Access and Functional Needs Toolkit: Integrating a Community Partner Network to Inform Risk Communication Strategies

Children represent one quarter of the U.S. population and are highly vulnerable during disasters. Emergencies often happen without warning and during times when children are separated from parents and other caregivers. On any given weekday, 69 million children are in schools or childcare and separated from their families for approximately 6 hours a day.

Research indicates that over a third of American households with children are not familiar with their school’s evacuation and emergency plans (35%), and even more do not know where their children would be evacuated to during a disaster (40%).¹⁹ Disaster planning for children includes potential provisions for medical needs, temporary care, shelter, reunification, and other services such as decontamination or quarantine.

Communication and early information warnings will alert children, parents, and other caregivers about potential risks and planning response scenarios.

Why children are at higher risk

Because children differ from adults in many ways, it is important to develop public health emergency response plans that take their needs into consideration. Children have different²⁰ self-preservation instincts, communication skills, unique medical needs, and physical and mental abilities. Their developmental attributes also make them particularly susceptible to mental health problems following disasters.²¹ Public health emergencies can disrupt children’s daily routines and displace them temporarily or long-term from their homes and families. Exposure to emergency situations can be stressful and sometimes traumatic, especially for children who have previously experienced trauma or have a pre-existing mental, emotional, developmental, or behavioral disorder.

Example of communication considerations for an extreme heat event

Risk communication materials should be targeted toward those who will receive, process, and act upon the information. When developing and disseminating messages and materials intended to keep children safe, engage a broad range of child-serving partners such as schools, daycare facilities, after-school care, youth sport leagues, parks and recreation organizations, pediatricians, and others.

Develop age-appropriate information to help children understand how to protect themselves. Repeat messages often, through different channels, to increase the reach of the message and the number of times it is heard. Student athletes may not perceive heat-related illness as a health risk because they routinely practice in hot weather outdoors or indoors with limited air-conditioning.²² However, teachers, coaches, and parents can reinforce risk communication messages to athletes to stay safe from extreme heat.

Key considerations for communication planning

• Engage with educational institutions and childcare facilities (schools, universities, daycare centers, etc.) on the importance of providing students with basic preparedness instruction. Providing school children with take-home materials for their parents may enhance preparedness.²³
• Create age-appropriate messages and materials. Children of different ages and developmental status understand emergencies and health risks differently.
• Ensure messaging addresses children’s unique needs.
• Empower children with age-appropriate education that teaches what to do in an emergency.
• Promote the importance of developing a family preparedness communication plan.
• Include messages on how caregivers can help children cope.
• Develop messaging for multiple locations where children congregate, for example, schools, childcare facilities, after-school care, youth sport leagues, parks and recreation organizations, and pediatrician offices.
• Ensure timely and effective delivery of messages for evacuation, relocation, and reunification of children in educational settings, childcare, or other child congregate facilities.

Figure 2: Example of CDC public health communication materials for children²⁴

Resources

Caring for Children in a Disaster

The National Child Traumatic Stress Network (NCTSN)

The Youngest Victims: Disaster Preparedness to Meet Children’s Needs

Children and Youth Task Force in Disasters: Guidelines for Development, September 2013

Planning for the Needs of Children in Disasters Toolkit

New York Children’s Issues Task Force Lessons Learned from Response and Recovery in Superstorm Sandy in New York

Children in Disasters: Do Americans Feel Prepared? A National Survey

Ready Wrigley books, checklists, mobile app, posters

Pregnant women are cited in PAHPRA (2013)¹ as “populations with special clinical needs” who may be at higher risk in a disaster and other public health emergency, like exposure to environmental toxins and infectious diseases. Disasters may limit a pregnant woman’s access to obstetrical facilities. This situation may result in giving birth outside of a health facility or in a facility that does not have access to her prenatal records containing information about high risk medical conditions. These could include preterm labor, triplet/twin gestation, previous stillborn, and vaginal bleeding.² Pregnant women may face additional risks, including mental distress and the psychosocial stressors of living and giving birth in a post-disaster environment.³

To ensure effective communication with pregnant women, partnership planning should include obstetrics and gynecology (OB/GYN) providers, certified midwives, maternal and child health programs, family planning clinics, hospital emergency preparedness committees, and related community supports. Bringing health care partners together can help develop messaging and materials that are appropriate for pregnant women.

