Kansas All-Hazards Behavioral Health Training Core Competencies  for Community Outreach Workers
What is KAHBH? <ul><li>KAHBH provides State-wide organization and coordination for behavioral health response to disaster ...
Key KAHBH Tasks <ul><li>Resource identification and collection </li></ul><ul><li>Training and education </li></ul><ul><li>...
KAHBH Network <ul><li>10 staff </li></ul><ul><li>15 Stakeholders </li></ul><ul><li>12 SRS Field Staff </li></ul><ul><li>29...
Outline of KAHBH Trainings <ul><li>KAHBH Core Behavioral Health Training   </li></ul><ul><li>DAY 1 (approx. 8 hours) </li>...
<ul><li>Paraprofessional Training </li></ul><ul><ul><li>½ day (4 hours) training  to provide non-behavioral health profess...
<ul><li>Future Specialty Trainings </li></ul><ul><ul><li>To be based on each community’s needs </li></ul></ul><ul><ul><li>...
Core Competencies, Terminology, and Regional Disaster Information
KAHBH  Core Objectives <ul><li>Understand the difference between Community Mental Health Center (CMHC) crisis counseling a...
KAHBH  Core Competencies <ul><li>Identifies relevant and appropriate data and information sources </li></ul><ul><li>Obtain...
KAHBH  Core Competencies <ul><li>Develops and adapts approaches to problems that take into account cultural differences </...
<ul><li>“ It is important to remember that mental health intervention is a prompt and effective medical response to a biot...
<ul><li>“ Mental Health is the linchpin to an effective response .” </li></ul><ul><li>Statement from April 2005 </li></ul>...
Terminology <ul><li>“ Behavioral Health”  </li></ul><ul><li>Mental Health  +  Substance Abuse </li></ul>
Terminology   (continued) <ul><li>All-Hazards = All-Hazards </li></ul><ul><li>Disasters ~ Bioterrorism ~ Major Community C...
Examples of All-Hazards Crisis  Counseling Program Services <ul><li>Outreach </li></ul><ul><li>Screening and Assessment </...
Program  Limitations <ul><li>Medications </li></ul><ul><li>Hospitalization </li></ul><ul><li>Long-term Therapy </li></ul><...
All-Hazards Crisis Counseling  and “Traditional”  Behavioral Health Practice <ul><li>Primarily Office-Based </li></ul><ul>...
<ul><li>The KAHBH Program follows the FEMA/SAMHSA CMHS Crisis Counseling Program as the primary model </li></ul><ul><ul><l...
Organizations Involved in  Behavioral Health Disaster Response <ul><li>Federal </li></ul><ul><ul><li>SAMHSA — S ubstance  ...
The KAHBH Program is not: <ul><li>American Red Cross Disaster Mental Health Services (ARC DMHS) </li></ul><ul><ul><li>ARC ...
The KAHBH Program <ul><li>Emphasizes the importance of ALL approaches to all-hazards/disaster events </li></ul><ul><li>Rec...
<ul><li>Regional  </li></ul><ul><li>Disaster Information </li></ul>
Module 1: Disaster  Classifications  and Phases Wichita tornado
Definition of a Disaster <ul><li>A disaster is a threatening or occurring event of such destructive magnitude and force as...
<ul><li>A disaster produces a range and level of immediate suffering and basic human needs that cannot be promptly or adeq...
Natural Disasters <ul><li>Floods </li></ul><ul><li>Tornados </li></ul><ul><li>Hurricanes </li></ul><ul><li>Typhoons </li><...
Human-Caused Disasters <ul><li>Intentional and unintentional </li></ul><ul><ul><li>Residential fires </li></ul></ul><ul><u...
Criteria for Presidential  Disaster Declaration “ [A]ny natural catastrophe (including any hurricane, tornado, storm, high...
Behavioral Health Response to Presidentially Declared Disaster Event City Response County Response State Response KDEM App...
Classification of  Disasters <ul><li>Natural vs. Human-caused </li></ul><ul><li>Degree of personal impact </li></ul><ul><l...
Critical Disaster  Stressors <ul><li>Threat to one’s life </li></ul><ul><li>Threat of harm to family </li></ul><ul><li>Des...
Phases of  Disaster Reactions <ul><li>Warning of threat </li></ul><ul><li>Impact </li></ul><ul><li>Rescue or Heroic </li><...
1 to 3 Days -------------------TIME-------------------------------------------1 to 3 Years   Zunin/Meyers Typical Phases o...
Comparing Criminally  Human-Caused and  Natural Disasters <ul><li>Causation </li></ul><ul><li>Appraisal of event </li></ul...
Terrorism Within the  United States <ul><li>“ An activity that involves a violent act or an act of dangerousness to human ...
Mass Violence Within  the United States <ul><li>“ An intentional violent criminal act, for which a formal investigation ha...
Summary <ul><li>Disasters can be classified according to a number of different variables, including natural vs. human-caus...
Module 2: Traumatic Reactions to Disasters
Effects of  Trauma <ul><li>Vary by a person’s age, developmental stage, prior condition, degree of personal impact </li></...
Psychosocial  Concerns <ul><li>Disruption of existing social/community </li></ul><ul><li>Impact of new social patterns </l...
What Scares Us? <ul><li>Things frighten us more if they are… </li></ul><ul><ul><li>Controlled by someone else </li></ul></...
Stressors in  Disaster Work <ul><li>Event related </li></ul><ul><li>Occupational </li></ul><ul><li>Organizational  </li></...
Stress  Basics <ul><li>Stress is : </li></ul><ul><ul><li>Normal </li></ul></ul><ul><ul><li>Necessary </li></ul></ul><ul><u...
Physical Changes with  Stress <ul><li>Pupils dilate </li></ul><ul><li>Dry mouth </li></ul><ul><li>Heart rate increases </l...
Emotional Changes with Stress <ul><li>Increased feelings of isolation </li></ul><ul><li>Depression </li></ul><ul><li>Anger...
Mental Changes with  Stress <ul><li>Decreased memory </li></ul><ul><li>Decreased attention span </li></ul><ul><li>Decrease...
Organizational  Approaches <ul><li>Effective management structure and leadership </li></ul><ul><li>Clear purpose and goals...
Individual  Approaches <ul><li>Management of workload </li></ul><ul><li>Balances lifestyle </li></ul><ul><li>Stress reduct...
Effects of Long-Term  Disaster Stress <ul><li>Anxiety and vigilance </li></ul><ul><li>Anger, resentment, and conflict </li...
Acute Traumatic  Stress Disorder <ul><li>The development, within one month of the event, of at least 3 of the following: <...
Long Term  Trauma <ul><li>For some, it may last months or years </li></ul><ul><li>The rates of PTSD are much higher among ...
Post-Traumatic  Stress Disorder <ul><li>Persistent re-experiencing of the event </li></ul><ul><li>Avoidance of things asso...
Other Long Term  Reactions <ul><li>Major depression </li></ul><ul><li>Suicidal thoughts and attempts </li></ul><ul><li>Alc...
Summary <ul><li>Disasters can elicit traumatic reactions in the victims who survive it.   </li></ul>
Additional Reactions to Disasters
Disaster Stress and  Grief Reactions <ul><li>Normal responses to abnormal situation – Often transitory in nature </li></ul...
Physical  Reactions <ul><li>Fatigue, exhaustion </li></ul><ul><li>Gastrointestinal distress </li></ul><ul><li>Appetite cha...
Emotional  Reactions <ul><li>Depression, sadness </li></ul><ul><li>Irritability, anger, resentment </li></ul><ul><li>Anxie...
Cognitive  Reactions <ul><li>Confusion, disorientation </li></ul><ul><li>Recurring dreams, nightmares </li></ul><ul><li>Pr...
Behavioral  Reactions <ul><li>Sleep problems </li></ul><ul><li>Crying easily </li></ul><ul><li>Avoiding reminders </li></u...
Spiritual  Reactions <ul><li>Withdrawal from places of worship or spiritual practices </li></ul><ul><li>Uncharacteristic r...
Chronic Stressors  in Disasters <ul><li>Family disruption </li></ul><ul><li>Work overload </li></ul><ul><li>Gender differe...
Loss and Grief <ul><li>Loss is a common theme in disaster settings </li></ul><ul><li>Common reactions to loss: </li></ul><...
Loss and Grief –  Signs of Trouble <ul><li>Using alcohol or drugs to  self-medicate </li></ul><ul><li>Using work or other ...
Emotional Numbness  or Extreme Agitation <ul><li>Immediate attention is needed </li></ul><ul><li>Possible referral for pro...
Summary <ul><li>Disasters may elicit a number of non-traumatic responses in its victims, including: </li></ul><ul><ul><li>...
Module 3: Providing Support During Disasters
All-Hazards Crisis Counseling  and “Traditional”  Behavioral Health Practice <ul><li>Primarily Office-Based </li></ul><ul>...
All-Hazards Crisis Counseling  and “Traditional”  Case Management <ul><li>Provide services to individuals with SPMI or oth...
In other words… <ul><li>CMHC Crisis Counseling </li></ul><ul><ul><li>Day-to-day crises </li></ul></ul><ul><ul><li>A few pe...
Key Concepts in  All-Hazards Behavioral Health <ul><li>No one who sees a disaster is untouched by it </li></ul><ul><li>Peo...
Overarching  Concepts <ul><li>Normal reactions to abnormal situation </li></ul><ul><li>Avoid “mental health” terms and lab...
Maslow’s Hierarchy of Needs www.tutor2u.net/business/images/maslow_hierarchy.gif
Guiding Principles in Providing Support <ul><li>First protect from danger </li></ul><ul><li>Focus on physical and material...
Guiding Principles in Providing Support  (cont) <ul><li>Do not give false assurances </li></ul><ul><li>Recognize the impor...
Crisis  Intervention <ul><li>Observe safe practices by showing concern for your own safety </li></ul><ul><li>Remain calm a...
Crisis Intervention  Steps <ul><li>Assess the situation </li></ul><ul><li>Establish rapport  </li></ul><ul><li>Identify th...
On-Scene  Interventions <ul><li>Direct to medical care, safety, shelter </li></ul><ul><li>Protect from trauma, media, onlo...
Immediate  Interventions <ul><li>Rapid assessment and triage </li></ul><ul><li>Psychological first-aid </li></ul><ul><li>C...
Immediate  Interventions  (continued) <ul><li>Participation in death notification </li></ul><ul><li>Behavioral health cons...
Psychological  First-Aid <ul><li>Provide comfort, empathy, an “ear” </li></ul><ul><li>Address physical needs </li></ul><ul...
Crisis  Intervention <ul><li>Promote safety and security </li></ul><ul><li>Gently explore trauma experience </li></ul><ul>...
Crime Victim  Assistance <ul><li>Protect victims’ rights </li></ul><ul><li>Ensure control over media </li></ul><ul><li>Pro...
Community  Outreach <ul><li>Initiate contact at gathering sites </li></ul><ul><li>Set up 24-hour telephone hotlines </li><...
Participation in  Death Notification <ul><li>Responsible notifier: </li></ul><ul><ul><li>Obtains critical information </li...
Brief Trauma  Interventions <ul><li>Factual information </li></ul><ul><li>Thoughts during event </li></ul><ul><li>Reaction...
Post-Disaster  Behavioral Health Interventions <ul><li>Case finding </li></ul><ul><li>Letters and phone calls </li></ul><u...
Key Events with  Behavioral Health Implications <ul><li>Death notification </li></ul><ul><li>Ending search and recovery </...
