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Kansas All-Hazards Behavioral Health Training

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Title: Kansas All-Hazards Behavioral Health Training


1
Kansas All-Hazards Behavioral Health Training
  • Core Competencies
  • for Community Outreach Workers

2
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

3
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

4
KAHBH Network
  • 10 staff
  • 15 Stakeholders
  • 12 SRS Field Staff
  • 29 CMHC Coordinators
  • Goal 200 KAHBH Network members

5
Outline of KAHBH Trainings
  • KAHBH Core Behavioral Health Training
  • DAY 1 (approx. 8 hours)
  • For all participants without CISM or ARC DMH
    training within the last 5 years (Mental health
    and paraprofessionals)
  • Module 1 Disaster Classifications and Phases
  • Module 2 Traumatic Reactions to Disasters
  • Module 3 Providing Support During Disasters
  • Module 4 Considerations for Special Populations,
    Cultural Competence, and Ethical Issues
  • Day 2 (approx. 3.5)
  • For ALL KAHBH Network members
  • Module 5 The FEMA/SAMHSA CMHS Crisis Counseling
    Assistance and Training Program
  • Module 6 The KAHBH Program Preparedness,
    Response, and Recovery for Kansas Communities
  • Module 7 Behavioral Health and the All-Hazards
    Disaster Response System
  • Module 8 KAHBH Community Outreach Teams
    Structure, Procedures, and Documents

6
  • Paraprofessional Training
  • ½ day (4 hours) training to provide
    non-behavioral health professionals with
    background information in working with people in
    crisis, communication skills, issues related to
    confidentiality and ethics, and other basic
    helping skills
  • The Role of the Helper
  • Professional and personal boundaries
  • Ethics, confidentiality, and dual relationships
  • Communication Skills
  • Challenges in Helping
  • Diversity and multicultural awareness as a helper
  • Helping in Crisis and Grief Situations

7
  • Future Specialty Trainings
  • To be based on each communitys needs
  • All non-mental health members will receive
    additional ½ day (4 hours) training on basic
    helping skills in crisis counseling
  • At least 2 members (1 MH and 1 NMH) from each
    area will receive specialized training in the
    following areas (to be provided online in 2-4
    hour trainings)
  • Children (under age 18)
  • Frail Elderly
  • Developmentally and physically disabled
  • Severe Mental Illness and People in active
    Substance Abuse Treatment
  • People in Correctional Institutions
  • College Students in dorms/away from
    home/Families/individuals relocated
  • People with high traumatic exposure
  • People in poverty and homeless
  • Roles of women in community (e.g. new moms,
    multiple caregivers)
  • Men and Women
  • Emergency responders involved in rescue/recovery
  • Multicultural issues
  • Farmers/Ranchers/Agricultural Workers/Rural
    Populations

8
Core Competencies, Terminology, and Regional
Disaster Information
9
KAHBH Core Objectives
  1. Understand the difference between Community
    Mental Health Center (CMHC) crisis counseling and
    the All-Hazards/Disaster Behavioral Health
    crisis counseling (FEMA/SAMHSA CMHS) model
  2. Understand human behavior in disasters
  3. Understand the key concepts of all-hazards
    behavioral health
  4. Understand the organizational aspects of disaster
    response
  5. Understand how to assess the needs of and
    intervene effectively with disaster survivors,
    including special populations
  6. Provide appropriate behavioral health assistance
    to survivors and workers at the community level
  7. Understand, recognize and manage stress in
    disaster work

10
KAHBH Core Competencies
  • Identifies relevant and appropriate data and
    information sources
  • Obtains and interprets information regarding
    risks and benefits to the community
  • Recognizes how the data illuminates ethical,
    political, scientific, economic, and overall
    public behavioral health issues
  • Prepare and implement behavioral health emergency
    response plans
  • Advocates for public health/behavioral health
    programs and resources
  • Effectively presents accurate demographic,
    statistical, programmatic and scientific
    information for professional and lay audiences
  • Utilizes appropriate methods for interacting
    sensitively, effectively, and professionally with
    persons from diverse cultural, socioeconomic,
    educational, racial, ethnic, and professional
    backgrounds, and persons of all ages and
    lifestyle preferences
  • Identifies the role of cultural, social, and
    behavioral factors in determining the delivery of
    public health/behavioral health services

