The At-risk Populations eTool

Welcome to the At-risk Populations eTool. This eTool is a companion to the At-risk Populations Workbook. It is designed to first give you helpful information about defining, locating, and reaching at-risk populations in your community. Phases 1, 2, and 3 follow the introduction, where you will learn how to build your own community outreach information network (COIN). The last sections of the eTool contain suggestions for next steps and how to help you keep your COIN current and an eToolbox with more helpful information and resources.

At the bottom of the page you can see the resource guide that will be helpful when you are reading through the sections or building your own plan. The resource guide also includes fillable PDF templates and a comprehensive fillable PDF—referred to as "Plan Components." These fillable PDF documents can be saved to your desktop. As you enter information in them, be sure to save your progress. Let's begin!

Introduction to the eTool

Crowd of people. The capacity to reach every person in a community is one of the major goals for emergency preparedness and response. The goal of emergency health communication is to rapidly get the right information to the entire population so that they are able to make the right choices for their health and safety. To do this, a community must know what subgroups make up its population, where the people in these groups live and work, and how they best receive information. Although knowing this type of information might seem obvious, many jurisdictions have not yet begun the process to define or locate their at-risk populations.

To maintain consistency with the Pandemic and All-Hazards Preparedness Act (PAHPA), this eTool uses the term “at-risk populations” to describe individuals or groups whose needs are not fully addressed by traditional service providers or who feel they cannot comfortably or safely use the standard resources offered during preparedness, response, and recovery efforts. These groups include people who are physically or mentally disabled (e.g., blind; deaf or hard-of-hearing; have learning disabilities, mental illness or mobility limitations), people with limited English language skills, geographically or culturally isolated people, homeless people, senior citizens, and children.

Row houses in a city.Regardless of terminology, trust plays a critical role in reaching at-risk populations. Reaching people through trusted channels has shown to be much more effective than through mainstream channels. For some people, trusted information comes more readily from within their communities than from external sources.

This eTool guides the user through a process that will help planners to define, locate, and reach at-risk populations in an emergency. Additional tools are included to provide resources for more inclusive communication planning that will offer time-saving assistance for state, local, tribal, and territorial public health and emergency management planners in their efforts to reach at-risk populations in day-to-day communication and during emergency situations.

If you follow the process outlined in this eTool, you will begin to develop a community outreach information network (COIN)—a grassroots network of people and trusted leaders who can help with emergency response planning and delivering information to at-risk populations in emergencies. Building a strong network of individuals who are invested in their community’s well-being, who are prepared and willing to help, and who have the ability to respond in an emergency is just the start. You must also include network members in your emergency preparedness planning, test the capacity of your COIN to disseminate information through preparedness exercises, and make changes to your preparedness plans based on the evaluation of those exercises.


Woman asking for information.One lesson learned from events since 2001, especially Hurricane Katrina in 2005, is that traditional methods of communicating health and emergency information often fall short of the goal of reaching everyone in a community. Although a great deal of work has been done, public engagement for emergency response planning remains low. Other reports and legislation have also acknowledged this challenge as indicated below.

In December 2008, the Trust for America’s Health released its sixth annual Ready or Not? Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism report.1 This report recommends that “risk communication and emergency planning activities need to include all segments of the population to ensure their voices are heard and incorporated.” The 2008 report further recommends that “federal, state, and local officials must design culturally competent risk communication campaigns that use respected, trusted, and culturally competent messengers.”

Ready or Not? Protecting The Public Health from Diseases, Disasters, and Bioterrorism cover. When enacted in December 2006, the Pandemic and All Hazards Preparedness Act required the U.S. Department of Health and Human Services (HHS) “to integrate the needs of at-risk individuals on all levels of emergency planning, ensuring the effective incorporation of at-risk populations into existing and future policy, planning, and programmatic documents.”2 PAHPA singled out risk communication and public preparedness as essential public health security capabilities, and it made state and local preparedness awards contingent upon an explicit mechanism, such as an advisory committee to obtain public comment and input on emergency plans and their implementation.

Furthermore, Homeland Security Presidential Directive 21 (HSPD-21), signed in October 2007, established the National Strategy for Public Health and Medical Preparedness, which includes community resilience as a critical component along with bio-surveillance, countermeasure distribution, and mass casualty care.3 Community resilience is how community and personal characteristics facilitate the ability to “bounce back" from adversity. This resource assists the inclusion of at-risk populations communication needs to promote their resiliency.

The Centers for Disease Control and Prevention (CDC), with the assistance of many state and local government and non-governmental agencies, has responded by compiling and disseminating information and materials for public health and emergency preparedness planners to better communicate health and emergency information to at-risk populations for all-hazard events. The process outlined in this eTool and the additional templates and materials included in the eToolbox are some results of this effort.

1 Trust for America’s Health. Ready or Not? Protecting the Public’s Health from Diseases, Disasters, Bioterrorism. December 2008.

2 Pandemic and All-Hazards Preparedness Act Progress Report. Assistant Secretary for Preparedness and Response. U.S. Department of Health and Human Services. 2008.

3 Homeland Security Presidential Directive 21. October 18, 2007.

The Categories

Columbian family.

Categories Checklist

Look in the resource guide for a checklist of people and groups that might fall into each category.

As planners and communities embark on the process of defining, locating, and reaching their at-risk populations, there are advantages to beginning with very broad categories. Working in broad categories can be an effective and manageable starting point. The key advantage of this approach is that it allows you to examine the nature of the vulnerability that might put someone at higher risk in an emergency.

For example, a plan to identify every language other than English spoken in a community will produce a very long list. On the other hand, a plan to identify demographically significant groups of individuals with no or limited English proficiency or those with very low literacy levels will yield one category: Language and Literacy.

Many sub-groups that make up broader categories of populations experience some of the same communication barriers. For instance, whether the intended audience speaks Spanish or "Thank you" in different languages.Chinese or simply does not read or understand English well, the communication barrier is a language or literacy issue and many of the strategies for message adaptation can be the same. Instead of translating emergency messages into 126 languages spoken in a community, public health departments have initiated pilot efforts to convey crucial information in simple, picture-based messages that are easily understood by everyone.

As you start to define, locate, and reach at-risk populations, five broad, descriptive categories will help you group people who are at risk:

Many individuals do not typically fall neatly into one category or population group or they might fall into more than one. In some cases, an individual might not fall into one of these categories but could have a family member who does. When this occurs, efforts to provide emergency services can be thwarted because family members do not want to be separated.

After a widespread emergency, people might find themselves stranded, displaced, destitute, homeless, or sick. They might experience challenges that leave them newly vulnerable or suddenly outside of mainstream communications in ways they did not experience before the emergency. These factors can create new at-risk populations.

Economic Disadvantage

Homeless man in a wheelchair.Start with economic disadvantage. If resources permit a community to address only one at-risk population characteristic, using poverty as a criteria may help reach a large number of people.

Economic disadvantage does not necessarily impair the ability of an individual to receive information, but it can significantly affect his/her ability to follow a public health directive if the individual does not have the resources or means to do what is being asked (e.g., stockpile food, stay home from work and lose a day’s pay, evacuate and leave their home, or go to a point of dispensing).

Economic disadvantage is so broad because many people that fall into other categories also live at or below the federal poverty level. When individuals are placed at risk because of both limited language or literacy and economic disadvantage, their risk is compounded, and planning efforts should reflect that.

Depressed woman hunched over holding her head.

Language and Literacy

This category includes people who have a limited ability to read, speak, write or understand English, have low literacy skills, or who cannot read at all (in English or in their native language).

It is important to consider language and literacy when you develop public health messages. To ensure that everyone can understand the information and follow public health directives, information must be culturally and linguistically appropriate and accessible to everyone.

Woman interpreting a document for a man.

Those who do not speak English as their primary language or have limited speaking, reading or writing ability are described by the term “limited English proficiency” (LEP).

Following the August 11, 2000, passage of Executive Order 13166 “Improving Access to Services for Persons with Limited English Proficiency,” LEP populations qualify for the same anti-discrimination protection designated for race, color, or national origin under Title VI of the Civil Rights Act. This is important because Title VI regulations forbid government funding recipients from restricting program benefits to individuals facing linguistic challenges with respect to a particular type of service, benefit or encounter.

