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Harris County Public Health Disaster Recovery Plan

State: TX Type: Model Practice Year: 2019

Harris County, Texas, the third largest county in the country, is located along the Gulf Coast where human health and well-being are continuously impacted by intricately intertwined man-made and natural events. Encompassing 1,777 square miles of sprawling urban and suburban landscape, Harris County is home to over 4.6 million residents and is continuing to grow at a rapid rate. With its size comes a great deal of diversity racially, ethnically, and socioeconomically Harris County has one of the most racially and ethnically diverse populations in the country. As a result, there are a number of vulnerable groups whose needs are not fully addressed by traditional services providers, or who feel they cannot comfortably or safely use the standard resources offered during preparedness, response, and recovery efforts. After Hurricane Harvey dropped 1 trillion gallons of water on Harris County causing wide-spread flooding in August 2017, Harris County Public Health (HCPH) initiated recovery efforts and provided health resources support to this large, diverse community. HCPH is a local health department for Harris County that provides comprehensive health services and programs to the community through a workforce of about 700 public health professionals, all of which are dedicated to improving the health and wellbeing of Harris County residents and the communities in which they live, learn, work, worship, and play. As recovery activities from Hurricane Harvey began demobilizing, HCPH performed an agency-wide After Action Review (AAR) to look at the agency response, as well as recovery activities. One important lesson learned from this process was the need for a recovery plan to guide recovery goals and activities. Recovery plans are an important element for all disaster responses, but for disasters of Hurricane Harvey magnitude, it is likely that the recovery process can last for months and the direction and foundation for these activities need to be established early. Many response activities can have a direct effect on future recovery activities; thus, it is important to plan for them before a disaster in order to have response and recovery interact seamlessly. From the AAR, HCPH created a Corrective Action Plan (CAP) assigning responsibility and deadlines for recommended activities. The CAP outlined goals and objectives that solidified the need for a recovery plan for the County. The creation of an agency-wide Recovery Plan is an important element of the CAP, and responsibility for this plan was given to the Office of Public Health Preparedness and Response (OPHPR). OPHPR is tasked with working on disaster preparedness and strengthening community resilience year-round. With a long-term view to building resilience as a cornerstone of recovery, it ensures that all recovery activities also contribute to strengthening community resilience where possible. The HCPH Recovery Plan was built on three initial steps: research, defining the purpose and scope of the plan, and leveraging partnerships. The first phase included reviews of published research on the theory of recovery planning, as well as examples of recovery plans from other jurisdictions. Currently, there are few established recovery plans at a local level, so research included plans at the national and state levels, as well. The second step was defining the purpose and scope. For HCPH, the purpose of the recovery plan focuses on health department activities and resources dedicated to providing services to the community to strengthen community resilience. Finally, the Recovery Plan worked with developed partnerships to deliver recovery services and resources. Unprecedented storms like Harvey highlight the need for guidance in the recovery process; specifically, recovery efforts need direction and oversight as time progresses and regular public health agency activities are restored. Through lessons learned from Harvey, HCPH has been able to jumpstart an accelerated recovery plan project that targets all objectives and outcomes addressed in the AAR and CAP. As we plan and implement for recovery, we also build community resilience to strengthen communities for the next disaster because for Harris County, it is a matter of when” the next disaster occurs, not if. Planning for recovery is still a relatively new concept; thus, with different jurisdictions and strategies, recovery plans will need to be definitive and undergo continual review and revision to prompt effective change. With more storms like Harvey on the horizon, local support around the Recovery Plan has helped set in motion various activities that will help target vulnerable populations and Harris County residents to further prepare and recover from natural and man-made disasters in the future. Website: http://publichealth.harriscountytx.gov/
