This document discusses research on disparities in disaster preparedness and lessons learned. It describes a framework for identifying, understanding, and reducing preparedness disparities. It also summarizes a study on evacuation decision making among low-income urban minorities during Hurricane Katrina, finding that social networks influenced decisions both positively and negatively. Finally, it outlines a culturally-targeted community-based program called PREP to promote preparedness among low-income Latinos in Los Angeles.
Telligent - APAN - How Governments are Harnessing the Value of Community and ...Telligent
Following the January 12 earthquake in Haiti, US Southern Command was charged with coordinating the Department of Defense response in support of the US Agency for International Development, involving the relief efforts of military, government, and non-government organizations. A swift decision was made that the All Partners Access Network (APAN) would be the central communication hub throughout the response. Built on Telligent Community, APAN was launched the next day - a full 10 months ahead of schedule. This use of community technology in Haiti saved lives and transformed disaster relief forever.
Join Telligent founder and CTO Rob Howard for a 60-minute webinar to learn how community and collaboration technologies were leveraged to coordinate the relief efforts of more than 300 different organizations. Howard will also show you how you can harness community technologies to collaborate across business units, autonomous organizations, global locations and time zones, and facilitate efficient exchange of critical information.
Telligent - APAN - How Governments are Harnessing the Value of Community and ...Telligent
Following the January 12 earthquake in Haiti, US Southern Command was charged with coordinating the Department of Defense response in support of the US Agency for International Development, involving the relief efforts of military, government, and non-government organizations. A swift decision was made that the All Partners Access Network (APAN) would be the central communication hub throughout the response. Built on Telligent Community, APAN was launched the next day - a full 10 months ahead of schedule. This use of community technology in Haiti saved lives and transformed disaster relief forever.
Join Telligent founder and CTO Rob Howard for a 60-minute webinar to learn how community and collaboration technologies were leveraged to coordinate the relief efforts of more than 300 different organizations. Howard will also show you how you can harness community technologies to collaborate across business units, autonomous organizations, global locations and time zones, and facilitate efficient exchange of critical information.
Community Resilience for the Environmental Health officerDavid Eisenman
Why is community resilience important to environmental health officers in public health? What are some challenges to incorporating this approach in EH?
What is resilience when it comes to talking about communities and disasters? I discuss the emergence and importance of social vulnerability as it relates to public health preparedness, too.
While the culture of poverty has usually been identified as a negative concept, we will reveal the true definition and its implications for child welfare. This workshop will focus on participants gaining the tools necessary to work with developmentally traumatized children and their families in a "culture of poverty."
The Lived Experience of Parenting a ChildWith Autism in a Ru.docxcdorothy
The Lived Experience of Parenting a Child
With Autism in a Rural Area:
the Invisible, Visible
Lindsey Hoogsteen, Roberta L. Woodgate
D
erived ftom the Greek word
"self," autism is a neurologi-
eal disorder where ehildren
seem to be enclosed in their
own world. Affecting boys three to
four times more than girls (Beauchesne
& Kelley, 2004; Behrman, Kliegman,
& Jenson, 2000), a once-thought rare
condition is becoming progressively
more common. Characterized by the
impaired ability to engage in social
interaction, impaired communica-
tion, restricted interests, and repeti-
tive behavior, children diagnosed
with autism face an incapacitating
life-long disability (Behrman et al.,
2000; Committee on Children with
Disabilities, 2001).
Although some researeh detailed
the lived experienee of what parents
of ehildren with autism faee (Cashin,
2004; DeGraee, 2004; Glass, 2001;
Gray, 1993, 1994, 2002; Woodgate,
Ateah, & Seeeo, 2008), the majority of
this work involved urban parents.
Few authors had researehed the expe-
rienees of families of ehildren with
disabilities who live in rural areas
(O'Callaghan, Allister, & Wilson,
2005; Seott-Findlay & Chalmers,
2001; Skinner & Sliflcin, 2007).
Moreover, no researeh was found on
the parenting experienees of parents
of ehildren with autism who live in
rural areas. To ensure that the eon-
cerns and needs of these parents and
children are adequately addressed,
research detailing these experiences
was warranted. Accordingly, a qualita-
Lindsey Hoogsteen, MN, RN, is a Register-
ed Nurse, Winnipeg Heatth Sciences Centre
- Chitdren's Hospitat, Winnipeg, t^anitoba,
Canada.
