Disaster Planning:
An Ethical Obligation
Instructor: Dr. Dawn-Elise Snipes
Executive Director: AllCEUs Counselor Education
Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery
This course is available on-demand here: https://allceus.com/member/cart/index/search?q=Risk+and+Disaster+Management or as part of our Recovery Residence Administrator Training Program https://allceus.com/member/cart/index/product/id/619/c/
Objectives
~ Rationale and Process for Disaster Planning
~ Preparing for Disaster
~ Continuity Planning
~ Management of Prescription Medications
~ Testing the Plan
Rationale
~ Disaster planning can save lives, minimize injury and emotional trauma, protect property and operational capability, and prevent or reduce interruptions in treatment.
~ The behavioral health treatment program has a special obligation to prepare for disasters because it provides essential services.
~ By their nature, disasters have an impact on behavioral health:
~ Most people who experience a disaster, whether as a victim or responder, will have some type of psychological, physical, cognitive, and/or emotional response to the event. Most reactions are normal responses to severely abnormal circumstances. (American Medical Association, 2005, p. 2)
Rationale
~ Disaster planning can prepare the program for continuing to provide the services to its existing clientele in order to prevent:
~ Relapse
~ Medical and psychological consequences for prematurely discontinuing medically managed detox or crisis stabilization
~ Homelessness if clients are in a residential facility
~ Client destabilization due to lack of access to medications prescribed and/or administered by the agency (antipsychotic injections, prescription refills, methadone)
~ Exacerbation of problems in at-risk populations as a result of lack of access to support
Rationale
~ Disaster Planning can help mitigate psychological issues in the community by providing services to new clients (Katrina)
~ Aid to other programs
~ Rapid response to influx of clients from other agencies or areas
Types of Disasters
~ Your facility is incapacitated or destroyed (fire, building flood, sink hole) but other facilities remain open and clients are in their homes
~ Your facility and others are incapacitated and clients are in shelters (Hurricane, blizzard, fires).
~ Your facility is functional in the aftermath of a natural disaster in which your patients are in shelters. (City-wide flood).
~ When the program must cease provision of nonessential services due to a sudden reduction in resources, infrastructure, or available personnel due to illness or diversion of resources.
Health department can provide a copy of the local Hazard Identification and Risk Assessment (HIRA)
Continuity Planning
~ Requires a program’s personnel to consider the threats that could adversely affect essential functions;
~ Determine the personnel, vital information (e.g., patient medical records including prescription records), and other resources required to continue those essential functions;
~ Develop plans for providing essential functions onsite or at alternate locations if needed
~ Make advance arrangements for obtaining the resources necessary to support essential functions throughout the disaster and recovery phases
~ Plan for the safety of all personnel during these periods.
Planning cont…
~ In its initial work, the disaster planning team conducts or gathers, from partner agencies in the community, a hazard identification and risk assessment
~ A hazard-specific appendix should not repeat information that is in either the basic plan
Types of Clients
~ Current clients
~ Current clients who are destabilizing
~ Guest clients
~ Prior clients whose recoveries are threatened
~ Individuals with an untreated mental health issue which must be addressed to prevent further deterioration
~ Family members of clients who need assistance to support their loved ones (Hotline, online support groups)
~ Patients who need prescription refills written
~ Patients on an opioid pain medication who cannot access their physician
The Plan
~ Introduction: Purpose of the plan and objectives
~ Concept of operations
~ Procedures for activating and deactivating (Who, What, When, How)
~ Staff responsibilities in the disaster
~ List of the personnel positions authorized to make requests for outside aid or assistance
~ the conditions under which to request aid
~ the procedures for managing requests to give aid
~ a list of resources that can be used in those efforts.
The Plan
~ Functional Annex (Response to a specific hazard type)
~ Hazardous weather/tornado warning
~ Facility Fire
~ Wildfire / Flood
~ Facility Flood
~ Hurricane / Blizzard
~ Earthquake
~ Viral Pandemic
~ Chemical Spill
~ Train or major vehicle wreck or explosion
The Plan
~ Implementation Instructions
~ Checklists and materials necessary to perform disaster related tasks
~ Scripts to respond to the media, public or consumers
~ Floorplans
~ Community Maps
~ Safety Related policies and procedures
~ Memoranda of Agreement including address of each facility, phone number and contact person
Keep It Simple
~ Basic plan should address
~ General procedures
~ Contain a general decision and notification tree
~ Plans for monitoring where clients go
~ Avoid having staff need to refer to multiple sections in the plan
~ If your agency has multiple locations or types of programs, each program type needs its own addendum to each functional annex (Detox, CSU, Residential, IOP, Adolescent)
~ Supervisory staff should maintain a paper copy and each building unit should maintain a paper copy in an accessible location
~ Administrative and Clinical staff must ALL be adequately trained including scenario training.
