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Link to KAHBH Core Training Manual
 

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  • Start with Disaster Timeline with group identifying when they became interested in disaster mental health work or have been involved in providing DMH services 1940s through present
  • 1) FEMA=Federal Emergency Management Agency SAMHSA CMHS= Substance Abuse Mental Health Services Administration Center for Mental Health Services I would emphasize here that many models were reviewed, and based on national information, as we developed the training, the SAMHSA CMHS model was identified as the “best practice” model. In addition, this is a model that has been around for many years and is the national model used because of the relationship between the CMHS and the mental health authority in each state. I would put it out on the table, that “yes,” there are problems with FEMA, and that the purpose of this program is to 1) increase the preparedness of providers to reduce the problems faced during the response—so that everyone will be more prepared and ready to respond in a disaster event, and 2) the focus is on providing SERVICES to the people of Kansas affected by a disaster event. I wouldn’t debate the FEMA issues, but emphasize the importance of what our goal is.
  • This is based on Public Health Core competencies. Necessary for any public health professional who may be attending trainings in order to be eligible for credit.
  • “Linchpin”—Central, cohesive element Emphasize focus on “ behavioral health”
  • Just state that funding is received through FEMA and CMHS to the KMHA for disaster services
  • Not discounting these approaches—these are separate response systems from FEMA/CMHS approach and need to be understood as such
  • Activity: Kansas Disaster trivia game—this is all from the KDEM State Mitigation Plan (2002) Kansas was hit by 2,149 tornadoes between 1950-1996 (True) None of those tornadoes have been F4 or F5 tornadoes (False—4 F5 and 1 F4 have struck Kansas) Kansas ranks 6th in tornado activity in the US (False--3 rd ) May 25, 1955: The Udall, Kansas Tornado—Ranks 7 th among the deadliest tornadoes recorded since 1950 (True) Over half the population of Udall, Kansas was killed as a powerful F5 tornado slashed through it. Tornadoes that day killed 115 people in Texas, Oklahoma and Kansas ( Tornados have struck in all 12 months in Kansas (False—not January) No earthquakes have been reported in Kansas (False—over 25—including one May 13, 1999 in Kansas City The area most vulnerable to the impact of an earthquake is the southwest corner of the state (False—northeast corner is most vulnerable b/c of population) Floods have been the leading natural disaster in the US during the 20 th Century (True) Kansas ranks 13 th in FEMAs National Flood Insurance Program flood losses nationally (False—23 rd ) Ammonia is the most common chemical involved in hazardous materials accidents (True) Two “known” incidents of terrorist activities and 1 recorded civil disturbance have occurred in Kansas (True—letter bombs mailed to Leavenworth prison and attacks on abortion clinic doctors (terrorist activities) and the 1920 Independence KS riots—racial event required KS National Guard deployment) Local Info re: Disasters April 26, 1991—Wichita /Andover tornado: 20 people were killed, plus 1 in Elk and 1 in Cowley counties. On the ground for 50 minutes and injured 302 people F3 tornado hit Sumner county on May 25, 1997 May 3, 1999—F4 hit Sedgwick county, killed 6 and injured 150—spread across 4 counties
  • Refer them to the SAMHSA Manual
  • Activity: TO understand the flow of events from disaster to community, county, state, and federal, simulate a relay race, using participants, and have them labeled and pass a baton from one to the next
  • This theoretical model--developed by Zunin and Meyers in California--outlines phases of a disaster in terms of individual and collective emotional response in the community. After the initial shock of a disaster, there is often an emotional “high” period--sometimes referred to as the “heroic” phase. This is the time in which people are still running on the adrenaline of the event. Community members and emergency workers may bond together in immediate response activities. This heroic phase often culminates in a honeymoon period, in which there is great optimism. Media may celebrate stories of dramatic rescues, survival, community spirit, volunteerism and donations of money and resources. Depending on the disaster, this phase may last for a few weeks or months. Next however, there is typically a time of disillusionment as the true extent of loss sinks in. The spirit of community cohesion may diminish as some aspects of the community recover faster than others. There may be competition for resources. Some may a sense of unfairness or anger at the bureaucracy. Over time--the healthy emotional recovery process can lead to predisaster emotional functioning--or higher--but on a steady course . . . Our job is to help that happen.
  • Ask participants: “Which would be worse” and “why”, to understand psychological differences in man-made events vs. tornado or fire
  • Where were you when 9/11 happened and how did it affect you? Do “grouping activity” Have them group according to the following factors: Outside Kansas, vs. in Kansas With family/friends, with coworkers, alone Heard the news directly on tv first vs. heard from someone else Were there, vs. knew someone vs. heard about (explain primary, secondary, and tertiary victims here)
  • Continue w/ mock scenario and apply to different age groups or cultures or professions. What if you are a chocolate addict or depend on it daily?
  • Activity: Use drawing of human body and put the reactions w/I appropriate body parts to create visual reminder of complexity of human beings and our reactions; use different colored markers to indicate physical, emotional, cognitive, behavioral reactions. Normalize and minimize, not pathologize and awfulize
  • Draw ecological model to illustrate impact on person’s system (concentric circles)
  • Denial, numbness, and shock (preoccupation with matters that do not include mentioning the loss) Temporarily reduces the intensity of the loss Should not be confused with "lack of caring" Should diminish as the ability to acknowledge the loss develops Anger Feeling abandoned by the lost loved one Generalized resentment toward life/God for the injustice of the loss Guilt over certain feelings (e.g., anger) Bargaining Thinking about what could have been done to prevent the loss Imagining all the things that will never be Making deals with God, e.g.exchange good behavior with something else. Depression Sleep and appetite changes Lack of energy and concentration Crying Loneliness, emptiness, isolation and self-pity Acceptance Requires time Signals healing Reorientation (integration of the loss into a new reality)   Show cycle of grief (get from Vickie)—Underscore uniqueness of grief Not really. I've just been to enough seminars and classes about grief that I am pretty familiar with E. Kubler-Ross' concept of how it works. So, with clients, I just write out the stages on the board starting with shock/denial and talk about what that would look like in real life before progressing on to anger, then bargaining, depression, and finally acceptance. I think the important part is to give examples of what each stage would look like and to stress that grieving is unique to each person. No two people will do it the same, including spouses, which can create conflict when one spouse doesn't think the other is actually grieving, when in reality they just have a different pattern. The stages are not something you neatly progress from one to the next. You may go through each of them several times before hitting acceptance or think you have hit acceptance only to start the entire process over again. I always ask clients to tell me which ones they feel they experienced and where they might be at the moment, but to normalize it all the way through by reminding them of the uniqueness of each person and how much of it depends on the level of relationship with the one being grieved for. Also, :"normal" grieving can take between 6 months and two years, again very unique, but that after a year, there should be progress made toward acceptance. It takes a year, generally, be/c you have to go trhough all the holidays and seasons without that person, which of course, restarts the cycle each time. One interesting point to make is how American culture denies death and grief compared to other cultures. For example, in many other ountries, the mourner wears only certain clothes that are identified as mourning garb. They wear this for one year as a symbol to other people to treat them with patience and respect. There are many examples like that. But in America, we are expected to get back to work after two days and we have even done away with the tradition of wearing black to funerals, so we have few identifiying marks of grieving, which only makes the griever feel more alone and abnormal. As you see, I could go on and on about grief. I think it is important to teach the stages of grief b/c I have seen great relief come over clients' faces when they realize that what they have been feeling is universal and doesn't mean they are crazy. I've had more than one of them ask me why no one has ever told them this before, like their dr. That is a good question. That is why I think it is important to stress the normalness of sadness in times of loss and acknowledge what has been lost and not simply change the subject or ignore it like we are prone to do in this country.
  • After the danger has passed and the other sources of stress in the situation are reduced to normal, people usually show some signs of stress reaction, which gradually reduces over a period of weeks or even months. However, if the stress symptoms remain high over a few weeks and do not show gradual reduction, this is a sign of a sustained traumatic reaction that may require referral for professional care. Making this decision is, of course, difficult and should be made in consultation with the supervisor of the volunteer.  It is important to recognize that such a referral could receive a very negative reaction from anyone who felt the referral meant that s/he was mentally ill, and could also lead to stigmatization and victimization within the community. This is unfortunate, as professional help should always be seen as another step toward health. Therefore, it is important to inform the person of your actions and intentions and to let him/her know that you care. Explain the reasons for the referral to the person and let them know specifically what kind of professional to whom you are referring.
