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Emergency Mental Health and
Traumatic Stress

An Overview of the Crisis Counseling Assistance and Training Program

Note: This is the first in a series of program guidance documents developed to ensure consistency in addressing key program issues in the Crisis Counseling Training and Assistance Program (CCP). The Crisis Counseling Training and Assistance Program is funded by the Federal Emergency Management Agency (FEMA) under the authority of the Robert T. Stafford Disaster Relief and Emergency Assistance Act. On behalf of FEMA, the Center for Mental Health Services (CMHS), Emergency Services and Disaster Relief Branch (ESDRB) provides technical assistance, program guidance and oversight.

Purpose
The purpose of this program guidance is to acquaint the reader with the legislative basis for and operational mechanisms of the Crisis Counseling Assistance and Training Program (CCP) and its component functions. This guidance is a reference tool for public sector State and local mental health agencies and other Federal personnel unfamiliar with the CCP.

Origin and Legislative Authority
The CCP is implemented as a supplemental assistance program available to the United States and its Territories, by the Federal Emergency Management Agency (FEMA). Section 416 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act, 1974 authorizes FEMA to fund mental health assistance and training activities in areas which have been Presidentially declared a disaster. The Center for Mental Health Services (CMHS), Emergency Services and Disaster Relief Branch (ESDRB) works with FEMA through an interagency agreement to provide technical assistance and consultation, training for State and local mental health personnel, grant administration and program oversight.

Program Overview
For over twenty five years, the Crisis Counseling Program has supported short term interventions with individuals and groups experiencing psychological sequelae to large scale disasters. These interventions involve the counseling goals of assisting disaster survivors in understanding their current situation and reactions, mitigating additional stress, assisting survivors in reviewing their options, promoting the use of or development of coping strategies, providing emotional support, and encouraging linkages with other individuals and agencies who may help survivors recover to their pre-disaster level of functioning. While always cognizant of those with special needs, the thrust of the Crisis Counseling Program since its inception has been to serve people responding normally to an abnormal experience.

Upon receiving a Presidential disaster declaration, a State Mental Health Authority (SMHA) will conduct a needs assessment to determine the level of stress being experienced by disaster victims and whether existing State and local resources can meet those needs. If not, the SMHA may choose to apply for a Crisis Counseling grant. Upon award of the grant, an SMHA typically provides funds to local mental health providers to hire additional staff to provide outreach and education on typical stress reactions and methods of reducing stress.

Supplemental funding for crisis counseling is available to State Mental Health Authorities through two grant mechanisms: (1) the Immediate Services Program (ISP) which provides funds for up to 60 days of services immediately following a disaster declaration; and (2) the Regular Services Program (RSP) which provides funds for up to nine months following a disaster declaration. While CMHS provides a limited amount of technical assistance to Immediate Service Programs, the monitoring responsibility remains with FEMA. For the RSP, FEMA has designated CMHS as the authority responsible for monitoring State programs.

Eligibility for CCP Grants
Only a State or Federally-recognized Indian Tribe may apply for a crisis counseling grant. The State determines the need for crisis counseling services by compiling disaster data and conducting a mental health needs assessment of the Presidentially-declared area. The SMHA must assess key indicators of disaster stress and determine geographic, social, cultural, ethnic and vulnerable populations for whom crisis counseling services should be provided. The State must also assess if responding to the mental health needs of the disaster victims is beyond the capacity of State and local resources. The needs assessment is the most crucial element of the grant application and should support the program plan and budget request.

The CCP Grant Process
Both the Immediate and Regular Services grant applications are submitted through the State Emergency Management Agency which then transmits the application to FEMA. The processes of grant review, allocation of funding, and grant oversight differ between the Immediate and Regular Service Programs.

Immediate Services Program

The ISP application is due 14 days after the President makes a disaster declaration and is collaboratively reviewed by CMHS and FEMA to ensure a speedy decision and access to funds as soon as possible. If approved, the ISP grant is then monitored by FEMA. If a State decides to apply for a Regular Services Grant, the ISP can be extended until the RSP application is reviewed and a funding decision has been made. If necessary, the ISP extension may include additional funds to carry the program through the review and decision process of the RSP, normally between six and ten weeks. Funds for the ISP are transferred from FEMA to the State Emergency Management Agency. The State must determine a mechanism for funds to be received by State and local mental health agencies involved in the CCP.