Medical Issues and Disability (physical, mental, cognitive, or sensory)

Woman in a wheelchair.According to the Americans with Disabilities Act, a person has a disability “if he or she (1) has a physical or mental impairment that substantially limits a major life activity, (2) has a record of such an impairment, or (3) is regarded as having such an impairment.”4 The most easily recognized people in this category are those who are blind, deaf, and hard of hearing, as well as those with health conditions that limit mobility or make them dependent on electricity. As much as 14% of the population has hearing, vision, or mobility limitations.5

People with mental disabilities are thought by many health and emergency planners to be the most challenging at-risk population in widespread emergencies because people who cannot understand and follow directions could jeopardize others in addition to themselves. Mental disability is a population category that will require priority attention in some emergencies.

4 Executive Summary: Compliance Manual Section 902, Definition of the Term “Disability.” March 2009. The U.S. Equal Employment Opportunity Commission. February 3, 2010.

5 Public Involvement Techniques for Transportation Decision-Making. December 1996. U.S. Department of Transportation Federal Highway Administration. April 2, 2008.

Isolation (cultural, geographic, or social)

Migrant worker working in a peach field.People can be isolated if they live in rural areas or in the middle of a densely populated urban core. There are many ways people might be considered isolated, including:

Lonely, elderly man sitting on a couch.


Elderly woman.Although many elderly people are competent and able to access health care or provide for themselves in an emergency, chronic health problems, limited mobility, blindness, deafness, social isolation, fear, and reduced income put older adults at an increased risk during an emergency.

Infants and children under the age of 18 can also be at-risk, particularly if they are separated from their parents or guardians. They could be at school, in day care, or at a hospital or other institution—places where parents expect them to be cared for during the crisis. There are also increasing numbers of children who are home alone after school. Separation of family members can cause its own havoc in a crisis, as demonstrated during evacuations for the 2005 hurricane season when members of some families were separated and sent to separate shelters and even to different states.

Creating a COIN in Your Community

Principles of Community Engagement (CDC, 1997) represents the first time the relevant theory and practical experience of community engagement has been synthesized and presented as practical principles for this important work. It defines key concepts and insights from the literature that support and influence the activities of community engagement.

A summary of Principles of Community Engagement can be found in the resource guide.

Every person who lives, works, or travels through your community should be able to access information in an emergency. To ensure that happens, regardless of the communication and other barriers, you must first know who is in your community at any given time and how best to reach them with messages that will motivate action.

Community engagement and collaboration is crucial to achieve truly inclusive emergency planning. Comprehensive preparedness is only possible when public health professionals integrate the knowledge and skills of governmental and local public service providers, community-based organizations (CBOs), faith-based organizations (FBOs), and public health toward a common goal of enhancing communication, response, and recovery efforts. Community organizations should be involved in emergency preparedness planning from the beginning and engaged at every step of the way.

The process to accomplish this mission is divided into three phases: define, locate, and reach. Each phase includes specific activities to help you create and maintain your own community outreach information network (COIN), a grassroots network of people and trusted leaders who can help with emergency planning and give information to at-risk populations during an emergency.

By following the steps in each of these phases, you will have laid a solid foundation for your network, and you will be more prepared to reach at-risk populations during an emergency.

Kentucky Outreach Information Network (KOIN)

Since many people can be difficult to reach through mainstream media in a disaster, the Kentucky Cabinet for Health and Family Services continues to build and maintain a person-to-person network that can reach these at-risk populations. This network is referred to as the Kentucky Outreach and Information Network (KOIN).

Through the KOIN, the state is using trusted people and agencies in local communities, informal and formal groups, and the media to get its preparedness messages out. The KOIN includes hundreds of trusted partners and can reach vulnerable segments of the population.

This network can be used not only in emergencies or disasters, but also to protect the population’s health in day-to-day situations such as immunization clinics, diabetes education/screening, or flu shots.

Phase 1: Defining At-risk Populations

Defining at-risk populations will require investigation to build an understanding of the unique demographics represented in your community. You will need to learn about the spoken languages, cultural practices, belief systems, and the physical and mental limitations of the residents.

In this first phase, you will identify the populations you consider at-risk and then initiate a dialogue and engage those who represent organizations and government agencies that can reach many people in your community. These organizations can provide a wealth of information about at-risk populations and their representatives. You will start building a network of collaborators and partners as you delve into the specific demographics that distinguish your community from others.

Step 1: Collect Population Information and Data

Graphic of the United States Census 2010 map.Begin by investigating and analyzing available data gathered by others to shed light on different population groups in your community. You can use many sources of population statistics from the national level down to local agencies. This quantitative data, previously gathered by others, will help you begin the process and build a “snapshot” of your community. Some resources that are available to help you with creating this snapshot include:

Snapshots of Data for Communities Nationwide (SNAPS)

SNAPS provides local-level community profile information nationwide. Data can be browsed by county and state or searched by zip code. It provides a “snapshot” of key variables for consideration in guiding and tailoring health education and communication efforts to ensure diverse audiences receive critical public health messages that are accessible, understandable, and timely.

Review the national (103KB/1 page) and state (252KB/1 page) information sources in the resource guide for more examples of resources that may be available to help you create this snapshot.

Step 2: Estimate the Number of People in At-risk Populations Living in Your Community

Once you have collected information, establish baseline criteria to define groups within your community. As you consider the data you are gathering, identify the categories that are significant to your community. You can then synthesize the data into a brief report to estimate the number of people in different population segments within your community. This will help you gain a greater understanding of the scope of the outreach required.

At first, you might want to only focus on a few populations that will give you access to the largest number of people. As your program grows and you establish more partnerships, you can then consider adding categories to your plan.

Review the national (103KB/1 page) and state (252KB/1 page) information sources in the eToolbox section for more examples of resources that may be available to help you create this snapshot.

Screen shot of the Population by Counties since 1996 in a table.Screen shot of a Population Growth Chart since 1970s.

Defining the groups and numbers within your region is one of the first steps to accessing the largest number of people possible during an emergency.

Step 3: Identify Overarching Organizations/Agencies and the Key Contacts That Can Help You

Many organizations and agencies in communities across the country have extensive knowledge about the needs of various at-risk populations. An overarching organization is the lead organization that might partner with or provide funding to many direct service providers. Overarching organizations that fund or partner with smaller, direct service providers are often the best place to start engaging your community. In many areas, this would be an organization such as the United Way.

Review the category checklist (165KB/3 pages) in the eToolbox section for more examples of overarching organizations/agencies and key contacts that may be available to help you.

Logos: United Way, Community Shares, The Salvation Army, American Red Cross.

These organizations provide a direct link to CBOs and FBOs that serve many different populations. These direct service providers and agencies have the know-how and “big picture” understanding that can be a valuable resource in planning for preparedness, response, and recovery activities. In Phase 2 of this process, you will work with your overarching organizations to identify these direct service providers and trusted leaders. Public libraries can also serve as excellent resources with information about community service providers, particularly in very small communities that do not have a community foundation or local United Way.

As you identify these organizations, determine the most appropriate representatives with whom you can work and the best approach (personal appointment, phone, mail, e-mail, etc.) to reach them. You might be working with the leader of the organization, the person who oversees community affairs, or a student intern. Whatever the level of authority, this person can become a valued resource.

Step 4: Facilitate Discussions With Key Contacts

This step establishes relationships and identifies other potential partners and collaborators. Make an appointment to meet the key contacts at the overarching organizations and agencies to introduce yourself and explain the critical role these organizations will play in the process of reaching at-risk populations during an emergency.

Cook County Shares Information With Their Partners

The Cook County Department of Public Health (CCDPH) in Illinois is taking a community-based approach to include at-risk populations in planning and preparedness efforts.

Fostering relationships with agencies that serve at-risk populations in the Chicagoland area is integral to the success of this endeavor. Since the summer of 2007, CCDPH has done extensive outreach to learn more about these agencies, their interest in emergency preparedness, and the value they see in partnering with a local health department.

