Indiana Division of Mental Health & Addiction

Indiana Division of Mental Health & Indiana Division of Mental Health & Addiction Addiction

Office of Addiction, Prevention and Office of Addiction, Prevention and Emergency ManagementEmergency Management

Office of Emergency Office of Emergency Management and PreparednessManagement and Preparedness

The Indiana Division of Mental Health and AddictionThe Indiana Division of Mental Health and AddictionOffice of Addiction, Prevention and Emergency Office of Addiction, Prevention and Emergency

ManagementManagement

Office of Emergency Management and PreparednessOffice of Emergency Management and Preparedness

The Mission of the Indiana Division of Mental The Mission of the Indiana Division of Mental Health and Addiction’s Office of Emergency Health and Addiction’s Office of Emergency Management and Preparedness is to coordinate Management and Preparedness is to coordinate all mental health and addiction activities prior to, all mental health and addiction activities prior to, during, and after an emergency or disaster, during, and after an emergency or disaster, including acts of terrorism.including acts of terrorism.

EstablishedEstablished

The Office of Emergency Management and The Office of Emergency Management and Preparedness and the Indiana Division of Preparedness and the Indiana Division of Mental Health and Addiction All Hazards Mental Health and Addiction All Hazards Committee was created in June 2003 with a Committee was created in June 2003 with a $300,000 three year grant from Substance $300,000 three year grant from Substance Abuse and Mental Health Services Abuse and Mental Health Services Administration. The Targeted Capacity Administration. The Targeted Capacity Expansion Grant was to Enhance State Expansion Grant was to Enhance State Capacity for Emergency Mental Health and Capacity for Emergency Mental Health and Substance Abuse Response.Substance Abuse Response.

Mental Health All Hazards Advisory Mental Health All Hazards Advisory CommitteeCommittee

Mental Health All Hazards Advisory Mental Health All Hazards Advisory committee established 2003. The All committee established 2003. The All Hazards Advisory Committee is functioning Hazards Advisory Committee is functioning and meeting on a monthly basis with and meeting on a monthly basis with subcommittees meeting more often. There subcommittees meeting more often. There are currently sixteen members who all have are currently sixteen members who all have been appointed by the Director of the been appointed by the Director of the Division of Mental Health and Addiction. The Division of Mental Health and Addiction. The chair of the All Hazards Committee also chair of the All Hazards Committee also serves as a member of the Division of serves as a member of the Division of Mental Health and AddictionMental Health and Addiction

Indiana All Hazards Committee Indiana All Hazards Committee Private Emergency Contractor Private Emergency Contractor Medical Hospital Medical Hospital Critical Stress Critical Stress

Management/State Clinical Management/State Clinical Director (CISD) Director (CISD)

Substance Abuse Disaster Substance Abuse Disaster Mental Health expert Mental Health expert

Private Practice Provider Private Practice Provider Chaplain/ Fire Department Chaplain/ Fire Department Medical Director DMHA Medical Director DMHA Indiana Department of Indiana Department of

Education State Fort Wayne Education State Fort Wayne National Organization ofNational Organization of

Victims Assistance (NOVA) Victims Assistance (NOVA) Federal Partners Federal Partners

Indiana Department of Indiana Department of Homeland Security Homeland Security

State Department of Health State Department of Health Local Health Department Local Health Department Community Mental Health Community Mental Health

Center Center Managed Care Organization Managed Care Organization

Addiction Provider Addiction Provider Red Cross State Mental Health Red Cross State Mental Health

Lead Lead Indiana Council of Community Indiana Council of Community

Mental Health CentersMental Health Centers Child Trauma Specialist Child Trauma Specialist Indiana University Indiana University Indiana-Purdue University Fort Indiana-Purdue University Fort

Wayne Wayne

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Office of Emergency Management and Preparedness Office of Emergency Management and Preparedness ResponsibilitiesResponsibilities

Train substance abuse and mental health Train substance abuse and mental health services providers with whom DMHA contracts services providers with whom DMHA contracts in crisis counseling programs and techniques.in crisis counseling programs and techniques.

Create linkages with mental health and Create linkages with mental health and addiction services providers not under addiction services providers not under contract with DMHA.contract with DMHA.

Identify and train a cadre of mental health Identify and train a cadre of mental health responders and crisis counselorsresponders and crisis counselors


Ongoing assessment of the mental health and Ongoing assessment of the mental health and addiction services provider system’s ability to addiction services provider system’s ability to respond to a major disaster. respond to a major disaster.

Educate county emergency management Educate county emergency management officials on the need to coordinate their officials on the need to coordinate their local/county emergency plans to respond to the local/county emergency plans to respond to the crisis counseling needs of victims of a disaster.crisis counseling needs of victims of a disaster.

Develop inter-agency coordination into the Develop inter-agency coordination into the emergency disaster response in all phases of emergency disaster response in all phases of planning.planning.


Train substance abuse and mental health Train substance abuse and mental health services providers with whom DMHA contracts services providers with whom DMHA contracts in crisis counseling programs and techniques.in crisis counseling programs and techniques.

