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Do financial incentives of introducing case mix reimbursement increase feeding tube use in nursing home residents Comfort feeding only: A proposal to bring clarity to decision-making regarding difficulty with eating for persons with advanced dementia anxiety symptoms vs adhd symptoms cheap ashwagandha 60 caps visa. Improving decision-making for feeding options in advanced dementia: A randomized anxiety 4th breeders purchase 60 caps ashwagandha amex, controlled trial anxiety 7 cups of tea purchase ashwagandha 60caps without prescription. Clinical guidelines #42: Dementia: Supporting people with dementia and their careers in health and social care [Internet]London anxiety symptoms go away order ashwagandha 60 caps otc. Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: A systematic review and meta-analysis anxiety rash pictures cheap 60 caps ashwagandha free shipping. Targeting intensive glycaemic control versus targeting conventional glycaemic control for type 2 diabetes mellitus anxiety and panic attacks 60caps ashwagandha fast delivery. Risk of fractures requiring hospitalization after an initial prescription of zolpidem, alprazolam, lorazepam or diazepam in older adults. American Geriatrics Society Updated Beers Criteria for potentially inappropriate medication use in older adults. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial. Prospective randomized comparison of therapy and no therapy for asymptomatic bacteriuria in institutionalized elderly women. Infectious Diseases Society of America Guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Screening for cognitive impairment in older adults: a systematic review for the U. Time lag to benefit after screening for breast and colorectal cancer: meta-analysis of survival data from the United States, Sweden, United Kingdom, and Denmark. Low-dose lung computed tomography screening for lung cancer: how strong is the evidence Anorexia-cachexia syndrome: a systematic review of the role of dietary polyunsaturated fatty acids in the management of symptoms, survival, and quality of life. Megestrol acetate and mirtazapine for the treatment of unplanned weight loss in the elderly. Prescribing optimization method for improving prescribing in elderly patients receiving polypharmacy. British Association of Critical Care Nurses position statement on the use of restraint in adult critical care units. Prevalence and variation of physical restraint use in acute care settings in the U. Physical and chemical restraints in acute care: their potential impact on rehabilitation of older people. Matching the environment to patients with delirium: lessons learned from the delirium room, a restraint-free environment for older hospitalized adults with delirium. Our geriatrics health professional members work together to provide interdisciplinary, patient- and family-centered team care to older adults. The society also works to bring the knowledge and expertise of geriatrics health professionals to the public via Numerous evidence-based guidelines agree that the risk of intracranial disease is not elevated in migraine. To avoid missing patients with more serious headaches, a migraine diagnosis should be made after a careful clinical history and an examination that documents the absence of any neurologic findings such as papilledema. Diagnostic criteria for migraine are contained in the International Classification of Headache Disorders. However, large multicenter, randomized controlled trials with long-term follow-up are needed to provide accurate estimates of the effectiveness and harms of surgery. These medications impair alertness and may produce dependence or addiction syndromes, an undesirable risk for the young, otherwise healthy people most likely to have recurrent headaches. They increase the risk that episodic headache disorders such as migraine will become chronic, and may produce heightened sensitivity to pain. The task force met twice by conference call to review the suggestions and choose items for further development, and then communicated electronically during the development and approval process. Final items were selected based on commonly encountered situations in headache medicine associated with poor patient outcomes, low-value care or misuse or overuse of resources. The utility of neuroimaging in the evaluation of headache in patients with normal neurologic examination. Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. American Headache Society urges caution in using any surgical intervention in migraine treatment. Migraine medications and evolution from episodic to chronic migraine: a longitudinal population-based study. Factors associated with the onset and remission of chronic daily headache in a population-based study. Incidence and predictors for chronicity of headache in patients with episodic migraine. Acute migraine medications and evolution from episodic to chronic migraine: a longitudinal population-based study. Migraine alone is the seventh highest specific cause of disability globally and the leading cause worldwide of neurological disability, according to the World Health Organization 2010 Burden of Disease Study. It also provides education and training to physicians, health professionals and the public about headache and encourages scientific research worldwide about the causes and treatment of headache and related problems. This has led many clinicians to utilize ultrasound to determine if splenic enlargement is present. However, because individual splenic diameters vary greatly, comparing splenic size to population norms is not a valid method to assess splenic enlargement. The cause of female athlete triad is an imbalance between energy intake and energy expenditure that leads to menstrual dysfunction (abnormal or