Addressing the Access and Functional Needs of At-Risk Individuals
At-risk individuals are people with access and functional needs (temporary or permanent) that may interfere with their ability to access or receive medical care before, during, or after a disaster or public health emergency.
Examples of at-risk populations may include but are not limited to children, pregnant women, older adults, people with disabilities, people from diverse cultures, people with limited English proficiency, people with limited access to transportation, people with limited access to financial resources, people experiencing homelessness, people who have chronic health conditions, and people who have pharmacological dependency.
At-Risk Populations
During a disaster or emergency, public health and medical professionals need to take action to protect the health of at-risk individuals. In addition, public health professionals and medical providers are often required by law or executive order to address the needs of at-risk individuals during disasters and emergencies.
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At-Risk Individuals Fact Sheet: This fact sheet explains existing requirements under the Public Health Service Act to address the needs of at-risk individuals, defines access and functional needs, and summarizes the CMIST Framework (Communication,
Maintaining health,
Independence,
Support and
Safety, and
Transportation) for addressing common and crosscutting access and functional needs. (At-Risk Individuals Program)
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Access and Functional Needs Web-Based Training: Addressing access and functional needs (AFN) is a crucial part of comprehensive disaster planning for the whole community and is mandated for inclusion in federal, state, local, tribal, and territorial public health emergency plans. ASPR has developed the HHS/ ASPR Access and Functional Needs Web-Based Training to help public health officials, emergency managers, and social/human service providers learn how to address AFN in disaster preparedness, response, and recovery.
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Access and Functional Needs: ASPR TRACIE Topic Collection: ASPR Technical Resources, Assistance Center, and Information Exchange (TRACIE) collected case studies, lessons learned, tools, and promising practices for working with individuals with disabilities during a disaster. This aims to prevent populations with access and functional needs from suffering disproportionately.
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Guidance on Integrating People with Access and Functional Needs into Disaster Preparedness Planning for States and Local Governments: This guidance provides information to help state and local government planners to address the access and functional needs of at-risk individuals in the communities they serve during disasters and emergencies. It includes resources on legislation, regulations, and executive actions. This guide also includes examples of real-world promising practices.
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Public Health Workbook to Define, Locate, and Reach Special, Vulnerable, and At-Risk Populations in an Emergency: This book by the CDC explains what at-risk populations are and how to estimate the number of people with access and functional needs in your community. This resource includes information on locating at-risk populations using digital mapping or other alternatives; conducting surveys and focus groups; and analyzing the data.
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Tools for Assessing the Scope of Access and Functional Needs within a Community: ASPR TRACIE compiled resources to help jurisdictions determine which community members have access and functional needs. This resource includes links that provide additional information about safety in a community with at-risk individuals.
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Access and Functional Needs Toolkit: Integrating a Community Partner Network to Inform Risk Communication Strategies: This toolkit provides examples of groups who are at risk of being disproportionately impacted during and after an emergency. In addition, there is a four-step action plan that works to successfully integrate a network of community partners into the risk communication process. This allows communities to evaluate their communication and improve partner integration practices.
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Advancing Equity with Data Tools: The Census Bureau's publicly available data sets and tools can assist federal agencies and other entities in the equitable distribution of resources, and in identify underserved communities. The Census Bureau collects comprehensive data from a multitude of sources about the nation’s economy and population, covering a range of topics, including demography, housing, socioeconomics, and businesses.
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Legal Requirements for Addressing the Disaster Public Health and Medical Needs of At-Risk Individuals: This section provides details on the legal requirements of public health and medical professionals when working to address the needs of at-risk individuals. There are federal laws and executive order requirements that must be followed when planning for a disaster.
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Disasters and Healthcare Disparity: An analysis and collection of resources on healthcare disparities after and during disasters. Underserved communities get hit especially hard during emergencies, so this list of technical resources focuses on health equity geared toward health care practitioners who are committed to addressing this disparity.
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COVID-19 At-Risk Individuals Resources: This ASPR TRACIE collection of resources on COVID-19 preparedness, response, recovery, and mitigation efforts focuses on at-risk individuals who are vulnerable to COVID-19. There are plans, tools and templates of immediately implementable resources.
