Title: Kansas All-Hazards Behavioral Health Training
1Kansas All-Hazards Behavioral Health Training
- Core Competencies
- for Community Outreach Workers
2What 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
3Key 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
4KAHBH Network
- 10 staff
- 15 Stakeholders
- 12 SRS Field Staff
- 29 CMHC Coordinators
- Goal 200 KAHBH Network members
5Outline 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
8Core Competencies, Terminology, and Regional
Disaster Information
9KAHBH Core Objectives
- Understand the difference between Community
Mental Health Center (CMHC) crisis counseling and
the All-Hazards/Disaster Behavioral Health
crisis counseling (FEMA/SAMHSA CMHS) model - Understand human behavior in disasters
- Understand the key concepts of all-hazards
behavioral health - Understand the organizational aspects of disaster
response - Understand how to assess the needs of and
intervene effectively with disaster survivors,
including special populations - Provide appropriate behavioral health assistance
to survivors and workers at the community level - Understand, recognize and manage stress in
disaster work
10KAHBH 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
11KAHBH 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
14Terminology
- Behavioral Health
- Mental Health Substance Abuse
15Terminology (continued)
- All-Hazards All-Hazards
- Disasters Bioterrorism Major Community
Crises
16Examples of All-Hazards Crisis Counseling
Program Services
- Outreach
- Screening and Assessment
- Counseling
- Information and Referral
- Public Education Social Advocacy
17Program Limitations
- Medications
- Hospitalization
- Long-term Therapy
- Providing Childcare or Transportation
- Fundraising activities
- Individual Advocacy
- Long-term Case Management
18All-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
20Organizations 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.)
21The 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
22The 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
24Module 1Disaster Classifications and Phases
Wichita tornado
25Definition 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.
27Natural Disasters
- Floods
- Tornados
- Hurricanes
- Typhoons
- Winter storms
- Tsunamis
- Hail storms
- Wildfires
- Windstorms
- Epidemics
- Earthquakes
28Human-Caused Disasters
- Intentional and unintentional
- Residential fires
- Building collapses
- Transportation accidents
- Hazardous materials releases
- Explosions
- Domestic acts of terrorism
29Criteria for Presidential Disaster Declaration
30Behavioral Health Response to Presidentially
Declared Disaster
Event
City Response
County Response
State Response
KDEM Application National Disaster
Presidentially Declared Disaster
31Classification of Disasters
- Natural vs. Human-caused
- Degree of personal impact
- Size and scope
- Visible impact/low point
- Probability of
- reoccurrence
32Critical 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
33Phases of Disaster Reactions
- Warning of threat
- Impact
- Rescue or Heroic
- Remedy or Honeymoon
- Inventory
- Disillusionment
- Reconstruction and recovery
34Typical Phases of Disasters
1 to 3 Days -------------------TIME---------------
----------------------------1 to 3 Years
Zunin/Meyers
35Comparing Criminally Human-Caused and
Natural Disasters
- Causation
- Appraisal of event
- Psychological impact
- Subjective experience
- World view/basic assumption
- Stigmatization of victims
- Media
- Secondary injury
36Terrorism 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
37Mass 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
38Summary
- 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
39Module 2Traumatic Reactions to Disasters
40Effects 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
41Psychosocial Concerns
- Disruption of existing social/community
- Impact of new social patterns
- Duration of recovery
- Cross-cultural impact
42What 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
43Stressors in Disaster Work
- Event related
- Occupational
- Organizational
- Family or personal life
44Stress Basics
- Stress is
- Normal
- Necessary
- Productive and destructive
- Acute and delayed
- Cumulative
- Identifiable
- Preventable and manageable
45Physical 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
46Emotional Changes with Stress
- Increased feelings of isolation
- Depression
- Anger
- Anhedonia (lack of joy)
- Slowed learning speed
- Impaired decision making
- Decreased self-awareness
47Mental Changes with Stress
- Decreased memory
- Decreased attention span
- Decreased intimacy
48Organizational Approaches
- Effective management structure and leadership
- Clear purpose and goals
- Functionally defined roles
- Team support
- Plan for stress management
49Individual Approaches
- Management of workload
- Balances lifestyle
- Stress reduction strategies
- Self-awareness
50Effects 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
51Acute 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
52Long 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.
53Post-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
54Other Long Term Reactions
- Major depression
- Suicidal thoughts and attempts
- Alcohol and drug abuse
- Anxiety disorders
- Dissociative disorders
55Summary
- Disasters can elicit traumatic reactions in the
victims who survive it.