Identify concerns and issues for a mental Identify concerns and issues for a mental health/crisis counseling response in the health/crisis counseling response in the Indiana State Operated Facilities Indiana State Operated Facilities

Seek State funding for continuation of Seek State funding for continuation of program once federal grant cycle is complete.program once federal grant cycle is complete.

Create linkages with mental health and Create linkages with mental health and addiction services providers not under addiction services providers not under contract with DMHAcontract with DMHA..

Office of Emergency Preparedness and Office of Emergency Preparedness and

ResponseResponse Awareness Training 2005 1,000 people trained Awareness Training 2005 1,000 people trained Disaster Mental Health Intervention Training Disaster Mental Health Intervention Training

– Initial, State Deployment Team 81 people trained Initial, State Deployment Team 81 people trained Registry of Deployable Mental Health RespondersRegistry of Deployable Mental Health Responders Hurricane Katrina Hurricane Katrina

Received a FEMA Grant for $700,000 Received a FEMA Grant for $700,000 Crisis Counseling Program for 5,000 Katrina Crisis Counseling Program for 5,000 Katrina

evacuees living in Indiana evacuees living in Indiana Pandemic InfluenzaPandemic Influenza

Working with the ISDH on the behavioral health Working with the ISDH on the behavioral health issuesissues

All Hazards Committee will be developing plan All Hazards Committee will be developing plan

Indiana Division of Indiana Division of Mental Health and Mental Health and

AddictionAddiction

Katrina Katrina

20052005

Indiana Hoosier Relief Indiana Hoosier Relief Indiana Mental Health Task ForceIndiana Mental Health Task Force

On August 31, 2005 the Indiana Division of On August 31, 2005 the Indiana Division of Mental Health and Addiction was contacted Mental Health and Addiction was contacted by the Indiana Department of Homeland by the Indiana Department of Homeland Security to put together a mental health Security to put together a mental health task force in support of the deployment of task force in support of the deployment of Task Force Indiana to the State of Mississippi Task Force Indiana to the State of Mississippi to support response and recovery efforts to support response and recovery efforts following Hurricane Katrina. The Indiana following Hurricane Katrina. The Indiana Task Force was sent to Mississippi through Task Force was sent to Mississippi through and in support of the Emergency and in support of the Emergency Management Assistance Compact (EMAC).Management Assistance Compact (EMAC).


The State of Indiana contacted State of The State of Indiana contacted State of Mississippi Department of Mental Health in Mississippi Department of Mental Health in order to inform them that the state of order to inform them that the state of Indiana has been deployed to go to the Indiana has been deployed to go to the gulf area. We became mental health gulf area. We became mental health coordinators for the Mississippi coordinators for the Mississippi Department of Mental Health the state of Department of Mental Health the state of Indiana was providing daily briefing to the Indiana was providing daily briefing to the Mississippi Department of Mental Health..Mississippi Department of Mental Health..

Incident Command StructureIncident Command StructureIndiana Mental HealthIndiana Mental Health

Task ForceTask Force

Indiana Division of

Mental Health and Addiction Director

Indiana Mental Health

Task ForceTeam

Leader

I


Task ForceClinical Director


Task ForceTeam

Members


It was clear to the team that the overall It was clear to the team that the overall mission of the Indiana Task Force would be mission of the Indiana Task Force would be in support of the Mississippi state in support of the Mississippi state department of mental health.To this end, department of mental health.To this end, the three teams in debriefing their mission the three teams in debriefing their mission saw that the overall goal of the mission saw that the overall goal of the mission was: was:

To provide mental health support to To provide mental health support to the Gulf Coast Community.the Gulf Coast Community.

GOAL:GOAL: To provide mental health To provide mental health support to the Gulf Coast support to the Gulf Coast

Community.Community.

OBJECTIVES:OBJECTIVES: To provide trauma care to first responders and To provide trauma care to first responders and

to do an assessment of mental health needs for to do an assessment of mental health needs for the gulf coast area affected by the storm.the gulf coast area affected by the storm.

To provide crisis counseling to hurricane victims.To provide crisis counseling to hurricane victims. To Transition the responsibility for continued To Transition the responsibility for continued

care and help to rebuild the infrastructure.care and help to rebuild the infrastructure. To manage the logistics of the disaster To manage the logistics of the disaster

response.response.

Team I Team I

– Assessments of Mental Health needs for the Assessments of Mental Health needs for the Mississippi Department of Mental Health, Mississippi Department of Mental Health, Worked primarily with first responders, fire Worked primarily with first responders, fire departments, law enforcement, Department departments, law enforcement, Department of Natural Resources. Public Works of Natural Resources. Public Works

Team II Team II

– Continued work with first responders, Continued work with first responders, worked with other non-governmental worked with other non-governmental agency. Provided crisis intervention agency. Provided crisis intervention outreach, spiritual support, integrated outreach, spiritual support, integrated ourselves into the community.ourselves into the community.

