Recovery, Renewal, Resilience

TMB 39 noted how “tackling loneliness” was a key priority for community wellbeing in the next year, particularly in rural areas with high numbers of elderly residents. For example, ‘TED Ageing Better’ in East Lindsey is working to foster sustainable resilience in older people by strengthening social capital in the community and providing specific support services. Consider, from TED in East Lindsey’s recent report:

• When establishing community well-being initiatives, focus on “flexible and person-centred” activities. For example:
  • Magna Vitae's Community Health Activity Project employs a range of outreach mechanisms (online, telephone, one to one and group meetings) to ensure their service is inclusive. This has led to higher levels of engagement, enabling the development of innovative activities to meet diverse needs of the community
• Co-produce recovery initiatives (see TMB 38) and underpin these initiatives with a common goal e.g. to increase social capital and thus resilience amongst older people in the community
• Strengthen “peer-to-peer relationships” which can develop ties amongst residents and increase their sense of belonging. Such initiatives benefited from the delivery of “activity packs” that keep residents engaged and connected to people in their community during periods of isolation and social distancing
• Build on the relationships developed through well-being initiatives and co-production activities to support digital inclusion and build digital skills e.g. through community donation programmes (computers/laptops) and skill-building workshops facilitated by local volunteers
• Examples of strategies to tackle loneliness in Northern Ireland (NI) include:
  • The Department for Communities works with Libraries NI and National Museums NI to deliver projects that address loneliness, e.g. “Supporting People”, a programme which aims to improve levels of digital connectivity and digital inclusion
  • The Village Catalyst Pilot Project, which aims to tackle social isolation and rural poverty. The project will repair vacated buildings and repurpose them to improve local access to critical services and facilities, and provide increased space for community-led projects and social activities

The British Red Cross recently shared a report ‘Communities of Humanitarian Thought: The Case for Change in a Time of Crisis’. The report considers the next steps on the following prominent humanitarian issues: Displacement & Migration; Health Inequalities, and Disasters & Emergencies. The report highlights the need for real change for people experiencing, or at risk of experiencing, crisis across various priorities:

• ‘Eliminate the gaps in health and social care’, by employing a person-centred approach to reduce access barriers and prevent people from “falling through the gaps between services”. The inequalities in health and social care exacerbated by COVID-19 require a more integrated approach, along with investment in care and support at the community level
• ‘Ensure humanitarian needs are met in emergencies’, by clearly defining the statutory responsibilities of national government and emergency response organisations, to ensure that they “fully meet the humanitarian needs of their communities”
• Review social protection infrastructure to learn lessons from the pandemic and best practice across the world, e.g. ‘Cash-based assistance in emergencies’, which has shown to deliver a more “dignified response” and enables people to rapidly access the resources they need during crisis
• ‘Provide safe and legal routes for people seeking asylum’, by reviewing domestic policy to ensure that the “end-to-end experience of a person in the asylum system is efficient, fair and humane”. The Sovereign Borders Bill presents an opportunity to evaluate and take action to improve the entire system
• ‘Uphold international law and principled humanitarian action’, by committing to humanitarian action and support for the most vulnerable communities across the world
• Recognise how young people and civil society drive climate action, e.g. the Youth Advisory Group on Climate Change, which strives to amplify youth voices and engage young people in an open and transparent dialogue on climate action

The Rural Lives project examined the impacts of the COVID-19 pandemic and lockdowns on individuals experiencing financial hardship and vulnerability in rural areas, and the responses to address those impacts. It investigated the contributions of "societal processes, individual circumstances, and various support sources (e.g. markets, state, voluntary/community organisations, and family and friends)". The study finds that lockdowns delivered an acute shock to rural economies and societies, many of which rely heavily on tourism and hospitality, and that the pandemic amplified the impacts of digital exclusion. Pre-COVID, a substantial proportion of rural residents were found to be financially vulnerable. This study suggests that many more will be at risk of financial hardship in the coming months and years as "the full impacts of the pandemic play out and sources of support become more constrained". The study suggests future actions to support people living in rural communities:

