DISASTER BEHAVIORAL HEALTH RESPONSE PLAN

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 Table of Contents

Section 1 - Introduction 3
About Behavioral Health and Disaster Events 3
Purpose 3
Scope 4
Planning Assumptions 5
Guiding Principles of Disaster Behavioral Health 6
Washtenaw County Health Department Responsibilities 6
Partner Responsibilities 7

Section 2 - Operations 7
Pre-Event Phase: Preparing for a Disaster Behavioral Health Response 7
Response Phase: Framework for a Disaster Behavioral Health Response 8
Staff Roles and Responsibilities 10
Response Activation 11
About Psychological First Aid 11
About Critical Incident Stress Management 13
Disaster Behavioral Health Operations 13
Implementation Process 15
Authority 16
Communication 16
Local, State, and Federal Roles 17
Isolation and Quarantine 18

Section 3 – Recovery and Evaluation 18

Maintenance of Operations 18
Debriefing and Data Collection 19
Community Mental Health Partner Contacts 19

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 Section 1 - Introduction

About Behavioral Health and Disaster Events

Mental health is an essential part of community resilience and recovery following a disaster.
Signs of stress post-disaster is a common experience for many individuals, thus, it is important to
monitor the physical, emotional, and behavioral health of those affected directly and indirectly,
as well as those responding to the needs of others after a traumatic event. While many
individuals are resilient and will recover on their own, others may develop or experience
exacerbation of existing mental health conditions.

Preparation and response are key functions that will aid to prevent or mitigate the negative
mental health outcomes in the population. Washtenaw County Health Department (WCHD) is
committed to protect the public health in the event of an emergency through preparation,
prevention, response, and aid in the recovery from any threat or disastrous event(s).

Purpose

The purpose of this document is to provide a working guideline that describes the response,
management, and recovery from any incident or event that poses a risk to mental health for
Washtenaw County residents. It is intended to ensure a coordinated, efficient, and effective
response to the mental health needs of individuals impacted by a disaster in the community. The
Behavioral Health Plan (BHP) defines:
 Agency roles and responsibilities
 Mental health resources
 Internal and external communication plans
 The community partners and coalitions that will help address and incident related to
behavioral health

This plan should be used in conjunction with existing emergency operations and response plans.

The BHP describes emergencies that will benefit from mental health interventions, for which
WCHD will coordinate.
The MHP is intended to be used as a guide and does not replace sound judgment nor anticipates
all situations and contingencies.
Indi
The Impact Pyramid (The victim count only vid
represents the tip of the iceberg) ual
vic
tim
s and
Family
Everyone that encounters a disaster is social networks
affected by varying degrees. Although
Rescue workers, medical care
many individuals cope well pre- and post- providers, their families and social
exposure to a disaster, a handful of networks
individuals may experience some
psychological or behavioral impairment Vulnerable populations and
that can potentially be manifested into a impacted businesses
mental illness. 3
Ordinary people and their communities
Scope

This document is integrated into the WCHD Emergency Preparedness Plan and outlines the
expectations of both staff and partner roles and responsibilities, response protocols within
controlled systems, establishes internal/external communication procedures, identifies authority
and references as defined by local, State, and Federal government mandates, and classifies at-risk
or vulnerable populations who many need additional mental health services.

The WCHD assists in the following areas for emergency preparedness:

I. Pre-Event Phase
o Assess:
 Understanding demographic and social characteristics.
 Identifying the language needs, cultural considerations, and reading levels
in Washtenaw County.
 Building relationships with public health officials, community
stakeholders, private and public medical providers, and school officials.
 Identifying policy and resources for staff support.
 Finding behavioral health treatment facilities in the community.

o Plan:
 Establishes the role of partners in mental health services during an
emergency.
 Identifies and trains mental health professionals and response staff to
provide counseling, outreach, and education during a crisis or emergency.
 Plans for interpreter and translation services.
 Train provider groups, including public health nurses, school health
professionals, and community support workers in psychosocial
consequences of disasters.
 Develops a risk communication plan and template.
 Develops a system to connect victims with emergency mental health
services when needed.

II. Response Phase:

o First meet basic safety and security needs of target populations.
o Provide Psychological First Aid at response sites.
o Use crisis and emergency risk communication principles in all messaging.
o Continue to monitor the mental health needs of victims and responders.
o Provide access to counselors in all appropriate languages.
o Distribute educational information appropriate to the event.
o Connect victims in acute distress with professional services.
o Provide coping resources for responders and their families.

III. Recovery Phase:

o Continue to monitor mental health needs in the affected population.
o Train social and community leaders on how to help their groups cope.

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 o Give the community opportunities to come together.
o Promote availability of coping resources.
o Anticipate and plan to deal with trauma reminders (such as anniversaries of the
event date, or the broadcast of similar incidents on the news).

IV. Evaluation Phase:

o Monitor for long-term mental stress in the community and for Post-Traumatic
Stress Disorder (PTSD).
o Identify and address gaps in the MHP.

Planning Assumptions

The definition of a disastrous event is any situation, i.e. natural (biological outbreaks, hurricanes,
tornadoes, floods, wildfires, etc.) or human-made (mass shootings, terrorist attacks, biological
warfare, environmental events), that poses a threat, causes damage, or loss of life. Disasters
threaten harm or death to the population, regardless of the extent, and can induce negative mental
health outcomes.

Effects of a disastrous event on mental health on any person may include:

 Anxiety
 Depression
 Aggression
 Alcohol and/or substance abuse
 Sleep deprivation
 Weight loss/gain
 Post-Traumatic Stress Disorder

Washtenaw County addresses and considers religious and cultural components in every
community when preparing for and responding to disasters as well as assisting with connecting
individuals to health resources. As part of WCHD planning and response strategies staff will
provide appropriate interventions for all types of disaster victims including debriefing,
counseling, public education, and referral to licensed mental health professionals when
necessary.

Many individuals do not see themselves needing mental health services following a disaster and
will not seek out such services. Therefore, a traditional, office-based approach to providing
services may be ineffective. Disaster behavioral health responders must actively seek out
individuals who have experienced a disaster through community settings such as schools,
shelters, hospitals, and the homes of those impacted.

