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The Dialogue
A QUARTERLY TECHNICAL ASSISTANCE BULLETIN ON DISASTER BEHAVIORAL HEALTH
Fall 2007
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information, SAMHSA does not necessarily endorse any specific products or services provided by public or private organizations unless expressly stated. In addition, SAMHSA does not necessarily endorse the views
expressed by such sites or organizations, nor does SAMHSA warrant the validity of any information or its fitness for any particular purpose.
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ASK THE FIELD
The Dialogue: During the winter months,
what are some issues disaster behavioral health
responders should be aware of for States that
experience severe winter weather?
Rick Calcote:
The impact on people who
struggle through severe winter weather, which
can suddenly cripple infrastructure and threaten
survival, is probably the same regardless of
where they live. Winter months can drive the
heartiest of us indoors. We normally become a
bit more isolated. But when ice, snow, and wind
bury a town in an unrecognizable landscape and
steal the power that lights and heats our homes,
isolation takes on a profound new meaning. We
feel acutely vulnerable as we realize that many
of the expected conveniences of modern life are
suddenly inaccessible. It can be unnerving to
know that emergency personnel cannot reach
you and that you and your family are stranded.
Severe winter storms bring with them the
specter of cold weather survival. Some people
are unprepared and unequipped to respond to
unremitting conditions that can threaten health
and safety. The work required to simply stay
warm and to meet basic needs can be exhausting.
When there is no power it can be a frustrating
if not desperate task just to feed your family.
This is especially true for low-income families or
apartment dwellers that rely on restaurants and
stores for daily food supplies. It is a disquieting
experience to know that you may not be able to
protect and feed those you love. The resultant
tension and uncertainty can adversely affect
family interactions.
Property damage and injury also top the list of
problems stemming from severe winter weather.
Water pipes can burst flooding kitchens,
bathrooms, and basements. Subsequent electrical
fires caused by shorted wiring can result once
power is restored. Carbon monoxide poisoning
as well as fires and explosions are the common
results of uninformed attempts to utilize
alternative heat sources. These unexpected
events bring additional physical, financial, and
medical hardships.
A story of surviving winter weather illustrates
the power of resilience and community
cooperation when coping with disaster.
January 9, 2005, the 300 residents of Kaktovik,
AK, suffered a blizzard with 75 mph winds that
wrapped the little Beaufort Sea community in
20-foot snow drifts, and an ambient temperature
of 50 below zero. Though severe winter storms
are certainly not uncommon or unexpected
along Alaska’s northernmost coast, this storm
quickly became deadly. Within hours, the town’s
primary power generator failed. In the midst
of already life-threatening conditions, there
was suddenly no heat, no light, and no water.
More than 150 people sought shelter in a small
maintenance building powered by a single
backup generator. Though one telephone line
miraculously remained open, the fierce weather
sealed off the community from the rest of the
world for 2 more days.
When Kaktovik’s plea for assistance came
through from the North Slope Borough offices
in Barrow, the Alaska Division of Homeland
Security and Emergency Management set in
motion what was to become one of the most
challenging rescue operations in history.
Hundreds of civilian and military personnel
staged an airlift operation that spanned the
equivalent of a four-State area in the lower 48.
But their most determined attempts to mobilize
technicians, supplies, and equipment toward the
beleaguered community stalled in the face of zero
visibility. Responders, already feeling an acute
sense of urgency, instituted an amazing plan to
reach the community overland.
While this activity built around them, the people
of Kaktovik appeared to sit patiently and wait.
During a phone conversation from the State
Emergency Coordination Center in Anchorage
to the little maintenance facility 650 miles away,
background laughter was heard over the scratchy
static. The people in Anchorage exchanged
smiles, and collectively breathed a sigh of relief.
Anchorage had just informed them that the
last two attempts to reach them had failed. The
Kaktovik incident commander eased the tension
more when he quipped that they had no other
particular place to go and would just sit and wait
for company to arrive. Their casual attitude,
however, masked that they were all quite busy
locating and moving supplies, working overtime
to clear paths and roads, and checking on the
well-being of family and neighbors.
On the morning of January 11, a lone HH-60
Pavehawk helicopter lifted off from Eielson AFB
in Fairbanks, more than 350 miles to
the south of Kaktovik. This was the fourth
attempt to reach the community. Utilizing an Air
Force HC-130 Hercules tanker as a midair gas
station, the determined crew started the final leg
of their journey through a storm that still raged
along the arctic coast. Against all odds,
and the advice of the Hercules crew, the
Pavehawk helicopter managed to reach Kaktovik
where they dropped off emergency generators
and two technicians. Shortly after their arrival,
partial power was restored. It would take another
2 days before full power flowed again through the
entire community.
Severe winter weather, like any natural disaster,
challenges our ability to withstand hardship
and maintain our strengths. In part, resilience is
derived from community. When people expend
energy toward care and support of one another
they are probably more likely to realistically
appraise and accept circumstances. When
people band together in common purpose, they
are more likely to experience hope and less
likely to experience anger and express criticism
toward authority for not being able to alter those
circumstances. The telephone lifeline in Kaktovik
no doubt helped fuel the community’s sense
of hope. They knew that the outside world was
taking steps to rescue them. Information,
at the very least, can clearly promote well-being.
In times of sudden isolation and disquieting
loss of protective comfort, information can help
people feel connected and safe.
Rick Calcote, M.S., LMFT, is the Disaster Planning
Coordinator in the Division of Behavioral Health
for the State of Alaska’s Department of Health and
Social Services.
