Moderator: Hello and
welcome everyone. This is Marcela Aguilar
from the Substance Abuse and Mental Health Services
Administration’s Disaster Technical Assistance
Center or SAMHSA DTAC. I will be your host
for this webinar. Let’s begin with Promising
Practices in Disaster Behavioral Health:
Logistical Support. The webinar will feature
Ms. Terri Spear, Emergency Coordinator of
the SAMHSA Office of Policy, Planning & Innovation; Ms. Lori McGee, Training and Curriculum
Manager of SAMHSA DTAC; and Mr. Steve Crimando, Principal of
Behavioral Science Applications. We will start with
Ms. Terri Spear; Ms. Spear serves as Emergency
Coordinator in the Substance Abuse and Mental Health Services
Administration, Division of Policy Innovation where she
coordinates the SAMHSA response in emergency situations, including ensuring cross-SAMHSA coordination regarding terrorism
and mass trauma events. She serves as the primary SAMHSA
liaison with counterparts in other Federal, State, local,
and voluntary agencies, organizations, and
governments participating in crisis response operations. Ms. Spear earned
master of education in counseling psychology
from the State University of New York at Buffalo. Please welcome
Ms. Terri Spear. Ms. Spear: Thank you. SAMHSA wishes to welcome all of
those accessing this webinar. The development of this
series is directly linked to the efforts SAMHSA included
in its March 2011 document Leading Change: A
Plan for SAMHSA’s Roles and Actions, 2011-2014. SAMHSA introduces eight new
strategic initiatives that will guide SAMHSA’s work to help
build strong communities, prevent behavioral
health problems, and promote better health. This is this sixth webinar in
the series of nine webinars that are occurring
across the summer. The program is intended
for State and Territorial Behavioral Health Coordinators
as well as others involved in disaster planning,
response, and recovery. This initiative falls under
trauma and justice within our strategic initiatives. Research has shown that
8.9 percent of men and 15.2 percent of women in the U.S. reported
a lifetime experience of a natural disaster. We know that over the past
10 years the number of disasters occurring across
the country ranges between 65 to 100 federally declared
disasters and many more that occur that are not declared. Planning is of utmost
importance and this series is focused on disseminating
the best of what is known to equip the best response possible with the resources at hand. Moderator:
Thank you Ms. Spear. I would now like to
introduce Ms. Lori McGee. Ms. McGee serves as the
Training and Curriculum Manager for SAMHSA DTAC. She has more than 11 years’
experience working with program and curriculum
developers to improve services using evaluation findings. At SAMHSA DTAC she
supervises the development of training, both in
person and web based. She is also the lead on
the Crisis Counseling Assistance and Training
Program activities. Ms. McGee has worked with
at-risk and delinquent youth populations, populations
receiving mental health services, women and family in crisis, and minority students. She has prior experience
in providing counseling, legal services to survivors
of domestic violence, and in developing programs to reduce and prevent violence in schools. Ms. McGee holds a bachelor’s in
psychology from Barnard College and a master’s in criminology
and criminal justice from the University of
Maryland, College Park. Please welcome
Ms. Lori McGee. Ms. McGee: Hello everyone. For those of you that are
joining us again in this series we welcome you back. For those who might be
joining us for the first time, we are glad to have you with us
and hope that you will continue to join us for the remaining
webinars in this series. A reminder that the webinars
are recorded and archived. We will send that information
out as soon as we have it if you missed one or if you
anticipate missing one of the future ones. I would like to take a
minute to talk about SAMHSA DTAC and our services. Our mission is to provide
training and technical assistance to States,
Territories, and Tribes in hopes that they are better prepared
for and able to respond to disaster behavioral health
needs in their communities. When I say the term
“disaster behavioral health” we are including mental
health and substance abuse. You can see a little snippet
on the slide here that is a copy of the
front of our brochure. If you would like more
information about what we do or some of the services
we offer you can always download that
from our website. We provide an array of
services; these services are free. We provide consultations
and training on DBH topics including disaster
preparedness and response, acute interventions,
promising practices, special populations such
as children and youth, older adults, Tribes,
people with disabilities or access and functional needs. We also provide dedicated training and
technical assistance. This is primarily in the areas
of FEMA’s Crisis Counseling Assistance and
Training Program. Also, identification and
promotion of promising practices of which this
webinar is a piece of that. That work is geared towards
disaster preparedness and planning and integration of DBH into the emergency management and public health fields. We also have additional
resources; this is a screen shot of our website
where you can find our Disaster Behavioral Health
Information Series. These series contain toolkits
or resources, handouts, leaflets on a bunch of different topics
falling into the categories of DBH preparedness and response,
specific disaster such as a flood or a tornado and
also specific populations, like those mentioned before,
children and youth or older adults, various
different populations. We wanted to make sure you
are aware of some of the free e-communications
that we have. There is a monthly Bulletin,
this is a newsletter of resources and events and you
can subscribe by emailing us. We also offer The Dialogue;
this is a quarterly journal of articles written by professionals in the field and you can subscribe to it by following the instructions on your screen, going to the
SAMHSA website and entering your email address and
checking on The Dialogue for your preferred
communication. Finally, we have the Discussion
Board; this is a place to post different resources, we
ask questions of the field; we can use it for if
