A Quarterly Technical Assistance Journal on Disaster Behavioral Health Produced by the SAMHSA Disaster Technical Assistance Center

The Dialogue

2020 | VOLUME 16 | ISSUE 1

Supporting U.S. Territories and Island Populations After Disasters IN THIS ISSUE 3 In This Issue 4 Contributors 5 Technical Assistance Snapshot 6 Island CCP Draws on Close-knit Community in Support of Recovery 9 A Holistic Approach to Supporting Survivors After Disasters 12 Preparing to Train Island Populations 16 Recent Technical Assistance Requests

Cover photo provided by Brian Beck.

The Dialogue is a quarterly technical assistance journal on disaster behavioral health which is produced by the Substance Abuse and Mental Health Services Administration (SAMHSA) Disaster Technical Assistance Center (DTAC). Through the pages of The Dialogue, disaster behavioral health professionals share information and resources while examining the disaster behavioral health preparedness and response issues that are important to the field. The Dialogue also provides a comprehensive look at the disaster training and technical assistance services SAMHSA DTAC provides to prepare states, territories, tribes, and local entities so they can deliver an effective disaster behavioral health response. SAMHSA DTAC provides disaster technical assistance, training, consultation, resources, information exchange, and knowledge brokering to help disaster behavioral health professionals plan for and respond effectively to mental health and substance misuse needs following a disaster. To learn more or receive The Dialogue, please call 1–800–308–3515, email dtac@samhsa. hhs.gov, or visit the SAMHSA DTAC website at https://www.samhsa.gov/dtac.

The Dialogue is not responsible for the information provided by any web pages, materials, or organizations referenced in this publication. Although The Dialogue includes valuable articles and collections of information, SAMHSA does not necessarily endorse any specific products or services provided by public or private organizations unless expressly stated. In addition, SAMHSA does not necessarily endorse the views expressed by such sites or organizations, nor does SAMHSA warrant the validity of any information or its fitness for any particular purpose. A Quarterly Technical Assistance Journal on Disaster Behavioral Health Produced by the SAMHSA Disaster Technical Assistance Center

In This Issue

Island populations face unique challenges preparing for, responding to, and recovering from disasters. Island communities tend to be isolated and more reliant on their own resources and community members for daily needs. Assistance in the form of supplies, materials, and personnel may take more time to arrive after a disaster due to logistical difficulties after an incident. Cultural and societal roles and values differ between islands even if they are in close proximity to each other. Disaster planners and responders need to keep this in mind when working with island populations.

According to the Federal Emergency Management Agency website, since 2010 American Samoa, , Hawaii, the Northern , Puerto Rico, and the U.S. Virgin Islands had a total of 45 disaster declarations including emergency declarations, major disaster declarations, and fire management grant declarations. after Super Typhoon Yutu. Our next article focuses on The Substance Abuse and Mental Health Services training efforts undertaken in the U.S. Virgin Islands Administration (SAMHSA) Disaster Technical after Hurricanes Irma and Maria. The concluding Assistance Center (DTAC) has several planning and article was submitted by a clinician working in Puerto responding resources for disaster behavioral health Rico after Hurricanes Irma and Maria. professionals working with island populations: Do you have any experience responding to disasters • The Dialogue: Cultural and Population Sensitivity affecting island populations? Other disaster responders in Disaster Behavioral Health Programs can learn from your efforts. We encourage you to contact us to share your stories. ■ • Helping Older Adults After Disasters: A Guide to Providing Support Captain Erik Hierholzer, B.S.N. Program Management Officer, Emergency Mental Health and • Stronger Together: An In-Depth Look at Selected Traumatic Stress Services Branch Community-Level Approaches to Disaster [email protected] Behavioral Health Nikki Bellamy, Ph.D. Public Health Advisor, This issue of The Dialogue focuses on programs Emergency Mental Health and Traumatic Stress delivered to island populations after disasters. We start Services Branch the issue with an interview from a Crisis Counseling [email protected] Assistance and Training Program (CCP) staff member in the Commonwealth of the . Shannon Loomis, M.A. Director, SAMHSA DTAC He shares his experiences working with the survivors [email protected]

