CULTURAL COMPETENCY IN DISASTER RESPONSE: A REVIEW OF CURRENT CONCEPTS, POLICIES, AND PRACTICES Office of Minority Health U.S. Department of Health and Human Services Contract # HHSN2639999000291 Task Order # C-2555 Task 4.1: First Responders - Environmental Scan February 2008 Acknowledgments Systems Research Applications International, Incorporated (SRA International, Inc.) would like to acknowledge the U.S. Department of Health and Human Services’ Office of Minority Health for sponsoring this project and for laying the foundation for this work by developing the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care and for making significant contributions to cultural competency training for health care providers. We sincerely thank the Office of Minority Health Project Officer, Guadalupe Pacheco, for his ongoing dedication, commitment and guidance throughout the preparation of this document. We extend our gratitude to the members of the National Project Advisory Committee (NPAC) and Consensus-Building Panel who generously lent their expertise through expert surveys and interviews. We would especially like to thank those individuals who have helped us extensively by offering us specific materials and resources, both after reviewing the preliminary draft and at the beginning of the project as we were gathering initial materials. The Project Officer and the First Responders project staff are listed below. Project Officer Guadalupe Pacheco, M.S.W. Special Assistant to the Deputy Assistant Secretary for Minority Health Office of Minority Health, DHHS Project Officer Project Staff Ann S. Kenny, MPH, BSN, RN Billie Hubbs, BS Project Director Health Research Associate SRA International, Inc. SRA International, Inc. Elizabeth Graham, BA Darci L. Graves, MA, MA Health Research Associate Sr. Health Care Education Specialist Astute Technology SRA International, Inc. Ilana Dickman, MPH Jason Goldwater, MA, MPA Health Care Analyst Senior Member SRA International, Inc. SRA International, Inc. Eileen Hederman, BA Health Research Associate Astute Technology --ii- NPAC Members Dennis P. Andrulis, PhD, MPH Reneé Joskow, DDS, MPH Center for Health Equality Office of Health Affairs Drexel University of Public Health U.S. Public Health Service Dahna Batts, MD, FACEP Nataly Kelly Centers for Disease Control and Independent Consultant Prevention U.S. Public Health Service Luisa López, MSW National Association of Social Work Juliet Choi, JD American Red Cross Francis G. Lu, MD San Francisco General Hospital Cindy Lou Daniel Federal Emergency Management John C. Scott, MS Agency Center for Public Service Department of Homeland Security Communications Edward Gabriel, MPA, AEMT-P Kenrick A. Small, JD Walt Disney Corporation Office of Civil Rights Sandy Hunter, PhD, NREMT-P Bruce Young, MSW Eastern Kentucky University National Center for Post-Traumatic Stress Disorder, Veterans Affairs Consensus-Building Panel Members Ritu Sahni, MD, FACEP National Association of EMS Physicians Oregon Health and Science University Andy Hunt, MSW, LICSW Substance Abuse and Mental Health Services Association (SAMHSA) U.S. Public Health Service Âna-Marie Jones Collaborating Agencies Responding to Disasters (CARD) The information presented in this report does not necessarily reflect the views and opinions of the U.S. Department of Health and Human Services, Office of Minority Health, or SRA International, Inc. --ii- To cite information from this report, please use the following reference: SRA International, Inc. (2008). Cultural Competency in Disaster Response: A Review of Current Concepts, Policies, and Practices. Report prepared for the Office of Minority Health. Rockville, MD: SRA International, Inc. --ii- Table of Contents LIST OF FIGURES......................................................................................................................................V LIST OF ACRONYMS............................................................................................................................ VII EXECUTIVE SUMMARY .......................................................................................................................... 1 PURPOSE AND METHODS ............................................................................................................................ 1 RATIONALE FOR CULTURAL COMPETENCY IN THE DISASTER RESPONSE ARENA ....................................... 2 ORGANIZATION OF EMERGENCY AND DISASTER RESPONSE IN THE UNITED STATES.................................. 2 APPLYING THE CLAS STANDARDS AT EVERY PHASE OF DISASTER ........................................................... 2 CONCLUSION .............................................................................................................................................. 4 ADDENDUMS: PROFESSION-SPECIFIC INFORMATION .................................................................................. 4 1. INTRODUCTION .................................................................................................................................... 8 DEFINITION OF CULTURAL COMPETENCE................................................................................................. 11 PURPOSE OF THE ENVIRONMENTAL SCAN ................................................................................................ 12 TECHNOLOGY AND EDUCATION FOR DISASTER RESPONDERS .................................................................. 13 METHODS USED TO DEVELOP THE SCAN .................................................................................................. 16 ORGANIZATION OF THE SCAN................................................................................................................... 17 2. RATIONALE FOR CULTURAL COMPETENCE IN DISASTER RESPONSE ARENA ............ 18 WHAT IS A DISASTER?.............................................................................................................................. 21 CHARACTERISTICS OF DISASTERS ............................................................................................................ 24 THE PHASES OF DISASTER ........................................................................................................................ 25 3. ORGANIZATION OF EMERGENCY AND DISASTER RESPONSE IN THE UNITED STATES ...................................................................................................................................................................... 29 LOCAL EMERGENCY RESPONSE................................................................................................................ 29 STATE-LEVEL EMERGENCY AND DISASTER RESPONSE ............................................................................. 31 NATIONAL DISASTER RESPONSE .............................................................................................................. 33 DEFENSE SUPPORT TO CIVIL AUTHORITIES .............................................................................................. 35 NATIONAL VOLUNTARY ORGANIZATIONS ACTIVE IN DISASTERS (NVOAD) .......................................... 36 RESPONSE TO HURRICANE KATRINA ........................................................................................................ 36 4. APPLYING THE CLAS STANDARDS AT EVERY PHASE OF DISASTER................................ 38 PREPAREDNESS......................................................................................................................................... 41 RESPONSE................................................................................................................................................. 45 RECOVERY ............................................................................................................................................... 47 5. CONCLUSION....................................................................................................................................... 53 ADDENDUMS: PROFESSION-SPECIFIC INFORMATION.............................................................. 58 A. EMERGENCY MANAGERS..................................................................................................................... 59 B. EMS PERSONNEL................................................................................................................................. 67 C. SOCIAL WORKERS................................................................................................................................74 D. THE AMERICAN RED CROSS ................................................................................................................ 83 E. MENTAL HEALTH AND DISASTER MENTAL HEALTH PROFESSIONALS.................................................. 87 F. U.S. PUBLIC HEALTH SERVICE COMMISSIONED CORPS...................................................................... 112 G. MILITARY PERSONNEL....................................................................................................................... 117 H. CITIZEN CORPS .................................................................................................................................. 123 APPENDIX A. REFERENCES............................................................................................................... 126 APPENDIX B. SEARCH TERMS.......................................................................................................... 166 APPENDIX C. DISASTER RESPONSE EXPERT SURVEY RESULTS