Team III Team III – Helped to rebuild mental health infrastructure Helped to rebuild mental health infrastructure

local mental health organizationlocal mental health organization

Mississippi Department of Mental Health Mississippi Department of Mental Health other mental health groups other mental health groups

Development of training program for Development of training program for Principals, Principals, teachers, parent and school teachers, parent and school counselors in dealing counselors in dealing with kids following with kids following Hurricane Katrina in the Gulf Hurricane Katrina in the Gulf Coast Coast School Districts. School Districts.

Provided Trainings for principals, teachers, Provided Trainings for principals, teachers, parent parent and school counselors in dealing with and school counselors in dealing with kids kids following Hurricane Katrina in the Gulf following Hurricane Katrina in the Gulf Coast Coast School Districts. School Districts.

Directed resources and modeled coordination Directed resources and modeled coordination of of resources as a disaster response resources as a disaster response

Created color books deal with hurricanes, Created color books deal with hurricanes,

Lessoned Learned – things that Lessoned Learned – things that worked well:worked well:

Having an overall team leader and a clinical director for Having an overall team leader and a clinical director for mental health.mental health.

Having shirts that identified us as mental health/crisis Having shirts that identified us as mental health/crisis intervention workers.intervention workers.

Conducting nightly debriefing for the mental health task Conducting nightly debriefing for the mental health task forceforce

Having a cadre of qualified and trained people to select for Having a cadre of qualified and trained people to select for deployment deployment

Having a multi-disciplinary task force that integrated and Having a multi-disciplinary task force that integrated and worked well together. worked well together.

Having all teams within the Indiana Task Force debriefed Having all teams within the Indiana Task Force debriefed before they are released from deployment. before they are released from deployment.

People should know what to expect while on deployment. People should know what to expect while on deployment. – Timeframe people will be on deployment Timeframe people will be on deployment – Conditions to expect Conditions to expect – A better understanding of incident command is A better understanding of incident command is

needed.needed.

Lessons learned Lessons learned

Confidentiality agreement should be signed by all of Confidentiality agreement should be signed by all of the task force members, especially the mental health the task force members, especially the mental health task force.task force.

Communication should be available for mental health Communication should be available for mental health team members (i.e., cell phones or other forms of team members (i.e., cell phones or other forms of reliable communication).reliable communication).

A Public Information Officer is needed as part of the A Public Information Officer is needed as part of the mental health task force.mental health task force.

Lesson learnedLesson learned

Hats for mental health team members should Hats for mental health team members should be provided for better identification.be provided for better identification.

An air cooled or air conditioned mess tent An air cooled or air conditioned mess tent would be beneficial for workers to eat, do would be beneficial for workers to eat, do paper work, and have meetings with team paper work, and have meetings with team members or local responders/agencies.members or local responders/agencies.

Lesson learnedLesson learned

A comprehensive contact guide should be A comprehensive contact guide should be developed with the contact information of developed with the contact information of Family and Social Services (FSSA) Family and Social Services (FSSA) executives.executives.

A secured credit card should be issued to A secured credit card should be issued to the mental health team leader for the mental health team leader for purchases of necessary supplies and purchases of necessary supplies and equipment while on deployment.equipment while on deployment.

A wireless card should be purchased to A wireless card should be purchased to

allow for computer access to FSSA and allow for computer access to FSSA and other web resources.other web resources.

Lessons learned Lessons learned

A A medical person should be in charge of medical person should be in charge of Emergency Support Function (ESF) 8. Emergency Support Function (ESF) 8.

A quick, initial assessment should be conducted A quick, initial assessment should be conducted

before sending down the full task force. before sending down the full task force.

More people should be trained and equipped to More people should be trained and equipped to fulfill the mental health team leader role. fulfill the mental health team leader role.

Lessons learnedLessons learned A financial system should be developed to A financial system should be developed to

allow purchases of needed supplies and allow purchases of needed supplies and resources before deployment, (i.e., shirts, resources before deployment, (i.e., shirts, hats, educational brochures, supplies for hats, educational brochures, supplies for children, etc.). children, etc.).

Additional staff should be trained and Additional staff should be trained and educated to continue regular operations in educated to continue regular operations in the Office of Emergency Response and the Office of Emergency Response and Preparedness while other staff are on a Preparedness while other staff are on a disaster deployment. disaster deployment.

Recommendations for Best PracticesRecommendations for Best PracticesIssue: Better coordination between other disaster Issue: Better coordination between other disaster

relief services andrelief services andour team.our team.

Discussion: Having difficulty getting into Discussion: Having difficulty getting into American Red Cross shelters.American Red Cross shelters.

Resolution: Having a memorandum of Resolution: Having a memorandum of understanding between state andunderstanding between state and

national relief organizations, life ARC national relief organizations, life ARC and/or FEMAand/or FEMA

Recommendations for Best PracticesRecommendations for Best PracticesIssue: Faster deployment to direct trauma Issue: Faster deployment to direct trauma

victims.victims. Discussion: Assignments were Discussion: Assignments were

delayed the first delayed the first couple of days, couple of days, leading to some lack of effective time leading to some lack of effective time use.use.

