A Quarterly Technical Assistance Journal on Disaster Behavioral Health Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue 2019 | VOLUME 15 | ISSUE 1

Disaster Apps, Tools, and Technology IN THIS ISSUE 1 In This Issue 1 Contributors 3 Technical Assistance Snapshot 5 Social Media Before, During, and After Disasters 8 SAMHSA’S Disaster App Helps Responders Access Critical Resources 10 SAMHSA Mobile App Helps Health Care Professionals Address Suicide 14 Are Your Families Prepared for a Disaster? 16 A Look Inside the Disaster Distress Helpline

Karen Bogenberger, a Federal Emergency Management Agency (FEMA) Corps, Disaster Survivor Assistance disability communications specialist, demonstrates a disaster-related app. Photo by Patsy Lynch/FEMA.

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. To receive The Dialogue, please go to SAMHSA’s home page (https://www.samhsa.gov), click the “Sign Up for SAMHSA Email Updates” button, enter your email address, 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 misuse needs following a disaster. To learn more, please call 1-800-308-3515, email [email protected], or visit the SAMHSA DTAC website at https://www.samhsa.gov/dtac.

The Dialogue is not responsible for the information provided by any webpages, 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 Today almost everyone from elementary school children education, and emergency outreach coordinator has to grandparents has a cell phone or access to one. This incorporated social media into his job. We then highlight abundance of technology provides an opportunity for three useful disaster-related apps. The National Child disaster planners to think about alternative ways, such Traumatic Stress Network’s Help Kids Cope app as disaster alerts via cell phones or disaster apps, to assists parents, caregivers, teachers, and responders communicate with target audiences. in supporting children through the stress of sheltering in place, evacuations, and healing after a disaster. There are mobile device apps that serve a wide range of The Substance Abuse and Mental Health Services disaster-related functions available for various audiences Administration (SAMHSA) Behavioral including disaster behavioral health Health Disaster Response App can be planners, disaster responders, and the used by disaster responders to help meet public. These apps and tools can assist According to the Pew the needs of survivors by providing with preparing before a disaster hits, Research Center, about preparedness and response information help responders and their family get 95 percent of Americans own a cell phone. and assistance in finding local mental ready for a deployment, and assist with health and substance use services. The center also reports that communication during a disaster. SAMHSA’s Suicide Safe Mobile App the share of Americans In addition to apps, social media has who own smartphones helps health care professionals assess a proven useful during disaster response. is 77 percent, more than patient’s risk of suicide. We wrap up this Social media has become a common double the percentage the issue with an article about the Disaster center found in 2011. way for people to communicate on a Distress Helpline, which provides 24/7, Source: http://www.pewinternet.org/ day-to-day basis. A Pew Research fact-sheet/mobile 365-day-a-year crisis counseling and Center survey showed that today support to people experiencing emotional around 70 percent of Americans use a distress related to natural or human- social media platform to connect with caused disasters. others, access news, share information, and seek out Do you have a favorite app or tool that you use entertainment (https://www.pewinternet.org/fact-sheet/ during disasters? Would you recommend a specific social-media). This number has increased from 2005 technology to others in the disaster behavioral health when only about 5 percent of Americans used field? We encourage you to contact us to share your social media. recommendations and experiences. ■ Disaster planners should work to integrate these Captain Erik Hierholzer, B.S.N. Program Management communication tools into their planning activities. Officer, Emergency Mental Health and Traumatic Stress A Congressional Research Service report, Social Services Branch Media and Disasters: Current Uses, Future Options, [email protected] and Policy Considerations, states that in the last 5 years social media has played an increasing role in Nikki Bellamy, Ph.D. Public Health Advisor, Emergency emergencies and disasters (https://ofti.org/wp-content/ Mental Health and Traumatic Stress Services Branch uploads/2012/07/42245_gri-04-11-2011.pdf). [email protected]

This issue highlights several tools and apps that may Shannon Loomis, .A. Director, SAMHSA Disaster be useful before, during, and after a disaster. The first Technical Assistance Center article of this issue highlights how a public information, [email protected]

