applies to ethical or -- warfare in a traditional sense but not insurgencies, civil war mike, counterterrorism efforts and things like that. .. in the non-narrow legal sense. and you're quite right, counterinsurgency is for. it's four in the commonly

understood sense if not in the very narrow legal definition of what war is. it's on conflict. i think it's worth just mentioning that the thing that the martin's cause, in all 20th century law conflict, you find the martin's cause. and effectively -- i can't remember exactly what it says, but its flavor is just because it's not written in a while but does not mean you can do it. in a nutshell. what it says as we might not have captured everything in this particular piece of law that were seen applies to all. if we haven't, we rely on ethical principles. if it's customary to me do it anyway, even if it's not written down. if it is a violent assault on the conscience of humankind, just because the law doesn't say it's illegal, doesn't mean you can do it. it's wrong. and you find in the geneva convention, just a little

paragraph. i said just because it's not raining down, does that mean it's okay. >> so what is a vacuum in iraq, doesn't mean you can feel that vacuum with anything you want. you still must apply ethical principles. what others like to jump in on this question? >> he said that much more expertly than i could, but i think there's a distinction that we must hear about policing operations nowadays, which somehow i never get the thing about policing operations because policing has different sets of rules them all to warfare. so for instance, if someone is holding hostages come you don't bomb the building. please are much more careful about collateral damage. so i think it's important, rather than call warfare would be actually doing the opposite and pull it apart and have a different set of rules for policing operations that we have further warfare.

>> i would have a very short answer to your question into the last one. and regarding preemption, e. you don't know whether it's your adversary intention. so should you try, she chewed distressed it is always possible in human population. what should you presume when you are in responsibility? when you're in the political leadership now? the reason for risk at stake, so we come back to your first question saying what additional risk should we take not only in ourselves -- and life at lurch

and it is obvious that if the answer is we will never take any kind of risk, then it is a whole vision for the political community, which emerges and obviously to just political goals. so, it seems to me, that when we still cornered in the province, we should think that before being cornered, we should have more about peace. and when it was possible and

maybe it is always possible. >> so you too would say we mustn't give up on last resorts too quickly or jump too quickly to last resorts? >> yes. in order to build trust, probably we have to acknowledge some kind of good faith i mean. probably your adversary wants to harm you. okay, good faith is not that. when i present some kind of good faith means to understand that your adversary is not always and this is supremely unjust to the people for leadership. and that it has some kind of

idea that you can disagree with and you can say rather it is imperfect and yet -- and yet, your adversary is not that dean only on that intention as a gangster or an evildoer. this happens sometimes, but not always. and so, we have to understand this kind in the ideas of justice. it's not only as the ideas of good, which are many. if the ages of justice which are many. and so we are not getting out of the problem with this justice. so the problem is diplomacy, you know, can we figure out where imperfectly we can make spinning together very imperfect for

different ideas of justice or is that compromise by itself unjust? this is the choice to be made. compromise are not compromising. not only in domestic policy, but also in world policy. >> there's a lot of elements and not in the point about the potential need to compromise in some cases, but also your point about respecting different views of justice and not going into a conflict with the assumption that your enemy does not have a concept of justice, even if it differs. >> it could be dehumanizing for everybody, not assuming that we all refer to some kind of saying i do it justice, which would be all embracing to be all

embracing idea of justice. but the fact is -- and we see these quite well in domestic policy, that we are sensitive -- more sensitive to some dimension of justice. i would talk about dimensions of justice as we talk about dimensions of time or space, you know? and when i listened to your debates, which is so artfully said pitcher republican is working not this bad. that is from a foreign point of view. and it seems to me that while everything is true, you know, this is some kind of tragedy, you know.

well, distressed -- i don't want to be too graphic. >> now, thank you for your thoughts. next up on the roger. >> yes, my name is roger kram and i teach courses at hiram college about the disadvantages of new technology. and i don't know whether this story is true or not, the six weeks ago on national public radio, the former cia agent was interviewed, who was still active with the state department he said that two months ago and armed drone aircraft was taken over from signals coming up from tel aviv. andy was throwing -- the aircraft was darwin for miles out toa, believe it or not, beach, where the aircraft circled for our, aiming the

camera stone on the women. now it was later found that it was a 17 and a 19-year-old hacker that had done this. true or not, when we fired our weapons by remote signals, especially if they're armed, what is the likelihood of advanced hackers being able to take over these weapons systems? >> if you like this is a question for you, no. >> charges are dimensions of cyberwarfare. and i think what we've got a remote-controlled machine, it's particularly susceptible to being taken over. i don't know about that particular instance. you might also true. but i do know that, for instance, the taliban were fine on my laptops with film footage from the drones on a piece of software they bought in sweden

for $10. and that's all it to. but i think the trouble is if you go away for the remote control -- it is not discussed or not to united states plans for the lot since 2004 have gone towards anonymous systems, so that packable in the same way because you've cut the remote link and they're not shame about either, so that's why it's a much worse scenario. because you've got machines that can't discriminate between combatants and civilians at all. and so we start using us. >> you take the human out of the loop altogether. mikey take him the monotonous loop altogether. >> to talk about them in stages with one person and executive control of many machines. again, if there is an executive control, that's fancy because it takes away the whole point of having them autonomous. you need them autonomous for things like dogfighting. if you go into deep mission and if you're fighting a nation such

as china or russia, not the taliban, someone who is technologically sophisticated, they will chip the signals, be able to jam the radio signals. but for me, this is a much, much worse scenario than having people take over the drones. >> they can also -- if they take over the drones, they can send our weapons against us. >> will stop using them. >> i would also just mention in this context that some of the folks on the stage here, but other scholars that a number of institutions, including this one, are involved in a research consortium to look at some of these issues. but those of u.s. interest it is called stepmom, which is a long acronym that stands for consortium on emerging technology military operations and national security and it is for scholars interested in the subject and i direct you to the stepmom.org website for more questions of this nature.

yes, ma'am. >> hi, my name is so weird, most than 913. >> thank you, for joining us. actually, my view of peace -- i've never known war before in my life. and my view of peace is completely void of war. so when you tell -- when people tell us that were is simply a way to manufacture peace, i would ask you, why? >> i don't think it's a way to manufacture peace. i think it's a way at times to return to a piece. it's fortunate that you've never known board. that's a good thing. there are many people in many nations at your age with no nothing but violence.

and i would ask you even what's the definition of peace. without a lot about what is the definition of poor, but there are times when you can say that in the avoidance of warfare, because nations do not resort to conflict, that there are citizens of different nations who are subject to due a lack of peace all the time physically and in their spirits for the oppression that they go through. that lack of warfare piece for them, do you automatically transcend from your either at war or peace. you know, those are certainly things to think about. and my own thought about it i think about the women and the children and there's a u.n. security council resolution passed about 10 years ago called 13.5 that it would invite you to go and read. and it talks about the brunt of

warfare, but i'd say the brunt of a lack of peace globally, impacts women and children in a way that doesn't impact men. and in many cases, that's because in different societies or nations, women could not even stand and a microphone situation like you are doing right now, to be able to address that kind of a question. and moving forward, much of the research that's been done in the last 10 or 15 years, there's a really fine article i think written about five years ago by a group of researchers at harvard, talk about statistically over the course of hundreds of years the impact on women and children of warfare and that if we in fact increase the education of women and we provide opportunity for them, then by nature we therefore secure were peaceful

circumstances and that warfare is something that is not resorted to as often. there are many instances where there are crimes of humanity perpetrated against women particularly in the form of or terror kind of situations like that or oppression, that some would define as short of warfare, but certainly could not be, you know, in many ways construed as a way for them to have a peaceful life. so, i'm happy that you have had the absence of warfare in your life and that you have had peace. and i have a daughter who was 20, who i hope never noticed those kinds of circumstances that either women are subject to another nations. i would tell you i think one of the things that's very important is as we look to secure peace, that we do it on the basis that

is not only across the lines of countries, so that were not at war, but that in fact the kind of existence that people have this one of opportunity and one of liberty and one of education and one of peace that they have an ability to feel secure no matter where they are. >> another comment. >> i wish i could speak like yourself. if they have never experienced anything but peace. i have never experienced anything but boring truth between different wars. i think you've got the picture somewhat wrong. i mean, the picture is not as peace, then someone comes at the idea of having war in order to have peace. the pictures you have something which is not accept the bull, which could be a war of one side or another, which could be

genocide and other circumstances. then, you wage a war in order to stop that activity, which is tremendous. but when you wage a war, you carry it out, you have to constantly think about what's going to happen after the war has ended. and you have to think about peace. so waging a war is not just getting victory over your enemy. waging a war and the proper way is to gain victory over your enemy, but in a way that enables all of the involved parties to strike a peace among themselves when the war ends. >> i know, george, you've written extensively about just peace. did you want to join a comment? >> well, i guess the addendum to this is even if we could envision that dream in the folk song of all the people from

other nations coming together in signing a document, which they renounced war, we essentially have that at the united nations convention in 1948. that was what it was intended to do. what do we do with a convention like that that grant the minor parties and signatories to the document, the unlimited right to do a limited run within their own borders. the sort of thing that admiral carper is referring to. what about the holocaust? what about the people of rwanda? so, what we need and do not have yet is a way of protecting peaceloving individuals who are going about their own business in 19 drug business whether their identity as a nation from being harassed and arrest with violence and death. i think its right not to call that concerned more. it's instead bought in for a law

enforcement and we have no way beside the ad hoc way we go about it now in the current national order for protecting the rights of older people and therefore or rwanda, in israel, in wherever they may be. we don't have a right or a method of doing that. and so, we relied on what our customs of war insofar as they can be made to fit this, to try and accomplish this. this is why afghanistan lingers on. it's not that anybody wishes to make war on the poor afghan people. it's rather that what kind of state can be established so those people will be a lot to live their lives without imminent threat in terror as criminal activity doubles threaten their security. we don't have any good answer to that and we don't have any good way of protecting it. we were doing it now is a particularly good, but it's only have. and so what we do is look to

people like yourselves to come up with better instruments for the ones we currently have, less conflicted thoughts interested in germans that would guard the rights and the security of vulnerable peoples. >> the fact that you're here listening to this conversation and that you care gives us all a bit of hope and we appreciate your presence. thank you. >> good morning. due to time i'll try to be very brief. first of all, thank you for all of your work. i want to recommend shannon french's book to everyone, the code of the lawyer. and it's quite fitting we began our discussion and they make clear how utterly important it is to have guiding moral and ethical principles at every level from protecting civilians in ecology and infrastructure toward troops who actually do the combat and although it to

leadership. some of the comments, of course, are compelling and disturbing and i want to bring up this point. i worked with veterans from all over the world and for many of the wars in living memory for over 31 years. there is no compelling justification to a soldier who has been in combat for taking a civilian life. there is no compelling justification when a combatant decides before, during or after the conflict that the causes or the gains were illegitimate. and there is no compelling justification to a combatant when they determine that they are war was not truly and exclusively a last resort. the only justification i've ever encountered in working with combatants all over the world is when they absolutely

unquestionably determined that they fought and had to kill in order to protect the immediate and absolute threat to their families, their children's lives, their homes. and every other case except those who have psychopathic tendencies, are combatants break down into what we call posttraumatic stress disorder and moral trauma is at its heart. so how do we apply the ethical standards to all of you representing so that such a high level, but the conscience of our combatants and civilians are absolutely unconventionally protect you. >> excellent question. thank you. who would like to take this first? i think wendi and the asa. >> that's an outstanding point. i have had people who have worked for me who have come back

and gone through that posttraumatic stress. and my own father with you that from. no one at that point in time, although they categorized it as ptsd, no one offered assistance. i would tell you in my own state, that i believe fundamentally that someone particularly or trim 11 might not have the concerts, but we volunteer force and get the volunteers sometimes will come back with the same kinds of issues. there are a number of really fine books with my actually one gal, a psychologist who is in iraq, who came back having been a psychologist they are, who was supposed to be -- i'm i'll use the word ministering to our troops on the ground and yet no one was asking her how she was

doing. okay, and it even parallels i would tell you friends of mine who are.as an emergency rooms and places like los angeles, who go through that same kind of trauma and stress. and when we were dispatching troops to haiti to be on the ground for the kinds of operations they were going to be doing there for relief, one of the first things i did because i'm a fellow ecology major, i'm not an engineer. one of the first things i did was e-mail the four-star who is sending sending our folks down there and say sir, please consider dispatching now people who will be trained to minister to the troops spiritually, emotionally, medically because of what they're going to see. the conflict on their consciences as doing relief efforts, where we were not even in warfare, okay? and the fact that they couldn't intercede, especially for the

