Hurricane Recovery - Transcript

Moderator: Haley McCalla
Presenters: Scott Damon, MAIA; Meghan Griffin, MPH
Date/Time: October 17, 2018, 1:00 – 2:00 pm ET

HALEY McCALLA: Good afternoon, everyone. My name is Haley McCalla and I am an ORISE fellow with the CDC, division of emergency operations. Thank you for joining us for today’s Webinar titled “Hurricane Recovery.” Today we will hear from CDC’s Scott Damon and Meghan Griffin. If you do not wish for your participation to be recorded, please exit at this time.
You can earn continuing education by completing this Webinar. Instructions on how to earn continuing education can be found on our website emergency.cdc.gov/epic. The course access code is EPIC1017 with all letters capitalized. To repeat, the course access code to receive continuing education is in all caps EPIC1017. Today’s Webinar is interactive.
To make a comment, please click the chat button on your screen and then enter your thoughts. To ask a question, please use the Q&A button. The Q&A session will begin after both presenters have presented. We are very fortunate to have two presenters today. Scott Damon is our speaker from CDC.
Scott has been the health communication lead for asthma and community health branch since 2002. In this role, he develops and oversees CDC’s communication on asthma, air pollution, climate and indoor air health issues such as carbon monoxide poisoning and mold exposure. Meghan Griffin is our speaker from the Substance Abuse and Mental Health Services Administration, also known as SAMHSA. Meghan is responsible for planning, managing, and evaluating grants for the crisis counseling, training, and assistance program, also known as CCP. This program directly supports the crisis counseling services for survivors of major disasters.
CCP also provides training and technical assistance on disaster mental health issues and response management. Thank you both so much for joining us today. I’ll go ahead and get your slides up and then you can begin.