• Diversify rural economies and support "good work" to offer people a fair and secure income, e.g. by providing targeted funding and support to help people to establish small businesses that increase the strength of other sectors (outside of those currently relied upon) and provide rural residents with "less precarious employment opportunities"
• Establish business support networks/signpost people to business advisory services to mitigate the negative effects of necessity entrepreneurship (e.g. people may lack confidence and/or knowledge about what is involved in setting up a viable business)
• Define and support the role of rural Voluntary and Community Social Enterprise (VCSE) sector, who have the potential to be a key actor when tackling the rise in rural youth unemployment
• Reinstate and support the expansion of mobile and outreach face-to-face services for the most vulnerable, especially those who may be more isolated due to physical distance from services, lack digital literacy or face mental health challenges
• "Continue partnership working and flexible funding" between service providers and VCSEs so that they can continue to play a joined-up signposting role, connecting rural communities to information, advice and services
• Integrate VCSEs into strategic planning to create effective partnership structures
• Explore the "rural potential for social care provision" review the experience of social care and carers during the pandemic to learn lessons. E.g. "deliver a more personalised and joined-up approach via informal cooperation between health and care workers, learning from more flexible work practices adopted during the pandemic"
• Enable communities to take a more active role in commissioning social care, and enable community groups to deliver care in their communities
• Co-produce service design with communities, pilot integrated ways of working with VCSEs and the community, and take locally-based approaches to service delivery that prioritise local community outcomes and individual needs/priorities
• Consider a combination of "person-based and place-based" social protection and welfare measures at national policy level

We bring together international lessons and actions to address the attainment gap and support vulnerable children who have lost out on significant learning time during the pandemic.

Read this case study in full by following the source link below to TMB Issue 33 (p.13-14).

Factors such as underlying health conditions, confined and over-crowded living spaces, limited facilities (e.g. running water, adequate sanitation), stigma and discrimination mean that Roma, Gypsy, Traveller and Boater communities are particularly vulnerable to the risks and associated impacts of COVID-19. Virus infection and death rates of these communities are currently unknown in the UK meaning formal data collection is needed. People in these communities are also likely to not be registered with a GP, to work in precarious job roles or be self-employed, meaning there is possibility that these communities will fall through the net with regards to COVID-19 vaccine programmes and the business/financial support initiatives provided during the pandemic. Consider:

• Partner with local and national organisations that work with Roma, Gypsy, Traveller and Boater communities to better understand their needs during the pandemic
• Work closely with the owners and managers of all residential sites and waterways for these communities to ensure that they stay open and alternative accommodation is arranged for people who become unwell and are required to self-isolate
• Provide additional temporary water, sanitation and waste disposal facilities to those communities who cannot access public facilities (due to closure of public infrastructure during lockdowns)
• Open additional local authority caravan sites temporarily to prevent overcrowding at designated caravan sites as COVID-19 requires these communities to remain static (e.g. holiday campsites that are not in use and would have basic facilities such as running water already in place)
• Establish a designated helpline in partnership with local health authorities (e.g. HSE Midlands Traveller Health Unit) to deal with COVID-19 queries
• Introduce a temporary moratorium to prevent people from being evicted from unauthorised camp locations
• Relax rules temporarily so those living on canal boats can moor in a safe place for an extended period of time
• Establish a targeted education support programme for children in these communities who are at risk of digital exclusion during periods of school closure
• Communicate with Roma, Gypsy, Traveller and Boater communities and the organisations that represent them to ensure that they are aware of and have access to social support mechanisms provided during the pandemic, e.g. Self-employment Income Support Scheme, vaccine programmes
• Include people who are living in these communities in research and outreach programmes to ensure learning is gained from their experiences and the diversity of impacts of COVID-19 on their lives is taken into account when planning for recovery

Billy Tusker Haworth, Lecturer in International Disaster Management at the Humanitarian and Conflict Response Institute, highlights the experiences of lesbian, gay, bisexual, transgender, intersex, and other queer identities during the pandemic and demonstrates the need for more nuanced and inclusive crisis response and recovery strategies. This briefing presents short term recovery strategies and longer term transformational activities to improve the care and wellbeing of LGBTIQ+ people during crises.

Read this briefing in full by following the source link below to TMB Issue 31 (p.2-5).

Data from the EU shows that 18 year olds who are in care are more likely to be not in employment, education or training, and experience higher levels of social exclusion or homelessness. COVID-19 has exacerbated their financial insecurity, poor mental health, and limited support networks as they transition to independent living. In addition to assessing the capacity of social work provision (TMB Issue 6), consider:

• Formally designate people who are leaving care as belonging to a vulnerable group
• Extend social protection programmes to make support services, such as financial support for food and accommodation, immediately available to those who leave care
• Ensure social services maintain regular personalised contact with those who leave care to advise them of what support is available during COVID-19
• Increase the capacity and flexibility of online communication with those who leave care, including availability of support forums
• Increase the capacity of mental health services, including outreach services and crisis support teams, by drawing on trained volunteers and enhance training in psychological first aid and safeguarding
• Partner with private care agencies, non-governmental organisations, corporate partners and care professionals to establish support and training/employment programmes
  • Establish a mentor programme to strengthen the support network of care leavers during their transition from care to independent living (e.g. ProgramaMentor, Galicia, Spain)
  • Provide employment advice to those who leave care, such as guidance on CV writing via an online workshop
  • Host virtual career or industry insights days to support those who leave care in making decisions on their next steps regarding education and employment
  • Establish targeted education and employment support for those who leave care, such as practical skills training on computing, email writing, giving presentations, and interviews; plus volunteering opportunities, work experience and apprenticeships for when lockdowns and restrictions end

