Kansas All-Hazards Behavioral Health Program

Preparedness, Response, and Recovery For

Kansas Communities

KAHBH Personnel

• Dr. Briana S. Nelson Goff, KSU/Family Studies & Human Services

• Charlie Griffin, KSU/Family Studies & Human Services

• Becky Rinehart, SRS Mental Health, Topeka • Stephanie Wick, FSHS MS Student• Anthony Walker, FSHS MS Student• Michael Smith, Psychology Undergraduate Student• Lizette Vargas, BRIDGES & DSP Undergraduate

Student

“Behavioral Health”

Mental Health + Substance Abuse

“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

“Mental Health is the linchpin to an effective response.“

Statement from April 2005

TOPOFF 3 Exercise

All-Hazards = All-Hazards

Disasters

Bioterrorism

Major Community Crises

State-Level Role of KAHBH

• During a disaster in Kansas, the Kansas Mental Health Authority through SRS collaborates with the Kansas Department of Emergency Management, Local Community Mental Health Centers, and FEMA in a Presidentially declared disaster

• FEMA has required each State to develop a crisis response plan in meeting the mental health and substance abuse needs at state and local levels, which are formally integrated into the State Emergency Operations Plan

• KDHE established a contract with KMHA to provide funds for 1 year to coordinate the development and implementation of the All-Hazards Behavioral Health Plan– 2nd year began 1/06

• In January 2005, Kansas Department of Social and Rehabilitation Services, Mental Health Authority, subcontracted with Kansas State University, School of Family Studies and Human Services

• The Kansas All-Hazards Behavioral Health (KAHBH) Project was developed through the subcontract

Event

City Response

County Response

State Response

KDEM Application National Disaster

Presidentially Declared Disaster

60 Days1) On-Site Command2) Local Outreach workers3) Supplies

9 MonthsIf needed apply forRegular ServicesProgram (RSP)

Sources of Information-Red Cros-KEMA-Adjutant General’s Office-Cities - Newspapers - New Releases

To Collect Data Per County-Casualties-Injured-Business-Schools-Homes-Homeless-Power-Food-Water--------------------------------------------Budget-Staff

KMHA has 14 Days to Apply for

Immediate ServicesProject (ISP)

Behavioral Health Response to Presidentially Declared Disaster

FEMA/SAMHSA Crisis Counseling

Assistance and Training Program

FEMA Crisis Counseling Assistance and Training Program

• Robert T. Stafford Disaster Assistance and Emergency Relief Act (P.L. 93-288 as amended)

• Interagency Federal Partnership

• Federal-State-Local Partnership

Organizational Partners in Crisis Counseling Program

• Community Mental Health Agencies• State Mental Health Authority• State Emergency Management Agency• Federal Emergency Management Agency

(Region and Headquarters)• Center for Mental Health Services

Administrative Staff

• Community Program Managers• State Disaster Mental Health Coordinator• Governor’s Authorized Representative• FEMA Crisis Counseling Coordinator• FEMA Human Services Officer• Federal Coordinating Officer• FEMA Headquarters Crisis Counseling

Coordinator• CMHS Project Officer

Disaster Operations Structure

CCP Organizational Chart:Small Provider

CCP Organizational Chart: Large Provider

Examples of Crisis Counseling Program Services

• Outreach

• Screening and Assessment

• Counseling

• Information and Referral

• Public Education

Program Limitations

• Medications• Hospitalization• Long-term Therapy• Providing Childcare or Transportation• Fundraising activities• Advocacy• Case Management

Crisis Counseling and “Traditional”

Behavioral Health Practice

• 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

• 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

“Traditional” Practice Crisis Counseling

Source: ESDRB Program Guidance, December, 1996

FEMA/CMHS Crisis Counseling Program

FY 2004 Grant Sites

FEMA/CMHS Crisis Counseling Program

FY 2004 Grant Sites

FEMA 1479 TX

(Hurricane Claudette)

FEMA 1479 TX

(Hurricane Claudette)

FEMA 1437 LA

(Flooding)

FEMA 1437 LA

(Flooding)

FEMA 1492 MD (Hurricane

Isabel))

FEMA 1492 MD (Hurricane

Isabel))

FEMA 1391 NY

9/11 Terrorism

FEMA 1391 NY

9/11 Terrorism

FEMA 1474 WV

(Floods)

FEMA 1474 WV

(Floods)FEMA 1506 SA (Cyclone)

FEMA 1506 SA (Cyclone) FEMA 1491 VA

(Hurricane Isabel)FEMA 1491 VA

(Hurricane Isabel)

FEMA 1498-CA

(Fires)

FEMA 1498-CA

(Fires) FEMA 1475 KY

(Severe Storms)

FEMA 1475 KY

(Severe Storms)

FEMA 1501 PR

(Storms & Flooding)

FEMA 1501 PR

(Storms & Flooding)FEMA 1322 AL

(Tornado)FEMA 1322 AL

(Tornado)

Summary

• The FEMA/CMHS Crisis Counseling Program works in conjunction with a number of organizational partners and administrative staff to provide services during disasters that differ from traditional mental health services

KAHBH Purpose

• KAHBH provides State-wide organization and coordination for behavioral health response to disaster and other all-hazards events

• Responsibilities of the KAHBH Project are outlined in 7 Primary Tasks

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

KAHBH Trainings• Core Behavioral Health Training

– Began Dec 2005– Based on SAMHSA/CMHS Training Manual– 1.5 day 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. 4)• 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 Crisis Response Interventions– Module 8: KAHBH Community Outreach Teams: Structure, Procedures, and Documents