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SAMHSA CSAT PILOT PROJECT D-ATM TO
BE LAUNCHED
Methadone is used in the treatment of
dependence on opioids such as heroin and
increasingly, many prescription pain medications.
However, it is a heavily regulated medication. The
proper dose is critical: too much, and someone
can die; not enough, and the person may fail to
stay in recovery. Patients must enroll for treatment
at a particular opioid treatment program (OTP, or
methadone clinic), and many must go to the clinic
every day. Methadone is a life-saving medication
that is not generally available in pharmacies. So,
people in methadone treatment may experience
a great deal of distress if they are unable to access
their clinics for scheduled doses.
For many methadone patients in the greater New
York City area, the memories of September 11,
2001, are especially painful. After the terrorist
attacks of that day, one OTP in the New York
area was destroyed, and others were temporarily
closed. In the middle of that chaos, with phones
and mass transportation not working, and police
barricades making some areas unreachable,
almost 1,000 methadone patients found
themselves displaced and sought treatment where
they could find it.
The hosting clinics, often overwhelmed
themselves, were faced with an ethical dilemma:
whether and how to treat someone who might
not even be a patient, but who desperately needs
treatment if they are. And what to do, when faced
with hundreds of such patients in addition to their
normal case load? As much as possible, clinics
phoned and faxed patients’ clinics repeatedly,
but often had to rely on patients’ memories. A
followup study found that patients’ reports were
generally accurate. The few who were not, were
higher-dose patients who feared they would not
be treated at all if they told the truth.
In the weeks that followed, many patients would
remember September 11, 2001, as the most
stigmatizing day of their lives. But out of the
devastation, an idea was born. The American
Association for the Treatment of Opioid
Dependence (AATOD), Committee of Methadone
Program Administrators of New York State
(COMPA), National Alliance of Methadone
Advocates (NAMA), and other stakeholders in the
opioid treatment community, quickly contacted
the SAMHSA Center for Substance Abuse
Treatment (CSAT) to propose a solution. It would
be a centralized, deliberately simple database that
would house the minimal information needed to
verify that a person was a methadone patient, and
if so, provide correct dosing information. Privacy
was paramount. The ultimate goal was a system
that would allow patients to be treated with
dignity and compassion in an emergency.
CSAT sponsored a 1-year planning project
working with COMPA, NAMA, and an
information technology expert. The resulting
report supported the feasibility of the original
concept, explored technical solutions, and
proposed the use of biometrics to help identify
patients for the central system. Focus groups with
OTP patients indicated that they were receptive
to biometrics, once they understood how they
would be used. In fact, biometrics are essential to
ensure the integrity of patient data. The system
does not need to store patient names or even a
graphic image of the finger scan. And importantly, the system can only be accessed when the patient
initiates the process by presenting a finger for
scanning. If a scan fails, a PIN is used, constructed
in a way that does not require patients to
remember a number. As a result, patients will not
have to carry or memorize information to be able
to access the system.
Following the planning study, CSAT provided
additional funding to develop the system and
pilot it in real-life OTPs around the country.
One major change in strategy was to make the
system interoperable with the clinical software
many programs already have in place instead of
custom-fitting to each individual OTP’s system.
Three software vendors volunteered to make their
systems Digital Access to Medication (D-ATM)
pilot-ready. There will also be a version for OTPs
that do not have sophisticated systems.
In February 2007, the Lower East Side Clinic
(LESC) in New York hosted a prepilot of the
system. It was conducted in the middle of a small
blizzard. The staff, administrators, and patients
were incredibly hospitable. They allowed CSAT to
come in and spent time learning about the system.
Each and every morning, the same three patients
came in to work on the enrollment and scanning
process. After the team left, LESC staff members
used the system, without incident, for several
more weeks. Their suggestions led to significant
refinements.
Walter Ginter, vice president of NAMA, who
has worked on the project since the beginning,
suggested the system’s new name: D-ATM; the
idea being that patients would be able to access
medication in as safe and routine a fashion
as they could expect to obtain money from a
bank machine. The name reflects an important
evolution in thinking about the system. After
September 11, 2001, terrorism was discussed, and
with Hurricane Katrina, thinking about disaster
was expanded. The Steering Committee pointed
out that the basic concern is service discontinuity,
which in many cases might be due to far more
routine causes, like blackouts, water main breaks,
or a missed flight, because any of those could be a
disaster for the patient.
The new phase kicked off within a week of
Hurricane Katrina. SAMHSA provided additional
funding so that the pilot program could expand
to three or four locations around the country,
including California, North Carolina, and
Louisiana. At this point, development of the
system is almost complete.
Recently, SAMHSA contacted OTPs in the
targeted areas about their interest in participating
in the pilot. The hope is to launch clusters of
D-ATM pilots in three or four areas in the next
few months. During that time, OTP staff will be
trained, patients will be enrolled, and tests will be
run including, potentially, a few real-life tests of
D-ATM’s usefulness in a water main break.
Ultimately, D-ATM is a program for people
who do all they can to stay in recovery, and the
OTPs who do all they can to help them. For
more information on the D-ATM project, go to
http://datm.samhsa.gov. For more information on
methadone and medication-assisted treatment, go
to http://www.dpt.samhsa.gov.
This article was contributed by Arlene Stanton,
Ph.D., NCC social science analyst, SAMHSA CSAT.