children to save the children was so traumatic for many of them. and this is something that we have to grapple with in the united states and i think globally about any relief efforts, and a wartime scenario that we have people who are traumatized by these things, i would say even our policemen and firefighters, certainly the one who responded after 9/11. this is something that we have to do. and i believe within my heart that it's not just a psychology piece, but it's a whole of person peace and not much of that has to come from the spiritual aspect of how to affect individual deal with it from a spiritual perspective, particularly knowing that they may have volunteered to go into that situation and then not fully understood what it is that they were going to get into. and i think one of the problems

for many, many years, through movies, through books, is that there is almost a claim or to order or to these kinds of things and people are sometimes attract to to do careers for the wrong reasons, when they may not be well prepared to handle the aftermath of what their choices are. >> i would like to let a few more of our panelists respond to this question. i'm very apologetic to those of you who've been waiting patiently in line there. we are going to run out of time. however, let me say this, i'm going to impose on our gracious panelists to hang around a little bit after the panel and perhaps those of you who have not gotten a chance, i do apologize, you could come up and speak to them and i sang a question. but now since we're so close to running out of time, i'd take any of them to make further comments in response, perhaps,

to our keynote speaker that takes final questionnaire. why don't we just begin and go sorted down the line than or skip around, i don't care. henri. >> thank you, shannon. >> war is a tragedy. it was should take a tragedy in a very precise meaning, which is something that sometimes you cannot avoid, cannot prevent from happening with a loud allowing something else has been witches may be even worse. i remember judy scaturro tax rate somewhere, a story of two

direct people not siding, but try and to stop the same floating wood, which is quite insufficient to bear both of them. we could have maybe there are siblings, maybe there are friends, maybe they are enemies. in any case, this is tragedy. we come to moments in life where one might shape the extension, great is that where for one adult life and which one should we take? and when we come to certain situation, either in more or elsewhere, it seems to me that

mere selfishness and self interesting or utilitarian ways of thinking are quite inappropriate and become more active. and dignity needs human dignity and tragedy and it's wicked higher ground. and it is not possible. it is not possible to reach these grounds without studying the concept of sacrifice. despite was made quite clear that if ethics is reasonably easy to deal with, then we come to the point where sacrifice happens. and then it seems that the concept of universal crumbles.

that's why i do not have the answers to all questions. i would like it, but really i do not. it's whether i can bear witness that when i was appointed at the sincere military academy or i suppose i knew. and quickly i realized that in fact talking about war made necessary a complete reworking of moral philosophy. you know, this is when we come to bore into peace. it is necessary to defend. in fact, all the questions in the military argue -- i can tell you first-time i was taking a

drink with him. he told me well, i was somewhere in serbia appeared in such things happen to me. i had to trigger or not to trigger. i think you can help me to answer should i trigger or not. you are useful, you're the right one. i think we should address all the questions, which emerged for continuing the will to war not to be satisfied with shallow answerscoming in now, because it worries than everyone and there is a lesson for power and a lesson for work, which we'll must acknowledge, we must not acknowledge.

we must observe and analyze. >> now, i realize, asa, you had to your hand out earlier. >> i'd like to address the issue raised by the last person i think the issue is much broader and much bigger. it doesn't have anything to do with behaving in an unjust way. assume i am perfectly justified in what i'm doing. and what i'm doing involves killing a terrorist that jeopardizes the lives of my family. on one end this killing as collateral damage, three of his neighbors. now, i'm perfectly justified in doing it. still, i come home and i have

mixed feelings. i'm delighted to have been able to protect my family. my family. i'm delighted -- extremely delighted. on the other hand, i'm very sorry, extremely sorry to have taken the lives of three people who are innocent in the sense of not dangerous, not jeopardizing the life of anybody. so i have this mixed feelings. so moral psychology and took the picture not just when they committed an atrocity. but we do the perfect action, when we carry out the perfect action, which is perfectly justified, we still have the kind of mixed feelings. moreover, assume there is no collateral damage. assume i am a helicopter pilot. i kill the terrorists and are you to save the life of my combatants. i return home. i'm delighted to save the lives. i hate it but i had to kill

people, but i had to do it. i'm perfectly justified when i do it. but if those persons i killed were not innocent at all. they were terrorists. still, i feel sorry. so moral psychology should be applied to people who find themselves recalling tragedy. whatever you're going to do, it's going to have to aspects. one about which you have and one about which you're perfectly set. and so, not only in ptsd cases, which is much delayed, and training, and insurrection, embracing of every stage when you carry out or you command people to carry out such activities, you have to take

into account, you have to cultivate those true emotions. be very proud and show perseverance and be courageous when you defend and when you protect your force. never forget that a human dignity, which is undeniable of whoever is that person. if he is still a person, i have to kill him. i would do it again tomorrow, but i don't like doing it. i have to do it and i do it. and i find myself with those mixed feelings. and that should be a regular reaction of combatants. and i think when i speak to pilots and people of other branches it is the defense force is an ordinary -- a regular ordinary mixture of feelings that people have.

>> david. >> you very eloquently put it about the mold of the hearts of many ptsd. it's something that if people are better prepared for, you can minimize. you can never eliminate. if you code, put them in the robotic world, which i don't think anybody really want to go completely over to. we don't want that. there should be a cost, a human cost. we have to accept the limits of people into the situation, when we send our men and women to war to cope with overestimate to do come with better look after them afterwards as well and that's part of the proportion cared or a station. this is part of the proportion calculations to cost your own people, past your society, cost relationships, cost of the children have long-term implications of what you're doing to your people is good in

the end justified -- a dance justify what you've got to do? of the proportionate calculation is very important. there's a very fine statistic in the u.k. from the conflict in the early 1980s. more for confederates have died on their own hands through suicide post-conflict than died in the conflict. the duty we carry after the conflict is just as profound as dirty care before. our veterans have a very high-profile. there's a reason why anybody here would've heard -- >> wonderful town. but it's also the first time as the repatriated casualties for afghanistan come through after our airline and they come out to pay their respects every time. it's always national news and

regrettably it's national news about once or twice a week at the moment, but it always makes headlines. my fear is that 10 years from now, after the supposed atrocity on, when we've left them in those will become forgotten once more and we might see a repeat of what happened and i really hope we don't do that again. >> thank you. >> like wendi i was a psych major as well. i've been involved in therapy, but never with army soldiers and posttraumatic stress. slicing posthypnotic stress. and you have to be very careful at their pace. i've looked at a lot of the research and sometimes therapists are actually supposed to be causing posttraumatic stress because they get in there and asked the questions. but i don't think it's the case of this kind of stress. but you know, strangely, we've made a lot of progress and work

on a posttraumatic stress. at what point a minute been called shell shock and other times people would've been shot for her. at least it's progress to look at the idea therapy. on the other hand, and actually gives me the idea that soldiers are suffering posttraumatic stress. give me great hope for humanity in fact. because you probably know there's a lot of historians thereby factor brigadier marshall, who people suspect might've been a bit suspect, where he talks about the soldiers during world war ii that the vast majority of them shot over the hug and of the enemy. there've been many of the civil war here come the battle of gettysburg with dozens of muskets from the battlefield and multiply loaded, so people were in shooting. you can tell from the fierce conflict and historians have gone back as far as alexander the great video at last because they never retreated. and it will kill them pierced a

fierce. so that is when it's very strange things aboard. i think david grossman, at this whole thing of trilogy but now you don't get this business of people shooting of a type. people are trained not of ethics. their most trained in killing, so they will kill. and this is a side effect to really kill. but the idea, it sounds grotesque of me to say this, but the idea that so many are suffering from posttraumatic stress gives me great deal of hope >> you had a response already. would you care to read anything quite >> i think those are all great points and industrial that there is a great deal of compassion. we do train people in the art of warfare. fundamentally it is about warfare. i am charged to fight and win the nation's wars if we in fact

go to war. i would tell you paramilitary strategies out there now, particularly in maritime strategy is that is just as important to preserve the peace as it is to be ready to go to war. so we punish ourselves to do all of those things. but when the subject someone to those combat situations and they have to make a decision based upon training and based upon the things that are expected of them and people died as a result, that is what we have to do is be able to deal with that when they come back and develop those kinds of programs that we didn't, you know, many years ago didn't deal with that. it's very free canal that you'll actually hear senior commanders talk about their own experiences. but that does imply, thankfully, that there's a level of caring and compassion. but i will also tell you that

our political's leadership is very taken back i every single person that is a casualty or dies. i mean, i think probably if the truth were known, they are some of them along though they have not been in combat or feeling a great deal and would probably even need, you know, some types of counseling or help themselves, depending upon the position that they're actually in as a political leader. because i get a daily download of every casualty that's going on, even though i'm not in command of those individuals, i care about where they are and what they're going through and what the repercussions are for society and globally for that. because in many cases coming in now, when i spoke to the young lady earlier, the 13-year-old that got up and thank you for coming in thank you for asking

your question, that in the aftermath of war, people who are not being dealt with adequately and many other nations and the wars in their own regions, or the civil wars in their own regions they be so for the tissues in anger, but they going perpetuate other catastrophic or tragic events against their own populations as a result of those kinds of things. so it's a very serious issue and one that i think that we need to not only look into for the united is going to certainly globally. what do we do to deal with those kinds of things, so we equip our people to go back and society no matter where they're going to. >> dr. lucas, i'm going to give you the last comment. >> well, i wonder if many of you sitting out there found this last two hours disturbing, confusing and perhaps unsatisfying farewell, you

should. the present state of conflict in the 21st century is disturbing, very confusing and quite unsatisfying. my concern personally desire men and women who may put in uniform and placed in harms way, somehow maintained a sense of what their role and purpose in their vision is in the midst of this very confusing, disturbing and unsatisfying situation. they are tough and good people and they've had a traditional way of summing up what their role is in all of this. they will say and then suddenly presents many times, we are the pointy end of this beer. our job is to go kill people and break things when you're the government and the people order us to do so until somebody quarters us to stop. and my rejoinder at present is usually that may have been so. but now, unfortunately, the confusing, disturbing and unsatisfying thing is there are plenty of people out there on

the darker regions in the new global order who are killing people, breaking things and generally doing all they can to make human life for everyone as miserable as possible. your job is to interpose yourself between them and their thick times and order them to stop. >> let's thank all of our panelists. [applause] >> up next on c-span 2, president obama pardons to white house turkeys for thanksgiving.

