Planning for Public Health & Health Care Recovery

Planning for Public Health & Health Care Recovery Governor s Hurricane Conference May 13, 2015 Innovation t Collaboration t Accountability t Responsiveness t Excellence

AGENDA The Federal Perspective Byron Mason Division of Emergency Management Recovery Support Function Planning Evan Rosenberg Florida Department of Health Planning and Collaboration with Social Services Victor Johnson A Local Level Perspective and Lessons Learned Natasha Strokin 2

OBJECTIVES Understand the transition from response to recovery Understand the National Disaster Recovery Framework (NDRF) and triggers for activation Understand public health and health care recovery support function at the federal, state, and local level Identify critical public health and health care primary and supporting recovery partners 3

Health and Social Services Recovery Support Function Assists locally-led recovery efforts in the restoration of public health, health care and social services networks to promote the resilience, health and well-being of affected individuals and communities. Recovery Does NOT Begin When Response Ends. Inter-RSF Coordination is Essential Ensures prioritization of health and social services recovery needs across sectors (e.g., housing, infrastructure). Continuity Restoration Access to Services H+SS RSF Field Coordinator Byron R. Mason HHS/ASPR OEM BB: 202-308-8142 Byron.Mason@hhs.gov H+SS RSF Core Recovery Mission Areas Public Health Impacts Health Care Services Impacts Behavioral Health Impacts Environmental Health Impacts Food, Drug, & Reg. Medical Product Safety Social Services Impacts Referral to Social Services or Disaster Case Management Long-term Recovery Impacts to Responders Schools and Children in Disaster

Florida s Recovery Support Function Planning Evan Rosenberg, Chief Bureau of Recovery Florida Division of Emergency Management THE FLORIDA DIVISION OF EMERGENCY MANAGEMENT

NDRF MAIN COMPONENTS The NDRF document is roughly 250 pages, and it is a recommended read (chock full of best practices and other ideas that you can use at an agency and/or local level). Get a copy here: https://www.fema.gov/medialibrary/assets/documents/24647?fromsearch=fromsearch&i d=5124 But the NDRF really brings 2 new concepts to the table: The concept of a Federal Disaster Recovery Coordinator (FDRC), and The concept of Recovery Support Functions (RSF s) THE FLORIDA DIVISION OF EMERGENCY MANAGEMENT

RECOVERY SUPPORT FUNCTIONS The piece of the NDRF that we are really here today to discuss, is that which introduces the Recovery Support Functions, or RSF s THE FLORIDA DIVISION OF EMERGENCY MANAGEMENT

RSF FUNCTIONAL AREAS Community Planning and Capacity Building Economic Health and Human Services Housing Infrastructure Natural and Cultural Resources THE FLORIDA DIVISION OF EMERGENCY MANAGEMENT

LEAD FEDERAL AGENCIES Community Planning and Capacity Building: DHS/FEMA Economic: Department of Commerce Health and Human Services: HHS Housing: HUD Infrastructure: DOD/USACE Natural and Cultural Resources: Department of Interior THE FLORIDA DIVISION OF EMERGENCY MANAGEMENT

IMPORTANT POINTS ABOUT RSF S RSF s will be activated on a case-by-case basis, depending on the needs of survivors in a given disaster. The main purpose of the RSF s is not to bring an influx of cash; that is still the point of the PA, IA and HMGP programs. What the RSF s do is coordinate technical assistance from FEMA and other federal programs as needs are determined THE FLORIDA DIVISION OF EMERGENCY MANAGEMENT

GENERAL STATE OF THINGS IN FL Right now, we are working with a number of agencies, and coalitions of agencies, to establish RSF s and lead agencies within those RSF s Florida currently has a very robust ESF structure: We have 18 ESF s identified, whereas the federal ESF structure only has 15, Technically ( legally ), Florida ESF s are always on and ready to serve the citizenry THE FLORIDA DIVISION OF EMERGENCY MANAGEMENT

