Kansas All-Hazards
Behavioral Health
Training
Core Competencies
for Community Outreach Workers
1
What is KAHBH?
• KAHBH provides State-wide organization
and coordination for behavioral health
response to disaster and other all-hazards
events
– Training and preparing Kansas professionals
and paraprofessionals to serve in behavioral
health capacity during an event
– Providing technical assistance and all-hazards
behavioral health information to Kansans
2
Key KAHBH Tasks
• Resource identification and collection
• Training and education
• Development of Annex to KEOP, KAHBH
Plan, and Standard Operating Procedures
• State-wide network recruitment and
coordination
• Preparedness, response, and recovery
activities
3
KAHBH Network
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10 staff
15 Stakeholders
12 SRS Field Staff
29 CMHC Coordinators
Goal: 200+ KAHBH Network members
4
Outline of
KAHBH Trainings
KAHBH Core Behavioral Health Training
• DAY 1 (approx. 8 hours)
– For all participants without CISM or ARC DMH training within the last 5
years (Mental health and paraprofessionals)
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Module 1: Disaster Classifications and Phases
Module 2: Traumatic Reactions to Disasters
Module 3: Providing Support During Disasters
Module 4: Considerations for Special Populations, Cultural Competence, and
Ethical Issues
• Day 2 (approx. 3.5)
– For ALL KAHBH Network members
• Module 5: The FEMA/SAMHSA CMHS Crisis Counseling Assistance and
Training Program
• Module 6: The KAHBH Program: Preparedness, Response, and Recovery for
Kansas Communities
• Module 7: Behavioral Health and the All-Hazards Disaster Response System
• Module 8: KAHBH Community Outreach Teams: Structure, Procedures, and
Documents
5
• Paraprofessional Training
– ½ day (4 hours) training to provide non-behavioral
health professionals with background information
in working with people in crisis, communication
skills, issues related to confidentiality and ethics,
and other basic helping skills
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The Role of the Helper
Professional and personal boundaries
Ethics, confidentiality, and dual relationships
Communication Skills
Challenges in Helping
Diversity and multicultural awareness as a helper
Helping in Crisis and Grief Situations
6
• Future Specialty Trainings
– To be based on each community’s needs
– All non-mental health members will receive additional ½ day (4 hours)
training on basic helping skills in crisis counseling
– At least 2 members (1 MH and 1 NMH) from each area will receive
specialized training in the following areas (to be provided online in 2-4 hour
trainings):
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Children (under age 18)
Frail Elderly
Developmentally and physically disabled
Severe Mental Illness and People in active Substance Abuse Treatment
People in Correctional Institutions
College Students in dorms/away from home/Families/individuals relocated
People with high traumatic exposure
People in poverty and homeless
Roles of women in community (e.g. new moms, multiple caregivers)
Men and Women
Emergency responders involved in rescue/recovery
Multicultural issues
7
Farmers/Ranchers/Agricultural Workers/Rural Populations
Core Competencies,
Terminology, and Regional
Disaster Information
8
KAHBH
Core Objectives
1.
2.
3.
4.
5.
6.
7.
Understand the difference between Community Mental Health
Center (CMHC) crisis counseling and the AllHazards/Disaster Behavioral Health “crisis counseling”
(FEMA/SAMHSA CMHS) model
Understand human behavior in disasters
Understand the key concepts of all-hazards behavioral health
Understand the organizational aspects of disaster response
Understand how to assess the needs of and intervene
effectively with disaster survivors, including special
populations
Provide appropriate behavioral health assistance to survivors
and workers at the community level
Understand, recognize and manage stress in disaster work 9
KAHBH
Core Competencies
• Identifies relevant and appropriate data and information sources
• Obtains and interprets information regarding risks and benefits to the
community
• Recognizes how the data illuminates ethical, political, scientific,
economic, and overall public behavioral health issues
• Prepare and implement behavioral health emergency response plans
• Advocates for public health/behavioral health programs and resources
• Effectively presents accurate demographic, statistical, programmatic and
scientific information for professional and lay audiences
• Utilizes appropriate methods for interacting sensitively, effectively, and
professionally with persons from diverse cultural, socioeconomic,
educational, racial, ethnic, and professional backgrounds, and persons of
all ages and lifestyle preferences
• Identifies the role of cultural, social, and behavioral factors in determining
10
the delivery of public health/behavioral health services
KAHBH
Core Competencies
• Develops and adapts approaches to problems that take into account
cultural differences
• Collaborates with community partners to promote the health/behavioral
health of the population
• Identifies community assets and available resources
• Describes the role of government in the delivery of community behavioral
health services
• Identifies the individual’s and organization’s responsibilities within the
context of the KAHBH Program and its core functions
• Creates a culture of ethical standards within organizations and
communities
• Helps create key values and shared vision and uses these principles to
guide action
• Identifies internal and external issues that may impact delivery of
essential public behavioral health services (i.e., strategic planning)
• Promotes team and organizational learning
11
“It is important to remember that mental health
intervention is a prompt and effective medical response
to a bioterrorism attack. Early detection, successful
management of casualties, and effective treatments
bolster the public’s sense of safety and increase
confidence in our institutions. Because the overriding
goal of terrorism is to change people’s beliefs, sense of
safety, and behaviors, mental health experts are an
essential part of planning and responding.”
Statement from the Conference Transcript:
Responding to Bioterrorism: Individual and Community Needs,
October 19-21,122001
“Mental Health is the linchpin to an
effective response.”