Roberta L. Woodgate, PhD, RN, is a
Canadian Institute of Health Research
Applied Chair in Reproductive, Chiid and
Youth Services and Policy Research, and a
Member of the Facutty of Nursing, University
of t\/lanitoba, Manitoba, Canada.
This qualitative study explored the lived experiences of parents parenting a child
with autism whiie living in a rural area. The philosophy of hermeneutic phenom-
enology was used to guide this inquiry, and interviews of 26 families served as
primary data. Thematic statements were isolated using van Manen's (1990)
selective highlighting approach. "Making the invisible, visible" emerged as the
essence of the parents' experience. Parents shared that although autism was an
invisible disability, they in fact made it visible in their constant battles to ensure
their child received the best quality of life. The major themes of this essence
included a) he's not the Rain Man, b) society's lack of knowledge and under-
standing, and c) doing it on our own. Findings from this study may be used to
guide program development that is concerned with improving the quality of life of
families of children with autism living in rural areas.
tive study that explored the lived
experiences of parents parenting a
child with autism in a rural area was
undertaken. This article describes the
essence of the parents' experienee.
Method
Th.
Community Resilience for the Environmental Health officerDavid Eisenman
Why is community resilience important to environmental health officers in public health? What are some challenges to incorporating this approach in EH?
What is resilience when it comes to talking about communities and disasters? I discuss the emergence and importance of social vulnerability as it relates to public health preparedness, too.
While the culture of poverty has usually been identified as a negative concept, we will reveal the true definition and its implications for child welfare. This workshop will focus on participants gaining the tools necessary to work with developmentally traumatized children and their families in a "culture of poverty."
The Lived Experience of Parenting a ChildWith Autism in a Ru.docxcdorothy
The Lived Experience of Parenting a Child
With Autism in a Rural Area:
the Invisible, Visible
Lindsey Hoogsteen, Roberta L. Woodgate
D
erived ftom the Greek word
"self," autism is a neurologi-
eal disorder where ehildren
seem to be enclosed in their
own world. Affecting boys three to
four times more than girls (Beauchesne
& Kelley, 2004; Behrman, Kliegman,
& Jenson, 2000), a once-thought rare
condition is becoming progressively
more common. Characterized by the
impaired ability to engage in social
interaction, impaired communica-
tion, restricted interests, and repeti-
tive behavior, children diagnosed
with autism face an incapacitating
life-long disability (Behrman et al.,
2000; Committee on Children with
Disabilities, 2001).
Although some researeh detailed
the lived experienee of what parents
of ehildren with autism faee (Cashin,
2004; DeGraee, 2004; Glass, 2001;
Gray, 1993, 1994, 2002; Woodgate,
Ateah, & Seeeo, 2008), the majority of
this work involved urban parents.
Few authors had researehed the expe-
rienees of families of ehildren with
disabilities who live in rural areas
(O'Callaghan, Allister, & Wilson,
2005; Seott-Findlay & Chalmers,
2001; Skinner & Sliflcin, 2007).
Moreover, no researeh was found on
the parenting experienees of parents
of ehildren with autism who live in
rural areas. To ensure that the eon-
cerns and needs of these parents and
children are adequately addressed,
research detailing these experiences
was warranted. Accordingly, a qualita-
Lindsey Hoogsteen, MN, RN, is a Register-
ed Nurse, Winnipeg Heatth Sciences Centre
- Chitdren's Hospitat, Winnipeg, t^anitoba,
Canada.
Roberta L. Woodgate, PhD, RN, is a
Canadian Institute of Health Research
Applied Chair in Reproductive, Chiid and
Youth Services and Policy Research, and a
Member of the Facutty of Nursing, University
of t\/lanitoba, Manitoba, Canada.
This qualitative study explored the lived experiences of parents parenting a child
with autism whiie living in a rural area. The philosophy of hermeneutic phenom-
enology was used to guide this inquiry, and interviews of 26 families served as
primary data. Thematic statements were isolated using van Manen's (1990)
selective highlighting approach. "Making the invisible, visible" emerged as the
essence of the parents' experience. Parents shared that although autism was an
invisible disability, they in fact made it visible in their constant battles to ensure
their child received the best quality of life. The major themes of this essence
included a) he's not the Rain Man, b) society's lack of knowledge and under-
standing, and c) doing it on our own. Findings from this study may be used to
guide program development that is concerned with improving the quality of life of
families of children with autism living in rural areas.
tive study that explored the lived
experiences of parents parenting a
child with autism in a rural area was
undertaken. This article describes the
essence of the parents' experienee.