Tips for effective planning and communication for pregnant women

1. Create a plan to ensure that all women have access to safe environments to deliver babies.
2. Develop strategies to share health messages and materials with women in rural and hard-to-reach areas.
3. Develop strategies to reach women when traditional methods are not available.
4. Prepare educational materials on the following topics to give to pregnant women and families with infants:
   • Disaster preparedness and recovery
   • Maternal and child health issues
   • Prenatal and well-baby services
5. Encourage pregnant women to have evacuation plans (and plans for prenatal care and/or delivery should they need to evacuate), and emergency birth kits.
6. Stress the importance of continuing prenatal care for pregnant women during emergency/disasters.
7. Share information about signs of preterm labor.

The U.S. Census Bureau American Community Survey data indicate that in 2015, more than 25 million people had limited English proficiency (LEP), accounting for 9% of the U.S. population 5 years and older. In 2015, more than 20% of individuals with LEP lived in households with an annual income below the official poverty level.³⁶ Over the last decade, nearly every community across the nation experienced significant growth in its immigrant population and diversity of languages spoken.³⁷

Language and culture provide the context for how people make sense of information. Cultural beliefs and values influence how an individual interprets a public health message. Therefore, translating messages into another language does not guarantee comprehension or ensure readability, and some words might not have an equivalent translation. Language and literacy barriers can hinder people’s ability to understand how to protect themselves during an emergency.

Effective communication planning for individuals with LEP and limited literacy involves engaging partners who have established relationships within the community of focus. Partners will often include social and information networks that individuals with LEP and limited literacy skills turn to for information. Engaged partners can help test messages with the intended recipients and maximize meaningful interpretation and action. In addition, partners can be a key outlet for disseminating information. Effective communication strategies are culturally and linguistically appropriate and respect the beliefs, practices, and needs of the population. Therefore, a diverse group of partners will be required to adequately address the varied LEP communities.

The Civil Rights Division’s Language Map App³⁸ (Figure 3) is an interactive mapping tool that helps users identify the concentration of languages spoken by LEP individuals in a community. Users can click on a state or county to identify the number or percentage of LEP persons, download language data, or visually display LEP maps for presentations.

When disaster strikes, financially and socially disadvantaged individuals often lack access to resources that could keep them safe—like an extensive social network, transportation to evacuate, or supplies for an emergency kit.⁴¹

Economic disadvantage does not decrease ability to understand public health information. Rather, limited resources imply a potential decreased ability to receive and follow public health recommendations.

For example, residents may be told to prepare an emergency food and water supply for sheltering-in-place. Families and individuals who cannot afford an unexpected, potentially expensive purchase of several days’ or weeks’ worth of bottled water and nonperishable food will be unable to follow this recommendation.

According to the National Institute for Literacy, 43% of adults with the lowest literacy rates in the United States live in poverty. Economic disadvantage further challenges access to communications.⁴²

Planning considerations for farmworkers

Farmworkers are traditionally defined as people whose primary incomes are earned through permanent or seasonal agricultural labor. Farmworker households tend to have high rates of poverty, live disproportionately in housing of poor condition, and have high rates of overcrowding and low rates of homeownership.⁴³

Large numbers of farmworkers and migrants living in substandard housing conditions in rural communities lost housing during the 2007 San Diego firestorm. General findings from a fire impact assessment study⁴⁴ include

• Lack of general information about the evacuation process, emergency preparedness, and procedures for accessing resources. Furthermore, farmworkers and migrants did not know whom to contact for more information about the evacuation procedure and/or to find available shelters .
• Farmworkers and migrants were disproportionately exposed to fire impacts.
• Large numbers of farmworkers and migrants living in substandard housing conditions in rural communities lost housing during the fires and had no recourse for recovery.
• Farmworkers and migrants did not receive appropriate evacuation notifications.
• Economic effects of the fires are compounded by language, cultural, and social barriers that limit access to support programs and services.
• Farmworkers and migrants did not receive adequate information about emergency relief eligibility criteria.
• According to the survey, close to half of the participants reported having urgent and long-term needs for food and water.⁴⁵

Data from the 2016 single-year American Community Survey¹ indicate that over 10 million U.S. households do not own a private vehicle. “Populations with limited transportation” refers to individuals and families  who do not have a personal vehicle. Also referred to as “carless populations,” they generally rely on public transportation daily for work, school, worship, and leisure. Evacuation-related messaging is critical to ensuring individuals know how to access transportation and where to go.

