speier, a. (2006) louisiana office of mental health overview of louisiana’s disaster mental health...
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Speier, A. (2006) Louisiana Office of Mental Health
Overview of Louisiana’s Disaster Mental Health
Preparedness and Response to Hurricane Katrina
The 22nd Annual Rosalynn Carter Symposium on Mental Health Policy
November 9, 2006The Carter Center, Atlanta Georgia
Anthony H. Speier, Ph.D.Louisiana Office of Mental Health
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Speier, A. (2006) Louisiana Office of Mental Health
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Speier, A. (2006) Louisiana Office of Mental Health
Disaster Preparedness2005
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Speier, A. (2006) Louisiana Office of Mental Health
Pre- Katrina Disaster Preparedness:
4,000 DHH Employees Trained in 2004
Special Needs Shelter Disaster Mental Health TrainingHospital Evacuation Readiness
350 OMH and OAD Employees Trained in May 2005All Hazards Response Planning
Crisis Counseling Intervention With Special Populations
Disaster Mental Health Intervention in Incidents Involving Mass Casualties
DHH Disaster Task Force Staff Call Out Registry
OMH CMHC Staff Assist at Sp NS
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Speier, A. (2006) Louisiana Office of Mental Health
Pre-Katrina Disaster PreparednessJuly-August 2005
Disaster Response DrillsIncluding Practice Evacuations
of OMH Hospitals
Disaster Response Plans For :•Each OMH Hospital and Region
•Hurricane Pam Exercise week of Katrina•Planning for SpNS, SARBOS, and TMOSA
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Speier, A. (2006) Louisiana Office of Mental Health
Pre-Incident Activities:Hurricane Katrina August 25-28,
2005
OEP Command CenterDHH Operations
Open Special Needs Shelter (SNS) Operations
New OrleansBaton Rouge
Terrebonne ParishLafayette
Lake CharlesAlexandria
Monroe
Evacuation of •Southeast Louisiana State Hospital •New Orleans Adolescent Hospital to Eastern Louisiana Mental Health System
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Speier, A. (2006) Louisiana Office of Mental Health
Initial Locations of OMH Incident Response:
OEP Command Center
OPH Command Center
SARBONew Orleans
TMOSA Sites•New Orleans•Baton Rouge
Emergency Response SitesOPH Command CenterTMOSASARBONOPD SitesOEP – Tent Cities for Police UnitsBaton Rouge Sites
Special Needs SheltersNew OrleansBaton Rouge
Houma/TerrebonneLafayette
Lake CharlesAlexandria
Monroe
Evacuation of Charity Hospital in New Orleans Acute Unit to Central Louisiana State Hospital
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Speier, A. (2006) Louisiana Office of Mental Health
OMH Incident Response:August 29, 2005 to November 2006
Behavioral Health Command Center
7 Mobile Crisis Teams (Shelter support)
Family Call Center
SAMHSA Emergency Response Grant
Initial Crisis Counseling Grant
SAMHSA/Westover Clinical Teams through
6/30/06
Hospitals Evacuated through April 2006
SpNS and General Shelters operate through early 2006
Continuity of Operations
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Speier, A. (2006) Louisiana Office of Mental Health
Post Katrina/Rita Realities2006
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Speier, A. (2006) Louisiana Office of Mental Health
Evacuation Planning
• People will not plan their personal evacuation before the threat of a storm.
• Making a family/personal evacuation plan is not easily accomplished
• People are worn out
• People need structure and leadership
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Speier, A. (2006) Louisiana Office of Mental Health
Sheltering Staff
• Staff need reassurance and relief while on the deployment.
• Job structure is important.• Maintain a buddy system.• Value and respect for each other is essential.• Staff need to be recognized for their efforts.• Shift change debriefings and on-site stress
managers.• Need to know who is in charge.
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Speier, A. (2006) Louisiana Office of Mental Health
Sheltering Evacuees
• Psychological first-aid is needed by everyone.
• Basic needs must be assessed and met.
• Need sufficient staffing to recognize behavioral problems before they become overwhelming.
