Diversity, Equity, Inclusion, and Accessibility in Disaster Behavioral Health 

The Dialogue 

2024 | VOLUME 19 | ISSUE 2 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 
The Dialogue is not responsible for the information provided by any web pages, materials, or organizations referenced in this publication. Although 

The Dialogue includes valuable articles and collections of information, SAMHSA does not necessarily endorse any specific products or services 

provided by public or private organizations unless expressly stated. In addition, SAMHSA does not necessarily endorse the views expressed by such 

sites or organizations, nor does SAMHSA warrant the validity of any information or its fitness for any particular purpose.

The Dialogue is a quarterly technical assistance journal on disaster behavioral health which 

is produced by the Substance Abuse and Mental Health Services Administration (SAMHSA) 

Disaster Technical Assistance Center (DTAC). Through the pages of The Dialogue, disaster 

behavioral health professionals share information and resources while examining the 

disaster behavioral health preparedness and response issues that are important to the field. 

The Dialogue also provides a comprehensive look at the disaster training and technical 

assistance services SAMHSA DTAC provides to prepare states, territories, tribes, and local 

entities so they can deliver an effective disaster behavioral health response. 

SAMHSA DTAC provides disaster technical assistance, training, consultation, resources, 

information exchange, and knowledge brokering to help disaster behavioral health 

professionals plan for and respond effectively to mental health and substance misuse needs 

following a disaster. 

To learn more or receive The Dialogue, please call 1–800–308–3515, email dtac@samhsa. 

hhs.gov, or visit the SAMHSA DTAC website at https://www.samhsa.gov/dtac. 

CONTENTS 

3 In This Issue 

4 Contributors 

7 How Michigan’s “Stay Well” Program Supported Diversity During the COVID-19 Disaster 

13 DEI: A Legacy in Action 

17 Stress, Resilience, and Psychological First Aid for Buffalo: An Exercise in Cultural Humility 

25 Recent Technical Assistance Requests 

COVER photo by Adobe Stock 
2024 | VOLUME 19 | ISSUE 2 | PAGE 3 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

The field of disaster behavioral health (DBH) has

increasingly recognized the critical importance of

diversity, equity, inclusion, and accessibility (DEIA).

DEIA in DBH refers to the intentional efforts and

strategies aimed at ensuring that individuals from

diverse backgrounds, with varying abilities, and across

different demographic groups receive fair and equitable

access to mental health and substance use services

and support during and after disasters. This approach

recognizes the unique vulnerabilities and needs of

diverse populations, emphasizing the importance of

cultural humility, accessibility, and inclusivity in disaster

response and recovery efforts.

Improving DEIA in DBH is a multifaceted process

that can look different from community to community.

Efforts should be tailored to the needs, current

and anticipated, of the population to be served. By

addressing DEIA considerations in DBH, communities

can enhance their resilience and better support

the mental well-being and behavioral health of all

individuals affected by disasters.

In this issue of The Dialogue, we explore various

perspectives and experiences of DEIA in DBH. The

authors who have contributed to this issue have shared

their challenges, humbling moments, and lessons

learned. It is not always easy to examine one’s personal

privilege and implicit biases for the good of the whole.

To pursue improved DEIA in DBH, however, one must

view their community and its needs through a lens of

historical trauma, expose weaknesses in processes that

may have been established under systemic racism, and

reflect on one’s own inherent prejudices. This can be

hard work, and we thank the authors who shared their

experiences here.

In the first article of this issue, personnel from the

State of Michigan share their experiences reaching

diverse communities during the COVID-19 pandemic,

and a number of strategies for successful outreach

to those populations. Next, Dr. Kermit Crawford,

In This Issue 

Clinical Associate Professor Emeritus from the

Boston University Chobanian & Avedisian School of

Medicine, reflects on his role in the DBH response to

9/11, and the need for continuous quality improvement

in DBH efforts. The final article, from staff at the

State University of New York at New Paltz that were

part of the DBH response to the Buffalo, New York,

supermarket shooting in 2022, is a special feature in this

issue. This slightly longer piece is a “deep dive” into

the immediate DBH response to a racially motivated act

of mass violence, and includes the authors’ experiences

determining how to best serve the needs of a diverse

community and learning the lessons of cultural humility

that emerged with that process.

If you have experience with pursuing improved DEIA in

DBH, other planners and responders can learn from your

efforts and experience. Please contact us to share your

stories and lessons learned.

CAPT Maryann E. Robinson, Ph.D., RN, Acting

Traumatic Stress Branch Chief, Disaster Behavioral

Health Branch Chief

maryann.robinson@samhsa.hhs.gov

Nikki Bellamy, Ph.D., Public Health Advisor,

Division of Trauma and Disaster Behavioral Health

nikki.bellamy@samhsa.hhs.gov

Shannon Loomis, M.A., Director, Substance Abuse

and Mental Health Services Administration Disaster

Technical Assistance Center

dtac@samhsa.hhs.gov
2024 | VOLUME 19 | ISSUE 2 | PAGE 4 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

Paula Detwiller, M.A., is a

Writer/Editor at the Michigan

Department of Health and

Human Services. When the

COVID-19 pandemic began,

Detwiller was enlisted to help

write a proposal for the Federal Emergency Management

Agency (FEMA)/SAMHSA Crisis Counseling

Assistance and Training Program (CCP) grant that

resulted in Michigan’s Stay Well program. Over the

past 4 years, she has been Stay Well’s Communications

Specialist, editing public-facing educational content and

coordinating marketing and promotions. A former radio

news reporter and anchor, Detwiller earned a B.A. in

journalism from Michigan State University and an M.A.

in communication from California State University,

Sacramento. Her career in journalism and marketing has

taken her to six states and strengthened her appreciation

of this nation’s growing diversity.

Robin Jacobowitz, Ph.D., is the

Director of Education Projects

at the Benjamin Center for

Public Policy Initiatives at

the State University of New

York at New Paltz (SUNY

New Paltz). Her expertise is in research and program

evaluation, with a substantive focus on education policy

and public schools. Her most recent research includes

analyses of the New York State assessment program

in grades 3–8, work-based learning in public schools,

and mental health challenges faced by first responders.

Recent program evaluation work includes analyses

of the effects of mental health awareness training on

participants’ abilities to support mental health needs

of youth following a disaster event and a countywide

initiative to address the opioid crisis. In addition to

her research, Jacobowitz works with regional school

Contributors 

Kermit A. Crawford, Ph.D., is

Clinical Associate Professor

Emeritus from the Boston

University Chobanian &

Avedisian School of Medicine,

also formerly Associate

Professor and the Avalon Endowed Chair of Psychology

at Hampton University. He is a licensed psychologist,

teacher, researcher, and consultant. He was Principal

Investigator and Executive Director of a $17.7 million

Reimagine Workforce Preparation Grant from the

U.S. Department of Education (2020) until October

31, 2022. Crawford is formerly Director of the Center

for Multicultural Mental Health (CMMH) at Boston

University School of Medicine and Boston Medical

Center and Executive Director of the Massachusetts

Marathon Bombing Victims/Survivors Resiliency

Center. He has done extensive work in multicultural

behavioral health disaster response, trauma, addictions,

and culturally informed practices across the nation.