COVID-19 has created new uncertainties that challenge the provision of critical support services to vulnerable families and children. Food programmes need to ensure that vulnerable children receive nutritious food, both inside and outside of school. They also need to facilitate access to other support services, and be delivered in ways that maintain the dignity and respect of recipients, their families and communities. Consider the need to:

• Integrate access to sufficient, nutritious food as part of an overarching plan to combat COVID-19, promote healthy societies, and mitigate long-term health issues
• Establish an assurance programme with service level agreements to increase confidence in emergency food provision, create feedback systems, and enable rapid amendment to services
• Provide guidance to parents so they know what services they are entitled to access
• Ensure parents are aware of "wrap-around" services e.g. anti-poverty schemes
• Analyse the impacts of food programmes on children's diets
• Consult parents and community groups about how to build dignity and choice into emergency and ongoing food provision, and develop opportunities for active involvement planning and delivery
• Develop community-based nutrition awareness and home-based cooking training programmes to support parents in providing balanced meals on a low budget
• Strengthen working partnerships with local government agencies, civic groups, voluntary sector, and social arms of corporations to improve implementation of food programmes
• Remove financial barriers to receiving food support and minimize stigma about 'handouts' e.g. by using a 'pay-as-you-feel' system

Mobile home residents face a number of health and environmental challenges that have been exacerbated during the pandemic. Residents face compounding health issues as mobile homes are difficult to keep warm in winter and cool in summer. Heating and ventilation costs can also create financial burdens which can have negative health impacts - especially as many people living in mobile homes have lower incomes and face job insecurity. This demographic also face increased risk due to site locations and occupancy agreements. In the UK, many mobile home sites are at risk of flooding and storm damage due to their proximity to water. To combat this, residents are normally asked to leave for 6 weeks of the year- during storm season. During COVID-19 this creates a number of issues as movement of people during these 6 weeks is a huge infection risk. The UK government has therefore requested that sites remain open for those using mobile homes as their primary residence. Consider:

• Emergency planning for extreme weather events/ COVID-19, including COVID-safe evacuation plans
• Increased community liaison and communication to share evacuation plans clearly to residents so they are able to prepare and act quickly and safely
• Identify local COVID-secure emergency accommodation in case evacuation of residents is needed
• Increase community liaison during periods of extreme heat to ensure residents are able to stay safe, especially during periods of lockdown, shielding or quarantine
• Provide clear information to residents in multiple languages and have multi-lingual community health visitors to ensure health and wellbeing information is translated

COVID-19 has added thousands more cases to the backlog faced by courts in England and Wales, has delayed proceedings for those already in the justice system, impacted police capacity and could negatively impact reporting of more serious crimes. Delays in processing and handling criminal cases has negative impacts on the health and wellbeing of victims, and could lower confidence in the justice system. Consider how to effectively support those involved in criminal proceedings by:

• Making arrangements with telecoms companies to provide free access to websites that provide information/support to victims of crime to avoid mobile data usage. This should include websites run by organisations such as charities, official government sites (including health), the police, and law courts
• Increasing communications with victims about the progress of their cases. This may require careful partnership working with specialist organisations to mitigate victims' anxieties and create additional capacity for services such as the police, who may be increasingly stretched during COVID
• Ensuring there is support for specialist communications from all partnering organisations. This may include the use of translators, experts able to speak with children, or those with special educational needs

Some people who are not able to not wear a face covering are reporting being confronted in enclosed public places and, as a result, being fearful and unwilling to leave their homes. Consider:

• Information campaigns to make the public aware that some people may not be able to wear face coverings. For example, the UK government provides three 'reasonable' reasons for not wearing a covering:
  • You have a physical/mental illness, impairment, or disability that means you cannot put on, wear or remove a face covering
  • Putting on, wearing or removing a face covering would cause you severe distress
  • You are travelling with/providing assistance to, someone who relies on lip-reading
• Whether it is appropriate to encourage those who cannot wear a face covering to get an exemption card or wear an exemption badge to reduce the likelihood of confrontation

Example face covering exemption card: https://hiddendisabilitiesstore.com/hidden-disabilities-face-covering.html

Inclusive recovery practices are essential as additional groups of vulnerable people emerge from the COVID-19 pandemic, alongside data on the disproportionate effects of COVID-19 on vulnerable and marginalised people. In particular, people living with visible and invisible disabilities have been adversely impacted by the virus due to challenges in accessing health services, and because they are at greater risk of experiencing complex health needs, worse health outcomes, and stigma[1].