loss of periods) and low bone mineral density. Treatment includes increasing caloric intake and/or decreasing energy expenditure (exercise) to restore normal menses, which can take up to 12 months or longer. We recommend a multi-disciplinary approach to treatment that includes a physician, dietitian, mental health professional (when appropriate) and support from coaches, family members and friends. Treatment should focus on a guided exercise program to correct lumbopelvic and lower limb strength and flexibility imbalances. Degenerative meniscal tears may respond to non-operative treatments such as exercise to improve muscle strength, endurance and flexibility. Other treatment options include mild analgesics, anti-inflammatory medication, activity modification or corticosteroid injection. If mechanical symptoms such as locking, painful clicking or recurrent swelling are present, or if pain relief is not obtained after a trial of non-operative treatment, arthroscopy may be warranted. If significant osteoarthritis is also present, other surgical options should be considered. The goal was to identify common topics in the practice of sports medicine that, supported by a review of the literature, would lead to significant health benefits and a reduction of common procedures that can be unnecessary or cause harm. For each item, evidence was reviewed from peer-reviewed literature and several sports medicine consensus statements. American Medical Society for Sports Medicine position statement: concussion in sport. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport, Zurich, November 2012. Consensus statement on concussion in sport-the third international conference on concussion in sport held in Zurich, November 2008. Female athlete triad and its components: toward improved screening and management. Prospective predictors of patellofemoral pain syndrome: a systematic review with meta-analysis. A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus. Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomized trial. Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears By nature of their training and experience, sports medicine physicians are ideally suited to provide comprehensive medical care for athletes, sports teams or active individuals who are simply looking to maintain a healthy lifestyle. Research shows that using purposeful activity (occupation) in interventions is an intrinsic motivator for patients. Such activities can increase attention, endurance, motor performance, pain tolerance, and engagement, resulting in better patient outcomes. Conversely, non-purposeful activities do not stimulate interest or motivation, resulting in reduced patient participation and suboptimal outcomes. Many children and youth are affected by challenges in processing and integrating sensations that negatively affect their ability to participate in meaningful and valued occupations. Processing and integrating sensations are complex and result in individualized patterns of dysfunction that must be addressed in personalized ways. Interventions that do not target the documented patterns of dysfunction can produce ineffective or negative results. Therefore, it is imperative to assess and document specific sensory difficulties before providing sensory-based interventions such as Ayres Sensory Integration, weighted vests, listening programs, or sensory diets. Use of an overhead pulley for individuals with a hemiplegic shoulder resulting from a stroke or other clinical condition is considered too aggressive and should be avoided, as it presents the highest risk of the patient developing shoulder pain. To improve occupational performance, cognitive-based interventions should be embedded in an occupation relevant to the patient. Examples of cognitive-based interventions include awareness approaches, strategy training, task training, environmental modifications, and assistive technology. The use of cognitive-based interventions not based on occupational performance will result in suboptimal patient outcomes. Phase I was completed with an online member survey that resulted in 328 responses. Following the elimination of duplicate responses and items outside the scope of occupational therapy practice, the list was narrowed down to 62 items. This survey resulted in 4,860 responses that were analyzed, resulting in the final 5 items. A comparison of performance in added-purpose occupations and rote exercise for dynamic standing balance in persons with hemiplegia. Enhancing occupational performance through occupationally embedded exercise: A meta-analytic review. Specific sensory techniques and sensory environmental modifications for children and youth with sensory integration difficulties: A systematic review. Council for Exceptional Children standards for evidence-based practices in special education. Guest Editorial-State of the science of sensory integration research with children and youth. Efficacy of occupational therapy using Ayres Sensory Integration: A systematic review. Occupational therapy practice guidelines for children and youth with challenges in sensory processing and sensory integration. Physical agent modalities: Theory and application for the occupational therapist (2nd ed. Effects of task-oriented training as an added treatment to electromyogram-triggered neuromuscular stimulation on upper extremity function in chronic stroke patients. The effect of heat applied with stretch to increase range of motion: A systematic review. Evidence-based cognitive rehabilitation: Updated review of the literature from 2003 through 2008. Effectiveness of interventions to improve occupational performance of people with cognitive impairments after stroke: An evidence-based review. Symptoms such as pain and limitations of activity are the most common reasons to pursue