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DISASTER PLANNING FOR BEHAVIORAL HEALTH ORGANIZATIONS
SEPTEMBER 9, 2020
LAURA COLLINS, LICSWMARC AVERY, MD
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Disaster Preparedness: Two Sessions to cover:
1. The Elements of Disaster Preparation
2. Continuity Planning
3. Management of Prescription Medications
4. Planning for a Pandemic
5. Completing, testing, activating, deactivating the plan
6. Competency-based orientation and training
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Today’s Agenda1. Welcome and Introductions
2. Learning objectives for today
3. Reflecting on COVID-19
4. The Why
Part 1: Prevention/Mitigation
1. The Hazard Vulnerability Analysis
Part 2: Preparedness
1. Administrative
2. Facility
3. Staff
4. Clients
Part 3: Response
1. Continuity Planning
Part 4: Management of Prescription Medications
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Welcome and Introductions
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Today’s ObjectivesAfter today’s training, you will be able
to:
1. Describe the first 3 of 4 phases of disaster preparedness
2. Review the components of a Hazard Vulnerability Analysis, the
Incident Command System and MOU’s.
3. Discuss the elements of Continuity Planning during a
disaster
4. Describe strategies for accessing medications and protecting
PHI during a disaster
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Resources Informing the Training Sessions
➢Substance Abuse and Mental Health Services Administration
(SAMHSA)➢Disaster Planning Handbook for Behavioral
Health Treatment PROGRAMS➢Technical Assistance Publication
Series : TAP 34
➢Commission on Accreditation of Rehabilitation Facilities (CARF)
➢BH Standards Manual - Health and Safety
➢Centers for Medicare and Medicaid (CMS)➢Core Emergency
Preparedness Rule Elements
➢The Joint Commission (TJC):➢Comprehensive Accreditation Manual
for
Behavioral Health Care - Emergency Management
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Your organization’s experience during COVID – chat in!
What did you learn about your agency’s disaster response
plan?
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WHY develop a disaster plan?
Mandates associated with regulatory, licensure/certification,
Medicaid/Medicare rules
The behavioral health impact of a disaster◦ Existing
patients
◦ The community
◦ Surge in need
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Key components of a Disaster Plan – working through the
Phases
1. MITIGATION
2. PREPAREDNESS
3. RESPONSE
4. RECOVERY
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Phase 1: Prevention/ Mitigation
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Phase 1: Mitigation – Developing a Risk Assessment ToolThe
Hazard Vulnerability Analysis
HAZARD IDENTIFICATION
PROBABILITY VULNERABILITY PREPAREDNESS
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Potential Hazards Natural Disasters
◦ Hurricanes◦ Tornadoes◦ Heavy thunderstorms◦ Flash flooding◦
Flooding◦ Mud/rockslides◦ High winds◦ Hail◦ Severe winter weather◦
Avalanche◦ Extreme high heat◦ Drought◦ Wildfire◦ Earthquake◦
Volcano eruption◦ Tidal wave/Tsunami
Man-made Disasters◦ War (conventional, biological, chemical
or nuclear)◦ Toxic material emission/spill (from a
train or nearby plant)◦ Riot or other civil disorder◦ Nuclear
plant melt down or other
nuclear disaster◦ Terrorism◦ Fire
Technological Failures◦ Electrical
◦ Communications
◦ IT System
◦ Heating/Cooling
Other◦ Pandemic
◦ Community infrastructure breakdown (bridge collapse, dam break
etc)
◦ Utility failure
◦ Transportation failure
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Thought exercise: 5-7 minutesWhat do you think are your top 5
potential hazards for your organization?
◦ This is not just about Natural Disasters
◦ Think about… ◦ Utilities
◦ Communications
◦ Technology unique to your organization
◦ Man-made threats
◦ Infrastructure vulnerabilities in the community
Report out!