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Contributors

Melissa Brymer, Ph.D., Psy.D. Emotional and Spiritual Care Committee (ESCC), co- is the Director of Terrorism chaired the VOAD ESCC from 2013 and Disaster Programs of the to 2014, and launched the Oregon VOAD Emotional University of California, Los and Spiritual Care Committee in June 2017. Prior to Angeles (UCLA) and Duke Link2Health Solutions, Inc. (part of the Mental Health University National Center for Association of New York City), Mr. Burgess worked Child Traumatic Stress (NCCTS) and its National Child for 10 years in youth violence prevention and trauma Traumatic Stress Network (NCTSN). In this capacity intervention, including as Director of School Programs Dr. Brymer has been involved with the development at Safe Horizon, one of the nation’s largest service of acute interventions, assessment, and educational providers for victims of crime and abuse. materials in the area of terrorism, disasters, and school crises. She is the lead author of Psychological First Aid for Schools and Skills for Psychological Recovery Eric Frank has over 20 years’ by NCTSN and the National Center for Posttraumatic involvement in public safety. Stress Disorder. She has served as a consultant for Starting as a firefighter/ many federal, state, and local agencies across the emergency medical technician, country and internationally after disasters, terrorism, he rose in the ranks to fire chief school shootings, and other mass violence tragedies. of his department. Mr. Frank Dr. Brymer is the lead advisor to the Newtown Public then served as the Disaster and Emergency Services Schools Recovery Program, and is the Principal Coordinator of Stillwater County in Montana. During Investigator for a National Institute of Justice research this time he oversaw and rewrote the county’s emergency project examining the short- and long-term impact of 12 operations plan, helped the county achieve a Pre-Disaster different school shooting and mass violence incidents. Mitigation Grant, reviewed plans for wildfire suppression in Stillwater County, and launched the first use of social media by emergency management in Montana. Christian Burgess, M.S.W. is Director of the Disaster Mr. Frank came to work for the Clark Regional Distress Helpline (DDH), a Emergency Services Agency (CRESA) in 2012. program of the Substance Abuse Originally tasked with working on the county’s and Mental Health Services emergency plans and facility safety plans, Mr. Frank now Administration administered serves as Public Education, Outreach, and Information by the nonprofit Mental Health Association of New Coordinator for CRESA in Vancouver, Washington. York City. DDH calls (1-800-985-5990) and texts (text At CRESA, Mr. Frank has continued to seek new ‘TalkWithUs’ to 66746) are answered by a network of strategies to change behavior regarding personal independently operated crisis centers located throughout preparedness, including hosting Disaster Movie Nights the country who provide 24/7 multilingual, confidential and holding online preparedness challenges such as crisis counseling and support to disaster survivors and 30Days, 30Ways. He presents regularly regarding responders throughout any phase of a natural or human- personal preparedness, and using social media as part caused disaster. Mr. Burgess serves on the National of emergency management and school safety. He also Voluntary Organizations Active in Disaster (VOAD) oversees the Citizen Corps programs in Clark County, 2019 | VOLUME 15 | ISSUE 1 | PAGE 2 A Quarterly Technical Assistance Journal on Disaster Behavioral Health Produced by the SAMHSA Disaster Technical Assistance Center working closely with public safety volunteers throughout this position, Dr. Louie is engaged in the dissemination the county. Mr. Frank is a 2017 graduate of the National of and training in acute interventions for responding Emergency Management Advanced Academy, and he to terrorism, disasters, and school violence. Dr. Louie also serves as a board member of the Washington State is also involved in the development of educational Emergency Public Information Network. materials and resources for professionals, teachers, and families preparing for and responding to catastrophic events. Previously, Dr. Louie worked as a disaster Kristine Louie, Ph.D. is the behavioral health specialist for the SAMHSA Disaster Assistant Director of the Technical Assistance Center. In this capacity, she Terrorism and Disaster provided technical assistance to states, territories, and Program of the UCLA and federally recognized tribes providing behavioral health Duke University NCCTS. In support following natural disasters.

TECHNICAL ASSISTANCE SNAPSHOT Crisis Counseling Assistance and Training Program (CCP) REFERRAL DATA HIGHLIGHTS CCP grantees from the grants listed below referred disaster survivors to a range of additional services between October 3, 2017, and October 3, 2018. These data are from both Immediate Services Program (ISP) and Regular Services Program (RSP) grants. ■ AS-4357 ■ FL-4337 ■ MO-4317 ■ SC-4286 ■ TX-4332 ■ CA-4344 ■ GA-4297 ■ NC-4285 ■ TN-4293 ■ TX-4377 ■ CA-4353 ■ HI-4366 ■ PR-4339 ■ TX-4223 ■ VI-4340

REFERRAL ISP RSP BOTH

Mental health services 27,354 20,101 47,455

Substance misuse services 1,016 1,404 2,420

Resources for those with disabilities 3,003 4,240 7,243 or other access or functional needs No referral provided 29,885 18,916 48,801

Community services 63,253 74,307 137,560

Other 6,496 5,076 11,572

Crisis counseling program services 85,672 95,047 180,719

TOTAL 216,679 219,091 435,770

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Recent Technical Assistance Requests In this section, read about recent questions the Substance Abuse and Mental Health Services Administration (SAMHSA) Disaster Technical Assistance Center (DTAC) staff have answered and technical assistance requests to which they have responded. Send your questions and comments to [email protected].