Statement from April 2005
TOPOFF 3 Exercise
13
Terminology
“Behavioral Health”
Mental Health + Substance Abuse
14
Terminology
(continued)
All-Hazards = All-Hazards
Disasters ~ Bioterrorism ~ Major Community Crises
15
Examples of All-Hazards Crisis
Counseling Program Services
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Outreach
Screening and Assessment
Counseling
Information and Referral
Public Education & Social
Advocacy
16
Program
Limitations
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Medications
Hospitalization
Long-term Therapy
Providing Childcare or Transportation
Fundraising activities
Individual Advocacy
Long-term Case Management
17
All-Hazards Crisis Counseling
and “Traditional”
Behavioral Health Practice
“Traditional” Practice
• Primarily Office-Based
• Focus on Diagnosis &
Treatment of Mental Illness
• Attempt to Impact Personality
& Functioning
• Examines Content
• Encourages Insight into Past
Experiences & Influence on
Current Problems
• Psychotherapeutic Focus
Disaster Crisis
Counseling
• Primarily Home & Community Based
• Assessment of Strengths, Adaptation
& Coping Skills
• Seeks to Restore Pre-Disaster
Functioning
• Accepts Content at Face Value
• Validates Appropriateness of
Reactions and Normalizes
Experience
• Psycho-educational focus
Source: ESDRB Program Guidance, December, 1996
18
• The KAHBH Program follows the
FEMA/SAMHSA CMHS Crisis Counseling
Program as the primary model
– Federal program
• Over 30 year history
• “Best Practice” nationally recognized material
– Collaboration between FEMA, SAMHSA
CMHS, state mental health authority (SRS in
Kansas), and local responders
– Community based
• Focus on providing services to the general
population
• Includes paraprofessionals or community “heroes”
19
as potential providers
Organizations Involved in
Behavioral Health Disaster
Response
• Federal
– SAMHSA—Substance Abuse Mental Health Services
Administration & CMHS—Center for Mental Health Services
– FEMA—Federal Emergency Management Agency
• State
– KDEM—Kansas Dept. of Emergency Management
• KDHE—Kansas Dept. of Health and Environment
– SRS—Kansas Dept. of Social and Rehabilitation Services
• Local
– Local emergency management agencies
– CMHC—Community Mental Health Centers
– Local professionals and para-professionals (substance abuse
professionals, clergy, doctors/nurses, fire/police department, 20
volunteers, etc.)
The KAHBH Program is not:
• American Red Cross Disaster Mental Health
Services (ARC DMHS)
– ARC requires a masters-level licensed mental health professional
– ARC mental health workers are volunteers and do not receive
reimbursement for their services
• Critical Incident Stress Management (CISM)
– Model developed and approved for use with first responders, but
often is applied to many areas of crisis response, which may not be
appropriate
21
The KAHBH Program
• Emphasizes the importance of ALL
approaches to all-hazards/disaster events
• Recognizes and supports collaboration
between behavioral health responders and
other responders in all-hazards/disaster
events
• Works to provide State-wide organization
and coordination for behavioral health
response to disaster and other all-hazards
events
22
Regional
Disaster Information
23
Module 1:
Disaster
Classifications
and Phases
24
Wichita tornado
Definition of a
Disaster
A disaster is a threatening or
occurring event of such destructive
magnitude and force as to:
• dislocate people
• separate family members
• damage or destroy homes
• injure or kill people
25
• 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.
26
Natural Disasters
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Floods
Tornados
Hurricanes
Typhoons
Winter storms
Tsunamis
Hail storms
Wildfires
Windstorms
Epidemics
Earthquakes
27
Human-Caused Disasters
• Intentional and unintentional
– Residential fires
– Building collapses
– Transportation accidents
– Hazardous materials releases
– Explosions
– Domestic acts of terrorism
28
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
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Emergency Relief Act (P.L. 93-288 as amended)
Behavioral Health Response to
Presidentially Declared Disaster
Event
City Response
County Response
State Response
KDEM Application
National Disaster
Presidentially
Declared Disaster
30
Classification of
Disasters
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Natural vs. Human-caused
Degree of personal impact
Size and scope
Visible impact/low point
Probability of
reoccurrence
31
Critical Disaster
Stressors
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Threat to one’s life
Threat of harm to family
Destruction of home or community
Significant media attention
Witnessing others’ trauma
Being trapped or unable to evacuate
32
Phases of
Disaster Reactions
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Warning of threat
Impact
Rescue or Heroic
Remedy or Honeymoon
Inventory
Disillusionment
Reconstruction and recovery
33
Typical Phases of Disasters
Honeymoon
(Community
Cohesion)
Reconstruction
“Heroic”
A New Beginning
Pre-disaster
Disillusionment
Warning
Threat
Impact
Inventory
Trigger Events and Anniversary
Reactions
34
Zunin/Meyers
1 to 3 Days -------------------TIME-------------------------------------------1 to 3 Years
Comparing Criminally
Human-Caused and
Natural Disasters
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Causation
Appraisal of event
Psychological impact
Subjective experience
World view/basic assumption
Stigmatization of victims
Media
Secondary injury
35
Terrorism Within the
United States
• “An activity that involves a violent act or an act of
dangerousness to human life that is in violation of the
criminal laws of the United States, or of any
State…and that appears to be intended to intimidate
or coerce a civilian population…
or to influence the policy
of government by
assassination or
kidnapping.”
[18 U.S.C. 3077]
36
Mass Violence Within
the United States
• “An intentional violent criminal act, for which a
formal investigation has been opened by the
FBI or other law enforcement agency, that
results in physical, emotional, or
psychological injury to a sufficiently large
number of people as to significantly increase
the burden of victim assistance for the
responding jurisdiction”
37
Summary
• Disasters can be classified according to
a number of different variables,
including natural vs. human-caused
• Most disasters have distinguishable
phases, beginning with the pre-disaster
and warning phase and ending with the
reconstruction phase
38
Module 2:
Traumatic Reactions to
Disasters
39
Effects of
Trauma
• Vary by a person’s age, developmental stage,
prior condition, degree of personal impact
• Vary by the disaster’s severity, the amount of
advance warning, the level of community
preparedness
• May include physical, emotional, cognitive or
behavioral reactions
40
Psychosocial
Concerns
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Disruption of existing social/community
Impact of new social patterns
Duration of recovery
Cross-cultural impact
41
What Scares Us?
