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

                             1
      What is KAHBH?
• KAHBH provides State-wide organization
  and coordination for behavioral health
  response to disaster and other all-hazards
  events
  – Training and preparing Kansas professionals
    and paraprofessionals to serve in behavioral
    health capacity during an event
  – Providing technical assistance and all-hazards
    behavioral health information to Kansans

                                                2
   Key KAHBH Tasks

• Resource identification and collection
• Training and education
• Development of Annex to KEOP, KAHBH
  Plan, and Standard Operating Procedures
• State-wide network recruitment and
  coordination
• Preparedness, response, and recovery
  activities
                                       3
     KAHBH Network

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



                                       4
              Outline of
           KAHBH Trainings
KAHBH Core Behavioral Health Training
• DAY 1 (approx. 8 hours)
   – For all participants without CISM or ARC DMH training within the last 5
     years (Mental health and paraprofessionals)
       •   Module 1: Disaster Classifications and Phases
       •   Module 2: Traumatic Reactions to Disasters
       •   Module 3: Providing Support During Disasters
       •   Module 4: Considerations for Special Populations, Cultural Competence, and
           Ethical Issues
• Day 2 (approx. 3.5)
   – For ALL KAHBH Network members
       • Module 5: The FEMA/SAMHSA CMHS Crisis Counseling Assistance and
         Training Program
       • Module 6: The KAHBH Program: Preparedness, Response, and Recovery for
         Kansas Communities
       • Module 7: Behavioral Health and the All-Hazards Disaster Response System
       • Module 8: KAHBH Community Outreach Teams: Structure, Procedures, and
         Documents
                                                                                    5
• Paraprofessional Training
  – ½ day (4 hours) training to provide non-behavioral
    health professionals with background information
    in working with people in crisis, communication
    skills, issues related to confidentiality and ethics,
    and other basic helping skills
     •   The Role of the Helper
     •   Professional and personal boundaries
     •   Ethics, confidentiality, and dual relationships
     •   Communication Skills
     •   Challenges in Helping
     •   Diversity and multicultural awareness as a helper
     •   Helping in Crisis and Grief Situations

                                                             6
• Future Specialty Trainings
  – To be based on each community’s needs
  – All non-mental health members will receive additional ½ day (4 hours)
    training on basic helping skills in crisis counseling
  – At least 2 members (1 MH and 1 NMH) from each area will receive
    specialized training in the following areas (to be provided online in 2-4 hour
    trainings):
      •   Children (under age 18)
      •   Frail Elderly
      •   Developmentally and physically disabled
      •   Severe Mental Illness and People in active Substance Abuse Treatment
      •   People in Correctional Institutions
      •   College Students in dorms/away from home/Families/individuals relocated
      •   People with high traumatic exposure
      •   People in poverty and homeless
      •   Roles of women in community (e.g. new moms, multiple caregivers)
      •   Men and Women
      •   Emergency responders involved in rescue/recovery
      •   Multicultural issues
                                                                                  7
      •   Farmers/Ranchers/Agricultural Workers/Rural Populations
   Core Competencies,
Terminology, and Regional
   Disaster Information




                            8
                 KAHBH
              Core Objectives
1.   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 9
                 KAHBH
            Core Competencies
• Identifies relevant and appropriate data and information sources
• Obtains and interprets information regarding risks and benefits to the
  community
• Recognizes how the data illuminates ethical, political, scientific,
  economic, and overall public behavioral health issues
• Prepare and implement behavioral health emergency response plans
• Advocates for public health/behavioral health programs and resources
• Effectively presents accurate demographic, statistical, programmatic and
  scientific information for professional and lay audiences
• Utilizes appropriate methods for interacting sensitively, effectively, and
  professionally with persons from diverse cultural, socioeconomic,
  educational, racial, ethnic, and professional backgrounds, and persons of
  all ages and lifestyle preferences
• Identifies the role of cultural, social, and behavioral factors in determining
  the delivery of public health/behavioral health services                10
                 KAHBH
            Core Competencies
• Develops and adapts approaches to problems that take into account
  cultural differences
• Collaborates with community partners to promote the health/behavioral
  health of the population
• Identifies community assets and available resources
• Describes the role of government in the delivery of community behavioral
  health services
• Identifies the individual’s and organization’s responsibilities within the
  context of the KAHBH Program and its core functions
• Creates a culture of ethical standards within organizations and
  communities
• Helps create key values and shared vision and uses these principles to
  guide action
• Identifies internal and external issues that may impact delivery of
  essential public behavioral health services (i.e., strategic planning)
• Promotes team and organizational learning                                11
“It is important to remember that mental health
intervention is a prompt and effective medical response
to a bioterrorism attack. Early detection, successful
management of casualties, and effective treatments
bolster the public’s sense of safety and increase
confidence in our institutions. Because the overriding
goal of terrorism is to change people’s beliefs, sense of
safety, and behaviors, mental health experts are an
essential part of planning and responding.”
                           Statement from the Conference Transcript:
         Responding to Bioterrorism: Individual and Community Needs,
                                                                 2001
                                                  October 19-21,12
―Mental Health is the linchpin to an
        effective response.‖

            Statement from April 2005
                 TOPOFF 3 Exercise


                                       13
      Terminology




        ―Behavioral Health‖
Mental Health + Substance Abuse
                           14
         Terminology
               (continued)




    All-Hazards = All-Hazards
Disasters ~ Bioterrorism ~ Major Community Crises
                                               15
Examples of All-Hazards Crisis
Counseling Program Services