  • This should be about lunch time 
  • Refer them to P. 53-59 of Training Manual for more info
  • Refer to P. 60 of Training Manual for more information
  • Activity: What would you need most? Work in groups to make a list
  • You may come across someone who is extremely agitated and who may be having trouble calming down. Such people may become a danger to themselves or others. For instance, thoughts of suicide are a common theme. While psychological support is not intended as a solution for such situations, it is still important to have an understanding of how to react in a crisis. Above all, remember to maintain your own safety. If you do not feel safe with the person, get out and get help.
  • ***Consider cultural competency to be an umbrella over all disaster behavioral health training, services, and activities**** ***These are a few groups identified in the literature on disaster behavioral health*** Activity: Have people in each of these “roles” and provide the following scenario: You leave tonight and find that you lost your home in a disaster. Everything you had is gone except the things you have with you right now. What would you need most: in the next day? In the next week? In the next month? What avenues would you use to meet those needs? What would you not know how to access? ***CONSIDER
  • Remember “crisis counseling” refers to all-hazards or disaster crisis counseling
  • The Stafford Act was passed in 1973. Although the Stafford Act has been amended twice since passage, section 416, which authorizes the Crisis Counseling Program, has remained unchanged. The first CCP grant was awarded to Alaska on January 14, 1974. Total costs were $2,060.00. Since 1974, FEMA, CMHS and our predecessor agency, NIMH, have awarded more than $137 million in crisis counseling grants. Of the 50 States, DC and 9 U.S. Territories, only 9 States have never had a crisis counseling program.
  • The Stafford Act was passed in 1973. Although the Stafford Act has been amended twice since passage, section 416, which authorizes the Crisis Counseling Program, has remained unchanged. The first CCP grant was awarded to Alaska on January 14, 1974. Total costs were $2,060.00. Since 1974, FEMA, CMHS and our predecessor agency, NIMH, have awarded more than $137 million in crisis counseling grants. Of the 50 States, DC and 9 U.S. Territories, only 9 States have never had a crisis counseling program.
  • The Stafford Act was passed in 1973. Although the Stafford Act has been amended twice since passage, section 416, which authorizes the Crisis Counseling Program, has remained unchanged. The first CCP grant was awarded to Alaska on January 14, 1974. Total costs were $2,060.00. Since 1974, FEMA, CMHS and our predecessor agency, NIMH, have awarded more than $137 million in crisis counseling grants. Of the 50 States, DC and 9 U.S. Territories, only 9 States have never had a crisis counseling program.
  • The types of services provided through these grants include outreach, simple assessments, counseling and information services.
  • The types of services provided through these grants include outreach, simple assessments, counseling and information services.
  • While the FEMA/CMHS Crisis Counseling Program has over 30 year history, the field of disaster crisis counseling is still considered by many to be an “emerging” field within mental health. In fact, the field of disaster mental health has experienced its most rapid growth in the last decade and continues to evolve and refine itself based on lessons from each disaster experience. Like many mental health fields that have emerged from the mainstream--the crisis counseling program has sometimes defined itself in contrast to “traditional mental health services.” This slide, which is based on a CMHS program guidance, contrasts traditional office-based services with the crisis counseling model [walk through contrasting bullets]. Activity: Return to Chocolate scenario (get new members up to speed): Create psychometrics, treatment plans, genogram, diagnosis, etc. to compare “Traditional” MH practice to crisis counseling
  • State the obvious to those who saw this twice in the first day training—Yes, repetition is sometimes important!  Refer to P. 60 of Training Manual for more information
  • The 2005 map will be interesting!!!!
  • The major program activity is the administration of Crisis Counseling Grants as part of a longstanding and highly successful partnership with the Federal Emergency Management Agency (FEMA) The two types of grants provided for under the Stafford Act and implementing regulations are Immediate Services and Regular Services grants. [TALK BRIEFLY ABOUT TECHNICAL REQUIREMENTS]
  • (see SRS map) This model is a federal program and all information is based on best practice, nationally recognized material. Refer participants to SAMHSA website for more information
  • Not discounting these approaches—these are separate response systems from FEMA/CMHS approach and need to be understood as such ARC trains clinically licensed mental health professionals only in their network—ARC training CISM—specialized training—purpose is to reduce stress for first responders KAHBH is not intended to replace or compete with these, but to provide state-wide coordination and collaboration around behavioral health services when a disaster or all-hazards event occurs. Some KAHBH members may be members of both groups (ARC and CISM). Role and experience in these other disaster mental health resources is beneficial
  • Be indigenous to the communities they serve, as they will be aware of issues in the community and not viewed as “outsiders” by the disaster victims. Indigenous workers come from within the local community and are often part of the cultural or ethnic group receiving services. They are familiar to and recognized by community members. They may be community leaders or have a nurturing role in their communities. They may be mental health professionals already working in the community. Other examples of indigenous workers include retired persons, students and active community volunteers. Indigenous workers may have formal training in counseling or related professions, or they may be paraprofessionals or professionals in other fields, as well. Possess experience working with various populations in need, including children, elderly, minorities, and disadvantaged. This expertise is invaluable in a disaster situation. Be capable of providing all-hazards behavioral health services through non-traditional methods . Working in a disaster may require public education activities, including public speaking at community meetings or local disaster-related events. Crisis counseling and all-hazards outreach work often is provided in victims’ homes, local restaurants, schools, or other informal places. Disaster workers should be able to function in these environments. Be sensitive to cultural issues and able to provide services that are culturally appropriate.
  • Just briefly overview this information verbally from slides 76-87 that were described in detail on Day 1.
  • As a note: there are a LOT of trainings to navigate through on the FEMA website. Also, it requires patience with the site, and TIME to navigate through it. Plan on BLOCKS of time to complete the trainings. Very helpful, necessary information, but BE PATIENT!
  • The following are guidelines which may vary depending upon the scope and nature of the disaster and varying needs and stresses as the response effort matures. 1)      Team Leaders and members should serve in the field no longer than five (5) full and continuous days on site (inclusive of travel time) in a single rotation.  On the final day, the outgoing team leader will brief the incoming team leader. 2)      Team Leaders and members shall plan a reasonable amount of time for rest while in the field, but no less than eight (8) continuous hours in each twenty-four (24) hour period. 3)      Each team is required to meet at the end of the day or shift and prior to assignment to shelters for the night, to share information, plan for the next day's work and emotionally process the day’s activities together. 4)      Team members and Leaders are required to leave the disaster area and return home for at least (10) full days before serving a subsequent rotation. 5)      Team Leaders and members shall receive the next two (2) full scheduled working days off as Administrative Leave beginning the day after their return to their home and communities.  The leave must be taken at this time.  It cannot be considered Compensatory Time to be taken at a later date. 6)      Debriefing is mandatory for all staff involved in KAHBH response, including daily debriefings and post-rotation debriefings.
  • KAHBH NETWORK DEBRIEFING PROCEDURES: Debriefing encompasses the exchange of information for purposes of planning and coordinating services, as well as, the need for all staff involved in the disaster to deal with the emotional effects of the experience.  Debriefing is a specific clinical skill and only people trained in a debriefing model will be permitted to carry out this function.  Participation in debriefing is mandatory for all staff involved in KAHBH Response . Process Debriefing:          While in the field, team members will process the day’s activities and the plans for the next day with their team leader.          While in the field, team leaders will check in daily with the DMH Disaster Response Team to process the day and to report their own and their team's challenges. Post Rotation Debriefing:          All employees who carry out field work in the affected area will have at least one debriefing session in their home community before returning for a subsequent rotation.          Post rotation debriefing will be documented by a roster of those leading the debriefing and those attending the debriefing.          The CMHC Coordinator/Community Outreach Team Leader will organize debriefing sessions for Network members responding in their area.          Response workers may be debriefed within five to seven days of returning to their home facility or CMHC (these debriefings may occur during the employee's Administrative Leave period).          Post-Response debriefing will be arranged as needed for each group of response workers.
  • Trainers: This is when you should quickly review the KAHBH Core Training Manual and refer to additional info that expands on what was presented in the training, but also note additional info. Note how manual is organized: - p. 5-51: SAMHSA manual (show the participants the manual and inform them its out of print. This is key information from this manual. - p. 53-62: Other SAMHSA info that expands on presented material - p. 63-88: KAHBH specific information

Link to KAHBH Core Training Manual Link to KAHBH Core Training Manual Presentation Transcript

  • Kansas All-Hazards Behavioral Health Training Core Competencies for Community Outreach Workers
  • What is KAHBH?
