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Presented at the 23rd Annual Conference of the National Association for Rural Mental Health

Grand Forks, North Dakota, August 10, 1997
 
 In June of 1996, a wild fire near Big Lake, AK destroyed over 300 homes. A national disaster was declared and national resources became available to supplement the overwhelmed local capacity. Mental health disaster counseling services had a critical role in the response to the disaster. In addition to the obvious risks of the existing service system being overwhelmed by the fire, there also was a need to manage the assistance that arrived in a storm of their own. The Alaska experience was positive. Suggestions are made to make the best use of outside assistance and to avoid more help than was helpful.

Purpose

The purpose of this paper is to describe the initial experience of the mental health system in Alaska to a wild fire in Big Lake, Alaska. The roles played by partners in the ongoing mental health system are contrasted with the additional help that came with the disaster. Managing the resources in the disaster was a pragmatic challenge. How the assistance was accepted offered choices that supported local autonomy with national expertise and experience. An interesting phenomena during a disaster is that everyone wants to help during the initial phases; during later phases, many are too exhausted to help. Balancing resources can be a challenge. In small states where mental heath disaster planning is likely to be a part-time function, the balance of management choices is not likely to be anticipated. Suggestions are made to assist in making the best use of outside assistance and to avoid more help than was necessary or helpful.
Background of the Disaster


The Miller’s Reach/Big Lake Wildfire on June 3, 1996 about a mile southwest of Houston and 60 miles north of Anchorage, Alaska. The fire burned out of control until June 10, 1996, when the weather changed. Hot spots continued through the summer. In its path 37,330 acres of spruce, birch and poplar were burned, 433 structures were destroyed including 344 homes. The primary Red Cross shelter registered 2,100 evacuees. Over 1,600 firefighters were on the line at the peak of the fire.

Mental Health Disaster Response: Initial Disaster Response Sequence


Initially, the local communities were alerted of the fire on 6/2/96 and as a result, when the fire raged out of control on 6/3/96, the communities reacted instantly with a wide variety of clothing, food, and shelter assistance.

The impact on the local mental health center, Life Quest, also was instant. Ten employee homes from the local CMHS, allied mental health agencies and several mental health consumers were threatened by the fire. Three Life Quest staff lost their homes. The majority of staff cleared their regular schedules in order to respond to the disaster. Most scheduled services at the CMHC (Life Quest) were suspended. Staff also began volunteering to provide 24-hour coverage at the shelter and assembly areas for the fire fighting efforts.

On day one, the State Of Alaska, Division of Mental Health and Developmental Disabilities (DMHDD) staff also joined the effort and sent out an alert to all the CMHC’s in the state for the need to provide crisis counseling on a 24-hour basis for the next several weeks. Life Quest controlled the schedule to utilize staffing from the centers around the state. This coverage was also coordinated with the American Red Cross. Four DMHDD staff provided 140 hours of assistance from 6/4/96 through 6/7/96. DMHDD, Life Quest, and allied agencies contacted over 1,000 people between 6/4/96 and 6/10/96 to deal with the initial stages of the disaster. Over 80 mental health professionals volunteered during those early days of the disaster.

On Day One, four sites were covered by mental health staff as follows:

  • Wasilla High School-Red Cross Shelter/Headquarters – During the next week more than 2,100 people were registered as displaced, and shelter was provided to over 400 per night at its peak;
  • Kings Lake Camp – Shelter provided housing for 90 – 150 people/evening;
  • Big Lake Fire Department – The most impacted volunteer fire department. Eleven of 23 firefighters lost their homes; and
  • Meadow Wood Mall/Houston High School – Assembly areas for fire fighters before they were dispatched to the fire. Stress was most apparent at the assembling areas for local crews who were fighting for their own homes and their neighbors’ homes.


By Day Five, three additional sites were covered:

  • The FEMA Disaster Relief/Assistance Center provided information from federal and state agencies and began replacing lost documents;
  • Wasilla Middle School/Red Cross Service Center – Provided Red Cross assistance to families and was the base of outreach to displaced families;
  • Big Lake Church – Near the most impacted population areas; outreach extended to fire-fighters and their families; and
  • Lions Club resource distribution center.