you have a question of your colleagues that are also using the Discussion Board. It is an area to converse with
one another about DBH topics and you can subscribe by going
to the website listed here. Finally, I wanted to point out
if you have any training or technical assistance needs
for yourself or your staff or your colleagues, you can always call us-the toll-free number is 1-800-308-3515-and you can
email us or you can visit our website and browse around and
look for more information on whatever topic it is or
resource it is that you need. Here is our Project Director,
Dr. Amy Mack, and I know she always looks forward to hearing
from you; you can phone her directly or send her an email. If you have any training
or technical assistance needs just give us a shout. Moderator: Thank you
so much Ms. McGee. I would now like to
introduce Mr. Steve Crimando. Mr. Crimando is renowned expert
with more than 20 years of experience in disaster planning,
consulting, and training. He is a clinician and
educator specialized in crisis intervention, disaster recovery, and traumatic event response. He has achieved the
status of diplomate of the American Academy of Experts
in Traumatic Stress and is a board-certified
expert in traumatic stress. He also holds Level Five
Certification in Homeland Security through the American
College of Forensic Examiners International where he serves
on the board of directors for the International College
of the Behavioral Sciences. Please welcome Mr. Crimando. Mr. Crimando: Thank
you Marcela and thank you everyone for
joining us today. As we said earlier,
regardless of if this is your first webinar with us
or you are rejoining us for another session I certainly
hope that there is a lot of useful information
we can share today. As was mentioned earlier, we
will be taking some questions via chat and answering them
towards the end of this session. I have looked at the list of
participants that is here on my screen and I see that there are
a lot of names that I recognize and I certainly understand and
appreciate that there are many individuals participating today
that have extensive experience in developing disaster behavioral health plans and a lot of experience
responding to disasters. My invitation to each of you is
not in any way to discard your existing plans, but rather
what I refer to the three As, adopt, adapt, and apply. Adopt some new learning about
innovative ways of thinking about and planning for
the needs of individuals, families, and communities
in the wake of a disaster. Adapting and updating your
plans to incorporate some of the interesting approaches
and promising practices that we are discussing and
integrating them into your overall State,
Territory, or tribal emergency and disaster plans. Lastly, applying these concepts
in the larger context of your jurisdictions’ unique risks and resources can ensure that these ideas accurately fit the
disaster behavioral health needs of your community. Our program today will focus
on disaster behavioral health planning standards,
specifically the one addressing logistical support. In our time together we
will identify the critical elements of logistical support,
before during, and after a disaster and identify
promising practices and how personnel and
resources are deployed. We will also address those
elements of an effective logistical support
system to include the identification of training
mechanism response personnel and utilization of
VOADs and volunteers. There are many moving parts
to a comprehensive disaster behavioral health plan and there
are even more involved with an actual deployment. In this session we will
share some lessons learned and promising practice from the
field that can help you better prepare to address the
logistical challenges from notification, activation, and deployment, to communications and supervision in the field
right through demobilization. There are 11 indicators
that demonstrate clarity in the logistical support
section of a NIMS-compliant disaster behavioral
health plan. Let me quickly go through
the list of these 11. First, a list of resources
for personnel and how resources
will be deployed. Number two, a description
of how the State utilized services through
interstate and other Federal programs such as
EMAC, ESAR-VHP and the Medical Reserve Corps. Number three is a plan for
utilization of volunteers, including those VOADs,
volunteers organizations active in disaster. Number four, a list of
titles for responders. You may remember one of our
central Incident Command System and NIMS concepts is there are
very discreet and different titles for folks during response activities they may coordinate or associate with
their day jobs. Number five is a description
of the process for deploying, activating, and
backing up personnel; we refer to that as the
cascade of authority. Number six, a section to
address crosstraining between emergency management,
public health, and disaster behavioral
health personnel. Seven, identification of
disaster behavioral health personnel in ways
that makes them identifiable out in the field. We will discuss ideas
like visually identifying clothing, things
of that nature. Number eight, a process for notifying key
response personnel. Nine, outlining the roles and
the coordination of volunteers. The last of these are
numbers 10 and 11 that address the identification of specific
training mechanisms, including things like training and Incident Command Systems and NIMS, other specific disaster behavioral health skills, and the overall National
Response Framework. Lastly, number 11, that the
plan should contain and clearly identify mechanisms
for communication between different agencies, between our leadership and those deployed out in the field and we will
go into some depth about how we really look at promising
practices in communications as we address that specific
part of the standard. When we discuss logistical
support it is important for planners to consider incidents
of all different types all different sizes, even
large-scale and catastrophic events that may require
us requesting or sending resources across State lines. As such it is important
for the State Coordinator and all of us involved in
planning to be well briefed in interstate and Federal programs
such as EMAC, ESAR-VHP, and as I mentioned, the Medical Reserve
Corps and to fully describe in our plan how the State may utilize these services and share resources with