While disability alone may not be related to an increased risk of contracting COVID-19, some people with disabilities might be at a higher risk of infection or severe illness because of their underlying medical conditions[2]. In particular, “adults with disabilities are three times more likely than adults without disabilities to have heart disease, stroke, diabetes, or cancer than adults without disabilities”2. In the UK, working-age women with a disability are more than 11 times more likely to die from COVID-19 than women without a disability, and for men, the death rate was 6.5 times higher than for men without a disability[3].

Health-care staff should be provided with rapid awareness training on the rights and diverse needs of people living with disabilities to maintain their dignity, safeguard against discrimination, and prevent inequities in care provision[4]. Advice on how to do this is extremely important. In the UK, guidance on how to safely care for people with disabilities is provided to protect carers and the person they are caring for, and includes consideration of[5]:

• Protecting yourself and the person you care for e.g. appropriate use of PPE in specific settings
• Supporting the person you care for through change e.g. providing accessible information
• Maintaining the health and wellbeing of carers

In recovery, some people with disabilities may have restricted access to social networks, systems that provide support, job security, consistency of income, education – aspects that others may take for granted. “The more a person is excluded, the more challenging the recovery, and persons with disabilities often fall in this category.”[6] Recovery from COVID-19 must therefore reflect disability-inclusive strategies to provide action-oriented directions for government officials and decision makers responsible for post-disaster recovery and reconstruction.

The Disability-Inclusive Disaster Risk Recovery Guidance Note[7] developed by the World Bank / Global Facility for Disaster Reduction and Recovery (GFDRR) aims to accelerate global action to address the needs of persons with disabilities. Overall, the World Bank and GFDRR estimate that a quicker and more inclusive recovery could reduce losses to well-being by $65 billion a year[8].

Disability-inclusive recovery is about including people with disabilities in recovery planning and enabling equal opportunities through the removal of barriers. This can be done by gathering baseline disability data and incorporating it into needs assessments, by mainstreaming disability inclusion in recovery programmes, and by recommending specific interventions. There are four essential steps to support inclusive risk planning:[9]

• Collect data on barriers and accessibility improvements to understand and assess disability inclusion in recovery and reconstruction
• Adopt appropriate disability legislation to support a disability-inclusive recovery process that will prioritize needs and allocate resources. New policies should be in alignment with the UN Convention on the Rights of Persons with Disabilities to guide disability-inclusive recovery and reconstruction
• Establish institutional mechanisms to ensure the meaningful participation of persons with disabilities in the planning and designing of recovery and reconstruction processes. Also identify and designate an agency with responsibility for coordinating and overseeing disability affairs in recovery and reconstruction. Additionally, ensure standards for disability inclusion in recovery are established and communicated
• Target households and groups that have limited ability to self-recover, including households with persons with disabilities, to receive financial support and other interventions. Set standards for disability inclusion in budgeting and procurement quickly and ensure they are applied across the recovery and reconstruction process. Also require full consideration of accessibility, including the principles of universal design, as a condition of financial contributions and assistance by all involved in recovery.

Disability-inclusive recovery can help reduce poor representation of people living with disabilities in post-disaster recovery efforts. This provides an opportunity to build a more accessible environment that is inclusive and resilient to future disasters, and to reduce the disproportionate risks faced by people living with disabilities by[10]:

• Making infrastructure resilient and accessible (barrier-free buildings and land use planning)
• Setting up programs to actively employ persons with disabilities, such as hiring them in the recovery and reconstruction planning and implementation process
• Making healthcare and education readily available and ensuring healthcare is accessible to persons with disabilities before and after a disaster
• Communicating hazard exposure and risk information in a way that can be understood and acted upon (for example, sign language interpretation and plain language)
• Improved accessibility before and after a disaster also benefits older people, those who are ill or have been injured, pregnant women, and some indigenous and non-native language speakers

Recovery is often tumultuous and traumatic, but it is also an opportunity to renew systems and processes by understanding and addressing unequal practices and structures. By making disability inclusion a priority in the recovery agenda, we can ensure more self-sufficient, inclusive, and resilient societies for all.

[1] https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30076-1/fulltext

[2] https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-increased-risk.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fpeople-at-higher-risk.html

[3] https://www.bbc.co.uk/news/uk-53221435

[4] https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30076-1/fulltext

[5] https://www.gov.uk/government/publications/covid-19-supporting-adults-with-learning-disabilities-and-autistic-adults

[6] https://blogs.worldbank.org/sustainablecities/ensuring-equitable-recovery-disability-inclusion-post-disaster-planning

[7] http://documents1.worldbank.org/curated/en/559111587448620405/pdf/Disability-Inclusive-Disaster-Recovery-Guidance-Note.pdf

[8] https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30076-1/fulltext

[9] https://blogs.worldbank.org/sustainablecities/ensuring-equitable-recovery-disability-inclusion-post-disaster-planning

[10] https://blogs.worldbank.org/sustainablecities/ensuring-equitable-recovery-disability-inclusion-post-disaster-planning

To read this case study in its original format follow the source link below to TMB Issue 19 (p.15-16).

