STATE OF TEXAS

                            EMERGENCY MANAGEMENT PLAN

                  RECORD OF CHANGES




ARC    American Red Cross: provides behavioral healt...
GDEM Governor’s Division of Emergency Management: responsible for response and initial
      recovery efforts in the...
                                                        Table of Contents

                                DISASTER BEHAVIORAL HEALTH PLAN


       See DEM Basic Plan Sectio...
   4. Behavioral health facilities that survive emergency situations with little or no
      damage may still be una...

      A. GENERAL

         1. Disaster Behavioral Health all-hazards preparedness and r...
       e. Identifying obstacles to the recuperative capacities of individuals and
          supporting all positive ...

   1. When a major incident involves multiple fatalities, the IC may request the
      assistance of mu...


   1. The provider functions as the ...
     c. Maintaining emergency staffing lists and notification procedures

2. Provider

     a. Designate a coordinat...
             g. Coordinates access to controlled areas as needed. Positive identification
                (and proof...
        B. External agencies providing DBH support are expected to conform to the general
        guidance provide...
        2. State hospitals and LMHA’ will provide fiscal reports, outlining the cost of crisis
B. DMHS is responsible for the development, maintenance, and distribution of this
   Plan. DMHS and other designated...


Primary Agency:     Department o...
DRAFT        TAB B

                                     DISASTER BEHAVIORAL HEALTH ESF ACTION GUIDE

3. Escalated Response (Level 2)

   a. Activate components needed to conduct emergency/disaster operations

   b. Im...
   staffing the SERT and the RAU. Furthermore, DMHS acts as DBH liaison between DEM,
   FEMA, and SAMHSA.

4. FEMA C...
•   The Rapid Assessment Unit (RAU)

As needed, DBH staff may also be required at the following locations:
• Tempora...
       DMHS contact information:
       Main Office: 512-458-7219
       Fax:         512-458-7472