As a result, CCDPH has had the opportunity to present on how to “Be Aware, Get Prepared, and Take Action,” a campaign that promotes individual and family preparedness to clients of partner agencies. More specifically, the presentation emphasized the role of public health, raised awareness about potential emergencies, and described how to put together an emergency kit and create a family communications plan.

Offer reciprocal assistance to the organizations and agencies that you ask for help. You might be able to help these potential partners by offering to share information or resources. Remember that they may also have concerns about spreading resources too thin.

Arrange a time to meet with several key contacts at a location most convenient for the attendees. If time and travel constraints make face-to-face meetings impractical, consider alternative means of getting together, such as a conference call. Regardless of meeting format, your role will be to facilitate the discussions and brainstorming on topics such as:

As you collaborate with your planning partners, be sure to address the terminology you will be using as descriptors, or definitions, for the at-risk populations you wish to include.

Step 5: Stay in Touch

Sustaining community engagement is as important as building relationships. It is important to stay in touch—not only to update your partners on your activities but also to stay updated on staff turnover and transitions in partner organizations. It is important to communicate with your contacts on a regular basis and build in a mechanism to maintain updated contact information. You might find it helpful at this stage to provide regular brief updates on the progress of your work through e-mail, mail, or telephone calls. Later, as resources allow, you might want to develop a newsletter (in print or electronic formats) to keep people in your network connected, informed, and responsive. Build opportunities into your communication and outreach activities for feedback from your partner organizations.

Screen shot of "In Touch" newsletter. Man on the telephone. Two men laughing at something they see in the newsletter.

Regularly scheduled phone calls, newsletters, fliers around the community, and meetings can help you maintain and update your COIN network.

How to Use the Information

You have been collecting information that you will use throughout the process to locate and reach your community’s at-risk populations. You need to be able to manage the information in a way that can grow as you acquire new data, contacts, characteristics, and other details.

Develop a database. A database is one of the best ways to record information so you can track multiple factors, share data with others, and keep information current. Record specific demographic information about key contacts at organizations and government agencies including:

A database template in the list on the eToolbox page illustrates different headings and information categories to get you started.

Screen shot example of an Excel list.

Your database does not have to be complex. You can use a simple table in word processing software to organize the information that you collect. If you want to plan for a more robust database and have information technology (IT) staff to help you develop, build, and plan for future growth of your database, including them now in your planning activities will be beneficial. If they are involved from the beginning and understand your goals, they will be better able to help you anticipate ways to organize the data so that it will be most useful as you expand your database.

Phase 2: Locating At-risk Populations

In most jurisdictions, a good approach to locating at-risk populations is to combine geographic information system (GIS) technology with information acquired through community collaboration and networking in the data collection process.

In this phase, you will map gathering places and trusted sources within your community. Developing this system will help you get a visual representation of the network you are developing. Eventually this will allow you to identify gaps in coverage.

This phase will also lead you through further engaging community members in this process. In the “define” phase, you started building your network through representatives of organizations. You are now taking your COIN to the next level by engaging people who are on the front lines of providing service to the at-risk populations in your community, members of your identified groups, and their trusted leaders.

Step 1: Assess Existing Processes to Locate At-risk Populations

Three people having a discussion.You probably already know who some at-risk populations are and how to reach them because they are enrolled in programs and receive services from your agency. State and local public health departments, for example, know women who are connected through the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and generally know how to get in touch with them; or they know how to contact daycare providers who can help locate parents and guardians in an emergency.

To avoid duplicating efforts, you might find it helpful to conduct an inventory of your department’s current activities that include techniques and abilities to locate people. Interview others in your department or agency about the successes and barriers they have experienced in locating people who use their services. You might want to ask questions such as:

This type of intra-departmental assessment can provide locating strategies as well as data that can be used in the mapping process. You might also consider asking your partners to gather this information from their networks.

Using Other Government Resources to Locate Specific Populations

In Montana, the road crews who clear snow off the roads in the winter know which people need their roads cleared because of mobility issues. Therefore, they know who may need mobility assistance in emergencies.

Step 2: Choose Digital Mapping or Alternate Methods

Research indicates that about 80% of all government information has a geographic component.6 A GIS captures and stores data that are then displayed on a map for analysis. These systems can include a wide variety of information including geographic, social, political, environmental, and demographic data.

Mapping Resources

If you do not have access to digital mapping resources, you might want to consult with organizations that could become partners to help you map your at-risk populations. Examples of such organizations include:

  • The Metropolitan Planning Organization (MPO) or regional council that serves your area (in regional communities with populations over 50,000)
  • Your state GIS coordinator
  • Your state GIS data clearinghouse
  • The geography department at local colleges and universities
  • Your state department of transportation
  • Your state or county department of emergency management
  • Your local police, fire, or public works departments

In addition, your state demographer maintains data on populations in your state and can be a resource for analyzing these data. The state demographer will often have GIS professionals on staff. To locate resources with GIS software to help you, start with MPOs and regional councils. MPOs may be the most likely to have the GIS software to locate at-risk populations. You might also want to contact your state GIS coordinator to request information about the data clearinghouse for your state. The National States Geographic Information Council is the professional organization that will be able to direct you to the GIS coordinator or the contact for your state.

Although mapping technology is available in the United States, mapping of specific populations is sporadic. In many coastal communities, for example, mapping is used by fire departments and cities in evacuation planning. In other places, Area Agencies on Aging or county offices on elderly affairs have mapped older populations. Other local agencies might be using digital mapping techniques to display information ranging from neighborhood crime data to environmental information such as air quality and the amount of smog.

In addition, every state has a GIS coordinator who is familiar with the digital mapping activities in the state. In most states, resources to help update and interpret demographic data to map at-risk populations and track changing population dynamics are available at the state departments of public health, family services, transportation, commerce, economic development, ethnic affairs, or other similar offices.

When using GIS software to locate at-risk populations, you will bring the population data you collected to define populations into the mapping program. Some GIS mapping software comes with U.S. Census data embedded.

Remember that the timeframe between U.S. Census data updates and its reliance on self-reporting will require that you update your data periodically. Also, consider printing out the data at regular intervals so the information is accessible in emergencies should widespread power outages occur.

Example of a city street map.If you do not have access to or are unable to use GIS software, post a map of your community on a wall. Use the census and other data you have collected in the "define" phase and information gathered from community collaborators to determine where your at-risk populations might be found. Use pushpins or markers for a visual representation.

In small communities, mapping is often viewed as unnecessary because “everyone knows everyone else.” Yet, mapping—whether it is done with colored pins on a paper map or electronically—provides an exceptionally clear picture of where at-risk population groups might be found during an emergency. It is a time-saving benefit regardless of community size or diversity. Saving time is especially important when the people responding with emergency support come from outside a community and might be unfamiliar with the local demographics. The best planning efforts will incorporate both geographically mapping the populations with their gathering places and forming collaborations and partnerships to create additional lasting relationships with various groups and their trusted sources.

The geography or IT department at local colleges and universities might be able to provide names of students who would develop your GIS system in return for course credit. You might also locate knowledgeable students who are willing to serve as interns or even volunteer their time to help you. You can also contact departments of transportation or local police and fire departments to see if they use GIS software and are willing to assist. Ask to speak with someone in the GIS, research, or planning departments when seeking this information.

Mapping is a community-building process. You will collect information from sources at the local level and from those who know the community (e.g., police officers, public works crews, utility workers, tribal entities, social service providers, places of worship, barber shops, and schools).

This information will help you dig deeper into your community for information about neighborhoods and the people who live there, about community centers and the people who congregate there, and about the places and people to whom those most at-risk will turn in a time of crisis.

6Geographic Information Systems: Challenges to effective data sharing. United States General Accounting Office. June 10, 2003.

Step 3: Locate and Map Gathering Places for the At-risk Populations You Have Identified

Shoppers inside a mall.Collaborate with your partners to find the places where your identified populations gather. This will help you to locate individuals and groups within these populations. People who share important aspects of their lives gravitate socially and geographically to traditional gathering places or venues where they feel comfortable.

Obvious examples are soup kitchens for homeless populations or day-worker sites that attract undocumented immigrants. In very small communities, the post office may be a central point for daily information sharing and community updates, and the local postmaster is often a knowledgeable and trusted community resource. Commercial locations can be important gathering places. For example, people who live in remote rural areas gather at shopping locations on weekends. In many cases, employees at these stores will be trusted information sources because they are part of extended families in the area and are therefore excellent resources to find people and share health or emergency information.