bunion or hammertoe surgery. Patients having surgery for bunions and hammertoes are at risk for a wide range of complications such as nerve damage, infection, bone healing problems and toe stiffness. Symmetric flat feet or high arches are common conditions, and generally they are asymptomatic. The development of the arch is not related to external supports, and no evidence exists that any support is needed in asymptomatic patients. With six months of consistent, non-operative treatment, plantar fasciitis will resolve up to 97% of the time. Surgery has a much lower rate of success and has the added possibility of post-operative complications. When compared to non-weightbearing X-rays, deformities of the forefoot, midfoot and hindfoot have been shown to increase on weightbearing X-rays. In addition, narrowing of the ankle joint space on standing X-rays is associated with symptoms of arthritis. Therefore, weightbearing X-rays, when possible, give the most accurate assessment of the functional bony anatomy of the foot and ankle.
Competence and resilience have been linked with several protective factors consisting of individual anxiety eating disorder ashwagandha 60 caps generic, family anxiety quotes bible purchase ashwagandha 60 caps visa, and environmental variables (Masten & Coatsworth anxiety early pregnancy cheap ashwagandha 60 caps, 1998) anxiety symptoms in men order ashwagandha 60caps with mastercard. Resilience develops from very ordinary adaptational processes and is not limited to remarkable individuals (Masten anxiety symptoms vs heart attack cheap ashwagandha 60 caps online, 2001) anxiety high blood pressure generic ashwagandha 60caps amex. Additional individual factors associated with resilience include an easygoing disposition, positive temperament, and sociable demeanor; internal locus of control and external attributions for blame; effective coping strategies; degree of mastery and autonomy; special talents; creativity; and spirituality (Werner & Smith, 1992). Additional familial and environmental factors that have been found to foster resilience include parenting with warmth, structure, and high expectations of the child; socioeconomic resources; ties to extended family; involvement with prosocial 20 Pro ective Factors actor Coping and Protective Factors While exposure to complex trauma has a potentially devastating impact on the developing child, there is also the possibility that children in these situations can nevertheless function effectively and competently across a variety of domains (Kendall-Tackett, Williams, & Finkelhor, 1993; Masten & Coatsworth, 1998). Resilience is no longer regarded as a static attribute or a single, global construct but rather is viewed as multi-determined and evolving domains of competency, consisting of interacting forces Complex Trauma in Children and Adolescents National Child Traumatic Stress Network In situations of severe adversity, poor parenting and cognitive skills increase the risk of maladaptive child behavior patterns, while normative intellectual skills and parenting protect the child and foster growth of competence (Masten, 2001). Ultimately, supportive connections and cognitive resources help buffer children against the worst effects of trauma and serve as "inoculations against adversity" (Schimmer, 1999). Other research has illuminated the importance of coping strategies on long-term mental health outcomes in response to complex trauma exposure in childhood (Vaillant, 1986; Vaillant, Bond, & Vaillant, 1986). Coping strategies represent the expression of psychological defense mechanisms that develop in childhood as protective responses that accentuate, limit, or block perceptions of inner and outer reality as a means of managing trauma and deprivation. The more severe the exposure to complex trauma in childhood, the stronger the use of certain coping strategies-such as sublimation, humor, altruism and suppression-has been associated with successful management of life problems and promotion of positive mental health in adulthood. In contrast, reliance on primitive defense mechanisms including dissociation, projection, passive aggression and hypochondriasis is linked to greater functioning deficits and more severe psychopathology over time. Approaches to Comprehensiv prehensive Approaches to Comprehensive Comple Trauma plex Assessment of Complex Trauma in Children Typically, regardless of the initial trauma event that prompts referral for treatment services, the accepted standard of care involves conducting a comprehensive assessment, which uses observations, clinical interviews with child/ adolescent and primary caretakers, collateral information (as appropriate- schools, child protection, previous therapist, forensic interviewer, pediatrician, etc. Clinical interviews should follow a consistent format using a specific comprehensive form completed by the clinician. The assessment should also include the use of standardized assessment instruments that include self-report measures as well as measures completed by caretakers and/or teachers based on types of trauma, developmental/chronological factors, and availability of informants. Such a comprehensive assessment conducted over several sessions will establish treatment goals based on the phase-oriented model of trauma treatment. Since trauma evaluations often involve the criminal and/or probate court systems, it is imperative that the evaluations be conducted in a forensically sound, as well as clinically rigorous manner. Specifically, questions must be asked in a non-leading manner and be accompanied by thorough documentation of all relevant disclosures. Even when referrals begin as a clinical assessment, any disclosures that occur are often the backbone of legal efforts to keep a child safe. The evaluation should begin with the reason