A major challenge in disseminating transportation-related communications is identifying the number and location of transportation-disadvantaged individuals in the region. Definition varies by location. In large metropolitan areas like New York City or Washington, DC, public transit use is high and coverage extensive, so carless or transit-dependent populations would not usually be considered at-risk. However, the same population in a small city with limited transportation options may be disproportionately affected by an emergency. Wherever they are, people who are without a car or are dependent on public transit will likely need transportation assistance in  an emergency requiring evacuation.

Example of communication considerations for an extreme heat event

Consider the extreme heat events in 1995 and 1999 in Chicago, and the 2003 heat wave in France. Mortality risk factors included lacking AC in the residence, living alone, and not going to a cool place daily. Limited access to reliable transportation can potentially affect compliance with public health recommendations, especially if a person lives alone or has limited mobility, a debilitating health condition, or limited financial resources. To protect individuals with limited transportation options, engage various partners to assist in  developing and disseminating actionable extreme heat messaging.

One in four adults—or 61 million people in the United States—have a disability that affects major life activities. The most common disability, mobility, affects one in seven adults and becomes more common with age, affecting about two in five adults age 65 and older.⁴⁸

Various types of disabilities include hearing, vision, speech, and mobility, as well as cognitive, intellectual, and mental impairment. An individual with a disability, as defined by the Americans with Disability Act (ADA), is a person who

• has a physical or mental impairment that substantially limits one or more major life activities,
• has a history of a physical or mental impairment, or
• is perceived by others to have such an impairment.⁴⁹

In the context of the ADA, “disability” is a legal term rather than a medical one.⁵⁰ Under Title II of the ADA guidance, all state and local governments are required to take steps to ensure that their communications with people with disabilities are as effective as their communication with others. This is especially important during an emergency.

FEMA and other federal agencies expanded the term “disability” to include “people with disabilities and others with access and functional needs.” This expanded definition of disability includes people who may or may not fall within the definitions of civil rights laws and encompasses cross-disability issues.⁵¹

Example of communication considerations for an extreme heat event

A CDC study examined Medicare heat-related illness (HRI) claims. Medicare beneficiaries under 65 years of age are individuals with disabilities. They have a debilitating physical or mental disease or end-stage renal disease. The study found that beneficiaries younger than 65 years had a rate of HRI outpatient visits nearly double that for all other age categories (>65 years). The findings indicate that planning for the needs of individuals with disabilities is important during heat waves. Planners need to ensure that individuals with disabilities receive heat safety communication messages and services, for example, access and transport to a cooling station. ⁵²

Half of all adults in the United States have at least one chronic condition, such as diabetes, heart disease, or obesity. One in four people has multiple chronic conditions. One in three people aged 65 and older has multiple chronic conditions. About 11.2 million U.S. adults have experienced a serious mental illness such as bipolar disorder, major depression, and schizophrenia.

A chronic illness is a condition that lasts a year or longer and limits activity. It may be an unstable, terminal, or contagious condition requiring ongoing care. People with chronic conditions often rely on medication or electricity-dependent medical and assistive equipment, such as ventilators and wheelchairs.

Disasters can disrupt electricity and water supplies and limit access to routine care, treatment, or accessible transportation. Critical medical services such as dialysis or chemotherapy might not be available because of business closures or lack of transportation. A study of personal disaster preparedness of dialysis patients in North Carolina indicated that, despite the availability of online and printed disaster preparedness material, more efforts are required to ensure messages are received.⁵⁹

After an incident, inform the affected population of the status and availability of health care facilities, pharmacies, and other health services. Understanding how the public prepares for a disaster or emergency provides communication planners with data to guide pre-incident planning strategies and emphasize the importance of personal preparedness.

