Promising Practices in Disaster Behavioral Health Planning: Assessing Services and Information


Moderator: Hello
and welcome everyone! This is Marcela Aguilar
from the Substance Abuse and Mental Health Services
Administration’s Disaster Technical Assistance
Center (or SAMHSA DTAC). I will be your host
for this webinar. Now, let’s begin with Promising Practices in
Disaster Behavioral Health: Assessing Services
and Information. The webinar will feature
Dr. Anthony Speier, Interim Assistant
Secretary for the Louisiana Office of
Behavioral Health. This is the fifth webinar in
the series of nine webinars presented by SAMHSA. The webinar is intended for
State and Territory Disaster Behavioral Health Coordinators
and others involved with disaster planning,
response, and recovery. The webinar will be about sixty minutes in length. Before I turn the webinar over
to Dr. Speier I would like to take a few minutes to
provide an overview of SAMHSA’s Disaster
Technical Assistance Center. SAMHSA DTAC’s mission is
to provide training and technical assistance to States,
Territories, and Tribes so that they are prepared for
and able to respond to disaster behavioral
health needs. When I use the term
disaster behavioral health please note that this term
refers to both mental health and substance abuse
issues and needs. As you can see on the screen
we have a brochure that you can download for
free from our website. I will provide the
website address shortly. SAMHSA DTAC provides an array
of free services that include consultation and training
about disaster preparedness and response, such as, compassion
fatigue training and working with special populations
such as children and youth, older adults, Tribes, and
people with disabilities and access and
functional needs. Dedicated training and
technical assistance for presidentially declared
disaster grants, such as the FEMA Crisis Counseling
Assistance and Training Program, also known as CCP and the
identification and promotion of promising practices
such as this webinar series. We also wanted to make
sure everyone is aware of the free resources that are
available to you on our website. This slide is of the
Disaster Behavioral Health Information Series,
also known as DBHIS. Here you can find tip sheets,
fact sheets, booklets, and other materials about disaster behavioral health preparedness and response, information about specific kinds of disasters such as floods, tornadoes,
hurricanes, and so forth. Also, information on specific
populations such as the ones I mentioned earlier. These are our various
e-communications. The Bulletin is our
monthly newsletter that contains relevant resources. The Dialogue is our quarterly
publication written by disaster behavioral health professionals in the field. Lastly, our discussion board,
a mechanism for disaster behavioral health
professionals to ask questions, share comments,
and discuss disaster behavioral health-related
topics with each other. Ways to subscribe
are also on the screen. As promised here is
our contact information. If you would like to request
training or technical assistance for you and
your staff please either call the toll-free
number or email us. Be sure to visit
our website, too. As always, if you
would like to contact SAMHSA DTAC Project Director Dr. Amy Mack directly
please feel free to do so. Her contact information
is on the screen. I would now like to
introduce Dr. Anthony Speier. Dr. Speier serves as the
Interim Assistant Secretary for Development in the Louisiana
Office of Behavioral Health. He has served as Deputy
Assistant Secretary for the Office of Mental
Health and Chair of the Adult Services Division of
the National Association of State Mental Health
Program Directors. He is also currently
overseeing the Deepwater Horizon Oil Spill
Recovery Operations. Please welcome
Dr. Anthony Speier. Dr. Speier: Thank you and
good afternoon everyone. I’m glad you are able to
join us in this webinar. This webinar speaks to the
assessing services and information and how to
use that information in a constructive, proactive
strategy in your planning and ultimately in your response
and recovery operations. One of the things that this
process will help you with is if you have been involved in a
disaster you know that all of the sudden no one knew who you
were and now they want you to be all things to all people. That is an impossible task
and all you end up doing is being frustrated. Your staff is frustrated and
everyone is disappointed because you didn’t meet
their expectations. A big part about first knowing
what your capabilities are and having a way to continually evolve that information and knowledge keeps everybody’s
expectations within reasonable limits and allows
you the opportunity to meet those expectations. The learning objectives for
this particular webinar are to identify the methods of
assessing capacity for providing services, data to determine
when behavioral health needs are overwhelmed,
and the mechanisms to ramp up services as needed. Secondly, to identify critical
resources and services needed before, during, and after a
disaster, describe the methods of conducting a needs
assessment regarding your special population groups which every disaster is filled with unique groups of people
who are impacted. The last is to discuss methods
and strategies to coordinate care for various