The creation and implementation of a recovery plan is a new concept in the field of public health, especially at the local government level; therefore, the Harris County Public Health Recovery Plan (HCPH) is innovative. Instead of solely looking at recovery from an emergency management perspective, the plan developed by HCPH is focused on the response efforts of the public health department, and touches on how partnerships with agencies like the Harris County Office of Homeland Security and Emergency Management (HCOHSEM) can greatly benefit recovery efforts in the County. HCOHSEM has an emergency management-specific recovery plan, which solidifies the need for a health-specific recovery plan. Similarly, the HCPH Recovery Plan is not only novel as a result of its focus on public health, but also because this Recovery Plan has been separated from the HCPH Continuity of Operations (COOP) Plan. By separating the two, the HCPH Recovery Plan is designed around recovery systems and actions designed to support communities through the recovery process, rather than the roles and responsibilities for departmental reconstitution. The development of the HCPH Recovery Plan resulted from the lessons learned from Hurricane Harvey. Although the plan was written after this unprecedented storm, its scope is greater than just natural disasters – the purpose is to provide the framework for recovery efforts for all disasters and emergencies, both natural and man-made. Through mapping out recovery actions, the plan will involve all divisions within HCPH and their partners, resulting in a resilient and capable Harris County community. The majority of the major disasters that threaten Harris County have wide-spread effects; therefore, the HCPH Recovery Plan targets the entirety of Harris County – over 4.6 million people. According to the US Census, 43% of the population is Hispanic/Latino, 30% is White alone, 20% is Black/African American alone, and about 8% is Asian; in addition, roughly 145 languages are spoken in the county. After Hurricane Harvey, over 154,000 homes were flooded and over 60,000 were rescued in Harris County alone. Unfortunately, many of these families are still struggling to return to their homes. Although HCPH continues to work diligently to address the health needs of these community members, had a Recovery Plan existed prior to the commencement of response and recovery efforts, it could have ensured that recovery process reached even larger swaths of the population more efficiently. In order to be able ensure efficiency in the recovery process, there are a number of activities that take place at HCPH that need to function together in order to provide the best services and support to the Harris County community. These activities include: community assessments such as the CDC-designed Community Assessment for Public Health Emergency Response (CASPER), a fleet of mobile units dispatched to take public health to the public and provide much-needed services and resources, increased engagement and outreach, epidemiological surveillance of disaster-related diseases, and targeted messaging around the health effects of recent disaster events. Data-gathering in order to ensure evidence-based decision making and strategy definition is of heightened importance after a disaster; a variety of methodologies for the collection and analysis of data is also an important component of the Recovery Plan. Another example of the benefits of this plan, is that topics like mental health and flu prevention can be addressed holistically and directly from the very beginning of the recovery process. All of these activities (as well as many others including the normal operations of the Health Department), and the variety of divisions, offices, and partners needed to carry out these activities need to be coordinated, they need to have a unified vision, and the principles of health equity and one health need to be observed at all times. The HCPH Recovery Plan provides the framework to do just that. LHD and Community Collaboration The LHD should have a role in the practice's development and/or implementation. Additionally, the practice should demonstrate broadbased involvement and participation of community partners (e.g., government, local residents, business, healthcare, and academia). If the practice is internal to the LHD, it should demonstrate cooperation and participation within the agency (i.e., other LHD staff) and other outside entities, if relevant. An effective implementation strategy includes outlined, actionable steps that are taken to complete the goals and objectives and put the practice into action within the community. Goal(s) and objectives of practice What did you do to achieve the goals and objectives? Steps taken to implement the program Any criteria for who was selected to receive the practice (if applicable)? What was the timeframe for the practice were other stakeholders involved? What was their role in the planning and implementation process? What does the LHD do to foster collaboration with community stakeholders? Describe the relationship(s) and how it furthers the practice goal(s) Any start up or in-kind costs and funding services associated with this practice? Please provide actual data, if possible. Otherwise, provide an estimate of start-up costs/ budget breakdown. Enter the LHD and Community Collaboration related to your practice The core goal of the Harris County Public Health (HCPH) Recovery Plan is to guide the Public Health Department in the activities