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Contributors

Brian Beck, M.S. is the Program also worked as a research assistant with the Carlos Manager for the CCP Y.U.T.U. Albizu University and the Department of Justice, for the (You, Us, Together, United) within identification of the psychosocial characteristics of sex the Commonwealth Healthcare offenders in Puerto Rico. Corporation’s Community Guidance Center. This CCP provides services After the passage of Hurricanes Irma and María, Dr. to Super Typhoon Yutu survivors on the islands of Maldonado worked as a mental health services facilitator and , two of three inhabited islands in the U.S. and as a team leader of the ASSMCA “Anímate” Project, Commonwealth of the Northern Mariana Islands. Mr. offering the first psychosocial assistance to community Beck holds a B.S. in psychology from the University members. of Pittsburgh, an M.S. in management from Colorado Technical University, and has spent a large part of his career in collegiate academic advising and management Jenny Wiley, M.S.W., LCSW brings consulting for small businesses. From Denver, Colorado, 16 years of disaster mental health he moved to Saipan alone to start a new chapter in experience, including overseeing life just 12 days prior to Super Typhoon Yutu making the Missouri disaster mental health landfall—the strongest typhoon to hit U.S. soil since response to disasters, administering 1935. Mr. Beck is a survivor himself and gratitude and the mental health portion of the humility form the foundation of his flexibility after a Centers for Disease Control and Prevention public disaster. He spends his free time kayak fishing, scuba health grant and the Hospital Preparedness Program. diving, and swimming with his dog, Cato. Ms. Wiley has completed numerous Federal Emergency Management Agency (FEMA) incident command courses and works collaboratively across agency boundaries in the Jonathan Maldonado, Psy.D. is a completion of plans and guides including the Behavioral licensed clinical psychologist who Health Emergency Template for Health Care Agencies. works as a Clinical Supervisor of She led three CCPs for Missouri. the SAMHSA Emergency Response Grant Project of La Administración Ms. Wiley now consults and teaches throughout the de Servicios de Salud Mental y United States and its territories. She is certified to teach Contra la Adicción (ASSMCA), the Mental Health and the FEMA CCP required curriculum and in 2017 co- Anti-Addiction Services Administration in Puerto Rico. taught the Train-the-Trainer CCP course. She also teaches Dr. Maldonado obtained his Psy.D. at The Carlos Albizu Skills for Psychological Recovery (SPR), Psychological University, where he got certified and trained to work First Aid (PFA), the FEMA Planning for the Needs of with survivors of domestic violence. Children (G366) course, and children’s disaster mental health courses. In 2017, Ms. Wiley was a facilitator Dr. Maldonado completed his internship at the Office and presenter for the SAMHSA All-Hazards Disaster of Rehabilitation and Treatment of the Department of Behavioral Health State Planning Meeting. Between 2017 Correction and Rehabilitation of Puerto Rico, where he and 2019, Ms. Wiley made eight trips to the U.S. Virgin offered individual therapy, group therapy, and personality Islands teaching the CCP courses, PFA, and SPR. assessment services to the inmates. Dr. Maldonado

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TECHNICAL ASSISTANCE SNAPSHOT SAMHSA Support After Hurricanes Irma and Maria Clinical Services in U.S. Virgin Islands and Puerto Rico by Year

5,000 4,629 YEAR 1 YEAR 2 4,000

3,000 2,223 2,406 2,000

1,000 677 421 256

U.S. Virgin Islands Puerto Rico Total

SAMHSA funded additional support to help Puerto Rico and the U.S. Virgin Islands after Hurricanes Irma and Maria. Funding was made available for disaster behavioral health, trauma, and other capacity- building trainings, as well as clinical disaster behavioral health treatment services for remote and underserved areas affected by hurricanes. The trainings and services were offered during 2018 and 2019.

Types of Natural Disasters Experienced in Island Communities

FLOODS HURRICANES TSUNAMIS VOLCANOES EARTHQUAKES

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INTERVIEW Island CCP Draws on Close-knit Community in Support of Typhoon Recovery An interview with Brian Beck, M.S.