• Pre-planned protocols for managing behavioral issues.
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Speier, A. (2006) Louisiana Office of Mental Health
OMH Emergency Preparedness Post Katrina/Rita
1. Each hospital/region/district has a designated Emergency Preparedness Coordinator.
2. OMH has established a state level Emergency preparedness work unit.
3. OMH holds bi-weekly (were weekly during the major part of hurricane season) meetings with the regional managers, CEOs and the emergency preparedness coordinators.
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Speier, A. (2006) Louisiana Office of Mental Health
OMH Emergency Preparedness Post Katrina/Rita
4. OMH now has a state wide disaster preparedness and response plan consisting of regional plans and hospital plans. – These plans designate functions to be performed at
Special Needs Shelters by OMH in conjunction with OPH, OAD and OCDD.
– Protocols for accessing psychiatric crisis services during a disaster have been identified for each region.
– Staff have been identified who will function as crisis counselors and as general assistance staff 24 hrs a day for a period of five days.
– It is our intention to place this information on an easily accessible section within the OMH web site.
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Speier, A. (2006) Louisiana Office of Mental Health
OMH Emergency Preparedness Post Katrina/Rita
5. Currently we are developing local clinic level plans for all hazard preparedness and response. This will include the provision that all staff have personal emergency response plans and have an established procedure for contacting supervisors following a storm if they must evacuate. – It is also our intention to assist all consumers who are OMH clients with
their own emergency preparedness plans, which will be reviewed and updated at six month intervals just as treatment plans are currently reviewed.
6. OMH and the regional housing coordinators have been working with assisted living programs OMH funds to assure each of these sites has an emergency response and evacuation plan. – As emergency preparedness matures into a routine program within
OMH we will initiate a wide array of preparedness drills for provider agencies and our consumers.
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Speier, A. (2006) Louisiana Office of Mental Health
OMH Emergency Preparedness Post Katrina/Rita
7. During the current hurricane season we have:– Conducted a mock evacuation drill for NOAH and SELH
evacuating to ELMHS,
– a "shelter-in-place" drill for NOAH, SELH, ELMHS, and CLSH in response to a category 2 or less hurricane or a hazardous materials incident.
– Our biggest challenge is managing the evacuation of employee families to ELMHS but we are actively working on that issue.
– We currently have planned an evacuation drill for the evacuation of acute psych units at WO Moss, UMC, and Chabert to CLSH with their staff. This will occur within the next two weeks.
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Speier, A. (2006) Louisiana Office of Mental Health
OMH Emergency Preparedness Post Katrina/Rita
8. OMH is also working with DHH and the Louisiana Hospital Association to plan for the evacuation of all psych patients from public and private facilities.
– There has been some very creative thinking which will probably result in some utilization of private bed space/staff as part of the response and sheltering effort. These discussions are underway and will hopefully result bin a strategy prior to the 2007 hurricane season.
9. OMH is also participating with OPH in preparation for a bird flu pandemic.
– We are designing the exercise and will test it out in December in Region5.
10. OMH is a full participant with DHH:– on all emergency response planning and evacuation efforts, – workforce readiness,– advise DHH on issues regarding mental health,– and the specific needs of persons with mental illness.
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Speier, A. (2006) Louisiana Office of Mental Health
OMH Emergency Preparedness Post Katrina/Rita
11. OMH has worked with DHH in establishing a separate Behavioral Health desk to handle all behavioral health issues at the regional and statewide levels. This will allow for the rapid identification of issues/needs and the mechanisms for securing the necessary resources for our response.
– 99% of OMH community staff have completed all four of the required training courses in the National Incident Management System.
12. OMH has established an emergency response pharmacy plan for securing OMH medical supplies during a disaster. – We have also resolved most of the issues regarding access to
psych medications at special needs shelters.
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Speier, A. (2006) Louisiana Office of Mental Health
Behavioral Health Incident Management: Communication Pathway
2006 Hurricane SeasonSTATE
EOC
State EOC DHH DESK
(Independence Blvd.)
