National Commission on Children and Disasters. 2010 Report to the ...

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Although CCP provides referrals for treatment services, children and families often have limited access to traditional mental health providers due to a chronic shortage of mental health providers, 78 and limited insurance coverage in connection with mental health and substance abuse services. 79 Mississippi officials implementing the State-level CCP after Hurricane Katrina reported to the GAO that they wanted to serve as many people as possible because fewer providers were available to accept referrals. 80 According to New York, Louisiana, and Mississippi officials who spoke with the GAO, CCP clients could have benefited from improved crisis counseling beyond the CCP model whether or not they displayed symptoms indicating the need for referrals. 81 In response to requests from New York, Louisiana, and Mississippi to allow their CCPs to offer enhanced services, FEMA and SAMHSA permitted the development of pilot programs offering enhanced crisis counseling services “consistent with the non-clinical, short-term focus of the CCP model.” 82, 83 New York’s enhanced services after 9/11 were provided by mental health professionals based on cognitive behavioral approaches and included up to 12 counseling sessions to help individuals referred for enhanced services develop skills to cope with anxiety, depression, or other symptoms of post-disaster stress. 84 In Louisiana and Mississippi, individuals who were referred for enhanced services following Hurricane Katrina were provided services by mental health professionals in a single “stand-alone” session. 85 However, if needed, clients could obtain additional enhanced sessions or referrals for mental health and substance abuse treatment services. 86 The <strong>Commission</strong> urges FEMA and SAMHSA to formally modify the current CCP model to include the provision of “enhanced services” in large-scale disasters where the mental health impact is unlikely to be adequately addressed by “typical” CCP services. In February 2008, the GAO recommended that FEMA and SAMHSA expeditiously “determine what 78 U.S. Government Accountability Office, Hurricane Katrina: Barriers to Mental Health Services for Children Persist in Greater New Orleans, Although Federal Grants Are Helping to Address Them, GAO-09-563, (Washington, DC: GAO, 2009), 7, http://www.gao.gov/new.items/d09563.pdf. 79 Ramya Sundararaman and C. Stephen Redhead, Mental Health Parity: Federal and State Action and Economic Impact, RL31657, ed. Congressional Research Service (Washington, DC: The Library of Congress, 2008), 1. 80 U.S. Government Accountability Office, Catastrophic Disasters: Federal Efforts Help States Prepare for and Respond to Psychological Consequences, but FEMA’s Crisis Counseling Program Needs Improvements, 28. 81 Ibid. 82 Ibid. 83 SAMHSA’s “six operating principles are (1) disaster-trained clinical professionals are a key component of specialized crisis counseling teams; (2) an active outreach must be maintained; (3) appropriate assessment and referral techniques will be utilized; (4) specialized techniques must be appropriate to the short-term, temporary nature of CCP and phases of disaster recovery; (5) specialized techniques must focus on immediate practical needs and priorities of survivors; and (6) training, supervision, and oversight are critical to successful implementation and operation.” Ibid., 29. 84 Ibid. 85 Ibid. 86 Ibid. 40 NATIONAL COMMISSION ON CHILDREN AND DISASTERS: 2010 REPORT
types of [enhanced] crisis counseling services should be formally incorporated into CCP and make necessary revisions to program policy.” 87 In response, FEMA and SAMHSA officials indicated they intended to consider incorporating certain types of enhanced services into the CCP model. 88 However, no form of enhanced services has yet been codified or communicated to communities as a program enhancement that can be made available after a disaster. Without enhanced services being formally incorporated into the CCP model, some States or communities may lack knowledge of the potential availability of enhanced services and therefore may not request or plan to provide them. Institutionalizing the availability of enhanced services by formally incorporating them into the CCP model for disasters where the mental health impact is unlikely to be adequately addressed by “typical” CCP services would enable any State to more effectively prepare prior to a disaster, develop their CCP proposals, and provide their populations with needed counseling services. Finally, while the CCP does provide a means to address bereavement support, the services reflect a focus on trauma treatment. Reliance on a professional network that has an exclusive trauma focus to provide technical assistance, support, and just-in-time training has resulted in limited attention to bereavement support outside the context of addressing trauma syndromes or symptoms. The inclusion of broader bereavement subject matter expertise is a critical gap, and more conscious and thoughtful attention to bereavement support within outreach, education, and counseling services delivered through the CCP would be an important step toward addressing broader disaster mental health needs of children and families. Recommendation 2.5: Congress should establish a single, flexible grant funding mechanism to specifically support the delivery of mental health treatment services that address the full spectrum of behavioral health needs of children including treatment of disaster-related adjustment difficulties, psychiatric disorders, and substance abuse. Despite the existence of CCP and other Federal assistance programs, the <strong>Commission</strong> remains concerned that the mental health needs of many children and families affected by disasters will go unmet. As the Congressional Research Service noted in a 2006 report: “Survivors of a disaster often need a range of mental health services that go beyond those provided for by CCP, which only provides referral to mental health services.” 89 Without additional assistance to address barriers to mental health treatment for children, which commonly preexist disasters and preclude surge capacity thereafter, many children will be unable to access the treatment they need. 87 Ibid., 33. 88 Ibid., 34. 89 Ramya Sundararaman, Sarah A. Lister, and Erin D. Williams, Gulf Coast Hurricanes: Addressing Survivors’ Mental Health and Substance Abuse Treatment Needs, 13. NATIONAL COMMISSION ON CHILDREN AND DISASTERS: 2010 REPORT 41
Page 1 and 2: NATIONAL COMMISSION ON CHILDREN AND
Page 3 and 4: ii The 2010 Report to the President
Page 5 and 6: Each new disaster presents distinct
Page 8 and 9: Contents Abbreviations.............