behavioral health responders, teams,
and personnel. There is a series of
standards which you will be hearing more about that
DTAC has been working on. This particular one is
called standard five and the standard itself is,
the plan demonstrates a range and clarity of services. That is needs assessment
and ongoing identification of need and your capability
will provide that clarity. Just a few of the indicators
are on the next three slides and I will highlight a few of them. The implementation
strategy needs to be clear. You should have a clear
methodology and that is dependent on the capacity of
your State to assess various aspects of the necessary
information, both within and without your own organizations. Methods for effective
communication, such as having a communication plan,
description of the continuum of care that you
will be able to offer as well that you are responsible for
and a process for identifying the availability of resources. The needs assessment
process should be specific to variables and items
that are reflective of special population groups. You should be able to
provide a full scope of services and spend some time
on what the referral networks will be that are most
active in a disaster. They are often different
from those that are active in non-disaster times. Points of data
for knowing where the behavioral health
needs are overwhelmed. You can have threshold points
that you don’t want to exceed. Then of course, a written
plan for moving beyond the State’s capacity when
things do become overwhelming. Lastly on the last slide
with respect to standards, you need the mechanics,
the mechanisms for ramping up your services. You need a good
descriptor of the acute elements of your response. What I mean by acute elements
are the primary response sites and what it takes to
operationalize them from a behavioral health perspective. Description of coordination
between both mental health and substance abuse services. Simple things, making sure
you have an active and updated list of where meetings are for
people to go to for substance abuse support is very helpful for people who are displaced. A plan to address responder
care; without the responders you have to remember
we are not machines. Without the responders being
able to stay on duty and active your whole response effort
becomes greatly distressed. This item of stress management
and healthy behaviors of your responders is a crucial feature to work out ahead of time. A description of
deployment strategies. The more ambiguity you can take
out of a situation for the staff to be involved the better off
you will be and they will be. Some points to remember, when
integrating a formal needs assessment methodology-everyone
asks for a needs assessment but nobody ever tells you exactly what they mean or how to do it. These are some points that we
have acquired over the various disasters that Louisiana
has been involved in. I am going to spend a
moment reading these. Needs assessment involves
the acquisition of multiple levels of information regarding demographics, socioeconomic, and environmental factors. Here what we are speaking of is
that there are multiple levels within each of these
content ranges, demographic, socioeconomic,
and environmental. They interact and they
interact specifically with the geographic location. Understanding your State and who
acquires and keeps this kind of information ahead of time,
having some baseline indicators will assist you greatly in
seeing what kind of disruption to the individuals and
communities is taking place. Second is, needs assessment
is ongoing prior to and through incident recovery. Continually redefining the
stakeholder groups most relevant to the phase of
disaster response. You will find and those of
you that have done emergency recovery and response work,
know that the volunteer groups, the different response
agencies vary with the phase of the disaster. Therefore, your stakeholders
vary and your data points and your needs assessment
will also vary. What is important now might
not be so important later. The pre-incident planning
information informs the actual DBH incident program design. It is your actual program
design which leads to both short-term and long-term
interventions. Over the next few webinars-I
know the one that I will be doing in a few weeks will talk
about scalability and that is part of what we are really emphasizing here, having a general program design and then one that works for you on the short term
and the long term. Just as a rule of thumb,
successful response strategies involve these three things,
the analysis of present and future needs at the individual
level and then relating those needs to what are the instrumental supports or tangible items
needed and available to the recovery effort. Continuing re-assessment
factors-you don’t have to keep reinventing the wheel. You have to keep running
the same wheel down the road over and over and that
keeps you with some reliability in your data sets. The assessment of available
community resources, which is a strength assessment model as opposed to assessment of loss. You should have those
indicators pre-identified. Assessment of additional
categories of impact, like in the case of a terrorist
event, they are going to be a whole new set of
variables and the concept of risk assessments will change. One should give some
