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Office of Human Services Emergency Preparedness and Response
National Commission on Children and Disasters: 2010 Report to the President and Congress

Appendix B: Index to Recommendations and Responsible Entities

Recommendations President Congress Relevant Federal Agencies States, Tribes, Territories and Localities Non-Governmental Entities
1. Disaster Management and Recovery
1.1: Distinguish and comprehensively integrate the needs of children across all inter- and intra-governmental disaster management activities and operations. X X All X X
The President should develop a National Strategy for Children and Disasters. X        
The Executive Branch, Congress, and non-Federal partners should prioritize children separately from "at-risk" population categories. X X All X X
The Executive Branch at all levels of government should establish and maintain permanent focal points of coordination for children and disasters, supported by sufficient authority, funding, and policy expertise. FEMA should establish Children's Integration Specialists at the regional level. X   All X  
The Executive Branch and non-Federal partners should incorporate children as a distinct priority in base disaster planning documents and relevant grant programs. X   All X  
The Executive Branch and non-Federal partners should incorporate education, child care, juvenile justice, and child welfare systems into disaster planning, training, and exercises. X   DHS/FEMA HHS
The Executive Branch and non-Federal partners should incorporate children as a distinct priority in relevant target capabilities, preparedness training, and exercises, with specific target outcomes and performance measures. X   All X  
The Executive Branch and Congress should institute accountability and progress monitoring measures to track implementation of Commission recommendations and capability improvements. X X All X  
1.2: The President should accelerate the development and implementation of the National Disaster Recovery Framework with an explicit emphasis on addressing the immediate and long-term physical and mental health, educational, housing, and human services recovery needs of children. X        
1.3: DHS/FEMA should ensure that information required for timely and effective delivery of recovery services to children and families is collected and shared with appropriate entities.     All X X
Government agencies and non-governmental organizations should collect information on children and families necessary to identify and support their immediate and long-term recovery needs.     All X X
DHS/FEMA should expand information sharing with appropriate government agencies and non-governmental organizations to enable the delivery of recovery services.     DHS/FEMA    
DHS/FEMA should pre-identify and credential additional local and out-of-State voluntary and non-governmental organizations and networks that provide disaster assistance to children and families.     DHS/FEMA    
1.4: DHS/FEMA should establish interagency agreements to provide disaster preparedness funding, technical assistance, training, and other resources to State and local child serving systems and child congregate care facilities.     DHS/FEMA
2. Mental Health
2.1: HHS should lead efforts to integrate mental and behavioral health for children into public health, medical, and other relevant disaster management activities.   X All X  
Congress should direct HHS to lead the development of a disaster mental and behavioral health Concept of Operations (CONOPS) to formalize disaster mental and behavioral health as a core component of disaster preparedness, response, and recovery efforts.   X HHS    
2.2: HHS should enhance the research agenda for children's disaster mental and behavioral health, including psychological first aid, cognitive-behavioral interventions, social support interventions, bereavement counseling and support, and programs intended to enhance children's resilience in the aftermath of a disaster.     HHS    
HHS should convene a working group of children's disaster mental health and pediatric experts to review the research portfolios of relevant agencies, identify gaps in knowledge, and recommend a national research agenda across the full spectrum of disaster mental health for children and families.     HHS    
2.3: Federal agencies and non-Federal partners should enhance pre-disaster preparedness and just-in-time training in pediatric disaster mental and behavioral health, including psychological first aid, bereavement support, and brief supportive interventions, for mental health professionals and individuals, such as teachers, who work with children.     DHS/FEMA
2.4: DHS/FEMA and SAMHSA should strengthen the Crisis Counseling Assistance and Training Program (CCP) to better meet the mental health needs of children and families.     DHS/FEMA
Simplify the Immediate Services Program (ISP) grant application to minimize the burden on communities affected by a disaster and facilitate the rapid allocation of funding and initiation of services.     DHS/FEMA
Establish the position of Children's Disaster Mental Health Coordinator within State-level CCPs.     DHS/FEMA
Formally modify the CCP model to indicate and promote "enhanced services" where the mental health impact is unlikely to be adequately addressed by "typical" CCP services.     DHS/FEMA
Include bereavement support and education within services typically provided under the CCP.     DHS/FEMA
2.5 Congress should establish a single, flexible grant funding mechanism to specifically support the delivery of mental health treatment services that address the full spectrum of behavioral health needs of children including treatment of disaster-related adjustment difficulties, psychiatric disorders, and substance abuse.   X      
3. Child Physical Health
3.1: Congress, HHS, and DHS/FEMA should ensure availability and access to pediatric medical countermeasures (MCM) at the Federal, State, and local levels for chemical, biological, radiological, nuclear, and explosive threats.   X DHS/FEMA
Provide funding and grant guidance for the development, acquisition, and stockpiling of MCM specifically for children for inclusion in the Strategic National Stockpile (SNS) and all other federally funded caches, including those funded by DHS/FEMA.   X HHS    
Amend the Emergency Use Authorization to allow the FDA, at the direction of the HHS Secretary, to authorize pediatric indications of MCM for emergency use before an emergency is known or imminent.   X      
Form a standing advisory body of Federal partners and external experts to advise the HHS Secretary and provide expert consensus on issues pertaining specifically to pediatric emergency MCM.     HHS    
Within the HHS Biomedical Advanced Research and Development Authority, designate a pediatric leader and establish a pediatric and obstetric working group to conduct gap analyses and make research recommendations.     HHS    
Include pediatric expertise on the HHS Enterprise Governance Board or its successor and all relevant committees and working groups addressing issues pertaining to MCM.     HHS    
Establish a partnership between the proposed MCM Development Leader and key pediatric stakeholders within and outside government.     HHS    
3.2: HHS and DoD should enhance the pediatric capabilities of their disaster medical response teams through the integration of pediatric -specific training, guidance, exercises, supplies, and personnel.   X HHS
HHS should develop pediatric capabilities within each National Disaster Medical System (NDMS) region.     HHS    
HHS should establish a "reserve pool" of pediatric health care workers to assist in NDMS disaster response.     HHS    
HHS and DoD should establish a Pediatric Health Care Coordinator on each disaster medical response team and develop strategies to recruit and retain team members with pediatric medical expertise.     HHS
3.3: HHS should ensure that health professionals who may treat children during a disaster have adequate pediatric disaster clinical training.     HHS
The President should direct the Federal Education and Training Interagency Group for Public Health and Medical Disaster Preparedness and Response (FETIG) to prioritize the development of pediatric core competencies, core curricula, training, and research. X        
The FETIG should support the formation of a Pediatric Disaster Clinical Education and Training Working Group to establish core clinical competencies and a standard, modular pediatric disaster health care education and training curriculum.     HHS
3.4: The Executive Branch and Congress should provide resources for a formal regionalized pediatric system of care to support pediatric surge capacity during and after disasters. X X HHS    
HHS should include pediatric surge capacity as a "Required Funding Capability" in the Hospital Preparedness Program.     HHS    
States and hospital accrediting bodies should ensure all hospital emergency departments stand ready to care for ill or injured children through the adoption of emergency preparedness guidelines jointly developed by the American Academy of Pediatrics, the American College of Emergency Physicians, and the Emergency Nurses Association.       X X
3.5: Prioritize the recovery of pediatric health and mental health care delivery systems in disaster-affected areas. X X DHS/FEMA
Congress should establish sufficient funding mechanisms to support restoration and continuity of for-profit and non-profit health and mental health services to children.   X      
The Executive Branch should recognize and support pediatric health and mental health care delivery systems as a planning imperative in the development and implementation of the National Health Security Strategy and National Disaster Recovery Framework. X   DHS/FEMA
HHS should create Medicaid and Children's Health Insurance Program incentive payments for providers in disaster areas.     HHS    
The American Medical Association should adopt a new code or code modifier to the Current Procedural Terminology to reflect disaster medical care in order to facilitate tracking of these services and as a means for enhanced reimbursement from public and private payers.         X
3.6: EPA should engage State and local health officials and non-governmental experts to develop and promote national guidance and best practices on re-occupancy of homes, schools, child care, and other child congregate care facilities in disaster-impacted areas.     EPA    
EPA and HHS should expand research on pediatric environmental health risks associated with disasters.     EPA