In October 2018, Super Typhoon A CCP grant was established to help debris off roads. We did that almost Yutu swept over the Commonwealth the CNMI recover from Yutu. The until Christmas, and during that time of the Northern Mariana Islands Dialogue recently spoke with its most of us didn’t have a place to (CNMI), with major effects on the program manager about the program live. Most of us were without water islands of Saipan and Tinian. With and challenges it has faced, as well or power for at least 2 months. winds reaching 180 miles per hour, as strengths the program has built Yutu was the strongest tropical upon in enhancing the local area’s Resilience is built into the culture cyclone to hit the United States since ability to endure difficult conditions. here. Everyone tried to pitch in to 1935 (Masters, 2018; Dwyer, 2018; help, and no one was really sad or Mooney, Eilperin, & Chiu, 2018). What was your experience complaining. Yutu took 2 lives, injured more than of Yutu? Many Americans know very 130 people, knocked out water and I moved to Saipan on October 12, little about the CNMI, even power, and damaged or destroyed 2018, 12 days before Yutu hit. I had though it’s part of the country. significant portions of the island’s been planning to teach at Northern What are the islands like? buildings and critical infrastructure Marianas College, but it was (FEMA 2018; Eugenio, H., 2018; destroyed in the typhoon. I helped The CNMI consists of 14 islands. Eugenio, H. V., 2018; Fortin, 2018). bring water to villages and clear Saipan is the capital. The CNMI

Photo provided by Brian Beck.

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was part of the Trust Territory of the Pacific Islands before becoming a commonwealth. Previously, the CNMI has been part of Spain, Yutu was Germany, and Japan. stronger than Saipan is about 200 Hurricanes miles north of Guam, SAIPAN and about 45 square Katrina, Harvey, TINIAN miles in size. The and Maria 2017 census said that approximately 48,000 people live in Saipan. I would guess that there are fewer now. Tinian has about 1,500 people.

The CNMI is fascinating culturally. Super Typhoon Yutu passes over Tinian on October 24, 2018. Satellite image by Satellite image by Chamorros trace evidence of their National Oceanic and Atmospheric Administration (NOAA). ancestry back to 3500 BC, and to make a couple of good friends When we work with survivors, Carolinians arrived in the mid to late here and in Guam who are licensed we often arrange for after-hours 1700’s. Both cultures are officially clinicians. I get good technical appointments or use back-door considered to be the only indigenous assistance from them, and from entrances to homes or temporary people of the CNMI. In addition to SAMHSA DTAC. shelters. We have met survivors in Chamorros and Carolinians, people third party, neutral locations as well. here are Filipino, Chinese, Korean, We have undergone pretty severe Russian, and Japanese. economic austerity. The central We have been careful in our government lost revenue from messaging to be culturally Have you faced challenges in tourism, and this has affected just appropriate. We try to get away your CCP? If so, how have you about everyone in the CNMI from from the term “mental health.” addressed them? the businesses sustained by tourism, “Mental” doesn’t have a good It’s not easy to plan outreach work to the employees in both the public connotation. We replace that with on Saipan and Tinian, because and private sector who’ve lost their “behavioral health.” It is important the islands haves no house or lot jobs or had their hours cut. It has that our messaging is congruent with numbers. To help with this, we’ve been challenging, but everyone is normalizing the common reactions partnered with Central Statistics pointed in the right direction, toward these survivors may have. to get aerial maps and draw recovery and building local capacity. deployment plans. What should disaster workers There is a huge stigma around keep in mind when working We do not have many mental asking for help here. Many don’t with island populations? health and substance use treatment seem to want to ask for help because The most important thing is to be professionals on the islands. I’ve they don’t want to appear to be a sincere and respectful. You may had to do a lot of homework and burden to others. We have had to get not understand the nuances of the networking. I have been fortunate creative in how we help survivors.

