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

the Dialogue 2015 | VOLUME 11 | ISSUES 3–4

The Road to Recovery: Looking Back 10 Years After Hurricane Katrina ∙

IN THIS ISSUE 2 Katrina the Aftermath and Recovery: 17 Hurricane Katrina: Recovery and A Special Infographic Insert Resilience Among Children 3 Special Feature: Gulf Coast Disaster 19 Katrina’s First Responders: Behavioral Health Coordinators Look An Interview with Danny Adams, Back Assistant Fire Chief, Ret./Disaster Behavioral Health First Responder 10 Part of the Fabric of Recovering Communities: The Katrina Assistance Lead, Baton Rouge, Louisiana Project 22 Native American Communities Affected by Hurricanes Katrina 11 All Hands: SAMHSA’s Response to and Rita Hurricane Katrina 25 Recommended Resources 14 Turning Rebuilding Into Reengineering: New Orleans School Systems 26 Upcoming Events After Katrina 27 Additional Webinars and Trainings

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 behavioral health (mental health and substance abuse) response to disasters. To receive The Dialogue, please go to SAMHSA’s home page (http://www.samhsa.gov), enter your email address in the “Mailing List” box on the right, and mark the checkbox for “SAMHSA’s Disaster Technical Assistance newsletter, The Dialogue,” which is listed in the Newsletters section. 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 abuse needs following a disaster. To learn more, please call 1-800-308-3515, email [email protected], or visit the SAMHSA DTAC website at http://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 the Dialogue In This Issue

how their disaster behavioral health response operations have changed as a result of Hurricane Katrina. Other articles focus on the unique challenges of supporting special populations—children, first responders, and Native Americans—following Hurricane Katrina.

This special edition is in memory of all those who lost their lives and is in honor of all those who survived. We wish to thank everyone who worked tirelessly to support the survivors on their road to recovery— a new normal.

We hope you find the articles in this edition helpful and we encourage your feedback—what is your “new normal”? More than 1,800 people lost their lives as a result of Hurricane Katrina. Warmest regards, Source: FEMA CAPT Erik Hierholzer, B.S.N. Program Management Officer, Emergency Mental The 2005 hurricane season broke many weather records Health and Traumatic Stress Services Branch in the United States, including the most named storms [email protected] (28), most hurricanes (15), second-highest number of Nikki Bellamy, Ph.D. hurricanes to strike the United States (6—Cindy, Dennis, Public Health Advisor, Emergency Mental Health and Katrina, Ophelia, Rita, and Wilma), the most major Traumatic Stress Services Branch (category 3 or higher) hurricanes (4—Dennis, Katrina, [email protected] Rita, and Wilma), costliest (Katrina), and most intense (Wilma) (Blake, Landsea, & Gibney, 2011; Farris, 2007; Brenda Mannix National Oceanic and Atmospheric Administration, SAMHSA DTAC Project Director National Climatic Data Center, 2012). [email protected] More than 1,800 people lost their lives. Over 1 million people were displaced with nearly 600,000 evacuated References from the effects of Hurricane Katrina. Millions more Blake, E. S., Landsea, C. W., & Gibney, E. J. (2011). The deadliest, costliest, and most intense United States tropical cyclones from 1851 to 2010 (and survivors were left to find a new normal. It’s the 10-year other frequently requested hurricane facts) (NOAA Technical Memorandum NWS NHC-6). Miami, FL: National Weather Service, National Hurricane anniversary of that devastating season, and this edition Center. Retrieved from http://www.nhc.noaa.gov/pdf/nws-nhc-6.pdf of The Dialogue focuses on the recovery of the Gulf Farris, G. S. (2007). The major hurricanes of 2005: A few facts. In G. S. Farris, G. J. Smith, M. P. Crane, C. R. Demas, L. L. Robbins, & D. L. Lavoie Coast and those associated with the response. (Eds.), Science and the storms: The USGS response to the hurricanes of 2005 (U.S. Geological Survey Circular 1306) (pp. 12–15). Reston, VA: U.S. Two articles share lessons learned from the SAMHSA Geological Survey. National Oceanic and Atmospheric Administration, National Climatic Data response perspective. A special feature Q&A with Center (Cartographer). (2012). Continental United States hurricane strikes the State Disaster Behavioral Health Coordinators of 1950–2011 [Map]. Retrieved from http://www1.ncdc.noaa.gov/pub/data/ images/2011-Landfalling-Hurricanes-32x34.pdf Alabama, Louisiana, Mississippi, and Texas describes

2015 | VOLUME 11 | ISSUES 3–4 | PAGE 1 A Quarterly Technical Assistance Journal on Disaster Behavioral Health Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue

Katrina The Aftermath and The Recovery

The Aftermath 1.504 Million Estimated number of individuals 70% aged 16 years and older that evacuated of all occupied units from their homes, even temporarily, were damaged because of Hurricane Katrina Katrina displaced more than Number of Evacuees by State 1,000,000 people in the 19 percent 75 percent Mississippi Gulf Coast region. Louisiana

Up to 600,000 households were still displaced a month later.

At their peak, hurricane evacuee 6 percent shelters housed 273,000 people. Alabama At least 114,000 house- holds were relocated to FEMA trailers. Source: Groen, J. A., & Polivka, A. E. (2008, March 1). Hurricane Katrina evacuees: Who Source: The Data Center they are, where they are, and how they are faring. Monthly Labor Review, 32–51. Retrieved from http://www.bls.gov/opub/mlr/2008/03/art3full.pdf

The Recovery

Change in the Number of Housing Units in the New Orleans Metro Area Compared to the Change in Population of the City of New Orleans, 2005–2014

600,000 Number of housing units in Population of the city of the New Orleans metro area 592,800 New Orleans 553,627 Percent Change in 520,000 Housing Units 494,294 July 2005 to July 2006 -35.2% 438,278 440,000 July 2006 to 2012 20.8% 384,320 Percent Change in 360,000 Population July 2005 to July 2006 -114.7% 280,000 July 2006 to 2014 230,172 40.1%

200,000 July 2005 July 2006 2014

Source: Population Estimates and Intercensal Population Estimates

In 2014, New Orleans returned Unemployment Rate: Louisiana Versus the Nation to the list of the nation’s 50 September 2005 most populous cities, ranking 50th at 384,320. 11.4% 4.8% Percent of evacuees who returned to their pre- Nation Katrina residences or county, October 2005– October 2006 Louisiana

71% April 2015

Percent of evacuees who did not return to their pre- Katrina residences and did not even return to the 5.4% county in which they were living, October 2005– 6.6% October 2006 Louisiana Nation 68% Source: U.S. Bureau of Labor Statistics, Local Area Unemployment Statistics; U.S. Bureau of Labor Statistics, April, 2015 Percent of Louisiana natives affected by the storm that no longer live in the State 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 23%* health and substance abuse needs following a disaster. *8% of Louisiana's population in 2005

Source: Groen, J. A., & Polivka, A. E. (2008, March 1). Hurricane Katrina evacuees: Who they are, where they are, and how they are faring. Monthly Labor Review, 32–51. Retrieved from http://www.bls.gov/opub/mlr/2008/03/art3full.pdf

2015 | VOLUME 11 | ISSUES 3–4 | PAGE 2 A Quarterly Technical Assistance Journal on Disaster Behavioral Health Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue

SPECIAL FEATURE Gulf Coast Disaster Behavioral Health Coordinators Look Back Perspectives From Alabama, Louisiana, Mississippi, and Texas

In this special Q&A, Chance Freeman from Texas, Kris Jones from Mississippi, Acquanetta Knight from Alabama, and Cassandra Wilson from Louisiana share their insights from responding to Hurricane Katrina and talk about how disaster preparedness and response have changed in the ensuing 10 years.

