Speier, A. (2006) Louisiana Office of Mental Health Overview of Louisiana’s Disaster Mental Health Preparedness and Response to Hurricane Katrina The 22.

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



Disaster Preparedness2005


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


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


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


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


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


Post Katrina/Rita Realities2006


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


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.


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.


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.



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.



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.



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.



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.



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.


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:


The Louisiana Crisis Counseling Program


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).


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.


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.


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


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


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.


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.


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


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.


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?


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


State-wide Services Highlights

• Training– Disaster Mental Health Services– Psychological First Aid– Cultural Competency– Data Privacy/HIPAA– Disaster Stress and Trauma


Louisiana Spirit Crisis Counseling Program

Data (9/1/05 – 8/31/06)

Immediate Services Program


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


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


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


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


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+


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


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)


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


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


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


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.


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.


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.


Response Bias

• Women and older adults were over-represented in the survey sample.

• There did not appear to be racial/ethnic or geographic biases.


Too Many Cooks Spoil the Broth

Practice and Policy Considerations


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


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)


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


Incident Classification

• Disaster vs Catastrophic Event

• Program Model and Funding defined by incident type


Identify Disaster Incident Thresholds

• Intensity of the incident

• Duration

• Displacement

• Resource loss—infrastructure damage

• Loss of human capital


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


Basic Services for Individuals and Communities

• Crisis response

• Stress management

• Outreach

• Accessibility

• Treatment interventions consistent with trauma exposure and phase of response/recovery.


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?


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.


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


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.


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.



Hope is the enemy of despair.

If you think you have lost yours, call to just talk

and be heard. 1-800-273-TALK

Speier, A. (2006) Louisiana Office of Mental Health Overview of Louisiana’s Disaster Mental Health Preparedness and Response to Hurricane Katrina The 22.

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