money flows, and matchupkendrick meek, incumbent, versus billionaire geoff brain he spent $24 million of his own money -- kendrick meek versus billionaire jeff green who spent $24 million. guest: many expect meeks -- he was up by significant margins. this is a late surge. jeff green spent $24 million of his own money. tv as all summer. people did not know who he was. some billionaire, the best man at his wedding was mike tyson. the outsider we have in florida this year. it will be pretty interesting. but kendrick meek got help from bill clinton, barack obama last week. it has been an interesting race.

host: and his anti- establishment atmosphere, how did the incumbent who was down in the polls able to come back? more to do with kendrick meek or the issue over jeff green's money and his yacht? guest: kendrick meek brought up how did this guy makes his money. as he said in many of his ads, he has been pending against homeowners who has taken -- have taken a big hit in florida in the past few years over foreclosures and things like that. host: let's jump ahead to the general election because whenever candidate comes out ahead, whether jeff green or kendrick meek, neither fares were well and a three-year matchup, charlie crist or marker rubio -- marko rubio. they both come in last place.

meek said once the primary is over, democrats will start getting the kind of. right now lot of democrats are supporting charlie crist, current republican governor who dropped out of the primaries and has become an independent. host: this is a story in "the washington post," frontpage in florida. tea party favorite tempered his tone. a story about marco rubio. what is his latest tactic? it is obviously by this headline favored by the tea party but needs to be able to attract conservative democrats and independents in the fall. guest: he has won over conservative republicans, the tea partiers but charlie crist has taken all of the moderates. he is picking up the democrats and is leading in the polls. what's rubio needs to do is pick

up more of the moderate republicans and show he is the true republican candidate and they should support it. host: showing a picture of charlie crist running as an independent. what can we expect after this primary is over today as far as money and attention paid to this general election race? guest: this is where the start off is, where it is going to get pretty big. charlie crist has plenty of money to spend, so does rubio and rubio now has the republican establishment support. kendrick meeks as the unions behind him and african-americans make up the large percentage of voters, so he will be picking up support as well. host: in the republican gubernatorial primary bid tomorrow, bill mccollum versus rick scott. guest: very similar to the senate race. bill mccollum has seen a resurgence.

running against a very wealthy man in rick scott. just as in the senate primary, bill mccollum brought up rick scott's past as a health industry executive. his company was charged for medicare fraud and fined $1.70 billion. he brought this up and he has also gotten support from jeb bush and other republican establishment figures down there who have gotten behind him with money and support and people are rallying around him and he is now seeing a resurgence. host: and whoever comes out ahead in this race would face to in the fall? guest: the chief financial officer. democrats really like her and they think she has a bright future. it is going to be a tough one. there is also an independent candidate, the son of a former governor, the late gov. lawton chiles. both races are very similar.

host: in a general election match up there will be a three- way contest for governor. who is bearing ahead and hypothetical? guest: right now sink is up by a point or two but it is very close. host: we have run through the florida race is. what will people be watching for in washington? what tomorrow's primary says and what florida will say about the mood of the country and what happens in november? guest: this has been the year of the outsider candidate so florida is kind of going against the grain. we have seen about five or six incumbents lose their primaries this year and all of the seven it has been the anti- establishment mood and all of the 70 establishment candidates are looking better. so, i think people are going to be kind of interested to see --

kind of different than what we have been seeing in the summer. host: arizona, john mccain faces a republican challenge from j.d. hayworth. guest: it is so good there has not been a pole and about a month. it is kind of telling. upholstered in not want to spend money when everybody knows what will happen in the last one shows mccain up 20 points. host: at first did not look good for john mccain. guest: it looks very bad and people thought that this could be the year that this guy left -- it is the anti-establishment year, and who is more establishment and the former presidential nominee? it looked very bad. it was within 10 points for a while, even tan points in april. host: does -- hayworth have backing from the tea party? guest: he does not paired -- does not. it is a fractured group.

but most tea party groups came out and said we did not support this guy. host: you think it hurt him? guest: absolutely. in many other places, including florida, tea party support and help someone, including sharron angle and next door in nevada. host: does he face a challenge from the left in the next election? guest: know, everyone expects him to win. host: what does he do strategy- wise? because an order to fend off a j.d. hayworth, he says he was not a maverick, changed his tune on certain policy issues and so what do you think we will hear from him? guest: a good question. i think we will see him afloat around the country helping other candidate so we will hear quite a bit. but certainly, the biggest thing hayworth -- changing his stand on his sheep -- issues. host: republican line from

jacksonville, florida. caller: i have been listening to your comments about florida. look, with all due respect, let me correct a few things. you referred to the candidate meeks as the incumbent -- he is not. he is a young man who only got into congress because his mother was the congressman and he took over for her. he is not the incumbent senator. you referred to green and his problems -- he just does not have any problems, he is successful. but meeks has set severe ethical problems. if you look at any ads in florida about this election you can see that editorials from newspapers all over florida talking about meeks' at the core problems. that is important. you should know that. you mentioned alex cink -- yes, she is a smart young lady but the reason she is in politics, her husband also ran for governor of the last race and he was the democratic nominee, that is how she got in.

with all due respect, but -- she is not that great a politician. host: who will you be voting for tomorrow? caller: i already voted. i voted republican ticket with a few additions. i think anybody in florida and the situation the state is and is not going to go democratic. meeks has got real problems and i would like to hear your young man from "roll call" go into them because the things they are quoting on ads and the board's their showing on tv are just devastating. host: we will talk about it. could tell us who you will vote for any general election? caller: it will be rubio. i met the young man, he is nice and competent. charlie crist, someone we have the best the pope's four but over the years he just goes from one side to the other and it is sad. he takes one issue one day, goes on one side the next day -- honestly, the next day he is on the other side and i would like to hear your young man talk

about that, too. host: let's talk about the general election match. problems ahead. guest: kendrick meeks has big problems because he is in very good politicians, charlie crist and marco rubio, likable people. they will get most of the support. kendrick meeks has an uphill climb -- he is not the incumbent but he is the establishment candidate for democrats and it seems florida democrats are coming home to the establishment candidate because they did not know much about jeff greene. he has been on the air. but other than that, they did not know who this guy is. he does not have a record. so. meeks, they know -- host: michigan. michael, democratic line. talking about primary day tomorrow. go ahead. caller: i am happy to see that marco rubio is falling down in

the polls. this is a precept for the failure of the upcoming election for the tea party favorite. these candidates on the tea party have proven to be extremist in all regards to policy -- financial, domestic, foreign policy. these are very primitive- thinking people. and marco rubio basically has 20 center solutions for 21st century world. host: what kind of support is he getting from the tea party members? financial? grass roots? what kind of support? guest: it is mainly grassroots. it is building up enthusiasm just for the election, period. the more people who know an election is coming of the more people who are walking around and knocking on doors and getting excited. those are all good things all candidates would love to have. host: is he losing some of the tea party enthusiasm as he,

according to this headline, tries to temper his tongue? guest: i don't think he will. because elections are about contrast. he is up against charlie crist, who a lot of conservative republicans in florida don't like. they think he is too moderate and they did not want to vote for him for the senate. they ran him out of the primary. these are the people want to get to the polls and vote and they will vote for rubio. host: however they doing money wise? guest: really well. they are kind of going neck and neck. they will have plenty of money to spend. host: where are they getting it from? guest: charlie crist has a nationwide network. he has built in support. and rubio, he has built up support. since charlie chris left -- rubio has establishment support. host: you have a primary in your

state as well. who will you be voting for? caller: i voted for the -- i and somewhat embarrassed, i voted for the tea party candidate only because i am an anti-incumbency. host: you voted for -- who is that again? guest: i believe his name is miller or something like that. host: de would have for joe miller but you said you are embarrassed? caller: i am not really a tea party person, more of a coffee person. host: all right. we take your point. look at it had nine -- palin isn't interested onlooker. she endorsed joe miller against 70 summer cousy, the incumbent. guest: murkowski, there was a

poll where she was up 30 points. but this guy, this attorney, joe miller, as support for mike huckabee and sarah palin, which certainly put his name on the map but it certainly has not been enough for people to turn away from murkowski who has been in office since 2002. host: newspaper said many expect murkowski be favored, in a state that about his security. that is the headline in "the philadelphia inquirer were" in this race. security is the key issue in alaska's gop. she is running on the opposite campaign -- saying my security brings money home to this state and that is why you want to re- elect me. guest: she tied herself to the late ted stevens, and he was

beloved. the airport is named after him. lots of knows -- roads are named after him. he brought back so much money. she says i will be a continued nation of that. host: that is the headline in "the new york times" this morning. in alaskan republican primary, two names not on ballad may play big roles, a matchup between sarah palin, who endorsed mr. miller, and lisa murkowski tying herself to ted stevens. host: republican line, you are up next. caller: i want to clear out wanting of -- rick scott does have a lot of problems. host: jeff green? caller: talking about rick scott. i am sorry. he is. meeks -- but rick scott has

problems. he has been going back and forth to cuba. he claims he did not. pictures of him on the boat. i am independent. i am voting for meeks, and before i vote for somebody -- bill mccollum. these crazy people, they call themselves the tea party. most people vote. they always tend to vote for people who have their radical views. rick scott was supposed to have done a debate with bill mccollum and he did not show up rick scott has been dodging. he sent his mama to that place. that is all i got to say. host: in a general election matchup for the senate seat, you said you will support meeks. are you going -- you are an independent.