    • KAHBH provides State-wide organization and coordination for behavioral health response to disaster and other all-hazards events
      • Training and preparing Kansas professionals and paraprofessionals to serve in behavioral health capacity during an event
      • Providing technical assistance and all-hazards behavioral health information to Kansans
  • Key KAHBH Tasks
    • Resource identification and collection
    • Training and education
    • Development of Annex to KEOP, KAHBH Plan, and Standard Operating Procedures
    • State-wide network recruitment and coordination
    • Preparedness, response, and recovery activities
  • KAHBH Network
    • 10 staff
    • 15 Stakeholders
    • 12 SRS Field Staff
    • 29 CMHC Coordinators
    • Goal: 200+ KAHBH Network members
  • Outline of KAHBH Trainings
    • KAHBH Core Behavioral Health Training
    • DAY 1 (approx. 8 hours)
      • For all participants without CISM or ARC DMH training within the last 5 years (Mental health and paraprofessionals)
        • Module 1: Disaster Classifications and Phases
        • Module 2: Traumatic Reactions to Disasters
        • Module 3: Providing Support During Disasters
        • Module 4: Considerations for Special Populations, Cultural Competence, and Ethical Issues
    • Day 2 (approx. 3.5)
      • For ALL KAHBH Network members
        • Module 5: The FEMA/SAMHSA CMHS Crisis Counseling Assistance and Training Program
        • Module 6: The KAHBH Program: Preparedness, Response, and Recovery for Kansas Communities
        • Module 7: Behavioral Health and the All-Hazards Disaster Response System
        • Module 8: KAHBH Community Outreach Teams: Structure, Procedures, and Documents
    • Paraprofessional Training
      • ½ day (4 hours) training to provide non-behavioral health professionals with background information in working with people in crisis, communication skills, issues related to confidentiality and ethics, and other basic helping skills
        • The Role of the Helper
        • Professional and personal boundaries
        • Ethics, confidentiality, and dual relationships
        • Communication Skills
        • Challenges in Helping
        • Diversity and multicultural awareness as a helper
        • Helping in Crisis and Grief Situations
    • Future Specialty Trainings
      • To be based on each community’s needs
      • All non-mental health members will receive additional ½ day (4 hours) training on basic helping skills in crisis counseling
      • At least 2 members (1 MH and 1 NMH) from each area will receive specialized training in the following areas (to be provided online in 2-4 hour trainings):
        • Children (under age 18)
        • Frail Elderly
        • Developmentally and physically disabled
        • Severe Mental Illness and People in active Substance Abuse Treatment
        • People in Correctional Institutions
        • College Students in dorms/away from home/Families/individuals relocated
        • People with high traumatic exposure
        • People in poverty and homeless
        • Roles of women in community (e.g. new moms, multiple caregivers)
        • Men and Women
        • Emergency responders involved in rescue/recovery
        • Multicultural issues
        • Farmers/Ranchers/Agricultural Workers/Rural Populations
  • Core Competencies, Terminology, and Regional Disaster Information
  • KAHBH Core Objectives
    • Understand the difference between Community Mental Health Center (CMHC) crisis counseling and the All-Hazards/Disaster Behavioral Health “crisis counseling” (FEMA/SAMHSA CMHS) model
    • Understand human behavior in disasters
    • Understand the key concepts of all-hazards behavioral health
    • Understand the organizational aspects of disaster response
    • Understand how to assess the needs of and intervene effectively with disaster survivors, including special populations
    • Provide appropriate behavioral health assistance to survivors and workers at the community level
    • Understand, recognize and manage stress in disaster work
  • KAHBH Core Competencies
    • Identifies relevant and appropriate data and information sources
    • Obtains and interprets information regarding risks and benefits to the community
    • Recognizes how the data illuminates ethical, political, scientific, economic, and overall public behavioral health issues
    • Prepare and implement behavioral health emergency response plans
    • Advocates for public health/behavioral health programs and resources
    • Effectively presents accurate demographic, statistical, programmatic and scientific information for professional and lay audiences
    • Utilizes appropriate methods for interacting sensitively, effectively, and professionally with persons from diverse cultural, socioeconomic, educational, racial, ethnic, and professional backgrounds, and persons of all ages and lifestyle preferences
    • Identifies the role of cultural, social, and behavioral factors in determining the delivery of public health/behavioral health services
  • KAHBH Core Competencies
    • Develops and adapts approaches to problems that take into account cultural differences
    • Collaborates with community partners to promote the health/behavioral health of the population
    • Identifies community assets and available resources
    • Describes the role of government in the delivery of community behavioral health services
    • Identifies the individual’s and organization’s responsibilities within the context of the KAHBH Program and its core functions
    • Creates a culture of ethical standards within organizations and communities
    • Helps create key values and shared vision and uses these principles to guide action
    • Identifies internal and external issues that may impact delivery of essential public behavioral health services (i.e., strategic planning)
    • Promotes team and organizational learning
    • “ It is important to remember that mental health intervention is a prompt and effective medical response to a bioterrorism attack. Early detection, successful management of casualties, and effective treatments bolster the public’s sense of safety and increase confidence in our institutions. Because the overriding goal of terrorism is to change people’s beliefs, sense of safety, and behaviors, mental health experts are an essential part of planning and responding.”
    • Statement from the Conference Transcript:
    • Responding to Bioterrorism: Individual and Community Needs ,
    • October 19-21, 2001
    • “ Mental Health is the linchpin to an effective response .”
    • Statement from April 2005
    • TOPOFF 3 Exercise
  • Terminology
    • “ Behavioral Health”
    • Mental Health + Substance Abuse
  • Terminology (continued)
    • All-Hazards = All-Hazards
    • Disasters ~ Bioterrorism ~ Major Community Crises
  • Examples of All-Hazards Crisis Counseling Program Services
    • Outreach
    • Screening and Assessment
    • Counseling
    • Information and Referral
    • Public Education & Social Advocacy
  • Program Limitations
    • Medications
    • Hospitalization
    • Long-term Therapy
    • Providing Childcare or Transportation
    • Fundraising activities
    • Individual Advocacy
    • Long-term Case Management
  • All-Hazards Crisis Counseling and “Traditional” Behavioral Health Practice
    • Primarily Office-Based
    • Focus on Diagnosis & Treatment of Mental Illness
    • Attempt to Impact Personality & Functioning
    • Examines Content
    • Encourages Insight into Past Experiences & Influence on Current Problems
    • Psychotherapeutic Focus
    • Primarily Home & Community Based
    • Assessment of Strengths, Adaptation & Coping Skills
    • Seeks to Restore Pre-Disaster Functioning
    • Accepts Content at Face Value
    • Validates Appropriateness of Reactions and Normalizes Experience
    • Psycho-educational focus
    “ Traditional” Practice Disaster Crisis Counseling Source : ESDRB Program Guidance, December, 1996
    • The KAHBH Program follows the FEMA/SAMHSA CMHS Crisis Counseling Program as the primary model
      • Federal program
        • Over 30 year history
        • “ Best Practice” nationally recognized material
      • Collaboration between FEMA, SAMHSA CMHS, state mental health authority (SRS in Kansas), and local responders
      • Community based
        • Focus on providing services to the general population
        • Includes paraprofessionals or community “heroes” as potential providers
  • Organizations Involved in Behavioral Health Disaster Response
    • Federal
      • SAMHSA — S ubstance A buse M ental H ealth S ervices A dministration & CMHS — C enter for M ental H ealth S ervices
      • FEMA — F ederal E mergency M anagement A gency
    • State
      • KDEM —K ansas D ept. of E mergency M anagement
        • KDHE — K ansas D ept. of H ealth and E nvironment
          • SRS —Kansas Dept. of S ocial and R ehabilitation S ervices
    • Local
      • Local emergency management agencies
      • CMHC — C ommunity M ental H ealth C enters
      • Local professionals and para-professionals (substance abuse professionals, clergy, doctors/nurses, fire/police department, volunteers, etc.)
  • The KAHBH Program is not:
    • American Red Cross Disaster Mental Health Services (ARC DMHS)
      • ARC requires a masters-level licensed mental health professional
      • ARC mental health workers are volunteers and do not receive reimbursement for their services
    • Critical Incident Stress Management (CISM)
      • Model developed and approved for use with first responders, but often is applied to many areas of crisis response, which may not be appropriate
  • The KAHBH Program
    • Emphasizes the importance of ALL approaches to all-hazards/disaster events
    • Recognizes and supports collaboration between behavioral health responders and other responders in all-hazards/disaster events
    • Works to provide State-wide organization and coordination for behavioral health response to disaster and other all-hazards events
    • Regional
    • Disaster Information
  • Module 1: Disaster Classifications and Phases Wichita tornado
  • Definition of a Disaster
    • A disaster is a threatening or occurring event of such destructive magnitude and force as to:
      • dislocate people
      • separate family members
      • damage or destroy homes
      • injure or kill people
    • A disaster produces a range and level of immediate suffering and basic human needs that cannot be promptly or adequately addressed by the affected people, and impedes them from initiating and proceeding with their recovery efforts.