Method
Th.
Increasing Communications Success by Thinking Differentlycrosbymarketing
A recent special session of the National Health Council’s Communications Affinity Group and Grassroots Affinity GroupsTeam featured a presentation by two members of Crosby Marketing Communications’ leadership team: Vice President and Healthcare Practice Leader Denise Aube and Executive Creative Director Joel Machak.
The presentation, entitled “Increasing Communications Success by Thinking Differently,” focused on how to apply behavioral economics principles to healthcare marketing. Informed by 20+ years of experience working with national health systems, patient advocacy groups and government agencies, Aube and Machak shared real world examples of how people behave in “predictably irrational ways” and discussed how thinking differently about messaging and outreach strategies can influence behavior change.
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Strategies to End Homelessness: Current Approaches to EvaluationTheHomelessHub
The purpose of this paper is to provide a summary of research on interventions that aim to end or reduce homelessness. Our specific goals were to gain an understanding of the different populations for whom interventions have been tested and the type of interventions evaluated, as well as to create an inventory of the indicators used to assess the effectiveness of interventions. We provide an overview of the methodology used to gather research on strategies to end homelessness. In the findings, we review the types of interventions evaluated, highlight the populations studied, and summarize the indicators of effectiveness used in the evaluations. Finally, we discuss the findings of this review in relation to current and future research on homeless interventions.
Myra Muramoto at Consumer Centric Health, Models for Change '11HealthInnoventions
Communities at Change Agents. Helpers Program: A Social & Community Network Approach to Tobacco Cessation. The University of Arizona College of Medicine,
Department of Family & Community Medicine
Science for Change Agents, Innovators & Entrepreneurs. Day 3
Complex systems in nature
Self-organisation & entropy
Chaos Theory & Modelling Chaos
Scale-free Networks & Power Laws
Designing resilient and self-organising human systems
The Cynefin Codel: Change Making in Simple, Complicated, Complex and Chaotic real-world contexts
MASTERCLASS FOR KAOS PILOTS, DENMARK
The linkages among childhood maltreatment, adolescent mental health, and self...Christine Wekerle
The linkages among childhood maltreatment, adolescent mental health, and self-compassion: The Maltreatment and Adolescent Pathways (MAP) Longitudinal Study
1. From Disparities Research to
Disparities Interventions in
Disaster Preparedness
Lessons Learned and Thoughts
About the Future
David P. Eisenman, MD MSHS
Associate Professor of Medicine
David Geffen School of Medicine at UCLA
2.
3. Mentors and Colleagues
Steve Asch, MD, MPH
Linda Bourque, PhD
Jonathan Fielding, MD, MBA, MPH
Lillian Gelberg, MD, MSHS
Deborah Glik, ScD
Dennis Mileti, PhD
Martin Shapiro MD, PhD
4. Framework for eliminating
disparities
DETECTING UNDERSTANDING REDUCING
Identify which Determine why Identify how
disparities disparities occur disparities can be
exist eliminated
Kilbourne, et al. AJPH, 2006.
5. Framework for eliminating
disparities
DETECTING UNDERSTANDING REDUCING
Identify which Determine why Identify how
disparities disparities occur disparities can be
exist eliminated
Before:
More likely to be under-prepared
During:
More likely to experience loss,
injury, disease and death
After:
More likely to experience slower
response and recovery
Graham, Office of Minority Health’s Agenda to Integrate Racial and Ethnic Communities into Emergency Preparedness”
presented at Public Health Preparedness Summit, 2009
6. Research Gaps
Survey research or case studies focused
mainly on disparities between broad
majority versus minority groups.
Factors that cause disparities less
understood
– Contextual factors?
– Barriers and promoters?
Few outcome studies, fewer using
prospective designs or theory-based
interventions.
7. Lessons Learned…
Vulnerable populations want to get
prepared.
Social networks influence disaster
behaviors, for better and for worse.
Culturally targeted programs can
improve preparedness…
…but only so much. Why?
8. How would vulnerable
groups prepare after
September 11th?
Protection Action Decision Model
(Lindell & Perry); Extended
Parallel Process Model (Witte)
– Address how we process threats and
taking protective actions
– Link self-appraisal of personal
vulnerability to protective actions.
Threat severity (how severe will the
effects be?); susceptibility (how likely
it will happen to me?)
