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7 Behavioral Health
Pages 243-286

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From page 243...
... 485) , the committee proposes the following key recovery strategies for the behavioral health sector that should cut across all phases of the disaster cycle and that represent recurring themes throughout this chapter: 1  Forthe purposes of this report, the term "behavioral health" encompasses "the interconnected psychological, emotional, cognitive, developmental, and social influences on behavior, mental health and substance abuse" (HHS, 2014, p.
From page 244...
... BEHAVIORAL HEALTH IN THE CONTEXT OF A HEALTHY COMMUNITY Behavioral health and its integration with health promotion, health care, education, and social services are increasingly appreciated as essential to the realization of healthy communities and healthy individuals (SAMHSA, 2003)
From page 245...
... . Although rates of mental illness of this order of magnitude will present significant challenges to a community's recovery from a disaster, these data show that even after the most horrific disasters, the majority of the exposed population will not develop diagnosable behavioral health disorders.
From page 246...
... Posttraumatic stress disorder 19.8 35.1 Major depression 8.0 17.0 Panic disorder 5.8 3.2 Generalized anxiety disorder 0.0 5.3 Alcohol use disorder 0.0 0.0 Any diagnosis 20.5 40.4 SOURCE: North et al., 2005. Moreover, while most will be resilient in the face of disaster and experience only mild, transient stress reactions, certain populations are especially vulnerable to behavioral health disorders and require targeted outreach and intervention.
From page 247...
... Although much of the focus is on those agencies and organizations directly supporting behavioral health services, it is important to remember that the trauma of the event itself is only one contributor to psychosocial sequelae after a disaster. The cascade of challenges experienced by disaster survivors after the immediate threat has passed is a key factor as well; thus, behavioral health interventions can in the broadest sense include all actions that reduce the adversities and associated stress of the short-term response and 3  "Before,during, and after an incident, members of at-risk populations may have additional needs in one or more of the following functional areas: communication, medical care, maintaining independence, supervision, and transportation.
From page 248...
... . The availability of many federal resources after a disaster, including behavioral health assets, depends on a presidential disaster declaration even though those that do not receive such a declaration may generate significant mental health needs in the impacted population (Hyde, 2014)
From page 249...
... BEHAVIORAL HEALTH 249 FIGURE 7-1  Federal roles in behavioral health preparedness, response, and recovery.
From page 250...
... . The main goals of the CCP are to contact a large number of people through face-to-face outreach, to provide basic crisis counseling and connection to community support systems, and to make referrals to traditional mental health or substance abuse treatment services when necessary.
From page 251...
... . Some states have recommended that funding through the Immediate Services Program be made available automatically after a presidential disaster declaration.8 The review process for the Regular Services Program also is lengthy, sometimes necessitating multiple extensions of the Immediate Services Program, which is disruptive to counseling and can delay training of Crisis Counseling Assistance and Training Program staff (FEMA, 2013; Walker, 2014)
From page 252...
... such as the American Red Cross, play a key role in providing psychosocial support and spiritual care after disasters. Under its congressional charter, the Red Cross provides an array of services and offers substantial behavioral health capacity for disasters through its corps of trained mental health volunteers that respond to such events across the country.
From page 253...
... To accommodate the surge in behavioral health needs that typically occurs after a disaster, local mental health and emergency management authorities may look to nonprofit and private-sector partners to assist in the community's behavioral health response. Many local Red Cross chapters provide mental health services following community emergencies such as a fire or motor vehicle accident resulting in fatalities, as well as larger disasters such as floods or tornadoes.
From page 254...
... Disaster behavioral health services also may be delivered through private-sector for-profit organizations under contract to state and local governments or private employers. Examples of these private providers include Crisis Care Network, Kenyon International, and the KonTerra Group.
From page 255...
... This multiplicity of individuals and organizations involved in disaster behavioral health requires effective leadership and coordination at all levels. Coordination is required horizontally among the public, nonprofit, faith-based, and private organizations that make up the local behavioral health sector, and it must also extend across other sectors, including local social services (e.g., case management, homeless programs)
From page 256...
... Testimony provided to the committee by experts in disaster behavioral health supported conclusions drawn from the literature that there is virtually no emphasis on integrating behavioral health into intermediate- and long-term recovery planning at the state and local levels (Herrmann, 2014)
From page 257...
