Read the transcript of the third episode of the Resiliency in Disaster Behavioral Health podcast. MODERATOR: Welcome to Resiliency in Disaster Behavioral Health, a six‑part podcast series from the Substance Abuse and Mental Health Services Administration. The goal of this podcast is to inform local behavioral health agencies on strategies for building resiliency in individuals and the community before, during, and after a disaster. The series discusses specific behavioral health interventions across the stages of disaster response, in addition to focusing on the needs of specific populations. In this installment, Tom Thomson, the Access Specialist and Disaster Coordinator for the Oklahoma Department of Mental Health and Substance Abuse Services, talks about how an agency can prepare itself for a disaster, increase employee resilience, and serve the community in a time of need. TOM THOMSON: Hello. Today we’ll look at how behavioral health agencies can prepare against disruptions such as disasters and still be able to resume core operations by providing an acceptable level of functioning and structure. One of the ways to do that is through a Continuity of Operations, or COOP, plan, sometimes known as a CONOPS plan. Part of what we look at in a COOP plan is the minimum level of services; in other words, what is the minimum level of service or the minimum number of services that an agency can provide and still fulfill its function and its mission statement? Sometimes it’s necessary to go back and look at an agency’s mission statement in order to determine exactly what expectations are for that agency. Second, who are the key personnel necessary to provide that minimum level of service? Here we should not only think about direct service staff, but support staff as well. It’s also important to make sure we have backups for critical positions. And what about supplies? Not only paper clips and pencils, but things like generators, fuel for the generators to keep us going for a few days if we have to shelter in place or if our building is without power. Key documents and backups of those documents may be necessary for us to continue to do our jobs. Policies and procedures that will be in place while the disaster is going on. There may be key policies and procedures that we need to enact specifically for a disaster and others that we want to overlook or forget about for a little while, while the disaster is taking place. One of the things that always helps is a clear chain of command. Having this decided up front can save a great deal of frustration. And again, it’s always a good idea to make sure we have backups for these type of critical positions. Alternate service and administrative sites are also key to providing good disaster resilience. It’s also a good idea to have more than one alternate site, just in case somebody else needs to use the site we originally planned to use. Training and exercises provide staff the opportunity to experience what it feels like to respond to a disaster situation and gives organizational leadership the chance to identify weaknesses in their CONOPS plan. This type of situation‑based practice in advance of the disaster or crisis has been shown to improve organizational and personal resiliency. The more familiar we are with any given situation and the more we know how to respond to it, the less stress we tend to feel. Some of the trainings you may want to consider could be incident command training, Psychological First Aid training, regular first aid, and some tabletop and/or functional exercises. Establishing staff care and communications plans should always be done prior to a disaster to avoid disruption of service later. One of the first things that’s always vital in managing staff in a disaster is to establish—for the staff to establish a family safety plan. As in the previous section, you’ll find some duplication in this list as well. Supervision and clear chain of command are vital, as is regular monitoring, redundant leadership roles and critical positions, clear job duties and expectations. Job action sheets can be a good tool to use in this instance. Planning and exercising, again, are vital to establish better staff care in a disaster; defining a shift link and sticking to it, mandatory breaks and time off, rotation of shift duties so that no one person gets the most difficult cases and the most difficult duties every day. For staff stress management and stress reduction, in the pre‑disaster phase we want to look at things like diet, eating a proper diet—that is, not existing primarily on caffeine and sugar—exercise on a regular basis, sleep. It’s always good to get enough sleep, and many of us don’t. National recommendations tend to be anywhere from 6 to 8 hours. Having—being engaged in some sort of pleasurable or meaningful activity. The agency can sponsor some team‑building activities as well to increase staff cohesion. In the response phase of a disaster, it’s a good idea to do a pre‑deployment staff assessment and briefing. There are some tools out there that are canned and ready to use. The Red Cross has one of them, and there are others being developed in other parts of the country. Increasing supervision in a response phase is always a good idea as well, to assure that staff are clear on their duties. For communications, one of the first things we want to make sure that the staff do is communicate with their families so they’re not worrying about them in a