ff
Homeless Planning for Homeless Planning for
Emergencies: Seattle & King Emergencies: Seattle & King Emergencies: Seattle & King Emergencies: Seattle & King
County County
Heather Barr RN Public Health Seattle & King County Heather Barr RN, Public Health Seattle & King County Robin Pfohman, Public Health- Seattle & King County Susan Vaughn, Catholic Community Services
Overview Overview
Health Care for the Homeless backgroundHealth Care for the Homeless background
Public Health Preparedness andPublic Health Preparedness and
Public Health Preparedness and Public Health Preparedness and vulnerable population planning
vulnerable population planning
C iC i dd tt itiiti ff titi
Crises and opportunities for actionCrises and opportunities for action
Community partner perspectiveCommunity partner perspective-- Catholic Catholic Community Services
Community Services
ChallengesChallengesgg
Sustaining the partnershipsSustaining the partnerships
Mission of HCHN Mission of HCHN Mission of HCHN Mission of HCHN
The Health Care for the Homeless Network The Health Care for the Homeless Network The Health Care for the Homeless Network The Health Care for the Homeless Network (HCHN) provides health care services for (HCHN) provides health care services for people experiencing homelessness in King people experiencing homelessness in King people experiencing homelessness in King people experiencing homelessness in King
County and provides leadership to help County and provides leadership to help
change the conditions that deprive our change the conditions that deprive our change the conditions that deprive our change the conditions that deprive our
neighbors of home and health neighbors of home and health
What is Health Care for the What is Health Care for the Homeless (HCHN) Project?
Homeless (HCHN) Project?
Sited at Public HealthSited at Public Health Seattle &Seattle &
Sited at Public HealthSited at Public Health-- Seattle & Seattle &
King County in the mid 80’s King County in the mid 80’s
Federal GrantFederal Grant --180 nation wide180 nation wide
Federal Grant Federal Grant 180 nation wide180 nation wide
Contract with 12 agencies at Contract with 12 agencies at various service sites (40 +) various service sites (40 +)
Sites serve variety of population Sites serve variety of population groups
groups
A f li i l id d
A f li i l id d
A range of clinical providers and A range of clinical providers and staff who provide outreach peer staff who provide outreach peer counseling
counseling counseling counseling
HCHN Team Locations HCHN Team Locations
SheltersShelters -- women men youth familieswomen men youth families
Shelters Shelters women, men, youth, familieswomen, men, youth, families
DropDrop--in centers, hygiene centersin centers, hygiene centers
T iti l d t h i
T iti l d t h i
Transitional and permanent housingTransitional and permanent housing
Sobering CenterSobering Center
Mobile Medical VanMobile Medical Van
Direct outreachDirect outreach -- encampments streetencampments street
Direct outreach Direct outreach encampments, streetencampments, street
Countywide servicesCountywide services
How do HCHN teams work?
How do HCHN teams work?
How do HCHN teams work?
How do HCHN teams work?
Trauma informed careTrauma informed care-- working with a working with a gg wounded population
wounded population
Meet the person "where they are“Meet the person "where they are“
Meet the person where they areMeet the person where they are
Build trusting relationships Build trusting relationships
UU hh dd titi dd titi titi ll
Use harm reduction and motivational Use harm reduction and motivational interviewing techniques
interviewing techniques
Build relationships with the agencies that Build relationships with the agencies that host them
host them
HCHN Health and Safety HCHN Health and Safety
Project
Project -- 1994 1994
Established best practice guidelines model policiesEstablished best practice guidelines model policies
Established best practice guidelines, model policiesEstablished best practice guidelines, model policies
Provided training and technical assistance to any Provided training and technical assistance to any agency serving homeless residents in King County agency serving homeless residents in King Countygg yy gg gg yy
Environmental Health, EMS, CDEnvironmental Health, EMS, CD--EpiEpi
Assured basic standards were met at City of Seattle Assured basic standards were met at City of Seattle yy funded shelters
funded shelters
Provided consultation Provided consultation
P id d H l h d i li
P id d H l h d i li
Provided Health education to clientsProvided Health education to clients
Focused on Communicable Disease Education and Focused on Communicable Disease Education and Prevention
Prevention Prevention Prevention
Why are homeless and poor people Why are homeless and poor people y y p p p p p p
more vulnerable to communicable more vulnerable to communicable diseases than are people who live in diseases than are people who live in diseases than are people who live in diseases than are people who live in
homes and have decent incomes?
homes and have decent incomes?