in that three-way matchup, would you switch to charlie crist? caller: i mean -- charlie crist is my second choice. i don't have a problem. i just think his own party turned against him. all because he took a picture with president obama, and all of the sudden he is the enemy. host: charleston, west virginia. jim on the democratic line. caller: the choice is simple for america. the party of hope versus the party of hate. the republicans hate public unions, they hate pop -- private unions, they hate welfare, they hate the port, the republicans hate the unemployed, the republicans hate health care for the poor. host: what about the overall themes of the democratic party versus the republican party and how it is playing out? guest: not playing out well for

democrats this year. they are looking to lose anywhere between 20 and more than 40 seats in the house. they are going to lose probably at least five seats in the senate. the democratic party is not a good brand of this year for many reasons, but most of all, they have candidates running in districts that normally vote republican. the last two years, the last election cycle, people have not been excited about the republican party. now it seems there is just as anti washington thing going on. host: president obama has been hitting the trail and doing some speeches. his latest version of the stump speeches, when you are driving the car you put it in d to go forward and r to go backwards. is that gaining traction? guest: i am not sure how much traction it is getting. i did not see too much. both parties accept the fact that democrats will be losing a

lot of seats. i am not sure the president can do much about that but he can help them raise money. host: back to florida. republican line in port richey. go ahead. caller: i just want to say that we so it -- we should use the track of politicians to vote for them rather than watching their commercials on tv. the commercials on tv this year have been horrible. it is just an outrage, the way that they spend so much money backing -- bashing each other. here we are, the american people are supposed to be intelligent, watching this ad when people are losing homes, people are losing jobs, all of our money should have been used for helping the people rather than telling people -- trying to shake people's views on politics. host: what about that ad wars in

florida? guest: action a good point. the possibly could have been an oversaturation of jeff green and red spot ads. -- representative spot ads. they want to see you walking in a parade or those sorts of things and talking to people. maybe the green-scott campaign did not work. host: races and arizona -- gov. brewer, primary day, what is her fate? guest: she is going really well. every cent she signed the immigration bill, the much- publicized immigration bill, her stock has risen. and all the republicans who wanted to run against her have dropped out. so, she is facing nominal opposition and she will win. host: a name that is popped up is ben quayle, how is it looking

for him? guest: not too good. he had a few stumbles over the last few weeks. the biggest was him being tied to this scandalous website, he was a contributing writer to this website, the start up, and there are several other candidates in the race who are raising money, raising their profile, so i am not sure it is looking to good for him and i do not think many people expecting to win. host: the next phone call. richard, independent line in new hampshire. caller: i did not catch to this gentleman's name. host: kyle trygstad from "roll call" newspaper. caller: the question in my mind is this. everything transpiring this morning is opinion. we are listening to your opinion. i am willing to listen to it because i think you are knowledgeable and i think greta is a good hostess -- excuse me,

host, i guess. my point is this, it all boils down to opinion. for example, the discussion of arizona. the discussion of alaska, since death, everything has changed up there. my point is i just hope we get good, unbiased opinion. i think we're in getting this this morning but i did not know what transpires later on. greta, you are doing a good job. i like you as well as i like the gentleman who started this network. he was fair and unbiased. host: brian lamb? thanks, appreciate it. guest: alaska is an interesting race. murkowski has been a good senator, i think most alaskans will say that for both parties, so i did not think there is too

much trouble. sarah palin did endorse the other person and i think it's at the low bid more about sarah palin than it does about this gentleman. she thinks he is the more conservative guy and she is going to endorse the ball over the country who are more conservative. host: what does a about her relationship with lisa murkowski. they are not that -- guest: they are not that close. she defeated her father a few years ago. she knows who is going to win. she knows miller is not going to win but she is taking kind of a stand. host: pine bluff, arkansas, vivien, democratic line. caller: i just wanted to follow up because there was a caller earlier who continent -- commented on congressman -- meek and his "at the" issues and i am hoping you could elaborate on that -- "s. nikole" issues.

and in arkansas, a woman named joyce elliott is running for congress and she was not polled at least in the polls that were discussed and the media, polled when the primary, and she did. wondering if you could comment on her as well. guest: i have not followed the elliott raised to closely but i do know the questions about meek -- he took over his mother's former seat and he supposedly took earmarks for a company she is now working for. that is where the problems have arisen. host: let us go to maryland, derek, independent line. caller: i am a regular listener. the only programming that i really enjoyed. it is unbiased. the c-span library is so great,

if anybody has not going to it yet but that is not why i called. good morning. i read a great op-ed piece in "the new york times" today about the ground zero mosque and how it is playing into this election. it is just great. i think the democrats are actually going to do a lot better than all the pundits say. president bush has been very, very quiet. but he's got a book coming out november 9. "decision points." i am sure it is going to get leaked before. nobody is talking about why we are in this predicament. people have really short memories. but once the book leaks, there will be lots of memories revived and people changing their minds about some of these

extreme right wing candidates. host: the book does come out after primary day -- excuse me, after the election. guest: that is an interesting point. you will not see president bush on the campaign trail this year. probably a well-timed date. host: republican line, texas. good morning. go ahead. caller: i have a question for the gentleman. with everything going on in the country i just wanted to ask you a question -- i think anyone who is a thinker and knows what is going on knows the democratic party is trying to create a revolution and take the country from socialist to communists. my question is, do you think we can get through this without a revolution in do you think --

i will hang up and listen to your answer. guest: i think it would be tough. nothing can get through the senate this year. it is a road block, these days. republicans will certainly take up in number of seats. we will see how things change. host: pour pdf, florida. david, republican line. caller: mark rubio has some problems, and on the state republican tricks and things that he did. greene bet against the people with his real-estate.

i feel like the american public needs to wake up to the fact that the democrats are trying to put this country back together. host: who are you going to vote for? caller: meeks and sink. host: if you could, tell us what we can expect, what we should watch, in florida. guest: this is supposed to be one of the hottest races in the country. one of the more interesting races in a while. it is a three-way race with crist, meeks, and sink. host: so

>> as time ticked closer to the number of elections, tomorrow florida will be voting. we will look at the republican and democratic candidates for the senate seat there. we will start our coverage at a 30 p.m. eastern. and then that focuses on arizona, where john mccain is balancing -- battling a former house member for the nomination. >> is history week on book tv. daniel grann percy fawcett -- on

peter mancall. all this week on c-span2. >> we are all pawns on the chessboard and we're paying -- playing our parts in the drama. >> i express my sincere regret about the encounter with capitol hill police. >> i cannot walk away and have you during the campaign because i am annoying. >> current and former member is delivering apologies directly to their colleagues on the for the house. what's more on line and read about them at c-span is video library. it is searchable and free. it is washington your way.

going forward now what meeting of the national commission on children and disasters. witnesses include craig fugate. this is about 2.5 hours. >> thank you. good morning, ladies and gentlemen. we're. it started here. if you would please take your seat. the meeting will begin. this meeting is now called to order.

good morning and wedding -- welcome to the quarterly meeting of the task service. i am the newly appointed official for the commission. my ph.d. is and human services and i have been working in emergency management for about a last six years. i am the director of the office of human services and emergency preparedness and response in the administration for children and families. since july 6. this is my first commission meeting so let's get started. highlights of. tim clarke is the recording secretary for this meeting. i would like to turn over the meeting to mark schreiber, the chair person for the commission. >> that you very much and welcome aboard. i want to say good morning to my fellow commissioners.

just coming back from a couple of days off, it is great to see your smiling faces. i will welcome the public to allow our public meeting. -- to our quarterly meeting. reportorking on our 2010 for the president and the congress. as you all know, over the last 18 months we have taken an exhaustive look at the persistent gaps in meeting the needs in children before, during, and after disasters. we reviewed hundreds of reports and articles, held numerous hearings, field visits, and public meetings. we have testified on capitol hill and made presentations at several national patterns of government officials and disaster response volunteers. i know i speak on behalf of my fellow commissioners in thanking everyone who is worked so hard on this report that we are going to discuss today and hopefully vote on.

the benign neglect of children that permeates disaster management policy planning and an has developed over several years and will take several years to eliminate. the work is exciting and much progress, but it is far from complete and in many ways is just beginning. if children as you have heard us say of the last 18 months make up 25% of our nation's population. in many ways outlined in this report, they continue to be neglected when it comes to disaster management. if we're not protecting our children before, during, and after a disaster, will jeopardize in the future of our country. general pockets of improvement and exciting opportunities -- but we are calling on the president to submit to congress a cohesive national strategy that addresses the unique needs of children and incorporate them

into disaster policy planning and decisions. as you saw on the front page of "usa today," "children still cannot get past katrina," a study by our colleague talking about the fact that kids affected in the gulf coast arles' nearly five times more likely than other children to have the emotional disturbances, and fewer than half of those children have week health. there was a report a couple of weeks ago talking about 12 states in the country had basic minimum requirements for child where facilities in k-12. as a country, and frankly as a people, we have let our kids down. we have let them down and katrina and we're not prepared as a country to address children's needs today is disaster were to hit. i also noticed that the fourth

storm of the season is approaching. we will be staring at this issue again as a country in a couple of days. i hope we will take steps to address and make some recommendations to the president. 74 million kids are at risk in this country. the time for talk has long gone by. we really do call on the president and his administration who have timely joined us here today to put together a cohesive national strategy and we've talked about it for too long. five years is too along. we need to make concrete changes. having said that, like to ask dr. mike anderson if you have an opening statement. >> i appreciated. today is a very important day. 18 months of hard work has come to some fruition with our 2010 report. and i want to thank our incredible staff for all their hard work.

it is an important date for the partners in our effort who are responsible for putting this commission together. it is also important that our federal partners in this effort -- people from the month as well as hhs. i want to thank them for their partnership and their support. there is also much work remains to be done as part says and i look forward to ongoing conversations and addressing the challenges they still remain. 25% of our population are under represented in planning for, responding to cover recovering from, and mitigating disasters. we hope that this 2010 report will shine a light on these issues and make america safer for kids. as we prepare for this large scale disaster, we must be better prepared for large-scale disasters involving children if we are ready for one child who

is critically ill in this country, from ems systems to local emergency apartments, from day care centers to school nurses, off from transport teams to tertiary facilities, each must be prepared for the needs of children. we know that this is sobering. while most kids are cared for in the ers, less than 6% of facilities have the facilities recommended. been large-scale disasters, my colleagues and hhs, the department of defense, and fema must make sure that the psychological needs are met. finally i want to thank you for your leadership coming your dedication to america's children, and for all the work you've done for the commission. >> thank you and i appreciate that. but all we talk to the panelists, i want to ask irwin

landau -- run letter which one i signed a spotlight and makes sure that the actions happen as a result of this report. to much call in washington and not enough response on this issue. >> i will keep this very brief but i appreciate your indulgence. hollis said couple words as it pertains to children, something that we should all focus on. we're talking about a recovery from the major disasters. their two reports. one is san "u.s. today," which comes to an article that we wrote as children as bellwethers. hal children do in the aftermath of a major disaster and especially how they do and recovery is the litmus test of how we are doing in general and

recovered. we are not recovered from a disaster until vulnerable children say that we are. what they're saying to the that we in many other people have seen is that even with the trend, five years ago, but probably 20,000 children in the gulf still feeling the affects a persistent displacement, lack of uncertainty about their future, and what so on address mental health needs. the other study that we came out with a few weeks ago with similar and had to do with the gulf oil spill. we found out one and out of three children were facing physical and emotional psychological problems that in fact would not go away because the oil was capped. i think we have to make sure that public officials understand that the consequences are round disasters for children do not end when the physical problems stops. when the stops blowing or the oil is controlled, that is not the end. for many families it is just the

beginning. and i must say that i'm concerned as other members of the commission are that we're still waiting for the national recovery framework we were supposed to have seen coming from the administration in june, i believe. we are still waiting and the children are still waiting, most important. we need to get that out and have that be the guidance for us in terms of how we proceed with recovery that will help children in particular. thank you. >> 90, per one -- thank you, irwin. thank you all for your work on behalf of the kids and for work not only individually but with your agencies. we want read statements from each of you and then we will open up to questions. mr. fugate, would you like to start off? >> i was given all lot of