other jurisdictions through these programs. As we describe logistical
support there is a number of important indicators
that demonstrate that this standard has been
thoroughly addressed. Some specifics are listing
titles for and visually identifying disaster
behavioral health responders. A description of identification
may include things like hats or jackets or lanyards or other articles of clothing that would help disaster behavioral health
responders to be identified, locate their teammates, be
spotted by their supervisors, be picked out so they could
be approached by consumers and also so overall incident management personnel can spot us in a crowd, can
have a sense of where our personnel are in an
active, deployed situation. In addition, we describe a
process for using, coordinating, and supervising volunteers;
more on that later. A discussion of how disaster
behavioral health personnel may cross-train with other
disciplines, such as our public health workers or other sorts
of emergency management and response professionals. We will explore many of these
indicators in others as well as some promising practices and
advice from different State planners throughout the session. For example, several State
planners identified that exercising the plan was one
of the most useful ways to serve its logistical needs. One planner specifically
developed a form for structuring an initial needs assessment
for what sort of equipment and supplies would be needed in
a given response and stressed the importance of frequently updating those checklists and needs assessments from disaster
recovery sites so they could stay on top of logistic
needs in real time during a deployment or activation. At least one planner
cautioned that this standard should not be taken lightly. The lack of logistical
planning could undermine an otherwise very solid plan. The NIMS concept of logistics
helps us shape and form the idea of what is an NIMS-compliant
Incident Command System approach to the logistics or
logistical support needs for disaster behavioral health. Of course, this encompasses
services, support needs for an incident, things that
speak directly to who are essential personnel, what
are critical facilities; what sort of equipment and supplies
should be anticipate needing during deployment and how we
actually access those supplies. Applied to disaster behavioral
health plan it is important that the plan clearly
demonstrates and describes these methods
of logistical support. Meeting the standard means
that the plan describes how the State utilizes service
and identification of personnel resources and specifically
how they are deployed. Many of the planners
noted specifically that an understanding and following
the Incident Command System including clear logistic
sections in disaster behavioral health plan was one of the
most critical elements in facilitating a timely
delivery of needed resources during an actual event. As much as this may seem like
it is someone else’s job to take care of those logistics
it is very central to what we need to do in our disaster
behavioral health plans to make sure that the unique needs for disaster behavioral health responders are in line and ready
to go when we are called upon. While there are 11 different
indicators of the NIMS-compliant logistic section we know that
by and large these 11 indicators fall into three main groups. I am going to structure my
discussion for the remainder of my section in this
way to look at logistics from three categories. Those categories are personnel,
partners, and communication. Personnel discusses how disaster
behavioral health responders are recruited, screened, and
trained as well as how teams are formed, deployed, and supervised out in the field. When we discuss partners this
can range from working with those across State lines
through EMAC or ESAR-VHP but specifically to things like
MOUs to written agreements and relationships
with local VOADs. Lastly, that category
that I mentioned, communications, including
mechanisms for notifying, deploying personnel and
processes to receive timely information in the form of
situation reports, safety briefings, and so forth so our
folks are always in the loop. Those can also address and we
will also touch on issues that may also incorporate other
Incident Command concepts like staging and transportation
of responders. We will go deeper into each of
these and try to provide some useful examples from the
States and the different promising practices
that have been developed. The first of these
categories was personnel, the people involved. You can easily imagine
several different emergency response disciplines that
are heavily reliant on equipment and supplies
and that is not us. In disaster behavioral
health services we are primarily dealing with people. This concept of being
people-centric applies to both victims and survivors
of a disaster, but also the wellness of our
teams, our own personnel. This is not to say that we
can ignore other logistical concerns because we are light
on gear and light on equipment. We will always have
logistic needs, such as communications and
transportation. It makes sense for us to start
our discussion of logistics today with our people and how
we prepare and organize them, how we supervise them,
and how we ensure their safety out in the field. As a potential user’s
manual your State disaster behavioral health response
plan must articulate and define all of its elements
including the people piece of this because you have to
envision a day when someone else who is not as familiar with
disaster behavioral health may pick up that manual, pick up
that plan and really need to be able to dig in and
get a good understanding of all of those moving parts. In our plan our
descriptions of the who, the people involved should
actually discuss who that pool of potential disaster
behavioral health responders is. In doing so it is helpful to
detail how disaster behavioral response capabilities are
developed in the State, the Territory, or Tribe. Meaning, how potential
responders are identified, how are they recruited,
screened, trained, supervised, and supported both
with personal skills but the logistical skills they
will need on deployment as well. While this is not always
mentioned in the plan several States have created
periodic disaster mental health e-newsletters. I look at our list of