   f.   Provide a model of an organized statewide response to the psychological and emotional
        needs of emerg...
d. Provide disaster , as defined in the Performance Contract, to impacted individuals,
   families, and businesses i...
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  2. 2. DRAFT STATE OF TEXAS EMERGENCY MANAGEMENT PLAN DISASTER BEHAVIORAL HEALTH APPROVAL AND IMPLEMENTATION This Plan is hereby accepted for implementation and supersedes all previous editions. ___________________ Date Eduardo Sanchez Commissioner Department of State Health i
  4. 4. DRAFT Definitions Acronyms ARC American Red Cross: provides behavioral health at all aviation incidents, shelters, and disaster service sites CCP Crisis Counseling Program: FEMA grants (Two part-ISP & RSP) for providing outreach, crisis counseling, psycho-education, and referrals in presidentially declared disaster areas CISM Critical Incident Stress Management: a multi-component crisis intervention modality that includes education, preparedness, defusing, via either group or one-on-one settings, and post-service follow-ups; the target population is First Responders CMHS Center for Mental Health: a division of SAMHSA; the regular crisis-counseling program is managed through this entity DADS Department of Aging and Disability: provides a comprehensive array of aging and disability, support, and opportunities that are easily accessed in local communities DARS Department of Assistive and Rehabilitative: provides rehabilitation, for the blind and for the deaf and hard of hearing, and includes the Interagency Council on Early Childhood Intervention DBH Disaster Behavioral Health: Any accepted psychological modality utilized to provide psychological assistance to responders and survivors of significant events and disaster. DDC Disaster District Committee: chaired by DPS; coordinates the district emergency response; the first step in management of state resources in an emergency DHS Department of Homeland Security (Federal): prevents terrorist attacks within the United States, reduces America's vulnerability to terrorism, and minimizes the damage from potential attacks and natural disasters DMH Disaster Mental Health: provision of stress management and/or crisis counseling following a critical incident or disaster DMHS Disaster Mental Health: a team within the Community Preparedness Section of the Department of State Health; responsible for disaster behavioral health response and recovery efforts in a state or federally declared emergency DPS Department of Public Safety: an agency of the of Texas, created to provide public safety; houses the Division of Emergency Management (DEM) DRC Disaster Recovery Center: a FEMA facility established in the community affected by the disaster where persons can meet face-to-face with federal, state, local, and volunteer agencies to discuss their disaster-related needs DSHS Department of State Health : a state agency that provides public health programs that, help protect all Texans from illness, prevent the spread of disease, provide direct health , and promote emergency preparedness EAP Employee Assistance Program: a no-cost behavioral health program provided by employers for employees to help them cope with stressors such as burnout, depression, and substance abuse via short-term counseling and/or referral, if needed MACC Multi Agency Coordination Center: DSHS emergency operations center, serves as the command center and response and recovery operations headquarters during emergencies ESF Emergency Support Function: a type of direct Federal assistance that a State is most likely to need (e.g. mass care, health and/or medical) FEMA Federal Emergency Management Agency: serves as the primary coordinating agency for disaster response and recovery activities iii
  5. 5. DRAFT GDEM Governor’s Division of Emergency Management: responsible for response and initial recovery efforts in the state HIPAA Health Insurance Portability and Accountability Act: the adoption of privacy and security standards in order to protect individually, identifiable health information HRSA Health Resources and Administration: principal federal agency for protecting the health of all Americans and providing essential human IC Incident Commander: the individual responsible for the overall management of the response ICP Incident Command Post: a facility located at a safe distance from an emergency site where the Incident Commander, key staff, and technical representatives can make decisions and deploy emergency manpower and equipment ISP Immediate Program: a type of crisis counseling program that may fund up to 60 days of crisis counseling from the date of the disaster declaration JFO Joint Field Office: a headquarters housing local, state, and federal (FEMA) resources during a state or federal emergency LMHA Local Mental Health Authority: thirty-nine community behavioral health centers that provide to a specific geographic area of the state called the local service area MHP Mental Health Professionals: degreed in human field; may be licensed PIC Person in Charge: The individual at the DSHS Multi Agency Coordination Center responsible for DSHS management of the response PIO Public Information Officer: media questions and interviews are channeled to the PIO on scene; he/she ensures that the information released to the public is accurate RAU Rapid Assessment Unit: provides rapid needs assessment to document population- based needs following a natural disaster RSP Regular Program: The Regular Crisis Counseling Program funds up to nine months of crisis counseling from the date of grant award. SAMHSA Substance Abuse and Mental Health Administration: Federal agency whose mission is to build resilience and facilitate recovery for people with or at risk for substance abuse and mental illness. SERT State Emergency Response Team: a team consisting of representatives from state agencies and other appropriate organizations which is deployed in or near an area affected by a disaster to conduct initial damage/needs assessments SMHA State Mental Health Authority: agency responsible for all aspects pertaining to the provision of mental health community; DSHS is the SMHA for Texas SOC State Operations Center: a site from which GDEM provides mitigation, preparedness, and response and recovery activities; in Austin this site is located at the DPS headquarters SOP Standard Operating Procedures: provide a basis for orienting and educating new staff via clear and concise definitions, policies, and standard procedures TSA The Salvation Army: provides spiritual ministry, individual and family trauma counseling and emotional support, comforts the bereaved, conducts funeral and memorial, and chaplaincy to staff and volunteers TxOHS Texas Office of Homeland Security: prevents terrorist attacks within Texas, reduces Texas vulnerability to terrorism, and minimizes the damage from attacks and natural disasters VOAD Volunteer Organizations Active in Disaster: voluntary organizations that coordinate planning efforts in response to a disaster iv