Community  Interventions <ul><li>Memorials and rituals </li></ul><ul><li>Usual community gatherings </li></ul><ul><li>Anni...
Summary <ul><li>The role of behavioral health in crisis response may include the following: </li></ul><ul><ul><li>On-scene...
Survivor Risk and Resiliency Factors <ul><li>Psychological </li></ul><ul><li>Capacity to tolerate stress </li></ul><ul><li...
Teaching Strategies for  Enhancing Resilience <ul><li>Encourage making connections with others </li></ul><ul><li>Redirect ...
Teaching Strategies for Enhancing Resilience <ul><li>Nurture a positive view of self </li></ul><ul><li>Encourage keeping t...
Summary <ul><li>The effectiveness of  all-hazards support  and crisis intervention during a disaster may be affected by a ...
Module 4: Considerations for Special Populations, Cultural Competence, and Ethical Issues
Special/Vulnerable Populations <ul><ul><ul><li>NO ONE IS UNTOUCHED BY DISASTER… </li></ul></ul></ul><ul><ul><ul><li>NO ONE...
Statement of Principles for Special Needs Populations <ul><li>Equitable access for all </li></ul><ul><li>Respect for the d...
Cultural  Competence <ul><li>Recognize the importance of culture and respect diversity </li></ul><ul><li>Maintain a curren...
Basic Cultural  Sensitivity <ul><li>Convey respect, good will, courtesy </li></ul><ul><li>Ask permission to speak with peo...
Ethical  Issues <ul><li>Most information on ethics and disasters is from international disasters or recent research with d...
Key Ethical Issues  in Disasters <ul><li>Readiness of survivors to address disaster and trauma issues </li></ul><ul><li>He...
Summary <ul><li>Competent disaster behavioral health practices require special attention given to special/vulnerable popul...
<ul><li>Day 2 </li></ul><ul><li>All KAHBH Network Members </li></ul>
Module 5: The FEMA/SAMHSA Crisis Counseling Assistance and Training Program
The FEMA Crisis Counseling  Assistance and Training Program <ul><li>Robert T. Stafford Disaster Assistance and Emergency R...
Organizational Partners  in Crisis Counseling Program <ul><li>Community Mental Health Agencies </li></ul><ul><li>State Men...
Administrative  Staff <ul><li>Community Program Managers </li></ul><ul><li>State Disaster Mental Health Coordinator </li><...
The Acronym Game! <ul><li>KDEM </li></ul><ul><li>CMHS </li></ul><ul><li>KEOP </li></ul><ul><li>KAHBH </li></ul><ul><li>ISP...
The Acronym Game! <ul><li>KDEM: Kansas Department of Emergency Management </li></ul><ul><li>CMHS </li></ul><ul><li>KEOP </...
The Acronym Game! <ul><li>KDEM: Kansas Department of Emergency Management </li></ul><ul><li>CMHS: Center for Mental Health...
The Acronym Game! <ul><li>KDEM: Kansas Department of Emergency Management </li></ul><ul><li>CMHS: Center for Mental Health...
The Acronym Game! <ul><li>KDEM: Kansas Department of Emergency Management </li></ul><ul><li>CMHS: Center for Mental Health...
The Acronym Game! <ul><li>KDEM: Kansas Department of Emergency Management </li></ul><ul><li>CMHS: Center for Mental Health...
The Acronym Game! <ul><li>KDEM: Kansas Department of Emergency Management </li></ul><ul><li>CMHS: Center for Mental Health...
The Acronym Game! <ul><li>KDEM: Kansas Department of Emergency Management </li></ul><ul><li>CMHS: Center for Mental Health...
The Acronym Game! <ul><li>KDEM: Kansas Department of Emergency Management </li></ul><ul><li>CMHS: Center for Mental Health...
The Acronym Game! <ul><li>KDEM: Kansas Department of Emergency Management </li></ul><ul><li>CMHS: Center for Mental Health...
The Acronym Game! <ul><li>KDEM: Kansas Department of Emergency Management </li></ul><ul><li>CMHS: Center for Mental Health...
The Acronym Game! <ul><li>KDEM: Kansas Department of Emergency Management </li></ul><ul><li>CMHS: Center for Mental Health...
The Acronym Game! <ul><li>KDEM: Kansas Department of Emergency Management </li></ul><ul><li>CMHS: Center for Mental Health...
The Acronym Game! <ul><li>KDEM: Kansas Department of Emergency Management </li></ul><ul><li>CMHS: Center for Mental Health...
Examples of Disaster Crisis  Counseling Program Services <ul><li>Outreach </li></ul><ul><li>Screening and Assessment </li>...
Program  Limitations <ul><li>Medications </li></ul><ul><li>Hospitalization </li></ul><ul><li>Long-term Therapy </li></ul><...
All-Hazards Crisis Counseling  and “Traditional”  Behavioral Health Practice <ul><li>Primarily Office-Based </li></ul><ul>...
All-Hazards Crisis Counseling  and “Traditional”  Case Management <ul><li>Provide services to individuals with SPMI or oth...
FEMA/CMHS  Crisis Counseling Program FY 2004 Grant Sites FEMA 1479 TX (Hurricane Claudette) FEMA 1437 LA  (Flooding) FEMA ...
Summary <ul><li>The FEMA/SAMHSA CMHS Crisis Counseling Program works in conjunction with a number of organizational partne...
Event City Response County Response State Response KDEM Application  National Disaster Presidentially Declared Disaster 60...
FEMA/SAMHSA CMHS All-Hazards/Disaster  Crisis Counseling  Program Grants: Immediate Services   Program and   Regular Servi...
<ul><li>Immediate Services Program: </li></ul><ul><ul><li>Application due within 14 days of Presidential disaster declarat...
Summary <ul><li>Presidentially declared disaster areas may receive funding from the state for 60 days of services ( Immedi...
Module 6: The KAHBH Program:  Preparedness, Response, and Recovery for Kansas Communities
Organizations Involved in  Behavioral Health Disaster Response <ul><li>Federal </li></ul><ul><ul><li>SAMHSA — S ubstance  ...
 
State-Level Role  of KAHBH <ul><li>During a disaster in Kansas, the Kansas Mental Health Authority through SRS serves as a...
<ul><li>KDHE established a contract with KMHA to provide funds for 1 year to coordinate the development and implementation...
KAHBH Purpose <ul><li>KAHBH provides State-wide organization and coordination for behavioral health response to disaster a...
Key KAHBH Tasks <ul><li>Resource identification and collection </li></ul><ul><li>Training and education </li></ul><ul><li>...
KAHBH Network <ul><li>10 staff </li></ul><ul><li>15 Stakeholders </li></ul><ul><li>12 SRS Field Staff </li></ul><ul><li>29...
KAHBH Stakeholder  Supporting Agencies <ul><li>Kansas Department of Health & Environment, Office of Local & Rural Health, ...
KAHBH Plan and Operations Manual <ul><li>The initial Kansas All-Hazards Behavioral Health Annex has been drafted and submi...
<ul><li>KAHBH </li></ul><ul><li>Plan </li></ul>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, C...
KDEM KS Citizens KS Citizens State  Plan KAHBH State Stakeholders Education: Trainings, Universities, Conferences American...
KDEM KS Citizens KS Citizens State  Plan KAHBH State Stakeholders Education: Trainings, Universities, Conferences American...
KDEM KS Citizens KS Citizens State  Plan KAHBH State Stakeholders Education: Trainings, Universities, Conferences American...
KDEM KS Citizens KS Citizens State  Plan KAHBH State Stakeholders Education: Trainings, Universities, Conferences American...
KDEM KS Citizens KS Citizens State  Plan KAHBH State Stakeholders Education: Trainings, Universities, Conferences American...
KDEM KS Citizens KS Citizens State  Plan KAHBH State Stakeholders Education: Trainings, Universities, Conferences American...
Role of KAHBH  Network Members <ul><li>SAMHSA/CMHC Model </li></ul><ul><li>Professionals and paraprofessionals working in ...
The KAHBH Program is not: <ul><li>American Red Cross Disaster Mental Health Services (ARC DMHS) </li></ul><ul><ul><li>ARC ...
<ul><li>The goal of KAHBH is to collaborate and work to coordinate  all  behavioral health services before, during, and af...
Network members  should be: <ul><li>Indigenous to the communities they serve </li></ul><ul><li>Possess varied experience w...
Key Characteristics/Abilities  of KAHBH Personnel <ul><li>Key personal characteristics and abilities of those particularly...
Module 7: Behavioral Health  and  the All-Hazards Disaster Response System
The Role of Behavioral Health  in All-Hazards Response <ul><li>Behavioral health consultation </li></ul><ul><li>Liaison wi...
<ul><li>The role of behavioral health in  all-hazards crisis response may  include the following: </li></ul><ul><ul><li>On...
Emergency Operations  Center (EOC) <ul><li>Provides a common, centralized operation location </li></ul><ul><li>Ensures cle...
Incident Command  System (ICS) <ul><li>Standardized, on-scene, all-hazards incident management system </li></ul><ul><li>Pr...
Incident Command  System (ICS) <ul><li>A proven management system based on successful business practices </li></ul><ul><li...
Incident Command  System (ICS) <ul><li>Meets the needs of incidents of any kind or size </li></ul><ul><ul><li>Used to mana...
ICS Organizational  Structure <ul><li>Operations </li></ul><ul><ul><li>Directs activities to reduce the immediate hazard a...
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 S...
<ul><li>As responders to all-hazards events, it is critical that behavioral health providers become part of the emergency ...
Federal  requirement  that  all responders: <ul><li>Follow ICS procedures </li></ul><ul><li>Receive ICS and NIMS training ...
<ul><li>Strongly encourage the following ICS and NIMS training for KAHBH Members </li></ul><ul><ul><li>ICS 100, Introducti...
<ul><li>Training available online </li></ul><ul><li>www.fema.gov/nims </li></ul><ul><ul><li>NIMS Training (on the left of ...
Module 8: KAHBH Community Outreach Teams:  Structure, Procedures, and Documents
KAHBH Network: <ul><li>COT Structure </li></ul><ul><li>COT Call-Up Procedure </li></ul><ul><li>COT Member Rotation </li></...
 
<ul><li>The KAHBH Program Coordinator(s) will:  </li></ul><ul><li>Receive and collate data from the Community Outreach Tea...
<ul><li>The CMHC Coordinators/ </li></ul><ul><li>Community Outreach Team Leaders will: </li></ul><ul><li>Be responsible to...
The KAHBH Network Members will:   <ul><li>Provide crisis counseling, debriefing, and support to survivors when the disaste...
<ul><li>These are guidelines that may vary depending upon: </li></ul><ul><ul><li>the  scope  and  nature  of the disaster ...
Recommended Guidelines for On-Site Schedule <ul><li>Team Leaders and workers : </li></ul><ul><li>No more than 5 full conti...
Recommended Guidelines for Off-Site Schedule <ul><li>Team members should leave the site after 10 days of work </li></ul><u...
Post Rotation Debriefing <ul><li>All employees who carry out field work in the affected area should have at least one debr...
<ul><li>FEMA/SAMHSA CMHS </li></ul><ul><li>Crisis Counseling Program </li></ul><ul><li>Forms </li></ul><ul><li>and </li></...
<ul><li>Concluding Comments </li></ul><ul><li>Questions? </li></ul>
Acknowledgements Training material is based on SAMHSA/CMHS Disaster Technical Assistance Training Toolkit materials. Thank...