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

                                   16
           Program
          Limitations
•   Medications
•   Hospitalization
•   Long-term Therapy
•   Providing Childcare or Transportation
•   Fundraising activities
•   Individual Advocacy
•   Long-term Case Management
                                      17
All-Hazards Crisis Counseling
      and “Traditional”
 Behavioral Health Practice
  “Traditional” Practice                           Disaster Crisis
  • Primarily Office-Based                          Counseling
  • Focus on Diagnosis &                  • Primarily Home & Community Based
    Treatment of Mental Illness           • Assessment of Strengths, Adaptation
  • Attempt to Impact Personality           & Coping Skills
    & Functioning                         • Seeks to Restore Pre-Disaster
  • Examines Content                        Functioning
  • Encourages Insight into Past          • Accepts Content at Face Value
    Experiences & Influence on            • Validates Appropriateness of
    Current Problems                        Reactions and Normalizes
  • Psychotherapeutic Focus                 Experience
                                          • Psycho-educational focus
                                                                       18
  Source: ESDRB Program Guidance, December, 1996
• The KAHBH Program follows the
  FEMA/SAMHSA CMHS Crisis Counseling
  Program as the primary model
  – Federal program
    • Over 30 year history
    • ―Best Practice‖ nationally recognized material
  – Collaboration between FEMA, SAMHSA
    CMHS, state mental health authority (SRS in
    Kansas), and local responders
  – Community based
    • Focus on providing services to the general
      population
    • Includes paraprofessionals or community ―heroes‖
                                                      19
      as potential providers
Organizations Involved in
Behavioral Health Disaster
       Response
• Federal
  – SAMHSA—Substance Abuse Mental Health Services
    Administration & CMHS—Center for Mental Health Services
  – FEMA—Federal Emergency Management Agency
• State
  – KDEM—Kansas Dept. of Emergency Management
      • KDHE—Kansas Dept. of Health and Environment
          – SRS—Kansas Dept. of Social and Rehabilitation Services
• Local
  – Local emergency management agencies
  – CMHC—Community Mental Health Centers
  – Local professionals and para-professionals (substance abuse
    professionals, clergy, doctors/nurses, fire/police department, 20
    volunteers, etc.)
The KAHBH Program is not:
• American Red Cross Disaster Mental Health
  Services (ARC DMHS)
  – ARC requires a masters-level licensed mental health professional
  – ARC mental health workers are volunteers and do not receive
    reimbursement for their services

• Critical Incident Stress Management (CISM)
  – Model developed and approved for use with first responders, but
    often is applied to many areas of crisis response, which may not be
    appropriate


                                                                  21
 The KAHBH Program
• Emphasizes the importance of ALL
  approaches to all-hazards/disaster events
• Recognizes and supports collaboration
  between behavioral health responders and
  other responders in all-hazards/disaster
  events
• Works to provide State-wide organization
  and coordination for behavioral health
  response to disaster and other all-hazards
  events                                   22
     Regional
Disaster Information



                       23
     Module 1:

   Disaster
Classifications
 and Phases

                  24
Wichita tornado
        Definition of a
          Disaster
A disaster is a threatening or
occurring event of such destructive
magnitude and force as to:
  • dislocate people
  • separate family members
  • damage or destroy homes
  • injure or kill people
                                  25
• A disaster produces a range
  and level of immediate suffering
  and basic human needs that
  cannot be promptly or
  adequately addressed by the
  affected people, and impedes
  them from initiating and
  proceeding with their recovery
  efforts.                       26
    Natural Disasters
•   Floods
•   Tornados
•   Hurricanes
•   Typhoons
•   Winter storms
•   Tsunamis
•   Hail storms
•   Wildfires
•   Windstorms
•   Epidemics
•   Earthquakes         27
Human-Caused Disasters

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

                                   28
       Criteria for Presidential
        Disaster Declaration

―[A]ny natural catastrophe (including any hurricane,
tornado, storm, high water, wind-driven water, tidal
wave, tsunami, earthquake, volcanic eruption,
landslide, mudslide, snowstorm, or drought), or,
regardless of cause, any fire, flood, or explosion in
any part of the United States, which in the
determination of the President causes sufficient
severity and magnitude to warrant major disaster
assistance under this act . . .
                         Source: Robert T. Stafford Disaster Assistance and
                           Emergency Relief Act (P.L. 93-288 as amended)29
Behavioral Health Response to
Presidentially Declared Disaster
              Event

          City Response

         County Response

          State Response

        KDEM Application
         National Disaster

          Presidentially
         Declared Disaster         30
           Classification of
              Disasters
•   Natural vs. Human-caused
•   Degree of personal impact
•   Size and scope
•   Visible impact/low point
•   Probability of
    reoccurrence

                                31
Critical Disaster
   Stressors
     •   Threat to one’s life
     •   Threat of harm to family
     •   Destruction of home or community
     •   Significant media attention
     •   Witnessing others’ trauma
     •   Being trapped or unable to evacuate




                                       32
            Phases of
        Disaster Reactions
•   Warning of threat
•   Impact
•   Rescue or Heroic
•   Remedy or Honeymoon
•   Inventory
•   Disillusionment
•   Reconstruction and recovery

                                  33
               Typical Phases of Disasters
                                   Honeymoon
                                      (Community
                                       Cohesion)
                                                                                      Reconstruction
               “Heroic”                                                                 A New Beginning
Pre-disaster
                                                  Disillusionment
Warning
           Threat
                    Impact




                                                                     Trigger Events and Anniversary
                       Inventory
                                                                     Reactions

                                                                                                      34
                1 to 3 Days -------------------TIME-------------------------------------------1 to 3 Years
Zunin/Meyers
    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
                                  35
         Terrorism Within the
            United States
• ―An activity that involves a violent act or an act of
  dangerousness to human life that is in violation of the
  criminal laws of the United States, or of any
  State…and that appears to be intended to intimidate
  or coerce a civilian population…
  or to influence the policy
  of government by
  assassination or
  kidnapping.‖
         [18 U.S.C. 3077]



                                                            36
     Mass Violence Within
      the United States

• ―An intentional violent criminal act, for which a
  formal investigation has been opened by the
  FBI or other law enforcement agency, that
  results in physical, emotional, or
  psychological injury to a sufficiently large
  number of people as to significantly increase
  the burden of victim assistance for the
  responding jurisdiction‖
                                                 37
              Summary
• Disasters can be classified according to
  a number of different variables,
  including natural vs. human-caused
• Most disasters have distinguishable
  phases, beginning with the pre-disaster
  and warning phase and ending with the
  reconstruction phase

                                         38
      Module 2:

Traumatic Reactions to
     Disasters




                         39
           Effects of
            Trauma
• Vary by a person’s age, developmental stage,
  prior condition, degree of personal impact

• Vary by the disaster’s severity, the amount of
  advance warning, the level of community
  preparedness

• May include physical, emotional, cognitive or
  behavioral reactions

                                                  40
         Psychosocial
          Concerns
•   Disruption of existing social/community
•   Impact of new social patterns
•   Duration of recovery
•   Cross-cultural impact




                                              41
      What Scares Us?

• Things frighten us more
  if they are…                    • than things that are…
   – Controlled by someone           – In our control
     else                            – Helpful or beneficial to us
   – Not beneficial in any way         or society
     to anyone                       – Easily and quickly
   – Hard to treat or treatment        diagnosable and
     is not available to               treatable
     everyone                        – Survivable
   – Catastrophic or deadly          – Familiar and routine
   – Exotic or unusual