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Create your HVA Tool➢ List potential hazardous
events for your organization
➢ Evaluate each event for ➢ Probability
➢ Include frequency it might occur
➢ Vulnerability
➢ Include degree of impact
➢ Preparedness
➢ Consider strength of current plans and previous experience
with the event
➢ Multiply the ratings for each area➢ The scale will range
from 0-27
Event Probability Level of vulnerability
/Degree of disruption
Preparedness Score
High
(3)
Moderate
(2)
Low
(1)
High
(3)
Moderate
(2)
Low
(1)
Low
(3)
Moderate
(2)
High
(1)
Ice Snow
Flooding
Earthquake
Hurricane
Hazardous Material Accident
Fire
Tornado
Volcano
Civil Disturbance
Mass Causality
Event
Terrorist Attacks
Pandemic/Infectious Disease
Electrical failure
Communications Failure
Information System Failure
Water failure
Transportation
Interruption
Environmental/
Altered Air Quality Pollution
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HVA Tool - ExcelNaturally Occurring EventsIncludes tabs for
technological, human and hazardous material disasters
SEVERITY = (MAGNITUDE - MITIGATION)
EVENT
PROBABILITY
HUMAN IMPACT PROPERTY IMPACT BUSINESS IMPACT PREPARED-NESS
INTERNAL RESPONSE EXTERNAL RESPONSE
RISK
Likelihood this will occur Possibility of death or injury
Physical losses and damages Interuption of services Preplanning
Time, effectivness, resoucesCommunity/ Mutual Aid staff and
suppliesRelative threat*
SCORE 0 = N/A 1 = Low 2
= Moderate 3 = High
0 = N/A 1 = Low 2
= Moderate 3 = High
0 = N/A 1 = Low 2
= Moderate 3 = High
0 = N/A 1 = Low
2 = Moderate 3 = High
0 = N/A 1 = High
2 = Moderate 3 = Low or none
0 = N/A 1 = High
2 = Moderate 3 = Low or none
0 = N/A 1 = High
2 = Moderate 3 = Low or none0 - 100%
Hurricane 0%
Tornado 0%
Severe Thunderstorm 0%
Snow Fall 0%
Blizzard 0%
Ice Storm 0%
Earthquake 0%
Tidal Wave 0%
Temperature Extremes 0%
Drought 0%
Flood, External 0%
Wild Fire 0%
Landslide 0%
Dam Inundation
Volcano 0%
Epidemic 0%
AVERAGE SCORE 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0%
*Threat increases with percentage.
0 RISK = PROBABILITY * SEVERITY
0 0.00 0.00 0.00
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From the HVACreate your Agency’s Priorities for Disaster
Planning
Regardless, CARF requires the following categories be included
in your plan:
▪ Fires
▪ Bomb threats
▪ Natural disasters
▪ Utility failures
▪ Medical emergencies
▪ Violent or other threatening situations
▪ Which of these procedures are still in development with your
agency?
▪ Chat in or Share
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Phase 2: Preparedness
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Phase 2: Preparedness
ADMINISTRATIVE FACILITIES STAFF READINESS PATIENT EDUCATION
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AdministrativePreparedness
Relationship with State and local Emergency Management
Coordinators/Reps/Groups
Financial Resiliency
Incident Command Structure & Command Center
Agency Agreements
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Preparedness : State and Community Representatives and
Groups
Date Addressed
State/Community
Representative/Group
Names, Titles, and Contact Information
(phone number[s], email)
State disaster behavioral health coordinator
Other behavioral health treatment programs in the community
Public health department
Emergency response organizations
Local office of the Drug Enforcement Administration (DEA)
State Opioid Treatment Authority (SOTA)
Organizations of Pre-Credentialed Volunteers such as Citizen
Corps Council (CCC) or Medical Reserve Corps (MRC)
Voluntary organizations
Vendors and other nearby businesses
Media contact and Public Information Officer of Incident Command
System (ICS)
Other:
https://www.hca.wa.gov/assets/program/disaster-contacts-bh.pdf
Health Care Authority (HCA) - Amanda Lewis 360-725-9411
360-628-1730 © [email protected] Opioid Treatment Programs -
Jessica Blose360-725-1088 [email protected] Dept. of Health
(DOH) - Trevor Covington Mental & Behavioral Health Response
Coordinator 360-236-4477 [email protected]
https://www.hca.wa.gov/assets/program/disaster-contacts-bh.pdf
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Prepare for Financial Resiliency
Planning for period of decreased visits/admissions/revenue:
➢Establish a contingency or reserve fund/line of credit (e.g. to
maintain payroll if billing is disrupted)
Planning ahead for
➢Emergency grant proposal writing
➢Temporary modification of fees
➢Intensive marketing and outreach
➢Expansion into community disaster-specific behavioral health
response and support activities
Careful tracking and documentation of
➢Costs and services provided during the disaster so that
reimbursements are facilitated
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Preparedness: Creating/refining your Incident Command System
Looking at this diagram,
what would be your role on the ICS team?