• Things frighten us more
if they are…
– Controlled by someone
else
– Not beneficial in any way
to anyone
– Hard to treat or treatment
is not available to
everyone
– Catastrophic or deadly
– Exotic or unusual
• than things that are…
– In our control
– Helpful or beneficial to us
or society
– Easily and quickly
diagnosable and
treatable
– Survivable
– Familiar and routine
42
Stressors in
Disaster Work
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Event related
Occupational
Organizational
Family or personal life
43
Stress
Basics
• Stress is:
– Normal
– Necessary
– Productive and destructive
– Acute and delayed
– Cumulative
– Identifiable
– Preventable and manageable
44
Physical Changes with
Stress
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Pupils dilate
Dry mouth
Heart rate increases
Increased HCI (Hydrochloric Acid)
Sleep disturbances
Lower back pain
Stomach motility inhibited (peristalsis)
Blood flow changes
Increased cholesterol production
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Emotional Changes with
Stress
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Increased feelings of isolation
Depression
Anger
Anhedonia (lack of joy)
Slowed learning speed
Impaired decision making
Decreased self-awareness
46
Mental Changes with
Stress
• Decreased memory
• Decreased attention span
• Decreased intimacy
47
Organizational
Approaches
• Effective management structure and
leadership
• Clear purpose and goals
• Functionally defined roles
• Team support
• Plan for stress management
48
Individual
Approaches
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Management of workload
Balances lifestyle
Stress reduction strategies
Self-awareness
49
Effects of Long-Term
Disaster Stress
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Anxiety and vigilance
Anger, resentment, and conflict
Uncertainty about the future
Prolonged mourning of losses
Diminished problem-solving
Isolation and hopelessness
Health problems
Lifestyle changes
50
Acute Traumatic
Stress Disorder
• The development, within one month of
the event, of at least 3 of the following:
– Dissociation, emotional numbing
– A re-experiencing of the event
– Behavioral avoidance
– Increased physiologic arousal
– Social-occupational impairment
51
Long Term
Trauma
• For some, it may last months or years
• The rates of PTSD are much higher among
victims of violent crimes than victims of other
types of traumatic events
• Crime victims who believed they would be
killed or seriously injured were much more
likely to develop PTSD than victims whose
crimes did not involve life-threatening injury.
52
Post-Traumatic
Stress Disorder
• Persistent re-experiencing of the event
• Avoidance of things associated with
event
• Symptoms of increased arousal
• Distress or impairment
in social, occupational,
or other areas
53
Other Long Term
Reactions
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Major depression
Suicidal thoughts and attempts
Alcohol and drug abuse
Anxiety disorders
Dissociative disorders
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Summary
• Disasters can elicit traumatic reactions
in the victims who survive it.
55
Additional Reactions to
Disasters
56
Disaster Stress and
Grief Reactions
• Normal responses to abnormal situation
– Often transitory in nature
• Reactions:
– Emotional and psychological strain
– Acute stress
– Post traumatic stress
– Grief reactions
– Immediate and practical problems in living
57
Physical
Reactions
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Fatigue, exhaustion
Gastrointestinal distress
Appetite changes
Tightening in the throat or chest
Other somatic complaints
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Emotional
Reactions
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Depression, sadness
Irritability, anger, resentment
Anxiety, fear
Despair, hopelessness
Guilt, self-doubt
Unpredictable mood swings
59
Cognitive
Reactions
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Confusion, disorientation
Recurring dreams, nightmares
Preoccupations with disaster
Trouble concentrating or remembering
things
• Difficulty making decisions
• Questioning spiritual beliefs
60
Behavioral
Reactions
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Sleep problems
Crying easily
Avoiding reminders
Excessive activity level
Increased conflicts with family
Hypervigilance, startle reactions
Isolation or social withdrawal
61
Spiritual
Reactions
• Withdrawal from places of worship or
spiritual practices
• Uncharacteristic religious involvement
• Being troubled by biblical or historical
predictions
• Questioning meaning and beliefs
• Anger with God or higher power
• Loss of faith
62
Chronic Stressors
in Disasters
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Family disruption
Work overload
Gender differences
Bureaucratic hassles
Financial strain
63
Loss and Grief
• Loss is a common theme in disaster
settings
• Common reactions to loss:
– Denial, numbness or shock
– Anger
– Bargaining
– Depression
– Acceptance
– Reorientation
64
Loss and Grief –
Signs of Trouble
• Using alcohol or drugs to
self-medicate
• Using work or other distractions
to avoid feelings
• Hostility and aggression toward
others
• Avoiding or minimizing emotions
65
Emotional Numbness
or Extreme Agitation
• Immediate attention is needed
• Possible referral for professional care
• When referring:
– Inform the person of your intention
– Recognize that the referral may cause a
negative reaction
66
Summary
• Disasters may elicit a number of nontraumatic responses in its victims,
including:
– Grief reactions
– Physical reactions
– Emotional reactions
– Cognitive reactions
– Behavioral reactions
67
Module 3:
Providing Support During
Disasters
68
All-Hazards Crisis Counseling
and “Traditional”
Behavioral Health Practice
“Traditional” Practice
• Primarily Office-Based
• Focus on Diagnosis &
Treatment of Mental Illness
• Attempt to Impact Personality
& Functioning
• Examines Content
• Encourages Insight into Past
Experiences & Influence on
Current Problems
• Psychotherapeutic Focus
Disaster Crisis Counseling
• Primarily Home & Community
Based
• Assessment of Strengths,
Adaptation & Coping Skills
• Seeks to Restore Pre-Disaster
Functioning
• Accepts Content at Face Value
• Validates Appropriateness of
Reactions and Normalizes
Experience
• Psycho-educational focus
Source: ESDRB Program Guidance, December, 1996
69
All-Hazards Crisis Counseling
and “Traditional”
Case Management
“Traditional” Case Management
• Provide services to individuals
with SPMI or other disability
• Services provided for indefinite
duration
• Responsible and accountable
for client service provision
• Power to influence services for
their client
• Long-term relationship with
clients
Disaster Crisis Counseling
• Provide services to disaster
survivors who often have a high
level of functioning
• Services provided do not require
continuity of care
• Empower disaster victims to
advocate for services needed
• Short-term relationship with
disaster victims
Source: ESDRB Program Guidance, December, 1996
70
In other words…
• CMHC Crisis Counseling
– Day-to-day crises
– A few people from a target population
experiencing severe reactions (suicide, violence,
psychiatric problems, substance abuse)
• All-Hazards/Disaster Crisis Counseling
– Event specific
– Targets the general population (lots of people)
experiencing low levels (but significant) reactions
(with a few experiencing severe reactions)
71
Key Concepts in
All-Hazards Behavioral
Health
• No one who sees a disaster is untouched by it
• People experience individual and collective
trauma
• Securing disaster relief can be emotionally
stressful
• Most people pull together during and after a
disaster, but their effectiveness is diminished
• Most people do not see themselves as needing
behavioral health services following a disaster
and will not seek out such services
72
Overarching
Concepts
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Normal reactions to abnormal situation
Avoid “mental health” terms and labels
Assistance is practical
Assume competence
Focus on strengths and
potentials
• Encourage use of support
network
• Active, community fit
• Innovative in helping
73
Maslow’s Hierarchy of Needs
www.tutor2u.net/business/images/maslow_hierarchy.gif
74
Guiding Principles
in Providing Support
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First protect from danger
Focus on physical and material care
Be direct, active and remain calm
Focus on the “here and now” situation
Provide accurate information about the
situation
• Assist with mobilization of resources
75
Guiding Principles
in Providing Support (cont)
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Do not give false assurances
Recognize the importance of taking action
Reunite with family members
Provide and ensure emotional support
Focus on strengths and resilience
Encourage self-reliance
Respect feelings and cultures of others
76
Crisis
Intervention
• Observe safe practices by showing
concern for your own safety
• Remain calm and appear relaxed,
confident and non-threatening
77
Crisis Intervention
Steps
1.
