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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 22.

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Presentation on theme: "Speier, A. (2006) Louisiana Office of Mental Health Overview of Louisiana’s Disaster Mental Health Preparedness and Response to Hurricane Katrina The 22."— Presentation transcript:

1 Speier, A. (2006) Louisiana Office of Mental Health Overview of Louisiana’s Disaster Mental Health Preparedness and Response to Hurricane Katrina The 22 nd Annual Rosalynn Carter Symposium on Mental Health Policy November 9, 2006 The Carter Center, Atlanta Georgia Anthony H. Speier, Ph.D. Louisiana Office of Mental Health

2 Speier, A. (2006) Louisiana Office of Mental Health

3 Disaster Preparedness 2005

4 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 Training  Hospital Evacuation Readiness 350 OMH and OAD Employees Trained in May 2005 All 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

5 Speier, A. (2006) Louisiana Office of Mental Health Pre-Katrina Disaster Preparedness July-August 2005 Disaster Response Drills Including 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

6 Speier, A. (2006) Louisiana Office of Mental Health Pre-Incident Activities: Hurricane Katrina August 25-28, 2005 OEP Command Center DHH Operations Open Special Needs Shelter (SNS) Operations New Orleans Baton Rouge Terrebonne Parish Lafayette Lake Charles Alexandria Monroe Evacuation of Southeast Louisiana State Hospital New Orleans Adolescent Hospital to Eastern Louisiana Mental Health System

7 Speier, A. (2006) Louisiana Office of Mental Health Initial Locations of OMH Incident Response: OEP Command Center OPH Command Center SARBO New Orleans TMOSA Sites New Orleans Baton Rouge Emergency Response Sites OPH Command Center TMOSA SARBO NOPD Sites OEP – Tent Cities for Police Units Baton Rouge Sites Special Needs Shelters New Orleans Baton Rouge Houma/Terrebonne Lafayette Lake Charles Alexandria Monroe Evacuation of Charity Hospital in New Orleans Acute Unit to Central Louisiana State Hospital

8 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

9 Speier, A. (2006) Louisiana Office of Mental Health Post Katrina/Rita Realities 2006

10 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

11 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.

12 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.

13 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.

14 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.

15 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.

16 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.

17 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 Region 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.

18 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.

19 Speier, A. (2006) Louisiana Office of Mental Health Behavioral Health Incident Management: Communication Pathway 2006 Hurricane Season STATE EOC State EOC DHH DESK (Independence Blvd.) DHH EOC (Bluebonnet Blvd.) Behavioral Health Section Chief OAD OCDD OMH Disaster Operations Executive Staff 9 DHH Regional Commanders (OPH) Behavioral Health Regional Liaison OAD OCDD OMH Regional Managers Designee and 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:

20 Speier, A. (2006) Louisiana Office of Mental Health The Louisiana Crisis Counseling Program

21 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).

22 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, –$34,651, 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.

23 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.

24 Speier, A. (2006) Louisiana Office of Mental Health 3 West Feliciana Washington St. Tammany Tangipahoa St. Helena Livingston Coupee Pt. East Avoyelles Baton Rouge W. Iberville Orleans John St. Charles St. Bernard Plaquemines Jefferson Ascension St. James s Assumption Lafourche Terrebonne BeauregardAllen Calcasieu Cameron Jefferson Davis Evangeline St. Landry Acadia Vermilion Lafayette St. Martin Iberia Vernon Rapides Winn Grant LaSalle Catahoula Concordia Caldwell Natchitoches Caddo Bossier Red River DeSoto Sabine Webster Bienville Claiborne Lincoln Jackson UnionMorehouse Ouachita RichlandSt Franklin Tensas Madison Carroll WestEast 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

25 Speier, A. (2006) Louisiana Office of Mental Health 3 West Feliciana Washington St. Tammany Tangipahoa St. Helena Livingston Coupee Pt. East Avoyelles Baton Rouge W. Iberville Orleans John St. Charles St. Bernard Plaquemines Jefferson Ascension St. James s Assumption Lafourche St. Mary Terrebonne BeauregardAllen Calcasieu Cameron Jefferson Davis Evangeline St. Landry Acadia Vermilion Lafayette St. Martin Iberia Vernon Rapides Winn Grant LaSalle Catahoula Concordia Caldwell Natchitoches Caddo Bossier Red River DeSoto Sabine Webster Bienville Claiborne Lincoln Jackson UnionMorehouse Ouachita Richland Franklin Tensas Madison Carroll WestEast Rita …. Louisiana Spirit East

26 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.

27 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.

28 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 Mental Health Agencies

29 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.

30 Speier, A. (2006) Louisiana Office of Mental Health Facilitating Integration School Districts Community Service Providers Mental Health Service Providers How to facilitate collaboration & coordination of services so that more needs are met effectively and efficiently?

31 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 Lifeline TALK –Stress Management Cadre –First Responder Agencies –Special Population Groups

32 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

33 Speier, A. (2006) Louisiana Office of Mental Health Louisiana Spirit Crisis Counseling Program Data (9/1/05 – 8/31/06) Immediate Services Program

34 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 Contacts 9,848,987 Materials Distributed –Child/youth self-help –Grief and bereavement –Stress management –Assisting first responders

35 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

36 Speier, A. (2006) Louisiana Office of Mental Health Brief, Individual, and Group Contacts Over 1,000,000 In-Person Contacts have been made.

37 Speier, A. (2006) Louisiana Office of Mental Health Individual Contacts by Service Area

38 Speier, A. (2006) Louisiana Office of Mental Health Individual Contacts By Age

39 Speier, A. (2006) Louisiana Office of Mental Health Individual Crisis Counseling Contacts by Race

40 Speier, A. (2006) Louisiana Office of Mental Health Referrals by Type

41 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.

42 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 ,162 participants (15%) returned surveys 80% resided in one of the disaster- declared parishes Survey was designed on a 5 th grade reading level

43 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

44 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.

45 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.

46 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.

47 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.

48 Speier, A. (2006) Louisiana Office of Mental Health Too Many Cooks Spoil the Broth Practice and Policy Considerations

49 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

50 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)

51 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

52 Speier, A. (2006) Louisiana Office of Mental Health Incident Classification Disaster vs Catastrophic Event Program Model and Funding defined by incident type

53 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

54 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

55 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.

56 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?

57 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.

58 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

59 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.

60 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.

61 Speier, A. (2006) Louisiana Office of Mental Health

62 Hope is the enemy of despair. If you think you have lost yours, call to just talk and be heard TALK


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