>> now, the annual turkey pardoning ceremony with president obama at the white house. two birds named apple insider will spend the rest of their life at mount vernon.

george washington's home in virginia. the president is joined by his daughters, sasha and the layout. >> ladies and gentlemen, the president of the united states. [applause] >> please, everybody, have a seat. good morning. i have my to trusty assistant tier, malia and sasha are one of the most important duties i carry out as president. before everybody as home for thanksgiving, there is one official duty and sworn to uphold as the most powerful leader nation on earth and today at the awesome responsibility of granting a presidential party to a pair of turkeys. now, for the record, let me say that it feels pretty good to stop at least one shellacking this november. [laughter] this year's national turkey goes by the name of apple, and his

feathered understudy, is appropriately named, seder. they are being presented today by the chairman of the national turkey federation. yubert and i just want to point out that yubert seems very comfortable with that turkey. as well as the man who helped raise and handle them since birth, ira brister. where is ira? give ira h. big round of applause for raising such a good turkey. i want to thank you both for raising joining at the white house. they came from the posher farms will spur branch, just of modesto, california. out of about 20,000 turkeys, born impostors find the summer, 25 were selected for a final competition got involved strutting their stuff before a

panel of judges with an eclectic mix of music playing in the background. kind of like a turkey version of "dancing with the stars." [laughter] except the stakes for the contestants was much higher. [laughter] only one pair would survive and win the big prize, life. and an all expenses paid trip to washington, where they've been living up on corn feed at the w. hotel. the w. hotel has really been putting them up. [laughter] is great advertising. they do want to stay at the w. [laughter] and after today, apple and fighter will spend their entire event at the same beautiful place our first president spent his, mount vernon, virginia.

the later this afternoon, our family will also deliver to turkeys who didn't quite make the cut to martha's table, which is an organization that does extraordinary work of the folks who are struggling here in d.c. and i want to thank the good teeple at jaindl's terkel farms in pennsylvania who donated these turkeys dears in the road. now this of course is what truly meant by thanksgiving, a holotype they've asked us to be thankful for what we have come and generous to those who have less. it's a time to spend with the ones we love and a chance to show compassion and concern to people we've never met. it's a tradition that has brought us together as a community since before we were a nation, when the ground we are standing on was nothing but wilderness. back in the simple act of survival was often the greatest blessing of all. and later, president lincoln declared the first national day

of thanksgiving in the midst of the civil war. or in the depths of the great depression, global businesses gave donations and charities open their doors to families who didn't have a place to celebrate escaping. in times of war, our military has gone through great lengths to get our men and women on the frontlines a turkey dinner and a taste of home. so in america, we come together when times are hard. we don't give up, we don't complain, we don't turn our backs on one another. instead, we look after one another and we pitch and it would give what we can. and in the process, we revealed to the world what we love so much about this country. that's who we are. and that's what thanksgiving reminds us to be. i hope everyone takes sometime during the holiday season to give back and serve their community in some way. and they also want to take a moment to say how grateful i am to the men and women who are

serving this country bravely and selflessly in places far away from home right now. you and your families are in our thoughts and in our prayers and you make me so very proud to be your commander-in-chief. so on behalf of michelle, sasha, and malia and myself, i want to wish everybody a wonderful and happy and safe thanksgiving. and now, it is my great honor as well to give apple and cider a new lease on life. so, as president of the united states, you are hereby pardoned from the thanksgiving dinner table. [laughter] may you have a wonderful and joyful life at mount vernon. god bless you. and god bless the united states of america. [applause]

[inaudible] [inaudible conversations] >> you have my blessing. [laughter] [inaudible conversations] >> can somebody explain to me what the whole bottle thing is about? [inaudible] [inaudible conversations]

[inaudible conversations]

>> now, a meeting of the national commission on children and disasters. speakers include fema administrator, craig fugate and health and human services. this is two and a half hours. [inaudible conversations] >> welcome and thank you for standing by. at this time participants will be in listen only mode and tell the question-and-answer time. today's conference is being recorded. if you have any objection in the disconnect. all turnbuckle over to your host. you may begin. >> thank you. good morning, ladies and gentlemen. we're going to get started here. so if you would please take your seat, the meeting will begin. this meeting is now called to

order. good morning and welcome to the quarterly public meaning of the national commission for children and disasters. i am juliana sadovich, and is designated official for the commission. i'm a nurse officer in the u.s. public health service corps. my phd is in human services and i have been working in emergency management for about the last six years. i'm the director of the office of human services emergency preparedness and response in the industry should for children and families. since july 6. this is my first commission meeting, so let's go to get started. first, i would like to appoint mr. tim clark as recording secretary for this meeting. and i would like to turn over the meeting to mr. mark shriver, the chairperson for the commission. >> good morning, thank you very much. well, port on the good to have

you. but to say good morning to my fellow commissioners. i'm coming back from a couple days off and it's great to see your smiling faces here this morning. i want to welcome the public to her quarterly meeting as julie just said. today is an important milestone for the national commission on children and disasters. we're finalizing our 2010 report to the president into congress. over the last 18 months as the commissioners all know, we've taken an exhaustive look at the persistent gaps in meeting the needs of children before, during and after disasters. we've reviewed hundreds of reports and articles, held numerous hearings, subcommittee meeting, field visits and public meetings. we've testified on capitol hill. we've made presentations at several national gatherings of government officials and disaster response volunteers. i know i speak on behalf of my fellow commissioners in thanking everyone who has worked so hard on this report that we're going to discuss today and hopefully

vote on and i've worked on the subcommittees and its various well. i'd been eyeing to neglect the children that permeate the disaster management policies, planning, decision-making developed over several years and will take several years to eliminate. so i'll look with exciting and progress is far, for a complete and in many ways is just beginning. children as well as heard this commission say over the last 18 months make up 25% of our nation's population, but in many ways as outlined in this report, they continued to be neglect did when it comes to disaster management. if were not protecting our children before, during and after disasters, then were jeopardizing the future of our country. there are pockets of improvement and exciting opportunities, but today we are calling him the president to submit to congress a cohesive national strategy that addresses unique needs of children and incorporate them to

disaster a policy spending decisions and plans. but i'm sure many of you saw this morning on the front page of "usa today," under the headline, children still can't get past katrina, a study by our colleague erwin rabiner, talking about the fact that kids affect did in the coast are nearly five times more likely than other constructs of your emotional disturbances in fewer than half of those children are believed to have received the hope. this was in today's newspaper.

are at risk in this country. the time for talk has long had gone by. we really do call upon the president and some of his administration claimed they joined us here today to put together a cohesive national strategy, we've talked about it for too long. 18 months is too long, five years is too long. we need to make steps, we need to make concrete changes. having said that, i would like to ask dr. mike anderson, vice chair, if you have any comments to make? >> i agree today is an important day in the like of the commission, hard work has come to fruition with the issue of our 2010 report and i want to thank the incredible staff,

fellow commissioners for all their hard work. it's important to the partners in the non-governmental organizations, child of a scsi groups who are responsible for putting the commission together and i want to thank them for their hard work. we will hear today from folks from fema as well as hhs. i want to thank them for their partnership and support of our endeavors. but there's also much work that remains to be done as mark said. i look forward to ongoing conversations and addressing the challenges that still remain. but as you point out, mr. chairman, today is more important for america's children, 22 to 25% of our population are underrepresented in the planning for, responding to, recovering from and mitigating for disaster. we hope the 2010 report will shine light on important issues and make america safe for our kids. but as we prepare for the large-scale disasters we must be better prepared for my call the disaster of one. we can be prepared for large-scale disasters involving

children if we are ready for one child who is critically ill or injured in this country. from the ems systems to local emergency departments from day care centers to school nurses come from transport teams to care facilities. each of these important links in the chain of survival must be prepared for the needs of children. we know, as you know, mr. chairman, that while most kids are cared for an adult emergency rooms in the country less than 6% of those facilities have the required ticker and -- equipment. we'll start to make a dent in those numbers. likewise large-scale disasters to colleagues and hhs, department of defense and fema to name a few must assure that children's medical, social and psychological needs are met. i believe the report combined with ongoing partnerships the federal and state partners will make this a safer country for our children. finally i want to thank you for your leadership, dedication to america's children and for all the work you've done for the commission. thank you. >> thank you. i appreciate that.

before we move on to the panel, i want to ask irwin redlener to see a few words. i think you say about shining the spotlight if we want to shine a spotlight we want to make sure election results as a result of this report. too much talk in washington and not enough response on this issue so irwin -- >> thanks, mark. i will keep this brief. i will see a couple words about the recovery as it pertains to children, and something the whole commission has focused on and had a chance to work with commissioners on. what we are talking about when we talk of recovery from the major disaster. so the two reports, one was featured today in usa today that basically an article we've wrote called children as bellwethers, meaning how children do in the aftermath of a major disaster and especially in recovery is the litmus test to how we are

doing in general and recovery. the way i put this recently as we are not recovered from a disaster until full merkel children say we are coming and what they are seeing through the data that we and many other people collected is even with katrina, five years ago we had probably 20 to 30,000 children in the gulf still feeling the effects of persistent displacement, lack of uncertainty and lots and lots of unaddressed mental health needs. the other study we cannot with a few weeks ago was similar that had to do with the gulf oil spill when we found one out of three children were facing physical and emotional, psychological problems that in fact would not go away because the oil was kept. we have to make sure public officials understand the consequences around disasters for children do not end when the physical problem stops. when the wind stops blowing from a hurricane or the oil spill is controlled that's not the end. for many children is the

beginning. and finally come to that point, i must say i am concerned as other members of the commission or that we are waiting for the national recovery framework which we were supposed to have seen coming from the administration in june i believe, and still waiting and the country's children are still waiting most importantly, and i think we need to get that out and have that be the guidance in terms of how we proceed with the recovery to the children in particular. thank you. >> thank you, irwin. we have got administrator fugate, assistant secretary lurie and from families and children hhs. thank you for coming in your work on behalf of kids and for your work not only individually that your agencies to work with the commission. we will lav brief statements and then open up for questions. administrator fugate, would you like to start off? >> thank you. as you say talk is cheap in d.c.

and i was given talking points to talk about the great stuff we're doing. the problem is until the disaster we won't know how great it was and i think that's the crux of the matter. we look back at katrina has anniversary we can see a lot of things that could have been done differently. and the steps we've taken with fema to address those needs you're well aware of in your also well aware we still the way to go. the emphasis we are placing on children is to look at this as part of a community as a whole. as you point out, 25% of the population is made up of children but when you read a plan and children aren't mentioned in the requirements for planning its the first strike against making sure we are successful so we have been rewriting those documents. we call it the community preparedness guidance to make sure children are addressed not as an afterthought or assumption, but it's actually in there that you have to look at what children's needs are going to be. we've taken the steps of forming, again, a process but an

important step, of children's working group that took the approach looking at children's issues and prepared this, response recovery through all of our programs including grant programs that provide homeland security funding to state and local governments for acts of terrorists and other disasters to address these issues and the guidance to make sure were children and related issues are not excluded because they weren't mentioned as eligible for that type of funding. finally as establishing within the children's working group the position will be in the office of the administrator to continue the work as we integrate issues throughout the program. the other thing we did is we looked back at i think taking a step back what are the things that need to accrue early in the disaster to start the stability and allow us to bring resources to children more effectively? one of the issues this commission raised was to care centers. again, fema does not regulate or provide oversight today care centers, but in the aftermath of the disaster there had been some

question whether day care services would be eligible for reimbursement for state and local government. we've clarified that and the answer is yes. we also put emphasis on getting schools opened in the aftermath of a disaster, not necessarily schools back to normal but really become a tremendous point simplification for bringing services to children and when you look back at the children is getting them back into a routine they are back with people they are used to come back into not necessarily normal situations but back into a routine. and we again find many disasters especially the size of katrina, the tendency of the association of being relocated multiple times. the fact of what the future held and oftentimes uncertainty even about the basic necessities of when what i go back to school often times exasperated children's issues and in many cases prolong the trauma they suffered. we know we can bring the services but quickly if we can start addressing the issues

early in the disaster response that will give us i think a better outcome in the future. but dealing with this is not something that irwin, 24 family ephriam this is the other part fema is committed to and the set fenestration we are trying to bring out the silo of each agency to approach a problem from their standpoint of use or authorities believe as you point out there are overlapping authorities, competencies' with other families which are not fema's and rather than fema trying to assume the roles we want to work as part of a team and become as we look at it in the demonstration had tickets for children's issues and understand that it's not fema as a team, we are part of a team and the other folks at the table and the other programs that represent tremendous keeping these both david support for children but also become key points of focus in the disaster working with in those. so as the train goes by -- [laughter]

i will conclude my remarks and stand by for the questions the commission has for us. >> thank you very much. administrator fugate. dr. lurie? >> good morning and thanks for the opportunity to be here. following the one administrator fugate's comments, we come to act are doing a lot of free riding. we've had experience the past year because those to want to be sure we hard a lawyer and make things into our evil thing infrastructure. examples, h1n1 talked about countermeasures for kids and that problems around the country outside of the federal government like some pharmacists having trouble, pounding, simple things we used to talk about doing have to get enlarged. in haiti with about the electronic of record to fine-tune our response, notice 40% of the people were kids instantly to change the response. and now, with the oil spill in haiti looking at the behavioral

host needs of the communities including very much behavioral health needs of kids and continue to fine-tune our response each one of those who is back and makes us want to rewrite our plan, strengthen our infrastructure to address the needs of kids as we see them. we've had tons of valuable input from this commission from the national science board from loss of export stakeholders and all of them i think helped us move forward in this important area. we are working hard to catch up to fema in this regard. because the gulf situation with the anniversary of katrina and the oil spill is on everybody's mind i want to just provide a little bit of information about what is currently under way and then talk to you and provide current and upcoming activity to both of the agency's leadership group response issues and countermeasures. certainly the oil spill has underscored an awful lot of things and if you heard from