• Paraprofessional Training – All nonbehavioral health members/paraprofessionals– 4 hours training on basic helping skills in crisis

counseling• 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

• 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

Other Training

• 2005 All-Hazards Behavioral Health Symposium: Preparedness, Response, and Recovery in Kansas– October 6-7, 2005– Kansas Highway Patrol Academy in Salina,

KS

KAHBH Network

• 10 staff

• 15 Stakeholders

• 12 SRS Field Staff

• 29 CMHC Coordinators

• Goal: 200+ KAHBH Network members

KAHBH Stakeholder Supporting Agencies

• Kansas Department of Health & Environment, Office of Local & Rural Health, Topeka• SRS Mental Health Authority, Topeka• SRS Health Care Policy, Addiction & Rehabilitation Services, Topeka• Kansas State University, School of Family Studies and Human Services, Manhattan• University of Kansas School of Medicine, Department of Preventive Medicine & Public

Health, Wichita• Lawrence Therapy Services, Lawrence• Mental Health Center of East Central Kansas, Emporia• Regional Prevention Center, Olathe• Mid-America Addiction Technology Transfer Center, Kansas City• COMCARE, Wichita• American Red Cross, Midway Kansas Chapter, Wichita• Wyandot Center, Kansas City• Association of Community Mental Health Centers of Kansas, Inc., Topeka• Center for Counseling & Consultation, Great Bend • Prairie View Behavioral & Mental Health Care, Newton **• Heartland Assessment Center, Roeland Park, KS **

**Resigned due to accepting positions in other states

KAHBH Plan and Standard Operating Procedures

• The initial Kansas All-Hazards Behavioral Health Annex has been drafted and submitted to the Kansas Department of Emergency Management (KDEM) to be reviewed and accepted into the Kansas Emergency Operations Plan. – KDEM acceptance currently is pending

• The State Plan will provide a detailed description of the behavioral health preparedness, response, and recovery in Kansas

• Preliminary drafts of the KAHBH Standard Operating Procedures have been developed and are to be reviewed by the SRS Contract Manager.

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KAHBHANNEX

(Submitted to KDEM)

KAHBHPlan

KAHBH Standard Operating Procedures

Preparedness ActivitiesResponse Activities

Recovery Activities

The goal of KAHBH is to collaborate and work to coordinate all behavioral health services before, during, and after an all-hazards event in Kansas.

Organizations Involved in Disaster Response

• Federal– SAMHSA—Substance Abuse Mental Health Services Administration &

CMHS—Center for Mental Health Services

– FEMA—Federal Emergency Management Agency

• State– KDHE—Kansas Dept. of Health and Environment

• KDEM—Kansas Division of Emergency Management– 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.)

Role of KAHBH Network Members

• SAMHSA/CMHC Model

• Professionals and paraprofessionals working in teams

• Based on SRS CMHC Regions– 27 total areas in Kansas

KAHBH is not:

• American Red Cross Disaster Mental Health Services

• Critical Incident Stress Debriefing

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

Network members should be:

• Indigenous to the communities they serve

• Possess varied experience

• Non-traditional methods

• Sensitive to cultural issues

KDEM

KS Citizens

KS Citizens

State Plan

KDEM

KS Citizens

KS Citizens

State Plan

KAHBH

KDEM

KS Citizens

KS Citizens

State Plan

KAHBH

State Stakeholders

KDEM

KS Citizens

KS Citizens

State Plan

KAHBH

State Stakeholders

American Red Cross

KDEM

KS Citizens

KS Citizens

State Plan

KAHBH

State Stakeholders

American Red Cross

Education: Trainings, Universities, Conferences

KDEM

KS Citizens

KS Citizens

State Plan

KAHBH

State Stakeholders

Education: Trainings, Universities, Conferences

American Red Cross

Governor’s Bioterrorism Coordinating

Council(SRS Mental Health

Authority rep joined 4/04

KDEM

KS Citizens

KS Citizens

State Plan

KAHBH

State Stakeholders

Education: Trainings, Universities, Conferences

American Red Cross

Governor’s Bioterrorism Coordinating

Council(SRS Mental Health

Authority rep joined 4/04

County Data Bank

KDEM

KS Citizens

KS Citizens

State Plan

KAHBH

State Stakeholders

Education: Trainings, Universities, Conferences

American Red Cross

Governor’s Bioterrorism Coordinating

Council(SRS Mental Health

Authority rep joined 4/04

County Data Bank

KS Train

KDEM

KS Citizens

KS Citizens

State Plan

KAHBH

State Stakeholders

Education: Trainings, Universities, Conferences

American Red Cross

Governor’s Bioterrorism Coordinating

Council(SRS Mental Health

Authority rep joined 4/04

County Data Bank

KS Train

Disaster Exercises

KDEM

KS Citizens

KS Citizens

State Plan

KAHBH

State Stakeholders

Education: Trainings, Universities, Conferences

American Red Cross

Governor’s Bioterrorism Coordinating

Council(SRS Mental Health

Authority rep joined 4/04

County Data Bank

KS Train

Disaster Exercises

1st responders/ Critical Incident Stress Management

KDEM

KS Citizens

KS Citizens

State Plan

KAHBH

State Stakeholders

Education: Trainings, Universities, Conferences

American Red Cross

Governor’s Bioterrorism Coordinating

Council(SRS Mental Health

Authority rep joined 4/04

County Data Bank

KS Train

Disaster Exercises

1st responders/ Critical Incident Stress Management