SO WHY DO WE NEED RSF S? From the previous slide, we can see that we are in pretty good shape in FL, at least structurally, should we have a triggering event tomorrow BUT, while we are set up well, we may not be set up optimally for the needs of survivors and the community as a whole, as recovery moves longer-term Remember that we are talking potentially years after an event. By this time survivors basic needs are already being met, and we are talking about repairing/reestablishing individual and community-based networks THE FLORIDA DIVISION OF EMERGENCY MANAGEMENT

MORE THAN JUST BEING IN-LINE WITH FEMA If we were to use the existing ESF structure, we would obviously be out-of-phase with the federal structure. But that is rarely a limiting concern for us here in FL! (once again, note that we have more ESF s than they do) THE FLORIDA DIVISION OF EMERGENCY MANAGEMENT

MORE THAN JUST BEING IN-LINE WITH FEMA Instead think about it from an organizational footprint. Let s use the Health and Social Services RSF as an example: If we wanted to use the existing ESF structure, I suppose that we could aggregate ESF 8 (Health & Medical), 6 (Mass Care) & 15 (Volunteers & Donations) together, but Who would be the lead agency? Are the experts at our ESF partners the same experts as we would need in Recovery? Are ESF roles in the EOC the same as RSF roles in the JFO (and beyond)? What functions are we missing? THE FLORIDA DIVISION OF EMERGENCY MANAGEMENT

THE OPPORTUNITY Instead of taking non-optimized structures and cobbling them together as best we can, we have the opportunity at the onset to create the optimal structure for Florida How do we get there we use/build coalitions between stakeholder agencies, with local buy-in THE FLORIDA DIVISION OF EMERGENCY MANAGEMENT

GENERALLY We could certainly veer away from the Federal structure we are all about what is doing what is best for Florida. However, at least at first, at the State level we are going to build a structure to mate up nicely with the Federal side This does not mean that it will be this way forever. Nor does it mean that all local structures will end up looking like a carbon copy of the State s structure. THE FLORIDA DIVISION OF EMERGENCY MANAGEMENT

II CONCEPT OF OPERATIONS Some Guiding Principles as we Move Outward THE FLORIDA DIVISION OF EMERGENCY MANAGEMENT

RSF CONCEPT OF OPERATIONS 1. At the State level, RSF s will be established (initially) to mate up with the 6 Federal RSF s established under the NDRF. 2. A Lead Agency will be established for each Florida RSF, with each Lead Agency supplying a designated Point of Contact for the RSF, which will be conspicuously posted on FDEM s website. 3. The purpose of RSF s is to assist in the coordination of the flow of information, services and resources between all levels of government Federal, State and Local. THE FLORIDA DIVISION OF EMERGENCY MANAGEMENT

COO (CTD.) 4. RSF s may be activated by joint Federal-State agreement after a federally declared disaster, or by the FDEM Recovery Chief during a State or Local disaster or emergency (regardless of whether there is a State or Local EO). 5. RSF activation shall not necessarily mean that staff are required to occupy a seat in the State EOC, Federal-State JFO or Local EOC. RSF activation shall be taken to mean that appropriate staff are to be made available for Emergency Management duties on an as-needed basis. THE FLORIDA DIVISION OF EMERGENCY MANAGEMENT

COO (CTD.) 6. RSF activation shall not be taken to imply that all RSF s need to be activated at one time. The nature of the given disaster or emergency shall govern which RSF s (or parts of RSF s) are to be activated by the FDEM Recovery Chief. 7. This Concept of Operations (and any associated structural plans) will be memorialized within the State CEMP Plan, and its associated appendices and annexes, as appropriate. THE FLORIDA DIVISION OF EMERGENCY MANAGEMENT

RULEMAKING AND FUTURE STEPS How do We Codify the Work We are Doing? THE FLORIDA DIVISION OF EMERGENCY MANAGEMENT