Factors that Increase Vulnerability Factors that Increase Vulnerability Factors that Increase Vulnerability Factors that Increase Vulnerability
AccessAccess transportationtransportation Oppression racismOppression racism
Access Access -- transportation, transportation, insurance, $, lack of
insurance, $, lack of knowledge
knowledge
Oppression, racism, Oppression, racism, poverty
poverty
Shelters overShelters over--crowdedcrowded
Fear Fear -- of sickness, of of sickness, of
hospitals, of mortality, CPS, hospitals, of mortality, CPS, judgement
judgement
Lack of access to hygiene Lack of access to hygiene facilities
facilities
Poor nutritionPoor nutrition judgement
judgement
Past experiences with systemPast experiences with system
Mental health issuesMental health issues
Poor nutritionPoor nutrition
StressStress
Sleep deprivationSleep deprivation
Drug and alcohol issuesDrug and alcohol issues
Sleep deprivationSleep deprivation
Chronic health conditionsChronic health conditions
Established a Foundation Established a Foundation Established a Foundation Established a Foundation
Concepts of disease prevention applicableConcepts of disease prevention applicable
Concepts of disease prevention applicable Concepts of disease prevention applicable to dealing with pandemic flu
to dealing with pandemic flu
History of providing flu vaccine clinics onHistory of providing flu vaccine clinics on
History of providing flu vaccine clinics on History of providing flu vaccine clinics on site at shelters
site at shelters
C id i th d f i k l t
C id i th d f i k l t
Considering the needs of sick people at Considering the needs of sick people at shelters
shelters
Expanding hours to accommodate and Expanding hours to accommodate and
isolate sick people, establishing “flu room”
isolate sick people, establishing “flu room”
Crisis Creates Opportunity &
Crisis Creates Opportunity &
Interest Interest
““
New” germs New” germs
New germs New germs
Identified case at a site Identified case at a site -- MRSA, bird MRSA, bird ,, flu, etc
flu, etc
Key prevention measures cover many Key prevention measures cover many diseases
diseases
Alcohol Based Hand Gel Alcohol Based Hand Gel Alcohol Based Hand Gel Alcohol Based Hand Gel
Early resistance to putting up dispensers Early resistance to putting up dispensers -- Early resistance to putting up dispensers Early resistance to putting up dispensers -- now common practice
now common practice
Wash ‘em wash ‘em wash ’em
Wash ‘em wash ‘em wash ’em
Wash em, wash em, wash em
Wash em, wash em, wash em
Vulnerability of Homeless People in Vulnerability of Homeless People in
E i /Di
E i /Di
Emergencies/Disasters Emergencies/Disasters
Transportation issuesTransportation issues
Transportation issuesTransportation issues
CommunicationCommunication
U di t bl tt U di t bl tt
Unpredictable patternsUnpredictable patterns
Lack of social supportLack of social support
Inability to achieve isolation in public Inability to achieve isolation in public places
places p
p
Fear of “system”Fear of “system”
Live in a constant state of emergencyLive in a constant state of emergency
Live in a constant state of emergencyLive in a constant state of emergency
Consider the partic lar Consider the partic lar Consider the particular Consider the particular
vulnerability of all vulnerability of all population groups of population groups of population groups of population groups of
homeless people homeless people
Small Disasters are Helpful!
Small Disasters are Helpful!
Small Disasters are Helpful!
Small Disasters are Helpful!