In addition, focusing on the function of support systems are crucial to recovery. Workers should
attempt to keep families together when at all possible. Family members should be involved as
much as possible in each other’s recovery. For individuals with limited support systems, disaster
support groups can be useful to counter isolation and reduce negative mental health outcomes.

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The highest priorities are always the life/safety for staff, responders, and the public health and
safety of Washtenaw County residents and visitors. WCHD may work with other local health
departments, communicating local health needs to the state. WCHD will support and work in
partnership with local, state, and federal response efforts.

Guiding Principles of Disaster Behavioral Health

1. When a disaster occurs in the community, everyone is affected, to different degrees.

2. Many disasters are unforeseen and the psychological impacts they have may or may not
manifest into a mental illness immediately.
3. Stress reactions to a disaster are expected and understandable following a disaster.
4. People who have pre-existing stressors before a disaster and/or those who have
differential needs may require extra assistance with recovery. These include, but are not
limited to: children, elderly, disabled, economically disadvantaged, minority groups,
those who require emergency medical care, those who have experienced previous
traumatic events, mentally ill, and disaster relief workers.
5. Mental health concerns exist in most aspects of preparedness, response, and recovery.
6. Individuals who needs mental health assistance respond to active, genuine interest and
concern.
7. Disaster relief assistance may be confusing for survivors. They may express frustration,
anger, and feelings of helplessness related to governmental and non-governmental
disaster assistance.
8. Some individuals may reject assistance.

Washtenaw County Health Department Responsibilities

WCHD emphasizes safety and efficiency in the event of an emergency. The Mental Health Plan
is positioned to help cultivate community resilience and help address behavioral/mental impacts
following a disaster. WCHD will work alongside behavioral health providers, social services,
trained volunteers, and the federal government to ensure individuals in Washtenaw County can
access behavioral health services before and after a disaster, monitor the behavioral health
impacts of disasters, share information and resources with the public, educate the public, and
direct those who need help to the appropriate resources. Other main roles and responsibilities
include:
 Provide oversight for the MHP in the case of an emergency
 Coordinate with other agencies and partners on mental health planning
 Provides information to both healthcare providers and individuals about mental health
resources within the community
 Increase awareness and education on how disasters impact mental health and wellbeing
 Identifying, assessing, and determining specific needs of the community impacted by a
disaster in order to develop individualized plan of health services
 Referring affected individuals and assisting with access to health services
 Providing translation for those facing language barriers

Partner Responsibilities

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Washtenaw County Community Mental Health (WC CMH) is the primary community mental
health provider in Washtenaw County for individuals with a serious mental illness (SMI), a
developmental disability (DD), or children with serious emotional disturbances. In the event of
activation of the MHP, WC CMH may have the following duties and other partners (if
applicable):
 Provide 24/7 access to information and referral regarding behavioral health and substance
abuse services
 Provide 24/7 crisis hotline and 24/7 access to services
 Determine eligibility and level of care for the impacted individual(s)
 Perform suicide risk assessments for individuals impacted by the disaster
 Petition for involuntary hospitalization and pick-up order services
 Evaluate and provide care/treatment
 Coordinate with CMS

Section 2 - Operations

I. Pre-Event Phase: Preparing for a Disaster Behavioral Health Response

Prior to a disaster, WCHD and partners will assist to enhance the emotional resiliency of the
communities and provide or refer behavioral health services for potential risk groups. WCHD
will take the following approaches to disaster mental health response preparedness/training:

- Share disaster behavioral health response training guidance with partners and vice versa.
This will build the capacity within the region for appropriate disaster response. This may
include, but not limited to, Psychological First Aid training, Red Cross training for
mental health providers, and Critical Incident Stress Management (CISM) training.
- Provide PFA training for a core group of 12(might change number) identified WCCMH
personnel, with continued training for all other staff members to be implemented in
certain phases of a disaster.
- For all staff, provide guidance and assistance in developing family and pet/livestock
individual preparedness plans and emergency kits in anticipation of extended periods of
disaster response.
- Washtenaw County Health Department and Emergency Operation Center (EOC) will
provide the community with information regarding disaster preparedness in the home and
workplace.

II. Response Phase: Framework for a Disaster Behavioral Health Response

When an incident of public health emergency has been identified, the WCHD will immediately
report to the Emergency Operation Center (EOC) where discussions regarding the protocol will
occur and the needs for behavioral/mental health services. The need for such services may be
immediate or may come hours into the incident depending on the severity of the incident.

Disaster behavioral health services will be provided to individuals impacted by disaster via a
range of services; which is based on an increasing level of intervention intended to minimize the

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psychological impact of a disaster, promote community resiliency, and refer to long-term
psychological services.

Psychological First Aid (PFA) is the primary modality of intervention during a disaster and is the
entry point to accessing different levels of health services. PFA will be used to identify and refer
individuals impacted for further assistance in behavioral/mental health services.

Critical Incident Stress Management or CISM can also be a supplemental method to PFA in
order to navigate the health services and can include providing referral for individuals impacted
by a disaster to community-based mental health services. Disaster crisis counseling services are
provided on a continuum, based on need, and may be operationalized through the use of an
assistance center and outreach/response activities.

A. Factors That Determine the Stressfulness of a Disaster

 Features of the Disaster
Familiarity with the event
Ability to avoid the event
Suddenness of its onset
Impact intensity
Course and duration
Degree to which it can be controlled
 Community or Societal Factors
Previous level of community resources
Level of preparedness
Extent and nature of damage
Community’s experience with event
Social/political unrest
Availability of resources to rebuild
 Characteristics of the Individuals Involved
Actual losses (including threat of loss)
Previous experience with similar events
Level of background stress in the individual’s life
Physical or psychological closeness to event
Effectiveness of one’s coping mechanisms
Nature and extent of available social support

B. Potential Risk Groups

 Infants, children, seniors
 Documented and undocumented immigrants, non-English speakers, other cultural
and/or ethnic groups, etc.
 Low-visibility groups: homeless, mobility-impaired, unemployed, mentally
challenged, etc.
 People with serious and/or persistent mental illnesses
 People in group facilities: hospitals, nursing homes, prisons
 Human Service, Healthcare and Disaster Relief Workers

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C. Common Survivor’s Needs and Reactions
 Concern for basic survival
 Grief over loss of loved ones and loss of valued possessions
 Fear and anxiety about personal safety and physical safety of loved ones
 Sleep disturbances
 Concerns about relocation, isolation, or crowded living conditions
 A need to talk about events and feelings associated with disaster
 A need to feel one is a part of the community and recovery efforts