While multiple agencies assisted with the efforts to provide 24-hour coverage, the bulk of the weight was on Life Quest. Two staff even were released to be fire-fighters. Ultimately, they were unable to maintain the pace. Staff were required to reduce their crisis activities in order to control their own stress and to take care of the ongoing demands at the mental health center.

Grant Funded Crisis Services


The Immediate Services Grant provided quick crisis counseling resources and became effective on June 7, 1996. The Regular Services Grant was continued these resources and became effective on September 30, 96 for an additional 9-month period.

The Division of Mental Health and Developmental Disabilities monitored the Immediate Services grant and provided overall program management and guidance to Life Quest. Life Quest was responsible for the day-to-day operation of Project Fireweed, the name given to the crisis counseling response team. Life Quest is the third largest mental health program in the State Of Alaska and has successfully provided services to this community for over 12 years. In addition to providing the crisis counseling services, Life Quest also was responsible for the data collection for reporting purposes and assessing the continuing needs for services beyond the 60-day grant period. The Division of Mental Health and Developmental Disabilities was responsible for the reports to the Center for Mental Health Services and the Federal Emergency Management Agency in Region X.

As indicated above, many crisis counseling services were provided during the first eight days. Most of the counseling services provided were to impacted individuals who were in the shelters. As the shelters closed, an extensive outreach effort needed to be made by Project Fireweed. Project Fireweed, outreach counselors attempted to locate survivors and to assess their emotional needs. The crisis counselors also provided one or more of the following services: crisis counseling; peer support; door-to-door outreach and mail-outs to FEMA applicants; public information/education in community meetings; consultation to Matanuska-Susitna Borough emergency staff; and referral to other agencies for services.

Outreach counselors worked in pairs. Some of the survivors were concerned about looters, and some residents of this area were suspicious of governmental programs or agency representatives who were unfamiliar to them. For purposes of staff safety, security and accessibility of staff, staff had pagers or cellular phones. Outreach involved investigative work to determine the present location of families. This effort was accomplished through collaboration with other agencies that had been working with the individuals or families. Referrals from other agencies recognizing the need for crisis counseling services have also occurred. In their effort to provide services, staff were required to drive their private vehicles. The area is quite large geographically. The staff were reimbursed for mileage. In addition, there were a few homes that were only accessible by water, so a boat may still be required periodically to serve those families.

The target populations included the following: children, teens, fire-fighters, elderly, minorities, veterans, disadvantaged adults, business community, and the community at large.

When the outreach counselors identified a need that required skills beyond their ability, a referral was made to a Master’s level worker. That worker assessed the matter further and provided assistance to the parents and youth or referred the family to the mental health program if mental health treatment was required. The worker also coordinated with community agencies and churches to assist them in their work with families.

Information regarding "common reactions" to the fire was provided to organizations and other helping agencies. A pamphlet was developed for distribution to help individuals recognize thoughts, feelings and behaviors that are typically experienced after a disaster. Red Cross handouts were also available.

Project Fireweed provided crisis counseling and outreach services seven days a week, eight hours each day, with an on-call after-hours service through Life Quest’s Emergency Mental Health Services. An office was established in the center of the disaster. The office provided a hub from which flexible outreach services were provided throughout the affected area. Project Fireweed staff worked closely with the Big Lake Fire Response Center, which provided material assistance to fire victims. The Resource Center was an ecumenical response by the Valley Christian Conference.

Project Fireweed Staffing Levels


The lead Project Fireweed Supervisor/Clinician was hired within the first week of the Immediate Services Grant award. The second supervisor/clinician and the balance of the 13 person team were hired within two weeks of the award.

Supervisor/Clinicians — These two positions (Masters level clinicians) supervised and coordinated 2 crisis teams, which provided 7 days per week coverage.

Child/Family Specialists — These two positions (Masters level clinicians) accessed the needs of parents and youths.

Outreach Counselors — These eight positions (Bachelor degree or lower) provided case finding and crisis counseling functions.