for referral, the presenting concerns, and the history of those presenting problems. Important historical information includes: developmental history, family history, trauma history for child and family, attachment relationship(s) for child/ adolescent and primary caregiver(s), child protective services involvement and placement history, illnesses, losses, separation/ abandonment by parent, deaths, parental/family mental illness, substance abuse, legal history, coping skills, strengths of child/adolescent and family, and any other stressors. Clinicians need to evaluate for all types of traumatic experiences since there is considerable evidence supporting multiple traumatic exposures. In addition to assessing traumatic exposures, the clinicians must evaluate adaptations to complex trauma in the seven domains described earlier: biology, attachment, affect regulation, dissociation, behavioral management, cognition, and self-perception. These domains should be assessed in terms of their current presentation, as well as their developmental trajectories. Standardized Standardized Measures Assessment measures are administered as part of the initial evaluation; at 6-month, or ideally, 3month intervals to track treatment progress and inform clinical decision-making in an individualized and empirically based manner; as well as at termination so as to determine treatment outcome and guarantee the appropriateness of termination. Follow-up is also recommended, when possible, to determine endurance of positive treatment outcomes. It is important to assess multiple areas of functioning and to gather information from multiple informants. Often, this means clinicians working with child protective services and the court system to develop a safer living environment. It is also critical to engage the family and the school, as well as other primary support figures, in order to create a network that will develop safety within the living environment. It is then possible for psychosocial treatments to provide recovery from the damages of abuse and rehabilitation of skills lost or never formed. The final challenge is the transmission and maintenance of these skills in the day-to-day world. This final effort can take root in treatment but will need partnering with the family and with community agencies. There is consensus that treatment development should take a phase-based, or sequential approach. Research with traumatized adults indicates that treatments in which all aspects of work occur simultaneously tend to create "information overload" such that learning never fully occurs. This is likely to be especially true of children whose ability to attend to and process information is less well developed than adults. The sequential order of the treatment is such that the lessons learned in one phase serve as a building block for those to come next. The process is not linear, however, so that it is often necessary to revisit earlier phases of treatment in order to remain on the overall trajectory. Before any treatment can truly begin, the safety of the child and family must be addressed. It would be impossible for any child, or adult, to 23 Approaches to Treatment Approaches to Treatment of Complex Trauma in Children Comple Trauma plex Approaches Phase-Based Approaches Inter erv Intervention Needs Interventions for traumatized children and adolescents must be developed and tested which directly address the specific complex trauma domains. Almost all traumatized youth face the task of living in a continually traumatizing environment or finding a place in a new environment. Thus, the initial tasks of treatment are focused on creating a system of care and safety in which a Complex Trauma in Children and Adolescents National Child Traumatic Stress Network The focus of treatment at this early juncture largely involves building a network for the child and family. Thus, clinicians work closely with child protective services, the school system, and other providers for the family to develop safety and a treatment plan that addresses the needs of the child, as well as the family. Within the treatment relationship, the focus is on building trust and a positive working relationship. The emotion regulation skills of the second stage help clients review their traumatic experiences. Once children possess improved methods for coping and an increased capacity for emotion regulation, they are better able to communicate and process traumatic memories. This process leads to a decrease in psychological distress concerning their history and to reduced reactivity to the inevitable traumatic reminders (schools, streets, sounds) in their home environment. The development of emotion regulation along with social skills also allows youth to see themselves as different from the people they were at the time of the traumatic events. The contrast between who they were during these events and who they are becoming, with the help of the skills work, provides them with a more confident view of themselves and the notion that change is possible. The goal of the last phase of treatment is to instill principles of resiliency in youth so that they can continue to develop in positive, healthy, and functional ways and avoid future victimization and/or aggressive behaviors. Phase 4 interventions involve the creation or reinforcement of assets that build resiliency (DeRosa et al. These activities can include involving the youth in creative projects or youth programs, identifying expectations and responsibilities, working with families and communities to maximize safety and encourage youth to achieve and develop their unique talents. The traumatic experience can then move from being the central aspect of their lives to being a part of their history. Comple Trauma Treatment Programs for plex Complex Trauma