DISASTER BEHAVIORAL HEALTH EMERGENCY RESPONSE PLAN
(revised July 2006)
The Kentucky Community Crisis Response Board (KCCRB) created under KRS Chapter 36 is recognized as the lead disaster behavioral health agency by the state mental health authority, the Department for Mental Health and Mental Retardation Services (DMHMRS), Kentucky Division of Emergency Management (KyEM) and the American Red Cross (ARC), and has the primary responsibility to ensure provision of disaster behavioral health services for the Commonwealth through the Kentucky Community Crisis Response Team (KCCRT) and other available behavioral health resources.
The “Robert T. Stafford Disaster Relief and Emergency Assistance Act,” establishes the requirement that states plan for the provision of disaster behavioral services. It authorizes financial assistance to State/local agencies or private organizations to provide crisis counseling services including outreach, referrals, psycho-education, and short-term interventions, to survivors of major manmade or natural disasters. Section 416 of this act specifically addresses the behavioral health function.
The purpose of the disaster behavioral health response plan is to mitigate the adverse effects of disaster-related trauma by promoting and restoring psychological well-being and daily life functioning of individuals and the community.
Each individual is unique in responding to the stress and sudden precipitous losses associated with a disastrous event, whether natural or manmade. The plan encompasses the psychological, social and educational-related supports required to facilitate recovery. It provides a framework for the following activities: planning for disaster events, responding to the immediate impact of an event, and assisting Kentucky’s residents and visitors to recover from the impact of a disaster over the long term.
III. SITUATION AND ASSUMPTIONS
1. Kentucky is vulnerable to a number of hazards that may occur with or without warning. These hazards could result in loss of life, damage to or destruction of homes and businesses or evacuations of the latter, loss of personal property, disruption of food, routine medical, pharmaceutical, or utility services distribution, or pose serious health risks and other situations that adversely affect the daily life functions.
2. Emergency situations could result in the loss of communication, transportation, and normal social assembly, creating potential behavioral health hazards.
3. Hospitals, nursing homes, group homes, ambulatory care centers, schools, shelters, churches and other facilities, which provide behavioral health care and support for special needs populations, may be damaged or destroyed or may be overwhelmed in dealing with medical response.
4. Behavioral health facilities that survive emergency situations with little or no damage may still be unable to operate normally. This could be due to a lack of utilities, impact of the event on normally available staff or an inability to safely report for duty, or damage suffered by communication or transportation systems.
5. Local behavioral health providers, both public and private, that survive emergency situations, with little or no damage, may be called upon to provide both personnel and physical resources to the community.
6. Use of chemical, biological, radiological, nuclear, or explosive weapons of mass destruction may lead to widespread disorientation. The behavioral health needs that may result from such events would quickly overwhelm the local response system, thus requiring state and/or federal assistance.
7. Emergency responders, victims, and others who are affected by emergency situations may experience varying levels of stress and anxiety. They may also display other physical and psychological symptoms that could adversely affect their ability to respond and perform and may impact their personal lives.
1. All people involved in a disaster are affected by it in some way, from its most immediate victims (including their family members and friends), to emergency response workers (fire fighters, police officers, emergency medical personnel, emergency management, etc.), and the public at large. Research suggests that the majority of people, following a disaster, will return to pre-event psychological functioning within a relatively short time.
2. Each person’s response to a disaster is unique, based on his/her trauma history, health status, culture, beliefs, social support systems, and personal resiliency. Reactions to the event can be cognitive, emotional, physical, behavioral and spiritual, and may not manifest for several weeks and months following the incident.
3. People with special needs, especially those with pre-existing behavioral health and substance abuse illnesses, older individuals, or people with disabilities, may be more prone to experience severe stress reactions or relapse than other populations.
4. The public will require information on how to recognize and cope with the short and/or long-term risk of sustained stress caused by a disaster or arising from its effect.
5. Outreach, early psychological first aid and referrals can assist survivors to meet new challenges and offer support in their recovery process to return to pre-disaster performance and functioning levels.