The Dialogue: How has your the state psychiatric hospitals and Emergency Database to facilitate approach to disaster behavioral state university psychiatry units call-back of staff for emergency health planning and response in several areas of the state to assignments. improved or evolved since Hurricane practice evacuation and shelter-in- Katrina? place protocols for each agency. We expanded planning and Also, suicide prevention, substance readiness activities after Hurricane Acquanetta Knight (AK), Alabama: use screening and referral, and Katrina in a statewide effort to There has been an increased focus domestic violence training were integrate behavioral health into among partners and stakeholders on incorporated into the Louisiana overall public health response. We incorporating cultural competence Spirit Crisis Counseling Assistance revised data collection systems into planning, especially as it and Training Program (CCP). for substance use services to relates to sheltering during disaster. Additionally, all state employees determine if clients served were Since Katrina, disaster behavioral are now required to complete affected by or displaced as a health training has also been Emergency Support Function result of a disaster. We established designed to expand the response (ESF)-8 training. protocols for emergency access to workforce. At least annually, psychiatric services in disasters, training on the effects of trauma To build response capacity, as well as protocols for use in during disaster, posttraumatic we developed a Behavioral medical special needs shelters stress disorder related to disaster, Health Cadre to offer support to (MSNSs) and for public/quasi- and Psychological First Aid (PFA) individuals who need crisis, grief, private hospitals with psychiatric has been provided statewide. and loss assistance after traumatic units to shelter at the state’s Plans include the development events that is beyond the capability psychiatric hospitals in the central of a Critical Incident Stress of local response systems. Also, and northeast parts of the state. We Management tabletop exercise. we established protocols to employ developed contingency contracts for needed CCP staff at the state level transportation of psychiatric clients Cassandra Wilson (CW), Louisiana: (short term), as contracts are no to sheltering sites, and we pre- We also have expanded training longer feasible, and Louisiana has identified psychiatric surge beds for and exercises, including routine now implemented an Employee evacuated shelterees or evacuees. tabletop exercises conducted with continued on page 4

2015 | VOLUME 11 | ISSUES 3–4 | PAGE 3 A Quarterly Technical Assistance Journal on Disaster Behavioral Health Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue continued from page 3 We also enhanced backup systems role at the community level with CCP. Additionally, we made for critical data and improved support from the state as needed. evacuation preparation plans more emergency communications Coordination of the behavioral comprehensive, with specific systems for critical staff. We health resource is also being pushed details of supplies, equipment, and initiated annual reviews and updates out to the locals to promote a personnel that need to be in place with state psychiatric hospitals for seamless response system and to prior to the arrival of evacuees. prestaging of supplies and staffing, strengthen partnerships with other HVAC-capable generators are now and we created written evacuation ESF agencies. on site at psychiatric facilities, agreements with providers for use nursing homes, and hospitals of the state’s psychiatric facilities Since Katrina, the state has through Federal Emergency as an evacuation/shelter site. also focused on improving how Management Agency Hazard Additionally, we now include in services are delivered. In the Mitigation grants. our response plans the deployment Louisiana Spirit CCP, trained first of members of the behavioral responders and stress managers Kris Jones (KJ), Mississippi: health first responder team and were deployed statewide to support Mississippi had the opportunity to local governing entities in affected other responders post-event. We change and improve our disaster regions to assist with evacuation have made this component of behavioral health planning and and sheltering. Louisiana Spirit a permanent part response. Prior to Katrina, a formal of our CCPs. We also developed system did not exist. Post-Katrina, Also, local government entities and implemented tools for local the Department of Mental Health have taken ownership of the government entities to support (DMH) recognized the importance primary behavioral health responder timelier implementation of the of solidifying disaster planning and continued on page 5

Houston, TX., 9/1/2005 -- Hurricane Katrina survivors sitting on cots after being evacuated from New Orleans to a Red Cross shelter in the Houston Astrodome. FEMA photo/Andrea Booher

2015 | VOLUME 11 | ISSUES 3–4 | PAGE 4 A Quarterly Technical Assistance Journal on Disaster Behavioral Health Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue continued from page 4 response activities as part of the agency’s mission. DMH created the Division of Disaster Preparedness and Response to manage not only disaster preparedness and response activities but also continuity of operations activities for the public mental health system. Subsequently, that division has increased its level of responsibility and oversight and is now the Office of Incident Management. The office remains responsible for disaster preparedness and response activities, as well as the agency’s incident management reporting system for agencies certified by DMH.

Chance Freeman (CF), Texas: Texas is fortunate to have a robust New Orleans, La., October 1, 2005 — Pharmacist Ed Tate fills an order for Paul Lio, RN at the D.M.A.T. network of volunteers and 39 (Disaster Medical Assistance Team) center. MARVIN NAUMAN/FEMA photo mental health authorities willing to respond to any disaster. However, since Katrina, Texas has focused on disaster behavioral health response TD: In your opinion, what is the most important lesson(s) learned from developing tools to assist disaster teams. These teams will be trained the behavioral health response to behavioral health responders according to qualifications established Hurricane Katrina? in tracking encounter data and by the state’s Disaster Behavioral Health Consortium and will include response/recovery expenses. This AK: To me, the most important individuals with specialized training toolkit is accompanied by a training lesson learned during Katrina was in Incident Command, PFA, spiritual that explains the role of crisis the importance of making sure care, victims assistance, and Critical counselors, how disaster response first responders had information Incident Stress Management. The differs from the clinical setting, and regarding behavioral health state also recognized the need to how to track encounters as well as resources, particularly information develop local/regional Disaster how to track and report response specific to substance use disorder Behavioral Health Consortia. These expenses. The toolkit is updated treatment. During Katrina, states groups will serve as advisory groups regularly based on lessons learned and regions were able to effectively to local and regional public health from previous response activities plan and develop emergency planners, emergency managers, and and as advancements in data treatment protocols for evacuees incident command. Lastly, the state gathering are made. who presented without prescriptions. is still in the process of incorporating These emergency policies, coupled Understanding Texas’ vastness providers of substance use treatment with the dissemination of treatment and diverse cultures, the state is services into the overall emergency and response information, proved to developing and rostering regional management landscape. be critical strategies. continued on page 6 2015 | VOLUME 11 | ISSUES 3–4 | PAGE 5 A Quarterly Technical Assistance Journal on Disaster Behavioral Health Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue continued from page 5 CW: One key lesson for Louisiana support and PFA to survivors local levels prior to an event and was that behavioral health agencies evacuated to MSNSs and critical the need to engage individuals who should be prepared with training transportation needs shelters are most knowledgeable about the and resources to respond to requests across the state. operations of state systems during for crisis support from other partner an event. During the response to ■■ agencies. Also, as Acquanetta The specialized crisis counseling Katrina, DMH learned that the mentioned earlier, cultural services developed during height of an event is not the time competence and appropriateness are Katrina should be utilized to learn the incident management crucial. In Louisiana, we learned to help survivors develop structure, its moving parts, and its that community staffing post- the skills needed to recover key players. Although the CCP is event should reflect the makeup psychologically. a valuable resource to behavioral of the area to help broker into ■■Continuing partnerships are health agencies during and after an communities that need services. essential in each affected area event, DMH quickly learned that We learned the importance of (public, private, faith-based, engaging individuals who are most identifying specific cultures and advocacy organizations, etc.), knowledgeable about the operations ensuring that services and staff can either directly or indirectly. of state systems led to more meet their needs. positive outcomes for communities, KJ: Two of the most important rather than hiring “unseasoned” Some of our other lessons learned lessons learned from Katrina were staff with little systems experience. are as follows: the importance of establishing Through our experience with relationships with emergency Katrina and subsequent disasters, ■■It is critical to educate staff to ensure coordination of crisis management partners at state and we have found that people affected by the event most often need assistance with getting basic needs met. When people were successful in getting those needs met, we found that the longer-term mental health effects of the event were lessened.

