Texas Department of State Health Services Disaster Behavioral Health Services Chance A. Freeman

1. Disaster Behavioral Health 101 Texas Department of State Health Services Disaster Behavioral Health Services Chance A. Freeman Branch Manager

2. Overview of Disaster Behavioral Health (DBH) • What DBHS & DBH Providers Do • What DBHS & DBH Have To Offer • Define • What Disaster Behavioral Health Is • What Disaster Behavioral Health Is Not • DBH Coordination – How to request DBH • Local/Regional/State • What Should Be Done • What Should Not Be Done

3. What LMHAs DoDay-to-Day LMHAs provide mental health services to adults and children who have chronic, severe and persistent mental illnesses such as: • Schizophrenia • Major depression • Bipolar disorder • Other disorders which require crisis resolution or ongoing support and treatment.

4. LMHA Service Areas

5. Crisis Counseling vs.Traditional Mental Health Traditional • Primarily office-based • Focuses on diagnosis and treatment of mental illness • Attempts to impact personality and functioning • Examines content • Encourages insight into past experiences and influence on current problems • Psychotherapeutic focus Crisis Counseling • Primarily home and community-based • Assessment of strengths, adaptation and coping skills • Seeks to restore pre-disaster functioning • Accepts content at face value • Validates appropriateness of reactions and normalizes experience • Psychoeducational focus

6. What OSARs DoDay-to-Day • Outreach, Screening, Assessment and Referral Centers (OSARs) are the first point of contact for those seeking substance abuse treatment services. • Regardless of ability to pay, Texas residents who are seeking substance abuse services and information may qualify for services based on need.

7. Definition of Disaster Behavioral Health (DBH)http://www.phe.gov/Preparedness/planning/abc/Documents/DisasterBehavioralHealth.pdf Disaster behavioral health is the provision of mental health, substance abuse, and stress management to disaster survivors and responders. • U.S. Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response

8. What is DBH? (cont.) • The primary goal is to decrease the stress of an event and mitigate future problems • Modalities may include Psychological First Aid, Spiritual Care, Substance Abuse services, Critical Incident Stress Management (CISM), Crisis Counseling, or other crisis intervention and disaster specific support services

9. What is DBH? (cont.) • Community based • Focus on strengths & coping skills • Restore functioning • Confirms reactions are common/normal • Focus is educational

10. What DBH is NOT, or at least SHOULD NOT be... • We ARE NOT there to provide traditional therapy • We ARE NOT there to make a diagnosis • We ARE NOT there to “look” for customers or consumers

11. Possible DBH Outreach Locations • Disaster Recovery Center (DRC) • Incident Command Post (ICP) • Points of Distribution (POD) • Mass Care Shelter • Joint Field Office (JFO) • Disaster District Committee (DDC) • Regional Health and Medical Operations Center (RHMOC) • Family Assistance Center (FAC) • Re-entry Points

12. Typical Phases of Disaster Source: Zunin/Meyers, as cited in U.S. Department of Health and Human Services. (2000). Training manual for mental health and human service workers in major disasters (DHHS Publication 90–538). Washington, DC: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration , Center for Mental Health Services.

13. Department of State Health Services Disaster Behavioral Health Services (DBHS) • Responsible for all-hazards disaster preparedness, response and recovery in Texas • DBHS is housed in Adult Mental Health Services • Works closely with Community Preparedness Section of DSHS

14. DBHS Program Functions Serve as the liaison to the Texas Division of Emergency Management and other federal resources on disaster behavioral health issues Coordinate all DBH, Crisis Counseling and Critical Incident Stress Management services during a state or federally declared disaster Provide brief crisis counseling services during state or federal critical incidents or disasters

15. Develop and submit all State and FEMA grant applications on behalf of DSHS & the impacted communities Assist in the development of internal emergency response abilities and resources and assist in the coordination of internal response and recovery activities from traumatic events Program Functions (cont)

16. DBHS Partners • Texas Division of Emergency Management (TDEM) • Federal Emergency Management Agency (FEMA) • Substance Abuse and Mental Health Services Administration (SAMHSA) • Center for Mental Health Services • 39 Community Mental Health Centers aka – Local Mental Health Authority

17. DBHS Partners (cont.) • 140 Substance Abuse Providers • Voluntary Organizations Active In Disasters (VOADs) • Texas Critical Incident Stress Management Network (CISM) • American Red Cross • DBH Consortium

18. Incident Command System (ICS) The Incident Command System (ICS) is a standardized, on-scene, all-hazards incident management approach that: • Allows for the integration of facilities, equipment, personnel, procedures and communications operating within a common organizational structure. • Enables a coordinated response among various jurisdictions and functional agencies, both public and private. • Establishes common processes for planning and managing resources. • ICS is flexible and can be used for incidents of any type, scope and complexity. Source: http://www.fema.gov/incident-command-system

19. TEXASICS Structure FEMA EMAC OFFICE OF THE GOVERNOR SOC-TDEM DSHS SMOC DDC HSR-RHMOC LOCAL RESPONSE EOC & EMC DISASTER!

20. Typical Local Response

21. Questions

22. Useful Resources • DSHS DBHS http://www.dshs.state.tx.us/mhsa-disaster/ • National Child Traumatic Stress Network PFA http://www.nctsn.org/content/psychological-first-aid http://www.nctsnet.org/content/pfa-mobile • World Health PFA model http://www.who.int/mediacentre/news/releases/2011/humanitarian_relief_20110819/en/index.html • Substance Abuse Mental Health Services Administration (SAMHSA) http://store.samhsa.gov/pages/searchResult/psychological+first+aid http://disasterdistress.samhsa.gov/ • FEMA Incident Command System Training http://www.training.fema.gov/EMIWeb/IS/ICSResource/index.htm • National Standards For State & Local Planning – Public Health Preparedness Capabilities http://www.cdc.gov/phpr/capabilities