Response efficacy (will recommended
actions help me?); Self-efficacy
9. RDD telephone survey of the non-institutionalized adult
population in Los Angeles County;
6 languages: English, Spanish, Chinese (Mandarin &
Cantonese), Korean & Vietnamese
Over sampled Asian and African Americans
59% cooperation rate
“In the past year, has anyone in your household done any
of the following in response to the possibility of terrorism:
1) purchased or maintained emergency supplies of food,
water or clothing? 2) Developed an emergency plan for you
and your family?”
10.
11. Implications
Vulnerable groups (ethnic minorities,
disabled, immigrants) amenable to
improving preparedness.
Tailored and targeted programs may
work for diverse population
segments of Los Angeles
12. Literature on increased
protective behaviors among
minority groups
Eisenman, et al., AJPH, 2009
Uscher-Pines L, Am J Prev Med, 2009
Page, L., et al., Biosecur Bioterror, 2008
Rubin, GJ., et al., BMJ 2008
13.
14. Reasons for non-evacuation
Little known about low-income,
urban, minority communities
Transportation, shelter, historical
experience cited in surveys
Decision-making is multifactorial
and socially embedded; surveys
don’t address this.
Qualitative research is needed
15. Purpose
To study the experience of Hurricane Katrina
evacuees to understand evacuation decision-
making in impoverished, urban, mainly minority
communities.
Participants describe factors affecting evacuation
that are more complex than previously
reported, interacted with one another, and
were socially influenced.
Eisenman, et al., AJPH, 2007
16. Quick response research
Mon Tues Wed Thurs Fri
Aug 29 30 31 Sept 1 2
Katrina NOLA Astrodome Houston
landfall evacuated opens shelters
house 27K
Eisenman
camping trip
5 6 7 8 9
Labor Day NSF grant IRB Work in Recruitment
submitted; fly shelter clinic; begins
to Houston IRB approval
17.
18. Major Themes:
Social network
Transportation Trust
Risk
Shelter perception
Message
Money, jobs,
understanding
property
Health
19. Transportation
I mean, if you've got 20 people
trying to get in one car it's not
going to happen. So some people,
you just stay because you have to.
20. Shelter
Really truly, we had cars, but we
didn't know anybody to go to.
They said go to Texas but I didn't
know anybody in Texas.
21. Health
I could have made it on
my own, but it was just
my aunt and my uncle.
Every few steps he
made…she forgot his
walker…every few steps
he made he was falling
down.
22. Social networks
My plans were to leave. Unfortunately we
received a call and we had to come back
home. My mother-in-law had called for us to
come back…. You know when they get a
certain age they get confused.
My mother-in-law wouldn't leave the house.
My husband wouldn't leave her and I'm not
going to leave him.
23. Social networks
Like my Mom said, she's been through
Betsy, Camille, all the hurricanes, the
major hurricanes and she just wasn't
evacuating. So I wasn't going to leave my
Mom to stay there by herself.
I had a 90 year old mother that I was
taking care of and she would not leave
that house for hell or high water.
24. The influence of social networks:
conclusions and recommendations
Demonstrates interactions between factors
influencing evacuation
– Counterpart to Drabek’s finding “ families move as
units and remain together, even at the cost of
overriding dissenting opinions.”
Broad networks hindered and facilitated
evacuation
– Stretched limited resources
– Obligations to extended family, especially elderly
who resisted evacuation or were frail, inhibited
individuals and nuclear families
Disaster research and policy must address social units
not just individuals.
25.
26. •Programa para Responder a Emergencias con Preparación.
•A culturally-targeted, community-based program to
promote disaster preparedness among low income Latinos
•UCLA, Coalition for Community Health (CCH), Los
Angeles County Department of Public Health
27. Preparedness in Los Angeles is
low...
Family Emergency Plan
39.3%
3 Days Food/Water 82.0%
Battery-Powered Radio 93.6%
First Aid Kit 70.8%
Flashlight 76.2%
Spare Batteries 77.4%
30% 40% 50% 60% 70% 80% 90% 100%
* While most residents have each item, only 45% have
all 5 items; <40% have plan.
28. Latinos less likely to have supplies (OR=0.73) and
Spanish speakers less likely to have emergency
plan (OR=0.61)*
60%
56.4%
47.4% 47.5%
42.5%
45%
41.8% 40.8% 38.8% White
Latino
Africa American
32.2%
APIs - Chinese
30%
APIs - Korean
22.5%
16.8%
15%
Disaster Supplies Emergency Plan
* Controlled for age, gender, income, education, community, country of
origin, health.