... Engaging in Disaster Preparedness and Recovery Planning Activities To ensure that behavioral health providers are prepared to function as part of a coordinated health system after a disaster, they need to be actively engaged in pre-disaster preparedness activities. One mechanism for integrating behavioral health into pre-disaster planning for response and recovery is through exist 15  An example of an emergency preparedness program focused on increasing social connectedness is SF72, which was developed by the San Francisco Department of Emergency Management.
From page 258...
... . To facilitate and expedite the deployment of behavioral health services after a disaster, behavioral health professionals who wish to assist can be encouraged to affiliate with a local or state-based disaster behavioral health team (e.g., American Red Cross, local MRC unit)
From page 259...
... When post-disaster behavioral health needs are not adequately addressed, they can become chronic and subsequently lead to an increased demand for long-term behavioral health services. In the immediate postdisaster stage, interventions need to focus on alleviating the emotional suffering caused by the traumatic events, reinforce short- and longer-term adaptive functioning and coping, provide clear communication aimed at destigmatizing help seeking for those in distress, prevent the progression to mental illness or substance abuse, address the immediate mental health needs of those with preexisting behavioral health disorders, and refer those severely affected to appropriate therapeutic services.
From page 260...
... is a widely accepted technique used during the response phase by first responders and other disaster workers to address these initial priorities. In 2006, the National Center for Posttraumatic Stress Disorder and the National Child Traumatic Stress Network released the second edition of Psychological First Aid Field Operations Guide, a set of comprehensive guidelines on the definition and use of PFA (Brymer et al., 2006)
From page 261...
... increase the number represented in the second group. Although no single evidence-based psychosocial support program can be applied in all communities after a disaster, expert consensus documents highlight the important elements of a disaster behavioral health program (see Box 7-2)
From page 262...
... The behavioral health strategy should be incorporated into the larger social recovery strategy. Cultural barriers, including language, need to be considered in the development of broad-based psychosocial support programs so that subpopulations within the community are not excluded.
From page 263...
... . It is a flexible, modular approach developed by the National Center for Posttraumatic Stress Disorder and the National Child Traumatic Stress Network for use during the Crisis Counseling Regular Services Program.
From page 264...
... , it is important to be aware of potential ethical and legal implications. There also are other ethical and legal implications of disaster behavioral health that, while they need to be understood, are beyond the scope of this report (Flynn and Speier, 2014)
From page 265...
... . Existing federal block grants -- the Substance Abuse Prevention and Treatment Block Grant and the Community Mental Health Services Block Grant, as well as the Social Services Block Grant -- also can be used to fund
From page 266...
... Many of the most vulnerable populations have difficulty accessing services or may refrain from doing so because of associated stigma. Programs that reach these vulnerable populations in community settings such as schools, community centers, and homeless shelters can help extend the reach of behavioral health and psychosocial support programs to those in greatest need.
From page 267...
... . The hurricane tended to exacerbate existing mental health issues in children exposed to previous traumas, such as community violence, domestic abuse, and child sexual abuse, indicating a need to be prepared to deal with trauma not related to the disaster when planning disaster behavioral health interventions.
From page 268...
... . Leveraging relationships forged during a disaster can lead to better long-term integration of behavioral health services with other community services (medical care, education, and social services)
From page 269...
... RESEARCH NEEDS The evidence base to support behavioral health interventions after a disaster is distressingly inadequate, relying heavily on consensus expert opinion. Significant investment in research is critical to • establish a more rigorous evidence base on the effectiveness of interventions that are currently used commonly for psychosocial support, including psychological first aid, crisis counseling, and psychoeducation (North and Pfefferbaum, 2013; Pfefferbaum et al., 2012)
From page 270...
... • better match interventions to specific target groups, including vulnerable populations such as children; and • rigorously evaluate the effect of strengthening social networks on the incidence of post-disaster behavioral health disorders. SUMMARY OF FINDINGS AND RECOMMENDATION Through testimony and a review of the literature, the committee identified the following key behavioral health challenges related to disaster recovery: • Even during steady-state times, behavioral health services may not meet a community's behavioral health needs, especially for underserved populations.
From page 271...
