disaster planning: preparing for outtages, facility shut downs and other emergencies

Disaster Planning:

An Ethical ObligationInstructor: Dr. Dawn-Elise Snipes

Executive Director: AllCEUs Counselor Education

Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery

AllCEUs Counselor Education Unlimited CEUs $59 & Specialty Certificates $89 1

Objectives

Rationale and Process for Disaster Planning

Preparing for Disaster

Continuity Planning

Management of Prescription Medications

Testing the Plan


Rationale

Disaster planning can save lives, minimize injury and emotional trauma, protect property and operational capability, and prevent or reduce interruptions in treatment.

The behavioral health treatment program has a special obligation to prepare for disasters because it provides essential services.

By their nature, disasters have an impact on behavioral health:

Most people who experience a disaster, whether as a victim or responder, will have some type of psychological, physical, cognitive, and/or emotional response to the event. Most reactions are normal responses to severely abnormal circumstances. (American Medical Association, 2005, p. 2)


Rationale

Disaster planning can prepare the program for continuing to provide the services to its existing clientele in order to prevent:

Relapse

Medical and psychological consequences for prematurely discontinuing medically managed detox or crisis stabilization

Homelessness if clients are in a residential facility

Client destabilization due to lack of access to medications prescribed and/or administered by the agency (antipsychotic injections, prescription refills, methadone)

Exacerbation of problems in at-risk populations as a result of lack of access to support


Rationale

Disaster Planning can help mitigate psychological

issues in the community by providing services to

new clients (Katrina)

Aid to other programs

Rapid response to influx of clients from other agencies

or areas


Types of Disasters

Your facility is incapacitated or destroyed (fire, building flood,

sink hole) but other facilities remain open and clients are in

their homes

Your facility and others are incapacitated and clients are in

shelters (Hurricane, blizzard, fires).

Your facility is functional in the aftermath of a natural disaster

in which your patients are in shelters. (City-wide flood).

When the program must cease provision of nonessential services

due to a sudden reduction in resources, infrastructure, or

available personnel due to illness or diversion of resources.

Health department can provide a copy of the local Hazard

Identification and Risk Assessment (HIRA)AllCEUs Counselor Education Unlimited CEUs $59 & Specialty Certificates $89 6

Continuity Planning

Requires a program’s personnel to consider the threats that could adversely affect essential functions;

Determine the personnel, vital information (e.g., patient medical records including prescription records), and other resources required to continue those essential functions;

Develop plans for providing essential functions onsite or at alternate locations if needed

Make advance arrangements for obtaining the resources necessary to support essential functions throughout the disaster and recovery phases

Plan for the safety of all personnel during these periods.


Planning cont…

In its initial work, the disaster planning team

conducts or gathers, from partner agencies in the

community, a hazard identification and risk

assessment

A hazard-specific appendix should not repeat

information that is in either the basic plan


Types of Clients Current clients

Current clients who are destabilizing

Guest clients

Prior clients whose recoveries are threatened

Individuals with an untreated mental health issue which must be addressed to prevent further deterioration

Family members of clients who need assistance to support their loved ones (Hotline, online support groups)

Patients who need prescription refills written

Patients on an opioid pain medication who cannot access their physician


The Plan

Introduction: Purpose of the plan and objectives

Concept of operations

Procedures for activating and deactivating (Who, What, When, How)

Staff responsibilities in the disaster

List of the personnel positions authorized to make requests for outside aid or assistance

the conditions under which to request aid

the procedures for managing requests to give aid

a list of resources that can be used in those efforts.


The Plan

Functional Annex (Response to a specific hazard type)

Hazardous weather/tornado warning

Facility Fire

Wildfire / Flood

Facility Flood

Hurricane / Blizzard

Earthquake

Viral Pandemic

Chemical Spill

Train or major vehicle wreck or explosion


The Plan

Implementation Instructions

Checklists and materials necessary to perform disaster

related tasks

Scripts to respond to the media, public or consumers

Floorplans

Community Maps

Safety Related policies and procedures

Memoranda of Agreement including address of each

facility, phone number and contact person


Keep It Simple

Basic plan should address

General procedures

Contain a general decision and notification tree

Plans for monitoring where clients go

Avoid having staff need to refer to multiple sections in the plan

If your agency has multiple locations or types of programs, each program type needs its own addendum to each functional annex (Detox, CSU, Residential, IOP, Adolescent)

Supervisory staff should maintain a paper copy and each building unit should maintain a paper copy in an accessible location

Administrative and Clinical staff must ALL be adequately trained including scenario training.