Treatment Programs for Children and Adolescents Adolescents While most treatment of traumatized children and their families takes place within community mental health settings, hospitals, schools, and home-based family stabilization teams, there are a number of trauma-specific treatment programs in development for children and adolescents. Several of these are modeled upon earlier work conducted with adults (Cloitre et al, 2002; Ford, in press; Turner, DeRosa, Roth & Davidson, 1996), although these interventions are clearly modified in order to be developmentally appropriate. There are several treatment models designed for children of different ages and their families (Cloitre et al. The treatment of choice for infants and toddlers uses a parent-child dyadic model (HembreeKigin & McNeil, 1995; Lieberman et al. Because attachment is critical to overall healthy development, as well as to recovery from trauma, parental attunement is the primary goal of treatment. Thus, the child has the best chances for healing and recovery when intervention is early and focuses on the parent-child relationship. For latency age children who have been sexually abused, Cohen & Mannarino (1998) have designed a treatment program in which children participate in a short-term trauma-specific intervention, while parents simultaneously 24 Complex Trauma in Children and Adolescents National Child Traumatic Stress Network This intervention has been associated with a reduction in depressive symptomatology and an increase in social competence. Similarly, Kagan (in press) has developed Real Life Heroes, a program for traumatized children that utilizes creative arts, life story work, and the metaphor of heroes to help children and their parents to increase skills for overcoming trauma and to build or rebuild attachments. There are several group models in development for adolescent girls with histories of sexual or physical abuse (Cloitre, Koenen, Cohen & Han, 2002) and witnessing domestic violence (DeRosa et al. Cloitre and colleagues are developing a 16-session treatment for adolescent girls who have been physically or sexually abused. This treatment is organized into three of the phases described earlier: skills training in emotion management and interpersonal effectiveness, trauma narrative story telling, and resiliency-building. Each of the treatments just reviewed has been manualized in order to carefully document the details and mechanisms of the interventions, and to ensure fidelity across treatment providers. With the creation of manuals documenting effective treatments for children and adolescents experiencing complex trauma outcomes, we can begin to affect standards of care and influence best practices guidelines. The clear benefit of manualized treatments is that they can be disseminated and used to train clinicians across various settings. Manuals must also be tailored to address developmental differences in children and adolescents. Focusing on one of these types of community intervention, school-based interventions can provide critical access for students in need of mental health services, and can address multiple financial, psychological and logistical barriers to treatment. Traumainformed programs are currently being implemented and tested in schools and residential settings and are also confronting the "real world" challenge of working with the large and underserved population of children and 25 Complex Trauma in Children and Adolescents National Child Traumatic Stress Network The traumatized children and adolescents seen in schools and the community are often those easily identified as "at risk" due to chronic deficits in their ability to regulate attention, affect and behavior. These deficits often lead to specialized and/or alternative school and home placements in which the staff, teachers, and counselors frequently become primary caretaker(s) and attachment figures. Therefore, when working with traumatized children in the community; providers must consider both the child and the context as the targets of intervention. Cook, Henderson, and Jentoft, (2003) propose a "milieu" model of working with traumatized children in the community. In order to strengthen the attachment between child and caretaker(s), it is essential that four basic principles be implemented. The first is to create a structured and predictable environment through the establishment of rituals and routines. The third principle is that the caretaker is helped to model effective management of intense affect by supporting the child in both labeling and coping with emotional distress. It should be noted that in order to respond to rather than react to a child requires that the adult model adaptive coping in regard to his or her own emotional response to difficult circumstances. The fourth principle revolves around praise, reinforcement and the opportunities to focus on a child doing something positive so as to help the child to identify with competencies rather than deficits. These principles are likely to promote increased security in attachment relationships, which will then become the basis for the development of all other competencies including regulation of attention, affect, and behavior. It should be noted that these principles could be applied in a variety of contexts including clinic based, school based, home based and community based settings. Enhancement of self-regulatory capacities and increases in competency across domains are common goals among trauma-specific schoolbased approaches (DeRosa et al. The goal is to increase cognitive, emotional, physical, and spiritual mastery (James, 1989). Examples of techniques used to promote cognitive mastery include direct teaching, story telling, and bibliotherapy. Children who are traumatized or neglected often exhibit inhibited play or the