Example of a soup kitchen: a worker serving a glass of water to a man.

Step 4: Identify and Map Trusted Sources in the At-risk Communities

People are more likely to receive information and act on it when the message comes from a trusted source they view as credible. Some examples of trusted sources or non-traditional leaders in your community may be the PTA president, local pastor, and respected school teacher. Spokespersons in authority are not always perceived as the credible, trusted sources we hope they will be in delivering information to the general public and might even be less credible for the at-risk populations you are trying to reach.

New America Media

New America Media (NAM) is the largest national collaboration of ethnic news organizations. Founded in 1996, NAM is headquartered in California, where ethnic media are the primary source of news and information for over half of the state’s new ethnic majority.

Behind-the-scenes view of a television broadcasting room.This lack of credibility underscores why it is so important to build your network, or COIN, of trusted spokespersons with whom your at-risk populations will identify and trust. These individuals might not serve in an official capacity or be known to public health and emergency providers yet, but they can serve as a channel of information and become a cadre of leaders in emergencies. The same qualities that make them leaders in their communities often make them willing to serve as a liaison between health professionals and at-risk populations before and during an emergency.

A COIN might also include members of the media, especially those who have closer connections to at-risk populations, such as the local ethnic media outlets. These media outlets can be a very powerful voice and provide a close connection to the populations they serve. Another trusted source might be the director of a multicultural community center or a community health worker. In addition to having the confidence of the people the center serves, this person might also have a good network already in place to reach community members through an e-mail listserv, telephone tree, mailing list, or simple word-of-mouth.

Group of teenagers in a room working together on a project.Include trusted sources in meetings and planning sessions with other community organizations and service providers. Add them to your database, capturing their contact information and how they prefer to be reached. As you build your network of trusted sources, map their locations in your community so you can begin to get a visual representation of the network you are developing.

Eventually you will be able to integrate this information in such a way that you can develop digital maps showing the locations of trusted sources, spokespersons and community resources coordinated with the populations that they serve. Later on, this graphic representation of your network and the populations that they serve will help you identify gaps in coverage for at-risk populations in your community.

Engaging community members in activities to locate at-risk populations requires collaboration, contribution, and commitment. You will be asking very busy people to share their time, energy, and information to help you disseminate emergency and public health information. You will be developing long-term relationships built on respect, credibility, and a shared concern that people in at-risk population groups are included in health and emergency planning, response, and recovery.

The process of identifying trusted leaders in your community is an ongoing process. You will want to continuously identify who is missing from the COIN. Your current COIN members may be a good resource in directing you to such non-traditional leaders.

Step 5: Facilitate Discussions With Representatives From Community Organizations Connected With At-risk Populations

Community members in a room.Ongoing engagement of your partners and representatives from community organizations is important throughout each phase of this process. You can host a meeting or conference call with the representatives of community organizations that you have already identified to discuss the issues involved as you locate at-risk populations. Talking with representatives of community organizations that serve at-risk populations, including those that address human service needs as well as community needs, is essential to determine which organizations can help you the most. Not every community representative will have a role to play in the "locate" phase, but they can be valuable connections to reach groups and to disseminate health or emergency information. This dialogue will enable you to meet community collaborators who can help you learn where to locate at-risk population groups. Ask community collaborators to explain:

Step 6: Expand Your COIN to Include Service Providers, Businesses, and Others Who Work With, Represent, and Belong to At-risk Populations

Mission dinner.An overarching organization is the lead organization that might partner with or provide funding to many direct service providers. The service provider organizations are a more direct link to the populations they serve. You first contacted overarching organizations and government agencies in the “define” phase. These organizations can now serve as a link to service providers, providing detailed information and saving you time and resources.

If the overarching organization is unable to provide the requested information about its member organizations, you might have to contact the service providers directly to get the information you need. In such cases, an important way to build trust is to build upon existing relationships. Many CBOs and FBOs are already involved in public health initiatives to reach at-risk populations to eliminate health disparities. Reach out to these programs to enlist their help to reach the partners for your network.

At the local level, small FBOs such as missions, ministries, or individual congregations can provide informal community outreach through programs that visit sheltered-in populations or provide after-school mentoring. By asking general questions about such programs, you might locate some of the at-risk populations in your community.

Ad for the Healing Place: "other programs offer shelter for a night, we teach her how to build a new life".As you expand your list of organizations and contacts, the following tips might be helpful:

After identifying those organizations most appropriate to locate at-risk populations, you can begin to discuss the roles of your department and the other network members to locate and reach everyone in your jurisdiction, regardless of individual or community barriers.

How to Use the Information

As you continue to build and develop the network, maintaining the trust and anticipating possible concerns of your members will ensure the future success of your COIN.

Develop policies and procedures for the information you gather and maintain confidentiality of contact information for your COIN members. As you continue building and updating your database, the information you collect will likely become very attractive to other partners (including federal and state agencies), and you might get requests to share contact information for your network members.

Volunteers holding hands with the words "volunteer" on their shirts.The success of your network is built upon trust. Demonstrate your commitment to COIN members by having clear policies for how contact information will be used and by clearly defining confidentiality issues at the start of your relationship with each member. As keeper of this important contact information, decide ahead of time if you would be willing to disseminate messages on behalf of other partners during normal, non-emergency times, and include policies and procedures for non-emergency communications.

Expand and update your database. You will want to continue expanding the database you created in the "define" phase by adding contact information for community collaborators and program partners. You might also want to add the places where you have been able to locate at-risk populations and their gathering spaces.

As the work to locate and reach at-risk populations continues over time, members of your COIN might change or their contact information might change. Keeping your database current will be extremely important as your work moves forward.

Phase 3: Reaching At-risk Populations

Three people reviewing materials for a meeting.In an emergency, messages must not only inform and educate, but they must also mobilize people to follow public health directives. People are reached by using the languages they speak in dissemination methods such as television, radio, newspaper, bill inserts, or fliers. Messages are also spread by word-of-mouth (often the most effective communication method) and through social and community networks. For people to act, they must understand the message, believe the messenger is credible and trustworthy, and have the capacity to respond.

By now you have developed a COIN that has extensive knowledge about the needs of various at-risk populations in your community. The organizations in your COIN can provide a direct, trusted link to the populations they serve. The challenge is to incorporate their skills, knowledge, and communication strategies into your plans to reach at-risk populations. This integration will provide a more inclusive response in public health emergencies.

A Case Study in North Dakota

The objective of a study in North Dakota was to develop communication strategies to reach special populations in the state before, during, and after a crisis. Investigators used telephone interviews and telephone focus groups with organizations that represent special populations. Areas of inquiry included attitudes and concerns about crises, sources of information used and those identified as most credible, methods to reach people during a crisis event, and awareness of and attitudes about the agencies and organizations that affect risk communications. Telephone focus groups are a cost-effective way of canvassing the views of professionals who provide services to and interact regularly with special populations.

McGough, M., Frank, L.L., Tipton, S., Tinker, T., & Vaughan, E. (2005). Communicating the Risks of Bioterrorism and Other Emergencies in a Diverse Society: A Case Study of Special Populations in North Dakota. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science, 3 (5).

Step 1: Survey Agencies and Organizations to Learn About Their Successes and Failures

The best way to learn what works well is to ask people who are already in the business of reaching at-risk populations. You can conduct a simple interview or survey with people in and outside your agency who routinely communicate with members of at-risk populations. This might include professionals such as first responders (fire, police, and emergency medical services), people who are in charge of programs such as Meals on Wheels, tribal elders, instructors in English-as-a-second-language classes, ethnic media representatives, and health care practitioners at clinics.

You will be able to use this information to start planning appropriate ways to augment your existing communication plan to include at-risk population outreach. This survey interview can help you identify practices that succeed—some of which you might want to incorporate in your plan—and those that failed to accomplish any measurable objective.

Firefighters standing in front of a firetruck. Teacher helping her students.

