Upon completion of this course, you will be able to:

• Identify each of the nine mission areas and their core functions
• Identify which public sector agencies support the nine core mission areas in a given scenario
• Identify the practices and capabilities associated with implementation of HSS recovery functions
• Outline the process and legal requirements for requesting federal HSS recovery assistance
• Describe the key features of a post-disaster impact assessment
• Determine the priority needs of a community following a disaster
• Outline strategies for coordinating recovery actions across local, state, and federal partners
• Identify best practices for coordination and implementation of the HSS RSF
• Identify the ways in which the HSS RSF interacts with and supports the other five RSFs

By the end of this section, you should be able to describe the HSS RSF, its top priorities, and the nine Core Mission Areas as they relate to health and social services recovery from emergencies and disasters.

Recovery Support Functions (RSFs) are the primary organizational element of the NDRF's sector-based approach. A coordinated approach helps communities take intentional and organized action to achieve their recovery priorities. RSFs are a powerful tool for organizing and coordinating recovery stakeholders at all levels of government.

Recovery Speed and Effectiveness

(Orange Curve) Some communities struggle with recovery, experiencing long periods of slow growth and diminished opportunity.

(Red Curve) Others progressively self-organize to restore and rebuild to where they would have been had there not been a disaster.

(Blue Curve) The RSF model decreases disaster impact and enhances recovery by coordinating pre-planning and recovery support.

Strong organization is often the biggest determinate for an effective recovery effort

In executing its mission, the federal HSS RSF's top three priorities of work are:

• To help state departments of health, social services, and education better understand and describe the extent and nature of HSS recovery issues
• To identify short-term courses of action for meeting immediate recovery needs
• To support affected states and communities in the development and implementation of recovery plans and capabilities necessary for long-term recovery.

• Develop and implement strategies to assess and monitor public health, conduct disease surveillance, and prevent injury in the disaster-affected community
• Assist in development and implementation of risk communications and public health messaging
• Provide technical assistance for the delivery of site-specific hazard awareness related to recovery

Some of the Federal Agencies and Partners that support this Mission Area include:

• Federal Emergency Management Agency
• Environmental Protection Agency
• Department of the Interior
• Department of Labor
• American Red Cross
• United States Department of Agriculture
• Veterans Administration

Assessment of disaster-related structural, functional, and operational impacts to health care facilities such as:

• Hospitals
• Clinics
• Nursing homes
• Assisted living centers
• Blood banks
• Dialysis centers
• Substance abuse treatment facilities
• Poison control centers
• Medical and dental offices

Some of the Federal Agencies and Partners that support this Mission Area include:

• Federal Emergency Management Agency
• DHS Civil Rights and Civil Liberties
• Department of the Interior
• US Department of Agriculture
• Department of the Treasury
• DHS National Protection & Programs Directorate
• American Red Cross
• Department of Transportation
• Small Business Association
• Veterans Administration

• Observe the environment of affected communities to determine if post-disaster conditions can cause adverse public health effects
• Provision of technical assistance (e.g., scientific data and models) and environmental health trainings
• Identify and mitigate public health threats to sheltering, potable water, and wastewater that can cause or exacerbate negative environmental health outcomes

Some of the Federal Agencies and Partners that support this Mission Area include:

• Federal Emergency Management Agency
• DHS Civil Rights and Civil Liberties
• Environmental Protection Agency
• Department of the Interior
• Department of Labor
• American Red Cross
• United States Department of Agriculture

• Assess structural, functional, and operational impacts to behavioral health facilities and programs
• Transition Crisis Counseling Assistance & Training activities
• Provide guidance on stress management and mitigation
• Engage with community behavioral health partners to assess needs, provide technical assistance, identify best practices, and connect practitioners with resources
• Engage stakeholders in developing strategies for behavioral health assessment, surveillance, and long-term treatment

Some of the Federal Agencies and Partners that support this Mission Area include:

• Federal Emergency Management Agency
• DHS Civil Rights and Civil Liberties
• Department of the Interior
• American Red Cross
• National Volunteer Organizations Active in Disaster
• Veterans Administration

• Provide technical assistance to FDA-regulated biologic, device, drug, animal feed, and human food establishments to protect public health
• Assess impacted community food supply networks to ensure food safety
• Determine if local public health organizations validating local food safety functions are encountering capacity limitations
• Assessing impacts of supply chain disruptions on recovery 

Some of the Federal Agencies and Partners that support this Mission Area include:

• Federal Emergency Management Agency
• Department of the Interior
• Department of Treasury
• United States Department of Agriculture
• Department of Transportation

• Assess structural, functional, and operational disaster impacts to social services facilities and programs
• Assess impacts to at-risk individuals
• Identify disaster-related social services needs that cannot be met with community resources
• Provide technical assistance in assessing health care services needs and the applicability of federal program flexibilities and waivers for meeting those needs

Some of the Federal Agencies and Partners that support this Mission Area include:

• Federal Emergency Management Agency
• Department of the Interior
• Department of Justice
• Small Business Association
• Department of the Treasury
• Corporation for National and Community Service
• DHS Civil Rights and Civil Liberties
• National Volunteer Organizations Active in Disaster
• United States Department of Agriculture
• Veterans Administration

• Implement a coordinated system for referring individuals and families with unmet disaster needs to appropriate social services
• Leverage federal social services programs to mitigate social disruption while transitioning individuals and families back to self sufficiency
• Facilitate delivery of federal-supported Disaster Case Management (DCM)

Some of the Federal Agencies and Partners that support this Mission Area include:

• Federal Emergency Management Agency
• DHS Civil Rights and Civil Liberties
• Department of Justice
• Department of Labor
• American Red Cross
• National Volunteer Organizations Active in Disaster
• United States Department of Agriculture
• Veterans Administration

• Determine which groups of responders should be included in a health care or disease registry program to monitor long-term physical and behavioral health
• Establish and implement long-term tracking of responder health
• Determine the appropriate duration and content of long-term health tracking
• Common recovery issues tend to center around environmental health and behavioral health risks 

Some of the Federal Agencies and Partners that support this Mission Area include:

• Department of Justice
• Department of the Interior
• American Red Cross
• Department of Labor

• Support the restoration of the educational environment for students and staff in impacted communities
• Coordinate health and social services delivery, through liaisons, to impacted schools
• Support state, territorial, tribal, and local government efforts to coordinate the enrollment of displaced or homeless students, and the delivery of educational, health, and social services to them

Some of the Federal Agencies and Partners that support this Mission Area include:

• Federal Emergency Management Agency
• Environmental Protection Agency
• Department of the Interior
• Department of Energy
• American Red Cross
• National Volunteer Organizations Active in Disaster
• Small Business Association
• United States Department of Agriculture

Mission and Organization:

• HSS RSF facilitated access to safe water, ensure a safe water supply, and address short and long-term health needs for impacted communities
• Primary & Supporting Agencies: FEMA, EPA, USDA

Federal support includes:

• Provision of technical expertise and personnel
• Increasing access to nutritious foods that combat lead absorption
• Increasing access to healthcare
• Increasing access to early childhood education
• Provision of technical assistance for the development of consistent public messaging

Applicable Mission Areas:

• Public Health/Social Services Impacts
• Environmental Health Impacts
• Children and Youth in Disasters 

Mission and Organization:

• Human Services sector suffered significant impact from flooding, electrical system damage, medical equipment damage, power outages, etc.
• Disproportionate effect on children, families, and seniors due to social disruption of schools, homes, childcare facilities, senior housing, etc.
• Primary & Supporting Agencies: FEMA, USACE, SBA, USDA, VA, HHS, EPA, NVOAD

RSF Coordinated Federal support included:

• Facilitated the communication of regulatory relief grant opportunities and ensured HSS providers were connected with available assistance.
• Peer-to-Peer Leadership planning workshops for school leaders
• Capacity building psychological first aid training
• Targeted behavioral health training for first responders
• Development of healthcare facility recovery guides based on Texas-based best practices

Applicable Mission Areas:

• Health Care Services Impacts
• L-T Recovery Impacts to First Responders
• Social Services Impacts
• Children in Disasters

The HSS RSF mission is:

• To assist locally-led recovery efforts in the restoration of public health, healthcare, and social services networks
• To restore capacity, and reconnect, impacted communities to health and social services

The top three HSS RSF mission priorities:

• Help state agencies understand and describe extent of HSS recovery issues
• Identify short-term courses of action for meeting immediate recovery needs
• Support affected states in developing and implementing recovery plans

The 9 Core Mission Areas of the HSS RSF:

• Public Health
• Health Care Service Impacts
• Environmental Health Impacts
• Behavioral Health Impacts
• Food Safety and Regulated Medical Products
• Social Service Impacts
• Referral to Social Services/Disaster Case Management
• Long-Term Recovery Impacts to First Responders
• Children in Disasters (Schools, Children & Youth)

By the end of the section, you should be able to:

• Describe the premise and methods for collaboration in support of HSS Recovery.
• Describe the organization of the HSS RSF and how it interacts with other RSFs, state and local government, and private sector stakeholders.
• Identify, in general, who sets recovery priorities and what federal RSFs provide.