... Although behavioral health has been promoted as a critical concept in HHS reference materials and operational plans, the committee found no evidence of its widespread uptake outside of the health sector or of efforts to facilitate a coordinated, cross-sector approach to the delivery of adequate behavioral health services. The HHS Disaster Behavioral Health CONOPS, discussed previously in this chapter, represents a critical step forward, but the committee agrees with the findings of the Disaster Mental Health Subcommittee of the National Biodefense Science Board that a national policy is needed to overcome the fragmentation that currently impedes the horizontal and vertical coordination of behavioral health services and their integration into disaster preparedness, response, and recovery and with the disaster-related efforts of other sectors.
From page 272...
... cooperative agreements, should work together and with other key community stakeholders, including state and local emergency managers, to integrate behavioral health into efforts to build community resilience and enhance planning for long-term behavioral health recovery. Opportunities to leverage other funding sources, such as the Substance Abuse Prevention and Treatment Block Grant, Community Mental Health Services Block Grant, and Social Services Block Grant, should be evaluated.
From page 273...
... . Priority: Engage in Disaster Preparedness and Recovery Planning Activities Primary Actors: Emergency Management Agencies, Behavioral Health Authorities, Disaster Relief Organizations (including the American Red Cross)
From page 274...
... . £ Encourage interested behavioral health professionals to affiliate with a local disaster mental health response team (e.g., American Red Cross, Medical Reserve Corps)
From page 275...
... £ Deliver universal interventions through mental health teams, first responders, and other disaster relief workers to − attend to practical needs of survivors, − connect survivors to additional community resources, and − enhance the ability of survivors to cope. Priority: Expand the Provider Pool to Meet Increased Demand for Behavioral Health Services Primary Actors: Behavioral Health Authorities, Community- and Faith-Based Organizations, First Responders, Disaster Relief Organizations, Corrections System, Education System, Pri vate Sector, Child Care Organizations Key Partners: State/Local Health Departments, Law Enforcement Agencies, Judicial System, Social Services Agencies Key Recovery Strategy: • Integrate behavioral health activities and programming into other sectors (e.g., education, health care, social services)
From page 276...
... £ Engage the faith-based community to help survivors with grief, bereavement, and other emotional responses to the disaster. Priority: Reestablish Services for Community Members with Preexisting Behavioral Health Disorders Primary Actors: Behavioral Health Authorities Key Partners: Health and Medical System Partners, State/Local Health Departments, Social Services Agencies, Community- and Faith-Based Organizations Key Recovery Strategy: • Provide a spectrum of behavioral health services and use an approach based on stepped care (from supportive intervention to long-term treatment)
From page 277...
... to extend the reach of psychosocial support interventions to children under 5 years. £ Engage community- and faith-based organizations to better reach adult populations, including vulnerable populations, that may not seek out behavioral health services.
From page 278...
... £ Train paraprofessionals and volunteers to identify people who may need support for mental health or substance abuse issues. Priority: Take Steps to Ensure the Behavioral Health of Responders, Care Providers, and Recovery Workers Primary Actors: Behavioral Health Authorities, State/Local Health Departments, Health and Medical System Partners Key Partners: Employers of Responders and Recovery Workers Key Recovery Strategies: • Integrate behavioral health activities and programming into other sectors (e.g., education, health care, social services)
From page 279...
... £ Collocate behavioral health services with primary care and/or social services when feasible. £ Leverage relationships forged during a disaster to increase long-term system capacity and integration of behavioral health services with other community services.
From page 280...
... Watson. (National Center for Posttraumatic Stress Disorder and National Child Traumatic Stress Network)
From page 281...
... 2013. Federal Emergency Management Agency Crisis Counseling Assistance and Training Program guid ance.
From page 282...
... 2014. HHS disaster behavioral health concept of operations.
From page 283...
... 2009. Evaluation of a national effort to reach Hurricane Katrina survivors and evacuees: The crisis counseling assistance and training program.
From page 284...
... 2014. Snapshot from Superstorm Sandy: American Red Cross mental health risk surveillance in lower New York State.
From page 285...
... Paper presented at IOM Committee on Post-Disaster Recovery of a Community's Public Health, Medical, and Social Services: Meeting Two, February 3, Washington, DC. WHO (World Health Organization)


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