2.
3.
4.
5.
Assess the situation
Establish rapport
Identify the main problem(s)
Deal with feelings and emotions
Generate and explore alternative coping
strategies
6. Formulate an action plan
7. Follow up
78
On-Scene
Interventions
• Direct to medical care, safety, shelter
• Protect from trauma, media, onlookers
• Connect to family, information, comfort
(Myers and Wee, 2003)
79
Immediate
Interventions
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Rapid assessment and triage
Psychological first-aid
Crisis intervention
Crime victim assistance
Psycho-education
Information briefings
Community outreach
80
Immediate
Interventions
(continued)
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Participation in death notification
Behavioral health consultation
Debriefing and community meetings
Information and referral
81
Psychological
First-Aid
• Provide comfort, empathy, an “ear”
• Address physical needs
• Provide concrete information about
what will happen next
• Link to support systems
• Reinforce coping strengths
82
Crisis
Intervention
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Promote safety and security
Gently explore trauma experience
Identify priority needs and solutions
Assess functioning and coping
Provide:
– Reassurance
– Psycho-education
– Practical assistance
83
Crime Victim
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Assistance
Protect victims’ rights
Ensure control over media
Provide criminal justice information
Facilitate access to compensation
Streamline bureaucratic procedures
84
Community
Outreach
• Initiate contact at gathering sites
• Set up 24-hour telephone hotlines
• Outreach to survivors through media,
Internet
• Educate service providers
• Use bilingual and bicultural workers
85
Participation in
Death Notification
• Responsible notifier:
– Obtains critical information
– Notifies next-of-kin directly, simply, and in
person
– Expects intense reactions
– Provides practical assistance
– Mental health, participates on team,
provides support and information
86
Brief Trauma
Interventions
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Factual information
Thoughts during event
Reactions and feelings
Psycho-education
Problem-solving and action
87
Post-Disaster
Behavioral Health
Interventions
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Case finding
Letters and phone calls
Community outreach
Brief counseling (individual and group)
Case management
Public education through media
Information and referral
88
Key Events with
Behavioral Health
Implications
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Death notification
Ending search and recovery
Bulldozing homes/neighborhoods
Criminal justice proceedings
Returning to impacted areas
Funeral and memorials
89
Community
Interventions
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Memorials and rituals
Usual community gatherings
Anniversary commemorations
Symbolic gestures
90
Summary
• The role of behavioral health in crisis
response may include the following:
–
–
–
–
–
–
–
–
–
On-scene interventions
Immediate interventions
Psychological first aid
Crisis interventions
Crime victim assistance
Community outreach
Death notification
Brief trauma interventions
Post-disaster inventions
91
Survivor Risk and
Resiliency Factors
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Psychological
Capacity to tolerate stress
Prior trauma history
Socioeconomic and education level
Family stability
Social support
Gender roles
92
Teaching Strategies for
Enhancing Resilience
•Encourage making connections with others
•Redirect from seeing crises as insurmountable
problems
•Encourage accepting change as a part of living
•Encourage movement toward goals
•Encourage taking directive actions
•Observe opportunities for self-discovery
93
Teaching Strategies for
Enhancing Resilience
•Nurture a positive view of self
•Encourage keeping things in perspective
•Encourage maintaining a positive outlook
•Encourage self care (emotional and
physical)
94
Summary
• The effectiveness of
all-hazards support
and crisis intervention
during a disaster may be
affected by a number of
survivor risk and resiliency
factors
95
Module 4:
Considerations for Special
Populations, Cultural
Competence, and Ethical Issues
96
Special/Vulnerable
Populations
NO ONE IS UNTOUCHED BY DISASTER…
NO ONE IS NOT VULNERABLE
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Children (under age 18)
Frail Elderly
Developmentally and physically disabled
Severe Mental Illness and People in active Substance Abuse Treatment
People in Correctional Institutions
College Students in dorms/away from home/ families/individuals relocated
People with high traumatic exposure
People in poverty and homeless
Emergency responders involved in rescue/recovery
Multicultural issues
Farmers/Ranchers/Agricultural Workers/Rural Populations
Other roles of men and women that be increase vulnerability
97
Statement of Principles for
Special Needs Populations
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•
•