  • Natural Disasters
    • Floods
    • Tornados
    • Hurricanes
    • Typhoons
    • Winter storms
    • Tsunamis
    • Hail storms
    • Wildfires
    • Windstorms
    • Epidemics
    • Earthquakes
  • Human-Caused Disasters
    • Intentional and unintentional
      • Residential fires
      • Building collapses
      • Transportation accidents
      • Hazardous materials releases
      • Explosions
      • Domestic acts of terrorism
  • Criteria for Presidential Disaster Declaration “ [A]ny natural catastrophe (including any hurricane, tornado, storm, high water, wind-driven water, tidal wave, tsunami, earthquake, volcanic eruption, landslide, mudslide, snowstorm, or drought), or, regardless of cause, any fire, flood, or explosion in any part of the United States, which in the determination of the President causes sufficient severity and magnitude to warrant major disaster assistance under this act . . . Source : Robert T. Stafford Disaster Assistance and Emergency Relief Act (P.L. 93-288 as amended)
  • Behavioral Health Response to Presidentially Declared Disaster Event City Response County Response State Response KDEM Application National Disaster Presidentially Declared Disaster
  • Classification of Disasters
    • Natural vs. Human-caused
    • Degree of personal impact
    • Size and scope
    • Visible impact/low point
    • Probability of
    • reoccurrence
  • Critical Disaster Stressors
    • Threat to one’s life
    • Threat of harm to family
    • Destruction of home or community
    • Significant media attention
    • Witnessing others’ trauma
    • Being trapped or unable to evacuate
  • Phases of Disaster Reactions
    • Warning of threat
    • Impact
    • Rescue or Heroic
    • Remedy or Honeymoon
    • Inventory
    • Disillusionment
    • Reconstruction and recovery
  • 1 to 3 Days -------------------TIME-------------------------------------------1 to 3 Years Zunin/Meyers Typical Phases of Disasters Warning Threat Pre-disaster “ Heroic” Honeymoon (Community Cohesion) (Coming to Terms) Working Through Grief Reconstruction A New Beginning Disillusionment Trigger Events and Anniversary Reactions Impact Inventory
  • Comparing Criminally Human-Caused and Natural Disasters
    • Causation
    • Appraisal of event
    • Psychological impact
    • Subjective experience
    • World view/basic assumption
    • Stigmatization of victims
    • Media
    • Secondary injury
  • Terrorism Within the United States
    • “ An activity that involves a violent act or an act of dangerousness to human life that is in violation of the criminal laws of the United States, or of any State…and that appears to be intended to intimidate or coerce a civilian population… or to influence the policy of government by assassination or kidnapping.”
    • [18 U.S.C. 3077]
  • Mass Violence Within the United States
    • “ An intentional violent criminal act, for which a formal investigation has been opened by the FBI or other law enforcement agency, that results in physical, emotional, or psychological injury to a sufficiently large number of people as to significantly increase the burden of victim assistance for the responding jurisdiction”
  • Summary
    • Disasters can be classified according to a number of different variables, including natural vs. human-caused
    • Most disasters have distinguishable phases, beginning with the pre-disaster and warning phase and ending with the reconstruction phase
  • Module 2: Traumatic Reactions to Disasters
  • Effects of Trauma
    • Vary by a person’s age, developmental stage, prior condition, degree of personal impact
    • Vary by the disaster’s severity, the amount of advance warning, the level of community preparedness
    • May include physical, emotional, cognitive or behavioral reactions
  • Psychosocial Concerns
    • Disruption of existing social/community
    • Impact of new social patterns
    • Duration of recovery
    • Cross-cultural impact
  • What Scares Us?
    • Things frighten us more if they are…
      • Controlled by someone else
      • Not beneficial in any way to anyone
      • Hard to treat or treatment is not available to everyone
      • Catastrophic or deadly
      • Exotic or unusual
    • than things that are…
      • In our control
      • Helpful or beneficial to us or society
      • Easily and quickly diagnosable and treatable
      • Survivable
      • Familiar and routine
  • Stressors in Disaster Work
    • Event related
    • Occupational
    • Organizational
    • Family or personal life
  • Stress Basics
    • Stress is :
      • Normal
      • Necessary
      • Productive and destructive
      • Acute and delayed
      • Cumulative
      • Identifiable
      • Preventable and manageable
  • Physical Changes with Stress
    • Pupils dilate
    • Dry mouth
    • Heart rate increases
    • Increased HCI (Hydrochloric Acid)
    • Sleep disturbances
    • Lower back pain
    • Stomach motility inhibited (peristalsis)
    • Blood flow changes
    • Increased cholesterol production
  • Emotional Changes with Stress
    • Increased feelings of isolation
    • Depression
    • Anger
    • Anhedonia (lack of joy)
    • Slowed learning speed
    • Impaired decision making
    • Decreased self-awareness
  • Mental Changes with Stress
    • Decreased memory
    • Decreased attention span
    • Decreased intimacy
  • Organizational Approaches
    • Effective management structure and leadership
    • Clear purpose and goals
    • Functionally defined roles
    • Team support
    • Plan for stress management
  • Individual Approaches
    • Management of workload
    • Balances lifestyle
    • Stress reduction strategies
    • Self-awareness
  • Effects of Long-Term Disaster Stress
    • Anxiety and vigilance
    • Anger, resentment, and conflict
    • Uncertainty about the future
    • Prolonged mourning of losses
    • Diminished problem-solving
    • Isolation and hopelessness
    • Health problems
    • Lifestyle changes
  • Acute Traumatic Stress Disorder
    • The development, within one month of the event, of at least 3 of the following:
      • Dissociation, emotional numbing
      • A re-experiencing of the event
      • Behavioral avoidance
      • Increased physiologic arousal
      • Social-occupational impairment
  • Long Term Trauma
    • For some, it may last months or years
    • The rates of PTSD are much higher among victims of violent crimes than victims of other types of traumatic events
    • Crime victims who believed they would be killed or seriously injured were much more likely to develop PTSD than victims whose crimes did not involve life-threatening injury.
  • Post-Traumatic Stress Disorder
    • Persistent re-experiencing of the event
    • Avoidance of things associated with event
    • Symptoms of increased arousal
    • Distress or impairment in social, occupational, or other areas
  • Other Long Term Reactions
    • Major depression
    • Suicidal thoughts and attempts
    • Alcohol and drug abuse
    • Anxiety disorders
    • Dissociative disorders
  • Summary
    • Disasters can elicit traumatic reactions in the victims who survive it.