D. Reactions that Signal Possible Need for Mental Health Referral

 Disorientation (dazed, memory loss, unable to give date/time or recall recent
events…)
 Depression (pervasive feeling of hopelessness & despair, withdrawal from
others…)
 Anxiety (constantly on edge, restless, obsessive fear of another disaster…)
 Mental Illness (hearing voices, seeing visions, delusional thinking…)
 Inability to care for self (not eating, bathing, changing clothing or handling daily
life)
 Suicidal or homicidal thoughts or plans
 Problematic use of alcohol or drugs
 Domestic violence, child abuse or elder abuse

E. Common Disaster Worker Stress Reactions

Behavioral and Emotional Responses/Symptoms
• Anxiety, fear
• Grief, guilt, self-doubt, sadness
• Irritability, anger, resentment, increased conflicts with friends/family
• Feeling overwhelmed, hopeless, despair, depressed
• Anticipation of harm to self or others; isolation or social withdrawal
• Insomnia
• Gait change
• Hyper-vigilance; startle reactions
• Crying easily
• Gallows humor
• Ritualistic behavior

Cognitive Responses/Symptoms
• Memory loss, Anomia (difficulty naming objects or people)
• Calculation difficulties; Decision making difficulties
• Confusion in general and/or confusing trivial with major issues
• Concentration problems/distractibility
• Reduced attention span and/or preoccupation with disaster\
• Recurring dreams or nightmares

Physiological Responses/Symptoms

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 • Fatigue
• Nausea
• Fine motor tremors
• Tics
• Paresthesia
• Profuse Sweating
• Dizziness
• GI Upset
• Heart Palpitations
• Choking or smothering sensation

Staff Roles and Responsibilities

The WCHD may help in the event of an emergency by providing assistance in the following:
- Establish community resource centers and family re-unification sites
- Refer first responders and others affected by the disaster to Washtenaw County services
- Ensure Washtenaw County staff are trained in Psychological First Aid
- Help acquire support and volunteers
- Provide consistent and accurate health education information pertaining to disaster
behavioral health issues

The Emergency Manager will notify WCHD regarding the disaster incident and activate EOC
depending on severity of the disaster. The Emergency Manager is responsible for communicating
disaster behavioral health needs with relevant staff and communicating with other administrators.

The EOC staff will be trained in PFA and will be able to identify victims in need of debriefing
and make referrals to mental health services. EOC staff will fulfill other positions requested by
the Health Officer as well.

Nurses on call will provide referrals alongside EOC and assist individuals presenting adverse
psychological symptoms or substance abuse that call the WCCMH 24/7 hotline.

Health educators will assess and respond to the information needs of the general public while
considering any logistical constraints related to effective communication, equipment needs, and
the public information call center staffing. In addition, health educators will need to consider the
medium of communication in which information is delivered, language barriers, and reading
capacities of certain populations appropriately when disseminating disaster behavioral health
information. They are responsible for coordinating with Washtenaw County and other local
counties, the Michigan Department of Health and Human Services (MDHHS), and the Centers
for Disease Control and Prevention (CDC) to develop common and consistent health messages
related to disaster behavioral health.

All other WCHD staff will report to normal workstations unless instructed otherwise.

Response Activation

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 Public Health Emergency Response Personnel:

a. As soon as the immediate threats of the disaster are attended to and the public safety
is ensured, WCHD will brief all responding public health employees and volunteers
on the importance of recognizing emotional or physical stress in themselves or others,
and on the basics of Psychological First Aid.
b. In the case of prolonged effects of a disaster, staff will assist in the briefings between
shifts of the event
c. WCHD will request professional behavioral health support from WCCMH and local
agencies and providers.
d. Throughout the event, WCHD will update its website to include additional behavioral
health resources and referral information from responders.

WCHD will focus on health promotion, communication, and education activities in the
community to increase and enhance resiliency. Although the MHP is aimed to identify and
mitigate psychological distress among victims, it will also require close attention to be paid to
the needs of those under isolation and quarantine orders and/or those affected by social
distancing.

About Psychological First Aid

Psychological First Aid (PFA) is an evidence-informed modular approach developed by the

National Child Traumatic Stress Network (NCTSN) and the National Center for PTSD, with
contributions from individuals involved in disaster research and response, to help children,
adolescents, adults, and families in the immediate aftermath of a traumatic event. PFA is
designed to reduce the initial distress caused by traumatic events and to foster short- and long-
term adaptive functioning and coping. PFA does not assume that all survivors will develop
severe mental health problems or long-term difficulties in recovery. Instead, it is based on an
understanding that disaster survivors and others affected by such events will experience a broad
range of early reactions (e.g., physical, psychological, behavioral, spiritual). Some of these
reactions will cause enough distress to interfere with adaptive coping, and recovery may be
helped by support from compassionate and caring disaster responders. One does not have to be a
mental health professional to deliver PFA.

PFA core actions constitute the basic objectives of providing early assistance within days or
weeks following an event. Providers should be flexible, and base the amount of time they spend
on each core action on the survivors’ specific needs and concerns. The core skills are designed to
be helpful in addressing the survivors’ and responders’ needs and concerns. PFA is designed for
delivery in diverse settings. Mental health and other disaster response workers may be called
upon to provide PFA in general population shelters, special needs shelters, field hospitals and
medical triage areas, acute care facilities (e.g., Emergency Departments), staging areas or respite
centers for first responders or other relief workers, emergency operations centers, crisis hotlines
or phone banks, feeding locations, disaster assistance service centers, family reception and
assistance centers, homes, businesses, and other community settings.

The eight PFA Core Actions include:

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 1. Contact and Engagement: To respond to contacts initiated by survivors, or to initiate
contacts in a non-intrusive, compassionate, and helpful manner.
2. Safety and Comfort: To enhance immediate and ongoing safety, and provide physical and
emotional comfort.
3. Stabilization (if needed): To calm and orient emotionally overwhelmed or disoriented
survivors.
4. Information Gathering on Current Needs and Concerns: To identify immediate needs and
concerns, gather additional information, and tailor Psychological First Aid interventions.
5. Practical Assistance: To offer practical help to survivors in addressing immediate needs
and concerns.
6. Connection with Social Supports: To help establish brief or ongoing contacts with
primary support persons and other sources of support, including family members, friends,
and community helping resources.
7. Information on Coping: To provide information about stress reactions and coping to
reduce distress and promote adaptive functioning.
8. Linkage with Collaborative Services: To link survivors with available services needed at
the time or in the future.

