Texas Department of State Health Services Disaster Behavioral Health Services

Chance A. FreemanBranch Manager

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Disaster Behavioral Health 101

Overview of Disaster Behavioral Health (DBH)

• What DBHS & DBH Providers Do• What DBHS & DBH Have To Offer• Define

• What Disaster Behavioral Health Is• What Disaster Behavioral Health Is Not

• DBH Coordination – How to request DBH• Local/Regional/State• What Should Be Done• What Should Not Be Done

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What LMHAs DoDay-to-Day

LMHAs provide mental health services to adults and children who have chronic, severe and persistent mental illnesses such as: •Schizophrenia•Major depression•Bipolar disorder•Other disorders which require crisis resolution or ongoing support and treatment.

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LMHA Service Areas4

Crisis Counseling vs.Traditional Mental Health

Traditional• Primarily office-based• Focuses on diagnosis and

treatment of mental illness• Attempts to impact

personality and functioning• Examines content• Encourages insight into

past experiences and influence on current problems

• Psychotherapeutic focus

Crisis Counseling• Primarily home and

community-based• Assessment of strengths,

adaptation and coping skills• Seeks to restore pre-

disaster functioning• Accepts content at face

value• Validates appropriateness

of reactions and normalizes experience

• Psychoeducational focus

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What OSARs DoDay-to-Day

• Outreach, Screening, Assessment and Referral Centers (OSARs) are the first point of contact for those seeking substance abuse treatment services.

• Regardless of ability to pay, Texas residents who are seeking substance abuse services and information may qualify for services based on need.

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Definition of Disaster Behavioral Health (DBH)http://www.phe.gov/Preparedness/planning/abc/Documents/DisasterBehavioralHealth.pdf

Disaster behavioral health is the provision of mental health, substance abuse, and stress management to disaster survivors and responders.

• U.S. Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response

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What is DBH? (cont.)• The primary goal is to decrease the stress of an event and mitigate future problems

• Modalities may include Psychological First Aid, Spiritual Care, Substance Abuse services, Critical Incident Stress Management (CISM), Crisis Counseling, or other crisis intervention and disaster specific support services

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What is DBH? (cont.)

•Community based•Focus on strengths & coping skills•Restore functioning•Confirms reactions are common/normal

•Focus is educational

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What DBH is NOT, or at least SHOULD NOT be...

•We ARE NOT there to provide traditional therapy

•We ARE NOT there to make a diagnosis

•We ARE NOT there to “look” for customers or consumers

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Possible DBH Outreach Locations

• Disaster Recovery Center (DRC)• Incident Command Post (ICP)• Points of Distribution (POD)• Mass Care Shelter• Joint Field Office (JFO)• Disaster District Committee (DDC)• Regional Health and Medical Operations Center (RHMOC)

• Family Assistance Center (FAC)• Re-entry Points

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Typical Phases of DisasterEmotional

Highs

EmotionalLows

Setback

Source: Zunin/Meyers, as cited in U.S. Department of Health and Human Services. (2000). Training manual for mental health and human service workers in major disasters (DHHS Publication 90–538). Washington, DC: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration , Center for Mental Health Services.

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Department of State Health Services Disaster Behavioral Health Services (DBHS)•Responsible for all-hazards disaster preparedness, response and recovery in Texas

•DBHS is housed in Adult Mental Health Services

•Works closely with Community Preparedness Section of DSHS

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DBHS Program Functions1. Serve as the liaison to the Texas Division of

Emergency Management and other federal resources on disaster behavioral health issues

2. Coordinate all DBH, Crisis Counseling and Critical Incident Stress Management services during a state or federally declared disaster

3. Provide brief crisis counseling services during state or federal critical incidents or disasters

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4. Develop and submit all State and FEMA grant applications on behalf of DSHS & the impacted communities

5. Assist in the development of internal emergency response abilities and resources and assist in the coordination of internal response and recovery activities from traumatic events

Program Functions (cont)15

•Texas Division of Emergency Management (TDEM)

•Federal Emergency Management Agency (FEMA)

•Substance Abuse and Mental Health Services Administration (SAMHSA)

•Center for Mental Health Services•39 Community Mental Health Centers

aka – Local Mental Health Authority

DBHS Partners16

•140 Substance Abuse Providers•Voluntary Organizations Active In Disasters (VOADs)

•Texas Critical Incident Stress Management Network (CISM)

•American Red Cross•DBH Consortium

DBHS Partners (cont.)17

Incident Command System (ICS)The Incident Command System (ICS) is a standardized, on-scene, all-hazards incident management approach that:

• Allows for the integration of facilities, equipment, personnel, procedures and communications operating within a common organizational structure.

• Enables a coordinated response among various jurisdictions and functional agencies, both public and private.

• Establishes common processes for planning and managing resources.

• ICS is flexible and can be used for incidents of any type, scope and complexity.

Source: http://www.fema.gov/incident-command-system

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TEXAS ICS Structure

EMACFEMA

LOCAL RESPONSE

EOC & EMC

DDC HSR-RHMOC

SOC-TDEMOFFICE OF THE GOVERNOR

DSHS SMOC

DISASTER!

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Typical Local Response20

21Questions

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• DSHS DBHSDSHS DBHShttp://www.dshs.state.tx.us/mhsa-disaster/

• National Child Traumatic Stress Network PFANational Child Traumatic Stress Network PFAhttp://www.nctsn.org/content/psychological-first-aidhttp://www.nctsnet.org/content/pfa-mobile

• World Health PFA modelWorld Health PFA modelhttp://www.who.int/mediacentre/news/releases/2011/http://www.who.int/mediacentre/news/releases/2011/humanitarian_relief_20110819/en/index.htmlhumanitarian_relief_20110819/en/index.html

• Substance Abuse Mental Health Services Administration (SAMHSA)Substance Abuse Mental Health Services Administration (SAMHSA)http://store.samhsa.gov/pages/searchResult/psychological+first+aidhttp://store.samhsa.gov/pages/searchResult/psychological+first+aid

http://disasterdistress.samhsa.gov/http://disasterdistress.samhsa.gov/

• FEMA Incident Command System Training FEMA Incident Command System Training http://www.training.fema.gov/EMIWeb/IS/ICSResource/index.htmhttp://www.training.fema.gov/EMIWeb/IS/ICSResource/index.htm

• National Standards For State & Local Planning – Public Health National Standards For State & Local Planning – Public Health Preparedness CapabilitiesPreparedness Capabilitieshttp://www.cdc.gov/phpr/capabilitieshttp://www.cdc.gov/phpr/capabilities

Useful Resources