Enhancing Regional Disaster Mental Health Preparedness Plan

1. The FEMA Region III Operational Response Plan and Responder Training Plan Enhancing Regional Disaster Behavioral Mental Health Preparedness This document was prepared under a grant from FEMA's Grants Programs Directorate, U.S. Department of Homeland Security.  Points of view or opinions expressed in this document are those of the authors and do not necessarily represent the official position or policies of FEMA's Grants Programs Directorate or the U.S. Department of Homeland Security.

2. Background In 2009, a Behavioral Health Capability Needs Assessment was conducted in the National Capital Region (NCR) • This assessment showed that we do not have nearly enough responders and/or volunteers trained in disaster behavior mental health nor enough staff provide counseling over a long period of time.  More training across the region, across disciplines, and in our community was needed to increase capacity to respond to disaster situations. • This assessment also showed that some agencies did not have response plans or their plans were outdated. 

3. Project Rationale • Fill the gap in DBMH standards recognized by the NCR Health and Medical Regional Programmatic Working Group • Enhance Operational Response Planning within and across States, Counties and Cities • Create a strategy to align disaster behavioral mental health employee training resources with regional priorities • Improve regional states’ capacity to share behavioral mental health personnel across state boundaries

4. RCPGP Project Overview • District of Columbia Homeland Security and Emergency Management Agency asked the All Hazards Consortium to support a procurement to: • Develop an Operational Disaster Behavioral Mental Health Response Plan (Operational Response Plan) and • Disaster Behavioral Mental Health Training Plan • …for the six states in Federal Emergency Management Agency (FEMA) Region III: Virginia, Maryland, Delaware, Pennsylvania, West Virginia, and the District of Columbia. West Virginia RCPGP Educational Workshop

5. Operational DBMH Response Plans • This Plan (in the form of an Operational Response Plan Template) addresses the mental health agency’s role and responsibilities as a support agency in accordance with each state’s response plan and: • Utilizes the National Incident Management System (NIMS) and an operational Incident Command System (ICS). • Addresses the use of Disaster Behavioral Mental Health Response Teams as part of the response including activation, community outreach strategies, and demobilization. • Identifies the personnel, supplies, and training necessary to establish the Teams. • Addresses the use of volunteers and paraprofessionals in conjunction with the Teams and all necessary training. West Virginia RCPGP Educational Workshop

6. Operational Response Plan • The Operational Response Plan (ORP) Template provides the disaster response framework for any public entity (state, county or city) as well as components useful to individual behavioral health providers • The ORP captures resources and DBMH assistance in support of applicable Emergency Support Functions (ESFs). • The ORP provides an operational and strategic plan to meet response requirements and to maintain continuity of operations to meet the needs of consumers during a public emergency.

7. Examples of Team Responses Emergency Response (No Disaster Declared) • This type of response is the most common for DMH. In this discussion the major parts of the response will be covered (staff deployment, administration, financing, etc.) Disaster Declared • Practical elements involved with a disaster response (the types of interventions provided such as PFA, triage, record keeping, etc.) Overview of the regional training plan and the core competencies all responders must possess. Catastrophe • A catastrophe is an incident that permanently interrupts or alters the continuity of the status quo in terms of impacts upon human physical and mental health, culture language, economy and environment creating irrecoverable losses. West Virginia RCPGP Educational Workshop

8. Response Teams • Coordinate mental health activities through needs assessment and the provisioning of appropriate crisis support services and counseling for first responders, victims, families, and special vulnerable populations. • Mental Health Response Teams (MHRTs) • Surge Response Teams • Emergency Response Teams

9. Mental Health Response Teams • Provide emergency and crisis behavioral mental health support to first responders, victims, families, and visitors. • Coordinate all mental health activities and monitor mental health needs/compile assessments. West Virginia RCPGP Educational Workshop

10. Disaster Behavioral Mental Health Training Plan • This FEMA Region III DBMH Training Plan, developed through a process informed by best practices research and ultimately adopted through regional consensus, addresses the process for implementing a sustainable training program for emergency response teams, volunteers, and private providers of behavioral mental health services and: • Includes input from lead agencies of the Emergency Support Functions (ESF) that the mental health agencies support, specifically, ESF 6 (Mass Care) and ESF 8 (Public Health) • Addresses the core content of the training curriculum and shall include the development of a cadre of local, qualified trainers with a train the trainer component. • Includes the process of training trainers in the implementation of the Training Plan through a detailed report on training resources available to the region.