Step 2: Conduct Focus Groups or Community Roundtables

Town hall meeting.An important next step is to use community assessment techniques (surveys and focus groups) to reveal in-depth details on the barriers and specific communication needs of at-risk populations in your community. Although these techniques can be the same used in research, you can use them for local program purposes not for creating general knowledge. Policies and procedures should be followed to ensure the privacy of the participants and the information collected.

Focus groups and community roundtables allow you to talk directly with members of the populations you want to reach. Your COIN members can help you in establishing and facilitating these focus groups. For example, their existing relationships could be beneficial to you as you recruit participants, pose appropriate questions, and gather information. This information can give you a better understanding of your at-risk populations by delving into topics such as:

Reaching Specific Populations

The Texas Department of Health undertook a project to identify message content and channels of communication among eight specified hard-to-reach populations. Methodology included a literature review, demographic mapping to determine key areas of concentration, key informant interviews, and focus groups.

Interviews and/or focus groups were conducted with population members and key informants for these populations: African American, Hispanic, the mentally ill, and rural. Interviews were used to validate key informant opinions and to assess effective communication strategies. Topics covered include:

  • Best communication methods to reach the population in an emergency
  • Most and least trusted messengers
  • Who the population would contact to confirm information they receive; and
  • Most preferred way for the information to be presented

(Barriers to and Facilitators of Effective Risk Communication Among Hard-to-Reach Populations in the Event of a Bioterrorist Attack or Outbreak; Texas Department of Health; February 2004;

Group of people conducting a meeting.This information can be obtained by asking leading questions like:

Community meeting.Before you conduct focus groups or community roundtables, check with your COIN and within your own agency to determine if these have already been done. Also consider the best ways to access your intended population. For example, if your target demographic is the elderly, conducting a focus group might not be effective because elderly people might have transportation or mobility issues that prohibit them from attending a focus group. This population may also mistrust people they do not know and worry about their personal safety.7

Woman conducting a telephone survey.In these instances, a telephone interview might be a more appropriate data collection method if trusted members of the community adequately prepare this population for such outreach. Telephone surveys are not without limitations and do not capture those without telephones, are possibly biased due to mobile phone use, and have a potentially low response rate because of caller identification and answering machines. As an alternative, a written survey delivered by a trusted source, such as a Meals on Wheels provider or a family member, could be an effective way to encourage participation.

A written survey, whether administered in-person or through the Internet, does not have the qualitative capability of assessing perceptions, attitudes, and behaviors through interpersonal communication and interaction. However, it can provide statistical data that reveal recurring themes, best communication methods and practices, media outlets used most often, and information sources that are trusted by the populations you are trying to reach.

If you plan focus groups for your intended population, schedule them at convenient times and at locations such as multi-cultural community centers, churches, schools, or senior centers that are easily accessible. You might need to arrange for interpreter services, depending on the specific population you are inviting.

American Sign Language Resources

The following resources can help you locate foreign language and American Sign Language (ASL) interpreting services and additional information that will be helpful:

  • National Council on Interpreting in Health Care (NCIHC)
  • Registry of Interpreters for the Deaf (RID)
  • National, state and local on-site interpreting providers
  • State and local interpreting associations
  • Recommendations from local organizations that frequently use interpreting services (CBOs, clinics, hospitals, courts, law offices, etc.)

7 McKinlay, JB. (1991). Optimal survey research methods for studying health-related behaviors of older people. Vital Health Stat 5, 6, 81-92.

Step 3: Analyze Data Gathered From the Surveys, Focus Groups, and Your Focus Groups, and Your Previous Assessment Efforts

Man working on data analysis.As you review your findings from the "define" and "locate" phases of this process, along with your recent focus groups and surveys, you might see common characteristics and needs that will enable you to create a list of key findings for each population. Look for common themes and emerging patterns that relate to reaching at-risk populations with messages they understand and to which they can respond.

Your findings might show that some cultural groups are less trustful of official government messages than the population as a whole and that they desire communication materials that are culturally relevant to their group. CBOs and FBOs can serve an important role in reinforcing and validating information for these groups who might receive information through mainstream channels first. The messages disseminated through these trusted sources will be consistent and reinforce the messages through the mainstream channels.

Step 4: Collaborate With Community Organizations

Group of people in a meeting room.Your assessment provides the basis for understanding the cultural and linguistic characteristics of your community and the communication barriers faced by at-risk populations. Such findings will serve as the basis for developing communication strategies that overcome communication barriers and convey information that is understandable and relevant to members of the diverse populations.

Community collaborators who have become a part of your network will bring their experiences in implementing communication strategies to the process. Ask your collaborators to share their strategies. In an emergency, public information must meet the needs of at-risk populations to be effective. Some communication tactics include:

Group of people discussing the next steps of a project.As part of your ongoing efforts to strengthen your local community’s capacity to respond to a public health emergency, you can conduct workshops with representatives of at-risk populations and community leaders who are already committed to participating in your agency’s outreach work. The workshops:

Depending on the size of your jurisdiction, you might choose to have a series of workshops in different locations. Activities at these sessions might include:

Group of people planning a meeting.Collaborate with community organizations or bring COIN members to the planning table to address the needs of at-risk populations in your agency’s all-hazards emergency preparedness plan by:

Step 5: Identify Appropriate, Trusted Messengers to Deliver Messages

At-risk populations might respond differently to a message depending on the messenger. For many groups, the person delivering the message is often better received if he or she is from a similar racial or ethnic group or is in a similar situation as the intended audience. Doors are more likely to open for peers who deliver health care messages to their neighbors than for someone from a different background who lives outside the neighborhood.

Even when members of an at-risk population group have access to the mainstream media, they might be more responsive (and therefore more willing to follow directions) if someone they know or trust delivers the message. For instance, elderly persons might watch television and listen to the radio, but might be more easily persuaded to take action if encouraged to do so by family or caregivers. For non-English speakers, a family member or representative of their faith community might have the most influence in delivering information.

Getting Creative with Trusted Messengers

Some localities have become creative with their methods of reaching the public in an emergency. For example, one local health jurisdiction has signed agreements to post emergency information on the marquees of banks, churches, grocery stores, and other local businesses. In addition to these important messages coming from local trusted community sources, this is useful in general for smaller communities where the might not be local daily media outlets.

People to consider as messengers include:

Man standing behind a pulpit in a church. A woman getting her hair done at a hair salon. TV reporter.

As you meet with community members to build your network, ask representatives from the different groups who they consider to be the best person to disseminate messages to their community. Avoid making assumptions about who the trusted person might be based upon your interactions with other groups.

How to Use the Information

Group of people standing outside of a building.As your COIN continues to grow, you will want to ensure that you keep in touch with the members and that you are incorporating their input into your existing communication and emergency operations plans.

Update your database. In your existing database, add vertical headings (such as barriers, channels, and messages) and enter the new information from your assessment on barriers for at-risk populations, preferred channels of communication, and the messages ranked most effective by your focus groups. This information will be an excellent resource and help you keep focused on the goals you have set.

Woman standing a whiteboard with Teamwork, Strategy and Sucess written on it.Enhance your communication plan to reach at-risk populations. Using key findings from your surveys, focus groups, and other searches, along with the information in your database, you can enhance your existing communication plan to include at-risk population groups and to designate the appropriate, trusted spokespersons. Be sure to include members of the at-risk populations in your planning sessions. Encourage them to provide input so that your communication plan is feasible and appropriate.

Your plan could be a supplement to your organization’s existing crisis and emergency risk communication (CERC) plan, or it could be incorporated into the body of the CERC plan itself. Elements to address in your communication plan include:

Next Steps

Three people looking at a computer.In a community, this systematic process can be used by all emergency planners to work together to define, locate and reach at-risk populations. It is hoped that everyone exploring the process will work to connect with one another and to coordinate their activities. Now that the process is complete, you will need to continue strengthening the relationships that you have developed.

Exercise your network with drills and preparedness exercises. Include your COIN members in preparedness exercises and drills to test their capability to disseminate information to the at-risk populations they represent. Using the information in your database, plan and carry out a simple drill to test your network using an e-mail message. Before the test, alert COIN members and give instructions for their response.