Request: SAMHSA DTAC received a request from an addressing vulnerability in preparedness and experienced state disaster behavioral health coordinator response work. It also has a strong incorporation to conduct an in-depth review of several books focused of the Crisis Counseling Assistance and Training on disaster behavioral health. The SAMHSA DTAC team Program. looked at whether the book offered a solid background in disaster behavioral health and covered the major issues SAMHSA DTAC ultimately recommended two of professionals should expect to encounter in planning, the three books textbooks that would work well in a response, and recovery activities. college course. Disaster Mental Health Interventions was recommended to be used for a course in which Response: SAMHSA DTAC created a report including additional supplemental materials will be used because summaries for each textbook. Highlights from each it provides an overview of the field rather than a deep summary are below: dive in the subject matter. Mental Health and Disasters was recommended to be used for a course where the 1. Disaster Mental Health Interventions: Core text will serve as the structure of the course because Principles and Practices by James Halpern, Ph.D. and Karla Vermeulen, Ph.D. of its robust and technical chapters. The third book, Behavioral Health Response to Disasters, may be more This textbook uses case studies and real-world appropriate for current professional staff, rather than examples to demonstrate the content discussed. It students without professional experience. covers all aspects of disaster mental health and places emphasis on how disaster mental health differs from Request: SAMHSA DTAC received a request counseling in a clinical setting. in the [email protected] email box from a police lieutenant who had recently participated in 2. Mental Health and Disasters by Yuval Neria, Ph.D., Sandro Galea, M.D., Dr.P.H., and Fran H. Norris, SAMHSA’s Shield of Resilience online training course Ph.D. for law enforcement officers. The individual was very This textbook provides a detailed look at disaster impressed with the course and thought the content was mental health, including discussion of special groups so valuable that he wanted to upload it into his own and vulnerable populations that may require special agency’s training catalogue so that he would be able to considerations during planning, response, and track who completed the course. recovery. It also references disasters outside of the Response: SAMHSA DTAC thanked the individual . for his interest in the online course and provided him 3. Behavioral Health Response to Disasters by Julie with several options to provide him with a compatible Framingham, M.S.W. and Martell Teasley, Ph.D. format that can be uploaded to his agency’s portal. This textbook has a strong emphasis on disaster To access the course and for more information, go to behavioral health in the United States, and specifically https://www.samhsa.gov/dtac/shield-of-resilience- the public health-related disaster behavioral health training-course. ■ system. It focuses on cultural competency and

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Social Media Before, During, and After Disasters By Eric Frank

These days, many Americans have preparing for disasters, highlight individuals in a smaller area, such as a smartphone with us at all times our planning process, and advertise a specific neighborhood. that we use as a minicomputer, where and when we might be in camera, music player, day planner, person out in the community. It has Social media can be one more dictionary, calculator, and yes, a allowed me to amplify our messages part of your agency’s alert system, mobile phone. Our mobile devices by using humor, video, and pictures, allowing you to connect with the have become our lifelines in more bringing to life information I believe community not only during the ways than one. One important way everyone should receive. emergency, but before and after as we use our smartphones is to access well. It allows messages to be shared social media, which lets us choose Building a Relationship With and amplified quickly. the Community the information we want to see and It is crucial to start building a When emergencies happen, public learn about. relationship before an emergency safety agencies need to connect with the community. People today As the Public Information, with the communities they are have a lot of information options. Education, and Outreach sworn to protect. There are many We no longer have to wait for Coordinator for the agency I ways to do so. Some jurisdictions network news, or the next print represent, social media allows me have notification systems for major, version of a newspaper. Breaking to have a two-way conversation large-scale disasters or events where news happens every second, with the community I serve. It has the message needs to hit everyone. and with more and more digital become one of the leading tools These systems can text, call, or platforms, it can be overwhelming. for me to share information about email residents and businesses The information intake can be like throughout an affected drinking from a fire hose, and now area. Other systems we also have to try to figure out if are designed to serve

Google People Finder was developed in 2010 in response to the Haiti earthquake. The application allows users to post and 7 million+ users search for the status of people affected by near Nepal checked in using a disaster. During the 2015 Nepal earthquake, ’s Safety Check after well over 7,500 records on the People the April 2015 earthquake. Finder were searched.

Source: Eastern Kentucky University. (n.d.). [When disaster strikes: Technology’s role in disaster aid relief] [Infographic]. Retrieved from https://safetymanagement.eku.edu/resources/infographics/when-disaster-strikes-technologys-role-in-disaster-aid-relief

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the information popping up in front of us is even factual. The better Facebook, YouTube, and your conversation is with your community when things are good, Twitter are some of the the better chance you will have at most popular social ensuring the proper information is networking sites when being shared during an incident. natural disasters strike. Integrated Communications: Social Media and Beyond Source: Velev, D., & Zlateva, P. V. (2012). Use of social media in natural disaster management. Paper presented at the 2012 International Conference on Innovation, Trade Building a battle rhythm is important and Economics 2012, , China. Retrieved from https://www.researchgate.net/ publication/271585520_Use_of_Social_Media_in_Natural_Disaster_Management to ensure your information is seen when it needs to be. Disasters and emergencies can be stressful. Your of waiting for a press release. gone tomorrow, your content is gone community does not need the added Whatever the platforms used in as well. Archiving and backing up stress of trying to find information. your communities, learn how you information is important, along with can use them. These days, I see four providing links in social media to It is important to do a little research main platforms: Facebook, Twitter, your website. and figure out what, if any, platforms , and Snapchat. Your your community uses the most. I agency or organization may also It’s important to engage with have found more rural communities share information via their website, your community at least three to rely much more on Facebook, and a blog, or on a popular neighborhood four times a week. Keep content Facebook Groups, while more platform called Nextdoor. If you are fresh and new. It’s important you urban settings rely on Twitter. In not on Nextdoor, see if it’s being interact because of the data-driven my experience, the mainstream used in your community, and reach algorithms that run behind the media also prefers Twitter, instead out to see if you can have an agency scenes on social networking sites. platform created. If you are not posting regularly, your audience will not see the A study by the American It is important to note that social information you share unless you media platforms do not replace other stay active with them. Bonus Tip: Red Cross shows more methods of sharing information. Including videos in posts, especially people are turning to They should complement other on Facebook, makes people more sites such as Facebook ways of communicating with likely to see them due to current the community, such as using algorithms. and Twitter to learn emergency alert systems, holding about emergencies, get meetings and events, working with Let me illustrate this point a little the media, and providing updates more. According to the data, if you information, and check through your agency’s website. have a personal (non-work) account on friends and family. on Facebook, most likely you have Best Practices in Social Media between 200 and 300 “Facebook Source: Velev, D., & Zlateva, P. V. (2012). Use of Be sure to recognize that you do not friends.” Yet in your , social media in natural disaster management. Paper presented at the 2012 International Conference on own any of the content you post on how many of those 200 friends do Innovation, Trade and Economics 2012, Hong Kong, China. Retrieved from https://www.researchgate.net/ social media. The platform does, and you see posts from? It’s usually publication/271585520_Use_of_Social_Media_in_ if by some chance that platform is far fewer than your total group of Natural_Disaster_Management