6. An informed public will be better able to cope with the stresses associated with a disaster.
7. Although many stress-related problems are associated with disasters, there is usually adequate local capability to meet most emergency situations, even if it is only for a limited period of time.
8. Disaster behavioral health workers will not enter an impacted area until their safety can be assured through the local/State EOC or the Incident command.
9. In order to supplement local behavioral health resources, state and possibly federal assistance will be available upon request by the impacted county Emergency Operations Center (EOC) or the State Emergency Operations Center (SEOC).
10. The American Red Cross (ARC), Voluntary Organizations Active In Disaster (VOAD) and other organizations may be used to provide behavioral health assistance to disaster victims. Such assistance will be coordinated through the local/State EOC or the Incident command.
11. Local professional volunteer organizations, charitable groups and faith-based teams may also respond to emergency events; such assistance will be coordinated through the local/State EOC or the Incident command.
12. Disaster behavioral health workers will triage, assess, provide early psychological first aid, and make referrals, consistent with the level of training or the level of individual need.
13. Current standards of care, including the individual’s right to confidentiality and individual’s right to refuse services, will be observed and practiced.
14. Behavioral health responders will adhere to the requirements of Kentucky Statutes regarding mandatory reporting of suspected abuse of children, disabled and the frail elderly and duty to warn of intentions to harm self or others.
IV. CONCEPT OF OPERATIONS
1. All-hazards preparedness and response must be coordinated at all levels, including local, state, and federal, to mitigate the short and long-term affects of stress, prevent stress related morbidity and implement a coordinated, sustained recovery operation.
2. The Kentucky Department for Public Health (DPH) is the primary point of contact in the event of a public health emergency.
3. The Kentucky Community Crisis Response Board (KCCRB) created under KRS Chapter 36 is recognized as the lead disaster behavioral health coordinating agency by the state mental health authority, the Department for Mental Health and Mental Retardation Services (DMHMRS), Kentucky Division of Emergency Management (KyEM) and the American Red Cross (ARC), and has the primary responsibility to assess and insure the provision of disaster behavioral health services for the Commonwealth.
4. Any or all disaster behavioral health support teams (as described in VII) may be requested to activate in response to a disaster or state or federally declared emergency. Activation is normally at the request of local government through the SEOC.
5. During local emergencies or disasters the county EOC will serve as the local point of contact for the KCCRB and will be supported by the KCCRB and disaster behavioral health teams as needed.
6. Local provisions and plans must be made for the following:
a. Establishment of a Disaster Behavioral Health Plan for Emergency Response Appendix in the County Emergency Operations Plan (CEOP).
b. Inclusion of a disaster behavioral health liaison appointed at the local level to ensure coordinated behavioral health response and recovery efforts.
c. Disaster behavioral health response teams will triage individuals who have been impacted by the disaster for behavioral health needs.
d. Medical intervention including transportation and hospitalization for people exhibiting profound behavioral health symptoms.
e. Preparing advisories for the public, in coordination with the Incident Public Information Officer or the Joint Information Center, on issues such as stress symptom identification and management.
f. Conducting behavioral health assessments of, and support for, special needs shelters, Points of Distribution, Alternate Treatment Sites, Disaster Recovery Sites, Comfort Stations, Isolation and Quarantine sites, etc.
g. Development of mechanisms to track the number and types of contacts made by disaster behavioral health workers.
h. Establishment of stress management procedures for first responders and caregivers.
B. BEHAVIORAL HEALTH SERVICES:
1. Appropriate disaster behavioral health services must be made available for responders, their families, victims, survivors and other community members during emergency response and recovery operations, including triage, assessment, early psychological first aid, and referral.
2. Disaster behavioral health response teams (as described in VII below) will be activated upon notification by the SEOC.
C. BEHAVIORAL HEALTH SUPPORT FOR EMERGENCY RESPONDERS:
KCCRB will coordinate disaster behavioral health services for all emergency responders. KCCRB will also ensure disaster behavioral health responder stress management procedures are in place and provide education on stress management to responder agencies.