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Engaging Community-Based Organizations: Promising Practices for Reaching At-Risk Individuals for COVID-19 Vaccination and Information: COVID-19 disproportionately impacted at-risk and underserved populations including communities of color and low-wage essential workers. This resource explains the importance of equity considerations for access to timely and accurate information and vaccination; describes the role of community-based organizations as trusted entities that know their clients and communities; and recommends ways to employ the CMIST Framework to address access and functional needs. (At-Risk Individuals Program)
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Community-Based Organizations during COVID-19: This toolkit provides resources to help leaders of community-based organizations ensure continuity of operations and maintain programs during disasters. (At-Risk Individuals Program)
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Telehealth Webinar for Community Based Organizations Series: This three-part webinar series explains the importance of telehealth services for at-risk individuals. Part one focuses on helping community-based organizations better understand issues related to services, payment, and partnerships surrounding telehealth services. Part two focuses on enhancing accessibility and language access. Part three focuses on addressing barriers to access and connectivity for people experiencing homelessness and low-income populations. Recordings, transcripts, and Q&A are provided. (At-Risk Individuals Program)
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Hurricane Sandy Recovery Workshop Summary Report: Lessons Learned and Promising Practices for Home and Community-Based Service Providers: Nearly half of all people who died as a direct or indirect result of Hurricane Sandy were at-risk individuals. The National Association of County & City Health Officials (NACCHO), in partnership with ASPR, convened a workshop and released a report following Hurricane Sandy that details gaps in response operations of the tri-state area of New York, New Jersey, and Connecticut. The report describes challenges and lessons learned from home and community-based service providers and local health departments as well as innovations and promising practices to foster resilience and recovery to address the needs of at-risk individuals with access and functional needs. (At-Risk Individuals Program)
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Information on Federal Programs to Sustain Nutrition for At-Risk Individuals: This resource provides a table with information on federal nutrition programs and the various at-risk populations they serve. This resource can be used to match federal nutrition programs by the category of recipient they serve and provides links to for additional information. (At-Risk Individuals Program)
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Capacity-Building Toolkit for including Aging & Disability Networks in Emergency Planning: Older adults and people with disabilities are better able to remain in their homes and live independently, thanks in part to the work of Community Based Organizations (CBOs). Many disasters and emergencies disproportionately impact older adults and people with disabilities. This toolkit guides CBOs in planning to address the access and functional needs of older adults and people with disabilities by providing resources and recommendations, along with planning worksheets and templates that can be tailored to the CBO’s mission and the specific needs of the communities they serve. Additionally, public health and emergency management professionals can use the toolkit to learn how to partner with CBOs that serve older adults and people with disabilities to address emergency planning, response, recovery, and mitigation. (At-Risk Individuals Program)
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Working with Older Adults and People with Disabilities: Tips for Treatment and Discharge Planning (PDF) (Spanish): Understanding how to interact with community-dwelling older adults and people with disabilities includes recognizing the importance of individuals self-determination and independence. While some individuals may require additional medical support during an emergency, this resource explains the importance of ensuring that older adults and people with disabilities return to the least restrictive environment following discharge from medical care. (At-Risk Individuals Program)
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Addressing the Need of Older Adults in Disasters Web Based Training: By the year 2035, the U.S. Census Bureau projects that there will be more Americans over the age of 65 than under the age of 18. Many disasters and public health emergencies disproportionately impact older adult populations, especially those ages 85 and older. This course is designed to improve the capabilities of public health and medical professionals to address the access and functional needs of community-dwelling older adults in disasters. Public health and medical responders can use the information, resources, tools, and strategies from this free, online training to address the needs of older adults during in common emergency situations including natural disasters and infectious disease outbreaks. (At-Risk Individuals Program)
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Disaster Preparedness Planning for Older Adults: Disasters can be particularly disruptive to the daily living of older adults and their caregivers. This compendium of resources includes material from federal and national organizations on addressing the need of older adults in public health emergencies and disasters. (At-Risk Individuals Program)
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Population-Specific Resources: Older Adults (General): ASPR TRACIE’s collection of resources for health care providers who work with older adults during disasters covers general care as well as specific resources for those with dementia, chronic illnesses, PTSD, diabetes, and those in nursing homes.
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Population-Specific Resources: Older Adults (COVID-19): This collection of resources for health care providers who work with older adults focuses on ways to enhance safety, work with caregivers, ease the sense of isolation while social distancing, limit exposure to the virus, and ensure safer hospital discharges.