CF: Substance use-related services are important components of emergency planning, response, and recovery. During Katrina, we underestimated the number of individuals who needed opioid treatment services. However, communities stepped up and did what was needed to Baton Rouge, La., January 21, 2006 - Discussions with planning team members and local residents at the ensure individuals received the Louisiana Recovery Planning Day open house was one method used to gather public input that will identify priority recovery issues unique to each community. This event served as the first of several opportunities for medications, treatment, and wrap- Louisiana citizens and organizations to join the local, state and federal initiative to create long-term recovery around services that they needed. plans for rebuilding hurricane affected areas in Louisiana. Robert Kaufmann/FEMA This is a true testament of how continued on page 7 2015 | VOLUME 11 | ISSUES 3–4 | PAGE 6 A Quarterly Technical Assistance Journal on Disaster Behavioral Health Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue continued from page 6 dedicated Texas is when it comes to ensured availability of onsite CF: Understanding the size and caring for those in need. behavioral health support at scope of the event, Texas would locations such as parish pickup sites have requested additional assistance TD: Knowing what you know now and assembled trained behavioral through Texas-based membership about disaster behavioral health health mobile crisis teams. We organizations such as the National planning and response, how would also would have developed and Association of Social Workers– you have done things differently in Hurricane Katrina? implemented organized systems Texas Chapter and the Texas and structures at the state level to Psychological Association. The AK: The only thing that comes track all evacuees and quickly link state would have also looked to to mind is alerting the disaster them to identified resources while the Texas Voluntary Organizations response workforce to the in shelters and upon discharge. Active in Disaster (VOAD) for magnitude of the disaster, which Finally, we would have established volunteers and engaged substance was unprecedented and somewhat a protocol for mental health clinics use providers much sooner. unforeseen. While anyone patients’ medication planning TD: What were some of the most watching news accounts could during an emergency or disaster. significant behavioral health impacts understand the severity of the among survivors/evacuees and how hurricane’s initial impact, the sheer KJ: Knowing what we know were those different or similar to number of people presenting with now, DMH approaches disaster behavioral health much differently: those among residents already living overwhelming needs was in some in the community (who could also be technical assistance related to ways difficult to prepare for and considered survivors)? predict. However, Alabama, and disaster preparedness and planning the surrounding Gulf states, did a for DMH-certified provider AK: The most significant heroic job in responding to these agencies has been integrated into differences were cultural. needs, addressing behavioral health DMH’s routine practice; and Alabamians, for the most part, concerns, and welcoming evacuees workforce development in the areas sought shelter in neighboring on short notice. of PFA, mental health first aid, and communities during Katrina’s onset suicide prevention is ongoing. A and returned to their communities CW: There are several things we critical component of local disaster as soon as possible. Conversely, would have done differently, based response has become the use of individuals and families from the on what we learned from Katrina. mobile crisis response teams (made New Orleans area traveled several Some I have touched on already. up of clinicians, case managers, hundred miles to take shelter. Others include better integration and peers) funded through state In many cases, these shelters of behavioral health services appropriation, but operated by were developed in rural areas into overall state planning and local community mental health of Alabama. In some instances, response efforts. We also would centers. The primary role of these transport occurred so rapidly that have more thoroughly planned teams is to respond to behavioral evacuees didn’t know their shelter for and tracked behavioral health health crises in their communities; destinations. These individuals clients to be evacuated—ensuring however, the teams respond to and experienced uncertainties about clinics/providers include readiness coordinate with state and local their futures and, in some cases, planning with clients and their emergency management agencies longed for reconnection with their families, and that clients have during an event. This enables DMH loved ones. They also missed access to emergency behavioral to put into practice the philosophy traditional Louisiana customs health services. We would have that events are best handled locally. and foods that provided a daily continued on page 8 2015 | VOLUME 11 | ISSUES 3–4 | PAGE 7 A Quarterly Technical Assistance Journal on Disaster Behavioral Health Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue continued from page 7 sense of comfort, routine, and entire community and the lengthy 2000 and 2014 censuses). However, security. Rural Alabamians made recovery process. this population decline could be the every attempt to welcome and result of multiple changes in the accommodate evacuees. Preparing Also, the capacity to rebound was area and not specifically related to communities and providing just- just not there for many who found Hurricane Katrina. in-time or PFA training may have themselves homeless and living on empowered more rural areas of the streets, in abandoned structures, Another source estimates that as Alabama to better understand the or under bridges with little hope many as 30,000 evacuees have customs and culture of evacuees. of recovery. Residents felt they permanently relocated to Baton could not survive outside of their Rouge and the surrounding area. CW: There was a lack of PFA community and had limited to no Because there was not a formal training among all responders access to behavioral health services. tracking system in place post- to better prepare them to handle Katrina, repatriation of evacuees TD: In general, how many evacuees survivors/evacuees experiencing from various shelters (in state and went home versus stayed in their emotional distress. Another issue out of state) focused on returning new location? was cultural insensitivity or survivors using state and federal ignorance of responders, which CW: This number is not definitive. transportation assets. The LA Swift increased the psychological impact According to the U.S. Census bus line between New Orleans and on survivors. And many evacuees Bureau, the population estimates for Baton Rouge, which was started in the workforce underestimated the New Orleans suggest a 21 percent after Hurricane Katrina to help psychological impact of losing an decrease (difference between the people return to their homes and continued on page 9

New Orleans, Sept.1, 2005 -- Survivors of Hurricane Katrina arrive at New Orleans Airport where FEMA’s D-MAT teams have set up a medical hospital and where people will be flown to shelters in other states. Photo: Michael Rieger/FEMA

2015 | VOLUME 11 | ISSUES 3–4 | PAGE 8 A Quarterly Technical Assistance Journal on Disaster Behavioral Health Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue continued from page 8 jobs in New Orleans, transported school systems. Also, relocation of resources based upon word of mouth over 12,000 commuters monthly residents resulted in a significant or previous experience. Colleges, the from Baton Rouge to New Orleans loss of staff. faith-based community, and citizens from 2006 until 2013 to help provided support to adults and displaced residents rebuild their CF: The greatest challenges we children who were being sheltered. homes and livelihoods (Samuels, experienced regarding evacuees The governor established a state 2013). included: office to manage the extensive supply of donations and to develop a TD: How many evacuees did your ■■Locating appropriate service list of volunteers willing to provide state take in following Hurricane delivery sites, especially additional services. Katrina? for methadone maintenance medications CF: Texas communities welcomed AK: It’s reported that 14,500 evacuees. Many benefited from evacuees took shelter in Alabama ■■Accommodating the large the rich culture that the evacuees following Katrina. In addition to number of individuals in need of brought with them. The evacuees shelters established by VOADs, behavioral health providers who stayed enriched their Alabama used its statewide ■■Obtaining medical records communities through music, art, community college and parks and food. ■ systems to provide shelter and ■■Tracking clients separate from temporary housing. Texas residents Contributed by: ■■ Chance Freeman, former Texas TD: What were the challenges to ■■ Being affected by Hurricane Rita Disaster Behavioral Health providing services to evacuees? 1 month after Katrina Coordinator, Texas Department of State Health Services AK: Overall, the challenges were TD: How did the communities who ■■ Acquanetta Knight, Director of few. It’s amazing how seamlessly received evacuees respond to them? Planning and Resource Development the response effort worked. In large at the Alabama Department of CW: Overall, communities part, this is because partnerships Mental Health are maintained in Alabama when seemed to welcome evacuees, ■■ Kris Jones, Director, Bureau of with the exception of those areas disasters and disaster recovery are Quality Management, Operations & not in progress. These preexisting less receptive to the culture or Standards, Mississippi Department relationships stood the most powerful perceived culture of the evacuees. of Mental Health test of time to date in the state. Many states made provisions for a ■■ Cassandra Wilson, Director, number of evacuees with housing Emergency Preparedness Operations, CW: Our greatest challenges were and jobs. Other evacuees were Louisiana Department of Health and not knowing where people were, met with fear and with less-than- Hospitals, Office of Behavioral Health and a completely shut down desirable accommodations for this Reference transit system. Most in the New diverse population. Samuels, D. (2013, July 26). LA Swift service will Orleans area were evacuated to end July 31, funding proposal not accepted. The AK: News stories during the time Times-Picayune. Retrieved from http://www. various other cities and states nola.com/traffic/baton-rouge/index.ssf/2013/07/ immediately after the storm. With reported how welcomed evacuees la_swift_service_will_end_july.html limited or no infrastructure left, it felt in Alabama. One story indicated was increasingly difficult to locate that the reputation of some of survivors in need of services. Alabama’s shelters resulted in This was especially true of the evacuees specifically seeking those

2015 | VOLUME 11 | ISSUES 3–4 | PAGE 9 A Quarterly Technical Assistance Journal on Disaster Behavioral Health Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue

Part of the Fabric of Recovering Communities: The Katrina Assistance Project Contributed by Anne Mathews-Younes, Ed.D., D.Min., Director, Division of Prevention, Traumatic Stress, and Special Programs, SAMHSA Center for Mental Health Services

