1. United States Department of Health & Human Services Office of the Assistant Secretary for Preparedness and Response Disaster Behavioral Health Darrin Donato Senior Policy Analyst U.S. Department of Health & Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) Office for Policy and Planning (OPP) Division for At-Risk Individuals, Behavioral Health, and Community Resilience (ABC) Phone: 202-245-0758 darrin.donato@hhs.gov

2. ASPR: Resilient People. Healthy Communities. A Nation Prepared. Office of the Assistant Secretary for Preparedness and Response (ASPR) HHS ASPR was created under the Pandemic and All Hazards Preparedness Act in the wake of Katrina to lead the nation in preventing, preparing for, responding to, and recovering from the adverse health effects of public health emergencies and disasters. Web site: US Department of HHS's Public Helath Emergency Website US Department of HHS's Public Helath Emergency Website

3. ASPR: Resilient People. Healthy Communities. A Nation Prepared. ASPR OPP DIVISION FOR AT-RISK INDIVIDUALS, BEHAVIORAL HEALTH, & COMMUNITY RESILIENCE (ABC) Mission: Provide subject matter expertise, education, and coordination to internal and external partners to ensure that the functional needs of at-risk individuals and behavioral health issues are integrated in the public health and medical emergency preparedness, response, and recovery activities of the nation to facilitate and promote community resilience and national health security. Email: abc.info@hhs.gov http://www.phe.gov/abc Phone: 202-260-1229  Key Responsibilities: Policy guidance Providing expertise & technical assistance Interagency coordination Regarding: At-risk Individuals Behavioral Health Community Resilience

4. ASPR: Resilient People. Healthy Communities. A Nation Prepared. DISASTER BEHAVIORAL HEALTH Disaster behavioral health refers to mental health, substance abuse, and stress management needs and issues concerning: –Disaster survivors –Disaster responders –People with pre-existing behavioral health conditions –Behavioral health care infrastructure –Individual and community resilience and recovery –Messaging/risk communication Needs may emerge immediately May develop or increase over time Proven link to physical health 3

5. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 4 DISASTER BEHAVIORAL HEALTH (2) Following an emergency event survivors and responders may display symptoms and stress reactions such as: Emotional symptoms - irritability or excessive sadness. Cognitive dysfunction - difficulty making decisions or following directions. Physical symptoms such as headache, stomach pain, or difficulty breathing. Behavioral reactions – increased alcohol/tobacco consumption, sleep disturbance, interpersonal conflict, failure to adhere to physical or medication needs, failure to adhere to public health directives.

6. ASPR: Resilient People. Healthy Communities. A Nation Prepared. THE RESILIENT TRAJECTORY [Bonanno, 2004, 2005, 2008] 5

7. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 6 WHY WE’RE CONCERNED Mental disorder in a given year--Americans 18+:26.2%, 57.7 million [NIMH] Serious mental disorder--Americans 18+: 6%, 13.2 mil. [NIMH] Have mental disorder--Americans <18: 10.5 to 17.4% [HHS statistic from NMHA] Illicit substance use in past month--12 or older: 8.1% [SAMHSA] Alcohol dependence/abuse --12 or older: 7.7% [SAMHSA] ____________________________________________________________________ Limited behavioral health services/infrastructure at baseline Infrastructure/services likely to be impacted by disaster Exposure to death, risk to life, and displacement may increase behavioral health problems [Salcoglu et al. 2001, Norris et al. 2002] 18 mo. post-Katrina NOLA Metro PTSD: 24.1% [Kessler et al, 2008] 6

8. ASPR: Resilient People. Healthy Communities. A Nation Prepared. BEHAVIORAL HEALTH RESPONSES TO TRAUMA & DISASTERS 7

9. ASPR: Resilient People. Healthy Communities. A Nation Prepared. MESSAGES MATTER 8

10. ASPR: Resilient People. Healthy Communities. A Nation Prepared. DISASTER BEHAVIORAL HEALTH RESPONSE Trained behavioral health responders work in shelters, medical and psychiatric facilities, or may engage in outreach and educational activities in communities to facilitate the resiliency and recovery of survivors and responders by: Providing psycho-education and information on physical and environmental hazards. Engaging in supportive listening. Screening individuals who are at greater risk for longer-term adverse reactions. Ensuring referral to appropriate medical, psychological, or tangible services. 9

11. ASPR: Resilient People. Healthy Communities. A Nation Prepared. Disaster Behavioral Health Response Psychological First Aid Safety - be safe, feel safe Calming – rest, relax, sleep Efficacy – skills and confidence Connectedness – social support emotional and instrumental Hope - optimism Hobfoll et al Psychiatry 70 10

12. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 11 SOME PFA TRAINING OPTIONS Exposure Based/Overview Training: NDMS Training Web Site: 70 minute PFA for Responders - ─Link to NACCHO's PFA ProgramLink to NACCHO's PFA Program Skill Based Training: SAMHSA’s National Child Traumatic Stress Network Online Skills Based PFA Training 4-6 Hours ─ Link to NCTSN's website for their PFA informationLink to NCTSN's website for their PFA information Locally Provided PFA courses ─American Red Cross ─Academic Institutions ─State Mental and Behavioral Health Agencies

13. ASPR: Resilient People. Healthy Communities. A Nation Prepared. NATIONAL POLICY DRIVERS 12

14. ASPR: Resilient People. Healthy Communities. A Nation Prepared. HHS DBH CONOPS 13

15. ASPR: Resilient People. Healthy Communities. A Nation Prepared. COORDINATION STRUCTURE Behavioral Health Coordinating Structure and Information Flow in Preparedness, Response, and Recovery Information transmission is both sequential and interrelated among: Preparedness Response Recovery Personnel Infrastructure  Activities in each phase overlap 14

16. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 15 STATE DISASTER BEHAVIORAL HEALTH RESPONSE ASSETS Every state behavioral health agency has a Disaster Mental Health Coordinator. State behavioral health response may rely on a coalition of response groups. Most states have state-level behavioral health responder capacity, to coordinate with or bolster other voluntary, state, or local assets. Most states have State Disaster Behavioral Health Plans

17. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 16 STATE DISASTER BEHAVIORAL HEALTH RESPONSE ASSETS (2) States may use Emergency Management Assistance Compact (EMAC) to request state-to-state behavioral health assets. After a presidential disaster declaration, states may apply for a FEMA Crisis Counseling Assistance and Training Program (CCP) grant. Often an unmet needs committee of behavioral health and human services stakeholders will form following the immediate disaster response.

18. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 17 BEHAVIORAL HEALTH RESPONSE Community Response Managed by State Federal Responder Support Managed by HHS Community Response Managed by HHS Medical Reserve CorpsNational Disaster Medical Service- Disaster Medical Assistance Teams Office of Force Readiness and Deployment -Public Health Service Commissioned Corps ESAR-VHPFederal Occupational Health National Disaster Medical Service- Disaster Mortuary Assistance Teams Crisis Counseling Program Employee Assistance Programs

19. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 18 HHS Disaster Behavioral Health Assets and Capabilities Federal Grants FEMA’s Crisis Counseling Assistance and Training Program (CCP) - provides individual and community crisis counseling and education. The CCP consists of two types of grants: oThe Immediate Services Program (ISP) grants provide funds for up to 60 days of services immediately following a Presidential declaration of a disaster that includes FEMA Individual Assistance. oThe Regular Services Program (RSP) grants provide funds for up to nine months of additional crisis counseling services. The SAMHSA Emergency Response Grant (SERG) funding - when existing resources are overwhelmed and other resources are unavailable.

20. ASPR: Resilient People. Healthy Communities. A Nation Prepared. 19 HHS Disaster Behavioral Health Assets and Capabilities (2) Additional Federal Disaster HHS Behavioral Health Resources: ASPR’s ABC - technical assistance, coordination, and communication. CDC - post-disaster surveillance and needs assessments. SAMHSA’s National Mental Health Information Center - web-based resource for training materials and publications. http://mentalhealth.samhsa.gov SAMHSA’s Disaster Technical Assistance Center SAMHSA’s National Disaster Distress Line (1-800-985-5990). NIMH - disaster mental health research. ASPR’s Hospital Preparedness Program Funding (HPP) – often supports behavioral health activities and training. CMS - reimburses for mental health services through SCHIP, Medicaid and Medicare.

21. ASPR: Resilient People. Healthy Communities. A Nation Prepared. DISASTER BEHAVIORAL HEALTH STEW: DEVELOPING THE RECIPE Ingredients – All Assets Are Not Created Equal ─State Mental Health Assets ─American Red Cross Disaster Mental Health Volunteers ─ESAR-VHP ─Medical Reserve Corps ─FEMA Crisis Counseling Program ─NDMS ─OFRD ─Community Faith Based Volunteers ─Voluntary Organizations ─Community Members ─Military Assets Chaplains Mental Health Professionals ─Materials and Guidance 20