Analysis of Risk Communication Strategies and Approaches with At-Risk Populations to Enhance Emergency Preparedness, Response, and Recovery: Final Report. B. Innovative Practices

12/01/2008

We now highlight risk communication activities that are particularly innovative strategies for reaching at-risk populations. We deemed a practice as innovative if it stood out from typical or core activities as determined by informants and the research team. These particular practices have strong promise for increasing public awareness of risks in advance of an emergency, and increasing compliance with public health recommendations during and following an emergency. We were not able to list all of the innovative practices but have attempted to emphasize those deemed innovative by informants and that, based on the literature review and compendium, appear to move the field beyond typical practice.

  1. Developing emergency response plans that include the media, public, partners, and stakeholders. Below we describe several promising practices pertaining to involving key groups in emergency planning.

    • Involving at-risk populations in the planning process. Although other sites (Florida and DC) also involve at-risk populations in risk communication activities, the level of involvement in California was particularly noteworthy. California emergency response planners have 45 partners actively participating on committees to reach everyone in the state. These community participants not only guide disaster planning, policies, and approaches; they are trained members working on verifiable outcomes and goals to make risk communication plans usable across groups. The primary goal of the network is to get command center emergency information back to the partner organizations through real-time communication channels (email, wireless devices) and for community partners to return feedback about their local needs. All of the 110 individuals involved in this network are integrally linked into the warning center system around the clock. Individuals are selected from organizations because they have decision making capacities and other resources for at-risk populations (e.g., are sign language interpreters, have a wheelchair accessible vehicle). The committees strive to use “people first” language that attributes positive labels to people, such as “people with disabilities,” and avoids negative labels, such as “the handicapped” or “the disabled.” The committees also emphasize functional approaches to disaster planning and response. As noted previously, this community participation approach is well supported by the literature review. This is also one means of enhancing the comprehensiveness of the risk communications--a theme identified from the compendium of risk communications--since local partners are more likely to be aware of needs of at-risk populations specific to their communities.

    • Establishing partnerships to prepare families. April is Family Preparedness Month in Oklahoma. McReady is a private-public partnership designed to prepare families for emergencies, particularly weather-related emergencies. McDonald’s restaurants across the state displayed a variety of brochures available to the public including a family preparedness guide, a coloring book for kids on weather safety, a brochure about the OK-WARN program (a program for communicating with the deaf and hard-of-hearing), and a preparedness guide for sheltering in place. The Oklahoma Department of Emergency Management also partners with two local television stations and their weather reporter to visit schools and give special presentations. They have developed a DVD that is distributed to all schools in the state and includes Oklahoma’s First Lady, a popular weather reporter in the state, and the Oklahoma Gas and Electric’s mascot talking about preparedness issues. Finally, the Oklahoma Department of Emergency Management and its McReady partners attend community safety fairs to present information about emergency preparedness. In 2009, the state plans to disseminate preparedness materials in Spanish through the McReady program. This substantial collaboration effort is consistent with the theme of community engagement identified in the compendium review.

    • Helping pregnant women prepare. As part of home visits to pregnant women served by maternal and child health funding, the case workers in Montgomery County discuss Plan 9 in the context of pregnancy planning. During these visits, the workers check how women have progressed in their planning using the Plan 9 assessment (e.g., water, flashlight). The program has developed an additional assessment form based on case management forms for other populations, in which they adapted the Plan 9 list for the specific supply needs of pregnant or parenting women, such as formula, Tylenol, and diapers. This inclusion of pregnant women as a population in need of specific risk communication messages addressed a gap in current research: Both the literature review and compendium found limited attention to the preparedness needs of pregnant women.

    • Using technology to map the needs of at-risk populations. Florida purchased and developed software to determine and map community resources, with attention to the needs of at-risk populations. Like the vulnerability mapping tool that RAND is developing, it would be useful to use such a tool to import local Census data for identifying and locating at-risk populations. The tool could provide information for planners on where to target resources before, during, and after an emergency. Our literature review highlighted the central role of vulnerability assessment in program development.

  2. Conducting trainings, drills, and exercises. The sites also informed us about some innovative training activities being conducted.

    • Including children with disabilities in exercises and drills. This is particularly important for school-based exercises in which those at-risk are often excluded, despite the fact that they constitute the majority of individuals who will need help in that setting. Even simple knowledge about how to exit the classroom must be clearly communicated. This approach being used in California is consistent with the literature. Several of the citations we reviewed highlighted the special needs of children and pointed to school-based communication interventions as particularly effective in reaching this population. This approach also directly addresses two themes that arose from the compendium of risk communications: tailoring the format to the audience and using active approaches to engage that audience.

    • Engaging the community. Florida is working with high school youth as “mitigators” for disasters to raise awareness among youth in their schools and their families. Youth are also sent to senior centers and other senior housing facilities to conduct preparedness awareness sessions with senior citizens. Having youth interact with senior citizens makes emergency preparedness more collaborative and enjoyable for those involved. Some of the methods of interaction were to play “windy bingo” and ”hurricane jeopardy,” activities that were well-received. The games were created by the youth (so they learned in the process) and enjoyed by the residents. The games also stimulated discussion about emergency preparedness. Senior citizens, in turn, shared their experiences in disasters over their lifetime so that some intergenerational learning took place. Bilingual youth are also involved as community educators with at-risk populations, including migrant camp areas and other neighborhoods whose residents may respond better to these interactive forms of communication than to typical didactic messaging.