  6. 6. DRAFT Table of Contents DISASTER BEHAVIORAL HEALTH PLAN I. AUTHORITY...............................................................................................................O-1 II. PURPOSE...................................................................................................................O-1 III. SITUATION AND ASSUMPTIONS..............................................................................O-1 A. Situation.............................................................................................................O-1 B. Assumptions......................................................................................................O-2 IV. CONCEPT OF OPERATIONS....................................................................................O-2 A. General..............................................................................................................O-2 B. Behavioral Health ..............................................................................................O-3 C. Mortuary ............................................................................................................O-4 D. Statewide Behavioral Health Assistance............................................................O-4 E. Texas Crisis Consortium....................................................................................O-4 F. Behavioral Health Support for Emergency Responsibilities...............................O-5 V. ORGANIZATION AND ASSIGNMENT OF RESPONSIBILITIES.................................O-5 A. Organization......................................................................................................O-5 B. Assignment of Responsibilities..........................................................................O-6 VI. DIRECTION AND CONTROL......................................................................................O-8 VII. EMERGENCY RESPONSE LEVELS/ACTION GUIDES.............................................O-8 VIII. CONTINUITY OF GOVERNMENT..............................................................................O-8 IX. ADMINISTRATION AND SUPPORT...........................................................................O-8 A. Reporting...........................................................................................................O-8 B. Maintenance and Preservation of Records........................................................O-9 C. Post Incident Review.........................................................................................O-9 D. Exercises...........................................................................................................O-9 X. DEVELOPMENT AND MAINTENANCE......................................................................O-9 Tabs: A. Behavioral Health ESF Organization B. Disaster Behavioral Health ESF Action Guide C. Behavioral Health Disaster Assistance Qualifications D. DSHS- Disaster Mental Health and Crisis Counseling Program E. DSHS- Critical Incident Stress Management Network F. Local Mental Health Authority (LMHA) iv
  7. 7. DRAFT DISASTER BEHAVIORAL HEALTH PLAN I. AUTHORITY See DEM Basic Plan Section I (ftp://ftp.txdps.state.tx.us/dem/plan_state/state_plan_20040211.pdf) II. PURPOSE A. The purpose of this Plan is to establish and provide operational guidelines for disaster behavioral health preparedness, response, and recovery. B. This Plan is applicable to all locations, agencies, organizations, and personnel with behavioral health Emergency Support Function (ESF) responsibilities. C. While this Plan provides specific guidelines for state disaster behavioral health response, the secondary intent is to provide response and recovery guidelines for all behavioral health responders. III. Clarifications Provider: For the purpose of this Plan the term "provider" will represent the entity providing response and/or recovery disaster behavioral health. During state or federal emergencies it is expected that several organizations will be responding simultaneously. The term “provider” will also represent consortiums of disaster behavioral health providers. Disaster: For the purpose of this Plan the term "disaster" will represent any event, criminal incident (including those of a terroristic nature), or emergency. Disaster Behavioral Health: For the purpose of this Plan, the phrase "Disaster Behavioral Health" will include but is not limited to Disaster Mental Health, Psychological First Aid, CISM, CRT, Victim Crisis Counseling, Trauma Counseling, Crisis Counseling and Pastoral Counseling after a disaster. IV. SITUATION AND ASSUMPTIONS A. SITUATION 1. The State of Texas is vulnerable to a number of hazards that may occur with or without warning. These hazards could result in damage or destruction to homes, businesses, State Facilities or evacuations of the latter, loss of personal property, disruption of food, pharmaceutical, or utility distribution, or pose serious health risks and other situations that adversely affect the daily quality of life. 2. Emergency situations could result in the loss of communication, transportation, and normal social assembly, creating potential behavioral health hazards. 3. Hospitals, nursing homes, group homes, ambulatory care centers, churches and other facilities that provide behavioral health care for special needs populations could be damaged or destroyed and may need to be evacuated. O-1