>> SCOTT DAMON: Thank you, Haley. Good afternoon.
And thank you, everyone, for who is online. As noted, I’m the health communication lead for the Asthma and Community Health Branch. Some of you might remember it was formerly called the Health Pollution and Air Branch. I have been there since 2002 and been doing emergency responses of various kinds for CDC going back to 2001. Next slide, please.
So what we want to talk about this afternoon — what we’re going to talk about is the communication response to some of the comment post-hurricane hazards, things that we pretty much know are going to happen. This is a basic list here. It’s not exhaustive, but we know that there’s always going to be flooding issues. There’s going to be drowning issues and associated accidents. The first two related.
People driving into flooding areas. There will be power outage issues along the lines of carbon monoxide poisoning and electrocution from downed power lines. There will be cleanup issues in terms of mold exposure. In terms of injury prevention. Also safe food and water issues and infectious and chronic disease issues.
Next slide, please. So this slide actually talks about last year’s 2017’s hurricane season. You can see the graphic follows basically the four-week period, although obviously there was a considerable aftermath after September 21st when the hurricanes were going through. When we made this slide, one of the captions for it was 2017 was an unusual year because seven of the 13 named storms were intense enough to be named hurricanes. The other day I was looking at the weather service site and so if a this year seven of the 14 named storms have become hurricane and we are definitely not out of the hurricane season yet.
Some of you will recall that back in 2012, Hurricane Sandy hit right around Halloween. So not all these make landfall but, again, two years like this in a row, these are two years that they will probably be in the top 18 or so of the past 170 years for hurricanes. Also this year, we’ve had a hurricane in Hawaii which isn’t unheard of but is somewhat unusual, a cyclone hit Guam. We have had some significant tropical system flooding moving in from the eastern Pacific into the southwest U.S., a few instances of nontropical storm-associated flooding in the upper Midwest and elsewhere. And this is on top of both these years 2017 and 2018 resources already being somewhat strained because some of the same resources and some of the same people, like me, get involved in wildfire response.
And we have had a couple of bad wildfire seasons in a row, too. Next slide. So, like I said, we know things are going to happen like flooding and drowning, things like that. So we have an idea of how we’re going to be responding before the storm hits. These things follow sort of a pattern.
And this is a chart that we — or table that we developed maybe a decade ago when we were also dealing with several years in a row of hurricanes — hurricane response. And you can see it starts with the prestorm or prelandfall time period when we are looking at messaging about evacuation, flood safety and power outage risks, especially carbon monoxide poisoning and moves up until one month after the storm and the following period. A couple caveats to this, we made a couple of adjustments to it. We actually do the mold messaging a little earlier than two to four weeks. We usually start one week post-storm and carbon monoxide messaging actually continues as long as the power outages continue.
In Florida, we will certainly continuing along with that this time period. And obviously Puerto Rico last year we continued quite some time with that. A second caveat is, of course, that each event has its own unique aspects. And Puerto Rico and the Virgin Islands last year there were definite struck issues not only with the electrical grid but with some of the housing stock and the building stock. In the Carolinas this year, we have been concerned about hog farms and coal ash pits overflowing into the riverways and streams.
And in Florida last week we were concerned in the areas where Michael came ashore, we were concerned that the red tide that was already there would be stirred up more by both the storm surge and the wind. Next slide, please. So how do we communicate in an emergency? Not quite like the image you see. Basic CDC activities, basic CDC principles, we work with lay and clinical audiences to basically disseminate timely and accurate information.
And how we do it is through our joint information center which gets activated. A lot of you probably know in a response scenario in the field, typically FEMA, sometimes others, will stand up — well, a JIC is how we refer to it to coordinate the response among the various responding agencies. Here at CDC, we stand up the JIC to coordinate response among the various responding centers. Remember, centers, plural, for disease control. I’m in the environmental health center.
The infectious disease centers get involved. Sometimes the chronic disease center. And even the global health center. Last year’s storms moving through the Caribbean moved through a lot of the small island nations. The Web and social media is the backbone of the response.
It’s what we can obviously get out the most quickly. We work with EPIC. I know there’s a typo there. Sorry about that. We distribute a lot of print materials.
Last year, we distributed tens of thousands of copies of the homeowners and renters guide from mold cleanup after disaster which was something put together by CDC, NIH, EPA, FEMA and HUD. Printed them, laminated them and shipped them out to disaster recovery centers and similar places for further distribution. And we do a lot of clinician outreach. Most typically that’s through our health alert network and we send out a notice on health alert network. This year and last year we sent one out on carbon monoxide poisoning for physicians and others having to present in an emergency room, will be able to recognize it and diagnose it properly which both enhances the treatment of the individual in front of them but also flags them to know that there might be other people back at that house that are getting poisoned.
And, of course, it helps with surveillance because it helps with reporting of CO cases. So, again, we work with lay and clinical audiences. We also work with the news and social media. We both track what is showing up there and, of course, respond to inquiries and interview requests. And we work with partners to get messages coordinated with local and State Departments of health.
I’m sure a lot of you are on today with other parts of the department of human and health services where we sit, like SAMHSA. With FEMA, with EPA, with the Department of Defense when appropriate. Tindall base in Florida certainly got hit last week. With nongovernment organizations and the CDC foundation which is our EPIC-private partner which helps us do things in a more expeditious way than sometimes is possible through government channels. Best example I can give you of that actually isn’t a hurricane response but back during the Ebola response, four years ago, they were very helpful in getting things distributed and printed in a rapid way in areas where we were working in Africa.
Next slide, please. So just to get into what some of the major topics or the major dangers are, flooding and drowning, like I said, is probably number one. Certainly has been this year. This includes people — basically people who ignore what that sign says on drive on to the road. That’s preliminary data but we do think in Florence that’s probably going to be the number one cause of mortality this year, is flooding and drowning — sorry, drowning deaths.
Next slide. We also know that carbon monoxide poisoning is always a major cause of mortality. In these events — or in the aftermath of these events. Basically people will use portable generators as well as things like a charcoal grill, a camp stove or a gas oven for power, for heat, for cooking and use it indoors. The image you see here is some material that we developed based on some research I did maybe eight, ten years ago qualitative and quantitative work and we distributed a lot of copies of this during the hurricanes, especially last year.