11. Rationale for a Regional Plan • Fill the gap in DBMH standards recognized by the NCR Health and Medical Regional Programmatic Working Group • Create a strategy to align disaster behavioral mental health employee training resources with regional priorities • Improve regional states’ capacity to share behavioral mental health personnel across state boundaries West Virginia RCPGP Educational Workshop

12. Basis for the Regional Plan • This regional training plan was based upon: • Competencies established by a stakeholder experts working collaboratively through the association of public health schools and the CDC • Identification of available regional and national training resources • Best practices research, including a survey of disaster behavioral mental health stakeholders nationwide • Incorporation of ICS / NIMS training • Collaborative input from the disaster behavioral mental health state agency leads in FEMA region III

13. Methodology to Engage Stakeholders • Collaborative input from regional stakeholders was accomplished through meetings, conference calls (at least two in VA) as well as two region-specific surveys: • Survey #1 – shared information from best practices research and nationwide stakeholder survey and asked preliminary questions • Survey #2 – shared results from Survey # 1 and reexamined more closely what state leads wanted to see in a regional plan West Virginia RCPGP Educational Workshop

14. Target Audiences for DBMH Training 87% of state leads agreed the plan should target different responder training groups. Virginia RCPGP Educational Workshop - UVA

15. Primary Core DBMH Training Per feedback from state stakeholders and national DBMH experts, all responder groups should take 3 courses (minimal threshold for deployment): • NIMS –ICS-100 and ICS-700 • All Hazards DBMH Training • Psychological First Aid (4 hr ARC version)

16. Core Training: First Responders * indicates training concepts also supported by the best practices report and the consensus core competencies

17. Core Training: Nonprofessional Responders * indicates training concepts also supported by the best practices report and the consensus core competencies

18. Core Training: Professional Responders * indicates training concepts also supported by the best practices report and the consensus core competencies

19. A Regional Training Certification? 87% of state agency representatives said yes when asked: “Should the region establish a standard training certification that is recognized across state borders?" Virginia RCPGP Educational Workshop - UVA

20. Core Requirements for a Regional Training Certification West Virginia RCPGP Educational Workshop

21. Auxiliary Requirements for a Regional Training Certification

22. Challenges Specific to a Regional Certification • Stakeholders were asked about the challenges and barriers to developing a volunteer certification process. They suggested a number of potential "trip hazards." Some respondents have been involved in previous efforts to develop a certification process, so they were able to provide some of the challenges and barriers their groups encountered in such an effort. • Funding (for training, background checks, database maintenance) • Science-based curriculum or not? Agreement on model to use / what is the authority for standardization? • Legal liability • Labor intensive process / time required • Ethical issues (worker's comp, volunteer protection, appeals process..) • Getting people to trainings • Politics / who will take charge of it? • Retention / turnover

23. Relevant Findings:Regional Input (not only WV) • States are indicating a need for more intensive TA and support than originally anticipated • A few state DBMH teams have expressed a need for better collaboration and communication with their ESF lead agencies • State cultural differences and personalities within leadership are important drivers for whether DBMH issues are sufficiently addressed in broader emergency preparedness planning • Several emergency/deployment scenarios rely heavily upon DBMH response capacity and awareness of this reality is increasing

24. Next Steps • Currently, we are funded to: • Train and Exercise the Operational Response Plan and DBMH Training Plan for five states and the District in FEMA Region III. This includes public and private entities operating at the state and local levels (all ESFs invited) West Virginia RCPGP Educational Workshop

25. Additional Thoughts • Course-based training is great but we need more opportunities to learn through exercises (this also keeps volunteers more engaged) • Funding for training is a major concern – and many states have lost or cut funding recently (20% cut in PA, for example). • Like many states and municipalities, WV is largely dependent on local public and private entities to provide direct behavioral health services. Helping those local entities become better prepared not only for their own emergencies (COOP) but for external deployment on response teams is important

26. Getting Back to WV Where is WV now? What is next?

27. Your Involvement • How can you be involved as either a participant or a convener of a training and/or table-top exercise? • Whom would you suggest I contact to participate?

28. Wrapping Up Questions? West Virginia RCPGP Educational Workshop

29. Contact information Colin Newlin Braintree Solution Consulting, Inc. Washington, DC cnewlin@braintreeconsulting.com Tel: (202)232-8212 www.braintreeconsulting.com