5. Response & Recovery (Just-in-Time Implementation)

5.3. Structures & Systems

building blocks

Why do these structures and systems matter in pediatric disaster behavioral health response and recovery?

Disaster response and recovery rely heavily on established structures and systems to navigate and address the immense challenges created by hazards and their impacts. Understanding and connecting to these structures is a critical component of just-in-time implementation of this framework. 

Key actions to take when connecting to these systems and structures:

Incident Management

Incident Command System/Hospital Incident Command System (ICS/HICS) 

What to know:

Incident Command System is a standardized approach to incident management used by many responding agencies across the United States.36 Meanwhile, Hospital Incident Command System is “…based on principles of the Incident Command System (ICS), which assists hospitals and health care organizations in improving their emergency management planning, response, and recovery capabilities for unplanned and planned event.”37 The teams that use this system to respond to incidents are called Hospital/Incident Management Teams (HIMT/IMT).

Key features to be aware of include an operational planning process, standardized but flexible organizational structures, and clear lines of responsibility/authority. 

Critical Action(s) :

Define the intended goals and strategies for the pediatric disaster behavioral health effort by following the Pediatric Disaster Behavioral Health Response Operational Planning Process.
Identify proposed response/recovery strategies and associated team structure, using the above process.
Then integrate into the HIMT/IMT and associated ICS/HICS planning processes and organizational structure.
  • This should be done in collaboration with the facility’s emergency management or the established ICS/HICS leadership team.
  • Recommendations on how to integrate into the operational planning process are outlined in the ICS/HICS integration section.

Agency/Department/Emergency Operations Centers

What to know:

Emergency Operations Centers (EOCs) are the “location from which leaders of a jurisdiction or organization coordinate information and resources to support incident management activities.”38 These centers serve as a central hub for information and coordination of response and recovery activities. Within a facility, these may be called Department Operations Centers (if one department engaged) or Agency Operations Centers (if the whole agency engaged). At a jurisdictional level, there are often county or city EOCs activated to support incident response. These titles may vary from organization to organization, but the purpose of these centers remains similar. Frequently, both Emergency Support Functions and Recovery Support Functions are coordinated through EOCs at a jurisdictional level. 

In addition to integration into ICS/HICS structures and their processes, EOCs represent another critical connection point for pediatric disaster behavioral health response.

Critical Action:

Ensure connection of pediatric disaster behavioral health response/recovery efforts with the broader response infrastructure through activated EOCs.
  • EG: If a casework function is established broadly for this disaster, behavioral health efforts should be connected with casework teams.
  • Within a facility, joining a HICS structure likely achieves this integration. Meanwhile, the health care facility likely has a liaison to the City/County/State/Tribal EOC – or the local Emergency Support Function #8 Lead Agency within that EOC.
  • In this case, integration with broader community efforts can likely be achieved by working through the facility’s HICS structure to engage the broader community (likely through the Liaison Officer role).

Emergency Support Functions (ESFs) & Recovery Support Functions (RSFs)

What to know:

Emergency Support & Recovery Support Functions describe the structure for grouping response functions and the agencies that deliver them. While ESFs describe immediate and short-term response objectives and coordination approaches, RSFs describe the recovery objectives and structures.

Specifically, Emergency Support Function #6 (Mass Care, Emergency Assistance, Temporary Housing, and Human Services) and Emergency Support Function #8 (Public Health/Medical/Behavioral health) are critical connection points for a pediatric disaster behavioral health response. Meanwhile, the Health, Education, and Human Services RSF houses behavioral health recovery efforts. It is important to note that not all communities use the RSF and ESF structure nor is it mandated to do so. Although how these functions may be organized varies from community to community, a schema for organizing response/recovery activities into broad categories will exist locally. For example, some states have elected to separate education and health services functions in recovery planning efforts. 

Critical Action:

Coordinate with emergency management or Liaison Officer (if ICS/HICS activated) to understand the broader response/recovery infrastructure, as it may relate to pediatric behavioral health. To include relevant functions such as casework, sheltering, family reunification, and so forth.
Ensure coordination of externally facing activities with community at large through these and other structures.

Health Care Coalitions (HCCs)

What to know:

Health Care Coalitions (HCCs) are often comprised of health care organizations/systems, local emergency management, and public health departments, and first response agencies. These coalitions “…serve as the multiagency coordination groups that support and integrate with ESF-8 activities…”39 such as the delivery of medical services, often to include behavioral health. Health care organizations and systems are often engaged members of these coalitions.

it is important to keep in mind that not all HCCs follow the same structure nor do all HCCs have a “response mission.” Some are only focused on preparedness activities while others are actively engaged in response and recovery. Regardless, HCCs should be engaged in local ESF#8 structures (more on those below). 

Critical Action:

Coordinate with your Liaison Officer (if ICS/HICS activated) or Emergency Management team to understand the mission and capabilities of the HCC as they relate to pediatric disaster behavioral health.
Engage the HCC in coordination of these activities in partnership with other engaged organizations, where pediatric behavioral health intersections exist.

Community/Voluntary Organizations Active in Disasters (COADs/VOADs)

What to know:

Voluntary Organizations Active in Disasters (VOADs) are coalitions of community-based, nonprofit, non-governmental, and faith-based organizations that coordinate to respond and recover from disasters. Most states have a state VOAD while some have local coalitions called Community Organizations Active in Disasters (COADs). 

These coalitions represent an important partner for community engagement, service delivery, messaging, and wrap-around support services during a disaster. 

Critical Action:

Coordinate with your Liaison Officer (if ICS/HICS activated) or Emergency Management team to identify if any local COADs/VOADs are active in this incident.
  • They can often be identified and reached through engagement with the local EOC.
Identify potential intersections and collaboration opportunities with these organizations within the scope of your defined pediatric disaster behavioral health response/recovery efforts.
  • For example, many of these organizations are active in providing sheltering or long-term recovery support.

Long-term Recovery Organizations/Groups (LTRO/LTRGs)

What to know:

Long-term Recovery Organizations/Groups (LTRO/LTRGs) are coalitions of community organizations and members that coordinate elements of long-term recovery after a disaster. Often, these organizations do not exist prior to a disaster and are formed after the incident by existing partners. They are frequently supported and/or chaired by COADs/VOADs. 

These coalitions represent an essential connection point for ongoing coordination of disaster behavioral health needs and supports within an impacted community. 

Critical Action:

Coordinate with your Liaison Officer (if ICS/HICS activated) or Emergency Management team to identify if any LTROs/LTRGs are active, or will become active, for this disaster.
  • They can often be identified and reached through engagement with the local EOC or COAD/VOAD
Establish coordination with LTROs/LTRGs for connections, collaborations, and insights into community needs and resources beyond formal/governmental efforts.