                                                                42
              Stressors in
             Disaster Work

•   Event related
•   Occupational
•   Organizational
•   Family or personal life




                              43
Stress
Basics
   • Stress is:
     – Normal
     – Necessary
     – Productive and destructive
     – Acute and delayed
     – Cumulative
     – Identifiable
     – Preventable and manageable

                            44
Physical Changes with
        Stress
•   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
                                               45
Emotional Changes with
        Stress
•   Increased feelings of isolation
•   Depression
•   Anger
•   Anhedonia (lack of joy)
•   Slowed learning speed
•   Impaired decision making
•   Decreased self-awareness
                                      46
 Mental Changes with
        Stress
• Decreased memory
• Decreased attention span
• Decreased intimacy




                             47
         Organizational
          Approaches

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

                                       48
            Individual
           Approaches
•   Management of workload
•   Balances lifestyle
•   Stress reduction strategies
•   Self-awareness




                                  49
       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
                                      50
        Acute Traumatic
        Stress Disorder

• The development, within one month of
  the event, of at least 3 of the following:
  – Dissociation, emotional numbing
  – A re-experiencing of the event
  – Behavioral avoidance
  – Increased physiologic arousal
  – Social-occupational impairment

                                               51
           Long Term
            Trauma
• For some, it may last months or years
• The rates of PTSD are much higher among
  victims of violent crimes than victims of other
  types of traumatic events
• Crime victims who believed they would be
  killed or seriously injured were much more
  likely to develop PTSD than victims whose
  crimes did not involve life-threatening injury.

                                                    52
        Post-Traumatic
        Stress Disorder

• Persistent re-experiencing of the event
• Avoidance of things associated with
  event
• Symptoms of increased arousal
• Distress or impairment
  in social, occupational,
  or other areas

                                            53
        Other Long Term
           Reactions
•   Major depression
•   Suicidal thoughts and attempts
•   Alcohol and drug abuse
•   Anxiety disorders
•   Dissociative disorders



                                     54
              Summary
• Disasters can elicit traumatic reactions
  in the victims who survive it.




                                             55
Additional Reactions to
       Disasters



                          56
    Disaster Stress and
      Grief Reactions

• Normal responses to abnormal situation
  – Often transitory in nature
• Reactions:
  – Emotional and psychological strain
  – Acute stress
  – Post traumatic stress
  – Grief reactions
  – Immediate and practical problems in living
                                                 57
Physical
Reactions
  •   Fatigue, exhaustion
  •   Gastrointestinal distress
  •   Appetite changes
  •   Tightening in the throat or chest
  •   Other somatic complaints




                                 58
               Emotional
               Reactions
•   Depression, sadness
•   Irritability, anger, resentment
•   Anxiety, fear
•   Despair, hopelessness
•   Guilt, self-doubt
•   Unpredictable mood swings

                                      59
         Cognitive
         Reactions
• Confusion, disorientation
• Recurring dreams, nightmares
• Preoccupations with disaster
• Trouble concentrating or remembering
  things
• Difficulty making decisions
• Questioning spiritual beliefs
                                         60
              Behavioral
              Reactions
•   Sleep problems
•   Crying easily
•   Avoiding reminders
•   Excessive activity level
•   Increased conflicts with family
•   Hypervigilance, startle reactions
•   Isolation or social withdrawal
                                        61
           Spiritual
          Reactions
• Withdrawal from places of worship or
  spiritual practices
• Uncharacteristic religious involvement
• Being troubled by biblical or historical
  predictions
• Questioning meaning and beliefs
• Anger with God or higher power
• Loss of faith
                                             62
       Chronic Stressors
         in Disasters
•   Family disruption
•   Work overload
•   Gender differences
•   Bureaucratic hassles
•   Financial strain



                           63
       Loss and Grief

• Loss is a common theme in disaster
  settings
• Common reactions to loss:
  – Denial, numbness or shock
  – Anger
  – Bargaining
  – Depression
  – Acceptance
  – Reorientation
                                       64
Loss and Grief –
Signs of Trouble
   • Using alcohol or drugs to
     self-medicate
   • Using work or other distractions
     to avoid feelings
   • Hostility and aggression toward
     others
   • Avoiding or minimizing emotions


                                   65
    Emotional Numbness
    or Extreme Agitation
• Immediate attention is needed
• Possible referral for professional care
• When referring:
  – Inform the person of your intention
  – Recognize that the referral may cause a
    negative reaction



                                              66
              Summary
• Disasters may elicit a number of non-
  traumatic responses in its victims,
  including:
  – Grief reactions
  – Physical reactions
  – Emotional reactions
  – Cognitive reactions
  – Behavioral reactions

                                          67
       Module 3:

Providing Support During
        Disasters




                           68
All-Hazards Crisis Counseling
      and “Traditional”
 Behavioral Health Practice
 “Traditional” Practice                     Disaster Crisis Counseling
 • Primarily Office-Based                     • Primarily Home & Community
 • Focus on Diagnosis &                         Based
   Treatment of Mental Illness                • Assessment of Strengths,
 • Attempt to Impact Personality                Adaptation & Coping Skills
   & Functioning                              • Seeks to Restore Pre-Disaster
 • Examines Content                             Functioning
 • Encourages Insight into Past               • Accepts Content at Face Value
   Experiences & Influence on                 • Validates Appropriateness of
   Current Problems                             Reactions and Normalizes
 • Psychotherapeutic Focus                      Experience
                                              • Psycho-educational focus
      Source: ESDRB Program Guidance, December, 1996                   69
All-Hazards Crisis Counseling
      and “Traditional”
      Case Management
 “Traditional” Case Management                  Disaster Crisis Counseling
 • Provide services to individuals             • Provide services to disaster
   with SPMI or other disability                 survivors who often have a high
 • Services provided for indefinite              level of functioning
   duration                                    • Services provided do not require
 • Responsible and accountable                   continuity of care
   for client service provision                • Empower disaster victims to
 • Power to influence services for               advocate for services needed
   their client                                • Short-term relationship with
 • Long-term relationship with                   disaster victims
   clients

       Source: ESDRB Program Guidance, December, 1996                    70
In other words…
 • CMHC Crisis Counseling
   – Day-to-day crises
   – A few people from a target population
     experiencing severe reactions (suicide, violence,
     psychiatric problems, substance abuse)


