FEMA Community Counseling Assistance and Training Program Toolkit.pdf

FEMA

Crisis Counseling Assistance and Training Program Guidance CCP Application Toolkit, Version 5.3, April 2023

Note: Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Mental Health Services (CMHS) Project Officers are available to provide technical assistance and consultation on the Crisis Counseling Assistance and Training Program (CCP). If you would like to speak with a CMHS Project Officer, please contact the SAMHSA Disaster Technical Assistance Center (DTAC) at 1-800-308-3515 (Monday–Friday 9 a.m.–5 p.m. eastern time), and a staff member will forward your request to the appropriate Project Officer.

You may obtain CCP applications, supplemental instructions, and guidance documents by calling SAMHSA DTAC as indicated above or by emailing SAMHSA DTAC at DTAC@samhsa.hhs.gov.

mailto:DTAC@samhsa.hhs.gov

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Table of Contents

Introduction

Section I: Program Overview

The Crisis Counseling Assistance and Training Program

Eligibility Requirements

CCP Timeline

Crisis Counseling Definition

Services Funded Through the CCP

Providers of CCP Services

CCP Primary and Secondary Services

Primary CCP Services

Secondary CCP Services

Section II: CCP Model

Typical Individual Reactions to a Disaster

Typical Community Reactions to a Disaster

The Crisis Counseling Approach

The Value of the Crisis Counseling Approach

The Significance of the Needs Assessment

The Goal of the CCP

The CCP Model

Identifying People in Need of Crisis Counseling

CCP Resource Linkage Versus Case Management and Advocacy

CCP Sub-recipients and Staff

The Number of Visits Allowed by a Crisis Counselor

How Crisis Counselors Are Trained

The Differences between Crisis Counseling and Traditional Mental Health Treatment

How the CCP Addresses Severe Disaster Reactions

Section III: Program Management and Implementation

Main Components of a Program Management Plan

Media and Marketing and the CCP

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Effective Staffing of the CCP

Training

Staff Stress Management

Data Collection, Evaluation, and Reporting

Quality Assurance

Section IV: Pre-award Requirements

Applying for the ISP Grant

Instruction for Submission of the ISP Application Packet

Extension of the ISP Performance Period

Applying for the RSP Grant

Instructions for Submission of the RSP Application Packet

General Provisions

Conflict of Interest

Mandatory Disclosures

Performance Goal

Section V: Post-award Requirements

Revision of Budget and Program Plans

Period of Performance

ISP Period of Performance

ISP Grant No-cost Administrative Extension (for up to 60 days)

RSP Period of Performance

Procurement Requirements Under a Federal Award

Reporting (Programmatic and Fiscal Requirements)

Sub-recipient Monitoring and Management

Determining Sub-recipient or Contractor Classification

Monitoring and Management

Remedies for Noncompliance and Specific Conditions

Termination

Opportunities to Object and Appeals of Application Decisions

Appeals of Remedies for Noncompliance

Objections/Appeals of Decisions Regarding Allowable Costs

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Objections/Appeals of Termination or Suspension

Closeout and Retention Requirements for Records

ISP

RSP

Section VI: Budget and Fiscal Management

The Influence of the CCP Model (Fundable Costs)

The Budget Narrative

Requests for Budget Adjustments

Pre-award Costs (ISP Phase)

Indirect Costs

Cost Sharing, In-kind Resources, or Matching

Transfer of Funds

ISP

RSP

Appendix Section

Appendix A. Definitions

Appendix B: CCP Services, Positions, and Job Descriptions

Appendix C: Instructions for the Budget Narrative

Required Supporting Documentation To Be Maintained by the CCP

Appendix D: SF-424 Tip Sheet

Appendix E: Federal Financial Report (FFR) SF-425

Appendix F: Federal Financial Report (FFR) SF-425 Instructions

FFR Instructions

Reporting Requirements

Line-item Instructions for the FFR

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Introduction The Crisis Counseling Assistance and Training Program (CCP) is a federally funded supplemental program administrated by the U.S. Department of Homeland Security (DHS) Federal Emergency Management Agency (FEMA). Section 416 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act, 42 U.S.C. § 5183, authorizes FEMA to fund mental health assistance and training activities in areas that have been declared a major disaster by the President. The Center for Mental Health Services (CMHS), within the Substance Abuse and Mental Health Services Administration (SAMHSA), works with FEMA through an interagency agreement to provide technical assistance, consultation, grant administration, program oversight, and training for state mental health authorities, U.S. territories, and designated tribal authorities.

The mission of the CCP is to assist individuals and communities in recovering from the effects of natural and human-caused disasters through the provision of community-based outreach and psycho-educational services. The CCP supports short-term interventions that involve assisting disaster survivors in understanding their current situation and reactions, mitigating stress, developing coping strategies, accessing sources of emotional support, and encouraging linkages with other individuals and agencies that help survivors in their recovery process.

