Community Resilience Jill J Artzberger, MPH 2011 Texas Emergency Management Conference Thursday, April 28, 2011

Background 2011 – 2016 Public Health Emergency Preparedness (PHEP) Funding Purpose 2011 – 2016 Public Health Emergency Preparedness (PHEP) Funding Purpose Public Health Preparedness Capabilities: National Standards for State and Local Planning Public Health Preparedness Capabilities: National Standards for State and Local Planning 2012 – 2016 Texas Public Health and Medical Emergency Management Strategic Plan (DRAFT) 2012 – 2016 Texas Public Health and Medical Emergency Management Strategic Plan (DRAFT)

Community Resilience Domain Community Preparedness Community Preparedness Community Recovery Community Recovery

Community Preparedness CDC Definition The ability of communities to prepare for, withstand, and recover – in both the short and long terms – from public health incidents.

Community Preparedness Texas DSHS Definition Sustained ability of communities to prepare for, withstand, and recover – in both the short and long terms – from public health incidents

Community Preparedness: Public Health’s Role Support the development of systems that support recovery Support the development of systems that support recovery Participate in awareness training Participate in awareness training Promote awareness of and access to resources Promote awareness of and access to resources Engage public and private organizations that represent at-risk individuals Engage public and private organizations that represent at-risk individuals Identify populations at higher risk for adverse health outcomes Identify populations at higher risk for adverse health outcomes Receive and/or integrate health needs of displaced populations Receive and/or integrate health needs of displaced populations Source: Public Health Preparedness Capabilities

Community Preparedness Functions 1. Determine risks to the health of the jurisdiction 2. Build community partnerships to support health preparedness 3. Engage community organizations to foster public health, medical, and mental/behavioral health social networks 4. Coordinate training or guidance to ensure community engagement in preparedness efforts Source: Public Health Preparedness Capabilities

Community Recovery CDC Definition The ability to collaborate with community partners (e.g., healthcare organizations, business education, and emergency management) to plan and advocate for the rebuilding of public health, medical, and mental/behavioral health systems to at least a level of functioning comparable to pre-incident levels, and improved levels where possible.

Community Recovery Texas DSHS Definition The ability to implement sustainable short and long term recovery and adaptation processes during and after an incident. This capability encompasses the rebuilding of public health, medical, and mental health systems to at least a level of functioning comparable to pre-incident levels, and improved levels where appropriate.

Community Recovery Functions 1. Identify and monitor public health, medical, and mental/behavioral health system recovery needs 2. Coordinate community public health, medical, and mental/behavioral health system recovery operations 3. Implement corrective actions to mitigate damages from future incidents

Community Resilience

Key Components Physical and psychological health of the population Physical and psychological health of the population Social and economic well-being Social and economic well-being Individual, family, and community knowledge and attitudes regarding self-reliance and self-help Individual, family, and community knowledge and attitudes regarding self-reliance and self-help Effective risk communication Effective risk communication Level of social integration of government and nongovernmental organizations in planning, response, and recovery Level of social integration of government and nongovernmental organizations in planning, response, and recovery Social connectedness of community members Social connectedness of community members

Capabilities Active engagement of community stakeholders in health event planning and personal preparedness Active engagement of community stakeholders in health event planning and personal preparedness Development of social networks Development of social networks Creation of health-promoting opportunities to improve physical and psychological health of the community Creation of health-promoting opportunities to improve physical and psychological health of the community Plans and programs that address and support the functional needs of at-risk individuals Plans and programs that address and support the functional needs of at-risk individuals Institution of plans to respond effectively to the post- disaster physical and psychological health needs of community members Institution of plans to respond effectively to the post- disaster physical and psychological health needs of community members Rebuilding plans for health and social systems that can be activated immediately Rebuilding plans for health and social systems that can be activated immediately

Resilient Community Concepts Engagement at the community level, including a sense of cohesiveness and neighborhood involvement or integration Engagement at the community level, including a sense of cohesiveness and neighborhood involvement or integration Partnership among organizations, including integrated pre-event planning, exercises, and agreements Partnership among organizations, including integrated pre-event planning, exercises, and agreements Sustained local leadership supported by partnership with state and federal government Sustained local leadership supported by partnership with state and federal government Effective and culturally relevant edcucation about risks Effective and culturally relevant edcucation about risks

Concepts (cont’d) Optimal community health and access to quality health services Optimal community health and access to quality health services Integration of preparedness and wellness Integration of preparedness and wellness Rapid restoration of services and social networks Rapid restoration of services and social networks Individual-level preparedness and self-sufficiency Individual-level preparedness and self-sufficiency Targeted strategies that empower and engage vulnerable populations Targeted strategies that empower and engage vulnerable populations Financial resiliency of families and businesses Financial resiliency of families and businesses Efficient leveraging for recovery Efficient leveraging for recovery

Building Community Resilience Wellness Wellness Access Access Education Education Engagement Engagement Self-Sufficiency Self-Sufficiency Partnership Partnership

