3. The Pediatric Disaster Behavioral Health Framework

3.3. Partnerships & Roles

Introduction

Partnerships

Pediatric disaster behavioral health needs emerge across time, settings, and systems, often after traditional disaster response has demobilized. Effective response and recovery requires a whole community effort. While children’s hospitals do not lead all pediatric disaster behavioral health efforts, they should expect pediatric disaster behavioral health needs to present in a wide variety of community touchpoints, such as schools, adult-focused medical sites, and emergency shelters. The resources to meet these needs are likely to be widely distributed across the community as well. Connecting and coordinating with community partners is essential to implementing the toolkit framework. Defining each organization’s role is essential to effectively operationalize the framework.

PDBH – Overview of Children’s Hospital & Community Partner Potential Roles

The table below outlines the dynamic relationship between children’s hospitals and the broader community in supporting pediatric disaster behavioral health. It recognizes each community will bring different needs, partnerships, resources, and capabilities to a response and recovery effort. This partnership framework defines how functions could be distributed across systems and how children’s hospitals can enable those functions to operate cohesively. These potential roles are not prescriptive and should be validated and established within the context of the local community.

For a detailed list of potential partner roles and capabilities in PDBH, please see the PDBH Partnership Table. For expanded information on how to engage these organizations including initial steps, please see the Emergency Management section of this toolkit focused on implementation with partners.

Situational Awareness
Children’s Hospitals Potential Roles
  • Develop and share a pediatric-focused, systems-based framework of behavioral health needs and capacity over time.
  • Collaborate to create common indicators and methods to support consistent tracking across partners.
  • Identify and highlight trends and gaps for both awareness and action.
  • Bring: pediatric expertise, analytics, data infrastructure, convening power.
Other Healthcare Settings Potential Roles
  • Contribute observations on demand, capacity, and access; surface emerging trends.
  • Share de-identified data and insights to validate and refine the overall picture.
  • Bring: diverse access points, frontline perspective, relationships with families.
Broader Community Potential Roles
  • Contribute observations on demand, capacity, and access; surface emerging trends.
  • Share de-identified data and insights to validate and refine the overall picture.
  • Bring: trusted messengers, community networks, safe gathering spaces, volunteer energy.
Care
Children’s Hospitals Potential Roles
  • Develop strategies to manage pediatric behavioral health surge, including coordination and partnership with other organizations.
  • Organize capacity to match needs across the continuum of care and phases of disasters, considering both individual and population-level strategies.
  • Reduce barriers to receiving care, including advocating for regulatory and legal changes as needed.
  • Bring: pediatric specialists, consultation, training capacity, complex-care capabilities.
Other Healthcare Settings Potential Roles
  • Prepare for need to support pediatric behavioral health needs, where possible, when pediatric-specific resources are overloaded.
  • Coordinate with pediatric-specific resources to manage influx of pediatric behavioral health needs via triage and referral.
  • Identify needs early, support brief interventions, and coordinate handoffs.
  • Bring: local access points, longitudinal relationships, flexible care delivery.
Broader Community Potential Roles
  • Reduce practical and cultural barriers to care where possible, e.g., transportation, childcare, language, trust.
  • Connect with the pediatric system of care, ideally through established partnerships to provide information about available services, conducting triage, and/or providing referral.
  • Bring: peer and caregiver support, material assistance, culturally responsive supports.
Education & Technical Assistance
Children’s Hospitals Potential Roles
  • Provide clear, actionable pediatric behavioral health guidance for leaders, responders, and the public.
  • Develop scalable tools and trainings; coach teams on behavioral health-informed practice.
  • Bring: subject matter expertise, training platforms, credibility with clinical audiences.
Other Healthcare Settings Potential Roles
  • Reinforce consistent messages and integrate skills into everyday practice.
  • Share feedback on what resonates and where more guidance is needed from developed resources.
  • Bring: staff reach, patient-education channels, quality-improvement processes.
Broader Community Potential Roles
  • Amplify simple, culturally, and linguistically appropriate messages through trusted channels.
  • Offer community-friendly skills-building for caregivers and youth.
  • Bring: communication channels, trusted voices, ability to convene audiences.
Coordination
Children’s Hospitals Potential Roles
  • Convene partners around shared pediatric behavioral health goals and priorities, including via any established planning structures.
  • Clarify roles, escalation paths, and accountability; track progress and gaps.
  • Bring: convening power, project management, measurement capacity.
Other Healthcare Settings Potential Roles
  • Align operations and referral pathways; participate in shared plans and resource sharing.
  • Maintain situational updates and adjust services as needs evolve.
  • Bring: operational flexibility, facilities, multidisciplinary teams.
Broader Community Potential Roles
  • Align community supports with care pathways and synchronize resources to reduce duplication.
  • Sustain long-term recovery momentum and provide feedback from those directly affected.
  • Bring: long-term presence, social capital, diverse support resources, advocacy.