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NECESSARY STEPS IN THE TRANSFORMATION TO TRAUMA-INFORMED CARE
In the early 1990s, public mental health and
substance abuse service providers began to
recognize the magnitude of the sheer number
of people coming in to their programs who
had abuse experiences, giving rise to “trauma
syndrome.” Initially, much attention was focused
on the pervasiveness of trauma (prevalence
and frequency), the medical and physical
health consequences, the precipitous spiritual
questioning engendered, and the interrelationship
of trauma with commonly labeled psychiatric and
substance abuse disorders.
What followed from the recognition of the
presence of trauma, however, was a related
realization that existing providers lacked the
capacity to effectively assist people with histories
of abuse and trauma. A number of deeply
troubling service delivery failures related to
this incapacity to treat trauma within public
mental health and substance abuse systems were
identified—including widespread lack of screening
and assessment for trauma, lack of training in
trauma treatment approaches, and misdiagnosis
or underdiagnosis of trauma followed by a
standard regimen of inappropriately targeted
services-as-usual, which often led to the revolving
door of treatment and discharge. Even when
correctly diagnosed, trauma was typically viewed
as a one-shot event in the lives of consumers/survivors, rather than an ongoing series of events
woven throughout the life cycle. And even less
attention was paid to the intergenerational cycle of
trauma that kept recurring in each new generation
of children within trauma-impacted families.
These concerns all helped to illustrate that mental
health and substance abuse systems of care had
long been serving consumers/survivors with
little or no awareness of trauma and its impacts.
A guiding precept for providers—as well as
consumers/survivors—seemed to be, “Don’t
ask (about trauma), don’t tell (about trauma).”
What has been learned is that it is necessary
to serve trauma survivors in an environment
that is immediately and directly supportive,
comprehensively integrated, and that strives
to be empowering for consumers/survivors.
Service systems must be designed, from the first
contact, to respond proactively to the special
vulnerabilities and triggers of past trauma for
consumers/survivors. They must also support an
active leadership role for consumers/survivors in
developing and implementing their personal goals
and life development strategies.
Providers must come to see themselves as
supporters of the recovery process rather than
controllers of the recovery process. This shift
in roles has profound implications for the way
business is done under this new treatment
paradigm. The goal is trauma-informed care
(TIC) which is designed not to treat the symptoms
related to traumatic impacts, but to organize and
deliver services in a manner that meets the unique
trauma-related needs of consumers/survivors.
Following are steps that a program, agency, or
institution can take to begin the transformation to
a trauma-informed environment. These steps may
occur in various sequences, but all are critical to
the development of TIC.
Facilitate Consumer/Survivor Empowerment
Consumers/survivors must have a leadership role in the
development of a recovery plan. They need to be supported in cultivating
self-advocacy skills and in developing self-empowerment. Staff needs to
be trained to facilitate the recovery process. When we consider that many
providers are also trauma survivors, agency planning needs to create separate
provisions for staff to address and work through their own trauma experiences
in a context outside of the provider-consumer/survivor relationship.
Commit to New TIC Organizational
Mission and Dedicated Resources
Build support and buy in from those who control
the resources in a given program, hopefully
resulting in a new organizational mission
statement and related operating procedures
that reflect a commitment to develop staff
understanding and capacity to respond to and
support those they serve.
Conduct Universal Screening for Trauma
Ask each consumer/survivor questions, early in
the first contact, to determine whether he or she
has experienced violence, abuse, neglect, disaster,
terrorism, or war. These questions not only help
to obtain the information needed to plan an
appropriate safety and recovery plan, but also
confirm to consumers/survivors that their trauma
histories matter.
Establish Safety for Consumers/Survivors
Measures must be taken, from the time of initial
contact, to ensure the physical, psychological,
social, and moral safety of consumers/survivors.
Safety is defined by each consumer/survivor’s
personal needs and boundaries. Safety is necessary
for recovery to begin and proceed.
Provide Ongoing TIC Staff Training and
Education
Provide mandatory TIC training to all agency
staff—from custodial workers and receptionists
to managerial and treatment personnel—on the
nature and impact of trauma, and how to better
understand and respond to people with trauma
histories. Central to each training session should
be the active integration of consumers/survivors.
Improve Staff Hiring Practices
Screen job applicants to assess their trauma-informed
values and beliefs and job competencies,
with special emphasis on relationship building
and de-escalation skills. The screening process
should help to foster greater professional and
personal self-awareness (including the impact of
the applicant’s own trauma histories on his or her
capacity to provide trauma services).
Update Policies and Procedures
Identify and replace policies and procedures
that serve as damaging replications or triggers of
consumer/survivor past traumatic experiences,
with special attention to replacing highly
destructive treatment procedures such as
seclusion and restraint with psychiatric advance
directives and individually developed crisis
stabilization plans.
The challenge of TIC is being welcomed and
proactively pursued by many different health
and human service organizations and systems,
at multiple levels of care, across the Nation.
Providers are beginning to see the benefits of
TIC—not just for consumers/survivors, but also
for the effectiveness of their overall programs and
services.
The National Center for Trauma-Informed Care
(NCTIC) will continue to help nurture new and
developing trauma-informed care programs
so that best practices and lessons learned can
be identified and shared with others who are
making the transformation to TIC. There will be
a focus on building relationships with people and
organizations from various health and human
service areas to distill their wisdom into practical
fact sheets and policy guidelines for moving
forward with the transformation to TIC. Potential
and actual adopters of TIC will be brought
together in various types of meetings so that they
can share their experiences and concerns. NCTIC
welcomes contributions of ideas, comments, case
studies, and other information to this learning
process.
This article was contributed by Susan Salasin,
public health advisor, Prevention and Program
Development Branch, SAMHSA Center for Mental
Health Services (CMHS).