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friends. Instead you see just those I encourage you to use a tool like platforms all at once from one post from friends you interact with. TweetDeck or Hootsuite to follow source. Each platform has a different I challenge each of you to pick a specific hashtags. In my area, I audience, and each audience uses couple random friends that you follow hashtags including #Vanwa the platform differently. They can haven’t seen something from in a (used to identify posts related to tell when you are not sharing content while. Visit their page. Chances are, Vancouver, Washington); #Clarkwa that is organic to that platform. It is they have posts you haven’t seen (related to Clark County in the easiest way to lose followers. because of the algorithms running in Washington); and #Clark911 (related the background. The same happens to emergencies in Clark County). Conclusion with organizations and causes that When I post to social media on Social media doesn’t replace you follow. If you do not interact Instagram, or Twitter for the agency, traditional methods of regularly, their posts drop off. these hashtags are added so folks, communicating with your including my local media, have a community. It is a tool to be used On other platforms like Instagram way of sifting through the haystack in combination with others. It can and Twitter, posts happen in a split for that needle. help amplify your message, and if second. If those posts do not have used effectively, it provides for a hashtags you are following, nine I am not a fan of tools that allow conversation with the community times out of ten you will miss them. you to schedule posts to multiple you serve. ■

Following Hurricane Sandy in 2012, “hurricane” was mentioned on Twitter 1.1 million times within a 21-hour time period.

Source: Fraustino, J. D., Liu, B., & Jin, Y. (2012). Social media use during disasters: A review of the knowledge base and gaps. Final report to U.S. Department of Homeland Security, Science and Technology Directorate, Human Factors/Behavioral Sciences Division. College Park, MD: National Consortium for the Study of Terrorism and Responses to Terrorism. Retrieved from https://www.start.umd.edu/sites/default/files/files/publications/START_SocialMediaUseduringDisasters_LitReview.pdf

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SAMHSA’S Disaster App Helps Responders Access Critical Resources By SAMHSA DTAC Staff

These days, emergency preparedness almost always requires us to consider our mobile devices. How can survivors reach friends, family, or first responders in case of a disaster? How can responders access critical resources to provide support to survivors if there is no electricity or Wi-Fi?

Many federal agencies and humanitarian organizations have developed apps to help individuals facing disasters communicate with loved ones, store medical information, receive and share weather alerts, and even locate pet hospitals. In the midst of the disaster or just after, though, an app won’t help mitigate the immediate or lasting effects of what “When the president declares a major disaster, just took place—unless it can help responders help survivors in real time. FEMA’s deployed personnel include

Designed specifically for disaster digital communications specialists behavioral health responders, the who monitor social media on a daily basis, Substance Abuse and Mental Health Services Administration (SAMHSA) picking up relevant references to FEMA and Disaster App lightens the load for the current disaster. The digital team shares responders by providing access to trauma- and disaster-related posts from survivors with experts who can resources—right on a smartphone, help answer questions and clarify concerns.” in real time, at the touch of a button. It provides resources for any type Source: Federal Emergency Management Agency (FEMA). (2018, April 16). Social media and emergency preparedness [Press release]. Retrieved from https://www.fema.gov/ of traumatic event at every phase news-release/2018/04/16/social-media-and-emergency-preparedness of response: from pre-deployment readiness, to on-the-ground assistance, and post-deployment support.