Social Determinants of Health are the environmental conditions in which people live, learn, work, play, worship, and age, which affect a wide range of health, functioning, quality-of-life outcomes, and risks.

These determinates include: healthy food access, living/working conditions, employment, housing, health care access and quality, etc.

Addressing these conditions in disaster recovery guides communities toward reducing inequities while increasing baseline community health.

Example: A community recovering from a disaster decides to integrate social service, school, and public recreation program improvements into its recovery plans to improve public welfare and service access.

Affecting the social determinants of health in disaster recovery requires close inter-sectoral collaboration between public and private stakeholders at the local, tribal, state, regional, and national levels.

Such collaborative efforts involve thousands of near-simultaneous, inter-related decisions being made as part of an overarching process. As such, communication and coordination is imperative.

Recovery leaders need to communicate and coordinate as much as possible before, during, and after an event to:

• Maximize efficiencies
• Minimize delays, disruptions, and duplication of effort

The NDRF defines which federal agencies are in each RSF, and their levels of responsibility. The Federal Interagency Operations Plan (FIOP) for Recovery defines how they work together.

Each RSF is composed of:

• One Coordinating Agency
• Primary Agencies
• Supporting Agencies (technical assistance)

The organizations assigned to these roles may have multiple lead and support responsibilities and be part of multiple RSFs.

Each agency brings a unique skill, capability, authority, or resource to the recovery effort.

Coordinating Agencies are responsible for supervising the strategic planning and execution of their assigned RSF's role in federal disaster recovery efforts. The HSS RSF's Coordinating Agency is the Department of Health and Human Services (HHS).

Coordinating Agencies appoint a Field Coordinator (FC) for each incident to lead execution of the RSF's Core Mission Areas and coordinate efforts.

FCs from the different RSFs coordinate closely to ensure unified effort. This integration is guided by the Recovery FIOP. The Federal Disaster Recovery Coordinator (FDRC) is responsible for facilitating this collaboration.

Primary Agencies provide RSF Field Coordinators, technical assistance with impact analyses, and implementation support for RSF Core Missions - each of which has a designated primary agency.

The HSS RSF Primary Agencies are:

• Corp. for National and Community Service (CNCS)
• Dept. of Agriculture (USDA)
• Dept. of Homeland Security (DHS - multiple agencies)
• Dept. of Housing and Urban Development (HUD)
• Dept. of the Interior (DOI)
• Dept. of Justice (DOJ)
• Dept. of Labor (DOL)
• Environmental Protection Agency (EPA)

Supporting Agencies provide technical assistance to the RSF Coordinating Agency and Primary Agencies to inform and support the development and implementation of RSF-specific missions.

The HSS RSF Supporting Agencies include:

• American Red Cross (ARC)
• Department of Commerce (DOC)
• Department of Education (DOE)
• Department of Transportation (DOT)
• Department of the Treasury
• Department of Veterans Affairs (VA)
• Natl. Voluntary Orgs. Active in Disaster (NVOAD)
• Small Business Administration (SBA)

There is a defined process for activating and deploying the federal HHS RSF. Remember: not all RSF members are activated for every disaster.

• The Coordinating Agency (HHS) deploys a Field Coordinator to verify the situation and determine recovery needs
• Primary and Supporting agencies are activated based on their ability to fulfill those needs
• Activated agencies deploy resources, organize around their assigned mission areas, and link closely with state and local level peers.

Deployed Primary and Supporting Agency staff generally work out of the federal Joint Field Office.

Ultimately, the Federal RSFs focus on facilitating stakeholder collaboration and promoting intergovernmental and public-private partnerships.

RSF members additionally provide funding, expertise, and specialized resources for accomplishing local recovery priorities.

Disaster recovery is driven and executed by the communities affected by them. The Federal HSS RSF exists, specifically, to support these efforts as they pertain to to public health and social services.

Recovery is a marathon -- states, tribes, territories, and communities will be the inheritor of the outcomes of a the recovery effort.