CHAT IN
Remember to have backups, and backups for the backupsand an
identified Command Center (with a backup)
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Incident Command System –Roles and Responsibilities
Incident commander is responsible for assignments of other roles
if current assignments aren’t onsite/available.
➢Command Team (Liaison/Safety/Public Information Officers) is
responsible for communication and collaboration with the multiple
agencies on site, and working with the local officials, the
public/media.
➢Operations Team handles tactical operations, coordinates the
command objectives, and organizes and directs all resources to the
disaster site.
➢Planning Team provides the necessary information to the Command
Center to develop the action plan that will accomplish the
objectives. They also collect and evaluate information as it is
made available.
➢Logistics Team provides personnel, equipment, and support for
the Command Center. They handle the coordination of all services
involved in the response, from locating rescue equipment to
coordinating the response for volunteer organizations.
➢Finance Team accounts for funds used during the response and
recovery aspect of the disaster. They monitor costs related to the
incident and provide accounting analyses
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Applying the ICS to your Organization
As a member of your ICS team (or equivalent) during COVID, did
you need to take on a role or task that was unexpected?
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Preparedness: Negotiating Memoranda of Understanding or
Agreements
➢These are essentially Mutual Aid Agreements, and should
include
➢Arrangements for use of alternate facilities
➢Agreements to provide essential services on a temporary basis
to another program’s clients
➢Agreements to support computer system needs in a move to an
alternate location
➢Provision of evacuation transportation assistance
➢Lending or borrowing personnel to temporarily fill key staffing
gaps
➢Payment arrangements, reimbursement and allocating costs for
any of the above
➢Roles, scope of responsibilities
➢Procedures for requesting, providing and ending aid
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Preparedness –MOU’s
What organization/s do you think you will need to have an MOU in
place, and why?
CHAT IN
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Preparedness -Facilities
Supplies – key provisions/food, medications, office, vendors
Utilities – plan for water and power
Records Protection – backup plan, off-site storage – the
facility go kit
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Preparedness –Staff and Clients
Staff readiness – self preparedness, training, drills
Client education – at intake, including evacuation plan
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Staff Readinesshttps://www.ready.gov/september➢ Encourage staff
to develop plans for their households
➢ Administrative and direct-service, including peers
➢ Preparing staff for supporting the clients in a disaster
➢ Training on disaster-related BH topics
➢ Psychological First Aid Training for First Responders
➢ Resilience, stress management
➢ See SAMHSA’s Disaster BH Info Series
www.samhsa.gov/dtac/dbhis/
➢ Routine and unannounced training exercises and drills
➢ Record: Drill prep and after-action reports
➢ Tools: Job Action sheets; staff inventory worksheets
https://www.ready.gov/septemberhttp://www.samhsa.gov/dtac/dbhis/
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Client Preparedness
➢Include disaster preparedness at intake➢To patient and
surrogate decision-maker
➢Emergency instructions provided to patient and posted in the
facility
➢Emergency Health Information card
➢Obtain client-locator information
➢Mental Health Advance Directive (MHAD)
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ADMINISTRATIVE –
ICS, MOU’S, LOCAL/STATE RECORD PROTECTION
FACILITIES –
SUPPLIES, UTILITIES, RECORDS
STAFF READINESS PATIENT EDUCATION
Assessing your Organization’s Preparedness
Based on what you’ve heard so far, what jumps out at you in
terms of what your organization still needs?