V. ORGANIZATION AND ASSIGNMENT OF RESPONSIBILITIES
1. The local EOC behavioral health liaison functions as the local disaster behavioral health-coordinator.
a. The local EOC has primary responsibility for requesting assessment and provision of coordinated disaster behavioral health support services during locally designated emergencies or disasters.
b. In the event that local behavioral health response becomes overwhelmed or can no longer maintain the level of response required by the event; the local EOC will request additional disaster behavioral health resources through KCCRB at the SEOC.
c. The KCCRB representative at SEOC will assess the need for additional behavioral health resources and determine which state assets are appropriate to meet the need.
d. The KCCRT state representative will be responsible for activating disaster behavioral health response teams.
2. The KCCRB functions as the State disaster behavioral health coordinating agency.
a. The KCCRB representative at the SEOC will contact the EOC’s in impacted areas to coordinate behavioral health assets.
b. Upon receipt of official notification of an actual or potential emergency situation; it is the responsibility of the KCCRB representative at the SEOC to receive and evaluate all requests for disaster behavioral health assistance and to disseminate such notification to appropriate local behavioral health organizations, voluntary organizations, and disaster behavioral health response teams for assessment and action.
c. During a state and/or federal emergency, KCCRB has the primary responsibility of ensuring coordinated behavioral health services.
d. In the event of a federal declaration, it is the responsibility of KCCRB to evaluate the need for and pursue funding for a FEMA Crisis Counseling Program (CCP) Grant.
B. ASSIGNMENT OF RESPONSIBILITIES:
1. General: All agencies or organizations assigned to disaster behavioral health function are responsible for following:
a. Designating and training representatives of their agency in compliance with training standards established for disaster behavioral health response teams (as described in VII. below);
b. Ensuring that disaster behavioral health standard operating procedures are developed and maintained;
c. Maintaining current emergency notification procedures.
2. Regional Health & Medical Committee:
a. Designate a primary and secondary regional disaster behavioral health consultant to work with Emergency Operations Centers to perform pre-emergency planning for emergency behavioral health services and coordinate the latter during major emergencies and disasters, when requested.
3. KCCRB Representative(s) at SEOC:
a. Coordinate disaster behavioral health activities from the SEOC or other location, as appropriate;
b. Rapidly assess community behavioral health needs, based on established protocols for assessment and accountability as established by the KCCRB;
c. Oversee and coordinate the efforts of regional, state, or external behavioral health organizations activated for an emergency; request additional resources as the need develops;
d. Ensure that disaster behavioral health teams, responding to a disaster site, establish a disaster behavioral health element with local emergency management;
e. Coordinate with state and federal officials regarding state and federal behavioral health assistance;
f. Establish communications with disaster behavioral health response teams;
g. Ensure that positive identification (and proof of licensure, if required) and contact information is obtained from all disaster behavioral health responders;
h. Coordinate the procurement, screening, and allocation of behavioral health supplies and resources, including human resources, required to support behavioral health operations;
i. Provide, through the incident PIO, information to the news media for the public on dealing with emerging behavioral health issues;
j. Establish preventive behavioral health services by informing the general population about resiliency and normal coping behaviors;
k. Coordinate the provisions of disaster behavioral health services for disaster victims, emergency workers, and others suffering psychological trauma due to the emergency situation.
4. Public Information Officer (PIO)/Joint Information Center (JIC):
A KCCRB representative will coordinate with the Joint Information Center and may request that local PIOs distribute public emergency information provided by behavioral health officials. A disaster behavioral health expert will review all risk communication intended for the public.
5. The Faith-Based Community:
Provides spiritual care and counseling on an individual or group basis as requested or referred. When possible, service provision by state or national faith-based organizations should be coordinated with the local EOC or the KCCRB representative at the SEOC, in order to coordinate response and prevent duplication of effort.
6. American Red Cross (ARC):
Provides and coordinates behavioral health capabilities at mass care shelters, ARC service sites, mine disaster sites and transportation crash sites. When possible, service provision should be coordinated with the local EOC or the KCCRB representative at the SEOC, in order to coordinate a continuum of care to providers within the community.