Crawford is the recipient of several national, state, and

local awards, citations, and recognitions. He is a former

member of the National Center for Injury Prevention

and Control’s Board of Scientific Counselors for the

Centers for Disease Control and Prevention (CDC)

and the Committee on Developing Evidence-Based

Standards for Psychosocial Interventions for Mental

Disorders of the Institute of Medicine. He is currently

a member of the Disaster Behavioral Health Response

Cadre of the Substance Abuse and Mental Health

Services Administration (SAMHSA) and others. In

addition to his earned doctorate from Boston College,

he is recipient of an honorary doctorate from William

James College. Crawford is a former psychologist for

the National Football League, assigned to the New

England Patriots.
2024 | VOLUME 19 | ISSUE 2 | PAGE 5 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

districts on a variety of initiatives, including the Science

Lab Initiative, which supports the creation of science

labs and science-related project-based learning.

Prior to SUNY New Paltz, Jacobowitz worked at New

York University’s (NYU’s) Institute for Education and

Social Policy and University of Chicago’s Chapin Hall

Center for Children. She holds an M.Ed. in education

policy from the Harvard University Graduate School

of Education and a Ph.D. from the Robert F. Wagner

Graduate School of Public Service at NYU. She is a

trustee of the Kingston City School District Board of

Education.

Jody Lewis, M.A., LLP, has

worked in public behavioral

health at the Michigan

Department of Health and

Human Services for the past

45 years. In early 2020, she

led the pursuit of a FEMA/SAMHSA CCP grant as

part of a comprehensive behavioral health response

to the COVID-19 pandemic in Michigan. The grant

became the basis for Michigan’s Stay Well program,

with Lewis serving as Director. Lewis is the state’s

Disaster Behavioral Health Coordinator and the

Behavioral Health Liaison for Michigan’s Community

Health Emergency Coordination Center. Her work

in disaster behavioral health response began with

assisting survivors of Hurricane Katrina when they

were evacuated to Michigan. During the Flint water

emergency in 2016, Lewis provided leadership for

the development and implementation of a SAMHSA

Emergency Response Grant (SERG) and the SAMHSA

Resiliency in Communities After Stress and Trauma

(ReCAST) grant. She was also instrumental in

developing behavioral health approaches to Michigan’s

hepatitis A outbreak and environmental polyfluoroalkyl

substances (PFAS) contamination. Most recently, she

led the development and implementation of Michigan’s

Tri-County Strong CCP grant to mitigate the impact

of Michigan’s 2021 flooding disaster in metropolitan

Detroit.

Amy Nitza, Ph.D., is the

Executive Director of the

Institute for Disaster Mental

Health at SUNY New Paltz.

She is a psychologist who

specializes in providing mental

health training in academic and nonacademic settings

both nationally and internationally, with an emphasis

on disaster mental health and trauma recovery. As a

Fulbright Scholar at the University of Botswana, she

trained mental health and school counselors and studied

the use of group counseling interventions in HIV/AIDS

prevention among adolescents. She has collaborated

with the University of Notre Dame in Haiti to develop

trauma-related interventions for children in domestic

servitude, and to provide training for teachers in dealing

with traumatized children in the classroom. She is also

currently collaborating with UNICEF USA to develop

and implement a program of mental health support for

children impacted by Hurricane Maria in Puerto Rico.

Nitza is the author and editor of numerous publications,

including the recent book Disaster Mental Health Case 

Studies: Lessons Learned from Counseling in Chaos. 

She is a Fellow of the Association for Specialists in

Group Work and serves on the Executive Board of the

Society for Group Psychology and Group Psychotherapy

(Division 49) of the American Psychological

Association. She holds a Ph.D. in counseling

psychology from Indiana University.

Price Pullins, M.A., is a Chief

Behavioral Psychologist

and Consultant with the

Michigan Department of

Health and Human Services.

In this capacity, he has been

a trusted advisor to the Stay Well program throughout

its pandemic lifespan. Trained in clinical psychology

and applied behavior analysis at Western Michigan

University, Pullins is a subject matter expert in disaster
2024 | VOLUME 19 | ISSUE 2 | PAGE 6 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

behavioral health. He has worked in many areas of the

Michigan public mental health system, including serving

as the Director of the Mount Pleasant Regional Center

for Developmental Disabilities and Assistant Director

of Psychology for the Kalamazoo Psychiatric Hospital.

Pullins is credited with developing and implementing

State of Michigan public policy for autism treatment and

is recognized internationally for his work in developing

the largest psychosocial rehabilitation program for

patients needing long-term care in psychiatric hospitals.

Karla Vermeulen, Ph.D., is

an Associate Professor of

Psychology at SUNY New

Paltz, where she also serves

as the Deputy Director of the

Institute for Disaster Mental

Health. In addition to training disaster responders and

trauma workers from diverse backgrounds, including

mental health and healthcare professionals, educators,

first responders, museum professionals, and librarians,

she teaches undergraduate and graduate courses on

disaster mental health, grief counseling, and lifespan

developmental psychology. Her research on the impact

of multiple stressors on emerging adults is the subject

of her third book, Generation Disaster: Coming of Age 

Post-9/11, which was published in 2021 as part of the

Oxford University Press Emerging Adulthood series.

Erin Wallace is the Founder

and Managing Director

of Bright Leaf Consulting

Services in Grand Rapids,

Michigan. She has over 20

years of experience working in

program development, creation, and implementation.

Wallace joined the Michigan Stay Well program in

2020, assisting with its evolution and eventually

serving as Project Manager until the program ended in

2023. She earned her B.S. in interdisciplinary health

services and gerontology from Western Michigan

University. Much of her career has been spent providing

education and support to healthcare administrators and

staff, particularly in community-based and residential

organizations for the aging. She exhibits an immense

passion for individual and organizational wellness,

coupled with a realistic and hands-on approach to

improving services to often-underserved populations.
2024 | VOLUME 19 | ISSUE 2 | PAGE 7 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

Typical disasters such as floods,

fires, or hurricanes occur at a

moment in time and then recede

as victims reconstruct their lives.

But as we all know, the COVID-19

pandemic did not behave like that.

It rolled along for months like

a runaway train—speeding up,

slowing down, speeding up again—

and altering the lives of diverse

populations along the way.

In retrospect, it was a good thing

disaster behavior health personnel at

the Michigan Department of Health

How Michigan’s “Stay Well” Program Supported 

Diversity During the COVID-19 Disaster 

By Paula Detwiller, M.A., Stay Well grant program, Michigan Department of Health and Human Services

(MDHHS); with contributions from Stay Well program colleagues and MDHHS disaster behavior health specialists

Jody Lewis, M.A., LLP, Erin Wallace, and Price Pullins, M.A. 

and Human Services (MDHHS)

wasted no time applying for the

Crisis Counseling Assistance and

Training Program (CCP) grant

offered by the Federal Emergency

Management Agency with technical

support from SAMHSA. Awarded in

March 2020, the grant allowed the

team to quickly build what became

known as the “Stay Well” program

with a critical mission: to provide

emotional support to vulnerable

groups throughout the state

struggling with COVID-19-related

distress.