CHAT IN or Share
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Phase 3: Response
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Phase 3: Response
CODE IS INITIATED
Activate INCIDENT COMMAND SYSTEM
PROCEDURES – EVACUATION, SHELTER-IN-PLACE
ID ESSENTIAL AND NON-ESSENTIAL PERSONNEL
EXERCISING CONTRACTS/MOU’S
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Know your organization’s Emergency CodesFLIP CHARTS WITH
RESPONSE INSTRUCTIONS ARE UPDATED AND ACCESSIBLE
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Response –Shelter-in-Place
Assignment of staff to:
➢Shut down critical operations including the ventilation system
if advised given the emergency
➢Transport the facility go-kit and an emergency supply of
medications
➢Seal/lock the room as needed for the specific hazards (e.g., a
biohazard incident) that warrant sealed rooms
➢Head count (using a prepared roster)
➢Assist with contacting family/loved ones/caregivers
➢Coordinate sleeping arrangements, if needed
➢Maintain contact with emergency authorities
➢Maintain and store supply of food/water in preparation
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Response – Business Continuity Planning
Identify essential functions
Identify essential staff
Provide for continuity of
leadership
Arrange for alternate facilities
Ensure interoperable
communications
Protect vital records and databases
Develop resources to manage human
capital
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Essential & Non-Essential Functions
Essential for all programs:
➢Provide crisis stabilization, crisis intervention, or other
emergency services to outpatients
➢Conduct basic screening, intake, and discharge procedures
➢Track clients affected by dispersal and evacuation to ensure
they continue to receive needed behavioral health services
➢Assist clients in accessing needed medications
➢Conduct drug testing for mandated clients
➢Assist with case management activities such as linking to
resources, including helping clients obtain replacements or
refills, as appropriate, for needed medications (outpatient)
➢Document transfer of clients and their records to another
provider
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Essential for Residential Treatment Programs
•Provide residential care for patients who do not meet discharge
criteria.
•Stabilize patients undergoing nonmedical (social)
detoxification (see section below for essential functions of a
program providing medically managed detoxification).
•Continue medications and supportive counseling to patients to
prevent decompensation or escalation of symptoms of behavioral
health disorders.
•Coordinate or address transportation needs for accessing
medical services.
•Provide case management services, as appropriate, to move
patients toward discharge readiness
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Essential for Detox Programs
Follow
Follow established medically managed detoxification
protocols
Stabilize
Medically stabilize patients; closely monitor patients’
withdrawal symptoms
Transfer
Transfer patients who require a higher level of medical care
than the program can provide to an appropriate facility; provide
residential care for patients who remain at the facility
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Essential for Opioid Treatment Programs
identities and dose information for patients receiving
medicationConfirm
access to prescribed or dispensed medications (e.g., methadone,
buprenorphine)Facilitate
case management to assist with medically appropriate transfer or
dischargeProvide
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Non-Essential Functions
➢Perform extended intake and discharge procedures
➢Conduct nonmandated drug testing
➢Offer routine counseling and education
➢Provide general mental and substance use disorder prevention
services
➢Host onsite mutual-help group meetings
➢Donate meeting space for community groups
➢Provide residential care for patients who can be discharged
➢Medically detoxify patients who can be safely transferred to
and detoxified in another setting
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Identifying Essential Staff ➢Building a roster
Information Primary Staff Member Backup Backup Backup
Name
Office phone
Office email
Alternate email
Cell phone
Home phone
Phone contact outside city*
Notes†
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Provide for Continuity of Leadership:Order of Succession and
Delegation of Authority
Leadership Position Example Order of Succession
Executive Director/ Administrator
1. Assistant director
2. Clinical director
3. Clinical nurse supervisor
Clinical Director
1. Clinical nurse supervisor
2. Clinical nurse
3. Senior licensed counselor or program manager
Medical Director or Chief Psychiatrist
1. Staff physician2. Advanced registered nurse practitioner (or
other staff member with
independent prescriptive authority)3. Certified physician
assistant (or other staff member with independent
prescriptive authority)
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Arrange for Alternate Facilities –including Relocation
Planning
DDisaster Scenario Primary Alternate Facility:
Name, Address, Contact Information, and NotesSecondary Alternate
Facility:Name, Address, Contact Information, and Notes