thinking to when you are doing all-hazards planning, what are the different classes of events and what are
the variable sets that would be associated with that? Each disaster is unique. The assessment of special
circumstances associated with the incident should also
include questions specific to the degree, what is
the human causation. In Katrina we thought it
was a natural event and then there were human causation
factors associated with the massive amount of
flooding that we have. The indirect impact on
communities and extent of ongoing threat and
uncertainty all have to be evaluated in the process. Here is a rationale,
this is a bureaucratic rationale for needs assessment. I will go over it. Focus at Federal Crisis
Counseling Program are authorized under the Stafford
Act and the whole point is to determine who is at risk, what
is the identified strategy for assisting communities and individuals in moving through the process of
response and recovery. There are always those “who”
and “what” questions and then the “how” is
really the strategy. As long as you stay on
the who, what, and how you pretty well can design
a needs assessment. It can be as elaborate or
as simple as you need it. It just needs to be effective. When you are working with
the needs assessment data and you are trying to determine
the recovery trajectory of individuals and communities,
your needs assessment starts to become not just a
bunch of numbers but a way to design
your programs. These are some of the
points to keep in mind, knowing what your existing
infrastructure is. What I mean by that is
your resources, your buildings, your service delivery sites. The ability to sustain
pre-incident service levels. As a behavioral health authority
you had a whole cadre of people dependent upon your service,
either run by the county or local nonprofit agencies
that you need to sustain. Matching of recovery issues
with the resource needs and of a strategy of continuity of
operations and as you bring on new services because of the
new issues associated with the disaster, how do you
sustain those services? What is your funding and
your human resource and skills that will be needed? The complexity, your
assumptions of scope of the disaster behavioral
health recovery needs really speaks to the complexity of it. Understanding the mental
health needs of the stricken population will always vary
by the scope, size, and the severity of the disaster. Individuals, disaster
victims or survivors, are at greater or lesser
risk due to their exposure. Some historical experiences
they have had and the human makeup issues. We know that there are
some stress experiences and stressors, things that
people experience that are more likely to cause long-term
issues for them than others. You also need to keep in
mind that it is not just the individual who has had
the exposure that is affected, it is his or her
whole household. This is true for response
workers as well as people who are impacted in a negative way and categorized as survivors. When you calculate the
impact and recovery needs you can’t rely just on the
quantitative numbers of direct victims that are impacted,
number of dead, number who have lost their homes,
the number who are injured. You need to go
beyond those numbers. That last bullet about
subpopulations and their risk and what signifies
risk in those populations also needs to be factored
into your plan to address the response needs
of the community. Some structural elements that
I consider essential components of a response strategy
are these following items. You need to have your
professional staff trained in community-based
service delivery. You can’t be in a situation
where you are using people who are hospital-based service providers or pure clinic service providers that you are going to turn loose on your communities and expect them to be
effective community outreach workers and in-home
service providers. Pre-incident training and
orientation allows these levels of professionals to
transfer their knowledge base and skill sets into those new
environmental surroundings. Access, you should have this. We have always
found this helpful. Local universities are
often the best resource to get access to disaster
mental health experts. It is really a content
expertise you want here, how grief and loss issues,
trauma disorders other items I have listed up here
play themselves out within the context of
a disaster event. Keeping in mind that the
child and adult lifespan developmental issues and
disorders that people are confronted with and many
people no longer live in institutions but
in their homes. You will come in contact
with individuals with these needs much more frequently than
one would have ten years ago. Without saying, the assessment
of cultural competency issues and ongoing weaving of that capacity to be culturally competent in your delivery of care is an ongoing process. Understanding in your response
strategy a role for core social and community action groups;
oftentimes these are leaders and nonprofits or civic groups that
are active in the particular communities that are impacted
and have the notoriety within those communities as leaders
are most helpful to you. Volunteer agency support
needs to be woven in. Your political structure
and politically active groups that are indigenous also need
