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Access and Functional Needs

Guidance on Integrating People with Access and Functional Needs into Disaster Preparedness Planning for States and Local Governments

During a disaster, it has been observed that certain at-risk individuals, specifically those with access and functional needs, have required additional response assistance before, during, and after an incident.   These additional considerations for at-risk individuals with access and functional needs are vital towards inclusive planning for the whole community, and have been mandated for inclusion in federal, state, territorial, tribal, and local public health emergency plans by the Public Health Service (PHS) Act.  Such plans must also meet applicable requirements of the Americans with Disabilities Act (ADA).
This guidance will introduce and connect you to available resources and inclusive strategies for integrating the access and functional needs of at-risk individuals into emergency preparedness, response, and recovery planning at all jurisdictional levels.

I.    Guidance

ASPR/Hospital Preparedness Program (HPP) and CDC/Public Health Emergency Preparedness (PHEP)
ASPR’s Hospital Preparedness Program (HPP) and CDC’s Public Health Emergency Preparedness (PHEP) cooperative agreements provides leadership and funding to states, territories, and eligible municipalities to improve surge capacity and enhance community and hospital preparedness for public health emergencies.  HPP Program funding supports the following activities: Enhanced Planning, Increasing Integration, and Improving Infrastructure. PHEP cooperative agreements specifically target the development of emergency-ready public health departments that are flexible and adaptable. Both HPP and PHEP Capabilities address planning for at-risk individuals.

Centers for Disease Control and Prevention Public Health Workbook: To Define, Locate, and Reach Special, Vulnerable, and At-risk Populations in an Emergency
This CDC workbook is intended to provide public health and emergency preparedness planners with better ways to communicate health and emergency information to at-risk individuals with access and functional needs for all-hazards events through step-by-step instructions, resources guides and templates.  For example, a step-by-step guide is available to assist you in creating a COIN (Community Outreach Information Network) in your communities to gather trusted community leaders and a network of people who can help with emergency planning and give information to at-risk populations during an emergency. View Workbook >>

A Toolkit for State and Local Planning and Response
This interactive tool helps state and local health departments better identify, plan for, and respond to at-risk individuals with access and functional needs. This web-based GIS tool uses US Census data to identify at-risk populations with access and functional needs, ranging from frail older adults, children, populations with limited English proficiency, and populations with limited resources.  Available to public health department representatives, this user-friendly tool also links users to information on promising strategies for integrating assistance for special needs populations into public health planning and response. Funding for this toolkit was provided by HHS ASPR. View Toolkit >>

ADA Best Practices Tool Kit for State and Local Governments, Chapter 7 Addendum 2: The ADA and Emergency Shelters: Access for All in Emergencies and Disasters
This Addendum to the ADA Best Practices Tool Kit discusses some of the key issues that emergency managers and shelter operators need to address in order to comply with the Americans with Disabilities Act (ADA) when they plan for and provide sheltering during emergencies and disasters. View Toolkit >>

ADA Best Practices Tool Kit for State and Local Governments: Title II Checklist
This Checklist is designed for use as a preliminary assessment of your emergency management programs, policies, procedures, and shelter facilities. View Toolkit >>

Communicating with Vulnerable Populations: A Transportation and Emergency Management Toolkit
This toolkit describes how to create a communication process to reach vulnerable populations regarding their transportation options in emergencies.  It provides a framework and tools for constructing a scalable, adaptable communication process built on a network of agencies from public, private, and nonprofit sectors. View Toolkit>>

FEMA Comprehensive Preparedness Guides
In November 2010, FEMA released the Developing and Maintaining Emergency Operations Plans: Comprehensive Preparedness Guide (CPG) 101 Version 2.0 which provides information and instruction aimed to help tribal, state, territorial, and local governments develop emergency plans.  CPG101 also includes guidance for people with access and functional needs.
In 2010, FEMA also released the Comprehensive Preparedness Guide (CPG) 101 Supplement: Household Pet and Service Animal Planning Checklist. This supplement contains planning considerations to guide the integration of household pet and service animal issues into the existing emergency operations plan. The checklist follows the requirements set forth in the Pets Evacuation and Transportation Standards Act of 2006.