The information presented in the program guidance is organized into seven sections: Program Overview, CCP Model, Program Management and Implementation, Pre-award Requirements, Post-award Requirements, Budget and Fiscal Management, and the Appendix Section. The program guidance should be used in conjunction with the following:

• Immediate Services Program (ISP) and Regular Services Program (RSP) applications and supplemental instructions

• 44 Code of Federal Regulations (C.F.R.) § 206.171

• Super Circular Requirements 2 C.F.R. Part 200

Section I: Program Overview

The Crisis Counseling Assistance and Training Program

The CCP consists of services focused on preventing or mitigating adverse repercussions of a disaster.

This goal is achieved with a public health approach. Beginning with the most severely affected group and moving outward, the program seeks to serve a large portion of the population affected by the disaster. CCP services are community-based and take place anywhere survivors are, including, but not limited to, survivor homes, shelters, temporary living sites, and churches and other places of worship.

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The CCP services include supportive crisis counseling, psycho-education, development of coping skills, and linkage to appropriate resources, while assessing and referring those members of the community who are in need of intensive mental health and substance use treatment to appropriate community resources. The CCP engages community gatekeepers and organizations through direct contact with stakeholder groups, such as unmet-needs committees, and participation in community events in order to facilitate response activities and services to survivors.

Eligibility Requirements

States, U.S. territories, and tribes that have been affected by a major disaster are eligible to receive CCP services.

If the severity and magnitude of the disaster are beyond the scope of the state’s, tribe’s, or territory’s ability to respond, the state, tribe, or territory may submit an application for supplemental federal assistance through the CCP.

The CCP is a supplemental disaster relief program and is not intended to supplant existing state and local resources. To obtain assistance under the CCP program, the Governor or his/her authorized representative must initiate an assessment of the need for crisis counseling services within 10 days of the date of the major disaster declaration. In order to receive CCP funding, the state, territory, or tribe must provide a description of its resources and capabilities, as well as local resources and capabilities, and an explanation of why these resources cannot meet existing need.1 Following the grant award and throughout the life of the program, grantees are expected to conduct ongoing needs assessment to justify continued supplemental funding.

Immediate Services Program: The ISP application must be submitted to the FEMA Regional Administrator no later than 14 days from the date of declaration. The ISP provides funding not to exceed 60 days from the date of the declaration, except if the state, territory, or tribe has submitted an application for the RSP. If an RSP application is submitted, the ISP may continue for 30 additional days while the RSP application is being reviewed for funding.2

Any funds granted pursuant to an ISP must be expended solely for the purposes specified in the approved application and budget, regulations, the terms of conditions of the award, and the applicable principles prescribed in 44 C.F.R. Part 13.3

The state, territory, or tribe may appeal the Regional Administrator’s decision by submitting information justifying a reversal of the decision within 60 days of the date of notification of the

1 § 206.171 (3)(d)(f)(iii)

2 § 206.171 (f)(1)(i)(ii)

3 § 206.171 (f)(v)

CCP Guidance, Version 5.3 | Page 3 application decision. The Regional Director shall review the material submitted, and after consultation with the Secretary, notify the state, territory, or tribe, in writing within 15 days of receipt of the appeal, of his/her decision.4

The Regular Services Program: The RSP application must be submitted by the governor or his/her authorized representative to the Assistant Administrator for the Recovery Directorate through the Regional Administrator, and simultaneously to the Secretary, no later than 60 days following the declaration of the major disaster. The RSP will not exceed 9 months from the date of the Notice of Award (NOA), except that upon the request of the state, territory, or tribe to the Regional Administrator and the Secretary, the Assistant Administrator for the Recovery Directorate may extend the program period for more than 90 days where he or she deems it to be the public interest.5

The state, territory, or tribe may appeal the Assistant Administrator’s decision, in writing, within 60 days of the date of notification of the decision. The Assistant Administrator, in consultation with the Secretary and Regional Administrator, shall review the material submitted and notify the state, territory, or tribe, in writing within 15 days of receipt of the appeal, of his/her decision.6

CCP Timeline

4 § 206.171 (f)(5)(i)

5 § 206.171 (g)(4)(i)

6 § 206.171 (5)

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Crisis Counseling Definition

Crisis counseling means the application of individual and group treatment procedures which are designed to ameliorate the mental and emotional crises and their subsequent psychological and behavioral conditions resulting from a major disaster or its aftermath.7

Services Funded Through the CCP

The CCP funds the following services:

• Individual crisis counseling

• Basic supportive or educational contact

• Group crisis counseling

• Public education

• Community networking and support

• Assessment, referral, and resource linkage

• Development and distribution of educational materials

• Media and public service announcements

Providers of CCP Services

CCP services can be provided by the state, territory, or tribe or through a contract with local mental health service providers that are familiar with the communities affected by the disaster. The CCP encourages the use of mental health professionals and trained paraprofessionals, preferably people who live and work in the community and reflect the cultural makeup of the community served.

