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

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• 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

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• 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

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Core Competencies, Terminology, and Regional
Disaster Information
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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

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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

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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

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• 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

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

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Terminology

• Behavioral Health
• Mental Health Substance Abuse

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Terminology (continued)

• All-Hazards All-Hazards
• Disasters Bioterrorism Major Community
  Crises

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Examples of All-Hazards Crisis Counseling
Program Services

• Outreach
• Screening and Assessment
• Counseling
• Information and Referral
• Public Education Social Advocacy

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Program Limitations

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

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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
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• 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

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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.)

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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

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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

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• Regional
• Disaster Information

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Module 1Disaster Classifications and Phases
Wichita tornado
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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

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• 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.

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Natural Disasters

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

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Human-Caused Disasters

• Intentional and unintentional
• Residential fires
• Building collapses
• Transportation accidents
• Hazardous materials releases
• Explosions
• Domestic acts of terrorism

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Criteria for Presidential Disaster Declaration
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Behavioral Health Response to Presidentially
Declared Disaster
Event
City Response
County Response
State Response
KDEM Application National Disaster
Presidentially Declared Disaster
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Classification of Disasters

• Natural vs. Human-caused
• Degree of personal impact
• Size and scope
• Visible impact/low point
• Probability of
• reoccurrence

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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

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Phases of Disaster Reactions

• Warning of threat
• Impact
• Rescue or Heroic
• Remedy or Honeymoon
• Inventory
• Disillusionment
• Reconstruction and recovery

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Typical Phases of Disasters

1 to 3 Days -------------------TIME---------------
----------------------------1 to 3 Years
Zunin/Meyers
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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

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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

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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

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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

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Module 2Traumatic Reactions to Disasters
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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

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Psychosocial Concerns

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

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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

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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

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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

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Other Long Term Reactions

• Major depression
• Suicidal thoughts and attempts
• Alcohol and drug abuse
• Anxiety disorders
• Dissociative disorders

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Summary

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

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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

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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

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Crisis Intervention

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

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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