Kansas All-Hazards Behavioral Health Training

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

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

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

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

5. Outline of KAHBH Trainings KAHBH Core Behavioral Health Training • DAY 1 (approx. 8 hours) • For all participants without CISM or ARC DMH training within the last 5 years (Mental health and paraprofessionals) • Module 1: Disaster Classifications and Phases • Module 2: Traumatic Reactions to Disasters • Module 3: Providing Support During Disasters • Module 4: Considerations for Special Populations, Cultural Competence, and Ethical Issues • Day 2 (approx. 3.5) • For ALL KAHBH Network members • Module 5: The FEMA/SAMHSA CMHS Crisis Counseling Assistance and Training Program • Module 6: The KAHBH Program: Preparedness, Response, and Recovery for Kansas Communities • Module 7: Behavioral Health and the All-Hazards Disaster Response System • Module 8: KAHBH Community Outreach Teams: Structure, Procedures, and Documents

6. 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

7. 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

8. Core Competencies, Terminology, and Regional Disaster Information

9. KAHBH Core Objectives • Understand the difference between Community Mental Health Center (CMHC) crisis counseling and the All-Hazards/Disaster Behavioral Health “crisis counseling” (FEMA/SAMHSA CMHS) model • Understand human behavior in disasters • Understand the key concepts of all-hazards behavioral health • Understand the organizational aspects of disaster response • Understand how to assess the needs of and intervene effectively with disaster survivors, including special populations • Provide appropriate behavioral health assistance to survivors and workers at the community level • Understand, recognize and manage stress in disaster work

10. 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

11. 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

12. “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

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

14. Terminology “Behavioral Health” Mental Health + Substance Abuse

15. Terminology(continued) All-Hazards = All-Hazards Disasters ~ Bioterrorism ~ Major Community Crises

16. Examples of All-Hazards Crisis Counseling Program Services • Outreach • Screening and Assessment • Counseling • Information and Referral • Public Education & Social Advocacy

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

18. 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 All-Hazards Crisis Counseling and “Traditional” Behavioral Health Practice “Traditional” Practice Disaster Crisis Counseling • Primarily Home & Community Based • Assessment of Strengths, Adaptation & Coping Skills • Seeks to Restore Pre-Disaster Functioning • Accepts Content at Face Value • Validates Appropriateness of Reactions and Normalizes Experience • Psycho-educational focus Source: ESDRB Program Guidance, December, 1996

19. 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

20. 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.)

21. 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

22. 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

23. Regional Disaster Information

24. Module 1:Disaster Classifications and Phases Wichita tornado

25. 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

26. 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.

27. Natural Disasters • Floods • Tornados • Hurricanes • Typhoons • Winter storms • Tsunamis • Hail storms • Wildfires • Windstorms • Epidemics • Earthquakes

28. Human-Caused Disasters • Intentional and unintentional • Residential fires • Building collapses • Transportation accidents • Hazardous materials releases • Explosions • Domestic acts of terrorism

29. “[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) Criteria for Presidential Disaster Declaration

30. Behavioral Health Response to Presidentially Declared Disaster Event City Response County Response State Response KDEM Application National Disaster Presidentially Declared Disaster

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

32. 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

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

34. Honeymoon(Community Cohesion) ReconstructionA New Beginning “Heroic” Pre-disaster Disillusionment Warning Threat (Coming to Terms) Working Through Grief Impact Trigger Events and Anniversary Reactions Inventory Typical Phases of Disasters 1 to 3 Days -------------------TIME-------------------------------------------1 to 3 Years Zunin/Meyers

35. 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

36. 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]

37. 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”

38. 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

39. Module 2:Traumatic Reactions to Disasters

40. 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

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

42. 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 What Scares Us?

43. Stressors in Disaster Work • Event related • Occupational • Organizational • Family or personal life

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

45. Physical Changes with Stress • Pupils dilate • Dry mouth • Heart rate increases • Increased HCI (Hydrochloric Acid) • Sleep disturbances • Lower back pain • Stomach motility inhibited (peristalsis) • Blood flow changes • Increased cholesterol production

46. Emotional Changes with Stress • Increased feelings of isolation • Depression • Anger • Anhedonia (lack of joy) • Slowed learning speed • Impaired decision making • Decreased self-awareness

47. Mental Changes with Stress • Decreased memory • Decreased attention span • Decreased intimacy

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

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

50. Effects of Long-Term Disaster Stress • Anxiety and vigilance • Anger, resentment, and conflict • Uncertainty about the future • Prolonged mourning of losses • Diminished problem-solving • Isolation and hopelessness • Health problems • Lifestyle changes