Questions to consider when identifying roles and responsibilities among organizations:

Every community has different needs, resources, relationships, and response structures. Children’s hospitals should use the questions below to clarify where they are best positioned to lead, where they should support or advise, and where community partners may be better positioned to serve as the primary lead. These questions are intended to support local adaptation of the Pediatric Disaster Behavioral Health framework rather than prescribe a single model.


Understanding the Local PDBH Landscape

    1. Where are pediatric disaster behavioral health needs most likely to present in our community? Consider emergency departments, inpatient units, outpatient clinics, schools, shelters, family assistance centers, primary care, community behavioral health providers, child-serving agencies, and virtual settings.
    2. Which children and families are most likely to be missed if our hospital only focuses on patients who present to our facility?
    3. Which systems or partners already have trusted relationships with children, families, caregivers, schools, or specific communities?
    4. Where are there known gaps in pediatric behavioral health access, referral pathways, language access, culturally responsive care, transportation, or caregiver support that could worsen after a disaster?

Clarifying the Children’s Hospital Role

    1. For each Pediatric Disaster Behavioral Health function, is our hospital best positioned to lead, support, advise, coordinate, or refer? Consider this separately for situational awareness, care, education and technical assistance, and coordination.
    2. What pediatric-specific expertise, services, data, infrastructure, or convening power can our hospital contribute that other partners may not have?
    3. Which activities are essential for our hospital to perform directly because of our pediatric expertise or role in the health care system?
    4. Which activities could be performed more effectively by partners with stronger community reach, longer-term presence, or trusted local relationships?
    5. Where might our hospital unintentionally duplicate work already being done by schools, community behavioral health providers, public health, emergency management, or child-serving organizations?
    6. What role should our hospital play when pediatric behavioral health needs exceed our own clinical capacity?
    7. What decisions can our hospital make independently, and what decisions require coordination with community partners, public health, emergency management, or governmental authorities?

PDBH Situational Awareness

    1. What information would our hospital need to understand pediatric behavioral health needs across the community, not just inside the hospital?
    2. What indicators could help us recognize changes in pediatric behavioral health demand, acuity, access barriers, or service capacity over time?
    3. Which partners can contribute information from schools, shelters, outpatient care, community organizations, first responders, family-facing services, or other access points?
    4. How will we share pediatric behavioral health trends and gaps with partners in a way that supports action while protecting privacy and avoiding unnecessary burden?

PDBH Care

    1. What level of pediatric behavioral health care can our hospital realistically provide during a disaster or surge event?
    2. Which children, youth, caregivers, or staff would require direct hospital-based services, and which could be better served through community-based supports, brief interventions, referral, or consultation?
    3. What triage, referral, and handoff processes are needed so children and families can move between hospital-based, outpatient, school-based, shelter-based, and community supports?
    4. What partners can help reduce practical barriers to care, such as transportation, childcare, language access, technology access, cost, or trust?
    5. What contingency plans are needed if pediatric specialty behavioral health resources are unavailable, overwhelmed, or geographically inaccessible?

PDBH Education and Technical Assistance

    1. Who in our community may need pediatric disaster behavioral health guidance before, during, or after a disaster?
    2. What education or technical assistance is our hospital uniquely qualified to provide to health care partners, schools, emergency managers, responders, shelters, caregivers, or the public?
    3. What messages, tools, or training should be developed centrally by the hospital, and what should be adapted or delivered by trusted community partners?
    4. How will we ensure guidance is practical, developmentally appropriate, culturally and linguistically responsive, and usable by non-specialists?

PDBH Coordination

    1. Which existing emergency management, health care coalition, public health, school, or child-serving structures can be used to coordinate pediatric disaster behavioral health planning and response?
      • If no clear coordination structure exists, what role should our hospital play in convening partners or helping establish one?
    2. Who will track unresolved needs, service gaps, duplication of effort, and emerging risks over time?
    3. How will coordination continue after the initial response phase, when pediatric behavioral health needs may persist or increase but response structures may begin to demobilize?

Testing Local Fit

    1. If a major disaster occurred today, what pediatric disaster behavioral health activities would our hospital be expected to perform, and are those expectations realistic?
    2. Where do our current plans rely on informal relationships, assumptions, or individual champions rather than defined roles and processes?
    3. What would partners expect from our hospital, and have those expectations been discussed directly?
    4. What would our hospital expect from partners, and have those partners agreed that they can fill those roles?
    5. What tabletop exercises, drills, or planning discussions could help test whether the proposed roles are feasible, coordinated, and sustainable?