Disaster Crisis Counseling Program

Crisis Counseling Programs for the Rural Community
Disaster Crisis Counseling Program
The Nature of Disasters
Definition of a Federal Disaster Declaration

The Federal Emergency Management Agency (FEMA) provides supplemental funding to States for short-term crisis counseling projects to assist survivors/victims of Presidentially declared major disasters. FEMA supplements, but does not supplant, mental health services traditionally provided by State and local mental health agencies. The Crisis Counseling Assistance and Training Program (commonly referred to as the Crisis Counseling Program) was first authorized by the U.S. Congress under the Disaster Relief Act of 1974 (Public Law 93-288) and later modified by the Robert T. Stafford Disaster Relief and Emergency Assistance Act of 1988 (Public Law 100-707). FEMA is responsible for administering the disaster assistance programs of the Stafford Act, including Federal assistance for crisis counseling services.

A major disaster, as defined by the Stafford Act, is any natural catastrophe, or regardless of cause, any fire, flood, or explosion, which in the determination of the President causes damage of sufficient severity and magnitude to warrant major disaster assistance to supplement efforts and available resources of States, local government, and disaster relief organizations in alleviating the damage, loss, hardship, or suffering caused by the disaster.

Disaster Types

Different types of disasters covered by the Stafford Act that may impact rural areas include: hurricane, tornado, storm, high water, wind driven water, tidal wave, tsunami, earthquake, volcanic eruption, landslide, mudslide, snowstorm, drought, fire, flood, or explosion. Disasters also differ by a number of characteristics including the following:

Origin of disaster (natural versus human-caused)


Length of warning time

Intensity of the event

Extent of property damage

Number of persons impacted

Number of injuries and deaths

Dynamics of the recovery period
Each type of disaster has its own unique pattern of destruction and characteristics that affect the emotional response of disaster victims (NIMH, 1983):

Flood disasters can result in long incident periods and the evacuation of whole communities.

Earthquakes strike without warning and after shocks intensify fright and despair.

Tornadoes randomly choose their victims, skipping one house and striking the next.

Hurricanes can be unpredictable and suddenly change course causing the evacuation of large areas.
Disasters may be classified as either natural or human-caused. The following chart describes the different characteristics of natural and human-caused disasters. Blame is a characteristic that differs significantly for natural and human-caused disasters. Disaster survivors of human-caused disasters may blame and feel anger toward individuals, groups, or organizations they believe caused or contributed to the disaster. In contrast, survivors of natural disasters may blame and feel anger toward themselves, believe it is "God's Will" or a punishment. Survivors of natural disasters may project their anger onto caretakers, disaster workers, or others (CMHS, 1996).


Natural vs. Human-Caused Disasters

Natural Human-Caused
Causes Forces of nature Human error, malfunctioning
Examples Earthquakes, hurricanes, floods Airplane crashes, major chemical leaks, nuclear reactor accidents
Blame No one Person, government, business
Scope Various locations Locations may be inaccessible to rescuers, unfamiliar to survivors, little advance warning
Post-disaster
Distress High Higher, often felt by family members not involved in actual disaster

Source: CMHS. Psychosocial Issues for Children and Families in Disasters. A Guide for the Primary Care Physician. Washington, D.C.: U.S. Department of Health and Human Services; Publication No. (SMA) 96-3077, 1996.


Definition of Crisis Counseling Services
The Crisis Counseling Program, as it has been supported in the past twenty-five years by the Federal government, provides for short-term interventions with individuals and groups experiencing psychological sequelae from Presidentially-declared disasters. This type of intervention involves classic counseling goals of helping people to understand their current situation and reactions, assisting in the review of their options, providing emotional support, and encouraging linkage with other resources and agencies who may assist the individual. The assistance is focused upon helping the person deal with the current situation in which they may find themselves.

It draws upon the assumption, until there are contradictory indications, that the individual can resume a productive and fulfilling life following the disaster experience if given support, assistance, and information at a time and in a manner appropriate to his or her experience, education, developmental stage, and ethnicity (CMHS, 1994.

The Emergency Services and Disaster Relief Branch (ESDRB) of the Center for Mental Health Services (CMHS) will provide technical assistance to states in developing a grant request.
The ESDRB can be reached by phone at (301) 443-4735.
The Crisis Counseling Program is unique in comparison to the mix of Federal programs made available through a Presidential disaster declaration. It is the one program for which virtually anyone qualifies and where the person affected by disaster does not have to recall numbers, estimate damages, or otherwise justify need. The program provides primary assistance in dealing with the emotional sequelae to disaster.

Robert T. Stafford Act

The Stafford Act authorizes the President to provide training and services to alleviate mental health problems caused or aggravated by declared disasters. The Crisis Counseling Program is designed to provide supplemental funding to States for short-term crisis counseling services and is implemented when creating such services are beyond the resources of the State or local providers, given a Presidential disaster declaration.

