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DISASTER PLANNING FOR BEHAVIORAL HEALTH ORGANIZATIONSTRAINING SESSION #2

SEPTEMBER 23, 2020

LAURA COLLINS, LICSWMARC AVERY, MD

Welcome & Re-introductions

Today’s Agenda

1. Follow-up from Session #12. Pandemic Planning3. Completing & Testing

the Plan4. Tabletop drill planning5. Activating, Deactivating

the Plan6. Recovery Planning

Today’s Objectives1. Discuss the planning assumptions for a pandemic

2. Review the process of completing, testing, activating and deactivating your disaster plan

3. Plan a tabletop exercise to work through an HVA scenario you identify

4. Describe the recovery stage of the disaster planning cycle

Recap of Resources Informing the Training Sessions

Substance Abuse and Mental Health Services Administration (SAMHSA)

Disaster Planning Handbook for Behavioral Health Treatment PROGRAMSTechnical 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

What have you done or thought about doing since Training Session #1?

WHAT IS YOUR NEW PRIORITY FOR DISASTER PLAN READINESS?

SHARE YOUR ORGANIZATION'S PROGRESS IN PLANNING

Pandemic Planning

Potential Effects of a Pandemic on BH Treatment Programs

Outpatient Treatment Programs

Client drop-in and attendance at individual appointments and group events may decline. Alternatively, clientdrop-in and attendance may surge because of concern, panic, or lack of other psychological or medicalsupport.

Services may have to be provided using procedures to reduce influenza transmission (addressed in the section below).

Staffing shortages may occur as clinicians become ill or stay at home to care for ill family members.

The entire program or specific services may close during local outbreaks of disease. Revenues may decline

dramatically, with effects on the viability of the program.

Residential Treatment Programs

Patients may become ill and need to be isolated.

Staff may need to take care of patients who become ill.

The facility may be quarantined.

Visitation may need to be suspended or highly restricted. Electronic communications may replace actual onsite visitation.

Medically Managed Detoxification Programs

Beds may be redirected for use by patients with influenza.

Medical and nursing staff may be redirected to care for patients with influenza.

Necessary antiviral drugs may be slow in arriving or not be available at the necessary levels.

Influenza symptoms (e.g., fever, nausea, diarrhea) may be difficult to differentiate from withdrawal symptoms.

A surge in patients may occur that includes people who are infected with influenza, people who misinterpretinfluenza symptoms as withdrawal symptoms, and people who seek psychological or medical support.

Opioid Treatment Programs (OTPs)

An OTP may need to provide patients with take-home methadone doses for longer periods than usual (following guidelines from the Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment [CSAT], Division of Pharmacologic Therapies [DPT]).

The program may need to provide patients with take-home doses earlier in their recovery than usual (again, following CSAT’s guidelines).

Increased numbers of patients may need to have doses brought to them because they have contracted a communicable disease.

Hospital emergency departments may be operating at capacity and unavailable for methadone maintenance treatment of patients whose home OTP has closed.

Patients in fear of not receiving scheduled doses may overwhelm the program as they seek additional take-home supplies or support.

Programs may be at increased risk of theft or diversion of medications.

Prevention Programs

The program may be discontinued until the local pandemic crisis is over.

Planning Assumptions for a Pandemic

Potential effects and strategies:

•Staffing• Scope changes

• Work shifts

• Telecommuting

• Quarantine

•Coordination with County/State

•Sanitation

•Prioritizing services

•Managing higher risk patients

•Methadone

•Telehealth services

•Visitation

Planning for the BH Impacts of COVID-19

SAMHSA, 2015

Forecasted Behavioral Health Symptoms from COVID-19 Over Time with Key Milestones

Adapted from DOH, 4/2020

Anxiety Fear

Acting “Out” or “In” Substance

Use, Withdrawal, Aggression

DepressionGrief/Loss

Suicide, Domestic Violence

Holiday Stress

Resiliency, Return to ‘Normal’

Planning for the BH Impacts of COVID-19

What behavioral health reactions have you seen at your agency or in the community?