  8. 8. DRAFT 4. Behavioral health facilities that survive emergency situations with little or no damage may still be unable to operate normally. This could be due to a lack of utilities, an inability for staff to safely report for duty, or damage suffered by communication and/or transportation systems. 5. Behavioral health facilities that survive emergency situations with little or no damage may be called upon to provide both personnel and physical resources to the community. They may also be used as quarantine facilities. 6. Use of nuclear, chemical, or biological weapons of mass destruction would lead to widespread anxiety, fear, and disorientation. The behavioral health needs that would result from such events would quickly overwhelm the local behavioral health response system, thus requiring state and/or federal assistance. 7. Emergency responders, survivors, and others who are affected by crisis situations will experience varying levels of stress and anxiety at different times. They may also display physical and/or psychological symptoms that could adversely affect activities of daily living and may have a prolonged behavioral or physical health impact. B. ASSUMPTIONS 1. Although many stress-related problems are associated with disasters, there is an adequate local capability to meet most emergency situations, although only for a limited period of time. It is understood that rural and very rural communities may have few or no disaster behavioral health capabilities. 2. The public will require information on how to recognize and cope with the short and/or long-term risks of sustained stress caused by a disaster. 3. In order to supplement local behavioral health resources, state and possibly federal assistance will be available upon request or by direction of the Texas Office of Homeland Security (TxOHS) or the Governor’s Division of Emergency Management (GDEM). 4. The American Red Cross and Salvation Army are expected to provide DBH assistance to disaster victims. However, such assistance will be time limited and location specific. 5 Local professional and volunteer organizations, charitable groups, and faith- based groups, which typically respond to emergency events, will generally do so. During times of stress, faith-based organizations are normally the most sought after counseling resource. 6. Special needs populations (Children, the elderly and the disabled) have a more difficult time expressing their status and needs and are more susceptible to physical and psychological stressors. It is understood that special populations will require additional medical and psychological resources and that special attention should be made to meeting their needs. O-2
  9. 9. DRAFT IV. CONCEPT OF OPERATIONS A. GENERAL 1. Disaster Behavioral Health all-hazards preparedness and response must be coordinated at the local, state, and federal levels, to mitigate the short and long term affects of stress, prevent stress-related morbidity, and implement a coordinated, sustained recovery. 2. The Department of State Health (DSHS), which includes Public Health, Mental Health and Substance Abuse components, is the State Mental Health Authority (SMHA). State Hospitals, as well as Local Mental Health Authorities (LMHAs), are responsible for pre-disaster preparation, as well as response and recovery efforts needed to ensure patient and client safety. 3. Providers are responsible for ensuring accurate reporting of information when requested by Disaster Mental Health (DMHS). 4. DMHS is the component of DSHS that is responsible for disaster behavioral health preparedness, response, and recovery in Texas. 5. This document is based upon the concept that the emergency functions of disaster behavioral health will generally parallel their normal day-to-day functions. Such functions that do not contribute directly to the emergency operation may be suspended for the duration of the emergency and the resources that would normally be committed to those functions will be redirected to the accomplishment of emergency tasks. 6. During local emergencies or disasters the LMHA will serve as the responding Disaster Behavioral Health Authority for the SMHA and will be supported by the SMHA and other behavioral health resources as needed. 7. During local emergencies or disasters, pastoral, public, and private behavioral health organizations (including consortiums) will respond in coordination with emergency management to events requiring DBH assistance. 8. Local provisions and plans must be made for the following: a. Establishment of a DBH component with local emergency management b. Establishment of a DBH component at the Emergency Operations Center and/or Incident Command Post (ICP) when activated c. Triage of the acutely stressed and psychologically disabled d. Medical care, including hospitalization and transportation of the psychiatrically disabled including those with substance abuse needs (Methadone, etc) O-3
  10. 10. DRAFT e. Identifying obstacles to the recuperative capacities of individuals and supporting all positive coping strategies f. Constructing advisories for the public on issues such as stress symptom identification and management g. Conducting DBH assessments of, and support for, congregate care and service (Inoculation, shelters) facilities h. Development of a mechanism for reporting information and needs to the state disaster behavioral health authority i. Establishment of stress management procedures for emergency personnel (EMS, Hospitals) and first responders j. Establishment of stress management protocols for DBH responders B. DISASTER BEHAVIORAL HEALTH 1. Appropriate DBH assistance must be made available for responders, survivors, and other community members during emergency response and recovery operations. may include psychological first aid, critical incident stress management, crime victim assistance, Crisis Counseling Programs, referral to other organizations, and education about normal, predictable reactions to a disaster and how to cope with them appropriately. 2. DBH workers will immediately report to their designated sites and begin provision of psychological first aid and triage. They will coordinate service provision with Incident Command (IC) or site supervisor using the following treatment priorities: a. First Priority, Most Urgent - Agitated, endangering the safety of self or others - Passive, endangering the safety of self or others b. Second Priority, Urgent - Acutely distressed with either increased or decreased activity, but capable of direction with verbal command and one-on-one support c. Third Priority, Non-urgent - Acutely distressed with either increased or decreased activity, but capable of direction with verbal command and does not require one-on-one support 3. In addition to private, local, and state DBH providers, Volunteer Organizations Active in Disaster (VOAD), both Texas-based and National, will provide targeted stress management and/or crisis counseling at selected sites O-4