“We knew from the start that the

people most vulnerable to distress

were going to be the historically

marginalized groups—racial and

ethnic minorities, non-English

speakers, low-income residents,

people with disabilities, people

with a history of mental health

challenges, and members of the

LGBTQIA+ community,” said Jody

Lewis, original Director of the Stay

Well program. “And with the strict

public health orders in place, we

couldn’t meet people face to face

like we had in previous disasters.

This image was used in a social media post to promote the Stay Well counseling line in 2020. 
2024 | VOLUME 19 | ISSUE 2 | PAGE 8 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

We would need to find other ways of

connecting.”

Laying the Foundation

The first thing Lewis’ grant team

did was launch—and promote—

the Stay Well counseling line.

Anyone in Michigan could call in

anonymously, any time of the day

or night, and receive emotional

support or referral information. Calls

were fielded by experienced crisis

counselors who received additional

training in disaster behavioral

health (a SAMHSA requirement).

Interpretation was available in 120+

languages.

The next step was to hire outreach

specialists who would each support

one of the vulnerable populations

identified in the grant proposal:

seniors, children and families,

healthcare professionals, those with

racial/ethnic health disparities, the

unemployed, the housing insecure,

people with disabilities, people

with substance use disorder, and

immigrants with limited English

skills. The team looked for

specialists with expertise in meeting

the unique mental health needs of

their designated population group,

along with knowledge of the systems

and organizations in place to serve

that group. That way, they could

reach individuals through those

organizations.

The team quickly set up a website

and posted brochures with

COVID-19 coping tips for adults,

older adults, and kids—available

for download in English, Spanish,

Arabic, Chinese, and German.

As COVID-19 cases spread

throughout the state, outreach

specialists went to work creating

psycho-educational webinars

for their assigned population

groups. Through education, these

webinars were designed to validate,

normalize, and humanize people’s

emotional responses to the pandemic

(i.e., “you are experiencing a

normal response to an abnormal

situation”) as well as offer practical

strategies for coping. To ensure

inclusivity, American Sign Language

interpreters were made available.

Gaining Momentum 

The Stay Well program relied on

two things to attract the right virtual

audiences for these webinars:

targeted marketing and selective

networking. With the help of Brogan

and Partners, a metro Detroit-based

creative marketing firm, Stay Well

rolled out a comprehensive media

campaign with the tagline “Be

Kind to Your Mind.” The campaign

included TV and radio spots; social

media; animated mobile ads; signage

for buses and bus shelters; and print

ads for African American, Arab

American, Asian American, and

Hispanic publications. This print ad ran in January 2021 in the Detroitbased Latino Press Newspaper, recognized as the 

largest Hispanic media outlet in Michigan. 

The first thing Lewis’ grant 

team did was launch—and 

promote—the Stay Well 

counseling line. Anyone 

in Michigan could call in 

anonymously, any time 

of the day or night, and 

receive emotional support 

or referral information. 
2024 | VOLUME 19 | ISSUE 2 | PAGE 9 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

The other method of drawing

audiences was to enlist the help

of community organizations that

were already a trusted resource

for their constituents. Partnerships

were formed with family services,

local health departments, homeless

shelters, advocacy groups, school

districts, trade associations,

emergency medical services

organizations, and addiction

counseling centers, as well as the

State of Michigan departments of

civil rights, education, aging adult

services, and rehabilitative services.

Through these connections, Stay

Well got brochures distributed

at COVID testing sites in lowincome neighborhoods (one of the

few places people were visiting

in person at the time). Later, Stay

Well connected with emergency

preparedness coordinators

across Michigan, requesting that

vaccination clinics also hand out

Stay Well brochures.

Always Evolving 

As the pandemic “runaway train”

zigged and zagged, Michiganders

experienced different pain points.

There was sickness, death, and

grief. Large-scale unemployment.

Postponed funerals, weddings,

and sporting events. Political

skirmishes—even death threats—

erupted over mask-wearing and the

timeline for sending kids back to

school. Hope emerged as vaccines

became available, businesses

reopened, and stimulus checks were

issued. Then came the arrival of

COVID variants, vaccine refusals,

and shocking evidence of how

deeply the pandemic affected youth

mental health.

“The Stay Well team was watching

the impacts of all these pain points

and constantly adapting their

programs to address them,” said Dr.

Debra Pinals, the state’s Medical

Director for Behavioral Health and

advisor to the Stay Well program.

By design, the program hired

outreach specialists who were

themselves diverse, coming

from different racial and ethnic

backgrounds and bringing realworld experience with traumatized

individuals from all walks of life.

Many of the outreach specialists

were licensed clinical social

workers. Over the years the team

included a paramedic, a school social

worker for at-risk kids, an addiction

counselor, a police officer, a youth

mental health counselor, and an

eldercare manager, among other

community-based positions.

“Most of our team members had

second jobs in their respective fields,

so they knew where, when, and how

emotional support was needed,” said

Erin Wallace, Stay Well’s Program

Manager. “We met as a group

every week to brainstorm ideas for

programming that would hit the

mark.”

Here are examples of programs and

tools they developed for diverse

groups.

Older adults 

People in nursing homes were

among the first U.S. victims of

COVID-19. That fact caused older

adults across Michigan to suffer

tremendous anxiety along with

loneliness from forced isolation.

Stay Well offered an emotional

lifeline by forming a virtual support

group (on Zoom) for older adults. As

proof of its effectiveness, a handful

of participants who met in the group

became friends who continue to

socialize to this day. In addition,

...The Stay Well counseling 

line supported a large 

number of older adults 

residing in long-term care 

facilities throughout the 

state. Many expressed 

gratitude for a friendly 

voice and listening ear.... 
2024 | VOLUME 19 | ISSUE 2 | PAGE 10 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

the Stay Well counseling line

supported a large number of older

adults residing in long-term care

facilities throughout the state. Many

expressed gratitude for a friendly

voice and listening ear, at any time

of day, to help them feel connected

again.

not, professional burnout became

commonplace, especially among

overburdened essential workers.

Stay Well responded with a public

webinar called Addressing Burnout,

which helped employees cope with

the burnout, compassion fatigue,

and secondary traumatic stress

they were feeling while performing

their duties. The webinar attracted

a total of 1,901 Zoom attendees. It

was later renamed Beyond Burnout

and customized specifically for first

responders, healthcare workers,

teachers, and beleaguered public

health officers, helping these groups

understand their stress and regain

positive perspective.

Teens and young adults 

Throughout the pandemic, as studies

documented increasing rates of

anxiety, depression, and suicide

among young people, Stay Well

offered a number of resources to

help. Two free brochures, Tips for 

Teens and Tips for LGBTQ Youth, 

provided ideas and links for coping

with pandemic restlessness and

stress. A webinar called Friends

Helping Friends explained what a

panic attack looks like, how anxiety

can change a friend’s behavior,

and how to best offer support. (A

companion webinar with similar

content was developed for parents.)

Staying Well: An Emotional Health

Workshop for Teens supported

adolescents struggling with big

emotions. And a series of 5-minute

videos called Take a Pause 

demonstrated mindfulness and

meditation techniques that teens

could access online when needed.