RULEMAKING Currently the State CEMP does not contain any information on RSF s We were still trying to wrap our heads around the NDRF the last time that the State CEMP was updated But then again, the State CEMP only speaks about recovery in sweeping generalities anyway ( plans should be developed ) 2015 will be the year in which we begin to establish RSF s through the State CEMP The State CEMP goes to rulemaking in 2016 We intend to have annexes (or at least placeholders!) in the State CEMP for each RSF by then! THE FLORIDA DIVISION OF EMERGENCY MANAGEMENT

BASIC TIMEFRAME By end of June 2015 Identify a lead agency for each RSF, and obtain agency buyoff By end of July 2015 Hold an introductory RSF workgroup meeting for each RSF, and begin the collaborative process By end of September 2015 Have a Mission Statement and Concept of Operations developed for each RSF By end of December 2015 Have a draft annex to the CEMP written by each RSF THE FLORIDA DIVISION OF EMERGENCY MANAGEMENT

Planning for Public Health & Health Care Recovery Victor Johnson, Administrator Community Resilience Program Department of Health (DOH) Governor s Hurricane Conference May 13, 2015 Innovation t Collaboration t Accountability t Responsiveness t Excellence

PREPARING FOR HEALTH CARE RECOVERY Planning for community and health care system recovery will put partners and resources in place and ready to act 25

COMMUNITY AND HEALTH CARE SYSTEM RECOVERY Community recovery is the ability to collaborate with community partners 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 26

WHOLE COMMUNITY RECOVERY Community Partners: Business Community Leadership Cultural & Faith- Based Groups Education & Childcare Elder Services Emergency Management Health Care Housing & Sheltering Media Mental/Behavioral Health Social Services 27

CORE RECOVERY MISSION AREAS Health and Social Services Recovery Support Function (RSF) Core Mission Areas Directly Related to Community Health and Health Care Systems 28

PUBLIC HEALTH 29

HEALTH CARE SERVICES IMPACTS Hurricane Andrew State Archives of Florida, Florida Memory, http://floridamemory.com/items/show/133885 State Archives of Florida, Florida Memory, http://floridamemory.com/items/show/133786 30

HEALTH CARE SERVICES IMPACTS 31

BEHAVIORAL HEALTH IMPACTS 32

ENVIRONMENTAL HEALTH IMPACTS 33

LONG-TERM RECOVERY IMPACTS TO FIRST RESPONDERS Responder Base Camp 34

RSF HEALTH OUTCOMES Restore capacity of essential health services Encourage behavioral health systems to meet needs Promote health and well-being of affected individuals, particularly vulnerable populations 35

RSF HEALTH OUTCOMES Assist in continuity of essential health services Reconnect displaced populations with essential health services Protect heath of population and responders from long-term effects Promote clear communications and public health messaging 36

WHAT S HAPPENING AT DOH Awareness Planning Collaborations Coordination with healthcare coalitions Local support and resources Sharing of best practices 37

RECOVERY WORKGROUP Interagency Health and Social Services Recovery Workgroup Capitalizes on healthcare coalition structure Collaborations to respond to recovery gaps, needs and priorities ESF8 (health and medical) partners, community sector organizations and subject matter experts 38

WORKGROUP PURPOSE Facilitate coordination, planning, problem solving and leveraging of resources Provide guidance at the state level Support local coalitions in incorporating health and medical recovery into whole community emergency planning Support the transition to a Health and Social Services Recovery Support Function 39

WORKGROUP GOALS Collaborate with state level partners Provide guidance to communities Facilitate incorporation of recovery into state and local preparedness planning and response Address identified gaps and promote continuity of health and well-being Emphasize well-being of vulnerable populations and persons with access and functional needs 40

RECENT & UPCOMING EVENTS Workgroup Meeting Boot Camps Resource Sharing www.flordiahealth.gov (Search Recovery ) 41