Regular Services Program

The RSP application is due 60 days after the disaster declaration and is submitted through the State Emergency Management Agency to FEMA. CMHS has the responsibility for reviewing the application. The RSP application review is completed through a formal, confidential peer review process administered by CMHS. Based on the peer review, CMHS provides a formal recommendation to the FEMA Regional Office responsible for the disaster response and recovery. The recommendation can result in one of three decisions: approval, approval with conditions or recommendations or disapproval. The FEMA Region makes a recommendation of its own and submits their recommendation along with the CMHS recommendation to FEMA Headquarters to make the final decision. If funding is approved, FEMA Headquarters transfers funds to CMHS. CMHS then transfers funds through a Notice of Grant Award (NOGA) directly to the State Mental Health Authority (SMHA). The RSP grant is monitored by CMHS however all monitoring is done in coordination with the FEMA Region and FEMA Headquarters.

Services Funded
Disaster mental health interventions include outreach and education for disaster survivors, their families, local government, rescuers, disaster services workers, business owners, religious groups and other special populations. All Crisis Counseling Programs are primarily geared toward assisting individuals in coping with the extraordinary stress caused by the disaster. Crisis Counseling Programs are strongly encouraged to coordinate with other public and private agencies responding to the disaster to ensure that needs are met with the most effective use of exisiting resources. The Crisis Counseling Program does not support long term, formal mental health services such as medications, office-based therapy, diagnostic services, psychiatric treatment or substance abuse treatment (refer to CCP-PG-02 for additional information). Services that are supported are short-term interventions with individuals and groups experiencing psychological reactions to a major disaster and its aftermath. Outreach is the primary method for delivering crisis counseling services to disaster survivors. It consists primarily of face-to-face contact with survivors in their natural environments in order to provide disaster-related crisis counseling services.

The following descriptions characterize services most frequently funded by the CCP:

• Individual Crisis Counseling Services assist disaster survivors in understanding their current situation and reactions, reviewing their options, addressing their emotional support and linking with other individuals and agencies who may assist them. During individual services, crisis counseling staff are active listeners who provide emotional support.
  
  
• Group Crisis Counseling Services involves providing/facilitating support groups, meeting with citizens, working in classrooms with affected students, working with affected teachers and administrators after school, discussing disaster-related issues with families, assisting people in understanding their current situation and reactions, reviewing their options, addressing their emotional support and linking with other individuals and agencies who may provide assistance. Groups may be facilitated by a mental health professional, a paraprofessional or the group members themselves.
  
  
• Education Services include the distribution or presentation of information on the project or crisis counseling-related topics. Educational information may be provided through brochures, flyers posted in public areas, mailings and training to human service personnel such as the clergy or teachers. The media is often a partner in providing information through Public Service Announcements, newspaper articles and advertisements. Educational information may also be provided to groups of people. The key difference between group education services and group crisis counseling services is that project staff present psychoeducational information to groups rather than facilitate the sharing of experiences between members of the group.
  
  
• Referrals are a key component of the CCP. In most disasters, the majority of survivors have needs that can be met by short-term, relatively informal interventions. However, in some circumstances, some disaster survivors may need long-term, more formal mental health services that are beyond the scope of the Crisis Counseling Program. Survivors requiring longer-term, more formal mental health treatment should be referred to an appropriate agency or licensed mental health professional. Some disaster recovery needs may be more physical, structural or economical in nature and addressing these issues is outside the scope of the CCP (Refer to CCP-PG-04 for additional information). In these instances, CCP staff play a key role in referring survivors to specific disaster services available through FEMA Teleregistration, the American Red Cross, the Salvation Army, Interfaith Disaster Recovery Services and Unmet Need Committees.

Technical Assistance
Available technical assistance materials include application kits and guidelines, six program guidances that further clarify the scope of the CCP, training manuals, publications and videos about working with specific populations. Following is a list of materials currently available:

General Materials
Pilot Application Kit
Budget Estimating and Reporting Toolkit
Guidelines for Reviewers of CCP Grant Applications
Crisis Counseling Assistance and Training Program: Best Practices

Program Guidances

Publications

Videos

CMHS/ESDRB project staff are available to provide technical assistance by telephone or in person.

Center for Mental Health Services
Emergency Services and Disaster Relief Branch
5600 Fishers Lane, Room 17C-20
Rockville, MD 20857
(301) 443-4735
(301) 443-8040 FAX

01/2001