  • Additional Reactions to Disasters
  • Disaster Stress and Grief Reactions
    • Normal responses to abnormal situation – Often transitory in nature
    • Reactions:
      • Emotional and psychological strain
      • Acute stress
      • Post traumatic stress
      • Grief reactions
      • Immediate and practical problems in living
  • Physical Reactions
    • Fatigue, exhaustion
    • Gastrointestinal distress
    • Appetite changes
    • Tightening in the throat or chest
    • Other somatic complaints
  • Emotional Reactions
    • Depression, sadness
    • Irritability, anger, resentment
    • Anxiety, fear
    • Despair, hopelessness
    • Guilt, self-doubt
    • Unpredictable mood swings
  • Cognitive Reactions
    • Confusion, disorientation
    • Recurring dreams, nightmares
    • Preoccupations with disaster
    • Trouble concentrating or remembering things
    • Difficulty making decisions
    • Questioning spiritual beliefs
  • Behavioral Reactions
    • Sleep problems
    • Crying easily
    • Avoiding reminders
    • Excessive activity level
    • Increased conflicts with family
    • Hypervigilance, startle reactions
    • Isolation or social withdrawal
  • Spiritual Reactions
    • Withdrawal from places of worship or spiritual practices
    • Uncharacteristic religious involvement
    • Being troubled by biblical or historical predictions
    • Questioning meaning and beliefs
    • Anger with God or higher power
    • Loss of faith
  • Chronic Stressors in Disasters
    • Family disruption
    • Work overload
    • Gender differences
    • Bureaucratic hassles
    • Financial strain
  • Loss and Grief
    • Loss is a common theme in disaster settings
    • Common reactions to loss:
      • Denial, numbness or shock
      • Anger
      • Bargaining
      • Depression
      • Acceptance
      • Reorientation
  • Loss and Grief – Signs of Trouble
    • Using alcohol or drugs to self-medicate
    • Using work or other distractions to avoid feelings
    • Hostility and aggression toward others
    • Avoiding or minimizing emotions
  • Emotional Numbness or Extreme Agitation
    • Immediate attention is needed
    • Possible referral for professional care
    • When referring:
      • Inform the person of your intention
      • Recognize that the referral may cause a negative reaction
  • Summary
    • Disasters may elicit a number of non-traumatic responses in its victims, including:
      • Grief reactions
      • Physical reactions
      • Emotional reactions
      • Cognitive reactions
      • Behavioral reactions
  • Module 3: Providing Support During Disasters
  • All-Hazards Crisis Counseling and “Traditional” Behavioral Health Practice
    • Primarily Office-Based
    • Focus on Diagnosis & Treatment of Mental Illness
    • Attempt to Impact Personality & Functioning
    • Examines Content
    • Encourages Insight into Past Experiences & Influence on Current Problems
    • Psychotherapeutic Focus
    • Primarily Home & Community Based
    • Assessment of Strengths, Adaptation & Coping Skills
    • Seeks to Restore Pre-Disaster Functioning
    • Accepts Content at Face Value
    • Validates Appropriateness of Reactions and Normalizes Experience
    • Psycho-educational focus
    “ Traditional” Practice Disaster Crisis Counseling Source : ESDRB Program Guidance, December, 1996
  • All-Hazards Crisis Counseling and “Traditional” Case Management
    • Provide services to individuals with SPMI or other disability
    • Services provided for indefinite duration
    • Responsible and accountable for client service provision
    • Power to influence services for their client
    • Long-term relationship with clients
    • Provide services to disaster survivors who often have a high level of functioning
    • Services provided do not require continuity of care
    • Empower disaster victims to advocate for services needed
    • Short-term relationship with disaster victims
    “ Traditional” Case Management Disaster Crisis Counseling Source : ESDRB Program Guidance, December, 1996
  • In other words…
    • CMHC Crisis Counseling
      • Day-to-day crises
      • A few people from a target population experiencing severe reactions (suicide, violence, psychiatric problems, substance abuse)
    • All-Hazards/Disaster Crisis Counseling
      • Event specific
      • Targets the general population (lots of people) experiencing low levels (but significant) reactions (with a few experiencing severe reactions)
  • Key Concepts in All-Hazards Behavioral Health
    • No one who sees a disaster is untouched by it
    • People experience individual and collective trauma
    • Securing disaster relief can be emotionally stressful
    • Most people pull together during and after a disaster, but their effectiveness is diminished
    • Most people do not see themselves as needing behavioral health services following a disaster and will not seek out such services
  • Overarching Concepts
    • Normal reactions to abnormal situation
    • Avoid “mental health” terms and labels
    • Assistance is practical
    • Assume competence
    • Focus on strengths and potentials
    • Encourage use of support network
    • Active, community fit
    • Innovative in helping
  • Maslow’s Hierarchy of Needs www.tutor2u.net/business/images/maslow_hierarchy.gif
  • Guiding Principles in Providing Support
    • First protect from danger
    • Focus on physical and material care
    • Be direct, active and remain calm
    • Focus on the “here and now” situation
    • Provide accurate information about the situation
    • Assist with mobilization of resources
  • Guiding Principles in Providing Support (cont)
    • Do not give false assurances
    • Recognize the importance of taking action
    • Reunite with family members
    • Provide and ensure emotional support
    • Focus on strengths and resilience
    • Encourage self-reliance
    • Respect feelings and cultures of others
  • Crisis Intervention
    • Observe safe practices by showing concern for your own safety
    • Remain calm and appear relaxed, confident and non-threatening
  • Crisis Intervention Steps
    • Assess the situation
    • Establish rapport
    • Identify the main problem(s)
    • Deal with feelings and emotions
    • Generate and explore alternative coping strategies
    • Formulate an action plan
    • Follow up
  • On-Scene Interventions
    • Direct to medical care, safety, shelter
    • Protect from trauma, media, onlookers
    • Connect to family, information, comfort
            • (Myers and Wee, 2003 )
  • Immediate Interventions
    • Rapid assessment and triage
    • Psychological first-aid
    • Crisis intervention
    • Crime victim assistance
    • Psycho-education
    • Information briefings
    • Community outreach
  • Immediate Interventions (continued)
    • Participation in death notification
    • Behavioral health consultation
    • Debriefing and community meetings
    • Information and referral
  • Psychological First-Aid
    • Provide comfort, empathy, an “ear”
    • Address physical needs
    • Provide concrete information about what will happen next
    • Link to support systems
    • Reinforce coping strengths
  • Crisis Intervention
    • Promote safety and security
    • Gently explore trauma experience
    • Identify priority needs and solutions
    • Assess functioning and coping
    • Provide:
      • Reassurance
      • Psycho-education
      • Practical assistance
  • Crime Victim Assistance
    • Protect victims’ rights
    • Ensure control over media
    • Provide criminal justice information
    • Facilitate access to compensation
    • Streamline bureaucratic procedures
  • Community Outreach
    • Initiate contact at gathering sites
    • Set up 24-hour telephone hotlines
    • Outreach to survivors through media, Internet
    • Educate service providers
    • Use bilingual and bicultural workers
  • Participation in Death Notification
    • Responsible notifier:
      • Obtains critical information
      • Notifies next-of-kin directly, simply, and in person
      • Expects intense reactions
      • Provides practical assistance
      • Mental health, participates on team, provides support and information
  • Brief Trauma Interventions
    • Factual information
    • Thoughts during event
    • Reactions and feelings
    • Psycho-education
    • Problem-solving and action
  • Post-Disaster Behavioral Health Interventions
    • Case finding
    • Letters and phone calls
    • Community outreach
    • Brief counseling (individual and group)
    • Case management
    • Public education through media
    • Information and referral
  • Key Events with Behavioral Health Implications
    • Death notification
    • Ending search and recovery
    • Bulldozing homes/neighborhoods
    • Criminal justice proceedings
    • Returning to impacted areas
    • Funeral and memorials
  • Community Interventions
    • Memorials and rituals
    • Usual community gatherings
    • Anniversary commemorations
    • Symbolic gestures
  • Summary
    • The role of behavioral health in crisis response may include the following:
      • On-scene interventions
      • Immediate interventions
      • Psychological first aid
      • Crisis interventions
      • Crime victim assistance
      • Community outreach
      • Death notification
      • Brief trauma interventions
      • Post-disaster inventions
  • Survivor Risk and Resiliency Factors
    • Psychological
    • Capacity to tolerate stress
    • Prior trauma history
    • Socioeconomic and education level
    • Family stability
    • Social support
    • Gender roles
  • Teaching Strategies for Enhancing Resilience
    • Encourage making connections with others
    • Redirect from seeing crises as insurmountable problems
    • Encourage accepting change as a part of living
    • Encourage movement toward goals
    • Encourage taking directive actions
    • Observe opportunities for self-discovery
  • Teaching Strategies for Enhancing Resilience
    • Nurture a positive view of self
    • Encourage keeping things in perspective
    • Encourage maintaining a positive outlook
    • Encourage self care (emotional and physical)
  • Summary
    • The effectiveness of all-hazards support and crisis intervention during a disaster may be affected by a number of survivor risk and resiliency factors
  • Module 4: Considerations for Special Populations, Cultural Competence, and Ethical Issues
  • Special/Vulnerable Populations
        • NO ONE IS UNTOUCHED BY DISASTER…
        • NO ONE IS NOT VULNERABLE
        • Children (under age 18)
        • Frail Elderly
        • Developmentally and physically disabled
        • Severe Mental Illness and People in active Substance Abuse Treatment
        • People in Correctional Institutions
        • College Students in dorms/away from home/ families/individuals relocated
        • People with high traumatic exposure
        • People in poverty and homeless
        • Emergency responders involved in rescue/recovery
        • Multicultural issues
        • Farmers/Ranchers/Agricultural Workers/Rural Populations
        • Other roles of men and women that be increase vulnerability
  • Statement of Principles for Special Needs Populations
    • Equitable access for all
    • Respect for the diversities of communities
    • Community-based partnerships
    • Representation of the diversity of communities, in all phases of emergency management
    • Accountability for implementation at local, regional and state levels
  • Cultural Competence
    • Recognize the importance of culture and respect diversity
    • Maintain a current profile of the cultural composition of the community
    • Ensure that services are accessible, appropriate, and equitable
    • Recognize the role of help-seeking behaviors, customs, and traditions, and natural support networks
    • Involve as “cultural brokers” community leaders and organizations representing diverse cultural groups
    • Ensure that services and information are culturally and linguistically competent
  • Basic Cultural Sensitivity
    • Convey respect, good will, courtesy
    • Ask permission to speak with people
    • Explain role of behavioral health worker
    • Acknowledge differences in behavior due to culture
    • Respond to concrete needs
    • Dominant language/English fluency
    • Immigration experience and status
    • Family values
    • Cultural values and traditions
  • Ethical Issues
    • Most information on ethics and disasters is from international disasters or recent research with disaster survivors
    • Key Considerations:
      • Ability/vulnerability of survivors
      • Active role in response and recovery
      • Direct vs. indirect victimization
  • Key Ethical Issues in Disasters
    • Readiness of survivors to address disaster and trauma issues
    • Helper competency and accountability
    • Power and hierarchy of helpers
    • Cultural diversities and oppressions
  • Summary
    • Competent disaster behavioral health practices require special attention given to special/vulnerable populations, cultural and ethical issues, and stressors in disaster work
    • Day 2
    • All KAHBH Network Members
  • Module 5: The FEMA/SAMHSA Crisis Counseling Assistance and Training Program
  • The FEMA Crisis Counseling Assistance and Training Program
    • Robert T. Stafford Disaster Assistance and Emergency Relief Act (P.L. 93-288 as amended)
    • Interagency Federal Partnership
    • Federal-State-Local Partnership
  • Organizational Partners in Crisis Counseling Program
    • Community Mental Health Agencies
    • State Mental Health Authority
    • State Emergency Management Agency
    • Federal Emergency Management Agency (Region and Headquarters)
    • Center for Mental Health Services
  • Administrative Staff
    • Community Program Managers
    • State Disaster Mental Health Coordinator
    • Governor’s Authorized Representative
    • FEMA Crisis Counseling Coordinator
    • FEMA Human Services Officer
    • Federal Coordinating Officer
    • FEMA Headquarters Crisis Counseling Coordinator
    • CMHS Project Officer
  • The Acronym Game!