  11. 11. DRAFT C. MORTUARY 1. When a major incident involves multiple fatalities, the IC may request the assistance of multiple disaster behavioral health representatives. At the scene, these representatives address the psychological needs of survivors, families, First Responders, and the general public. 2. The local DBH provider will coordinate with the IC to direct behavioral health resource management. 3. The on-site DBH coordinator will assess the scene to determine the number of counselors needed to provide immediate assistance. Injured survivors with DBH needs may be assisted on-site or directed to designated health care facilities. D. STATEWIDE BEHAVIORAL HEALTH ASSISTANCE 1. Psychologically affected disaster survivors and emergency responders will need active DBH intervention during and/or after a disaster. Affected survivors will be able to obtain aid from existing local DBH resources including faith-based providers. If the demand for such increases or is ongoing, there will be a need for additional resources as local providers are or may become disaster victims themselves. 2. If existing local resources are or become inadequate to meet the need for DBH, external providers may be requested. The SMHA will direct the emergency reallocation of DSHS resources and work with local and external DBH responders to ensure a coordinated, seamless response. E. BEHAVIORAL HEALTH SUPPORT FOR EMERGENCY RESPONDERS The DSHS CISM Network assists emergency service (EMT, firemen) and law enforcement personnel who have experienced critical incidents such as line-of-duty deaths, mass fatalities, and local disasters. CISM teams are available, upon request, on a 24-hour basis regardless of disaster declaration. Texas Department of Public Safety, Victim Program provides the following support to law enforcement, victims and their families including: Criminal Justice Support Referral to assigned detective Status of case information Arrest notification Court accompaniment Information and referrals to local social service providers Notification and assistance in filing for Crime Victims' Compensation Assistance with evidence return Short-term counseling Personal Advocacy Crisis Intervention O-5
  12. 12. DRAFT 1) ORGANIZATION AND ASSIGNMENT OF RESPONSIBILITIES A. ORGANIZATION 1. The provider functions as the local DBH-coordinating agency. a. The provider has primary responsibility for assessment and provision of coordinated emergency behavioral health during locally designated emergencies or disasters. b. In the event that local response by the provider becomes overwhelmed or can no longer maintain the level of response required by the event; the lead DBH agency/group must request additional DBH resources through the DPS Disaster District Committee (DDC). c. The DDC will notify the State Operations Center (SOC) of requests for DBH resources made by the provider. d. The SOC will notify the SOC-DSHS representative of the need for additional resources, forwarding this request to the DSHS Multi Agency Coordination Center (MACC). e. Upon notification by the SOC, the DSHS MACC representative will contact Disaster Mental Health to coordinate behavioral health assets. 2. DSHS functions as the state level DBH coordination agency. a. Upon receipt of official notification of an actual or potential emergency situation, it is the responsibility of DMHS to receive and evaluate requests for DBH assistance and to disseminate such notification to the appropriate local behavioral health organizations for assessment and action. b. During a state and/or federal emergency, DMHS has the primary responsibility of ensuring coordinated behavioral health. c. In the event of federal declaration, it is the responsibility of DMHS to evaluate the need for and pursue a FEMA Crisis Counseling Program (CCP) Grant. B. ASSIGNMENT OF RESPONSIBILITIES 1. General All agencies or organizations assigned to the Behavioral Health Emergency Support Function (ESF) are responsible for the following: a. Designating and training representatives of their organization b. Ensuring that DBH standard operating procedures are developed and maintained O-6
  13. 13. DRAFT c. Maintaining emergency staffing lists and notification procedures 2. Provider a. Designate a coordinator to perform pre-emergency planning for emergency DBH and to coordinate during emergencies and disasters. b. Provide qualified staff to support operations at designated locations. c. Provide to emergency workers, disaster victims, and others experiencing emotional or psychological trauma. 3. Designated Local Behavioral Health Response Coordinator a. Upon arrival at the IC/EOC/MOC (Medical Operations Center), begin assessment and coordination of emergency and short-term stress management and DBH needs. This may include, but is not limited to activating and assigning personnel to triage, responder stress management, and support for congregate facilities and for other service sites as directed and as resources permit. b. The coordinator is responsible for anticipating the duration of the response, in addition to determining how the latter will impact staffing and other resource needs. The coordinator ensures information flow, makes certain requests for assistance is timely, and maintains administrative and fiscal records. c. In the event DSHS is activated, the coordinator will be the liaison between the local effort and the state (DMHS). 4. State Disaster Behavioral Health Coordinator (DMHS) a. Establishes communication with responding DBH resources b. In consultation with local DBH responders and local government, will perform a rapid assessment of community behavioral health needs c. Oversee and coordinate the efforts of DSHS/external DBH organizations and request and direct additional resources as needed d. Ensure that emergency behavioral health teams responding to a disaster site establish a behavioral health element with local emergency management e. Communicate with neighboring behavioral health organizations on matters related to assistance from other jurisdictions f. Coordinate with state and federal officials on matters regarding state and federal behavioral health assistance O-7