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Commonwealth of the are largely Mandarin-speaking they need help and that, to be strong Northern Mariana Islands Chinese and Taiwanese people. To enough to help others, they need to reach them, we had our materials first take care of themselves. translated into Mandarin, worked with a local Falun Dafa group, and We try to create an environment networked with Chinese private where it will be easier for folks to schools. endure future . Yutu was stronger than Hurricanes Katrina, What are some unique Harvey, and Maria. We had another strengths of residents in the typhoon in February of this year, a CNMI? super typhoon, and then three more I would say that respect and after that. We’ll have more; it’s part gratitude form the practical basis of of life here. We’re working on our most local capacity here. Lifestyle messaging, videos, teaching coping also plays a role. Living without skills, and normalizing reactions, running water or electricity literally all as much as possible in native is the baseline for some survivors on languages. our islands. There is an idea in the What would you recommend field of disaster behavioral health disaster workers new to the that survivors don’t make good first community do before working responders. Here survivors make with island populations? the best first responders, because of how integrated the community Obviously, try to get as well versed is. Our team has varying levels of as you can in the local culture. When education in disaster behavioral I was planning on moving here, I health, but they can be very effective did a lot of research. But even if you because they show sincere empathy, know nothing, if you come with an culture, but if you approach people and because they come across not open heart and mind and respectful with an open mind, they will be as clinicians, but more as neighbors approach, people here are very warm glad. People are warm and accepting or concerned friends or relatives. and generous and will treat you very of outsiders here. It’s a collectivist This by itself helps break down the well. culture that revolves around respect cultural stigma of asking for and A lot of love is shown through food and family. receiving help. here. The best I was ever fed was doing cleanup work right after Yutu. It’s difficult to find marginalized Have you worked on building a That was one of the first things I communities on islands. Although program legacy? we identified special populations noticed about my team. We were at We’re doing our best through for our CCP grant application, we a buffet, and several of them made messaging campaigns to break down discovered another one: unemployed plates of food to share with the rest the stigma that keeps people from contract workers in immigration of the table. It’s a very automatic asking for help. We’ve created a limbo who have been fired or laid thing for residents here to take care pre-typhoon messaging protocol off and overstayed visas. They were of each other. It makes you feel so to let people know that it’s okay if hesitant to interact with us. They grateful.■

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A Holistic Approach to Supporting Survivors After Disasters By Jonathan Maldonado, Psy.D.

After Hurricanes Irma and María hit Puerto Rico in 2017, I worked as a Mental Health Services Facilitator and as Team Leader of the San Juan region of the Mental Health and Anti-Addiction Services Administration (ASSMCA) “Anímate” Project, offering the first psychosocial help to members of the community. After several months conducting relief and crisis intervention sessions in the community, I began providing additional clinical treatment and services in mental health, as part of the recovery efforts for Puerto Rico. We realized that At first, the idea was to work in our services would collaboration with the ASSMCA, which would provide us with office have a greater reach space in which to offer these mental Photo by Yuisa Ríos/FEMA. and provide more health services to the community members who were referred to us. benefits if we could Because of the experience gained take them directly to during the months of community directly to the community. We service through the “Anímate” agreed to cover the entire island, the community. Project, we knew that many people including Vieques and Culebra affected by the hurricanes did not Islands, which are accessed by have access to transportation or ferry. We directed all Mental the ability to reach an office due Health Services Facilitators of located in FEMA Disaster Recovery to advanced age, lack of financial the “Anímate” Project teams and Centers and Community Recovery resources, or lack of a family support the ASSMCA Social Assistance Centers. network. Program line to refer to us those participants who needed clinical Although in general, Hurricanes Because of these factors, we mental health interventions. Soon, Irma and María resulted in many realized that our services would we began receiving referrals from cases of posttraumatic stress, have a greater reach and provide other agencies, community leaders, the greatest effect we saw in the more benefits if we could take them social workers, and case managers participants we helped was the

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exacerbation of symptoms of such as the separation of the family the survivors. Some of the most preexisting conditions, such as due to emigration and Puerto concerning social problems were major depression, panic disorder, Rico’s political and social situation the loneliness and lack of a family and generalized anxiety. Issues caused emotional instability among support network in older adults and the difficulty in accessing FEMA assistance for reconstruction. For many participants, it was resulted in very hard to reach the FEMA the longest blackout in U.S. history— Disaster Recovery Centers due to transportation problems or lack of it took 328 days for power to be restored in all knowledge about the centers, while others had difficulty in providing neighborhoods in Puerto Rico (FEMA, 2018). ownership title of their properties, giving up on the process. Situations like these resulted in feelings of hopelessness, sadness, and frustration in many people.

Bringing our clinical services to the community opened our eyes to the social needs many survivors faced. I often felt that the psychotherapy fell short of the pressing needs of people who did not have a

Photos provided by Dra. Monserrate Allende Santos.