 • All-Hazards/Disaster Crisis Counseling
   – Event specific
   – Targets the general population (lots of people)
     experiencing low levels (but significant) reactions
     (with a few experiencing severe reactions)
                                                           71
        Key Concepts in
    All-Hazards Behavioral
            Health
• No one who sees a disaster is untouched by it
• People experience individual and collective
  trauma
• Securing disaster relief can be emotionally
  stressful
• Most people pull together during and after a
  disaster, but their effectiveness is diminished
• Most people do not see themselves as needing
  behavioral health services following a disaster
  and will not seek out such services
                                                72
          Overarching
           Concepts
• Normal reactions to abnormal situation
• Avoid ―mental health‖ terms and labels
• Assistance is practical
• Assume competence
• Focus on strengths and
  potentials
• Encourage use of support
  network
• Active, community fit
• Innovative in helping
                                           73
Maslow’s Hierarchy of Needs




                                                             74
      www.tutor2u.net/business/images/maslow_hierarchy.gif
     Guiding Principles
    in 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
                                           75
     Guiding Principles
in 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
                                                76
          Crisis
       Intervention




• Observe safe practices by showing
  concern for your own safety
• Remain calm and appear relaxed,
  confident and non-threatening       77
     Crisis Intervention
            Steps
1. 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
                                             78
         On-Scene
       Interventions
• Direct to medical care, safety, shelter
• Protect from trauma, media, onlookers
• Connect to family, information, comfort

                         (Myers and Wee, 2003)




                                                 79
           Immediate
         Interventions
•   Rapid assessment and triage
•   Psychological first-aid
•   Crisis intervention
•   Crime victim assistance
•   Psycho-education
•   Information briefings
•   Community outreach
                                  80
           Immediate
         Interventions
              (continued)


•   Participation in death notification
•   Behavioral health consultation
•   Debriefing and community meetings
•   Information and referral



                                          81
     Psychological
       First-Aid
• Provide comfort, empathy, an ―ear‖
• Address physical needs
• Provide concrete information about
  what will happen next
• Link to support systems
• Reinforce coping strengths

                                       82
             Crisis
          Intervention
•   Promote safety and security
•   Gently explore trauma experience
•   Identify priority needs and solutions
•   Assess functioning and coping
•   Provide:
    – Reassurance
    – Psycho-education
    – Practical assistance
                                            83
Crime Victim             Assistance

   •   Protect victims’ rights
   •   Ensure control over media
   •   Provide criminal justice information
   •   Facilitate access to compensation
   •   Streamline bureaucratic procedures



                                              84
        Community
         Outreach
• Initiate contact at gathering sites
• Set up 24-hour telephone hotlines
• Outreach to survivors through media,
  Internet
• Educate service providers
• Use bilingual and bicultural workers

                                         85
      Participation in
     Death Notification
• Responsible notifier:
  – Obtains critical information
  – Notifies next-of-kin directly, simply, and in
    person
  – Expects intense reactions
  – Provides practical assistance
  – Mental health, participates on team,
    provides support and information
                                                    86
         Brief Trauma
         Interventions
•   Factual information
•   Thoughts during event
•   Reactions and feelings
•   Psycho-education
•   Problem-solving and action


                                 87
         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
                                              88
         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
                                     89
           Community
          Interventions
•   Memorials and rituals
•   Usual community gatherings
•   Anniversary commemorations
•   Symbolic gestures



                                 90
                  Summary
• The role of behavioral health in crisis
  response may include the following:
   –   On-scene interventions
   –   Immediate interventions
   –   Psychological first aid
   –   Crisis interventions
   –   Crime victim assistance
   –   Community outreach
   –   Death notification
   –   Brief trauma interventions
   –   Post-disaster inventions
                                            91
       Survivor Risk and
       Resiliency Factors
•   Psychological
•   Capacity to tolerate stress
•   Prior trauma history
•   Socioeconomic and education level
•   Family stability
•   Social support
•   Gender roles
                                        92
 Teaching Strategies for
 Enhancing Resilience

•Encourage making connections with others
•Redirect from seeing crises as insurmountable
problems
•Encourage accepting change as a part of living
•Encourage movement toward goals
•Encourage taking directive actions
•Observe opportunities for self-discovery
                                                  93
 Teaching Strategies for
 Enhancing Resilience

•Nurture a positive view of self
•Encourage keeping things in perspective
•Encourage maintaining a positive outlook
•Encourage self care (emotional and
physical)

                                            94
Summary

• The effectiveness of
  all-hazards support
  and crisis intervention
  during a disaster may be
  affected by a number of
  survivor risk and resiliency
  factors
                         95
         Module 4:

  Considerations for Special
    Populations, Cultural
Competence, and Ethical Issues




                                 96
             Special/Vulnerable
                Populations
             NO ONE IS UNTOUCHED BY DISASTER…
                 NO ONE IS NOT VULNERABLE

•   Children (under age 18)
•   Frail Elderly
•   Developmentally and physically disabled
•   Severe Mental Illness and People in active Substance Abuse Treatment
•   People in Correctional Institutions
•   College Students in dorms/away from home/ families/individuals relocated
•   People with high traumatic exposure
•   People in poverty and homeless
•   Emergency responders involved in rescue/recovery
•   Multicultural issues
•   Farmers/Ranchers/Agricultural Workers/Rural Populations
•   Other roles of men and women that be increase vulnerability        97
Statement of Principles for
Special Needs Populations

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



                                                            98
               Cultural
             Competence
• Recognize the importance of culture and respect diversity
• Maintain a current profile of the cultural composition of the
  community
• Ensure that services are accessible, appropriate, and
  equitable
• Recognize the role of help-seeking behaviors, customs,
  and traditions, and natural support networks
• Involve as ―cultural brokers‖ community leaders and
  organizations representing diverse cultural groups
• Ensure that services and information are culturally and
  linguistically competent

                                                            99
            Basic Cultural
             Sensitivity

•   Convey respect, good will, courtesy
•   Ask permission to speak with people
•   Explain role of behavioral health worker
•   Acknowledge differences in behavior due to culture
•   Respond to concrete needs
•   Dominant language/English fluency
•   Immigration experience and status
•   Family values
•   Cultural values and traditions
                                                         100
                Ethical
                Issues

