Community Disaster Readiness: Baton Rouge Responds to a Behavioral Health Crisis

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Community Disaster Readiness Baton Rouge
Responds to a Behavioral Health Crisis

• By Jan Kasofsky Ph. D.
• Executive Director
• Capital Area Human Services District

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Essentials What We Know Works

• Establish a local convening agency and location
• Establish a network of providers
• Communicate to the community as fast as possible
• Use one brief screening/triage tool and one chart
  or EMR
• Target services to special populations

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Essentials What We Know Works

• Utilize multiple service delivery
  strategies/maintain flexibility
• Locally develop the intermediate and long term
  plan
• Provide pre-disaster and ongoing PTSD training to
  staff
• Leadership must be active, present and visible
  where you are deploying staff
• Preach self care and look for signs of burn
  out/fitness to work

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Immediate Response Must Address

• Communication/Intelligence
• Locating evacuees
• Intelligence received from Command Center
• Status of evacuees
• Reliability of cell/satellite phones and wireless
  email
• Jurisdictional boundaries between FEMA, Red Cross
  and providers

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Immediate Response Must Address

• Volunteer/staff issues
• Stress trauma credentialing knowledge about
  culture, poverty and location
• Traffic
• Pharmaceutical needs

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Immediate Response Must Address

• Controlling infectious/contagious diseases
• Facility limitations impacting service
• deliver y on site
• Limitations of the Stafford Act
• Limited transportation to permanent sites
• Elder care

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Immediate Response Must Address

• Provider Communication
• Daily briefings
• Locating evacuees
• Multi-disciplinary site specific deployment
• Directing deployment focused on special
  populations (integrated BH/primary care teams)
• Ongoing intelligence
• Posting daily minutes on website
• Use of La Spirit

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Who do we look for?

• People with mental illness and/or addictive
  disorders (with and without prior treatment
  episodes)
• Volunteer providers who were traumatized
• Homeless population seeking refuge
• Medically fragile (elderly, disabled)

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Who do we look for? (continued)

• People who began using drugs and alcohol due to
  trauma
• Chronic substance abusers and addicts
• Individuals whose substance use increased to
  problematic usage stage due to trauma/displacement
  
• Individuals in recovery who relapsed
• People who were in active treatment for an AD
• People with chronic diseases, needing meds

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Outreach Strategies to Prevent BH Crisis

• Locate and deploy quickly
• Provide appropriate, accessible, timely services
  to maintain MH stability, prevent on-set of
  serious mental illness, and provide treatment and
  referrals for ongoing care to people in crisis
• Anticipate and be prepared to treat people with
  chemical dependency

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Outreach Strategies to Prevent BH Crisis
(continued)

• Seek out and stabilize or move out elderly and
  those with disabilities
• Establish 12 step support groups on site
• Develop process of referral to o/p treatment
  social/medical detox and to methadone clinics
  provide medical support as safe and possibly on
  site

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Communication to the Public for BH assistance
Ongoing Efforts

• Provided information on where to call and where
  to go for help
• Key message Normal to feel overwhelmed and
  anxious, dont turn to drugs and alcohol
• There is help out there no matter where you
  are.

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Communication Modalities to Reach the Public

• Communication to Public
• Television
• Brochures
• Newspaper articles
• 800 and referral booklet
• Primary care and behavioral health directory

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Immediate Treatment Access Needed

• Clinic-based behavioral health Tx expansion
  (Assisted by evacuee provider volunteers, local
  private practice psychiatrists, drug reps)
• Walk-in policy
• Rapid triage/assessment/stabilization approaches

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Rapid Triage/Assessment/Stabilization Approaches

• Standardized, Community-wide Uniform Triage and
  Screening Tools (developed by Collaborative)
• Behavioral health/primary care triage tool
• BH screening tool (2nd level)
• Trauma screening tool
• Addictive disorders screen (3rd level)
• Referral process and hand-off

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• Immediate Hurdles
• Communication/Intelligence
• Locating evacuees and new sites (split for weeks
  throughout the community)
• No intelligence from Command Center
• Communication between on-site providers difficult
• Still no coordination between case management
  agencies
• Jurisdictional disputes among local agencies and
  FEMA
• Safety and security
• Demographics of inhabitants unknown

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Transitional CommunitiesNovember 2005- April 2006

• Outreach
• Deployment and new model developed by
  Collaborative to address
• Medical record difficulties
• Special needs folks
• Use of non-local, short-term volunteers (SAMSHA,
  others)
• Operating out of tents, cars, outside (no shelter
  provided)
• No case managers, specialization and no
  coordination
• Transportation to permanent sites limited