11
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 individuals and organizations
    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

12
  • 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 publics
    sense of safety and increase confidence in our
    institutions. Because the overriding goal of
    terrorism is to change peoples beliefs, sense of
    safety, and behaviors, mental health experts are
    an essential part of planning and responding.
  • Statement from the Conference Transcript
  • Responding to Bioterrorism Individual and
    Community Needs,
  • October 19-21, 2001

13
  • Mental Health is the linchpin to an effective
    response.
  • Statement from April 2005
  • TOPOFF 3 Exercise

14
Terminology
  • Behavioral Health
  • Mental Health Substance Abuse

15
Terminology (continued)
  • All-Hazards All-Hazards
  • Disasters Bioterrorism Major Community
    Crises

16
Examples of All-Hazards Crisis Counseling
Program Services
  • Outreach
  • Screening and Assessment
  • Counseling
  • Information and Referral
  • Public Education Social Advocacy

17
Program Limitations
  • Medications
  • Hospitalization
  • Long-term Therapy
  • Providing Childcare or Transportation
  • Fundraising activities
  • Individual Advocacy
  • Long-term Case Management

18
All-Hazards Crisis Counseling and Traditional
Behavioral Health Practice
Traditional Practice
Disaster Crisis Counseling
  • Primarily Office-Based
  • Focus on Diagnosis Treatment of Mental Illness
  • Attempt to Impact Personality Functioning
  • Examines Content
  • Encourages Insight into Past Experiences
    Influence on Current Problems
  • Psychotherapeutic Focus
  • Primarily Home Community Based
  • Assessment of Strengths, Adaptation Coping
    Skills
  • Seeks to Restore Pre-Disaster Functioning
  • Accepts Content at Face Value
  • Validates Appropriateness of Reactions and
    Normalizes Experience
  • Psycho-educational focus

Source ESDRB Program Guidance, December, 1996
19
  • The KAHBH Program follows the FEMA/SAMHSA CMHS
    Crisis Counseling Program as the primary model
  • Federal program
  • Over 30 year history
  • Best Practice nationally recognized material
  • Collaboration between FEMA, SAMHSA CMHS, state
    mental health authority (SRS in Kansas), and
    local responders
  • Community based
  • Focus on providing services to the general
    population
  • Includes paraprofessionals or community heroes
    as potential providers

20
Organizations Involved in Behavioral Health
Disaster Response
  • Federal
  • SAMHSASubstance Abuse Mental Health Services
    Administration CMHSCenter for Mental Health
    Services
  • FEMAFederal Emergency Management Agency
  • State
  • KDEMKansas Dept. of Emergency Management
  • KDHEKansas Dept. of Health and Environment
  • SRSKansas Dept. of Social and Rehabilitation
    Services
  • Local
  • Local emergency management agencies
  • CMHCCommunity Mental Health Centers
  • Local professionals and para-professionals
    (substance abuse professionals, clergy,
    doctors/nurses, fire/police department,
    volunteers, etc.)

21
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

22
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

23
  • Regional
  • Disaster Information

24
Module 1Disaster Classifications and Phases
Wichita tornado
25
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

26
  • 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.

27
Natural Disasters
  • Floods
  • Tornados
  • Hurricanes
  • Typhoons
  • Winter storms
  • Tsunamis
  • Hail storms
  • Wildfires
  • Windstorms
  • Epidemics
  • Earthquakes

28
Human-Caused Disasters
  • Intentional and unintentional
  • Residential fires
  • Building collapses
  • Transportation accidents
  • Hazardous materials releases
  • Explosions
  • Domestic acts of terrorism

29
Criteria for Presidential Disaster Declaration
30
Behavioral Health Response to Presidentially
Declared Disaster
Event
City Response
County Response
State Response
KDEM Application National Disaster
Presidentially Declared Disaster
31
Classification of Disasters
  • Natural vs. Human-caused
  • Degree of personal impact
  • Size and scope
  • Visible impact/low point
  • Probability of
  • reoccurrence

32
Critical Disaster Stressors
  • Threat to ones life
  • Threat of harm to family
  • Destruction of home or community
  • Significant media attention
  • Witnessing others trauma
  • Being trapped or unable to evacuate