It’s hard to believe that it has been the country deployed to fill the cruise ships where first responders 10 years since Hurricane Katrina gap between the services offered and their families lived. In all these hit the Gulf Coast. The memory of through the Crisis Counseling settings, KAP professionals brought the disaster is still fresh for many Assistance and Training Program hope to people and helped foster a people. In Katrina’s aftermath, the (CCP) grant and the services needed new sense of community. need for mental health (MH) and to restore essential local MH and substance abuse (SA) services was SA service delivery systems. KAP evolved into an innovative, unprecedented and at times seemed field-based model for providing overwhelming. In addition to the clinical MH and SA services, an Enter the “Orange Shirters” enormous numbers of affected approach that many equated with the individuals, the storm’s destruction In all, 130,000 people received mobile medical and surgical teams left many state and local MH and services. Two weeks after Katrina’s used by the military. SA agencies unable to serve their landfall, KAP “orange shirters” communities. Practitioners were spread out over the disaster-affected Katrina brought the need dislocated, facilities damaged, area, offering care wherever they for professional MH and found people in need. They helped patient records destroyed, SA care into public view and distribution channels for individuals displaced by the storm pharmaceutical supplies disrupted. and supported the efforts of first and demonstrated the Most seriously, many hospitals were responders. By maintaining a visible importance of these services closed, so emergency psychiatric presence where people gathered in the recovery process. services were hard to find. and reaching out to people in need, KAP professionals entered the KAP personnel took treatment out SAMHSA determined that as mainstream of life in the newly of traditional clinical settings and many as 500,000 people needed created communities of “dislocated” became part of the fabric of these behavioral health assistance after and often distressed people. recovering communities. Katrina’s landfall and so moved The clinicians often had to modify swiftly to create the Katrina The SAMHSA KAP initiative was their traditional approaches and Assistance Project (KAP). KAP was essential to rebuilding communities improvise in the fragmented post- funded by the Federal Emergency in the Gulf Coast region. While it disaster environment. Sometimes Management Agency through did not involve bricks and mortar, they had to see an agency’s regular SAMHSA (at approximately it contributed strength of a different clients, find and engage new ones, $12 million) to support the MH kind. KAP offered hope where and provide professional support and SA needs of people affected it had been washed away, and to local agency staff. Their orange by Hurricane Katrina. Over 600 empowered people to rebuild lives shirts could be seen in shelters, licensed, well-trained, and resilient shattered by Katrina’s destruction. ■ MH and SA clinicians from across tent cities, trailer parks, and on the

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All Hands: SAMHSA’s Response to Hurricane Katrina Contributed by Brenda Mannix, Project Director, SAMHSA Disaster Technical Assistance Center, and former SAMHSA Incident Commander During Hurricane Katrina

Hurricane Katrina struck on Coordinator, who at that time was What I remember most always August 29, 2005. Even 10 years Daniel Dodgen, Ph.D., and staff of comes back to people—the people later, I am flooded by a jumble of the Emergency Mental Health and who were affected, our colleagues memories and emotions, and it is so Traumatic Stress Services Branch in local and state agencies, difficult to focus on just a few short (EMHTSSB) within the Center for many of whom themselves were operational lessons learned. Mental Health Services, led by Mr. disaster survivors and yet became Seth Hassett, M.S.W. EMHTSSB responders, and my colleagues When Katrina hit, SAMHSA— houses both the FEMA/SAMHSA- at SAMHSA and from around for the first time—activated an funded Crisis Counseling Program the federal government who emergency response center for a and the National Child Traumatic volunteered to support SAMHSA’s disaster. Previously, SAMHSA Stress initiative; both programs efforts. In total, more than half of participated in very limited provided intensive services and SAMHSA’s employees worked in roles during national drills and supports to the states, communities, the emergency response center or exercises, so few employees had and individuals affected by the were deployed to Gulf Coast states any experience with incident disaster. Mr. Hassett also served to assist in response operations. command or disaster response as SAMHSA’s first Incident The other half of the Agency’s activities. The majority of disaster Commander for Hurricane Katrina, staff picked up the work of their response work was carried out until he transferred command to me. deployed colleagues and carried by the SAMHSA Emergency continued on page 12

Photo: Steve Zumwalt/FEMA

2015 | VOLUME 11 | ISSUES 3–4 | PAGE 11 A Quarterly Technical Assistance Journal on Disaster Behavioral Health Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue continued from page 11 on regular business. There was no on-the-ground assessments, and types of disasters and emergencies. “I” in that team, and I continue to handling sickness, injuries, and It is built on scalable, flexible, and be proud of being a part of that other emergencies—which included adaptable concepts identified in response. for instance, Hurricane Rita. the National Incident Management System (NIMS) to align key roles Hurricane Katrina was a unique and responsibilities across the A New Framework response for SAMHSA. In most nation. This updated framework disasters SAMHSA provides Following Hurricane Katrina, the places a strong emphasis on technical assistance, training U.S. Department of Homeland planning and partnership building. resources, and coordination and Security and FEMA led an effort SAMHSA required all staff to consultation regarding mental to update and revise the National become trained on NIMS and health and substance use treatment Disaster Recovery Plan, which encourages all states, communities, needs. Katrina destroyed so much became the National Response and facilities to develop disaster infrastructure in the Gulf Coast and Framework. The National Response response plans, update them so many people were evacuated Framework describes how the regularly, and train staff on and unable to return that a typical federal government responds to all continued on page 13 mental health response could not be launched. For the first time in its history, FEMA awarded a mission assignment to SAMHSA to provide mental health and substance use services. SAMHSA staff, clinicians from other agencies—such as the Health Resources and Services Administration, the National Institute of Mental Health, and the Centers for Disease Control and Prevention—and clinicians from around the country were deployed to provide support to survivors, help relieve clinicians who also needed to attend to their own recovery, and stand up treatment facilities. With so many deployed people, we quickly had to develop policies to ensure everyone’s health and safety— managing tours of duty, managing each state’s licensing requirements and temporary reciprocity requirements, providing time for rest, transitioning back to work, Photo: Marvin Nauman/FEMA providing an opportunity to share

2015 | VOLUME 11 | ISSUES 3–4 | PAGE 12 A Quarterly Technical Assistance Journal on Disaster Behavioral Health Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue continued from page 12 Incident Command. Through SAMHSA staff either knew the the Division of State Assistance the SAMHSA-funded Disaster right people to connect with for within the HHS Administration Technical Assistance Center, resources or knew people who for Children and Families. Captain states and communities can access knew the right people. It’s all about Maryann Robinson, Ph.D., is the disaster planning and response relationships. Many of the people I current Branch Chief of EMHTSSB. tools, including tip sheets, program worked with during the Hurricane As for me, I am just finishing my guides, and webcasts discussing Katina response have moved on to first year as Project Director for best practices in planning for other roles and positions, but they SAMHSA’s Disaster Technical disaster behavioral health needs and are still people I count on as expert Assistance Center. I am pleased to responding to special populations. resources and great colleagues. be in a role where I can continue to help connect people to each All of these advancements are Dr. Daniel Dodgen is now the other in preparation for responding for naught if you don’t have Director for the Division of At-Risk to disasters. I look forward to relationships with people and Individuals, Behavioral Health continuing this dialogue, so please organizations. SAMHSA’s and Community Resilience within reach out and let us know what you Hurricane Katrina response efforts the HHS office of the Assistant think of this edition and what other succeeded in part because of the Secretary for Preparedness and information would be helpful to you partnerships and relationships it had Response. Ms. Terri Spear replaced in your disaster preparedness and with other agencies, organizations, Dr. Dodgen as SAMHSA’s response activities. ■ and states. Knowing whom to Emergency Coordinator. Mr. contact is 90 percent of the battle. Hassett is now the director of

SAMHSA’s response efforts succeeded in part because of the partnerships and relationships it had with other agencies, organizations, and states. Knowing who to contact is 90 percent of the battle. SAMHSA staff either knew the right people to connect with for resources or knew people who knew the right people. It’s all about relationships.