DHH EOC
(Bluebonnet Blvd.)
Behavioral Health Section
Chief
OAD
OCDD
OMHOMH
Disaster Operations
Executive Staff
9 DHH RegionalCommanders
(OPH)
Behavioral Health Regional Liaison
OAD
OCDD
OMH
OMH Regional Managers
Designeeand Inpatient
Facility Manager or Designee
(Same illustration is applicable to OAD and OCDD)
Human Services District./Authority
(AD/DD/MH)
•Behavioral Health Branch Manager location is Independence Blvd. •Staffing is provided by OAD/OCDD/OMH)
* note:
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Speier, A. (2006) Louisiana Office of Mental Health
The Louisiana Crisis Counseling Program
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Speier, A. (2006) Louisiana Office of Mental Health
What is Louisiana Spirit?
• Louisiana Spirit is an outreach crisis counseling program designed to address the emotional and mental health needs of those impacted by Hurricanes Katrina and Rita.
• It is funded through the Federal Emergency Management Agency (FEMA) and administered through the Substance Abuse and Mental Health Services Administration, Center for Mental Health Services (CMHS).
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Speier, A. (2006) Louisiana Office of Mental Health
ISP and RSP Grant Awards
• The State of Louisiana was awarded a total of – $19,990,655 for the Immediate Services Program
through August 31, 2006. – $34,651,835.00 for Regular Services Program
(RSP) for Hurricane Katrina parishes.– $2,308,237 for Hurricane Rita parishes.– $ 2,044,724 for the Undeclared Parishes (Northern
Louisiana).– A total of $39,004,796 for ongoing RSP services. – Louisiana Spirit CCP funds are targeted to the
residents of all 64 parishes affected by the devastation of Hurricanes Katrina and Rita.
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Speier, A. (2006) Louisiana Office of Mental Health
Staff and Core Service Providers
• Louisiana Spirit Hurricane Recovery program currently employs a diverse workforce of over 500 staff, primarily Crisis Counselors and Outreach Workers.
• Six Provider Agencies in designated service areas:– Louisiana State University Health Science Center
(LSUHSC) Department of Psychiatry, – Catholic Charities Archdioceses of New Orleans, – Harmony Family Support & Outreach Services, – Options for Independence , Inc., – Volunteers of America of Greater Baton Rouge – Volunteers of America of Greater New Orleans.
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Speier, A. (2006) Louisiana Office of Mental Health
3
WestFeliciana
Washington
St. Tammany
Tangipahoa
St.Helena
Livingston
CoupeePt.
East
Avoyelles
Baton RougeW.
Iberville Orleans
JohnSt.
St.Charles
St. Bernard
Plaquemines
Jefferson
AscensionSt.
JamessAssumption
Lafourche
Terrebonne
Beauregard Allen
Calcasieu
Cameron
JeffersonDavis
Evangeline
St. Landry
Acadia
Vermilion
Lafayette
St.Martin
Iberia
Vernon Rapides
Winn
Grant
LaSalleCatahoula
Concordia
Caldwell
Natchitoches
Caddo
Bossier
RedRiverDeSoto
Sabine
Webster
Bienville
Claiborne
Lincoln
Jackson
Union Morehouse
OuachitaRichlandSt
FranklinTensas
Madison
CarrollWest East
Service Area III: Options
Service Area II: VOA GNO
Service Area I: CCANO
Louisiana Spirit
Service Area IV: Harmony
Service Area V: VOA GBR
St. Mary
East
Undeclared: VOA GBR
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Speier, A. (2006) Louisiana Office of Mental Health
3
WestFeliciana
Washington
St. Tammany
Tangipahoa
St.Helena
Livingston
CoupeePt.
East
Avoyelles
Baton RougeW.
Iberville Orleans
JohnSt.
St.Charles
St. Bernard
Plaquemines
Jefferson
AscensionSt.