From 2005 to 2015, the U.S. population 65 years and older increased by 30%, from 36.6 million to 47.8 million. By 2060, that age group is projected to more than double to 98 million people. Age by itself does not create vulnerability. However, older adults are more likely than younger populations to have chronic illnesses; functional limitations; and physical, sensory, and cognitive disabilities. Three in four Americans aged 65 and older have multiple chronic conditions.⁶⁸

While individual needs vary, older adults (>65 years of age) are disproportionately affected in emergencies. Age-related declines in mobility can also make evacuating or preparing for a disaster more challenging. Further, disruption of support services like meal delivery and care-giving assistance can make weathering a disaster more difficult.

Example of communication considerations for an extreme heat event

People aged 65 years or older are more prone to heat-related health problems. Every year, heat exposure kills older adults disproportionately. From 1999–2009, CDC found that of the 7,233 heat-related deaths reported, 69% were males and 36% were adults aged ≥65 years.⁶⁹

Readiness of older adults

Two-thirds of older adults surveyed had no emergency plan, according to the Preparedness for Natural Disasters among Older U.S. Adults: A Nationwide Survey.⁷⁰ In addition, they had never participated in any disaster preparedness educational program and were not aware of relevant resources.

Understanding the emergency preparedness levels among this population is important for planning effective emergency communications and outreach. Communication plans must also address potential barriers for accessibility, like technological limitations (less internet access and smart phone use) and social isolation.

Step 1 recommendations and tools will identify opportunities to create or expand existing community partner engagement practices and further integrate partners into your preparedness activities. This step allows emergency planners to engage with community organizations to create accessible risk communication strategies and materials. Community and faith-based organizations are valuable community assets before, during, and after a disaster.

Community partner networks are as unique as communities themselves. People are more likely to receive information and act on it when the message comes from a source they view as credible. Governmental institutions are not always perceived as credible. Community and faith-based organizations are familiar, trusted organizations and can convey critical emergency information.

Action Item 3: Conduct a partner meeting  

• Develop an agenda. Use the Meeting Agenda Template to outline the flow of the meeting, items to be discussed, and decisions to be made.
• Send meeting invitations. Include details about how the meeting information is communicated and how to request services such as Braille, sign language interpreters, and readers. Sample Meeting Invitations are in Appendix A.
• Review the Accessible Meeting Tip Sheet in Appendix A.
• Provide copies of the agenda to the partners before the meeting. Send meeting reminders to the partner network in advance of the meeting.

Conducting the meeting

• Provide meeting handouts.

• • Meeting Agenda
  • Communication Pathway Graphic
  • Opportunities to Engage

• Facilitate introductions and walk through the agenda.
• Introduce the whole-community approach and access and functional needs framework.

• • Highlight how the whole-community approach leverages the knowledge and experience of individuals in a community to help public health and emergency management understand and meet the actual emergency communication needs for the whole community.
  • Repeat information from your earlier outreach communications about what you are asking the community partner network to do.
  • Identify and address any questions or concerns about barriers to participation.

• Acquaint the partners with the current risk assessment and risk communication activities in your community.

• • With a basic understanding of these key planning activities, your partners will have greater insight into how their organization can contribute expertise and knowledge.
  • Suggested activity: Engage attendees in an interactive activity (for example, alerts and messaging for a widespread water contamination event or local ice storm) to illustrate risk communication planning that meets the needs of the whole community. See Appendix B for resources.
• Use the Opportunities to Engage Worksheet
  • Use this worksheet to gather information on how to leverage the expertise and knowledge of your network partners.
• Use the Communication Pathway Template
  • Use this graphic to help your network members understand how messages, alerts, and notifications will flow from risk communicators to partners and the represented populations. Each partner organization can customize the Communication Pathway Template to identify specific channels for dissemination.
• Solicit feedback on what success looks like for the network.
  • Understand what your network hopes to accomplish through their involvement.
• End the meeting with a brief “next steps” discussion.
  • Summarize action items for each participant. If you have asked the participants to submit further information, be sure to explain what information you need, when you need the information, and where to submit. Ask for questions and feedback on the meeting.
• Document key discussion points, decisions, and next steps on the Meeting Agenda Template.
  • Within one week after the meeting, send the completed agenda and meeting notes to participants. Keep a copy of these meeting summaries to document your partner engagement activities.