Project Assistant — This position provided clerical support, data organization and ensured that the office was staffed during office hours.

Administrative Functions — More extensive administrative functions, such as personnel work and payroll specific to this project were provided by the parent organization, Life Quest. A twenty-four hour crisis line was managed by Life Quest.

By the end of Month One, both shelters had closed, and most of the initial service centers had closed and more durable service centers were opening:

  • the Disaster Assistance Center moved to a location more central to most victims and would remain on site for another month;
  • Project Fireweed opened its doors as a distinct Crisis Counseling program with federal funding; and
  • the Resource Center opened as a local center for material assistance utilizing and coordinating local and national charitable contributions.


By the end of Month 13, most formal service organizations had closed or soon would:

  • Project Fireweed Closed – CMHC sought additional grants to continue with a mental health counseling capacity – Project delivered 9,849 crisis contacts through the 13 month period; and
  • The Resource Center continued to be open for one more month with building assistance staff continuing for two months through the building season.

 

Final Service Summary


All individual and community services were provided by Project Fireweed, the single State appointed grant recipient. A total of 9,849 contacts with survivors were recorded by the program during the Regular Services Grant. Of these, 3,654 people received outreach, crisis counseling, information & referral, or screening & diagnosis services individually or with their family group. Depression/agitation/anxiety was the most frequently reported issue, although normal reactions of stress, grief, and anger were also prevalent. A total of 6,195 contacts were made with survivors through community groups during the reporting period. Education and support were the most frequently offered services to the 284 groups served.

Theoretical Orientation of Organizing the Response


The central organizing theme for all our disaster response planning was local control and local program design. Pragmatically, we also borrowed concepts from people who had experienced national disasters as much as possible but adapted their solutions to the local perceptions of reality. "We did it our way – with a little help from our friends."

Outside helpers were viewed as transient resources that we utilized to support the success of the permanent resource infrastructure. The ongoing resource, in this case the community mental health center, Life Quest, would be there when outside helpers left. We wanted the community to remain attached to the long-term resource.

The hazard of outside experts was that they might be too ready to rescue local resources from the responsibility for an effective response. The temptation was to let them; many helpers in a disaster are themselves victims and overwhelmed to a certain degree; help was needed but should be titrated according to a careful assessment of the need.

Collaborative Partnerships


Even without extensive prior planning, Alaska’s crisis counseling response to this disaster progressed relatively smoothly. All the agencies went out of their way to be collaborative partners. How can we help each other? How can we help our community? The "heroic" phase or "can do" attitude of helping "our community" continued through all the phases of the disaster. This was our community and we owned the solution. Collaborative partnerships were central to our responses. Federal, state and local agencies were usually there "to help."

Community Mental Health Center Role


Life Quest was the community mental health center responsible for the service area where the disaster occurred. Life Quest staff spontaneously volunteered in the shelters as the shelters opened. Initially, they were alone but within a couple days they had organized a formal 24 hour roster which included mental health professionals from surrounding areas. Mental health staff were in the shelters, disaster services centers, on mobile Red Cross vans, fire assembly areas, and local volunteer fire stations.

Life Quest staff also participated with radio and television information interviews and public information announcements. With FEMA/CMHS grants, Life Quest was the sole grantee who provided crisis counseling for 13 months.

Roles:

  • primary, initial, and permanent responder to all local disasters that require a disaster response;
  • manages most local disasters with current resources such as suicides or deaths among students or family members in school system;
  • proactively encourages disaster training among staff members such as CISD, Red Cross Disaster Training, and FEMA training when available;
  • asks for outside help when existing structure is overwhelmed;
  • assists with grant application for disaster grant application; and
  • assists with shaping and implementing helpful media coverage.