JamessAssumption
LafourcheSt.Mary
Terrebonne
Beauregard Allen
Calcasieu
Cameron
JeffersonDavis
Evangeline
St. Landry
Acadia
Vermilion
Lafayette
St.Martin
Iberia
Vernon Rapides
Winn
Grant
LaSalleCatahoula
Concordia
Caldwell
Natchitoches
Caddo
Bossier
RedRiverDeSoto
Sabine
Webster
Bienville
Claiborne
Lincoln
Jackson
Union Morehouse
OuachitaRichland
FranklinTensas
Madison
CarrollWest East
Rita ….
Louisiana Spirit
East
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Speier, A. (2006) Louisiana Office of Mental Health
Goals and Strategies• Deliver services to large numbers of residents affected by
Hurricanes Katrina and Rita who are diverse in age, ethnicity, and needs.
• Louisiana Spirit program design is multifaceted to reflect the culture, traditions, needs, and values of Louisiana residents.
• Service delivery, is designed to promote recovery among individuals, communities, and the entire affected population in Louisiana.
• The evaluation and quality improvement programs provide a constant flow of feedback and continually informs service delivery.
• Significant time and resources are dedicated to stakeholder support.
• A sustainable recovery requires ongoing community engagement and the routine monitoring of the health and recovery of the entire population.
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Speier, A. (2006) Louisiana Office of Mental Health
Community Based Outreach
• Louisiana Spirit is community based, not office based.• Counseling is brief (1-6 sessions), practical and is
designed to help survivors return to a pre-disaster level of functioning, renwing the spirit of individuals and communities.
• Services target direct and indirect victims/survivors, evacuees displaced by the hurricanes and host communities throughout Louisiana.
• Programming targets special populations thought to be at risk including rescue and law enforcement personnel, children, and those with pre-existing health and behavioral health vulnerability.
• Services include support to stakeholders involved in the lives and recovery of hurricane victims/survivors as well as communities at large.
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Speier, A. (2006) Louisiana Office of Mental Health
Level of Service Needed
Education & Information
Psychological First Aid
Referral for Tx
Crisis, Trauma, Grief Loss Counseling
LA Spirit
LA Spirit
LA Spirit
Mental Health
Agencies
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Speier, A. (2006) Louisiana Office of Mental Health
Children and Adolescent Services
• LSUHSC has provided over 5000 confidential screening assessments have been carried out by teachers and LSUHSC faculty, together with the assistance of SAMHSA volunteers and Louisiana Spirit Crisis Counselors at the request of school districts and administrations.
• Children and adolescents surveyed were those returning to the St. Bernard Parish Unified School District, students returning to Orleans and Plaquemines Parishes, and displaced and receiving students in St. John the Baptist Parish.
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Speier, A. (2006) Louisiana Office of Mental Health
Facilitating Integration
School Districts
Community Service Providers
Mental HealthService Providers
How to facilitate collaboration & coordination of services so that more needs are met effectively and efficiently?
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Speier, A. (2006) Louisiana Office of Mental Health
State-wide Services Highlights
• Collaborative Partners and Services– Louisiana Family Recovery Corps– Schools, public and private– State agencies, Region and District providers,
OAD, DSS, OPH– Faith-based organizations– Crisis hotline through SAMHSA Lifeline1-800-273-
TALK – Stress Management Cadre– First Responder Agencies– Special Population Groups
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Speier, A. (2006) Louisiana Office of Mental Health
State-wide Services Highlights
• Training– Disaster Mental Health Services– Psychological First Aid– Cultural Competency– Data Privacy/HIPAA– Disaster Stress and Trauma
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Speier, A. (2006) Louisiana Office of Mental Health
Louisiana Spirit Crisis Counseling Program
Data (9/1/05 – 8/31/06)
Immediate Services Program
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Speier, A. (2006) Louisiana Office of Mental Health
Summary
• 197,750 Individual Contacts (140,151 first visits)
• 756, 054 Brief Contacts• 176,034 Phone or E-mail Contacts• 9,848,987 Materials Distributed
– Child/youth self-help – Grief and bereavement – Stress management– Assisting first responders
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Speier, A. (2006) Louisiana Office of Mental Health
Group Counseling and Public Education
141,266 Contacts Within Group Total– Group Counseling-49,047
• Crisis counseling with 2 or more persons
– Public Education- 92,219• Didactic presentations to community and other
stakeholder groups
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Speier, A. (2006) Louisiana Office of Mental Health
Brief, Individual, and Group Contacts
Over 1,000,000 In-Person Contacts have been made.