People struggling with grief 

A recurring webinar series called

Coping with Grief and Loss became,

sadly enough, the Stay Well

program’s most frequently attended

series. Launched in late 2021, it ran

repeatedly for 2 years, gaining a

loyal following. Attendees reported

being comforted by the camaraderie

and support of others, whether they

were grieving the loss of loved

ones, jobs, or a former way of life.

The multipart series was led by an

outreach specialist instrumental

in attracting members of her

predominantly Arabic-speaking

community in metro Detroit—adults

who would not traditionally seek

emotional support outside of their

families.

Mental health maintenance 

for all 

When winter turned to spring in

2021, the Stay Well team wanted

to acknowledge that everyone had

been touched in some way by the

This social media post promoted a three-part Stay 

Well webinar series for K–12 educators in the 

winter of 2022. 

School-age children 

When students returned to

classrooms after missing a year of

academics and socialization, they

often had trouble focusing and

managing their emotions. Teachers

were becoming overwhelmed

trying to manage student behavior.

In response, Stay Well created

a three-part webinar series for

teachers called Helping Students 

Thrive: Tools for Promoting SocialEmotional Development. Educators

from around the state expressed their

enthusiasm and thanks.

Essential workers 

As the pandemic created a divide

between employees who could work

from home and those who could

Throughout the 

pandemic, as studies 

documented increasing 

rates of anxiety, 

depression, and suicide 

among young people, 

Stay Well offered a 

number of resources 

to help. 
2024 | VOLUME 19 | ISSUE 2 | PAGE 11 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

turmoil, fear, and sadness COVID

brought, and could perhaps use some

mental health maintenance. The

result was the Summer Resilience 

Series, consisting of eight weekly

webinars featuring guest speakers

on mindfulness, art, music, exercise,

and other optimism-restoring

practices. The speakers were all

from Michigan, and selecting

presenters from various backgrounds

was intentional to encourage a

diverse group of attendees.

“It was a time for healing, and

people let us know how much they

appreciated it,” said Wallace.

That project led to more ideas

for helping to build emotional

resilience. A new webinar series was

started for parents and their kids

called Draw Your Feelings! Helping 

Your Child Grow Emotionally 

Through Art. As more and more

families joined in, the series was

renamed Creative Coping and

repeated every couple of months.

Another webinar series, Beyond the 

Plate, explored emotional issues

around eating and the pandemic’s

impact on our diets and self-image.

Stay Well also produced a set of

animated videos called Cultivating 

Joy, using sketch imagery and

narration to demonstrate the

therapeutic value of positive

psychology, joyful activities, and

an attitude of gratitude. The videos

were posted to the Stay Well website

and ultimately received more than

3,400 total views.

As the pandemic began to recede in

2022, Stay Well captured a societal

yearning for calm by starting a

giveaway program called “Create

Your Calm.” They designed and

produced educational items branded

with that motto and made them

available free of charge to schools,

libraries, businesses, and other

community organizations across

the state. The collection included

posters demonstrating chair-yoga

poses, posters and stickers for kids

illustrating the “square breathing”

technique, magnets imprinted with

a simple grounding exercise, and

squeezy “stress balls” to relieve

tension in the body. Hardcopies of

multi-language brochures could

also be ordered. At last count, 1,200

orders were placed for a total of

670,000 items.

Takeaways and Lessons 

Learned 

It’s only fitting that a prolonged

disaster with widespread mental

health impacts warranted a

prolonged response—and Stay

Well was able to keep operating

for more than 2 years after the

CCP grant funding was exhausted,

using state and federal funding

sources. The official end of the

COVID-19 public health emergency,

however, reduced opportunities for

continued funding and the program

had no choice but to sunset at the

end of 2023. Stay Well’s legacy

of impactful programming is still

available, in recorded form, on

the MDHHS website. Meanwhile,

the team was happy to share a few

takeaways for behavioral health

professionals interested in creating

similar programs for future disaster

response:

• Find ways to destigmatize.

Mental health remains a

touchy subject in the national

conversation, particularly for

some racial and ethnic groups.

To bypass the stigma attached to

seeking mental health services,

try positioning programs as

This slide promoted the variety of guest speakers in Stay Well’s Summer Resilience Series, July–August 

2021. 
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A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

“By engaging with the whole community during nonemergency 

times, organizations can develop relationships over time and 

become trusted messengers for all populations. . . . Some best 

practices for building trust in disaster planning and response 

include the following: 

Lead with humility. Go into every encounter with 

an open mind and an understanding that survivors 

may be experiencing trauma and hardship. It’s also 

important to understand the historical trauma 

experienced by the communities you are serving, 

their resilience, and the environmental injustices 

they may be facing. 

Use a mix of outreach strategies and 

channels. To engage and build rapport with 

multicultural populations, use a variety of 

communication methods so that survivors are 

more likely to become aware of your program. 

Communications should be culturally appropriate 

and use language familiar to your audiences” 

(Emergency Partners Information Connection, 2023). 

“enrichment” rather than outright

mental health support. Stay Well’s 

Summer Resilience Series and

Beyond the Plate were examples

of this approach. They sparked

interest in residents who may have

needed our services, but probably

would not have sought them

otherwise.

• Create incentives for

participation. Certain vulnerable

populations will not readily accept

offers of emotional support. For

example, first responders and

healthcare workers who witnessed

daily life-and-death COVID drama

were in desperate need of support

but had little time to access it.

Along with time and energy

constraints, these professionals

have an others-come-first mindset,

which runs counter to the self-care

mindset needed to heal. Stay Well

found that one way to reach these

professionals, however, was to

offer continuing education credits

for attending the webinars.

• Allow time for interaction. Stay

Well discovered that scheduling

discussion time following certain

psycho-educational webinars,

such as Coping with Grief and

Loss, added to the participant

experience. Some people find

it difficult to share their inner

fears and worries with loved

ones but will open up in the

company of like-minded strangers.

Unburdening in that way can

create a sense of relief. ■
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A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

I have practiced my profession of

psychology for more than 30 years.

Diversity, equity, and inclusion

(DEI) was always a consideration,

whether as an individual contributor

or as a leader. Each succeeding year,

I am reminded of the gravity of

the term “practice” as I continue to

learn and grow, hopefully becoming

an even better practitioner. Years

of practice enable more effective

integration of knowledge and

experience. The combination

contributes to enhanced wisdom and,

theoretically, yields better results.

Lessons from times past can, and

often do, have application in current

times. In this regard I am reminded

of such a lesson that elucidated the

importance of DEI for a lifetime of

learning and practice.

This example takes me back to

March of 2001. I was working

as Director of the Center for

Multicultural Mental Health

(CMMH) in the Department of

Psychiatry at Boston University

School of Medicine. In that

month I was asked if my team of

clinicians (mostly psychologists

and doctoral-level psychology

interns) would agree to join the

Metro-Boston Emergency Mental

Health Response Team. We

were a multicultural, multiracial,

multiethnic, multilingual,

multigender, and multigenerational

team. We explicitly centered valuing

differences; equitable, quality

services delivery; innovation;

and creative thinking within the

ethical framework of our respective

trainings and profession. It was an

easy “yes” responding to the request,

although in that moment I had no

idea of how profound that decision

would ultimately be to my program

and to my career. None of us could

have predicted the seminal event that

would happen 6 months later which

would change the course of U.S.

history and of our lives. While this

event happened more than 22 years

ago, the lessons learned shaped the

careers of many who were involved,

and the lessons remain relevant

today.