FEMA National Disaster Housing Strategy
In 2009, FEMA released its National Disaster Housing Strategy, which calls for national and state efforts to plan for accessible housing that can be made available after a disaster.  The National Council on Disability (NCD) recommends that each state create task forces on disaster housing consistent with the Strategy, and involve disability organizations. View Strategy >>

CMIST Framework
CMIST – Communication, Maintaining Health, Independence, Services and Support, Transportation – provides a flexible, cross-cutting approach to defining at-risk individuals to address a broad set of common access and functional needs irrespective of specific diagnoses, status, or labels (e.g., pregnant women, children, elderly). Ultimately, individuals with access and functional needs must be addressed in all federal, territorial, tribal, state, and local emergency and disaster plans. For more information, check out the At-Risk Individuals fact sheet.

II. Executive Actions

Executive Order 13347 – Individuals with Disabilities in Emergency Preparedness
In 2004, Executive Order 13347 -- Individuals with Disabilities in Emergency Preparedness -- established the Interagency Coordinating Council on Emergency Preparedness and Individuals with Disabilities (ICC).  Chaired by the Department of Homeland Security, the ICC helps to ensure that the federal government accounts for the safety and security of people with disabilities during disasters. The ICC is made up of representatives from federal agencies including: Environmental Protection Agency, General Services Administration, Health and Human Services, Office of Personnel Management, Social Security Administration, Department of Transportation, Department of the Treasury, Department of Agriculture, and Department of Justice, among others. Other invited members include the U.S. Access Board, the National Council on Disability, and the Federal Communications Commission.  View Executive Order >>

FEMA Office of Disability Integration and Coordination In 2009, the President created and staffed the new position of Senior Advisor on Disability Issues within FEMA to report to the administrator. This senior staff position is responsible for addressing emergency management issues relating to the disability community and is intended to enhance preparedness efforts at the agency’s highest levels.  Beginning in February 2010, this advisor is now the Director of the Office of Disability Integration and Coordination.  Learn More >>

III.    Legislation and Regulations

A.    Disaster Preparedness

Pandemic and All-Hazards Preparedness Act
In 2006, the Pandemic and All-Hazards Preparedness Act (PAHPA) lead to the creation of the Office of the Assistant Secretary for Preparedness and Response (ASPR) to lead the nation in preventing, preparing for, and responding to the adverse health effects of public health emergencies and disasters.  ASPR focuses on preparedness planning and response; building federal emergency medical operational capabilities; countermeasures research, advance development, and procurement; and grants to strengthen the capabilities of hospitals and health care systems in public health emergencies.  The office provides federal support, including medical professionals through ASPR’s National Disaster Medical System, to augment state and local capabilities during an emergency or disaster.  Under the PHS Act, HHS is the lead agency for the National Response Framework (NRF) for Emergency Support Function 8 (ESF).  ASPR is the Secretary’s principal advisor for all health and medical services support function in a health emergency or public health event. The PHS Act, as amended by PAHPA (2006) and PAHPRA (2013), established a variety of requirements for addressing needs of at-risk individuals with access and functional needs in public health emergency preparedness and response.

The Pets Evacuation and Transportation Standards Act of 2006
The Pets Evacuation and Transportation Standards Act amends the Stafford Act, and requires evacuation plans to take into account the needs of individuals with household pets and service animals, prior to, during, and after major disaster or emergency.  Learn More >>

Federal Communications Commission – Emergency Alert System Rules
In October 2005, the Federal Communications Commission (FCC) expanded the Emergency Alert System (EAS) rules to require EAS participation by digital television broadcasters, digital cable television providers, and digital broadcast radio, Digital Audio Radio Service, and Direct Broadcast Satellite systems. The FCC’s EAS rules require that an EAS provide access to people with disabilities by providing both visual and aural alerts. Under the rules, a visual EAS alert does not have to be an exact transcription of an audio alert, but must be “any method of visual presentation which results in a legible message conveying the essential emergency information.” Learn More >>

Post-Katrina Emergency Management Reform Act (PKEMRA)
The Post-Katrina Emergency Reform Act, amended the Homeland Security Act of 2006. Effective March 31, 2007, the Act aims to strengthen the Department of Homeland Security/FEMA’s ability to prevent, prepare for, protect against, respond to, and recover from disaster.