talking points to tell you what a great step that we're doing. the problem is that until there is a disaster, we will not know how great it was. that is the crux of the matter. we look back at the train as it, on a five-year anniversary and was a lot of things that could have been done differently. and the steps that we've taken within fema to address some of those needs, you are aware of. we still have a ways to go. but the emphasis where policy on children is to look at this is part of the community as a whole. were you point out, when you read a plan and children are not even mentioned in the requirements for planning, at it is a strike against being successful. we have been rewriting the basic documents, the community preparedness guidance 101 to make sure that children are not an afterthought or assumption but are actually in there that you have to look at what children's needs are going to be. if we've taken the steps of forming this process, but an important step, her children's

working group which took the approach of looking at children's issues but in preparedness response and recovery to all our programs including grant programs that provide only security funding, state and cal governments to prepare for if acts of terrorism and other disasters to address these issues in the guide is to make sure that if children related issues were not excluded because they were not mentioned as eligible for that type of funding. and finally, establishing within the working group of permanent position that will be for the minister continue this work as we continue its children's issues to what the program. the other thing we did is look back at taking a step back -- one of the things they need to occur early in the disaster to allow us to bring resources to children more effectively, one of the issues that this commission race was a care centers. again, fema does not regulate or provide oversight to day care centers, but in the aftermath of the disaster there had been some question whether day care

services would be eligible reimbursement for state and local government. with clarify that in the answer is yes. if we've also put more emphasis on getting schools reopened in the aftermath of disaster. unnecessarily things go back to normal, but we know the schools become a tremendous. amplification for bringing services to children. and when you look at some of the troubles that children have, is getting children back into a routine where they are back with people they are used to, and necessarily normal system's but back into a routine. many disasters especially the size of katrina, the tendency of the association of been relocated multiple times, the act was not what the future held, and oftentimes an uncertainty even about basic necessities of went what i go back to school, often times exasperated -- exasperated children's issues and prolonged the trauma that they suffered. we can bring those services back quickly if we can start addressing these issues early in the disaster response that would

give us a better outcome in the future. dealing with this is not something that they might come along consol. it is going to take couple family effort. and that is the other part that fema is committed to. in this administration we're trying to break down the silos to approach the problem from a single one of you. there is overlapping, parties, and rather than fema assuming those roles, we want to work part of the team and become -- will look at the -- we are part of the team. the other folks here will tell you then the other programs that represent tremendous capabilities updated day but also become key points of focus in a disaster and working within those. a bracket train horn] as the

train goes by, i will conclude my comments and wait for the questions that the panel may have. >> good morning, and bake for the opportunities here. calling up on the administrators at comments, we have done a lot of rewriting. we have all had experience of the past year that caused us to want to be sure that we hardware -- hard wired this entity of all the infrastructure. examples, h1n1 taught us about countermeasures for kids. it also taught us that problems around the country, outside the federal government, like some pharmacists having trouble compound in simple things that we used to think about doing, and in haiti, we looked at our electronic health records to fine-tune our response, and 40% of the people were seen the kids instantly to change our response there. and now we're dealing with the oil spill in haiti looking at the behavioral health needs of

the community, including data kids. and we continue to fine-tune our response, and each one wants us -- makes us want to strengthen our of the structure to address the needs for kids as we see them. with that tons of valuable input from this commission, from the national science board, from lots of experts -- all of them have helped us move toward in this very important area and we're working hard to catch up to fema. because of the gulf situation, but because of the train and the call oil spill so much in everyone's mind, i want to provide information about what is currently under way there and talk to you and provide updates about the current and upcoming activities both with our inner agency groups, response issues, and countermeasures. certainly the oil spill had underscored an awful lot of things and you have heard from others about those children's

issues. behavioral health issues been right up there on the radar screen. our actions have been relieved of is on preventing injury and illness, preventing exposure to hazardous substances, if not only among response personnel but the general public, to monitoring the long and short- term potential to help impact, and to ensure the safety of seafood. children have the potential for long-term impact. children need seafood. there has to be a lot of calibration of all of these exposures and all these things. we're working very hard across the department to be of the monitor and ensure safety. as you know, the secretary ask you about the workshop what's happened down in the gall to look at the site to the basement critics basis of what is known and to identify research and surveillance opportunities. many of the recommendations involve looking at children not as a product and i think we're

very focused on that and i want to assure you that children, pregnant women, and others are very much the focus of our activity including board. if much of our short-term focus has been and behavioral health. we have made frequent trips to the call to participate in community of fans and hear from affected populations. it was actually after one of the sessions that i reached back out to those of you on this commission that we deal with as well as aap, because of the needs of cognitions. -- clinicians. i appreciate the average that you have done and that other provider groups have done as we move forward. the experience also provided --

let us along with others to write a piece of behavioral health and the call. and i thought i would pass around some copies for you in case you have not had a chance to see it. we've been working hard with just about everyone to ensure funding for whatever health services as well as messaging a 1-800 line. is a wonderful example of how we're all join together -- as you know, domestic violence issues and others are housed together. acrossed to see spikes' the hot lines to worry about and try to monitor very carefully child abuse which is up -- something to move forward to address the issues of kids. we recognize the kids are going

back to school and getting to our normal routine in the next couple of weeks in the call. and a guide for teachers and school administrators with tips about how to talk to kids about the oil spill disaster and the kinds of thoughts and feelings they are having that are going on. it is right around the corner and this is in collaboration across the entire department and very much with the department of education. our children's working group which david and i co-chair is up and running and we are really pleased about that. his already increased collaboration in coordination tremendously across hhs. we have 20 different agencies representative. it has an extensive -- we're learning a lot from the way they used that the matrix to help our coordination in the future. already the working group has been an amazing resource. they have come out and read many parts of the department to share across the part of what is going

on. some tangible results that i know you'll be happy about have been bringing together people to discuss the pediatrics requirements of the strategic national stockpile, and be part of our 2010 annual review. administrator fugate and david and i have agreed that are working groups will meet together at least twice a year to be with a share what we are learning to coordinate, and to get mutual activities underway. and there's been an awful lot that i can detail with you. if you like that tangible activity that comes 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 some really exciting work that is going on here through these kennedy-shriver initiatives in human development, or they have been working with traumatized children for a while and the a lot of very inexpensive

prosthesis, and $30, that is now in use and post-earthquake haiti. i brought this along to show people. it is little and it is cheap so that you concur with it, and it lets kids be able to do things like grip. it is another tangible example of something really cool that has come from our efforts and i wanted to be of a share that with you today. on the medical countermeasures side, the review was released on friday. finally. the last time i met with you, i too would be around the corner and it turned out to be a long corner. but i was glad to be there to read about the lessons learned about needing to do a better job to do with countermeasures for kids, and i had an opportunity in response to this question to detail a number of activities that are already under way. if happy to talk about the during the question and answer period. if you like.

and finally, we continue to be thrilled to have in the direct -- andy garrett involved. he led the hiring and pediatrics dealt with pediatric countermeasures. with his leadership, but many efforts which i in detail for you are under way to change the configuration of barton, develop guidelines for children, to deal with basic pediatric care, etc. i want to say how much i have appreciated the commission's focus and activities. i want to assure you that we are in this for the long run. our communication fema is in this for the long run. and we're working on sustainability plans. when i first met with you a year ago, i told you that i was launching this effort in my office with janet leigh, who is gone the activities up and running.

she will be leaving at the end of the year, and we're in the process of identifying staff to carry on this effort for the long haul. my goal and i'm sure is yours is to be sure that when all of our tenures and, we had baked enough of this into the infrastructure an organization that content -- that children will continue to be a focus and never be forgotten. i look forward to the discussion that follows. >> thank you. mr. chairman, commission members, welcome. we're delighted to have you. as i moved back into the acting deputy secretary role, all the lab work without the -- with the commission throughout my tenure here, it is a good to continue the strong collaboration i've had with you. we're delighted to host you here at acf. we have primary responsibility for meeting with human services and needs of children, we considered disaster preparedness to be a critical part of our mission.

we're working very closely with and hhs, what dr. laurie, with her response that, and with the month -- with dr. lurie, with her response staff, and with payment. we do not know where the next disaster will strike, but we know that children will be heavily affected and that is what we considered this an important part of the work we do at acf. a lot to talk about our structure for addressing human services preparedness and response issues within acf up in children and some of the things we're doing in pipe program airs at the commission has identified as important and give you updates on where we are in each of those five areas, and then i will open up for discussion afterward. our minister of structure within acf is drawn office of human services, and it has all poor

acronym, and it is headed by our captain, and you know her as the designated federal official to the commission but she has recently joined us as a director of sector ofocefer, and this is how seriously that we take the issues that we're dealing with. she has worked as a nurse officer in the public health service with extensive experience and his had experience in the medical readiness, and also is chief of staff and the office of weapons of mass destruction, operations, an incident managements in the department of homeland security. we have a wealth of experience with her and we think it she will bring our worth any area to

a higher level than we have had previously. she and her team are officially responsible for facilitating our support of the mat in emergency support section 6, to stage and make sure that they are in a position and at the capacity provide the services that children need in the wake of the disaster. and we continue to play a vital role in ensuring that children needs are being met while they are displaced were sheltered during disasters and we work with organizations on the ground, state agencies, if to make sure that supplies are in state comp -- are in place, the services are available, and address the city needs and make sure that safety particles are in place to make sure that children are protected in the situation. pfizer said, like the focus on five specific program areas that are within our pope leo that are relevant to the discussion and that the commission has identified as important in the wake of a disaster. if a child care, child welfare,

head start, services for what we call our unaccompanied alien children program, and our disaster case management program. let me start with child care. the child care program is administered by our child care bureau. 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 highlights of what the child's bureau has done over the years. first of all, the bureau has provided technical assistance and guidance to the child care expertise, primarily states, to increase the number of states that have comprehensive, statewide emergency preparedness plans in place. and since 2008, we have been asking them to report to us on the progress that they are making in developing these comprehensive plans as part of their biennial state plan for

submissions that they are required to make to us to tell us how they are using federal funds that are provided to them for talk care purposes. the doctor bureau has also provided policy guidance costs about flexibility in spending funds in response to federal or state declared emergency situations to make sure that there is continuity, opt-out care services to children in disastermost importantly, we hae partnered with fema to identify and remedy gaps in post-disaster services. they have changed policies in ways that we think is very responsive to the commission's concerns and the needs of children. we have done everything we can do to make sure we get bored out to child care and development fund grantees about expenses now eligible for reimbursement post- disaster.