And this is very — based on research but it also emphasizes the three points we made for CO poisoning in emergency situations for even years preceding that which basically boiled down to what I have called the three Ds, three D words, that CO is deadly. You need to keep the generator outside at a distance of at least 20 feet from any window, door or vent. And you need to be using a carbon monoxide detector. And, of course, in this case, it’s one that’s working on a battery since the power is out. Just to point out quickly, all the CO materials are available online at cdc.gov/co.
Next slide. Other power outage issues include fallen power lines where the message is pretty simple, stay away and call someone. Flooded homes, people are returning to homes and maybe the water has gotten into the walls or electrical system or maybe there’s even a wire down. Obvious issues there. Those are safe cleanup issues.
And then water-damaged power tools. We had an unfortunate situation in the Carolinas this year that a gentleman using a portable generator was electrocuted when he plugged two extension cords together and they were wet. Next slide, please. Mold or safe cleanup of mold is also an important issue after the hurricane and for a while afterwards. Our concern is that people do it safely, whether they are using bleach or something else so we recommend personal protective equipment like you see in the graphic here for eye protection, for respiratory protection, for skin protection.
And we also very strongly recommend that people with certain medical conditions, respiratory conditions like asthma, COPD or immune compromised conditions just stay away. Don’t get involved in the cleanup and don’t hang around the cleanup. Also, this isn’t just in terms of mold, children should not take part in disaster cleanup work, because ever injuries, because people of doing the work need to be mindful of their own safety and not be watching to make sure children aren’t getting hurt. Children should just be kept away from doing disaster cleanup work. Next slide, please.
There are a number of other issues with cleanup work, injury issues. A lot of people use chain saws because trees fall down and we remind people to be mindful of the safety and safety of the people around them and be aware of who might be the other side of that tree when you are cutting on it. Hurricanes tend to happen in hotter times of the year, in hotter places in the country. Tell people, you got to take heat stress seriously. You have got to make sure you stay hydrated.
That includes drinking the right drinks, avoiding things with caffeine, certainly things with alcohol. They don’t hydrate you all that well. And this is a building I think in St. Croix, Virgin Islands last year. When you are doing tearout or when the hurricane has started the tearout for you, as you see here, there can be lead or asbestos stirred up that definitely people need to be very careful about. And, finally, in terms of cleanup, obviously we tell people, you know, clean yourself up when you are done doing your work for the day.
But also if you happen to have gotten chemicals or floodwater or, you know, something you’re not sure quite what it might be on your skin to wash up with soap and water as soon as you can. Next slide, please. Safe food and water, definitely an issue if refrigeration is out with power out. Food can spoil quickly or it can be contaminated with floodwaters. Obviously that can make people sick.
During an emergency situation, medical services may not be as accessible, whether the road is blocked or whether the medical provider is not providing full services. We do encourage people — and we encourage you to encourage people to stockpile canned food ahead of time, throw out spoiled food. Actually that’s for always throw out spoiled food, not just after a hurricane. Clean off canned food that might have been flooded — cans that might have been flooded. We do have instructions on our website — that one I don’t remember off the top of my head the URL — on how to clean those off so you can still open the can as long as the can wasn’t punctured or something like that.
And, finally, in terms of water, bottled water is best. Boiled water second. And treated water is probably the third choice there. Next slide. Infectious diseases are always possible.
Maybe they’re not quite as definite as drowning and accidents, but we do know that various diseases can occur when sewage systems are disrupted or when people are living in crowded conditions like a shelter, that if there was some disease that was endemic in the area prior to the storm, it can blow up to be epidemic fairly quickly. We do also note that mosquitoes will almost definitely show up and sometimes they will carry disease. And you see the advice there. And also, of course, there are animals that get loose. There are wild animals who have basically been displaced from their homes and there are dead animals after a storm when people should basically keep away from them, make sure their children are keeping away from them, and report them to the right authorities.
Next please. In terms of chronic diseases, the message is the Boy Scout message: Be prepared. Not just gathering enough food and water but also medical supplies for at least three days and then to have with you — plan ahead if you can and have at least a week supply, hopefully more of your prescription medications on hand. Also to have your important medical records, if you are not evacuating some place safe, if you are evacuating with you so if nothing else you can get your prescription renewed if that’s important — if that comes up, rather.
Some of the diseases we look at, this is the asthma page. But we also look at cancer, diabetes, epilepsy, high blood pressure and other things as important chronic diseases that people need to be prepared for. Also need to remember that medical services can be compromised after a storm like this. Obviously the loss of power can compromise things like cold chain for medication storage, including for people who keep their medication at home. There can be disruptions to smaller clinics, dialysis clinics, and people who do in-home dialysis or oxygen tanks, like someone with COPD.
Obviously if you don’t have power, you will have problems with that. In addition some smaller clinics and some ambulance services might have evacuated their staff and so that can definitely be a problem for both chronic diseases and injury. Next slide. This is the next-to-last thing I wanted to bring up. This is also a picture from St. Croix last year, people who look really closely into the corners can figure out that’s a Home Depot.
And we work with Home Depot and other businesses, retailers to try and amplify how we get the message out. What you see here is a display of what people need — what we recommended people pick up for mold cleanup. If you look on the bucket, you probably can’t read it but it just lists what people need to get in the store, including a bucket. You also see on the table printed materials and the poster from us. So we encourage you to work with businesses to do this kind of thing, to use their own channels they have, websites, their internal email and other things to get messages out.
And also if it’s a story that does something like sells a generator, maybe train their staff so when someone is buying a generator they can say to them: Remember, this is where you need to keep it, 20 feet away. And do you have a CO detector at your house, does it have working batteries. We would encourage you to try to do that sort of thing as well. Next slide, please.
Finally, there are long-term recovery issues. I don’t remember — I think this picture is from Hurricane Sandy. Mold is a — definitely a long-term issue. Look at this picture, it’s all the way up into the ceiling. And long-term cleanup issue.
Housing can be an issue as well. One thing don’t necessarily always think of is that rental housing can become in short supply. Power can take a long time to recover. There will be some pockets in Florida where that seems to be happening as well. Agricultural and industrial waste can overflow not just into the water but into the soil.
And, finally, there are some mental health issues. That’s the next speaker’s province. I will say “next slide, please.” Thank you. And Meghan.