participants today and I see a few representatives
from States that actually do create newsletters either in
hard copy or e-versions to blast out to their
community of responders. That is very helpful because
even very motivated and energetic responders can
lose their interest in being part of a team if they
are very seldom deployed. Newsletters and other forms of
communication like this can help retain those responders
that we have worked so hard to recruit, train, and
prepare for activation. There are a number of different
strategies, even pre-disaster that help you build a community
of responders and build some cohesion between those team members, a sense of comfort they will certainly need
during an actual activation. Let me get square
with my slides. Several Coordinators have
stressed the importance of clarity in roles,
responsibilities, and even titles during activation. This clarity was identified by
many people participating in our survey and interviews
as a very important area in logistical support, including the nature of the supports the State will provide for
presidentially versus non-presidentially or
non-declared disasters. Clarity around how
that is different. Expectations for what a
State will do and what other local organizations such as
community mental health centers should be ready to do during
a disaster and clarity in the roles and responsibilities
of the responders, including training requirements. What should they have under
their belt at a minimum are what creates our core
competencies for a responder. Everyone has NIMS training,
ICS training, introduction to our disaster skills, those sort of things
that come together. On the issue of crosstraining
with partners we understand that this becomes another important indicator of an effective logistical support concept
in the logistics section. That is language that is
included in your plan that addresses crosstraining
between other sorts of emergency management personnel,
public health workers, and our disaster behavioral
health personnel so there is an understanding of what
our scope of expertise is, where we could be most helpful, how we plug into the
larger command structure. All of those things become much
more clear through crosstraining efforts with the other response
entities that would be in play during an actual deployment. Several Coordinators also
focused on the importance of ongoing ICS training and its
relationship that may facilitate for the relationships that
are facilitated and come about by these sorts of trainings. We get to meet partners
pre-event and form relationships with them but
as I said, clarifying our roles and responsibilities
pre-event when we are at a low level of stress is
one of the best things we can do in our
crosstraining efforts. As with other standards,
multidisciplinary exercises, whether they are tabletop or
full-scale drills are seen as very helpful and crosstraining
and exercising helps us test the assumptions about how partners
will fulfill their roles and helps us more accurately
align our expectations. Let’s give a case example about
one way a specific State got involved with this and learned some lessons through a tabletop. In a recent e- or web-based
webinar exercise of a mock earthquake the mock
disaster in this State our disaster behavioral
health system participated in an online experience. Folks in the northern part of
the State were asked to deploy, it made good sense that if the
southern part of the State was affected in a mutual aid way, let’s get folks from the north. Very quickly it surfaced
that there was an issue for responders in how they
would be transported to the affected areas. One of the most basic
things that surfaced was that the disaster behavioral
responders in that State were not State employees and did
not have the authority to rent vehicles or use State
vehicles and were very much compromised in their ability to travel down to the affected area and participate
in the response. An exercise and exercises in
general have the ability to surface these important
logistical gaps and here specifically in the area
of transportation and you will remember this,
exercises, all types, are designed to test the plan
and not test people. Here, a gap in the plan around
transportation was identified. Exercises, even web-based ones, are very successful
at doing that. Remember that idea: testing
the plan not testing people. Some logistical concerns are
truly nuts-and-bolts issues. For example, indicators of an
effective logistic section can range from things like ID cards
for individual responders. As I mentioned before,
visually identifying clothing for team members. Such items can make it
easier for supervisors and team members to keep an
eye on each other as well as being recognized
by other groups. ID cards can also play
an important role in accountability. You will remember that Incident
Command System concept of checking in, checking
out, knowing where our personnel are at any time. The NIMS/ICS concept of
accountability also includes those ideas of having
orderly chain of command, a clear check-in process for all
responders, including our folks; an assignment of only one supervisor per each individual, that concept of unity of
command that will be in place during an actual deployment. It is important for team leaders
and supervisors in the field to know that many disaster
behavioral health responders are deployed or to know how many are deployed at any given minute and the status and whereabouts
of those personnel. Clarity in command and control,
clear check-in and check-out process, and the ability to
reach those responders quickly to inform them of updates or changing operations all critical to logistical support. How disaster behavioral
personnel are rotated, backed up, and even demobilized are an
important aspect of the plan and an effective logistics section describes these processes. Logistics is also very
often thought of as stuff. As I mentioned earlier,
specifically gear or the type of equipment and supplies that
responders need to execute a specific function,
their discipline. Logistics also includes
personnel as well as the materials and
tools they will need. Disaster behavioral
responders typically travel pretty light compared to most
other disaster responders. Some equipment and
supplies are still necessary. In addition, it may be
