Enhancing Regional Disaster Behavioral Mental

Report
The FEMA Region III
Operational Response Plan and
Responder Training Plan
Enhancing Regional Disaster
Behavioral Mental Health
Preparedness
This document was prepared under a grant from FEMA's Grants Programs Directorate, U.S. Department of Homeland Security. Points
of view or opinions expressed in this document are those of the authors and do not necessarily represent the official position or
policies of FEMA's Grants Programs Directorate or the U.S. Department of Homeland Security.
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Background
In 2009, a Behavioral Health Capability Needs
Assessment was conducted in the National
Capital Region (NCR)
–
–
This assessment showed that we do not have nearly
enough responders and/or volunteers trained in disaster
behavior mental health nor enough staff provide
counseling over a long period of time. More training
across the region, across disciplines, and in our
community was needed to increase capacity to respond
to disaster situations.
This assessment also showed that some agencies did not
have response plans or their plans were outdated.
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Project Rationale
 Fill the gap in DBMH standards recognized by the
NCR Health and Medical Regional Programmatic
Working Group
 Enhance Operational Response Planning within and
across States, Counties and Cities
 Create a strategy to align disaster behavioral mental
health employee training resources with regional
priorities
 Improve regional states’ capacity to share
behavioral mental health personnel across state
boundaries
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RCPGP Project Overview
District of Columbia Homeland Security and Emergency
Management Agency asked the All Hazards Consortium to
support a procurement to:
• Develop an Operational Disaster Behavioral Mental Health
Response Plan (Operational Response Plan) and
• Disaster Behavioral Mental Health Training Plan
…for the six states in Federal Emergency Management Agency
(FEMA) Region III: Virginia, Maryland, Delaware, Pennsylvania,
West Virginia, and the District of Columbia.
West Virginia RCPGP Educational Workshop
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Operational DBMH
Response Plans
This Plan (in the form of an Operational Response Plan Template) addresses
the mental health agency’s role and responsibilities as a support agency in
accordance with each state’s response plan and:
• Utilizes the National Incident Management System (NIMS) and an
operational Incident Command System (ICS).
• Addresses the use of Disaster Behavioral Mental Health Response
Teams as part of the response including activation, community
outreach strategies, and demobilization.
• Identifies the personnel, supplies, and training necessary to establish
the Teams.
• Addresses the use of volunteers and paraprofessionals in conjunction
with the Teams and all necessary training.
West Virginia RCPGP Educational Workshop
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Operational Response Plan
• The Operational Response Plan (ORP) Template
provides the disaster response framework for any
public entity (state, county or city) as well as
components useful to individual behavioral health
providers
• The ORP captures resources and DBMH assistance in
support of applicable Emergency Support Functions
(ESFs).
• The ORP provides an operational and strategic plan
to meet response requirements and to maintain
continuity of operations to meet the needs of
consumers during a public emergency.
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Examples of Team Responses
Emergency Response (No Disaster Declared)
• This type of response is the most common for DMH. In this discussion the
major parts of the response will be covered (staff deployment, administration,
financing, etc.)
Disaster Declared
• Practical elements involved with a disaster response (the types of interventions
provided such as PFA, triage, record keeping, etc.) Overview of the regional
training plan and the core competencies all responders must possess.
Catastrophe
• A catastrophe is an incident that permanently interrupts or alters the continuity
of the status quo in terms of impacts upon human physical and mental health,
culture language, economy and environment creating irrecoverable losses.
West Virginia RCPGP Educational Workshop
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Response Teams
• Coordinate mental health activities through
needs assessment and the provisioning of
appropriate crisis support services and
counseling for first responders, victims,
families, and special vulnerable populations.
• Mental Health Response Teams (MHRTs)
– Surge Response Teams
– Emergency Response Teams
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Mental Health Response Teams
• Provide emergency and crisis behavioral
mental health support to first responders,
victims, families, and visitors.
• Coordinate all mental health activities and
monitor mental health needs/compile
assessments.
West Virginia RCPGP Educational Workshop
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Disaster Behavioral Mental
Health Training Plan
This FEMA Region III DBMH Training Plan, developed through a process
informed by best practices research and ultimately adopted through
regional consensus, addresses the process for implementing a sustainable
training program for emergency response teams, volunteers, and private
providers of behavioral mental health services and:
• Includes input from lead agencies of the Emergency Support
Functions (ESF) that the mental health agencies support, specifically,
ESF 6 (Mass Care) and ESF 8 (Public Health)
• Addresses the core content of the training curriculum and shall
include the development of a cadre of local, qualified trainers with a
train the trainer component.
• Includes the process of training trainers in the implementation of the
Training Plan through a detailed report on training resources available
to the region.
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Rationale for a Regional Plan
 Fill the gap in DBMH standards recognized by the
NCR Health and Medical Regional Programmatic
Working Group
 Create a strategy to align disaster behavioral mental
health employee training resources with regional
priorities
 Improve regional states’ capacity to share
behavioral mental health personnel across state
boundaries
West Virginia RCPGP Educational Workshop
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Basis for the Regional Plan
This regional training plan was based upon:
 Competencies established by a stakeholder experts working
collaboratively through the association of public health
schools and the CDC
 Identification of available regional and national training
resources
 Best practices research, including a survey of disaster
behavioral mental health stakeholders nationwide
 Incorporation of ICS / NIMS training
 Collaborative input from the disaster behavioral mental
health state agency leads in FEMA region III
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Methodology to Engage
Stakeholders
Collaborative input from regional stakeholders was
accomplished through meetings, conference calls (at
least two in VA) as well as two region-specific surveys:
 Survey #1 – shared information from best practices
research and nationwide stakeholder survey and asked
preliminary questions
 Survey #2 – shared results from Survey # 1 and
reexamined more closely what state leads wanted to
see in a regional plan
West Virginia RCPGP Educational Workshop
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Target Audiences for DBMH
Training
87% of
state
leads
agreed
the plan
should
target
different
responder
training
groups.