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Link to KAHBH Core Training Manual

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Link to KAHBH Core Training Manual

  1. 1. Kansas All-Hazards Behavioral Health Training Core Competencies for Community Outreach Workers
  2. 2. What is KAHBH? <ul><li>KAHBH provides State-wide organization and coordination for behavioral health response to disaster and other all-hazards events </li></ul><ul><ul><li>Training and preparing Kansas professionals and paraprofessionals to serve in behavioral health capacity during an event </li></ul></ul><ul><ul><li>Providing technical assistance and all-hazards behavioral health information to Kansans </li></ul></ul>
  3. 3. Key KAHBH Tasks <ul><li>Resource identification and collection </li></ul><ul><li>Training and education </li></ul><ul><li>Development of Annex to KEOP, KAHBH Plan, and Standard Operating Procedures </li></ul><ul><li>State-wide network recruitment and coordination </li></ul><ul><li>Preparedness, response, and recovery activities </li></ul>
  4. 4. KAHBH Network <ul><li>10 staff </li></ul><ul><li>15 Stakeholders </li></ul><ul><li>12 SRS Field Staff </li></ul><ul><li>29 CMHC Coordinators </li></ul><ul><li>Goal: 200+ KAHBH Network members </li></ul>
  5. 5. Outline of KAHBH Trainings <ul><li>KAHBH Core Behavioral Health Training </li></ul><ul><li>DAY 1 (approx. 8 hours) </li></ul><ul><ul><li>For all participants without CISM or ARC DMH training within the last 5 years (Mental health and paraprofessionals) </li></ul></ul><ul><ul><ul><li>Module 1: Disaster Classifications and Phases </li></ul></ul></ul><ul><ul><ul><li>Module 2: Traumatic Reactions to Disasters </li></ul></ul></ul><ul><ul><ul><li>Module 3: Providing Support During Disasters </li></ul></ul></ul><ul><ul><ul><li>Module 4: Considerations for Special Populations, Cultural Competence, and Ethical Issues </li></ul></ul></ul><ul><li>Day 2 (approx. 3.5) </li></ul><ul><ul><li>For ALL KAHBH Network members </li></ul></ul><ul><ul><ul><li>Module 5: The FEMA/SAMHSA CMHS Crisis Counseling Assistance and Training Program </li></ul></ul></ul><ul><ul><ul><li>Module 6: The KAHBH Program: Preparedness, Response, and Recovery for Kansas Communities </li></ul></ul></ul><ul><ul><ul><li>Module 7: Behavioral Health and the All-Hazards Disaster Response System </li></ul></ul></ul><ul><ul><ul><li>Module 8: KAHBH Community Outreach Teams: Structure, Procedures, and Documents </li></ul></ul></ul>
  6. 6. <ul><li>Paraprofessional Training </li></ul><ul><ul><li>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 </li></ul></ul><ul><ul><ul><li>The Role of the Helper </li></ul></ul></ul><ul><ul><ul><li>Professional and personal boundaries </li></ul></ul></ul><ul><ul><ul><li>Ethics, confidentiality, and dual relationships </li></ul></ul></ul><ul><ul><ul><li>Communication Skills </li></ul></ul></ul><ul><ul><ul><li>Challenges in Helping </li></ul></ul></ul><ul><ul><ul><li>Diversity and multicultural awareness as a helper </li></ul></ul></ul><ul><ul><ul><li>Helping in Crisis and Grief Situations </li></ul></ul></ul>
  7. 7. <ul><li>Future Specialty Trainings </li></ul><ul><ul><li>To be based on each community’s needs </li></ul></ul><ul><ul><li>All non-mental health members will receive additional ½ day (4 hours) training on basic helping skills in crisis counseling </li></ul></ul><ul><ul><li>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): </li></ul></ul><ul><ul><ul><li>Children (under age 18) </li></ul></ul></ul><ul><ul><ul><li>Frail Elderly </li></ul></ul></ul><ul><ul><ul><li>Developmentally and physically disabled </li></ul></ul></ul><ul><ul><ul><li>Severe Mental Illness and People in active Substance Abuse Treatment </li></ul></ul></ul><ul><ul><ul><li>People in Correctional Institutions </li></ul></ul></ul><ul><ul><ul><li>College Students in dorms/away from home/Families/individuals relocated </li></ul></ul></ul><ul><ul><ul><li>People with high traumatic exposure </li></ul></ul></ul><ul><ul><ul><li>People in poverty and homeless </li></ul></ul></ul><ul><ul><ul><li>Roles of women in community (e.g. new moms, multiple caregivers) </li></ul></ul></ul><ul><ul><ul><li>Men and Women </li></ul></ul></ul><ul><ul><ul><li>Emergency responders involved in rescue/recovery </li></ul></ul></ul><ul><ul><ul><li>Multicultural issues </li></ul></ul></ul><ul><ul><ul><li>Farmers/Ranchers/Agricultural Workers/Rural Populations </li></ul></ul></ul>
  8. 8. Core Competencies, Terminology, and Regional Disaster Information
  9. 9. KAHBH Core Objectives <ul><li>Understand the difference between Community Mental Health Center (CMHC) crisis counseling and the All-Hazards/Disaster Behavioral Health “crisis counseling” (FEMA/SAMHSA CMHS) model </li></ul><ul><li>Understand human behavior in disasters </li></ul><ul><li>Understand the key concepts of all-hazards behavioral health </li></ul><ul><li>Understand the organizational aspects of disaster response </li></ul><ul><li>Understand how to assess the needs of and intervene effectively with disaster survivors, including special populations </li></ul><ul><li>Provide appropriate behavioral health assistance to survivors and workers at the community level </li></ul><ul><li>Understand, recognize and manage stress in disaster work </li></ul>
  10. 10. KAHBH Core Competencies <ul><li>Identifies relevant and appropriate data and information sources </li></ul><ul><li>Obtains and interprets information regarding risks and benefits to the community </li></ul><ul><li>Recognizes how the data illuminates ethical, political, scientific, economic, and overall public behavioral health issues </li></ul><ul><li>Prepare and implement behavioral health emergency response plans </li></ul><ul><li>Advocates for public health/behavioral health programs and resources </li></ul><ul><li>Effectively presents accurate demographic, statistical, programmatic and scientific information for professional and lay audiences </li></ul><ul><li>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 </li></ul><ul><li>Identifies the role of cultural, social, and behavioral factors in determining the delivery of public health/behavioral health services </li></ul>
  11. 11. KAHBH Core Competencies <ul><li>Develops and adapts approaches to problems that take into account cultural differences </li></ul><ul><li>Collaborates with community partners to promote the health/behavioral health of the population </li></ul><ul><li>Identifies community assets and available resources </li></ul><ul><li>Describes the role of government in the delivery of community behavioral health services </li></ul><ul><li>Identifies the individual’s and organization’s responsibilities within the context of the KAHBH Program and its core functions </li></ul><ul><li>Creates a culture of ethical standards within organizations and communities </li></ul><ul><li>Helps create key values and shared vision and uses these principles to guide action </li></ul><ul><li>Identifies internal and external issues that may impact delivery of essential public behavioral health services (i.e., strategic planning) </li></ul><ul><li>Promotes team and organizational learning </li></ul>
  12. 12. <ul><li>“ 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.” </li></ul><ul><li>Statement from the Conference Transcript: </li></ul><ul><li>Responding to Bioterrorism: Individual and Community Needs , </li></ul><ul><li>October 19-21, 2001 </li></ul>
  13. 13. <ul><li>“ Mental Health is the linchpin to an effective response .” </li></ul><ul><li>Statement from April 2005 </li></ul><ul><li>TOPOFF 3 Exercise </li></ul>
  14. 14. Terminology <ul><li>“ Behavioral Health” </li></ul><ul><li>Mental Health + Substance Abuse </li></ul>
  15. 15. Terminology (continued) <ul><li>All-Hazards = All-Hazards </li></ul><ul><li>Disasters ~ Bioterrorism ~ Major Community Crises </li></ul>
  16. 16. Examples of All-Hazards Crisis Counseling Program Services <ul><li>Outreach </li></ul><ul><li>Screening and Assessment </li></ul><ul><li>Counseling </li></ul><ul><li>Information and Referral </li></ul><ul><li>Public Education & Social Advocacy </li></ul>
  17. 17. Program Limitations <ul><li>Medications </li></ul><ul><li>Hospitalization </li></ul><ul><li>Long-term Therapy </li></ul><ul><li>Providing Childcare or Transportation </li></ul><ul><li>Fundraising activities </li></ul><ul><li>Individual Advocacy </li></ul><ul><li>Long-term Case Management </li></ul>
  18. 18. All-Hazards Crisis Counseling and “Traditional” Behavioral Health Practice <ul><li>Primarily Office-Based </li></ul><ul><li>Focus on Diagnosis & Treatment of Mental Illness </li></ul><ul><li>Attempt to Impact Personality & Functioning </li></ul><ul><li>Examines Content </li></ul><ul><li>Encourages Insight into Past Experiences & Influence on Current Problems </li></ul><ul><li>Psychotherapeutic Focus </li></ul><ul><li>Primarily Home & Community Based </li></ul><ul><li>Assessment of Strengths, Adaptation & Coping Skills </li></ul><ul><li>Seeks to Restore Pre-Disaster Functioning </li></ul><ul><li>Accepts Content at Face Value </li></ul><ul><li>Validates Appropriateness of Reactions and Normalizes Experience </li></ul><ul><li>Psycho-educational focus </li></ul>“ Traditional” Practice Disaster Crisis Counseling Source : ESDRB Program Guidance, December, 1996
  19. 19. <ul><li>The KAHBH Program follows the FEMA/SAMHSA CMHS Crisis Counseling Program as the primary model </li></ul><ul><ul><li>Federal program </li></ul></ul><ul><ul><ul><li>Over 30 year history </li></ul></ul></ul><ul><ul><ul><li>“ Best Practice” nationally recognized material </li></ul></ul></ul><ul><ul><li>Collaboration between FEMA, SAMHSA CMHS, state mental health authority (SRS in Kansas), and local responders </li></ul></ul><ul><ul><li>Community based </li></ul></ul><ul><ul><ul><li>Focus on providing services to the general population </li></ul></ul></ul><ul><ul><ul><li>Includes paraprofessionals or community “heroes” as potential providers </li></ul></ul></ul>
  20. 20. Organizations Involved in Behavioral Health Disaster Response <ul><li>Federal </li></ul><ul><ul><li>SAMHSA — S ubstance A buse M ental H ealth S ervices A dministration & CMHS — C enter for M ental H ealth S ervices </li></ul></ul><ul><ul><li>FEMA — F ederal E mergency M anagement A gency </li></ul></ul><ul><li>State </li></ul><ul><ul><li>KDEM —K ansas D ept. of E mergency M anagement </li></ul></ul><ul><ul><ul><li>KDHE — K ansas D ept. of H ealth and E nvironment </li></ul></ul></ul><ul><ul><ul><ul><li>SRS —Kansas Dept. of S ocial and R ehabilitation S ervices </li></ul></ul></ul></ul><ul><li>Local </li></ul><ul><ul><li>Local emergency management agencies </li></ul></ul><ul><ul><li>CMHC — C ommunity M ental H ealth C enters </li></ul></ul><ul><ul><li>Local professionals and para-professionals (substance abuse professionals, clergy, doctors/nurses, fire/police department, volunteers, etc.) </li></ul></ul>