inability to play while others may reenact their experiences. Thus, play is essential to facilitate healing and to learn skills that are later necessary in different developmental phases (James, 1994). Activities such as yoga, music, movement, sports (in school/program settings, and drama can be modified to be included in individual and group work. In addition, such activities can and should be included in treatment planning as adjunctive auxiliary treatment methods. These activities support children in a number of ways including: (1) Finding a new vehicle of expression that decreases arousal and increases soothing; (2) 26 Complex Trauma in Children and Adolescents National Child Traumatic Stress Network Body oriented treatments and activities can teach children to change their physiological response to threatening stimuli, which will ultimately lead to improvement in their functioning. These techniques provide effective therapy for children who experience extreme physical vulnerability and who have distorted body concepts (James, 1989). Finally, adjunctive therapies provide a natural forum for mentoring, affiliation, integration, and socialization all of which are essential to enhancing resiliency. Trauma-specific milieu treatment appears to have been successful in increasing ability to regulate affect. This has been demonstrated by fewer suspensions and aggressive outbursts, increasing ability to regulate attention as indicated by increased time spent on academic tasks, increasing affiliation and group cohesion as reflected by fewer peer conflicts, and increasing compliance with rules and expectations, which may also suggest improvement in adult-child attachment relationships (Cook et al. The principles of the school-based model described are designed to be applicable in other types of community settings, including residential programs, shelter systems, and child protection agencies. In order to effect significant systemic change for traumatized children, it is imperative to work closely with these community systems, so that a phase-oriented model that focuses on safety first, skill building, meaning making, and enhancing resiliency can be implemented on a broad scale. Psychopharmacological Inter erv Psychopharmacological Inter ventions Psychopharmacological interventions for traumatized children and adolescents are primarily considered to be adjunctive to psychosocial treatment modalities. They aid in the management of symptoms that might interfere with the attention and learning demands of psychosocial treatments, or that can threaten to disrupt a placement.
Users of this self-assessment tool can indicate conformity anxiety symptoms 3 days purchase ashwagandha 60 caps with mastercard, partial conformity anxiety quotes funny discount ashwagandha 60 caps amex, or nonconformity as well as evidence of conformity anxiety symptoms yawning generic 60caps ashwagandha free shipping, corrective action anxiety symptoms zenkers diverticulum order ashwagandha 60caps otc, task assignment anxiety meditation buy ashwagandha 60caps low price, a schedule for action anxiety symptoms cures generic ashwagandha 60caps with amex, or other information in the Comments column. The entity shall develop and implement a competency-based training and education curriculum that supports all employees who have a role in the program. This crosswalk is intended purely as a high-level comparison of the component section of the indicated standards. Reference should be made the actual details in each section if a full comparison is needed. Business Impact Analysis 6 Business Continuity Plan Development and Implementation 1. Business Continuity Plan Exercise, Audit and Maintenance 7 Exercises, Evaluations, and Corrective Actions 7. Information in this annex is intended to be adopted by the entity at its discretion, replacing Chapters 1 through 9. By adopting this annex, the entity is committing to using a management system standard for implementation and maintenance of the program. This standard shall establish a common set of criteria for all-hazards disaster/emergency management and business continuity programs, hereinafter referred to as "the program. This standard provides the fundamental criteria for a management system designed to develop, implement, assess, and maintain the program for prevention, mitigation, preparedness, response, continuity, and recovery. Where terms are not defined in this chapter or within another chapter, they shall be defined using their ordinarily accepted meanings within the context in which they are used. A document, the main text of which contains only mandatory provisions using the word "shall" to indicate requirements and which is in a form generally suitable for mandatory reference by another standard or code or for adoption into law. The ability of an entity to manage incidents that have the potential to cause significant security, financial, or reputational impact. An appraisal or determination of the effects of the incident on humans, on physical, operational, economic characteristics, and on the environment. An ongoing process to prevent, mitigate, prepare for, respond to , maintain continuity during, and recover from an incident that threatens life, property, operations, or the environment. A governmental agency or jurisdiction, private or public company, partnership, nonprofit organization, or other organization that has emergency management and continuity of operations responsibilities. A verbal plan, written plan, or combination of both, that is updated throughout the incident and reflects the overall incident strategy, tactics, risk management, and member safety that are developed by the incident commander. The combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents. The ability of diverse personnel, systems, and organizations