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family support network, economic we cannot ignore the more pressing the importance of seeing the resources, or transportation to obtain needs, and we have committed human being in a holistic way, medical services, in addition to the ourselves to intercede. with a biopsychosocial approach. deterioration of their residences, Hurricanes Irma and María which in many cases only had a The challenge of our own physical uncovered a preexisting social blue awning as a ceiling. On many security also arose. On many reality in Puerto Ricans and occasions, as a clinical psychologist, occasions, we visited areas with a aggravated it by destroying their I also had to perform the role of a high incidence of crime or that were residences and separating many social worker and refer several older very remote and hard to reach. For families. A survivor’s mental health adults living in unsafe conditions these cases, we accompanied social needs could not be adequately to the appropriate agencies, for workers of the zones or sought the addressed separate and apart from relocation to a safer home. We support of the work team of the the physical and social needs such as encountered other needs in patients “Anímate” Project. lack of adequate housing. It is only that went beyond a major problem During this transformative when treating the whole person can at the psychological level. In the experience, I was able to reaffirm true progress be made. ■ work we carry out in the community,

Top 5 Costliest U.S. Hurricanes Hurricanes Maria and Irma had total costs of $94.5 billion and $52.5 billion, respectively. Hurricane Maria now ranks as the third costliest PUERTO RICO weather disaster on record for the nation, and Irma ranks as the fifth costliest.

Katrina 2005 170.0 BILLION

Harvey 2017 131.3 BILLION

Maria 2017 094.5 BILLION

Sandy 2012 074.8 BILLION

Irma 2017 052.5 BILLION

Source: https://www.ncdc.noaa.gov/billions/dcmi.pdf

Hurricane Maria approaching Puerto Rico. Photo by NOAA GOES-16. Retrieved from https://www.climate.gov/news-features/understanding-climate/hurricane- marias-devastation-puerto-rico.

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Preparing to Train Island Populations By Jenny Wiley, M.S.W., LCSW

The U.S. Virgin Islands experienced out on all the islands forcing many back-to-back category 5 hurricanes to depend on generators for months in September 2017. On September 6, or go without power. There were St. Thomas and St. John had a direct long lines to get water, food, and hit from while St. medicine. Pregnant women about Croix had less damage from the 185 to give birth were evacuated from mile per hour winds. However, on St. Thomas to St. Croix and, September 19, 2017, St. Croix was unfortunately, endured the wrath also battered by the 165 mile per of both hurricanes. The most hour winds from Hurricane Maria. serious patients from the damaged One study found that After Hurricane Irma, St. Croix had hospitals were evacuated to Alabama responded to St. Thomas and St. without family support. For most following Hurricane Maria John with supplies including food island residents, evacuation before and Hurricane Irma, and water leaving them ill-equipped the storm was not an option and 6 in 10 adults had to deal with a devastating hurricane therefore going to shelters or depressive symptoms. 2 weeks later. sheltering in place were their only choices. At the beginning of 2019, Source: Michael et al., 2019 Both hurricanes caused significant some families still had blue tarps on destruction and affected the lives their roofs and belongings stored in of all residents of the U.S. Virgin plastic bags for protection from the Islands. Electricity was knocked elements.

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The level of damage to the islands Photo provided by Dra. Monserrate Allende Santos. CCP management staff and local was such that St. John, St. Thomas, disaster behavioral health leadership and St. Croix received major regarding the conditions on the disaster declarations allowing them islands and their citizens. Power was to be eligible to apply for a CCP. restored in the main areas, but brown I was invited to provide all the outs still occurred and preparing required CCP trainings as well as to proceed without PowerPoint Psychological First Aid (PFA) and projection was essential. SAMHSA Skills for Psychological Recovery DTAC supplied the handout (SPR). The first of the required CCP materials as even making copies was trainings, Core Content Training, challenging. occurred in December 2017. Two providers, Beautiful Dreamers Providing disaster behavioral health support and training meant serving St. Thomas and St. John, Among children and Island Therapy Solutions continually being aware of the serving St. Croix, were engaged by surveyed, over 40% conditions in which the crisis the government of the U.S. Virgin had symptoms of counselors found themselves. Their Islands to provide crisis counseling posttraumatic stress homes were damaged or destroyed. services to the residents. The grant Some had family members living more than a year after with them or they were living with was managed through Lutheran Hurricanes Irma Social Services (LSS) of the U.S. others. Many were living in their Virgin Islands. and Maria. damaged homes. They had to adjust Source: Michael et al., 2019 hours for the beginning and ending Challenges to Providing of school as students went to school Training on the Islands in shifts. A few developed health conditions. Recovery is drawn out Prior to delivering training, it due to the dynamics of island living. was important to consult with the Everything must be shipped in and