Resolution:Resolution: Having a team leader Having a team leader deployed first to work out deployed first to work out assignmentassignment

needs with local officials before the needs with local officials before the rest of team arrives.rest of team arrives.

Recommendations for Best PracticesRecommendations for Best PracticesIssue: Deployment Guidelines: More precise and Issue: Deployment Guidelines: More precise and

defined “rules or guidelines” needed for team defined “rules or guidelines” needed for team members before they deploy.members before they deploy.

Discussion:Discussion: There was some confusion as to what team There was some confusion as to what team members could or couldn’t do.members could or couldn’t do.

Resolution:Resolution: Suggested Guidelines:Suggested Guidelines:

Follow incident command procedures at all timesFollow incident command procedures at all times Debriefing in small groups are expected each eveningDebriefing in small groups are expected each evening Remember that at all times you are a state employee and Remember that at all times you are a state employee and

must be aware how statements you make may reflect must be aware how statements you make may reflect politically on the state.politically on the state.

Confidentiality…have each team member sign Confidentiality…have each team member sign confidentiality agreement and remind team members that confidentiality agreement and remind team members that they are not to relate anything that would reflect negatively they are not to relate anything that would reflect negatively on the individuals and organizations that we were sent to on the individuals and organizations that we were sent to help.help.

Recommendations for Best PracticesRecommendations for Best PracticesIssue: there was no uniform Identification for team Issue: there was no uniform Identification for team

members.members.

Discussion: uniform, easily recognized Identification Discussion: uniform, easily recognized Identification would have proven beneficial in many cases. The would have proven beneficial in many cases. The blue shirt identification was great, but we all needed blue shirt identification was great, but we all needed similar badgessimilar badges

Resolution: Have identification made prior to Resolution: Have identification made prior to deployment. Team members could send in small deployment. Team members could send in small photos to put on identification or bring those photos photos to put on identification or bring those photos with them. Uniform identification holders would also with them. Uniform identification holders would also be beneficial.be beneficial.

Recommendations for Best PracticesRecommendations for Best PracticesIssue: Confusion about who we were and what Issue: Confusion about who we were and what

“authority” we had.“authority” we had.

Discussion: We often spent a lot of time telling Discussion: We often spent a lot of time telling

individuals or agencies who we were and since individuals or agencies who we were and since there were ten team members there was the there were ten team members there was the possibility of ten different versions being told. possibility of ten different versions being told.

Resolution: Have access to a short, one Resolution: Have access to a short, one paragraph letter of introduction on state paragraph letter of introduction on state letterhead that explains what an EMAC is and letterhead that explains what an EMAC is and why we were asked to be there Also explain that why we were asked to be there Also explain that all licensure transfers to the existing stateall licensure transfers to the existing state..

Wish list.Wish list.

Uniform identification…with photo easily recognizedUniform identification…with photo easily recognized More than two blue t shirtsMore than two blue t shirts Business Cards for Indiana Task Force with space for Business Cards for Indiana Task Force with space for

user to write name and telephone number onuser to write name and telephone number on Map of area deployed toMap of area deployed to Printed list of all team members phone numbers Printed list of all team members phone numbers

prior to deploymentprior to deployment Handouts that could easily be modified…put on discHandouts that could easily be modified…put on disc Something from lessoned learned with confusion Something from lessoned learned with confusion

with Red Cross….prior agreementwith Red Cross….prior agreement Pocket DSM-IV and medication handbookPocket DSM-IV and medication handbook Letter of understanding from Red CrossLetter of understanding from Red Cross Copy of mutual understanding memo between Red Copy of mutual understanding memo between Red

Cross, NOVA, and CISMCross, NOVA, and CISM

Provided Services to Provided Services to Indiana Hoosier Relief Indiana Hoosier Relief FEMA FEMA Biloxi Fire Department Biloxi Fire Department Gulfport Fire Department Gulfport Fire Department Harrison County Public Works Harrison County Public Works Harrison County Emergency Harrison County Emergency

Management Management Gulfport Memorial Hospital Gulfport Memorial Hospital Gulfport Psychiatric Inpatient Gulfport Psychiatric Inpatient

unit unit Gulfport Behavioral Health Gulfport Behavioral Health

program program Gulf Coast Mental Health Gulf Coast Mental Health

Center Center Florida Department of Natural Florida Department of Natural

Resources Resources Medial Clinic operated by Medial Clinic operated by

Indiana Hoosier ReliefIndiana Hoosier Relief

Mississippi Department of Mississippi Department of Mental Health Mental Health

Mississippi Department of Mississippi Department of Health Health

SAMHSA SAMHSA Gulfport Schools Gulfport Schools Biloxi SchoolsBiloxi Schools Jackson County Youth Jackson County Youth

Coalition Coalition Red Cross Red Cross Salvation Army Salvation Army Hands Across USA Hands Across USA Children Health Fund Children Health Fund State of Kansas Mental Health State of Kansas Mental Health

Task Force Task Force

11,579

Number of People in the Gulf Coast touched by the Indiana Mental health Hoosier Relief Task Force

