1. © 2014 The Litaker Group LLC All Rights Reserved Draft Document Not for Release or Distribution Texas Department of State Health Services Disaster Behavioral Health Regional Planning Meetings Facilitated Discussion Scenario May and June 2014 For Information Contact Dr. John R. Litaker at jlitaker@litakergroup.comjlitaker@litakergroup.com The Litaker Group, LLC

2. © 2014 The Litaker Group LLC All Rights Reserved Draft Document Not for Release or Distribution 2 1.This is not a tabletop exercise; it is a facilitated discussion using a scenario-based question and answer format 2.The information presented in the scenario has been carefully chosen to represent real actions or activities that could occur 3.Today’s discussion should focus on the disaster behavioral health aspects of the actions and activities discussed 4.The scenario is based on a local, regional, and state response 5.An incident command has been established and the Disaster District Committee, State Operations Center, RHMOC, and State Medical Operations Center have been activated 6.For purposes of this facilitated discussion each PHEP capability is discussed separately, but in reality they would occur concurrently, and likely intertwine 7.Keep in mind your roles, responsibilities, and authority throughout the discussion Assumptions for Today’s Meeting

3. © 2014 The Litaker Group LLC All Rights Reserved Draft Document Not for Release or Distribution 3 Capability 5 Fatality Management Capability 5 Fatality Management Capability 7 Mass Care Capability 7 Mass Care Capability 14 Responder Safety and Health Capability 14 Responder Safety and Health Definition: The ability to coordinate with other organizations (e.g., law enforcement, healthcare, emergency management, and coroner) to ensure the proper recovery, handing, identification, transportation, tracking, storage, and disposal of human remains and personal effects; certify cause of death; and facilitate access to mental health / behavioral health services to family members, responders, and survivors of an incident. Disaster Behavioral Health Issues Associated with this Capability: Coordination with multiple agencies Flow of information/communication to provide accurate and timely information to families/friends Privacy for families/friends Counselors with the appropriate experience and training for this type of incident Cultural competency Public Health Emergency Preparedness (PHEP) Capabilities Fatality Management (Capability #5)

4. © 2014 The Litaker Group LLC All Rights Reserved Draft Document Not for Release or Distribution 4 Capability 5 Fatality Management Capability 5 Fatality Management Capability 7 Mass Care Capability 7 Mass Care Capability 14 Responder Safety and Health Capability 14 Responder Safety and Health Definition: The ability to coordinate with partner agencies to address the public health, medical, and mental health / behavioral needs of those impacted by an incident at a congregate location Disaster Behavioral Health Issues Associated with this Capability: Differences between Red Cross shelter and other shelters for DBH services Conditions in shelter that lead to behavioral health problems (e.g., frustration, anxiety, depression) such as crowding, lack of privacy, substance abuse/sobriety, etc. Self-deployed helpers Public Health Emergency Preparedness (PHEP) Capabilities Mass Care (Capability #7)

5. © 2014 The Litaker Group LLC All Rights Reserved Draft Document Not for Release or Distribution 5 Capability 5 Fatality Management Capability 5 Fatality Management Capability 7 Mass Care Capability 7 Mass Care Capability 14 Responder Safety and Health Capability 14 Responder Safety and Health Definition: The ability to protect public health agency staff responding to an incident and the ability to support the health and safety needs of hospital and medical facility personnel if requested. Disaster Behavioral Health Issues Associated with this Capability: Secondary trauma Concerns for family while responder is in the field Pre/Post evaluations Follow up for responders post event Public Health Emergency Preparedness (PHEP) Capabilities Responder Safety and Health (Capability #14)

6. © 2014 The Litaker Group LLC All Rights Reserved Draft Document Not for Release or Distribution 6 Modules Module 1 Mass Care Capability #7 Module 1 Mass Care Capability #7 Module 2 Responder Safety and Health Capability # 14 Module 2 Responder Safety and Health Capability # 14 Module 3 Fatality Management Capability #5 Module 3 Fatality Management Capability #5

7. © 2014 The Litaker Group LLC All Rights Reserved Draft Document Not for Release or Distribution 7 Module 1 Mass Care (Capability #7) – Scenario Module Focus: In a mass care environment, what is your role in supporting the behavioral health needs of the shelter population? Scenario 1.Two shelters are open. One is operated by the American Red Cross and the other by municipal government 2.The American Red Cross shelter has 110 persons and the municipal shelter has 90 3.People are showing up to both shelters with their pets, but neither shelter is equipped to accommodate pets 4.Some individuals are running low on psychotropic medications and are beginning to decompensate 5.The local methadone clinic was flooded and some people in the shelter use methadone 6.There are people in the shelter who are exhibiting signs of sadness, anger, and frustration because of the flood 7.The manager of the municipal shelter has requested help

8. © 2014 The Litaker Group LLC All Rights Reserved Draft Document Not for Release or Distribution 8 Module 1 Mass Care (Capability #7) – Questions Module Focus: In a mass care environment, what is your role in supporting the behavioral health needs of the shelter population Questions 1.Is there a need for DBH response? Why or why not? 2.What is the process for how this decision is made? 3.What do you need from DBH responders? 4.Who would DBH responders report to at the shelter? 5.Who are the DBH responders in your community? Who would provide DBH resources during a disaster in your community?