>> MEGHAN GRIFFIN: Great.
Thank you, Scott. As mentioned, my name is Meghan Griffin. I’m a federal project officer with the crisis counseling program which is on the emergency mental health and traumatic stress services branch at SAMHSA. Next slide, please. So in this portion of the Webinar, I’ll start off by did he fining what we been by — defining what we mean by disaster behavioral health and describing some of the services we provide at SAMHSA.
We will describe some resources we have available here. And we know that disasters do affect people all across the United States and around the world and I do want to acknowledge that some of you may be currently experiencing a disaster or a traumatic event in your community and that you may also be preparing or responding to or recovering from a disaster. But we have lots of resources that are available to you. And I also want to highlight this picture here, is from one of our programs that’s actually currently serving in Puerto Rico. They call their program (saying name), which means Project Cheerup in Spanish.
And this picture is of a crisis counselor providing some one-on-one support to a disaster survivor just after Hurricane Maria. Next slide, please. So the definition that you see here comes from the office of the assistant secretary for preparedness and response, or the ASPR at Health and Human Services. At SAMHSA what we like to highlight is it’s the culmination of mental health, substance abuse and stress management services that really make up the crux of disaster behavioral health. And the services that we provide can run the gamut from just basic support to education about common reactions, coping mechanisms and methods and then, of course, linkage to resources for professional behavioral health, more long-term clinical services to disaster survivors as necessary.
And it’s also important to note that while we primarily respond to natural disasters that have received a FEMA declaration, we also provide support when there is a large scale or traumatic event within a community. Some of those types of events are like the Flint water crisis, the Ebola crisis that we partnered with CDC on and other mass casualty events like shootings that occurred in Las Vegas and Florida. And all of those types of incidents or events, our main focus is to help assist survivors in understanding the situation and the reactions that they’re having to the event to help them regain a sense of mastery or control over the situation, identify, label and express their emotions, adjust to the disaster and the losses that have occurred as they adapt to their new normal, managing their stress and developing effective coping strategies as they’re moving forward, especially when it comes to making decisions and developing action plans for what needs to happen next because recovery can be a long-term process. And then educating survivors and the community at a whole — as a whole as to what resources are available to assist them in their recovery process. Next slide, please.
So as I previously mentioned, SAMHSA’s primary crisis counseling program, our official title is the crisis counseling assistance and training program. But we’re more commonly known as the Crisis Counseling Program or the CCP. It is a FEMA-funded program and it’s administered through an interagency partnership between SAMHSA and FEMA so we work on it together. And it is a grant program. So the eligible grantees are the states, U.S. territories, and federally recognized tribes that have received an individual assistance from FEMA.
The primary focus of this program is to provide short-term behavioral health support when the disaster response exceeds the states’, tribes’ or territories’ capacity to serve the community. It typically lasts for up to one year. But as I’ll discuss a little bit later in this presentation, sometimes recovery goes on for a bit longer than a year. So we make adjustments accordingly. But the states or the tribes or territories, whoever has received the disaster declaration and been awarded the grant, then we’ll partner with local community mental health service agencies that are within their jurisdictions to actually provide the services.
And we typically use a paraprofessional model to provide those services so the crisis counselors themselves are not required to be licensed clinical professionals but will receive all of the training necessary to help them provide the services and make referrals to further services as they’re needed. I do want to highlight that clinical behavioral health treatment and diagnostic services are not a part of this program because we use mainly paraprofessionals to provide the services. So they’re not required to make a diagnosis or provide direct long-term clinical treatment themselves but they can make referrals to programs and other services that are available if that is needed for the disaster survivor. Next slide, please. So the information that you’ll see on the next few slides will portray some of the common disaster reactions that you’ll see.
First in adults and then I’ll talk a little bit about children. So everyone who experiences a disaster will be affected by it in some way, but not everyone will experience it in the same way or have the same reactions. So we do know that there are some common reactions across the board in a few different categories. And I’ll highlight each of the reactions and the physical, cognitive, emotional, and behavioral categories over the next few slides. But I do want to highlight this tip sheet that you see here on this slide.
This is one of our tip sheets that’s available through the SAMHSA store. It’s titled “Tips for Survivors of a Disaster or Other Traumatic Events,” this one focuses particularly on managing stress. We do have many other tip sheets and a few others I’ll make sure to highlight throughout my presentation. And most of these but not all of them are available in multiple languages as well. Next slide, please.
So as I mentioned, you’ll see a variety of reactions to the disasters and the stress related to the disaster. And in the physical category that you see on the left-hand side of your screen, what we typically see are reactions like digestive and appetite issues, trouble sleeping, sweating or chills from someone who’s not typically sick or has, you know, reaction to an infectious disease as Scott had mentioned. For cognitive reactions, what we typically see are survivors express as though it’s harder for them to think things through and to solve problems and go about the everyday tasks that usually require their concentration or memory. In the disasters aftermath, you also see a heightened sense of worry and just the ability to make decisions kind of on the spot is a much more difficult than it previously was. You really see these effects start to take place in the immediate aftermath of the disaster when you are starting to see some of the FEMA assistance come into a community and disaster survivors are asked to start to register for assistance.
They need to make decisions about contacting their insurance provider, finding all their paperwork and documentation, meeting with the inspectors, and just thinking through all of those processes can start to become very difficult for someone who has recently experienced a disaster. So you will also see heightened emotions start to express themselves along with anxiety, fear and sadness. You will also see a lot of anger within the community. And sometimes disaster survivors may notice that they have — they feel as though their emotions are missing altogether. They feel a sense of numbness and disconnection with the event that’s occurred.
They almost feel nothing at all. Behavioral changes — or behaviors that had once been typical are now starting to change as well. So you’ll see sleep patterns, drug and alcohol use, also anger patterns start to shift and change as a person has been affected. And they may become much more or less active than they typically were. So they may not want to do anything at all because they just can’t process — mentally process through the situation that has greatly affected them.