to be woven in and you also need to target goals for project
activity such as quantity and quality of staff that
you will be providing. The next slide shows you how
all of this rolls together and allows you to look at both
long-term and short-term recovery project
design or program design. I won’t spend a lot
of time on this. I will invite you at your
leisure to look at it in a little more detail or
just save it and look at when you have an event
you need to plan for. It is basically trying to show
you that in the red background that a disaster happens, an
incident response is triggered, hopefully a planned one and
the constituent groups are the OEP the emergency preparedness organization or office in your local area. It might be called
homeland security or have different names
in different States. That response infrastructure
plus the other kinds of stakeholders identified and
then once you involve all of the input from those people
you want to go through the steps listed in the blue backgrounds
of getting coordinated data acquisition, understanding the goals of your needs assessment, the assessment analysis
of the information you are getting and stakeholder
identifications that is further defined with short- and
long-term program goals and your design to actually implement those goals. This is an ongoing process
and can be interpreted at the most simplistic level or within
the most complex disasters. When you do your modeling given
your own State needs you can play with this and have your
team members play with this under a number of different
scenarios and it is a very fruitful and active process
for people to go through. I am going to spend a little
bit of time speaking about some of the things that we have
learned and this may fall into the category of the best
way to learn and tailor your planning processes for your own
State is to recall some event you have been through and how
your response was structured within a context like we are presenting here if you don’t have a current disaster event
to use as your reference point. This is in response to Katrina. We have always considered
ourselves pretty good at hurricane preparedness
and response. In this particular slide
you will see that the Department of Health and
Hospitals has always had a disaster task force for the
last 10 years, has a bunch of very interested people on it
from different parts of a massive-one of the largest
departments-in the State Government of Louisiana. We have organized all
of the 12,000 employees into a callout registry. We have identified special roles
for at that point in time with the Office of Mental
Health and where were our primary sites and social needs
shelters and medical shelters. We felt pretty good about
that and we trained on that. We trained in 2004 a few
months before Katrina hit in late August of 2005. We did routine training
including the Federal Government participants on
all-hazards response training, evacuation strategies, etcetera. One can look at that
and say, “That is okay. That is not any problem.” On a day-to-day basis it
is not really a problem. Let me go into this a
little bit more before I tell you what
our problem was. Disaster response drills
also included these various people and it may be of some
interest to some of you, the term SARBO and team TMOSA,
search and rescue base of operations and temporary medical operations staging area. You won’t see those terms
in any current literature. Those were terms that were
developed here in Louisiana to deal with the evacuation of
people out of New Orleans knowing that we would
have to fly people out and putting them in
different staging areas. That is what those
terms referred to. The office of emergency
preparedness which was not under an Incident Command
structure in the way we talk about it today was our
center of operations and they had to take on tasks like
we evacuated our hospitals and we had a number of special
missions with respect to sheltering of at-risk people in the locations identified here. To show you a little bit of
the potential for complexity and miscommunications, you see
all of these different boxes, you see all of these functions. This could work really
well or not work really well depending on the personalities
involved not on its structure because its structure is not sustainable as you see it there. We fast-forward this and
the basic response went from August 29th, which was the
day of the incident through late November and that
was the first phase of it. I wanted to show you the number of items people were working on. If you consider each of those
boxes a mission or a major activity you can see where you
really are almost doing multiple disasters simultaneously
in your response network. As we moved past that and
really took into account lessons learned and our Federal
friends and colleagues also learned a lot from this and
new realities and how you address major incidents,
in our case hurricanes. We had to make some
assumptions and one of the first is that people
won’t plan for their own personal evacuation before
the threat of the storm. I would ask each of you
to look into yourselves. How many of you have
emergency preparedness plans that are personal plans
for your family and people dependent on you that
you can activate within the next half hour and other