756,054
197,750141,266
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
Brief Contacts Individual Contacts Group Contacts
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Speier, A. (2006) Louisiana Office of Mental Health
Individual Contacts by Service Area
43393
14253
63147
29880
48760
0
10000
20000
30000
40000
50000
60000
70000
Service Area I Service Area II Service Area III Service Area IV Service Area V
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Speier, A. (2006) Louisiana Office of Mental Health
Individual Contacts By Age
168521848 2225 2821
45012
66659
0
10000
20000
30000
40000
50000
60000
70000
Age 0-5 Age 6-11 Age 12-17 Age 18-39 Age 40-64 Age 65+
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Speier, A. (2006) Louisiana Office of Mental Health
Individual Crisis Counseling Contacts by Race
1047 1886
68682 68257
396
0
10000
20000
30000
40000
50000
60000
70000
80000
American Indian Asian Black Pacific Islander White
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Speier, A. (2006) Louisiana Office of Mental Health
Referrals by Type
53198
22318
1163
64895
80948
0
10000
20000
30000
40000
50000
60000
70000
80000
90000
Crisis CounselingServices
Mental HealthTreatment
Substance AbuseTreatment
Disaster ServicesReferrals
Other (socialservices/supports)
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Speier, A. (2006) Louisiana Office of Mental Health
Community Networking and Coalition Building
• Captures the number of individuals Louisiana Spirit came in contact with for the purpose of networking with the community and building local coalitions.
5852
1753
28593
8298
3381
0
5000
10000
15000
20000
25000
30000
Options Harmony VOA CatholicCharities
LSU
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Speier, A. (2006) Louisiana Office of Mental Health
Katrina Participant Feedback Survey
(Fran Norris, Ph.D. and Elizabeth Mercer, MSW, August 2006)
• Survey distributed last week of April 2006
• 2,162 participants (15%) returned surveys
• 80% resided in one of the disaster-declared parishes
• Survey was designed on a 5th grade reading level
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Speier, A. (2006) Louisiana Office of Mental Health
Participant Feedback Survey- Results
• 28% of participants felt their lives had been threatened during the disaster
• 19% had been involved in rescue or recovery work
• 74% experienced community destruction
• 69% experienced damage to their home
• 61% displacement
• 58% financial loss
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Speier, A. (2006) Louisiana Office of Mental Health
Stress Reactions
• 58% of participants had poor stress tolerance• 54% depression• 51% arousal symptoms• 36% felt they needed help or more help from a counselor
to deal with their reactions to the disaster• 40% met criteria for severe distress with( 7out of 11
items withintense stress reactions).• Participants in non-declared parishes averaged almost 6
intense reactions, compared to 5 among participants living in non-declared parishes.
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Speier, A. (2006) Louisiana Office of Mental Health
Stress Reactions (cont.)
• Younger adults, ethnic minorities, and participants with less than 12 years of education had more intense reactions than did older adults, White participants, and participants with 12 or more years of education.
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Speier, A. (2006) Louisiana Office of Mental Health
Program Ratings
• The program performed best in terms of the respectful manner in which counselors interacted with participants, regardless of their race, culture, or religion.
• The results suggest that the crisis counseling program is doing what it is supposed to do quite well.
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Speier, A. (2006) Louisiana Office of Mental Health
Response Bias
• Women and older adults were over-represented in the survey sample.
• There did not appear to be racial/ethnic or geographic biases.
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Speier, A. (2006) Louisiana Office of Mental Health
Too Many Cooks Spoil the Broth
Practice and Policy Considerations
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Speier, A. (2006) Louisiana Office of Mental Health
Pre-Incident Readiness
• Elevate All Hazards Behavioral Health Emergency Preparedness to a core function of local and state agencies.