At the appointed time and day, send an e-mail test to the network members. Consider including information on individual emergency preparedness in the email to COIN members to promote public education events or activities. You might even consider using your network to disseminate non-emergency public health messages periodically. As you get more experience and a better understanding of your network membership, it will become easier to separate groups for different message dissemination purposes.

When exercising the capacity of the network for information dissemination, look for gaps in message delivery. Questions that you and your COIN members should ask include:

These exercises should generate after-action reports that will outline the gaps in your emergency communications and preparedness plans. Be sure to revise and update your preparedness plans based upon the after-action report findings.

Continue to include your network in preparedness planning and exercises for at-risk populations and regularly repeat the cycle to:

Jigsaw puzzle with the word "Community" on it.Expand your scope. Once you have been able to successfully define, locate, and reach members of your initial at-risk population groups, you can expand your initiative to include more groups using the same steps you followed in each phase of this process.

Other ways to expand your scope in this work include:

We encourage you to make the connections to build a robust and functional COIN that will serve your community well during an emergency.

The At-risk Populations eToolbox

Plan Components, Use this fillable form to keep track of your community data and contacts.Public Health Workbook To Define, Locate, and Reach Special, Vulnerable, and At-Risk Populations in an EmergencyIn addition to a comprehensive resource guide, this eTool contains links to other resources that will help you develop your COIN plan to define, locate, and reach your at-risk populations in an emergency. Use the worksheet “Plan Components” to track your plans, ideas, and resources in a fillable PDF format.

The fillable PDF “Plan Components” form makes it easy to keep track of your at-risk populations COIN data. Just click in the field boxes for each entry and fill in the blanks with your own data. Add fields when you need them.

Download and print out a copy of the PDF workbook, “At-risk Populations Workbook To Define, Locate, and Reach Special, Vulnerable, and At-risk Populations in an Emergency.”

Contact CDC with questions or comments about this eTool

Resource Guide



Resource Dictionary



Plan Components


CDC’s Office of Public Health Preparedness and Response (OPHPR) would like to thank all of the professionals who supported this project and generously shared their time, expertise, and insight.

Unfortunately, there are far too many contributors to allow formal acknowledgement of each and every person. It is hoped that in reading through this eTool, those who contributed will recognize their work and be proud of the role that they played.

Resource Dictionary


2-1-1 is an easy to remember telephone number that, where available, connects people with important community services and volunteer opportunities. United Way chapters across America are spearheading the implementation of 2-1-1.United Way of America and the Alliance for Information and Referral Systems strongly support federal funding so that every American has access to this essential service.

American Association on Intellectual and Developmental Disabilities (AAIDD)

AAIDD is an organization that promotes policies, information, and human rights for people with intellectual and developmental disabilities.

Also see disability resource list at

American Foundation for the Blind (AFB)

A nonprofit organization that advocates for the blind or visually impaired in the United States.

American Red Cross

The American Red Cross offers humanitarian care to the victims of war and aids victims of devastating natural disasters. Over the years, the organization has expanded its services, with the aim of preventing and relieving suffering.

Area Agency on Aging (AAA)

The AAA provides local services that make it possible for older individuals to remain at home, preserving their independence.

Area Health Education Centers (AHEC)

The AHEC (Area Health Education Centers) program was developed by Congress in 1971 to recruit, train and retain a health professions workforce committed to underserved populations. Together, with the Health Education and Training Centers program, helps bring the resources of academic medicine to bear in addressing local community health needs. By their very structure, AHECs and HETCs are able to respond in a flexible and creative manner in adapting national health initiatives to the particular needs of the nation’s most vulnerable communities.

Asian and Pacific Islander Health Forum (AAPIHF)

A national advocacy organization that promotes policy, program, and study to improve the health and well-being of Asian American and Pacific Islander communities.

Behavior Risk Factor Surveillance System (BRFSS)

CDC’s BRFSS is the world’s largest, on-going telephone health survey system, tracking health conditions and risk behaviors in the United States yearly since 1984. Conducted by the 50 state health departments as well as those in the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands with support from CDC, BRFSS provides state-specific information about issues such as asthma, diabetes, health care access, alcohol use, hypertension, obesity, cancer screening, nutrition and physical activity, tobacco use, and more. Federal, state, and local health officials use this information to track health risks, identify emerging problems, prevent disease, and improve treatment.

BRFSS Operational and User’s Guide

The User’s Guide is a manual covering all aspects of BRFSS survey operations and includes information on many aspects of the BRFSS survey that can help you as you develop survey tools and need to train people to conduct telephone surveys.

CDC Emergency Preparedness & Response

This site is intended to increase the nation’s ability to prepare for and respond to public health emergencies. This site provides information on preparing for specific hazards such as bioterrorism, chemical emergencies, radiation emergencies, mass casualties, and natural disasters and severe weather.

Centers for Independent Living (CIL)

CILs are non-residential, private, and CBOs that provide services for individuals with all types of disabilities. The CILs program provides grants for agencies that are designed and operated within a local community by individuals with disabilities and provide an array of services. At a minimum, centers must provide core services (information and referral, independent living skills training, peer counseling, and individual and systems advocacy) and most centers also provide additional services such as community planning and decision making; school-based peer counseling, role modeling, and skills training; working with local governments and employers to open and facilitate employment opportunities; interacting with local, state, and federal legislators; and staging recreational events that integrate individuals with disabilities with their able-bodied peers.

Community Action Agencies (CAA)

CAAs work to fight poverty at the local level. The Community Action Partnership was established in 1971 as the National Association of Community Action Agencies and is the national organization representing the interests of the 1,000 CAAs working to fight poverty at the local level.

Community Development Block Grant Program (CDBG)

The CDBG program is a flexible program that provides communities with resources to address a wide range of unique community development needs. Beginning in 1974, the CDBG program is one of the longest continuously run programs at HUD.

The CDBG program works to ensure decent affordable housing, to provide services to the most vulnerable in our communities, and to create jobs through the expansion and retention of businesses. CDBG helps local governments tackle serious challenges facing their communities. The CDBG program has made a difference in the lives of millions of people and their communities across the nation.

Office of Community Planning and Development (CPD)

The Office of Community Planning and Development (CPD), U.S. Department of Housing and Urban Development (HUD) seeks to develop viable communities by promoting integrated approaches that provide decent housing, a suitable living environment, and expand economic opportunities for low and moderate income persons. The primary means is the development of partnerships among all levels of government and the private sector, including for-profit and non-profit organizations.

Crisis and Emergency Risk Communication (CERC)

Updated in 2006, this resource provides tools for communicating to the public, media, partners and stakeholders during an intense public health emergency.

CERC: For Leaders by Leaders

Developed in 2005, this course provides tools for speaking to the public, media, partners and stakeholders during an intense public-safety emergency, including terrorism.

Fundamentals of Crisis and Emergency Risk Communication (CERC)

This toolkit was developed by Yale Center for Public Health Preparedness to support a “train the trainer” program for state and local public health practitioners in public health emergency preparedness.

Emergency Risk Communication CDCynergy

Based on CERC principles, ERC CDCynergy is a step-by-step tutorial and performance support tool to help federal, state, and local public health communicators systematically plan, implement, and evaluate emergency health communications. Contained on a single CD-ROM, ERC CDCynergy contains resources, examples, and tools for pre-event planning and preparation, communication response during and after an event, and advice from risk communication experts.

Disability Preparedness Center

This disability preparedness web site provides practical information on how people with and without disabilities can prepare for an emergency. It also provides information for family members and service providers of people with disabilities. In addition, this site includes information for emergency planners and first responders to help them prepare for serving persons with disabilities.

Diversity Rx

A clearinghouse of information on how to meet the language and cultural needs of minorities, immigrants, refugees and other diverse populations seeking health care.

Emergency Food and Shelter Programs (EFSP)

The EFSP is an organization created to supplement the work of local social service organizations within the United States to help people in need of emergency assistance—shelter, food, and other support services.

Federal Emergency Management Agency (FEMA)

FEMA’s continuing mission within the DHS is to lead the effort to prepare the nation for all hazards and effectively manage federal response and recovery efforts following any national incident. FEMA also initiates proactive mitigation activities, trains first responders, and manages the National Flood Insurance Program.