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Equitable access for all
Respect for the diversities of communities
Community-based partnerships
Representation of the diversity of communities, in all
phases of emergency management
• Accountability for implementation at local, regional
and state levels
98
Cultural
Competence
• Recognize the importance of culture and respect diversity
• Maintain a current profile of the cultural composition of the
community
• Ensure that services are accessible, appropriate, and
equitable
• Recognize the role of help-seeking behaviors, customs,
and traditions, and natural support networks
• Involve as “cultural brokers” community leaders and
organizations representing diverse cultural groups
• Ensure that services and information are culturally and
linguistically competent
99
Basic Cultural
Sensitivity
•
•
•
•
•
•
•
•
•
Convey respect, good will, courtesy
Ask permission to speak with people
Explain role of behavioral health worker
Acknowledge differences in behavior due to culture
Respond to concrete needs
Dominant language/English fluency
Immigration experience and status
Family values
Cultural values and traditions
100
Ethical
Issues
• Most information on ethics and disasters
is from international disasters or recent
research with disaster survivors
• Key Considerations:
– Ability/vulnerability of survivors
– Active role in response and recovery
– Direct vs. indirect victimization
101
Key Ethical Issues
in Disasters
• Readiness of survivors to address
disaster and trauma issues
• Helper competency and
accountability
• Power and hierarchy
of helpers
• Cultural diversities
and oppressions
102
Summary
• Competent disaster behavioral health
practices require special attention given
to special/vulnerable populations,
cultural and ethical issues, and
stressors in disaster work
103
Day 2
All KAHBH Network
Members
104
Module 5:
The FEMA/SAMHSA Crisis
Counseling Assistance and
Training Program
105
The FEMA Crisis Counseling
Assistance and Training Program
• Robert T. Stafford Disaster
Assistance and Emergency Relief Act
(P.L. 93-288 as amended)
• Interagency Federal Partnership
• Federal-State-Local Partnership
106
Organizational Partners
in Crisis Counseling Program
•
•
•
•
Community Mental Health Agencies
State Mental Health Authority
State Emergency Management Agency
Federal Emergency Management Agency
(Region and Headquarters)
• Center for Mental Health Services
107
Administrative
Staff
•
•
•
•
•
•
•
Community Program Managers
State Disaster Mental Health Coordinator
Governor’s Authorized Representative
FEMA Crisis Counseling Coordinator
FEMA Human Services Officer
Federal Coordinating Officer
FEMA Headquarters Crisis Counseling
Coordinator
• CMHS Project Officer
108
The Acronym Game!
•
•
•
•
•
•
•
•
•
•
•
•
•
KDEM
CMHS
KEOP
KAHBH
ISP
ICS
PIO
NIMS
ARC
ESF
VOAD
SOP
FEMA
109
The Acronym Game!
•
•
•
•
•
•
•
•
•
•
•
•
•
KDEM: Kansas Department of Emergency Management
CMHS
KEOP
KAHBH
ISP
ICS
PIO
NIMS
ARC
ESF
VOAD
SOP
FEMA
110
The Acronym Game!
•
•
•
•
•
•
•
•
•
•
•
•
•
KDEM: Kansas Department of Emergency Management
CMHS: Center for Mental Health Services
KEOP
KAHBH
ISP
ICS
PIO
NIMS
ARC
ESF
VOAD
SOP
FEMA
111
The Acronym Game!
•
•
•
•
•
•
•
•
•
•
•
•
•
KDEM: Kansas Department of Emergency Management
CMHS: Center for Mental Health Services
KEOP: Kansas Emergency Operations Plan
KAHBH
ISP
ICS
PIO
NIMS
ARC
ESF
VOAD
SOP
FEMA
112
The Acronym Game!
•
•
•
•
•
•
•
•
•
•
•
•
•
KDEM: Kansas Department of Emergency Management
CMHS: Center for Mental Health Services
KEOP: Kansas Emergency Operations Plan
KAHBH: Kansas All-Hazards Behavioral Health Program
ISP
ICS
PIO
NIMS
ARC
ESF
VOAD
SOP
FEMA
113
The Acronym Game!
•
•
•
•
•
•
•
•
•
•
•
•
•
KDEM: Kansas Department of Emergency Management
CMHS: Center for Mental Health Services
KEOP: Kansas Emergency Operations Plan
KAHBH: Kansas All-Hazards Behavioral Health Program
ISP: Immediate Services Program
ICS
PIO
NIMS
ARC
ESF
VOAD
SOP
FEMA
114
The Acronym Game!
•
•
•
•
•
•
•
•
•
•
•
•
•
KDEM: Kansas Department of Emergency Management
CMHS: Center for Mental Health Services
KEOP: Kansas Emergency Operations Plan
KAHBH: Kansas All-Hazards Behavioral Health Program
ISP: Immediate Services Program
ICS: Incident Command System
PIO
NIMS
ARC
ESF
VOAD
SOP
FEMA
115
The Acronym Game!
•
•
•
•
•
•
•
•
•
•
•
•
•
KDEM: Kansas Department of Emergency Management
CMHS: Center for Mental Health Services
KEOP: Kansas Emergency Operations Plan
KAHBH: Kansas All-Hazards Behavioral Health Program
ISP: Immediate Services Program
ICS: Incident Command System
PIO: Public Information Officer
NIMS
ARC
ESF
VOAD
SOP
FEMA
116
The Acronym Game!
•
•
•
•
•
•
•
•
•
•
•
•
•
KDEM: Kansas Department of Emergency Management
CMHS: Center for Mental Health Services
KEOP: Kansas Emergency Operations Plan
KAHBH: Kansas All-Hazards Behavioral Health Program
ISP: Immediate Services Program
ICS: Incident Command System
PIO: Public Information Officer
NIMS: National Incident Management System
ARC
ESF
VOAD
SOP
FEMA
117
The Acronym Game!