COVID-19 has exacerbated the health and social care inequalities experienced by LGBTQ+ people as they are likely to living with conditions that impact their health and well-being. LGBTQ+ people are at high risk of pre-existing poor mental health; social isolation; substance misuse; living in unsafe environments; financial instability; homelessness; and negative experiences with health services as a result of their sexual orientation or gender identity. Consider partnering with LGBTQ+ organisations to:

• Support test track and trace. The LGBT Foundation's community survey on COVID-19found that: 64% of respondents would rather receive COVID-19 support from an LGBT specific organisation. This rises in other LGBTQ+ groups to: 71% of Black, Asian and minority ethnic LGBT people; 69% of disabled LGBT people, 76% of trans people and 74% of non-binary people
• Collect sexual orientation and trans status data alongside COVID-19 transmission and infection data to provide reliable data on the impact of COVID-19 on LGBTQ+ people
• Provide safe accommodation during COVID-19; 8% of respondents to the LGBT Foundation's community survey said they felt unsafe where they were currently staying
• Prepare for the hospitalisation of trans people (e.g. allocation to wards with the gender they identify with, or providing private areas)

COVID-19 has been a struggle for client-facing businesses - and sex work is no different[1]. What complicates support for those in sex work is the stigmatisation and lack of recognition workers receive[2]. Sex workers are less likely to seek, or even be eligible for, government-led social protection or economic initiatives to support small businesses[3] which has proved a serious issue during COVID-19. Most sex work has ceased due to social distancing and travel restrictions, leaving many marginalised, and economically precarious people even more vulnerable[4]. While some sex workers have been trying to move their work online4, many have been financially compromised3 resulting in potentially unsafe practices, both in terms of contracting COVID-19, and increased risk of homelessness and abuse[5]

Sex worker-led organisations have therefore had to set up hardship funds to fill the gap left by exclusionary government policies2. Such policies are demonstrated by delays in opening licensed sex work premises in Germany, where sex work is legal[6]. The Association of Sex Workers in Germany argued that brothels “could easily incorporate pandemic safety measures adopted by other industries, including face masks, ventilating premises and recording visitors’ contact details”6. Such measures have been successful in Zambia where authorities were able to trace a number of COVID-19 cases working with sex workers as investigations aimed not to “stigmatise or discriminate against them”[7].

Key interventions to address the impacts of COVID-19 among sex workers have been identified, with a view that “all interventions and services must be designed and implemented in collaboration with sex-worker-led organisations”[3]. These include[3]:

• Providing financial benefits and social protection for all sex workers, including migrants with illegal or uncertain residency status
• Stopping arrests and prosecutions for sex work which have been shown to be harmful to health
• Targeting health promotion advice on prevention of COVID-19 with language translation
• Distributing of hand sanitiser, soap, condoms, and personal protective equipment
• Maintaining and extending person-centred services to address needs e.g. mental health, substance use, physical and sexual violence, and sexual and reproductive health
• COVID-19 testing and contact tracing among sex workers

[1] https://www.bbc.co.uk/news/technology-52183773

[2] https://www.opendemocracy.net/en/beyond-trafficking-and-slavery/covid-19-illuminates-discriminatory-sex-work-policies/

[3] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31033-3/fulltext

[4] https://www.bbc.co.uk/news/business-52821861

[5] https://www.swarmcollective.org/blog

[6] https://www.reuters.com/article/us-health-coronavirus-germany-brothels/hamburg-sex-workers-demand-germanys-brothels-reopen-idUSKCN24D09U

[7] https://www.bbc.co.uk/news/world-africa-52604961

To read this case study in its original format, follow the source link below to TMB Issue 17 (p.18).

The COVID-19 pandemic has been a challenging time for everyone, especially in trying to adjust to new routines and living and working environments. This may be particularly true for children with autism and their parents, as children with autism have trouble adjusting to, coping with, and understanding change. To help with this, help parents to explain the current situation in clear and simple ways and can help children with autism to adjust to the 'new normal'. One way of doing this is to provide parents with access to materials that frame COVID-19 as a germ that can make people sick, so it is important to stay away from others and not touch things.