Regional

Teams

Incident Command

Task ForceMental Health

Task Force Health

Task Force Emergency Health

Logistics Administration

Command/Control of Medical Support ElementIndiana Task Force

IN Div of Mental Health & Addiction

Drew Klatte

TEAM LEADER

CLINICAL DIRECTOR

TEAM MEMBERS

Incident Command StructureIndiana Mental Health Task Force

Response Team OverviewResponse Team Overview To Develop a Disaster Response To Develop a Disaster Response

Mental Health TeamMental Health Team– Support first respondersSupport first responders– Support victimsSupport victims– Support team membersSupport team members– Support communitySupport community

Type of TeamType of Team– State TeamState Team– 10 Homeland Security Districts Team10 Homeland Security Districts Team

The Collaborative Team Behind the The Collaborative Team Behind the Disaster Team ConceptDisaster Team Concept

Indiana Division of Mental Health and Indiana Division of Mental Health and AddictionsAddictions

Indiana Homeland SecurityIndiana Homeland Security Indiana State Department of HealthIndiana State Department of Health Indiana All Hazards CommitteeIndiana All Hazards Committee Affiliated Service Providers of Indiana Affiliated Service Providers of Indiana

(ASPIN)(ASPIN) Ten Indiana Homeland/Public Health Ten Indiana Homeland/Public Health

DistrictsDistricts

Team ProvidesTeam ProvidesMental Health SupportMental Health Support

• Follows chain of commandFollows chain of command• Provides support to other respondersProvides support to other responders• Follows Psychological First Aid ModelFollows Psychological First Aid Model• Ancillary support to the mental health Ancillary support to the mental health

systemsystem• Put on “band aids” until the system can Put on “band aids” until the system can

resumeresume• Assist the community and local mental Assist the community and local mental

health agencieshealth agencies

Team StructureTeam Structure

Incident CommandIncident Command Mental Health Team Mental Health Team

Leader/DirectorLeader/Director Team Clinical DirectorTeam Clinical Director Team membersTeam members Chaplains Chaplains

– Type I TeamType I Team– Type II TeamType II Team

Mental Health Team LeaderMental Health Team Leader

Overall command of the mental health Overall command of the mental health response teamresponse team

Makes community contactsMakes community contacts Develops mission assignmentsDevelops mission assignments Identify needs of the mental health teamIdentify needs of the mental health team Community assessmentsCommunity assessments Liaison with State & local mental health Liaison with State & local mental health

authoritiesauthorities

Team Clinical DirectorTeam Clinical Director

Assist Team Leader (final decision Assist Team Leader (final decision maker)maker)

Reports directly to Team LeaderReports directly to Team Leader Provides “clinical” leadership and Provides “clinical” leadership and

decision makingdecision making Assist with assignmentsAssist with assignments Assumes other responder dutiesAssumes other responder duties Coordinates daily debriefings of teamCoordinates daily debriefings of team

Expectations of Team LeadersExpectations of Team Leaders

Team accountabilityTeam accountability

Team maintenanceTeam maintenance

Coordinate regular team meetingsCoordinate regular team meetings

Coordinate additional team trainingCoordinate additional team training

Attend “Team Leader Follow-up Meeting”Attend “Team Leader Follow-up Meeting”

OtherOther

Team Member Job DescriptionTeam Member Job Description

Attend Full Day Regional TrainingAttend Full Day Regional TrainingAvailable to respond as team membersAvailable to respond as team membersCredential and follow incident command…Credential and follow incident command…NIMSNIMSRead Psychological First Aid ManualRead Psychological First Aid ManualAttend set number of team meetingsAttend set number of team meetingsAttend additional team trainingsAttend additional team trainingsConfidentialityConfidentialityTeam allegiance Team allegiance Will not “self-promote” or promote Will not “self-promote” or promote affiliationsaffiliations

Mental Health Team MembersMental Health Team Members

1.1. Follow incident command structureFollow incident command structure

2.2. Follows direction of team leader and Follows direction of team leader and clinical director clinical director

3.3. Accept assignments Accept assignments

4.4. Report issues/problems Report issues/problems

5.5. Data collectionData collection

6.6. Participates in team debriefingsParticipates in team debriefings

ConnectingConnecting

State mental health authorityState mental health authority Local mental health authorityLocal mental health authority State health State health EOCEOC FEMA/ DRCFEMA/ DRC EOC Emergency Support Function 8 EOC Emergency Support Function 8

LeaderLeader

Connecting Connecting

First Responders:First Responders:– Police, fire, public workers, coronerPolice, fire, public workers, coroner

TV/radio/newspaper HR depts.TV/radio/newspaper HR depts. Red Cross sheltersRed Cross shelters Salvation Army sheltersSalvation Army shelters Non Governmental Organizations Non Governmental Organizations Hospital HR depts.Hospital HR depts.