WORKGROUP MEETINGS 42

BOOT CAMPS 43

RESOURCE SHARING WWW.FloridaHealth.gov Type the word Recovery in the search box 44

FOR MORE INFORMATION Thank you! Victor Johnson, Administrator Community Resilience Program Bureau of Preparedness & Response Division of Emergency Preparedness & Community Support (850) 245-4346 Victor.Johnson@flhealth.gov BPR.CommResCHDSupport@flhealth.gov 45

A Local Perspective on Planning for Public Health & Health Care Recovery Natasha Strokin Public Health Preparedness Program Manager Governor s Hurricane Conference May 13, 2015 Innovation t Collaboration t Accountability t Responsiveness t Excellence

THE LOCAL RECOVERY PLAN Maintained by Miami-Dade Office of Emergency Management. Part of Volume III of the CEMP. Directs how the county will command and coordinate recovery (short-term to long-term). Can be activated for small-scale disasters involving a few agencies to large-scale disasters requiring a Federal disaster declaration. The recovery phase is led by the Recovery Task Force. Day to day management of the Recovery Operations Center (ROC) falls to the Recovery Manager. 47

RECOVERY OPERATIONS CENTER The ROC provides the ability for recovery organizations to engage in uninterrupted integrated planning and long-term coordination of resources and personnel. The ROC will operate virtually or, in extreme cases, in a fixed facility. The Mayor will activate the ROC, which will be managed by the Recovery Manager. The ROC will coordinate with the FEMA/State Joint Field Office on recovery strategies and activities. 48

COMMAND AND COORDINATION Recovery Action Plan This plan is created by the Recovery planning team and identifies the objectives, priorities and task assignments of the Recovery Task Force and the RSFs. 49

COMMAND AND COORDINATION Situation Reporting During the recovery phase the ROC will maintain situation awareness via WebEOC and create and publish a Situation Report. Types of information collected and reported on will include but not limited to: Status of infrastructure repairs and estimated restoration timeframes. Amount of debris cleared and/or reduced. How many disaster survivors require housing assistance? If applicable, the #s of survivors who have applied for Federal Individual Assistance. Federal, state and/or local funds obligated to recovery operations. 50

RECOVERY SUPPORT FUNCTIONS There are 12 Recovery Support Functions (RSFs) who function as a coordinating structure similar to the ESFs. The RSFs guide and manage initial recovery functions and facilitate problem solving. Improve access to resources and foster coordination among county, municipal, state, federal, nongovernmental partners and stakeholders. 51

RECOVERY SUPPORT FUNCTIONS The RSFs are: Economic Environment Finance Health Housing Infrastructure Intergovernmental Land Use Public Information/Outreach Mitigation/LMS Social Services Transportation 52

RSF HEALTH CEMP: Emergency Support Function Recovery Plan: Recovery Support Function PDRP: Technical Advisory Committee (TAC) ESF 8 (Health & Medical) Recovery Support Function Health Health and Social Services TAC The purpose of RSF Health is to support the provision of health services during the immediate and long-term recovery phase to address the long-term restoration of health services and environmental health needs. 53

RECOVERY ACTIVITIES Public Health Messaging Resiliency Planning Long-Term Health of Response and Recovery Personnel Disease Surveillance and Epidemiological Investigations Environmental Health Health Care Facility Restoration 54

LESSONS LEARNED Tabletop exercise with all 12 RSFs held February 2014. Tabletop objectives: Orient agencies to RSF Discuss potential conflicts/issues Determine planning needs 55

LESSONS LEARNED We need more recovery training & exercises! Communication, particular in regards to decision making, between agencies could be improved. Specific, task-oriented exercises are needed to help focus on recovery. Little emphasis was placed on the cost of proposed solutions. Lack of resources allocated to recovery. 56

FOR MORE INFORMATION Thank you! Natasha Strokin Florida Department of Health in Miami-Dade Public Health Preparedness Program Manager Natasha.Strokin@flhealth.gov 786-336-1332 57