Next slide, please. So children and teenagers can experience all of these same effects that we see in adults but we often also see that their reactions vary by age, especially in younger children. We often see that they take a step back or two in development. So losing skills they recently acquired. For example, young children who recently stopped sucking their numb may start doing that again.
Whereas, slightly older children like adolescents or youth-age children who had recently taken on responsibilities like doing chores or taking care of a pet may not be able to do those same types of responsibilities that they had once done before the event. We do offer this tip sheet specifically for helping children understand the situation that they have gone through and help them cope with the effects of the event itself. And then the other thing I really want to highlight with this tip sheet is that it provides some conversation guides and prompts to help start that conversation with children and youth that are at an age-appropriate level for the person that you are having this conversation with. Because sometimes that’s the most difficult thing to do, is just where to start the conversation. Next slide, please.
Some of the other reactions that we often see in young children is that they may become afraid of the dark, afraid of monsters and strangers. In older children, we also see the separation anxiety start to come back. They start to fear leaving their parents or caregivers when they’re going to school, their visiting friends. That’s something that may not have been present before the disaster, but it’s something you can expect to see afterwards. But you can also start to see children act out the effects of the disaster within their play and their play activities as a way to help them process what they’re going through, rather than express it outright but rather slow it in their play.
Also like adults, you expect to see behavioral, physical changes as well as changes in emotions in their typical reactions. There’s a few others there that you can see on the screen. Next slide, please. On a more optimistic note, in behavioral health, we talk about the many, the some, and the few. The good news is that many disaster survivors are naturally resilient and they will recover overtime without any formal intervention just by connecting with the natural support functions that are available to them within their community can.
Those are systems like their family, clergy, classmates, teachers, co-workers and just community organizations or agencies that may be readily accessible right now. Some folks may require more outreach and support in understanding what they’re going through and develop a plan to get them through the process. That’s the area that we really like to focus on. And then a few disaster survivors will have a very severe reaction and will require some referrals to more clinical mental health or substance use services or treatment services and long-term care. But what we’ve really liked to focus on is linking the survivors to the resources that they need within their existing resources of the community and supporting those that are at higher risk for more severe reactions.
And ultimately providing a case finding element to assure that individuals with that higher level of need are referred to the appropriate services that are already available. Next slide, please. Okay. So these are the different phases of the disaster that we typically see an entire community go through in the aftermath or leading up to the predisaster period and then also throughout the aftermath of the event itself. And I’ll go through each one of these phases and talk about some of the typical reactions that you’ll see throughout each one of them.
So in phase 1, this is the predisaster phase. This is often where we see the most sense of fear and uncertainty. But can also depend on the type of event itself that’s taking place. When it’s a natural disaster like a hurricane, we often have a prolonged period of time. Now, as Scott mentioned, hurricane seasons can go on for quite a while.
And there are continuous warnings and watches and threats of impact that are occurring throughout that time. So this can be a very prolonged period. But in other instances like a tornado or a man made disaster like a terrorist attack or a mass casualty event, the public doesn’t have a lot of prewarning before the event. So it can also be a very short time frame. In phase 2, this covers the impact of the event itself this can be characterized by a wide range of reactions.
This is the shortest phase because it only includes the direct impact of the event itself. We quickly move into phase 3, the heroic phase. This is where we see the highest level of activity and, yet, the lowest level of productivity. There really is a large sense of altruism throughout the community because the community is really coming together and starting to exhibit a lot of adrenaline-induced rescue behavior. They want to help out their neighbors, and they want to help save lives and ensure that everyone is going to be safe and okay.
But this can really impair the risk assessment that needs to take place because everyone is going at full speed and not able to actually assess the situation that has just occurred. So then we see this pass into phase 4 which is the honeymoon phase. And you see a major dramatic shift in emotions. Throughout the honeymoon phase, this is when you are first starting to see disaster assistance become available within the community and a sense of optimism kind of takes over the community because there’s a lot of resources that are flooding into the community and there is an idea or a sense that everything will be able to return to normal as quickly as possible. And this honeymoon phase can last a few weeks immediately after the disaster.
But unfortunately that leads into phase 5 which is the disillusionment phase. And in disillusionment, what you see is that the communities and individuals start to realize the limits of that assistance. So what they thought they were going to be able to do and rebuild is not actually going to be possible. They won’t necessarily be able to return to normal as it was before the disaster but they will have to adapt to a new normal. You will also see a number of triggering events that occur kind of throughout this phase which can cause emotions to rise and fall kind of throughout this entire phase.
And this is usually the longest phase of the disaster recovery process and can last anywhere from up to a few months to years after the event itself has actually occurred. Again, this can vary depending on the type of event that’s occurred and also just the magnitude of the destruction and devastation that the community has gone through. And this can also cross the anniversary of the event itself and that can also cause some emotional responses within the community as well as they pass that one-year mark and either the recovery has gotten to a point where they had expected it to or it has not. And that’s usually a very significant triggering event as well. But as they then finally move into phase 6, which is the reconstruction phase, this is where we generally see the first sense of recovery within the community.
And the community has taken the responsibility to rebuild their lives and starts to adjust to that new normal, while continuing to grieve the losses they had experienced from the disaster. But they really can start to reconstruct what they have and acknowledge the losses that have occurred throughout this phase. And, again, the reconstruction period can last years after the disaster itself. Next slide, please. So this is the final tip sheet that I will highlight for this section, although I will talk a little bit more about all the rest of our resources that we have available.
But I do want to highlight the tip sheet that we have specifically for grief. And this is the tip sheet for survivors. We also offer this tip sheet in a format that is directed towards the first responder community as well. And, you know, whether a disaster is natural or human caused, grief and loss of loved ones can be compounded by the sorrow and anger of your loss of homes or possessions as well as a sense of fear or anxiety at the loss of safety and security that you once had within the community. So everything that you would typically expect to feel through the grieving process is just compounded and elevated after a disaster.