Advise parents to reiterate important rules to children with autism is also important to help them cope, such as:

• Washing hands well and often (for at least 20 seconds)
• Not touching their nose, mouth, and eyes
• Keeping at least 6 feet away from other people
• Wearing a cloth face covering or face mask in public places

Face coverings may be difficult for autistic children, some parents have had successes in attaching the ear loops on masks to their child's favourite hat with buttons to reduce sensitivity. Make authorities (such as transport providers, Police) aware of "Facemask Exemption Cards" that have been produced by organisations for parents to print out for those who cannot wear a mask. Local government can support parents of children with autism by working with respected specialist organisations to advise parents e.g. one encouraging mask wearing

• Demonstrate using the face mask on a preferred object or person, such as a stuffed animal, a doll, or a family member
• Allow the person to choose among different types of fabric face masks to find one that is most comfortable
• Start by practicing wearing the face mask for short durations of time, allowing for breaks when needed
• Plan initial outings in low-demand environments that are quiet and calm, so that the individual can experience success wearing the face mask
• Use a printed photo or digital photo of the individual wearing a face mask as a visual cue to wear the mask before outings

In addition to these changes, losing the daily routine that going school provides adds an additional layer of complexity for children with autism, and outs them at risk of not receiving the social care and support they require. While, some children may have found home schooling difficult, the time spent away from school may have resulted in the development of a new routine at home where they feel safe. As such, returning to school may cause anxiety and distress. Local government should inform teachers that some ways of reducing these anxieties include:

• Providing a visit to the school before it reopens if possible, to help children familiarise themselves with their environment and staff again
• Encouraging homes to introduce changes that are made in school at home e.g. explain social distancing measures, ask for photos of new classroom layouts to show children
• Asking parents for information about your child during COVID-19 so they have an understanding of their needs and how these may have changed due to COVID-19 restrictions

COVID-19 has also been a challenging time for parents of children with autism. One parent in the UK stated that support for them and their child had been reduced to occasional phone calls and they felt like they had been "left to struggle alone". They also stated that they were repeating the same or similar activities with their child from before lockdown and that it felt like their child's development had stalled. They stated that increased resources from their child's support worker such as a timetable of activities and development would have helped and made the experience of self-isolation and lockdown "less distressing".

Providing specialised phone lines and centralised hubs with resources for parents is vital, to ensure their well-being and that of their children, via reliable information and support. Local government can help employers to realise that parents also need to find ways to balance work and childcare responsibilities this can include:

• Arrange to work from home to ensure supervision, or childcare sharing arrangements with friends and family
• Prepare information about the child's support needs and successful learning and behaviour strategies for anyone caring for the child
• Develop an emergency contact list, and discuss it with friends and family. Include names and numbers of your personal autism support network, as well as medical providers
• Contact local organizations who may be able to offer support.
• Look through the child's medical records or evaluations related to autism as these may have recommendations on areas to focus on and can help you with making learning plans while schools are closed
• Reach out to others to maintain social support for the whole family e.g. social media, social media groups for autistic people and their families, and other virtual support groups that provide online resources for finding empathy and ideas while self-isolating or in lockdown

To read this case study in its original format (including references) follow the source link below to TMB Issue 16 (p.19-20).

With many schools closed, and young people adapting to learning remotely from home, access to the internet and digital devices has become imperative. As a result there is a growing divide between children who have internet access and those who do not. In Spain, disadvantaged students are 14% less likely to get online, compared to students who were not disadvantaged. Additionally, disadvantaged students in the country were without a tablet, a laptop or any way of linking into online platforms, and many disadvantaged families were not confident with technology when it was provided to them. In some cases teachers have resorted to using class WhatsApp groups, as most households had access to a mobile phone. To support online learning from home consider:

• Training teachers, students and their families to use online platforms and technology (and not assuming that they already have those skills)
• The availability of technology at home (e.g. mobile phones) and alternative teaching/ communication methods such as using WhatsApp
• Partnerships with internet providers to support disadvantaged families with the cost of internet access
• Partnering with software and technology firms to support disadvantaged children to gain access to hardware such as tablets and software
• Donation campaigns through schools to collect old phones, laptops and tablets that can be refurbished and distributed

The main housing insecure groups include:

1. Asylum seekers (with and without access to statutory support)
2. Private renters
3. Prisoners who have been released

To support these groups consider:

• Mapping housing supply and working in partnership with private businesses, landlords and public services to develop ethical lettings agencies
• Leasing properties off private landlords for a substantial period and letting through ethical lettings agencies
• Ask contractors for commitments to build affordable housing rather than contribute cash donations
• Removing caps on housing benefits
• Ensuring housing allowances for renters meets the rent profile of the area they are renting in
• Mapping facilities e.g. recreation centres that can be turned into emergency shelters for homeless people
• Mapping risks of shared accommodation and capacity during heat waves/winter and risk of infection
• Providing prepaid cards for use for essential shopping e.g. food, medication

References: Chief Resilience Officer, USA and a representative of a UK Local Authority

This briefing details how to consider people who have been disproportionately impacted by COVID-19; how they can be identified; and how they could be involved and supported in recovery and renewal. We offer a methodology for identifying those impacts (the process), developed from the steps taken by Greater Manchester to identify the people in their area impacted by the pandemic.