CCP Primary and Secondary Services

There are two types of CCP services: primary and secondary. Primary CCP services are higher in intensity, as they involve personal contact with individuals, families, or groups. Secondary CCP services have a broader reach and less intensity with a focus of reaching as many people as possible.

Primary CCP Services

Individual Crisis Counseling Individual crisis counseling involves a process of engagement lasting at least 15 minutes. It focuses on helping disaster survivors understand their reactions, review their options, and connect with other individuals and agencies that may assist them in improving their situations. Staff members who provide individual crisis counseling are active listeners who offer reassurance, practical assistance, 7 § 206.171 (b)(3)

CCP Guidance, Version 5.3 | Page 5 psycho-education, and emotional support, and who teach behavioral techniques for coping with stress.

Brief Educational or Supportive Contact Educational information or emotional support is provided to individuals or groups, and typically is less than 15 minutes in duration. CCP staff members who provide brief educational or supportive contact are helpful educators and active listeners. They offer general support and provide general information, typically on resources and services available to disaster survivors. During this type of intervention, crisis counselors do not usually engage in in-depth discussion as they would during individual crisis counseling or psycho-education.

Group Crisis Counseling Group crisis counseling occurs when disaster survivors and community members are brought together to meet for more than 15 minutes. A trained crisis counselor leads the group. The structure and format of group crisis counseling may vary, but group members should have similar levels of exposure to the disaster. Groups may be supportive or psycho-educational in nature. CCP crisis counselors who facilitate this service encourage the group members to do most of the talking, and they offer skills to help the group members cope with their situations and reactions. Throughout the process, the counselors assist group members with referrals to services often needed.

In addition to psycho-education or support groups, the CCP also promotes the development of self-help groups. A mental health professional or paraprofessional normally facilitates the CCP-initiated self-help groups; a group can work toward autonomy by inviting a member to be a co-facilitator.

Initially, the crisis counselor may be the primary leader of the group. Later, the group may continue without the presence of a professional or paraprofessional counselor, and be led by one or more of the group members. When group members are responsible for their own group process without the benefit of the presence of a professional or paraprofessional (a self-help support group), the group is no longer a CCP effort, since the quality of the group process cannot be guaranteed and lacks reporting or accountability mechanisms.

Public Education CCP outreach staff provide survivors with information and education about typical reactions, helpful coping strategies, and available disaster-related resources. CCP staff members commonly provide this service through public speaking at community forums, professional in-service meetings, and local government meetings. In contrast to the group crisis counselor, the CCP staff member who conducts public education does most of the talking. The need for public educational services is likely to increase throughout the course of the CCP.

Assessment, Referral, and Resource Linkage Crisis counselors receive training in assessing an individual’s or family’s need for referral to additional disaster relief services or mental health or substance use treatment. Crisis counselors refer survivors experiencing severe reactions to the appropriate level of care. Furthermore, survivors can receive a referral for other disaster relief resources to meet a wide range of physical, structural, or economic

CCP Guidance, Version 5.3 | Page 6 needs. The crisis counselors who provide assessment and referral services need to be knowledgeable about local resources and work diligently to engage community organizations.

Community Networking and Support Crisis counselors build relationships with community resource organizations, faith-based groups, and local agencies. They often attend community events to provide a compassionate presence and to be available to provide crisis counseling services when needed. They may initiate or attend unmet-needs committee or long-term recovery group meetings, or other disaster relief-oriented gatherings. It is important to note that communities, families, and survivors should “own” their community events. Crisis counseling staff can provide useful consultation during the planning process and valuable information and services at these events to demonstrate their support for members of the community.

Secondary CCP Services

Development and Distribution of Educational Materials Crisis counselors distribute flyers, brochures, tip sheets, and web-based materials to educate survivors and the community. Topics include basic disaster information, typical reactions to disaster, coping skills, and individual and community recovery and resilience. Materials that address the needs of at-risk populations, as well as materials developed in multiple languages, should be available.

Materials may be handed out or left in public places, published in local newspapers, or mailed to survivors in areas most affected by a disaster. Examples of these materials can be obtained from the SAMHSA Disaster Technical Assistance Center (DTAC).

Media and Public Service Announcements CCP staff engage in media activities and public messaging in partnership with local media outlets;

state, territory, tribal, and local governments; charitable organizations; or other community brokers of information. Media activities and messaging are designed to reach a large number of people in order to promote access to CCP services and educate survivors and the community about disaster reactions, coping skills, and individual or community recovery and resilience. Venues for this messaging vary and may include media interviews with CCP spokespeople, television or radio public service announcements, use of websites or email, or advertising.