to work together seamlessly. Immediate and ongoing activities, tasks, programs, and systems to manage the effects of an incident that threatens life, property, operations, or the environment. Process of hazard identification, and the analysis or probabilities, vulnerability, and impacts. The process of collecting, evaluating, and disseminating information related to the incident, including information on the current and forecasted situation, and on the status of resources for management of the incident. Person or group of people that has its own functions with responsibilities, authorities, and relationships to achieve its objectives (F. When applying the term risk and components of risk management, this should be related to the objectives of the organization that include, but are not limited to the disaster/ emergency management and business continuity objectives as specified in F. Set of interrelated or interacting activities which transforms inputs into outputs. Such actions fall outside the concept of "corrective action" in the sense of this definition. The organization shall determine external and internal issues that are relevant to its purpose and that affect its ability to achieve the intended outcomes of its disaster/emergency management and business continuity management system. When establishing its disaster/emergency management and business continuity program, the entity shall determine: (1) Its relevant interested parties and (2) Their requirements. The organization shall determine the scope of the disaster/ emergency management and business continuity management system, such that the boundaries and applicability of the management system can be clearly communicated to relevant internal and external parties. When determining the scope of the management system the organization shall consider: (1) the external and internal issues referred to in Section F. The organization shall, establish, implement, maintain and improve disaster/emergency management and business continuity management system in accordance with the requirements of this International Standard including the processes needed and their interactions. Persons in top management and other relevant management roles throughout the organization shall demonstrate leadership with respect to the disaster/emergency management and business continuity management system. The policy shall: (1) Be appropriate to the purpose of the organization; (2) Provide the framework for setting disaster/emergency management and business continuity objectives; (3) Include a commitment to satisfy applicable requirements; (4) Include a commitment to continual improvement of the disaster/emergency management and business continuity program and management system; (5) Be communicated within the organization; (6) Be available to interested parties, as appropriate. The organization shall determine and provide the resources needed for the disaster/emergency management and business continuity management system. The goal of the curriculum shall be to create awareness and enhance the knowledge, skills, and abilities required to implement, support, and maintain the program. The entity shall maintain and improve the program by evaluating its policies, program, procedures, and capabilities using performance objectives. The organization shall continually improve the suitability, adequacy or effectiveness of the disaster/emergency management and business continuity management system. This form of continuous improvement allows the entity to set goals (short term through long term), track progress, and eliminate waste in cost and effort while monitoring present state through future state. This also helps in justifying expenses and substantiating the need for capital, personnel, and other process components that can help to improve implementation of an emergency management and business continuity program. Best practices, lessons learned, and other criteria discovered during the assessment can be shared throughout, resulting in process improvement for the entire organization. There are multiple approaches to evaluating the maturity of an emergency management and business continuity program, and multiple models have been published. Regardless of the approach selected, a continued focus on a quantifiable process and its use throughout all levels of the organization will provide maximum benefits for the entity. Originally created for use in software development, the model has been adopted by other disciplines. The five maturity levels are Initial (ad hoc), Repeatable, Defined, Managed, and Optimizing. Within a lifecycle of assessment-improvement-re-assessment, there are three interlocking elements: Knowledge (learn about best practices); Assessment (identify current capabilities and areas for improvement); and Improvement (take steps to achieve performance improvement goals). This can be done through a "maturity model" or other form of internal metrics the organization has adopted and committed to monitoring for tracking progress through a defined time period. The program promotes the coordination among representatives from the industry, local-level institutions, and the public. The city, with a population of over 300,000, is an important seaport whose harbor reaches a depth of 40 ft (12 m). The process must consider not just what it takes to be ready but also the elements that build capabilities to recover rapidly and improve resilience. The training and education provided to employees should include preparations needed for the evacuating and sheltering of families, as well as the unique needs of populations with functional needs, before reporting for duty and include redundancy of the information needed to aid in personal recovery. A plan must ensure that affected populations understand and are prepared for self-sufficiency