• Most information on ethics and disasters
  is from international disasters or recent
  research with disaster survivors
• Key Considerations:
  – Ability/vulnerability of survivors
  – Active role in response and recovery
  – Direct vs. indirect victimization
                                           101
    Key Ethical Issues
      in Disasters
• Readiness of survivors to address
  disaster and trauma issues
• Helper competency and
  accountability
• Power and hierarchy
  of helpers
• Cultural diversities
  and oppressions
                                      102
              Summary
• Competent disaster behavioral health
  practices require special attention given
  to special/vulnerable populations,
  cultural and ethical issues, and
  stressors in disaster work




                                          103
      Day 2




All KAHBH Network
      Members       104
        Module 5:

The FEMA/SAMHSA Crisis
Counseling Assistance and
    Training Program


                        105
The FEMA Crisis Counseling
Assistance and Training Program

• Robert T. Stafford Disaster
  Assistance and Emergency Relief Act
  (P.L. 93-288 as amended)
• Interagency Federal Partnership
• Federal-State-Local Partnership

                                   106
   Organizational Partners
in Crisis Counseling Program

• Community Mental Health Agencies
• State Mental Health Authority
• State Emergency Management Agency
• Federal Emergency Management Agency
  (Region and Headquarters)
• Center for Mental Health Services

                                        107
         Administrative
             Staff
• Community Program Managers
• State Disaster Mental Health Coordinator
• Governor’s Authorized Representative
• FEMA Crisis Counseling Coordinator
• FEMA Human Services Officer
• Federal Coordinating Officer
• FEMA Headquarters Crisis Counseling
  Coordinator
• CMHS Project Officer

                                             108
    The Acronym Game!
•   KDEM
•   CMHS
•   KEOP
•   KAHBH
•   ISP
•   ICS
•   PIO
•   NIMS
•   ARC
•   ESF
•   VOAD
•   SOP
•   FEMA                109
    The Acronym Game!
•   KDEM: Kansas Department of Emergency Management
•   CMHS
•   KEOP
•   KAHBH
•   ISP
•   ICS
•   PIO
•   NIMS
•   ARC
•   ESF
•   VOAD
•   SOP
•   FEMA                                         110
    The Acronym Game!
•   KDEM: Kansas Department of Emergency Management
•   CMHS: Center for Mental Health Services
•   KEOP
•   KAHBH
•   ISP
•   ICS
•   PIO
•   NIMS
•   ARC
•   ESF
•   VOAD
•   SOP
•   FEMA                                         111
    The Acronym Game!
•   KDEM: Kansas Department of Emergency Management
•   CMHS: Center for Mental Health Services
•   KEOP: Kansas Emergency Operations Plan
•   KAHBH
•   ISP
•   ICS
•   PIO
•   NIMS
•   ARC
•   ESF
•   VOAD
•   SOP
•   FEMA                                         112
    The Acronym Game!
•   KDEM: Kansas Department of Emergency Management
•   CMHS: Center for Mental Health Services
•   KEOP: Kansas Emergency Operations Plan
•   KAHBH: Kansas All-Hazards Behavioral Health Program
•   ISP
•   ICS
•   PIO
•   NIMS
•   ARC
•   ESF
•   VOAD
•   SOP
•   FEMA                                             113
    The Acronym Game!
•   KDEM: Kansas Department of Emergency Management
•   CMHS: Center for Mental Health Services
•   KEOP: Kansas Emergency Operations Plan
•   KAHBH: Kansas All-Hazards Behavioral Health Program
•   ISP: Immediate Services Program
•   ICS
•   PIO
•   NIMS
•   ARC
•   ESF
•   VOAD
•   SOP
•   FEMA                                             114
    The Acronym Game!
•   KDEM: Kansas Department of Emergency Management
•   CMHS: Center for Mental Health Services
•   KEOP: Kansas Emergency Operations Plan
•   KAHBH: Kansas All-Hazards Behavioral Health Program
•   ISP: Immediate Services Program
•   ICS: Incident Command System
•   PIO
•   NIMS
•   ARC
•   ESF
•   VOAD
•   SOP
•   FEMA                                             115
    The Acronym Game!
•   KDEM: Kansas Department of Emergency Management
•   CMHS: Center for Mental Health Services
•   KEOP: Kansas Emergency Operations Plan
•   KAHBH: Kansas All-Hazards Behavioral Health Program
•   ISP: Immediate Services Program
•   ICS: Incident Command System
•   PIO: Public Information Officer
•   NIMS
•   ARC
•   ESF
•   VOAD
•   SOP
•   FEMA                                             116
    The Acronym Game!
•   KDEM: Kansas Department of Emergency Management
•   CMHS: Center for Mental Health Services
•   KEOP: Kansas Emergency Operations Plan
•   KAHBH: Kansas All-Hazards Behavioral Health Program
•   ISP: Immediate Services Program
•   ICS: Incident Command System
•   PIO: Public Information Officer
•   NIMS: National Incident Management System
•   ARC
•   ESF
•   VOAD
•   SOP
•   FEMA                                             117
    The Acronym Game!
•   KDEM: Kansas Department of Emergency Management
•   CMHS: Center for Mental Health Services
•   KEOP: Kansas Emergency Operations Plan
•   KAHBH: Kansas All-Hazards Behavioral Health Program
•   ISP: Immediate Services Program
•   ICS: Incident Command System
•   PIO: Public Information Officer
•   NIMS: National Incident Management System
•   ARC: American Red Cross
•   ESF
•   VOAD
•   SOP
•   FEMA                                             118
    The Acronym Game!
•   KDEM: Kansas Department of Emergency Management
•   CMHS: Center for Mental Health Services
•   KEOP: Kansas Emergency Operations Plan
•   KAHBH: Kansas All-Hazards Behavioral Health Program
•   ISP: Immediate Services Program
•   ICS: Incident Command System
•   PIO: Public Information Officer
•   NIMS: National Incident Management System
•   ARC: American Red Cross
•   ESF: Emergency Support Function
•   VOAD
•   SOP
•   FEMA                                             119
    The Acronym Game!
•   KDEM: Kansas Department of Emergency Management
•   CMHS: Center for Mental Health Services
•   KEOP: Kansas Emergency Operations Plan
•   KAHBH: Kansas All-Hazards Behavioral Health Program
•   ISP: Immediate Services Program
•   ICS: Incident Command System
•   PIO: Public Information Officer
•   NIMS: National Incident Management System
•   ARC: American Red Cross
•   ESF: Emergency Support Function
•   VOAD: Voluntary Organizations Active in Disaster
•   SOP
•   FEMA                                             120
    The Acronym Game!
•   KDEM: Kansas Department of Emergency Management
•   CMHS: Center for Mental Health Services
•   KEOP: Kansas Emergency Operations Plan
•   KAHBH: Kansas All-Hazards Behavioral Health Program
•   ISP: Immediate Services Program
•   ICS: Incident Command System
•   PIO: Public Information Officer
•   NIMS: National Incident Management System
•   ARC: American Red Cross
•   ESF: Emergency Support Function
•   VOAD: Voluntary Organizations Active in Disaster
•   SOP: Standard Operating Procedures
•   FEMA                                             121
    The Acronym Game!
•   KDEM: Kansas Department of Emergency Management
•   CMHS: Center for Mental Health Services
•   KEOP: Kansas Emergency Operations Plan
•   KAHBH: Kansas All-Hazards Behavioral Health Program
•   ISP: Immediate Services Program
•   ICS: Incident Command System
•   PIO: Public Information Officer
•   NIMS: National Incident Management System
•   ARC: American Red Cross
•   ESF: Emergency Support Function
•   VOAD: Voluntary Organizations Active in Disaster
•   SOP: Standard Operating Procedures
•   FEMA: Federal Emergency Management Agency        122
 Examples of Disaster Crisis
Counseling Program Services