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evening value respect and the island culture. “Compared with 2016, the number of suicides in Puerto Rico was 16% higher 4 months after these Be prepared to adjust presentation hurricanes and 26% higher 6 months after Hurricane times. Depending on the audience, agenda start times and the Maria. Specifically, 26 people—nearly one a day—took commencement of the training their own lives in November 2017.” may be different. Although some Source: Ramphal, 2018 audiences are timely, others are more laid back and training may be delayed as much as 30 minutes to getting the supplies necessary for culture, and customs before going. an hour. Food is also an important repairs has taken months and for Island culture is different from part of the U.S. Virgin Islands’ some nearly 2 years. And yet, the living in the states and each island culture. The CCP does not provide empathy and flexibility displayed is unique in its history, religious, food but LSS, the providers, and by the crisis counselors for others ethnic, and cultural makeup. In crisis counselors generously shared while living in the same conditions St. Thomas, Dr. Vincentia Paul- their local dishes despite their was remarkable. All exercises within Constantin graciously taught a hardships. Knowing this helps one to the CCP training have purpose segment about the culture of the adequately prepare. and meaning, but it emerged that islands. She and Carla S. Perkin the crisis counselors appreciated were interviewed about culture Flexibility is always needed by those that demonstrated self-care, awareness by SAMHSA DTAC for trainers. Through no fault of the particularly the visualization activity an article in Volume 14, Issue 3–4 of providers, things happen such as in Section 4 of the CCP Disaster The Dialogue, available at https:// equipment failure, materials not Anniversary Training Guide. www.samhsa.gov/dtac/disaster- arriving, last minute room and/ This visualization exercise was behavioral-health-resources/ or complete location changes. designed to promote relaxation and dialogue. Another invaluable The ability to adjust on the fly is identify some things that would be resource was the CCP teams who crucial when training in any disaster helpful to enhance personal stress were community members and affected area. management. Feedback regarding reflected the languages, culture, and Lift the mood with humor the PFA and SPR courses indicated religions in the islands. and activities. Lightening the that the skill building within the Don’t pretend to be who you atmosphere with humor, appropriate courses would immediately help fun activities, candy, and small the participants in their various aren’t. As disaster behavioral health professionals, we appreciate the prizes also assisted in lifting the fields and these courses were highly mood. Again, it was the astute local valued. importance of being genuine. CCP teams related that some responders leadership that brought it to my Lessons Learned When desiring to be accepted would try to attention. I think I resisted adding Training on the Islands speak the lingo or use island accents. activities due to having to carry Unfortunately, it only served to extra supplies as things are not Call on the experts. I had never make relationships more difficult readily available on the islands. It been to the U.S. Virgin Islands to establish. Social graces such was a lesson learned: just don’t carry so I learned as much as I could as saying good morning or good chocolate to a warm island. ■ about the makeup of the islands,

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RECOMMENDED RESOURCES

Developing Cultural Competence in Disaster Psychological First Aid Field Operations Guide: 2nd Mental Health Programs: Guiding Principles and Edition Recommendations The Psychological Fist Aid (PFA) Field Operations This manual from the SAMHSA Store gives guidance, Guide provides guidance on how to assist children, recommendations, and additional resources for adolescents, adults, and families in the aftermath of a developing a disaster mental health response that is natural or human-caused disaster. This downloadable culturally appropriate and effective. Taking the time guide from the National Child Traumatic Stress Network to properly understand an area’s culture can help provides more in-depth information, handouts for strengthen communication and support the efforts of a survivors, and handouts to distribute and copy. disaster recovery plan. Download the guide at https://bit.ly/2Q2fLZ7. Find the manual at https://bit.ly/33MJzgp. Effective Coordination of Recovery Resources for U.S. Virgin Islands Territorial Emergency State, Tribal, Territorial and Local Incidents Management Agency: Tsunamis This resource from FEMA was developed for state, This web page from the U.S. Virgin Islands Territorial tribal, territorial, and local government officials to Emergency Management Agency covers information better understand their role in the recovery process on tsunamis and the importance of acting quickly in after a natural or human-caused disaster. This guide the event of one. The page provides links to evacuation highlights the various tasks of the recovery process that maps for St. Croix, St. John, and St. Thomas. It also are often challenging and how coordination can be better includes a link to an alternate resource where you can developed and recovery plans enhanced. learn to understand the difference between various terms This resource is available at https://bit.ly/2PL3eck. that identify a tsunami hazard. Find the web page at https://bit.ly/2ph9eib.

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Recent Technical Assistance Requests In this section, read about responses SAMHSA DTAC staff have provided to recent technical assistance (TA) requests. Send your questions and comments to [email protected].