that are necessary to support and strengthen the health of the community as it progresses through the recovery process after a disaster. Additionally, another key goal of the Recovery Plan is to support current efforts to strengthen the resilience of Harris County. In order to achieve these goals, a comprehensive and inclusive Recovery Plan founded in the principles of health equity, one health, and whole community is imperative. Therefore, the process to create the plan progressed through a number of steps for completion. Initially, the HCPH Office of Public Health Preparedness & Response (OPHPR) reviewed a variety of resources on the theory of recovery planning, as well as examples of recovery plans from other jurisdictions. Research was completed within 6 months of the completion of the Hurricane Harvey After Action Review and Corrective Action Plan. One of the fundamental relationships used in creating the Recovery Plan was with the Harris County Office of Homeland Security and Emergency Management (HCOHSEM). HCOHSEM provided general guidance on recovery planning at the county level, as well as the expectations of agency-level planning. The framework provided by HCOHSEM was used to create a basic draft plan – the second step of the process –, which was completed one year after Hurricane Harvey. Finally, as a result of Hurricane Harvey, HCPH has reviewed and revised a number of plans in addition to creating the new Recovery Plan. Part of this process has also included involving other Harris County agency partners and community partners to review these plans and provide input. This ensured that HCPH included partner input in the Recovery Plan, as well as ensure effective and timely communication and information sharing during the recovery process. During recovery efforts, all of HCPH cooperates with organizations participating in recovery activities, including those pre-disaster, those in the transition from response, and through short-term, intermediate, and long-term recovery operations. These external partners include the members of the Long Term Recovery Committee as well as other faith-based groups, social services, local hospitals and clinics, EMS, behavioral health, public works, water district, public safety, volunteer organizations, and many more. Because a successful recovery process for the community can be contingent upon the successful collaboration between all these organizations, HCPH invited all partner organizations to participate specifically in the planning process of the development of the Recovery Plan.
The core goal of the Harris County Public Health (HCPH) Recovery Plan is to guide the Public Health Department in the activities that are necessary to support and strengthen the health of the community as it progresses through the recovery process after a disaster. Additionally, another key goal of the Recovery Plan is to support current efforts to strengthen the resilience of Harris County. In order to achieve these goals, a comprehensive and inclusive Recovery Plan founded in the principles of health equity, one health, and whole community is imperative. Therefore, the process to create the plan progressed through a number of steps for completion. Initially, the HCPH Office of Public Health Preparedness & Response (OPHPR) reviewed a variety of resources on the theory of recovery planning, as well as examples of recovery plans from other jurisdictions. Research was completed within 6 months of the completion of the Hurricane Harvey After Action Review and Corrective Action Plan. One of the fundamental relationships used in creating the Recovery Plan was with the Harris County Office of Homeland Security and Emergency Management (HCOHSEM). HCOHSEM provided general guidance on recovery planning at the county level, as well as the expectations of agency-level planning. The framework provided by HCOHSEM was used to create a basic draft plan – the second step of the process –, which was completed one year after Hurricane Harvey. Finally, as a result of Hurricane Harvey, HCPH has reviewed and revised a number of plans in addition to creating the new Recovery Plan. Part of this process has also included involving other Harris County agency partners and community partners to review these plans and provide input. This ensured that HCPH included partner input in the Recovery Plan, as well as ensure effective and timely communication and information sharing during the recovery process. During recovery efforts, all of HCPH cooperates with organizations participating in recovery activities, including those pre-disaster, those in the transition from response, and through short-term, intermediate, and long-term recovery operations. These external partners include the members of the Long Term Recovery Committee as well as other faith-based groups, social services, local hospitals and clinics, EMS, behavioral health, public works, water district, public safety, volunteer organizations, and many more. Because a successful recovery process for the community can be contingent upon the successful collaboration between all these organizations, HCPH invited all partner organizations to participate specifically in the planning process of the development of the Recovery Plan.