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Direct Services Workforce Shortages during COVID-19: Direct services providers (DSP) help many at-risk individuals maintain their health and well-being while living at home. This fact sheet describes implications of the DSP workforce shortages; provides workforce and client estimates; and provides just-in-time solutions to DSP workforce shortages. (At-Risk Individuals Program)
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Discharge Planning and Care Coordination during the COVID-19 Pandemic: Maintaining Services for Adults with Disabilities Who Live in Community Settings: This planning tool is designed to guide nurses and others conducting acute care discharge planning for adults with disabilities to ensure continuation and reconnection with long-term supports and services (LTSS) and home and community-based services. Developed by the At-Risk Individuals Program, Administration for Community Living, and Centers for Medicare and Medicaid Services, this resource focuses on the use of person-centered planning and the
CMIST Framework to provide strategies for supporting independent living post-discharge to the most integrated setting of their choice. (At-Risk Individuals Program)
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Personal Preparedness for Individuals with Disabilities: Sheltering in Place and Evacuation: This fact sheet contains information and a check list for emergency planning in the event of evacuation or sheltering in place. Created for families and individuals with disabilities, it promotes personal preparedness by describing emergency planning activities as well as the critical items and information for building an emergency “go-kit.” (At-Risk Individuals Program)
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Exercise Requirements for an Intermediate Care Facility for Individuals with Intellectual Disabilities: The Centers for Medicare and Medicaid Services (CMS) Emergency Preparedness Rule requires intermediate care facilities for individuals with intellectual disabilities to conduct exercises. This resource from ASPR TRACIE provides an overview of the scope and frequency of exercise requirements, including a series of related resources to help with exercise planning.
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Understanding How to Accommodate Service Animals in Healthcare Facilities: This fact sheet provides an overview of policy guidance to help health care professionals accommodate people with service animals. Find out about requirements and limitations – the dos and don’ts - of interacting with individuals with disabilities with service animals. (At-Risk Individuals Program)
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Planning Considerations for the Extremely Obese for Disasters and Public Health Emergencies: This fact sheet provides details on health consider for individuals who are extremely obese and includes planning considerations for public health emergencies and disasters. (At-Risk Individuals Program)
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Meeting the Needs of Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) Individuals During Disasters and Emergencies: FEMA’s 2020 annual National Preparedness Report identified communities of color, single parents, lesbian, gay, bisexual, and transgender people as being at the highest risk or more severely impacted during disasters. To ensure access to medical and disaster behavioral health services after a disaster, emergency planers should strive to provide safe access to, and experiences in, emergency shelters for LGBTQI+ individuals and families. This fact sheet describes actions that emergency planners, LGBTQI+ community members and shelter providers can effectively meet their needs.
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HHS Maternal-Child Health Emergency Planning Toolkit: Designed to improve the capacity of health care, public health, and social services professionals and emergency managers in addressing the needs of people who are pregnant, postpartum, and/or lactating and typically developing infants and young children, this toolkit outlines basic planning steps, highlights key resources and promising practices, and explains data and information to be integrated into emergency planning for maternal-child health (MCH) population. It includes modules on preparedness, response, and recovery planning, and a module with case studies covering four emergency scenarios. Throughout, the toolkit promotes understanding of health equity and applying the social determinants of health, developing organizational resilience, and understanding of the needs of MCH population before, during, and after emergencies. (At-Risk Individuals Program)
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HHS Child and Adolescent Health Emergency Planning Toolkit: Designed to improve the capacity of health care, public health, and social services professionals and emergency managers in addressing the needs of children and youth with special health care needs (CYSHCN) in emergency preparedness, response, recovery, mitigation, and community resilience activities. This toolkit outlines basic planning steps, highlights key resources and promising practices, and explains data and information to be integrated into emergency planning for CYSHCN. It includes modules on preparedness, response, and recovery planning, and a module with case studies covering three emergency scenarios. Throughout, the toolkit promotes understanding of health equity and applying the social determinants of health, developing organizational resilience, and understanding of the needs of CYSHCN population before, during, and after emergencies. (At-Risk Individuals Program)
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Population-Specific Resources: Maternal-Child Health and Gender Issues: Women who are pregnant, postpartum and/or lactating and infants have unique needs during and after disasters. This ASPR TRACIE resource collection focuses on maternal-child health and gender issues, detailing the needs of both infants and mothers.