irwin and other skills and children's issues and behavioral health issues being right there on the radar screen. so our actions have been focused on preventing injury and illness preventing it exposure to substances not only among response personnel the general public to monitor short and long term health impacts and to ensure safety of seafood. children have the potential for long-term health impacts. there is to become a bridge into the exposure of these things as we move forward and we are working hard across the department to be able to monitor and ensure safety. as you know, the secretary asked the institute of medicine to host a public workshop which has been done in the gulf to look at the scientific basis of what's known and to identify research and surveillance opportunities again many of the recommendations and all of looking at children not a

surprise and we are focused on that. i want to assure you that children, pregnant women, others are crocus of our activities moving forward. much of our short-term focus as you know has been on behavioral health. the surgeon general of the administrator and i have made frequent trips to the gulf to principate in community evens and hear from populations it was actually after one of those sessions that i reached back out to those of you from the commission we deal with as well as for help. one of the things i was struck by in addition to the need of families and children were the needs of clinician's. very much hurting and suffering as a result of this, and i appreciate your a much the outreach the you've done and that other provider groups have done as we move forward. the experience also led us along

with my clinical scholar to write a piece on behavioral mental health and the gulf and i thought i would president copies for all of you in case you hadn't had a chance to see a. i will say samsa has been working hard with just about everyone to ensure funding for behavioral health services as well as messaging 1-800-alana and surveillance to meet the needs. it's a good a symbol of how acs and the rest of us are joined together. as you know the domestic violence and other issues are usually palace. we work seamlessly to identify issues related to domestic violence despite the cost to the hotlines to worry about and try to monitor carefully child abuse which is a frequent and move forward again to address the needs of kids. another piece that is still in development but i hope will be

released soon is recognizing kids are going back to school, getting in a normal routine in the next couple of weeks in the gulf and a guide for teachers and school administrators with tips about how to talk with kids about the oil spill disaster and the kind of thoughts and feelings that happened that are going on is i think reverend the corner and this isn't collaboration in a crystal department with samsa and very much the department of education our children's working group with judge david and i co-chair is up and running and we are really pleased about that. it is already increased collaboration coordination tremendously across hhs. 20 different agencies represented and has been under way with a pretty extensive needs assessment learning a lot from the way fema did it using the fema matrix to help with our coordination in the future in doherty the working group has been an amazing resource. they've come out and we've to many parts of the department and

shared across the department a lot of what is going on, some really tangible results by no you will be happy about has been bringing together people to discuss the pediatric requirements for the strategic national stockpile and there will be part of our 2010 annual review. administrator fugate and i agreed to were working groups are going to need to give her at least twice a year to be able to share what we are learning to coordinate and to get me to watch activities underway. and there's just been an awful lot i can deal with you if you like really tangible nativity that's come from this. one of the things i learned about as a result of the children's working group that i wanted to share with you today is exciting work that's gone on through kennedy shriver institute of him and to limit where they have been working on issues that traumatize children and they've developed a very

inexpensive pediatric prosthesis $30. it is now in use in post earthquake eda rheedlen this along to show people. it lets kids -- it's cheap so you can grow with it and that lets people do things like grip, so it's another tangible example of something really cool that has come from our efforts and i wanted to be able to share that with you today. on the medical countermeasures side as you know the countermeasure review was released on friday finally the last time i met with you to view it would be just around the corner. what turned out to be long corner but it's here and i was thrilled chris was there to hear and read about the shah out secretary gates, one of our lessons learned about needing to do a better job dealing with countermeasures for kids, and i had an opportunity in response to his question to detail a number of activities already under way and i am happy to talk about those to link the question and answer period as you like.

and finally we continue to be thrilled to have andy garate and all from our medical response side. he led the way in our hiring pediatricians and we now have a pediatrician embargo to help with pediatric countermeasures but with andy's leadership many efforts again which i can detail for review under way to change the configuration of the team to the old guidelines for children to deal with basic pediatric care etc.. so in closing i want to say how much have appreciated the commission's energy focus and activity on. i want to assure you that we are in this for the long run. our work communication with fema is in this for the long run a working on the sustainability plan. when i first met with you year ago or whatever it was i told you i was launching this effort in my office with a fellow who's gotten a lot of the activities

of and running. she will be as all fellows to leaving at the end of the year and we are in the process of identifying and staff to carry on this effort for the long haul. my goal is to ensure when all of our tenure in we have baked enough of this into the infrastructure and organizations the children will continue to be a focus and never be forgotten. so i look forward to the discussions that follow. >> mr. chairman, commission members, welcome. we are delighted to have you. as i was taken to the acting assistant secretary will also work with the commission throughout my tenure, it's wonderful to have the opportunity to really continue the strong collaboration that we've had with you. we are delighted to host you and because we are the operating division within hhs has primary responsibility for meeting the human services needs we consider disaster preparedness and

response to the part of our mission working very closely within hhs and her preparedness response and then with fema and that mr. fugate and his colleagues homeland security we can only do it together in partnership. of course we don't know where the next disaster will strike but we know that when it does the honorable populations and children principally among them will be most heavily affected and that is why we consider this to be an important part of the work we do and what i would like to briefly this morning is talk a little bit about our structure for addressing human service preparedness response issues within acs affecting children and then talk specifically about some things we are doing in the five primary as the commission has identified as important and if you update on where we are on those five areas and then i can open up for discussion afterwards. our administrative structure for addressing these issues is through what we call our office

of human services' emergency preparedness and response has a very poor acronym which we have grown to love but it's not easy to love and it is headed now by our director. you know her as the designated federal official to the commission. but she has recently joined us as director after an impressive career and i want to give you a sense of her history because i think the fact we have brought some one of her stature and to the program as the director is a testament to how serious we take the issues we are dealing with. she's worked as a nurse officer in the public health service with extensive experience in disaster management and in the office of medical readiness in the office of health affairs and also as chief of staff in the office of weapons of mass destruction operations and incident management in the department of homeland security. so she brings a wealth of experience to us and we are delighted to have her here and we think that she will bring our work in the area of disaster

response preparedness to a higher level than we have had previously. she and her team are officially responsible for facilitating acf support of fema in the core function which calls for in-depth assessment on the ground states to make sure they are in a position at the capacity to provide the services children need in the week of the disaster. we continue to play a vital role in assuring children's needs are being met while they are displaced or sheltered during disaster and we work with organizations on the ground and state agencies to make sure the supplies are in place and service available to address child's specific needs making sure safety protocols are in place to make sure children are protected in the situations. as i said i would like to focus on five specific program areas and the portfolio that i think particularly relevant to the discussion and the commission has identified as important in the week of disasters. those are child care, child

welfare, head start, services through what we call our children's programming and disaster management program. let me start with child care, and the child care program within acf is administered by the child care bureau, and the bureau has taken a number of actions to address the challenges posed by disaster situations and to improve emergency preparedness and response in the wake of a disaster and let me give you some of the highlights of what the child care bureau has done the past year. first the bureau has provided technical assistance and guidance to child care demint guarantees premier li states to increase the number of states and i know this is the commission concerning the states have comprehensive statewide emergency preparedness plans in place and since 2008 we've been asking those guarantees to report to us on the progress they are making in developing the comprehensive plans as a part of their biannual state

plan submissions they are required to make and how they are using several funds provided to them for child care purposes. the child care bureau has also provided policy guidance which outlines the flexibility states have and other guarantees on spending child care and development funds in response to federal or state declared emergency situations to make sure the others continuity of child care services to children in disaster situations, and probably most importantly we've partnered closely with fema as administrator fugate mentioned in his remarks to identify and remedy gaps in post disaster child care services, and if fema has changed its policies over the past years in ways we think have been very responsive to the commission's concerns and the needs of children, we have done everything that we could do to make sure we get the word out to child care to the land on the guarantees about the expenses the now eligible for the reimbursement post disaster

under [inaudible] 's program, and we have coasted with fema decision at the meeting just this month to discuss and explain the guideline. we want to make sure states understand and are prepared to take advantage of the new and reverse what opportunities fema recently made available to them in the wake of disasters. finally went to mention the child-care bureau launched a new website, part of the acf web site, which features child care resources for planning and responding to disasters and emergency and if you haven't taken a look at it i encourage you to do so it's easy to find a website that has resources for guarantees, states, providers, parents, people who are displaced. is a very comprehensive, very accessible, very user-friendly web site with a wealth of resources about child care access in disaster situations and so we are very proud to have that new with sight of land running.

not as the child-care bureau. closely named within the acf family's the children's bureau, and the different portfolio it is responsible for child welfare services and monitors states, disaster plans for children who are in foster care who may be displaced during disaster situations, and those plans allow for the continuous tracking of foster care during emergencies. in the area in the child welfare area we are continuing to enforce requirements under the 2006 child and family services review in portland act states locate and ensure services to children who are understand care or supervision who are affected or displaced by disaster situations. the states are responsible to respond to new child welfare cases in disaster areas to remain in communication with his workers in essential child welfare personnel displaced by disaster to majeure records are preserved and to coordinate and share information with other states as people are displaced across the lines and we must

ensure there is continuity from state to state for children who are in state custody. we also support states in developing and updating their plans for providing a framework on the expectation of agencies, non-profit agencies on the ground to provide child welfare services but to make sure they are also appropriately trained foster parents and child welfare staff to protect child from in disaster situations. we have a national resource center for child welfare data and technology which fund, and it has refined 80 days on reconnecting families and the progress of the database is to aid states, local government come any jurisdiction responsible for children in the wake of a disaster to make sure those children who become displaced or separated from the family through the reconnect family database allows the agencies to track them and try to reconnect them with either their family or the placement in which they were located prior to

the disaster and reduce the number of children who are left stranded in disaster situations. semidey fit, if you could hit a couple highlights of the last couple things -- >> i just want to say our research bureau because similar responsibilities for young children during the day they similarly have policies in place to authorize operation centers in the wake of disasters. our division of unaccompanied children services has also worked closely with states in 2007, 2008 they provided support when hurricanes move through texas to make sure children could be protected, identified, and the final thing i want to mention is the case management which i know has been important to the commission. we made significant strides over the last year. december of last year we executed the agreement with fema under which we can now implement a sastre case management after a disaster has been declared by the president requires us to do it within 72 hours authorizes fema to use the funding to pay

for it, the first pilot as you know which was responded to the needs of people who were victimized by hurricane gustav and ike back in 2008 that have been completed. we have an evaluation we are working together to review that and see what lessons can be learned to strengthen the program but the most important thing is we now have the mechanism in place to provide disaster case management to the partnership within 72 hours of the week future disaster. so i'm delighted to be here. dr. lurie mentioned the department of hhs which we co-chair and we are excited about the potential to increase the response to children's needs, not just within acf and prepared this response, but across all the program areas within hhs. thank you trey much. >> thank you committee fit. i would just ask a couple of questions and open it up to folks. administrator fugate, i didn't know about the position you just mentioned about from the

full-time position within fema headquarters. that's fantastic. as you know fema recently announced it was going to fill its ability specialists in the regional offices, and i know that's not focused specifically on kids' issues. is there any consideration of doing that for children's issues going forward so there is someone in your regional offices that will be focusing on kids issues? >> mr. chairman commesso pps tuna with the american facilities act it covers notñó÷+ only the delivery of services but our day-to-day business. part of the job of the positions is to ensure compliance with the requirements just from our day-to-day operations which is not then where we want it to be. but it also was going to reflect clich planning. communities are not made with just one type of individual who everything fits when you try to do something and because communities are very diverse and have a lot of different challenges and issues, this

position again focusing on disability compliance under the aba, children with disabilities seems to be the most vulnerable to start expanding that and looking at issues in general, other types of -- i hate the term special needs because it tends to be no to your ability in another box, so what did we decided to do instead of building blocks is we want to plan for real, not for easy. so while this position is being titled the focus on disabilities, again part of this will be our day to day responsibility assuring fema is inclusive and accessible and of robert delivery services but also as we plan for disaster response using this as a focal plan for these issues including children to plan for real. that means you don't just have one simple answer that takes care of the entire population. i like to try to keep things very simple. when someone asks for meals to feed a community the first response oftentimes is to send

things like mre and i try to be to picture for mr. to talk about being inclusive and planning for real was i have two grandsons one turned a-year-old. he can't do that mre bag and gets the point across you have to step back and a lot of times you call it neglect and i think it's because we have solutions that seem to fit the needs and told you step back and ask the question will what about ethics and to get this blank look and say okay step back how do you meet this need? we have defeated population and it's not all healthy adults who can live off of the mre. there's going to be different dietary requirements. what does the community need? oftentimes the easy answer isn't the real answer, so again, the longwinded answer to this one is yes, we are going to look at expanding this will to plan for real, not for ec but we also have significant requirements being inclusive in our delivery of services that are also of the reasons why this position was established in each of the

reasons. >> lowercase a wan hearing is there was a reason why it was on the disabilities issue i anderson your support and were going to look strongly that the insurer or incorporating this on kids issues going forward. >> i know that atf had conversations with the child care disaster preparedness and you mentioned a little bit about this. what is the timeline for developing those and to stop beating them and has there been discussion about requiring states that get federal dollars to meet the basic minimum requirements for child care centers to get the federal dollars that they become a requirement rather than reporting back? can we tie those federal dollars to making sure this child care facilities are safe for kids? >> the program guidance will be held very soon so there should be available shortly.