56Additional Reactions to Disasters
57Disaster 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
58Physical Reactions
- Fatigue, exhaustion
- Gastrointestinal distress
- Appetite changes
- Tightening in the throat or chest
- Other somatic complaints
59Emotional Reactions
- Depression, sadness
- Irritability, anger, resentment
- Anxiety, fear
- Despair, hopelessness
- Guilt, self-doubt
- Unpredictable mood swings
60Cognitive Reactions
- Confusion, disorientation
- Recurring dreams, nightmares
- Preoccupations with disaster
- Trouble concentrating or remembering things
- Difficulty making decisions
- Questioning spiritual beliefs
61Behavioral Reactions
- Sleep problems
- Crying easily
- Avoiding reminders
- Excessive activity level
- Increased conflicts with family
- Hypervigilance, startle reactions
- Isolation or social withdrawal
62Spiritual 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
63Chronic Stressors in Disasters
- Family disruption
- Work overload
- Gender differences
- Bureaucratic hassles
- Financial strain
64Loss and Grief
- Loss is a common theme in disaster settings
- Common reactions to loss
- Denial, numbness or shock
- Anger
- Bargaining
- Depression
- Acceptance
- Reorientation
65Loss 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
66Emotional 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
67Summary
- Disasters may elicit a number of non-traumatic
responses in its victims, including - Grief reactions
- Physical reactions
- Emotional reactions
- Cognitive reactions
- Behavioral reactions
68Module 3Providing Support During Disasters
69All-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
70All-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
71In 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)
72Key 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
73Overarching 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
74Maslows Hierarchy of Needs
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75Guiding 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
77Crisis Intervention
- Observe safe practices by showing concern for
your own safety - Remain calm and appear relaxed, confident and
non-threatening
78Crisis Intervention Steps
- Assess the situation
- Establish rapport
- Identify the main problem(s)
- Deal with feelings and emotions
- Generate and explore alternative coping
strategies - Formulate an action plan
- Follow up
79On-Scene Interventions
- Direct to medical care, safety, shelter
- Protect from trauma, media, onlookers
- Connect to family, information, comfort
- (Myers and Wee, 2003)
80Immediate Interventions
- Rapid assessment and triage
- Psychological first-aid
- Crisis intervention
- Crime victim assistance
- Psycho-education
- Information briefings
- Community outreach
81Immediate Interventions (continued)
- Participation in death notification
- Behavioral health consultation
- Debriefing and community meetings
- Information and referral
82Psychological 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
83Crisis Intervention
- Promote safety and security
- Gently explore trauma experience
- Identify priority needs and solutions
- Assess functioning and coping
- Provide
- Reassurance
- Psycho-education
- Practical assistance
84Crime Victim Assistance
- Protect victims rights
- Ensure control over media
- Provide criminal justice information
- Facilitate access to compensation
- Streamline bureaucratic procedures
85Community 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
86Participation 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
87Brief Trauma Interventions
- Factual information
- Thoughts during event
- Reactions and feelings
- Psycho-education
- Problem-solving and action
88Post-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
89Key Events with Behavioral Health Implications
- Death notification
- Ending search and recovery
- Bulldozing homes/neighborhoods
- Criminal justice proceedings
- Returning to impacted areas
- Funeral and memorials
90Community Interventions
- Memorials and rituals
- Usual community gatherings
- Anniversary commemorations
- Symbolic gestures
91Summary
- 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
92Survivor Risk and Resiliency Factors
- Psychological
- Capacity to tolerate stress
- Prior trauma history
- Socioeconomic and education level
- Family stability
- Social support
- Gender roles
93Teaching 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
94Teaching 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)
95Summary
- The effectiveness of all-hazards
support and crisis
intervention during a disaster may be affected by
a number of survivor risk and resiliency factors
96Module 4Considerations for Special
Populations, Cultural Competence, and Ethical
Issues
97Special/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
98Statement 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
99Cultural 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
100Basic 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
101Ethical 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
102Key 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
103Summary
- 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
105Module 5The FEMA/SAMHSA Crisis Counseling
Assistance and Training Program
106The 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
107Organizational 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
108Administrative 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
109The Acronym Game!
- KDEM
- CMHS
- KEOP
- KAHBH
- ISP
- ICS
- PIO
- NIMS
- ARC
- ESF
- VOAD
- SOP
- FEMA
110The Acronym Game!
- KDEM Kansas Department of Emergency Management
- CMHS
- KEOP
- KAHBH
- ISP
- ICS
- PIO
- NIMS
- ARC
- ESF
- VOAD
- SOP
- FEMA
111The 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
112The 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
113The 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
114The 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
115The 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
116The 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
117The 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
118The 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
119The 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
120The 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
121The 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
122The 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
123Examples of Disaster Crisis Counseling Program
Services
- Outreach
- Screening and Assessment
- Counseling
- Information and Referral
- Public Education Social Advocacy
124Program Limitations
- Medications
- Hospitalization
- Long-term Therapy
- Providing Childcare or Transportation
- Fundraising activities
- Individual Advocacy
- Long-term Case Management
125All-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
126All-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
127FEMA/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)
128Summary
- 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
129Behavioral 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
130FEMA/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
132Summary
- 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)
133Module 6The KAHBH Program Preparedness,
Response, and Recovery for Kansas Communities
134Organizations 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)
136State-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
138KAHBH 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
139Key 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
140KAHBH Network
- 10 staff
- 15 Stakeholders
- 12 SRS Field Staff
- 29 CMHC Coordinators
- Goal 200 KAHBH Network members
141KAHBH 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
142KAHBH 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.
143KAHBH ANNEX (Submitted to KDEM)
KAHBH Training Operations Manual
144KS Citizens
KDEM
State Plan
KS Citizens
145KS Citizens
KAHBH
KDEM
State Plan
KS Citizens
146KS Citizens
State Stakeholders
KAHBH
KDEM
State Plan
KS Citizens
147KS Citizens
State Stakeholders
KAHBH
KDEM
State Plan
American Red Cross
KS Citizens
148KS Citizens
State Stakeholders
KAHBH
KDEM
State Plan
Education Trainings, Universities, Conferences
American Red Cross
KS Citizens
149KS 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
150KS 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
151KS 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
152KS 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
153KS 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
154KS 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
155Role of KAHBH Network Members
- SAMHSA/CMHC Model
- Professionals and paraprofessionals working in
teams - Based on SRS CMHC Regions
- 27 total areas in Kansas
156The 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.
158Network 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
159Key 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
160Module 7Behavioral Health and the
All-Hazards Disaster Response System
161The 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
163Emergency 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)
164Incident 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
165Incident 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
166Incident 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
167ICS 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
168Basic Incident Command Structure
INCIDENT COMMAND
Operations
Planning
Logistics
Finance/ Administration
169ICS 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
171Federal 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