Internal (only the behavioral health treatment program site is
affected)
Local (the program site and its community are affected)
Regional or national (the emergency affects a broad geographical
area)
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Interoperable Communications
GroupLandline Phone
Cell Phone/ Smart-phone
Web Site or Intranet
2-Way Radio or Walkie-Talkie
Satellite Phone
Hotline (outside facility)
GETS,WPS, or Priority Listing for Electric Service* Amateur
RadioRecorded Message
Sign on Door
In-Person
Announcement via Media (social network such as Twitter, TV,
radio)
Other
Emergency responders
Essential staff
Nonessential staff
Clients
Client families
Substance Abuse and Mental Health Services Administration
(SAMHSA)
Drug Enforcement Administration (DEA)
Vendors/ insurers
Providers of mutual aid
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Interoperable Communications –Protecting Vital Records and
Databases
Category of Record or Database
Onsite Computer
Offsite Server
Laptop (battery operated)
Portable Memory Device (e.g., encrypted flash drive, encrypted
DVD)
PaperCopies in Facility Go Kit
Other
Staff Members With Authority To Retrieve or Enter Information
and Who Have Access to Passwords or Authentication Procedures for
Accessing the Record or Database
Current client medication information
Other client medical information
Client psychosocial history
Client billing informationDrug testing dataPersonnel
information
PayrollComputer systems information (network diagram,
passwords)
Vendor records
Other:
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Managing Human Capital – Developing Resources
➢Maintaining contact with staff with system to inform
staff/supervisors➢location/contact info
➢Work status (essential/nonessential)
➢Work schedules➢Including working at home, reassignments,
alternate transportation
➢Compensation and Leave
➢Staffing➢Accommodations, coverage
➢Training
➢Staff behavioral health needs
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Special Topic: Medications
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Oversight of Clients on Prescription Meds
Improving access to prescription meds◦ Photo ID◦ Med containers◦
Written Rx◦ Packaging labels (dose, physician, refill info)◦
Payment receipts
Continued methadone dosing◦ Storing medical records in alternate
location or central database
◦ Washington System for Tracking Resources, Alerts and
Communication (WATrac)
◦ SMART ID cards
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Tool for Preparedness and Response in a Disaster:Washington
System for Tracking Resources, Alerts and Communication
Web-based System that serves two important roles for healthcare
orgs in WA State1. Daily tracking of facility status and bed
availability and, 2. Incident management and situational awareness
during a disaster response
Provides tools for organizations to track resources, locate
available trauma care, notify partners of emergency events,
communicate online in real-time, ID vulnerabilities, share
documents, export system data in reports
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Treating or Referring the Outside/Guest Patient
➢Handling the Influx◦ Follow SAMHSA’s Federal Guidelines for
Opioid Treatment 2013 (Exhibit 5-3)
➢The displaced Buprenorphine patient➢Most treated in non-OTP
clinics➢ Resources found in Buprenorphine Physician &
Treatment
Program Locator at
http://buprenorphine.samhsa.gov/bwns_locator
➢Refer or treat pain patients, as appropriate (recommend local
physician/pain management specialist)
http://buprenorphine.samhsa.gov/bwns_locatorhttp://buprenorphine.samhsa.gov/bwns_locator
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Prescribed Medications – things to consider for all BH
providers
• Clients educated about basics of backup for meds and med
supplies in disaster scenarios.-including how to obtain
prescription replacement or refills from alternate facility
• Checked with public health on the public stockpiled of
medications, if indicated
• Coordinated medication efforts with local disaster planning
committees.• Plans are in place for transfer and tracking of
patients to alternate facility• Handling an influx of new
patients
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Prescribed Medications – things to consider for OTP (Opiate
Treatment Providers)
• Use of alternate prescribers (e.g. if PCP not available)•
Referral of pain patients• What if opiate supplies are destroyed or
become inaccessible• Handling and Transferring controlled
substances • Key Procedures (e.g. exception requests to SAMHSA)•
Med Recs -- Patient medical records at a secure location, ability
to transfer
records• Use of state central Rx databases and communications
systems
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Summary, plus what’s ahead for our Next Session
1. Planning for a Pandemic2. Completing, testing,
activating,
deactivating the plan3. Competency-based orientation and
training
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Next Steps –Planning for Session #2:
Homework and Technical
Assistance
1. CREATE OR UPDATE YOUR HVA
2. PLAN FOR REPORT-OUT ON MOA PROGRESS
3. CHOOSE A SECTION/S OF YOUR DISASTER PLAN TO DEVELOP
4. ONE OR TWO CALLS BETWEEN TODAY AND THE 23RD TO PROVIDE
ASSISTANCE