>> very soon for you may not be for me so what is very soon? >> i don't have a specific date. we have to go through the hhs clearance process and i will get back to you with a date on that. with regard to the specific regulatory requirements, as you know, the responsibility for licensing and regulating child care providers of the rest of the state level, the federal level, and many programs is under block to grant structure so they have the primary responsibility, and currently what we require to use all the providers are meeting health and safety standards but they are not very specific with regard to disaster emergency preparedness issues and that has been a concern of the commission. what the president did as a part of his fiscal year 2011 budget proposal which is before the congress is to propose a set of principles for reauthorization of the child care development fund block grant program which would allow us to strengthen the

requirements on states and a number of ways and the focus would be broadly to increase the number of children who are in safe, healthy, nurturing a child care settings. that's a broad and what we hope to working with the congress through the reauthorization of the program is to specify exactly what what mean including disaster prepared this response so we're looking to work with congress to strengthen our authority to create requirements that the states expand on the health and safety to exist on quite a number of areas including a emergency preparedness and response. >> i think that when the members of congress did ask us to meet with them when we describe that there are child care facilities that may be their staff or sending their kids to but don't have plans in place in case of a major disaster including the evacuation plan and unification plan, taking care of kids with special needs, when it becomes

real compared to talking about, you know, the safety and broad things like that when you talk of safety if there's a much different is faster than at to make it real i can't imagine anyone in congress would get a call from a constituent saying i am talking like it off with a child care facility and i don't know that that is safe and if a disaster were to happen i mean, that's real, and i've got to think if we are giving federal dollars to the states we ought to be mandating the state ensure those children are safe. we know if you go to a fast-food joint or high interest on the food is safe because there has been an inspector making sure the food is safe for their closing the place down and if we are not doing that for kids making sure they're safe and you drop them off and you go to work i mean, it goes like administrator fugate's examples okay we provided food but a

one-year-old can't [inaudible] [laughter] i have a five give him that i am stuck in a shelter there will be hell to pay in my situation. so i think if we make it real compared to to talk of a safety in general areas and say when you talk to offer a child care facility you don't know whether that is safe. it would agitate parents and if you go to a mcdonald's burger has been inspected. >> i completely agree with you that is the direction we indicated we want to move 3i know senator landrieu introduced legislation will give authority to do that so morgan congress we can establish authority to give direction to states to require the kind of protections that you are referring to. >> can i ask one more question. the disaster case management

which might knows a lot more about is that going to be renewed or do we have a time frame or is that an agreement between acf and fema x by zearing in december, royte? >> we're both looking quizzical but i think we can both commit our intention is to keep in place and anything we need to do to renew we will certainly make sure we do from our end. >> i'm not sure if it was referring to the actual case management in hurricanes but it's a process we're going to use. we demonstrated we can use the stafford act funds and as was pointed out case management and the process was used we needed to step up, so one of the things they're basically doing is ensuring the states aren't ready to go they will come in and provide the immediate needs as we get the state's spot. this oftentimes is based on the history if they had experienced disasters often times the state will have a stick to case management plans, contractors and vendors to provide that support but if the state to

overwhelm or doesn't have that capability having the ability to the federal agency to provide the initial case management until we can get a longer term stable state contract traditionally the and provide grants directly to the states for the case management when they requested but as we demonstrated there were gaps so essentially in this case to fill the gap once we demonstrate we could do it we could produce that in the future disasters if it is warranted. it won't always be necessary but i think it is an important tool we now have and we demonstrated we can implement of the state doesn't have case management or cannot scale fast enough for case management we do have a federal partner that we can enter into an agreement with and to ask them and fund them out of the disaster recovery fund. >> which might be referring to is we have specifically appropriate funding from congress not for providing disaster case management which we do hour with refunding from fema would need to ensure we have appropriate case managers

to provide the service. that funding is appropriate on a year-to-year basis so we don't know for sure if congress will give that funding but that won't affect our continued ability to provide disaster case management wants fema author resistance to do so. >> i know you've done a lot of work on this issue. did you to follow on that? >> by the mcconaughy think we need to emphasize that, and i'm speaking now as an actual senior citizen but i've seen a lot of administrations come and go and i don't think it is always been good people in various administrations wherever the team from ander think we have a unique situation of extraordinarily dedicated federal officials represented by the three of you and i just want to make sure that while i am wildly frustrated i am extremely appreciative of the dedication and intelligence and commitment you have brought to this question. so i would like to ask a little bit more about this -- the study that was done on the ike gustav

case management. what is the result? >> well, evaluation is currently under review with fema as well to see we did the evaluation actually in several steps, the evaluation of the implementation of the program and then the outcome of evaluation to see with their families would receive the services they need and restored to the predecessor -- >> so this is taking an extraordinarily long time and i don't really understand why it is taking so long and the problem isn't if you couple that with the data that we and others are finding we have children still from years ago who needed case management and programs terminated without resolution of cases, people fall through the cracks and now we are paying a very steep price as far as children are concerned who did not get what he needed, and i think -- i am feeling to understand talking now with the

social scientist hat on i'm trying to understand why it's taken so long to evaluate a study to see if families were helped, it feels like a very, very long time ago, and i think we need to get this done and we need that recovery from work. if one of you could respond to why we don't have a recovery from work yet as we speak here i would greatly appreciate it. >> i can speak to the evaluation and i will let my colleague speak to the framework issue. i think the disaster case management par let served the victims began in the late summer or early fall 2008. it was originally conceived as an 18 month pilot which would have carried through believe march of this year and actually we got an extension from fema because there were some cases for which services haven't been completed so it went a little bit further into this year so it's only a few months ago the pilot ended. it's not a very long time to complete the outcome evaluation but we're moving forward as aggressive as we can and hope to

report on the outcome of that evaluation as quickly as we can. >> the framework is still in process. we are going into working with the other federal agencies and a final recommendations and clearance process we experienced means the agency became heavily engaged in. that being said, your respective of having a public strategy we were implementing it in the tennessee floods, and again what i think as the chairman points out, words on paper are not an action so what did you do? we noticed one of the things this deterrent for children is to be displaced from their homes in the aftermath of the disaster family need shelter for weeks. we took elements of that plan and partnership with hud and did something we haven't done before. instead of letting people come to us and ask for a census and waiting for that process to help them, we targeted families that

were in shelters and people in shelters as a party. but ascent case workers into the shelters and did immediate work to get people into housing. so rather than letting this process work passively, we took elements of the strategy and engaged in active work to get people placed heart of the shelter into a more permanent housing situation. again, we think in many cases the stability of things like that bring to a family are important parts for children. so while that doesn't necessarily stand out as the children specific issue we think getting children out fulfill the duplication of planning for real. so many of those omans carper of the strategy looking at how we provide housing in the aftermath of the disaster because we know that children be moved multiple times are not having a stable environment is a key factor. so those elements were

implemented. we are taking many of the concept better in that strategy and again, tennessee been of the larger events this year we began implementing that to make sure we were taking those elements in the draft and actually running them in the event so while that is in process we are doing many things we've identified as the key steps to bring stability to the community when its children's issues as a stable home or housing situation we think is one of the key things early in fought even to estimate the last thing i want to ask is i'm very interested in the denominator question so in tennessee how many families needed whatever the services were and how many got them packs i know it's very tempting in the running of an agency to talk about what has been done and put a lot has been done as i acknowledge the question that troubles me is what was the need and how far along? all the children and households

affected, tuna with the denominator was because of thing that is what probably you want to know and certainly what we would like to know for kids get so any sense of -- >> i would be able to break it down that way. what i can give you numbers for is how many people were in shelters and how quickly we were able to get them into the housing situation, and i think in this case just demonstrating we did something we haven't done before which is having a hard going to the shelters with us and to case management and literally get people into a rental property versus a loss when the system to have to register, go through whole process. we knew those that were in shelters the greatest need, those that were not were in a hotel, motel, friends and family, so we targeted shelters and again this is something we started as early as last year in the floods, but looking at the more systemic issues we think compound children's recovery and that is schools open and

shelters closed and in affordable housing. these are the macrothings we are trying to do at the response level but also a policy level and that gives us a better way of addressing issues azo her other federal partners, acf and others to be looking at specific, children are having individually. we have at least help set the stage to provide steve allin guilherme to minimize that trauma or the duration of it. >> thank you. >> i want to publicly thank dr. lurie and others for their continuous support. it's great you've reached out to us month after month and we appreciate that. i want to turn to the medical countermeasures as you mentioned in your comments, dr. lurie, was on the call last week when the secretary told of the enterprise review and was also heartened to hear from shall from the first four or five minutes the fire

was wonderful but as others have said the devil is in the details how we possibly affect the countermeasures or the needs of children in this country. to specific areas and the first is the wide review. how we begin the pediatric issue constantly thinking about children's issues and second, you may not have time to answer all this, but the authorization, how do we use that tool the fda has even before the crisis and before a biological attack to make sure kids needs are addressed? it's great there's an enterprise review and now the devil is in the details. >> let me talk about a couple of things that have already begun in this regard. i'm pretty focused on the fact that the learning contrast with individuals it has to rest with the system and so the way that

we do the medical enterprise system and manage it going forward is i think a tremendous focus. we just completed a series of, and we are going through a series of reviews of the major areas and the portfolio. three of the four have just taken place, and one is the operating procedures and the other questions asked, one of the box is you've got to check what are the end user's requirement, and in their, you know, what is the anticipated population of children and it's not just children because as you know children of to print images and sizes need different doses. all those things. so much more look at the requirement process and down the road in terms of developing what

we call target product profile to be sure we can have those end user requirements beaten to the process up front. i don't think you will see other requirements going forward that don't explicitly say what are the needs for children here and there has a mentioned in response to the question of the announcement of the review we've already started doing a number of other concrete activities in that regard. one of will highlight the three leads to your question he is one of the issues with the current has to do with the palate ability of the current in a white onyx and if you try to compound them and mix them up there so terrible kids will just spit them out. one of the things we have now is work underway thru contract with the developer to figure out how to make the stuff more palatable. i would be quick to point out the countermeasures in the

stockpile you ought to be able to offer other pediatric medicine, too said the benefit will go beyond the stockpile. the fda has committed as you heard from the commissioner to looking at its legal and a regulatory framework as it comes to you we are hoping there is something that is in between and a full license somewhere that helps us deal specifically with a challenging issues about getting for kids in case of an emergency. the work to develop the framework has begun, and i believe when all is said and done you will be quite pleased with that as well. >> david, did you -- >> i have a quick question for administrator fugate.

in your remarks you talk about silos, which has been a term that has been used frequently over the past year and half in the commission. the chairman talks of the need for the cohesive national strategy, and it seems to me the primary way to accomplish this through information and one of the hurdles we talked about is the challenge of information sharing city agencies with their federal and state, non-profit and otherwise have access to key information are very pleased with your staff a couple months ago to be in the evacuation tracking system i know the state based system so i guess my question is addressing this on a long-term basis is going to be extensive and complicated for a host of reasons. interest in your assessment on where you are in moving toward improved information acquisition and sharing and where you see

the primary hurdles. >> one of the first hurdles is what information do we need? there's always the assumption we have to have visibility on everything and trust me, that isn't the solution, it actually is impossible. everything who says we need to track every individual every person what we need to do this trap by exception and this goes back to something i would be ashamed if i don't bring this out and that is what we are talking of the federal role and responsibility always starts with a family. next on this national preparedness month and for many families that have children taking the steps to one, make sure you have a family disaster plan that you talk to your children and explain this is a key part of helping them be resilient i think for those families that can come have think that plan explaining at with children if nothing else. and we took a day care centers. one of the things we know from

just every day evens it doesn't take the country in a style of disaster they can rush to the community. when children don't know the plan is or school or day care centers, how to reach parents and family members, with the contacts are it comes back to do we have a good understanding of what we are supposed to do? so for the families that can, they should be making the plans to include children, talking to their children about disasters and hazards as we work with our partners to increase our participation and focus on children i think it's one thing we don't really talk about this preparedness and schools and other things the more children understand what the environment they lived and the threats and what we can do to minimize the threats and the more in power they are and this goes back to resilient children are those the understand how the community and their family have a plan and that the understand what's going on. it's the unknown that is challenging so we look at this.