Following a disaster, state, tribal, territorial, and local governments are responsible for:

• Determining recovery goals and priorities
• Managing recovery efforts in their jurisdictions
• Coordinating allocation of federal support

Federal RSFs only provide support to affected jurisdictions. They must coordinate assistance delivery through state and tribal authorities.

Communication and coordination between public and private stakeholders at local, tribal, state, regional, and national levels is critical.

RSFs are composed of Primary Agencies, Supporting Agencies, and a Coordinating Agency.

• The Department of Health and Human Services is the Coordinating Agency for the HSS RSF

• Once activated, RSF agencies deploy resources, organize around their assigned mission areas, and work closely with state-level peers to share information, establish common objectives, and coordinate recovery activities

• HSS RSFs exist to align multi-agency resources with community-driven public health and social services recovery efforts

By the end of the section, you should be able to:

• Describe the flow of activities that characterize recovery operations.
• Describe the steps of the recovery operations process.
• Identify methods for achieving an efficient transition of services.
• Describe the phrases of federal HSS RSF operations and its primary support activities. 

Personnel on-site conduct assessments of the physical damage and service disruptions caused by the disaster. Comparison of this data against the community's baseline reveals the disaster's impact.

Data Inputs

• Physical Damage Data
• Services Disruption Data
• Community Baseline
• Community Development Goals

Analytical Outputs

• Disaster Impact
• Resource Gaps and Recovery Needs
• Challenges

The multi-disciplinary, and resource intensive, nature of recovery makes effective partnerships critical. The first step in developing effective partnerships is identifying stakeholders. Once stakeholders have been identified, partnerships can be established by formalizing mechanisms for collaboration.

Tips for Identifying Stakeholders

• Do your research before making contact
• Go to the stakeholders in person
• Look for community organizations and leaders
• Remember that stakeholders are not all local, obvious, or directly visible

Tips for Building Coalitions

• Be familiar with stakeholder priorities and interests
• Educate the stakeholders as necessary
• Establish regular communication
• Help solve problems and challenges

Stakeholders collaborate to develop a course of action for resolving each known issue. This involves defining a desired end state; creating objectives, tasks, and metrics to measure success; as well as identifying necessary resources. Once this is done, stakeholders work together to gather the resources necessary for implementation.

Tips for Developing a Course of Action

• Integrate input from all stakeholders
• Be mindful of statutes, regulations, and authorities
• Develop multiple options to compare and combine
• Keep it simple
• Make it measurable

Remember: A successful course of action focuses on an identified issue or barrier, identifies the resource it needs, and facilitates interventions that close the distance between the need and the resource required.

Ensuring adequate support for a chosen course of action is critical to successful implementation. Key forms of support include informational, political, and physical resources. Many of these are facilitated or sourced via the HSS RSF.

What kinds of resources are there?

• Information on recovery resources, deadlines, and requirements
• Knowledge about how to manage long-term recovery issues
• Buy-in or formal agreements among affected or implementing stakeholders
• Funding and people to support repairs, planning, and capability gaps

Tips for ensuring adequate support include

• Be specific when asking stakeholders to contribute resources
• Define how much and for how long
• Align interests with the resources requested
• Get it in writing

The recovery operations process is iterative by nature. This allows for both constant improvement and adaptation to shifting situations, issues, and needs.

The initial iteration of the operations process is slow and hectic. However, with effective management and coordination, efficiency increases with each iteration and more is accomplished with less management effort.

Course of Action implementation will often continue while the recovery operations process repeats.

Transition generally signals a gradual slowing of the recovery operations process.

Recovery issues (and interventions) are also temporal in nature -- meaning, they will change over time. The severity will shift, those impacted will change, and the corresponding actions needed will need to adapt accordingly. 

The transition of renewed and improved Health and Social Services operations back to day-to-day providers is the ultimate functional goal of HSS RSF operations.

Bearing the following points in mind can smooth this process.

• Transition begins as soon as operations start
• Incremental transition smooths the process
• Closely monitor resource availability and needs as draw-down occurs

Recovery involves multiple waves of activity:

• Initial Actions: assess disaster impacts, identify stakeholders, and organize recovery efforts
• Recovery Operations: mobilize resources to resolve recovery issues and help local service providers regain their capabilities.
• Transition: recovery resources draw-down and demobilize as services and recovery projects are transferred to local providers or completed

Federal HSS Operations are structured around conducting a Mission Scoping Assessment, developing a Recovery Support Strategy (RSS), and implementing the RSS.