  •   Outreach
  •   Screening and Assessment
  •   Counseling
  •   Information and Referral
  •   Public Education & Social
      Advocacy
                                  123
           Program
          Limitations
•   Medications
•   Hospitalization
•   Long-term Therapy
•   Providing Childcare or Transportation
•   Fundraising activities
•   Individual Advocacy
•   Long-term Case Management
                                     124
All-Hazards Crisis Counseling
      and “Traditional”
 Behavioral Health Practice
“Traditional” Practice                      Disaster Crisis Counseling
• Primarily Office-Based                 • Primarily Home & Community Based
• Focus on Diagnosis &                   • Assessment of Strengths, Adaptation
  Treatment of Mental Illness              & Coping Skills
• Attempt to Impact Personality          • Seeks to Restore Pre-Disaster
  & Functioning                            Functioning
• Examines Content                       • Accepts Content at Face Value
• Encourages Insight into Past           • Validates Appropriateness of
  Experiences & Influence on               Reactions and Normalizes
  Current Problems                         Experience
• Psychotherapeutic Focus                • Psycho-educational focus

                                                                       125
Source: ESDRB Program Guidance, December, 1996
All-Hazards Crisis Counseling
      and “Traditional”
      Case Management
 “Traditional” Case Management                  Disaster Crisis Counseling
 • Provide services to individuals             • Provide services to disaster
   with SPMI or other disability                 survivors who often have a high
 • Services provided for indefinite              level of functioning
   duration                                    • Services provided do not require
 • Responsible and accountable                   continuity of care
   for client service provision                • Empower disaster victims to
 • Power to influence services for               advocate for services needed
   their client                                • Short-term relationship with
 • Long-term relationship with                   disaster victims
   clients

       Source: ESDRB Program Guidance, December, 1996                   126
                      FEMA/CMHS
               Crisis Counseling Program
                    FY 2004 Grant Sites
                                                             FEMA 1492 MD
                                                               (Hurricane
                                                                 Isabel))



                                                                              FEMA 1391 NY
                                                                              9/11 Terrorism
                                                                              FEMA 1474 WV

FEMA 1506 SA                                                                      (Floods)
  (Cyclone)                                                                   FEMA 1491 VA
                                                                            (Hurricane Isabel)
FEMA 1498-CA
    (Fires)                                                                   FEMA 1475 KY
                                                                             (Severe Storms)

                                                                            FEMA 1501 PR
                                                                              (Storms &
                                                     FEMA 1322 AL             Flooding)
                                                       (Tornado)

                                      FEMA 1437 LA
                       FEMA 1479 TX
                                       (Flooding)                              127
                        (Hurricane
                        Claudette)
              Summary
• The FEMA/SAMHSA CMHS Crisis
  Counseling Program works in
  conjunction with a number of
  organizational partners and
  administrative staff to provide services
  during disasters that differ from
  traditional mental health services

                                             128
         Behavioral Health Response to
         Presidentially Declared Disaster

                               Sources of Information
                          -American Red Cross
                          -KDEM
                          -Adjutant General’s Office                                             9 Months
     Event                -Cities
                            - Newspapers
                                                                                            If needed apply for
                            - New Releases                                                   Regular Services
                          -Kansas WEB EOC
                                                                                              Program (RSP)
 City Response               To Collect Data Per County
                          -Casualties
                          -Injured
                          -Business
                          -Schools
                          -Homes
County Response           -Homeless
                          -Power
                          -Food
                          -Water
                          -------------------------------------------        60 Days
 State Response           -Budget                                       1) On-Site Command
                          -Staff
                                                                        2) Local Outreach workers
                                                                        3) Supplies
KDEM Application
 National Disaster
                             KMHA has 14 Days
                               to Apply for
   Presidentially
                            Immediate Services
  Declared Disaster
                              Program (ISP)


                                                                                                       129
 FEMA/SAMHSA CMHS
  All-Hazards/Disaster
   Crisis Counseling
    Program Grants:

Immediate Services Program
           and
 Regular Services Program
                             130
• Immediate Services Program:
 – Application due within 14 days of
   Presidential disaster declaration
 – Funds 60 days of services

• Regular Services Program:
 – Application due within 60 days of
   Presidential declaration
 – Funds nine (9) months of services
                                       131
               Summary
• Presidentially declared disaster areas may
  receive funding from the state for 60 days
  of services (Immediate Services Program,
  ISP), up to 9 months of services (Regular
  Services Program, RSP)