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New Orleans, La., June 12, 2013 -- FEMA Louisiana Recovery Office Deputy Director of Programs Andre Cadogan joins city of New Orleans Mayor Mitch Landrieu, Recovery School District Superintendent Patrick Dobard and other federal, state and local government officials at the Fisk Howard school groundbreaking ceremony. Photo: Lynette Fontenot/FEMA

Turning Rebuilding Into Reengineering: New Orleans School Systems After Katrina Contributed by CAPT Jon Perez, Ph.D., SAMHSA Regional Administrator for Health and Human Services Region IX

Hurricane Katrina caused Orleans. After the hurricane, New important area of support that enormous damage in Louisiana Orleans schools were destroyed involved helping the Louisiana and Mississippi, destroying homes and the entire school system was Department of Education (DoE) and businesses, communities, and decimated. recover from the enormity of entire public service systems. One the damage caused to the public of those systems severely damaged This is a brief story about how education system in southern was the public school system sometimes just a little help can Louisiana. I led a small team of across much of southern Louisiana bring big results. four U.S. Public Health Service and Mississippi, and particularly As part of SAMHSA’s massive officers that integrated into the DoE the Orleans Parish public school recovery effort for Katrina, there recovery team during the critical system, which includes New was also a little known, but period immediately following the continued on page 15

2015 | VOLUME 11 | ISSUES 3–4 | PAGE 14 A Quarterly Technical Assistance Journal on Disaster Behavioral Health Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue continued from page 14 hurricane when DoE created the learned about the destruction, the DoE what to do, but be members models it would eventually use more they wondered how, if ever, of their team, and work side-by- to create the new public school they could repair it all. That was side with them to more fully assess models for Orleans Parish and where the SAMHSA team came damage, begin short-term recovery New Orleans. Ten years after the in…the group was composed of operations, and chart longer term destruction, those resulting public behavioral health professionals, a healing for the school systems and school models are being lauded for couple with decades of emergency their students. their innovation. and disaster response experience working with entire recovery From New Orleans to Baton The job facing DoE was systems. And while our team hadn’t Rouge, the team assessed, overwhelming as Katrina destroyed seen this kind of devastation before consulted, engaged constituents, virtually all the existing New in the United States, we had seen it and developed immediate Orleans and Orleans Parish school in other places, and we knew that action plans to get educational districts: helping the team heal would help programs, if not all the schools, the larger system heal as well. operating again. This alone was All 65,000 public school students an extraordinary effort involving were forced to evacuate the city. The SAMHSA team became part the range of educational personnel Administrators, teachers, and support of the DoE team and functioned and resources in the state, and the staff were similarly displaced. The as liaisons between the ongoing remaining students themselves. storm also took an enormous physical federal response and state But it was during these activities, toll on the public schools’ long- personnel, as additional staff for and during ongoing deliberations neglected facilities. According to a DoE, and perhaps most importantly among everyone affected, that facilities assessment done in 2008, as counsel for the DoE team the possibilities for real successes more than two-thirds of the district’s leadership. We were people from became evident. 300 plus buildings were considered the outside who came not to tell continued on page 16 to be in “poor” or “very poor” condition due to storm damage and long-neglected maintenance. (Cowen Institute for Public Education Initiatives at Tulane University, 2010, p. 4).

This destruction affected an already troubled school system that perennially ranked as among the lowest performing school systems in the country. And those charged with addressing these problems were all personally affected by the hurricane, as well.

“Overwhelmed” was the word most often used by the DoE team to describe the situation Baton Rouge, La., January 17, 2006 - This class is being conducted in a new modular building used as a temporary classroom at Audubon Elementary School. Robert Kaufmann/FEMA and themselves, as the more they

2015 | VOLUME 11 | ISSUES 3–4 | PAGE 15 A Quarterly Technical Assistance Journal on Disaster Behavioral Health Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue continued from page 15 As more information became What If...? available, and more constituents— from elected officials to students Rebuilding Reengineering and families—were consulted, the Integration = idea of just repairing a previously Critical Change problem-plagued system became Crisis Change untenable. But for the DoE team, what were the realistic alternatives? Victim of Leader of How do you repair and rebuild on Disaster Innovation such a scale?

It was here the integrated in innovation. “What if…” became Orleans. Although structures and team, and its members with the mantra, and renewed energy policies continue to evolve, the perspectives outside DoE, to promote large scale change overarching reform mechanisms provided a critical change in became evident. that were catalyzed by Hurricane thinking about the overall response Katrina and its subsequent The changes seen now in the New paradigm. Specifically, we flooding in 2005 continue to define Orleans school systems, again ceased approaching the recovery the public education model. School described by the Cowen Institute at effort as system “rebuilding,” autonomy, parental choice, and Tulane University, which has been and began working on system high-stakes accountability remain involved with the effort from the “reengineering.” Inherent in this hallmarks of the system. beginning, are remarkable: was the idea that in great crisis, (Sims & Vaughan, 2014, p. 2). opportunity for great change was The 2013-14 school year marks A small team helping another small also present. What it did for the the eighth full school year since team can sometimes promote the team itself was shift the stance the dramatic transformation of achievement of significant things. from victim of disaster to leaders the public school system in New And it is a testament to the efforts of Louisiana, its people, its government, its schools and administrators, and even a small team of personnel sent by SAMHSA to help in a time of overwhelming need. ■

References

Cowen Institute for Public Education Initiatives at Tulane University. (2010). The state of public education in New Orleans: Five years after Hurricane Katrina. Retrieved from http:// www.coweninstitute.com/wp-content/ uploads/2010/07/katrina-book.final_. CIpageSmaller.pdf

Sims, P, & Vaughan, D. (2014). The state of public education in New Orleans: 2014 report. New Orleans, LA: Cowen Institute for Public Education New Orleans, La., Nov. 7, 2012 -- The Recovery School District has constructed Arthur Ashe Elementary School, a Initiatives at Tulane University. Retrieved from state-of-the-art 97,000 square foot Kindergarten through 8th grade school at the previous site of Bienville School, “http://www.speno2014.com/” which was destroyed by Hurricane Katrina. Lillie Long/FEMA

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Houston, TX., 9/8/2005 -- Elementary school students wave good bye to their parents as they leave the Reliant center for their first day of school in Texas. FEMA photo/Andrea Booher

Hurricane Katrina: Recovery and Resilience Among Children Contributed by Joy D. Osofsky, Ph.D., and Paul J. Ramsay Chair, Department of Psychiatry and Pediatrics, Louisiana State University Health Sciences Center

