This document discusses emergency planning for homeless populations in Seattle and King County. It provides background on Health Care for the Homeless and describes challenges homeless individuals face during emergencies due to issues like lack of transportation, communication barriers, and medical vulnerabilities. The document also outlines past emergency situations like earthquakes, disease outbreaks, and pandemics that have strengthened planning efforts and partnerships between public health and social services to better meet the needs of homeless communities during crises.

1. ffHomeless Planning forHomeless Planning for
Emergencies: Seattle & KingEmergencies: Seattle & KingEmergencies: Seattle & KingEmergencies: Seattle & King
CountyCounty
Heather Barr RN Public Health Seattle & King CountyHeather Barr RN, Public Health Seattle & King County
Robin Pfohman, Public Health- Seattle & King County
Susan Vaughn, Catholic Community Services

2. OverviewOverview
 Health Care for the Homeless backgroundHealth Care for the Homeless background
 Public Health Preparedness andPublic Health Preparedness and Public Health Preparedness andPublic Health Preparedness and
vulnerable population planningvulnerable population planning
 C i d t iti f tiC i d t iti f ti Crises and opportunities for actionCrises and opportunities for action
 Community partner perspectiveCommunity partner perspective-- CatholicCatholic
Community ServicesCommunity Services
 ChallengesChallengesgg
 Sustaining the partnershipsSustaining the partnerships

3. Mission of HCHNMission of HCHNMission of HCHNMission of HCHN
The Health Care for the Homeless NetworkThe Health Care for the Homeless NetworkThe Health Care for the Homeless NetworkThe Health Care for the Homeless Network
(HCHN) provides health care services for(HCHN) provides health care services for
people experiencing homelessness in Kingpeople experiencing homelessness in Kingpeople experiencing homelessness in Kingpeople experiencing homelessness in King
County and provides leadership to helpCounty and provides leadership to help
change the conditions that deprive ourchange the conditions that deprive ourchange the conditions that deprive ourchange the conditions that deprive our
neighbors of home and healthneighbors of home and health

4. What is Health Care for theWhat 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’sKing County in the mid 80’s
 Federal GrantFederal Grant --180 nation wide180 nation wide Federal GrantFederal Grant 180 nation wide180 nation wide
 Contract with 12 agencies atContract with 12 agencies at
various service sites (40 +)various service sites (40 +)
 Sites serve variety of populationSites serve variety of population
groupsgroups
A f li i l id dA f li i l id d A range of clinical providers andA range of clinical providers and
staff who provide outreach peerstaff who provide outreach peer
counselingcounselingcounselingcounseling

5. HCHN Team LocationsHCHN Team Locations
 SheltersShelters -- women men youth familieswomen men youth families SheltersShelters women, men, youth, familieswomen, men, youth, families
 DropDrop--in centers, hygiene centersin centers, hygiene centers
T iti l d t h iT 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 outreachDirect outreach encampments, streetencampments, street
 Countywide servicesCountywide services

7. 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 aworking with agg
wounded populationwounded 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 relationshipsBuild trusting relationships
 U h d ti d ti ti lU h d ti d ti ti l Use harm reduction and motivationalUse harm reduction and motivational
interviewing techniquesinterviewing techniques
 Build relationships with the agencies thatBuild relationships with the agencies that
host themhost them

8. HCHN Health and SafetyHCHN Health and Safety
ProjectProject -- 19941994
 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 anyProvided training and technical assistance to any
agency serving homeless residents in King Countyagency serving homeless residents in King Countyg y g g yg y g g y
 Environmental Health, EMS, CDEnvironmental Health, EMS, CD--EpiEpi
 Assured basic standards were met at City of SeattleAssured basic standards were met at City of Seattleyy
funded sheltersfunded shelters
 Provided consultationProvided consultation
P id d H l h d i liP id d H l h d i li Provided Health education to clientsProvided Health education to clients
 Focused on Communicable Disease Education andFocused on Communicable Disease Education and
PreventionPreventionPreventionPrevention

9. Why are homeless and poor peopleWhy are homeless and poor peopley p p py p p p
more vulnerable to communicablemore vulnerable to communicable
diseases than are people who live indiseases than are people who live indiseases than are people who live indiseases than are people who live in
homes and have decent incomes?homes and have decent incomes?