Action Items

1. Update jurisdictional risk assessment.
2. Review risk messages and materials.
3. Review dissemination strategies.
4. Improve quality of messages and dissemination process.

Step 2: Integrate Partners

Step 1 was about building the partner network. Step 2 encourages planners to integrate partners in the development and review of risk assessments and relevant population profile updates, health messages, materials, dissemination strategies, and quality improvement actions.

Action Item 1: Update jurisdictional risk assessment

All disasters are local. The community is always growing and changing as are the known hazards and new threats that emergency managers must plan for. A vital part of emergency management and public health planning is understanding the diverse populations that make up the community. Knowledge of the demographic characteristics in a jurisdiction is crucial for emergency communications that are timely, tailored, and accessible to the whole community. Risk assessment population profile data inform local all-hazards planning decisions and provide the basis for understanding the access and functional needs of a community.

CDC’s Public Health Emergency Preparedness and Response Capabilities: National Standards for State, Local, Tribal, and Territorial Public Health⁷² identifies jurisdictional risk assessments as a priority activity to strengthen community preparedness.  Publicly available national and state datasets such as those from the U.S. Census Bureau contribute important population profile information for risk assessments. Experience teaches us that many organizations conduct community needs and health assessments that can yield needed data specific to smaller geographic areas and contribute to understanding who resides in the community.

Below are some tips to help you integrate your partners in risk assessment updates.

Tip 1: Leverage partners’ knowledge of the community. 

Community partners have valuable insights and perspectives that add to communication planners’ understanding of how emergencies, such as pandemic influenza or an environmental hazard, would affect the safety of specific populations in the community. Integrating partners in the risk communication process also ensures underrepresented populations are planned for, particularly groups for which local data sources are limited. Faith-based partners and trusted spokespersons are likely to play an important role by contributing relevant information on how to craft effective messages for target audiences that are geographically remote or reluctant to trust public health messaging.

For planning purposes, recognize that the whole membership of your network will not likely be used for all your activities. For example, some partners may have extensive community population data and therefore may play a more significant role in the updates to the jurisdictional risk assessment. Other community partners could best contribute to the review of cultural and linguistically appropriate messaging.

Tip 2: Integrate partners as subject matter experts and stakeholders in activities.

• Review identified jurisdictional hazards and public health vulnerabilities for potential effect on community members who are likely to be disproportionately affected. Inform preparedness planners about special considerations that may exist within the jurisdiction.
• Update population size and characteristics of the jurisdiction such as population density, demographics, and other community risks that could adversely affect public health, related health care, human services, mental/behavioral health, and environmental health systems. Identify
  • populations with access and functional needs,
  • risk communication channels, and
  • effective strategies for delivering accessible, understandable, and timely public health information.
• Review updated all-hazards communication plans to ensure they consider the needs of individuals with disabilities and others with access and functional needs.

Action Item 2: Review risk messages and materials.  

Most risk communication planners have a variety of existing preparedness and disaster materials, including key messages that can be quickly disseminated before an event, during the response, and in the recovery stages. Individuals with access and functional needs and partner organizations have valuable insight on whether these resources are accessible, understandable, and culturally and linguistically appropriate for the populations they are intended to inform.

Tip: Review existing messages and materials with partners.

Make a list of existing resources such as brochures, flyers, toolkits, shelter evacuation signage, the local public health department website, etc. Determine your priorities for reviewing these resources. Consider reviewing the material and messages in phases to keep the partner review tasks manageable. Use the Reviewer Checklist and Comments Worksheet available in Appendix A to document the review process and to identify messages and materials that need improvement.

