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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: or as part of our Recovery Residence Administrator Training Program
~    Rationale and Process for Disaster Planning
~    Preparing for Disaster
~    Continuity Planning
~    Management of Prescription Medications
~    Testing the Plan
~    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)

~    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
~    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 ‚Äúguest‚ÄĚ 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 ‚Äúshared‚ÄĚ with programs experiencing an influx of clients to reduce payroll load
~    Consider how to support client retention through active outreach following a disaster

~    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