  21. 21. The KAHBH Program is not: <ul><li>American Red Cross Disaster Mental Health Services (ARC DMHS) </li></ul><ul><ul><li>ARC requires a masters-level licensed mental health professional </li></ul></ul><ul><ul><li>ARC mental health workers are volunteers and do not receive reimbursement for their services </li></ul></ul><ul><li>Critical Incident Stress Management (CISM) </li></ul><ul><ul><li>Model developed and approved for use with first responders, but often is applied to many areas of crisis response, which may not be appropriate </li></ul></ul>
  22. 22. The KAHBH Program <ul><li>Emphasizes the importance of ALL approaches to all-hazards/disaster events </li></ul><ul><li>Recognizes and supports collaboration between behavioral health responders and other responders in all-hazards/disaster events </li></ul><ul><li>Works to provide State-wide organization and coordination for behavioral health response to disaster and other all-hazards events </li></ul>
  23. 23. <ul><li>Regional </li></ul><ul><li>Disaster Information </li></ul>
  24. 24. Module 1: Disaster Classifications and Phases Wichita tornado
  25. 25. Definition of a Disaster <ul><li>A disaster is a threatening or occurring event of such destructive magnitude and force as to: </li></ul><ul><ul><li>dislocate people </li></ul></ul><ul><ul><li>separate family members </li></ul></ul><ul><ul><li>damage or destroy homes </li></ul></ul><ul><ul><li>injure or kill people </li></ul></ul>
  26. 26. <ul><li>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. </li></ul>
  27. 27. Natural Disasters <ul><li>Floods </li></ul><ul><li>Tornados </li></ul><ul><li>Hurricanes </li></ul><ul><li>Typhoons </li></ul><ul><li>Winter storms </li></ul><ul><li>Tsunamis </li></ul><ul><li>Hail storms </li></ul><ul><li>Wildfires </li></ul><ul><li>Windstorms </li></ul><ul><li>Epidemics </li></ul><ul><li>Earthquakes </li></ul>
  28. 28. Human-Caused Disasters <ul><li>Intentional and unintentional </li></ul><ul><ul><li>Residential fires </li></ul></ul><ul><ul><li>Building collapses </li></ul></ul><ul><ul><li>Transportation accidents </li></ul></ul><ul><ul><li>Hazardous materials releases </li></ul></ul><ul><ul><li>Explosions </li></ul></ul><ul><ul><li>Domestic acts of terrorism </li></ul></ul>
  29. 29. 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)
  30. 30. Behavioral Health Response to Presidentially Declared Disaster Event City Response County Response State Response KDEM Application National Disaster Presidentially Declared Disaster
  31. 31. Classification of Disasters <ul><li>Natural vs. Human-caused </li></ul><ul><li>Degree of personal impact </li></ul><ul><li>Size and scope </li></ul><ul><li>Visible impact/low point </li></ul><ul><li>Probability of </li></ul><ul><li>reoccurrence </li></ul>
  32. 32. Critical Disaster Stressors <ul><li>Threat to one’s life </li></ul><ul><li>Threat of harm to family </li></ul><ul><li>Destruction of home or community </li></ul><ul><li>Significant media attention </li></ul><ul><li>Witnessing others’ trauma </li></ul><ul><li>Being trapped or unable to evacuate </li></ul>
  33. 33. Phases of Disaster Reactions <ul><li>Warning of threat </li></ul><ul><li>Impact </li></ul><ul><li>Rescue or Heroic </li></ul><ul><li>Remedy or Honeymoon </li></ul><ul><li>Inventory </li></ul><ul><li>Disillusionment </li></ul><ul><li>Reconstruction and recovery </li></ul>
  34. 34. 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
  35. 35. Comparing Criminally Human-Caused and Natural Disasters <ul><li>Causation </li></ul><ul><li>Appraisal of event </li></ul><ul><li>Psychological impact </li></ul><ul><li>Subjective experience </li></ul><ul><li>World view/basic assumption </li></ul><ul><li>Stigmatization of victims </li></ul><ul><li>Media </li></ul><ul><li>Secondary injury </li></ul>
  36. 36. Terrorism Within the United States <ul><li>“ 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.” </li></ul><ul><li>[18 U.S.C. 3077] </li></ul>
  37. 37. Mass Violence Within the United States <ul><li>“ 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” </li></ul>
  38. 38. Summary <ul><li>Disasters can be classified according to a number of different variables, including natural vs. human-caused </li></ul><ul><li>Most disasters have distinguishable phases, beginning with the pre-disaster and warning phase and ending with the reconstruction phase </li></ul>
  39. 39. Module 2: Traumatic Reactions to Disasters
  40. 40. Effects of Trauma <ul><li>Vary by a person’s age, developmental stage, prior condition, degree of personal impact </li></ul><ul><li>Vary by the disaster’s severity, the amount of advance warning, the level of community preparedness </li></ul><ul><li>May include physical, emotional, cognitive or behavioral reactions </li></ul>
  41. 41. Psychosocial Concerns <ul><li>Disruption of existing social/community </li></ul><ul><li>Impact of new social patterns </li></ul><ul><li>Duration of recovery </li></ul><ul><li>Cross-cultural impact </li></ul>
  42. 42. What Scares Us? <ul><li>Things frighten us more if they are… </li></ul><ul><ul><li>Controlled by someone else </li></ul></ul><ul><ul><li>Not beneficial in any way to anyone </li></ul></ul><ul><ul><li>Hard to treat or treatment is not available to everyone </li></ul></ul><ul><ul><li>Catastrophic or deadly </li></ul></ul><ul><ul><li>Exotic or unusual </li></ul></ul><ul><li>than things that are… </li></ul><ul><ul><li>In our control </li></ul></ul><ul><ul><li>Helpful or beneficial to us or society </li></ul></ul><ul><ul><li>Easily and quickly diagnosable and treatable </li></ul></ul><ul><ul><li>Survivable </li></ul></ul><ul><ul><li>Familiar and routine </li></ul></ul>
  43. 43. Stressors in Disaster Work <ul><li>Event related </li></ul><ul><li>Occupational </li></ul><ul><li>Organizational </li></ul><ul><li>Family or personal life </li></ul>
  44. 44. Stress Basics <ul><li>Stress is : </li></ul><ul><ul><li>Normal </li></ul></ul><ul><ul><li>Necessary </li></ul></ul><ul><ul><li>Productive and destructive </li></ul></ul><ul><ul><li>Acute and delayed </li></ul></ul><ul><ul><li>Cumulative </li></ul></ul><ul><ul><li>Identifiable </li></ul></ul><ul><ul><li>Preventable and manageable </li></ul></ul>
  45. 45. Physical Changes with Stress <ul><li>Pupils dilate </li></ul><ul><li>Dry mouth </li></ul><ul><li>Heart rate increases </li></ul><ul><li>Increased HCI (Hydrochloric Acid) </li></ul><ul><li>Sleep disturbances </li></ul><ul><li>Lower back pain </li></ul><ul><li>Stomach motility inhibited (peristalsis) </li></ul><ul><li>Blood flow changes </li></ul><ul><li>Increased cholesterol production </li></ul>
  46. 46. Emotional Changes with Stress <ul><li>Increased feelings of isolation </li></ul><ul><li>Depression </li></ul><ul><li>Anger </li></ul><ul><li>Anhedonia (lack of joy) </li></ul><ul><li>Slowed learning speed </li></ul><ul><li>Impaired decision making </li></ul><ul><li>Decreased self-awareness </li></ul>
  47. 47. Mental Changes with Stress <ul><li>Decreased memory </li></ul><ul><li>Decreased attention span </li></ul><ul><li>Decreased intimacy </li></ul>
  48. 48. Organizational Approaches <ul><li>Effective management structure and leadership </li></ul><ul><li>Clear purpose and goals </li></ul><ul><li>Functionally defined roles </li></ul><ul><li>Team support </li></ul><ul><li>Plan for stress management </li></ul>
  49. 49. Individual Approaches <ul><li>Management of workload </li></ul><ul><li>Balances lifestyle </li></ul><ul><li>Stress reduction strategies </li></ul><ul><li>Self-awareness </li></ul>
  50. 50. Effects of Long-Term Disaster Stress <ul><li>Anxiety and vigilance </li></ul><ul><li>Anger, resentment, and conflict </li></ul><ul><li>Uncertainty about the future </li></ul><ul><li>Prolonged mourning of losses </li></ul><ul><li>Diminished problem-solving </li></ul><ul><li>Isolation and hopelessness </li></ul><ul><li>Health problems </li></ul><ul><li>Lifestyle changes </li></ul>
  51. 51. Acute Traumatic Stress Disorder <ul><li>The development, within one month of the event, of at least 3 of the following: </li></ul><ul><ul><li>Dissociation, emotional numbing </li></ul></ul><ul><ul><li>A re-experiencing of the event </li></ul></ul><ul><ul><li>Behavioral avoidance </li></ul></ul><ul><ul><li>Increased physiologic arousal </li></ul></ul><ul><ul><li>Social-occupational impairment </li></ul></ul>
  52. 52. Long Term Trauma <ul><li>For some, it may last months or years </li></ul><ul><li>The rates of PTSD are much higher among victims of violent crimes than victims of other types of traumatic events </li></ul><ul><li>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. </li></ul>
  53. 53. Post-Traumatic Stress Disorder <ul><li>Persistent re-experiencing of the event </li></ul><ul><li>Avoidance of things associated with event </li></ul><ul><li>Symptoms of increased arousal </li></ul><ul><li>Distress or impairment in social, occupational, or other areas </li></ul>
  54. 54. Other Long Term Reactions <ul><li>Major depression </li></ul><ul><li>Suicidal thoughts and attempts </li></ul><ul><li>Alcohol and drug abuse </li></ul><ul><li>Anxiety disorders </li></ul><ul><li>Dissociative disorders </li></ul>
  55. 55. Summary <ul><li>Disasters can elicit traumatic reactions in the victims who survive it. </li></ul>
  56. 56. Additional Reactions to Disasters
  57. 57. Disaster Stress and Grief Reactions <ul><li>Normal responses to abnormal situation – Often transitory in nature </li></ul><ul><li>Reactions: </li></ul><ul><ul><li>Emotional and psychological strain </li></ul></ul><ul><ul><li>Acute stress </li></ul></ul><ul><ul><li>Post traumatic stress </li></ul></ul><ul><ul><li>Grief reactions </li></ul></ul><ul><ul><li>Immediate and practical problems in living </li></ul></ul>
  58. 58. Physical Reactions <ul><li>Fatigue, exhaustion </li></ul><ul><li>Gastrointestinal distress </li></ul><ul><li>Appetite changes </li></ul><ul><li>Tightening in the throat or chest </li></ul><ul><li>Other somatic complaints </li></ul>
  59. 59. Emotional Reactions <ul><li>Depression, sadness </li></ul><ul><li>Irritability, anger, resentment </li></ul><ul><li>Anxiety, fear </li></ul><ul><li>Despair, hopelessness </li></ul><ul><li>Guilt, self-doubt </li></ul><ul><li>Unpredictable mood swings </li></ul>
  60. 60. Cognitive Reactions <ul><li>Confusion, disorientation </li></ul><ul><li>Recurring dreams, nightmares </li></ul><ul><li>Preoccupations with disaster </li></ul><ul><li>Trouble concentrating or remembering things </li></ul><ul><li>Difficulty making decisions </li></ul><ul><li>Questioning spiritual beliefs </li></ul>