disaster instead of worrying about or taking care of the duties at hand. One of the things that can be done is a simple texting plan, and this can be tested from time to time among family members. Assemble “Are you okay?" "Yes, I’m okay” texts between family members can be very useful as a simple way to make sure family members are safe. It’s always a good idea to have a contingency plan, though, because sometimes cell towers are down. Texting is a good way to communicate, and as an alternate to cell phone activity since, cell phone signals can be overwhelmed at times, especially in a disaster. Email is also useful as an alternate text—as an alternate to regular telephone use. Push‑to‑talk phones can be used if your agency has a need for assured communications in a short or a small area, especially like in a state hospital. Walkie‑talkies can also be used in the place of push‑to‑talk phones. Ham radio or amateur radio can be used for longer distances. You might check with your staff to see if anybody is a ham radio operator. Satellite phones is a little more costly option. Social media has been shown recently to be very useful in disasters. It’s a good way to get information out to a large number of people quickly. The danger here is just that sometimes inaccurate information can be distributed as well, so we want to make sure any information that goes out is accurate and that we monitor any social media outlets for accuracy on a constant and consistent basis. Local media, local mass media, such as television stations and radio stations, can also be very useful in times of disaster for distributing information not just to your staff, but to the general public as well. Of course, we always want to make sure that those messages are accurate. For example, we want to make sure that we don’t tell the media that we need a certain type of supply because that can often lead to an overabundance of water or gloves or socks or just about anything else you can think of. Engaging in pre‑disaster relationship building with other organizations and agencies is vital. One of the key agencies in any state, or one of the key groups, rather, in any state, is the VOAD group, also known as Voluntary Organizations Active in Disaster. The VOADs are agencies such as the Red Cross, Salvation Army, UMCOR—or United Methodist Committee on Relief—Catholic Charities, and other faith‑based organizations. One of the figures that I saw recently is that over 80 percent of the services delivered in any disaster are delivered by the voluntary agencies, not by the government, which is—which tells us why it’s so vital to connect with these agencies in a time of disaster. They’re the ones that are going to be out in the field really providing the services and usually before any of the government agencies are out in the field. Building relationships with other agencies like the state and local emergency management agencies and law enforcement agencies is also a good idea, particularly when we think of the fact that disaster scenes are becoming more and more closed to people that don’t have pre‑existing relationships and/or are not a part of a recognized agency. Other state and local government agencies that you might think of in making prearranged or pre‑disaster contact with could be the home—your state’s Homeland Security agency; human services such as welfare, child services, et cetera; the state and local health departments; the Department of Commerce; and the Department of Agriculture. In Oklahoma, especially, Agriculture is a big player in the state, period, and in a disaster they can have resources such as trucks and trailers that can haul animals, livestock that need to be relocated in the instance of floods or fires, and other resources that we might not ordinarily think about. Then some other agencies that not every state has, but certainly some do, are Port Authorities, Forestry, Departments of Transportation—everybody has a Department of Transportation—the utility companies, and the railways as well. These are all agencies that sometimes it’s a good idea to make an effort to reach out to in advance because the old saying goes that the last thing we want to do is to try to pass around business cards during a disaster. The next thing I’d encourage you to think about is understanding how your community’s disaster response plans work in your state and locality. For example, how is incident command used in your state? If you look at the federal versus the state versus the local emergency management plans, which takes precedence in your state and in your community? What kind of cross‑jurisdictional issues do you have in a particular disaster area? For example, does it cross county lines? Does it cross city lines? If you have two metro areas that bump up against each other? In disasters in 2013, we definitely ran up against that in Oklahoma around the central Oklahoma area. There was some confusion about who had jurisdiction in what area. Now, these thing were eventually worked out, and everybody was good‑natured about it and didn’t try to step on anybody’s toes, but it’s always a good idea to have these things figured out in advance if you can. Look at other agencies’ plans and how and/or if you fit with those plans, such as the Health Department, Department of Agriculture, et cetera. For example, in Oklahoma there is such a thing as the Catastrophic Health Emergency Plan, wherein the Health Department is the lead agency in any large