29. Promotora
Local lay community residents trained in basic
health promotion skills working with fellow
community members who are under-served by the
health care system.
Use their cultural knowledge, social networks, and
leadership role in the community to model
behavior, overcome barriers, and create change.
Provide connections between community and
health care system including informal counseling,
service assistance, education.
Improved health care access, prenatal care, health
behaviors.
Not previously used in U.S. disaster preparedness
30. PREP logic model
PREP CAB Focus CAB Interven New
Groups tion behavior
CBPR
CBPR CBPR CBPR
CBPR
HBM
PADM HBM
PADM
SI
31. “Disaster Kit”
Only half heard of term “disaster kit”
or “emergency kit”
– What's the difference between a disaster
kit and a first aid kit?
– Storage, like when we buy something we
say this is for storage
– Emergency things
Eisenman, et al., JHCPU, 2009
32.
33. Communication Plan
For most very fuzzy
having the means to get communications
from others during a disaster
– A portable radio.
– If there is no electricity you can’t ever charge
your cell phone.
– a little book with all the emergency phone
numbers
– walkie talkies
Kind of like an emergency exit.
34.
35. PREP Experiment:
Overview
Randomized, longitudinal two-group cohort
design of a culturally-tailored, disaster
preparedness program
– ‘high-intensity’ vs ‘low-intensity’ groups
Latino immigrant adults living in Los Angeles
County, recruited using Respondent Driven
Sampling
– Eligibility: Latino, adult, domiciled in Los Angeles, 1
adult per household
Baseline and 3-months post-intervention
telephone assessments.
36. Theoretical Model
Demographic Milling/norms H1: Disaster
supplies
Culture/Beliefs: Perceived
benefits H2: Communication
(fatalism, locus of
plan
responsibility, Perceived
literacy) barriers
Self-efficacy
37. Media
Culturally tailored
brochure
Laminated shopping card
Pre-printed/perforated
communication cards
38. Platica
Small group
discussion, 1 hour
Led by a trained
promotora
Held at community
site.
+ Media materials
N=25
39. Respondent Driven Sampling
A type of chain referral sampling method
that uses social network theory to gather
a sample representative of the target
“hidden” population.
7 seeds
– Recruitment instructions, 4 coupons with
unique codes, 5$ per eligible recruit
– All persons who called the study number and
presented a valid coupon were assessed for
eligibility.
43. Summary
Culturally tailored materials did very well,
often doubling proportions of
preparedness.
Significantly greater proportion of
participants in the platica arm reported
increases in important outcomes.
44. Improving Communication
Plans
Nationally, fewer people have plans than
supplies, even after media campaigns.
Platicas led more participants to develop a
written plan than media
Is this due to social interaction resolving
participants’ ambiguities?
– Emergency communication plan requires
discussion and agreement
– Promotoras suited for clarifying uncertainties
and misunderstandings
45. Perceived benefit of a plan
Responses to Pre- Post-
“Having a plan for
….is helpful.”
Strongly 32 (17%) 79 (42.3%)
disagree
Mildly agree 3 (1.6%) 6 (3.2%)
Neither agree 4 (2.1%) 1 (0.5%)
or disagree
Mildly agree 20 (10.7%) 9 (4.8%)
Strongly agree 128 (68.5%) 92 (49%)
46. Emergency Plan
perceived benefit of a plan
Confusion and fuzzy understanding
– Do we need different plans for different
emergencies? For different times of the day
and week? Doesn’t it matter what the
authorities say during the emergency? Is text
better than telephone?
47. Emergency Plan
Family emergency planning cannot
totally be done in the family vacuum
“Species-level” changes in
communication
Are we dubious about the benefit of a
plan?
48.
49.
50.
51.
52.
53.
54.
55. Emergency Medication
Supply
Did not improve in PREP
People in poor physical or mental
health are less likely to be prepared.
– Eisenman, DMPHP, 2009.
Inflexible drug-dispensing policies
prevent the public from building
reserves
– Carameli and Eisenman DMPHP, 2010.
56. “The fact that every family’s plan involves other
parts of the community is why I strongly believe
that there needs to be one day in the year
dedicated to the emergency planning process. If
we as a nation feel it is really important for the
public to develop emergency plans, it would be
far more effective if everyone was doing that at
the same time — rather than asking individuals
to do it on their own so the planning can be
integrated.”
John Solomon, incaseofemergencyblog.com, 9/13/10