Section II: CCP Model Section I of the CCP guidance provides an overview of the CCP. Brief descriptions of the services provided by the CCP and eligibility and application requirements are discussed. Some information on key elements of the needs assessment process for service provision and on program reporting requirements is also included. This section is intended to provide an overview of the program model and the importance of understanding how the model works in coordination with the program plan, the assessment process, and the budget to have a cohesive CCP that meets the mental health needs of disaster survivors.

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Typical Individual Reactions to a Disaster

Typical reactions to a disaster include physical, emotional, cognitive, and behavioral responses that may be experienced by individuals and families. Each category of disaster response includes a diverse set of reactions that may change over time. For example, a survivor may experience hypervigilance immediately after a disaster and then, over time, lapse into a state of chronic fatigue. Whether the reactions are adaptive or become distressing, people who are affected by a disaster may experience more than one type of reaction, and these reactions may change over time. Many people may experience anxiety, loss of sleep or appetite, stress, grief, irritability, hopelessness, and family conflict.

Typical Community Reactions to a Disaster

While each survivor experiences the disaster as an individual, he or she also experiences it as part of a community. The following figure illustrates six phases of a community’s response to a disaster.

• Phase 1, the pre-disaster phase, is characterized by fear and uncertainty. The specific reactions a community experiences depend on the type of disaster. Disasters with no warning can cause feelings of vulnerability and lack of security; fears of future, unpredicted tragedies;

and a sense of loss of control or the loss of the ability to protect oneself and one’s family. On the other hand, disasters with warning can cause guilt or self-blame for failure to heed the

CCP Guidance, Version 5.3 | Page 8 warnings. The pre-disaster phase could be as short as hours, or even minutes, such as during a terrorist attack; or it could be as long as several months, such as during a hurricane season.

• Phase 2, the impact phase, is characterized by a range of intense emotional reactions. As with the pre-disaster phase, the specific reactions also depend on the type of disaster that is occurring. Slow, low-threat disasters have psychological effects different from those of rapid, dangerous disasters. As a result, these reactions can range from shock to overt panic. Initial confusion and disbelief typically are followed by a focus on self-preservation and family protection. The impact phase is usually the shortest of the six phases of disaster.

• Phase 3, the heroic phase, is characterized by a high level of activity with a low level of productivity. During this phase, there is a sense of altruism, and many community members exhibit adrenaline-induced rescue behavior. As a result, risk assessment may be impaired.

The heroic phase often passes quickly into phase 4, the honeymoon phase.

• Phase 4, the honeymoon phase, is characterized by a dramatic shift in emotion. During the honeymoon phase, disaster assistance is readily available; community bonding occurs.

Optimism exists that everything will return to normal quickly. As a result, numerous opportunities are available to establish and build rapport with affected people and groups, and to build relationships with stakeholders. The honeymoon phase typically lasts only a few weeks.

• Phase 5, the disillusionment phase, is characterized by a stark contrast to the honeymoon phase. During the disillusionment phase, communities and individuals realize the limits of disaster assistance. As optimism turns to discouragement and stress continues to take a toll, negative reactions, such as physical exhaustion or substance use, may begin to surface. The increasing gap between need and assistance leads to feelings of abandonment. Especially as the larger community returns to business as usual, there may be an increased demand for services, as individuals and communities become ready to accept support. The disillusionment phase can last months, and even years. It is often extended by one or more trigger events, which usually include the anniversary of the disaster.

• Phase 6, the reconstruction phase, is characterized by an overall feeling of recovery.

Individuals and communities begin to assume responsibility for rebuilding their lives, and people adjust to a new “normal” while continuing to grieve losses. The reconstruction phase often begins around the anniversary of the disaster and may continue for some time beyond that. Following catastrophic events, the reconstruction phase may be years in duration.

The Crisis Counseling Approach

Crisis counseling is a strengths-based, outreach-oriented approach to helping disaster survivors identify and access personal and community resources that will aid the recovery process. It consists primarily of supportive, educational, face-to-face interventions with individuals and communities in their natural environments. The CCP seeks to empower survivors by educating them about disaster

CCP Guidance, Version 5.3 | Page 9 reactions, teaching them coping skills, assessing them for individual needs, and linking them to appropriate community resources.

Crisis counseling is considered strengths-based because it assumes most disaster survivors are naturally resilient. By providing support, education, and linkage to needed community resources, crisis counseling helps equip survivors to address and recover from the negative consequences of disaster.