Wellness and Access Wellness – Promote pre- and post-incident population health, including behavioral health Wellness – Promote pre- and post-incident population health, including behavioral health Access – Ensure access to high-quality health, behavioral health, and social services Access – Ensure access to high-quality health, behavioral health, and social services

Education Education – Ensure ongoing information about preparedness, risks, and resources before, during, and after a disaster Education – Ensure ongoing information about preparedness, risks, and resources before, during, and after a disaster

Engagement and Self-Sufficiency Engagement – Promote participatory decision making planning, response, and recovery activities Engagement – Promote participatory decision making planning, response, and recovery activities Self-Sufficiency – Enable and support individuals and communities to assume responsibility for their preparedness Self-Sufficiency – Enable and support individuals and communities to assume responsibility for their preparedness

Partnership Partnership – Develop strong partnerships within and between government and nongovernmental organizations Partnership – Develop strong partnerships within and between government and nongovernmental organizations

Activities

Wellness Activities Promote public understanding of health and wellness Promote public understanding of health and wellness Ensure sufficient community health resources, along with the capability to leverage those resources to achieve desired outcomes Ensure sufficient community health resources, along with the capability to leverage those resources to achieve desired outcomes

Access Activities Ensure continuity of healthcare and related social services Ensure continuity of healthcare and related social services Facilitate transition in recovery planning Facilitate transition in recovery planning Provide health services and remove barriers to accessing them Provide health services and remove barriers to accessing them

Education Activities Bolster community resiliency by providing accurate information about health threats Bolster community resiliency by providing accurate information about health threats Train and educate partner agencies and develop an effective and coordinated communication system or network Train and educate partner agencies and develop an effective and coordinated communication system or network Build basic health literacy and awareness of health issues Build basic health literacy and awareness of health issues

Engagement Activities Involve community members in planning and decision making on issues relating to response and recovery Involve community members in planning and decision making on issues relating to response and recovery Include community members in planning exercises for health incidents Include community members in planning exercises for health incidents Build connections among social networks and community organizations Build connections among social networks and community organizations

Self-Sufficiency Activities Encourage personal and community preparedness Encourage personal and community preparedness Encourage civic responsibility Encourage civic responsibility Promote effective bystander responses Promote effective bystander responses Foster self- and community-reliance Foster self- and community-reliance

Partnership Activities Establish pre-event memorandums of understanding that delineate clear roles and responsibilities among partners Establish pre-event memorandums of understanding that delineate clear roles and responsibilities among partners When possible, partnership agreements should be supported by a dedicated workforce to implement agreed upon activities When possible, partnership agreements should be supported by a dedicated workforce to implement agreed upon activities Assess the extent of existing networks and social routines among community members and organizations, with attention to identifying strategies to reinforce them Assess the extent of existing networks and social routines among community members and organizations, with attention to identifying strategies to reinforce them

Monitor and Evaluate Progress Monitor continuity/quality of care and long- term health effects before, during, and after a health incident Monitor continuity/quality of care and long- term health effects before, during, and after a health incident Regularly conduct research and evaluation to advance science and practice associated with community resilience Regularly conduct research and evaluation to advance science and practice associated with community resilience Use monitoring, research, and evaluation data for continuous quality improvement Use monitoring, research, and evaluation data for continuous quality improvement

Implementation of Activities How will we know if these activities are working? How will we know if these activities are working? What capacities are needed for communities to implement community resilience building activities? What capacities are needed for communities to implement community resilience building activities? How long will it take communities to achieve full implementation of community resilience building activities? How long will it take communities to achieve full implementation of community resilience building activities?

Proposed Measurement Areas Wellness Wellness Disability status Disability status Poverty level Poverty level Health status of the population Health status of the population Access Access Health insurance coverage Health insurance coverage Availability of healthcare providers in medically underserved areas Availability of healthcare providers in medically underserved areas Education Education Level of health literacy in the population Level of health literacy in the population Dissemination of risk information and subsequent uptake or use of information Dissemination of risk information and subsequent uptake or use of information

Proposed Measurement Areas Engagement Engagement Identification of at-risk individuals through engagement Identification of at-risk individuals through engagement Social connectedness of general population for disaster response and recovery Social connectedness of general population for disaster response and recovery Self-Sufficiency Self-Sufficiency Health department education with at-risk populations Health department education with at-risk populations Level of citizen preparedness and sense of self-reliance Level of citizen preparedness and sense of self-reliance Partnership Partnership Local Emergency Planning Committee composition Local Emergency Planning Committee composition Role of NGOs in community response and recovery plans Role of NGOs in community response and recovery plans

Questions Jill J Artzberger, MPH Senior Program Manager, TECS PERLC Texas A&M Health Science Center School of Rural Public Health (979)

Resources Public Health Preparedness Capabilities: National Standards for State and Local Planning (CDC, March 2011) Texas Public Health and Medical Emergency Management 5-Year Strategic Plan (Draft) (Texas DSHS, April 2011) Building Community Resilience to Disasters (RAND, 2011)