important for disaster behavioral health responders or
team leaders to have access to laptops, other sorts of communication devices that are enabled in a way for them to access Internet or web-based resources and to communicate seamlessly throughout their command and through
the response chain. In this context, indicators of a
NIMS-compliant logistic section also include developing a list
or checklist of resources for responders including the items
they will need to successfully deliver disaster
behavioral health services. This may discuss vehicles,
communication devices such as radios or mobile phones, and if
the State plan describes the possibility of on-demand
training to bring more responders into the loop
then there also needs to be a discussion of what kind of
platforms, what kind of equipment would be
necessary to deliver those on-demand trainings. Very important concept and
one that many States have struggled with, many
jurisdictions have wrestled with is the idea of
typing, resource typing. Very central to the
NIMS and ICS sorts of approaches and specific to
disaster behavioral health is the concept of resource
typing or standardizing our equipment or how we
describe it in ways that others can request, others
from other jurisdictions can request those resources. It comes into play very
strongly when we do discuss EMAC, the Emergency
Management Assistance Compact. Whether these are physical
resources or human resources, how we type those resources
becomes very important especially to intrastate
and interstate sharing or resources during
a time of disaster. To broaden that just a little
bit you may recall from any of your ICS or NIMS training
the three terms here that apply, category, kind, and type. They sound very much
interchangeable, sound very much the same but
you will remember they each have a different meaning. “Categories” specifically,
refers to the function for which a resource is most useful. Big broad categories,
firefighting, law enforcement, behavioral health,
medical, and so on. While the term “kind”
describes a broad class of characterization such
as teams, personnel, equipment, and supplies; it is
breaking it down more finely. Lastly, the term “type”
is a measure of minimum capability to
perform the function. You will remember those
concepts, but applied to disaster behavioral health
responders and teams requires a little bit of different
thinking to apply the ideas of category, kind, and type. Request for out-of-State
disaster behavioral health resources are processed
through EMAC, the Emergency Management
Assistance Compact. Specific to disaster behavioral
health services these resources typically include
counselors trainers, technical consultants,
and so forth. Other resources, such as
informational materials are best accessed and most
often directly from FEMA or through SAMHSA. Let’s look at an example of
resource typing applied to disaster behavioral health. At least one State addressed the
typing challenge by structuring what they called behavioral
health support packages. The package combined personnel
specifically, one behavioral health worker, one clinical
behavioral health worker, and one psychologist with specific equipment and here the specific equipment is two vehicles or
rental cars, one cell phone, one GPS unit, and
one laptop computer. By articulating what is meant
by a disaster behavioral health package, anyone requesting
that sort of support across State lines very clearly knew what they were getting and had a way to understand how to use
that resource when it arrived. The package also, in this model,
articulated the mission of the package, the group of people
and the sort of equipment that they had and specifically
defined the mission as delivering Psychological First Aid, critical incident stress debriefing for responder groups,
meaning traditional first responder groups, and general
sorts of behavioral health support for victims and
survivors in the overall population affected
by a disaster. That is an example of taking
the NIMS terminology and concept and drilling it down
to a disaster behavioral health sort of application. When we talk about team
development let me make sure we are squared up here. Yes, this is exactly what
I want to address next, the span of control. Another important NIMS/ICS
concept you may recall, another good indicator of the logistical
standard is how the disaster behavioral health teams, individuals and teams are developed, deployed,
and managed in the field. It is helpful to not only
identify training mechanisms that people will need to
understand deployment such as Incident Command System and
NIMS but also remember that key concept from Incident Command about span of control. You will remember
that span of control means the ratio of
supervisors to workers. How do we structure a team,
the logistical section should detail the structure of that
team, including how many personnel will be on a team, pairs of two, your worker and a buddy and how many pairs would report to a
single supervisor. You will remember the
recommendation is an optimal number of one to five, one
supervisor to five workers, stretching somewhere in the
range of three on the low end to seven on the high end. Think about that because the
idea is for a number of reasons, having close supervision
and close support that no one supervisor should
be responsible for that many people at any one time. The last of these core
elements was partners, those core categories. When we talk about critical
partners it also extends to those programs that
are so important to us. For example, as we look at those
programs whether they are in our State or national,
we discuss things that I mentioned earlier such
as EMAC, the interstate Emergency Management
Assistance Compact. The Emergency System for
Advance Registration of Volunteer Health Professionals,
what you heard me mention as ESAR-VHP before, and what
many of you know as the MRC or Medical Reserve Corps. Programs, for example, like
ESAR-VHP are designed to help register and coordinate health
professionals and others who have indicated their interest
in volunteering to provide assistance during an emergency. EMAC, as previously mentioned,
is an organization specifically established to manage interstate
resource requests during a disaster and as many of you
know, the Medical Reserve Corps, part of the larger Citizen