•
•
•
•
•
•
•
•
•
•
•
•
•
KDEM: Kansas Department of Emergency Management
CMHS: Center for Mental Health Services
KEOP: Kansas Emergency Operations Plan
KAHBH: Kansas All-Hazards Behavioral Health Program
ISP: Immediate Services Program
ICS: Incident Command System
PIO: Public Information Officer
NIMS: National Incident Management System
ARC: American Red Cross
ESF
VOAD
SOP
FEMA
118
The Acronym Game!
•
•
•
•
•
•
•
•
•
•
•
•
•
KDEM: Kansas Department of Emergency Management
CMHS: Center for Mental Health Services
KEOP: Kansas Emergency Operations Plan
KAHBH: Kansas All-Hazards Behavioral Health Program
ISP: Immediate Services Program
ICS: Incident Command System
PIO: Public Information Officer
NIMS: National Incident Management System
ARC: American Red Cross
ESF: Emergency Support Function
VOAD
SOP
FEMA
119
The Acronym Game!
•
•
•
•
•
•
•
•
•
•
•
•
•
KDEM: Kansas Department of Emergency Management
CMHS: Center for Mental Health Services
KEOP: Kansas Emergency Operations Plan
KAHBH: Kansas All-Hazards Behavioral Health Program
ISP: Immediate Services Program
ICS: Incident Command System
PIO: Public Information Officer
NIMS: National Incident Management System
ARC: American Red Cross
ESF: Emergency Support Function
VOAD: Voluntary Organizations Active in Disaster
SOP
FEMA
120
The Acronym Game!
•
•
•
•
•
•
•
•
•
•
•
•
•
KDEM: Kansas Department of Emergency Management
CMHS: Center for Mental Health Services
KEOP: Kansas Emergency Operations Plan
KAHBH: Kansas All-Hazards Behavioral Health Program
ISP: Immediate Services Program
ICS: Incident Command System
PIO: Public Information Officer
NIMS: National Incident Management System
ARC: American Red Cross
ESF: Emergency Support Function
VOAD: Voluntary Organizations Active in Disaster
SOP: Standard Operating Procedures
FEMA
121
The Acronym Game!
•
•
•
•
•
•
•
•
•
•
•
•
•
KDEM: Kansas Department of Emergency Management
CMHS: Center for Mental Health Services
KEOP: Kansas Emergency Operations Plan
KAHBH: Kansas All-Hazards Behavioral Health Program
ISP: Immediate Services Program
ICS: Incident Command System
PIO: Public Information Officer
NIMS: National Incident Management System
ARC: American Red Cross
ESF: Emergency Support Function
VOAD: Voluntary Organizations Active in Disaster
SOP: Standard Operating Procedures
FEMA: Federal Emergency Management Agency
122
Examples of Disaster Crisis
Counseling Program Services
•
•
•
•
•
Outreach
Screening and Assessment
Counseling
Information and Referral
Public Education & Social
Advocacy
123
Program
Limitations
•
•
•
•
•
•
•
Medications
Hospitalization
Long-term Therapy
Providing Childcare or Transportation
Fundraising activities
Individual Advocacy
Long-term Case Management
124
All-Hazards Crisis Counseling
and “Traditional”
Behavioral Health Practice
“Traditional” Practice
• Primarily Office-Based
• Focus on Diagnosis &
Treatment of Mental Illness
• Attempt to Impact Personality
& Functioning
• Examines Content
• Encourages Insight into Past
Experiences & Influence on
Current Problems
• Psychotherapeutic Focus
Disaster Crisis Counseling
• Primarily Home & Community Based
• Assessment of Strengths, Adaptation
& Coping Skills
• Seeks to Restore Pre-Disaster
Functioning
• Accepts Content at Face Value
• Validates Appropriateness of
Reactions and Normalizes
Experience
• Psycho-educational focus
Source: ESDRB Program Guidance, December, 1996
125
All-Hazards Crisis Counseling
and “Traditional”
Case Management
“Traditional” Case Management
• Provide services to individuals
with SPMI or other disability
• Services provided for indefinite
duration
• Responsible and accountable
for client service provision
• Power to influence services for
their client
• Long-term relationship with
clients
Disaster Crisis Counseling
• Provide services to disaster
survivors who often have a high
level of functioning
• Services provided do not require
continuity of care
• Empower disaster victims to
advocate for services needed
• Short-term relationship with
disaster victims
Source: ESDRB Program Guidance, December, 1996
126
FEMA/CMHS
Crisis Counseling Program
FY 2004 Grant Sites
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 1322 AL
(Tornado)
FEMA 1479 TX
(Hurricane
Claudette)
FEMA 1501 PR
(Storms &
Flooding)
FEMA 1437 LA
(Flooding)
127
Summary
• The FEMA/SAMHSA CMHS Crisis
Counseling Program works in
conjunction with a number of
organizational partners and
administrative staff to provide services
during disasters that differ from
traditional mental health services
128
Behavioral Health Response to
Presidentially Declared Disaster
Event
City Response
County Response
State Response
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
KDEM Application
National Disaster
Presidentially
Declared Disaster
9 Months
If needed apply for
Regular Services
Program (RSP)
60 Days
1) On-Site Command
2) Local Outreach workers
3) Supplies
KMHA has 14 Days
to Apply for
Immediate Services
Program (ISP)
129
FEMA/SAMHSA CMHS
All-Hazards/Disaster
Crisis Counseling
Program Grants:
Immediate Services Program
and
Regular Services Program
130
• Immediate Services Program:
– Application due within 14 days of
Presidential disaster declaration
– Funds 60 days of services
• Regular Services Program:
– Application due within 60 days of
Presidential declaration
– Funds nine (9) months of services
131
Summary
• Presidentially declared disaster areas may
receive funding from the state for 60 days
of services (Immediate Services Program,
ISP), up to 9 months of services (Regular
Services Program, RSP)
132
Module 6:
The KAHBH Program:
Preparedness, Response, and
Recovery for Kansas Communities
133
Organizations Involved in
Behavioral Health Disaster
Response
• Federal
– SAMHSA—Substance Abuse Mental Health Services
Administration & CMHS—Center for Mental Health Services
– FEMA—Federal Emergency Management Agency
• State
– KDEM—Kansas Dept. of Emergency Management
• KDHE—Kansas Dept. of Health and Environment
– SRS—Kansas Dept. of Social and Rehabilitation Services
• Local
– Local emergency management agencies
– CMHC—Community Mental Health Centers
– Local professionals and para-professionals (substance abuse
professionals, clergy, doctors/nurses, fire/police department, 134
volunteers, etc.)
