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Summer 2013, Volume 21, Number 3

SAMHSA's Disaster Distress Hotline serves as the central point of contact on a subway billboard following the tragedy in Boston.

SAMHSA Disaster Distress Helpline serves as the central point of contact on a subway billboard following the tragedy in Boston.

Emergency Response: SAMHSA's Regional Administrators

When Hurricane Sandy slammed into New Jersey last October, the damage was unprecedented. From ripped-up boardwalks on the Jersey shore to a flooded lower Manhattan, the impact would be felt for months to come. For SAMHSA's Region II Administrator Dennis O. Romero, M.A., the disaster was a test of preparedness, communication, and effective response—in short, a test of SAMHSA's regional administrator (RA) system itself.

In January 2012, SAMHSA placed RAs in each of the 10 Department of Health and Human Services' (HHS) regional offices for the first time in its history. By spreading some of its staff across the country, SAMHSA helped to ensure that mental and substance use disorders are addressed in the regions along with all other health issues. The RAs provide information to communities; providers; state, territorial, and tribal representatives; and others in their regions. They facilitate SAMHSA's collaboration with other HHS colleagues. They also help SAMHSA stay informed about behavioral health needs throughout the country.

"The RAs have been remarkably effective at making sure behavioral health has been at the table for discussion at the state level," said Anne Herron, Director of the Division of Regional and National Policy Liaison at SAMHSA, who serves as the coordinator between the RAs and SAMHSA's central office. "This wasn't possible when everything was centralized in Rockville, MD."

Two recent events—Hurricane Sandy and the Boston Marathon bombings—show that the RA system is especially well-suited to responding to disasters and terrorism.

In the Eye of the Storm

For Mr. Romero, laying the groundwork for responding to a disaster like Hurricane Sandy began as soon as he became SAMHSA's Region II administrator. Since assuming his post, he has made personal connection a priority. First meetings often take place on location, so he can get a feel for the culture, staff, resources, and needs of local stakeholders. In the crisis of this storm, he said, those relationships proved their worth.

Satellite view of Hurricane Sandy.

Satellite view of Hurricane Sandy.

"Because I had been able to establish really good relationships with the mental health and substance abuse commissioners of both New Jersey and New York, it was easy to reach out to them and provide them with a lot of wonderful resources from SAMHSA on recovery and post-disaster behavioral health to make available to the provider community."

Those resources included a document SAMHSA's central office compiled listing all of SAMHSA's disaster-related information and resources, plus a separate document listing resources specifically for children. Mr. Romero also put together and distributed a spreadsheet of contact information for SAMHSA's Disaster Technical Assistance Center (DTAC), state disaster coordinators, and the like. "That was a quick way for them to know how to get hold of each other," he said.

Mr. Romero also played a key role in channeling on-the-ground feedback from local and state representatives to SAMHSA, so that federal support and services could be in place as quickly as possible. After the hurricane passed, he initiated daily phone calls with the state disaster mental health and substance abuse coordinators, and other local representatives about the needs they had identified, and how SAMHSA could help. "I'd go back to SAMHSA and work with the DTAC, Center for Mental Health Services, and our emergency coordinator," he said. "There was a very quick turnaround and quick response back to the states."

"Without that regional presence, I don't know how we would have accomplished what we did."
- Dennis O. Romero, M.A., SAMHSA Region II Administrator

In some cases, he just listened. "I tried to be simply a listening ear for them and give them an opportunity to vent," he said. In New York, for example, the Acting Commissioner of the Office of Mental Health, Kristen Woodlock, R.N., M.P.A., started her new job the day the storm hit. "I was able to provide some support and be a presence to the states, so they wouldn't be alone in the recovery post-disaster," said Mr. Romero. He also worked closely with neighboring RA A. Kathryn Power, M.Ed., who covers Region I, which was also affected by the storm. "This was peer support of a different nature," said Mr. Romero. "We were supporting, helping, listening, and responding."

It soon became clear that the region would need longer-term strategies, too. The affected RAs knew they needed to plan for what might be coming six or eight months later after the disaster—historically a time when substance abuse, mental health concerns, and domestic violence incidents tend to rise. "During one of our calls, the New York State Office of Alcoholism and Substance Abuse Services actually suggested that we try to connect with people who had been down this path before," said Mr. Romero. He turned to RA Michael Duffy, R.N., in Region VI, who shared lessons learned in Hurricane Katrina's aftermath.

As a former State Director for Addiction (prevention, treatment and recovery services) who experienced Hurricanes Katrina, Rita, and Gustav, Mr. Duffy offered to reach out to the Medical Director for Louisiana Office of Behavioral Health, Dr. Rochelle Dunham, and the current Executive Director of Behavioral Health Services for the Metropolitan Human Services District (Orleans, St. Bernard, and Plaquemines Parishes), Calvin Johnson. Mr. Duffy facilitated a discussion that highlighted medication management for Medically Assisted Treatment, restoration of the loss of approximately one-third of the prevention and treatment capacity, and the handling of destroyed case records.

"There are no manuals—just your experience and the support of those on your team. Dennis Romero gave me contacts in other states, with experience. We had regular calls to communicate our support or resource needs."
- Kristen Woodlock, R.N., M.P.A., Acting Commissioner of the Office of Mental Health, New York

Mr. Duffy said, "For those who have experienced a disaster, it is always important and healing to find a way to give back to those who are also experiencing their own disaster."

Boston Marathon Response

While storms can be predicted hours or days before, what happened in Boston on April 15, 2013, came without warning. Two pressure cooker bombs exploded at the finish line of the Boston Marathon, and the city instantly took on a stark atmosphere of worry, concern, and fear.

RA Kathryn Power quickly mobilized to manage the crisis intervention and mental health support that would be needed in the weeks and months to come.

She supported both the regional HHS mental health team and incident response coordination team, explained Ms. Power. The Boston Public Health Commission yielded requests for HHS to provide support to 21 organizations, including the Boston Athletic Association, emergency medical services and public safety agencies, hospitals, educational institutions, and philanthropic organizations.

"Depending on the nature of the crisis, the designated lead response agency, and the role of the local-state-federal collaboration, there will be distinct differences and we need to be flexible, nimble, responsive, and immediate."
- A. Kathryn Power, M.Ed., SAMHSA Region I Administrator

"HHS was able to respond to every request and provided educational information, psychological first aid, counseling, and referral to more than 1,100 distressed individuals," said Ms. Power.

"The HHS/Office of the Assistant Secretary for Preparedness and Response team in Boston coordinated massive amounts of information and resources in demonstrated leadership and partnership that made it possible for federal, state, local, and nongovernmental agencies to support one another in meeting the needs of the injured and distressed," said Ms. Power. "SAMHSA continues to provide information and support to all the ongoing efforts."

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