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MINIMIZING THE ONGOING PSYCHOLOGICAL IMPACT OF MILITARY DEPLOYMENT
With the large number of military personnel
returning from deployments in Iraq and
Afghanistan, it is likely that many mental health
and medical practitioners will find themselves
serving returnees from Operation Iraqi Freedom
(OIF) and Operation Enduring Freedom (OEF).
Although many of those returning to the United
States will successfully pick up their lives in spite
of transition challenges, others will continue to
struggle with the continuing emotional effects of
their deployment experiences, so that healthcare
providers must take note when they are serving
military personnel or veterans and proactively
respond to their needs.
It is now widely appreciated that deployments
in the global war on terrorism can take a
considerable toll on those deployed as well as on
their families. Family separations and exposure
to harsh physical conditions are part of the
routine experience of those sent overseas. But
in addition, stressors encountered in combat
include a wide range of potentially traumatic
experiences, including coming under fire, being
injured/wounded, handling dead bodies, killing
enemy combatants, and experiencing the loss
of a friend. Such events are part of the common
experience of most of those serving in Iraq. Some
military personnel will also be exposed to sexual
harassment or sexual assault while deployed.
Research to date has suggested that approximately
19 percent of service members deployed to Iraq
and 11 percent serving in Afghanistan may
experience posttraumatic stress disorder (PTSD)
and other mental health problems after their
return home. PTSD is a disorder that includes
symptoms of re-experiencing, avoidance, and
arousal. Trauma survivors commonly continue
re-experiencing or reliving their traumas via
intrusive thoughts, images, or dreams. Their
bodies are on alert and they experience physical
hyperarousal. Because re-experiencing the trauma
and the feeling of being in constant danger are
so upsetting, trauma survivors change their
lives to avoid things that remind them of their
experiences. Current estimates of PTSD are
around 12–13 percent 3–4 months after return,
and around 17 percent after 1 year. Depression,
generalized anxiety, and alcohol abuse are also
significant problems for many returnees, as are
difficulties with anger, relationship problems, and
sleep problems. Many individuals will experience
stress reactions that will not qualify as a mental
health disorder because their symptoms are
fewer in number or less intense than would be
required for a diagnosis. But these reactions may
nonetheless cause significant distress, interfere
with functioning and quality of life, and require
attention from healthcare professionals.
Most mental health care
is actually delivered in
primary care medical
settings. This is, in part,
because of the widespread
reluctance of many individuals to seek mental
health treatment and is common among those
returning from Iraq and Afghanistan with PTSD.
They report concern about being seen as weak, or
being treated differently by others if they go for
help. Therefore, individuals with PTSD or other
deployment-related problems will seek assistance
for a physical health complaint that is related to
PTSD. They may describe medically unexplained
pain, headaches, difficulty sleeping, stomach
problems, or other stress symptoms. Research on
OIF returnees has indicated higher rates of sick
call visits, missed workdays, and physical health
symptoms among those with PTSD.
Given that veterans will be seeking medical care,
and sometimes mental health support, there are
some key actions that providers can take:
- Know if the patient is an active duty returnee or veteran.
Providers should ask patients/clients if they have served in the
military and if they have been deployed. Consider including a brief
PTSD screen in the written intake information packet. Mental health providers
should consider using a validated measure of PTSD to assist in the assessment
process.
- Become more familiar with PTSD and
other post-deployment problems. The U.S.
Department of Veterans Affairs (VA) and the
U.S. Department of Defense have collaborated
to produce a practice guideline for the
management of PTSD, available online at
http://www.oqp.med.va.gov/cpg/PTSD/PTSD_Base.htm. Or go to the National Center for
PTSD Web site at http://www.ncptsd.va.gov
to learn more about the challenges faced by
returnees. Of special usefulness is the Iraq War
Clinician Guide that outlines principles of care.
- Talk to the person. As with disaster
survivors, the offer of an understanding ear
and education about and “normalization”
of reactions can often lead to a productive
discussion of problems and the options for
addressing them.
- Give written patient education materials. The
Iraq War Clinician Guide includes handout
materials that can be downloaded and shared with clients. Handouts include: Warzone-Related Stress Reactions: What Veterans Need to Know, Coping with Traumatic Stress Reactions,
and Warzone-Related Stress Reactions: What
Families Need to Know. A useful self-help book
for returnees and their families is: Armstrong,
K., Best, S., & Domenici, P. (2006). Courage
after fire: Coping strategies for troops returning
from Iraq and Afghanistan and their families.
Berkeley, CA: Ulysses Press.
- Make a referral. If it is determined that an
individual may be experiencing PTSD or other
reactions requiring assistance, the possibility
of referral should be explored. PTSD treatment
can be of significant help to these individuals.
Research indicates that a number of treatments
are effective in reducing trauma-related PTSD
and depression symptoms. The VA healthcare
system has a range of services available for
OIF and OEF veterans. Located across the
country, they range from small, local clinics
to large hospitals. At these facilities, veterans
can receive help for both physical and mental
health problems and consult with experts in
PTSD and related problems. Vet Centers are
another great resource for getting help. Vet
Centers are located throughout the country
and are primarily focused on helping veterans
readjust to life after deployment. They offer
readjustment and mental health counseling,
and provide veterans with help in facing post-deployment challenges. OIF and OEF
veterans are eligible to receive free healthcare
and readjustment services for any conditions
related to combat service through VA for
2 years following active duty. Those who
served in the National Guard or Reserves and
were deployed to a war zone are eligible for the
same benefits. To find out more information
about veterans’ benefits, or to locate the
nearest VA clinic or hospital, encourage
individuals to call 1-877-VETS or go to
http://www.vba.va.gov/EFIF. For Vet Center
information, call 1-800-827-1000 or go to
http://www.va.gov/rcs.