Follow the source link below to read this briefing in full (p.2-7).

Every local government area is likely to have a large number of people who are vulnerable but not eligible for a government food parcel delivery. Some of these people will not be able to access the food they need to stay at home due to:

• Too little money to buy food (including problems with benefits payments)
• Personal crisis for reasons other than COVID-19 (e.g. domestic violence)
• Health issues, disability or caring roles personally, or in the household
• Lack of friends, family or social support to deliver food

In Greenwich, strategic 'food pathways' have been mapped to organise partnerships for large-scale food provision for vulnerable groups, and to relieve pressure on food banks. Pathways include:

• • A model for local governments, local resilience forums and the voluntary sector to work in partnership.
  • To determine appropriate interventions, local governments triage those requiring food support into people who are:
    • financially secure but cannot shop
    • financially insecure and can shop
    • financially insecure and cannot shop
  • A model for community/ third sector groups. Based on this triage, community groups can assess the needs of community and provide appropriate interventions e.g. emergency individual meals or signposting to services

The youth may have vulnerabilities that include:

• Safeguarding concerns e.g. those with special educational needs, carers
• Exposed to domestic abuse, financial pressures and poverty, and additional caring responsibilities
• Limited access to computers for studies
• No internet access or costly data packages
• Reliance on public hotspots (currently unavailable)

Consider:

• Free, publicly available internet as part of corporate, and social responsibility providers
• Strategic investments that promote the safety of youth and information to counteract 'fake news'
• Wellbeing and safety of youth via specialised youth work during/post COVID-19 for those at risk of domestic abuse or exploitation (gangs, sexual)
• Creatively engage with youth through established organisations (schools, Youth Parliament and Young Peoples Foundations, community, faith-based organisations)
• Review of additional risks and legalities from COVID-19 legislation, in particular those 'at risk' of offending due to lack of understanding and communication aimed at youth
• Youth engagement in future recovery and renewal plans to co-develop preventative plans to support meaningful transitions to education, employment and training

PPE shortages, lack of testing, and a vulnerable population have seen care homes in England and Wales become hotspots of the COVID-19 epidemic[1]. The impacts of COVID-19 have been hugely disruptive in the care home sector; affecting patients and all aspects of care. The context of these challenges has been attributed to:

• A decline in funding for social care in the past 10 years, even as demand for care has risen as a result of an ageing population[2]
• Daily ~1.5 million older people – one in seven over-65s – go without the help they need with tasks such as washing, dressing and eating2
• Deaths in care homes (from all causes and Covid-19) are increasing - the increased community deaths reflects the prioritisation of social care[3]
• Moving such populations out of hospitals during Covid-19 means systems pressures are pushed elsewhere including into the community:
  • people were reportedly discharged from hospital to care homes without testing for Covid-19[4]
  • people who became ill in care homes were largely not tested for the virus and most were not admitted to hospital[5]

The UK Government has stated that their number one priority for adult social care is infection control during the COVID-19 pandemic[6]. While mitigating the spread of the disease is of paramount importance, protective measures such as isolation are associated with a morbidity of its own[7]. The lack of supervision as a result of staff shortages put care home residents at increased risk of injury and mental health issues, for example those with dementia often stop eating as a result of depression which can hasten death7.

Before the UK Government released their Plan to Rebuild[8] which includes a section on protecting care homes, a number of actions were identified within the sector to address growing concerns over how COVID-19 was being managed in care homes.

Actions to address the situation for care homes include:

• Central/local government and the care home sector should work together to make testing in care homes happen[9].
• More PPE, testing and funding to:
  • Ensure care home residents are safeguarded
  • Prevent avoidable hospital admissions
  • Improve the mental health of families who may be worried that their relatives in care do not have the support they need[10]
• More guidance for care home managers on:
  • Receiving residents from hospitals when they have not been tested
  • Permitting relatives to say goodbye to loved ones
  • Preventing staff making a dozen home visits a day - potentially spreading virus
  • Facilitating staff speaking out about unsafe conditions (five carers reportedly lost their jobs in the past fortnight after speaking out about their concerns)[11]
• In Scotland, the Care Inspectorate (the sector’s regulator) would examine every care home’s conduct during the pandemic12
• Social care should be viewed as part of healthcare and vice versa
• Nurses are working continually on helplines to support families affected[12]
• Consider relatives’ visitation/entry permissions to nursing homes as lockdowns ease[13]:
  • Limit the number of visitations per week and permit only one family member to visit at a time
  • Prevent children and young people (under 14) from visiting
  • Require visitors to reserve a time-slot– and not allow visitors unless they have made a reservation
  • Space visitors throughout the day and across the week to preserve social distancing
  • Prevent entry to visitors if they are ill, under quarantine or in isolation, or if they are waiting for the results of COVID-testing
  • Escort each visitor to use hand sanitizer on entering the care home and on departure
  • Escort each visitor to the resident’s room and back without stopping in the common areas
  • Visitors must adhere to the 2-meter distance regulations, and avoid direct contact with other care home residents
  • Urge visitors to download the COVID tracing app to their smartphone
  • Adapt this advice to circumstances of each care home (e.g. the size of the home, the situation at any given time, the number of confirmed infections in the local community)