Virginia RCPGP Educational Workshop UVA
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Primary Core DBMH Training
Per feedback from state stakeholders and national
DBMH experts, all responder groups should take 3
courses (minimal threshold for deployment):
 NIMS –ICS-100 and ICS-700
 All Hazards DBMH Training
 Psychological First Aid (4 hr ARC version)
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Core Training: First Responders
CORE TRAINING FOR FIRST RESPONDERS
STATE LEAD
RATINGS
* National Incident Management System (NIMS) IS-700 /
Incident Command System (ICS) IS-100
93.3%
* Self-care
93.3%
* Psychological First Aid (America Red Cross version - 4 hrs)
80.0%
* Mental Health Triage
57.1%
Red Cross Training
53.8%
* indicates training concepts also supported by the best practices report and the
consensus core competencies
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Core Training: Nonprofessional
Responders
CORE TRAINING FOR NONPROFESSIONAL
RESPONDERS
STATE
LEAD
RATINGS
* Self-care
93.3%
* National Incident Management System (NIMS) IS-700 / Incident
Command System (ICS) IS-100
86.7%
* All Hazards Disaster Mental Health Training
73.3%
* Psychological First Aid (America Red Cross version - 4 hrs)
71.4%
* Ethics in Crisis Response
71.4%
* indicates training concepts also supported by the best practices report and the
consensus core competencies
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Core Training: Professional
Responders
CORE TRAINING FOR PROFESSIONAL RESPONDERS
STATE LEAD
RATINGS
* National Incident Management System (NIMS) IS-700 /
Incident Command System (ICS) IS-100
100.0%
Crisis Response Training
92.9%
* All Hazards Disaster Mental Health Training
86.7%
* Cultural Diversity in Crisis Response
85.7%
Resilience
85.7%
* indicates training concepts also supported by the best practices report and the
consensus core competencies
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A Regional Training
Certification?
87% of state agency representatives said yes when asked:
“Should the region establish a standard training
certification that is recognized across state borders?"
No
13%
Yes
87%
Virginia RCPGP Educational Workshop UVA
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Core Requirements for a
Regional Training Certification
CORE
National Incident Management System (NIMS) ISTRAINING 700 / Incident Command System (ICS) IS-100
All Hazards Disaster Mental Health Training
Cultural Diversity in Crisis Response
Mental Health Triage
Crisis Response Training
Self-care
Psychological First Aid (16 hour version)
Basic Principles of the Crisis Counseling Program
West Virginia RCPGP Educational Workshop
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Auxiliary Requirements for a
Regional Training Certification
AUXILIARY
Ethics in Crisis Response
TRAINING
Compassion Fatigue Training in dealing with Loss
(Select any
Working with Special Populations (children, seniors, prisoners,
three of these those with disabilities / severe mental illness)
courses)
Trauma Issues
Critical Incident Stress Management Model Training
Bereavement & Death Notification / Grief / Loss Issues
Crisis Leadership
Red Cross Training
Substance Abuse Triage / Substance Use & Trauma
Resilience
Compassion Fatigue Prevention and Resiliency
Field Therapy
Trauma Focused Cognitive Behavioral Therapy (CBT)
Medical Reserve Corps Training
Advanced Trauma Focused Cognitive Behavioral Therapy (CBT)
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Challenges Specific to a
Regional Certification
Stakeholders were asked about the challenges and barriers to developing a
volunteer certification process. They suggested a number of potential "trip
hazards." Some respondents have been involved in previous efforts to develop a
certification process, so they were able to provide some of the challenges and
barriers their groups encountered in such an effort.
•Funding (for training, background checks, database maintenance)
•Science-based curriculum or not? Agreement on model to use / what is
the authority for standardization?
•Legal liability
•Labor intensive process / time required
•Ethical issues (worker's comp, volunteer protection, appeals process..)
•Getting people to trainings
•Politics / who will take charge of it?
•Retention / turnover
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Relevant Findings:
Regional Input (not only WV)
• States are indicating a need for more intensive TA and
support than originally anticipated
• A few state DBMH teams have expressed a need for better
collaboration and communication with their ESF lead agencies
• State cultural differences and personalities within
leadership are important drivers for whether DBMH issues
are sufficiently addressed in broader emergency
preparedness planning
• Several emergency/deployment scenarios rely heavily upon
DBMH response capacity and awareness of this reality is
increasing
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Next Steps
• Currently, we are funded to:
– Train and Exercise the Operational Response Plan
and DBMH Training Plan for five states and the
District in FEMA Region III. This includes public
and private entities operating at the state and
local levels (all ESFs invited)
West Virginia RCPGP Educational Workshop
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Additional Thoughts
• Course-based training is great but we need more
opportunities to learn through exercises (this also keeps
volunteers more engaged)
• Funding for training is a major concern – and many states
have lost or cut funding recently (20% cut in PA, for example).
• Like many states and municipalities, WV is largely
dependent on local public and private entities to provide
direct behavioral health services. Helping those local entities
become better prepared not only for their own emergencies
(COOP) but for external deployment on response teams is
important
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Getting Back to WV
Where is WV now?
What is next?
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Your Involvement
•How can you be involved as either a
participant or a convener of a training and/or
table-top exercise?
•Whom would you suggest I contact to
participate?
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Wrapping Up
Questions?
West Virginia RCPGP Educational Workshop
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Contact information
Colin Newlin
Braintree Solution Consulting, Inc.
Washington, DC
[email protected]
Tel: (202)232-8212
www.braintreeconsulting.com
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