again, though he evacuation to to track every individual and to be hard to do but there are certain groups we have to track and again i think acf ehud to this. our states have to do where they have the primary responsibility children in foster care. children that are either because of the dependent status upon programs or in the care of the state the evacuation are important to track. children that are separated or half family members to have lost in the aftermath of disaster and then as pd and other disasters talked on unaccompanied foreign nationals who are here either because treatment or even to the sham and i think those are the populations that if we are going to devote resources to the have to be the first priority and as we get a better handle on that we can include more and more but to track each individual we think again not possible.

but focus on the ones you need to track, what reason are you talking and those are the ones most honorable and the dependency to connect those assistants and resources when they get to where they are going. particularly when they are moved out of the setting they already have the support network. >> i know we are wrapping up. i just wanted to ask a couple of months questions, questions. david, in this discussion you brought up and cried mentioned with the child welfare system i would like to be a lot to talk to you out follow-up recommendations on this report of the child welfare systems and we've not made much progress with that approach within your department. it would be good to get together after this discussion to try to follow-up on that if that is okay. and i guess just following on that you talk about the progress made on head start and other areas of one to be sensitive to your time, maybe all three of

you with the one or two things are that are your biggest problems and what you think should be done that this commission can follow-up on. if he were on my seat what are the one or two things you think the biggest gaps within your group, within your department. >> i guess i would say the most important thing you can do which is to maintain the focus on this issue. we now have the mechanisms in place with hhs and across federal agencies to do the planning and implementation we need to do. the important thing is to keep the focus and emphasis so there is no diversion of attention from the issues we are talking about here today. >> so there is nothing within your agency that specifically we should focus on or you're not going to tell me that? [laughter] >> i think you told us that and that is what we are moving on. i think we are moving on that

agenda. we need your continued support and focus to make sure that the momentum continues. >> i guess just in irwin's comments that we are impressed and supportive but frustrated at times and you heard that from this commission, from me as well. having said that, dr. lurie, is their anything you want to say or add on to that? >> first, to appreciate to the monthly calls we have had with irwin and mike and steve it. the country helpful in us getting through a number of issues and having a really good communication, and again i would say maintaining the focus is important. the one thing i would like us to focus on is having us look at children as assets in the response and disaster. there are many untapped ways to

unleash not necessarily what isn't, but the children of many of your have to offer in helping us manage through and cover from, families recover from disasters, and i would like to see us put more focus on that in the coming year of the defense of the last year and a routine disasters we deal with i think have given a lot of good ideas and that is a place to go for all of us in the future. ..

and then i guess just also whether there are one or two things you would like us to focus on or that we should focus on? >> mr. chairman as far as the grant programs, this'll be our first grant cycle to see what the awards are so since those will be going out as we make those awards, one is to one is to scrub it and see if there's any difference again. i wouldn't be too dismayed in the first year. you would see a lot responsive that because my observation having been on the state and when you guys mother take several years for groups to understand and build it into the request cycle and get that up front. this is marginal. i would be more concerned if that didn't happen next year that would have been out for little bit longer so i would

expect more advocacy groups to be aware of it and be targeting funding for that. and i don't think of -- make even tennessee as big as it is i don't think there has been enough events to trigger some of these programs if we would need on a larger scale disaster. i think we saw some smaller cases but it goes back to the data. i think from a social science perspective, response data is not usually in a good. we have to go back in a year or two and see what were the outliers that were not addressed in go what happened and why were they not addressed? we are not there yet on anything since then. mr. chairman i will give you three. first one is daycare centers. even though we have identified that daycare centers are being provided by local and state government are eligible for reimbursement you well know many daycare centers and communities are small operations that do not have substantial resources i had a large-scale disaster to reconstitute themselves and i think as we put emphasis on getting schools open, pre-k i

think is still going to be a significant issue. if there's not a place for children to go so parents can go back to work as hard to get one community going and two again we see these as places where we can bring resources to children more effectively. i don't think it is a theme issue as it is relevant to than a trip industry but i still think that pre-k is going to be a challenge for us and its catastrophic disasters and that is again i think something we will continue to work with our federal partners and there may have to be additional programs delivered by state and local government until the daycare processes can come back on line and it may have to take a form similar to what we have done with our crisis counseling programs where we did the casework, but i do have that concern. i still think daycare is going to be a critical gap in the catastrophic dam disasters is because the niche of industry and how difficult it will be for many of us providers to come disaster. my second one is the drug and

countermeasures. as we get new guidance from hhs, to incorporate that into our funding and to our proved purchase list and equipment in drug list because we provide the funding for the bulk of what state and local governments are purchasing in addition to the national pharmaceutical stock while so again, this'll be a secondary effect and is the new countermeasures for pediatrics are identified and signed off on that they get built into the grant guidance and also to the improved equipment list so that those are eligible. and this is again my plea and i think it was already mentioned here several times. my experiences tell me that the more we incorporate children, particularly in the k-12 range, into preparedness activities, the more resilient children become to the effects of disasters. we continue to work with our partners at hhs but also with the department of education to look at how do we take preparedness messages to all

levels but particularly to the elementary school in the muck at the k-12. giving them information so they are better informed about what can happen. again this is not about scaring people are scaring children are trying to shield children from unfortunately the disasters that occur. is really about parents and they have a role to play. as many of us know some of the best things we can change behavior come from children. so kind of this idea that we don't call them victims, we call them survivors and as a point that we need to look at survivors as a resource and children become my very powerful tool in promoting the message of preparedness which increases i think the more successful outcome in a disaster but also empowers children because they now have a role to play and again as we have seen time and time again people people whoever participation in an event, they have a positive influence, or able to address the stress and adjust to it much more

effectively than if they are not included or not aware of what is going on and don't have a way to participate and don't really have a way to contribute that. i think that again comes back to not looking at the public is a liability but looking at the public is a resource and brick mason children as part of that resource. >> very appropriate mr. chairman. >> thank you administrator fugate. thanks to all three of you. you were here too long, so go. thank you very much and it was great to have you here. thank you for your great work. appreciate it. we are going to move into a discussion on the report by asking commissioners to give a brief outline of each chapter. there are a few outstanding issues that we need to discuss and have a general discussion about the report and the steps at the end. before i ask larry to walk us through the disaster management and recovery piece of it, are we clear on the process here?

christie you have any comments you want to make? >> no, i think you are okay. >> you think we are all right. larry t. want to start us off on disaster management and recovery? >> mr. chairman disaster management and recovery. we are reviewing the recommendations and opening for any discussion on the recommendations. recommendation 1.1 which is distinguished and comprehensively integrate the needs of children across all entered and intra-government operations and is an overarching consideration. if we truly want to protect our nations future. specifically under this recommendation the president should develop a national strategy for children and disasters. the executive branch, congress and nonfederal partnership prioritize children separately from at-risk population categories. the executive branch at all levels of government should establish and maintain permanent focal points of coordination for children and disasters supported by sufficient authority, funding and policy expertise.

the executive branch and nonfederal partners should incorporate children at the distinct priority and disaster planning documents and relative grant programs. the executive branch and nonfederal partners should incorporate education, childcare, juvenile justice and child welfare system into disaster planning, training and exercises. the executive branch of nonfederal partners should incorporate children as distinct priority and relevant target capabilities, preparedness training and exercises with specific target outcomes and performance measures. and finally the executive branch and congress should institute accountability and progress monitoring measures to track implementation of commission recommendations and capability improvements. that goes with the adage, that which is watched gets addressed. are there any discussions on recommendation 1.1 and disaster management recovery?

>> if i could i just want to point out an amendment that was in the third subrole as of this section, which is actually made as a request of the chairperson and more specifically to the issue of trading a focal point of coordination. specifically at the headquarters level and the senior agency level but also there is concern that these positions should be contemplated at the regional level. as an example atf, the regional offices have specific concern about children's issues and i think to the question that chairperson schriver raised to administrator fugate sort of a sub recommendation of the sub bullets which is to urge fema to create a similar point of contact at the regional level for children's issues. i think mr. schreiber said it is great news. that theme is looking to create

a position at the headquarters level, but obviously there needs to be a point of focus and coordination at the regional level so that is a suggestion that was made if the request of the chairperson and i just wanted to make sure everybody is aware of it. if there are any questions about it. >> moving on recommendation 1.2 on page 22. the president should accelerate the development and implementation of the national disaster he recovery framework with an explicit emphasis on addressing the immediate and long-term physical and mental health, educational, housing and human services recovery needs of children. recommendation 1.3, the department of homeland security and the federal emergency management agency should ensure that information required for

timely and effective delivery of recovery services to children and families is collected and shared with the appropriate entities. government agencies and non-governmental organizations should collect information on children and families, necessary to identify and support their immediate and long-term recovery needs. the department of homeland security and the federal emergency management agency should expand information sharing with appropriate government agencies and non-governmental organizations to enable the delivery of recovery services. the department of homeland security and federal emergency banishment agency should pre-identify and credential additional local and out-of-state voluntary and non-governmental organizations and networks that provide disaster assistance to children and families. >> a question on 1.3. do we ever discuss the question of what we mean by timeliness. i'm just coming back to what the chairman pointed out in terms of

when certain things happen or don't happen. my timing is maybe an unacceptable delay so i'm just trying to -- because that kind of wording lends itself to complete lack of clarity and never-ending non-completion of different tasks. >> the areas have been discussed on metrics. i don't believe there is a specific. i think the issue was that good information is on the actual needs that promotes an appropriate response to the right people to the right amount of time. it was to be promoted as immediate that with the ongoing declarations for disaster, we want to see this information sharing as it is possible. clearly there has been some movement on it, but as far as as

far as as whether it is trickling down at the state and local level and whether that information is being supported amongst local network supporting children and families, get it goes back to the overarching goal of do we have metrics and are we able to measure the implementation of the recommendation to the commission? >> i think timely, with a friendly amendment to timely becoming immediate and effective >> i guess what i would say is that mark we are talking about the question of the were timely information, timely action and i'm looking for a harder definition of what the expectation is. for example, i feel pretty confident in saying that the longer the delay in getting some certainty established in terms of housing for instance, for displaced children, the worse the outcome is going to be. if it was up to me i would say

we have 90 90 days for any disaster on american soil to get children into some stable environment with access to appropriate services. 90, too little or too many days, and i'm not sure what we are prepared to answer what that is right now but i would suggest something that the commission might want to be thinking about. in order to get some degree of metric that we can look to. and this really comes from what we all know about the situation where it is still five years later and we have kids that are still in uncertainty and not having the services they need. timeliness make sense from a child development point of view and i can see by the look on his face that he doesn't agree with me. [laughter] >> of answer and i'm having is that if we do everything that is recommended in this report, i think it will become timely. the issue is it is going to be

difficult to stipulate a particular time period. the other concern is if we do some parts timely that they are not in a coordinated way we might actually undermine some of the other recommendations we have, so a concrete example when the discussion about in tennessee, sending hud caseworkers into shelters i thought was an excellent example of expediting the timely delivery of housing services but i didn't hear we were sending a sea of case managers and. i heard we were sending in hud case managers so if we haven't defined what case management services are at a very wealthy those families at risk, child abuse and domestic violence or other exacerbation of mental health issues are properly removed from shelters and placed in stable housing that we may have missed the opportunity to identify and address some of those mental health needs. so i am concerned that we probably can't have immediate

services and immediate sharing of information. there'll always be some delay. is not going to be in real-time probably, so that i guess my strategy would be let's talk about really what are the components that need to be in place and get the right people they are providing the appropriate services and then timely, we leave to them. >> i'm concerned about that because i think one of the roles of the commission is to provide expertise that says this bureaucratic complication or series of things that has to be done is actually interfering with the appropriate place to that child's detriment. i don't think we have to be apologists for bureaucratic problems, delays and issues one it is now the longer this period of instability goes especially for families who are not supported in general, the more dangerous it is for kids and i would just take a more assertive view that let's at least say what would be best for children even if we on some level can