Highlights of H.E.A 1238Highlights of H.E.A 1238

Regional Team Regional Team GuidelinesGuidelines

Goals of Mental Health InterventionGoals of Mental Health Intervention

StabilizationStabilization Assessment of adaptation…referralAssessment of adaptation…referral Support efforts to become a Support efforts to become a

“survivor” not a “victim”“survivor” not a “victim” Restore environment of community, Restore environment of community,

school and other systemsschool and other systems

Team ExpectationsTeam Expectations

Respect Confidentiality at all levelsRespect Confidentiality at all levels Think out of box & still follow incident Think out of box & still follow incident

commandcommand Resource to other response team Resource to other response team

membersmembers Pre/During/Post-Self CarePre/During/Post-Self Care

Intervention Includes:Intervention Includes:

Listening Listening Reconnecting & Reinforcing coping skillsReconnecting & Reinforcing coping skills Encouraging active role in recoveryEncouraging active role in recovery ConsultingConsulting Triage…assessmentTriage…assessment Referral when appropriateReferral when appropriate Providing informationProviding information ““Does not include therapy or counseling”Does not include therapy or counseling”

Primary GuidelinesPrimary Guidelines

Follow response modelFollow response model – Incident command structureIncident command structure– Mental Health Team LeaderMental Health Team Leader– Mental Health Team Clinical directorMental Health Team Clinical director– Mental Health Team MembersMental Health Team Members– Psychological First AidPsychological First Aid

Continue developing response skillsContinue developing response skills Assist with and participate in team Assist with and participate in team

developmentdevelopment

Team Members Characters Team Members Characters

Knowledge of different populations Knowledge of different populations (children, elderly, (children, elderly, special needs, etc.)special needs, etc.)

Knowledge of different cultures, language, ethic, and Knowledge of different cultures, language, ethic, and spiritual backgrounds, etc.spiritual backgrounds, etc.

Flexible…Compatible Flexible…Compatible

Ability to deal with ambiguityAbility to deal with ambiguity

Knowledge of NIMS…incident commandKnowledge of NIMS…incident command

Understanding of allegiance to team…and not to self or Understanding of allegiance to team…and not to self or employeremployer

Mental Health RespondersMental Health Responders

Provide psychological first aid Provide psychological first aid • Individual…group…communityIndividual…group…community

Operate within the scope of Indiana Operate within the scope of Indiana license or job descriptionlicense or job description

Other duties as assignedOther duties as assigned Participates in daily debriefings Participates in daily debriefings

Response ModelResponse Model

Follow procedures & assignments as Follow procedures & assignments as directeddirected

Psychological First AidPsychological First Aid Respect cultural, spiritual & religious beliefs Respect cultural, spiritual & religious beliefs

and practicesand practices Maintain a professional relationship with all Maintain a professional relationship with all

individualsindividuals Response model will be adjusted as neededResponse model will be adjusted as needed

Team Member ReadinessTeam Member Readiness

Pre-deploymentPre-deployment At SiteAt Site Post DeploymentPost Deployment

Anticipate personal & professional needsAnticipate personal & professional needs Self-honesty about emotional capabilitiesSelf-honesty about emotional capabilities Self-honesty about physical capabilitiesSelf-honesty about physical capabilities Emotional & physical self-careEmotional & physical self-care ““Debriefings”Debriefings”

Assessment and InterventionAssessment and Intervention

Be aware that community members Be aware that community members may be:may be:

DysfunctionalDysfunctional ConfusedConfused ““ok” or in denialok” or in denial Unaware of mental health assistanceUnaware of mental health assistance Ambivalent about receiving assistanceAmbivalent about receiving assistance Resistant to any form of mental health Resistant to any form of mental health

serviceservice Referring you to those “more in need”Referring you to those “more in need”

Community Service SettingsCommunity Service Settings

Non-traditionalNon-traditional Ever-changingEver-changing AmbiguousAmbiguous Often chaoticOften chaotic Lack privacyLack privacy Lack quiet or comfortLack quiet or comfort

Possible Possible SitesSites

SheltersShelters HospitalsHospitals SchoolsSchools Community Government CenterCommunity Government Center Police/Fire StationsPolice/Fire Stations MorguesMorgues Anywhere/Anytime/AnyplaceAnywhere/Anytime/Anyplace

Services Delivery IssuesServices Delivery Issues

Not a clinicNot a clinic Often travel to clientsOften travel to clients ““Walking around” therapyWalking around” therapy Short-term…brief contactShort-term…brief contact

Clinical Role and Setting FluidClinical Role and Setting Fluid

Fluid (floo′ id)adj. 1. Fluid (floo′ id)adj. 1. able to move and able to move and change shape without change shape without separating when separating when under pressure. 2. like under pressure. 2. like a fluid, that can a fluid, that can change rapidly or change rapidly or easily; not settled or easily; not settled or fixedfixed

From Webster’s New World DictionaryFrom Webster’s New World Dictionary

Practitioner GuidelinesPractitioner Guidelines

““Instant” rapport neededInstant” rapport needed Rapid assessment often neededRapid assessment often needed Therapeutic skills neededTherapeutic skills needed Knowledge of trauma reactions Knowledge of trauma reactions

neededneeded A continuum of crisis interventionA continuum of crisis intervention