Fresh interest in preparedness Fresh interest in preparedness
Fresh interest in preparedness Fresh interest in preparedness
“Reality check” “Reality check”
Reality check Reality check
Training opportunity Training opportunity g pp g pp y y
Get to use those emergency kits Get to use those emergency kits
Barriers to Emergency Barriers to Emergency
P d
P d
Preparedness Preparedness
Disaster fatigueDisaster fatigue emergency uponemergency upon
Disaster fatigue Disaster fatigue -- emergency upon emergency upon emergency
emergency
M t d b t b
M t d b t b
Management concerned, but busy Management concerned, but busy coping with day
coping with day-- toto--day emergenciesday emergencies
Lack of funds, time, resources, storageLack of funds, time, resources, storage
Denial Denial
Short staffedShort staffed
Nisqually Earthquake Nisqually Earthquake
February 28 2001 February 28 2001 February 28, 2001 February 28, 2001
Pioneer Square Pioneer Square Pioneer Square Pioneer Square
2002 TB Outbreak
2002 TB Outbreak -- Homeless in Homeless in
S l
S l
Seattle Seattle
Over 1 year many sheltersOver 1 year many shelters
Over 1 year, many sheltersOver 1 year, many shelters
Health Dept TB Clinic and Health care for Health Dept TB Clinic and Health care for
th H l l d j l
th H l l d j l
the Homeless played a major role the Homeless played a major role
Established TB Coalition, a group of stakeEstablished TB Coalition, a group of stake--,, gg pp holders (shelter providers, City and County holders (shelter providers, City and County staff) that continue to meet quarterly
staff) that continue to meet quarterly)) qq yy
February
February 2003 2003
Avian Flu H5N1 2005 Avian Flu H5N1 2005
Led to the development of:
Led to the development of: pp
An Influenza Pandemic Planning Guide for An Influenza Pandemic Planning Guide for
Homeless and Housing Service Providers Homeless and Housing Service Providers Homeless and Housing Service Providers Homeless and Housing Service Providers
In this case, a near crisis offered an In this case, a near crisis offered an
opportunity to begin planning
opportunity to begin planning
Vulnerable Populations Action Team Vulnerable Populations Action Team Vulnerable Populations Action Team Vulnerable Populations Action Team
2006 2006
"When your disaster plans protect
"When your disaster plans protect and serve the most vulnerable in and serve the most vulnerable in
it ll l
it ll l
your community, all people are your community, all people are
better positioned to survive, thrive better positioned to survive, thrive and prosper "
and prosper "
and prosper.
and prosper.
Âna
Âna--Marie JonesMarie Jones Executive Director Executive Director
CARD (Collaborating Agencies Responding to Disasters) CARD (Collaborating Agencies Responding to Disasters) Oakland, California
Oakland, California
Vulnerable Populations Action Team Vulnerable Populations Action Team Vulnerable Populations Action Team Vulnerable Populations Action Team
Included Connected Prepared Included Connected Prepared Included. Connected. Prepared Included. Connected. Prepared..
Vision: By working collaboratively with Vision: By working collaboratively with Vision: By working collaboratively with Vision: By working collaboratively with
community partners, Public Health’s VPAT community partners, Public Health’s VPAT initiative ensures that no one group is
initiative ensures that no one group is initiative ensures that no one group is initiative ensures that no one group is more impacted than another in an
more impacted than another in an emergency
emergency emergency.
emergency.