understand that it may take longer than we are suggesting. also. >> let me make one recommendation about that. this recommendation if i'm really correctly is really the sharing of information to provide services. so maybe, it may not be that we need an amendment or change to this recommendation but we may have to identify other recommendations where that is most appropriate to make those changes. i was just referring to the recommendation that i am not sure how what change would make this particular one better. >> i could say, in terms of implementation of this recommendation certainly the way it is written would provide an opportunity for the commission to work with the agency to determine a reasonable, perhaps evidence-based time period based on experience, based on estevez said that very needs of children and families, so we could

certainly approach it that way as part of an implementation strategy goes. >> we also have to recognize that they there they are largely isn't a system in place to do that now so i think overarching this is it is going to take time to build the kinds of mechanisms to share information with all the entities that we believe are appropriate in the language, so i mean i think the recommendation as stated is aspirational, but i think it is absolutely appropriate. the goal is to share information in a timely way so that services can be provided. in order to do that we are going to have to build infrastructure and systems that cross governmental and agency platforms in order to share the information. so i think that is what larry school addresses. >> i think some of this is as we talked early in our tenure, there were

interpretations of privacy statutes and other policies preventing people from sharing information and in some cases even when people were contracted to provide services they couldn't get the information they needed to actually deliver the service. so it is more of a sharing of information to make sure that everything is coordinated before the actual delivery services. >> just one point. we raise this as we have gone through this process. while we are talking about this national system, we also talked in our committee meetings about the fact the majority of our disasters or responses don't even make it to the federal level, so when we have had this conversation we have talked about the fact that whatever that system looks like, and we are not talking about some unnecessarily building a database and all the hierarchy but the formalized policies in stuff that allows you to share information by electronics or whatever has to exist so that it happens at every level of the system.

the example i said is the system still works. the information sharing is this way, so i mean to ernie earn a's.it is going to take a while for this to happen but we have heard some very positive things in phone conversations about the fact that there is forward movement on this happening. >> and the final recommendation, 1.4, the department of homeland security and federal emergency management agency should establish interagency agreements to provide disaster preparedness funding, technical assistance, training and other resources to state and local child serving systems and in child congregate care facilities. any questions or comments regarding this recommendation? >> i think the point was brought up and mark's comment to follow

on some of the testimony provided is i agree with this recommendation, but we have to make sure it is coupled with the requirements that funding be used and that the planning of her or other funding may not be received. be the concern that i have is, we can offer funding for the planning purposes but for some of these groups, particularly childcare as was talked about, a small childcare center or a home daycare facility may not apply for that funding or may not ask is that funding but nonetheless it still needs to be prepared. so we have to think of other mechanisms that will ensure that this actually occurs. and i don't know that we need to revise this recommendation, but i would look to staff to make sure that it appears elsewhere on the report and perhaps even references back to this point. spivak and a metric, looking at the tracking of implementation

and commissioner recommendation. >> if there is another section, which i don't know they reported intimately as the staff do, the talked about the fact that for example disaster preparedness, planting and child congregate care facilities such as daycare should be made a requirement or continued funding according to revise health and safety standards. we might then reference back and say as recommended by the commission in 1.4, funding from chf and fema might be used to help meet this need, so if we could somehow tie that back together to save both that it is required but we have also suggested funding mechanisms and interagency agreement mechanisms to ensure that occurs in an effective way. >> mr. chairman that concludes chapter 1, disaster management and recovery.

>> thank you very much larry. are there any other questions for him on this issue? hearing none, david you are up on mental health. >> i will just say kind of in summary the mental health section recommendations, the only changes that i i believe are proposed were in format from the version reviewed by the commission that was sent out to the commissioners. our fairly minor editing changes and insertions of the names of agencies that have already been included and designated to take the lead in those efforts have been included to the beginning of the sentences but there otherwise is no significant change. so i will go to them fairly quickly. recommendation 2.1 was that hhs should lead efforts to integrate mental and behavior health for children into public health medical and other relevant disaster management activities and the congress to direct hhs to lead the development of a disaster mental and behavioral health concept of operations or con op to formalize disaster and

mental behavior health is a core component of disaster repaired his response and recovery effort and this is essentially the same as what we had in our interim report and that designates hhs should lead those efforts to do that. questions or comments? recommendation 2.2 was that hhs should enhance the research agenda for children's disaster mental and behavior health, including psychological first aid, cognitive paper intervention social support intervention, bereavement counseling and support in programs intended to enhance children's resilience in the aftermath of the disaster. hhs should have been a working group of children's disaster mental health and pediatric experts to review the research portfolios of relevant agencies, identify gaps in knowledge and recommended national research agenda across the full spectrum of disaster mental health for children and families. this again is essentially what was recommended in the interim report the addition of additional focus on children's

resilience and doing research to identify programs that would enhance children's resilience as we had heard in the testimony that this is an area of interest and need and also one that has not been particularly well studied today. any questions or comments? now go to 2.3. federal agencies and nonfederal partners should enhance pre-disaster preparedness and just-in-time training in pediatric disaster mental and behavior health including psychological first aid bereavement support and supportive intervention for mental health individuals such as teachers who work with children. again i believe this is similar to what we have recommended in the interim report. comments? then 2.4. dhs, temin samhsa should strengthen the crisis counseling assistance and training program for ccp to better meet the mental health needs of children and families.

the first bullet is to simplify the immediate services program or isp grant application to minimize the burden on communities affected by disaster and facilitate the rapid allocation of funding and initiation of services. think in the celebrations of the commission will propose saying that there would be funding available for up to 30 to 60 days in the absence of an application and through discussions with ccp and others involved felt the best way to compass that would be through a simplification of the isp process of this is essentially what we have discussed before but it is worded slightly differently. second was to establish the position of children's disaster mental health coordinator within the state level ccp's which was with a recommendation to come out of our iowa visit and to formally modify the cc'ed model to indicate and promote enhanced services and that is the term that has been used by ccp. where the mental health impact is unlikely to be adequately

addressed by typical ccp services, these recommendations regarding the ccp and the sub role is under attorney to the final report and reflect continued discussion with fema and samhsa and ccp's in particular about how we might enhance the mental health services provided after a disaster through that program. and the last bullet on that was on the next page, include bereavement support and education within services typically provided under the ccp. so any questions or comments on that recommendation, 2.4? in terms of 2.5, we recognize that this funding under ccp would not be sufficient in order to provide funding for direct mental health services because it is a more corrugated services referred services and build upon the mental health infrastructure already in place within the community but if that were lacking or insufficient as it

often is in communities as a baseline, we certainly will be after a major disaster. we recommend the that congress establish a single flexible grant funding mechanism to specifically support the delivery of mental health treatment services that address the full spectrum of behavior health needs of children including treatment of disaster related adjustment difficulties, psychiatric disorders and substance abuse. any questions on that are any of the recommendations in this section? then i will move on to the next session -- section. >> thank you very much david. >> mr. chairman unlike dr. schoenfeld i cannot say that there is a lot of editing particular as dr. lurie pointed out. the secretary released an enterprisewide view modified recommendation 3.1 and i do want to take a little bit of time

because we only have five more points. i think the coach in input we have received and others we may may -- but for those following the screen this is significantly different in a couple of areas. turning to medical countermeasures recommendation 3.1 congress on health and human services should ensure availability access to pediatric medical countermeasures at the federal, state and local levels for chemical biological radiological nuclear and explosive attacks. the specific subbullets underneath their really hasn't changed a whole lot, provide funding for the development acquisition and stockpiling of mcm specifically for children and for inclusion in the sms and federally funded caches. as you heard dr. lurie mentioned in 2010 they are re-examining the sms for pediatric material. number two is amended e. u. a., emergency use authorization to allow the fda the discretion of

the hhs secretary to authorize pediatric indications for medical countermeasures. before an emergency is known or eminent. during the h1n1 several e.u. a's were issued but we feel based upon good scientific knowledge that the secretary they be able to use this as a mechanism to put other particular agents in the stock pile. the next, which has been a little bit controversial, form a standard advisory panel to advise the secretary of hhs and provide expert consensus on issues pertaining specifically to pediatric emergency medical countermeasures. i want to complete the matter what the life of the commission is we have to have a constant presence at the discussions when it comes to medical countermeasures for kids, so while we have heard a little rid of the downsides of this, is to believe this is an important recommendation that the commission should stand behind. we also know there are other great agencies out there such as

hhs and biomedical advisory research and development authority and established a pediatric and obstetric working group gap analysis and make research recommendations. and then finally include expertise on the hhs enterprise governance board successor and i wanted to open to that produced for just a moment mr. chairman. all relevant committees and working groups returning to mcm. these are the five basic laws that we start with. the delve into some track changes that we can go a little bit into the body of it, there is a paragraph that starts witt goes all the way through -- the report recommends and in a report once again that dr. lurie alluded to. you can see on track changes appropriate hhs identifies a senior leader to the mcm

enterprise. the mcm development leader. the commission recommends that there be a partnership between the leader and key stakeholders both within and outside government. and i think you can read the rest including the academy and other ngo's and once again thanks to steve for helping us formulate. i believe that new enterprise, this new mcm development a leader is going to be a very important key person in the development of countermeasures for children and i actually feel it should be a bulletin to make that recommendation. we talked about having pediatric leaders at the table but we know this is a new enterprise coming out of hhs so i would say a friendly amendment with potential lenny va six bullet while working on one of the fifth bullets bullet to the will will that this mcm needs to partner with pediatric leadership in organizations. bruce. >> i have two questions on this actually. one is that to administrator

kube, going through as quickly, make sure that the funds that fema provides takes care of that. and then the other question i have for first through page 40 and i party talk to you about. the commission looks forward to working with ashbrook and its partners. of the commission is not extended, then it is a viewpoint in that sense that we wouldn't be working with them. i think we need to make sure that there is improvement in the capability exists and not resting on us at least two to excess. >> i think your point is well taken, bruised that we need to make sure that success and planning has been put in place and i think the children's champion such as aap and others should be listed there. while it may be a friendly amendment, when we talk about a -- and we still have a lifetime no matter what happens for a while but i think we have

to list important organizations there there is will. >> my point is i don't know how to address administrator's comments about blending. the my related to. >> he raised an issue at the end of this thing. i think it was his second at was the fact, something to do with his funding in the medical countermeasures and making sure gets into his grant guidance. >> the a medical countermeasures for both state and local probably are funded through fema, not through hhs. so, the compacts are available at the local level. that is also part of the issue. >> i just don't know where it gets tied in but he clearly made that the point that it is one of his concerns. >> mr. chairman could we ask dr. garret if you would comment about his roles in relationship

to what we are talking about? >> go ahead, please. >> well, we are just talking about the prospects for dealing with medical countermeasures and the federal government, and specifically around medical countermeasures, how do we funded and where it does it come from? who is minding that store? we talked about creating a new position, is that correct? >> the secretary's report did. the mgm lee. >> the mcm week. so, i will assign that to you personally. how would that relate to what you are doing around medical countermeasures in other words the notion that somebody should be at a senior level responsible for that at hhs?

with the court ask you to rise, please? [laughter] [inaudible] i am happy to answer questions question, barna has ownership of countermeasure development from the perspective of the agencies, so what they collaborate widely stakeholders?gggggggg certainly in our role and dmsgññ looking for ways of responsible for pediatric issues across-the-board. one i'm concerned about is the immersion, not a mercian -- what do i mean? the evolution of multiple sources of pediatric expertise and authority in a variety of

governmental agencies which may or may not be working so well together. i think what i would be looking for is a senior person overseeing or at least reporting to the secretary about all things pediatric that relate to disaster response. i don't know whether that is feasible in the american system of government currently but in an ideal world from a pediatric thing, i think. >> i'm not clear whether you are asking my opinion. >> i am asking you whether the creation of the senior person as the secretary is suggesting it is something -- we are talking about aap support. is that what we should be asking? >> well, i think having a point person i think medical countermeasures is a specific enough signed and we need someone builds in the overall system. if you are asking my opinion i think it is reasonable to have someone who is a pediatric

subject matter expertise and medical countermeasures within the overall superstructure in the overall countermeasures. >> okay. okay, so this is my point. i think there's a problem and potential issue for all of us as we are making recommendations with pediatric expertise around a lot of agencies that will do a good job but in terms of the overall watching the store as far as children's needs are concerned is where i am sort of struggling on how that happens exactly. >> thank you, dr. garret. >> my only thing still is i don't think we have addressed the grand tissue. >> let me go back to two-point because i want -- don't want 3.1 to take all morning. i think bullet one does talk to the funding development so at a high level, i think all i'll let one of the 3.1 addresses it. is not into the weeds as perhaps as much mr. fugate's want but i

think it does call the equitable funding at all levels and federally funded cash. >> i guess my point is, and i don't mean to put it in a bullet but i think some other narrative we need to be specific, he wants to make sure it is clear that he's fema grant funding is tied into that, is the only point. he actually went out of his way to give us that as one through three. three. >> just a fairly small amendment that would address this. so under that first bullet when we say providing funding for development acquisition and stockpiling, at the end we say in all of their federally funded caches. could we say including those funded under the fema, and under that way we would be calling it out in the bullet. >> the other amendment could provide funding and appropriate grant guidance.

speaking from a state perspective, the importance of that is authorized in your guidance we won't be asking for it for purchasing it. >> to bullet .53.1, once again i would like this recommendation to acknowledge the new enterprises emerging with the mcm lead and i don't think he needs a new bullet. i think that this new mcm lead has to have a positive pediatric -- no matter what the commission becomes. i think the mcm lead has to be tied into the -- in use and i don't know how to put that into verbiage. i just don't want that to be lost, that we acknowledge a newbie that has to work with the pediatric community from day one on this important issue.