Team members require knowledge Team members require knowledge of:of:

Trauma reactionsTrauma reactions Local culture and communityLocal culture and community Psycho-educational skillsPsycho-educational skills Psychological First AidPsychological First Aid Listening, observation, questioning Listening, observation, questioning

skillsskills Stress reactionsStress reactions Stress management techniquesStress management techniques

Clinical RolesClinical Roles

Triage/assessmentTriage/assessment ConsultConsult Crisis InterventionCrisis Intervention ““debriefing intervention”debriefing intervention” Reconnect and reinforce coping skillsReconnect and reinforce coping skills Referral when appropriateReferral when appropriate An assigned “non-clinical” roleAn assigned “non-clinical” role

Team Deployment & Team Deployment & CommunicationCommunication

Accept roleAccept role Work in pairs unless otherwise directedWork in pairs unless otherwise directed Report in location at all timesReport in location at all times Documentation/notesDocumentation/notes Communicate. Communicate. Communicate. Communicate.

Communicate.Communicate. Ambiguity and flexibility: Ambiguity and flexibility:

– “ “Walking the fine line” in responding Walking the fine line” in responding

AccomplishmentsAccomplishments

District Disaster Mental Health District Disaster Mental Health TeamsTeams Ten districts established with leaders Ten districts established with leaders

and members. Each district has:and members. Each district has: Regular MeetingsRegular Meetings Yearly Budget Yearly Budget Reporting RequirementsReporting Requirements Training Materials and Implementation Training Materials and Implementation

RequirementsRequirements Deployment MaterialsDeployment Materials ““To-Go” kitsTo-Go” kits


Policies & Procedures EstablishedPolicies & Procedures Established District Disaster Mental Health TeamsDistrict Disaster Mental Health Teams

CredentialingCredentialing CompositionComposition DeploymentDeployment Code of Conduct & EthicsCode of Conduct & Ethics

Field Guide RecognizedField Guide Recognized Center for Infectious Disease Research & Center for Infectious Disease Research &

Policy (CIDRAP) at the University of MinnesotaPolicy (CIDRAP) at the University of Minnesota Listed as promising practice on Listed as promising practice on

www.PandemicPractices.orgwww.PandemicPractices.org See press release handoutSee press release handout


Ardent Sentry ExerciseArdent Sentry Exercise Vigilant Guard full scale exercise Vigilant Guard full scale exercise

conducted by U.S. Army Northern conducted by U.S. Army Northern CommandCommand

May 10-13, 2007May 10-13, 2007 10K Nuclear Bomb Scenario10K Nuclear Bomb Scenario ParticipationParticipation

1,000+ Indiana First Responders (including 1,000+ Indiana First Responders (including Disaster Mental Health Teams)Disaster Mental Health Teams)

130+ Local Agencies130+ Local Agencies 41,000 “simulated” military troop 41,000 “simulated” military troop

deploymentdeployment

Other ActivitiesOther Activities

Indiana University Counseling and Indiana University Counseling and Psychological ServicesPsychological Services Result of Virginia Tech shootingResult of Virginia Tech shooting Forming partnership to enhance the Forming partnership to enhance the

behavioral health services provided to behavioral health services provided to university studentsuniversity students

Will continue meeting with staffWill continue meeting with staff Presented information to all county EMA Presented information to all county EMA

directors on the Mental Health Teamsdirectors on the Mental Health Teams

Other ActivitiesOther Activities

Indiana University Medical StudentsIndiana University Medical Students Public Health Emergency Response Rotation Public Health Emergency Response Rotation

through ISDHthrough ISDH Psychological First Aid Curriculum incorporatedPsychological First Aid Curriculum incorporated Monthly training presented by DMHAMonthly training presented by DMHA

Virginia Tech Aftermath – Campus SecurityVirginia Tech Aftermath – Campus Security Participate in a consortium organized by SAMSHA Participate in a consortium organized by SAMSHA

Administrator, US Attorney General and US Administrator, US Attorney General and US Department of EducationDepartment of Education

Formed partnerships with Indiana Student Formed partnerships with Indiana Student Counseling CentersCounseling Centers


Training (300+)Training (300+) Basic Crisis ResponseBasic Crisis Response Psychological First Aid (PFA)Psychological First Aid (PFA) PFA Train-the-TrainerPFA Train-the-Trainer Psycho-social impacts of mass disastersPsycho-social impacts of mass disasters

Field Living Skills TrainingField Living Skills Training All district teamsAll district teams 24 hour disaster field survival skills training24 hour disaster field survival skills training Incorporates Disaster Mental Health Response Incorporates Disaster Mental Health Response

ScenariosScenarios

Field Living SkillsField Living SkillsCamp HollandCamp Holland

Regional

Teams

Field Living Skills OverviewField Living Skills Overview Simulates field work environment under Simulates field work environment under

adverse conditions with little or no support adverse conditions with little or no support from the local community. from the local community.

Intense schedule - very little time for breaks Intense schedule - very little time for breaks or personal activities. or personal activities.