4. Emergency Medical Services and Pediatric Transport

4.1: The President and Congress should clearly designate and appropriately resource a lead Federal agency for emergency medical services (EMS) with primary responsibility for the coordination of grant programs, research, policy, and standards development and implementation. X X      
Establish a dedicated Federal grant program under a designated lead Federal agency for pre-hospital EMS disaster preparedness, including pediatric equipment and training.   X      
4.2: Improve the capability of emergency medical services (EMS) to transport pediatric patients and provide comprehensive pre-hospital pediatric care during daily operations and disasters.     DHS
Congress should provide full funding to the Emergency Medical Services for Children (EMSC) program to ensure all States and territories meet targets and achieve progress in the EMSC performance measures for grantees, and to support development of a research portfolio.   X      
As an eligibility guideline for Centers for Medicare & Medicaid Services reimbursement, require first response and emergency medical response vehicles to acquire and maintain pediatric equipment and supplies in accordance with the national guidelines for equipment for Basic Life Support and Advanced Life Support vehicles.     HHS    
HHS and DHS should establish stronger pediatric EMS performance measures within relevant Federal emergency preparedness grant programs.     HHS
HHS should address the findings of the EMSC 2009 Gap Analysis of EMS Related Research.     HHS    
4.3: HHS should develop a national strategy to improve Federal pediatric emergency transport and patient care capabilities for disasters.     HHS    
Conduct a national review of existing capabilities among relevant government agencies and the private sector for emergency medical transport of children.     HHS    
5. Disaster Case Management
5.1: Disaster case management programs should be appropriately resourced and should provide consistent holistic services that achieve tangible, positive outcomes for children and families affected by the disaster. X HHS
X  X
The Executive Branch and Congress should provide sufficient funds to build, support, and deploy a disaster case management system with nationwide capacity.  X HHS
DHS/FEMA should clarify the transition from Federal to State-led disaster case management programs.      DHS/FEMA    
Government agencies and non-governmental organizations should develop voluntary consensus standards on the essential elements and methods of disaster case management, including pre-credentialing of case managers and training that includes focused attention to the needs of children and families.     HHS

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