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For responders heading into disaster zones to help people in need, access to resources is critical to their “ [T]he Substance Abuse and Mental Health ability to provide quality support to Services Administration (SAMHSA) Disaster App survivors. The SAMHSA Disaster App features resources from the lightens the load for responders by providing original SAMHSA Disaster Kit at access to trauma- and disaster-related https://store.samhsa.gov/product/ resources—right on a smartphone, in real time, SAMHSA-s-Disaster-Kit/SMA11- DISASTER, a go-to resource for at the touch of a button.” disaster response, in addition to added features:

• Search for and map the locations • Access resources for self-care, and maintain individual privacy. of nearby treatment facilities using stress prevention, and guidance for The SAMHSA Disaster App SAMHSA’s Behavioral Health returning home from deployment addresses the needs of survivors Treatment Services Locator. to everyday life. AND responders by also including Responders can save treatment All content can be pre-downloaded self-care supports that can help locations to their device ahead of in case of limited Internet mitigate compassion fatigue—an time in case there is no Internet connectivity at the disaster site. issue caused by a combination of connectivity. burnout and secondary traumatic Formative research and interviews stress. Learn more about compassion • Boost confidence by completing with subject matter experts and fatigue at https://store.samhsa.gov/ disaster readiness checklists. end-users from across the U.S. system/files/sma14-4869.pdf. • Review training materials on a Department of Health and Human variety of topics from disaster Services, the Federal Emergency The SAMHSA Disaster App is counseling basics to information- Management Agency, the American available for free on iPhone®, specific terrorism response, as Red Cross, universities, and state Android™, and BlackBerry® well as stress prevention and health departments revealed that devices. Learn more and download management tips. responders prefer digital tools that the App at https://www.store. samhsa.gov/apps/disaster/. ■ • Filter content by topic, audience, can easily access local resources and language. • Share treatment facilities and content with colleagues and survivors via text message, email, or transfer the information to a computer for printing. • Retrieve publications and pre- downloaded treatment locations at any time, with or without an Internet connection.

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Suicide Rising Across the United States

Suicide rates rose across the United States from 1999 to 2016. Increase 38 - 58% Increase 31 - 37% Increase 19 - 30% Increase 6 - 18% Decrease 1%

SOURCE https://www.cdc.gov/vitalsigns/suicide/infographic.html#graphic1 SAMHSA Mobile App Helps Health Care Professionals Address Suicide By SAMHSA DTAC Staff

Suicide is a leading cause of death opportunities for individuals at Recognizing the need for in the United States. A recent study risk of suicide to access effective professionals to have access from the Centers for Disease Control treatment, many professionals to quick-reference, life-saving and Prevention shows that suicide receive limited or no training resources and training, the Substance rates increased in nearly every state on suicide risk assessment and Abuse and Mental Health Services from 1999 through 2016 (see the intervention. Increasing demands Administration (SAMHSA) CDC map above). on professional time create a barrier developed Suicide Safe, a mobile to having meaningful one-on-one app that helps professionals integrate While mental health and primary consultations with patients. suicide prevention strategies care settings provide unique into their practice and address

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suicide risk among their patients. It is a familiar resource for disaster depression, posttraumatic stress Suicide Safe is a free app based on responders because the SAMHSA disorder, and previous mental SAMHSA’s Suicide Assessment Disaster Kit, which is accessible at health problems with increases Five-Step Evaluation and Triage https://store.samhsa.gov/product/ in suicidal behaviors following (SAFE-T) card, available at https:// SAMHSA-s-Disaster-Kit/SMA11- natural disasters. Those studies store.samhsa.gov/product/SAFE-T- DISASTER, includes SAFE-T also identify some experiential Pocket-Card-Suicide-Assessment- practice guidelines and wallet cards. factors that may be associated with Five-Step-Evaluation-and-Triage- suicidal behaviors, including severe for-Clinicians/sma09-4432. Why Is Suicide Prevention destruction of property, injuries Important in Disaster sustained by relatives, and danger Response? to one’s own life, as well as adverse Several studies suggest an economic conditions, including high association of current major rates of unemployment.

More information is available in a SAMHSA Disaster Technical Assistance Center Supplemental Research Bulletin that examines the intersection of disasters and suicide. Issue five of the Supplemental Research Bulletin can be found at https://www.samhsa.gov/sites/ default/files/dtac/srb_sept2015.pdf.

While preventing human-caused disasters is not always possible and natural disasters are out of our hands, there is research on when mental health and substance use issues and/or suicidal ideation tends to occur in relation to a disaster. According to research contained within the Supplemental Research Bulletin, some studies found that suicidal ideation, plans, and attempts are more likely to start to occur several months after a disaster, rather than immediately after it.

By using suicide prevention strategies and tools such as Suicide Safe in communities affected by disasters early on, the hope is that more suicides can be prevented.

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What Is Included in the Suicide accessible from the app is To Live Safe Mobile App? To See the Great Day That Dawns: Suicide Safe helps professionals Preventing Suicide by American integrate suicide prevention Indian and Alaska Native Youth strategies into their practice. The app and Young Adults. This guide lays enables professionals to confidently the groundwork for comprehensive assist patients who present with prevention planning, with prevention suicidal ideation, communicate broadly defined to include programs effectively with patients and their that a community can use to families, determine appropriate promote the mental health of its next steps, and make referrals to youth. The guide also covers actions treatment and community resources, communities can take in response which are critical components of to a suicide to help heal and thereby saving lives. prevent related suicidal behaviors.