VI. DIRECTION AND CONTROL
A. Community behavioral health agencies are expected to continue routine activities during emergency situations. Direction and control of such operations will be by those that normally direct and control day-to-day behavioral health services. Community behavioral health agencies may receive referrals from Behavioral Health Support Teams and may participate as members of these teams.
B. Private, voluntary, and faith-based agencies providing behavioral health support during emergencies are expected to conform to the general guidance provided by the Incident Command System and carry out mission assignments, as directed by the local or state EOCs in conjunction with the KCCRB. However, organized behavioral health response teams will normally work under the immediate control of their team leaders.
VII. DISASTER BEHAVIORAL HEALTH SUPPORT TEAMS
A. TEAM COMPOSITION AND STAFFING:
1. KCCRB will maintain a work plan for disaster behavioral health support teams. The plan will include the final composition of disaster behavioral health teams. KCCRT members will be led by individuals with past experience in disaster response.
2. KCCRB may designate specialized teams (e.g. teams trained to deal with the elderly, shelter populations, children, people with disabilities, responders, etc.).
3. KCCRB will work with counties and/or regions to develop and train disaster behavioral health teams in Kentucky.
B. TEAM TRAINING:
1. KCCRB will identify disaster behavioral health team member competencies, and will establish minimum training requirements for team members.
2. KCCRB will initiate/review/endorse training programs and trainers.
3. KCCRB will be responsible for assuring that disaster behavioral health team members are appropriately trained.
C. TEAM DEPLOYMENT:
1. The KCCRT will be deployed by the KCCRB representative at the SEOC.
2. The appropriate type, composition and number of teams will be determined by KCCRB.
3. All requests for deployment will include the expected date/time of arrival and the name, title, location and telephone number of the local contact person.
4. Teams will report to assignments within 24 hours of activation in-state and within 72 hours of activation out-of-state.
5. Teams will be demobilized after 7 days of deployment. KCCRB will assure that operational debriefings are available as teams are demobilizing (such as submitting expenses/hours worked, etc).
VIII. ADMINISTRATION AND SUPPORT
1. In addition to reports that may be required by their parent organizations, disaster behavioral health response teams will provide situation reports through the local Incident Command System.
2. Expense reports for deployed teams will be reported through KCCRB.
B. MAINTENANCE AND PRESERVATION OF RECORDS:
1. MAINTENANCE OF RECORDS. Behavioral health operational records, generated during an emergency, will be collected and filed in an orderly manner by KCCRB. Record of events is preserved for use in determining the possible recovery of emergency operation expenses, response costs, assessing the effectiveness of operations, and updating emergency plans and procedures. Federal guidelines require that administrative records be held for a period of three years post event.
2. DOCUMENTATION OF COSTS. Expenses incurred in carrying out behavioral health services for certain hazards may be recoverable through FEMA or a third party. Hence, all agencies should maintain records of personnel and equipment used and supplies consumed, including substantiating documentation, during large-scale behavioral health operations for a period of no less than three years.
3. CLINICAL RECORDS. Individual clinical records will not be developed or maintained by Disaster Behavioral Health Support Teams during a disaster.
C. AFTER ACTION REVIEW/REPORTS:
Organizations should conduct an after action review of behavioral health response activities as soon as possible after an exercise or disaster event, based on KCCRB protocols. The purpose of this review is to identify both successful operational procedures and identify and implement needed improvements.
1. All local drills, tabletop exercises, functional exercises, and full-scale exercises should include behavioral health participation. Additional drills and exercises may be conducted for the purpose of developing and testing abilities to make behavioral health response to various types of emergencies more effective. Organizations that provide disaster behavioral health during emergency situations shall participate in emergency drills and exercises, when appropriate.
2. KCCRB shall test this preparedness and response plan annually, at minimum.
IX. PLAN DEVELOPMENT AND MAINTENANCE
A. The Kentucky Division of Emergency Management is the approving authority for this plan.
B. KCCRB is responsible for the development and maintenance of this plan. KCCRB is responsible for conducting annual reviews, coordinating all review and revision efforts, and incorporating information learned from exercises and actual events into this plan.