Consider the following communication questions when reviewing materials:

• Are the messages simple and concise?
• Do messages use short sentences and plain language to allow for easy translation of materials?
• Are written materials provided in bilingual or multi-lingual form?
• Are visual aids such as pictures and maps included to reinforce key messages?
• Do messages include directions and phone numbers?
• Are the materials available in large font?
• Have preferred communication methods (face-to-face, door-to-door, word-of-mouth) been identified?
• Have preferred media for delivering messages (such as local newspaper, religious leader, radio station) been identified for groups that may not use traditional channels?

Action Item 3: Review dissemination strategies.

When all primary communication systems and technology fail, communicators must think creatively and adapt to the crisis by identifying new communication channels. Social media is a powerful and commonly used tool for disseminating public information and emergency alerts. Determine how the network partners can play a role in social media activities in coordination with the lead agency activities.  For example, trusted leaders and other network members can be valuable in helping to dispel rumors or misinformation that may originate from their communities.

Action Item 4: Improve quality of messages and dissemination process.

Develop a realistic action plan to address the gaps and recommendations identified in the partner reviews of messages, materials, and dissemination strategies. For example, by the end of the H1N1 outbreak in April 2010, the United States had an estimated 60.8 million cases of influenza.⁷³ Public Health—Seattle & King County (PHSKC) works to achieve effective methods for culturally specific communication in an emergency to improve the distribution of timely information that is understood,  and more likely to be acted upon. Their H1N1 outreach strategies included 1) implementing community sponsored vaccine clinics, 2) engaging trusted leaders, and 3) using a community communications network (CCN) to improve PHSKC’s ability to reach out to communities that may not access traditional communication channels. The CCN includes more than 200 community partners.

Following the 2009 H1N1 influenza response, PHSKC identified the following communication and outreach recommendations for African, African American, American Indian, Alaska Native, and Russian/Ukraine communities:⁷⁴

• Work with community groups/organizations to develop culturally and linguistically appropriate public education materials specific to each community.
• Ensure public education materials meet the needs of individuals with low literacy.
• Explore ways to streamline messages and be strategic about the frequency of communications.
• Expand and strengthen relationships with community groups/organizations.
• Use personal, face-to-face communication to engage communities of color and immigrant/refugee communities in public health issues.
• Work with community leaders to disseminate information.
• Promote urgent health issues such as H1N1 within the broader context of health promotion and disease prevention.

Resources

Lesson 2: Communicating with the Whole Community

Colorado Department of Public Health and Environment, Community Inclusion in Colorado: Maps and inclusion exercise resources

Colorado Inclusive Planning Case Studies/Scenarios

Community Partnering: A Risk Assessment and Emergency Operations Planning Scenario

CDC Social Media Tools, Guidelines & Best Practices

Tips for Effectively Communicating with the Whole Community in Disasters

Twitter as a Potential Disaster Risk Reduction Tool

Preparedness and Safety Messaging for Hurricanes, Flooding, and Similar Disasters

Community partners can play a key role in reaching the populations they represent and sharing life-saving information from public health agencies. Testing the communication pathway prior to an actual public health threat is essential. This will help ensure all partners not only understand how to receive risk messages from the public health agency, but also understand what to do with the messages and when.

Action Item 1: Test the dissemination process.

How to conduct a test to determine your partners’ ability to receive and respond to an alert:

• Inform the partners that you will be conducting a test of the network. Provide the date and time the test will take place and give instructions on what they will be asked to do.
• On test day, send an email test to the partners and their back-up contacts. Indicate this is a “message test” in bold font on the email subject line.
• State clearly how the partners need to respond. For example, ask your network members to hit the “reply” button rather than “reply all.”
• Consider attaching non-emergency public health individual preparedness information that partners can use later to promote public education events or activities.
• When testing or exercising the capacity of your network for information dissemination, look for gaps in message delivery.
• Review who responded and who did not. Follow-up with those that did not respond and identify any communication barriers.

Action Item 2: Address gaps.

Document findings from each test of the messaging pathway. Create after-action reports following the tests to outline the gaps in your dissemination plan. Revise and update your communication pathway plan based on the after-action findings. Update and disseminate your communication pathway and your contact information worksheets as necessary.