we have in fact co-hosted the child care administrators meeting this month to discuss and explain the new guidance to grantees. we want to make sure states our understanding is prepared to take advantage of the reimbursement opportunities made available to them in the wake of recent disasters. finally, the child care bureau has launched a new website which features a child-care resources for planning and responding to disasters and emergencies. if you have not taken a look at, i encourage you to do so. it has resources for grantees, states, providers, parents, people displaced in emergencies. it is a very comprehensive, very user-friendly website with a wealth of resources about child care access in disaster situations. we are very proud to have that website up and running.

closely name is our children's bureau -- they are responsible for child welfare services. they monitor the state disaster plans for children in foster care and maybe displaced during a disaster situation. those plans allow for continuous tracking of foster children during emergencies. in that area, we are continuing to enforce requirements under the 2006 review and improvement act that states locate and insurance services to children under state care or supervision who are affected or displaced by disaster situations. states are responsible to respond to new child welfare cases in disaster areas and remain in communication with caseworkers and personnel displaced by disaster to make sure the records are preserved and coordinate services and share information with other states since people are often displaced across state lines. we want to make sure there is

continuity of services from state to state. we support states in developing and updating their plans for providing a framework setting out services on the ground and making sure they are also appropriately training foster parents and child welfare staff to protect children in disaster situations. we have a national resource center for child welfare data and technology which we fund. it has refined a database on reconnecting families and the purpose is to aid states, tribes, and local governments, any agency in the wake of disaster to make sure those children who become displaced or separated from families through the reconnect family database, this allows a child welfare to track them and reconnect them with the family or the placement where they were located prior to the disaster

and reduced the number of the children left stranded in disaster situations. >> if you want to hit the highlights. >> our headstart bureau has similar responsibilities. during the day, they have similar policies in place to authorize operation centers in the wake of disaster. her division of the unaccompanied children has worked closely with the states. in 2007 and 2008, they provided support in texas. disaster case management has been important to us and the commission. we made significant strides in that area over the past year. in december of last year, we executed interagency agreement with fema which we can now integrate that after the president declares a disaster. our first pilot responded to the

needs of people victimized by hurricane gustav and hurricane ike. that has been completed. we were working together to see what lessons can be learned to strengthen the program. we know how the mechanism in place to provide disaster case management to the femur partnership -- fema partnership. i'm delighted to be here and answer your questions. waschildren's working group mentioned and we are excited about the potential to increase their response to children's needs, not just within preparedness response, but across all the program areas in health and human services. >> thank you very much. just a couple of quick questions and i will open up. i did not know about the position, the full time position

within the same headquarters. that is fantastic. see the recently announced they would fill a disability integration specialist -- seem up recently announced they would fill the disability immigration specialist. is there any consideration on doing that for children's issues going forward so that there is somebody in your regional offices focused on kids' issues? >> absolutely. as you know, with the american disabilities act, it covers not only are delivery of services, but our daily business. part of this is to ensure our compliance just from our day-to- day operations which has not been where we wanted to be. it will also reflect the philosophy we have of "planning for easy and plan for real. communities are not made up of one type of individual who everything tries to fit when he tried to do something. communities are diverse and have many challenges and issues.

this focuses on disability compliance and children with disabilities tend to be our most vulnerable groups. in expanding that and looking at children's issues in general, i hate the term special needs because it tends to denote you are building another box. instead of keep building boxes -- building boxes, we want to -- part of this is our day-to-day responsibility, ensuring fema is an inclusive and accessible. but as we planned for disaster response, using this as a focal point to plan for real. that means you don't just have one simple answer that takes care of the population. i like to keep things simple. when somebody asks for meals, the first response is to send things like mre's.

we're talking about being inclusive. i have to grandson's. he cannot not through the mre bag. -- he can g gnaw through a mre bag. we have solutions and to lease that back and start asking the question about infants. we have to feed a population and the population is not all healthy adults. there'll be a lot of different dietary requirements. oftentimes, the easy answer is not the real answer. the long winded answer is yes, we're going to look at expanding its role and plan for real. we also have significant requirements for being inclusive and accessible in our delivery of services which is one of why -- one of the reasons as was established in each of

the reasons. >> -- each of the regions. >> my understanding is you're going to look strongly at incorporating this on kids' issues going forward? >> yes. >> i know that atf and see my have had conversations about disaster preparedness -- the atf andfema have had conversations about disaster preparedness. has there been discussion of our requiring states to get federal dollars to make the basic minimum requirements for child- care centers, that they become a requirement rather than reporting back? can you tie this to in federal dollars to making sure those facilities are safe for kids? >> we expect to have the program guidance out very soon. that should be available. >> my question is very soon for

you may not be very soon for me. what does very soon mean? >> i don't have a specific date. we have to go to the clearing process, and i will get back to you with the date on that. >> with regard to this specific regulatory requirement, the responsibility for licensing and regulating child care providers breasts at the state level, the federal level. the child program level is under state structure. we require states to certify their providers are meeting health and safety standards, but they're not specific with regard to disaster and emergency preparedness. that has been a concern of the commission. what the president did as part of his 2011 budget proposal which is currently before congress is proposing a set of principles for reauthorization of the child care and development fund which would allow us to strengthen requirements in a number of ways.

the focus would be broadly to increase the number of children who are in safe, healthy, nurturing a child care settings. that is abroad. what we hope to do through the reauthorization of the program is specify exactly what that would mean in a number of areas. we're looking to work with congress to strengthen our authority to create requirements that expand on the fairly general standards that exist in a number of areas, including emergency preparedness and response. >> when the members of congress asked us to come up and meet with them when we describe that there are child care facilities that may be their staffs are sending kids to that don't have plans in place, including evacuation, taking care of kids with special needs, when it becomes real as appeared -- as

compared to talking about safety -- maybe for safety it's just for fire. but if there's a much different disaster than that, make it real, i can't imagine anyone in congress if they say i'm chopping my kids off at a child care facility and -- i'm dropping my kid off at a child care facility and not know if they're safe disaster were to happen. that is real. if we are getting federal dollars, we ought to be mandating states ensure those children are safe. if you go to a fast-food joint or high and the place, we know the food is saved because we know there has been an inspector there and it's not safe, they will close the place down. it goes to the example of we have provided food but a one- year-old cannot gnaw through

that thing. i have a 5-year-old and a clear step in a shelter, there would be held to be paid with my kids. if we make it real s talking about safety in general areas and say when you drop the cap off a child care facility, you don't know if that child is safe, that will agitates some parents. you know if you go to mcdonald's or risk chris, the burger or stake is inspected. >> i completely agree. that's a direction we have indicated we want to move. i note legislation has been introduced that would give us the authority to do that. my hope is working with congress, we can establish authority to give us direction to states to require the kind of protection to be in place you are referring to. >> can i ask one more question? the disaster case management, is

that going to be renewed or do we have a time frame on that? i think that is expiring in december, right? >> i think we can best commit our intention is to keep it in place. anything we need to do to make sure that happens, we will do it. >> i'm not sure of is referring to case management in the aftermath of hurricane. we have demonstrated we can use the funds to do that and as been pointed out, the process that was used, we need to step up. one of the things in this agreement is ensuring that the states are not ready to go, they will come in and provide immediate needs. this is often times based on the history of the state. their state will have effective case management ready to provide support, but if the state is

overwhelmed or doesn't have the capability, having the ability for the federal agency to provide an initial case management until we can get a longer-term state contract, traditionally fema provided grants directly to the states. but as we demonstrated in several of these storms, there are gaps. we can certainly reproduce that if it is warranted. i think it's an important tool that we can demonstrate that. the state cannot scale up fast enough, we have a federal partner of and can enter into an agreement with and fund them out of the disaster recovery funds. we do have funds appropriated, but for making sure have appropriately credentialed managers to provide

the surface. -- provide the service. we don't know if congress will give us the funding, but that will not affect our ability to ride the service. goingon't know if you are to ask about that? >> we need to emphasize -- and speaking as an actual finances and. i've seen a lot of administrations come and go. there have been a lot of good people in various administrations, but we have some extraordinarily dedicated senior officials and i does want to make sure that while i'm wildly frustrated, i'm extremely appreciative of the dedication, intelligence and commitment your teams have brought to this question. but like to ask more about the study that was done -- what is

the result? >> the evaluation is currently under review with fema. we did the evaluation in several steps. we get an outcome evaluation to see if families in fact received the services they need and were restored -- >> this is taking an extraordinarily long time and i don't understand why it's taking so long. if you couple that with the data we are finding, we have children still from years ago he needed case management and programs terminated without resolution of cases and people fell through the cracks and we are paying a very steep price as far as children are concerned who did not get what they needed. i'm failing to understand -- and talking with a social science have on. i'm trying to understand why

it's taking so long to evaluate a study to see if families were helped. it feels like a long time ago. we need to get this done and we need the recovery framework. if one of you could respond to why we do not have a recovery from work as we speak here, i would greatly appreciated. >> i can speak to the evaluation. i don't think it's taking a long time. the disaster case management pilot that served hurricane gustav and hurricane ike victims began in fall of 2008 and was conceived as an 18-month pilot which carried it through march of this year. we got an extension from fema because some of the services had not been completed. it's only a few months ago that the pilot ended. i don't think that's a long time to complete an outcome evaluation. we're moving forward as aggressively as we can help to

people to report on that as quickly as we can. >> the framework is still in process. as we're going into working with other federal agencies on the file recommendations and clearance process, we experienced the oil spill in the gulf which means the agency's became engaged in. in respect of of having a public strategy, we were implementing it in the tennessee floods. as the chairman points out, words in paper are not action. what did you do? one thing that's detrimental to children is to be displaced from their homes. oftentimes, being in shelters for weeks -- we took our partnership with hud and it's something we had not done before. instead of letting people come to us and waiting for the process to help them, we

targeted families in shelters as a party. we sent in case workers and get immediate work to get people into housing. rather than letting this process work passively, we took elements of that strategy and engaged in active work to get people placed out of the shelter into a more permanent housing situation. in many cases, the stability that brings to a family is important to children. while it does not stand out as a children-specific issue, we thing getting children out of the shelter environment into a housing situation is real. a big emphasis of that strategy is looking at how do we provide housing in the aftermath of disaster because we know children being moved multiple times and not having a stable environment is a key factor. those elements were implemented and we take many of the concept

in that strategy and, tenn. being one of our larger events this year, we began implementing that to make sure we were taking those elements in the draft and actually running them. while that is in process, we're doing many of the things we have identified to bring stability to a community, particularly when it is children issues, a stable housing situation is critical to the event. >> i'm very interested in the denominator. in tennessee, for instance, how many families needed the services and how many got them? runningt's tempting in an agency to talk to at what has been done and quite a lot has been done as i acknowledge. but the question that troubles me is what is the need and how far along the get? did you take care of all of the