While crisis counseling assumes a natural resilience in the majority, it also includes screening and assessing for severe reactions in the minority. Crisis counselors know that a subset of people in the disaster-affected population will develop diagnosable conditions. They are trained to identify disaster survivors experiencing severe reactions and refer these individuals to appropriate treatment services and community resources.

The Value of the Crisis Counseling Approach

Although a disaster may leave most people physically unharmed, it affects everyone who experiences

it. A key step toward recovery is regaining a sense of control. Crisis counseling provides survivors with the support, education, and skills they need to regain a sense of control and rebuild their lives.

Crisis counseling assistance is practical in nature. Many survivors will not seek help, and some may even reject it. While survivors may not want “psychological counseling” or “mental health services,” they usually will welcome the genuine concern and concrete support offered by crisis counselors.

Crisis counseling also is valuable because it addresses the needs of the community as a whole, in addition to those of the individual. During a disaster, both individuals and communities experience a range of emotional highs and lows that typically are associated with the phases of disaster recovery.

Communities may move from a sense of heroism and altruism to a sense of hopelessness and abandonment, all in a short period of time. Crisis counselors provide support, education, and resource linkage services that empower individuals and communities and assist them in reaching the reconstruction phase of recovery.

The Significance of the Needs Assessment

Ongoing needs assessment is the foundation of the CCP. It is a continuous process necessary to ensure the relevance of the program for the duration of the effort. Formal sources for needs assessment might include analyses of damage assessments and registrants for services from FEMA or the CCP, and may involve other data sources including special use surveys and assessment tools.

A needs assessment also might rely on corroborative data including anecdotal evidence from crisis counselors or feedback from other disaster relief providers. These sources may be especially important to inform adaptation of program outreach and services to meet changing needs in communities affected by disaster.

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The application and needs assessment provide an opportunity for the state, territory, or tribe to demonstrate the nature and extent of mental health and substance use-related needs resulting from a disaster and how those needs surpass local resources and capabilities.

The needs assessment identifies populations who should be targeted to receive crisis counseling services. In most disaster situations, children, adolescents, older adults, and people with disabilities or other access and functional needs are considered special populations. The needs assessment may reveal additional groups who are vulnerable to disaster impacts or who have been particularly affected by the disaster.

The Goal of the CCP

The goal of the CCP is to help disaster survivors recover from adverse reactions to disaster and begin to rebuild their lives. The CCP focuses on helping them understand their personal reactions, helping them plan action steps and solutions to resolve losses and overcome adversities, and linking them to other community resources.

The CCP helps survivors prioritize their needs and connect with organizations or people who can assist them. Although the CCP is a temporary disaster relief program, it leaves behind a permanent legacy of more adaptive coping skills, educational and resource materials, and enhanced community linkages.

The CCP Model

The CCP is designed to provide immediate mental health support, primarily relying on face-to-face contacts with survivors in their communities. The CCP provides these support-centered services to survivors over a specific period of time. Eight key principles guide the CCP approach.

CCP services can be described as follows:

Strengths-based: Crisis counselors assume natural resilience in individuals and communities, and promote independence rather than dependence on the CCP, other people, or organizations. Crisis counselors help survivors regain a sense of control.

Outreach-oriented: Crisis counselors take services into the communities rather than waiting for survivors to come to them.

More practical than psychological in nature: Crisis counseling is designed to prevent or mitigate adverse repercussions of disasters rather than to treat them. Crisis counselors provide support and education, listen to survivors, and accept the content at face value. Crisis counselors help survivors to develop a plan to address self-identified needs and suggest connections with other individuals or organizations that can assist them. The CCP does not provide mental health or substance use treatment, or critical incident stress debriefing.

Anonymous: Crisis counselors do not classify, label, or diagnose people. No personally identifiable records or case files are kept.

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Conducted in nontraditional settings: Crisis counselors make contact with survivors in their homes and communities, not in clinical or office settings.

Culturally aware: The CCP model embraces cultural and spiritual diversity as reflected in culturally relevant outreach activities that represent the communities served.

Designed to strengthen existing community support systems: Crisis counselors support, but do not organize or manage, community recovery activities. Likewise, the CCP supplements, but does not supplant or replace, existing community systems.

Provided in ways that promote a consistent program identity: Crisis counselors should work together early to establish a unified identity. The CCP strives to be a single, easily identifiable program, with services delivered by various local agencies.

Identifying People in Need of Crisis Counseling

Program management and ongoing needs assessment are the foundation of the CCP. These continuous processes are necessary to ensure the effectiveness of the program for the duration of the effort. An initial needs assessment provides the rationale and justification for the CCP and identifies at-risk populations who will be targeted for outreach. Formal sources for needs assessment might include analyses of damage assessments and registrants for services from FEMA or the CCP, and may involve other data sources including special use surveys and assessment tools. A needs assessment also might rely on corroborative data including anecdotal evidence from crisis counselors or feedback from other disaster relief providers. These sources may be especially important to inform adaptation of program outreach and services to meet changing needs in communities affected by disaster.