Action Item 3: Develop message adaptation process.

Determine a process for partners to quickly modify or adapt urgent risk messages to meet the needs of the audiences they reach. Some partners may need help from public health communication staff to adapt messages before disseminating them to their target audiences.

Tip: To ensure the timeliness of messages, ask the partners to assess if they need help in adapting public health messages or alerts. Determine a protocol for them to request assistance before they share any information with their target audiences.

Resources

Commentary: A 2017 Best Practice for Private Sector Communications

Emergency Risk communications: Lessons learned from a rapid review of recent gray literature on Ebola, Zika, and Yellow Fever

Texting for Public Health Emergency Communication, Health Promotion, and Beyond

Training program and exercise helps provide risk communication to underserved communities

Sustaining community partnerships is as important as building relationships. Strive to have your communication partner network serve a long-term purpose. Bolster the momentum of your network—give people work to do! Members feel useful when they know they are contributing.

Tips for building sustainable community partnerships:

• Avoid meeting for the sake of meeting.
• Identify small, tangible tasks the group can accomplish and build from their successes.
• Keep moving forward to ensure long term functioning, as recommended by successful access and functional needs task forces.
• Avoid getting stuck on process, sequential action, or big projects.

Adapted from: https://static1.squarespace.com/static/5b4ce7dd1aef1d3d04b17323/t/5babfa0853450ad14e2d14bc/1537997348743/DAFN-Report-2016.pdf

Action Item 1: Integrate partners into drills and exercises

At the center of the whole-community approach is building broad, deep community reliance through partner integration. An important component of institutionalizing your engagement and communication activities is integrating these partners in jurisdictional exercises, drills, and tabletops. The 2018 Public Health Emergency Preparedness Capabilities, National Standards for State, Local, Tribal, and Territorial Public Health emphasizes integrating community partners in building community resilience.

Drills and exercises provide excellent opportunities to test whether risk communication messaging was effective for the whole community. Community partners can provide valuable input and feedback during exercises:

• Did plans include a combination of methods to provide prompt notification of emergencies to persons who are deaf or hard of hearing?
• Did communication messages adequately explain where and how to find accessible transportation to evacuate when it is in high demand during mass evacuations?
• Were communication barriers at points of dispensing (PODs), such as medical countermeasure instruction sheets not easily understood by individuals with limited literacy or language skills?
• Were shelter signage, communications, and materials available in multiple formats (large print, Braille, audio, electronic)?
• Did public messaging identify accessible transportation resources available to evacuate persons with mobility disabilities, including people who use wheelchairs or scooters, medical equipment (such as oxygen tanks), and service animals?
• Did public messaging identify how the needs of people with disabilities and others with access and functional needs will be addressed? Consider messaging for people who use wheelchairs, scooters, medical equipment, and service animals; those who need assistance getting from their homes to emergency transportation pickup locations or staging areas; and those with cognitive disabilities or serious mental illness.

Tip: Provide educational opportunities to build your network members’ knowledge of emergency management and community resilience. See the links in Appendix B for examples of basic emergency preparedness training (many are self-guided). Ask your network partners what types of training opportunities would equip them with the information they need.

Action Item 2: Document key partner activities

An important component of any initiative is documenting your efforts. A record of your activities (such as engagement, training, and integration efforts) and the outputs (such as “identified dissemination strategies” and “reviewed messages and materials for readability”) will be beneficial. They can

• Provide a roadmap to inform stakeholders of your jurisdiction’s actions to identify, plan for, and disseminate risk communication information effective for the whole community
• Serve as an evaluation tool
• Provide helpful anecdotes and be used to create “success stories” for formal and informal publications

Use the At-a-Glance Steps, Tools, and Action Checklist.

Action Item 3: Sustain partner support for community resilience.

Promote the community partner network through success stories. Acknowledge and praise any level of commitment your network partners can make. Use the Success Stories Template.

Establish formal relationships. Consider establishing more formal relationships with your network organizations through a Memorandum of Understanding or similar letters of commitment. Common components of such letters outline key roles and responsibilities of the partners and lead agency and the key objectives of the partnership.