Informed by formative research access to SAMHSA’s Behavioral The causes of suicide are complex and interviews with subject matter Health Treatment Services Locator, and determined by multiple experts and end users—including interactive sample cases, and combinations of factors, such as primary care and mental health conversation starters that can help serious mental illness, substance practitioners, suicide survivors, foster trust and guide meaningful misuse, painful loss, exposure and suicide prevention experts discussions. to violence or trauma, and social from federal, national, and isolation. As the federal leader in academic institutions—SAMHSA While the app can be useful for mental health and substance use identified the specific educational nearly any individual, SAMHSA disorders, SAMHSA is committed to needs, content, and features for considered culturally appropriate continuing to work with its partners Suicide Safe. resources in designing the app that to provide states, territories, tribal resonate with at-risk populations, entities, communities, and the public The tools include patient and such as tribal communities. One of with the assistance and prevention professional education materials, the downloadable tribal publications resources they need.

Suicide Safe is one resource that Visit the SAMHSA website and watch the Suicide Safe App can help. Visit the SAMHSA overview video to learn about the App’s key features and tools at Store at https://store.samhsa. https://store.samhsa.gov/apps/suicide-safe. gov/apps/suicidesafe/?WT. ac=IQS_20150501_ SuicideSafeCaseStudy to learn more and to access links to download Suicide Safe.■

The following page is an informational pullout poster that you can print and post. It provides adult disaster survivors with u information on common disaster reactions and how to get help.

2019 | VOLUME 15 | ISSUE 1 | PAGE 12 A Quarterly Technical Assistance Journal on Disaster Behavioral Health Have you experiencedProduced by the SAMHSA Disaster Technical Assistance a Center disaster? Disasters, both human-caused and natural, may cause behavioral, emotional, and physical reactions in the people who are affected. Most people who experience a disaster, whether it’s through direct or indirect exposure, are affected in some way.

Here are some common reactions to disasters: • Having trouble falling asleep, staying asleep, sleeping too much, or trouble relaxing • Noticing an increase or decrease in your energy and activity levels • Having difficulty talking about what happened or listening to others • Feeling anxious or fearful • Being overwhelmed by sadness • Feeling angry, especially if the event involved violence • Having headaches or other physical pains for no clear reason • Being jumpy or easily startled • Having trouble thinking clearly and concentrating • Having difficulty making decisions

Are you or a loved one experiencing any of these or other reactions to a recent disaster? THERE ARE PLACES TO GO FOR HELP. Disaster Distress Helpline FOR MORE INFORMAINFORMATIONTION on commoncommon disaster disaster reactions TOLL-FREE: 1-800-985-5990 (English and español) asreactions well as ways as well to cope as wayswith stress, to cope check with out stress, the Tips check for out TTY: 1-800-846-8517 Survivorsthe Tips offor a SurvivorsDisaster or ofOther a Disaster Traumatic or Event: Other Managing Traumatic TEXT: “TalkWithUs” (or “Hablanos” for español) to 66746 StressEvent: at Managing https://store.samhsa.gov/product/T Stress and other disasterips-for-Survivors- behavioral Mental Health Treatment Facility Locator of-a-Disaster-or-Other-Traumatic-Event-Managing-Stress/health resources on the Substance Abuse and Mental TOLL-FREE: 1-800-789-2647 (English and español) SMA13-4776. Other disaster behavioral health resources are also Health Services Disaster Technical Assistance Center TDD: 1-866-889-2647 availablewebsite onat thehttps://www.samhsa.gov/dtac Substance Abuse and Mental Health or Servicescall us at Disaster Technical Assistance Center website at https://www. National Suicide Prevention Lifeline 1-800-308-3515. samhsa.gov/dtac or call us at 1-800-308-3515. TOLL-FREE: 1-800-273-TALK (1-800-273-8255) TTY: 1-800-799-4TTY (1-800-799-4889) Substance Abuse Treatment Facility Locator TOLL-FREE: 1-800-662-HELP (1-800-662-4357) (24/7 English and español) 20182019 || VOLUMEVOLUME 1515 || ISSUEISSUE 11 || PAGE 113 TDD: 1-800-487-4889 A Quarterly Technical Assistance Journal on Disaster Behavioral Health Produced by the SAMHSA Disaster Technical Assistance Center

Are Your Families Prepared for a Disaster? By Melissa Brymer and Kristine Louie

Natural disasters can be a stressful experience for families. Whether it’s engaging children in activities Have Them Act Now. to prepare, talking to them about Download Help Kids Cope. what’s happening, or coping with the aftermath of a natural disaster, Parents may wonder: preparedness is critical. Help Kids “How do I talk to my kids Cope is a free, parent/caregiver- before, during, and after friendly app that highlights how disasters?” families can prepare, respond, and “How can I help my child recover from 10 different natural stay calm when we evacuate disasters or extreme weather in a wildfire?” emergencies (earthquakes, extreme “What reactions from my heat, floods, hurricanes, landslides, child are common and when tornadoes, tsunamis, wildfires, should I seek help?” windstorms, and winter storms). Help Kids Cope helps This app is for Apple and Android parents talk to their kids mobile devices. about the disaster they may face and how to best support Help Kids Cope was created by the them throughout. National Child Traumatic Stress Network and Ozark Center, Inc. and the Substance Abuse and Mental asking what they had learned at in response to insights shared by Health Services Administration school and may want to expand parents from the May 22, 2011, (SAMHSA). the discussion on what to do while deadly tornadoes that devastated driving. There are also audio Joplin, Missouri. Parents reported The app includes a variety clips of parents sharing additional that while many great resources of features: suggestions. were given to them, having to • Provides parents with guidance move to different locations made it on how to explain various • Specifies how to adapt easy to misplace them. They also disasters for children of different preparedness efforts for different mentioned that some resources developmental ages. For example, types of disasters. For example, if were difficult to access due to poor parents may want to draw a living or traveling near a coast that Internet connectivity or a lack of for younger children while is vulnerable to a tsunami, families power for an extended period of describing that a tornado is “a big, can learn about the natural warning time. Parents asked that we create swirling windstorm that comes out signs that signal immediate an app so that the resources were of a cloud during a thunderstorm. evacuation is needed. They can readily available on their phone. The twisting funnel cloud can also learn how to reduce smoke Based on these insights, we created touch down to the ground and is intake during a wildfire while Help Kids Cope with funding from moving fast.” For an adolescent, traveling in a car. The app reminds the Missouri Foundation for Health a parent may want to start by families to make sure babysitters