                                          132
          Module 6:

   The KAHBH Program:
  Preparedness, Response, and
Recovery for Kansas Communities



                             133
Organizations Involved in
Behavioral Health Disaster
       Response
• Federal
  – SAMHSA—Substance Abuse Mental Health Services
    Administration & CMHS—Center for Mental Health Services
  – FEMA—Federal Emergency Management Agency
• State
  – KDEM—Kansas Dept. of Emergency Management
      • KDHE—Kansas Dept. of Health and Environment
          – SRS—Kansas Dept. of Social and Rehabilitation Services
• Local
  – Local emergency management agencies
  – CMHC—Community Mental Health Centers
  – Local professionals and para-professionals (substance abuse
    professionals, clergy, doctors/nurses, fire/police department, 134
    volunteers, etc.)
135
         State-Level Role
            of KAHBH
• During a disaster in Kansas, the Kansas Mental
  Health Authority through SRS serves as a liaison
  to the Kansas Department of Emergency
  Management, local CMHCs, and FEMA in a
  Presidentially declared disaster
• FEMA recommends each State develop a crisis
  response plan in meeting the mental health and
  substance abuse needs at state and local levels,
  which are formally integrated into the State
  Emergency Operations Plan
                                               136
• KDHE established a contract with KMHA to
  provide funds for 1 year to coordinate the
  development and implementation of the 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                                 137
       KAHBH Purpose
• KAHBH provides State-wide organization
  and coordination for behavioral health
  response to disaster and other all-hazards
  events
  – Training and preparing Kansas professionals
    and paraprofessionals to serve in behavioral
    health capacity during an event
  – Providing technical assistance and all-hazards
    behavioral health information to Kansans
                                               138
    Key KAHBH Tasks

• Resource identification and collection
• Training and education
• Development of Annex to KEOP, KAHBH
  Plan, and Standard Operating Procedures
• State-wide network recruitment and
  coordination
• Preparedness, response, and recovery
  activities
                                       139
     KAHBH Network
•   10 staff
•   15 Stakeholders
•   12 SRS Field Staff
•   29 CMHC Coordinators
•   Goal: 200+ KAHBH Network members




                                       140
        KAHBH Stakeholder
        Supporting Agencies
•   Kansas Department of Health & Environment, Office of Local & Rural Health,
    Topeka
•   SRS Mental Health Authority, Topeka
•   SRS Health Care Policy, Addiction & Rehabilitation Services, Topeka
•   Kansas State University, School of Family Studies and Human Services, Manhattan
•   University of Kansas School of Medicine, Department of Preventive Medicine &
    Public Health, Wichita
•   Lawrence Therapy Services, Lawrence
•   Mental Health Center of East Central Kansas, Emporia
•   Regional Prevention Center, Olathe
•   Mid-America Addiction Technology Transfer Center
•   COMCARE, Wichita
•   American Red Cross, Midway Kansas Chapter, Wichita
•   Wyandot Center, Kansas City
•   Association of Community Mental Health Centers of Kansas, Inc., Topeka
•   Center for Counseling & Consultation, Great Bend
•   Prairie View Behavioral & Mental Health Care, Newton **
                                                                            141
•   Heartland Assessment Center, Roeland Park, KS **
      KAHBH Plan and
     Operations Manual
• The initial Kansas All-Hazards Behavioral Health
  Annex has been drafted and submitted to the
  Kansas Department of Emergency Management
  (KDEM) to be reviewed and accepted into the
  Kansas Emergency Operations Plan.
  – KDEM acceptance currently is pending
• The State Plan will provide a detailed description of
  the behavioral health preparedness, response, and
  recovery in Kansas
• Preliminary drafts of the Operations Manual have
  been developed and reviewed by the SRS
  Contract Manager.                                142
     KAHBH
     ANNEX
(Submitted to KDEM)



    KAHBH
     Plan




KAHBH Training
Operations Manual

                      143
                                              KS Citizens


                           State                          Disaster
                           Stakeholders                   Exercises
                                                                       County
             KAHBH                                                    Data Bank

State
        Education: Trainings,
Plan
        Universities,
                                              KDEM
        Conferences                                              KS Train
            1st responders/ Critical
                 Incident Stress     Governor’s
                  Management         Bioterrorism
                                   Coordinating           American
                                     Council
                                   (SRS Mental Health     Red Cross
                                   Authority rep joined
                                          4/04




                                              KS Citizens                         154
    Role of KAHBH
   Network Members

• SAMHSA/CMHC Model
• Professionals and paraprofessionals
  working in teams
• Based on SRS CMHC Regions
  – 27 total areas in Kansas



                                        155
The KAHBH Program is not:
• American Red Cross Disaster Mental Health
  Services (ARC DMHS)
  – ARC requires a masters-level licensed mental health professional
  – ARC mental health workers are volunteers and do not receive
    reimbursement for their services

• Critical Incident Stress Management (CISM)
  – Model developed and approved for use with first responders, but
    often is applied to many areas of crisis response, which may not be
    appropriate


                                                                 156
The goal of KAHBH is to
collaborate and work to
coordinate all behavioral health
services before, during, and
after an all-hazards event in
Kansas.
                               157
      Network members
         should be:
• Indigenous to the communities they serve

• Possess varied experience working with
  various populations in need

• Capable of providing all-hazards behavioral
  health services through non-traditional
  methods

• Sensitive to cultural issues                  158
Key Characteristics/Abilities
   of KAHBH Personnel
  • Key personal characteristics and abilities of
    those particularly suited for disaster work are:
     – Mature
     – Sociable
     – Calm
     – Knowledgeable about how systems work
     – Flexible
     – Tolerates ambiguity well
     – Empathetic
     – Genuine
     – Shows positive regard for others
     – Good listener                                   159
       Module 7:

   Behavioral Health
          and
the All-Hazards Disaster
   Response System


                           160
The Role of Behavioral Health
  in All-Hazards Response

 • Behavioral health consultation
 • Liaison with key agencies
 • Psychoeducation through media
 • Behavioral health services with survivors,
   families
 • Behavioral health services with responders
 • Stress management support


                                                161
• The role of behavioral health in
  all-hazards crisis response may
  include the following:
  – On-scene interventions
  – Immediate interventions
  – Psychological first aid
  – Crisis interventions
  – Crime victim assistance
  – Community outreach
  – Death notification
  – Brief trauma interventions
  – Post-disaster inventions
                                     162
Emergency Operations
    Center (EOC)

• Provides a common, centralized operation
  location
• Ensures clear delegation of responsibility
• Coordinates personnel, supplies & equipment
• Serves as a single point of information flow
• Relays warning to local officials and the
  public
• Works with the Incident Command System
  (ICS)
                                            163
 Incident Command
    System (ICS)

• Standardized, on-scene, all-hazards incident
  management system
• Provides basic direction and control
• Federal (NIMS) and local level (ICS)
  organized system
• Coordination of decision making among
  responder agencies
• Provides a chain of command

                                             164
 Incident Command
    System (ICS)

• A proven management system based on
  successful business practices
• The result of decades of lessons learned in
  the organization and management of
  emergency incidents
• Is a component of NIMS
• Has become the standard for emergency
  management across the country