The CCP utilizes a population exposure model to help identify and prioritize groups who could benefit from crisis counseling services. This model mirrors a “ripple effect,” illustrating how the effect of a disaster expands to wider segments of the community. The injured and bereaved represented in “A” are those with the highest level of exposure to the disaster and those most likely to benefit from CCP services that are delivered face-to-face and are of higher intensity. Those represented in each subsequent ring have a lesser degree or intensity of exposure. Those in ring “E” have experienced little to no direct exposure to the disaster and, thus, may be targeted for the lowest intensity of service such as public education and information.

Population Exposure Model A. Injured survivors, bereaved family members

B. Survivors with high levels of exposure to disaster trauma, or evacuated from disaster zones C. Bereaved extended family and friends, first responders D. People who lost homes, jobs, and possessions;

people with preexisting trauma and other dysfunction; at-risk groups and other disaster responders E. Affected people from the larger community

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A properly performed needs assessment is particularly important for identifying populations at greatest risk for mental health and substance use-related problems. A thorough and thoughtful needs assessment will help the state, territory, or tribe identify vulnerable groups and understand how they are most affected by the specific disaster.

CCP Resource Linkage Versus Case Management and Advocacy

CCP services include referrals and linkage to health and mental health services, disaster recovery resources, and tangible goods. Linkage may occur as a result of a single visit and includes limited or informal follow-up. The intent of CCP resource linkage services is to assist disaster survivors in accessing resources without developing the expectation of a long-term relationship and a structured case plan.

The emphasis for the crisis counselor is on empowering survivors to make plans, to become familiar with local resources, and to act on their own behalf to connecting with the resources they need.

Case management, as traditionally practiced by human service agencies, often involves more accountability on the part of the worker to ensure clients successfully access needed resources and supports. In a traditional case management model, it is common for a formal case plan to be established and for regular follow-up to occur. Traditional advocacy emphasizes a worker representing the needs and interests of the population served to ensure access to resources. In some cases, advocacy can be an adversarial process directed toward influencing a system, resource, or local mental health agency to serve a client.

The CCP model emphasizes empowerment and collaboration. For circumstances in which longer term, more intensive services are needed, a crisis counselor may provide some extra assistance or limited, short-term follow-up to a survivor who is particularly overwhelmed or who has literacy or language barrier issues. A crisis counselor, in the presence of a disaster survivor, may role-play making phone calls and show how asking important questions facilitates obtaining resources for the survivor and his or her family. The crisis counselor then encourages the survivor to accomplish these tasks on his or her own.

With reinforcement and guidance from the crisis counselor, often provided during a single visit, the survivor is then empowered to act independently to access resources. Whenever possible, the crisis counselor encourages disaster survivors to utilize resource lists and information to make their own phone calls, fill out their own forms, and set up their own appointments. Should advocacy for an individual or community be needed, crisis counselors should seek out faith-based organizations or other agencies to help respond to these needs.

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Traditional Case Management CCP Resource Linkage

Provides services to individuals who may have a serious and persistent mental illness or other disability of indefinite duration.

Provides services to disaster survivors, regardless of level of functioning.

Advocates for and influences the provision of services for clients.

Empowers disaster survivors to advocate for their own services and resources.

Includes filling out forms and arranging appointments for clients.

Assists disaster survivors in accessing services by guiding them through typical application and referral processes.

Assumes responsibility for ensuring clients access needed services, and may follow up with local mental health agencies to ensure compliance with appointments.

Assists disaster survivors in identifying services, and may follow up with survivors, while empowering them to be responsible for accessing their own services.

Has a responsibility to ensure continuity of care for clients.

Assists disaster survivors in accessing disaster-related services, as prioritized by survivors.

Involves long-term relationships with clients. Involves short-term relationships with disaster survivors.

CCP Sub-recipients and Staff

CCP sub-recipients usually are community behavioral health organizations that have an existing relationship with the state, territory, or tribe. The CCP requires training of paraprofessional staff who understand the cultures of the community and reflect the ethnic groups they serve.

CCP staff typically work in teams of two or more to perform outreach services. Typically, teams include a mix of behavioral health professionals and trained paraprofessionals. Each team should have a team leader who has the clinical expertise needed to supervise staff. Trained professional staff members also are responsible for assessing survivors for severe reactions. Remote communication devices, such as a mobile phone, are essential to ensure outreach worker safety.

The Number of Visits Allowed by a Crisis Counselor

The CCP does not limit the number of times crisis counselors may meet with individuals or families.