Resources for Individuals with Special Needs

Additional steps individuals with disabilities or special needs should take to prepare or respond to a disaster.

First Hours: Communicating in the First Hours

The Office of Public Affairs of the HHS and the CDC have developed messages and other resources for federal, state, local, and tribal public health officials to use during a response to an emergency. The messages apply to all Category A Biological Agents, as classified by CDC, as well as messages about chemical and radiological events and suicide bombing and were written to be used by federal public health officials and to be adapted for the use of state and local public health officials during a terrorist attack or suspected attack.

  • Use these messages as follows:
    • To communicate with the public during a terrorist attack or a suspected attack
    • To adapt for a specific event (These messages were written for fictitious situations, so assumptions were made about an event.)
    • To provide information during the first hours of an event
    • To save precious moments during the initial response time and to buy the time necessary for public health leaders to develop more specific messages

Geographic Information System (GIS)

GIS is a system for creating, storing, analyzing and managing spatial data and associated attributes. In the strictest sense, it is a computer system capable of integrating, storing, editing, analyzing, sharing, and displaying geographically-referenced information. In a more generic sense, GIS is a tool that allows users to create interactive queries (user created searches), analyze the spatial information, and edit data. Geographic information science is the science underlying the applications and systems, taught as a degree program by several universities.

Health Centers

The diverse public and non-profit organizations and programs that receive federal funding under section 330 of the Public Health Service (PHS) Act, as amended by the Health Centers Consolidated Act of 1996 (P.L.104-299) and the Safety Net Amendments of 2002.

They include:

  • Community Health Centers
  • Migrant Health Centers
  • Health Care for the Homeless Health Centers
  • Primary Care Public Housing Health Centers

Health Centers are characterized by five essential elements that differentiate them from other providers:

  • They must be located in or serve a high need community, i.e. “medically underserved areas” or “medically underserved populations;”
  • They must provide comprehensive primary care services as well as supportive services such as translation and transportation services that promote access to health care;
  • Their services must be available to all residents of their service areas, with fees adjusted upon patients’ ability to pay;
  • They must be governed by a community board with a majority of members health center patients; and,
  • They must meet other performance and accountability requirements regarding their administrative, clinical, and financial operations.

Health Insurance Portability and Accountability Act (HIPAA)

The Standards for Privacy of Individually Identifiable Health Information (“Privacy Rule”) establishes, for the first time, a set of national standards for the protection of certain health information. The HHS issued the Privacy Rule to implement the requirement of the HIPAA. The Privacy Rule standards address the use and disclosure of individuals’ health information—called “protected health information” by organizations subject to the Privacy Rule—called “covered entities,” as well as standards for individuals’ privacy rights to understand and control how their health information is used. Within HHS, the Office for Civil Rights has responsibility for implementing and enforcing the Privacy Rule with respect to voluntary compliance activities and civil money penalties.

A major goal of the Privacy Rule is to assure that individuals’ health information is properly protected while allowing the flow of health information needed to provide and promote high quality health care and to protect the public’s health and well-being. The rule strikes a balance that permits important uses of information, while protecting the privacy of people who seek care and healing. Given that the health care marketplace is diverse, the rule is designed to be flexible and comprehensive to cover the variety of uses and disclosures that need to be addressed.

Indian Health Service (IHS)

HIS IHS is the federal health program to promote healthy American Indian and Alaska Native people, communities, and cultures.

Meals On Wheels Association of America (MOWAA)

The oldest and largest organization in the United States representing those who provide meal services to people in need, MOWAA works toward the social, physical, nutritional, and economic betterment of vulnerable Americans.

The MOWAA provides the tools and information its programs need to make a difference in the lives of others. It also gives cash grants to local senior meal programs throughout the country to assist in providing meals and other nutrition services.

Mental Health America (MHA) or

Formerly National Mental Health Association (NMHA), a nonprofit organization addressing all aspects of mental health and mental illness.

Modern Language Association (MLA) Language Map

The MLA Language Map and its Data Center provide information about more than 47,000,000 people in the United States who speak languages other than English at home. It uses data from the 2000 U.S. Census to display the locations and numbers of speakers of 30 languages in the United States.

National Assessment of Adult Literacy

The 2003 National Assessment of Adult Literacy is a nationally representative assessment of English literacy among American adults age 16 and older. Sponsored by the National Center for Education Statistics (NCES), NAAL is the nation’s most comprehensive measure of adult literacy since the 1992 National Adult Literacy Survey (NALS).

Health Literacy Component

Introduces the first-ever national assessment of adults’ ability to use their literacy skills in understanding health-related materials and forms.

National Area Health Education Center (AHEC) Organization (NAO)

The national organization to support and advance the Area Health Education Center (AHEC)/Health Education Training Center (HETC) network in improving the health of individuals and communities by transforming health care through education.

There are currently 50 AHEC programs with more than 200 centers and a dozen HETCs operating in almost every state and the District of Columbia. Approximately 120 medical schools and 600 nursing and allied health schools work collaboratively with AHECs and HETCs to improve health for underserved and under-represented populations.

National Alliance on Mental Illness (NAMI)

The nation’s largest grassroots mental health organization dedicated to improving the lives of persons living with serious mental illness and their families. Founded in 1979, NAMI has become the nation’s voice on mental illness, a national organization including NAMI organizations in every state and in over 1,100 local communities across the country who join together to meet the NAMI mission through support, education, and advocacy.

National Association of the Deaf (NAD)

An organization that promotes, protects, and preserves the rights of deaf and hard-of-hearing individuals.

National Association on Alcohol, Drugs, and Disability (NAADD)

NAADD promotes awareness and education about substance abuse among people with co-existing disabilities.

National Association of Counties (NACo)

NACo is the only national organization that represents county governments in the United States. NACo understands the importance of strong public-private partnerships and is committed to assisting counties and businesses explore new, innovative ways of working together.

National Association of Regional Councils (NARC)

NARC is a non-profit organization that represents pro-active, multi-functional, full-service organizations that serve local units of government. Members are local elected officials and professionals who work with community leaders and citizens in several core areas, such as transportation, community and economic development, environmental quality, homeland security and emergency preparedness.

National Center for Cultural Competence (NCCC)

The mission of the NCCC is to increase the capacity of health and mental health programs to design, implement, and evaluate culturally and linguistically competent service delivery systems.

National Center for Cultural Competence Database

The NCCC Resource Database includes of a wide range of resources on cultural and linguistic competence (e.g. demographic information, policies, practices, articles, books, research initiatives and findings, curricula, multimedia materials and Websites, etc.). The NCCC uses specific review criteria for the inclusion of these resources. As part of the NCCC’s web-based technical assistance, a selected searchable bibliography of these resources is made available online. The database is not an exhaustive listing and it is updated on a regular basis.

National Center for Frontier Communities

The only national organization dedicated to the smallest and most geographically isolated communities in the United States—the frontier. The Center operates a clearinghouse for Frontier communities as a central point of contact for referrals, information exchange, and networking among geographically separated communities.

National Council on Aging (NCOA)

NCOA is a nonprofit service and advocacy organization headquartered whose mission is to improve the lives of older Americans.

National Council on Disabilities (NCD)

NCD is an independent federal agency that works to enhance the quality of life for all Americans with disabilities and their families.

National Council on Independent Living (NCIL)

NCIL is a membership organization that advances independent living and the rights of those with disabilities.

National Council of La Raza (NCLR)

The NCLR is the largest national Latino civil rights and advocacy organization in the United States. NCLR works to improve opportunities for Hispanic Americans.

National Council on Interpreting in Health Care (NCIHC)

NCIHC is committed to promoting ethics, standards and quality for medical interpreters in the United States.

National Family Association for the Deaf-Blind (NFADB)

A nonprofit association that works to ensure deaf and/or blind individuals are entitled to the same opportunities as other members of the community.

National Indian Health Board

The National Indian Health Board advocates on behalf of Tribal Governments and American Indians/Alaska Natives in their efforts to provide quality health care.