As is well known and very much economic difficulties, stress that, at grants,1 the Departments of on our minds at the time of the times, resulted in domestic violence Psychiatry and Pediatrics at 10th anniversary of Hurricane and substance use, and a change in Louisiana State University Health Katrina and the breach of the the life, routines, and familiarity Sciences Center have been levees, Katrina caused a disaster that children always knew. following—and providing school- of proportions not previously based intervention and treatment known in the United States. At Important questions can be asked services to—children affected by that time, and for many years that about the longer term effects Hurricane Katrina. In collaboration followed, there was increased of the trauma. Does having with schools, we have also been need for behavioral health support, such experiences early in life carrying out screenings once a consultation, intervention, and foretell unhappy and unstable year since Hurricane Katrina, treatment services. This was a result development? Or can such not only of the destruction and adversity result in greater strength, 1 Through the Louisiana Rural Trauma Services horrors witnessed by many, but also ability to cope, and resilience? Center in the National Child Traumatic Stress Network the long-term displacement and Depending on the circumstances funded by SAMHSA, Louisiana Spirit Crisis Response Program through the Office of Behavioral Health instability in families with children and experiences, both are true. of Louisiana, and then the Mental and Behavioral attending multiple schools, family Since 2005, as a result of multiple Health Capacity Project funded as part of the medical settlement following the Deepwater Horizon Oil Spill continued on page 18 2015 | VOLUME 11 | ISSUES 3–4 | PAGE 17 A Quarterly Technical Assistance Journal on Disaster Behavioral Health Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue continued from page 17 and as of 2015 have data on over with some transient increases at families have a plan—a much 54,000 children and adolescents. the time of new disasters. By 2014, more robust plan than was in These screenings help us track approximately 25 percent of the place at the time of Katrina. the course of behavioral health students met the cut-off for referral. ■■ symptoms, work with schools Second, it is recognized that some behavioral and emotional and communities, and guide the Percentage of Students Meeting reactions to trauma may be provision of services. the Cut-off for Behavioral Health “normal” or represent a new Referral Based on empirical data and “normal” with widespread anecdotal reports, our team has 2005 approx. 50% disaster and continuing anxiety. observed both significant, ongoing ■■ behavioral health problems, many Third, knowledge has pointed to of which are also related to family 2014 approx. 25% the importance of recognizing and dysfunction, as well as much addressing, in culturally sensitive resilience in the children. Most ways, behavioral health needs children demonstrate resilience, There has been a further slight of children and families after a even if persistent behavioral health decline in the past year. According major disaster. symptoms exist. There are so to the recovery timeline of the ■■Fourth, special behavioral health many stories describing long-term Centers for Disease Control needs of communities, for displacement and loss of parental and Prevention (2012), for most example, those of first responders employment. For example, one children, the greatest improvement (including teachers), and their teenager 3 years after Katrina in symptoms occurs in the first 3 families need to be recognized and stated, “I will never have the same years following a disaster and then addressed. Self-care for those who life that I had before Katrina and symptoms stabilize to expectable are responding and supporting I may never be successful or rich; national levels. After Hurricane others needs to be implemented. however, I know that after this Katrina, due to the severe nature experience I will be able to face of the disaster, not only has Finally, and perhaps most important, and overcome future adversities.” stabilization of symptoms in this we have learned that most children Students in one of our strength- disaster-prone region of the country will be resilient—especially with based programs reached out to taken longer, but it also remains support from adults. Therefore, in returning younger children to higher than national expectations. responding to disasters, it is crucial decrease risk-taking behaviors to be sensitive to both the needs of when usual activities were not Important lessons have been children and those of caregivers and available, and they volunteered learned and changes made in this community/education providers so with the school to help plant new region of the country even as we that they can be knowledgeable and trees to preserve the wetlands. now are in the middle of another emotionally available to support the hurricane season. children. We have learned that for Right after Hurricane Katrina, ■■First, the state is better prepared, recovery and resilience, schools and almost 50 percent of students met communities play key roles. ■ the cut-off for behavioral health with preparedness being embedded in all systems so referral, and the percentages Reference that by June of each year, most remained relatively high for Centers for Disease Control and Prevention. institutions, individuals, schools, (2012). Emergency preparedness and response: the next 4 years. Since 2010, Disaster mental health primer; key principles, communities, and children and issues and questions. Retrieved from http:// reductions progressively occurred emergency.cdc.gov/mentalhealth/primer.asp

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The “Spirit of Louisiana” is a fire truck given to New York City after 9/11. Following Hurricane Katrina, the city sent it to New Orleans with a full regiment of firefighters. Photo courtesy of Danny Adams

Katrina’s First Responders An Interview with Danny Adams, Assistant Fire Chief, Ret./Disaster Behavioral Health First Responder Lead, Baton Rouge, Louisiana

Danny Adams served the Baton to the bus triage process during which he served as one of the Rouge area as a firefighter evacuations and stress management primary trainers. He also provided for 30 years, retiring in 2008. for employees and volunteers coordinative assistance to stress As Assistant Fire Chief, he working with disaster response. managers and teams through the supervised the Critical Incident He leads the Behavioral Health OBH First Responder staff. Stress Management Team for the First Responder Team for OBH. What was your role in the immediate Baton Rouge Fire Department. He served as First Responder Hurricane Katrina response? He continues to serve on the Coordinator for the OBH/Louisiana Behavioral Health Board of the Spirit Program starting in 2006 At the time Hurricane Katrina International Association of Fire after Hurricanes Katrina and hit, I was nearing the end of my Fighters in Washington, DC. Rita, and as Quality Assurance/ career as Assistant Fire Chief in First Responder Liaison for the Baton Rouge. As Assistant Fire Mr. Adams currently works with Deepwater Horizon Oil Spill. Chief, part of my responsibility the Office of Behavioral Health Training provided by OBH included was running the Critical Incident (OBH)/Disaster Preparedness. safeTALK and Applied Suicide Stress Management (CISM) Team He is part of the state behavioral Intervention Skills Training for the department and the Baton health emergency response for (ASIST) for Hurricane Isaac for Rouge area. Once we realized all disasters, providing support

2015 | VOLUME 11 | ISSUES 3–4 | PAGE 19 A Quarterly Technical Assistance Journal on Disaster Behavioral Health Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue continued from page 19 the full devastation caused by the jurisdictions. New York City sent hurricane, my chief asked me to the “Spirit of Louisiana” (a fire help other firefighters cope with truck given to the city by Louisiana the stress surrounding the rescue after 9/11) with a full regiment of and recovery process. The OBH firefighters to serve as backup so Crisis Counseling Program (CCP) our people could go to see their grant to be implemented in the New families. Catholic Charities and Orleans service area was interested Louisiana State University, Health in recruiting a first responder Science Center for Psychiatry, also to coordinate and assist crisis provided much-needed assistance. counselors with reaching out to the Several first responders continue to first responder community. With my see behavioral health professionals background—coming from a family in their communities for more of law enforcement personnel—and intense counseling. job experience, I felt I was a good Did you find differences among the match for the job and agreed to first responder groups? come on board part-time, working for the OBH Louisiana Spirit CCP. We found firefighters to be more resilient due to the nature of Why do you think you were Many of the people our program successful in your role? the environment they work in. Typically, they work in groups or worked with were nearing the When I started my outreach work pairs and usually talk about what end of their careers and did not with Louisiana Spirit, I realized has happened when they return want to jeopardize their positions using only behavioral health from a call. Law enforcement by leaving their posts. Letting professionals to reach this group officers may not have a partner, them know that OBH Louisiana would not work. By pairing a making it more difficult to cope Spirit had people on site with their first responder with a behavioral with tragic events. OBH Louisiana families helping them allowed health professional, you add a Spirit partnered with a retired the first responders to continue on level of credibility that opened up officer, Dave Benelli from the New with their work. Two unfortunate doors for the crisis counselors and Orleans Police Department, who situations occurred where law help while reducing the stigma of later became a CCP First Responder enforcement officers took their mental health. When we ran into Team Lead for the Louisiana Spirit own lives. During these tragic resistance, as a part of the OBH Orleans Service Area to help the events, our program assisted the Louisiana Spirit team, I was able program gain access to the officers department and family through peer to reach out to the community first when we met with resistance. support. responder leadership as a peer, How did you best help the first Through the OBH Louisiana Spirit resulting in a request from this responder community? program, we also produced short community to “please come help videos using people and scenes my people.” I found that taking care of the from the community to increase wives and families of the first The Louisiana Spirit program also our creditability. These videos responders in the field was the best received assistance from other helped show first responders that way to help relieve their stress. their reactions to the disaster were continued on page 21 2015 | VOLUME 11 | ISSUES 3–4 | PAGE 20 A Quarterly Technical Assistance Journal on Disaster Behavioral Health Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue continued from page 20 normal. This group is not used As a community responder, I know Hurricane Katrina, and I have seen to asking for help. We tried to a lot of responders who had family leadership in this population (first reinforce the idea that “we are not in Houston, Texas, that they visited responders) work tirelessly to get superheroes; we are just human during their time off. support to address these issues beings.” while supporting their staff. Even 10 years later, you may still Reaching out to the nontraditional hear that people are dealing with The goal of OBH Louisiana Spirit first responders, those individuals the aftermath of Hurricane Katrina was to make sure responders that due to the extraordinary in the field. Some are still dealing understood that Hurricane Katrina circumstances found themselves with issues from the loss of their was a major disaster that caused in the role of a first responder, was home or income. Many responders compounding distress for everyone a little more challenging. One of had second jobs that were lost and that it is okay to ask for help. the groups that Louisiana Spirit during that period and had trouble When working with this population, worked with was the Department getting back their second source you need to show them that you of Wildlife and Fisheries. We (the of income. Disasters after Katrina can recover. An outcome was CCP first responder team) would that continued to re-traumatize that community first responder meet them on the docks and talk responders, such as the Deepwater departments were getting better to them before they would go out. Horizon Oil Spill in 2010, affected and more prepared to recognize Sometimes just talking to someone the income and livelihood of many signs of behavioral health issues in about what’s going on helps. In our responders operating camps and this population and how to connect outreach, we made sure we reached fishing boats in the shrimping them for further support. out to a special population we industry. Also Hurricane Isaac referred to as the “citizen groups.” in 2012 caused major flooding As a peer, I recently taught a class These groups were made up of in different areas of Louisiana at the New Orleans Fire Department community members who would that didn’t normally get flooded. and the new chief was very regularly get together to engage The responders were constantly supportive of the team-based efforts in rescue activities. Both of these handling the unexpected in their the department had been doing to groups proved to be very resilient. jobs and daily lives. support each other. He said that we By helping others they were also have to stay prepared for the next helping themselves through the However, overall, responders are disaster. I agree with that attitude recovery process. resilient. I’m seeing responder because this population needs to groups across the state come prepare and not react post-disaster. How is the population of first together now little by little. We are OBH promotes more community responders dealing with the long- not there yet, but as a responder, trainings and tips for coping with term effects of Katrina? I see a lot of good things being disasters. I strongly believe that brought to the table and revamping when you have the right coping skills Responders were in rescue mode of protocols to prepare responders instilled in your people, chances for for nearly 5 years after Hurricane for future disasters. Also, our work bad disaster reactions are reduced. ■ Katrina. Many were still living and continues at OBH to bridge the working out of trailers while their gap to offer support to responders families were staying out of state in during these times. I also heard apartments or hotels. Responders about a lot of domestic violence, would use their holiday and alcohol, and substance use after vacation time to visit their families.