Corps, coordinates a range of public health volunteer
workers to respond to different sorts of emergencies
and disaster scenarios. Volunteer and volunteer
organizations and disasters, VOADs are certainly an
important part of the resource mix necessary for a successful disaster behavioral health plan and as such should be described thoroughly in your logistics section. Clarity of the roles and
responsibilities of the volunteer organizations is an
essential aspect of the plan. The plan should anticipate and
describe even how spontaneous, unaffiliated volunteers may
be used to supplement a more sanctioned disaster
behavioral health response. Issues of liability for
protection for volunteers have been a challenge
for many States. Some States simply deal with
this by simply avoiding using volunteers due to
liability concerns. A number of States have
developed volunteer protection statutes for individuals
affiliated with State disaster behavioral health response
teams and they afford those volunteers some degree of protection if they are deployed in a sanctioned outreach. Those States with
credentialing programs also address the liability
issue in part by careful screening and background
checks, mandatory training in disaster behavioral health
skills but also topics like ethics in disaster response, cultural competencies in
disaster response, and so forth. These and similar team
development strategies improve customer protection for those
utilizing disaster behavioral health services and ensure that responders are cleared for work, potentially law
enforcement, or Homeland Security-sensitive assignments. Clarity of roles and
responsibilities between partners is important but
regardless of how strong your relationships are they
should be documented in MOUs. Remember there may be a time
where someone unfamiliar with your plan may have to step
in and implement it and a written agreement outlining
how partners will cooperate to deliver services is a very
important indicator of a strong logistic section. Examples of MOUs with the
Red Cross and VOADs for behavioral services
is one good example. At least one State Coordinator
developed an MOU with the American Red Cross to allow
that State’s disaster behavioral health responders, those who
are credentialed to work in Red Cross shelters where
traditionally only Red Cross mental health
workers were allowed. Those kind of discussions,
agreements, and then formalizing them in MOUs all
become very important. Lastly, communications. How teams are notified of an
impending disaster or crisis, the process for deploying
and transporting them, communications for personnel
working in the field become very important and
our last part of our discussion
today for logistics. Within the logistics
section other indicators of a NIMS-compliant sort of
approach include discussion of how personnel are notified, activated, and deployed. A description of a mechanism
for notification, activation, and deployment may also include details about how emergency information is shared from the SEMA, the State emergency management authority or OEMs,
Office of Emergency Management as well as public health
partners, law enforcement, and other Homeland Security entities
within the State and from branches of State, territorial, or tribal government. In addition to who will
communicate disaster-related information to our responders, how the information is shared, whether it is in
bulletins, advisories, warnings, or guidances,
should also be articulated. Part of this discussion may also
focus on a call-down list or other methods for
sharing information. Communication with disaster
behavioral health responders and other response agencies is
very important to the overall plan and to the
logistic section. It requires a degree of
pre-planning and coordination and failure to address communications-related issues can create some real
obstacles to an effective disaster behavioral
health response. I am going to start to
focus in on the keys of what we think or at least I have
found most helpful in thinking about or conceptualizing
this communication. I describe it as the three
Ts: target, timing, and type. “Target” is who do we
need to communicate with. Is this our responders,
other partners such as public health entities,
other agencies, and so forth? Once we have thought that
through, who do we need to coordinate or communicate
with, that leads us to the next question
about timing. When do I need to communicate
with them and together target and timing inform your decision
about type or what kind of communications, telephone,
text messaging, and so forth. Let me give you a real quick
example before we move on. If my task right now was to
communicate in a pre-incident timeframe with my disaster
behavioral health responders, just to notify them, just to stand them up of a potential emergency, I know most of
them are going to be at work or potentially at home so using
their home or work phone, using their cell phones might
be the most reasonable way. Target: my counselors,
timing: pre-event, type: I am going to use my traditional
telephone or landline. If I am looking at a different
phase of the emergency they have been deployed; they are
out in the field that may indicate a different timeframe and may indicate further a different type of communication that now may be cell phone or
radio communication. Lastly, we talk about a process
for giving folks updated and ongoing information in the
form of situation reports, situation briefings,
and safety briefings. Within the logistics section
it is helpful to describe how our responders and
supervisors will receive and share information related to
the evolving disaster situation, including receiving that at
the point of service delivery. Who is cleared to sit in
those briefings, what would be the frequency of those
briefings, things of that nature to make sure
that we are in the loop. Lastly, how do we actually get
to the event, to our point of delivering services becomes a
question of transportation and key, central to logistics. As mentioned in our other
example, when State Coordinators were asked in that exercise
what logistic needs surfaced we came back to the issue
of transporting workers from the northern section of the State to the southern during the earthquake scenario. There, as I pointed out, the
transportation issue quickly surfaced in that the responders