Coordination with Others / MOU

Memorandum of Understanding with:

Hospitals/Health Departments (Detox, crisis stabilization, medication maintenance)

Behavioral Health Disaster Response Team (Health Departments)

Emergency Management for evacuation of patients

Other clinics for mutual referral or staff borrowing

Sober homes for patients in addiction recovery

SAMHSA’s Disaster Technical Assistance Center (DTAC) specialists can help a program link with the disaster behavioral health coordinator for its State and answer questions about accessing state and federal funding

Health departments must coordinate disaster planning with the community’s behavioral health treatment systems


Role of the Health department Engaging and coordinating with emergency management,

healthcare organizations (private and community-based), behavioral health providers, community and faith-based partners

Support the development of public health, medical, and mental/behavioral health systems that support recovery

Participate in awareness training with community and faith-based partners on how to prevent, respond to, and recover from public health incidents.

Promote awareness of and access to medical and mental/behavioral health resources that help protect the community’s health and address the functional needs of at-risk individuals

Receive and/or integrate the health needs of populations who have been displaced due to incidents that have occurred in their own or distant communities


Role of the DEA

Monitors and reviews actions the program takes in

a disaster regarding controlled substances (e.g.,

relocating a methadone supply to an alternate

facility)

Inform the local DEA agent about the use of

controlled substances that are prescribed or

dispensed to patients and stored at the facility

(ADHD, Anxiety, Opiate)

The State Opioid Treatment Authority can assist in

making contact with the local DEA official


Role of the Media

Assist in coordination of services

Request including in local TV and Radio

emergency listings (operating status of the

program, where to go if closed)


PreDisaster Preparedness

Educate partners to destigmatize and ensure

continuity of care at “guest” agencies or in

shelters

Methadone / Suboxone

Schizophrenia

Educate the public about the importance and

availability of behavioral health services in an

emergency

Get Memoranda of Understanding


Pre-Disaster Preparedness

Educate local emergency response organizations about:

Characteristics of patients (especially residential)

Needs of patients during and after transport

Most appropriate settings most appropriate for relocation

Specific locations that have, through MOU, agreed to accept patients

Patients have a right to expect from general population emergency shelters support services that provides:

Access to medications to maintain health, mental health, and function

Refrigeration for medications

Assistance that may be required due to cognitive and intellectual disabilities.


Pre-Disaster Preparedness Identify Essential Functions

Safety of clients and visitors

Behavioral health emergency services including crisis and relapse prevention.

Track clients affected by dispersal and evacuation to ensure they continue to receive needed behavioral health services.

Assist clients in accessing needed medications.

Conduct drug testing for mandated clients.

Adhere to applicable State licensing standards.

Maintain treatment and billing records in accordance with regulatory requirements.

Protect client rights and privacy, including the integrity of PHI

As resources are available and based on mandates, provide disaster mental health services to the community including prevention specific guidance and crisis intervention


PreDisaster Preparedness

Become aware of funding sources in an

emergency and how to access them

State and Federal funds (e.g., Robert T. Stafford

Disaster Relief and Emergency Assistance Act)

Crisis Counseling Assistance and Training Program (CCP)

grants, which are funded by FEMA

SAMHSA Emergency Response Grants (SERGs)


Mitigate Risk

Improve facility’s ability to withstand a disaster

Hurricane window covering

Backup generators

Prepare for shelter-in-place for when evacuation is unsafe

(Chemical spill)

Stockpile supplies: Cots, linens, soap, toothpaste,

nonperishables for a 72-hour period

Prepare personal go-kits (1 per client) with water bottle,

flashlight, batteries, toiletries, and consider… t-shirt and

shorts, towel, high energy food bar (Can have clients bring

at admission)

Inventory and replace supplies at least quarterlyAllCEUs Counselor Education Unlimited CEUs $59 & Specialty Certificates $89 22

Mitigate Risk

Real-time data back-up of electronic health record at a remote location which can be accessed in emergency

Keep coolers on site for transportation of refrigerated medications

Ensure electric water pump (if any) are connected to back-up generator

Train all staff in emergency psychological first aid

Have a psychiatric advanced directive in the file for any patient who may destabilize in an emergency which includes helpful interventions and info about legal representative should they become incapacitated.


Mitigate Risk

Prepare for financial resiliency

How to enroll clients in emergency Medicaid

Reimbursability of services

Educate payors about modified counseling services to facilitate reimbursement

Some agencies may have a reduction in cash flow due to relocation of community residents

Staff members might be “shared” with programs experiencing an influx of clients to reduce payroll load

Consider how to support client retention through active outreach following a disaster


Summary

Disaster planning prepares for client safety and

continuity of care and financial solvency for

organizations in the event of a disaster

Getting MOUs with local agencies, the health

department and emergency services is vital to

preparation

A list of identified risks for your area can be accessed

at your local health department

All staff needs to be trained in the disaster procedure

and scenario training should occur periodically


disaster planning: preparing for outtages, facility shut downs and other emergencies

Healthcare