public health emergency. So the Department of Health, then, is the lead agency, and they call the shots with everybody else. And also in Oklahoma, the Department of Agriculture will take the lead in any large foreign animal disease outbreak. There is even a Foreign Animal Disease Plan in which there is a mental health component. You might check with your local AG authority to see if there is such a plan in your state and if you might participate in the planning or revision of that plan. What about the state Emergency Operations Plan? Is your agency mentioned in the state Emergency Operations Plan, and if so, how? What are your responsibilities? These plans are revised periodically, and it’s a good idea to make sure you’re at the table in some fashion to make sure that mental health concerns are not overlooked. Sometimes you can get a seat at the table by offering free trainings with continuing education for the emergency managers. Sometimes you can have training booths at conferences. Oklahoma has its own Emergency Management Conference, for example, every year, and some of the agencies participate in that conference. Some of us provide training. The Department of Mental Health provides training. The Oklahoma Medical Reserve Corps provides training at that conference, and in some cases the Department of Mental Health has had a table with outreach material and mental health and substance abuse material at that conference as well. And then, if you can, find and encourage an agency champion in the agency that you’re trying to develop inroads with. These people can be in any position, really, from the commissioner on down. So see if you can find somebody that has an investment in mental health in that other agency, and then really encourage them to feed with their support. Of course, we all know that outside of our agencies isn’t the only place that we sometimes need to garner support. As we all know, or at least as most of us know, during times when there are not disasters, people tend to forget about the importance of disaster mental health, even within our own agencies, and so sometimes it’s a little difficult to find additional funds for planning or exercising or anything else. So one of the things you might consider is associating your program, your disaster mental health program, with other existing, stronger, popular programs within your agency. This gives you a chance to broaden the scope of your program and do the cross‑training with some other people in your agency as well. Providing value‑added training, such as with emergency management agencies, is also a good idea. You can do this by providing CEUs to your licensed staff so that it gives them an incentive to get to the programs too, and this is also a really good way to build your cadre of mental health professionals. If you can provide licensure credit for people or continuing education units for people around the state, it’s a good, good way to bolster the number of people trained in various response modalities. One of the things that I’m often asked by people that are somewhat new to the field is, “If you could describe one word or say one word that is important to remember in responding to disasters, what would that word be?” And without fail, I always say “flexibility” because you can plan and plan and plan, and no matter how much you plan and how perfectly your exercises go, there’s always going to be something that turns up in every disaster that you didn’t plan for, and you’re going to have to readjust a little bit. So always be flexible and try not to let the unexpected throw you too much. And lastly, I want to leave you with these words, that I won’t claim that they’re wise, but I do believe that they’re true, and that is always remember it’s a marathon, not a sprint. In social marketing, they talk about how long it takes to change a system when instituting a system‑wide change, and one of the figures that I’ve heard in that area is that it takes as long as 15 years to enact social change within a system. That can seem like a very long time, but I think it’s probably true. In my own state, I really feel like it’s taken about 20 years for mental health to be consistently considered as part of the disaster planning process, and even with that, every once in a while, I still have to nudge people a little bit, just to not be forgotten. So, to recap, to increase organizational resiliency in your agency, create a COOP plan, pre‑train your staff, work on staff care and communications plans pre‑disaster, engage in pre‑disaster relationship building with other agencies and organizations, gain some understanding of your jurisdiction’s disaster plans and how your agency fits or doesn’t fit into those plans, promote your disaster mental health program both outside and inside of your agency, be flexible, and it’s a marathon, not a sprint. So tie on your highway shoes. It may be a long run. MODERATOR: Thank you for listening to the Resiliency in Disaster Behavioral Health podcast series. If you would like to learn more about the topics and materials discussed in this episode, contact the SAMHSA Disaster Technical Assistance Center at email@example.com or at 1‑800‑308‑3515. For products such as tip sheets, webcasts, and collections of research materials, visit our website at www.samhsa.gov/dtac. If you or someone you know are experiencing distress related to a natural or human‑caused disaster, call the Disaster Distress Helpline at 1‑800‑985‑5990.