On Tuesday, September 11, 2001,

upon arriving at work at 9 a.m.,

my assistant informed me of “an

accident” that happened as a “small

plane had flown into the World

Trade North Tower in New York

City.” At that point, we turned on a

television in our conference room to

watch the aftermath of what had just

taken place in NYC. Soon after, and

to our horror, another jet plane flew

into the second tower (South Tower).

At that point, it became clear that

this was an intentional act and was

devastating. We soon learned that

the two jets had flown from Boston’s

Logan International Airport and that

other apparently hijacked planes

originating from other locations

remained in flight.

DEI: A Legacy in Action 

By Kermit Crawford, Ph.D., Department of Psychiatry, Boston University Chobanian & Avedisian School

of Medicine
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A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

Within an hour, the Metro-Boston

Emergency Mental Health Team

was mobilized as part of the Unified

Incident Command System (UICS).

Mobilization included the CMMH

team. As we had drilled (full-scale

and tabletop), we were asked to

immediately come to the airport with

awareness of our responsibilities

and duties. Upon arriving at Logan

we were assigned to our positions.

I was assigned to coordinate staff

and direct activities in the adult

behavioral services room of the

Family Assistance Center (FAC).

The FAC was the first congregate

station, after intake, registration,

vetting, and clearance, where all

family members and significant

others of the victims who lost their

lives on the ill-fated flights were

assembled. All family/significant

others after vetting who chose to

join us were accommodated and, by

far, it was a majority.

The FAC was part of the UICS,

which included law enforcement

(e.g., Federal Bureau of

Investigation, Massachusetts State

Police), members of the National

Transportation Safety Board,

uniformed responders, hospital

personnel, and other agencies, such

as the Medical Examiner’s Office.

This was the nerve center of all that

happened at Logan over the next

week plus. It was surreal, and the

memories remain so vivid.

In addition to the family members

and significant others, we provided

trauma behavioral health services to

airline personnel, including ground

crew, counter staff, grounded flight

crews from around the nation and

world, and other airport personnel.

We organized ourselves, along with

partnering agencies, to provide

services 24 hours a day, 7 days a

week.

As mentioned previously, there

were many lessons learned and/

or reinforced from this unique, and

hopefully never to be repeated,

event. One such lesson was that

the success of crisis intervention

correlates to a high degree with

prior preparation. This related to

the notable benefit of prior drills

(communication approaches,

emergency planning, and strategic

partnerships). The strength,

commitment, trustworthiness, and

competence of colleagues was also

indispensable in this novel, fastmoving, critical incident.

This was a real-life example of

much of what we previously learned

in trauma response and of our

commitment to all aspects of our

service. The importance of DEI was

patently evident. The beneficiaries

were the many individuals that we

helped in this crisis situation.

More than 40 years of research and

numerous implementation efforts

related to DEI have taken place

(Washington, 2022). Organizations,

such as CMMH, progress through

predictable steps toward reaching

efficacy and effectiveness with

DEI (ranging from skill building to

role-modeling to problem-solving to

camaraderie and mutual respect and

support). The five associated stages

are awareness, compliance, tactical

implementation, integration, and

sustainment. An organization’s DEI

work is ideally conducted pre-crisis

and integrated into daily operations,

decision-making, and organizational

culture.

Implementation of DEI is a

systematic developmental process

progressing from the foundational

stages through to the final stage.

Foundational to our CMMH Crisis

Response Team (CRT) was a

collective vision of values and a

commitment to what was essential

to manifest these values. The vision

centered on a keen awareness and

understanding of the importance

of inclusion and diversity, both

individually and collectively in

our operations, services, activities,

and organizational culture.

Awareness included a demonstrable

commitment to recruiting and

including staff from different races,

ethnicities, languages, genders,

religions, sexual orientations,

countries of origin, and other

important identities. This was shown

to be essential as many of the flight

victims’ families and significant

others were from several countries

The importance of DEI 

was patently evident. 

The beneficiaries were

the many individuals 

that we helped in this 

crisis situation. 
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A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

and cultures of origin. While a

daunting task, it would have been

even more challenging had we

not studied and practiced the DEI

principles and orientation prior

to the 9/11 emergency. It was not

simply knowing our professional

expertise, but also knowing our roles

and the transcendent aspects of what

we were attempting to accomplish.

It was about serving traumatized

families and individuals in the most

effective way possible (to the best

of our abilities) and about individual

and collective accountability.

The CRT was in compliance with

governmental regulatory direction

and guidelines (e.g., Federal

Emergency Management Agency,

Massachusetts state guidelines, and

other agencies). This meant staying

within the bounds of assigned duties

and responsibilities, appropriately

utilizing the UICS, and following

up. With this understanding, we

conducted our assigned duties.

There were multiple examples

of the effective implementation

and execution of our tactical DEI

approach. All families that entered

the FAC were greeted, screened, and

assigned to an individual clinician

unless they requested otherwise.

We paired families with culturally

matched and language-matched

clinicians, where feasible. However,

all clinicians were versed in the

multicultural approach to behavioral

health and DEI principles. Among

the first families to enter the FAC

was a Spanish-speaking family

from a Central American country.

Two Spanish-speaking members

of our staff greeted the family

(about 15 members) and escorted

and supported them (including

food) throughout their stay. Trauma

therapy, initially, was typically

secondary to vigilance and a

compassionate presence. Soon

after, an Italian family entered the

FAC and preferred just to be with

family. Their request was honored,

and they were informed of available

services, should they desire them.

For families with specific religious

practices, we would honor their

preference as they worked with

allied professions. Similar stories

were repeated over and over. We

were prepared for differences,

including having a Russian-speaking

clinician and cultural guide for a

Russian-speaking family. While

not all individual circumstances

could be so thoroughly addressed,

the needs of a vast majority of

traumatized individuals were met.

The CRT’s inclusion and diversity

efforts were integrated throughout

the CMMH organization from

“top-to-bottom and bottom-totop.” DEI was integrated into all

aspects of decision-making, policies,

practices, and accountability

measures. The impact of DEI on

The Federal Emergency Management Agency uses 

a measure called the National Risk Index (NRI) to 

identify levels of risk from natural hazards in locations 

across the United States. Using NRI and other federal 

data, the U.S. News & World Report found that risk 

levels varied by race and ethnicity, and people of 

almost all races and ethnicities other than nonHispanic white faced greater risks posed by natural 

hazards than white people (Johnson, 2022). 
2024 | VOLUME 19 | ISSUE 2 | PAGE 16 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

key stakeholders was incorporated

into our deliberations. This was

done through frequent discussions,

open and authentic communication,

information sharing, observation,

and other activities to support our

collective values and orientation.

In the steps toward reaching

effectiveness with DEI, the final

stage is that of sustainment.

This should emerge from the

foundation of the other four stages

and is done when inclusion and

diversity are fully integrated into

organizational operations and

culture. This commitment was

even reflected in our name, “The

Center for Multicultural Mental

Health.” With a strong leadership

team in place, we made efforts

to track progress, review actions,

provide feedback, hold each other

mutually accountable, and engage

in continuous quality improvement.

