy, to distribute the toolkit to their partner organizations as part of their efforts to increase their disaster preparedness resources. In the current environment of constrained funding, funders and partners are often unable to offer technical assistance to nonprofit grantees. The toolkit can offer an avenue to bridge the knowledge gap for organizations.

In the future, pilot testing will help refine the tool-kit into a practical instruction manual that nonprofit organizations, emergency managers, public health officials, and health providers can follow to improve both service providers' organizational preparedness and their local partnerships to address the disaster needs of community members who are homeless. VEMEC is developing a manual tailored for homeless service providers to undertake organizational preparedness planning. This manual will include pilot training in the form of webinars, in-person group trainings, train-the-trainer presentations for partners who work with nonprofit service providers, performance evaluation tools, and individual assistance with a small preidentified cohort of organizations. Organizations selected for this cohort will participate in an evaluation to assess the effectiveness of the pilot training and instruction manual.

Implications for Policy & Practice

  • Collaboration between local emergency management agencies and homeless service providers in advance of disaster is essential to communities' ability to develop the coordination capabilities needed to address the disaster needs of people experiencing homelessness.
  • Guidance about organizational disaster preparedness is vital for homeless service providers to develop the ability to continue providing services during disasters and can enhance their ability to collaborate with community partners.
  • Because of the heavy burden of predisaster medical and behavioral health issues faced by people experiencing homelessness, health care systems should form relationships with clinicians and provider agencies with experience serving homeless populations to ensure that their disaster care needs are met.
  • The toolkit is being translated into a disaster preparedness instructional manual and workbook for homeless service providers, designed to walk them through the steps of organizational disaster planning. VEMEC intends to pilot this resource with a cohort of nonprofit homeless service providers to measure both its usability and its effectiveness in enhancing their disaster preparedness capabilities.

For health care providers, local disaster health care coalitions are a good avenue for identifying community partners for strengthening their connections with homeless service providers, enhancing their ability to plan for the disaster health needs of people experiencing homelessness.34 Groups such as the Medical Reserve Corps can be valuable partners for local CBOs to help assess plans and partner for response and recovery.

Dissemination, training, technical assistance, and collaboration are all needed to transform the tool-kit from concepts and advisories to practical application. The toolkit's lessons can also help communities seeking to ensure that other at-risk populations with access and functional needs are adequately included in disaster planning. Homeless-serving organizations work with people experiencing homelessness daily and have unique capabilities in sheltering, temporary housing, crisis counseling, and other skill sets essential to postdisaster services. Building an inclusive emergency management system involves appropriately leveraging these and other existing assets and capabilities to address the disaster needs of people experiencing homelessness. Doing so will strengthen community resilience and significantly advance the inclusive vision of emergency management proposed in FEMA's whole community approach.

References

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Keywords:

disaster preparedness; emergency management; homeless populations; homelessness; public health emergency

© 2020 The Authors. Published by Wolters Kluwer Health, Inc.