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

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Kansas All-Hazards Behavioral Health

Training

Core Competencies

for Community Outreach Workers

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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

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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

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KAHBH Network

• 10 staff

• 15 Stakeholders

• 12 SRS Field Staff

• 29 CMHC Coordinators

• Goal: 200+ KAHBH Network members

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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 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 • 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 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

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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 public’s sense of safety and increase confidence in our institutions. Because the overriding goal of terrorism is to change people’s beliefs, sense of safety, and behaviors, mental health experts are an essential part of planning and responding.”

Statement from the Conference Transcript: Responding to Bioterrorism: Individual and Community Needs,

October 19-21, 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

• 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

“Traditional” Practice Disaster Crisis Counseling

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

– 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, 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 1:

Disaster 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

“[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)

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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 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

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Phases of Disaster Reactions

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

341 to 3 Days -------------------TIME-------------------------------------------1 to 3 Years

WarningWarningThreatThreat

Pre-disasterPre-disaster

“Heroic”“Heroic”

Honeymoon(Community

Cohesion)

Honeymoon(Community

Cohesion)

(Coming to

Terms)

Working Through G

rief

(Coming to

Terms)

Working Through G

rief

Reconstruction A New Beginning

Reconstruction A New Beginning

DisillusionmentDisillusionment

Trigger Events and Anniversary ReactionsTrigger Events and Anniversary Reactions

ImpactImpact

InventoryInventory

Zunin/MeyersZunin/Meyers

Typical Phases of Disasters

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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 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]

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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 2:

Traumatic Reactions to Disasters

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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

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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

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Stressors in Disaster Work

• Event related

• Occupational

• Organizational

• Family or personal life

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Stress Basics

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

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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

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Mental Changes with Stress

• Decreased memory• Decreased attention span• Decreased intimacy

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Organizational Approaches

• Effective management structure and leadership

• Clear purpose and goals

• Functionally defined roles

• Team support

• Plan for stress management

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Individual Approaches

• Management of workload

• Balances lifestyle

• Stress reduction strategies

• Self-awareness

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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

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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.

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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

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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

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Physical Reactions

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

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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

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Behavioral Reactions

• Sleep problems

• Crying easily

• Avoiding reminders

• Excessive activity level

• Increased conflicts with family

• Hypervigilance, startle reactions

• Isolation or social withdrawal

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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

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Chronic Stressors in Disasters

• Family disruption

• Work overload

• Gender differences

• Bureaucratic hassles

• Financial strain

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Loss and Grief

• Loss is a common theme in disaster settings

• Common reactions to loss:– Denial, numbness or shock– Anger – Bargaining– Depression– Acceptance– Reorientation

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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

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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

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Summary

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

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Module 3:

Providing Support During Disasters

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• Primarily Home & Community Based

• Assessment of Strengths, Adaptation & Coping Skills

• Seeks to Restore Pre-Disaster Functioning

• Accepts Content at Face Value• Validates Appropriateness of





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All-Hazards Crisis Counseling and “Traditional” Case Management

• Provide services to individuals with SPMI or other disability

• Services provided for indefinite duration

• Responsible and accountable for client service provision

• Power to influence services for their client

• Long-term relationship with clients

• 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

“Traditional” Case Management Disaster Crisis Counseling


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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)

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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

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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

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Maslow’s Hierarchy of Needs

www.tutor2u.net/business/images/maslow_hierarchy.gif

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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

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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

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On-Scene Interventions

• Direct to medical care, safety, shelter

• Protect from trauma, media, onlookers

• Connect to family, information, comfort

(Myers and Wee, 2003)

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Immediate Interventions

• Rapid assessment and triage

• Psychological first-aid

• Crisis intervention

• Crime victim assistance

• Psycho-education

• Information briefings

• Community outreach

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Immediate Interventions

(continued)

• Participation in death notification

• Behavioral health consultation

• Debriefing and community meetings

• Information and referral

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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

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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

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Crime Victim Assistance

• Protect victims’ rights

• Ensure control over media

• Provide criminal justice information

• Facilitate access to compensation

• Streamline bureaucratic procedures

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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

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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

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Brief Trauma Interventions

• Factual information

• Thoughts during event

• Reactions and feelings

• Psycho-education

• Problem-solving and action

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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

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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

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Community Interventions

• Memorials and rituals

• Usual community gatherings

• Anniversary commemorations

• Symbolic gestures

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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

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Survivor Risk and Resiliency Factors

• Psychological

• Capacity to tolerate stress

• Prior trauma history

• Socioeconomic and education level

• Family stability

• Social support

• Gender roles

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Teaching Strategies for Teaching Strategies for Enhancing ResilienceEnhancing 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

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Teaching Strategies for Teaching Strategies for Enhancing ResilienceEnhancing Resilience

•Nurture a positive view of self

•Encourage keeping things in perspective

•Encourage maintaining a positive outlook

•Encourage self care (emotional and physical)

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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

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Module 4:

Considerations for Special Populations, Cultural

Competence, and Ethical Issues

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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

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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

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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

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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

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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

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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

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Summary

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

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Day 2

All KAHBH Network Members

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Module 5:

The FEMA/SAMHSA Crisis Counseling Assistance and

Training Program

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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

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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

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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

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The Acronym Game!