    • KDEM
    • CMHS
    • KEOP
    • KAHBH
    • ISP
    • ICS
    • PIO
    • NIMS
    • ARC
    • ESF
    • VOAD
    • SOP
    • FEMA
  • The Acronym Game!
    • KDEM: Kansas Department of Emergency Management
    • CMHS
    • KEOP
    • KAHBH
    • ISP
    • ICS
    • PIO
    • NIMS
    • ARC
    • ESF
    • VOAD
    • SOP
    • FEMA
  • The Acronym Game!
    • KDEM: Kansas Department of Emergency Management
    • CMHS: Center for Mental Health Services
    • KEOP
    • KAHBH
    • ISP
    • ICS
    • PIO
    • NIMS
    • ARC
    • ESF
    • VOAD
    • SOP
    • FEMA
  • The Acronym Game!
    • KDEM: Kansas Department of Emergency Management
    • CMHS: Center for Mental Health Services
    • KEOP: Kansas Emergency Operations Plan
    • KAHBH
    • ISP
    • ICS
    • PIO
    • NIMS
    • ARC
    • ESF
    • VOAD
    • SOP
    • FEMA
  • The Acronym Game!
    • KDEM: Kansas Department of Emergency Management
    • CMHS: Center for Mental Health Services
    • KEOP: Kansas Emergency Operations Plan
    • KAHBH: Kansas All-Hazards Behavioral Health Program
    • ISP
    • ICS
    • PIO
    • NIMS
    • ARC
    • ESF
    • VOAD
    • SOP
    • FEMA
  • The Acronym Game!
    • KDEM: Kansas Department of Emergency Management
    • CMHS: Center for Mental Health Services
    • KEOP: Kansas Emergency Operations Plan
    • KAHBH: Kansas All-Hazards Behavioral Health Program
    • ISP: Immediate Services Program
    • ICS
    • PIO
    • NIMS
    • ARC
    • ESF
    • VOAD
    • SOP
    • FEMA
  • The Acronym Game!
    • KDEM: Kansas Department of Emergency Management
    • CMHS: Center for Mental Health Services
    • KEOP: Kansas Emergency Operations Plan
    • KAHBH: Kansas All-Hazards Behavioral Health Program
    • ISP: Immediate Services Program
    • ICS: Incident Command System
    • PIO
    • NIMS
    • ARC
    • ESF
    • VOAD
    • SOP
    • FEMA
  • The Acronym Game!
    • KDEM: Kansas Department of Emergency Management
    • CMHS: Center for Mental Health Services
    • KEOP: Kansas Emergency Operations Plan
    • KAHBH: Kansas All-Hazards Behavioral Health Program
    • ISP: Immediate Services Program
    • ICS: Incident Command System
    • PIO: Public Information Officer
    • NIMS
    • ARC
    • ESF
    • VOAD
    • SOP
    • FEMA
  • The Acronym Game!
    • KDEM: Kansas Department of Emergency Management
    • CMHS: Center for Mental Health Services
    • KEOP: Kansas Emergency Operations Plan
    • KAHBH: Kansas All-Hazards Behavioral Health Program
    • ISP: Immediate Services Program
    • ICS: Incident Command System
    • PIO: Public Information Officer
    • NIMS: National Incident Management System
    • ARC
    • ESF
    • VOAD
    • SOP
    • FEMA
  • The Acronym Game!
    • KDEM: Kansas Department of Emergency Management
    • CMHS: Center for Mental Health Services
    • KEOP: Kansas Emergency Operations Plan
    • KAHBH: Kansas All-Hazards Behavioral Health Program
    • ISP: Immediate Services Program
    • ICS: Incident Command System
    • PIO: Public Information Officer
    • NIMS: National Incident Management System
    • ARC: American Red Cross
    • ESF
    • VOAD
    • SOP
    • FEMA
  • The Acronym Game!
    • KDEM: Kansas Department of Emergency Management
    • CMHS: Center for Mental Health Services
    • KEOP: Kansas Emergency Operations Plan
    • KAHBH: Kansas All-Hazards Behavioral Health Program
    • ISP: Immediate Services Program
    • ICS: Incident Command System
    • PIO: Public Information Officer
    • NIMS: National Incident Management System
    • ARC: American Red Cross
    • ESF: Emergency Support Function
    • VOAD
    • SOP
    • FEMA
  • The Acronym Game!
    • KDEM: Kansas Department of Emergency Management
    • CMHS: Center for Mental Health Services
    • KEOP: Kansas Emergency Operations Plan
    • KAHBH: Kansas All-Hazards Behavioral Health Program
    • ISP: Immediate Services Program
    • ICS: Incident Command System
    • PIO: Public Information Officer
    • NIMS: National Incident Management System
    • ARC: American Red Cross
    • ESF: Emergency Support Function
    • VOAD: Voluntary Organizations Active in Disaster
    • SOP
    • FEMA
  • The Acronym Game!
    • KDEM: Kansas Department of Emergency Management
    • CMHS: Center for Mental Health Services
    • KEOP: Kansas Emergency Operations Plan
    • KAHBH: Kansas All-Hazards Behavioral Health Program
    • ISP: Immediate Services Program
    • ICS: Incident Command System
    • PIO: Public Information Officer
    • NIMS: National Incident Management System
    • ARC: American Red Cross
    • ESF: Emergency Support Function
    • VOAD: Voluntary Organizations Active in Disaster
    • SOP: Standard Operating Procedures
    • FEMA
  • The Acronym Game!