  61. 61. Behavioral Reactions <ul><li>Sleep problems </li></ul><ul><li>Crying easily </li></ul><ul><li>Avoiding reminders </li></ul><ul><li>Excessive activity level </li></ul><ul><li>Increased conflicts with family </li></ul><ul><li>Hypervigilance, startle reactions </li></ul><ul><li>Isolation or social withdrawal </li></ul>
  62. 62. Spiritual Reactions <ul><li>Withdrawal from places of worship or spiritual practices </li></ul><ul><li>Uncharacteristic religious involvement </li></ul><ul><li>Being troubled by biblical or historical predictions </li></ul><ul><li>Questioning meaning and beliefs </li></ul><ul><li>Anger with God or higher power </li></ul><ul><li>Loss of faith </li></ul>
  63. 63. Chronic Stressors in Disasters <ul><li>Family disruption </li></ul><ul><li>Work overload </li></ul><ul><li>Gender differences </li></ul><ul><li>Bureaucratic hassles </li></ul><ul><li>Financial strain </li></ul>
  64. 64. Loss and Grief <ul><li>Loss is a common theme in disaster settings </li></ul><ul><li>Common reactions to loss: </li></ul><ul><ul><li>Denial, numbness or shock </li></ul></ul><ul><ul><li>Anger </li></ul></ul><ul><ul><li>Bargaining </li></ul></ul><ul><ul><li>Depression </li></ul></ul><ul><ul><li>Acceptance </li></ul></ul><ul><ul><li>Reorientation </li></ul></ul>
  65. 65. Loss and Grief – Signs of Trouble <ul><li>Using alcohol or drugs to self-medicate </li></ul><ul><li>Using work or other distractions to avoid feelings </li></ul><ul><li>Hostility and aggression toward others </li></ul><ul><li>Avoiding or minimizing emotions </li></ul>
  66. 66. Emotional Numbness or Extreme Agitation <ul><li>Immediate attention is needed </li></ul><ul><li>Possible referral for professional care </li></ul><ul><li>When referring: </li></ul><ul><ul><li>Inform the person of your intention </li></ul></ul><ul><ul><li>Recognize that the referral may cause a negative reaction </li></ul></ul>
  67. 67. Summary <ul><li>Disasters may elicit a number of non-traumatic responses in its victims, including: </li></ul><ul><ul><li>Grief reactions </li></ul></ul><ul><ul><li>Physical reactions </li></ul></ul><ul><ul><li>Emotional reactions </li></ul></ul><ul><ul><li>Cognitive reactions </li></ul></ul><ul><ul><li>Behavioral reactions </li></ul></ul>
  68. 68. Module 3: Providing Support During Disasters
  69. 69. All-Hazards Crisis Counseling and “Traditional” Behavioral Health Practice <ul><li>Primarily Office-Based </li></ul><ul><li>Focus on Diagnosis & Treatment of Mental Illness </li></ul><ul><li>Attempt to Impact Personality & Functioning </li></ul><ul><li>Examines Content </li></ul><ul><li>Encourages Insight into Past Experiences & Influence on Current Problems </li></ul><ul><li>Psychotherapeutic Focus </li></ul><ul><li>Primarily Home & Community Based </li></ul><ul><li>Assessment of Strengths, Adaptation & Coping Skills </li></ul><ul><li>Seeks to Restore Pre-Disaster Functioning </li></ul><ul><li>Accepts Content at Face Value </li></ul><ul><li>Validates Appropriateness of Reactions and Normalizes Experience </li></ul><ul><li>Psycho-educational focus </li></ul>“ Traditional” Practice Disaster Crisis Counseling Source : ESDRB Program Guidance, December, 1996
  70. 70. All-Hazards Crisis Counseling and “Traditional” Case Management <ul><li>Provide services to individuals with SPMI or other disability </li></ul><ul><li>Services provided for indefinite duration </li></ul><ul><li>Responsible and accountable for client service provision </li></ul><ul><li>Power to influence services for their client </li></ul><ul><li>Long-term relationship with clients </li></ul><ul><li>Provide services to disaster survivors who often have a high level of functioning </li></ul><ul><li>Services provided do not require continuity of care </li></ul><ul><li>Empower disaster victims to advocate for services needed </li></ul><ul><li>Short-term relationship with disaster victims </li></ul>“ Traditional” Case Management Disaster Crisis Counseling Source : ESDRB Program Guidance, December, 1996
  71. 71. In other words… <ul><li>CMHC Crisis Counseling </li></ul><ul><ul><li>Day-to-day crises </li></ul></ul><ul><ul><li>A few people from a target population experiencing severe reactions (suicide, violence, psychiatric problems, substance abuse) </li></ul></ul><ul><li>All-Hazards/Disaster Crisis Counseling </li></ul><ul><ul><li>Event specific </li></ul></ul><ul><ul><li>Targets the general population (lots of people) experiencing low levels (but significant) reactions (with a few experiencing severe reactions) </li></ul></ul>
  72. 72. Key Concepts in All-Hazards Behavioral Health <ul><li>No one who sees a disaster is untouched by it </li></ul><ul><li>People experience individual and collective trauma </li></ul><ul><li>Securing disaster relief can be emotionally stressful </li></ul><ul><li>Most people pull together during and after a disaster, but their effectiveness is diminished </li></ul><ul><li>Most people do not see themselves as needing behavioral health services following a disaster and will not seek out such services </li></ul>
  73. 73. Overarching Concepts <ul><li>Normal reactions to abnormal situation </li></ul><ul><li>Avoid “mental health” terms and labels </li></ul><ul><li>Assistance is practical </li></ul><ul><li>Assume competence </li></ul><ul><li>Focus on strengths and potentials </li></ul><ul><li>Encourage use of support network </li></ul><ul><li>Active, community fit </li></ul><ul><li>Innovative in helping </li></ul>
  74. 74. Maslow’s Hierarchy of Needs www.tutor2u.net/business/images/maslow_hierarchy.gif
  75. 75. Guiding Principles in Providing Support <ul><li>First protect from danger </li></ul><ul><li>Focus on physical and material care </li></ul><ul><li>Be direct, active and remain calm </li></ul><ul><li>Focus on the “here and now” situation </li></ul><ul><li>Provide accurate information about the situation </li></ul><ul><li>Assist with mobilization of resources </li></ul>
  76. 76. Guiding Principles in Providing Support (cont) <ul><li>Do not give false assurances </li></ul><ul><li>Recognize the importance of taking action </li></ul><ul><li>Reunite with family members </li></ul><ul><li>Provide and ensure emotional support </li></ul><ul><li>Focus on strengths and resilience </li></ul><ul><li>Encourage self-reliance </li></ul><ul><li>Respect feelings and cultures of others </li></ul>
  77. 77. Crisis Intervention <ul><li>Observe safe practices by showing concern for your own safety </li></ul><ul><li>Remain calm and appear relaxed, confident and non-threatening </li></ul>
  78. 78. Crisis Intervention Steps <ul><li>Assess the situation </li></ul><ul><li>Establish rapport </li></ul><ul><li>Identify the main problem(s) </li></ul><ul><li>Deal with feelings and emotions </li></ul><ul><li>Generate and explore alternative coping strategies </li></ul><ul><li>Formulate an action plan </li></ul><ul><li>Follow up </li></ul>
  79. 79. On-Scene Interventions <ul><li>Direct to medical care, safety, shelter </li></ul><ul><li>Protect from trauma, media, onlookers </li></ul><ul><li>Connect to family, information, comfort </li></ul><ul><ul><ul><ul><ul><li>(Myers and Wee, 2003 ) </li></ul></ul></ul></ul></ul>
  80. 80. Immediate Interventions <ul><li>Rapid assessment and triage </li></ul><ul><li>Psychological first-aid </li></ul><ul><li>Crisis intervention </li></ul><ul><li>Crime victim assistance </li></ul><ul><li>Psycho-education </li></ul><ul><li>Information briefings </li></ul><ul><li>Community outreach </li></ul>
  81. 81. Immediate Interventions (continued) <ul><li>Participation in death notification </li></ul><ul><li>Behavioral health consultation </li></ul><ul><li>Debriefing and community meetings </li></ul><ul><li>Information and referral </li></ul>
  82. 82. Psychological First-Aid <ul><li>Provide comfort, empathy, an “ear” </li></ul><ul><li>Address physical needs </li></ul><ul><li>Provide concrete information about what will happen next </li></ul><ul><li>Link to support systems </li></ul><ul><li>Reinforce coping strengths </li></ul>
  83. 83. Crisis Intervention <ul><li>Promote safety and security </li></ul><ul><li>Gently explore trauma experience </li></ul><ul><li>Identify priority needs and solutions </li></ul><ul><li>Assess functioning and coping </li></ul><ul><li>Provide: </li></ul><ul><ul><li>Reassurance </li></ul></ul><ul><ul><li>Psycho-education </li></ul></ul><ul><ul><li>Practical assistance </li></ul></ul>
  84. 84. Crime Victim Assistance <ul><li>Protect victims’ rights </li></ul><ul><li>Ensure control over media </li></ul><ul><li>Provide criminal justice information </li></ul><ul><li>Facilitate access to compensation </li></ul><ul><li>Streamline bureaucratic procedures </li></ul>
  85. 85. Community Outreach <ul><li>Initiate contact at gathering sites </li></ul><ul><li>Set up 24-hour telephone hotlines </li></ul><ul><li>Outreach to survivors through media, Internet </li></ul><ul><li>Educate service providers </li></ul><ul><li>Use bilingual and bicultural workers </li></ul>
  86. 86. Participation in Death Notification <ul><li>Responsible notifier: </li></ul><ul><ul><li>Obtains critical information </li></ul></ul><ul><ul><li>Notifies next-of-kin directly, simply, and in person </li></ul></ul><ul><ul><li>Expects intense reactions </li></ul></ul><ul><ul><li>Provides practical assistance </li></ul></ul><ul><ul><li>Mental health, participates on team, provides support and information </li></ul></ul>
  87. 87. Brief Trauma Interventions <ul><li>Factual information </li></ul><ul><li>Thoughts during event </li></ul><ul><li>Reactions and feelings </li></ul><ul><li>Psycho-education </li></ul><ul><li>Problem-solving and action </li></ul>
  88. 88. Post-Disaster Behavioral Health Interventions <ul><li>Case finding </li></ul><ul><li>Letters and phone calls </li></ul><ul><li>Community outreach </li></ul><ul><li>Brief counseling (individual and group) </li></ul><ul><li>Case management </li></ul><ul><li>Public education through media </li></ul><ul><li>Information and referral </li></ul>
  89. 89. Key Events with Behavioral Health Implications <ul><li>Death notification </li></ul><ul><li>Ending search and recovery </li></ul><ul><li>Bulldozing homes/neighborhoods </li></ul><ul><li>Criminal justice proceedings </li></ul><ul><li>Returning to impacted areas </li></ul><ul><li>Funeral and memorials </li></ul>
  90. 90. Community Interventions <ul><li>Memorials and rituals </li></ul><ul><li>Usual community gatherings </li></ul><ul><li>Anniversary commemorations </li></ul><ul><li>Symbolic gestures </li></ul>
  91. 91. Summary <ul><li>The role of behavioral health in crisis response may include the following: </li></ul><ul><ul><li>On-scene interventions </li></ul></ul><ul><ul><li>Immediate interventions </li></ul></ul><ul><ul><li>Psychological first aid </li></ul></ul><ul><ul><li>Crisis interventions </li></ul></ul><ul><ul><li>Crime victim assistance </li></ul></ul><ul><ul><li>Community outreach </li></ul></ul><ul><ul><li>Death notification </li></ul></ul><ul><ul><li>Brief trauma interventions </li></ul></ul><ul><ul><li>Post-disaster inventions </li></ul></ul>