33
Phases of Disaster Reactions
  • Warning of threat
  • Impact
  • Rescue or Heroic
  • Remedy or Honeymoon
  • Inventory
  • Disillusionment
  • Reconstruction and recovery

34
Typical Phases of Disasters

1 to 3 Days -------------------TIME---------------
----------------------------1 to 3 Years
Zunin/Meyers
35
Comparing Criminally Human-Caused and
Natural Disasters
  • Causation
  • Appraisal of event
  • Psychological impact
  • Subjective experience
  • World view/basic assumption
  • Stigmatization of victims
  • Media
  • Secondary injury

36
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 Stateand 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

37
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

38
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

39
Module 2Traumatic Reactions to Disasters
40
Effects of Trauma
  • Vary by a persons age, developmental stage,
    prior condition, degree of personal impact
  • Vary by the disasters severity, the amount of
    advance warning, the level of community
    preparedness
  • May include physical, emotional, cognitive or
    behavioral reactions

41
Psychosocial Concerns
  • Disruption of existing social/community
  • Impact of new social patterns
  • Duration of recovery
  • Cross-cultural impact

42
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

43
Stressors in Disaster Work
  • Event related
  • Occupational
  • Organizational
  • Family or personal life

44
Stress Basics
  • Stress is
  • Normal
  • Necessary
  • Productive and destructive
  • Acute and delayed
  • Cumulative
  • Identifiable
  • Preventable and manageable

45
Physical Changes with Stress
  • Pupils dilate
  • Dry mouth
  • Heart rate increases
  • Increased HCI (Hydrochloric Acid)
  • Sleep disturbances
  • Lower back pain
  • Stomach motility inhibited (peristalsis)
  • Blood flow changes
  • Increased cholesterol production

46
Emotional Changes with Stress
  • Increased feelings of isolation
  • Depression
  • Anger
  • Anhedonia (lack of joy)
  • Slowed learning speed
  • Impaired decision making
  • Decreased self-awareness

47
Mental Changes with Stress
  • Decreased memory
  • Decreased attention span
  • Decreased intimacy

48
Organizational Approaches
  • Effective management structure and leadership
  • Clear purpose and goals
  • Functionally defined roles
  • Team support
  • Plan for stress management

49
Individual Approaches
  • Management of workload
  • Balances lifestyle
  • Stress reduction strategies
  • Self-awareness

50
Effects of Long-Term Disaster Stress
  • Anxiety and vigilance
  • Anger, resentment, and conflict
  • Uncertainty about the future
  • Prolonged mourning of losses
  • Diminished problem-solving
  • Isolation and hopelessness
  • Health problems
  • Lifestyle changes

51
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

52
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.

53
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

54
Other Long Term Reactions
  • Major depression
  • Suicidal thoughts and attempts
  • Alcohol and drug abuse
  • Anxiety disorders
  • Dissociative disorders

55
Summary
  • Disasters can elicit traumatic reactions in the
    victims who survive it.

56
Additional Reactions to Disasters
57
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

58
Physical Reactions
  • Fatigue, exhaustion
  • Gastrointestinal distress
  • Appetite changes
  • Tightening in the throat or chest
  • Other somatic complaints

59
Emotional Reactions
  • Depression, sadness
  • Irritability, anger, resentment
  • Anxiety, fear
  • Despair, hopelessness
  • Guilt, self-doubt
  • Unpredictable mood swings

60
Cognitive Reactions
  • Confusion, disorientation
  • Recurring dreams, nightmares
  • Preoccupations with disaster
  • Trouble concentrating or remembering things
  • Difficulty making decisions
  • Questioning spiritual beliefs

61
Behavioral Reactions
  • Sleep problems
  • Crying easily
  • Avoiding reminders
  • Excessive activity level
  • Increased conflicts with family
  • Hypervigilance, startle reactions
  • Isolation or social withdrawal

62
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

63
Chronic Stressors in Disasters
  • Family disruption
  • Work overload
  • Gender differences
  • Bureaucratic hassles
  • Financial strain