In addition to translating PFA into several languages, NCTSN members and partners have
worked to develop PFA adaptations for school personnel (for use in the aftermath of a school
crisis, disaster, or terrorism event), as well as community religious professionals, Medical
Reserve Corps members, and staff at facilities serving families and youth who are experiencing
homelessness.

A free online six-hour PFA course is available at https://www.nctsn.org/resources/psychological-

first-aid-pfa-online. This professionally-narrated course is for individuals new to disaster
responses who want to learn the core goals of PFA, as well as practitioners who would like a
review. It features innovative activities, video demonstrations, and mentoring tips from the
nation’s trauma experts and survivors.

About Critical Incident Stress Management

Critical Incident Stress Management (CISM) is a multi-component crisis preparedness and

intervention program. CISM is a system of crisis intervention meant to prevent psychological
damage associated with unusual and stressful events, also called critical incidents. CISM is
intended to support those who are prone to trauma exposure as well as those who have
experienced an intensely traumatic event.

CISM is not therapy, a tactical review, or a disciplinary tool. It is a designed as a support system
meant to achieve and address the following:

- Decrease the impact of a critical incident

- Normalize instinctive reactions to a critical incident
- Encourage recovery
- Restore functioning

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 - Determine need for further support and/or services

In Washtenaw County, CISM provides services for first responders while TERN (Traumatic
Events Response Network) provides services to the community. However, these two teams are
not strictly independent of one another and may respond to both the community and first
responders.

CISM/TERN offers free crisis response services to groups as well as individuals. When working
with a group CISM/TERN may hold a ‘defusing’ (8-12 hours after an event) or a ‘debriefing’ (at
least 24-72 hours after an event), which are both fairly formal group discussions of the event.
One-on-one counseling is also available in addition to providing/facilitating community meetings
about the event.

A crisis response can be requested by calling Metro Dispatch at 734-994-2911 and requesting
CISM or TERN services.  They will contact the on call person who will respond shortly to the
requester. 

Disaster Behavioral Health Operations

Depending upon the nature and scope of the disaster, the following operations may be activated
and may incorporate any of the disaster crisis counseling services provided by WCCMH or other
partners (3):
- Assistance Center
- Behavioral Health Outreach and Response
- Organizational Stress Prevention Management

1. Assistance Center

An Assistance Center may be implemented after any disaster when there may be a need
for individuals or groups of individuals to congregate, seek information, obtain support,
and connect with available services offered throughout Washtenaw County. The
establishment of an Assistance Center would be coordinated by the American Red Cross.

Potential target populations served by an Assistance Center would include family

members and friends of missing persons seeking information, support, services, and/or
reunification. It may also include anyone impacted by the incident or involved in the
response.

An Assistance Center should be located in close, but safe, proximity to the disaster
location and should have the following components, if applicable:
 Registration and management area
 Central waiting/briefing room
 Private rooms available for services such as counseling, meditation, death
notification, etc.

Administrative staff for the Assistance Center will have the following players:

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  Assistance Center Team Leader/Coordinator
 Communication Specialists
 Mental Health Specialist/Practitioner

2. Behavioral Health Outreach and Response

Disaster behavioral health outreach and continuity of care is a key component of an

effective disaster behavioral health response. Behavioral health outreach activities may
be offered to survivors, impacted directly or indirectly, as well as to the community as a
whole. Three approaches: behavioral health continuity of care, individual outreach, and
community relations may be used separately or in conjunction to meet the needs of the
event. Individual outreach efforts focus on locating and connecting individual survivors
who could benefit from behavioral health services and who might not otherwise access
these services. Community relations activities focus on providing behavioral health
support, linkage and advocacy for communities or groups affected by the disaster.
Behavioral health continuity of care activities focus on providing continued service to
current recipients of behavioral health services. An alternate care site could be needed.

Potential target populations served by behavioral health outreach and continuity of care
may include:
• Individuals living in the immediate proximity of the disaster or those most
impacted by the disaster
• Community at large
• Current behavioral health participants

Behavioral health outreach and continuity of care activities may include:

1. Telephone contact which may include activating a hotline.
2. Face-to-face interactions which may be provided in individual or group settings.
3. Distribution of educational or informational materials.
4. Risk communication, via the provision of behavioral health messages to the
community at large distributed via media.
5. Re-location of current behavioral health services to an alternate care site.
6. Volunteerism by community members.
7. Memorialization of event or celebration of life events in the community.
8. Advocacy for provision/resilience of basic needs and services.

3. Organization and Stress Prevention Management

Washtenaw County follows organizational approaches for stress prevention and

management as recommended by the U.S. Department of Health and Human Services,
Substance Abuse and Mental Health Services Administration (SAMHSA), and Center for
Mental Health Services. During an event, adopting these approaches will allow
Washtenaw County to anticipate stressors and shape responses rather than simply
reacting to a behavioral health crisis when it occurs. These approaches include:

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 - Providing effective management structure and leadership via clarifying the chain
of command and reporting relationships, having available supervisors, providing a
disaster orientation to all health care personnel, and resource abundance.
- Define purpose and goals.
- Define clear intervention goals and strategies appropriate to the assignment
setting.
- Define roles by function
- Orient and train staff with written role descriptions for each assignment setting.
When a setting is under the jurisdiction of another agency, inform workers of each
agency’s role, contact people, and expectations.
- Nurture team support.
- Create a buddy system to support and monitor stress reactions. Promote a positive
atmosphere of support and tolerance with frequent praise.
- Develop a plan for stress management. For example:
o Assess workers’ functioning regularly.
o Rotate workers among low-, mid-, and high-stress tasks.
o Encourage breaks and time away from assignment. Educate about signs
and symptoms of worker stress and coping strategies.
o Provide individual and group defusing and debriefing.
o Develop an exit plan for workers leaving the operation, including a
debriefing, reentry information, opportunity to critique, and formal
recognition for service

