Background: Federal Planning

1. Emergency Disaster Mental Health Preparedness and Response for Pennsylvania’s County Mental Health Disaster Coordinators (MHDCs)Sarah Powell, M.A.; Alice Hausman, PhD, MPH; Tamar Klaiman, MPH

2. Background: Federal Planning • 1974 - Robert J. Stafford Disaster Relief and Emergency Assistance Act • 1974 - Center for Mental Health Services administers Crisis Counseling granting program • 1978 – SAMHSA publishes training manual for mental health and human services workers in major disasters • 1994 – SAMHSA publishes handbook for mental health professionals on Disaster Response and Recovery • 2003 – SAMHSA and National Association of State Mental Health Program Directors (NASMHPD) publish Mental Health All-Hazards Disaster Planning GuidanceManual

3. State Planning • Each state is required to have a mental health all-hazards disaster plan • Commonwealth states (PA, MA, VA, KY) – local government takes lead • State Disaster Mental Health Coordinators (MHDC’s) often have multiple roles

4. Methods • Qualitative open-ended interviews via telephone or in person; 20 county MHDCs in PA; between Aug 2004 and Aug 2005 • Topic Areas included: • Disaster planning • Chains of command • Training needs • Relationships at county level • Experiences with FEMA crisis counseling grants • Lessons learned • Best practices

5. Desired Outcomes • Gain an understanding of the formal & informal networks that exist • Understand perceived needs in local coalition building and training • Assess ease or difficulty of establishing and maintaining robust mh disaster response plans

6. Respond to EMA request for counseling victims Initiate active response Mitigate rumor control Assist with risk communication Engage in debriefing or counseling Organize community meetings/debriefings Coordinate with Red Cross Sit in the EOC Staff DRC Coordinate crisis intervention or counseling in schools Roles and Responsibilities of MHDC’s

7. Findings – Planning and Response Coordination • Although enthusiastic, many MHDC’s lack resources, funding, and time to do their jobs effectively. • MHDCs do not report a responsibility to first responders. • Chains of command established under NIMS; wide variation of partnership with EMA • Mental health is often an after thought in response. • “I’ve always felt that mental health in this country is the last one in… generally we are not asked to respond until the feds come in a few weeks.”

8. Findings – Regional Relationships • Problems for some in coordinating efforts with VOADS (ex. Red Cross) • “I worry about duplication between the Red Cross and our job – to me I think they are doing it. I don’t understand why we have to do all the training.” • Many counties have good relationships with: • Neighboring county MHDCs • Red Cross • EMA • CISM teams • VOAD’s • NOVA • hospitals

9. Findings – Disaster Planning • Almost all MHDCs (19:1) have an All-Hazards plan • However, many MHDCs did not receive or had outdated templates and guidelines from the State • “We were told that we were going to get a unified template and we were told to go back to SAMHSA guidelines - I’m not aware of a template. Quite frankly, I’d prefer one. It would be much better to have a uniform plan.” • Gradients of disaster events require different response efforts -- has not been addressed

10. Findings – Relationship with the State • MHDCs feel they can call OMHSAS staff for assistance; while some prefer to not have this contact: • “You need to just decide what you are going to do and do it and just say ‘this is what I am doing.’ For the State to get down to the local level – that is just a pain. We know what our needs are better.”

11. Findings – DCORTs • Counties required to have a Disaster Crisis Outreach and Referral Team (DCORT) • two teams of ten and a back up team • 18 out of 20 counties had team in place; 2 counties had similar response teams • Training levels vary, though most attend the OMHSAS training • Training, recruitment, team make-up, and resources are not universal throughout the state

12. Findings – DCORT Teams • Variation in make-up of DCORT Teams • Combined DCORT and CISM teams • Combined DCORT with MHMR crisis intervention teams or Red Cross • Partnerships with Keystone Crisis Intervention Teams (KCIT)

13. Findings – DCORTs MHDC Frustrations: • Lack of authority in determining who gets membership in county DCORT • Lack of authority in county chain of command • When the State issues funding or trainings to groups not designated for response by MHDCs. • Initial requirement to have a disaster mental health response team with psychiatrist, psychologist, nurses, and social workers • Uses valuable resources for small scale disasters • “Those aren’t the people out in the field to take with you… Those people supervise the system of care. It’s helpful to have them should you have questions.”

14. Findings - Trainings • State sponsored ‘trainings’ at bi-annual meetings, basic and advanced DCORT trainings • Lack of adequate cultural competency & diverse populations training • “I went out to one of the two day trainings and thought about those issues in terms of response. We do not have a large Hispanic population, but we have a lot of seniors… diverse populations deserve just as much consideration.”

15. Recommendations - Training • MHDC Authority – MHDC should have authority to require trainings for team members • Timing and scheduling – multiple day trainings are difficult to attend • Funding- make training available for all staff • Practice - Make training more practical • Surge capacity • How to decrease trauma • Role of the DCORT team • Focus on CISM is not appropriate • What should M.H. response look like? • Cultural competency • Diverse populations/ Special Needs

16. Crisis Counseling Grant ProcessLessons learned FEMA – funded CCPs: • Disappointment about amount of money received • Time frame for grant submission too short • Time for spending funds too short • Reimbursement issues for services provided are unclear

17. Crisis Counseling Program Best Practices • Services need to be provided in a timely matter • Provide for the needs of MH workers as well as population served • Engage in public outreach rather than waiting for public to seek support • Collaborate with all key players well in advance: “establish relationships before you need them”

18. Recommendations • Add a full-time MHDC position to counties in PA. • Increase state support of operational plan creation, coalition building, and equipment. • Use clinical staff in an advisory capacity only, and train provider staff and paraprofessionals for field response. • Establish a solid command structure with OMHSAS as well as county and regional response network.

19. Conclusions • M.H. has a key role to play in county and regional planning. • Chain of command – go when you are called. • Good Leadership is critical. • Include non-traditional responders. • Communication and interoperability. • Respond quickly and effectively. • Ensure community resilience. • Use appropriate trauma interventions

20. Questions?