  92. 92. Survivor Risk and Resiliency Factors <ul><li>Psychological </li></ul><ul><li>Capacity to tolerate stress </li></ul><ul><li>Prior trauma history </li></ul><ul><li>Socioeconomic and education level </li></ul><ul><li>Family stability </li></ul><ul><li>Social support </li></ul><ul><li>Gender roles </li></ul>
  93. 93. Teaching Strategies for Enhancing Resilience <ul><li>Encourage making connections with others </li></ul><ul><li>Redirect from seeing crises as insurmountable problems </li></ul><ul><li>Encourage accepting change as a part of living </li></ul><ul><li>Encourage movement toward goals </li></ul><ul><li>Encourage taking directive actions </li></ul><ul><li>Observe opportunities for self-discovery </li></ul>
  94. 94. Teaching Strategies for Enhancing Resilience <ul><li>Nurture a positive view of self </li></ul><ul><li>Encourage keeping things in perspective </li></ul><ul><li>Encourage maintaining a positive outlook </li></ul><ul><li>Encourage self care (emotional and physical) </li></ul>
  95. 95. Summary <ul><li>The effectiveness of all-hazards support and crisis intervention during a disaster may be affected by a number of survivor risk and resiliency factors </li></ul>
  96. 96. Module 4: Considerations for Special Populations, Cultural Competence, and Ethical Issues
  97. 97. Special/Vulnerable Populations <ul><ul><ul><li>NO ONE IS UNTOUCHED BY DISASTER… </li></ul></ul></ul><ul><ul><ul><li>NO ONE IS NOT VULNERABLE </li></ul></ul></ul><ul><ul><ul><li>Children (under age 18) </li></ul></ul></ul><ul><ul><ul><li>Frail Elderly </li></ul></ul></ul><ul><ul><ul><li>Developmentally and physically disabled </li></ul></ul></ul><ul><ul><ul><li>Severe Mental Illness and People in active Substance Abuse Treatment </li></ul></ul></ul><ul><ul><ul><li>People in Correctional Institutions </li></ul></ul></ul><ul><ul><ul><li>College Students in dorms/away from home/ families/individuals relocated </li></ul></ul></ul><ul><ul><ul><li>People with high traumatic exposure </li></ul></ul></ul><ul><ul><ul><li>People in poverty and homeless </li></ul></ul></ul><ul><ul><ul><li>Emergency responders involved in rescue/recovery </li></ul></ul></ul><ul><ul><ul><li>Multicultural issues </li></ul></ul></ul><ul><ul><ul><li>Farmers/Ranchers/Agricultural Workers/Rural Populations </li></ul></ul></ul><ul><ul><ul><li>Other roles of men and women that be increase vulnerability </li></ul></ul></ul>
  98. 98. Statement of Principles for Special Needs Populations <ul><li>Equitable access for all </li></ul><ul><li>Respect for the diversities of communities </li></ul><ul><li>Community-based partnerships </li></ul><ul><li>Representation of the diversity of communities, in all phases of emergency management </li></ul><ul><li>Accountability for implementation at local, regional and state levels </li></ul>
  99. 99. Cultural Competence <ul><li>Recognize the importance of culture and respect diversity </li></ul><ul><li>Maintain a current profile of the cultural composition of the community </li></ul><ul><li>Ensure that services are accessible, appropriate, and equitable </li></ul><ul><li>Recognize the role of help-seeking behaviors, customs, and traditions, and natural support networks </li></ul><ul><li>Involve as “cultural brokers” community leaders and organizations representing diverse cultural groups </li></ul><ul><li>Ensure that services and information are culturally and linguistically competent </li></ul>
  100. 100. Basic Cultural Sensitivity <ul><li>Convey respect, good will, courtesy </li></ul><ul><li>Ask permission to speak with people </li></ul><ul><li>Explain role of behavioral health worker </li></ul><ul><li>Acknowledge differences in behavior due to culture </li></ul><ul><li>Respond to concrete needs </li></ul><ul><li>Dominant language/English fluency </li></ul><ul><li>Immigration experience and status </li></ul><ul><li>Family values </li></ul><ul><li>Cultural values and traditions </li></ul>
  101. 101. Ethical Issues <ul><li>Most information on ethics and disasters is from international disasters or recent research with disaster survivors </li></ul><ul><li>Key Considerations: </li></ul><ul><ul><li>Ability/vulnerability of survivors </li></ul></ul><ul><ul><li>Active role in response and recovery </li></ul></ul><ul><ul><li>Direct vs. indirect victimization </li></ul></ul>
  102. 102. Key Ethical Issues in Disasters <ul><li>Readiness of survivors to address disaster and trauma issues </li></ul><ul><li>Helper competency and accountability </li></ul><ul><li>Power and hierarchy of helpers </li></ul><ul><li>Cultural diversities and oppressions </li></ul>
  103. 103. Summary <ul><li>Competent disaster behavioral health practices require special attention given to special/vulnerable populations, cultural and ethical issues, and stressors in disaster work </li></ul>
  104. 104. <ul><li>Day 2 </li></ul><ul><li>All KAHBH Network Members </li></ul>
  105. 105. Module 5: The FEMA/SAMHSA Crisis Counseling Assistance and Training Program
  106. 106. The FEMA Crisis Counseling Assistance and Training Program <ul><li>Robert T. Stafford Disaster Assistance and Emergency Relief Act (P.L. 93-288 as amended) </li></ul><ul><li>Interagency Federal Partnership </li></ul><ul><li>Federal-State-Local Partnership </li></ul>
  107. 107. Organizational Partners in Crisis Counseling Program <ul><li>Community Mental Health Agencies </li></ul><ul><li>State Mental Health Authority </li></ul><ul><li>State Emergency Management Agency </li></ul><ul><li>Federal Emergency Management Agency (Region and Headquarters) </li></ul><ul><li>Center for Mental Health Services </li></ul>
  108. 108. Administrative Staff <ul><li>Community Program Managers </li></ul><ul><li>State Disaster Mental Health Coordinator </li></ul><ul><li>Governor’s Authorized Representative </li></ul><ul><li>FEMA Crisis Counseling Coordinator </li></ul><ul><li>FEMA Human Services Officer </li></ul><ul><li>Federal Coordinating Officer </li></ul><ul><li>FEMA Headquarters Crisis Counseling Coordinator </li></ul><ul><li>CMHS Project Officer </li></ul>
  109. 109. The Acronym Game! <ul><li>KDEM </li></ul><ul><li>CMHS </li></ul><ul><li>KEOP </li></ul><ul><li>KAHBH </li></ul><ul><li>ISP </li></ul><ul><li>ICS </li></ul><ul><li>PIO </li></ul><ul><li>NIMS </li></ul><ul><li>ARC </li></ul><ul><li>ESF </li></ul><ul><li>VOAD </li></ul><ul><li>SOP </li></ul><ul><li>FEMA </li></ul>
  110. 110. The Acronym Game! <ul><li>KDEM: Kansas Department of Emergency Management </li></ul><ul><li>CMHS </li></ul><ul><li>KEOP </li></ul><ul><li>KAHBH </li></ul><ul><li>ISP </li></ul><ul><li>ICS </li></ul><ul><li>PIO </li></ul><ul><li>NIMS </li></ul><ul><li>ARC </li></ul><ul><li>ESF </li></ul><ul><li>VOAD </li></ul><ul><li>SOP </li></ul><ul><li>FEMA </li></ul>
  111. 111. The Acronym Game! <ul><li>KDEM: Kansas Department of Emergency Management </li></ul><ul><li>CMHS: Center for Mental Health Services </li></ul><ul><li>KEOP </li></ul><ul><li>KAHBH </li></ul><ul><li>ISP </li></ul><ul><li>ICS </li></ul><ul><li>PIO </li></ul><ul><li>NIMS </li></ul><ul><li>ARC </li></ul><ul><li>ESF </li></ul><ul><li>VOAD </li></ul><ul><li>SOP </li></ul><ul><li>FEMA </li></ul>
  112. 112. The Acronym Game! <ul><li>KDEM: Kansas Department of Emergency Management </li></ul><ul><li>CMHS: Center for Mental Health Services </li></ul><ul><li>KEOP: Kansas Emergency Operations Plan </li></ul><ul><li>KAHBH </li></ul><ul><li>ISP </li></ul><ul><li>ICS </li></ul><ul><li>PIO </li></ul><ul><li>NIMS </li></ul><ul><li>ARC </li></ul><ul><li>ESF </li></ul><ul><li>VOAD </li></ul><ul><li>SOP </li></ul><ul><li>FEMA </li></ul>
  113. 113. The Acronym Game! <ul><li>KDEM: Kansas Department of Emergency Management </li></ul><ul><li>CMHS: Center for Mental Health Services </li></ul><ul><li>KEOP: Kansas Emergency Operations Plan </li></ul><ul><li>KAHBH: Kansas All-Hazards Behavioral Health Program </li></ul><ul><li>ISP </li></ul><ul><li>ICS </li></ul><ul><li>PIO </li></ul><ul><li>NIMS </li></ul><ul><li>ARC </li></ul><ul><li>ESF </li></ul><ul><li>VOAD </li></ul><ul><li>SOP </li></ul><ul><li>FEMA </li></ul>
  114. 114. The Acronym Game! <ul><li>KDEM: Kansas Department of Emergency Management </li></ul><ul><li>CMHS: Center for Mental Health Services </li></ul><ul><li>KEOP: Kansas Emergency Operations Plan </li></ul><ul><li>KAHBH: Kansas All-Hazards Behavioral Health Program </li></ul><ul><li>ISP: Immediate Services Program </li></ul><ul><li>ICS </li></ul><ul><li>PIO </li></ul><ul><li>NIMS </li></ul><ul><li>ARC </li></ul><ul><li>ESF </li></ul><ul><li>VOAD </li></ul><ul><li>SOP </li></ul><ul><li>FEMA </li></ul>
  115. 115. The Acronym Game! <ul><li>KDEM: Kansas Department of Emergency Management </li></ul><ul><li>CMHS: Center for Mental Health Services </li></ul><ul><li>KEOP: Kansas Emergency Operations Plan </li></ul><ul><li>KAHBH: Kansas All-Hazards Behavioral Health Program </li></ul><ul><li>ISP: Immediate Services Program </li></ul><ul><li>ICS: Incident Command System </li></ul><ul><li>PIO </li></ul><ul><li>NIMS </li></ul><ul><li>ARC </li></ul><ul><li>ESF </li></ul><ul><li>VOAD </li></ul><ul><li>SOP </li></ul><ul><li>FEMA </li></ul>
  116. 116. The Acronym Game! <ul><li>KDEM: Kansas Department of Emergency Management </li></ul><ul><li>CMHS: Center for Mental Health Services </li></ul><ul><li>KEOP: Kansas Emergency Operations Plan </li></ul><ul><li>KAHBH: Kansas All-Hazards Behavioral Health Program </li></ul><ul><li>ISP: Immediate Services Program </li></ul><ul><li>ICS: Incident Command System </li></ul><ul><li>PIO: Public Information Officer </li></ul><ul><li>NIMS </li></ul><ul><li>ARC </li></ul><ul><li>ESF </li></ul><ul><li>VOAD </li></ul><ul><li>SOP </li></ul><ul><li>FEMA </li></ul>
  117. 117. The Acronym Game! <ul><li>KDEM: Kansas Department of Emergency Management </li></ul><ul><li>CMHS: Center for Mental Health Services </li></ul><ul><li>KEOP: Kansas Emergency Operations Plan </li></ul><ul><li>KAHBH: Kansas All-Hazards Behavioral Health Program </li></ul><ul><li>ISP: Immediate Services Program </li></ul><ul><li>ICS: Incident Command System </li></ul><ul><li>PIO: Public Information Officer </li></ul><ul><li>NIMS: National Incident Management System </li></ul><ul><li>ARC </li></ul><ul><li>ESF </li></ul><ul><li>VOAD </li></ul><ul><li>SOP </li></ul><ul><li>FEMA </li></ul>
  118. 118. The Acronym Game! <ul><li>KDEM: Kansas Department of Emergency Management </li></ul><ul><li>CMHS: Center for Mental Health Services </li></ul><ul><li>KEOP: Kansas Emergency Operations Plan </li></ul><ul><li>KAHBH: Kansas All-Hazards Behavioral Health Program </li></ul><ul><li>ISP: Immediate Services Program </li></ul><ul><li>ICS: Incident Command System </li></ul><ul><li>PIO: Public Information Officer </li></ul><ul><li>NIMS: National Incident Management System </li></ul><ul><li>ARC: American Red Cross </li></ul><ul><li>ESF </li></ul><ul><li>VOAD </li></ul><ul><li>SOP </li></ul><ul><li>FEMA </li></ul>