Implementation Process

Disaster Behavioral Health

Plan is activated

Stand Assistance Centers

(family, Survivor, Provide support services as Determine need and refer to Stand down as instructed by
Reunification) if needed outlined in plan care incident commander
(physial or virtual)

Determine need and refer to

Washtenaw County Declares Isolation and Quarantine Provide Behavioral Health Stand down as instructed by
care/integrate into home
Disaster/Emergency procedures if needed Response incident commander
environment

Design and implement

behavioral health
Behavioral Health Stand down as instructed by
communication to
Communication incident commander
community and those
impacted

Behavioral Health
Provide support services to Determine need and refer to Stand down as instructed by
Emergency Outreach and
responders and public care incident commander
Response

Provide atlernate care site

Stand down as instructed by
for current behavioral health
incident commander
individuals

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Authority

Community and Response Personnel Behavioral Health Activation

Authority Responsibility Action Timeframe

Health Enact MH Plan Assign Behavioral Upon declaration of a
Officer/Incident Health (BH) Liaison disaster
Commander
BH Liaison Enact MH Plan Contact partners Upon assignment
BH Liaison/Partner Determine the MH Design a response Upon assignment
Representatives services needed plan
Media Liaison Deliver Behavioral Press releases As needed
Health messages to
the public
Assigned staff and Assistance Center Set up and staff the As needed
volunteers and Outreach center(s)
Response
Designated partner Continuity of care Provide ongoing As
resource centers post-event MH indicated/specified
services

Communication

Disaster Behavioral Health Organizational Chart

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 Washtenaw County
Emergency
Operations Center

Emergency
Preparedness

Coordinate
operations and
response

Washtenaw County Partner

Media Liaison
Health Department Organizations

Behavioral Health
American Red Cross Emergency Outreach
& Response

Communication
Assistance Center BH Assistance Alternate Care Sites
Outreach & Relations

Family, Survivor, and

Re-unification Public
Assistance

Responders

Local, State, and Federal Roles

Local Roles – WCHD will assist and/or take over coordination of resources while partners will
take the lead in providing actual behavioral health services. WCHD must be prepared to
coordinate services if state or regional resources are delayed in the event of an emergency.
WCHD is responsible for establishing and maintaining relations with supporting agencies and
planning for the emergency response. In order to do this, WCHD will begin assessments and
coordination of the emergency as well as its short term stress management and analyzing the
disaster behavioral health needs of the affected populations and communities. In addition to
coordination, Washtenaw County will do their best effort in providing qualified staff to support
behavioral health operations and assistance centers, provide referral services, and mobilize the
community towards recovery.
State Roles – When local resources are inadequate to meet the behavioral health needs following
a disaster in the community, coordination of reallocation of resources may be required. During a
state or federally declared emergency, or upon request of Washtenaw County, the Michigan

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Department of Health and Human Services (MDHHS) will be responsible for coordinating the
behavioral health response and recovery activities, assessing the needs of those impacted, and
disseminating public behavioral health education on critical incident stress management
techniques.
Federal Roles - When local and state capacity to respond to a disaster is exceeded, federal
support can be requested through the State Emergency Operations Center. Federal resources
include:
a. FEMA Crisis Counseling Program
b. Disaster Medical Assistance Team
c. US Department of Veterans Affairs Readjustment Counseling Service
d. American Red Cross Disaster Behavioral Health Service (ARC-DMHS)

Isolation and Quarantine

In the event that individual isolation or quarantine procedures must be imposed, whether it is one
or multiple parties, response for isolation and quarantine will be enacted. WCCMH will arrange
for coordination of mental health screening for the individual, crisis counseling and stress
management for confined persons. Screening, counseling and stress management will be based
upon assessment and recommendation of an authorized behavioral health practitioner. If isolation
or quarantine occurs in a hospital setting, the hospital behavioral health staff will coordinate
services as needed.
During an outbreak, if isolation or quarantine is implemented, daily assessment of the patient
will occur. This assessment is to include screening of affect and orientation of the individual to
determine if additional referral should occur. Opportunities for entertainment, exercise,
information and communication with family and friends will be insured.
Only in a crisis behavioral health situation would face to face intervention occur (with
appropriate personal protective equipment). For general stress management, screening and
individual counseling, a hotline and web application would be developed for distance
intervention. This could include, but is not limited to links to informational sites, on-line
screening tools, chat rooms with behavioral health staff, or individual online counseling.

Section 3 – Recovery and Evaluation

Maintenance of Operations
WCHD and partners will continue to deploy staff as needed to maintain behavioral health
support for victims. Implementing supervisory strategies that limit on-duty work hours, provide
rotations from more stressful to less stressful duties, require breaks away from the scene as
practicable, and pairing more experienced responders with those less experienced especially in

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long-term responses will assist employees in remaining rested and attuned to critical details in
their roles.
Lastly, the continuation of providing risk communications messages, behavioral health
information, and referral information will be ongoing.

Debriefing and Data Collection

Preparation before disaster and the activation of support systems in place after a disaster are
essential to recovery. While the community will experience a range of stress reactions to a
disaster incident, these reactions are usually mild and momentary. However, certain individuals
may potentially develop moderate to severe psychological distress, over time, if left untreated or
undetected. In order to address this gap, WCHD will provide post-event debriefing to all public
health responders, preferably before they leave the worksite. Furthermore, WCHD will continue
to work with partners to ensure that behavioral health recovery efforts are coordinated in addition
to collecting data on victims and responders for assessment.
Organizational debriefings that are collected in an After Action Report (AAR) are mandatory in
ascertaining the response actions that went well—along with actions, policies, and procedures
that could be improved. In the event that the Disaster Mental Health Plan is activated,
arrangements should be made as soon as possible to review the AAR.