members of your family could also activate it
without a lot of stress? The answer is probably
no for almost all of us. If you did, it is decayed and
you haven’t reactivated it or re-practiced it
on a routine basis. Emphasizing that on an ongoing
basis is really important. People get worn out cognitively
and emotionally and are not as able to manage stress
and stay as effective in their decisionmaking. Structure and leadership are
some mitigating factors which can assist with that process
or help deal with the burnout. People need information in
a way that is effective and meaningful to them. That is another way to speak
to the cultural competency of your messaging and how you are providing assistance to people. Sheltering staff, when
you go into a shelter and I would urge all of you, when
you get a chance to go to a shelter for whatever
reason you should and look at the number of roles that
are under way in the shelter. It is always amazing the
way it comes together. As you see from these items
here, for people to be effective, the staff
needs reassurance and relief on the deployment. They need to know they are doing
a good job and they need some downtime and some personal
time where they are not on call and at the beck and call
of everyone in the shelter. Their job structure is
important so they can judge their own performance by
knowing the expectations; having those
written is essential. You should establish a
buddy system going into the program that you are
assigned to participate in so somebody watches your
back and makes sure they can tell you when you are not
performing at the standards you would set for yourself. Continuing to respect each other
and value each other even in small simple ways takes
so much stress out of a situation for people. These little recognitions go
a long way and that is part of the leadership
role of whoever is in charge of the shelter. Shift change debriefings and onsite stress
managers are crucial. We do a 30-minute incident
briefing between our shifts changes so people know
what ongoing issues are and there will be a seamless
set of services available to those who are
depending on us. It is essential that staff
know who is in charge. A lot of people will sometimes
act like they are in charge but it is important to know the
actual structure of what is the command structure within that particular location. Psychological First Aid
is needed by everyone. Don’t find yourself in a
situation where you are making assumptions:
“They don’t need that.” We all need it and
can benefit from it. If you have not had the
training or have not built that training in, it is available
through the NCTSN website. Basic needs must be
assessed and met. As your ongoing process,
taking your same needs assessment model but doing
it at the individual level in the shelter environment. You have to have a
sufficient staffing or you aren’t going to be able
to address the behavioral health needs before they
become so overwhelming that you end up having to implement
a lot of crisis management protocols and even some
hospitalization of people. Having these preplanned
protocols to handle different settings in different
situations is an essential part of your planning. Most of what we have learned
from our experiences in 2005, we moved into using
much more of an Incident Command
structure process. This is one slice out of
it, as you now see our communication pathways and
our operations pathway is from the State-level Emergency
Operations Center down into the desk for ESF-8 which
is the health function. That is transferred to
the whole similar set of operations that mirrors the
State-level operation but specific to behavioral health. That is the message here,
having a specific Incident Command structure for your
behavioral health operations. For us that includes
developmental disabilities. What you see here is the
State level and you also see the regional-we
have nine operational regions in our State. The functions are just the
same but with this dotted line between Behavioral Health
Regional Liaison and the Behavioral Health
Section Chief; that linkage is essential to make all
of the rest of this flow. This particular model has worked
incredibly well with us and taken stress out of the process. This is the 2011 version
of this and there have been a few refinements. You see we have had a
consolidation of the Office of Addictive
Disorders and the Office of Mental Health into the
Office of Behavioral Health. That has simplified our
processes and increased the effectiveness of our
staff and their response. This next slide shows
you a concept of how to facilitate integration of
collaborative partnerships. Those overlapping boxes
where the shapes of the various entities,
community service providers, behavioral health service
providers and school districts; in this context these entities come together in unique and special ways because
of the incident. While you have the basic
concept of how they are partners during non-disaster times,
that changes a little bit. You need to be aware of
how it changes and who are the particular stakeholders
and bodies of influence within that process. There are some highlights
on statewide services and the kinds of
collaborative partnerships. These are post-Katrina and
you will notice that there are family-related groups,
public and private schools, a range of human service-