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Health Care Delivery Model for FEMA Trailer
Communities
Appropriate Assignment of Displaced Individual
Capital Area Human Services District (Convener)
Family Road (Convener)
Residents at Temporary Housing Sites
Health Services HUB (Adult Child) One
Coordinator
Facility Manager (KETA, Family Recovery Corps,
FEMA, Others)
Social Services HUB One Coordinator
Outreach Case Management (Family Recovery Corps
Liaisons, UMCOR, DSS, Spirit Teams Mental
Health, Medicaid Case Management, Others)
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Evacuees in FEMA villages, commercial sites or
other congregate locations
Residents at FEMA or other sites
Resident Advocate
Gatekeeper resident representative
Facility Manager or Virtual Site Coordinator
Point of contact and hub
Multidisciplinary (Virtual) Team Outreach
(Harmony), Case Management (LA Family Recovery
Corps, UMCORE providers) and Treatment Teams,
Other Providers
Outreach, triage, screening, assessment, referral
and follow-thru
Community Resources Capital Area HealthCare
Delivery Collaborative -Behavioral
Health - Primary Care Katrina Relief
Network -Social Services and Support
Specialty Services
Permanency and resolution of services to address
unmet needs
Long Term Recovery Committee (Unmet Needs
Committee)
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Transitional CommunitiesNovember 1, 2005- April
6, 2006

• Multi-disciplinary site specific deployment

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Transitional CommunitiesNovember 2005- April 2006

• CAHSD Clinic Expansion
• MH clinic at 40 increase
• Utilized medical/psych residents
• Expansion of child BH health clinics
• CAHSD School-based Triage/Tx Expansion
• Brokering cooperation
• Brokering meetings

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Ongoing EffortsMay 2006- November 2006

• Funding Received May 2006
• Expansion and Outreach for Adult Services
• Expanded capacity adding clinical staff at 3 main
  clinics and 5 satellite clinics, Access Unit
  (Baton Rouge Area Foundation - BRAF)
• Added crisis mental health mobile team
• Provided social workers for 2 FQHCs and assisted
  all to be funded by BRAF
• Added other special contract crisis and
  residential behavioral health services
• Added prison social worker
• BRAF and Red Cross initiated a voucher program

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Ongoing EffortsMay 2006- November 2006

• Funding Received May 2006
• Expansion and Outreach for Childrens Services
• Expanded clinic-based capacity
• Added a specialized crisis mental health mobile
  team
• Added 7 social workers in schools and public
  health units

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Ongoing EffortsMay 2006- March 2007

• Crisis Services in Crisis
• There is not adequate service capacity within
  this community to address the needs of high
  numbers of people experiencing behavioral health
  crises seeking/requiring services
• A continuum of crisis services does not exist in
  this community

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Ongoing EffortsMay 2006- March 2007

• Continuum of Behavioral Health Crisis Services
  Under Development
• Standardized screening and assessment tools
  training
• Interagency Services Coordination
• Crisis intervention team
• Mobile crisis team
• Crisis intervention unit
• Medical case management
• Assertive Community Treatment
• Coordinated referral to treatment
• Housing, long term or intermediate care,
  residential
• Public awareness

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Provider Community Key Innovations

• Standardized short triage and assessment tool for
  BH/primary care
• Statewide model for healthcare delivery to
  transitional communities
• Produced and secured funding, and placed in
  operation a regional response plan
• Multi-disciplinary, site specific deployment
  process, database, and direct contact with weekly
  deployment meetings
• Parish level behavioral health response plans
• Prior credentialing-registration-training
• Multi-sector development of regional BH crisis
  continuum
• Utilization of a Electronic Medical Record like
  the Recovery Health Information Network project

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Our Partners

• Shiloh Missionary Baptist Church
• Baton Rouge Area Alcohol Drug Center
• North Baton Rouge Tutorial
• OBrien House
• UPLIFTD/WCRC
• Reality House
• Family Road
• Childrens Advocacy Center
• YMCA
• ARC of Baton Rouge
• American Red Cross
• Volunteers of America
• Womans Hospital
• Local Law Enforcement Agencies
• Region 2 Dept. of Social Services
• Region 2 Office of Public Health
• Baton Rouge Area Foundation
• Medical Management Options
• Baton Rouge Crisis Intervention Center

• Our Lady of the Lake
• Baton Rouge General
• Southern University
• Case Management Agencies
• Louisiana Family Recovery Corp
• Pointe Coupee Health Services District
• Families Helping Families
• Mental Health Associations
• School Superintendents

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Capital Area Human Services District

• Jan Kasofsky, PhD
• Executive Director
• 4615 Government Street
• Baton Rouge, LA 70806
• 225-922-2700
• www.cahsd.org
• Special thanks to Lori Waselchuk, photojournalist
  and author,
• Baton Rouge, Louisiana