10. Factors that Increase VulnerabilityFactors that Increase VulnerabilityFactors that Increase VulnerabilityFactors that Increase Vulnerability
 AccessAccess transportationtransportation  Oppression racismOppression racism AccessAccess -- transportation,transportation,
insurance, $, lack ofinsurance, $, lack of
knowledgeknowledge
 Oppression, racism,Oppression, racism,
povertypoverty
 Shelters overShelters over--crowdedcrowded
 FearFear -- of sickness, ofof sickness, of
hospitals, of mortality, CPS,hospitals, of mortality, CPS,
judgementjudgement
 Lack of access to hygieneLack of access to hygiene
facilitiesfacilities
 Poor nutritionPoor nutritionjudgementjudgement
 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

11. Established a FoundationEstablished a FoundationEstablished a FoundationEstablished a Foundation
 Concepts of disease prevention applicableConcepts of disease prevention applicable Concepts of disease prevention applicableConcepts of disease prevention applicable
to dealing with pandemic fluto dealing with pandemic flu
 History of providing flu vaccine clinics onHistory of providing flu vaccine clinics on History of providing flu vaccine clinics onHistory of providing flu vaccine clinics on
site at shelterssite at shelters
C id i th d f i k l tC id i th d f i k l t Considering the needs of sick people atConsidering the needs of sick people at
sheltersshelters
 Expanding hours to accommodate andExpanding hours to accommodate and
isolate sick people, establishing “flu room”isolate sick people, establishing “flu room”

12. Crisis Creates Opportunity &Crisis Creates Opportunity &
InterestInterest
 ““New” germsNew” germs New germsNew germs
Identified case at a siteIdentified case at a site -- MRSA, birdMRSA, bird,,
flu, etcflu, etc
Key prevention measures cover manyKey prevention measures cover many
diseasesdiseases

13. Alcohol Based Hand GelAlcohol Based Hand GelAlcohol Based Hand GelAlcohol Based Hand Gel
Early resistance to putting up dispensersEarly resistance to putting up dispensers --Early resistance to putting up dispensersEarly resistance to putting up dispensers --
now common practicenow common practice

14. Wash ‘em wash ‘em wash ’emWash ‘em wash ‘em wash ’emWash em, wash em, wash emWash em, wash em, wash em

15. Vulnerability of Homeless People inVulnerability of Homeless People in
E i /DiE i /DiEmergencies/DisastersEmergencies/Disasters
 Transportation issuesTransportation issues Transportation issuesTransportation issues
 CommunicationCommunication
U di t bl ttU di t bl tt Unpredictable patternsUnpredictable patterns
 Lack of social supportLack of social support
 Inability to achieve isolation in publicInability to achieve isolation in public
placesplacespp
 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

17. Consider the partic larConsider the partic larConsider the particularConsider the particular
vulnerability of allvulnerability of all
population groups ofpopulation groups ofpopulation groups ofpopulation groups of
homeless peoplehomeless people

19. Small Disasters are Helpful!Small Disasters are Helpful!Small Disasters are Helpful!Small Disasters are Helpful!
Fresh interest in preparednessFresh interest in preparednessFresh interest in preparednessFresh interest in preparedness
“Reality check”“Reality check” Reality checkReality check
Training opportunityTraining opportunityg pp yg pp y
Get to use those emergency kitsGet to use those emergency kits

20. Barriers to EmergencyBarriers to Emergency
P dP dPreparednessPreparedness
 Disaster fatigueDisaster fatigue emergency uponemergency upon Disaster fatigueDisaster fatigue -- emergency uponemergency upon
emergencyemergency
M t d b t bM t d b t b Management concerned, but busyManagement concerned, but busy
coping with daycoping with day-- toto--day emergenciesday emergencies
 Lack of funds, time, resources, storageLack of funds, time, resources, storage
 DenialDenial
 Short staffedShort staffed

21. Nisqually EarthquakeNisqually Earthquake
February 28 2001February 28 2001February 28, 2001February 28, 2001
Pioneer SquarePioneer SquarePioneer SquarePioneer Square