    • KDEM: Kansas Department of Emergency Management
    • CMHS: Center for Mental Health Services
    • KEOP: Kansas Emergency Operations Plan
    • KAHBH: Kansas All-Hazards Behavioral Health Program
    • ISP: Immediate Services Program
    • ICS: Incident Command System
    • PIO: Public Information Officer
    • NIMS: National Incident Management System
    • ARC: American Red Cross
    • ESF: Emergency Support Function
    • VOAD: Voluntary Organizations Active in Disaster
    • SOP: Standard Operating Procedures
    • FEMA: Federal Emergency Management Agency
  • Examples of Disaster Crisis Counseling Program Services
    • Outreach
    • Screening and Assessment
    • Counseling
    • Information and Referral
    • Public Education & Social Advocacy
  • Program Limitations
    • Medications
    • Hospitalization
    • Long-term Therapy
    • Providing Childcare or Transportation
    • Fundraising activities
    • Individual Advocacy
    • Long-term Case Management
  • All-Hazards Crisis Counseling and “Traditional” Behavioral Health Practice
    • Primarily Office-Based
    • Focus on Diagnosis & Treatment of Mental Illness
    • Attempt to Impact Personality & Functioning
    • Examines Content
    • Encourages Insight into Past Experiences & Influence on Current Problems
    • Psychotherapeutic Focus
    • Primarily Home & Community Based
    • Assessment of Strengths, Adaptation & Coping Skills
    • Seeks to Restore Pre-Disaster Functioning
    • Accepts Content at Face Value
    • Validates Appropriateness of Reactions and Normalizes Experience
    • Psycho-educational focus
    “ Traditional” Practice Disaster Crisis Counseling Source : ESDRB Program Guidance, December, 1996
  • All-Hazards Crisis Counseling and “Traditional” Case Management
    • Provide services to individuals with SPMI or other disability
    • Services provided for indefinite duration
    • Responsible and accountable for client service provision
    • Power to influence services for their client
    • Long-term relationship with clients
    • Provide services to disaster survivors who often have a high level of functioning
    • Services provided do not require continuity of care
    • Empower disaster victims to advocate for services needed
    • Short-term relationship with disaster victims
    “ Traditional” Case Management Disaster Crisis Counseling Source : ESDRB Program Guidance, December, 1996
  • FEMA/CMHS Crisis Counseling Program FY 2004 Grant Sites FEMA 1479 TX (Hurricane Claudette) FEMA 1437 LA (Flooding) FEMA 1492 MD (Hurricane Isabel)) FEMA 1391 NY 9/11 Terrorism FEMA 1474 WV (Floods) FEMA 1506 SA (Cyclone) FEMA 1491 VA (Hurricane Isabel) FEMA 1498-CA (Fires) FEMA 1475 KY (Severe Storms) FEMA 1501 PR (Storms & Flooding) FEMA 1322 AL (Tornado)
  • Summary
    • The FEMA/SAMHSA CMHS Crisis Counseling Program works in conjunction with a number of organizational partners and administrative staff to provide services during disasters that differ from traditional mental health services
  • Event City Response County Response State Response KDEM Application National Disaster Presidentially Declared Disaster 60 Days 1) On-Site Command 2) Local Outreach workers 3) Supplies 9 Months If needed apply for Regular Services Program (RSP) Sources of Information -American Red Cross -KDEM -Adjutant General’s Office -Cities - Newspapers - New Releases -Kansas WEB EOC To Collect Data Per County -Casualties -Injured -Business -Schools -Homes -Homeless -Power -Food -Water ------------------------------------------- -Budget -Staff KMHA has 14 Days to Apply for Immediate Services Program (ISP) Behavioral Health Response to Presidentially Declared Disaster
  • FEMA/SAMHSA CMHS All-Hazards/Disaster Crisis Counseling Program Grants: Immediate Services Program and Regular Services Program
    • Immediate Services Program:
      • Application due within 14 days of Presidential disaster declaration
      • Funds 60 days of services
    • Regular Services Program:
      • Application due within 60 days of Presidential declaration
      • Funds nine (9) months of services
  • Summary
    • Presidentially declared disaster areas may receive funding from the state for 60 days of services ( Immediate Services Program, ISP ), up to 9 months of services ( Regular Services Program, RSP )
  • Module 6: The KAHBH Program: Preparedness, Response, and Recovery for Kansas Communities
  • Organizations Involved in Behavioral Health Disaster Response
    • Federal
      • SAMHSA — S ubstance A buse M ental H ealth S ervices A dministration & CMHS — C enter for M ental H ealth S ervices
      • FEMA — F ederal E mergency M anagement A gency
    • State
      • KDEM —K ansas D ept. of E mergency M anagement
        • KDHE — K ansas D ept. of H ealth and E nvironment
          • SRS —Kansas Dept. of S ocial and R ehabilitation S ervices
    • Local
      • Local emergency management agencies
      • CMHC — C ommunity M ental H ealth C enters
      • Local professionals and para-professionals (substance abuse professionals, clergy, doctors/nurses, fire/police department, volunteers, etc.)
  •  
  • State-Level Role of KAHBH
    • During a disaster in Kansas, the Kansas Mental Health Authority through SRS serves as a liaison to the Kansas Department of Emergency Management, local CMHCs, and FEMA in a Presidentially declared disaster
    • FEMA recommends each State develop a crisis response plan in meeting the mental health and substance abuse needs at state and local levels, which are formally integrated into the State Emergency Operations Plan
    • KDHE established a contract with KMHA to provide funds for 1 year to coordinate the development and implementation of the All-Hazards Behavioral Health Plan
    • In January 2005, Kansas Department of Social and Rehabilitation Services, Mental Health Authority, subcontracted with Kansas State University, School of Family Studies and Human Services
    • The Kansas All-Hazards Behavioral Health (KAHBH) Team was developed through the subcontract
  • KAHBH Purpose
    • KAHBH provides State-wide organization and coordination for behavioral health response to disaster and other all-hazards events
      • Training and preparing Kansas professionals and paraprofessionals to serve in behavioral health capacity during an event
      • Providing technical assistance and all-hazards behavioral health information to Kansans
  • Key KAHBH Tasks
    • Resource identification and collection
    • Training and education
    • Development of Annex to KEOP, KAHBH Plan, and Standard Operating Procedures
    • State-wide network recruitment and coordination
    • Preparedness, response, and recovery activities
  • KAHBH Network
    • 10 staff
    • 15 Stakeholders
    • 12 SRS Field Staff
    • 29 CMHC Coordinators
    • Goal: 200+ KAHBH Network members
  • KAHBH Stakeholder Supporting Agencies
    • Kansas Department of Health & Environment, Office of Local & Rural Health, Topeka
    • SRS Mental Health Authority, Topeka
    • SRS Health Care Policy, Addiction & Rehabilitation Services, Topeka
    • Kansas State University, School of Family Studies and Human Services, Manhattan
    • University of Kansas School of Medicine, Department of Preventive Medicine & Public Health, Wichita
    • Lawrence Therapy Services, Lawrence
    • Mental Health Center of East Central Kansas, Emporia
    • Regional Prevention Center, Olathe
    • Mid-America Addiction Technology Transfer Center
    • COMCARE, Wichita
    • American Red Cross, Midway Kansas Chapter, Wichita
    • Wyandot Center, Kansas City
    • Association of Community Mental Health Centers of Kansas, Inc., Topeka
    • Center for Counseling & Consultation, Great Bend
    • Prairie View Behavioral & Mental Health Care, Newton **
    • Heartland Assessment Center, Roeland Park, KS **
    • **Resigned due to accepting positions in other states
  • KAHBH Plan and Operations Manual
    • The initial Kansas All-Hazards Behavioral Health Annex has been drafted and submitted to the Kansas Department of Emergency Management (KDEM) to be reviewed and accepted into the Kansas Emergency Operations Plan.
      • KDEM acceptance currently is pending
    • The State Plan will provide a detailed description of the behavioral health preparedness, response, and recovery in Kansas
    • Preliminary drafts of the Operations Manual have been developed and reviewed by the SRS Contract Manager.
    • KAHBH
    • Plan
    KAHBH ANNEX (Submitted to KDEM) KAHBH Training Operations Manual
  • KDEM KS Citizens KS Citizens State Plan
  • KDEM KS Citizens KS Citizens State Plan KAHBH
  • KDEM KS Citizens KS Citizens State Plan KAHBH State Stakeholders
  • KDEM KS Citizens KS Citizens State Plan KAHBH State Stakeholders American Red Cross
  • KDEM KS Citizens KS Citizens State Plan KAHBH State Stakeholders American Red Cross Education: Trainings, Universities, Conferences
  • KDEM KS Citizens KS Citizens State Plan KAHBH State Stakeholders Education: Trainings, Universities, Conferences American Red Cross Governor’s Bioterrorism Coordinating Council (SRS Mental Health Authority rep joined 4/04
  • KDEM KS Citizens KS Citizens State Plan KAHBH State Stakeholders Education: Trainings, Universities, Conferences American Red Cross Governor’s Bioterrorism Coordinating Council (SRS Mental Health Authority rep joined 4/04 County Data Bank
  • KDEM KS Citizens KS Citizens State Plan KAHBH State Stakeholders Education: Trainings, Universities, Conferences American Red Cross Governor’s Bioterrorism Coordinating Council (SRS Mental Health Authority rep joined 4/04 County Data Bank KS Train
  • KDEM KS Citizens KS Citizens State Plan KAHBH State Stakeholders Education: Trainings, Universities, Conferences American Red Cross Governor’s Bioterrorism Coordinating Council (SRS Mental Health Authority rep joined 4/04 County Data Bank KS Train Disaster Exercises
  • KDEM KS Citizens KS Citizens State Plan KAHBH State Stakeholders Education: Trainings, Universities, Conferences American Red Cross Governor’s Bioterrorism Coordinating Council (SRS Mental Health Authority rep joined 4/04 County Data Bank KS Train Disaster Exercises 1 st responders/ Critical Incident Stress Management
  • KDEM KS Citizens KS Citizens State Plan KAHBH State Stakeholders Education: Trainings, Universities, Conferences American Red Cross Governor’s Bioterrorism Coordinating Council (SRS Mental Health Authority rep joined 4/04 County Data Bank KS Train Disaster Exercises 1 st responders/ Critical Incident Stress Management
  • Role of KAHBH Network Members
    • SAMHSA/CMHC Model
    • Professionals and paraprofessionals working in teams
    • Based on SRS CMHC Regions
      • 27 total areas in Kansas
  • The KAHBH Program is not:
    • American Red Cross Disaster Mental Health Services (ARC DMHS)
      • ARC requires a masters-level licensed mental health professional
      • ARC mental health workers are volunteers and do not receive reimbursement for their services
    • Critical Incident Stress Management (CISM)
      • Model developed and approved for use with first responders, but often is applied to many areas of crisis response, which may not be appropriate
    • The goal of KAHBH is to collaborate and work to coordinate all behavioral health services before, during, and after an all-hazards event in Kansas.