Vulnerable Populations Vulnerable Populations Vulnerable Populations Vulnerable Populations
• Blind
• Chemically dependent
• Impoverished
• Limited English Proficient
• Chemically dependent
• Children
• Clients of criminal justice system
• Limited English Proficient
• Medically Dependent, Medically Compromised
• Mentally Ill
• Deaf, deaf-blind, hard of hearing
• Developmentally disabled
• Emerging or transient special
Mentally Ill
• Physically Disabled
• Refugees and Immigrants
• Seniors
• Emerging or transient special needs
• Homeless and shelter dependent
• Undocumented persons
Reaching our Vulnerable Residents Reaching our Vulnerable Residents
R i PARTNERSHIPS R i PARTNERSHIPS Requires PARTNERSHIPS Requires PARTNERSHIPS
Emergency Management CBO & FBO/Networks
Preparedness Resources
Technical Assistance
• Key Human Services
• Knows Vulnerable Clients
Communication
Response Resources
• Trusted Entities
• Situational Awareness
Resources and Technical Resources and Technical
A i A i
Assistance Assistance
• Agency Emergency Planning:
www.kingcounty.gov/heal thservices/health/prepare thservices/health/prepare dness/VPAT/standards V l bl P l ti
• Vulnerable Populations Planning Toolkit:
www apctoolkits com/vuln www.apctoolkits.com/vuln erablepopulation
Communication Communication
Community Communication Network (CCN)
Receive
Reportp
Redistribute
Messaging:
Health Advisories: winter storm, H1N1, heat, ,
Health Alerts (activate after hours contact): Carbon Monoxide
Howard Hanson Dam & H1N1 Howard Hanson Dam & H1N1 Howard Hanson Dam & H1N1 Howard Hanson Dam & H1N1
January 2009 April 2009
“The Dam Flu Meeting”
“The Dam Flu Meeting” The Dam Flu Meeting The Dam Flu Meeting
Weekly Homeless Provider Stakeholder GroupWeekly Homeless Provider Stakeholder Group
Weekly Homeless Provider Stakeholder Group Weekly Homeless Provider Stakeholder Group established Summer 2009
established Summer 2009
Leveraged resources to hire a planner to Leveraged resources to hire a planner to gg pp support work
support work
Howard Hanson Dam Howard Hanson Dam –– Notification and Notification and Warning, Mass Care
Warning, Mass Care
H1N1 FluH1N1 Flu-- Situational Awareness, Tier Two Situational Awareness, Tier Two Shelter Plan, Vaccine Clinics
Shelter Plan, Vaccine Clinics
Howard Hanson Dam Howard Hanson Dam
Homeless residents are:
Homeless residents are:
Living outside in very temporary Living outside in very temporary structures, camps, cars
structures, camps, cars
Living in flood prone areasLiving in flood prone areas
Living in areas that are difficult to accessLiving in areas that are difficult to access--
Living in areas that are difficult to accessLiving in areas that are difficult to access intentionally
intentionally
Howard Hanson Dam Howard Hanson Dam Howard Hanson Dam Howard Hanson Dam
Homeless considerations for:
Homeless considerations for:
Homeless considerations for:
Homeless considerations for:
Notification and WarningNotification and Warning
Transportation and EvacuationTransportation and Evacuation
PrePre--messagingmessaging
ShelteringSheltering
Challenges: raising awareness, Challenges: raising awareness,
competing priorities, city by city planning competing priorities, city by city planningpp g pg p ,, y yy y y py p gg
H1N1 H1N1
Flu surveillanceFlu surveillance
Tami flu distributionTami flu distribution
Tami flu distributionTami flu distribution
Flu vaccine clinicsFlu vaccine clinics Ti T Sh lt
Ti T Sh lt
Tier Two ShelterTier Two Shelter
Communicable Disease VideoCommunicable Disease Video
ki /h l h i /h l h
ki /h l h i /h l h
www.kingcounty.gov/healthservices/health www.kingcounty.gov/healthservices/health /personal/HCHN/videos
/personal/HCHN/videos
Challenges: logistical issues, resources Challenges: logistical issues, resources
Activation Plan Activation Plan Activation Plan Activation Plan
Goals:
Goals:
Ad i di th d f h l l
Ad i di th d f h l l
Advise regarding the needs of homeless people Advise regarding the needs of homeless people in plans
in plans
Advocate on behalf of homeless residentsAdvocate on behalf of homeless residents
Advocate on behalf of homeless residentsAdvocate on behalf of homeless residents Activities:
Activities:
TwoTwo--way communication systemway communication system
Meet twice annually Meet twice annually
Mobilize quickly to respond in an emergency, Mobilize quickly to respond in an emergency, when necessary
when necessary
Catholic Community Services (
Catholic Community Services (CCS) CCS)
12 Family Centers across western Washington
45 emergency shelters and transitional housing programs
45 emergency shelters and transitional housing programs
Over 1.9 million hours of home care for the elderly/disabled
Over 1.4 million meals served
1,900 + affordable permanent housing units – including housing for migrant farm workers
Family Preservation and Foster Care Services
Family Preservation and Foster Care Services
Addiction recovery services
Catholic Immigration Services
H l P ti
Homeless Prevention
Statewide
Literacy and early learning programsy y g p g
Over 139,000 hours of Volunteer Chore Services
CCS Core Values CCS Core Values CCS Core Values CCS Core Values
CompassionCompassion -- Providing care, understanding and concern Providing care, understanding and concern for those we serve in order to honor the God
for those we serve in order to honor the God--given life andgiven life and for those we serve in order to honor the God
for those we serve in order to honor the God given life and given life and sacredness of each person at every stage and condition of sacredness of each person at every stage and condition of life.