for periods of time ranging from 72 hours to 14 days. Establish a system to identify, document, communicate, measure, educate, and train employees on how to plan for, understand, and implement the steps they need to take to prepare their families in the event of an emergency. Implement a program that educates and trains individuals to be informed of risks, community and individual protective actions, and skills required for effective response in an emergency or disaster situation. Individuals have specific responsibilities outside of their professional obligations. By taking personal preparedness measures, such as an individual risk assessment, family preparedness planning, and developing personal readiness kits, individuals will be able to respond to an emergency with a greater level of confidence that will help them meet their individual and household responsibilities as well as fulfill their professional duties and obligations. The preparedness and resiliency of employees from all sectors is a requirement for both public and private sector continuity and an emerging priority for resilience at all levels. It requires a specific focus on the education and training for individual and family preparedness that builds resiliency at a granular level. Being prepared for these events will build resilience for unforeseen future emergencies. Designated rally locations if separated in an emergency, home fire escape plan, communication plan for when household members are separated or normal communications are disrupted. Plans for all types of emergencies (natural disaster, fire, death in family, insurance claims) (5) Disaster resiliency plans. For separated families (child, elder and home care), financial and personal records and management, manage shifted roles and responsibilities of an absent family member. Survival kits for multiple locations and each household/family member, copies of identification and essential documents, contents of wallet, and medicine cabinet. The following represents the vital information necessary in preparation for, response to , and recovery from an event. The vital information is divided into five basic information areas and is presented with its intended purpose and a recommended checklist of data components. Emergency information may include the following: (1) Emergency communication methods (a) Emergency contacts (out-of-town, regional, primary, work, etc. The documents or portions thereof listed in this annex are referenced within the informational sections of this standard and are not part of the requirements of this document unless also listed in Chapter 2 for other reasons. The following documents or portions thereof are listed here as informational resources only. The American Red Cross Community Disaster Education provides information organized for home and family, workplace and employees, and school and students. Legal information can include the following: (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) Legal service provider information Marriage certificates Divorce and custody court orders Alimony and childcare court orders Adoption papers Wills and trusts Birth, marriage, and death certificates Powers of attorney and medical releases Location of identification cards Location of tax and financial records Medical directives and final considerations I. Education and training must prepare personnel to respond to emergencies and disasters and ensure performance of the organizations essential functions. Education and training of all personnel is critical for building the resilience that will allow the organization or business to recover rapidly and resume its mission and functions. As part of its training program, the organization must provide documentation of training conducted, the date of training, those completing the training, and the training facilitator/instructor. This process and its supporting documentation will help ensure that individuals have received the necessary guidance and support and know prior to , during, and after an event what is expected of them. Based on measures of documented understanding, adequacy, and effectiveness of the education and training, the organization must take any corrective actions to improve or enhance the individual and family preparedness education and training program. Building an Information Technology Security Awareness and Training Program, National Institute of Standards and Technology, Special Publication 800-50, csrc. Emergency Evacuation Planning Guide For People with Disabilities, National Fire Protection Association, People with disabilities, online resources from the National Fire Protection Association. Saving Lives: Including People with Disabilities in Emergency Planning, National Council on Disability Emergency Procedures for Employees with Disabilities in Office Occupancies, U. The copyright in this index is separate and distinct from the copyright in the document that it indexes. The licensing provisions set forth for the document are not applicable to this index. M U I/M Manufacturer: A representative of a maker or marketer of a product, assembly, or system, or portion thereof, that is affected by the standard. User: A representative of an entity that is subject to the provisions of the standard or that voluntarily uses the standard. Installer/Maintainer: A representative of an entity that is in the business of installing or maintaining a product, assembly, or system affected by the standard. Applied Research/Testing Laboratory: A representative of an independent testing laboratory or independent applied research organization that promulgates and/or enforces standards. Enforcing Authority: A representative of an agency or an organization that promulgates and/or enforces standards. 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