in the State were not State employees and were limited in
what they could do in terms of accessing transportation. Understandably, the State
did not want folks who were not State employees to use
their cars or rent cars in their name so this became
an issue that required different ways of thinking. The other part of
transportation, beyond how we get folks to our locations,
is the concept of staging. Most will remember this as
an ICS concept, staging you will remember is the bullpen,
where do we go and collect our personnel, organize them,
brief them, and hold them until they are assigned to a specific disaster behavioral health task. Go back to our Incident Command
concept of staging area, make sure we have a full
understanding of where we may put staging areas, what
are the basic requirements, how we operate with the staging
manager and make sure that this concept is actually articulated and described in our disaster behavioral health plan, in our
logistics section in a way that anyone picking up that plan can
understand all of the various elements that support getting our disaster behavioral health responders on the ground
to develop their service. Moderator: Thank you so
much for your presentation, Mr. Crimando. We are now going to open
up the floor for questions. It looks like we’ve
received three questions. I will read them one by one
and let you answer each one. The first question is, Can
you discuss any logistics considerations in setting up the venue that crisis counseling or disaster behavioral health
services might be delivered in. Mr. Crimando: I can think
of a few, and very often disaster behavioral health
planners and coordinators only have a limited say in the
where, the venue of where we may be delivering services. Of course, you can envision
many different places, whether it is a FEMA Disaster
Recovery Center where we might have one or two
counselors, to a large-scale shelter or Family Assistance Center where we may have dozens or more counselors. There are usually many
different forces in State, tribal, or territorial
governments that are picking the where we are
going to put this. We can lend a voice to that
discussion and the two places that make sense to me, where I
have seen most effective are to make sure those who are
making the decision about where to locate a service delivery site are sensitive to the environment-that there is low
stimulation, there is not a lot of traumatic reminders, that it
is easy to access, that we are looking at how the actual environment may trigger people’s emotional reactions. That certainly can affect
utilization, because if there are things that are rubbing
people the wrong way in the environment, that are arousing
them or stressing them further, people may simply avoid going
to those sites where we are delivering those services. The other part where
we can lend a voice is the setup of that environment. The one thing that comes to
mind for me is the idea of sometimes having quiet rooms. If we envision something
like a school gymnasium being used as a shelter or Family
Assistance Center and we are speaking with leadership
from the various other emergency management disciplines
and we are discussing where we will put this center and
how it is going to be designed, one of the things that is useful
for us in disaster behavioral health is to lend to that
discussion the need to maybe have a few quiet rooms. Why a quiet room? You can think of
several applications. Maybe we have a consumer
who is not responding well to all of the action, all
of the stimulation in the larger shelter environment or
Family Assistance Center and we want to break them away. Maybe it is someone who has a
specific need, maybe it is for prayer quietly or to be away
and be reflective and have some quiet space or if it is an
environment where our personnel or others may be involved in
breaking some very bad news we might want to do that away. As you articulate
that and you say, “We might need these rooms,” of
course you need to go back and brief your responders to say
“No one should be alone with a survivor or victim
in that quiet room. Let’s make sure we have a buddy,
some coverage and protection.” It opens up some other
logistical concerns but there is a place for us to
give good feedback in the location and the setup of
those physical environments where we can
deliver our services. Thanks so much Mr. Crimando. Moderator: Is it a good idea
for disaster behavioral health responders and DBH
teams to have their own radios? Mr. Crimando: That is a
question I have heard many times over the years and I
hate to give a wishy-washy answer but my wishy-washy answer
is going to be, it all depends. A more lawyerly term, the
totality of the circumstances. We obviously have as important
communication needs as any other responders but because as I mentioned before we tend to travel light, we are not in emergency response activities day to day like other first responders, we tend not to have those radios or be as
familiar with their operation. Let me tell you some of my
thinking on having radios. The one thing I would warn
against is independently going out and acquiring
and using radios. If you are getting on a radio
frequency you want to make sure that it is integrated
with, coordinated with the radio styles, the radio frequencies of all the other response agencies so we are not stepping on other frequencies and messing up other
people’s communications. It usually requires a
little bit of training to be proficient in using radio
communications and you certainly remember NIMS or ICS concept
about speaking in plain text and not using different kinds
of codes and radio codes. Most of our personnel, most
of our disaster behavioral responders are not as familiar
with even operating gear. If you buy it, you probably want
feedback from other players in your State, Tribe, or Territory
about what kind of gear to get so it interoperates
properly with others. How it will be used, where
the radios will be kept so they are not abused in
any way, how they are maintained and charged so
they are always up to gear. Then, as I said, the
coordination of frequencies but lastly it becomes a question
of who specifically, if we get a bank of radios who specifically
has those radios and most often it makes sense that certainly the leaders, the team leaders, supervisors, and the State