Request: SAMHSA DTAC received a TA request „ QPR (Question, Persuade, Refer)—This suicide from a member of the New York City Police Department prevention training helps participants to recognize the (NYPD) interested in suicide awareness and prevention warning signs of suicide and question, persuade, and resources and trainings to help train the civilian refer people at risk for suicide for help. Individuals members of the NYPD. do not need particular educational or professional background to complete QPR training and use QPR. Response: SAMHSA DTAC provided the following Learn more at https://qprinstitute.com. resources: „ SafeTALK—This half-day training teaches individuals „ Suicide Prevention Resource Center—Developed by steps to identify people with suicidal thoughts and SAMHSA, this website offers several trainings for any connect them to resources for help and support. Learn professional interested in improving their knowledge more about the training at https://www.livingworks. and skills in suicide prevention. Their trainings are net/safetalk. free, self-paced, and open to anyone. You can find them at https://www.sprc.org.

„ Applied Suicide Intervention Skills Training Request: SAMHSA DTAC received a TA request (ASIST)—This 2-day training program teaches from a disaster behavioral health professional requesting participants how to assist those at risk for suicide. resources on working with children during the Although many healthcare professionals use ASIST, anniversary of . anyone 16 years or older can use the approach, Response: In addition to sending information for regardless of professional background. Find the the CCP currently operating in Bay County, Florida, training program at https://www.livingworks.net/ SAMHSA DTAC provided the following resources: asist.

Are you looking for disaster behavioral health resources? Check out the new and updated SAMHSA DTAC Disaster Behavioral Health Information Series (DBHIS) installments.

https://www.samhsa.gov/dtac/dbhis-collections

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Request: SAMHSA DTAC received a TA request for resources and tools to assist in providing disaster behavioral health services in emergency shelters.

Response: SAMHSA DTAC provided the following resources:

„ Disaster Behavioral Health Interventions Inventory—This SAMHSA DTAC Supplemental Research Bulletin includes Psychological First Aid as an important disaster behavioral health model as well as specific assessment instruments such as Screening, „ Tips for Talking with and Helping Children and Brief Intervention, Referral to Treatment (SBIRT), Youth Cope After a Disaster or Traumatic Event: and Psychological Simple Triage and Rapid Treatment A Guide for Parents, Caregivers, and Teachers— (PsySTART). Find it at https://www.samhsa.gov/ This fact sheet helps parents and teachers recognize sites/default/files/dtac/supplemental-research- common reactions and highlights helpful ways to bulletin-may-2015-disaster-behavioral-health- respond. The fact sheet is available at https://store. interventions.pdf. samhsa.gov/product/sma12-4732. „ Psychological First Aid (PFA) Field Operations „ Tips for Families on Addressing Anniversaries—This Guide—Developed by NCTSN and the National tip sheet developed by the National Child Traumatic Center for PTSD, this guide provides core actions of Stress Network (NCTSN) offers parents andcaregivers PFA and handouts for survivors. It can be found at ways to help children cope with the anniversary of a https://www.nctsn.org/sites/default/files/resources/ disaster or traumatic event. The tip sheet is available pfa_field_operations_guide.pdf. at https://www.nctsn.org/resources/tips-families- „ addressing-anniversaries. Helping Survivors: Early Interventions Following Disaster and Mass Violence—This National Center „ Teacher Guidelines for Helping Students After a for PTSD web page provides early interventions Hurricane—This tip sheet developed by the NCTSN following disaster and mass violence. The web page offers guidance to teachers on how to help students is available at https://www.ptsd.va.gov/professional/ recover and cope after a hurricane. The tip sheet treat/type/disaster_earlyintervention_tx.asp. ■ is available at https://www.nctsn.org/resources/ teacher-guidelines-helping-students-after- hurricane.