IS-520: Introduction to Continuity of Operations Planning for Pandemic Influenzas (interactive online course), FEMA: http://training.fema.gov/EMIWeb/IS/IS520.asp

HCA Covid-BH Resources:

https://www.doh.wa.gov/Emergencies/COVID19/HealthcareProviders/BehavioralHealthResources

BHI Website:

https://bhi-telehealthresource.uwmedicine.org/

Pandemic Planning –Online Courses and Resources

http://training.fema.gov/EMIWeb/IS/IS520.asphttps://www.doh.wa.gov/Emergencies/COVID19/HealthcareProviders/BehavioralHealthResourceshttps://bhi-telehealthresource.uwmedicine.org/

Key components of a Disaster Plan – working through the Phases

1. MITIGATION

2. PREPAREDNESS

3. RESPONSE

4. RECOVERY

Preparedness and Response:

Completing, Testing, Activating and Deactivating the Plan

Assemble the plan

Distribute

Train and test

Activate the Plan

Deactivate and revise the plan

Assembling the Plan –SAMHSA Checklist

Preface, includes

• Record of changes and distributions

• Table of Contents

Basic Plan, includes

• Statement of purpose/objectives

• Conditions under which to activate, and procedures for activating

• Sequence of actions

• Methods and schedules for updating the plan, communicating changes and training staff

Assembling the Plan:

The Appendices –Continuity of Operations Plan

◦ Essential functions and essential staff positions

◦ Continuity of leadership and orders of succession

◦ Alternate facilities◦ MOU’s◦ Interoperable communications◦ Vital records/databases◦ Management of human capital◦ Testing and revision of the plan◦ Staff training plan

Staff Training

▪Which staff should you identify to join your disaster planning meetings?

▪How can you ensure that staff understand their roles and responsibilities in a disaster?

▪Who are your back-ups and back-up to the back-ups?

▪Who can you delegate Emergency Warden responsibilities to?

Assembling the Plan: Implementing Instructions –Necessary Materials to Perform Essential Tasks

◦ Safety policies and procedures◦ Job aids

◦ checklists ◦ worksheets◦ laminated wallet cards or sheets ◦ scripts that staff can use

◦ Communication tree listing◦ Contact information for essential groups ◦ MOU’s◦ Building addresses

◦ phone numbers◦ floor plans◦ evacuation routes

◦ Community maps

Distribute the Plan❑To staff members with assigned responsibilities

❑two copies

❑Develop a summary to provide to other staff members

❑Copies of the summary or full plan, as appropriate, to the County or State department that oversees behavioral health/SUD treatment

❑and other organizations with which you have developed relationships for disaster response

Train and Test –

Which of these might you do at your organization?

◦ Discussion-Based Seminars and Workshops

◦ Tabletop Exercises –◦ walk through responses based on different

scenarios◦ Functional Exercise –

◦ act-out/role-play◦ Field Exercise –

◦ Full-scale enactment◦ Each training exercise should build on

the previous

Testing the plan: Joint Commission’s focus on the 6 critical areas to be monitored

1. Communication: Effectiveness of communication both within the agency as well as with external response entities

2. Resource Mobilization and Allocation: Includes staff & responders, equipment, supplies, PPE and transportation

3. Safety & Security: Of staff, patients and facility

4. Staff Roles & Responsibilities: Includes staff knowledge, understanding, and effectiveness of response

5. Utility Systems: Availability of critical utilities and back-up plans for utility loss

6. Patient Clinical & Support Care Activities: Ability to maintain appropriate and effective patient care

Tabletop exercises – TTXDefinition: a simulated threat exercise in which participants gather to discuss incident scenarios

What it is:◦ An opportunity to practice

◦ A compliance need

What it isn’t:◦ A “live fire” exercise

◦ A training class

Can be used to:

◦ Enhance general awareness

◦ Validate plans and procedures

◦ Assess what is needed to guide the prevention of, protection from, response to and recovery from a defined incident

Goal of TTX’s are:

◦ Facilitate understanding of the process

◦ ID strengths and weaknesses

◦ Achieve a change in attitudes

Proposed Date and Time:

Name of Planner:

Participants (internal and external):

Type of Event:

Tabletop

Functional

Full Scale

Regional

Seminar/Training

Actual Event

Type of Incident:

Fire/Flood

Earthquake

Weather Event

Volcano

Utility Failure

Evacuation

Medical

Epidemic/Bio

Hazmat/Chem

Decontamination

Mass Casualty

Cyber

Code Amber

Security/Code Zebra

Bomb/Explosion

WMD

Civil Unrest

Other:

Elements to Be Included:

Communications

Resources

Safety and Security

Staff Response

Utility Systems

Patient Care

Goals and Objectives:

1. Add goal/objective 2. Add goal/objective 3. Add goal/objective 4. Add goal/objective

Summary of Scenario: (Include Timeline)

Sample Disaster Drill Planning Form

Break-outs: Designing your First Tabletop Exercise

Template for our Exercise

Breakouts: Engage in your First Tabletop Exercise

Template for our Exercise

Team Values: Promoting Curiosity and Creativity

IDEO Corporation: (www.ideo.com)

Rules of Brainstorming

Killers of Brainstorming

• One conversation at a time• Stay focused• Dismiss judgment • Encourage wild ideas.• Build on the ideas of

others• Be visual• Go for quantity

• Everybody gets a turn• Schedule brainstorming off-

site• Rely on experts for

brainstorming• Don’t waste time being silly• Write down everything• The leader starts

http://www.ideo.com/

Name of Event: Start End Location of Event: Date:

Name/Title of Reporter: Time:

Type of Event Check all that apply

Activity Type Event Type

Tabletop Drill Fire / Flood Medical Event Code Amber Functional Drill Earthquake Epidemic/Bio Event Security/Code Zebra Full Scale Drill Weather Event Hazmat/Chem Spill Bomb/Explosion Regional Drill Volcano Decontamination WMD Seminar/Training Utility Failure Mass Casualty Civil Unrest Actual Event Evacuation Cyber Event Other:

Participants List departments, agencies or individuals participating

Internal Participants

External/Regional

Goals/Objectives Evaluation List goals/objectives in the following critical areas, and rate performance. Multiple objectives can be listed for each area. If an area is not applicable to the drill, document as “NA”. Mention if item is follow-up to previous action item.

No

challe

nges

Fe

w

challe

nges

Ma

jor

Challe

nges

Unable

to

perf

orm

Communications Resources Safety & Security Staff Response Utility Systems Patient Care Check if event scenario included the following:

Actual or simulated patients received Tested performance when no community support available Summary of Scenario / Activities Include description of incident, number of victims, summary of actions taken, list of things that went well, etc. If evacuating patients, note location(s) evacuated, location of holding site(s), total time to evacuate, number of clients evacuated, and number of staff involved.

Key Areas for Improvement

1. Issue:

Discussion:

Recommendations:

Assigned To/Status

LEARN:

Disaster Activity After-Action Report

What did we Learn from this exercise?

Wrapping Up the Exercise – What Did you LEARN?

Activating the Plan – 4 Key Steps

Activate the Incident Command System

Decide on objectives and priorities

Create Incident Action Plan to accomplish objectives

Plan Follow through

Activating your Incident Command System

Who in your organization decides to activate and de-activate the disaster?

*Remember to have backups, and backups for the backupsand an identified Command Center (with a backup)

Deactivate and Revise the Plan

Ending state of emergency and resumes normal

operations

Reconstitution

Returning from an alternate facility to the home location

Contacting clients and reengaging

Deactivate and Revise the Plan

Arrange for return of patients on methadone

maintenance

Complete reconstruction of the facility

Debrief –

After-Action Report

After Action Plan

Review and Discussion:

Completing, Testing, Activating and Deactivating the Plan

Where are your gaps and priorities?

Assemble the plan

Distribute

Train and test

Activate the Plan

Deactivate and revise the plan

Key components of a Disaster Plan –Completing the Phases

1. MITIGATION

2. PREPAREDNESS

3. RESPONSE

4. RECOVERY

The Disaster Recovery Plan

Recovery

1. Resupplying

2. Reassessing Patient Care Capacity

3. Assessment of Financial Impact

4. Reviewing Staffing Needs and Planning

Recovery – Connect and Debrief

COORDINATE WITH THE

COMMUNITY

SUPPORT STAFF MEMBERS, CLIENTS AND

COMMUNITY

Continuous Plan Updates

Develop

Plan

Test

What are your next steps from here? WHAT IS YOUR NEXT PRIORITY FOR DISASTER PLAN READINESS?

SHARE YOUR ORGANIZATION'S NEXT STEPS IN PLANNING