64
Loss and Grief
  • Loss is a common theme in disaster settings
  • Common reactions to loss
  • Denial, numbness or shock
  • Anger
  • Bargaining
  • Depression
  • Acceptance
  • Reorientation

65
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

66
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

67
Summary
  • Disasters may elicit a number of non-traumatic
    responses in its victims, including
  • Grief reactions
  • Physical reactions
  • Emotional reactions
  • Cognitive reactions
  • Behavioral reactions

68
Module 3Providing Support During Disasters
69
All-Hazards Crisis Counseling and Traditional
Behavioral Health Practice
Traditional Practice
Disaster Crisis Counseling
  • Primarily Office-Based
  • Focus on Diagnosis Treatment of Mental Illness
  • Attempt to Impact Personality Functioning
  • Examines Content
  • Encourages Insight into Past Experiences
    Influence on Current Problems
  • Psychotherapeutic Focus
  • Primarily Home Community Based
  • Assessment of Strengths, Adaptation Coping
    Skills
  • Seeks to Restore Pre-Disaster Functioning
  • Accepts Content at Face Value
  • Validates Appropriateness of Reactions and
    Normalizes Experience
  • Psycho-educational focus

Source ESDRB Program Guidance, December, 1996
70
All-Hazards Crisis Counseling and Traditional
Case Management
Traditional Case Management
Disaster Crisis Counseling
  • Provide services to individuals with SPMI or
    other disability
  • Services provided for indefinite duration
  • Responsible and accountable for client service
    provision
  • Power to influence services for their client
  • Long-term relationship with clients
  • Provide services to disaster survivors who often
    have a high level of functioning
  • Services provided do not require continuity of
    care
  • Empower disaster victims to advocate for services
    needed
  • Short-term relationship with disaster victims

Source ESDRB Program Guidance, December, 1996
71
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)

72
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

73
Overarching Concepts
  • Normal reactions to abnormal situation
  • Avoid mental health terms and labels
  • Assistance is practical
  • Assume competence
  • Focus on strengths and
    potentials
  • Encourage use of support
    network
  • Active, community fit
  • Innovative in helping

74
Maslows Hierarchy of Needs
www.tutor2u.net/business/images/maslow_hierarchy.g
if
75
Guiding Principlesin Providing Support
  • First protect from danger
  • Focus on physical and material care
  • Be direct, active and remain calm
  • Focus on the here and now situation
  • Provide accurate information about the situation
  • Assist with mobilization of resources

76
Guiding Principlesin Providing Support (cont)
  • Do not give false assurances
  • Recognize the importance of taking action
  • Reunite with family members
  • Provide and ensure emotional support
  • Focus on strengths and resilience
  • Encourage self-reliance
  • Respect feelings and cultures of others

77
Crisis Intervention
  • Observe safe practices by showing concern for
    your own safety
  • Remain calm and appear relaxed, confident and
    non-threatening

78
Crisis Intervention Steps
  1. Assess the situation
  2. Establish rapport
  3. Identify the main problem(s)
  4. Deal with feelings and emotions
  5. Generate and explore alternative coping
    strategies
  6. Formulate an action plan
  7. Follow up

79
On-Scene Interventions
  • Direct to medical care, safety, shelter
  • Protect from trauma, media, onlookers
  • Connect to family, information, comfort
  • (Myers and Wee, 2003)

80
Immediate Interventions
  • Rapid assessment and triage
  • Psychological first-aid
  • Crisis intervention
  • Crime victim assistance
  • Psycho-education
  • Information briefings
  • Community outreach

81
Immediate Interventions (continued)
  • Participation in death notification
  • Behavioral health consultation
  • Debriefing and community meetings
  • Information and referral

82
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

83
Crisis Intervention
  • Promote safety and security
  • Gently explore trauma experience
  • Identify priority needs and solutions
  • Assess functioning and coping
  • Provide
  • Reassurance
  • Psycho-education
  • Practical assistance

84
Crime Victim Assistance
  • Protect victims rights
  • Ensure control over media
  • Provide criminal justice information
  • Facilitate access to compensation
  • Streamline bureaucratic procedures

85
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

86
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

87
Brief Trauma Interventions
  • Factual information
  • Thoughts during event
  • Reactions and feelings
  • Psycho-education
  • Problem-solving and action