9. © 2014 The Litaker Group LLC All Rights Reserved Draft Document Not for Release or Distribution 9 Modules Module 1 Mass Care Capacity #7 Module 1 Mass Care Capacity #7 Module 2 Responder Safety and Health Capacity #14 Module 2 Responder Safety and Health Capacity #14 Module 3 Fatality Management Capacity #5 Module 3 Fatality Management Capacity #5

10. © 2014 The Litaker Group LLC All Rights Reserved Draft Document Not for Release or Distribution 10 Module 2 Responder Safety and Health (Capability #14) – Scenario Module Focus: In an ongoing disaster, how would you meet the behavioral health needs of first responders? Scenario 1.First responders have been conducting swift water rescues 2.Some first responders and their families have been personally impacted by the flood 3.Operations are beginning to transition from rescue activities to recovery activities (i.e., retrieving the deceased) 4.Families of the missing are gathering where recovery efforts are taking place 5.First responders are beginning to show signs of stress and fatigue 6.First responders are housed together at a base camp and have requested a formal group debriefing

11. © 2014 The Litaker Group LLC All Rights Reserved Draft Document Not for Release or Distribution 11 Module Focus: In an ongoing disaster, how would you meet the behavioral health needs of first responders? Questions 1.What first responder populations could potentially benefit from DBH services? 2.What services would be provided to these first responders and their families? Would the services differ by population? 3.What are the likely needs of first responders and their families? 4.Who in your community could provide the DBH services you identified in (2) and (3) to first responders? 5.Based on this scenario, what is an action that may need to be taken to support the community? Module 2 Responder Safety and Health (Capability #14) – Questions

12. © 2014 The Litaker Group LLC All Rights Reserved Draft Document Not for Release or Distribution 12 Modules Module 1 Mass Care Capability #7 Module 1 Mass Care Capability #7 Module 2 Responder Safety and Health Capability #14 Module 2 Responder Safety and Health Capability #14 Module 3 Fatality Management Capability #5 Module 3 Fatality Management Capability #5

13. © 2014 The Litaker Group LLC All Rights Reserved Draft Document Not for Release or Distribution 13 Module 3 Fatality Management (Capability #5) – Scenario Module Focus: What types of disaster behavioral health services would be provided to the families of victims and those missing due to the flood? Scenario 1.A family assistance center is defined as a secure facility established to serve as a centralized location to provide information and assistance about missing or unaccounted for persons and the deceased. It is also established to support the reunification of the missing or deceased with their family members. 2.The family assistance center is located at a central location 3.The flood event resulted in 10 fatalities; 12 persons are not yet accounted for as a result of the flood 4.Based on national standards, a family assistance center can be expected to assist up to six persons per victim or missing person, in this case, the family assistance center would be expected to serve approximately 132 persons 5.The family assistance center is operational 24 hours per day for the first four or five days, depending on the needs of community

14. © 2014 The Litaker Group LLC All Rights Reserved Draft Document Not for Release or Distribution 14 Questions 1.What factors should be considered, based on your community, when thinking about the potential behavioral health needs to be addressed for family members at the family assistance center? You may wish to consider cultural issues, language, ethnicity, etc. 2.How will the spiritual needs of family members be met? 3.Who in your community could provide DBH services to family members? 4.Are there enough resources to meet the needs of family members, considering 24/7 operation for four or five days and up to 132 family members who might need assistance? If yes, how? If not, then how would you meet those needs? 5.Several groups have self-deployed to provide DBH services at the family assistance center. How should this be handled? Module 3 Fatality Management (Capability #5) – Questions Module Focus: What types of disaster behavioral health services would be provided to the families of victims and those missing due to the flood?

15. © 2014 The Litaker Group LLC All Rights Reserved Draft Document Not for Release or Distribution 15 1.Moving forward, are there any planning activities that need to occur based on today’s discussion? 2.Are there stakeholders not here today that need to be engaged? Who are these stakeholders. 3.What types of technical assistance would be helpful as you consider the DBH needs of your community? Closing Questions