Recovery, Renewal, Resilience

Many local governments have begun to take the lessons learn lessons from their COVID-19 response and amend strategies to improve emergency response plans for the future. E, ensuring these plans are disability inclusive is critical. Persons with disabilities can often be more vulnerable to risk during normal times and even more so in the height of a crisis. A recent paper explored the social determinants of disabled people’s vulnerability to COVID-19 and the impact of policy response strategies. The paper identifies recovery and renewal strategies that focus on reducing the social, economic, and environmental conditions that create disproportionate and unequal impacts. When re-evaluating local disaster preparedness and response, consider:

• Seek feedback from local people in your local community who live with a disability, and their carers, to understand how local response to COVID-19 met their needs or how their needs might be met more effectively in the future e.g. communications, access to services, community support mechanisms etc.
• Include strategies that recognise social vulnerability, as well as health related vulnerabilities, for example ‘universal basic income’ approaches to social security or ’housing first’ approaches to tackling homelessness
• Identify the various forms of risk that persons with disabilities might be exposed to, taking geographical and locale-specific risks into consideration. Needs will differ in the case of a flood/fire and evacuation than when faced with a health crisis
• Integrate the diverse and intersecting needs of persons with disabilities into preparedness and response plans. Co-produce these plans with them and their carers
• Identify the barriers that people with disabilities face in the community – work to reduce these barriers through long-term renewal initiatives, and not just in the case of emergency (e.g. re-designing local infrastructure to increase accessibility)
• Incorporate training for volunteers on the rights and diverse needs of people living with disabilities to maintain their dignity, safeguard against discrimination, and prevent inequalities in care provision (see UK guidance on supporting people with disabilities)

See: ‘Disability and Health Emergency Preparedness’ for guidance on identifying needs, tools and resources, and guidance for assessing preparedness and response programmes. See also: TMB Issue 19 for a further case study on disability-inclusive recovery and renewal.

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

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).

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

In California, the "Stay Home. Save Lives. Check In." initiative has been developed in partnership with the California Department of Aging, and three founding partners from the public, private and academic sectors. The project aims to counter strict social distancing with social bridging (one-on-one communication with older adults through check-in phone calls). The project will:

• Train and mobilise >1000 people to telephone call older Californians to check on their well-being, direct them to resources, and connect them on a personal level
• Prioritise reaching the most isolated older adults those living in pandemic hot spots, and those likely to be facing food insecurity via "Social Bridgers"
• Train callers to assess basic needs and make referrals. Callers will use a tested call script to ensure consistency and reliability and will empathise with each individual's experience of this pandemic
• Use Community Emergency Response Teams (CERT), trained volunteers affiliated with local public safety agencies
• Utilise United Airlines employees in San Francisco, San Jose and Los Angeles as they have a robust employee donation and volunteer system for disasters
• Use Sacramento State University gerontology students
• Expand partnerships in the coming weeks. Members of the public are not being solicited as callers at this time

Including those without safe accommodation e.g. homeless, victims of domestic abuse. Consider the sustainability of these measures into longer-term recovery.

Reference: Chief Resilience Officers, USA and Italy

Local government should provide early implementation of psychosocial support to build mental health provisions that can meet demands later on in recovery. Psychosocial support can be delivered on a self-selection basis, volunteers can be used to process this information.

Reference: State Volunteer Coordinator, USA