                                                165
  Incident Command
     System (ICS)
• Meets the needs of incidents of any kind or size
  – Used to manage Salt Lake City Olympics
• Allows personnel from a variety of agencies to
  meld rapidly into a common management
  structure
• Provides logistical and administrative support to
  operational staff
• Provides a cost effective method of
  management by avoiding duplication of efforts
                                                166
  ICS Organizational
      Structure
• Operations
  – Directs activities to reduce the immediate hazard and
    restore essential functions
• Planning
  – Acquires information on current and future situations
• Logistics
  – Support for basic needs (communication, medical, food,
    supplies, transportation)
• Finance/Administration
  – Tracks all costs
  – Provides administrative responsibilities for operation167
 Basic Incident Command
         Structure

                   INCIDENT
                  COMMAND




Operations   Planning   Logistics     Finance/
                                    Administration


                                                 168
ICS Supervisory Position Titles:
  *Chain of Command & *Unity of Command


Organizational Level                                Title                    Support Position
Incident Command                        Incident Commander                             Deputy
Command Staff                                     Officer                            Assistant
General Staff (Section)                            Chief                               Deputy
Branch                                            Director                             Deputy
Division/Group                                   Supervisor                              N/A
Strike team/Task force                            Leader                    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
                                                                                               169
 whom they report at the scene of the incident
As responders to all-hazards
events, it is critical that behavioral
health providers become part of the
emergency response system



                                   170
    Federal requirement that
        all responders:
• Follow ICS procedures
• Receive ICS and NIMS training
• Meet minimum standards

• ―All federal, state, territorial, tribal, private
  sector and non-governmental personnel at
  the entry level, first line supervisor level,
  middle management level and command
  and general staff level of emergency
  management operations must complete
  ICS-100 and FEMA-IS 700 level training.‖        171
• Strongly encourage the following ICS and
  NIMS training for KAHBH Members
  – ICS 100, Introduction to ICS
    • ALL responders/workers + supervisors/administrators
  – ICS 200, Basic ICS
    • supervisors/administrators
  – FEMA IS 700, NIMS: An Introduction
    • ALL responders/workers + supervisors/administrators
  – FEMA IS 800, National Response Plan
    (NRP): An Introduction
    • supervisors/administrators
                                                            172
• Training available online
• www.fema.gov/nims
  – NIMS Training (on the left of the screen)
  – Fact Sheets and information for these 4
    courses
• Local ―live‖ courses also may be
  available
  – Contact your local Emergency
    Management office

                                                173
        Module 8:

    KAHBH Community
     Outreach Teams:
Structure, Procedures, and
        Documents


                         174
       KAHBH Network:

•   COT Structure
•   COT Call-Up Procedure
•   COT Member Rotation
•   COT Member Debriefing
•   Forms/Documents

                            175
176
The KAHBH Program Coordinator(s) will:
• Receive and collate data from the Community Outreach
  Teams in the field.
• Ensure that FEMA/State briefings are attended daily
  at the Disaster Field Office to obtain updated damage
  assessment information and report data from KAHBH
  activities.
• Coordinate data collection from FEMA, American Red
  Cross, Kansas Department of Emergency Management
  officials, etc.
• Prepare the Immediate Services and Regular Services
  grant applications in a Presidentially Declared disaster.

                                                         177
The CMHC Coordinators/
Community Outreach Team Leaders will:
• Be responsible to the KAHBH Program in carrying out the overall mission
  at the local level
• While responsible to the KAHBH Program for their overall mission, report
  to the supervision of the local CMHC/hospital director or his/her designee
  on site.
• Advise the team leaders about where and to whom to report at the
  disaster site.
• Regardless of the office, division, CMHC or hospital, will be the point of
  contact for COT members for day to day direct supervision while in the
  field.
• Have the authority and responsibility to return team members to their
  home base if, in the judgment of the Team Leaders, any team members
  are unable to carry out the necessary tasks for any reason.
• Be responsible for summarizing contact data and reporting it daily to the
  KAHBH Coordinator
                                                                    178
The KAHBH Network Members will:
• Provide crisis counseling, debriefing, and support to
  survivors when the disaster exceeds the CMHC’s or
  hospital's capacity to respond effectively.
• Provide crisis counseling services to the survivors which
  include active listening, supportive counseling, problem
  definition and solving, information, education, referral,
  active or concrete assistance, advocacy, and
  reassurance.
• Identify survivors whose response, needs, and history
  make them especially vulnerable to the stress of the event
  and subsequent mental health problems. More frequent
  and intense support is to be provided to these individuals.
• Be responsible for documenting their contacts daily and
  reporting it to the CMHC Coordinator/Community
  Outreach Team Leader.                                    179
     KAHBH Network
        Rotation
• These are guidelines that may vary
  depending upon:
  – the scope and nature of the disaster
  – varying needs and stresses as the
    response effort matures



                                      180
     Recommended
  Guidelines for On-Site
        Schedule
Team Leaders and workers:
• No more than 5 full continuous days
• Will have a reasonable time of rest after
  10-12 hours work
• Will have daily briefings with response
  team
• Will have pre and post shift briefings
                                          181
      Recommended
   Guidelines for Off-Site
         Schedule
• Team members should leave the site after 10
  days of work
• Team members should have 2 days
  administrative leave
• Team members should have a debriefing at
  their home facility or CMHC within 5-7 days of
  returning from the event
• Team members returning to the event site
  should have one debriefing at home before
  returning for another rotation
                                               182
         Post Rotation
          Debriefing
• All employees who carry out field work in the affected area
  should have at least one debriefing session in their home
  community before returning for a subsequent rotation.
• The CMHC Coordinator/Community Outreach Team
  Leader will organize debriefing sessions for Network
  members responding in their area.
• Response workers may be debriefed within five to seven
  days of returning to their home facility or CMHC (these
  debriefings may occur during the employee's
  Administrative Leave period).
• Post-Response debriefing should be arranged as needed
  for each group of response workers.
                                                        183
  FEMA/SAMHSA CMHS
Crisis Counseling Program
          Forms
           and
      Documentation
                        184
Concluding Comments
     Questions?

                      185
 Acknowledgements
Training material is based on SAMHSA/CMHS Disaster
    Technical Assistance Training Toolkit materials.

    Thank you to the KAHBH Stakeholders for their
   feedback, suggestions, and improvements to the
                   KAHBH Program.
We would like to thank the Department of Preventative
Medicine & Public Health, University of Kansas School
 of Medicine-Wichita, for their valuable contribution of
       graphics and information to this training.

                                                      186

				
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