oriented State-level and local county and
municipal service agencies. The importance of including
your methadone providers in your planning and
response processes. Faith-based organizations
are essential. They are the key to reaching
so many levels of the community. Crisis hotline, the SAMHSA
talk line, as well as any local lines need
to be coordinated. You don’t want parallel lines
that are not communicating with each other in terms
of the phone access. Building a stress
management cadre which I will be glad to answer
questions about that. You can’t do without it,
please don’t try because you will regret it. First responder agencies,
this includes their unions and advocacy groups
and their retirees. Retirees from the first
responder agencies are some of your best employees when you
go into building your teams. Then again, who are your special
population groups that exist and need to be recognized and
cared for in particular ways. The planning
process is ongoing. You will get tired of it,
you will think, “I don’t want to plan anymore,” but you need
to be judicious in how you involve people so they
don’t get burnt out from the planning itself. You need to keep it
active throughout the course of the calendar year. Here are some points of
pre-incident readiness that one should consider
and be briefed on within your own State environment. It is important that you take
behavioral health emergency preparedness and raise it
to a core function within your local and
State agencies. You don’t think about
delivery of services without thinking about the
aspect of emergency preparedness associated with it. If you do that it
will change the level of attention and
funding available. Work with your commissioners
of behavioral health and local and State leaders. Behavioral health mitigation
funds, there is no such thing formally out of FEMA or
out of SAMHSA so this is something that you have
to cobble together, but it can be done if it is
one of your core functions, behavioral health emergency preparedness as a core function. Preparation of action request
forms, you can pre-write these ARFs, as they are known, of
resources you will need that will quickly be depleted if you
understand your capabilities. If you understand your
capabilities you can pretty well predict when
you are going to run out and you are going to
need something else. You can make those
pre-requests available so you are not down without
the necessary resources. Everybody should have the
appropriate levels of the NIMS training
that they require in their particular
role and function. Just a few more of these
readiness issues: call trees are very important. Pre-specification of job
functions so people know where they are to go, what they
are to do and how to do it, what the expectations are. Maintaining a volunteer
cadre ahead of time, having pre-vetted that group
of people, this is important. And practice, practice,
practice, especially for the different venues you know
you will be serving in. Preparing media shelf kits
so you have your basic information available and it
just needs to be structured for the various unique
features of that particular disaster, keeping in mind
the intensity of the incident, the duration, displacement
of people, resource loss, and loss of human capital. If you keep those variables
underway your outcomes for your needs assessment
process you can build a really excellent program. The basic services are-I
think you have heard a lot about some of these services,
your components of your plan should address all of these. These would be in your
program design itself. The basic component summary is
looking at these items here, you need to have an
education component, an ability to
provide a technique, a structured technique
of helping people, like Psychological First Aid, being
able to do a just-in-time training specific to the
disaster for your workers. Having an outreach capacity,
ability to treat trauma, ability to deal with
psychiatric crisis response not just disaster crisis
response and your media and quality assurance plans
and your financial, fiscal management
business plan features. Your response and recovery
goals, if you just operate under that guidance keep it
simple and mission focused and you will stay
right on track. Answering these questions,
we did this over and over, any meeting you would ask
these four questions, and we were able to be more
successful that way. What is a disaster-related
issue or challenge that is consuming you at the person
or the community level? What can you, the
person who is being consumed by it, do about it? What assistance do
you need from us, the behavioral
health authority? How do you know when the
issue or challenge is resolved? People stay in a constant state
of loss and don’t know when they resolved their issue. That is not an uncommon
thing to have happen. You have to remember that the
Crisis Counseling Program is a supplemental program. It is not a new mental
health system and therefore it must fit into
existing systems. More flexibility in
administration and local and State level is important. Try to build that
much into it. Again, here is the
logo that we have with Louisiana Spirit and it speaks
to something that we can do a badging of the program,
part of the communication. In our oil spill recovery,