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Population-Specific Resources: Maternal-Child Health and Gender Issues (COVID-19): This resource collection from ASPR TRACIE focuses on the impact that COVID-19 has had on maternal-child health, including issues in prenatal care, patient management, and optimizing obstetric care.
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Support for Pregnant Survivors of Abuse or Rape during Disasters: A Resource for First Responders (Spanish): Intimate partner violence is more common than any other health problem that affects women during pregnancy and the risk of intimate partner violence increases during an emergency. Developed by the At-Risk Individuals Program, Office on Women’s Health (OWH), and Administration for Children and Families (ACF), this fact sheet is designed to aid first responders in recognizing and referring pregnant survivors of abuse for services during an emergency. It provides strategies and information providers can use to refer survivors of intimate partner violence to resources and services. (At-Risk Individuals Program)
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Delivering Gender-Informed Health Services in Emergencies: Gender is correlated with differences in exposure to and perceptions of risk during disasters as well as physical and psychological disaster health impacts. This informational sheet provides an overview of delivering gender-informed health services during emergencies. (At-Risk Individuals Program)
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The Role of Healthcare Providers in Combatting Human Trafficking during Disasters: Health care providers can play a crucial role in preventing human trafficking, especially during and after emergencies. This page provides resources to help providers identify signs of human trafficking, understand the correlation between trafficking and disasters, and learn what to do if you suspect one of your patients is a victim of human trafficking.
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Culturally and Linguistically Appropriate (CLAS) in Maternal Health Care: This free e-learning program from the
Office of Minority Health HHS designed for maternal health care providers and students who wish to increase their cultural competency and ability to offer person-centered care, and combat implicit bias across the maternal health care field. It focuses on the Culturally and Linguistically Appropriate Services (CLAS) standards and awareness of self and patients . (At-Risk Individuals Program)
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Hurricane Response - Resources for Children with Special Health Care Needs: Children and youth with special health care needs include those at increased risk for chronic physical, neurological, developmental, behavioral, or emotional conditions who require health and social services related services beyond those required by children or youth typically. This resource compendium developed by ASPR’s At-Risk Individuals Program and HRSA’s Maternal-Child Health Bureau contains resources that families, organizations, and clinicians providing care can use to help meet the needs of children and youth with special health care needs and their families during and after disasters and emergencies. (At-Risk Individuals Program)
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Cultural and Linguistic Competency in Disaster Preparedness and Response Fact Sheet: This resource provides an overview of ways to enhance cultural and linguistic competency using the CLAS Standards. These standards provide emergency mangers, public health, and health care professionals with a framework for developing and implementing policies, programs, and services using the “five elements of cultural competency within disaster preparedness.” (At-Risk Individuals Program)
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Cultural and Linguistic Competency for Disaster Preparedness Planning and Crisis Response: A whole community approach requires that the needs culturally and linguistically diverse populations are included in emergency activities. The At-Risk Individuals Program compiled resources and tools to enhance cultural and linguistic competency. Addressing cultural and linguistic needs can reduce psychological distress during an emergency and aids the community’s ability to recover effectively. (At-Risk Individuals Program)
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Ensuring Language Access and Effective Communication during Response and Recovery: A Checklist for Emergency Responders (Spanish): Developed jointly by the At-Risk Individuals Program and the Office for Civil Rights, this checklist for emergency responders describes legal requirements for addressing communication needs for people with limited English proficiency and people with communication disabilities. The resource also outlines actions that responders can take to increase access. (At-Risk Individuals Program)
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Cultural Competency Curriculum for Disaster Preparedness and Crisis Response: Online Training from the Office of Minority Health: This free e-learning program from the Office of Minority Health helps emergency medical and first responders to deliver culturally and linguistically competent services during and after a disaster. It presents the Culturally and Linguistically Appropriate Services (CLAS) standards as a blueprint to increase cultural and linguistic competency including information and strategies to advance health equity, improve quality, and help eliminate health disparities.
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Ensuring Culturally and Linguistically Appropriate Crisis Communication: Culturally and linguistically appropriate services (CLAS) are respectful of and responsive to individual cultural health beliefs and practices, preferred languages, health literacy levels, and communication needs. This Office of Minority Health resource recommends using the CLAS strategies for ensuring culturally and linguistically appropriate crisis communication during a public health crisis or emergency is critical to ensuring everyone receives clear, trustworthy, and useful information.