  119. 119. The Acronym Game! <ul><li>KDEM: Kansas Department of Emergency Management </li></ul><ul><li>CMHS: Center for Mental Health Services </li></ul><ul><li>KEOP: Kansas Emergency Operations Plan </li></ul><ul><li>KAHBH: Kansas All-Hazards Behavioral Health Program </li></ul><ul><li>ISP: Immediate Services Program </li></ul><ul><li>ICS: Incident Command System </li></ul><ul><li>PIO: Public Information Officer </li></ul><ul><li>NIMS: National Incident Management System </li></ul><ul><li>ARC: American Red Cross </li></ul><ul><li>ESF: Emergency Support Function </li></ul><ul><li>VOAD </li></ul><ul><li>SOP </li></ul><ul><li>FEMA </li></ul>
  120. 120. The Acronym Game! <ul><li>KDEM: Kansas Department of Emergency Management </li></ul><ul><li>CMHS: Center for Mental Health Services </li></ul><ul><li>KEOP: Kansas Emergency Operations Plan </li></ul><ul><li>KAHBH: Kansas All-Hazards Behavioral Health Program </li></ul><ul><li>ISP: Immediate Services Program </li></ul><ul><li>ICS: Incident Command System </li></ul><ul><li>PIO: Public Information Officer </li></ul><ul><li>NIMS: National Incident Management System </li></ul><ul><li>ARC: American Red Cross </li></ul><ul><li>ESF: Emergency Support Function </li></ul><ul><li>VOAD: Voluntary Organizations Active in Disaster </li></ul><ul><li>SOP </li></ul><ul><li>FEMA </li></ul>
  121. 121. The Acronym Game! <ul><li>KDEM: Kansas Department of Emergency Management </li></ul><ul><li>CMHS: Center for Mental Health Services </li></ul><ul><li>KEOP: Kansas Emergency Operations Plan </li></ul><ul><li>KAHBH: Kansas All-Hazards Behavioral Health Program </li></ul><ul><li>ISP: Immediate Services Program </li></ul><ul><li>ICS: Incident Command System </li></ul><ul><li>PIO: Public Information Officer </li></ul><ul><li>NIMS: National Incident Management System </li></ul><ul><li>ARC: American Red Cross </li></ul><ul><li>ESF: Emergency Support Function </li></ul><ul><li>VOAD: Voluntary Organizations Active in Disaster </li></ul><ul><li>SOP: Standard Operating Procedures </li></ul><ul><li>FEMA </li></ul>
  122. 122. The Acronym Game! <ul><li>KDEM: Kansas Department of Emergency Management </li></ul><ul><li>CMHS: Center for Mental Health Services </li></ul><ul><li>KEOP: Kansas Emergency Operations Plan </li></ul><ul><li>KAHBH: Kansas All-Hazards Behavioral Health Program </li></ul><ul><li>ISP: Immediate Services Program </li></ul><ul><li>ICS: Incident Command System </li></ul><ul><li>PIO: Public Information Officer </li></ul><ul><li>NIMS: National Incident Management System </li></ul><ul><li>ARC: American Red Cross </li></ul><ul><li>ESF: Emergency Support Function </li></ul><ul><li>VOAD: Voluntary Organizations Active in Disaster </li></ul><ul><li>SOP: Standard Operating Procedures </li></ul><ul><li>FEMA: Federal Emergency Management Agency </li></ul>
  123. 123. Examples of Disaster Crisis Counseling Program Services <ul><li>Outreach </li></ul><ul><li>Screening and Assessment </li></ul><ul><li>Counseling </li></ul><ul><li>Information and Referral </li></ul><ul><li>Public Education & Social Advocacy </li></ul>
  124. 124. Program Limitations <ul><li>Medications </li></ul><ul><li>Hospitalization </li></ul><ul><li>Long-term Therapy </li></ul><ul><li>Providing Childcare or Transportation </li></ul><ul><li>Fundraising activities </li></ul><ul><li>Individual Advocacy </li></ul><ul><li>Long-term Case Management </li></ul>
  125. 125. All-Hazards Crisis Counseling and “Traditional” Behavioral Health Practice <ul><li>Primarily Office-Based </li></ul><ul><li>Focus on Diagnosis & Treatment of Mental Illness </li></ul><ul><li>Attempt to Impact Personality & Functioning </li></ul><ul><li>Examines Content </li></ul><ul><li>Encourages Insight into Past Experiences & Influence on Current Problems </li></ul><ul><li>Psychotherapeutic Focus </li></ul><ul><li>Primarily Home & Community Based </li></ul><ul><li>Assessment of Strengths, Adaptation & Coping Skills </li></ul><ul><li>Seeks to Restore Pre-Disaster Functioning </li></ul><ul><li>Accepts Content at Face Value </li></ul><ul><li>Validates Appropriateness of Reactions and Normalizes Experience </li></ul><ul><li>Psycho-educational focus </li></ul>“ Traditional” Practice Disaster Crisis Counseling Source : ESDRB Program Guidance, December, 1996
  126. 126. All-Hazards Crisis Counseling and “Traditional” Case Management <ul><li>Provide services to individuals with SPMI or other disability </li></ul><ul><li>Services provided for indefinite duration </li></ul><ul><li>Responsible and accountable for client service provision </li></ul><ul><li>Power to influence services for their client </li></ul><ul><li>Long-term relationship with clients </li></ul><ul><li>Provide services to disaster survivors who often have a high level of functioning </li></ul><ul><li>Services provided do not require continuity of care </li></ul><ul><li>Empower disaster victims to advocate for services needed </li></ul><ul><li>Short-term relationship with disaster victims </li></ul>“ Traditional” Case Management Disaster Crisis Counseling Source : ESDRB Program Guidance, December, 1996
  127. 127. 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)
  128. 128. Summary <ul><li>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 </li></ul>
  129. 129. 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
  130. 130. FEMA/SAMHSA CMHS All-Hazards/Disaster Crisis Counseling Program Grants: Immediate Services Program and Regular Services Program
  131. 131. <ul><li>Immediate Services Program: </li></ul><ul><ul><li>Application due within 14 days of Presidential disaster declaration </li></ul></ul><ul><ul><li>Funds 60 days of services </li></ul></ul><ul><li>Regular Services Program: </li></ul><ul><ul><li>Application due within 60 days of Presidential declaration </li></ul></ul><ul><ul><li>Funds nine (9) months of services </li></ul></ul>
  132. 132. Summary <ul><li>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 ) </li></ul>
  133. 133. Module 6: The KAHBH Program: Preparedness, Response, and Recovery for Kansas Communities
  134. 134. Organizations Involved in Behavioral Health Disaster Response <ul><li>Federal </li></ul><ul><ul><li>SAMHSA — S ubstance A buse M ental H ealth S ervices A dministration & CMHS — C enter for M ental H ealth S ervices </li></ul></ul><ul><ul><li>FEMA — F ederal E mergency M anagement A gency </li></ul></ul><ul><li>State </li></ul><ul><ul><li>KDEM —K ansas D ept. of E mergency M anagement </li></ul></ul><ul><ul><ul><li>KDHE — K ansas D ept. of H ealth and E nvironment </li></ul></ul></ul><ul><ul><ul><ul><li>SRS —Kansas Dept. of S ocial and R ehabilitation S ervices </li></ul></ul></ul></ul><ul><li>Local </li></ul><ul><ul><li>Local emergency management agencies </li></ul></ul><ul><ul><li>CMHC — C ommunity M ental H ealth C enters </li></ul></ul><ul><ul><li>Local professionals and para-professionals (substance abuse professionals, clergy, doctors/nurses, fire/police department, volunteers, etc.) </li></ul></ul>
  135. 136. State-Level Role of KAHBH <ul><li>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 </li></ul><ul><li>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 </li></ul>
  136. 137. <ul><li>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 </li></ul><ul><li>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 </li></ul><ul><li>The Kansas All-Hazards Behavioral Health (KAHBH) Team was developed through the subcontract </li></ul>
  137. 138. KAHBH Purpose <ul><li>KAHBH provides State-wide organization and coordination for behavioral health response to disaster and other all-hazards events </li></ul><ul><ul><li>Training and preparing Kansas professionals and paraprofessionals to serve in behavioral health capacity during an event </li></ul></ul><ul><ul><li>Providing technical assistance and all-hazards behavioral health information to Kansans </li></ul></ul>
  138. 139. Key KAHBH Tasks <ul><li>Resource identification and collection </li></ul><ul><li>Training and education </li></ul><ul><li>Development of Annex to KEOP, KAHBH Plan, and Standard Operating Procedures </li></ul><ul><li>State-wide network recruitment and coordination </li></ul><ul><li>Preparedness, response, and recovery activities </li></ul>
  139. 140. KAHBH Network <ul><li>10 staff </li></ul><ul><li>15 Stakeholders </li></ul><ul><li>12 SRS Field Staff </li></ul><ul><li>29 CMHC Coordinators </li></ul><ul><li>Goal: 200+ KAHBH Network members </li></ul>
  140. 141. KAHBH Stakeholder Supporting Agencies <ul><li>Kansas Department of Health & Environment, Office of Local & Rural Health, Topeka </li></ul><ul><li>SRS Mental Health Authority, Topeka </li></ul><ul><li>SRS Health Care Policy, Addiction & Rehabilitation Services, Topeka </li></ul><ul><li>Kansas State University, School of Family Studies and Human Services, Manhattan </li></ul><ul><li>University of Kansas School of Medicine, Department of Preventive Medicine & Public Health, Wichita </li></ul><ul><li>Lawrence Therapy Services, Lawrence </li></ul><ul><li>Mental Health Center of East Central Kansas, Emporia </li></ul><ul><li>Regional Prevention Center, Olathe </li></ul><ul><li>Mid-America Addiction Technology Transfer Center </li></ul><ul><li>COMCARE, Wichita </li></ul><ul><li>American Red Cross, Midway Kansas Chapter, Wichita </li></ul><ul><li>Wyandot Center, Kansas City </li></ul><ul><li>Association of Community Mental Health Centers of Kansas, Inc., Topeka </li></ul><ul><li>Center for Counseling & Consultation, Great Bend </li></ul><ul><li>Prairie View Behavioral & Mental Health Care, Newton ** </li></ul><ul><li>Heartland Assessment Center, Roeland Park, KS ** </li></ul><ul><li>**Resigned due to accepting positions in other states </li></ul>
  141. 142. KAHBH Plan and Operations Manual <ul><li>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. </li></ul><ul><ul><li>KDEM acceptance currently is pending </li></ul></ul><ul><li>The State Plan will provide a detailed description of the behavioral health preparedness, response, and recovery in Kansas </li></ul><ul><li>Preliminary drafts of the Operations Manual have been developed and reviewed by the SRS Contract Manager. </li></ul>
  142. 143. <ul><li>KAHBH </li></ul><ul><li>Plan </li></ul>KAHBH ANNEX (Submitted to KDEM) KAHBH Training Operations Manual
  143. 144. KDEM KS Citizens KS Citizens State Plan
  144. 145. KDEM KS Citizens KS Citizens State Plan KAHBH
  145. 146. KDEM KS Citizens KS Citizens State Plan KAHBH State Stakeholders
  146. 147. KDEM KS Citizens KS Citizens State Plan KAHBH State Stakeholders American Red Cross