Coordination with Others / MOU
~ Memorandum of Understanding with:
~ Hospitals/Health Departments (Detox, crisis stabilization, medication maintenance)
~ Behavioral Health Disaster Response Team (Health Departments)
~ Emergency Management for evacuation of patients
~ Other clinics for mutual referral or staff borrowing
~ Sober homes for patients in addiction recovery
~ SAMHSA’s Disaster Technical Assistance Center (DTAC) specialists can help a program link with the disaster behavioral health coordinator for its State and answer questions about accessing state and federal funding
~ Health departments must coordinate disaster planning with the community’s behavioral health treatment systems
Role of the Health department
~ Engaging and coordinating with emergency management, healthcare organizations (private and community-based), behavioral health providers, community and faith-based partners
~ Support the development of public health, medical, and mental/behavioral health systems that support recovery
~ Participate in awareness training with community and faith-based partners on how to prevent, respond to, and recover from public health incidents.
~ Promote awareness of and access to medical and mental/behavioral health resources that help protect the community’s health and address the functional needs of at-risk individuals
~ Receive and/or integrate the health needs of populations who have been displaced due to incidents that have occurred in their own or distant communities
Role of the DEA
~ Monitors and reviews actions the program takes in a disaster regarding controlled substances (e.g., relocating a methadone supply to an alternate facility)
~ Inform the local DEA agent about the use of controlled substances that are prescribed or dispensed to patients and stored at the facility (ADHD, Anxiety, Opiate)
~ The State Opioid Treatment Authority can assist in making contact with the local DEA official
Role of the Media
~ Assist in coordination of services
~ Request including in local TV and Radio emergency listings (operating status of the program, where to go if closed)
PreDisaster Preparedness
~ Educate partners to destigmatize and ensure continuity of care at “guest” agencies or in shelters
~ Methadone / Suboxone
~ Schizophrenia
~ Educate the public about the importance and availability of behavioral health services in an emergency
~ Get Memoranda of Understanding
Pre-Disaster Preparedness
~ Educate local emergency response organizations about:
~ Characteristics of patients (especially residential)
~ Needs of patients during and after transport
~ Most appropriate settings most appropriate for relocation
~ Specific locations that have, through MOU, agreed to accept patients
~ Patients have a right to expect from general population emergency shelters support services that provides:
~ Access to medications to maintain health, mental health, and function
~ Refrigeration for medications
~ Assistance that may be required due to cognitive and intellectual disabilities.
Pre-Disaster Preparedness
~ Identify Essential Functions
~ Safety of clients and visitors
~ Behavioral health emergency services including crisis and relapse prevention.
~ Track clients affected by dispersal and evacuation to ensure they continue to receive needed behavioral health services.
~ Assist clients in accessing needed medications.
~ Conduct drug testing for mandated clients.
~ Adhere to applicable State licensing standards.
~ Maintain treatment and billing records in accordance with regulatory requirements.
~ Protect client rights and privacy, including the integrity of PHI
~ As resources are available and based on mandates, provide disaster mental health services to the community including prevention specific guidance and crisis intervention
PreDisaster Preparedness
~ Become aware of funding sources in an emergency and how to access them
~ State and Federal funds (e.g., Robert T. Stafford Disaster Relief and Emergency Assistance Act)
~ Crisis Counseling Assistance and Training Program (CCP) grants, which are funded by FEMA
~ SAMHSA Emergency Response Grants (SERGs)
Mitigate Risk
~ Improve facility’s ability to withstand a disaster
~ Hurricane window covering
~ Backup generators
~ Prepare for shelter-in-place for when evacuation is unsafe (Chemical spill)
~ Stockpile supplies: Cots, linens, soap, toothpaste, nonperishables for a 72-hour period
~ Prepare personal go-kits (1 per client) with water bottle, flashlight, batteries, toiletries, and consider… t-shirt and shorts, towel, high energy food bar (Can have clients bring at admission)
~ Inventory and replace supplies at least quarterly
Mitigate Risk
~ Real-time data back-up of electronic health record at a remote location which can be accessed in emergency
~ Keep coolers on site for transportation of refrigerated medications
~ Ensure electric water pump (if any) are connected to back-up generator
~ Train all staff in emergency psychological first aid
~ Have a psychiatric advanced directive in the file for any patient who may destabilize in an emergency which includes helpful interventions and info about legal representative should they become incapacitated.
Mitigate Risk
~ Prepare for financial resiliency
~ How to enroll clients in emergency Medicaid
~ Reimbursability of services
~ Educate payors about modified counseling services to facilitate reimbursement
~ Some agencies may have a reduction in cash flow due to relocation of community residents
~ Staff members might be “shared” with programs experiencing an influx of clients to reduce payroll load
~ Consider how to support client retention through active outreach following a disaster
Summary
~ Disaster planning prepares for client safety and continuity of care and financial solvency for organizations in the event of a disaster
~ Getting MOUs with local agencies, the health department and emergency services is vital to preparation
~ A list of identified risks for your area can be accessed at your local health department
~ All staff needs to be trained in the disaster procedure and scenario training should occur periodically