Additionally, the Act requires that new leadership roles are created within DHS, including the position of National Disability Coordinator (NDC) (now part of the Office of Disability Integration and Coordination as of February 2010). The Act also includes provisions for the inclusion of people with disabilities in evacuation plans, accessible housing, and regional disability coordinators, among many other changes.  Learn More >>

Robert T. Stafford Disaster Relief and Emergency Assistance Act of 1988
The Robert T. Stafford Disaster Relief and Emergency Assistance Act, PL 100-707 was signed into law on November 23, 1988 as an amended version of the Disaster Relief Act of 1974. The Act provides the statutory authority for FEMA to coordinate most Federal disaster response activities. It also established a system through which financial and physical assistance can be obtained from FEMA following a presidential declared disaster. Learn More >>

B. Disability Equality

ADA Amendments Act of 2008 (ADAAA)
The ADA Amendments Act (ADAAA) broadens the scope of the definition of what it means to have a disability. These changes went into effect January 1, 2009. These amendments make it easier for people with access and functional needs to seek protection under the law. The ADAAA also mandates that individuals with access and functional needs be included in all disaster plans developed for a community under Title II.  Learn More >>

Americans with Disabilities Act (ADA)
The Americans with Disabilities Act (ADA) is a broad civil rights law that prohibits discrimination against people with disabilities. The law covers a wide range of areas, from employment to the accessibility of public buildings. The ADA also requires that people with disabilities have equal access to all government programs.  Learn More >>

Section 508 of the Rehabilitation Act of 1973
Section 508 of the Rehabilitation Act of 1973, as amended (29 U.S.C. 794d), requires that when federal agencies develop, procure, maintain, or use electronic and information technology, federal employees with disabilities have access to and use of information and data that is comparable to the access and use by federal employees who are not individuals with disabilities, unless an undue burden would be imposed on the agency.  Section 508 also requires that individuals with disabilities, who are members of the public seeking information or services from a federal agency, have access to and use of information and data that is comparable to that provided to the public who are not individuals with disabilities, unless an undue burden would be imposed on the agency. Learn More>>

Americans with Disabilities Act Accessibility Guidelines (ADAAG)
The Americans with Disabilities Act Accessibility Guidelines (ADAAG) covers the scoping and technical requirements necessary to ensure that buildings and facilities are accessible. The scoping and technical requirements outlined in the ADAAG must be applied during the design, construction, and alteration of buildings and facilities covered by Title II and Title III of the ADA to the extent required by regulations issued by federal agencies such as the Department of Justice and the Department of Transportation. Learn More >>


IV.    Promising Practices

Examples of Plans and Programs on Integrating People with Access and Functional Needs. Note: Examples provided are funded by ASPR HPP.

An Arizona partnership between public health and independent living advocates embarked on a project to better integrate people with functional needs into general population shelters during an emergency. The state health department purchased durable and adaptive equipment to support up to 1,000 people in shelters, and is currently training healthcare organizations to anticipate and meet the needs of people with functional disabilities during a disaster. Learn More >>

The state of Kentucky created a community engagement and collaboration network to achieve an inclusive emergency plan. The Kentucky Outreach and Information Network (KOIN) adapted their plan after the Community Outreach Information Network-a grassroots network of people and trusted leaders who can help with emergency response planning and delivering information to at-risk populations in emergencies.

The Cabinet for Health and Family Services in collaboration with the Kentucky Department for Public Health also created an archive of printable signs in various languages and sizes to better integrate and accommodate individuals with access and function needs into general population point of dispensing (POD) sites.

The city of Oakland, CA used the CMIST Framework to develop a comprehensive emergency plan that provides an inclusive approach to address the access and functional needs of the whole community.  Learn More >>


Key/Common best practices from each plan: used GIS to locate and track at-risk communities/individuals; built strong community partnerships; adapted plans from federal legislation to specific state needs. States also applied for funding from the US Department of Health and Human Services Hospital Preparedness Program (HPP).​