 

American Red Cross Role


The American Red Cross (ARC) is a voluntary organization with a worldwide reputation for rapid assistance in a Disaster. Their response teams responded immediately with volunteers from the local community, and then expanded with specialized teams from the whole state. National experts in each of the areas of disaster services soon followed the state staff. In Alaska, the Red Cross was the first to mobilize with the establishment of a shelter in a high school. The local Red Cross also initiated the first call to the Community Mental Health Center (CMHC) who in turn called the Regional Coordinator from the State Division of Mental Health and Developmental Disabilities. An initial structure for community mental health services was established within the first hours. Within a couple days, the CMHC had formalized a system of 24-hour staff at several sites. The national level Red Cross also sent a specialist in mental heath services. The initial service structure was essentially maintained and supported by the Red Cross throughout their mission on site. The on-site Red Cross remained for a month but the disaster effects still continued.

The Red Cross mental health mission also had a additional function to maintain the mental health of their staff. The Red Cross maintained the lead in this area with support from the local and state mental health staff. Follow-up support was provided for local volunteers for a few months after the shelters and the disaster head quarters were closed.

Roles:

  • provides proactive disaster training to licensed mental health professionals;
  • provides volunteer/training opportunities in disasters around the world;
  • responds with a little or a lot of assistance (as needed) to the local mental health service structure;
  • the ARC Crisis counseling priority is first to care for Red Cross staff. The second priority is to provide crisis counseling in their service centers, and then provide outreach crisis counseling services throughout the impacted area;
  • acts as organizer or co-organizer of the crisis counseling response services;
  • provides clear contact point for the public;
  • maintains some crisis response data; and
  • assists with shaping helpful media coverage.

 

Veterans Center Role


The local Veterans Center also played a vital role in the delivery of direct services. They were able to call in both materials and additional counselors as needed.

In this community, they also filled a unique niche in the direct service arena. The area impacted by the fire had one of the highest per capita of Vietnam era veterans both as residents and often as volunteer fire fighters. For the first couple days of the wild fire, volunteer fire fighters were the primary fire fighters. Fire fighting "Huey" helicopters and spotter planes leading the way for retardant bombers added to a feeling of Vietnam for many. Thirteen of these local firefighters lost their own homes. In this atmosphere, the counselors from the Veterans Center were readily identified as fellow "warriors." This unique acceptance led to an early division of labor with the CMHC. The Veterans Center took the lead of outreaching to the firefighters and other emergency service personnel.

Through the fire station chaplains, the Veterans Center also established a strong rapport with an ecumenical church association and provided training to several ministers to increase their counseling skills as another direct counseling resource.

Roles:

  • assists with disasters by providing counseling, food, clothing and referral for veterans and their family members;
  • can bring counselors from around the country;
  • serves more than veterans – were a unique alternative service for EMT and firefighter personnel;
  • worked cooperatively with local mental health organizing authority – using the authority of the local mental health authority rather than the Red Cross which required the use of staff licensed and trained by the Red Cross;
  • provides CISD training.

 

State Mental Health Role


The Division of Mental Health and Developmental Disabilities assigned two of their four regional staff to primarily manage the State mental health role for several weeks.

The first focus was on the task of providing mental health services within the shelters, emergency service centers and outreaching to the firefighters and other people closer to the fire. Over time the shelters closed and the focus of services shifted to people returning to their burned out home sites. The DMHDD assisted the local community mental health center by putting out a statewide alert for staff from other mental health programs around the state. One of the DMHDD staff was assigned a coordinating role with the other State offices, the Red Cross, the CMHC, and other volunteer staff including DMHDD staff from the state hospital and administrative offices.

The primary task of the first focus on direct services was to support the long-term mental health center in the service area. In Alaska, direct community mental health services were usually provided through local, non-profit agencies. Most of the mental health resources did come from the local CMHC. Additional volunteers were integrated into the effort organized by the local CMHC. The challenge for the DMHDD was to stay in the background behind the CMHC. The DMHDD orientation was to help the CMHC succeed because it would still be in the community when the transient resources available for the disaster withdrew. However, a background role for the DMHDD was difficult when many of the directors from other divisions or departments of state government were touring with the Governor and described the assistance available from the State. In this instance the DMHDD tried to remain supportive of the CMHC. The contrast between the DMHDD was that the other departments often provided direct services themselves (for example Public Assistance) rather than through grants to local programs.