But what we have also seen in some cases is that meeting the immediate physical needs after a disaster often takes priority over grieving for loss of life of loved ones or friends and family. So this process can be delayed or prolonged as well. So someone who may typically experience grief through a relatively quick process will see this elongated, even further after a disaster because you have to make sure that your safety and security comes first and dealing with the immediate safety of yourself after a disaster usually takes the first priority. But some of the tips that are often highlighted within this tip sheet is that making sure that you have someone to talk to that understands you and respects your situation of how you feel after you’ve experienced this loss, so we often recommend that you reach out to your family members and friends or faith leaders, whoever that you trust within your community, to really help you cope with this grief and recognize that you still may have these feelings after a very long time and that it’s okay for this process to be much longer than you typically would expect it to. So you really want to make sure that you take care of your physical health as well as your mental health by exercising, eating healthy, getting enough sleep.
And also allowing yourself to feel joy and sadness at the same time, that is often something that we see is overlooked. So grief doesn’t always have to be about sorrow and heartache but can also be about the good times as well. Next slide, please. So if you do feel that you need immediate help or someone to talk to, we do have a few resources available. The disaster distress help line is always available 24/7, 365 days a year and can provide immediate crisis counseling and also referrals to behavioral health treatment centers and support systems that are currently in your community as well.
It is a networked call center that can identify or help you identify what the best resource is that’s closest to you of where you currently are. This is a toll free, 1-800 number that you see here on the screen. They also have texting capability. It is available to all the U.S. states and territories and tribes. Although there also are some territories where it can be a little bit difficult to connect to so sometimes the territories have their own local phone lines as well.
But, of course, this number is always available. And then we also like to highlight another resource that’s not actually run by my team but is always available is the SAMHSA resource, The National Suicide Prevention Lifeline. They are also always available 24/7 and are linked directly with the Disaster Distress Helpline so if anyone is experiencing any thoughts of suicide or just would like more information about them, they are always available as well. Next slide, please. So now I will focus predominantly on the resources that we have available at SAMHSA.
We have our disaster technical assistance center which offers a plethora of resources to all of the states, territories, tribes and local providers as well as first responder communities and everyone that would like to utilize our resources. I highly recommend if you bookmark our site for future reference that you always have it available with you. The first link that you see on the slide is our direct website. The second link is the SAMHSA store which links for all of our tip sheets and printable publications that are available. And then we also have our disaster app which is a critical resource for first responders or behavioral health providers, really anyone who wants to be able to take the information with them on their phone.
It links to all of our resources as well. Everything that’s available on our website is also available through our app. So next slide, please. As I have been mentioning throughout this presentation, we have a number of tip sheets. We also have some guides and pamphlets that are available.
Some of the topics that these cover include the common reactions to disaster that I have just gone over and ways to support children. We also have some other special populations highlighted such as older adults and first responders. We have some tips for coping with public health emergencies and then also information about providing culturally appropriate services in the community. Next slide, please. So one of our largest resources that we have is the disaster behavioral health information series or DBHIS.
This is a searchable collection of all the disaster behavioral health resources that are available, free of charge, that have been available in the public domain and authorized for noncommercial use. Every resource that we have can be organized into a topic area, like disaster types, special population or audience. So if you are looking for a very specific thing, you can filter out exactly what you’re looking for or just take everything that’s within one of those specific categories that you see there. Basically if it’s been created, you can probably find it in one of these categories. Next slide, please.
We offer a variety of newsletters and bulletins throughout the year. The SAMHSA newsletter comes out monthly but we highlight updates in the field and use new resources. We also have “The Dialogue” that comes out quarterly. This is more focused for professionals in the field. We are always looking for contributors and article writers.
If anyone is interested in providing us topics or ideas, we always are looking for new people to add to our newsletters. We also have the Supplemental Research Bulletin which is also more geared towards behavioral health practitioners, planners and other responders. And this is a look at all of the research that we have recently acquired over the last year or so. This comes out twice a year and also highlights very specific topics. So if you are interested in subscribing, you can reach out to our email address that’s listed there.
Or you could also sign up through the gov delivery website which is also posted there, too. Next slide, please. So we also offer a disaster response template toolkit. But to access this, you do have to call us or email us. We don’t just have this listed directly on our website anymore.
But this template toolkit provides all of the resources like the printed materials that we offer as brochures, newsletters or tip sheets that have been removed of any logos or names. Because it is a template, you can go in and put in your local community’s contact information and really personalize it for the specific event that’s occurred in your area. But this has basically created all of the templates that you would need in the event that a disaster has occurred and you don’t have — the resources specifically in your area may not be readily accessible. Like, your office has lost Internet connection and you need to be able to create this newsletter but you can’t log into your work computer, you could just open up this template toolkit and print off the tip sheets or brochures or newsletters that you would need directly from this template because it’s already created for you. So this is a great resource to have in the event that a disaster has just recently occurred in your area.
Next slide, please. And then, finally, I would just like to highlight some of the Webinars that we provide at SAMHSA and also the podcast series that we have available. We’ve produced a number of these over the years. And we also have them on our website. They’re available for future use.
We’ve done some specifically on planning and resilience. And cultural awareness is a really popular one as well. All of those can be found on our website that’s listed there. And next slide, please. Okay.
And so this is our contact information for the Disaster Technical Assistance Center and our phone number that’s listed there as well as the main SAMHSA website and phone number. And that is the end of my presentation. I believe I will turn it back over to Haley.