  147. 148. KDEM KS Citizens KS Citizens State Plan KAHBH State Stakeholders American Red Cross Education: Trainings, Universities, Conferences
  148. 149. 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
  149. 150. 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
  150. 151. 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
  151. 152. 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
  152. 153. 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
  153. 154. 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
  154. 155. Role of KAHBH Network Members <ul><li>SAMHSA/CMHC Model </li></ul><ul><li>Professionals and paraprofessionals working in teams </li></ul><ul><li>Based on SRS CMHC Regions </li></ul><ul><ul><li>27 total areas in Kansas </li></ul></ul>
  155. 156. The KAHBH Program is not: <ul><li>American Red Cross Disaster Mental Health Services (ARC DMHS) </li></ul><ul><ul><li>ARC requires a masters-level licensed mental health professional </li></ul></ul><ul><ul><li>ARC mental health workers are volunteers and do not receive reimbursement for their services </li></ul></ul><ul><li>Critical Incident Stress Management (CISM) </li></ul><ul><ul><li>Model developed and approved for use with first responders, but often is applied to many areas of crisis response, which may not be appropriate </li></ul></ul>
  156. 157. <ul><li>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. </li></ul>
  157. 158. Network members should be: <ul><li>Indigenous to the communities they serve </li></ul><ul><li>Possess varied experience working with various populations in need </li></ul><ul><li>Capable of providing all-hazards behavioral health services through non-traditional methods </li></ul><ul><li>Sensitive to cultural issues </li></ul>
  158. 159. Key Characteristics/Abilities of KAHBH Personnel <ul><li>Key personal characteristics and abilities of those particularly suited for disaster work are: </li></ul><ul><ul><li>Mature </li></ul></ul><ul><ul><li>Sociable </li></ul></ul><ul><ul><li>Calm </li></ul></ul><ul><ul><li>Knowledgeable about how systems work </li></ul></ul><ul><ul><li>Flexible </li></ul></ul><ul><ul><li>Tolerates ambiguity well </li></ul></ul><ul><ul><li>Empathetic </li></ul></ul><ul><ul><li>Genuine </li></ul></ul><ul><ul><li>Shows positive regard for others </li></ul></ul><ul><ul><li>Good listener </li></ul></ul>
  159. 160. Module 7: Behavioral Health and the All-Hazards Disaster Response System
  160. 161. The Role of Behavioral Health in All-Hazards Response <ul><li>Behavioral health consultation </li></ul><ul><li>Liaison with key agencies </li></ul><ul><li>Psychoeducation through media </li></ul><ul><li>Behavioral health services with survivors, families </li></ul><ul><li>Behavioral health services with responders </li></ul><ul><li>Stress management support </li></ul>
  161. 162. <ul><li>The role of behavioral health in all-hazards crisis response may include the following: </li></ul><ul><ul><li>On-scene interventions </li></ul></ul><ul><ul><li>Immediate interventions </li></ul></ul><ul><ul><li>Psychological first aid </li></ul></ul><ul><ul><li>Crisis interventions </li></ul></ul><ul><ul><li>Crime victim assistance </li></ul></ul><ul><ul><li>Community outreach </li></ul></ul><ul><ul><li>Death notification </li></ul></ul><ul><ul><li>Brief trauma interventions </li></ul></ul><ul><ul><li>Post-disaster inventions </li></ul></ul>
  162. 163. Emergency Operations Center (EOC) <ul><li>Provides a common, centralized operation location </li></ul><ul><li>Ensures clear delegation of responsibility </li></ul><ul><li>Coordinates personnel, supplies & equipment </li></ul><ul><li>Serves as a single point of information flow </li></ul><ul><li>Relays warning to local officials and the public </li></ul><ul><li>Works with the Incident Command System (ICS) </li></ul>
  163. 164. Incident Command System (ICS) <ul><li>Standardized, on-scene, all-hazards incident management system </li></ul><ul><li>Provides basic direction and control </li></ul><ul><li>Federal (NIMS) and local level (ICS) organized system </li></ul><ul><li>Coordination of decision making among responder agencies </li></ul><ul><li>Provides a chain of command </li></ul>
  164. 165. Incident Command System (ICS) <ul><li>A proven management system based on successful business practices </li></ul><ul><li>The result of decades of lessons learned in the organization and management of emergency incidents </li></ul><ul><li>Is a component of NIMS </li></ul><ul><li>Has become the standard for emergency management across the country </li></ul>
  165. 166. Incident Command System (ICS) <ul><li>Meets the needs of incidents of any kind or size </li></ul><ul><ul><li>Used to manage Salt Lake City Olympics </li></ul></ul><ul><li>Allows personnel from a variety of agencies to meld rapidly into a common management structure </li></ul><ul><li>Provides logistical and administrative support to operational staff </li></ul><ul><li>Provides a cost effective method of management by avoiding duplication of efforts </li></ul>
  166. 167. ICS Organizational Structure <ul><li>Operations </li></ul><ul><ul><li>Directs activities to reduce the immediate hazard and restore essential functions </li></ul></ul><ul><li>Planning </li></ul><ul><ul><li>Acquires information on current and future situations </li></ul></ul><ul><li>Logistics </li></ul><ul><ul><li>Support for basic needs (communication, medical, food, supplies, transportation) </li></ul></ul><ul><li>Finance/Administration </li></ul><ul><ul><li>Tracks all costs </li></ul></ul><ul><ul><li>Provides administrative responsibilities for operation </li></ul></ul>
  167. 168. INCIDENT COMMAND Operations Planning Logistics Finance/ Administration Basic Incident Command Structure
  168. 169. 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
  169. 170. <ul><li>As responders to all-hazards events, it is critical that behavioral health providers become part of the emergency response system </li></ul>
  170. 171. Federal requirement that all responders: <ul><li>Follow ICS procedures </li></ul><ul><li>Receive ICS and NIMS training </li></ul><ul><li>Meet minimum standards </li></ul><ul><li>“ 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.” </li></ul>
  171. 172. <ul><li>Strongly encourage the following ICS and NIMS training for KAHBH Members </li></ul><ul><ul><li>ICS 100, Introduction to ICS </li></ul></ul><ul><ul><ul><li>ALL responders/workers + supervisors/administrators </li></ul></ul></ul><ul><ul><li>ICS 200, Basic ICS </li></ul></ul><ul><ul><ul><li>supervisors/administrators </li></ul></ul></ul><ul><ul><li>FEMA IS 700, NIMS: An Introduction </li></ul></ul><ul><ul><ul><li>ALL responders/workers + supervisors/administrators </li></ul></ul></ul><ul><ul><li>FEMA IS 800, National Response Plan (NRP): An Introduction </li></ul></ul><ul><ul><ul><li>supervisors/administrators </li></ul></ul></ul>
  172. 173. <ul><li>Training available online </li></ul><ul><li>www.fema.gov/nims </li></ul><ul><ul><li>NIMS Training (on the left of the screen) </li></ul></ul><ul><ul><li>Fact Sheets and information for these 4 courses </li></ul></ul><ul><li>Local “live” courses also may be available </li></ul><ul><ul><li>Contact your local Emergency Management office </li></ul></ul>
  173. 174. Module 8: KAHBH Community Outreach Teams: Structure, Procedures, and Documents
  174. 175. KAHBH Network: <ul><li>COT Structure </li></ul><ul><li>COT Call-Up Procedure </li></ul><ul><li>COT Member Rotation </li></ul><ul><li>COT Member Debriefing </li></ul><ul><li>Forms/Documents </li></ul>
  175. 177. <ul><li>The KAHBH Program Coordinator(s) will: </li></ul><ul><li>Receive and collate data from the Community Outreach Teams in the field. </li></ul><ul><li>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. </li></ul><ul><li>Coordinate data collection from FEMA, American Red Cross, Kansas Department of Emergency Management officials, etc. </li></ul><ul><li>Prepare the Immediate Services and Regular Services grant applications in a Presidentially Declared disaster. </li></ul>
  176. 178. <ul><li>The CMHC Coordinators/ </li></ul><ul><li>Community Outreach Team Leaders will: </li></ul><ul><li>Be responsible to the KAHBH Program in carrying out the overall mission at the local level </li></ul><ul><li>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. </li></ul><ul><li>Advise the team leaders about where and to whom to report at the disaster site. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>Be responsible for summarizing contact data and reporting it daily to the KAHBH Coordinator </li></ul>
  177. 179. The KAHBH Network Members will: <ul><li>Provide crisis counseling, debriefing, and support to survivors when the disaster exceeds the CMHC’s or hospital's capacity to respond effectively.  </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>Be responsible for documenting their contacts daily and reporting it to the CMHC Coordinator/Community Outreach Team Leader. </li></ul>
  178. 180. <ul><li>These are guidelines that may vary depending upon: </li></ul><ul><ul><li>the scope and nature of the disaster </li></ul></ul><ul><ul><li>varying needs and stresses as the response effort matures </li></ul></ul>KAHBH Network Rotation
  179. 181. Recommended Guidelines for On-Site Schedule <ul><li>Team Leaders and workers : </li></ul><ul><li>No more than 5 full continuous days </li></ul><ul><li>Will have a reasonable time of rest after 10-12 hours work </li></ul><ul><li>Will have daily briefings with response team </li></ul><ul><li>Will have pre and post shift briefings </li></ul>
  180. 182. Recommended Guidelines for Off-Site Schedule <ul><li>Team members should leave the site after 10 days of work </li></ul><ul><li>Team members should have 2 days administrative leave </li></ul><ul><li>Team members should have a debriefing at their home facility or CMHC within 5-7 days of returning from the event </li></ul><ul><li>Team members returning to the event site should have one debriefing at home before returning for another rotation </li></ul>
  181. 183. Post Rotation Debriefing <ul><li>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. </li></ul><ul><li>The CMHC Coordinator/Community Outreach Team Leader will organize debriefing sessions for Network members responding in their area. </li></ul><ul><li>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). </li></ul><ul><li>Post-Response debriefing should be arranged as needed for each group of response workers. </li></ul>
  182. 184. <ul><li>FEMA/SAMHSA CMHS </li></ul><ul><li>Crisis Counseling Program </li></ul><ul><li>Forms </li></ul><ul><li>and </li></ul><ul><li>Documentation </li></ul>
  183. 185. <ul><li>Concluding Comments </li></ul><ul><li>Questions? </li></ul>
  184. 186. 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.

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