Our organizational structure, based

on inclusion and diversity values,

had been in place in 2001 for 29

years prior. It remains today and

continues with its commitment to

inclusion and diversity now for 51

years. The organization continues

its legacy and to build an inclusive

culture.

One other point. In my opinion, an

overarching component of inclusion

and diversity, or any behavioral

health services for professionals, is

to do our best. As mentioned above,

what we do is called “practice” of

our profession and, again, the more

we practice the better we should

get. We are making successive

approximations to being our best

selves and professionals. There is

an analogous statistics term that

would say that we are striving to

achieve an asymptote (i.e., our best).

As with an asymptote, our best is

admittedly aspirational. Still an

asymptote is a value that, through

successive striving, gets us closer

and closer to the goal. This is despite

our inability to achieve it. This

implies both the challenge and the

virtue of the concept. This should

not be discouraging as the more we

strive, the better we become and—

theoretically—the closer we will

get to being “the best we can be.”

This is our conception of continuous

quality improvement.

Finally, we acknowledge that it took

a village to provide the services

and meet the challenge that CMMH

and others met on 9/11/2001. A

devastating event happened that

was met with an even greater good

by so many. Despite the challenge,

we managed and were honored for

excellence in service by several

external organizations. There

were other nuanced aspects of

operations that were accounted for

but not mentioned here. We were not

perfect, although we collectively and

individually aspired toward doing

our best every moment of every day.

There were lessons learned from

our work, as we discovered during

debriefing sessions. However, the

importance of the concepts and

values of DEI were evident from the

outset.

Although the example is somewhat

dated, DEI principles and values

continue to support effective

behavioral health operations and

interventions, and it is hoped that,

despite political and other “winds to

contrary,” this paragon of excellence

for behavioral health services will

sustain. The principles and values

of DEI in action are as relevant and

beneficial in 2023 as they were in

2001. ■
2024 | VOLUME 19 | ISSUE 2 | PAGE 17 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

Stress, Resilience, and Psychological First Aid 

for Buffalo: An Exercise in Cultural Humility

By Karla Vermeulen, Ph.D., Institute for Disaster Mental Health at the State University of New York at New

Paltz (SUNY New Paltz), Amy Nitza, Ph.D., Institute for Disaster Mental Health at SUNY New Paltz, and Robin 

Jacobowitz, Ph.D., the Benjamin Center at SUNY New Paltz

On May 14, 2022, an 18-year-old

white male walked into a Tops

Friendly Markets store in Buffalo,

New York, and opened fire, killing

10 people and injuring 3 more.

Two of the injured were white;

the rest of the victims were Black.

The shooting was labeled a racially

motivated act of domestic terrorism

(New York State Division of

Homeland Security and Emergency

Services, 2023). The shooter

targeted that particular store due to

its location in East Buffalo, where

72.5 percent of the population in

the ZIP code of the attack is Black.

The store where the attack occurred

played an important role in the

East Side neighborhood. Centrally

located in the community, it was the

only full-service grocery store within

a 3-mile radius. Residents relied on

it not only for the purchase of fresh

food but also to fill prescriptions,

pay utility bills, and access a 24/7

ATM.

The immediate response of

New York State (NYS) included

mobilization of Office of Victim

Services staff to provide direct

services on the ground, the provision

of $2.8 million to support victims

and their families with immediate

needs like funeral expenses, and the

establishment of a Family Resource

Center in coordination with the FBI.

Within 2 weeks, an NYS interagency

team was established to coordinate

the short-term response, with the

goal of identifying and addressing

the main needs of the community

and identifying areas where the

Psychological First Aid (PFA) is an approach to help survivors, witnesses, 

and responders to disasters and other traumatic incidents. Designed to 

address needs in the immediate aftermath of an incident, PFA offers mental 

health workers and other responders an organized method to help people 

meet their needs, cope with their reactions, and improve adaptive functioning 

over time. PFA was created by the National Child Traumatic Stress Network 

(NCTSN) and National Center for Posttraumatic Stress Disorder (PTSD) in 

collaboration with experts in disaster research and response. It is informed 

by evidence about how disasters and other collective traumas impact 

communities. Learn more at NCTSN’s About PFA web page and the National 

Center for PTSD’s web page about PFA. 
2024 | VOLUME 19 | ISSUE 2 | PAGE 18 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

state could best support the local

response.

The initial mental health response

was established at the Johnnie B.

Wiley Sports Pavilion, a community

location within the impacted area.

The response was coordinated by the

Erie County Department of Mental

Health and included key community

mental health providers, including

BestSelf Behavioral Health,

Spectrum Health Services, Endeavor

Health Services, and Crisis Services

of Buffalo and Erie County. Many of

the mental health responders onsite

were white. The presence of white

outsiders, sent in to offer “help”

in response to a racially motivated

attack by a white outsider, was not

welcomed or experienced as helpful

by the local community, revealing

a gap in preparedness which the

current project sought to address

as one part of a SAMHSA grant

awarded to NYS Office of Mental

Health (OMH).

Chris Marcello, M.P.A., Director

of the Buffalo-based OMH Western

New York Field Office, is serving

as the grant’s Project Director.

According to Chris, “When the

shooting happened, there was the

opportunity to apply for funding

through a SAMHSA Emergency

Response Grant (SERG). The SERG

program is specifically designed to

fund mental health services in the

wake of a disaster, often a natural

disaster, but in this case it was a

racially motivated massacre. . . .

Based on our relationship with the

Institute for Disaster Mental Health,

part of the $2.35 million grant was

to include Psychological First Aid

training.” Two other grant program

components funded nontraditional

mental health services through

community arts and social services

organizations, and traditional mental

health counseling provided for the

African American community by

African American clinicians through

BestSelf.

OMH turned to the Institute for

Disaster Mental Health (IDMH) at

SUNY New Paltz for the training

component of the grant based on

our longtime partnership. IDMH has

developed and taught disaster mental

health training curricula across NYS

for well over a decade, including

creating the disaster-focused

Psychological First Aid Train-theTrainer (PFA TTT) curriculum that

was the original focus of our part of

this broader project. The plan was

for IDMH to provide 10 PFA TTT

deliveries in spring and summer

2023, with a goal of training 150

Buffalo residents who would then

teach PFA in their communities.

The intention was to shift future

mental health response to include

significantly more people of color

than OMH was able to mobilize

after the Tops shooting.

In January 2023, Jennifer Lewis

Johnson, Ph.D., was brought in by

OMH as the Program Coordinator,
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A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

relocating from her home in Texas

to develop and oversee all activities,

and Vanessa Jones, B.S.W., M.Div.,

was hired as the Program Crisis

Counselor. Both women are African

American. Vanessa is a native of

the region and brought 30 years of

experience in community social

service work to the grant, while

Jennifer contributed extensive

training and project management

skills. Jennifer also renamed the

project “Reimagine, I am the 

Change” and created a butterfly

logo to emphasize the community’s

capacity for growth and renewal.