- Assist partners and families. Significant others
are presented with a wide variety of challenges
related to their veteran partner’s PTSD. The
term “caregiver burden” is sometimes used
to describe the types of difficulties associated with caring for someone with a chronic illness
such as PTSD. Caregiver burden includes the
objective difficulties of this work (e.g., financial
strain) as well as the subjective problems
associated with caregiver demands (e.g.,
emotional strain). Partners of veterans with
PTSD can experience high levels of caregiver
burden that include psychological distress,
negative mood, and anxiety. In general, the
worse the veteran’s PTSD symptoms, the more
severe the caregiver burden. This means that
partners of those who have been deployed
may often benefit from getting involved in
counseling to receive family education, join
a support group that combines both partners
and veterans, pursue individual counseling,
or participate in couples or family therapy. VA
PTSD programs and Vet Centers across the
country often offer opportunities for families of veterans to get involved in treatment. The
most important messages for partners are
that relationship difficulties and social and
emotional struggles are common when living
with a traumatized veteran. Partners should
seek support for themselves as well as their
loved ones.
- Stay involved with care. Community providers
are part of the treatment team for the returnee
and his or her family even if the individual
seeks care in the VA system. It is important to
continue to support the individual, encourage
ongoing treatment participation, and monitor
progress. Community mental health providers
may provide counseling services (e.g., family
counseling) that supplement VA care.
This article was contributed by Josef Ruzek, Ph.D.,
NCPTSD, Education Division.
SUICIDE PREVENTION INITIATIVES
Recently, VA implemented two major
suicide prevention initiatives. First,
it is partnering with the SAMHSA
National Suicide Prevention Lifeline
(1-800-273-TALK) to link veterans
in crisis to a specialized veterans call
center, putting them in immediate
contact with VA suicide prevention and
mental health professionals. Second,
VA has hired a Suicide Prevention
Coordinator for each of its 153 VA
Medical Centers nationwide. Their role
is to track and case manage veterans
identified as being at high risk for
suicide (this includes vets who call the
VA suicide prevention hotline and are
willing to be contacted); to provide
internal and community education to
promote awareness of suicide risk factors
and crisis management skills; and to
conduct outreach to local emergency
rooms, police departments, mental
health organizations, and veteran
service organizations to promote the
development of effective veteran suicide
prevention programming.
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USEFUL WEB SITES
VA: VA’s Web site provides a wide
range of information on veterans’ benefits and treatment facilities.
http://www.va.gov
Readjustment Counseling Services Vet Centers:
Information on the mission, organization, location, and contact information
for Readjustment Counseling Service’s Vet Centers. http://www.vetcenter.va.gov/Vet_Center_Services.asp
NCPTSD Web Site: NCPTSD is a research and education organization whose
mission is to help increase the understanding about trauma and its
effects. Their Web site has a wealth of information on trauma and
PTSD for all audiences. http://www.ncptsd.va.gov
International Society
for Traumatic Stress Studies (ISTSS) Web Site: ISTSS has a membership
directory of clinicians by State who are interested or specialize
in trauma and traumatic stress studies. http://www.istss.org
National
Institute of Mental Health (NIMH) Web Site: NIMH has excellent overviews
of a number of disorders related to trauma exposure including anxiety
disorders, depressive disorders, and substance use disorders. http://www.nimh.nih.gov/health/index.shtml
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SPECIAL FEATURE
FEMA EMERGENCY MANAGEMENT INSTITUTE: INDEPENDENT STUDY PROGRAM
The Summer 2007 issue of The Dialogue
featured an article on the Independent Study
Program offered by the Federal Emergency
Management Agency (FEMA). To build on
that article, a number of trainings have been
selected to be highlighted for disaster behavioral
health professionals.
The Independent Study Program is a series of
online training courses offered to emergency
management staff (Federal, State, local, and
tribal) at no cost. These courses can be
accessed online through the FEMA Emergency
Management Institute (EMI) Web site at
http://training.fema.gov. There are 59 courses
available on a variety of topics relating to disaster
preparedness and response. Following is a
selection of courses that may be of particular
interest to behavioral health professionals who
are active in planning for and responding to
disaster events.
IS-197.SP SPECIAL NEEDS
PLANNING CONSIDERATIONS
FOR SERVICE AND SUPPORT
PROVIDERS
COURSE OVERVIEW
All individuals, advocacy groups, organizations,
and institutions within the special needs service
and support system are encouraged to be proactive
and develop emergency plans. The purpose of
this course is to provide representatives of the
special needs service and support system with
the basic information and tools to develop their
own emergency plans. This course is designed for
people who work with older adults and people
with disabilities, and will teach how to partner
with local emergency management agencies and
better prepare for all phases of an emergency.
http://training.fema.gov/EMIWeb/IS/is197SP.asp
IS-240 LEADERSHIP AND INFLUENCE
COURSE OVERVIEW
Being able to lead others—to motivate them to
commit their energies and expertise to achieving
the shared mission and goals of the emergency
management system—is a necessary and vital part
of the job for every emergency manager, planner,
and responder. This course is designed to improve
leadership and influence skills. It addresses the
following topics:
- Leadership from within
- How to facilitate change
- How to build and rebuild trust
- Using personal influence and political savvy
- Fostering an environment for leadership development
http://training.fema.gov/EMIWeb/IS/is240.asp
IS-241 DECISION MAKING AND PROBLEM SOLVING
COURSE OVERVIEW
Being able to make decisions and solve problems
effectively is a necessary and vital part of the job for
every emergency manager, planner, and responder.