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Engaging Community Partners to Support Equitable Crisis Response and Recovery: Culturally and linguistically appropriate services (CLAS) are respectful of and responsive to individual cultural health beliefs and practices, preferred languages, health literacy levels, and communication needs. This Office of Minority Health resource offers action steps for operationalizing the National CLAS Standards. This resource provides suggested strategies for engaging community partners to build trust, promote community decision-making and collaboration, and gather feedback to make improvements to response and recovery efforts.
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Resources for Serving Persons with Limited English Proficiency (LEP): Entities that receive federal financial assistance must take reasonable steps to provide LEP individuals meaningful access to the programs, services, and information that they provide. This resource guide provides an overview of laws protecting LEP individuals and a list of translation and interpretation resources. (At-Risk Individuals Program)
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Population-Specific Resources: Cultural and Linguistic Diversity: This ASPR TRACIE collection of population-specific resources can be used to help health care professionals communicate with and provide support to diverse populations more effectively.
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American Indian & Alaskan Native Disaster Preparedness Resource: In order to help tribal communities during disasters, public health planners and emergency responders must first understand tribally specific cultural beliefs and practices. The At-Risk Individuals Program created a resource compendium to help health care professionals better understand tribally specific cultural beliefs and practices relevant to supporting tribes during and after disasters. (At-Risk Individuals Program)
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Guidance to State and Local Governments and Other Federally Assisted Recipients Engaged in Emergency Preparedness, Response, Mitigation, and Recovery Activities on Compliance with Title VI of the Civil Rights Act of 1964: The Department of Justice, Department of Homeland Security, Department of Housing and Urban Development, Department of Health and Human Services, and Department of Transportation issued guidance to help ensure that federally funded programs or activities do not discriminate against individuals and communities when providing emergency services. This publication describes steps to ensure compliance to Title VI of the Civil Rights Act.
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Homelessness Emergency Planning Toolkit: Disaster Preparedness to Promote Community Resilience, Information and Tools for Homeless Serving Providers and Disaster Professionals: Individuals and families experiencing homelessness are some of the most underserved members of our society and they are often disproportionately impacted by disasters and emergencies. This toolkit from the Departments of Veteran’s Affairs, Health and Human Services, and Housing and Urban Development is designed to help homeless service providers address the needs of individuals and families experiencing homelessness in emergencies. It includes three sections: 1) Creating and Inclusive Emergency Management Systems; 2) Guidance for Homeless Service Providers; and 3) Guidance for Health Care Providers. (At-Risk Individuals Program)
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Disaster Response for Homeless Individuals and Families: A Trauma-Informed Approach: People experiencing homelessness typically have limited resources and likely have past trauma, so they may be at a higher risk of an adverse physical or psychological reaction following a disaster. This fact sheet that provides information on planning for individuals and families experiencing homelessness during emergencies and understanding past trauma. (At-Risk Individuals Program)
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Population-Specific Resources: People Experiencing Homelessness: This resource collection by ASPR TRACIE helps planners create disaster plans that consider the care homeless communities. This resource includes information from HHS, National Health Care for the Homeless, and the Department of Veterans Affairs. Mental and physical help are important for those experiencing homelessness.
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Population-Specific Resources: People Experiencing Homelessness (COVID-19): This resource collection by ASPR TRACIE includes resources for health care providers, emergency managers, homeless shelters, and other providers who are assist people experiencing homelessness during the COVID-19 pandemic. This resource list provides information to help providers handle positive tests, address special pediatric considerations, take action to mitigate the spread of COVID-19, and more.
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Federal Programs that Support Individuals Experiencing Homelessness: To Identify forms of federal assistance that can provide additional support to agencies/organizations addressing the needs of individuals experiencing homelessness during the COVID-19 outbreak. This guidance provides lists of federal programs in a funding matrix that may be utilized help federal, state, and local funding to meet short- and long-term needs. (At-Risk Individuals Program)
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Homeless Shelter Resources for COVID-19: ASPR TRACIE developed a compilation of resources to help outpatient centers document COVID-19 test results for clients experiencing homelessness and information on managing designated shelters for people experiencing homelessness who have tested positive for COVID-19.