we just change it to coastal recovery from hurricane
recovery but people have grown to recognize
that as symbol of assistance to
them in a disaster. This is some of the media
print where a psychological disaster is the invisible damage
as compared with a backdrop of the tangible loss of structure
and damage to communities and the juxtaposition between
the two is something that is helpful to keep in
people’s minds. With that, I have provided
you with a reference section that you can read
at your leisure and that concludes my presentation. Moderator: Thank you
so much Dr. Speier. We are now going to open up
the floor for questions. We have received five so far. I will read each one
and let you answer. The first question is,
I am responsible for disaster behavioral
health in my State. It is a State with a small
population and we have not had a history of many disasters. Do we still need to do all
you are suggesting in terms of needs assessment and exercise
drills or do you only suggest this for States that are more
like Louisiana in that they are more likely to be hit by major hurricanes and other disasters? Dr. Speier: Thank you. That is a good question and
people want the answer to be that I don’t have to worry
about it, it is only those States that are subject to
all of the big disasters. If you take time to go through
the slides and look at them from the point of the principles
that are being addressed and the various levels of
variables that are mentioned, those are applicable
to all States. A good beginning point for
you is everybody has had a major fire somewhere in their State,
either a flood, they have had different kinds of things that are incidents not disasters where you will see these
same principles at work. Moderator: In building your
State’s behavioral health response capacity,
how do you address continuity of
operations post-event? Dr. Speier: Continuity of
operations is a term that refers to keeping your
business model and your service delivery models intact when an
exceptional event has occurred. When you start doing your
planning for the emergency response aspect of your duties
you also simultaneously plan for the staffing of
your ongoing business. You basically split your staff
into your responder’s staff and your continuity of
operations staff. Oftentimes people you will
find a lot of your staff has child care or older adult
caring responsibilities that they can’t play primary
roles in a response but they can play the appropriate
roles in the continuity of care. Planning that ahead of
time as part of your emergency preparedness
process is essential. The other pieces, if you
have a lot of people you are following on medication, you
can prescribe 30 days and fill prescriptions early for people than the 10-day window so that the demand for refills on
medication and medication checks will be reduced for the days
immediately following the event. Moderator: Are there any
realistic examples of how States can effectively
deal with staff burnout? Dr. Speier: There are; one
of the things to look at is- I don’t know if the Project
Liberty website is still up, but there was a lot of work
after 9/11 with uniformed staff who work in the public sector,
from subway drivers to fire and police and the long-term
exposure not to all of the physical features but to
the stress and how those different organizations
and faith-based communities worked together to
assist people with that. The examples that have been most
helpful to us is working with the fire and police agencies
from New York City who came down and assisted
us in our first responder anti-burnout campaign. One of the biggest features we
have found that is common to this and other disasters in the
country is use of a buddy system and the training of leadership to know not to always rely on the person who is
always volunteering to do the hard jobs. We all have a certain degree
of frailty we have to come to terms with and
you don’t want that to happen in the
middle of a mission. Moderator: Did you negotiate
MAAs with each partnership and how did you determine the cost? Dr. Speier: Usually with
partnerships we don’t negotiate funds for our planning
processes or even in the initial response phases. What we assume is that we
have a common purpose and a common mission. We collaborate within our
own existing funding streams. If we are going to use
a particular partner or collaborator in the delivery
of new services and there is a grant that we are going
after together then we would determine costs and we determine
costs on a market price for a particular service or we use
a cost reimbursement methodology and stick to the normal and
specific contracting and administrative requirements of
your particular State or locale. Moderator: You mentioned some
wonderful tools for evaluations, such as a needs assessment. We don’t have funding for
an evaluator on our staff. Are there needs assessments
already developed that we can adapt for our State? Dr. Speier: I think there are. If you were in that
situation and you had a particular disaster, what
you can’t predict with that would be reaching out to the
network either through DTAC or through the various
collaborations of State disaster emergency response personnel, you will find people have developed a lot of
needs assessment tools. You will also find that your
universities, your schools of sociology, social work,