Community Mental Health Partner Contacts

Support agencies provide disaster behavioral health services and support during the
preparedness, response, and recovery phases. Below, a list of mental health partners in Southeast
Michigan can be found:

Provider Services Area Language Address Phone # Website

ABA Insight, ABA Washtenaw Available 6267 Webster 734-252-6522 http://www.abainsight.net/
LLC Autism , Monroe, Through Church Road,
Services, Livingston Translator Dexter, MI
Outpatient 48130
Services
ABA ABA Washtenaw Available P. O. Box 663 734-972-2550 https://www.abaways.com
Pathways Autism Through Lakeland MI or 810-599- /
Services, Translator 481443 2129
Outpatient
Services
Adult CLS, Livingston, Available 8170 Jackson 734-408-0112 http://www.alslm.org/
Learning Licensed Monroe, Through Rd, Suite F
Systems Residential Washtenaw Translator Ann Arbor
MI 48103-
9100
Advanced Recreational Washtenaw Available 7794 Paint 734-547-5462 http://www.advancedthera
Therapuetic & Music Through Creek Drive, peuticsolutionsmi.com/
Solutions, Therapy Translator Ypsilanti, MI
LLC 48197
Avalon CLS Washtenaw Available 1327 Jones 734-663-5858 http://www.avalonhousing

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Housing Through Drive, Ann .org/
Translator Arbor, MI
48105
Beacon Licensed Livingston Available 555 Railroad 269-427-8400 https://beaconspecialized.
Specialized Residential Washtenaw Through St. Bangor MI org/
Living Lenawee Translator 49013-0069
Services
Bear River Outpatient Monroe, Available 5397 Howard 231-838-7155 https://www.bearriverhealt
Health Services, Washtenaw Through Rd, Petoskey, h.com/
SUD Translator MI 49770
Treatment
Agency
Bedside CLS, Washtenaw Available 2032 S. 734-219-7004 https://bedsideangelshc.co
Angel's Home Respite Through Congress St, m/
Care Translator Suite 1W,
Ypsilanti, MI
48197
Behavioral CLS, Livingston, Available 210 Town 248-643-8900 https://expertcare.com/
Outcomes Respite Washtenaw Through Center Drive,
Managment Translator Troy, MI
dba 48084
ExpertCare
Management
Services
BM Martis, Behavioral Lenawee, Available 575 S. Main 517-673-1907 N/A
LLC Psychology Washtenaw Through Street,
Translator Adrian, MI
49221
Camp Respite Washtenaw Available 12701 419-875-6828 http://campcourageous.co
Courageous Camp Through Watervill- m/
& The Arc of Translator Swanton
NW Ohio, Road,
Inc. Whitehouse,
OH 43571
Camp Tall Respite Lenawee, Available 943 Lennox 734-834-2495 http://chasingsummer.org/
Tree (Chasing Camp Washtenaw Through Street Ann
Summer, Inc.) Translator Arbor MI
48103
Camp Zip Respite Washtenaw Available 5840 North 734-323-3067 https://www.campziprec.c
Services Through Canton om/
Translator Center,
Canton, MI
48187
Catholic Outpatient Monroe, Available 15945 Canal 734240-3850 https://ccsem.org/
Charities of Services, Washtenaw Through Rd Clinton,
Southeast SUD Translator MI 48038
Michigan Treatment
Agency
Catholic Skill Washtenaw Available 4925 Packard 734-971-2730 http://csswashtenaw.org/
Social Building Through Road Ann
Services of Translator Arbor MI
Washtenaw 48108
County
Centria ABA Livingston, Available 41521 W 11 248-299-0030 https://centriahealthcare.c
Healthcare Autism Washtenaw Through Mile Road om/
Services, Lenawee, Translator Novi MI
Outpatient Monroe 48375-1803
Services
CHS Group CLS, Skill Monroe, Available 1505 Dixie 313-300-8162 https://www.chsgroupmic
LLC Building, Washtenaw Through Drive, Suite 4 higan.com/
Supported Translator Monroe MI

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 Employment 48162
Community Fiscal Livingston, Available 1851 734-482-3300 http://communityalliance-
Living Intermediary Washtenaw Through Washtenaw mi.org/
Network Translator Ave.
Ypsilanti MI
48197-1702
Community CLS Washtenaw Available 1851 734-482-3300 http://communityalliance-
Residence Through Washtenaw mi.org/
Corporation Translator Avenue
Ypsilanti MI
48197
Community Skill Washtenaw Available 32231 734-458-8140 https://communityworkop
Work Building, Through Schoolcraft portunities.com/
Opportunities Supported Translator Road Livonia
Employment MI 48150
Comprehensi Skill Monroe, Available 6001 N 313-535-8220 http://www.csdd.org/
ve Services Building, Washtenaw Through Adams Rd,
for the Supported Translator Suite 165
Development Employment Bloomfield
ally Disabled Hills, MI
48304
Courtyard Licensed Livingston, Available 3275 Martin 248-926-2920 http://www.courtyardman
Manor of Residential Washtenaw Through Rd. Suite 127 orwixom.com/
Wixom Translator Walled Lake
MI 48390
Creating ABA Washtenaw Available 4201 Varsity 734-369-8594 http://creatingbrighterfutur
Brighter Autism , Monroe, Through Drive, Ann es.com/
Futures Services, Livingston Translator Arbor, MI
Outpatient 48108
Services
Dearborn ABA Washtenaw Available 229 N. 313-278-4601 http://75.144.71.189/dssc/
Speech & Autism , Monroe Through Sheldon about_us.htm
Sensory Services, Translator Road,
Center Inc. Outpatient Plymouth MI
d/b/a Services 48170
Metropolitan
Speech,
Sensory &
ABA Centers
Eastern ABA Monroe, Available 1055 Cornell 734-487-2890 https://acc.emich.edu/
Michigan Autism Washtenaw Through Ypsilanti MI
University/ Services, , Lenawee Translator 48197-2214
Autism Outpatient
Collaborative Services
Center
Flatrock Licensed Lenawee Available 1345 Connell 810-354-8581 http://flatrockmanors.com/
Manor of Residential Washtenaw Through St 
Burton East , Monroe, Translator Burton MI 
Livingston 48529
Fowler Center Respite Lenawee, Available 2315 Harmon 989-673-2050 http://thefowlercenter.org/
Camp Livingston, Through Lake Rd.
Washtenaw Translator Mayville MI
48744
Friends Who CLS, Monroe, Available 2770 734-971-6300 http://friendswhocare.com
Care Nursing, Washtenaw Through Carpenter /
Respite, Translator Road, Suite
PrivateDuty 200 Ann
Nursing Arbor MI
48108
Full Circle Drop In Washtenaw Available 750 Towner 734-485-2020 N/A
Drop-In Center Through Blvd.