However, a crisis counselor should be cautious about establishing expectations of long-term services or relationships, given the program’s temporary nature. Typically, crisis counselors are trained to consider assessing survivors they have seen on three or more occasions for referral to other kinds of resources or behavioral health care if needed. Crisis counselors may see survivors more than three times to work on coping strategies, stress management activities, or other crisis counseling interventions.

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How Crisis Counselors Are Trained

FEMA and SAMHSA have developed a series of standardized CCP training modules for crisis counselors and program administrators. These required trainings teach crisis counselors about individual and community reactions to disaster, prepare them to deliver crisis counseling services, inform them about CCP procedures and data collection, and provide them with techniques to manage their own stress.

The state, territory, or tribe articulates a comprehensive training plan in the ISP and RSP applications.

These plans include the standardized CCP trainings and any supplemental training on disaster-related topics that the state, territory, or tribe deems appropriate. The standard CCP trainings developed by FEMA and SAMHSA are delivered by instructors experienced in the CCP model and trained to deliver CCP-required trainings. The names of instructors should be included in the ISP and RSP applications, and they should be approved by SAMHSA. Additional training provided must be based on specific disaster needs.

The Differences between Crisis Counseling and Traditional Mental Health Treatment

Mental health treatment, as typically defined within the professional community, implies the provision of assistance to individuals for a diagnosable disorder. In contrast, crisis counseling seeks to prevent the onset of diagnosable disorders by helping the majority of survivors understand that they are experiencing common reactions to extraordinarily uncommon events. With the help of psycho-education, emotional support, skills building, and linkage to services, most survivors will exhibit resilience and recovery.

While a mental health professional typically will provide services in an office or clinical setting, the crisis counselor supports people in their communities. Typical settings for crisis counseling may include a disaster survivor’s home, a workplace, a school, a community center, or even a coffee shop.

A mental health professional often will engage a client in short- or long-term recovery treatment, committing the person to a set number of sessions. The crisis counselor should treat each encounter as if it will be the only one, assisting the survivor with identifying needs and goals. In disaster situations, survivors often are forced to move from place to place, requiring this more psycho-educational approach. The mental health professional may be concerned with treating a particular symptom or set of symptoms; however, the crisis counselor uses a holistic approach, assessing and responding to all of the person’s needs within the context of his or her situation.

The mental health professional often takes a directive role, deciding what issues need to be addressed and in what manner. The crisis counselor assists survivors in identifying their most pressing difficulties and needs, as well as prioritizing and planning how they can address these needs best. The crisis counselor also is a supportive voice and may provide information about common reactions to disaster, effective coping strategies, and available community resources.

Finally, while a traditional mental health professional will make a diagnosis and treat mental illnesses, the crisis counselor will avoid classifying, labeling, or diagnosing people in any way. The crisis counselor keeps no individual records or case files.

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Key differences between the two approaches are summarized below.

Traditional Mental Health Crisis Counseling

Is office based. Is home and community based.

Diagnoses and treats mental illnesses. Assesses strengths and coping skills.

Focuses on personality and functioning. Seeks to restore or improve functioning.

Examines content. Accepts content at face value.

Explores past experiences and their influence on current problems.

Validates common reactions and experiences.

Has psychotherapeutic focus. Has psycho-educational focus.

Keeps records, charts, case files, etc. Does not collect any identifying information.

How the CCP Addresses Severe Disaster Reactions

Severe reactions to a disaster may include depressive disorders, suicidal behavior, substance use, acute stress disorder, posttraumatic stress disorder, dissociative disorders, and anxiety disorders. The treatment of severe reactions is beyond the scope of the CCP. However, assessing for severe reactions and making appropriate referrals are crucial parts of the program. Through training, crisis counselors know that few survivors will develop diagnosable conditions, but they must be able to identify those who do and refer them to the appropriate levels of care.

Section III: Program Management and Implementation CCP supervisory staff must ensure that services are delivered effectively to meet the needs of disaster survivors and at-risk individuals and groups. Training, supervision, regular meetings, analysis of service and fiscal data, and quality assurance systems are essential elements for effective program management. CCP staff collaborate to ensure that the resource and service components of the CCP work together in a manner consistent with the program model. FEMA and SAMHSA project officers have federal oversight responsibility for the CCP and will work with the state, territory, or tribe to ensure administrative consistency at all levels. Ongoing analysis ensures program services meet the changing needs brought on by the phases of community reactions to the disaster and aspects of disaster recovery.

The ISP and RSP grant applications provide details on how the state, territory, or tribe will provide training, manage and deploy resources, and ensure quality and accountability.

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Main Components of a Program Management Plan

The components of the program management plan vary given the needs of the state, territory, or tribe and the reach of the disaster. The interrelated components promote effective delivery of services, and evolve to meet new identified disaster needs.