22. 2002 TB Outbreak2002 TB Outbreak -- Homeless inHomeless in
S lS lSeattleSeattle
 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 forHealth Dept TB Clinic and Health care for
th H l l d j lth H l l d j lthe Homeless played a major rolethe Homeless played a major role
 Established TB Coalition, a group of stakeEstablished TB Coalition, a group of stake--, g p, g p
holders (shelter providers, City and Countyholders (shelter providers, City and County
staff) that continue to meet quarterlystaff) that continue to meet quarterly) q y) q y

23. FebruaryFebruary 20032003

24. Avian Flu H5N1 2005Avian Flu H5N1 2005
Led to the development of:Led to the development of:pp
An Influenza Pandemic Planning Guide forAn Influenza Pandemic Planning Guide for
Homeless and Housing Service ProvidersHomeless and Housing Service ProvidersHomeless and Housing Service ProvidersHomeless and Housing Service Providers

25. In this case, a near crisis offered anIn this case, a near crisis offered an
opportunity to begin planningopportunity to begin planning

26. Vulnerable Populations Action TeamVulnerable Populations Action TeamVulnerable Populations Action TeamVulnerable Populations Action Team
20062006
"When your disaster plans protect"When your disaster plans protect
and serve the most vulnerable inand serve the most vulnerable in
it ll lit ll lyour community, all people areyour community, all people are
better positioned to survive, thrivebetter positioned to survive, thrive
and prosper "and prosper "and prosper.and prosper.
ÂnaÂna--Marie JonesMarie Jones
Executive DirectorExecutive Director
CARD (Collaborating Agencies Responding to Disasters)CARD (Collaborating Agencies Responding to Disasters)
Oakland, CaliforniaOakland, California

27. Vulnerable Populations Action TeamVulnerable Populations Action TeamVulnerable Populations Action TeamVulnerable Populations Action Team
Included Connected PreparedIncluded Connected PreparedIncluded. Connected. PreparedIncluded. Connected. Prepared..
Vision: By working collaboratively withVision: By working collaboratively withVision: By working collaboratively withVision: By working collaboratively with
community partners, Public Health’s VPATcommunity partners, Public Health’s VPAT
initiative ensures that no one group isinitiative ensures that no one group isinitiative ensures that no one group isinitiative ensures that no one group is
more impacted than another in anmore impacted than another in an
emergencyemergencyemergency.emergency.

28. Vulnerable PopulationsVulnerable PopulationsVulnerable PopulationsVulnerable 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

29. Reaching our Vulnerable ResidentsReaching our Vulnerable Residents
R i PARTNERSHIPSR i PARTNERSHIPSRequires PARTNERSHIPSRequires PARTNERSHIPS
Emergency Management CBO & FBO/Networks
 Preparedness Resources
 Technical Assistance
• Key Human Services
• Knows Vulnerable Clients
 Communication
 Response Resources
• Trusted Entities
• Situational Awareness

30. Resources and TechnicalResources and Technical
A iA iAssistanceAssistance
• Agency Emergency
Planning:
www.kingcounty.gov/heal
thservices/health/preparethservices/health/prepare
dness/VPAT/standards
V l bl P l ti• Vulnerable Populations
Planning Toolkit:
www apctoolkits com/vulnwww.apctoolkits.com/vuln
erablepopulation

31. CommunicationCommunication
Community Communication Network (CCN)
 Receive
 Reportp
 Redistribute
Messaging:
Health Advisories: winter storm, H1N1, heat, ,
Health Alerts (activate after hours contact): Carbon
Monoxide

32. Howard Hanson Dam & H1N1Howard Hanson Dam & H1N1Howard Hanson Dam & H1N1Howard Hanson Dam & H1N1
January 2009 April 2009

33. “The Dam Flu Meeting”“The Dam Flu Meeting”The Dam Flu MeetingThe Dam Flu Meeting
 Weekly Homeless Provider Stakeholder GroupWeekly Homeless Provider Stakeholder Group Weekly Homeless Provider Stakeholder GroupWeekly Homeless Provider Stakeholder Group
established Summer 2009established Summer 2009
 Leveraged resources to hire a planner toLeveraged resources to hire a planner tog pg p
support worksupport work
 Howard Hanson DamHoward Hanson Dam –– Notification andNotification and
Warning, Mass CareWarning, Mass Care
 H1N1 FluH1N1 Flu-- Situational Awareness, Tier TwoSituational Awareness, Tier Two
Shelter Plan, Vaccine ClinicsShelter Plan, Vaccine Clinics

