Four Key Principles to Help Manage the COVID-19 Response at the Systems Level


The United States is experiencing a crisis unlike anything we have experienced before. The challenges associated with COVID-19 have significantly affected the systems that help people living with disabilities or experiencing homelessness. Every system, every provider, and every person affected by this crisis has needs.

State government agencies are stretched, with many employees working remotely and much existing work on hold in order to focus on the crisis. State resources will become limited due to the shock to our economic system. Cities are implementing public health plans and managing “stay-at-home” orders. Direct service providers, such as mental health and homelessness agencies, have had to reduce capacity and access due to staff shortages and social distancing, while continuing to provide safety net services. Hospitals are bracing to be overwhelmed by the number of people who will need hospital-level treatment. Complicating the situation, our personal health and that of our family members, friends, and colleagues is at risk, and many people are experiencing stressors such as loss of income, shrinking retirement plans and investments, working from home, homeschooling our children, and social distancing and stay-at-home orders.

Direct service providers are on the front lines in helping people living with disabilities and experiencing homelessness to remain healthy and stable in their communities during a crisis. Unfortunately, they are not typically the focus of disaster mitigation, preparedness, or response and recovery activities, leaving them to manage the crisis on their own. This can result in inefficient use of resources, lack of coordination and communication, and poor outcomes for the individuals being served. Vulnerable populations should be a focus for all aspects of disaster mitigation, including the current public health crisis, at the local, state, and federal levels.

Throughout my career, I have learned the importance of relying on a set of core principles to successfully manage major challenges, including systems-level crises and disasters. Whether you are reading this from the perspective of a federal or state government agency, a local system, a philanthropy, or as a provider, these four principles can serve as a framework in your work to help our communities navigate the Coronavirus crisis:

  1. An effective management structure is necessary in order to first control, then resolve the crisis, and finally implement recovery. Scattershot, piecemeal approaches delay access to critical resources and may exacerbate the crisis before it gets better. Management structures such as the Incident Command System and the U.S. Department of Health and Human Services’ Medical Surge Capacity and Capability (MSCC) Management System provide scalable approaches that can be used at any level as an organized way to manage the crisis. Incident command systems, such as command centers currently managing the COVID-19 crisis in most states, must involve direct services and homelessness systems in disaster response.
  2. Strong leadership, including both executive leadership and team leaders, is essential to crisis management and disaster recovery. Effective leaders demonstrate compassion and empathy to those impacted while simultaneously effectively managing the crisis as it is occurring. Strong leadership relies on a management framework that is informed and carried out by skilled subject matter experts.
  3. Large-scale crises and disasters are resolved successfully through collaboration, coordination, and partnerships — especially those established prior to the crisis. The needs of people living with disabilities and those experiencing homelessness cross into multiple systems and therefore require a multi-system, multi-level response.
  4. We emerge from a crisis because we are resilient. I am always amazed by the resilience of individuals who experience adversity, disability, stigma, oppression, racism, and disaster. A “culture of resilience,” as described in Disaster Resilience: A National Imperative (National Resource Council, 2012) is what is needed to collectively mitigate, prepare for, respond to, and recover from large-scale disasters like the one we are confronting now, and the ones that lie ahead.

These principles held true when, as deputy commissioner at the New Jersey Department of Human Services, I was involved in responding to various crises and disasters while overseeing the state’s public mental health system, as well as emergency preparedness and response with other state and local agencies. Some of the situations in which the principles were an invaluable tool to me included statewide hurricane preparedness, planning and response to the H1N1 swine flu pandemic in 2009, and operation and staffing of a mass shelter on a military base for citizens being evacuated to the United States in the immediate aftermath of the 2010 Haiti earthquake. During a state government shutdown in 2006, I used my disaster-related experience to ensure that the public mental health system remained functional during a temporary halt in government functions. These principles were also relevant earlier in my career when I was on a mental health team that responded to disasters such as plane crashes and flooding — and when, as a wildland firefighter, I joined others in responding to fires that threatened life and property.

As we experience the COVID-19 crisis now, there is significant uncertainty that lies ahead for all of us, both professionally and personally. The four principles above can help us begin to push past a sense of hopelessness and helplessness. History shows that we will emerge from this. Every crisis is unique — but lessons learned from other situations can nevertheless give us a sense of optimism and control as we understand that this crisis, like every other, can be managed.

Learn about TAC’s technical assistance services in disaster preparedness and recovery.

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Kevin Martone, L.S.W.

Kevin Martone, L.S.W., is TAC's Executive Director and a nationally recognized expert in behavioral health policy, system financing and design, Olmstead and community integration, homelessness, and best practice models of housing for persons with disabilities.