Typical components of a program management plan include the following:

• Performing ongoing needs assessment

• Developing and effecting outreach strategies to identify and serve affected individuals, groups, and the community

• Ensuring supervision and quality assurance at the state, territory, or tribe and sub-recipient levels

• Employing program media and marketing strategies

• Recruiting and hiring staff

• Providing training

• Providing staff stress management

• Ensuring effective fiscal management

• Accomplishing program evaluation

Media and Marketing and the CCP

Establishing identity and public awareness are key components of program management. It is important for the program to select a name in order to develop a cohesive identity among the sub-recipients. All CCP staff need to share a group identity. This is achieved through training and through the use of media and marketing strategies that define program services and inform the community about the CCP.

Strategies to build a program identity and to market services include the following:

• Developing a brand for the program: This involves establishing a clearly recognizable program name and logo, or design elements to appear on all program materials. Staff members are provided with items, such as t-shirts, business cards, hats, or badges, with the specific program name and logo.

• Using media outlets: Television, print, radio, and the internet can be used to increase awareness and accessibility of the CCP. Programs may develop public service announcements, interviews, articles, advertisements, letters to the editor, or educational materials.

• Establishing toll-free numbers or hotlines: A toll-free line may be established purely for informational purposes, or a hotline that provides counseling via phone may be incorporated into the program.

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• Establishing program websites: Program websites explain the CCP services and link to other disaster-related resources whenever possible.

• Developing and revising outreach and psycho-educational materials: Materials are tailored to address the unique characteristics of a specific disaster or CCP.

• Engaging in community networking: Staffing information booths and providing presentations at community events can be an effective way for the CCP to gain visibility. Staff also may attend meetings to discuss disaster survivors’ needs and available resources.

• Promoting word-of-mouth promulgation: Outreach workers may encourage people to spread the word about the CCP. This is sometimes the most effective method of program promulgation, and it is free!

Effective Staffing of the CCP

CCP staff roles and the number of hires for each position to include in the staffing plan are informed by the needs assessment. The state, territory, or tribe determines how staff members are deployed to meet the needs of disaster survivors and at-risk groups. For safety and efficacy, crisis counselors typically are deployed in teams. Team deployment is linked with the CCP outreach strategy in order to target services to those individuals and groups identified to be in the greatest need. In its essential staffing, the CCP should reflect the cultural demographics of the affected area and use professionals with prior training and experience in the mental health and substance use fields. For more detailed information regarding suggested position descriptions, refer to Appendix B: CCP Services, Positions, and Job Descriptions.

Training

In order for ongoing programs to be successful, skilled staff need to be trained on expectations and limits of services, and on how to ensure appropriate adherence to the CCP model. The quality of service provision is key to program success, and comprehensive training is essential.

The CCP model includes standard trainings performed at key points throughout the ISP and RSP. Training materials and recommendations for qualified trainers are provided by SAMHSA and through SAMHSA DTAC. Often, personnel from other assistance and disaster relief agencies are invited to attend to gain understanding of program services and the CCP model. CCP management must be proactive in planning for training. This includes scheduling meeting space and identifying appropriate trainers, when possible.

The required standard CCP trainings are organized into modules that are provided to states, territories, or tribes on CD by SAMHSA DTAC once a CCP is approved.

Core Content Training: This is the basic CCP skills-building training and includes administrative procedures and data collection information specific to the program. The course takes place in 2 days, during which time crisis counselors are provided with critical information and skills related to individual, group, and community outreach strategies. This training is conducted during the first few weeks of the

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ISP. However, ongoing training must be provided to ensure all new crisis counselors receive the Core Content Training prior to working independently within the program.

Transition to RSP Training: During this course, existing and newly hired CCP staff review key concepts related to crisis counseling skills, with an emphasis on longer-term service provision. This curriculum highlights how the needs of disaster survivors and communities evolve in the RSP and differ from those encountered in the immediate disaster response. If the state, territory, or tribe applied for the RSP only, it should begin with the Core Content Training. This training usually takes place as soon as formal RSP grant funding is awarded.

RSP Midprogram Training: This training typically is held 3–6 months into the RSP. Issues of staff morale and stress management for sub-recipients are addressed. A focus is maintained on how crisis counselors will continue to provide services under difficult circumstances. This training includes problem-solving techniques for specific issues commonly encountered in the CCP such as emerging substance use or significant mental health needs. It also begins to address the subject of program phasedown.

Disaster Anniversary Training: This training is held several weeks before the first anniversary of the disaster event. Crisis counselors are taught expected anniversary reactions and intervention strategies.

This training can be paired with the RSP Midprogram Training or the RSP Phasedown Training, depending on the anniversary date.

RSP Phasedown Training: Phasedown training should take place 6–8 weeks prior to the scheduled phasedown of the CCP. All CCP administrative and outreach staff attend.