  • Network members should be:
    • Indigenous to the communities they serve
    • Possess varied experience working with various populations in need
    • Capable of providing all-hazards behavioral health services through non-traditional methods
    • Sensitive to cultural issues
  • Key Characteristics/Abilities of KAHBH Personnel
    • Key personal characteristics and abilities of those particularly suited for disaster work are:
      • Mature
      • Sociable
      • Calm
      • Knowledgeable about how systems work
      • Flexible
      • Tolerates ambiguity well
      • Empathetic
      • Genuine
      • Shows positive regard for others
      • Good listener
  • Module 7: Behavioral Health and the All-Hazards Disaster Response System
  • The Role of Behavioral Health in All-Hazards Response
    • Behavioral health consultation
    • Liaison with key agencies
    • Psychoeducation through media
    • Behavioral health services with survivors, families
    • Behavioral health services with responders
    • Stress management support
    • The role of behavioral health in all-hazards crisis response may include the following:
      • On-scene interventions
      • Immediate interventions
      • Psychological first aid
      • Crisis interventions
      • Crime victim assistance
      • Community outreach
      • Death notification
      • Brief trauma interventions
      • Post-disaster inventions
  • Emergency Operations Center (EOC)
    • Provides a common, centralized operation location
    • Ensures clear delegation of responsibility
    • Coordinates personnel, supplies & equipment
    • Serves as a single point of information flow
    • Relays warning to local officials and the public
    • Works with the Incident Command System (ICS)
  • Incident Command System (ICS)
    • Standardized, on-scene, all-hazards incident management system
    • Provides basic direction and control
    • Federal (NIMS) and local level (ICS) organized system
    • Coordination of decision making among responder agencies
    • Provides a chain of command
  • Incident Command System (ICS)
    • A proven management system based on successful business practices
    • The result of decades of lessons learned in the organization and management of emergency incidents
    • Is a component of NIMS
    • Has become the standard for emergency management across the country
  • Incident Command System (ICS)
    • Meets the needs of incidents of any kind or size
      • Used to manage Salt Lake City Olympics
    • Allows personnel from a variety of agencies to meld rapidly into a common management structure
    • Provides logistical and administrative support to operational staff
    • Provides a cost effective method of management by avoiding duplication of efforts
  • ICS Organizational Structure
    • Operations
      • Directs activities to reduce the immediate hazard and restore essential functions
    • Planning
      • Acquires information on current and future situations
    • Logistics
      • Support for basic needs (communication, medical, food, supplies, transportation)
    • Finance/Administration
      • Tracks all costs
      • Provides administrative responsibilities for operation
  • INCIDENT COMMAND Operations Planning Logistics Finance/ Administration Basic Incident Command Structure
  • ICS Supervisory Position Titles: * Chain of Command & *Unity of Command Organizational Level Incident Command Command Staff General Staff (Section) Branch Division/Group Strike team/Task force Title Incident Commander Officer Chief Director Supervisor Leader Support Position Deputy Assistant Deputy Deputy N/A Single Resource Boss *Chain of Command : means there is an orderly line of authority within the ranks of the organization, with lower levels subordinate to, and connected to, higher ones *Unity of Command: means that every individual is accountable to only one designated supervisor to whom they report at the scene of the incident
    • As responders to all-hazards events, it is critical that behavioral health providers become part of the emergency response system
  • Federal requirement that all responders:
    • Follow ICS procedures
    • Receive ICS and NIMS training
    • Meet minimum standards
    • “ All federal, state, territorial, tribal, private sector and non-governmental personnel at the entry level, first line supervisor level, middle management level and command and general staff level of emergency management operations must complete ICS-100 and FEMA-IS 700 level training.”
    • Strongly encourage the following ICS and NIMS training for KAHBH Members
      • ICS 100, Introduction to ICS
        • ALL responders/workers + supervisors/administrators
      • ICS 200, Basic ICS
        • supervisors/administrators
      • FEMA IS 700, NIMS: An Introduction
        • ALL responders/workers + supervisors/administrators
      • FEMA IS 800, National Response Plan (NRP): An Introduction
        • supervisors/administrators
    • Training available online
    • www.fema.gov/nims
      • NIMS Training (on the left of the screen)
      • Fact Sheets and information for these 4 courses
    • Local “live” courses also may be available
      • Contact your local Emergency Management office
  • Module 8: KAHBH Community Outreach Teams: Structure, Procedures, and Documents
  • KAHBH Network:
    • COT Structure
    • COT Call-Up Procedure
    • COT Member Rotation
    • COT Member Debriefing
    • Forms/Documents
  •  
    • The KAHBH Program Coordinator(s) will:
    • Receive and collate data from the Community Outreach Teams in the field.
    • Ensure that FEMA/State briefings are attended daily at the Disaster Field Office to obtain updated damage assessment information and report data from KAHBH activities.
    • Coordinate data collection from FEMA, American Red Cross, Kansas Department of Emergency Management officials, etc.
    • Prepare the Immediate Services and Regular Services grant applications in a Presidentially Declared disaster.
    • The CMHC Coordinators/
    • Community Outreach Team Leaders will:
    • Be responsible to the KAHBH Program in carrying out the overall mission at the local level
    • While responsible to the KAHBH Program for their overall mission, report to the supervision of the local CMHC/hospital director or his/her designee on site.
    • Advise the team leaders about where and to whom to report at the disaster site.
    • Regardless of the office, division, CMHC or hospital, will be the point of contact for COT members for day to day direct supervision while in the field.
    • Have the authority and responsibility to return team members to their home base if, in the judgment of the Team Leaders, any team members are unable to carry out the necessary tasks for any reason.
    • Be responsible for summarizing contact data and reporting it daily to the KAHBH Coordinator
  • The KAHBH Network Members will:
    • Provide crisis counseling, debriefing, and support to survivors when the disaster exceeds the CMHC’s or hospital's capacity to respond effectively. 
    • Provide crisis counseling services to the survivors which include active listening, supportive counseling, problem definition and solving, information, education, referral, active or concrete assistance, advocacy, and reassurance.
    • Identify survivors whose response, needs, and history make them especially vulnerable to the stress of the event and subsequent mental health problems.  More frequent and intense support is to be provided to these individuals.
    • Be responsible for documenting their contacts daily and reporting it to the CMHC Coordinator/Community Outreach Team Leader.
    • These are guidelines that may vary depending upon:
      • the scope and nature of the disaster
      • varying needs and stresses as the response effort matures
    KAHBH Network Rotation
  • Recommended Guidelines for On-Site Schedule
    • Team Leaders and workers :
    • No more than 5 full continuous days
    • Will have a reasonable time of rest after 10-12 hours work
    • Will have daily briefings with response team
    • Will have pre and post shift briefings
  • Recommended Guidelines for Off-Site Schedule
    • Team members should leave the site after 10 days of work
    • Team members should have 2 days administrative leave
    • Team members should have a debriefing at their home facility or CMHC within 5-7 days of returning from the event
    • Team members returning to the event site should have one debriefing at home before returning for another rotation
  • Post Rotation Debriefing
    • All employees who carry out field work in the affected area should have at least one debriefing session in their home community before returning for a subsequent rotation.
    • The CMHC Coordinator/Community Outreach Team Leader will organize debriefing sessions for Network members responding in their area.
    • Response workers may be debriefed within five to seven days of returning to their home facility or CMHC (these debriefings may occur during the employee's Administrative Leave period).
    • Post-Response debriefing should be arranged as needed for each group of response workers.
    • FEMA/SAMHSA CMHS
    • Crisis Counseling Program
    • Forms
    • and
    • Documentation
    • Concluding Comments
    • Questions?
  • Acknowledgements Training material is based on SAMHSA/CMHS Disaster Technical Assistance Training Toolkit materials. Thank you to the KAHBH Stakeholders for their feedback, suggestions, and improvements to the KAHBH Program. We would like to thank the Department of Preventative Medicine & Public Health, University of Kansas School of Medicine-Wichita, for their valuable contribution of graphics and information to this training.