The core goal of the Harris County Public Health (HCPH) Recovery Plan is to guide the Public Health Department in the activities that are necessary to support and strengthen the health of the community as it progresses through the recovery process after a disaster. Additionally, another key goal of the Recovery Plan is to support current efforts to strengthen the resilience of Harris County. As Harris County continues to work through the recovery process, the Recovery Plan has been instrumental in focusing agency-wide efforts in effectively supporting recovery and strengthening resilience in Harris County communities. A key component of the Recovery Plan includes community engagement through the use of mobile health villages. These Villages include eight mobile units, each focusing on specific public health services such as a dental unit, a medical unit, a mosquito unit, a veterinary unit, etc. In addition, a cadre of staff and volunteers provide information on disaster preparedness, breast feeding, smoking cessation, and obesity prevention among others. HCPH continues to stage and operate these Villages, and some of the key data collected is on the demographics and needs of the populations partaking of services in the Mobile Health Villages. Attendance has steadily increased throughout the recovery process. In addition, HCPH aims to ensure that the Mobile Health Villages are set up in a wide variety of geographic locations around the County, and that they are also placed within the communities demonstrating need, specifically in terms of access to healthcare and food. In using the Recovery Plan to guide these activities and to link them with other recovery activities, the Mobile Health Villages have become more effective in reaching target populations and providing them with much needed services and resources. Community assessments known as Community Assessments for Public Health Emergency Response (CASPER) are also a key component of the HCPH Recovery Plan. Due to the Recovery Plan development, HCPH is carrying out a series of recovery CASPER assessments in addition to two response CASPER assessments conducted within weeks of Hurricane Harvey floodwaters receding. As HCPH continues to visit a variety of Harris County communities to assess recovery progress and needs, a larger portion of the community will have access and exposure to HCPH services and resources. In addition, data collected from all the assessments is compared and analyzed, in order to be used to help guide and prioritize Health Department activities through the recovery process as well as in strategic planning and general day-to-day activities. The Recovery Plan provides the framework that allows all these activities and pieces to be used together to provide the best support possible to communities as they continue to progress through the recovery process. A storm the magnitude of Hurricane Harvey will take years to recovery from. It is the intent of HCPH that the Recovery Plan will guide the continuation of the Hurricane Harvey process, as well as provide a framework for future recovery efforts in the County. However, it is the continued Hurricane Harvey activities that have influenced not only the creation of the Recovery Plan, but has also provided input to any modification, shifts in focus, and inclusion of tools and structures to ensure better recovery outcomes for the community.
Though the development of the Harris County Public Health (HCPH) Recovery Plan was borne from a need that arose from Hurricane Harvey, the Plan creation, implementation, and maintenance is part of the entire system of plans, SOGs, etc. under the purview of the Office of Public Health Preparedness and Response (OPHPR). By including it as part of this system, HCPH can ensure that the Recovery Plan will be reviewed annually and revised as needed, keeping it current and applicable to any new disaster that affects Harris County. The cornerstone of this plan lies in the relationship of HCPH with the Harris County Office of Homeland Security and Emergency Management (HCOHSEM). The plan was created using the template provided by HCOHSEM, and developed in close collaboration with their Long Term Recovery Specialist. This ensures that both agencies will not only activate their plans with a full knowledge of how they fit together, but also that any future revisions and reviews will be done in collaboration so that the plans continue to support to each other and provide effective and efficient recovery support to the community. In addition, if Hurricane Harvey has shown us anything, it is that disaster recovery for this level of major disaster must be done through the concerted collaboration of a variety of agencies and organizations. Therefore, the Recovery Plan process included a variety of mechanisms for partner inclusion in the development of the plan, and the review process will also include a variety of mechanisms for partner involvement. In order for recovery to be effective in Harris County, it is imperative that all agencies and organizations that touch communities through the preparedness, response, and recovery phases work together and collaborate on making the people that make up those communities stronger, healthier, and more prepared to face the next disaster.
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