  14. 14. DRAFT g. Coordinates access to controlled areas as needed. Positive identification (and proof of licensure, if required) and contact information is obtained from behavioral health responders needing entry. h. Coordinate the procurement and allocation of human resources required to support behavioral health operations i. Provide, through the incident PIO, information to the news media for the public on dealing with emerging disaster behavioral health issues j. Establish prevention by informing the general population about resiliency and normal coping behaviors k. Monitor stress levels in emergency facilities (staff permitting) l. Ensure responder stress management procedures are in place m. Ensure that responders receive debriefing when out-processing 5. Law Enforcement The DBH provider may request assistance with the transportation of agitated persons under emergency detention or orders of protective custody. 6. Local Public Information Officer (PIO) The provider may request that local emergency management PIOs distribute public emergency information provided by behavioral health officials. 7. The Faith-Based Community This community provides faith-based counseling on an individual or group basis as requested or referred. When possible, service provision should be coordinated with the DBH provider in order to prevent duplication of effort and to furnish referral options. 8. American Red Cross (ARC) The ARC provides and coordinates disaster behavioral health capabilities at mass care shelters, ARC service sites, and airline crash sites. When possible, service provision should be coordinated with the DBH provider in order to furnish referral options and coordinate a continuum of care. VI. DIRECTION AND CONTROL A. Routine behavioral health activities are expected to continue during less severe 4 crisis situations. Direction and control of such operations will be by those that 5 normally direct and control day-to-day behavioral health. O-8
  15. 15. DRAFT 6 B. External agencies providing DBH support are expected to conform to the general guidance provided by the Incident Command System and to carry out mission assignments as directed. However, organized DBH response units will work under the immediate control of their own supervisors. C. In a state or federally declared disaster, DMHS will assume direction of LMHA and State Hospital DBH assets. DMHS is also responsible for ensuring a coordinated response by all other DMHS activated/organized DBH response units. Again, response units will work under the immediate control of their own supervisors. VII. EMERGENCY RESPONSE LEVELS/ACTION GUIDES See the DEM State Emergency Management Plan, Section VII for a list of the response levels and types of activities that characterize each level. Annex N (Direction and Control) is maintained by DEM and addresses all hazards, functions, agencies, and response levels. Tab B outlines additional actions the ESF group members need to take at each response level to ensure the group is prepared to respond and support emergency operations. VIII. CONTINUITY OF GOVERNMENT A. Lines of succession for personnel with emergency management responsibilities will take place in accordance with existing policies and emergency management standard operating procedures (SOP's) for each agency/organization. B. Primary and support agencies will ensure their respective personnel are trained and able to operate in the event that regular agency members are absent. They will identify alternate or backup personnel and ensure that these individuals understand the lines of succession and recognize the pre-delegated authorities. In addition, they will task responsibilities of their individual agencies and ensure appropriate operating procedures contain sufficient detail so that alternate and/or backup personnel can use them in performing their responsibilities. C. Agencies will ensure that all records, necessary for emergency management operations, can be easily obtained from each member agency and that, if needed, these records can be duplicated at another location(s) if the primary records are destroyed. IX. ADMINISTRATION AND SUPPORT A. REPORTING 1. In addition to reports that may be required by their parent organizations, state hospitals and LMHA’s participating in emergency operations will provide situation reports to the IC, MACC, and DMHS. O-9
  16. 16. DRAFT 2. State hospitals and LMHA’ will provide fiscal reports, outlining the cost of crisis counseling response (i.e. salary, fringe, travel, and other approved response expenses), as requested to DMHS. B. MAINTENANCE AND PRESERVATION OF RECORDS 1, MAINTENANCE OF RECORDS. DBH operational and client records, generated during an emergency, will be collected and filed in an orderly manner so that a record of events is preserved. These records will allow for the following: the recovery of both emergency operations and response costs, assessment of the effectiveness of operations, and the updating of emergency plans and procedures. Federal guidelines require that records be held for a period of three years post event. 2. DOCUMENTATION OF COSTS. Expenses incurred while carrying out DBH may be recoverable from FEMA or a third party. All agencies should maintain records, including substantiating documentation, of personnel, equipment, and supplies used during any large-scale operation for a period of no less than three years post event. 3. PRESERVATION OF RECORDS. Vital behavioral health and medical records should be protected from the effects of a disaster to the maximum extent possible and in accordance with the Health Insurance Portability and Accountability Act (HIPAA). Should records be damaged during an emergency situation, professional assistance for preserving and restoring those records should be obtained as soon as possible. C. POST INCIDENT REVIEW Providers should conduct an after-action review of response activities immediately after an exercise or event. The purpose of this review is to identify successful operational procedures and needed improvements. D. EXERCISES 1. Local drills, tabletop exercises, functional exercises, and full-scale exercises should all incorporate DBH. Additional drills and exercises may be conducted for the purpose of developing and testing abilities and to make response to various types of emergencies more effective. DBH volunteer organizations and groups that provide emotional support during emergency situations shall be encouraged to participate in drills and exercises. 2. Providers should test their preparedness and response plans annually, at minimum. X. DEVELOPMENT AND MAINTENANCE A. The Commissioner of the Texas Department of State Health is the approval authority for this Plan and is responsible for its implementation. O-10
  17. 17. DRAFT B. DMHS is responsible for the development, maintenance, and distribution of this Plan. DMHS and other designated components of DSHS are responsible for conducting annual reviews, coordinating all review and revision efforts, and incorporating information learned from exercises and actual events into this Plan. C. This draft Plan is available at the following website: http://www.dshs.state.tx.us/comprep/dmh/dmhappendix.shtm O-11
  18. 18. DRAFT TAB A DISASTER BEHAVIORAL HEALTH ESF ORGANIZATION Primary Agency: Department of State Health Support Agencies: American Red Cross The Salvation Army Texas Department on Aging and Disability (DADS) Texas Department of Assistive and Rehabilitative (DARS) Texas Department of Public Safety, Victim Program O-1-1