135
State-Level Role
of KAHBH
• During a disaster in Kansas, the Kansas Mental
Health Authority through SRS serves as a liaison
to the Kansas Department of Emergency
Management, local CMHCs, and FEMA in a
Presidentially declared disaster
• FEMA recommends each State develop a crisis
response plan in meeting the mental health and
substance abuse needs at state and local levels,
which are formally integrated into the State
Emergency Operations Plan
136
• KDHE established a contract with KMHA to
provide funds for 1 year to coordinate the
development and implementation of the AllHazards Behavioral Health Plan
• In January 2005, Kansas Department of Social
and Rehabilitation Services, Mental Health
Authority, subcontracted with Kansas State
University, School of Family Studies and Human
Services
• The Kansas All-Hazards Behavioral Health
(KAHBH) Team was developed through the
subcontract
137
KAHBH Purpose
• KAHBH provides State-wide organization
and coordination for behavioral health
response to disaster and other all-hazards
events
– Training and preparing Kansas professionals
and paraprofessionals to serve in behavioral
health capacity during an event
– Providing technical assistance and all-hazards
behavioral health information to Kansans
138
Key KAHBH Tasks
• Resource identification and collection
• Training and education
• Development of Annex to KEOP, KAHBH
Plan, and Standard Operating Procedures
• State-wide network recruitment and
coordination
• Preparedness, response, and recovery
activities
139
KAHBH Network
•
•
•
•
•
10 staff
15 Stakeholders
12 SRS Field Staff
29 CMHC Coordinators
Goal: 200+ KAHBH Network members
140
KAHBH Stakeholder
Supporting Agencies
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Kansas Department of Health & Environment, Office of Local & Rural Health,
Topeka
SRS Mental Health Authority, Topeka
SRS Health Care Policy, Addiction & Rehabilitation Services, Topeka
Kansas State University, School of Family Studies and Human Services, Manhattan
University of Kansas School of Medicine, Department of Preventive Medicine &
Public Health, Wichita
Lawrence Therapy Services, Lawrence
Mental Health Center of East Central Kansas, Emporia
Regional Prevention Center, Olathe
Mid-America Addiction Technology Transfer Center
COMCARE, Wichita
American Red Cross, Midway Kansas Chapter, Wichita
Wyandot Center, Kansas City
Association of Community Mental Health Centers of Kansas, Inc., Topeka
Center for Counseling & Consultation, Great Bend
Prairie View Behavioral & Mental Health Care, Newton **
141
Heartland Assessment Center, Roeland Park, KS **
KAHBH Plan and
Operations Manual
• The initial Kansas All-Hazards Behavioral Health
Annex has been drafted and submitted to the
Kansas Department of Emergency Management
(KDEM) to be reviewed and accepted into the
Kansas Emergency Operations Plan.
– KDEM acceptance currently is pending
• The State Plan will provide a detailed description of
the behavioral health preparedness, response, and
recovery in Kansas
• Preliminary drafts of the Operations Manual have
been developed and reviewed by the SRS
142
Contract Manager.
KAHBH
ANNEX
(Submitted to KDEM)
KAHBH
Plan
KAHBH Training
Operations Manual
143
KS Citizens
State
Stakeholders
Disaster
Exercises
County
Data Bank
KAHBH
State
Plan
Education: Trainings,
Universities,
Conferences
KDEM
KS Train
1st responders/ Critical
Governor’s
Incident Stress
Bioterrorism
Management
Coordinating
Council
(SRS Mental Health
Authority rep joined
4/04
American
Red Cross
KS Citizens
154
Role of KAHBH
Network Members
• SAMHSA/CMHC Model
• Professionals and paraprofessionals
working in teams
• Based on SRS CMHC Regions
– 27 total areas in Kansas
155
The KAHBH Program is not:
• American Red Cross Disaster Mental Health
Services (ARC DMHS)
– ARC requires a masters-level licensed mental health professional
– ARC mental health workers are volunteers and do not receive
reimbursement for their services
• Critical Incident Stress Management (CISM)
– Model developed and approved for use with first responders, but
often is applied to many areas of crisis response, which may not be
appropriate
156
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.