The call to address these actions has been met by £3.2bn of additional funding for local authorities from the UK Government, which can be used to meet rising care home and additional pressures on social care. Additionally, a further £1.3bn has been provided for the NHS and local authorities to work together to fund the additional needs of people leaving hospital during the pandemic. The Governments priority areas are[14]:

1. Testing;
2. Infection prevention and control;
3. Workforce expansion through a recruitment campaign;
4. Clinical support through accelerated introduction of enhanced health support in care homes from GPs and community health services;
5. Guidance.
   

References:

[1] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31199-5/fulltext

[2] https://www.theguardian.com/commentisfree/2020/may/03/the-observer-view-on-care-home-deaths-being-an-indictment-of-our-society

[3] https://blogs.lse.ac.uk/politicsandpolicy/covid19-deaths-social-care/

[4] https://www.theguardian.com/commentisfree/2020/may/03/the-observer-view-on-care-home-deaths-being-an-indictment-of-our-society

[5] https://blogs.lse.ac.uk/politicsandpolicy/covid19-deaths-social-care/

[6] https://www.gov.uk/government/publications/our-plan-to-rebuild-the-uk-governments-covid-19-recovery-strategy/our-plan-to-rebuild-the-uk-governments-covid-19-recovery-strategy#our-roadmap-to-lift-restrictions-step-by-step

[7] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31199-5/fulltext

[8] https://www.gov.uk/government/publications/our-plan-to-rebuild-the-uk-governments-covid-19-recovery-strategy/our-plan-to-rebuild-the-uk-governments-covid-19-recovery-strategy#our-roadmap-to-lift-restrictions-step-by-step

[9] Age UK. https://www.ageuk.org.uk/latest-press/articles/2020/04/age-uk-response-to-more-care-home-deaths/

[10] Dementia UK https://www.dementiauk.org/coronavirus-care-home-deaths-up-hospital-cases-fall-our-response/

[11] https://www.theguardian.com/commentisfree/2020/may/03/the-observer-view-on-care-home-deaths-being-an-indictment-of-our-society

[12] Dementia UK https://www.dementiauk.org/coronavirus-care-home-deaths-up-hospital-cases-fall-our-response/

[13] National Commissioner of the Icelandic Police, Status Report on 24-4-20

[14] https://www.gov.uk/government/publications/our-plan-to-rebuild-the-uk-governments-covid-19-recovery-strategy/our-plan-to-rebuild-the-uk-governments-covid-19-recovery-strategy#our-roadmap-to-lift-restrictions-step-by-step

LGTBIQ+ people have a number of vulnerabilities. Consider:

• LGBTIQ+ people are less likely to have safe homes and are at a higher risk of homelessness (especially young people) and are at a high risk of domestic abuse
• The impacts of losing safe community spaces and the additional mental health impacts of this
• The complications with access to healthcare which can be especially hard for trans people who have specific medical needs
• The use of test, track and trace facilities for this vulnerable group. In South Korea a new wave of infections have been attributed to 3,000 people attending clubs that accommodated the LGBTIQ+ community. But only half of people in attendance have gone for testing, due to fears that doing so would reveal their sexuality. Confidence in personal safety and confidentiality is paramount in track, trace and treat processes

Additionally the need to identify a social work action plan to support families and vulnerable people as restricted movements are relaxed. This plan can identify:

• The social work skills needed to support families and vulnerable children
• The projected demand for such skills
• The capacity of the current social work system to deliver those skills
• Shortfalls in supply versus demand of skills
• Skills can be supported through non-social work providers such as volunteer organisations
• The training, supervision and resources are needed for volunteers to be safely involved
• What types of families and vulnerable children may be supported with those skills from non-social work providers
• The shortfall in families and vulnerable children who will need professionally-trained social workers
• How that shortfall can be addressed by professional social workers
• How many professional social workers can be trained, and when they will be available to work
• How to address any remaining shortfall in the short term

Local government should identify strategies to tackle spikes in gender based violence as a result of isolation, social distancing and quarantine measures. They should consider requirements for increased social and legal support for elongated/reoccurring lockdowns, and holistic partnerships with the voluntary sector to support and protect those at risk and educate both men and women.

References: Professor from the International Center for Collaborative Research on Disaster Risk Reduction; Hospital Executive; Chief Resilience Officer; UK Local Resilience Forum