Initial concerns among the OMH

staff—which were very much

shared by the IDMH staff, who are

all white—were about the race of

the trainers. Original plans were

for the IDMH Executive Director,

Amy Nitza, Ph.D., and Deputy

Director, Karla Vermeulen, Ph.D.,

supported by Project Coordinator

Andrew O’Meara, M.S., to deliver

the initial sessions and then to bring

in experienced co-trainers we had

previously worked with who live in

the region, but who are also white.

While we have worked with trainers

of color in local communities in

different parts of the world, we

were embarrassed to realize that

we had no one to bring in here in

New York. So, once we all started

openly discussing those concerns,

we pivoted to begin with Karla

co-training with a Black Buffalo

resident, André J. C. Stokes, M.S.W.,

CASAC. André had been involved

in the shooting response through

his role at BestSelf, which he had

presented on at a recent IDMH

conference, so he added firsthand

understanding of the event and the

community. André also consulted on

the training content and participated

in two focus groups with community

members. As we were preparing for

the first deliveries, Jennifer raised

the idea of Vanessa becoming a cotrainer for the later deliveries, which

worked beautifully.

Listening to the Community 

The next step in the process, after

multiple internal conversations

among the OMH and IDMH staff

members, was to hold two virtual

focus groups/listening sessions in

May with representatives from the

grantee organizations who were

receiving funding for nontraditional

mental health activities and who

would be some of the eventual

trainees. Among them were leaders

from the Pappy Martin Legacy

Jazz Collective, which uses jazz

concerts and music lessons as a

source of healing and connection,

and the Galactic Tribe, which uses

Afrofuturism and the Black Panther

story to inspire African American

youth to explore science, technology,

engineering, and mathematics field

activities.

These discussions were intense.

Participants were very honest about

their justified displeasure with the

idea of people from outside the

community coming in and thinking

they knew how to help—which was

precisely what they had experienced

immediately after the shooting,

and really throughout their lives.

As Chris Marcello observed, “I

think the individuals that were part

of these focus groups were hurt.

There is a historic level of distrust

of the state and of something that

refers to itself as an institute like

IDMH. There was so much work

to be done, and part of this work

was recognizing that we were

starting from a place of mistrust and

needed a trusting partnership, both

Website of a grantee that provided nontraditional mental health services and helped shape other services 

in Buffalo. 
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in developing and delivering the

training.”

Jennifer echoed that point about

trust, and the need to tailor the

training content to the specific crime

as well as the underlying cultural

factors: “We had a Caucasian young

man go into a predominantly Black

community and murder 10 Black

people. It was straight racism. So

cultural competency came up in our

conversations. How does that look?

How do we reframe it? How do

we word it? How is it relatable and

applicable? Systematic injustices

that lend themselves, of course, to

racism, to social injustices—how

do you talk about these things in

the framework of Psychological

First Aid? What is it that we’re

endeavoring to say to the community

about good mental health practices

without talking about poverty,

drugs, racism, and all of the other

social detriments or determinants

impacting this community? How

do you come into a predominantly

African American community

and not talk about faith, religion?

How do we talk about anger? And

displacement or microaggressions?

We needed real words, real

conversations.”

As Jennifer’s comments

demonstrate, these listening sessions

made it clear that while the Buffalo

community was still suffering

emotionally from the shooting, that

event was layered on top of multiple

chronic stressors and sources of

trauma that were not acknowledged

in the standard PFA curriculum,

particularly the impact of racism.

There were underlying issues with

both the original trainers and the

training materials that needed to be

addressed if there was any chance of

the program achieving the intended

goals.

Throughout these discussions, the

IDMH staff members did our best to

listen openly and non-defensively,

and to avoid taking these very

fair critiques of the original PFA

curriculum personally, though

that was challenging at times.

The real transformational shift in

our perspectives came after Karla

attempted to acknowledge the limits

of PFA, saying it’s the equivalent of

cleaning a wound so natural healing

processes can begin, but it’s not

sufficient to treat a broken leg. One

of the participants, John Washington,

Director of Training and Operations

at the Galactic Tribe, responded that

“some people in our community

have been walking around on two

broken legs their entire lives.”

That statement became our guiding

principle in reshaping the rest of the

project.

Revision Phase 

After that listening session ended,

the three IDMH staff members

agreed that a significant curriculum

overhaul was needed. That effort

wasn’t funded in the grant subaward,

but it was so clearly necessary, we

decided to proceed anyway. Based

on notes from the focus groups and

other discussions with the OMH

staff, we began revising the slides

and manuals with these main goals:

• Reduce the focus on traditional

disasters.

• Add content on stress reactions,

including the chronic and

intergenerational stressors many

Buffalo residents experience.

SERG Program Crisis Counselor and project co-trainer Vanessa Jones, third from left, with 

training participants. 
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• Add a section on the many forms

of racism and their physical and

mental health impacts.

• Expand material on maintaining

helper resilience.

• Emphasize the role of faith and

spirituality throughout.

• Increase interactivity and

opportunities for discussion.

• Change slide images to reflect the

Black population.

We also wanted to be very clear

about the limits of PFA, including

adding Mr. Washington’s quote (with

his permission) followed by a slide

noting that “No training or basic

intervention can change the source

of these chronic problems, but using

Psychological First Aid and other

methods we’ll discuss, you may be

able to provide your community

with some tools for coping with their

own reactions. That might help to:

• Validate the inequities they’re

living with

• Give them new approaches for

managing their emotional distress

• Give them energy to keep fighting

to change the system

Each draft was reviewed and

commented on by Amy and Andrew

at IDMH, Jennifer and Vanessa

at OMH, and André as a Buffalobased consultant. Once all were

reasonably satisfied with the new

version, Jennifer and Vanessa

organized three pilot deliveries in

August 2023, delivered by Karla and

André to a total of 22 participants.

These trainees were informed that

the curriculum was still a work

in progress and their feedback

was very much wanted for a final

round of revisions, and they fully

delivered on that request. Karla

returned home with pages of notes

about additional changes—some

structural, like areas to reorganize

or clarify, as well as many valuable

points about content additions. That

led to expansion of sections on the

mental health impacts of racism on

children and adults, the exhaustion

caused by code-switching, the role

of social determinants of health on

urban residents, and many other

improvements. Those changes

were made; everyone did a final

review; and the slide and manual

content were then locked down for

the remaining deliveries, which

were held from September through

November. Vanessa stepped into

the role of co-trainer as well as

organizer for these training cohorts,

and Jennifer attended sessions to

provide context and inspiration

about next steps for each cohort.

In the view of the grant Principal

Investigator (PI), New York State

OMH Associate Commissioner

Christopher W. Smith, Ph.D., “I

think the changes make it a more

adaptable training in general,

because the effects of trauma

and these traumatic community

events are widespread. Not only

were the content and the examples

made more specific to the African

American community, but they were

more embedded. The training now

addresses not only the traumatic

event, but also ways the response

is complicated by historical,

personal, environmental, and

community factors. The shift to

make the training more applicable

Co-trainer Karla Vermeulen, left, with a group of training participants (including Ms. Odessa, in a black 

hat, who returned the next day with framed photos and catfish lunches for the trainers).
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issues, and we were relieved to

receive high mean ratings on all

points:

and culturally competent for the

African American population also

makes it more appropriate for other

underserved populations as well.”