• Behavioral Health Mitigation Funds.• Preparation of Action Request Forms
(ARFs) for obvious resource needs. (such as additional staff, medical supplies and locations for psychiatric inpatient surge).
• NIMS training and exercises
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Speier, A. (2006) Louisiana Office of Mental Health
Pre-Incident Readiness
• Local, Regional and State All-Hazard Behavioral Health Preparedness Plans.
• Employee call trees and work assignments.• Job functions and initial assignment protocols
pre-specified.• Establish and maintain DMH volunteer cadre.• Practice Drills (Evacuations, Sheltering, etc.)• Media Shelf Kits (PSAs)
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Speier, A. (2006) Louisiana Office of Mental Health
Pre-filed State Emergency Response Plans
• Federal Certification of State’s basic disaster mental health plan…similar to block grant plan strategy.
• Six month program updates reflect:– Services to date– Indicators of individual and community
recovery and remaining challenges– Recovery strategy
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Speier, A. (2006) Louisiana Office of Mental Health
Incident Classification
• Disaster vs Catastrophic Event
• Program Model and Funding defined by incident type
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Speier, A. (2006) Louisiana Office of Mental Health
Identify Disaster Incident Thresholds
• Intensity of the incident
• Duration
• Displacement
• Resource loss—infrastructure damage
• Loss of human capital
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Speier, A. (2006) Louisiana Office of Mental Health
Needs Assessment and Recovery Trajectory
• Capacity of existing infrastructure
• Ability to deliver disaster mental health services and sustain pre-incident service levels
• Match Recovery issues with Resource Needs
• Continuity of operations
• Sustainability of new services
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Speier, A. (2006) Louisiana Office of Mental Health
Basic Services for Individuals and Communities
• Crisis response
• Stress management
• Outreach
• Accessibility
• Treatment interventions consistent with trauma exposure and phase of response/recovery.
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Speier, A. (2006) Louisiana Office of Mental Health
Response and Recovery: Keep It Simple and Mission Focused
• What is the disaster-related issue/challenge that is consuming you?
• What can you do about it?
• What assistance is needed to resolve it?
• How do you know when the issue/challenge is resolved?
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Speier, A. (2006) Louisiana Office of Mental Health
Response and Recovery: Keep It Simple and Mission Focused
• CCP is a supplemental program, not a new mental health system.
• Fit CCP into existing business model of state and provider agencies
• More flexibility in administration at the local and state level…administrative costs.
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Speier, A. (2006) Louisiana Office of Mental Health
Basic Disaster Mental Health Program Design
• Community Education, Training, and Outreach• Individual crisis support (including psychological
first aid)• Individual outreach– canvassing impacted area.• Treatment of trauma exposure• Crisis response for psychiatric emergencies• Media Plan• Evaluation Plan• Quality Assurance Plan • Business Plan—Fiscal Management
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Speier, A. (2006) Louisiana Office of Mental Health
Essential Project Management for Crisis Counseling Programs
Policy Recommendations
• Identify Recovery Trajectory and adjust at 6 month intervals.
• Single Grant Process with six month amendments linked to Recovery Trajectory Estimates.
• Initial grant funding based on per-capita allocation formula.
• Program Guidelines similar to the SAMHSA Emergency Response Grants (SERG)
• National Behavioral Health Model for Responding to Mass Casualties.
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Speier, A. (2006) Louisiana Office of Mental Health
What States Need
• Transparency and Support ---Not secret formulas for evaluating the adequacy of state CCP project applications ---
• Rapid and Definitive, Evidence-based Decision Making, (not personal opinions).
• Macro-level guidance.
• Access to content-knowledge expertise.
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Speier, A. (2006) Louisiana Office of Mental Health
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Speier, A. (2006) Louisiana Office of Mental Health
Hope is the enemy of despair.
If you think you have lost yours, call to just talk
and be heard. 1-800-273-TALK