children? do you know what the denominator was? that's what you would want to know and that's what we want to know in terms of advocating for kids. >> i would not be able to break 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 a housing situation. in this case, just demonstrating we have done something we have not done before which is having hud go into the shelter with us and to case management and get people into a rental property as opposed to allowing the system as they had done before where they have to register and go to the whole process. we knew those in the shelter had the greatest need. we targeted shelters and this is something we started as early as last year. looking at some of the more systemic issues compound children's recoveries which is get schools open, people into

stable housing, these are the macro things we are trying to do at the response level and policy level. that gives us a better way of addressing issues that are other partners. then began looking at specific, children are having individually. to a least provide a stable base to minimize the trauma or the duration of it. >> i want to publicly thank the doctor and her colleagues for their continued support of the medical subcommittee. it's great you reach out to us month after month. you mentioned in your opening comments, i was on the call last week when the secretary rolled out the enterprise-wide review and was heartened to hear her mention children in the first five minutes of her address. as others have said, the devil

is in the details. how do we positively affect countermeasures or the needs of children in this country. to the specific areas and that more if you wish -- how do we bake in pediatric issues so we're constantly thinking about them. second, how do we use the tool the fda has to even before a crisis or a biological attack or chemical attack to make sure kids needs are addressed? i did great there is an enterprise-wide review, now the devil is in the details. >> let me talk to you about a couple of things that have already begun. i am pretty focus on the fact that learning cannot rest with individuals. has to rest with the system. the way we do the medical

enterprise system and manage a going forward is a tremendous focus. we have just completed a series -- we are going through a series of and to and reviews of major areas in the portfolio, like smallpox, anthrax and so on. three of the four had just taken place and we have developed standard operating procedures on the others. one of the boxes you have to check is what are the end user requirements up front? in there, what is the anticipated population of children. it's not just children, children of different ages and sizes need different doses and metabolize drugs differently. a much more in-depth look as part of the requirements process. down the road, and terms of developing target product profiles, to be sure we can

have those end user requirements baked into the process of front. i do not think you will see other requirements going forward that did not explicitly say what are the needs for children here? in response to the question that the announcement of the review, we have already started doing a number of concrete activities in that regard. one that relates very much to your president is one of the issues with the current eua has to do it the possibility of the current antibiotics. if you try to mix them up, they taste so terrible that kids will spit them out. one of the things we have is work underway thru contract with a developer to figure how do you make this stuff more palatable? i'm a quick to point out of you can do this the countermeasures in the stockpile, you could do

it for a lot of other pediatric medicines. the benefit will go way beyond the stockpile. the fda has committed to actively working on looking at its eagle -- looking at its legal framework. we are hoping there is something that is in between that helps us deal specifically with some of the very challenging issues about getting mcm for kids in an emergency. i believe when all is said and done, you'll be quite pleased with that as well. >> i have a quick question trade in your remarks, you talked

about silos, which has been a term used frequently over the past year-and-a-half with in this commission. the chairman talked about need for a cohesive national strategy. but primarily to accomplish that is through information. -- the primary ways to accomplish that is there in formation. the agencies, whether federal, state, nonprofit or otherwise have access to key information. we're pleased and impressed with your staff to begin the national mass evacuation tracking system. i know that is a state-based system. my question as, addressing this on a long-term basis is going to be expensive and complicated for a host of reasons. i'm interested in your assessment on where you are in moving toward improved information, acquisition, and where you see the primary

hurdles. >> one of the first hurdles is what information do we really need? we have to have total visibility of everything and trust me, that's not the solution. it's impossible. everybody says we need to track every individual, every person, we need to track by exception. this goes to something -- it would be a shame if i do not bring this out. as much as we're talking about a federal responsibility and federal authorities, this always starts with the family. next month is national preparedness month. for many families that have children, taking the steps to make sure you have a family disaster plan, the top of your children, and you explain this as a key part of them being resilience, those families that have been plan, if nothing else -- as chairman, you talked about day care centers. one of the things we know from everyday events, it does not take a katrina-style disaster,

just small events that can disrupt a community. when children don't know what the plan is or how to reach parents or family members, with the contacts are, it comes back to do we have a good understanding of what we are supposed to do? for the families that can, they should be making those plans to include their children, talking to their children about disasters and hazards. as we work with our partners to increase our participation and focus on children, one thing we don't talk about is preparedness. the more children understand about the environment they lived and, the threats and we can do to minimize those threats, the more empowered they are. this comes back to resilient children are those that have a sense the community and family have a plan. that they understand what is going on. the unknown is what is challenging. so when we look at this, like

with an evacuation, in trying to track every individual, that going to be hard to do. but there are certain groups we've got to track. our states need to do, where they have the primary responsibility, children in foster care. children that are either because of dependent status upon programs or because they're actually in the care of the state, those populations are extremely important to track. unaccompanied children, children that have family members they have lost in disaster. and as haiti and other disasters have taught us, foreign nationals who are here because of treatment or evacuation, those are the types of populations this we're going to devote resources to have to be the first priority. as we get a better handle on that, we can include more. to track each individual, not possible. focus on the one detractor a

what reason are you tracking them. those are the ones that have a dependency and we need to make sure we can connect those resources when they going, particularly when they're moved out of their community setting where they already have the support network. >> i want ask a couple of last quick questions. there was discussion -- the child welfare systems. like to talk to you about the recommendations about the child welfare systems. we have not made much progress with that approach within your department. it would be good to get together after this discussion and tried to follow up on that. following up on that, you talked about some of the progress made on headstart and other areas. i want to be sensitive of your time, could you tell us what the one or two things are better

biggest problems and what you think should be done that this commission can follow-up on? if you were on my seat, what are the things you think of the biggest gaps in your department? if >> i think the most important thing is to maintain the focus on this issue. we have the mechanisms in place across federal agencies to do the planning and implementation. the important thing is to keep the focus, keep the emphasis so that there is no diversion of attention from the issues we're talking about today. >> there is nothing within your agency that we should specifically focus on are you are not going to tell me that? >> i think you have told us that and i think that's what we're moving on. adding to help set up the agenda and we're moving on the agenda. we need your continued support

and focus to make sure that momentum continues. >> i guess the eloquent comments about the fact that we are very impressed and support of the work you are doing, but frustrated at times -- you have heard this from this commission and for me as well. having said that, is there anything you want to add to that? >> i want to say how much i have appreciated the monthly calls we have. i think they have been very helpful in stepping through a number of issues and having good communication about those. i would say maintaining focus is terribly important. the one thing i would like us all to focus on is having us look at children as assets. in a response, in a disaster, i think there are many untapped

ways to unleash not necessarily with infants, but children of many other ages have to offer in helping us manage and recover and helping families recover from disaster. i would like to see us put more focus on that in the coming year. of the events of last year in the routine disasters we deal with has given us a lot of good ideas about how to do that and it's a place to go for all of us in the future. >> it would be helpful to me and the other commissioners when you talk about the ability to use federal grants for children's issue that you talk about the federal dollars that could be used for child care. you are very eloquently saying that talk is cheap.

is there any way to see -- and ellen may be in the future, but assuming you are here next year, are their systems in place where we could see whether the dollars are following the words we're talking about and the emphasis we're getting to kids? also, whether there are one or two things you like us to focus on? >> as far as the grant program, this would be our first grant cycle to see what the awards are. since those will be going out, what is to scrub that and see if there's any difference. i would not be too dismayed if in the average share you don't see much of that. my observation is when new guys come out, it takes a couple of years to be able to build it into the request cycle. this year is marginal. i would be more concerned the didn't happen next year. i would expect more advocacy groups to be aware of it and

targeting funding for that. -- i don't think there has been enough of the events to trigger some of the programs we would be out large- scale disaster. we solve some small cases, but i do not have the data to say what the changes. from a social science perspective, response data is not usually any good. we have to go back a year or two later and see why something wasn't addressed. we're not there ought anything sensitive. and i will be three issues. first, day care centers. even though we have identified day care centers is being provided by local a straight -- local or state government as being available for reimbursement, many of them are small operations and did not have substantial resources in a large scale disaster to reconstitute themselves. as we put emphasis on getting

schools open, pre kindergarten will be a significant issue. interest on a place to go for children so parents can go back to work, it's hard. issue ashink this is a it is relevant to the entire issue -- entire picture, this is something we will continue to work with our federal partners and there may have to be program delivered by the federal government until they care centers can come back on line and it may have to take a form similar to what we have done with crisis counseling. but i do have that concern and i think they care will be a critical gap in catastrophic disasters is because of the nature of the industry and how difficult will be for the providers to come back online. second, drug and countermeasures. as we get new guidance to

incorporate that into our funding and our proved purchase list and equipment and drug list, we provide the funding for the bulk of what state and local governments are purchasing in addition to the national pharmaceutical stockpile. this will be a secondary effect as these countermeasures are identified, approved, and signed off on. that there bolton to the grant guidance and approved equipment list, -- that they are built in to the grant approval. i think this was mentioned several times, my experiences tell me the more we incorporate children, particularly in the the kindergarten through 12th range into prepared as activities, the more brazilian children become to the effects of disaster. we continue to work with our partners at health and human services to look at how we take

preparedness' messages to all levels, but particularly elementary school and k-12. so they're better informed about what can happen -- this is not about scaring children are trying to seal the children from the disaster, it is about them having a role to play. some of the best messaging we can come home to change behavior comes from children. the idea that we do not call them super victims, we call them survivors. children become a very powerful tool in promoting the message of preparedness which increases the more successful outcome in a disaster but also empowers children because they have a role to play. as we see time and again, people have a participation in an event and a positive influence are able to address distress and adjust to it much more effectively than if they're not included or not aware of

what's going on or do not have a way to participate or contribute back. that comes to looking at the public as a resource and recognizing children as part of the resource where appropriate. >> thank you. many thanks to all three of you. you were here to long, so go. thank you very much. great to have you here. thank you for your good work. we are going to move into a discussion on the report by asking commissioners to give a brief outline of each chapter. there are few outstanding issues we need to discuss and have a general discussion about the report and next steps at the end. before i ask larry to walk us through the disaster management and recovery peace, are we clear on the process?

any comments? >> think you are ok. >> larry, which like to start a soft. >> chapter 1, disaster management and recovery, reviewing the recommendations and opening for any discussion on the recommendations. recommendation 1.1, distinguished and comprehensively integrate the needs of children across all government disaster management activities. this is an overarching consideration if we want to protect our nation's future. specifically and it is recommendation, the president should develop a national strategy for children and disasters. the executive branch, congress, and on federal agencies should it categorized children separately from the other categories. the executive branch should maintain permanent focal points for children in disasters supported by sufficient authority, funding and policy expertise.