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Charenton, LA October 18, 2005 - Tricia Mora, Vice Chairman of the Chitimarcha Tribe, and USCG Vice Admiral Thad Allen toured the mobile homes which FEMA provided for tribe members from several areas of Louisiana who were displaced by the hurricanes. Photo by Greg Henshall / FEMA

Native American Communities Affected by Hurricanes Katrina and Rita Contributed by Beth Boyd, University of South Dakota

While most Americans remember the most extensive damage, but the ■■Biloxi-Chitimacha Confederation that hundreds of thousands of following tribes also were affected: of Muskogee

African Americans were affected ■■ ■■ Tunica-Biloxi Tribe in Louisiana by Hurricanes Katrina and Rita Poarch Bank Creek Indian Tribe ■■ in the late summer of 2005, few in Alabama Chitimacha Tribe in Mississippi ■■ people know that thousands of Coushatta Indian Tribe Tribal leaders estimate that 5,000 Native Americans were also ■■Jena Band of Choctaw to 6,000 Native Americans lost affected by the storms. Six ■■United Houma Nation their homes and everything they federally recognized tribes and owned due to Hurricanes Katrina ■■ several smaller unrecognized tribes Pointe-au-Chien Tribe and Rita. Many of those displaced along the Gulf Coast experienced ■■Isle de Jean Charles Indian Band lived in areas around New Orleans the destructive effects of wind, rain, of Biloxi-Chitimacha prior to the storm and returned to and flooding. The Mississippi Band ■■Grand Caillou-Dulac Band their tribal communities in need of Choctaw reportedly experienced of shelter, food, water, clothing, continued on page 23 2015 | VOLUME 11 | ISSUES 3–4 | PAGE 22 A Quarterly Technical Assistance Journal on Disaster Behavioral Health Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue continued from page 22 and other resources. Some tribal communities along the Gulf Coast were affected by both storms and were then further stressed by providing shelter and resources to returning tribal members.

Difficulties Obtaining Assistance The media rarely covered these groups’ experiences. Because media coverage plays a major role in the ability to obtain assistance, they were largely overlooked by governmental and nongovernmental relief organizations. FEMA provided Purvis, MS., October 3, 2005 -- Over 1,000 trailers are getting ready for distribution at the FEMA Trailer Staging disaster relief services to affected Area in Purvis, Mississippi. Nicolas Britto/FEMA areas generally and the Bureau of Indian Affairs provided public safety and emergency services for federally recognized tribes. tribal groups without federal services that were centrally located recognition came from other tribes within the mainstream community For tribal groups that have not and Native American organizations simply did not reach or serve been officially “recognized” by the across the country. The National the diverse needs of all. This federal government, the process Congress of American Indians is especially true for providing of obtaining assistance can be set up a relief fund to assist the psychological support and serving even more complex. “Federal tribes in Alabama, Louisiana, and the behavioral health needs of those recognition” is a legal term that Mississippi. Tribal communities affected by the disasters. Culture establishes a tribe’s status as a across the country sent medical has a great influence on how a sovereign nation unto itself with personnel, relief workers, financial disaster is perceived, experienced, the right to self-govern, define their assistance, clothing, food, water, and processed, as well as how own membership, and engage in and mattresses. healing occurs. For many Native a “nation-to-nation” relationship Americans affected by the storms, with the United States. Federal the need for culturally competent recognition also entitles tribes to The Essential Role of Cultural support and healing was best met certain federal benefits, services, Competence by turning to their tribes or other and protections because of treaties This disaster taught disaster Native communities. and trust relationships made response organizations that services between the two governments. need to be culturally responsive in Language also plays a role in order to be truly helpful. For many determining whether tribes or Much of the post-hurricane rural and minority communities, tribal communities receive needed disaster assistance received by continued on page 24

2015 | VOLUME 11 | ISSUES 3–4 | PAGE 23 A Quarterly Technical Assistance Journal on Disaster Behavioral Health Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue continued from page 23 resources in a timely manner for and receiving disaster assistance. References following a disaster. There are Although this was not the most Boyd, B., Quevillon, R. P., & Engdahl, R. (2009). Working with rural and diverse communities after approximately 180 tribal languages significant issue following the disasters. In Dass-Brailsford, P. (Ed.), Crisis and disaster counseling: Lessons learned from still spoken in North America, and hurricanes of 2005, it often plays Hurricane Katrina and other disasters. Thousand many of those languages do not a role in the aftermath of natural Oaks, CA: Sage Publications. Dardar-Robichaux, B., & Verdin, C. (2005, have a word for “disaster.” The disasters in tribal communities. October 10). Indian tribes and Hurricane Katrina: concept of disaster is especially Overlooked by the federal government, relief The effect of Hurricanes Katrina organizations and the corporate media [Video]. difficult when the situation involves Democracy Now! Retrieved from http://www. and Rita has been long-lasting for democracynow.org/2005/10/10/indian_tribes_ a natural event. Events such as and_hurricane_katrina_overlooked many and has led to erosion of storms, floods, and earthquakes are Federal Emergency Management Agency. (2006, coastal lands, needs for elevated August 21). Native Americans find shelter with understood to be part of the natural tribes after Katrina. Retrieved from https://www. world and not conceptualized as lands and housing, and threats to fema.gov/news-release/2006/08/21/native- fishing and shrimping livelihoods.■ americans-find-shelter-tribes-after-katrina something unusual or a “disaster.” Indianz.com. (2005, September 2). Indian Country In some situations, this may responds to victims of Katrina. Retrieved from http://www.indianz.com/News/2005/010151.asp contribute to delays in tribes asking

KATRINA RESEARCH HIGHLIGHT: SUPPLEMENTAL RESEARCH BULLETIN In this issue of the SAMHSA DTAC Supplemental Research Bulletin, we review five articles about the intermediate and long-term negative mental health and substance misuse trends in survivors of Hurricane Katrina to seek an understanding of the lasting impact of large-scale disasters. The analysis looks at the positive effects of using coping skills and highlights the need to plan better in an effort to mitigate distress and attend to survivors who are displaced or evacuated from their communities and ultimately separated from their social supports as a result of a disaster. Read the analysis: http://archive. samhsa.gov/dtac/bulletin/ SupplementalResearchBulletin_ Issue3.tml.htm

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RECOMMENDED RESOURCES

TIP 59: Improving Cultural Competence This guidance defines and describes cultural competence and explains its importance in behavioral health (mental health and substance use disorder) treatment and services. It covers core areas of cultural competence for counselors and others who provide behavioral health services, ways for individual practitioners and organizations to be more culturally aware and competent, and information about counseling people of specific cultures (e.g., African American, Hispanic and Latino, white American).

Read and download the guidance at http://1.usa.gov/1yTZCrN

Applying Cultural Awareness to Disaster Behavioral Health Webinar This webinar covers key principles of cultural awareness and how people of different cultures interact around the time of a disaster. It also provides suggestions for more culturally aware disaster preparedness, response, and recovery.