  19. 19. DRAFT TAB B DISASTER BEHAVIORAL HEALTH ESF ACTION GUIDE Response Level Hazard Agency Action 4 Normal Conditions Provider * 3 Increased Readiness Provider * Conditions 2 Elevated Response Provider/ * Conditions DMHS 1 Emergency Conditions Provider/DMHS * *See Action Guide below for details on actions taken for each response level. DISASTER BEHAVIORAL HEALTH ESF ACTION GUIDE 1. Normal Conditions (Level 4) a. Review and update disaster behavioral health plans and related SOPs b. Review and update assignment of all behavioral health personnel, including contact information c. Coordinate with private industries, including corporate Employee Assistance Programs, on related behavioral health activities d. Establish and maintain a list of behavioral health resources e. Maintain and periodically test equipment f. Conduct or coordinate behavioral health training, drills, and exercises g. Develop behavioral health task assignments and identify potential behavioral health resource obstacles in service delivery 2. Increased Readiness (Level 3) a. As required, DMHS is activated to participate in SOC conference calls and/or staff the SOC or other designated sites b. Implement notification procedure and ensure appropriate disaster coordinator and key personnel are contacted and provided with information concerning the situation O-6-1
  20. 20. DRAFT 3. Escalated Response (Level 2) a. Activate components needed to conduct emergency/disaster operations b. Implement protective action plans and procedures c. Determine current and anticipated DBH needs and reporting requirements and implement facility and local behavioral health authority activation, including placement on standby, in accordance with established procedure d. Ensure disaster coordinator and key personnel continue to provide, and are provided with, information concerning the situation 4. Emergency Conditions (Level 1) a. Mobilize DSHS and/or provider DBH resources b. Gather and analyze situation information and submit status reports to the MACC controller c. Ensure disaster coordinator and key personnel continue to provide, and are provided with, information concerning the situation TAB C DISASTER BEHAVIORAL HEALTH (DBH) QUALIFICATIONS 1. During a State of Emergency, are provided to all individuals who are impacted by the disaster, regardless of their general behavioral well being prior to the event. Assistance may be provided to emergency responders or other individuals who may not normally be served by the provider. In the event that consumers of behavioral health are impacted, the program is designed to work with the disaster victims via the individual’s current support system. 2. During a state declared emergency, include but are not limited to, short-term counseling, grief counseling, crisis intervention, debriefing, facilitating community groups, stress management, and community education. It is obligatory that assistance be provided, as directed in but not limited to the disaster recovery centers. When necessary, staff may be asked to provide staffing at inoculation or decontamination sites, temporary morgues, death notification centers, hospitals, schools, nursing homes and other appointed locations. Staff will also establish contact with existing outreach based programs, especially those that provide substance abuse and homeless 3. DMHS is specifically assigned with the task of coordinating the DBH Program, applying for federal and state assistance and conducting psycho-educational programs. DMHS may be tasked to serve on the State Emergency Response Team (SERT) and the Rapid Assessment Unit (RAU). When necessary, a local provider may be asked to assist in O-6-2
  21. 21. DRAFT staffing the SERT and the RAU. Furthermore, DMHS acts as DBH liaison between DEM, FEMA, and SAMHSA. 4. FEMA Crisis Counseling Program Grant funds are only available after a federally declared disaster. DMHS is the applicant for this grant, on behalf of DSHS and the impacted communities. DSHS is the responsible agency for hiring CCP staff, providing training, grant management and closure. CCP grant applications follow strict program guidelines as outlined by FEMA and SAMHSA, addressing the scope of , record keeping, budgeting, hiring, job descriptions, training, reporting guidelines, and other areas of program management and ’ delivery. FEMA and SAMHSA expect the SMHA to serve as the active program administrator during all Crisis Counseling Programs. TAB D Department of State Health - Disaster Mental Health And Crisis Counseling Program The Mission of the DMHS Program is twofold: To lessen the adverse behavioral health effects of trauma for victims, survivors, and responders, whether those events are natural, criminal, accidental, or terroristic; and to assist in preparedness by ensuring disaster behavioral health is an integral component of a comprehensive private and public health response. This mission is accomplished through response to catastrophic events by providing: • Education and training • Assessment of need • Stress management • Individual and group crisis counseling through the CCP • Referral to victim assistance, disaster, and volunteer resources • Technical Assistance for FEMA Public Assistance Program • Policy development In the State of Texas Emergency Management Plan, DSHS is tasked to be the lead agency in the coordination of all DBH including preparedness, response, and recovery. To meet this task, the agency maintains a readiness capability through a cadre of DBH trained staff. include, but are not limited to: • Coordination of Disaster Behavioral Health • Development of crisis counseling programs (federally funded) • Information and referral to long term behavioral health • Stress management for responders, operations personnel, and victims • Education and training DMHS coordinates staff for the following: • State Operations Center (SOC) • Disaster Field Office (DFO) • Disaster Recovery Centers (DRCs) • State Emergency Response Team (SERT) O-6-3