National Oceanic and Atmospheric Administration (NOAA)NOAA Weather Radio All Hazards (NWR)

A nationwide network of radio stations broadcasting continuous weather information directly from the nearest National Weather Service office. NWR broadcasts official Weather Service warnings, watches, forecasts and other hazard information 24 hours a day, 7 days a week. Working with the Federal Communication Commission’s Emergency Alert System, NWR is an “All Hazards” radio network, making it a single source for comprehensive weather and emergency information. In conjunction with federal, state, and local emergency managers and other public officials, NWR also broadcasts warning and post-event information for all types of hazards—including natural (such as earthquakes or avalanches), environmental (such as chemical releases or oil spills), and public safety (such as AMBER alerts or 911 Telephone outages).

National Organization on Disability (NOD)

The mission of the National Organization on Disability (NOD) is to expand the participation and contribution of America’s 54 million men, women, and children with disabilities in all aspects of life. By raising disability awareness through programs and information, together we can work toward closing the participation gaps.

National Rural Health Association (NRHA)

NRHA is a national nonprofit membership organization. NRHA’s mission is to improve the health and wellbeing of rural Americans and to provide leadership on rural health issues through advocacy, communications, and education.

National Standards for Culturally and Linguistically Appropriate Services (CLAS)

The standards are intended to be inclusive of all cultures and not limited to any particular population group or sets of groups; however, they are especially designed to address the needs of racial, ethnic, and linguistic population groups that experience unequal access to health services. Ultimately, the aim of the standards is to contribute to the elimination of racial and ethnic health disparities and to improve the health of all Americans.

There are 14 CLAS standards organized by themes:

  • Culturally Competent Care (Standards 1-3),
  • Language Access Services (Standards 4-7)
  • Organizational Supports for Cultural Competence (Standards 8-14)

They include three types of standards of varying stringency:

  • CLAS mandates are current federal requirements for all recipients of Federal funds (Standards 4, 5, 6, and 7).
  • CLAS guidelines are activities recommended by the Office of Minority Health (OMH) for adoption as mandates by federal, state, and national accrediting agencies (Standards 1, 2, 3, 8, 9, 10, 11, 12, and 13).
  • CLAS recommendations are suggested by OMH for voluntary adoption by health care organizations (Standard 14).

Additional resources to help you apply the CLAS standards:

  • Diversity Rx

  • National Center for Cultural Competence (NCCC)

National States Geographic Information Council (NSGIC)

NSGIC is committed to efficient and effective government through the prudent adoption of geospatial information technologies (GIT). Members of NSGIC include senior state GIS managers and coordinators.

National Voluntary Organizations Active in Disaster (NVOAD)

NVOAD is an organization that coordinates planning efforts by many voluntary organizations responding to disaster. NVOAD is not itself a service delivery organization. Instead, it upholds the privilege of its members to independently provide relief and recovery services, while expecting them to do so cooperatively. NVOAD is committed to the idea that the best time to train, prepare, and become acquainted with each other is prior to the actual disaster response. Organizations and agencies that wish to become NVOAD members go through an application process and need to demonstrate their capability to work within the parameters agreed to by the members of NVOAD.

New America Media (NAM)

NAM is the country’s first and largest national collaboration of ethnic news organizations. Founded by the nonprofit Pacific News Service in 1996, NAM is headquartered in California, where ethnic media are the primary source of news and information for over half of the state’s new ethnic majority.

NOAA Weather Radio

See National Oceanic & Atmospheric Administration.

Paralyzed Veterans of America (PVA)

Congressionally chartered veterans service organization with a unique expertise on the special needs of veterans.

Pew Hispanic Center

The Pew Hispanic Center is a nonpartisan research organization that works to improve understanding of the U.S. Hispanic population.

Refugee Health Promotion & Disease Prevention (RHPDP) Initiative/Office of Refugee Resettlement (ORR)

An approach to health and mental health to increase awareness and interest in health promotion and disease prevention programs targeting refugees, and provide information and tools to assist organizations in related activities and services. The overall objective of this initiative is to increase the health and well-being of high risk refugee populations in the United States.

Regional Councils

Regional Councils are multi-service entities with state and locally defined boundaries that may deliver federal, state, and local programs while functioning as planning organizations. They are accountable to local units of government and typically work in comprehensive and transportation planning, economic development, workforce development, the environment, services for the elderly, and clearinghouse functions. According to the National Association of Regional Councils (NARC), nearly half of all MPOs operate as part of a Regional Council.

Registry of Interpreters for the Deaf (RID)

A national membership organization of professionals who provide sign language interpreting/ transliterating services for deaf and hard of hearing persons.

Reverse 911

REVERSE 911® is a communications solution that uses a patented combination of database and GIS mapping technologies to deliver outbound notifications. Users can quickly target a precise geographic area and saturate it with thousands of calls per hour. The system’s interactive technology provides immediate interaction with recipients and aids in rapid response to specific needs.

Users can also create a list of individuals with common characteristics (such as a Neighborhood Crime Watch group or emergency responder teams) and contact them with helpful information as needed. REVERSE 911® is used effectively in thousands of communities, counties, commercial businesses, schools and non-profit organizations to dramatically improve the lines of communication to the general population and targeted groups.

Snapshots of Data for Communities Nation-Wide (SNAPS)

SNAPS provides local level community profile information nation-wide. It can be browsed by county and state and searched by zip code. SNAPS serves as a valuable tool when responding to public health emergencies at the state, tribal, and local levels. It provides a “snapshot” of key variables for consideration in guiding and tailoring health education and communication efforts to ensure diverse audiences receive critical public health messages that are accessible, understandable, and timely.

Online access to SNAPS is available at:

Additional information and SNAP CD-ROMS can be requested by contacting the ECS Community Health Education Team at 404-639-0568.

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

WIC serves to safeguard the health of low-income women, infants, and children up to age 5 who are at nutritional risk by providing nutritious foods to supplement diets, information on healthy eating, and referrals to health care.

The Sphere Project

Launched in 1997 by a group of humanitarian Non-governmental Organizations and the Red Cross and Red Crescent movement, Sphere has an international scope and is based on two core beliefs: first, that all possible steps should be taken to alleviate human suffering arising out of calamity and conflict, and second, that those affected by disaster have a right to life with dignity and therefore a right to assistance. Sphere is three things: a handbook outlining minimum standards of support, a broad process of collaboration, and an expression of commitment to quality and accountability.

Strategic National Stockpile (SNS)

CDC’s Strategic National Stockpile is a national repository of antibiotics, chemical antidotes, antitoxins, life-support medications, IV administration, airway maintenance supplies, and medical/surgical items. The SNS is designed to supplement and re-supply state and local public health agencies in the event of a national emergency anywhere and at anytime within the U.S. or its territories. Once federal and local authorities agree that the SNS is needed, medicines will be delivered to any state in the U.S. within 12 hours. Each state has plans to receive and distribute SNS medicine and medical supplies to local communities as quickly as possible.

Substance Abuse and Mental Health Services Administration (SAMHSA)

A public health agency within the HHS, responsible for improving the accountability, capacity and effectiveness of the nation’s substance abuse prevention, addictions, treatment, and mental health services delivery system.

Tips for First Responders (2nd Edition)

This booklet provides tips for first responders on dealing with specific populations, including: seniors, people with service animals, mobility impairments, autism, deaf or hard of hearing, blind or visually impaired, cognitive disabilities, multiple chemical sensitivities, and mentally ill.

Trust for America’s Health (TFAH)

TFAH is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

TFAH released the fourth annual report: Ready or Not? Protecting the Public’s Health from Disease, Disasters, and Bioterrorism in December 2006.

U.S. Census Bureau

Part of the U.S. Department of Commerce, the U.S. Census enumerates the population once every ten years, and collects statistics about the nation, its people, and economy.

U.S. Citizenship and Immigration Services

Responsible for the administration of immigration and naturalization adjudication functions and establishing immigration services, policies, and priorities.

The United Way

The United Way is an overarching organization that mobilizes local leaders and their communities to identify and address local human needs.

Women and Infants Service Package (WISP)

National Working Group for Woman and Infant Needs in Emergencies in the United States

The goal of WISP is to ensure that the health care needs of pregnant women, new mothers, fragile newborns, and infants are adequately met during and after a disaster. The guidelines are intended to aid emergency planners and managers, maternal and child health organizations, professional associations, and federal, state and local government agencies.

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