the executive branch and non- federal partners should incorporate children as a distinct priority to base disaster planning documents and relative grant programs. the executive branch and non- federal partners should incorporate education, child care, a juvenile testis, and child welfare -- juvenile justice in child welfare training and exercises. the executive branch and on federal partner should incorporate children as a distinct priority in relative target capabilities, british training, and exercises with specific target outcomes and performance measures. the executive branch and congress should institute accountability and progress monitoring measures to track implementation of commission recommendations and the capability improvement. it goes with the added that which is watched its addressed. -- that which is watched gets addressed. and discussion? >> i want to point out an

amendment that was made to this section which was made at the request of the chair person and more specifically to the issue of creating a focal point of coordination, specifically at the headquarters level. there was a concern these positions should be contemplated at the regional level. as an example, acf, the regional office have specific concerns about children's issues. to the question raised, the sub- recommendation is to urge fema to create a similar point of contact for a children's issues. it is great news that fema is looking to create a position at

the headquarters level, but there needs to be a point of focus and coordination at the regional level. that suggestion was made at the request of the chair person. >> moving on, page 22. the president should accelerate the development and implementation of the national disaster recovery from mark 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 is security and the management agency should ensure recovery

services to children and families is collected and shared with appropriate entities. government agencies and non- governmental organization should collect affirmation and children and families necessary to support their immediate and long-term family needs. the department, and security and federal and urgency management agency should expand with non- government organizations to enable a delivery of recovery services. the department of homeland security and federal emergency management agency should identify local and out of state voluntary and non-governmental organizations and networks that provide disaster assistance to families and relatives. >> did we ever discussed the question of what we mean by timeliness? thejust coming back to what

chairman pointed out when certain things happen or don't happen. my timeliness may be your unacceptable delay. that kind of wording lens itself to a complete lack of clarity. the non completion of a particular task. >> [inaudible] >> the issue is good information on the actual needs promotes an appropriate response. the right resources to the right people at the right amount of time. was to be promoted as immediate that with the ongoing declarations of disaster, we wanted to see this information sharing as soon as possible. clearly, there has been some movement on at the as far as whether it's trickling down at

the state and local level whether the information is being supported among local works supporting children and families, it goes back to the overarching goal of do we have metrics and are we able to measure the implementations of the recommendations of the committee? >> would a friendly amendment to timely becoming a immediate and effective -- >> what i would say is that we are talking about the use of the word timely. i'm looking for a harder definition of what the expectation as. i feel pretty confident in saying the longer the delay in getting some certainty established in terms of housing for displaced children, the worse the outcome is going to be. if it was up to me, i would say you have 90 days for any

disaster on american soil to get children into some stable environment with access to appropriate services. 90 may be too little or too many, but -- i'm not sure we are prepared to answer what that is. i would suggest something the commission might want to be thinking about in order to get some degree of eight metric we can look to -- -- some degree of a metric we can look to. five years later, people are still needing services. something makes sense to a charge of development point of view. i can see by the look on his face he is not agreeing with me. is if concern i'm having we do everything that is recommended in this report, i think it will become timely. the issue is it will be difficult to stipulate

particular time. if we do some parts timely but not in a coordinated way, we might undermine some of the other recommendations we might have. as a concrete example, the discussion about in tennessee stent -- sending hud case workers into shelters is an excellent example of expediting the timely delivery of housing services, but i did not hear rescinding the case managers in -- i heard rescinding in hud case managers. if we have not identified what hud case managers are, it may be that those children at risk of child abuse or exacerbation of mental health issues are appropriately removed from shelters and placed in stable housing but they may have missed the opportunity to identify and address some mental health needs. why i'm concerned that we probably cannot have a media

services and information -- there will always be some delay. it's not always going to be in real time. my strategy would beat let's talk about what are the components that need to be in place, get the right people they're providing the appropriate services, and 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 complications or series of things that has to be done exactly interfering with appropriate placement of the child to the child to the detriment. i don't think we have to be ecologist for bureaucratic problems, delays, and issues when we know the longer this time of instability does, especially for families not supported in general, the more dangerous is for kids. i would take a more assertive view that let's at least say what would be best for children

even if on some level we can't understand what they are suggesting -- >> let me make one recommendation. this recommendation is on the sharing of information to provide services. it may not be that we need an amendment or change to the recommendation, but we need to made -- we need to identify other recommendations for its more proper it to make this change as. >> i could say going forward in terms of the implementation of the recommendation, the way it's written would provide an opportunity to work with and to provide an evidence-based timeframe based on the very needs of children and families.

we can certainly approach it that way as part of an implementation strategy going forward. >> we also have to recognize there is largely not a system in place to do that now. overarching this is that it's going to take time to build the kind of mechanisms to share information with the entities we believe are appropriate in the language. i think the recommendation has stated is aspirational. i think it's absolutely appropriate. the goal is to share information in a timely way so that services can be provided. in order to do that, we will have to build infrastructure and systems that cross governmental and agency platforms in order to share information. some of this is policy issue. as we talked earlier in our 10

year, there is concern of privacy statutes preventing people from staring information. -- people from sharing information. it's more sharing information to make sure reading is coordinated through the actual delivery services. >> we have raised this as we have gone through this process. while we are talking about this national system, we have talked in our committee meetings about the majority of our disasters or responses down even make it to the federal level. so, while we've had this conversation, we've talked about the fact that whenever the system looks like, and we are not talking about somebody building a database, if we're talking but a formalized policy that allows you to share information or whatever, this has to exist so that this happens at every level of the system. if fema doesn't turn the switch

on, it still works. it's going to take a while for this to happen, but we have heard some positive things -- there is some for movement on this. >> the final recommendation -- the homeland's security agency and federal emergency management agency should provide disaster training and other resources to state and local child serving systems and child concrete care facilities. any questions or comments regarding this recommendation? >> i think the point was brought up to follow up some of the

testimony provided -- we also have to make sure it's coupled with the requirements that the funding be used and the planning occur or other funding may not be received. the other concern i have this we can offer funding for the planning purposes, but for some of these groups, particularly child care, a small child care center or home day care facility may apply for that funding or may not access the funding but nonetheless, it still needs to be prepared. we have to think of other mechanisms that will insure this actually occurs. i don't know that we need to revise this recommendation, but i would like to staff to make sure it appears elsewhere on their report and perhaps even references back to this point. >> perhaps back in the metric, looking at the track of

commission implementation of commissioner recommendations? >> i don't know the report as intimately as staff, but it talks about the fact that the disaster preparedness planning in things such as day care should be made a requirement for funding for revised health and safety standards. we might reference back and say as recommended by the commission in 1.4, funding from dhs fema and might be used to meet this need. if we could tie that back together to say it's required but we also suggested funding mechanisms and interagency agreement mechanisms to make sure it occurs in an effective way. >> we can do that. >> that concludes chapter 1, disaster management and recovery. >> any other questions on this

issue? hearing none, david, you are up on mental health. >> i will say in summary that the mental health section recommendations, the only changes proposed from the diversion reviewed by the commission that was sent out to the commissioners are fairly minor editing changes. insertions of the names of agencies that have already been included as designated to take the need in those efforts have been included at the beginning of the sentence, but otherwise there is no significant change, so i will go through them fairly quickly. recommendation 2.1 is that hhs should integrate mental-health for children and to other disaster management activities and c'mon -- and congress should direct into lead the disaster mental health concept of operation to formalize disaster mental an april health as a core

component of disaster preparedness response and recovery efforts. this is essentially the same we had in our interim report and now designates it that hhs should lead does efforts in doing that. questions or comments? recommendation 2.2 is that hs should enhance the research agenda including psychological first aid, cognitive behavioral interventions, social support intervention, bereavement counseling in programming's intended to enhance children's resilience in the aftermath of a disaster. a working group should be convened of pediatric experts to review the research portfolios of agencies, identify gaps in knowledge and recommend a national research agenda across the full spectrum of disaster mental health for children and families. this is essentially what was recommended in the interim report with the addition of

focus on children's resilience and doing research to identify programs that would hands children's resilience. as we heard in testimony, this is an area of interest and need and one that has not been particularly well studied to date. any questions or comments? i will go to 2.3. federal agencies and non-federal partners should enhance prepared this in mental-health, including they should strengthen the crisis counselling assistance and counseling program to better meet the mental health needs of children and families.

to simplify the immediate isp grant application to minimize the burden and to facilitate the rapid allocation of funding. the discussions with ccp felt that the best way to accomplish that was simplification of the process. this is essentially, what we have discussed before. second was to go established the position of coordinator. this was a recommendation that have come out of our iowa visit. to indicate and promote enhanced services. that is a term that had been used by c cp -- ccp services.

the last bullet on that would to include treatment support and education within services typically provided under the ccp. any questions or comments on that recommendation? in terms of 2.5, we recognize that the funding would not be sufficient in order to provide funding for direct mental health services because they more coordinate services and build upon the mental health infrastructure already in place within the community. if that were lacking or

insufficient, we recommend that congress to establish a single flexible grant funding mechanism to specifically support the delivery of mental health treatment services that address a full spectrum of the behavioral health needs of children. i will move on to the next section. >> thank you very much. >> they released a wide review, we modified recommendations and i do want to take a little but talk of time -- a little bit of

time. we actually need more. the commission is on the table information on the screen, this is pretty significantly different in a couple of areas. recommendation 3.1 -- congress should ensure the availability at the federal, state, and local levels. the specific bullet underneath the there really have not changed whole lot. provide funding for the acquisition specifically for children and all federally funded. in 2010, they are re-examining the sms for pediatric materials. to allow the fda at the discretion of the hhs secretary

-- we feel that based upon good scientific knowledge, the secretary made able to use this as a mechanism to put other agents in the stockpile. the next has been a little bit controversial. external experts to advise the secretary of hhs on issues 14 specifically to pediatric emergency. i once again believe that no matter what the life of the commission is, we have to have a constant presence at the discussions when it comes to medical measures for kids. while we have pretty little bit of the downside to this standing advisory body, i think this is an important recommendation that the commission should stand behind. there are other great agencies be out there.