88
Post-Disaster Behavioral Health
Interventions
  • Case finding
  • Letters and phone calls
  • Community outreach
  • Brief counseling (individual and group)
  • Case management
  • Public education through media
  • Information and referral

89
Key Events with Behavioral Health Implications
  • Death notification
  • Ending search and recovery
  • Bulldozing homes/neighborhoods
  • Criminal justice proceedings
  • Returning to impacted areas
  • Funeral and memorials

90
Community Interventions
  • Memorials and rituals
  • Usual community gatherings
  • Anniversary commemorations
  • Symbolic gestures

91
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

92
Survivor Risk and Resiliency Factors
  • Psychological
  • Capacity to tolerate stress
  • Prior trauma history
  • Socioeconomic and education level
  • Family stability
  • Social support
  • Gender roles

93
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

94
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)

95
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

96
Module 4Considerations for Special
Populations, Cultural Competence, and Ethical
Issues
97
Special/Vulnerable Populations
  • NO ONE IS UNTOUCHED BY DISASTER
  • NO ONE IS NOT VULNERABLE
  • Children (under age 18)
  • Frail Elderly
  • Developmentally and physically disabled
  • Severe Mental Illness and People in active
    Substance Abuse Treatment
  • People in Correctional Institutions
  • College Students in dorms/away from home/
    families/individuals relocated
  • People with high traumatic exposure
  • People in poverty and homeless
  • Emergency responders involved in rescue/recovery
  • Multicultural issues
  • Farmers/Ranchers/Agricultural Workers/Rural
    Populations
  • Other roles of men and women that be increase
    vulnerability

98
Statement of Principles for Special Needs
Populations
  • Equitable access for all
  • Respect for the diversities of communities
  • Community-based partnerships
  • Representation of the diversity of communities,
    in all phases of emergency management
  • Accountability for implementation at local,
    regional and state levels

99
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

100
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

101
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

102
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

103
Summary
  • Competent disaster behavioral health practices
    require special attention given to
    special/vulnerable populations, cultural and
    ethical issues, and stressors in disaster work

104
  • Day 2
  • All KAHBH Network Members

105
Module 5The FEMA/SAMHSA Crisis Counseling
Assistance and Training Program
106
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

107
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

108
Administrative Staff
  • Community Program Managers
  • State Disaster Mental Health Coordinator
  • Governors Authorized Representative
  • FEMA Crisis Counseling Coordinator
  • FEMA Human Services Officer
  • Federal Coordinating Officer
  • FEMA Headquarters Crisis Counseling Coordinator
  • CMHS Project Officer

109
The Acronym Game!
  • KDEM
  • CMHS
  • KEOP
  • KAHBH
  • ISP
  • ICS
  • PIO
  • NIMS
  • ARC
  • ESF
  • VOAD
  • SOP
  • FEMA

110
The Acronym Game!
  • KDEM Kansas Department of Emergency Management
  • CMHS
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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

122
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

123
Examples of Disaster Crisis Counseling Program
Services
  • Outreach
  • Screening and Assessment
  • Counseling
  • Information and Referral
  • Public Education Social Advocacy

124
Program Limitations
  • Medications
  • Hospitalization
  • Long-term Therapy
  • Providing Childcare or Transportation
  • Fundraising activities
  • Individual Advocacy
  • Long-term Case Management

125
All-Hazards Crisis Counseling and Traditional
Behavioral Health Practice
Traditional Practice
Disaster Crisis Counseling
  • Primarily Office-Based
  • Focus on Diagnosis Treatment of Mental Illness
  • Attempt to Impact Personality Functioning
  • Examines Content
  • Encourages Insight into Past Experiences
    Influence on Current Problems
  • Psychotherapeutic Focus
  • Primarily Home Community Based
  • Assessment of Strengths, Adaptation Coping
    Skills
  • Seeks to Restore Pre-Disaster Functioning
  • Accepts Content at Face Value
  • Validates Appropriateness of Reactions and
    Normalizes Experience
  • Psycho-educational focus