>> HALEY McCALLA: Thank you so much, Meghan and Scott, for wonderful presentations. Though, we are close to 2:00 p.m., we’re going to go ahead and get through as many Q&A questions as possible because we have a lot of great questions.
So, Jonathan, can you go ahead and give us our first question?

>> JONATHAN LYNCH: Certainly. Scott, this first question comes — it’s a long question, so I will sum it up. He’s asking what to do in the situation where there’s no more Internet access but they need access to information.

>> SCOTT DAMON: Well, the first thing we’d recommend is if you know the storm is coming, we have online the key messages for the hurricane response.
It’s a long document. I think Jonathan has the URL for it. Download that, print it out so you have that in hand. Other than that, obviously you’re not going to be able to get to a lot of the online resources without at least phone access. But if you go to a disaster recovery center or location might that might have access to that kind of thing.
>> JONATHAN LYNCH: So another question comes from Nicole Bolpit who says. A lot of times the areas where it is has have challenged infrastructure and service systems. Is there any funding to support the building and mental health providers, referrals for qualified individuals to see if there are enough providers? That will be for Meghan.

>> MEGHAN GRIFFIN: Sure.
That is certainly a challenge and we do experience that in many of the disaster-affected areas. And that is one thing that we are focusing specifically on with the disaster behavioral health planning efforts that we have taken up with all of states and territories and we have also started reaching out to tribes as well to help encourage them to start to build up their infrastructure before the disaster even hits because as we’ve seen, once those services are impacted, you know, that’s extremely difficult to provide continuing services within any community after a disaster. So that is one of our primary focuses. But the grant programs that we typically have are mostly in the recovery period of the disaster itself. So we don’t provide direct funding for building infrastructure before the disaster but we do support states, tribes and territories in those efforts where we can by providing additional training and all of our resources that are available to them.

>> JONATHAN LYNCH: Thank you, Meghan. This question is for Scott. From Michael: Since many NGOs use youths as volunteers for cleanup work — it’s a challenging question, I understand — is there a recommended age cutoff or advice on how to determine which people should and shouldn’t participate?

>> SCOTT DAMON: Well, there’s not a recommended numerical age cutoff.
It’s a question of looking at the maturity of the volunteers, looking at what supervision is there of the volunteers that are doing this kind of work. One thing that we would recommend, of course, is that the more challenging work be done by adults, especially adults more experienced in this type of work and maybe the kids who are out there volunteering, it’s a great thing. Put them to work in a supervising way and doing the less dangerous work.

>> JONATHAN LYNCH: Thank you. Meghan, this question comes from Phyllis Cunningham.
How does SAMHSA inform teachers or school officials of the symptoms their students may demonstrate during a natural — following a natural disaster?

>> MEGHAN GRIFFIN: So we often encourage the states and the local behavioral health providers that are directly providing those services to partner with the schools and the Department of Education in each one of those states to ensure that they have access to the schools to provide those services and also can train the teachers of what to expect and how best to help their students cope with what they’ll see in a disaster. And then also ensuring that the schools that — a lot of the students in the disaster impact area may also have to move to a different school location. So sometimes we’ll see them having to go to a completely new school where they may not have their same friends around or the same teachers they had before. So we also want to make sure that the new school they are going to also has all of the resources available to them.
It’s something we highly encourage. We note it in our program as one of the primary special populations that we really encourage the crisis counselors to reach out to and work with in every disaster.

>> JONATHAN LYNCH: Okay. Thank you. Meghan, this is another question for you:
Does SAMHSA have material for disaster volunteer/service workers in preparation for deployment or returning from deployment?

>> MEGHAN GRIFFIN: Yes. A lot of that is readily available on the disaster app we mentioned. There is a section that’s specifically for disaster responders. So if you work for a voluntary agency, you don’t just have to be a first responder like a police officer or firefighter.
But any type of disaster responder, there are resources specifically for them and also for the general public. I believe on our DTAC website as well, we have a section that you can click on that will specifically bring you to all the resources that are geared towards the responder community, too. So we have all of that kind of filtered out under that section.

>> JONATHAN LYNCH: Thank you. Meghan, there’s two related questions that I’m going to combine.
Do you have any statistics on how many people generally seek health care after a hurricane? Any statistics on the incidence of suicide after a hurricane?

>> MEGHAN GRIFFIN: We do collect a bit of data throughout our program. One major aspect the Crisis Counseling Program is that it is completely anonymous, we don’t collect any publicly identifiable information with the counselor so we can generalize it across the population. But in specific disasters, we do often — because we work directly with state mental health and public health agencies as well as the local providers, we are able to often collect — or look at some of the data they collect as well.
In certain cases that kind of data is available. I don’t have it with me at the moment. I think that is something we might be able to follow up on if that person who asked the question is able to send us an email, that’s something we could look into.