  3. Coordinating risk communication planning with state and local agencies and non-government partners. Our informants identified as innovative several coordination activities that involve planning with the community to better reach at-risk populations.

    • Involving the faith community. Two innovative strategies for reaching out to the faith community stood out in Montgomery County. The Gospel Program is an effort to partner with local churches to disseminate Plan 9 materials. During the 2007-2008 year, the program received money to provide survival kits for congregants. The initiative focuses primarily on work within congregations, but there are plans to use bus advertising to reach out to congregants in the community. In addition, Montgomery County has developed the Strengthening the Strengtheners program, which uses parish nurses to conduct outreach. The parish nurses and other community nurses use a core set of materials to train others about emergency preparedness in their respective congregations. These strategies illustrate the power of community participation.

    • Regular meetings among PIOs across the state. In Florida, PIOs use meetings to discuss important messaging issues and recent disasters. This serves two purposes: It provides continuing education, and it ensures that PIOs across the state know each other and are not just, in the words of one informant, “exchanging business cards on the day of the disaster.”

    • Employing Americans with Disabilities Act (ADA; P.L. 101-336) coordinators in all county departments. Florida also works with a centralized ADA office and created a statewide disability position to help enforce ADA compliance. This strategy facilitates local tailoring of messages for PWD by providing a local opportunity for engaging these audiences more directly. Having a statewide disability position to help enforce ADA compliance better ensures that messages are made available in formats that are accessible to the relevant audiences (e.g., large print with sing language interpreter, appropriate color contrast, sound options, etc.).

    • Making emergency information readily available. Oklahoma uses a 211 phone line to make information available statewide. It serves as a step-down version of 911 for non-emergency needs. Staff in the call centers are available to answer questions about a variety of issues and either already have or will be provided with all messages that come from the Oklahoma Department of Emergency Management and other agencies, including the Oklahoma Department of Health, in the event of an emergency. The 211 call center receives the same messages that are sent to the media in the event of an emergency. The call center will also feed back information to emergency management staff about the kinds of questions that callers are asking so that messages can be further tailored and refined. Various agencies are involved in advertising the availability of 211 through TV spots, ads on buses, website announcements, etc. These practices are consistent with an overarching conclusion of the literature review: To achieve effective emergency risk communication, offer frequent messages in multiple modes that are locally and personally relevant.

  4. Training key state and local public health spokespersons in risk communication. We identified a number of innovative practices involving training in the sites we studied.

    • Building risk communication skills. In terms of training, local public health officials in California receive a risk communication tool kit for use with all populations, including those at-risk. The tool kit earned California the Public Relations Society of America 2005 PRism award for excellence in public relations. The kit trains direct service providers to be better prepared and to have their own plans in place locally. It also builds skills at the local level to teach risk communication. Agencies are trained to teach each at-risk population community that they are personally responsible for their own safety just like everyone else (rather than that they need to be treated as “special”).

    • Providing materials to first responders. In Oklahoma, a consortium of organizations representing PWD disseminates and provides training for a pocket-sized flip chart with guidelines for managing emergency response. The guidelines include a broad range of at-risk populations: senior citizens; those with service animals, those with mobility impairments; those with autism; individuals who are deaf, hard-of-hearing, blind, or visually impaired; those with cognitive disabilities; those with multiple chemical sensitivities; and individuals who are mentally ill. The demand for this information has been great, and the consortium is in the process of developing an on-line version for Fire and Rescue to use in their trucks. Exactly this sort of simple yet flexible tool was highlighted as an “all-star” from the compendium, since it addresses the needs of the audience and provides concrete motivations for recommended actions.

    • Conducting exercises and drills that include at-risk populations. Including at-risk populations in drills can reveal risk communication problems: For example, one drill in Florida showed that police did not know how to communicate with deaf persons and, as a consequence, were perceived as threatening by deaf persons. Because their emergency management department implements the drills through a modular system, they can select different components that are relevant to emphasize communication with particular at-risk populations. This approach to risk communication is consistent with tailoring the format to the audience and using active approaches to engage that audience, key principles arising from the compendium.

    • Developing action plans for homebound populations. Montgomery County, Maryland, developed a curriculum for case managers and home health aides. The curriculum trains aides and case managers to help clients prepare a “File for Life”--a list of medications and provider information that is placed on a refrigerator for family members and emergency medical technicians in the case of an emergency. Aides also work with clients to determine what needs to be replaced in their emergency kits (water, perishable items) and sometimes these aides shop for clients or ask family members to help shop.

  5. Establishing mechanisms to translate emergency messages into priority languages. Below we highlight two strategies used to translate materials for the needs of at-risk populations. The first example addresses not only language translation but also strategies for making cultural competency an integral component of translation. The second example highlights the use of interpersonal and social networks through community organizations which are important channels for reaching at-risk populations.

    • Tailoring messages for Latinos. Montgomery County, Maryland, also started the development of a telenovela4 integrating emergency preparedness messages for Latinos. Although lack of funding has hampered continuation of the effort, the idea represents a creative strategy for reaching this community. The lack of translation to other languages was noted with regards to the risk communications in the compendium.

    • Networking with the faith community. Montgomery County also readily involves the faith community to help with translation as with the Plan 9 materials (see section 3, “Coordinating”).

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