Page 10 and 11: EMSC Emergency Medical Services for
Page 12 and 13: Background The National</st
Page 14 and 15: Recommendation 1.2: The President s
Page 16 and 17: - Include pediatric expertise on th
Page 18 and 19: Recommendation 4.3: HHS should deve
Page 20 and 21: 8. Child Welfare and Juvenile Justi
Page 22 and 23: 11. Evacuation Recommendation 11.1:
Page 25 and 26: 1. Disaster Management and Recovery
Page 27 and 28: A major impediment to the prioritiz
Page 29 and 30: children are a core consideration i
Page 31 and 32: Recommendation 1.2: The President s
Page 33 and 34: Recommendation 1.3: DHS/FEMA should
Page 35 and 36: The Commission rec
Page 37 and 38: 2. Mental Health Recommendation 2.1
Page 39 and 40: 2. Mental Health Recommendation 2.1
Page 43 and 44: Recommendation 2.4: DHS/FEMA and SA
Page 45: urden on affected States and commun
Page 49: elated adjustment difficulties such
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Page 54 and 55: children are largely unavailable or
Page 56 and 57: children may take several years, th
Page 58 and 59: As highlighted in the Commi
Page 60 and 61: Recommendation 3.3: HHS should ensu
Page 62 and 63: Recommendation 3.4: The Executive B
Page 64 and 65: Notwithstanding the need for greate
Page 66 and 67: Finally, the Commission</st
Page 69 and 70: 4. Emergency Medical Services and P
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Page 73 and 74: Recommendation 4.2: Improve the cap
Page 75 and 76: In addition, the Commission
Page 77 and 78: NDMS and DoD are not the only entit
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Page 83: Not all disasters will involve disa
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Page 90 and 91: In response to the Commissi
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90 NATIONAL COMMISSION ON CHILDREN
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expertise. 272 While most school di
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Recommendation 7.2: Congress and ED
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Recommendation 7.3: Ensure that sch
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Another mechanism through which the
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sources. 303 Without comprehensive
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. Respond to new child welfare case
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Recommendation 8.2: Ensure that Sta
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The Commission sup
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Toward the goal of ensuring that ju
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evisions to the standards were need
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10. Housing Recommendation 10.1: Pr
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10. Housing Recommendation 10.1: Pr
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corresponding tasks related to the
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Finally, the Commission</st
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evacuees. 382 States also have the
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The Commission sup
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Recommendation 11.2: Disaster plans
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planning for the evacuation of scho
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Appendix A. Study Approach The <str
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Appendix B: Index to Recommendation
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• Include bereavement support and
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Relevant Federal Agencies President
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• DHS/FEMA should clarify the tra
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● Relevant Federal Agencies Presi
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• Congress should authorize DHS/F
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Appendix C: Model Executive Order o
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2. Children and Disasters Advisory
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• Support disaster plans, trainin
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• When children exhibit signs of
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Appendix F. Supplies for Infants an
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Non-Perishable Supplies & Equipment
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Supplemental Information Descriptio
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Appendix G. Subcommittee Members an
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Richard Muth, National</str
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Also, the Commission</stron
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Children’s Research Center^ Churc
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Planning and Learning Technologies,
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Honorable Sheila Leslie Appointed t
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Honorable Mark K. Shriver, MPA Chai
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NATIONAL COMMISSION ON CHILDREN AND
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