Throughout the training, students will be Throughout the training, students will be required to perform crisis counseling with required to perform crisis counseling with simulated disaster victims and situations.simulated disaster victims and situations.

Results - students will learn to be self Results - students will learn to be self sustaining, and gain confidence in their sustaining, and gain confidence in their ability to work and live in a disaster ability to work and live in a disaster environment. Also teaches students how environment. Also teaches students how teamwork plays a big part in making the teamwork plays a big part in making the unpleasant task of living and working in the unpleasant task of living and working in the field more manageable and less stressful.field more manageable and less stressful.

Field Living Skills FacultyField Living Skills Faculty

Field Living Skills Schedule – Day 1Field Living Skills Schedule – Day 1

8:30am8:30am Arrive, introduction and orientation Arrive, introduction and orientation 9:00am9:00am Establish need (working in/around disaster Establish need (working in/around disaster

area)area) 9:30am9:30am Dressing for the fieldDressing for the field 10:00am10:00am Personal Protective EquipmentPersonal Protective Equipment 10:30am10:30am Field SanitationField Sanitation 11:30am11:30am Lunch with MRE Demo and lectureLunch with MRE Demo and lecture 12:00pm12:00pm Field SafetyField Safety 1:00pm1:00pm Establishing your living areaEstablishing your living area 2:30pm2:30pm Break to unload vehiclesBreak to unload vehicles 3:00pm3:00pm Field exercise startsField exercise starts Mental Health Exercise Mental Health Exercise 5:00pm5:00pm Distribute evening mealDistribute evening meal Mental Health ExerciseMental Health Exercise

Field Living Skills – Tent set upField Living Skills – Tent set up

Field Living Skills Schedule – Day 2Field Living Skills Schedule – Day 2

6:00am6:00am Arise, breakfast and pack Arise, breakfast and pack up equipmentup equipment

7:00am7:00am Written ExamWritten Exam 7:30am7:30am Exercise reviewExercise review 8:00am8:00am Class dismissedClass dismissed 8:30am8:30am New class arrives (repeat New class arrives (repeat

cycle)cycle)

Field Living Skills – Team BuildingField Living Skills – Team Building

Field Living Skills – Yummy MREsField Living Skills – Yummy MREs

Field Living Skills – PFAField Living Skills – PFA

May/June 2008 Tornado & May/June 2008 Tornado & FloodingFlooding


May/June 2008 Tornado &FloodingMay/June 2008 Tornado &FloodingFalcon Crest ApartmentsFalcon Crest Apartments

May/June 2008 Tornado &FloodingMay/June 2008 Tornado &FloodingFalcon Crest ApartmentsFalcon Crest Apartments

Over 200 units destroyed and 400+ Over 200 units destroyed and 400+ people displaced.people displaced.

Some units were deemed structurally Some units were deemed structurally unsound and residents were not allowed to unsound and residents were not allowed to go back and gather any remaining go back and gather any remaining belongings. belongings.

20% of residents received low income 20% of residents received low income housing subsidies. housing subsidies.

Some residents were current patients at Some residents were current patients at local mental health centers. local mental health centers.



Columbus Regional HospitalColumbus Regional Hospital


Columbus Regional HospitalColumbus Regional Hospital

May/June 2008 Tornado &FloodingMay/June 2008 Tornado &FloodingColumbus Regional HospitalColumbus Regional Hospital

Entire basement and first floor floodedEntire basement and first floor flooded Critical functions suspended - laboratory, Critical functions suspended - laboratory,

pharmacy, information technology, central pharmacy, information technology, central processing/materials management, processing/materials management, storeroom, and food services/kitchen. storeroom, and food services/kitchen.

100 patients airlifted to other facilities (17 100 patients airlifted to other facilities (17 from Psychiatric Unit).from Psychiatric Unit).

Residents had to seek care elsewhere. The Residents had to seek care elsewhere. The nearest hospital is over 30 miles away. nearest hospital is over 30 miles away.

Over 1,700 employees - many had their Over 1,700 employees - many had their homes severely damaged or destroyed as homes severely damaged or destroyed as well. well.

Damage estimates - $25 million. Damage estimates - $25 million. Closed for 6 – 8 weeks.Closed for 6 – 8 weeks.

May/June 2008 Tornado &FloodingMay/June 2008 Tornado &FloodingRegional Mental Health Teams Regional Mental Health Teams

RespondsResponds

May/June 2008 Tornado &FloodingMay/June 2008 Tornado &FloodingCrisis Counseling ResponseCrisis Counseling Response

Missions request from Local EMA’s to Missions request from Local EMA’s to State for mental health teams, State for mental health teams,

Three regional teams (using current Three regional teams (using current district disaster mental health teams)district disaster mental health teams)

564 contacts made during Interim 564 contacts made during Interim (5/30-6/11)(5/30-6/11)

92 Referrals made92 Referrals made State of Indiana developed one stops State of Indiana developed one stops

for disaster relief, had teams onsitefor disaster relief, had teams onsite

Documents

Indiana Division of Mental Health & Addiction