psychology, and a lot of other different departments, especially a lot of the GIS mapping departments will have done a lot of work which will provide you with threshold data
and would be more than happy and might even have grants in place
that are ready to respond to a disaster event in your State. Moderator: Can you briefly talk
about the financial impact of using private consultants or
contractors in DBH response and if this is a viable option, especially given
limited State resources? Dr. Speier: You think
about this in two contexts. The cost of your experts
can usually be rolled into whatever your
long-term plan is. If it is a large event
which is the only time I would recommend that you have
experts, you will have either through the Stafford Act,
access to the CCP program or there will be some foundation
funding or unique funding like in the case of the oil
spill along the Gulf Coast, our funding comes from BP. When you do that you really
already have a funding source. The value, even if you don’t
is by using experts who are knowledgeable about the
field, protects you from your own conventional wisdom. Oftentimes the expert opinion
is based on experience in addressing the needs of
a particular population. You will find the intervention
you create is cheaper and less intrusive than you would
have otherwise done without that information. We also deploy as well
as employ a range of professionals to guide our
ongoing service development. You can get a lot of that
pretty cheap from statewide organizations, such as
your various colleges. Moderator: We have two
more questions for you. First, how do we effectively
include volunteers, especially those who are not part of a specific group or organization, such as community members who
want to help in the range of services available
during a disaster. Dr. Speier:
Volunteers are essential to successful response. Ongoing year-in year-out
activity is assisting in the communication of volunteer
opportunities in your States, such as through the American
Red Cross, through the different faith-based emergency
response voluntary actions in your State so you have
a pre-vetted, pre-established group of volunteers of people
who just want to help in that respect in a way that
they can have successful experiences in
providing assistance. People who want to provide
assistance specific to behavioral health, you
need to have a process of verifying credentials and
a term we use, vetting their eligibility to participate. That kind of activity, you
need to set your structure, the rules of the game, your
certifications process, and who on your staff
will be doing it. Do you have a contract to do
that vetting ahead of time or one that is activated
just during the disaster? You need to have thought
through those processes and if you do so, you can channel the
volunteer resource in terms of their skill set
to the appropriate venues to provide services. Moderator: Our final question. What are behavioral health
mitigation funds and how can States access them? Dr. Speier: Mitigation funds
are funds to help lessen the impact of an incident. They are most often understood
if you have a levee and it has been topping over, do you
improve the drainage assistance associated with it or do
you raise the levee 2 feet. Those would mitigate the
impact of a swollen river at X number feet
above flood stage. In behavioral health, there are
no such funds such identified. You can design through your
normal budgeting process in the State, procedures of
where you would request of your legislator
mitigation funds. I can tell you even in
Louisiana we have not been successful with that. What we are successful
with is if you have this communication going on
at the three levels of government, local,
county, and State. At the end of the year people
usually have some unspent funds. If you have an agreement that
people will take a percentage of that and buy materials and
resources, anywhere from MREs to appropriate protective
equipment you need, as well as hosting an education and
training seminar at various locations or doing
e-learning trainings. You can do a lot of one-time
activities that result in a pretty sophisticated
mitigation response at very little fiscal impact
because you are using money that was
obligated but unspent. Moderator: Thank you for
your presentation, Dr. Speier. This concludes the Assessing
Services and Information webinar, a part of the
Promising Practices in Disaster Behavioral
Health Planning series. Subsequent sessions
will explore each of the standards in greater depth,
providing examples, lessons learned, and good stories
about how to enhance your disaster behavioral health plan. Our next webinar will focus on
logistical support and will be held on August 10th
at 2 p.m. eastern time. The webinar will feature Mr.
Steve Crimando as the speaker. Other upcoming webinars
include, Legal and Regulatory Authority on August 18th
with Mr. Andrew Klatte. Integrating your Disaster
Behavioral Health Plan on August 25th with Mr.
Steven Moskowitz. Plan Scalability on August
30th with Dr. Anthony Speier who will be joining us for the
final webinar of this series. Thank you to Dr. Speier for
his presentation and to all of you for participating
in the Promising Practices in Disaster Behavioral Health: Assessing Services and
Information webinar.