This course is designed to improve decisionmaking
skills. It addresses the following topics:
- The decisionmaking process
- Decisionmaking styles
- Attributes of an effective decision maker
- Ethical decision making and problem solving
http://training.fema.gov/EMIWeb/IS/is241.asp
IS-242 EFFECTIVE COMMUNICATION
COURSE OVERVIEW
Being able to communicate effectively is a
necessary and vital part of the job for every
emergency manager, planner, and responder. This
course is designed to improve communication
skills. It addresses the following topics:
- Basic communication skills
- How to communicate in an emergency
- How to identify community-specific communication issues
- Using technology as a communication tool
- Effective oral communication
- How to prepare an oral presentation
http://training.fema.gov/EMIWeb/IS/is242.asp
IS-547 INTRODUCTION TO CONTINUITY OF OPERATIONS
COURSE OVERVIEW
This course is designed for a broad audience—from senior managers to those directly involved
in the continuity of operations (COOP) planning
effort. The course provides a working knowledge
of the COOP guidance found in Federal
Preparedness Circular 65, Federal Executive Branch
Continuity of Operations. The course provides
activities to enhance COOP programs. Topics covered in the course include an overview of what
COOP is and is not and the elements of a viable
COOP program.
http://training.fema.gov/EMIWeb/IS/is547.asp
IS-700 NATIONAL INCIDENT
MANAGEMENT SYSTEM (NIMS), AN
INTRODUCTION
COURSE OVERVIEW
February 28, 2003, President Bush issued
Homeland Security Presidential Directive
(HSPD)-5. HSPD-5 directed the Secretary of
Homeland Security to develop and administer a
National Incident Management System (NIMS).
NIMS provides a consistent nationwide template
to enable all government, private-sector, and
nongovernmental organizations to work together
during domestic incidents (for more information
about NIMS, go to http://www.fema.gov/emergency/nims/index.shtm).
This course introduces NIMS and takes
approximately 3 hours to complete. It explains the
purpose, principles, key components, and benefits
of NIMS. The course also contains planning
activity screens that give an opportunity to
complete some planning tasks during the course.
The planning activity screens are printable so that
they can be used after course completion.
http://training.fema.gov/EMIWeb/
IS/is700.asp
INDEPENDENT STUDY PROGRAM
COURSE LIST
For a complete list of available courses, or to
download the brochure, go to http://training.fema.gov/IS/.
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RECOMMENDED READING
RESPONDING TO CRISIS IN THE AFTERMATH
OF DISASTERS
This resource, developed by NCPTSD and the National
Child Traumatic Stress Network, is a three-disc
DVD series containing 16 educational vignettes that
demonstrate intervention strategies for children and
adults after a terrorist event or disaster. Each vignette
includes background information, key teaching points,
subtitles highlighting skills, and closed-captions.
The vignettes are consistent with psychological first aid (PFA) and current
disaster mental health practices. PFA is designed to reduce initial distress
caused by disasters and to foster short- and long-term adaptive functioning
and coping. It is a modular approach that includes eight core actions: Contact
and Engagement, Safety and Comfort, Stabilization, Information Gathering,
Practical Assistance, Connection with Social Supports, Information on Coping,
and Linkage with Collaborative Services. The DVD series can be ordered from
Nancy Timmons at the National Center for Child Traumatic Stress by calling
310-235-2633, Ext. 229, or by e-mailing her at ntimmons@mednet.ucla.edu
CSAT DISASTER RECOVERY RESOURCES FOR SUBSTANCE ABUSE TREATMENT PROVIDERS CD-ROM—UPDATE
SAMHSA CSAT has updated this resource with new
materials, including the following: Alcohol Screening
and Brief Intervention (SBI) for Trauma Patients;
Quick Guide for Administrators Based on TIP 45:
Detoxification and Substance Abuse Treatment; Quick
Guide for Clinicians Based on TIP 45: Detoxification and Substance Abuse
Treatment; Digital Access to Medication presentations; and CSAT Screening,
Brief Intervention, Referral, and Treatment initiative information. CD-ROMs
are available from SAMHSA by calling 1-800-729-6686 or by visiting
http://ncadi.samhsa.gov/. The electronic version is available at
http://www.samhsa.gov/csatdisasterrecovery/index.html.
PANDEMIC INFLUENZA: QUARANTINE, ISOLATION, AND SOCIAL DISTANCING TOOLBOX FOR PUBLIC HEALTH AND PUBLIC BEHAVIORAL HEALTH
Written by P. J. Havice-Cover, M.A., LPC, CACIII; and
Curt Drennen, Psy.D., RN, Colorado Department of
Human Services Division of Mental Health
This resource was designed and created by known
experts in the field of disaster behavioral health. It is a field manual that offers
planning and response guidance for public and behavioral health workers
who may be caring for those infected with a contagious illness, and who may
be dealing with the stress of a quarantine and isolation event. Early public
health actions are outlined, along with initial-, moderate-, and high-level
interventions depending on the level of exposure to disease.
This guide offers insight into public information as it relates to common fear
and the tendency for panic and rumors to emerge. The various factors that
influence fear are discussed. Fear and misinformation can lead to reactions that
may be detrimental to disease containment. Therefore, suggested activities are
provided for professionals to help address fear, panic, and anxiety.