34. Howard Hanson DamHoward Hanson Dam
Homeless residents are:Homeless residents are:
 Living outside in very temporaryLiving outside in very temporary
structures, camps, carsstructures, 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
intentionallyintentionally

35. Howard Hanson DamHoward Hanson DamHoward Hanson DamHoward 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 planningcompeting priorities, city by city planningp g p , y y y p gp g p , y y y p g

36. H1N1H1N1
 Flu surveillanceFlu surveillance
 Tami flu distributionTami flu distribution Tami flu distributionTami flu distribution
 Flu vaccine clinicsFlu vaccine clinics
Ti T Sh ltTi T Sh lt Tier Two ShelterTier Two Shelter
 Communicable Disease VideoCommunicable Disease Video
ki /h l h i /h l hki /h l h i /h l hwww.kingcounty.gov/healthservices/healthwww.kingcounty.gov/healthservices/health
/personal/HCHN/videos/personal/HCHN/videos
Challenges: logistical issues, resourcesChallenges: logistical issues, resources

37. Activation PlanActivation PlanActivation PlanActivation Plan
Goals:Goals:
Ad i di th d f h l lAd i di th d f h l l Advise regarding the needs of homeless peopleAdvise regarding the needs of homeless people
in plansin 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 annuallyMeet twice annually
 Mobilize quickly to respond in an emergency,Mobilize quickly to respond in an emergency,
when necessarywhen necessary

38. 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

39. CCS Core ValuesCCS Core ValuesCCS Core ValuesCCS Core Values
 CompassionCompassion -- Providing care, understanding and concernProviding care, understanding and concern
for those we serve in order to honor the Godfor those we serve in order to honor the God--given life andgiven life andfor those we serve in order to honor the Godfor those we serve in order to honor the God given life andgiven life and
sacredness of each person at every stage and condition ofsacredness 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 DiversityDiversity Welcoming the differences of race, culture, faith,Welcoming the differences of race, culture, faith,
and thought with a strong commitment to naming andand 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 competentProviding 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 andDefending and advocating for the rights of poor and
vulnerable people while working toward the common goodvulnerable people while working toward the common goodvulnerable people while working toward the common good.vulnerable people while working toward the common good.
 StewardshipStewardship -- Prudently developing and using the gifts andPrudently developing and using the gifts and
talents of employees and volunteers and the financialtalents of employees and volunteers and the financial
resources needed to live out our missionresources needed to live out our missionresources needed to live out our mission.resources needed to live out our mission.

40. Partnership with Public HealthPartnership with Public Health--
S l & Ki CS l & Ki CSeattle & King CountySeattle & King County
CommunicationsCommunications
 Vaccine distributionVaccine distribution
 Community Communication NetworkCommunity Communication Network-- HealthHealth
AdvisoriesAdvisoriesAdvisoriesAdvisories
Projects/programsProjects/programs
 Disaster Case ManagementDisaster Case Management
 Tier II ShelteringTier II Sheltering
TrainingTraining TrainingTraining
 Mobile Medical VanMobile Medical Van
 OutreachOutreach –– Public Health nursePublic Health nurse

41. Benefits of PublicBenefits of Public -- PrivatePrivate
P hiP hiPartnershipPartnership
 Serving the same target populationsServing the same target populations Serving the same target populationsServing the same target populations
 Leverage resourcesLeverage resources
L kill tL kill t Leverage skill setsLeverage skill sets
 Ability to disseminate quickly to theAbility to disseminate quickly to the
communitycommunity
 Ability to respond quicklyAbility to respond quicklyy p q yy p q y
 Increased respect and understanding ofIncreased respect and understanding of
the work we both dothe work we both do -- true collaborationtrue collaborationthe work we both dothe work we both do true collaborationtrue collaboration

42. Steps You Can TakeSteps 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 planningUse “Mini” crises to encourage planning
and partnershipand partnership
 Cultivate partnerships with agencies servingCultivate partnerships with agencies serving
vulnerable populationsvulnerable populations
 Plan togetherPlan together
 Sustain and improve partnershipsSustain and improve partnerships Sustain and improve partnershipsSustain and improve partnerships
 Be poised to respond to future crisesBe poised to respond to future crises