Coordinator and their deputies have access to those radios. I can’t imagine much of
a need in the field for every responder to have a
radio and I can only imagine a bad outcome in a lot of
superfluous radio chatter coming out of having
too many radios in play. Again, my wishy-washy answer
is yes but there is good discussion and argument
for radios for our teams out in the field; there are
a couple of good arguments against it and those are discussions that you want to have in your jurisdiction so if in fact you do use radios it is in concert with the other
services that would be using radios as well. Thanks Mr. Crimando. Moderator: Our last question
is a two-part question. Won’t everything a disaster
behavioral health responder needs be already available on
site when they are deployed? Should responders be
bringing their own equipment? Mr. Crimando: Obviously,
each event or deployment is going to be different in the
nature of the situation and where we as disaster behavioral
health responders may be sent. If we think of ourselves
as going to a FEMA Disaster Recovery Center it is usually
a fairly small contained environment, then it is fairly comfortable, things like food, water, coffeepot, and
things of that nature. If we are in a frontline
response or out in the field we are most often considered
second responders so first responders have established
and made the situation safe. Because of that a lot of
services are usually in place by the time we get there so Red
Cross and other VOADs may have canteens and meals and
things for comfort setup. We usually don’t have a need
to bring too much with us. I will tell you this, what
I have found is most helpful in training and working with
disaster behavioral health responders is to have a
little bit of a go kit that is just personalized
for yourself and for one day’s worth of supplies. Obviously, any disaster
behavioral health responder should take the same personal
and home readiness steps that everyone in our
population should take. Going to,
knowing that you have put your ducks in a row for
your home and your family and so forth kind of liberates
you so on the day you are activated and deployed
you know you can go. When we talk about readiness
at that level it is usually for 72 hours of self sustaining,
having a plan, having a kit, having those supplies
become important. The go kit that I am speaking
about for a responder, in most instances it suffices to have
a day’s worth of what you need personally to sustain yourself. Of course, the efforts during
the disaster are going to be focused on assisting the
victims and survivors of the event and we are going
there to be part of the solution hopefully and
not part of the problem. We don’t want to
create extra demand. What is in that personal kit? It is a change of clothes,
anything you personally need for health and comfort. If you wear glasses, a
spare pair of glasses, you wear contacts, a spare
pair of contacts, a small bottle of solution; it
is the middle of summer, sunscreen, a ball cap,
sunglasses; things to make you comfortable out in
the field so you are not scrambling around and now taxing
the system with what you need. Bottle of water, snack, simple
things like that because one of the concepts I did touch
on earlier is the idea that we may be sent to a staging area and at the staging area those kinds of accommodations
may not be established, there might not be meals
or snacks or anything for us personally
while we are in that bullpen environment
waiting for assignment. Make sure we take
with us what we need. I think yes, it is a safe
assumption to say as the disaster response unfolds
more of our basic needs, those goods and services
are onsite but in the very early hours of an event and
also somewhat depending on the nature of the event and
where we are assigned those things may not be available
so it is very sound for the disaster behavioral
health responder to pack a one-day
personal go kit. Lastly, on that note remember
to rotate that kit, if it has been sitting in your car
trunk throughout the heat of the summer, the
cold of the winter, things are going to go bad. What we have trained many
teams to do is just as we have all learned to change the
batteries in our smoke detectors in the spring
and the fall, the change of the clocks, rotate the
gear in your personal kit. Take out your wool socks
and your cold weather gear. Rotate in a T-shirt, a
lightweight windbreaker, a pair of jeans or khakis,
and things of that nature that you can comfortably
wear even in a fairly warm weather environment,
because you never know when you are going to get the call. Moderator: Thank you again for
your presentation, Mr. Crimando. Ms. Terri Spear has some closing
remarks for us. Ms. Spear. Ms. Spear: Thank you. Mr. Crimando, thank you
so much for your very thoughtful presentation. I am sure the people who
are participating in today’s webinar have learned
very much from your well-organized presentation. This concludes the
Logistical Support webinar, a part of the Promising
Practices in Disaster Behavioral Health
Planning series. Future sessions will explore
some of the remaining standards in greater depth, providing
examples, lessons learned, good stories about how
to enhance your disaster behavioral health plan. Moderator: Thanks Ms. Spear. Ms. McGee will now tell us
about the upcoming webinars. Ms. McGee: For next steps we
have another webinar coming up on August 18th that will
address legal and regulatory authority and it will be
presented by Mr. Andrew Klatte; we look forward to hearing
from him on the 18th. Looking a little further
into the future we have two other upcoming webinars
to round out this series: Integrating Your DBH Plan
that will take place on August 25th with Mr.
Steven Moskowitz and Plan Scalability finally on
August 30th and that will be with Dr. Anthony Speier. We look forward to
rounding out this series. If you have question
around any of these presentations or this series
or the activities behind it we encourage to
you to call us. If you can think of any
training or technical assistance needs that you have our
contact information is here; we are always eager to help. Let us know if you
need anything please. Moderator: Thank you so much
Ms. McGee and thank you all for participating in the Promising
Practices in Disaster Behavioral Health Logistical
Support webinar.

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