157
Network members
should be:
• Indigenous to the communities they serve
• Possess varied experience working with
various populations in need
• Capable of providing all-hazards behavioral
health services through non-traditional
methods
• Sensitive to cultural issues
158
Key Characteristics/Abilities
of KAHBH Personnel
• Key personal characteristics and abilities of
those particularly suited for disaster work are:
– Mature
– Sociable
– Calm
– Knowledgeable about how systems work
– Flexible
– Tolerates ambiguity well
– Empathetic
– Genuine
– Shows positive regard for others
– Good listener
159
Module 7:
Behavioral Health
and
the All-Hazards Disaster
Response System
160
The Role of Behavioral Health
in All-Hazards Response
•
•
•
•
Behavioral health consultation
Liaison with key agencies
Psychoeducation through media
Behavioral health services with survivors,
families
• Behavioral health services with responders
• Stress management support
161
• The role of behavioral health in
all-hazards crisis response may
include the following:
– On-scene interventions
– Immediate interventions
– Psychological first aid
– Crisis interventions
– Crime victim assistance
– Community outreach
– Death notification
– Brief trauma interventions
– Post-disaster inventions
162
Emergency Operations
Center (EOC)
• Provides a common, centralized operation
location
• Ensures clear delegation of responsibility
• Coordinates personnel, supplies & equipment
• Serves as a single point of information flow
• Relays warning to local officials and the
public
• Works with the Incident Command System
(ICS)
163
Incident Command
System (ICS)
• Standardized, on-scene, all-hazards incident
management system
• Provides basic direction and control
• Federal (NIMS) and local level (ICS)
organized system
• Coordination of decision making among
responder agencies
• Provides a chain of command
164
Incident Command
System (ICS)
• A proven management system based on
successful business practices
• The result of decades of lessons learned in
the organization and management of
emergency incidents
• Is a component of NIMS
• Has become the standard for emergency
management across the country
165
Incident Command
System (ICS)
• Meets the needs of incidents of any kind or size
– Used to manage Salt Lake City Olympics
• Allows personnel from a variety of agencies to
meld rapidly into a common management
structure
• Provides logistical and administrative support to
operational staff
• Provides a cost effective method of
management by avoiding duplication of efforts
166
ICS Organizational
Structure
• Operations
– Directs activities to reduce the immediate hazard and
restore essential functions
• Planning
– Acquires information on current and future situations
• Logistics
– Support for basic needs (communication, medical, food,
supplies, transportation)
• Finance/Administration
– Tracks all costs
– Provides administrative responsibilities for operation167
Basic Incident Command
Structure
INCIDENT
COMMAND
Operations
Planning
Logistics
Finance/
Administration
168
ICS Supervisory Position Titles:
*Chain of Command & *Unity of Command
Organizational Level
Incident Command
Title
Support Position
Incident Commander
Deputy
Officer
Assistant
Chief
Deputy
Director
Deputy
Supervisor
N/A
Leader
Single Resource Boss
Command Staff
General Staff (Section)
Branch
Division/Group
Strike team/Task force
*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
169
whom they report at the scene of the incident
As responders to all-hazards
events, it is critical that behavioral
health providers become part of the
emergency response system
170
Federal requirement that
all responders:
• Follow ICS procedures
• Receive ICS and NIMS training
• Meet minimum standards
• “All federal, state, territorial, tribal, private
sector and non-governmental personnel at
the entry level, first line supervisor level,
middle management level and command
and general staff level of emergency
management operations must complete
ICS-100 and FEMA-IS 700 level training.”171
• Strongly encourage the following ICS and
NIMS training for KAHBH Members
– ICS 100, Introduction to ICS
• ALL responders/workers + supervisors/administrators
– ICS 200, Basic ICS
• supervisors/administrators
– FEMA IS 700, NIMS: An Introduction
• ALL responders/workers + supervisors/administrators
– FEMA IS 800, National Response Plan
(NRP): An Introduction
• supervisors/administrators
172
• Training available online
• www.fema.gov/nims
– NIMS Training (on the left of the screen)
– Fact Sheets and information for these 4
courses
• Local “live” courses also may be
available
– Contact your local Emergency
Management office
173
Module 8:
KAHBH Community
Outreach Teams:
Structure, Procedures, and
Documents
174
KAHBH Network:
•
•
•
•
•
COT Structure
COT Call-Up Procedure
COT Member Rotation
COT Member Debriefing
Forms/Documents
175
176
The KAHBH Program Coordinator(s) will:
• Receive and collate data from the Community Outreach
Teams in the field.
• Ensure that FEMA/State briefings are attended daily
at the Disaster Field Office to obtain updated damage
assessment information and report data from KAHBH
activities.
• Coordinate data collection from FEMA, American Red
Cross, Kansas Department of Emergency Management
officials, etc.
• Prepare the Immediate Services and Regular Services
grant applications in a Presidentially Declared disaster.
177
The CMHC Coordinators/
Community Outreach Team Leaders will:
• Be responsible to the KAHBH Program in carrying out the overall mission
at the local level
• While responsible to the KAHBH Program for their overall mission, report
to the supervision of the local CMHC/hospital director or his/her designee
on site.
• Advise the team leaders about where and to whom to report at the
disaster site.
• Regardless of the office, division, CMHC or hospital, will be the point of
contact for COT members for day to day direct supervision while in the
field.
• Have the authority and responsibility to return team members to their
home base if, in the judgment of the Team Leaders, any team members
are unable to carry out the necessary tasks for any reason.
• Be responsible for summarizing contact data and reporting it daily to the
KAHBH Coordinator
178
The KAHBH Network Members will:
• Provide crisis counseling, debriefing, and support to
survivors when the disaster exceeds the CMHC’s or
hospital's capacity to respond effectively.
• Provide crisis counseling services to the survivors which
include active listening, supportive counseling, problem
definition and solving, information, education, referral,
active or concrete assistance, advocacy, and
reassurance.
• Identify survivors whose response, needs, and history
make them especially vulnerable to the stress of the event
and subsequent mental health problems. More frequent
and intense support is to be provided to these individuals.
• Be responsible for documenting their contacts daily and
reporting it to the CMHC Coordinator/Community
Outreach Team Leader.
179
KAHBH Network
Rotation
• These are guidelines that may vary
depending upon:
– the scope and nature of the disaster
– varying needs and stresses as the
response effort matures
180
Recommended
Guidelines for On-Site
Schedule
Team Leaders and workers:
• No more than 5 full continuous days
• Will have a reasonable time of rest after
10-12 hours work
• Will have daily briefings with response
team
• Will have pre and post shift briefings
181
Recommended
Guidelines for Off-Site
Schedule
• Team members should leave the site after 10
days of work
• Team members should have 2 days
administrative leave
• Team members should have a debriefing at
their home facility or CMHC within 5-7 days of
returning from the event
• Team members returning to the event site
should have one debriefing at home before
returning for another rotation
182
Post Rotation
Debriefing
• All employees who carry out field work in the affected area
should have at least one debriefing session in their home
community before returning for a subsequent rotation.
• The CMHC Coordinator/Community Outreach Team
Leader will organize debriefing sessions for Network
members responding in their area.
• Response workers may be debriefed within five to seven
days of returning to their home facility or CMHC (these
debriefings may occur during the employee's
Administrative Leave period).
• Post-Response debriefing should be arranged as needed
for each group of response workers.
183
FEMA/SAMHSA CMHS
Crisis Counseling Program
Forms
and
Documentation
184
Concluding Comments
Questions?
185
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.
186