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are oriented to evacuation paths contact if a child is missing. The • Highlights different reactions and how to keep pets and livestock app provides guidance on how to children can experience during safe. It has checklists to help with support children during the event the recovery phase and strategies preparedness planning. as well as steps parents can take to to support them. The app care for themselves. For example, provides contact information to • Assists with different action it includes strategies parents can the SAMHSA Disaster Distress steps families should take before, use to cope if separated from Helpline as well as guidelines for during, and after a disaster. This their children and communication when to seek help from a mental includes preparing the home services are out during a disaster health professional. for events where there is a pre- with no warning, such as an warning, managing the family earthquake. It also includes • The app links to additional anxiety while sheltering in place recommendations for addressing resources including children’s or evacuating, and addressing children’s difficult questions such activity books, tip sheets, safety issues immediately after as whether a family member is children’s books, and checklists. the disaster. The app includes alive when it isn’t known yet, what Support the dissemination information on how to find the the family will do next if they of the app in your nearest public shelter open in have to leave the home, or why the communities by: your area, how to register missing adults are looking so distressed. family members, or whom to • Encouraging school districts or Parent-Teacher Associations to include a description of the app in Take the time now and a newsletter or during September, download Help Kids Cope at which is National Preparedness Month https://www.nctsn.org/resources/ help-kids-cope. • Encouraging local utility companies, weather stations, and governmental emergency management websites to link the app

• Disseminating a flyer about the app during community fairs or preparedness workshops and demonstrate how to use the app

• Encouraging realtors or homeowners’ associations to include a flyer at closing for families new to the area so they can learn how to prepare for new threats

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A Look Inside the Disaster Distress Helpline By Christian Burgess

Disaster Distress Helpline: that the Disaster Distress Helpline In general, crisis counselors with Background (DDH) sprung in February 2012, as the DDH work to explore healthy Vibrant Emotional Health (formerly SAMHSA used the infrastructure coping with callers and texters; the Mental Health Association created for the OSDH (which was help to identify social supports; of New York City) has been phased down in December 2011) and connect with community-based partners with the Substance Abuse to create the country’s first crisis resources for follow-up care and and Mental Health Services hotline dedicated year-round to support. The goal of DDH call Administration (SAMHSA) since supporting survivors and responders and text interventions is to support launching the National Suicide experiencing distress or other mental survivors, responders, and others Prevention Lifeline in 2005. That health concerns related to any who may be struggling with distress year, the first significant increase natural or human-caused disaster. or other mental health concerns after in call volume to the Lifeline was a disaster to move forward on the in August—right after Hurricane How the DDH Operates and path of recovery. Katrina. During the weeks and What Services Are Provided The core services of the DDH months of recovery following The DDH is a sub-network of consist of a 24/7 hotline (1-800-985- Katrina, the Lifeline also provided the National Suicide Prevention 5990; press “2” for Spanish), which support and backup to crisis centers Lifeline, meaning that in order to is also available toll-free to the U.S. located in and serving communities answer calls or texts for the DDH, territories, and a texting option devastated by the disaster. It was a crisis center must first be a part (text TalkWithUs to 66746; text that experience, in addition to the of the larger Lifeline network. This “Hablanos” for Spanish). Support September 11 terrorist attacks that requirement is in place to ensure is provided in over 100 languages had occurred just 4 years prior, that DDH-networked call and text through third party interpretation which demonstrated the need centers are accredited and adhere services accessed via the hotline. for a 24/7, national crisis service to accepted standards and required Deaf and hard of hearing individuals dedicated to ensuring that everyone trainings in crisis assessment, can utilize the text option, connect in the United States and territories intervention, and referral whereby with the hotline via their preferred would have access to immediate callers and texters can receive relay provider, or connect with the crisis counseling and support as soon support based on these and other DDH via TTY at 1-800-846-8517. as a major disaster occurred. best practices. In addition, crisis centers in the DDH sub-network Because the DDH is a national In 2010, following the Deepwater also train staff and volunteers in the service, calls and texts are routed Horizon oil spill in the Gulf of National Child Traumatic Stress to the next available crisis center , SAMHSA once again Network’s Psychological First Aid and answered in the order they are partnered with Vibrant for the Oil (PFA) and receive further “Just In received. Spill Distress Helpline (OSDH) Time” training from Vibrant both project, a temporary service that year-round and in the aftermath of Recent Disasters and Common created a sub-network from Lifeline disasters that applies the principles Presenting Concerns centers located in and serving the of PFA to a disaster crisis call and In 2017, the DDH experienced Gulf region. It was from this project text setting. record utilization following