2020 | VOLUME 16 | ISSUE 1 | PAGE 17 A Quarterly Technical Assistance Journal on Disaster Behavioral Health Produced by the SAMHSA Disaster Technical Assistance Center

REFERENCES

Dwyer, C. (2018, October 24). Fortin, J. (2018, October 24). Ramphal, L. (2018). Medical and Super Typhoon Yutu, ‘strongest ‘Catastrophic’ super Typhoon Yutu psychosocial needs of the Puerto storm of 2018,’ slams U.S. Pacific slams into U.S. commonwealth in Rican people after Hurricane Maria. territory. National Public Radio. the Pacific.The New York Times. Baylor University Medical Center Retrieved from https://www.npr. Retrieved from https://www.nytimes. Proceedings, 31(3), 294–296. doi: org/2018/10/24/660224741/super- com/2018/10/24/us/super-typhoon- 10.1080/08998280.2018.1459399 typhoon-yutu-strongest-storm-of- yutu-pacific-mariana.html 2018-slams-u-s-pacific-territory Masters, J. (2018, October 24). Category Eugenio, H. (2018, October 30). 5 Super Typhoon Yutu pounding U.S. The Dialogue is not responsible for Second death reported as a result of Northern Mariana Islands. Category the information provided by any web Super Typhoon Yutu. Pacific Daily 6™. Weather Underground. Retrieved pages, materials, or organizations News. Retrieved from https://amp. from https://www.wunderground. referenced in this publication. guampdn.com/amp/1804553002 com/cat6/Category-5-Super- Although The Dialogue includes Typhoon-Yutu-Pounding-US- valuable articles and collections Eugenio, H. V. (2018, October 26). Northern-Mariana-Islands of information, SAMHSA does not Humanitarian crisis looms after Super necessarily endorse any specific Typhoon Yutu flattens parts of Saipan Michael, N., Valmond, J. M., Ragster, products or services provided by and Tinian. USA Today. Retrieved L. E., Brown, D. E., & Callwood, public or private organizations from https://www.usatoday. G. B. (2019, February). Community unless expressly stated. In addition, com/story/news/2018/10/25/ needs assessment: Understanding SAMHSA does not necessarily super-typhoon-yutu-leaves-1- the needs of vulnerable children endorse the views expressed by such dead-crisis-looms-saipan-and- and families in the U.S. Virgin sites or organizations, nor does tinian/1771400002 Islands post Hurricanes Irma and SAMHSA warrant the validity of Maria. Retrieved from https://cfvi. Federal Emergency Management any information or its fitness for any net/wp-content/uploads/2019/03/ Agency (FEMA). (2018, July). 2017 particular purpose. CFVI-CERC-Community- hurricane season FEMA after-action Needs-Assessment-E-Report_ The views, opinions, and content report. Retrieved from https:// February-2019_Bookmarked.pdf expressed in this publication do www.fema.gov/media-library- not necessarily reflect the views, data/1531743865541-d16794d43d30 Mooney, C., Eilperin, J., & Chiu, opinions, or policies of the Center 82544435e1471da07880/2017FEMA A. (2018, October 25). Category for Mental Health Services (CMHS), HurricaneAAR.pdf 5 typhoon Yutu devastates the the Substance Abuse and Mental Northern Marianas in worst storm to Health Services Administration FEMA. (2018, October 31). Northern hit any part of U.S. since 1935. The (SAMHSA), or the U.S. Department Mariana Islands Super Typhoon Yutu Washington Post. Retrieved from (DR-4404). Retrieved from of Health and Human Services https:// https://www.washingtonpost.com/ (HHS). www.fema.gov/disaster/4404 energy-environment/2018/10/25/ category-typhoon-devastates- northern-marianas-worst-storm- hit-us-since

2020 | VOLUME 16 | ISSUE 1 | PAGE 18 Prepare • Respond • Recover Inform • Assist

SUBSCRIBE The Dialogue is a publication for professionals in the disaster behavioral health field to share information, resources, trends, solutions to problems, and accomplishments. Contact SAMHSA DTAC to be added to The Dialogue subscription list. SHARE INFORMATION Readers are invited to contribute to The Dialogue. To author an article for an upcoming issue, please contact SAMHSA DTAC at [email protected]. ACCESS ADDITIONAL SAMHSA DTAC RESOURCES The SAMHSA DTAC Bulletin is a monthly e-communication used to share updates in the field, post upcoming activities, and highlight new resources. Contact SAMHSA DTAC to be added to the SAMHSA DTAC Bulletin subscription list. The SAMHSA Disaster Behavioral Health Information Series contains resource collections and toolkits pertinent to disaster behavioral health. Installments focus on specific populations, specific types of disasters, and other topics related to all-hazards disaster behavioral health preparedness and response. Visit the SAMHSA DTAC website at https://www.samhsa.gov/dtac/dbhis-collections to access these materials.

CONTACT US SAMHSA Disaster Technical Assistance Center Toll-free: 1–800–308–3515 [email protected] https://www.samhsa.gov/dtac