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Center Translator Ypsilanti MI
48198
Genoa Pharmacy Livingston, Available 3459 651-447-4445 http://www.genoahealthca
Healthcare Monroe, Through Wahington re.com/
Pharmacy Washtenaw Translator Dr. Suite
200A Eagan
MN 55122
Guardian Fiscal Lenawee, Available 215 Broadus 269-651-4500 https://www.gtindependen
Trac LLC Intermediary Livingston, Through St Sturgis MI ce.com/
Monroe, Translator 49091-1686
Washtenaw
Harbor Oaks Inpatient Washtenaw Available 35031 23 586-330-5298 http://www.harboroaks.co
Through Mile Road, m/
Translator New
Baltimore, MI
48047
Havenwyck Inpatient Lenawee, Available 1525 248-373-9200 https://havenwyckhospital.
Hospital Livingston, Through University Dr. com/
Monroe, Translator Auburn Hills
Washtenaw MI 48326-
2673
Henlyn Care Licensed Washtenaw Available P.O. Box 142 734-369-2203 N/A
Inc. Residential Through Whittaker MI
Translator 48190
Hillsdale Inpatient Lenawee, Available 168 S. Howell 517-437-5232 http://www.hillsdalehospit
Comm Health Livingston Through St. Hillsdale al.com/
Center , Translator MI 49242
Washtenaw
, Monroe
His Eye Is On CLS Washtenaw Available 6440 Merkel 734-424-3710 http://www.hiseyeisonthes
The Sparrow Through Dexter MI parrow.org/
Translator 48130
Home of New SUD Washtenaw Available 3115 734-975-1602 https://homeofnewvision.o
Vision Treatment , Lenawee Through Professional rg/
Agency Translator Drive, Ann
Arbor, MI
48104
Home Sweet CLS Washtenaw Available 34 North 734-879-0561 https://www.homesweetho
Home Care Through Washington mecs.com/
Services, Translator Street, Suite
LLC 34, Ypsilanti,
MI 48197
Hope Licensed Lenawee , Available 1256 Walker 616 301-8000 https://hopenetwork.org/b
Network Residential Monroe, Through Avenue ehavioral-health-services/
Behavioral Washtenaw Translator Grand Rapids
Health , MI 49504
Services Livingston
Hope Licensed Washtenaw Available 795 36th 616-248-5104 https://hopenetwork.org/
Network Residential Through Street SE P.O.
West Translator Box 141
Michigan Grand Rapids
MI 45501
Indian Trails Respite Lenawee, Available O-1859 Lake 616-677-5251 http://ikuslife.org/
Camp Camp Livingston, Through Michigan Dr.
Washtenaw Translator NW Grand
Rapids MI
49534
INI Group, CLS Washtenaw Available 2004 734-677-9271 http://inigroupllc.com/
Inc Through Hogback Rd.,
Translator Suite #7 Ann
Arbor MI

22
 48105
JOAK CLS, Washtenaw Available 3820 Packard 734-973-7764 http://www.joakhomes.co
American Licensed Through Road, Suite m/
Homes Residential Translator 1810 Ann
Arbor MI
48108
Judson Center ABA Washtenaw Available 4410 West 13 248-549-4339 http://judsoncenter.org/
Autism Through Mile Road,
Services, Translator Royal Oak,
Outpatient MI 48108
Services,
Respite
Just Us Club Respite, Washtenaw Available 3150 Glazier 734-994-8111 http://justusclub.org/
Skill Through Way Ann
Building Translator Arbor MI
48105
Kairos/Holy SUD Lenawee, Available 8759 Clinton 989-274-1026 https://holycrossservices.o
Cross Youth Treatment Livingston, Through Macon Rd. rg/programs/kairos/
& Family Agency Monroe, Translator (Corp/Billing
Washtenaw Address)
Clinton MI
49236
Language Interpretatio Washtenaw Interpreter 1 Lower 800-752-6096 https://www.languageline.
Line n Services Services Ragsdale or com/
Drive, Bldg wecare@lang
#2 Monterey uageline.com
CA 93940
LifeSpan...A Respite Lenawee Available 524 N 517-784-4426 http://www.lifespancs.com
Community Washtenaw Through Jackson PO /
Service Translator Box 1978
Jackson MI
49204-1978
Macomb CLS, Washtenaw Available 2 Crocker 586-469-4480 N/A
Residential Licensed , Monroe Through Blvd., Suite
Opportunities Residential Translator 205 Mt.
Clemens MI
48043
Michigan CLS, Lenawee, Available 113 N. 269-651-4500 http://agencywithchoice.c
Agency with Respite Livingston, Through Monroe om/
Choice, LLC Monroe, Translator Sturgis MI
(Agency With Washtenaw 49091-1686
Choice)
Michigan Music Washtenaw Available 426 517-884-4828 http://www.cms.msu.edu/
State Therapy Through Auditorium
University Translator Road, Room
Community 360, East
Music School Lansing, MI
48824
Michigan Private Duty Washtenaw Available 2850 South 734-677-1515 https://homecare.med.umi
Visiting Nursing, , Lenawee Through Industrial or 800-824- ch.edu/Michigan-Visiting-
Nurses Respite Translator Highway, 5504 Nurses
Suite #75 Ann
Arbor MI
48104
New Oakland Partial Washtenaw Available 6549 Town 248-467-9946 http://newoakland.org/
Child & Inpatient , Monroe Through Center Dr.
Family Center Translator Ste. A,
Clarkston, MI
48346--4824
Novel ABA, Washtenaw Available 526 W. 269-321-9556 http://www.novelresponse
Responses Outpatient Through Centre Ave, s.com/