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Hurricanes Harvey, Irma, and Maria; the Las Vegas shootings; and the wildfires in northern California. Call volume from August through October increased over 1,100 1 in 5 percent compared to the same time Americans has used period 3 months prior. Call volume an emergency app. following Hurricanes Florence and

Michael in September and October Source: University of San Francisco. (n.d.). [Social media: The new face of disaster of this year has thus far increased response] [Infographic]. Retrieved from http://onlinempa.usfca.edu/resources/webinars- infographics/social-media over 200 percent compared to the prior time period in July and August. Calls and texts in these early and families with longer-term mental Some concerns of DDH callers stages of the disaster cycle tend health resources in their community, and texters before, during, or in the to be shorter and more focused on such as to their nearest Lifeline- hours or days immediately after counselors disseminating accurate networked crisis center, Federal these and other disasters—from information and referrals from Emergency Management Agency- incidents of community unrest trusted sources to try and help funded Crisis Counseling Assistance to public health emergencies, the person feel calmer and more and Training Program grants that transportation accidents, and major in control of a still-developing, may have been operationalized, floods—include the following: unpredictable situation. or to other providers located via the SAMHSA Treatment Referral • Individuals and families (including During the long-term recovery of Locator. caregivers of children, the frail a disaster, calls and text exchanges elderly, or adults with special tend to be longer in duration, Whether in the preparedness, needs) feeling overwhelmed or and it becomes more common response, or recovery phase, the one anxious over evacuation or shelter- for the presenting concerns to be consistent, ubiquitous need callers in-place orders and other constant related to deeper mental health and texters are seeking from the streams of information. concerns triggered or exacerbated Disaster Distress Helpline is to be by experiences from the event (for listened to and heard. As one caller • Fear and uncertainty from those example, loss, economic strain, after Hurricane Sandy expressed, who can’t get in touch with displacement, painful memories “Thank you for listening, because no loved ones in the affected areas related to exposure to devastation one else has wanted to.” due to power outages or tied-up or threats to one’s or a loved communications. one’s safety and security) such as For More Information Email [email protected] for more • Immediate grief and other distress persistent anxiety, substance misuse, information about the DDH or to reactions related to any losses or thoughts and feelings consistent receive free copies of DDH wallet incurred during the disaster. For with symptoms of depression. cards and brochures in English or example, bereavement from the Crisis intervention happens more Spanish for distribution in provider loss of a loved one or pet, or frequently for callers and texters in offices and field-based operations damage or destruction to a home this phase and referrals are more such as Disaster Recovery Centers.■ or business. focused on connecting individuals

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RECOMMENDED RESOURCES

Accessible Communication Technology for Disaster National Center for PTSD: PTSD Coach Online Survivors Posttraumatic Stress Disorder (PTSD) Coach Online is This tip sheet from the Federal Emergency Management a tool developed by the National Center for PTSD to Agency (FEMA) shares a handful of different devices help anyone struggling with anxiety, anger, sadness, or that individuals with disabilities and other access and other emotions after a disaster or trauma. Individuals are functional needs can use after a disaster to communicate able to select a symptom they would like to work on, and gather information. Each of the devices listed is and PTSD Coach Online provides a variety of tools and provided by FEMA Disaster Recovery Centers. resources to help cope.

Find the tip sheet at https://bit.ly/2MyLThk. Find the tool at https://bit.ly/2vbAcaN.

American Red Cross Mobile Apps Mobile App: PFA Mobile The American Red Cross has a collection of mobile apps In collaboration with the National Center for PTSD, the designed to share information and help with disaster National Child Traumatic Stress Network provides the preparedness. These disaster apps distribute tornado and Psychological First Aid (PFA) Mobile app, a tool for hurricane warnings and flooding, notify you when an first responders who provide PFA to individuals before, earthquake occurs, and help monitor other weather and during, or after a disaster. This tool can be used by first emergency alerts. Additionally, there are applications responders who already know PFA to review guidelines for first aid care for yourself and your pets. All apps are and gather tips on how to best use PFA when responding available for both Android and Apple products. to a disaster.

Find all of the apps at https://rdcrss.org/2BIFVdw. Learn more and access the app at https://bit.ly/2pT3rvP. ■ Pacific Disaster Center: Disaster Alert App This app from the Pacific Disaster Center provides warnings before many kinds of natural and human- caused disasters. Users can customize the alerts they receive for storms, tornadoes, high winds, earthquakes, wildfires, and more. Disaster Alert can be downloaded on Android and Apple devices or used online.

Learn more and download the app at https://bit.ly/2N4XPaR.

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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 (https://www.samhsa.gov), click the “Sign Up for SAMHSA Email Updates” button, enter your email address, 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 https:// 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 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