The recovery operations process is iterative and involves the following steps:

1. Identify gaps, needs, and challenges
2. Identify stakeholders and develop working relationships
3. Collaborate to determine course of action and gain logistical support
4. Implement course of action
5. Evaluate efforts
6. Repeat

By the end of the section, you should be able to:

• Understand how HSS RSF roles, functions, and operations methods can be applied to support a community recovering from disaster.
• Review the coordination and support activities of the HSS RSF.
• Review the role of the HSS RSF in disaster recovery.
• Review the HSS Recovery Operations Flow and Process.

Each disaster affected community is unique. Each HSS RSF deployment must be tailored to fit the mission requirements. However, the HSS RSF's role and approach to recovery remains the same.

The following scenario will demonstrate how the structures and methodologies presented in this course may be applied.

Note how HSS RSF structures and methods are adapted to meet the community's priorities and needs.

Situation:

• Incessant rain for 4 weeks
• Rivers swell, levees break, streets flood
• Erosion causes trees to fall on structures
• Four counties lose power for 10 days
• Unconfirmed reports of 150 seniors dead
• 6 dialysis clinics closed - only 1 left
• Last 2 weeks of school cancelled

Key Affected Stakeholders:

• School System
• Department of Public Health
• Department of Social Services
• Residents
• Churches and Advocacy Groups
• Hospitals and Clinics

Response Actions:

• State of emergency declared and presidential disaster declaration requested
• ESFs 3, 6, 8, 10, 11, 12 activated
• 11 Impacted hospitals activate COOP plans

Situation:

• Floodwaters receding – residents returning
• 2,900 emergency shelters closed
• 600 people still in shelters, without homes
• 10,000 residents living in hotels
• Schools unable to implement summer feeding program and lost feeding sites

Recovery Actions:

• HSS RSF is active and deployed
• Stakeholders identified
• Coordination meetings start
• Impact and need assessments begin
• Troubleshooting persistent recovery issues

Assessment: Immediate Needs

• Food and water supply inspections
• Temporary Dialysis Clinics
• Behavioral Health Services
• Disaster Case Management

Assessment: Near-Term Needs

• Social service provision
• Structure health and safety inspections
• Re-establish school summer feeding

Situation:

• Immediate needs addressed and solutions to near-term needs are being implemented
• Additional issues identified: ­
• Insurance denials for survivors ­
• Childcare and school year uncertainty ­
• Health system challenges ­
• Increased reports of support requests regarding domestic violence and suicide ­ ­

Recovery Actions:

• Recovery operations process repeated
• Issues addressed and monitored
• Capacity-building efforts begin
• Transition starts as local providers restore their ability to absorb the post-disaster impacts 

The Role of the HSS RSF

• Inter-agency recovery coordination
• Information and resource sharing

Key HSS RSF Activities:

• Impact and Needs Assessment
• Local stakeholder identification & organization
• Meeting and planning facilitation
• Problem solving

HSS RSF Supports Available:

• Technical Assistance (access to expertise)
• Facilitated access to resources

Recovery Operations Flow

• Phase 1: Initial Actions
• Phase 2: Operations
• Phase 3: Transition

Recovery Operations Process

1. Identify Gaps, Needs, and Challenges
2. Identify Stakeholders and Build Coalitions
3. Determine COA & Ensure Adequate Support
4. Implement Course of Action
5. Evaluate Efforts
6. Repeat

The purpose of this course was to provide an in-depth orientation to the Health and Social Services (HSS) Recovery Support Function (RSF) from the federal perspective. It described the federal role, the public agencies that support it, the process by which they develop a unified strategy to support state and local recovery efforts, and how the RSFs work together to implement holistic recovery strategies.

• The federal role in all recovery efforts is to support the achievement of state and local recovery priorities by facilitating access to expertise, resources, and funding of federal flexibilities that would otherwise be unavailable.

• The primary cause of delays in provision of recovery assistance is the lack of pre-planned interfaces between local, state, and federal disaster recovery organizations. Assistance is expedited when common systems are used and integrated recovery plans are in place.

• Communication and coordination is at the core of all HSS RSF activities. The goal of these efforts is to establish a unified vision for recovery and ensure unified effort in accomplishing that vision. This relies of effective information and resource sharing - which the HSS RSF facilitates.

• The six-step process used to guide HSS recovery operations is iterative, scalable, flexible, and collaboration oriented. The resulting approach facilitates continuous improvement while allowing rapid response and adaptation to evolving issues and circumstances.