Source ESDRB Program Guidance, December, 1996
126
All-Hazards Crisis Counseling and Traditional
Case Management
Traditional Case Management
Disaster Crisis Counseling
  • Provide services to individuals with SPMI or
    other disability
  • Services provided for indefinite duration
  • Responsible and accountable for client service
    provision
  • Power to influence services for their client
  • Long-term relationship with clients
  • Provide services to disaster survivors who often
    have a high level of functioning
  • Services provided do not require continuity of
    care
  • Empower disaster victims to advocate for services
    needed
  • Short-term relationship with disaster victims

Source ESDRB Program Guidance, December, 1996
127
FEMA/CMHS Crisis Counseling ProgramFY 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 1501 PR (Storms Flooding)
FEMA 1322 AL (Tornado)
FEMA 1437 LA (Flooding)
FEMA 1479 TX (Hurricane Claudette)
128
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

129
Behavioral Health Response to Presidentially
Declared Disaster
Sources of Information -American Red
Cross -KDEM -Adjutant Generals Office -Cities
- Newspapers - New Releases -Kansas WEB EOC
To Collect Data Per County -Casualties -Injured
-Business -Schools -Homes -Homeless -Power -Food
-Water -------------------------------------------
-Budget -Staff
Event
9 Months If needed apply for Regular
Services Program (RSP)
City Response
County Response
60 Days 1) On-Site Command 2) Local
Outreach workers 3) Supplies
State Response
KDEM Application National Disaster
KMHA has 14 Days to Apply for Immediate
Services Program (ISP)
Presidentially Declared Disaster
130
FEMA/SAMHSA CMHSAll-Hazards/Disaster Crisis
Counseling Program GrantsImmediate Services
Programand Regular Services Program
131
  • 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

132
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)

133
Module 6The KAHBH Program Preparedness,
Response, and Recovery for Kansas Communities
134
Organizations Involved in Behavioral Health
Disaster Response
  • Federal
  • SAMHSASubstance Abuse Mental Health Services
    Administration CMHSCenter for Mental Health
    Services
  • FEMAFederal Emergency Management Agency
  • State
  • KDEMKansas Dept. of Emergency Management
  • KDHEKansas Dept. of Health and Environment
  • SRSKansas Dept. of Social and Rehabilitation
    Services
  • Local
  • Local emergency management agencies
  • CMHCCommunity Mental Health Centers
  • Local professionals and para-professionals
    (substance abuse professionals, clergy,
    doctors/nurses, fire/police department,
    volunteers, etc.)

135
(No Transcript)
136
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

137
  • KDHE established a contract with KMHA to provide
    funds for 1 year to coordinate the development
    and implementation of the All-Hazards Behavioral
    Health Plan
  • In January 2005, Kansas Department of Social and
    Rehabilitation Services, Mental Health Authority,
    subcontracted with Kansas State University,
    School of Family Studies and Human Services
  • The Kansas All-Hazards Behavioral Health (KAHBH)
    Team was developed through the subcontract

138
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

139
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

140
KAHBH Network
  • 10 staff
  • 15 Stakeholders
  • 12 SRS Field Staff
  • 29 CMHC Coordinators
  • Goal 200 KAHBH Network members

141
KAHBH Stakeholder Supporting Agencies
  • Kansas Department of Health Environment, Office
    of Local Rural Health, Topeka
  • SRS Mental Health Authority, Topeka
  • SRS Health Care Policy, Addiction
    Rehabilitation Services, Topeka
  • Kansas State University, School of Family Studies
    and Human Services, Manhattan
  • University of Kansas School of Medicine,
    Department of Preventive Medicine Public
    Health, Wichita
  • Lawrence Therapy Services, Lawrence
  • Mental Health Center of East Central Kansas,
    Emporia
  • Regional Prevention Center, Olathe
  • Mid-America Addiction Technology Transfer Center
  • COMCARE, Wichita
  • American Red Cross, Midway Kansas Chapter,
    Wichita
  • Wyandot Center, Kansas City
  • Association of Community Mental Health Centers of
    Kansas, Inc., Topeka
  • Center for Counseling Consultation, Great Bend
  • Prairie View Behavioral Mental Health Care,
    Newton
  • Heartland Assessment Center, Roeland Park, KS
  • Resigned due to accepting positions in other
    states

142
KAHBH Plan and Operations Manual
  • The initial Kansas All-Hazards Behavioral Health
    Annex has been drafted and submitted to the
    Kansas Department of Emergency Management (KDEM)
    to be reviewed and accepted into the Kansas
    Emergency Operations Plan.
  • KDEM acceptance currently is pending
  • The State Plan will provide a detailed
    description of the behavioral health
    preparedness, response, and recovery in Kansas
  • Preliminary drafts of the Operations Manual have
    been developed and reviewed by the SRS Contract
    Manager.