FEMA may fund two separate portions of the Crisis Counseling Program: Immediate Services (IS) and Regular Services (RS). The IS grant enables the State and its local agency to respond to the immediate mental health needs with crisis counseling services. IS can be funded for up to sixty days after the Presidential declaration. If an RS application has been submitted, the program period for the immediate services may be extended thirty days and additional funding may be awarded. FEMA may approve a longer extension, if the review process of the regular program application exceeds thirty days. Costs incurred from the date of the incident to the date of declaration may be reimbursable under the immediate services program. The RS provides up to nine months of crisis counseling services, community outreach, and consultation and education services to people affected by the disaster. Funding for RS is separate from IS. The State may apply for either or both portions of the Crisis Counseling Program.

Application for IS funding must be completed within fourteen days of the disaster declaration. The application must contain a disaster description, needs assessment, program plan, budget, and budget narrative. The needs assessment is based on the needs of the affected communities and the ability of the current mental health system to respond to those needs. A State must demonstrate that State and local resources are insufficient to provide adequate services.

Differences Between Disaster Mental Health and Traditional Mental Health Programs

Disaster Crisis Counseling Programs are a departure from traditional mental health practice in many ways. The program is designed to address incident specific stress reactions, rather than ongoing or developmental mental health needs (CMHS, 1994). Programs must be structured and implemented according to Federally established guidelines and for a specific period. Emphasis is on serving individuals, families, and groups of people - all of whom share a devastating event that most likely changed the face of their entire community.

CRISIS COUNSELING PROGRAM
Immediate Services
Application due in fourteen days
Sixty-day program
Extension if RS is applied for
Regular Services
Apply within sixty days of declaration
Nine month program
Applications must include
Disaster description
Needs Assessment
Program Plan
Budget
Budget narrative
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crisis counseling ceus

Outreach and crisis counseling activities are the core of the Crisis Counseling Program and create a unique set of challenges. Disaster crisis counseling requires breaking out of traditional ways of identifying people in need of services, providing access to those services, maintaining documentation, and determining effectiveness. Mental health professionals will work hand-in-hand with paraprofessionals, volunteers, community leaders, and survivors/victims of the disaster in ways that may be foreign to their clinical training. This publication will focus on the implementation of appropriate crisis counseling services for rural communities across the United States.

After The Disaster: A Children’s Mental Health Checklist

After The Disaster: A Children’s Mental Health Checklist

Disasters can be particularly traumatic to children. Sometimes, it can be difficult to determine the extent of the psychological trauma, and whether or not professional mental health services are indicated. This checklist is one way to assess a child’s mental health status.

Add up the pluses and minuses to obtain a final score. If the child scores more than 35, it is suggested you seek a mental health consultation.

Has the child had more than one major stress within a year BEFORE this disaster, such as a death in the family, a molestation, a major physical illness or divorce? If yes: +5


Does the child have a network of supportive, caring persons who continue to relate to him daily? If yes: -10


Has the child had to move out of his house because of the disaster? If yes: +5


Was there reliable housing within one week of the earthquake with resumption of the usual household members living together? If yes: -10


Is the child showing severe disobedience or delinquency? If yes: +5
Is the child showing any of the following as NEW behaviors for more than three weeks after the disaster?

Nightly states of terror? +5


Waking from dreams confused or in a sweat? +5


Difficulty concentrating? +5


Extreme irritability? +5


Loss of previous achievements in toilet or speech? +5


Onset of stuttering or lisping? +5


Persistent severe anxiety or phobias? +5


Obstinacy? +5


New or exaggerated fears? +5


Rituals or compulsions? +5


Severe clinging to adults? +5


Inability to fall asleep or stay asleep? +5


Startling at any reminder of the disaster? +5


Loss of ambition for the future? +5


Loss of pleasure in usual activities? +5


Loss of curiosity? +5


Persistent sadness or crying? +5


Persistent headaches or stomach aches? +5


Hypochondria? +5


Has anyone in the child’s immediate family been killed or severely injured in the disaster (including severe injury to the child)? +15
Note: Preoccupation with death, unusual accident proneness or suicidal threats are reasons for immediate consultations. It is also recommended that any child who has been seriously injured or who has lost a parent, sibling or caregiver by death, have a psychological evaluation and/or brief therapy.

Note: This checklist was developed under the auspices of Project COPE, a federal funded (FEMA) crisis counseling program activated in Santa Cruz, California, in response to the October 17, 1989 Loma Prieta Earthquake. The project provided individual, family and group counseling, agency debriefing services and a school intervention program. Over the course of 16 months, the project provided services to more than 25,000 individuals. Peter J. Spofford, M.S. served as Project COPE Director.