life.
DiversityDiversity -- Welcoming the differences of race culture faithWelcoming the differences of race culture faith
Diversity Diversity Welcoming the differences of race, culture, faith, Welcoming the differences of race, culture, faith, and thought with a strong commitment to naming and
and thought with a strong commitment to naming and combating institutional racism and discrimination.
combating institutional racism and discrimination.
ExcellenceExcellence -- Providing high quality professionally competentProviding high quality professionally competent
ExcellenceExcellence -- Providing high quality, professionally competent Providing high quality, professionally competent services with integrity, using best practices.
services with integrity, using best practices.
JusticeJustice -- Defending and advocating for the rights of poor and Defending and advocating for the rights of poor and vulnerable people while working toward the common good
vulnerable people while working toward the common good vulnerable people while working toward the common good.
vulnerable people while working toward the common good.
Stewardship Stewardship -- Prudently developing and using the gifts and Prudently developing and using the gifts and talents of employees and volunteers and the financial
talents of employees and volunteers and the financial resources needed to live out our mission
resources needed to live out our mission resources needed to live out our mission.
resources needed to live out our mission.
Partnership with Public Health Partnership with Public Health--
S l & Ki C S l & Ki C
Seattle & King County Seattle & King County
Communications Communications
Vaccine distributionVaccine distribution
Community Communication NetworkCommunity Communication Network-- Health Health Advisories
Advisories Advisories Advisories
Projects/programs Projects/programs
Disaster Case ManagementDisaster Case Management
Tier II ShelteringTier II Sheltering Training
Training
TrainingTraining
Mobile Medical VanMobile Medical Van
Outreach Outreach –– Public Health nursePublic Health nurse
Benefits of Public
Benefits of Public -- Private Private
P hi
P hi
Partnership Partnership
Serving the same target populationsServing the same target populations
Serving the same target populationsServing the same target populations
Leverage resources Leverage resources
L kill t
L kill t
Leverage skill setsLeverage skill sets
Ability to disseminate quickly to the Ability to disseminate quickly to the community
community
Ability to respond quicklyAbility to respond quicklyyy pp qq yy
Increased respect and understanding of Increased respect and understanding of the work we both do
the work we both do -- true collaborationtrue collaboration the work we both do
the work we both do true collaborationtrue collaboration
Steps You Can Take Steps You Can Take
Build a foundation of trustBuild a foundation of trust
Use “Mini” crises to enco rage planningUse “Mini” crises to enco rage planning
Use “Mini” crises to encourage planning Use “Mini” crises to encourage planning and partnership
and partnership
Cultivate partnerships with agencies serving Cultivate partnerships with agencies serving vulnerable populations
vulnerable populations
Plan togetherPlan together
Sustain and improve partnershipsSustain and improve partnerships
Sustain and improve partnerships Sustain and improve partnerships
Be poised to respond to future crisesBe poised to respond to future crises