143
KAHBH ANNEX (Submitted to KDEM)
  • KAHBH
  • Plan

KAHBH Training Operations Manual
144
KS Citizens

KDEM
State Plan
KS Citizens
145
KS Citizens

KAHBH
KDEM
State Plan
KS Citizens
146
KS Citizens
State Stakeholders

KAHBH
KDEM
State Plan
KS Citizens
147
KS Citizens

State Stakeholders
KAHBH
KDEM
State Plan
American Red Cross
KS Citizens
148
KS Citizens
State Stakeholders

KAHBH
KDEM
State Plan
Education Trainings, Universities, Conferences
American Red Cross
KS Citizens
149
KS Citizens
State Stakeholders

KAHBH
KDEM
State Plan
Education Trainings, Universities, Conferences
Governors Bioterrorism Coordinating Council (SRS
Mental Health Authority rep joined
4/04
American Red Cross
KS Citizens
150
KS Citizens
State Stakeholders

County Data Bank
KAHBH
KDEM
State Plan
Education Trainings, Universities, Conferences
Governors Bioterrorism Coordinating Council (SRS
Mental Health Authority rep joined
4/04
American Red Cross
KS Citizens
151
KS Citizens
State Stakeholders

County Data Bank
KAHBH
KDEM
State Plan
Education Trainings, Universities, Conferences
KS Train
Governors Bioterrorism Coordinating Council (SRS
Mental Health Authority rep joined
4/04
American Red Cross
KS Citizens
152
KS Citizens
State Stakeholders
Disaster Exercises

County Data Bank
KAHBH
KDEM
State Plan
Education Trainings, Universities, Conferences
KS Train
Governors Bioterrorism Coordinating Council (SRS
Mental Health Authority rep joined
4/04
American Red Cross
KS Citizens
153
KS Citizens
State Stakeholders
Disaster Exercises

County Data Bank
KAHBH
KDEM
State Plan
Education Trainings, Universities, Conferences
KS Train
1st responders/ Critical Incident Stress
Management
Governors Bioterrorism Coordinating Council (SRS
Mental Health Authority rep joined
4/04
American Red Cross
KS Citizens
154
KS Citizens
State Stakeholders
Disaster Exercises

County Data Bank
KAHBH
KDEM
State Plan
Education Trainings, Universities, Conferences
KS Train
1st responders/ Critical Incident Stress
Management
Governors Bioterrorism Coordinating Council (SRS
Mental Health Authority rep joined
4/04
American Red Cross
KS Citizens
155
Role of KAHBH Network Members
  • SAMHSA/CMHC Model
  • Professionals and paraprofessionals working in
    teams
  • Based on SRS CMHC Regions
  • 27 total areas in Kansas

156
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

157
  • 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.

158
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

159
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

160
Module 7Behavioral Health and the
All-Hazards Disaster Response System
161
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

162
  • 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

163
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)

164
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

165
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

166
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

167
ICS Organizational Structure
  • Operations
  • Directs activities to reduce the immediate hazard
    and restore essential functions
  • Planning
  • Acquires information on current and future
    situations
  • Logistics
  • Support for basic needs (communication, medical,
    food, supplies, transportation)
  • Finance/Administration
  • Tracks all costs
  • Provides administrative responsibilities for
    operation

168
Basic Incident Command Structure
INCIDENT COMMAND
Operations
Planning
Logistics
Finance/ Administration
169
ICS Supervisory Position Titles Chain of
Command Unity of Command
Organizational Level Incident Command Command
Staff General Staff (Section) Branch Division/Grou
p Strike team/Task force
Title Incident Commander Officer Chief Director Su
pervisor 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
170
  • As responders to all-hazards events, it is
    critical that behavioral health providers become
    part of the emergency response system

171
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 t
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