-- out there. pat establishes a work -- that establishes a working group to make recommendations. finally, include expertise on the hhs enterprise governance board or a successor. i want to delve into that just a second, chairman. these of the five basic bullets that we started with. if you delve into some great -- specifically on track changes. to there is a paragraph that starts with in december of 2009 and goes all the way through -- their report recommends -- and i am reading from the second paragraph.

you can read the rest, including the academy. banks to steve for helping us formulate this. it will be a very important key person and development of common measures for children. i think that there should be a bullet under this recommendation. we talked about governance and having pediatric leaders at the table. we know that this is a new projects. a friendly amendments' -- it -- this needs to partner with pediatric leadership and organizations. >> i do have two questions on this. one is back to administrators' statement. i do not see anything that

addresses the concern to make sure that the funds that fema provides takes care of that. the other question i have refers to page 40, as have our is spoken to you about. the commission looks forward to working with its partners. if the commission is not extended, is a moot point. we would not be working with them going forward. i think we need to make sure that there is forward movement and the capability still exists and it is not resting on us. >> we need to make sure that succession planning is in place. the great children's champions should be listed there. we still have a lifetime commitment, no matter what happens for a while.

we need to list important pediatric organizations there as well. >> i do not know how to address the administrative duty, it's in this section about finding that peanut controls related to -- funding that feed the controls. -- fema controls. something to do with his funding and the medical countermeasures to make sure that it gets into his grant guidance. >> the medical countermeasures for both state and local probably are funded through fema. that compaq's what is available at the local level. >> that is also part of the issue, too. >> he clearly made it a point that it was one of his concerns. >> could be i ask -- i would like to ask dr. garrett if he would comment about this.

his role and relationship to what we are talking about. >> we were talking about the the long-term prospects in dealing with countermeasures. if they were funded, where it would come from. who is minding that store? we talked about creating a new position. is that correct? >> the secretary did. >> i would assign that to you, personally. how would that relate to what you are doing around medical countermeasures? someone should be at a senior level responsible for that in the hhs.

the court asks you arise, please. [laughter] >> i am happy to answer your questions to the best of my ability. wildwood stakeholders within agency. certainly, in our role, we collaborate with them, but it there at this point. >> we are looking for ways to streamline its. really the senior personnel responsible for pediatric issues across the board. but i'm concerned about is the immersion -- what i am concerned about is 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. as a senior person overseeing or reporting to the secretary about all things pediatric that relate to disaster funds. i do not know if that is feasible. a good thing. >> not clear whether you are asking my opinion. >> i am asking you whether the creation of a senior person is something -- is that what we should be asking? >> i cannot answer that. i think having a point percent -- medical counter brett -- medical countermeasures is a specifics science. i think it is reasonable to have someone who has pediatric

expertise looking at medical countermeasures. >> this is my point. there is a potential issue for all bus, as we are making recommendations for pediatric expertise, that will do a lot of -- a lot of agencies will do a good job. who is watching the store is where i am struggling to find out how that happens. >> thank you, dr. garrett. >> i do not think we have addressed the grant issue. >> i think bullets number one it does talk to the developments. at a higher level, bullet 1 under 3.1 addresses end. i think it does call for the

equitable funding at all levels. >> i do not mean to put it in a bullet. we need to be specific. he raised that as a very specific issue that he wants to make sure that his team of grant funding is tied into that. he went out of this way to give us that. >> it is a small amendment that would address this. under the first bullet, when we say providing funding for development acquisition of stockpiling, at the end you would say, including those of funded under the fema -- we would be calling it out at that way -- at least that way. >> let me address that. >> provide funding and appropriate brandt guidance.

-- grant batons. -- grant guidance. unless it is authorized in your grant guidance, you will not be asking for a period -- for it. >> i would like this recommendation to the knowledge a new enterprise that is emerging. i do not think it needs a new bullet. this new mcm leader has to have a tie to the pediatric community. it has to be tied -- i do not know how to put that into burbage. i just do not want that to be lost. -- has to -- put that into

verbage. >> is definitely a big challenge. should he wait and on the eigh in-- should he wai on this? >> i think we are trying to craft language on the new enterprise review, the creation of a new lead. i think it is a great step for everyone. the issues in pediatric are so unique. you know the issues well. we want to make sure that this recommendation some halt -- that new leave it is somehow a pediatrician, or somehow tied

very intimately into the pediatric community. >> ok. >> i think that is the area where this recommendation makes the most sense. >> within the report itself is a recognition that there's a lot of folks would different policy responsibilities for medical countermeasure developments, decision making, acquisition, and so forth. the idea of this medical countermeasures lead is to be a point of contact in leadership across the entire enterprise. it is not specifically for a particular population. the language that has now been included in the text speaks to the importance of having such a position within the enterprise and the need to have that

position coordinate, communicate with the commission and other non-governmental organizations that have an active interest in medical countermeasures for children. i think it is stated pretty clearly. we can develop some language to do that. >> this is a general question. i do not know if there is an easy way to fix this. we have made a lot of recommendations that we have to have a spokesperson, an advocate, for children's needs. there might be one among many people. we also have to provide some funding for children's medical countermeasures. often there is a tendency to get the low hanging fruit, the items that are about ready to hit market. but i do not really see that we

have created any mechanism to remedy the deficiencies that we have in the current strategic national stockpile. we have attempted, just one measure, and have spent almost a decade. within the commission, a solid year. we still have not remedy that, even though it was very close to being able to get approved by the fda. i do not 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 equality of medical countermeasures and other federally funded cachets. going'm hearing now is forward, which the new countermeasures are going to be approved, and they have to go over children's dosing and indications. but i have not heard about going back and filling in gaps.

>> if you'll recall, one of the language changes that are proposed is to ask fda -- take a look i meant -- medical countermeasures that are currently in the stockpile and place a priority on getting them labeled for pediatric use. i guess we could week that language slightly to also address other immediate issues in. >> the concern that have is that yes, we are paying attention to it now. we may make it a priority, but we have a goal that we will hold -- that it reaches parity? that we actually eliminate the gap and then we will judge whether we have been successful, not if it has just been a priority that we have made some

effort, but actually we have remedy the problem? that is a concern that we have had. i do not know if we state that. >> the overall section says we need to go backwards, forwards, to make sure things are safe. the tenor of the section, that is there. i still believe the advisory body addresses some of your concerns. we have experts that helped reach consensus, helped reach eight research agenda. we have had disagreements about that body, but i stand behind it. >> david, are you referring to some benchmark across the federally funded medical countermeasures system? we want the gap filled in for

25% of the population. >> correct. >> why don't we put the number in? >> that the state, at least, that only once we have remedied or eliminated the gap in medical countermeasures for children within the national strategic stockpile or supported will we have succeeded in this effort. maybe it is just a sentence that you need to put in there, but i do think it is -- you have to say that it is ok to do more. we have to fix the problem. >> on the edited pages, the report recommends a resource with enhanced capabilities. the report recommends to work proactively with industry sponsors in targeted areas.

the commission recommends that one of the targeted regulatory scientific initiatives the pediatric labeling. once again, it does not have to be a seven the bullets. i just want to a acknowledge it. i think it is an important plan. i do not necessarily think it needs a different bullets. these are the edits that i see, mr. chairman. are there comment from the group? >> 3.2 -- hhs should enhance pediatric capabilities to the integration of training, guidance, exercise, supplies,

and personnel. we talked about this before. the reserve pool of health care workers and that we have the health care coordinator on each and every disaster team. on the record, i think they have done a nice job. i think that this one stands. comments from the commission? seeing none, 3.3 we have to talk about training. health officials that may treat children, we called for the the president to work directly to prioritize the core curriculum at and research. we have built some very good bridges with this group.

the core competencies are really part of the federal funds. it would be an excellent condition. this is pretty similar to our interim report. i think progress is being made. comments? 3.4 -- we are now talking about regionalization. the executive branch and congress should provide resources for formal regionalized pediatric system of care during and after a disaster. there were many wake-up calls during h1n1. we felt a lot of facilities that were not in any way shape or form ready to take care of children. this concept of regionalization -- i think we're just scratching at the surface.

this is something we need to spend some more time on and emphasized more. this is pretty much the recommendation we have in the interim report. >> why are we focusing on its more now? -- why aren't is refocusing on its more now? >> i think it is a start. it is a good point. this is a good start. we talk about funding and hospitals through regulatory should be prepared. i think it is a good start, if you will. i just think that would bar band with and the first 18 months, we have not delve into this as much as we should. i think the commission remains

important. anything else on 3.4? 3.5 -- recovery of pediatric -- this could be in the recovery section as well. we have an entire day symposium on recovery from disasters. we heard from great pediatricians and mental health experts and how a kid is to have the symptoms back -- system is back on line as quickly as possible. we have had a couple of weeks -- tweaks. the executive branch should recognize mental health delivery systems. we keep hearing about the national disaster recovery a

framework. incentive payment for providers that are still in disaster areas. we should adopt a new code modifier. comment on that? now to 3.6. eta and hhs should expand research on pediatric environmental help assess it

would disasters. we build some good bridges with epa and the national academy of pediatrics. there are some guidelines out there, they are not as well- known as we think there should be. there is not so much research as to what is safe and how little should there be any home before it is safe to return to a homicide take care center or a child care area? comments? that includes -- that concludes chapter 3. >> are there any other final comments or questions? very good. we're going to emergency medical services and pediatric transport. >> 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 delve into the issue of -- we identified that we cannot really get to the base of the problem because we did not know who to talk to any federal government. this is the impetus for recommendation 4.1. if better " -- a federal agency that is responsible for medical services. it calls for the president and congress to clearly designates emergency medical services would primary responsibilities for the coronation of grant programs, research, policy and standards, development, and implementation. concurrent to that is the second recommendation to establish a dedicated federal grant program underage designated federal agency for disaster preparedness, specifically

including pediatric equipment and training. in a discussion? we understood very clearly that without supporting the pediatric care needs on day-to-day operations, we cannot expect them to perform well during times of disaster. congress should try it -- surprise -- supply additional funding for children. this is a longstanding program run out of hhs that has done great work over the years in supporting children's care

across the country, but needs more support. we call for that specifically. ineligibility of guidelines for the center of medicare and medicaid services -- we request that reimbursement to the first responders organization who billed medicare and medicaid that they be required to meet the guidelines and advanced life-support equipment on their emergency response vehicles. hhs should establish strong pediatric performance measures would then the role of federal emergency preparedness grant programs. hhs should also address the findings of the gap analysis research. performance measures that we have passed -- that we have

asked about with the theatrical equivalent ambulances and facility guidelines agreements to expedite the pediatric transport. institutional as asian -- institutional asiization. >> we will be better prepared as a nation for large disasters involving kids if we can take care of that one child really, really well. this is one of the most important recommendations. >> without question. >> this may seem like a minor editorial issue. the performance measures for

pediatric care and transport, right there they are -- right now they are bolted and boxed. i did not understand -- i can understand an article or a chapter. i thought we were just boxing and balding are recommendations. could we just put this into the narrative and say, in particular, we would like to draw like to the critical measures which are -- i do not think it needs to be drawn out in that way. it is unclear to me why it is. >> so often, we talk about these lofty goals that we should care for kids better. what of my dear colleagues keep talking about metrics and taking care of could -- taking care of kids. it was a bullet before. >> i would suggest that we should put it in a bullet if we want to specifically need is

critical metrics. within the text, was what they are. if you are reading for the report, it is unclear as to what that means. i was not trying to minimize the importance of it. but i do not think what you're trying to convey is conveyed clearly. >> the whole thing is not clear to me. i am really frustrated about this. everybody knows that it is valuable. it is unbelievably criminally underfunded. the same message i gave to our federal officials i give to ourselves. let's get serious about this. what is the denominator that we have not achieved yet? if we need 100 times more money to make it functional for america's children, then say that. it will cost a lot of money. this is just rhetorical.

what is the cost? how does this party rank against others? -- this priority rand against others? if we advise them on rhetoric without specifics, without recognizing the need that is unmatched, we will be right -- we will not have a lot of work for the recipients to get. nobody in their right mind is saying that we should not have pediatric education for people to work on ambulances. what does that mean? it means that we need $50 million of appropriations to support -- we have to get to that point. otherwise, this is a shelbourne document at the end of the day. i am trying to avoid that. >> we actually did have a number specifically put in that was edited out during the process. it was 26 points 26.25.