Topics in this guide include general disaster preparedness, staff training
recommendations, information on personal protective equipment, culture and
diversity, and high-risk populations. Economic, social, and compliance issues are discussed in the context of quarantine and isolation disaster management.
This publication also provides the reader with a comprehensive overview of
mental health issues including depression, loneliness, grief, stress management
strategies, and ways to foster resilience.
12TH ANNUAL DISASTER RESOURCE GUIDE:
CONTINUITY IN A CHANGING WORLD
Since 1996, the Annual Disaster Resource Guide has
brought together the best of the best in one single
volume. For those seeking disaster preparation
products and materials, this guide focuses on
connecting people to preparedness resources
in an effort to protect families, businesses, and
communities. Magazines, trade shows, associations,
nonprofits, and educational institutions were
involved in the development of this guide.
Numerous disaster-related articles explore issues in disaster planning and
management, social concerns, information availability and security, and crisis
communications and response. Lessons from the Past—Ideas for the Future:
A Review of Global Threats and Risks discusses 23 global threats and efforts
to mitigate them. A Medical Response to Pandemic Flu reviews health-related
planning in the event of an outbreak. Selecting an Emergency Communications
Solution outlines the need for mass notification tools in the event of disaster,
and examines the necessary ingredients of such tools and how they may
provide an integral service during initial response efforts.
12th Annual Disaster Resource Guide features a wide range of useful information
regarding successful crisis intervention. Successful response and intervention
should involve upper-level management and executives, emergency operations
centers, and other authorities involved in running businesses or serving citizens.
Articles review models for the public and private sectors to unite in their
efforts and protect the Nation from the potentially dreadful consequences of
catastrophic events.
The publishers have created a miniguide available quarterly, an online e-guide
available weekly, and a daily guide, also online. For more information, go to
http://www.disaster-resource.com/freeguide.
REVISED CRISIS COUNSELING ASSISTANCE AND TRAINING PROGRAM APPLICATION AND MATERIALS
FEMA, partnering with SAMHSA CMHS, has made a number of revisions to the
Crisis Counseling Assistance and Training Program (CCP) application process
and materials. All applicants will now be required to use the updated CCP
applications.
Revised application documents are available in the CCP Guidance section of the
CMHS Web site at
http://mentalhealth.samhsa.gov/cmhs/
EmergencyServices/progguide.asp.
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CONFERENCE HIGHLIGHTS
2007 CONTINENTAL DIVIDE DISASTER BEHAVIORAL HEALTH CONFERENCE: SCIENCE TO PRACTICE, PRACTICE TO SCIENCE
This conference, August 6–7, 2007, was established
to help bridge the divide between practitioners
and scientists in the field of disaster behavioral
health, and to increase the effectiveness of care
provided to those affected by catastrophic events.
The conference was hosted by Curt Drennen,
mental health disaster response coordinator for
the State of Colorado. Presenters included Steve
Crimando, clinician and educator specializing
in crisis management, disaster recovery, and
traumatic stress; April Naturale, former director
of Project Liberty and consultant on disaster
response; and Charles Benight, founder and
director of the Colorado Springs Trauma, Health,
and Hazards Center at the University of Colorado.
“Planning for and Recovering from Pandemic,”
by Steve Crimando, focused on the production of
antiviral medication, nonpharmaceutical remedies
such as social distancing, and planning for the
increased demand on healthcare systems. “From
Research to Practice,” by April Naturale, focused
on important factors to consider during disaster,
the recovery model, and encouraging survivors
to tap into their own resilience. “Resilience and
Recovery,” by Charles Benight, offered insight into
resilience, perception of resilience, and how to
access people’s abilities to take action in crisis.
For complete conference materials, go to
http://www.cddbhc.com.
EMI BASIC CRISIS COUNSELING COURSE
This course took place August 13–16, 2007, at
the National Emergency Training Center in
Emmitsburg, MD. The purpose of this annual
course is to prepare State and Territory mental
health authorities and federally recognized
tribal organizations to successfully complete
CCP grant applications to respond quickly and
appropriately to disasters. The training curriculum
is designed for personnel who are responsible for
preparing the CCP grant applications following
a Presidential disaster declaration that includes
individual assistance.
Up to two individuals per State were invited
to participate in the training and to stay on
campus. Training topics included the CCP
grant application process, grant reporting
requirements, disaster mental health concepts,
and organizational aspects of disaster response.
A fictitious State named Minnark was used for
the disaster scenario materials. Participants
used Minnark newspaper articles and State
demographics to gather enough information to
create sample needs assessments, budgets, and
staffing plans. Participants were given experience
in tailoring their CCP applications to deal with
special populations and a late-breaking news
report from Minnark revealing serious substance
abuse issues.
Representatives from the following States and
Territories were present at this year’s training:
Alaska, Arizona, Arkansas, Delaware, District
of Columbia, Florida, Georgia, Idaho, Illinois,
Indiana, Kansas, Kentucky, Louisiana, Maine,
Maryland, Minnesota, Mississippi, Missouri,
Nebraska, Nevada, New Hampshire, New Jersey,
New Mexico, New York, Ohio, Oklahoma,
Oregon, Puerto Rico, South Carolina, South
Dakota, Tennessee, Vermont, Virginia,
Washington, West Virginia, and Wyoming.
For more information on EMI and its trainings,
go to http://training.fema.gov/. The Basic Crisis Counseling Course was cosponsored by FEMA
and SAMHSA CMHS.