23
 services Translator Portage, MI
49024
Nutritional Enhanced Washtenaw Available 3610 West 734-302-7575 https://thenutritionalhealin
Healing of Pharmacy Through Liberty Road, gcenter.com/
Ann Arbor Translator Ann Arbor,
MI 48103
Partners in CLS Washtenaw Available 1100 N. 734-214-3890 http://www.annarborppa.o
Personal Through Main, Suite rg/
Assistance Translator 117C Ann
Arbor MI
48104
Passion of SUD Monroe, Available 14930 734-344-5269 http://passionofmind.net/
Mind Treatment Washtenaw Through LaPlaisance
Agency Translator Rd #127
Monroe, MI
48161
Personalized SUD Monroe, Available 575 S Main St 734-451-7800 http://www.pnlh.org/
Nursing Light Treatment Washtenaw Through Suite 6,
House Inc Agency Translator Plymouth, MI
48170
Pharmacy Enhanced Washtenaw Available 5204 Jackson 734-821-8000 https://www.pharmacysol
Solutions Pharmacy Through Road, Ste. C, utionsonline.com/
Translator Ann Arbor,
MI 48103
Prader Willi Licensed Washtenaw Available 1746 262-569-3164 http://www.pwho.com/
Homes of Residential, Through Executive
Oconomowoc Skill Translator Drive,
, LLC Building Oconomowoc
, WI 53066
Premier SUD Monroe, Available 25639 Ford 313-277-3293 http://www.premiercare.or
Services of Treatment Washtenaw Through Road g/find-a-clinic/dearborn-
Michigan Agency Translator Dearborn heights-mi/
Heights MI
48127
Progressive CLS, Monroe, Available 2950 W. 248-641-7200 http://prs-inc.org/
Residential Licensed Washtenaw Through Square Lake
Services Residential Translator Road, Suite
209 Troy MI
48085
Promedicc Inpatient Lenawee , Available 718 North 734-240-5357 http://mercymemorial.org/
Monroe Monroe, Through Macomb
Regional Washtenaw Translator Street Monroe
Hospital MI 48162-
7815
Psych Behavioral Washtenaw Available 119 Bingham 517-402-4008 N/A
Resolutions, Psychology , Monroe Through Dr.,
LLC Translator Brooklyn, MI
49230
Quest Inc. CLS, Washtenaw Available 32231 734-458-8140 https://quest365.org/
Licensed Through Schoolcraft
Residential Translator Road Livonia
MI 48150
Renaissance CLS, Lenawee, Available 25 E. Main 734-439-0464 https://www.rchi.org/
Community Licensed Livingston Through (Corp.
Homes Inc Residential , Translator Address) P.O.
Washtenaw Box 166
(Mailing
Address)
Milan MI
48160-1284
Renaissance Licensed Washtenaw Available 25 E. Main 734-439-0464 https://www.rchi.org/

24
House Residential Through Street P.O.
Translator Box 166
Milan MI
48160
Residential ABA Washtenaw Available 2400 Science 517-657-7210 https://www.roi-mi.com/
Options, LLC Autism , Through Parkway,
Services, Livingston Translator Okemons, MI
Outpatient 48864
Services
Safehaus, Inc. Crisis Washtenaw Available 21506 Dean 586-806-4678 http://www.safehaus123.c
Residential Through Street, om/
Translator Warren, MI
48091
Saints, Inc. CLS, Washtenaw Available 35115 E. 734-722-2221 http://saintsinc.org/
Licensed Through Michigan
Residential Translator Avenue
Wayne MI
48184
Saline Area Respite Washtenaw Available 7265 Saline- 734-429-8000 https://www.salineschools.
Schools Through Ann Arbor org/
Translator Road Saline
MI 48176
Salvation SUD Lenawee, Available 3250 N 734-384-3402 https://centralusa.salvation
Army Harbor Treatment Monroe, Through Monroe St army.org/
Light - Agency Washtenaw Translator Monroe MI
Monroe 48162
Spectrum CLS, Washtenaw Available 28303 Joy 734-458-8729 http://www.spectrumhuma
Community Licensed Through Road n.org/
Services Residential Translator Westland MI
48185
St. Francis Respite Livingston, Available 10120 Murrey 517-688-9212 http://www.saintfrancisca
Camp on the Camp Lenawee, Through Rd. Jerome mp.org/
Lake Washtenaw Translator MI 49249-
9534
St. Louis Licensed Livingston Available 16195 Old US 734-475-8430 https://stlouiscenter.org/
Center Residential, Washtenaw Through 12 Chelsea
Respite Translator MI 48118
Synod CLS, Washtenaw Available 615 S. 734-483-9363 http://www.synodhelps.or
Community Licensed Through Mansfield g/
Services Residential Translator Street
Ypsilanti MI
48197
The Fowler Respite, Lenawee , Available 2315 989-673-2050 http://thefowlercenter.org/
Center Respite Washtenaw Through HARMON
Camp , Translator LAKE ROAD
Livingston MAYVILLE
MI 48744-
9737
Therapeutic Recreational Washtenaw Available 3514 Indigo 586-212-2671 http://www.therapeuticcon
Concepts, Therapy Through Drive, ceptsllc.com/
LLC Translator Sterling
Heights, MI
48310
Toepfer Licensed Washtenaw Available 1760 Dover 734-485-8281 www.thpx4.me
Home Residential Through Court
Translator Ypsilanti MI
48198
Touchstone Clubhouse Washtenaw Available 821 7th Street 586-764-9906 N/A
Services Through Port Huron
Translator MI 48060
Trinity Health Inpatient Lenawee, Available Box 223737 734-593-1311 http://www.trinity-

25
-Chelsea, St. Livingston, Through Pittsburgh PA health.org/michigan
Joseph, St. Washtenaw Translator 15251-2087
Mary , Monroe
Turning Leaf Licensed Washtenaw Available 621 Jolly Rd 517-393-5203 http://www.turningleafreh
Residential , Lenawee, Through Lansing MI ab.com/
Monroe Translator 48910
University of Inpatient Monroe, Available 1500 E. 734-936-4000 https://www.med.umich.e
Michigan Washtenaw Through Medical du/
Health Translator Center Drive
System Ann Arbor
MI 48109
University Interpretatio Washtenaw Interpreter 220 N. 5th 734-665-7295 http://www.univtrans.com/
Translators n Language Services Street Ann
Services LLC Service Arbor MI
48104
Wallace Behavioral Washtenaw Available 11326 313-590-6955 N/A
PsychService Psychology , Monroe Through Fordline
s, LLC Translator Street, Allen
Park, MI
48101
Washtenaw CMHSP Washtenaw Available 555 Towner, 734-544-3000 https://www.washtenaw.or
County Through Ypsilanti, MI g/839/Community-
Community Translator 48197 Mental-Health
Mental Health
Work Skills CLS, Livingston, Available 100 Summit 810-227-4868 http://www.wskills.com/
Corporation Respite, Washtenaw Through Street
Skill Translator Brighton MI
Building, 48116-2465
Supported
Employment

26