>> that is a nice number. [laughter] >> it would be an increase over what they currently have. one of the challenges that we faced in determination process of what number we would recommend is that we do not have a good idea of the gap. we struggle with actually being able to tell you how many ambulances there are in the united states. much less how much equipment we may need on each one. while we do know is that the performance measures developed and the pediatric committee supports would meet that need on each ambulance. >> i want to quantify -- how you quantify that? is the big question.

>> i would be happy to get this. i would say, thank you very much for the recommendations. if i am writing a congressional subcommittee -- what is it that you actually need? it is not actionable in this form. we have a limited life span, the commission, and will expire this year or two years from now. i think we need a very actionable set of recommendations in general. the administrator is telling us what they did in tennessee, but did that solve 10% of the problem or 96% of the problem? if we do not know that, i do not know how to evaluate that. >> why was the money edited out?

>> there were a couple of reasons. i was one of the people that suggested it. we had not really disgusted as a group and it was not clear how that number was ascertained. it may have been in the subcommittee, so it was very hard if it was adequate. was it even enough? i think there is the danger of saying we need $26.2 million and we really need $100 million. that was part of the reason. the other part was that there was not anyplace else in the whole report were we specified a dollar amount for other funding that we set were priorities. a kind of stood out from that perspective. if it is out of an institute of medicine report, we could say -- within the tax, we could say that the institute of medicine has recommended a dollar amount of whatever the number is and

the commission in the absence of further data at this point support that or recommends finding at least that level. i thought it seemed odd to say that we want this exact dollar amount. >> does that make sense to you? >> sort of. there needs to be a pediatric expertise in the mix. there is a very specific recommendation. we need to keep pushing on it. other recommendations are bureaucratic recommendations. if we'd just say, it would be nice to have more robust funding and we do not put a number in there, i know it is hard -- and i agree with what you were saying -- this got me started. i really think the dollar

amount would be beneficial in a lot of different areas of our recommendations. >> we are on this recommendation now. do we have an issue with that, chris? >> it makes reference to the budgets. >> i do not have a fundamental problem with that. if we were to take the performance measures and specifically identified them under sublet one -- sub bullet one as a that is where we want you to go. that is a very specific recommendation. we note they need increased fiscal support and we will identify what that is in the

body of the reports. but now we have given a clear benchmark that we can come back to in a year and say, how are we doing? does that bridge both the areas? >> putting the number back in is a great idea. >> this is recommending that we authorize that the appropriate the full amount that was authorized. at the very least, we can recommend that. >> we do not know whether the full amount -- what is the basis for the authorization. both congressional authorization, out of the air. i like david idea of tying it to something. if there is an independent academic or basis for estimating what the real number is,

otherwise, we're picking a number. >> agreed. >> in the absence of that, we could say that we need further study and that needs to be done to determine the actual funding that would be required. on an interim basis, we did support funding at the authorized level. >> if memory serves correctly, david, the report that came out in 2006 action recommend a specific dollar amount. i do not have memory. i think we action had in the interim report. >> i think the numbers that were expressed -- >> there better numbers. >> i don't remember. >> we are trying to decide a better number. >> these numbers are not necessarily scientifically based. they are numbers that are supported by numerous advocates

that are pushing for greater funding for the programs. that is really what we have to go along. >> i am perfectly happy about putting back again with the authorized numbers are. and the performance measures. that gives us something to go back to and physically look at and say, how did we meet this? what is the percentage? >> to remove it? -- do we moved it? >> to ensure all and build says are appropriately -- >> the commissioner was good enough to find an interim report that they recommended funding to be increased to $37.5 million. >> that is the language we are using with metrics in there.

>> we can certainly reference that. >> what we were doing was going to recommend much less than what we had recommended that the interim level? >> good catch. >> keep moving. >> i have one other comment. this has to do with the recommendations related to the gap analysis. the concern that i had about this section in the tax was that it was not disaster specific. i completely agree that we have to have a good system in place to support children on a day-to- day basis. but i do not think we should just advocate for having good research in general. we should be talking that it

needs to be disastrous pacific. as an example, we also talk about the need to increase randomized clinical trials. i do not know if that would be the right mechanism to do disaster related research. those were my concerns about that section. we also talk about the and portions of having a center for research, but we do not say that it is a center for research related to disaster preparedness. those are my concerns about that area. i think it is too vague. >> i think we can easily fix that by adding something along the lines -- pediatric disaster research. if you look at the gap analysis, you find that there are actual sections on disaster research. i know that is one of the big

gaps there as well. that is already in that gap analysis. we just need to highlight it. >> one option is that the paragraph that starts with -- better highlighted be edited down six vividly to say that we agree with the importance of addressing the gaps that were identified, but we also specifically would like resources devoted to research as it relates to disasters and not going to a lot of specifics that we need more randomized clinical trials. those to not seem to be directly related to that. >> correct. >> any objections? >> good. >> hhs to develop a national strategy to improve emergency transport and patient care capabilities.

they should conduct a national review of existing capabilities for emergency medical transport of children. this recommendation came out of our discussion with the department of defense as well as -- about the process by which we move patients around this country in a disaster environment. it was unclear if we were meeting the standards we felt were important. there was a factor that we felt was important to identify and understand to what extent it exists. we understand that the national ambulettes contract, there are certain requirements on them to meet when they dispatched there

ambulances to a disaster area. how does that functionally work toward ensuring that children get what they need during the transport process? this also speaks back to the recommendation of regionalization issue that during the times of a disaster involving a lot of children, we will have to move a lot of kids. we will need to be able to move these children safely and effectively. this is really an important follow along for the commission as well as hhs to ensure that we understand what our capability is and where the gap is currently in that capability. >> that would be the end of transport. >> any follow-up questions? >> talking about disaster case management. >> let's review where we are.

provide a consistent holistic services that achieved tangible outcomes. this is a general recommendation that we have discussed a multiple times in the past. the executive branch and congress should should provide adequate funds for disaster case management systems for nationwide capacity and that was touched on by the administrator earlier today. we should clarify the transition. a point that i want to emphasize, this is particularly important as we look back on the flow of things post katrina were the transition was a profoundly on clear and a lot of children fell to the >> during that process.

-- through the cracks during that process. discussions? comments? >> turned -- i turned the page than half of that was missing. -- i turned the page and half of it was missing. >> as i am looking through this and hearings today, i think -- to say adequate funds without defining that is not sufficient, not going as far as we could or

should go, in my opinion. i do not know that we have the -- 9 >> i agree with you. >> how should we handle this question? if the commission agrees that we should be getting more specific on a dollar amount, we do not have its, nor does anyone have its. >> the rack -- the administration made a recommendation? >> the president's budget has a $2 million request. towards disaster case management capacity. but we say here -- the original request medical glove years ago was for $10 million. -- the original request made 10

years ago was $10 million. >> it is a new program. it is a line item that has been provided specifically for the disaster case management program. >> do you have any sense whether the relevant executive- branch agencies thinks that $2 million is adequate? >> it is the president's request. what we say in the narrative is that the commission is concerned that $2 million is not enough to adequately support to a national disaster capacity building case management program. however, we do not have the capability for the information to be able to say, what we think that number should be. $10 million, up $25 billion, pick any number. we are concerned that $2 million is inadequate. it needs to be --

>> $2 million for the united states -- you could pick any number, but i would not pick $2 million. >> i do not know what number -- there is no standard here. we have expressed concern about it. we need to but stronger language in saying that -- it seems to me wholly insufficient? do we need to use a much stronger language? >> we say on page 64 that the amount is not sufficiently funded. we tell a little bit about the history, the funding history. and where things currently are. >> in the actual recommendation, though, i think we should be up the language there to get a lot

more assertive about the fact that the $2 million is not sufficient. could we ask for documentation of how the $2 million was rationalized? we may have the data, but where did it come from? it is probably just the number. suddenly, it is $2 million. >> are you asking me what they're plan was? >> what are the objectives for that $2 million national program? how does that work? >> their languages capacity building. i am confident that what they're talking about is developing a plan for. our recommendation calls for build support and deploy. it is a whole different animal. it seems to me that the recommendation ought to be not just research and plan for how we could do it under the best case scenario, but actually

develop a plan that deploys a case management system. i think we should come on stronger. >> you want to say, provide increased funds? we really do not have the capability to say no. specifically. -- say a number specifically. can we ask for an explanation? can we ask for a rationale for developing its funding target? >> if it really is $2 million to develop a plan, what does that plan involved? >> actually, what could be

instructive is the budget justification language that was submitted in the year when they requested $10 million. that would give you a sense of the scope of what was contemplated within the normal course of budget negotiation and what congress dealt they would appropriate. i am sure when the number came down to $2 million, they had to find a way to make do with a plan. in reality, there were only provided with $2 million to make it work. that is what is trying to be expressed in this section. for a plan to work adequately -- $2 million does not appear to be a sufficient amount. about casest talking

management here. this is not development of new drugs. we know what we need to know about case management and disasters. i just cannot quite get why we need a continued analysis. we had a study of the case management -- it was unnecessary. they talked about what they got to and what the results were. i do not think those things needed to be tested against one another. case management, as it is understood by people who actually practice in the field, is not up for a 5 burk 10-year exploratory process. at the end of the day, it does not end up in deployment. i feel like i would like to see the whole picture. what is it going to cost to deploy what people generally considered to be critical case

management after a disaster? >> david? >> it appears to me that as we finalize this report, there are a number of gaps in terms of how will be implemented in specific dollar amounts. i would think that that would be our own water commission would turn to next after we released the report. , let's get people in some experts together. what will actually take? that may be a better strategy than trying to grab at a number as we try and a vote on the report. >> i agree, david. for this 1 especially. the other one, -- bill line >> we have already talked about that. that.