View the webinar at http://bit.ly/1d1Ozmh

Understanding Historical Trauma When Responding to an Event in Indian Country: Tips for Disaster Responders This tip sheet helps disaster response workers better understand historical trauma in the Native American culture and how it may affect disaster preparedness and response efforts, and offers strategies for providing disaster response assistance with cultural sensitivity.

Download the tip sheet at http://1.usa.gov/1Hsf7tD

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UPCOMING EVENTS International Society for Traumatic Stress Studies 31st Annual Meeting; November 5 – 7, 2015; New Orleans, Louisiana American Public Health Association (APHA) Annual Meeting; October 31 – November 4, 2015; This year’s meeting will feature symposia, workshops, Chicago, Illinois and presentations on a variety of traumatic stress- related topics, including aspects of the biology, The annual meeting of the APHA attracts more than physiology, and treatment of posttraumatic stress 12,000 attendees from around the world. This year’s disorder; implementation of evidence-informed post- meeting will feature scientific and general sessions on disaster interventions; post-disaster grief; and long-term topics including disaster epidemiology, protecting outcomes after disasters. Meeting planners suggest disaster response workers, health care perspectives on that mental health care providers (psychiatrists, disaster preparedness and response, and research- psychologists, social workers, counselors), nurses, supported ways to reduce the impact of natural disaster researchers, marriage and family therapists, and war on survivors. administrators, victim advocates, journalists, and clergy http://apha.org/events-and-meetings/annual may benefit from this meeting. https://www.istss.org/am15/home.aspx National Pediatric Disaster Coalition Conference; November 2 – 4, 2015; Scottsdale, Arizona International Association of Emergency Managers The National Pediatric Disaster Coalition Conference is 63rd Annual Conference; November 13 – 18, 2015; designed to serve as a forum for exchange of lessons Clark County, Nevada learned and best practices, foster networking and This event may interest emergency managers, relationship development for better pediatric homeland security officials, first responder preparedness, expedite work to address children’s coordinators, business continuity planners, and others. needs related to disasters, and provide opportunities It provides educational sessions, hands-on training, for coalitions and alliances. Sessions will cover topics and opportunities for collaboration and networking. such as preparedness for children with access and Sessions at this year’s conference will cover topics functional needs, community resilience, work toward a such as applying research to practice in disaster national concept of operations for children’s and family management, post-disaster financial recovery, and mental health after a disaster, and reunification of animals in disasters. families after disasters. http://www.iaem.com/page.cfm?p=events/annual- https://www.npdcconference.org conference continued on page 27

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UPCOMING EVENTS continued from page 26 Association of Healthcare Emergency Preparedness Disaster Mental Health: Introduction Professionals 1st Annual Conference; November This free, 30-minute online course is designed to prepare 17-18, 2015; Omaha, Nebraska licensed or certified professionals (psychiatrists, This conference will focus on disaster preparedness for psychologists, clinical social workers, marriage and family health care facilities. It will provide a forum for therapists, psychiatric nurses, professional counselors, networking and information exchange. People who may school counselors, or school psychologists) to provide benefit from attending include disaster preparedness disaster mental health services through the American staff who work in inpatient acute care facilities, Red Cross. The course explains how disaster mental outpatient clinical services, in residential and long-term health figures into the full array of services that Red care facilities, preparedness coalitions, and public Cross chapters and disaster relief operations provide. It health agencies. also identifies the psychological effects of disasters, https://ahepp.site-ym.com/?page=AnnualConference differences between what people do as Red Cross disaster mental health workers and as mental health professionals, and next steps for people who would like ADDITIONAL WEBINARS to become Red Cross disaster mental health volunteers. AND TRAININGS http://www.redcross.org/take-a-class/disaster-training Disaster Planning and Disaster Response Trainings NEW! Behavioral Health Response to Ebola From the North Carolina Institute for Public Health This webinar for providers relates lessons learned while These online trainings cover a range of topics in supporting a quarantined individual who was homeless disaster preparedness and response, and disaster in Dallas, Texas, during the 2014 Ebola outbreak. behavioral health. Trainings and training modules that https://youtu.be/MFLBFEb2dok may be of interest include: ■ Assisting Persons With Disabilities During an Emergency Poster Winners – Elderly in Disasters: An Integrated Review ■ Disaster Behavioral Health In this webinar, presenters affiliated with the Daniel K. ■ Emergency Preparedness and the Need To Include Inouye Graduate School of Nursing at the Uniformed Persons With Disabilities: Basic Issues for Services University of the Health Sciences, discuss the Organizations To Consider content of their poster, which won and outstanding ■ Equipment and Resources To Assist Persons With poster award at the National Center for Disaster Disabilities During an Emergency Medicine and Public Health’s Annual Learning in ■ Introduction to Mental Health Preparedness Disaster Health Workshop. http://ncdmph.adobeconnect.com/r72x5v80yxb/ ■ Mental Health Interventions in Disasters

■ Preparing for a Hurricane

■ Responder Health and Safety

■ Self-Care for Disaster Responders

■ Working With Community Partners https://nciph.sph.unc.edu/tws/training_ list/?mode=view_kw_detail&keyword_id=2088 https://nciph.sph.unc.edu/tws/training_ list/?mode=view_kw_detail&keyword_id=2089 continued on page 28 2015 | VOLUME 11 | ISSUES 3–4 | PAGE 27 A Quarterly Technical Assistance Journal on Disaster Behavioral Health Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue

ADDITIONAL WEBINARS AND TRAININGS continued from page 27 Mental Health Preparedness From the John University of Minnesota School of Public Health’s Hopkins Center For Public Health and Online Courses Preparedness These free online courses address many topics in These free online trainings were developed to enhance disaster preparedness and response and disaster public health system competency, capacity and public behavioral health. Available courses include the health workers’ willingness to effectively respond to following: emergencies. Trainings focused on mental health ■ Crisis Intervention During Disaster (Public Health preparedness include: Emergency Training Series) ■ Disaster Mental Health Intervention ■ Dirty Bomb! After the Blast ■ Disaster Mental Health Planning ■ Disaster 101: An Immersive Emergency Preparedness ■ Introduction to Mental Health and Disaster and Crisis Leadership Workshop Preparedness ■ Global Outbreak: A Public Health ICS Simulation ■ Mental Health Consequences of Disaster ■ Introduction to Business Continuity Planning for ■ Psychology and Crisis Response Disasters and Emergencies

■ Roots of Terrorism ■ Isolation and Quarantine (Public Health Emergency Training Series) ■ Self-Care ■ NIMS (National Incident Management System) and ICS http://www.jhsph.edu/research/centers-and- (Incident Command System): A Primer for Volunteers institutes/johns-hopkins-center-for-public-health- preparedness/training/online/mental-health- ■ Personal and Family Emergency Preparedness trainings.html ■ Planning for and Engaging Special Populations in Emergency Preparedness Building Workforce Resilience Through the Practice of Psychological First Aid—A Course for ■ Preparing Employees for a Disaster in the Workplace

Supervisors and Leaders ■ Road to Resilience: Building Community Resilience to This 90-minute course from the National Association of Disasters County and City Health Officials provides training in ■ Road to Resilience: Protecting Animals in Disaster Psychological First Aid (PFA), including an overview of PFA, how leaders in emergency management and other ■ Special Populations (Public Health Emergency fields can use PFA, and exercises to help leaders learn Preparedness Series) how to use PFA in real-world situations. http://sph.umn.edu/ce/online https://live.blueskybroadcast.com/bsb/client/CL_ DEFAULT.asp?Client=354947&PCAT=7365&CAT=9403

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Behavioral Health is Essential To Health Prevention Works Treatment is Effective People Recover

SUBSCRIBE The Dialogue is a publication for professionals in the disaster behavioral health field to share information, resources, trends, solutions to problems, and accomplishments. To receive The Dialogue, please go to SAMHSA’s home page (http://www.samhsa.gov), enter your email address in the “Mailing List” box on the right, and select the box for “SAMHSA’s Disaster Technical Assistance newsletter, The Dialogue.” 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. To subscribe, please enter your email address in the “SAMHSA DTAC Bulletin” section of the home page of our website at http://www.samhsa.gov/dtac. 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 CONTACT US website at http://www.samhsa.gov/dtac/dbhis-collections to access these materials. SAMHSA Disaster Technical Assistance Center Toll-Free: 1-800-308-3515 [email protected] http://www.samhsa.gov/dtac