>> JONATHAN LYNCH: In general, if there’s any need for followup, you can email us at epic@cdc.gov. And we will follow up on all inquiries.
Scott, a question for you: What will happen if mold is not properly cleaned up?

>> SCOTT DAMON: Well, if it is not properly cleaned up — first, let me say when you are dealing with mold, you need to do two things. You need to clean it up and you need to take care of the moisture source. If you have a problem with your house, if there’s a leak in the roof after the hurricane and you don’t take care of that, the mold will come back.
If you are in a very humid area and you are not able to do anything about the high ambient humidity in the house, you will still have a problem. If you don’t clean it up or you try to paint over it or throw up new drywall and don’t do anything with the mold inside the walls, it will come back. There’s no question about that.

>> JONATHAN LYNCH: Meghan, this is a question for you. Have you noticed a difference in mental health needs and resiliency between those that evacuated versus those that did not?

>> MEGHAN GRIFFIN: Sure, that can be a difficult question to answer because those that have chosen to evacuate, they may have evacuated to a region that is not necessarily I you eligible to provide direct services to them so they would have to integrate into the services that are readily available in the community they evacuated to. In that case, they may not have readily available data that we can actually look at to see kind of how their reactions are to the disaster because we just don’t have any oversight as to where they have gone. That was one of our biggest challenges for Puerto Rico, was that almost 200,000 residences of Puerto Rico self-evacuated after hurricane Maria and we didn’t necessarily know where they went. And then eventually we realized they went to a number of different states. So it’s been really hard to ensure that we’re able to provide the same services to them as we would if they had remained on Puerto Rico.
So one of the major things that we also see is that the evacuation process can compound the reactions that you would typically see after a disaster. So you’re experiencing not just a loss of sense of the safety and security of the community but you’re moving to a whole new place and that has a completely additional set of stressors that are attached to it as well. And so everything that you once had in your support system back home is completely removed from you. You have to not only completely navigate a new system but deal with the loss of everything you had as you go through that new location.

>> JONATHAN LYNCH: We will take two more questions because we are running pretty far over here.
This is a question from John Williams I found interesting as well. Is there any information, product what he’s asking about, that are specifically geared to the behavioral health patients and members of that community for events like this?

>> MEGHAN GRIFFIN: So we generally have most of our resources for disaster survivors and more generalizable to the general public of disaster survivors. I can’t think of any off the top of my head that we may have geared towards specifically those already receiving the behavioral health services. I may have to follow up on that.

>> JONATHAN LYNCH: That’s okay. John, if you follow up by emails us, epic@cdc.gov. It’s a great question.

>> MEGHAN GRIFFIN: It is.

>> JONATHAN LYNCH: Finally, this question is:
Do you have any suggestions for engaging community members in organizing disaster preparedness/resilience efforts? She’s talking about overcoming the sort of avoidance of preparedness that seems to be an ongoing challenge. I would guess this would be both physical resilience and the social and emotional side that’s important as well. Scott, can you go first?

>> SCOTT DAMON: Sure.
The first thing I’d say is going back to one of my slides, work with the business community in your community to set up something so they can organize how they can help respond, whether it’s in terms of having the correct things in the stores, helping get the message out. We have found that the business community is very open to being a part of this. The second thing is for basic public health, don’t necessarily go to individuals and try to do this but go to faith-based groups and community-based groups. Civic groups are always very interested in engaging in this kind of thing. So you have an already built-up group of enthusiastic people there.

>> JONATHAN LYNCH: We v found the faith community to be incredibly helpful in this regard. Meghan, what about preparing for the emotional impacts?

>> MEGHAN GRIFFIN: Sure. I think one of the biggest issues is ensuring that you can lessen the stigma of talking about behavioral health issues within the community and that behavioral health should be talked about as just as important as your physical health. And so incorporating that language into all of your preparedness activities, I think it’s really important.
But I would also like to echo just working with your local community organizations and the services that are always available within the community to help kind of spread those messages and make sure that word is getting out because we have seen that sometimes pushing preparedness activities too much in certain communities can also have a very negative effect because it’s too overwhelming to think about that too early after the impact of a disaster and so there has to be a little bit of time before you’re ready to start thinking about already getting ready for the next event. But we have also seen in many communities that they are being affected by the same disasters repeatedly year after year. So you want to make sure that you have a plan in place that you can implement and make sure that you’re looking after yourself and your loved ones and your community as well.

>> SCOTT DAMON: Just wanted to add there’s been some greats coming up in the chat as well.

>> JONATHAN LYNCH: It was suggested that fire departments and police have regular meetings and often welcome people coming to their meetings and can participate and comment in that way.
I think that’s a great point. Thank you. That’s it, Haley.

>> HALEY McCALLA: Thank you very much, Jonathan, Meghan and Scott for a very informative Q&A session and thank you all of the attendees for your questions. I know we went over.
But if you still want your question answered, you are free to email them to EPIC@cdc.gov. And we’re happy to forward it to either Meghan or Scott. As a reminder, today’s presentation has been recorded and you can earn continuing education for your participation. Please follow the instructions found on emergency.cdc.gov/EPIC. The course access code is in all caps EPIC1017.
Thank you again, everyone, and have a great day.