CALIFORNIA DISASTER MENTAL HEALTH SUMMIT
Cosponsored by the California Department of
Mental Health and the California Department
of Public Health, this summit was held in
Sacramento August 23–24, 2007. It focused on
disaster mental health preparedness, response,
and recovery for the State of California. County
disaster mental health officials from 41 of
California’s 58 counties attended the summit,
as well as disaster mental health experts from
academia and the private sector.
Plenary speakers included Harvey Kayman
and Bonnie Selzler who addressed the physical,
economic, spiritual, and psychological impact
of pandemic influenza and the community
impact of pandemic influenza, respectively. The
summit addressed other topics including risk
communications and the development of disaster
mental health core competencies for California. In
addition, Merritt Schreiber provided participants
with an overview of the PsySTART Rapid Mental
Health Triage and Incident Management System
model. California county disaster mental health
officials were actively engaged throughout the
summit and worked to assess the challenges to the
provision of disaster mental health services and
identify priorities for the coming year.
SAMHSA DTAC participated in the summit by
presenting an overview of CCP and the behavioral
health implications for bioterrorism and pandemic
influenza. SAMHSA DTAC also distributed more
than 1,500 SAMHSA disaster behavioral health
publications to summit participants.
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UPCOMING MEETINGS
OFFICE FOR VICTIMS OF CRIME TRAINING AND TECHNICAL ASSISTANCE CENTER WORKSHOP ON COMPASSION FATIGUE AND VICARIOUS TRAUMA
JANUARY 29–30, 2008
ST. LOUIS
This workshop provides an overview of the definitions and symptoms
of compassion fatigue, burnout, vicarious trauma, and secondary PTSD,
and will include an interactive exploration of self-care techniques,
strategies for recognizing symptoms of compassion fatigue, and strategies
supervisors can use to ensure balance and self-care for those they
supervise. Topics include the following:
- Understanding the prevalence and symptoms
of compassion fatigue and vicarious trauma
- The impact of traumatic stress and fear on
victim-service professionals
- How to develop healthy coping strategies and
build resiliency
- How to develop an agency self-care plan and a
personal self-care plan
- Strategies for supervisors to ensure a healthy
environment for staff, as well as recognize
the signs of compassion fatigue in those they
supervise
For more information, go to https://www.ovcttac.gov/.
WORK, STRESS, AND HEALTH 2008: HEALTH AND SAFE WORK THROUGH RESEARCH, PRACTICE, AND PARTNERSHIPS
MARCH 6–8, 2008
WASHINGTON, DC
The American Psychological Association, the
National Institute for Occupational Safety and
Health, and the Society for Occupational Health
Psychology will convene this seventh international
conference on occupational stress and health in
Washington, DC, March 6–8, 2008, at the Omni
Shoreham Hotel. The conference is designed to
address the changing nature of work, and the
implications of these changes for the health,
safety, and well-being of workers. This year,
the conference will focus on the translation of
research to practice. Numerous topics of interest to
industry, employees, and researchers are covered in
the series including traumatic stress and resilience
for workers in hazardous occupations and disaster
relief operations. For more information, go to
http://www.apa.org/pi/work/wsh.html.
OFFICE FOR VICTIMS OF CRIME TRAINING AND TECHNICAL ASSISTANCE CENTER WORKSHOP ON THE MENTAL HEALTH RESPONSE TO MASS VIOLENCE AND TERRORISM
MARCH 25–27, 2008
SAVANNAH, GA
This course provides the basics of what mental
health providers, crime-assistance professionals,
faith-based counselors, chaplains, and others
in direct contact with victims need to know
to provide appropriate mental health support
following incidents involving criminal mass
victimization. The training includes the following
topics:
- Human responses to mass violence and
terrorism
- Mental health intervention
- Organizational response to mass violence and
terrorism and the mental health role
- Stress prevention, management, and
intervention
For more information, go to https://www.ovcttac.gov/.
18TH WORLD CONFERENCE ON DISASTER MANAGEMENT
JUNE 15–18, 2008
TORONTO, CANADA
The theme for the 2008 conference is Resiliency:
Individual, Community, and Business. It will
be of interest to people involved in the fields of
emergency management, business continuity,
emergency response, risk management,
information technology disaster recovery,
emergency health, and other related disaster
management disciplines. Emphasis will be placed
on networking and information exchange. For
more information, go to http://www.wcdm.org.
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Announcing SAMHSA’s eNetwork
SAMHSA’s eNetwork is a link to
SAMHSA for the latest news about grants,
publications, campaigns, programs, and
statistics and data reports. The eNetwork is
for anyone who wants to receive information
about SAMHSA’s work in the substance
abuse and mental health fields.
Once you join the eNetwork and indicate your areas of interest, you
will receive up-to-the-minute information that is important to you.
You also can unsubscribe at any time to instantly stop receiving information
from SAMHSA. What you receive depends on what information you want.
For example, you can receive the following:
- New grant announcements
- New National Survey on Drug Use and
Health data findings
- SAMHSA news releases
- Information about SAMHSA campaigns
and initiatives, such as underage drinking
prevention, suicide prevention, and
recovery month
- Newly published substance abuse
treatment publications, such as Treatment
Improvement Protocols (TIPs) or Substance
Abuse Treatment Advisories
To join SAMHSA’s eNetwork, register at http://www.samhsa.gov/
enetwork.
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CALL FOR INFORMATION
The Dialogue is an arena for professionals in
the disaster behavioral health field to share
information, resources, trends, solutions to
problems, and accomplishments. Readers are
invited to contribute profiles of successful
programs, book reviews, highlights of State
and regional trainings, and other news
items. If you are interested in submitting
information, please contact Kathleen Wood
at kathleenw@esi-dc.com.
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