  22. 22. DRAFT • The Rapid Assessment Unit (RAU) As needed, DBH staff may also be required at the following locations: • Temporary morgues and death notification centers • Decontamination sites • Hospitals • Community outreach centers and schools • Other locations as directed Responsibilities of the DMHS include: • Acting as DBH liaison between DSHS and GDEM • Notifying GDEM of dangers that CMHMRC consumers and personnel may be faced with during emergencies • Through the DSHS MACC requesting GDEM assistance for disaster response needs • Reporting disaster-caused injury, death, loss, and/or damage to CMHMRC’s • Notify the DSHS MACC and/or DSHS management of requests for Crisis Counseling Program (CCP) The CCP is a supplemental assistance program available to states by the Federal Emergency Management Agency (FEMA). Section 416 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act, 1974 authorizes FEMA to fund mental health assistance and training activities in areas which have been presidentially declared a disaster. The CCP consists of short-term (Less than one year) interventions with individuals and groups experiencing psychological reactions to a disaster or crisis event. These interventions involve the following goals: assisting disaster survivors in understanding their current situation and reactions, decreasing stress, aiding survivors in reviewing their options, promoting the use of or development of coping strategies, providing emotional support, and encouraging linkages with other individuals and agencies that can help survivors recover to their pre-disaster level of functioning. Since its inception, the thrust of the Crisis Counseling Program, while always cognizant and targeting to those with special needs (i.e. the elderly, children, the disabled, the homeless, ethnic and cultural minorities, and those with a very low income), has been to serve anyone affected by a disaster. Outreach is the primary method for delivering crisis-counseling to disaster survivors. It consists primarily of face-to-face contact with survivors in their natural environment. The most frequently funded by the CCP are individual and group crisis counseling and education. The CCP allows for referrals to long-term, more formal mental health and/or disaster-specific available through FEMA Teleregistration, the American Red Cross, the Salvation Army, Interfaith Disaster Recovery, local public health, the Unmet Need Committees, or other resources as needed. Funding for crisis counseling is available through the State Mental Health Authority through two grant programs: (1) the Immediate Program (ISP) which provides funding for up to 60 days of service and assessment, immediately following a disaster declaration, and (2) the Regular Program (RSP) which provides funding for continued for up to nine months following a disaster declaration. O-6-4
  23. 23. DRAFT DMHS contact information: Main Office: 512-458-7219 Fax: 512-458-7472 Additional information including this draft Plan, staff and contact information, forms, etc. may be found at: http://www.dshs.state.tx.us/comprep/dmh/default.shtm TAB E DEPARTMENT OF STATE HEALTH CRITICAL INCIDENT STRESS MANAGEMENT (CISM) NETWORK 1. The Texas CISM Network was established to assist emergency service personnel, including dispatchers/communications personnel, who have experienced a critical incident such as a line of duty death, the death of a child, or a scene involving multiple casualties and/or fatalities. 2. Jeffrey Mitchell, Ph.D., has defined a critical incident as, “any situation faced by emergency service personnel that causes them to experience unusually strong emotional reactions which have the potential to interfere with their ability to function, either at the scene, or later. All that is necessary is that the incident, regardless of the type, generates unusually strong feelings in the emergency workers.” 3. The education, , and intervention strategies are provided by Network teams comprised of peers and selected members of the clergy, trained in these strategies, and behavioral health professionals (BHP), cross-trained to work in emergency service agencies. These teams are available within the State of Texas on a 24-hour basis. 4. The Network provides a clearinghouse for information and is instrumental in the organization and ongoing stages of team development. DSHS receives and screens requests for intervention. 5. The goals of the Network are to: a. Provide the Critical Incident Stress Management and educational support necessary to ensure optimal functioning of Texas’ emergency service workers and their primary support systems b. Promote job retention for emergency personnel and reduce turnover rates c. Enhance the quality of response for persons in Texas needing emergency d. Conduct pre-incident educational programs to acquaint emergency service workers with stress management techniques available through the CISM program, as well as to provide initial and continuing education training for CISM team members e. Provide a model of interagency cooperation in Texas O-6-5
  24. 24. DRAFT f. Provide a model of an organized statewide response to the psychological and emotional needs of emergency personnel impacted by disasters/critical incidents g. The Network supplies teams to provide responsive and supportive intervention and stress management education to any emergency service agency in Texas involved in a critical incident h. Through the CISM process, the team will provide an organized approach to the management of stress reactions for emergency service personnel who have been exposed to, or who are showing signs of, traumatic stress experienced in the line of duty; the focus will be to minimize the harmful effects of job stress and accelerate the recovery of those personnel who have been traumatized in these situations i. Teams are not counseling or therapy providers; it is NOT the function of any CISM team to replace professional counseling or employee assistance programs, but rather to provide immediate, incident specific, supportive crisis intervention via a proven model j. The CISM Department can be activated by contacting: Main Office: 512-458-7473 Paul Tabor: 512-458-7128 Pager : 512-205-9031 (Paul Tabor) E-mail: paul.tabor@dshs.state.tx.us OR by contacting the SOC at 512-424-2208. TAB F LOCAL MENTAL HEALTH AUTHORITY (LMHA) 1. Authority Functions The LMHA shall plan, develop, coordinate, allocate, and develop resources for DBH with their service areas, in accordance with State Code §1-4, Attachment VIII. 2. Program The LMHA shall: a. Provide DMHS with the names and contact information of two professional mental health staff members to serve as disaster contacts b. Provide additional staff at a ratio of one professional for each quarter of a million (250,000) individuals in the local service area c. Provide professional staff members to be trained in disaster counseling and federal disaster grant procedures O-6-6
  25. 25. DRAFT d. Provide disaster , as defined in the Performance Contract, to impacted individuals, families, and businesses in the event of a state or federally declared emergency and upon notification from the SMHA e. Use level three (3) certified sign language interpreters, if available, for persons with hearing impairments. A level one (1) certified sign language interpreter is the minimum skill level accepted as an alternative arrangement. O-6-7