>> it is definitely a big challenge and maybe, not to belabor it that should dance option weigh in on this? is there anybody else in the broom i guess you might be able to weigh in on it because this is an important point. >> dan, -- [inaudible] >> i think we are trying to craft language dr. dodge and on the new enterprise review, the creation of the new mcm lead which we think it's a great step in medical countermeasures for everyone. because the issues in pediatrics are so unique off label use, e. a's, drugs in development and you know the issues well. we just want to make sure that this recommendation not to belabor the point that somehow that new mcm lead is number one a pediatrician which would be a bonus or number two, is somehow

tied very intimately into the pediatric community. >> this is from subwill let one. >> i think that is the area of this recommendation. report itself there are a lot of folks listed with different policy responsibilities where medical countermeasure development, decision-making, acquisition and so force of the idea of this medical countermeasure lead is to be a point of, as contacting leadership come across the entire enterprise. does not specifically for a particular population. the language that has now been included in the text of 3.1 speaks to the importance of having such a position within the enterprise and the need to have that position coordinate

and communicate with the commission and other non-governmental organizations that have an active interest in medical countermeasures for children. so i think it is stated pretty clearly in the text, to your point mike, you just want to see it stated clearly. >> correct. >> we can develop some language to do that. >> okay. once again i don't want to belabor the point. >> this is a general question. i don't doubt there is an easy way to fix this. the concern i have is we have made a lot of recommendations that we have to have a spokesperson and advocate for children's needs so that might be able one among many people. we also have to provide some funding for children's medical countermeasures, but often there's a tendency to get the low-hanging fruit, the items are inspired ready to hit market that we can speed up a little bit and take credit that we have funded it but i don't really see

that we have created any mechanism to remedy the deficiencies that we have in the current strategic national stockpile, and we have attempted just with one measure and have spent some of us almost a decade commission a solid year and still have not remedied that even though we come even though it was very close to being able to get approved by the fda, so i don't know if there is a way of underscoring the fact that we have to do more than a little bit more. we actually have to reach, whether it is parody paired he or he quality of children's medical countermeasures and the strategic national stop island of their federally funded cachem hearing now is going forward, when new countermeasures are going to be approved, they have to go for children's dosing and indications, but i haven't heard about going back and filling in

the gaps. >> david if you'll recall one of the language changes that are proposed in this section is to ask fda to come as one of their priorities now going forward within the charge of what this report in the secretary is asking fda to do, so to take a look at medical countermeasures that are currently in the stock pile and place a priority on getting them labeled for pediatric use, and i guess we could tweak that language slightly to also address other issues, immediate issues that you feel. >> the concern i have is that yes we are paying attention to it now. we may make it a priority but do we actually have it as is a goal that we will hold -- do we have a goal that it reaches parity, that we actually have actually eliminate the gap band that then we will judge whether we have been successful, not if it is just pin it priory that we have

made some effort but actually that we have remedied the problem. that is the concern that i have. i don't know that we state that. >> the overall section in that chapter does say there are gaps and we need to go backwards, forwards and everywhere in between. so i feel in the center of that section but that is there. number two i believe the advisory body that we have been talking about since literally the first committee meeting addresses some of your concerns. we have experts that help reform research -- research agenda and we have had disagreements about that naughty. i stand behind it and i think it is an important point and the seventh bullet point i wanted to make was just about that. >> david are you referring to some benchmark across the federally funded countermeasure system? >> yeah, we want the gap actually filled in for 25% of

the population. >> correct. >> i guess the question becomes where do we put the number in? i mean, -- or even if it is in the recommendation or in the text that we state it be set only once we have remedied or eliminated the gap in medical countermeasures for children within the strategic national stop pile and other federally sponsored or supported caches will we have succeeded in a separate. it may be just sentence you need to put in there but i do think we have to say it is not okay to do more. we actually have to fix the problem. >> i'm going to start to move on mr. chairman, sorry. on the edited pages, the report recommends -- the report recommends enhanced capabilities capabilities -- the report recommends the capacity to work proactively with industries and target area; that they will

develop and mcm. just give me the last sentence. edition the commission recommends one of the targeted regulatory scientific enhancement issues in a the report from the secretary talks a lot about scientific enhancement initiatives. for the labeling and formulation for existing mcm and the sms send want once again it doesn't have to be a seventh bullet. i just wanted to acknowledge i think that is an important point and something we have to focus on. >> i don't think that needs another poet because i think we have it in the body of the recommendation. other comments from the group? >> 3.2, we should go faster now. hhs and department enhancing pediatric capabilities and integration of pediatric

specific training, guidance exercises supplies and personnel we talked about this before with hhs and with the reserve pool for lack of a better term of health care workers and we have a health care coordinator on each and every disaster team. on the record i think and dms has done a nice job of sustaining an initiative like this so i think with some either edits, this one stands. comments from the commission? >> she nine, 3.3. we have to talk about training, 3.3, recommends health and human services should show health professionals that may treat children for disaster have adequate medical training. we call the president to work directly with what is called the -- to prioritize the development of core competencies, core curriculum training and research. we have built some very good bridges with this group and they are interested in working with subject matter interest to make

sure that these core competencies are part of the federal response and the disaster education training working group would be an excellent addition. once again this is similar to our force in the think progress is being made. comments or complaints? seeing none, 3.4. we are now talking about regionalization. the executive branch in kabul should provide resources for formal rachel weisz pediatric system of care to support the pediatric search capacity during and after disasters. there were many wake-up calls during h1n1 mr. chairman and one of them was a lot of non-pediatric silkies will be called upon to take care of children in a pandemic and at least in northeast ohio we found a lot of facilities that were not in any way shape or form ready to take care of children so this whole concept or regionalization i think quite frankly mr. chairman of scratching the surface of

recommendations around regionalization and we get a chance to move further down the path of the commission i think it would be something we are going to need to spend more time on and emphasize more. this is pretty much the similar recommendation we had in the interim report. >> why aren't we focusing on -- that is a major issue, illusion about what is out there in terms of pediatric expertise in the general community. >> it is a good.. i think this is a good start because we are talking about two major things, funding through health and human services, and in hospitals through regulatory bodies like the joint commission should be prepared because i think it is said good start if you will both funding as well as regulatory bodies. i just think that with their bandwidth in the first 18 months of the commission we haven't used them as much as we should and that is the -- another

reason the commission remains very important. anything else on 3.4? 3.5, prioritize the recovery of pediatric health and mental health care delivery systems and disaster affected areas. this actually could be in the recovery section as well. we had an entire day symposium on recovery from disasters. we heard from great pediatricians and mental health of patients in areas that were affected by the disaster and how cute is to have the systems back on line as quickly as possible. recommendation 3.5 has had a couple of tweaks, talking about harbors establish sufficient funding mechanisms to support continuity of for-profit and not-for-profit health care and mental health. fee of the executive branch is a poor kelvin and medical health and the health security strategies will this the national disaster recovery framework.

hhs should create medicaid and children's health incentive payments for providers still in disaster areas and that is a cogent recommendation on the ama adopt a new code or code modifier for cpt's such of you are taking care of the patient under all the careful circumstances, that your payment is reflective that so scheduled funding as well as funding to the practitioners. these are once again out of the recovery workshop that we had a couple months ago, several months ago. comments on that? now to 3.6. epa should engage non-governmental experts to develop a national guidance and best practices and reask bencie of homes, schools and child hunger could care facilities and disaster affected areas. the sub roll it is eta and and hhs should expand research on garments a health risks associated with disasters i

should say. we build some good bridges with epa and other partners in the american academy of electric. they are some guidelines out there but they are sort of siloed and not as well-known as we think they should be. there is not as much research as to what our particular agents and how little should there be in a home before it is safe to return to a home or a daycare center or a childcare area. without this is important. the next step. comments, complaints? >> thank you guys. any other final questions or comments? dr. anderson. we will go to great lord and emergency medical services and pediatric transport. reg. >> thank you mr. chairman. emergency medical services and pediatric transport provided the medical subcommittee with a lot

of work and effort. mostly because as we delved into the issue that we identified that we couldn't really get to the base of the problem because we didn't know who to talk to in the federal government. they currently lack, and this is the impetus for recommendation or .1, a federal agency that is responsible for emergency medical services. recommendation 4.1 which calls upon the president and congress to clearly designate and the properly resource aid lead federal agency for emergency medical services with primary responsibility for the coordination of grant broke dams, research, policy and standards, development and implementation. concurrency that is the second recommendation or the second bullet there which says, to establish a dedicated federal grant program under a designated lead federal agency for prehospital amf disaster

preparedness. specifically including pediatric equipment and training. any discussion? 4.2 speaks to what we identified were significant gaps in the capabilities prehospital, and therefore it was to improve the capability of the emf to transport pediatric patients and provide comprehensive hospital pediatric care during daily operations and disasters. we understood very clearly that without supporting the pediatric care needs of the prehospital care community on day-to-day operations we cannot expect them to form while during times of a disaster. congress should provide additional funding to emf services for children. this was a long-standing program run out of hhs that has done great work over the years in supporting ems for children care across the country, but it needs

more support and we call for that specifically. also an eligibility guideline for the center for medicare and medicaid services kindly referred to as cmf, we request that reimbursement to first responder organizations who billed medicare and medicaid, that they be required to meet the msc guidelines and life-support equipment on their prehospital care emergency response vehicles. hhs and dhs should establish strong pediatric amf performance measures within the relevant federal emergency preparedness grant for grams. hhs should also address the findings of the msc 2009 gap analysis of the ems related research. specific a mess performance measures that we have asked to put into grant guidance with

theatrical equipment on ambulances, and a facility guidelines agreement to expedite the pdf transfer, pediatric educational grants for providers institutionalization of the mfc and the state state and territorial government process, on line, off-line as well as written pediatric medical directions for prehospital care providers. >> a 22nd comment. i think we talked about in my opening, and we are going to be better prepared as a nation for larger disasters including kitsap we can take care that one child really well who becomes critically ill or injured. i think this is one of the most important recommendations to ensure kids across this country of could care each and every day. >> 4.3. >> eye to recommendations to consider for 4.2 in the first one is, to may seem like it a minor editorial issue but i have

suggested the mfc performance measures for prehospital care and transport. right now they are older than boxed, which i didn't understand why. i could understand an article or a chapter, you might balk certain things, but i thought we were just boxing and bolting our recommendations. so, could we just put this into the narrative and say in particular we like to draw a light to the critical measures which are, but i don't think it needs to be drawn out in that way because it is unclear to me why it is. >> i was one of the ones doing the editing. so often we talk about these lofty goals, we should care for kids better and be prepared. one of my dear colleagues keeps talking about metrics and taking care of kids and the reasons bolted is, let's do these things. it may be a minor edit and it should be in a text. it was a bullet before and because. >> i wouldn't suggest we put it in a bullet bullet if you sae