n this mid-course entry into your Nurse E-Portfolio for this course, you will be examining your perceptions of the nurse in the role of collecting and assessing information. Using the e-portfolio format, answer the following questions. Make sure you spend some time thinking about the answers to these questions before writing.

1. What have you learned so far in this course that will help you conduct effective health assessments?
2. What skills do you have you gained?
3. Describe any areas that are still unclear and ways you will gain clarity.

Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates.

Save your assignment as a Microsoft Word document. (Mac users, please remember to append the “.docx” extension to the filename.) The name of the file should be your first initial and last name, followed by an underscore and the name of the assignment, and an underscore and the date. An example is shown below:

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1- Richard Lennon    

After reviewing the article “First the Flood, Now the Fight” multiple times, I was unable to find clearly defined examples of horizontal or vertical integration in the article based off the definitions and examples we learned in the assigned video.  Horizontal integration is when a company or organization acquires a similar company or organization in the same industry or field.  The closest example to horizontal integration in the article occurred after the storm when FEMA oversaw and managed around 700 contractors and employees during the recovery process.  Vertical integration is when a company or organization acquires a company that operates either before or after the acquiring company or organization in the production process.  There was no clear demonstration of vertical integration that I found in this article.

Inter-organizational coordination after Katrina was poor and inconsistent at best.  It was stated in the article that “current and former officials at all levels blame FEMA workers’ inexperience with eligibility rules, weaknesses in U.S. disaster laws and inconsistent treatment by Congress for much of the wrangling”.  I think the biggest problem was that the destruction that Katrina caused was so geographically widespread, that FEMA had to divide their personnel and resources up amongst a much larger area then originally planned for.  Spreading their personnel out like this to cover a larger area is where I believe a lot of the problems happened, because it then forced them to have less experienced personnel operate in roles/capacities that they would otherwise not normally operate in because they were the only available resources at the time.  This could have been one of the causes for the repeated disputes amongst local governments and FEMA representatives due to the improper interpretation of rules and disaster laws by FEMA representatives.   

Horizontal recovery is something that I believe we in Emergency Management will revisit on many occasions.  A form of temporary horizontal integration is something that occurs during most disaster recoveries.  After a disaster, FEMA or a local emergency management agency usually takes over coordinating and leading the recovery effort.  During this time, they also take control of available rescue and recovery organizations to use in whatever way to carry out the organization’s goal and overall mission.  This is different than the corporate world where a company is taken over forever, whereas in the disaster recovery setting it is appropriate for this to occur on a temporary basis

2-Doug Harper    

Not having any formal education in Business Administration, but having an understanding of macro and micro economics to be honest I had heard of vertical and horizontal integration as it relates to business. Saying that the video presented really did a great job of “dumbing it down”, and did make it easier for me to understand. Taking the same concept and applying it to Emergency Management I tried to explain it to myself in simple terms. I came up with my definition(s) and my response below:

(1) Vertical integration: How a community interacts with the different levels of government. Basically local/municipal government officials deal with the state/province, then with the federal government. Each of the three levels of government communicates with each other. Much like in the fire service when Fire gets together with our EMS partners, and the PD we use the term “Unified Command”. The system works during an emergency as each agency sends a senior representative or the specialized staff (think of a Haz-mat call, you would want the Haz techs to be present during the meeting). We collectively determine a strategy, then devise the tactics to respond to the incident at hand. Depending on nature of the call, the lead agency is defined by the type of call. For example PD would be the lead for a bomb call, or report of possible terrorism event and use of say sarin gas. For a school bus overturned with mass casualties it may indeed be EMS, and for say a fire at a petrol facility Fire would be the lead. The take away is each agency plays a key role. Much like each level of government will have a part to play during a disaster.

To bring the above into context of the 1993 Midwest floods the level of vertical integration was great. Extreme I may say, This event was across 534 counties across 9 states and required $4.2B of direct federal aid. Also to be noted was the successful federal buyout program to remove families from rebuilding on the floodplain (this was studied in prior EMGT 6603). The States had a direct role as well as was seen as Missouri took up this program and had successful results. The Missouri State Emergency Management Agency (SEMA) played a direct role in administering the program for the residents of Missouri. This once again shows vertical integration in regards to EM. 

As for strengths and weaknesses I see the idea of “turf wars” being the largest hindrance and EM Managers must be cognative of and deal with as soon as they become aware of a dysfunctional arrangement beginning to take hold. On the other hand if an “expert” is needed, I feel confident within the vertical integration model one will be found whether from the state/province or federal government. Think of mutual aid extreme.

To strengthen and build on a best practice system, to make the response better once again I feel relationship building 101. Not during an event, but prior to a disaster the local EM Managers need to communicate, attend professional symposiums, visit, call, and provide periodic updates as to the happenings of their local community with state/provincial and federal persons who would be called upon during an event. In other words pre-planning by being able to know not just how to do something, but who will we call.

(2) Horizontal integration: How the community interacts with the additional resources available to them during the recovery phase (short term and long term). I think of groups/agencies such as The Red Cross, Salvation Army, local community groups whether informal (think convergent groups) or groups such as The Rotary Club or The Kinsmen Club (Canada), faith based groups, local BIA’s (Business Improvement Associations), local Ratepayer groups (if the entire community is completely destroyed such as from a wild fire or tornado this may not be practical) to name a few. This type of integration I think of as everyone is a “partner” and brings something to the table and are to be treated as equals.

As for horizontal integration I turn to the American Red Cross. I do so as many groups I am sure played a role but from this exert from my research shows the response was admirable: Since 1992, the American Red Cross (ARC) has recruited social workers and other mental health professionals to serve in the Disaster Mental Health (DMH) program, and the National Association of Social Workers (NASW) has partnered with them to support recruitment. In the aftermath of disasters, DMH volunteers support co-workers, survivors, and relief partners with identification of mental health needs (psychological triage), promotion of resilience and coping skills (psychological first aid, psychoeducation, public health messaging, and consultation), and targeted interventions (referrals, crisis intervention, casualty support, and advocacy) (http://www.socialworker.com/extras/social-work-month-2017/american-red-cross-expands-eligibility-for-disaster-mental-health-progra/). I found it ironic as one of our classmates in a Discussion paper talked about sending mental health care workers to a disaster scene during the PDA phase. It appears the ARC has a formal plan already in place with their DMH program. They were sent in during the 1993 floods.What an example of horizontal integration indeed.

The one issue when dealing with horizontal integration is the EM Manager must maintain oversight still. Think of having a strong IC (Incident Commander) in place. The IC makes the decisions, but goes to his/her resources and develops an effective IAP (Incident Action Plan). The resources in this case are our partners within the community (and of course the people themselves). On the opposite side of the spectrum, when you work with other community partners they feel they have a direct input into the decision making. Bring key players to the table/game and engage them, and the results will pay dividends I feel. 

To conclude EM Managers will use both concepts during recovery of vertical and horizontal integration. We need to work with locals and all the way up to federal and even international agencies. Think of having a “Rolodex” at your finger tips when needed, vs going to Google or worse the Governments “phone book” on who you are going to call. In other words pre-planning by being able to know not just how to do something, but who will we call.

1.Characterize the level of horizontal and vertical integration observed, including their effect on specific outcomes. 

2.Strengths and weaknesses in inter-organizational coordination should be described. 

3.What could be done to strengthen inter-organizational coordination, both vertically and horizontally, based on the information obtained from lectures and assigned readings. 

4.Summarize how vertical and horizontal integration may impact other topics discussed up to this point in the course that were not addressed in the case study provided. 

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