The second focus of the State effort was to write the Immediate Services grant to FEMA/CMHS, which provided financial support for the first 60-120 days of the disaster. The Immediate Services grant application needed to be written concurrent to organizing services during the initial and most chaotic phase of the disaster. If the need for mental health crisis services is expected to last more than 60 days, a more extensive Regular Services grant needed to be developed within the following month. These grants are between the State and FEMA/CMHS and thus the state role was critical. The local CMHC was to be the recipient and provider of services under the grant and also played a critical role in developing the grant proposals.

Roles:

  • encourage disaster training among their own and CMHC staff;
  • call on other CMHCs for additional assistance when needed;
  • assist in organizing outside help to support the local, permanent service structure;
  • avoid looking like the calvary if the local service structure can be helped to succeed;
  • take the lead role in applying for Immediate Services and Regular Services Grant in a Presidentially Declared Disaster;
  • coordinate local input and resources to support the development of the grant and design of services;
  • maintain management/monitoring responsibility for Crisis Counseling Grants awarded to the State; and
  • develop a mental health component to the State disaster plan – required for future federal assistance in a disaster.

 

FEMA / Center for Mental Health Services Role


The Federal Emergency Management Agency has the most overt role of providing material and organizational assistance to states during a presidentially declared disaster. The Federal Emergency Management Agency (FEMA) and the Center for Mental Health Services (CMHS) also have a cooperative role to support mental health services if the need is beyond the capacity of the existing mental health service system. Support is available through grants and technical assistance. The first grant is for Immediate Services and is available for the first 60 days; an extension may be available for an additional 60 days. If needed, a Regular Services Grant is also available for up to 9 additional months. Another extension may be available. Alaska requested and received both grants.

The Alaska Division of Emergency Services has a role in disasters comparable to FEMA and had a very visible role with the Governor’s Office to insure that all relevant State agencies placed a priority on providing the needed services. Federal aid was also coordinated through the Division of Emergency Services.

Roles:

  • makes crisis counseling training available (before, during, and after) to each state and territory both in reference to service design and grant applications;
  • provides extensive material available about crisis counseling;
  • provides extensive technical assistance on-site, by phone and by consultants, during a disaster; and
  • funds Crisis Counseling Grants during a Presidentially Declared Disasters.

 

Technical Assistance


The Red Cross, FEMA, and the CMHS each provided extensive written materials and personal technical assistance. The quality of assistance from those resource agencies was excellent — their experience was extensive. However, the middle of a disaster was not the time to listen or wait for consultants. Proactive planning and training is invaluable.

Recommendations


1. Plan — Each State has a disaster plan, become aware of your state plan and the mental health role. Does the disaster plan include a mental health role? Does it make sense?

2. Disaster Training — Take advantage of as much proactive training as possible. FEMA/CMHS have annual training for mental health staff responsible for coordinating the mental health response and writing the mental health grant in a disaster. The Red Cross also has training courses for licensed mental health professionals. Review the literature available from both of these agencies.

3. Related Training — Although technically different than the disaster counseling sponsored by FEMA/CMHS, training in Critical Incident Stress Debriefing is closely related and helpful to the crisis counseling mission of the state for both small and large disasters.

4. Experience — Seek experience or assistance from staff who has experience with mental health disaster response services if possible. FEMA/CMHS may fund a trainer and/or a consultant from states who have experienced a disaster. The Red Cross also provides volunteer opportunities for trained mental health staff to assist with disasters around the country; the experience is an obvious educational opportunity. Consider the experience of others as you design your own state response but retain local control and ownership.

5. Support the Permanent Service Structure — Use disaster assistance to support the existing mental health service system. Disaster assistance is transient; the community needs to increase its own strength and feel confident in its own ability to care for itself.

 



Robert Hammaker, Ed.D., Regional Mental Health Services Coordinator State of AK, Division of Mental Health and Developmental Disabilities, Wasilla, AK. Robert Irvine, L.C.S.W., M.B.A., Ed.D. CEO, Life Quest, Comprehensive Community Mental Health Center, Wasilla, AK. Karl Brimner, M.Ed., L.M.F.T., Director State of Alaska, Division of Mental Health and Developmental Disabilities, Juneau, Alaska.