• KDEM• CMHS• KEOP• KAHBH• ISP• ICS• PIO• NIMS• ARC• ESF• VOAD• SOP• FEMA

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The Acronym Game!

• KDEM: Kansas Department of Emergency Management• CMHS• KEOP• KAHBH• ISP• ICS• PIO• NIMS• ARC• ESF• VOAD• SOP• FEMA

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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

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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

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Examples of Disaster 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

125








• Primarily Home & Community Based• Assessment of Strengths, Adaptation

& Coping Skills• Seeks to Restore Pre-Disaster

Functioning• Accepts Content at Face Value• Validates Appropriateness of





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All-Hazards Crisis Counseling and “Traditional” Case Management

• Provide services to individuals with SPMI or other disability

• Services provided for indefinite duration

• Responsible and accountable for client service provision

• Power to influence services for their client

• Long-term relationship with clients

• 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

“Traditional” Case Management Disaster Crisis Counseling


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FEMA/CMHS Crisis Counseling Program

FY 2004 Grant Sites

FEMA/CMHS Crisis Counseling Program

FY 2004 Grant Sites

FEMA 1479 TX

(Hurricane Claudette)

FEMA 1479 TX

(Hurricane Claudette)

FEMA 1437 LA

(Flooding)

FEMA 1437 LA

(Flooding)

FEMA 1492 MD (Hurricane

Isabel))

FEMA 1492 MD (Hurricane

Isabel))

FEMA 1391 NY

9/11 Terrorism

FEMA 1391 NY

9/11 Terrorism

FEMA 1474 WV

(Floods)

FEMA 1474 WV

(Floods)FEMA 1506 SA (Cyclone)

FEMA 1506 SA (Cyclone) FEMA 1491 VA

(Hurricane Isabel)FEMA 1491 VA

(Hurricane Isabel)

FEMA 1498-CA

(Fires)

FEMA 1498-CA

(Fires) FEMA 1475 KY

(Severe Storms)

FEMA 1475 KY

(Severe Storms)

FEMA 1501 PR

(Storms & Flooding)

FEMA 1501 PR

(Storms & Flooding)FEMA 1322 AL

(Tornado)FEMA 1322 AL

(Tornado)

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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

Event

City Response

County Response

State Response

KDEM Application National Disaster

Presidentially Declared Disaster

60 Days1) On-Site Command2) Local Outreach workers3) Supplies

9 MonthsIf needed apply forRegular ServicesProgram (RSP)

Sources of Information-American Red Cross-KDEM-Adjutant General’s Office-Cities - Newspapers - New Releases-Kansas WEB EOC

To Collect Data Per County-Casualties-Injured-Business-Schools-Homes-Homeless-Power-Food-Water--------------------------------------------Budget-Staff

KMHA has 14 Days to Apply for

Immediate ServicesProgram (ISP)

Behavioral Health Response to Presidentially Declared Disaster

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FEMA/SAMHSA CMHSAll-Hazards/Disaster

Crisis Counseling Program Grants:

Immediate 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

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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)

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Module 6:

The KAHBH Program: Preparedness, Response, and

Recovery for Kansas Communities

134

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, volunteers, etc.)

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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

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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

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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

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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.

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KAHBHANNEX

(Submitted to KDEM)

KAHBHPlan

KAHBH TrainingOperations Manual

154

KDEM

KS Citizens

KS Citizens

State Plan

KAHBH

State Stakeholders

Education: Trainings, Universities, Conferences

American Red Cross

Governor’s Bioterrorism Coordinating

Council(SRS Mental Health

Authority rep joined 4/04

County Data Bank

KS Train

Disaster Exercises

1st responders/ Critical Incident Stress Management

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Role of KAHBH Network Members

• SAMHSA/CMHC Model

• Professionals and paraprofessionals working in teams

• Based on SRS CMHC Regions– 27 total areas in Kansas

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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

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

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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 7:

Behavioral 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)

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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


• 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


• 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

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INCIDENT

COMMAND

Operations Planning Logistics Finance/

Administration

Basic Incident Command Structure

169

ICS Supervisory Position Titles:

*Chain of Command & *Unity of Command

Organizational Level

Incident Command

Command Staff

General Staff (Section)

Branch

Division/Group

Strike team/Task force

Title

Incident Commander

Officer

Chief

Director

Supervisor

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

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As responders to all-hazards events, it is critical that behavioral health providers become part of the emergency response system

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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.”

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• 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

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• 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

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Module 8:

KAHBH Community Outreach Teams:

Structure, Procedures, and Documents

175

KAHBH Network:

• COT Structure

• COT Call-Up Procedure

• COT Member Rotation

• COT Member Debriefing

• Forms/Documents

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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.

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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

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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.

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• These are guidelines that may vary depending upon:– the scope and nature of the disaster

– varying needs and stresses as the response effort matures

KAHBH Network Rotation

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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

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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

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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.

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FEMA/SAMHSA CMHS

Crisis Counseling Program

Forms

and

Documentation

185

Concluding Comments

Questions?

186

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.

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

Documents

Transcript of 1 Kansas All-Hazards Behavioral Health Training Core Competencies for Community Outreach Workers.