Jennifer and the OMH team are now

in the process of creating a “training

hub” where participants will be

able to access all materials and get

support in planning deliveries, to

ensure they feel prepared to roll the

material out to their communities.

Train-the-Trainer Results 

Ultimately, Karla, André, and

Vanessa delivered 12 PFA TTT

sessions between August and

November 2023. A total of 142

community members participated.

Among the 102 participants

who completed a post-training

assessment conducted by OMH, 75

percent identified as Black/African

American and 17 percent as white.

Four-fifths were female, and ages

varied widely: 1 percent were 18–21

years old, 18 percent were 22–30,

36 percent were 31–49, 33 percent

were 50–64, and 12 percent were 65

or older. Community roles varied as

well:

• Community Leader: 36 percent

• Community Member: 13 percent

• Community Advocate: 8 percent

• Reimagine Grantee: 11 percent

• Faith-based Leader: 14 percent

• Other Role: 19 percent1

Several of the assessment questions

asked specifically about cultural

Post-training Evaluation 

Question 

Mean 

Score* 

The training staff was

representative of my

community.

3.6 

The training staff was

respectful of my culture/

ethnicity.

3.7 

The course content was

culturally appropriate. 3.7 

The course content

incorporated cultural

values and beliefs shared

in my community.

3.6 

*Participants used a 4-point Likert scale 

to indicate their agreement with each 

statement: 1 = Strongly disagree; 

2 = Disagree; 3 = Agree; 4 = Strongly agree 

see many people networking and

making connections about future

collaborations. We were particularly

honored that several participants

in the focus groups, including Mr.

Washington, attended later trainings

and expressed satisfaction with the

way we responded to their concerns.

One attendee, a retired police officer,

even returned the next day with gifts

of framed photographs of her cohort

plus catfish lunches for Vanessa and

Karla!

Key Takeaways for DEIAconscious Trainings 

Be humble about what you don’t 

know. The IDMH staff members

have expertise in PFA, disaster

mental health, and related topics,

but we did not know the Buffalo

community, and we have not

experienced the lifelong effects of

racism and inequality. While we

recognized that at the intellectual

Anecdotally, we also received many

positive comments at the end of

each session, and were gratified to

1 Because these percentages are rounded to the nearest 

whole number, total percentages exceed 100 percent. 
2024 | VOLUME 19 | ISSUE 2 | PAGE 23 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

level from the start, it didn’t make it

any easier to be told so—politely but

directly—by our partners at OMH

and by members of the original

focus groups. At times it was a real

challenge not to get defensive about

our qualifications and motivations,

but sitting back and absorbing the

critiques was essential, both in

terms of building trust from the

community and in terms of being

open to modifying the materials

appropriately.

Be transparent. Building on that

lesson in humility, as Vanessa and

Karla introduced themselves at the

start of each training, Karla would

openly acknowledge that she was an

outsider who looked like the people

whose presence was not welcome

after the Tops shooting, and that the

whole point of the project was to

build community capacity so that

kind of mismatched response didn’t

happen again. Putting that point out

into the room seemed to open the

door for some direct conversations

about racism and the Black

experience that we suspect might not

have occurred if Karla’s whiteness

hadn’t been acknowledged.

Find complementary training 

partners. It was absolutely essential

that Dr. Lewis Johnson served as the

face of the project for OMH, and

that one of the co-trainers for each

session be African American and

a longtime member of the Buffalo

community. We were also very

intentional in dividing the content

sections so the discussions about the

impacts of racism, how Black anger

is often misperceived, and the role of

faith as a source of both generational

blessings and “church hurt” were

led by André or Vanessa, while

Karla sat quietly on the sideline.

There’s no way those very powerful

conversations would have occurred

if Karla were presenting those

sections, and those discussions were

probably the most impactful part of

the experience for the participants

(and for the trainers).

These important lessons were

learned through the lived experience

of this partnership between the NYS

OMH and the Institute for Disaster

Mental Health over the past year.

As our earliest conversations with

community members revealed,

the project ran the risk of going

catastrophically wrong and simply

reinforcing existing mistrust

of Buffalo’s African American

communities toward the mental

health profession, in general as well

as in times of disaster. We hope

we not only avoided that outcome,

but collaboratively succeeded in

starting to build PFA capacity in

the city, as the new trainers now

plan to roll out the curriculum in

their neighborhoods, churches, and

organizations.

In the words of the project PI at

OMH, Chris Smith, “The work that

we did here, I think, is going to

have national implications. . . . It’s

one piece, but I think it’s a really

important piece, and I’m sure it

opened up IDMH to think about

things differently as well. Because,

you know, we all need that push

sometimes—we all need that perfect

storm to make us figure out how to

change the standard and set a new

standard, and that’s also what we

did here.” Our IDMH staff members

agree fully, and are grateful we had

the opportunity to collaborate with

OMH on this SAMHSA grant. ■

Participants mid-session, in the BestSelf Behavioral Health training room. 
2024 | VOLUME 19 | ISSUE 2 | PAGE 24 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

RECOMMENDED RESOURCES 

Diversity, Equity, and Inclusion in Disaster Planning 

and Response 

The SAMHSA Disaster Technical Assistance Center

(DTAC) has a page on the importance of diversity,

equity, and inclusion (DEI) in disaster planning. It shares

best practices and lists resources to help you incorporate

DEI into your disaster planning and response. Resources

include guides, tip sheets, and newsletters.

https://www.samhsa.gov/dtac/disaster-planners/

diversity-equity-inclusion

Guide to Cultural Awareness for Disaster Response 

Volunteers 

This guide developed by the American Psychological

Association provides tips for disaster response

volunteers on communicating effectively with people

from cultures different from their own. The guide goes

into detail on tips, including how to tune in to nonverbal

behaviors, learn by asking, and more. It also has a page

explaining what different words mean, including culture,

race, ethnicity, diversity, and multiculturalism.

https://www.apa.org/topics/disasters-response/culturalawareness-guide.pdf

Disaster Recovery Guidance Series: DisabilityInclusive Disaster Recovery 

This resource from the Global Facility for Disaster

Reduction and Recovery provides direction for people

who work in disaster recovery, including government

officials. It offers data on people with disabilities that

may be helpful in planning for post-disaster needs, key

principles for making disaster recovery inclusive, and

the various barriers that individuals with disabilities may

experience and how to address them.

https://documents1.worldbank.org/curated/

en/265011593616893420/pdf/Disability-InclusiveDisaster-Recovery.pdf

Cultural Competence in Preparedness Planning 

Webinar 

The Centers for Disease Control and Prevention

held a webinar in April 2019 that discussed the

disproportionate effects a disaster can have on people

of various cultures. Learn more about why cultural

competence matters in disaster planning and resources

available to help you build on your understanding.

https://bit.ly/3TeSEKYp

Action Toolkit—In the Eye of the Storm: A People’s 

Guide to Transforming Crisis & Advancing Equity in 

the Disaster Continuum 

This guide from the NAACP can help organizations

build equity into the different phases of emergency

management, including prevention, preparedness,

response, and recovery. Each module can stand alone,

allowing you to utilize what is most relevant to your

community.

https://naacp.org/resources/eye-storm-peoplesguide-transforming-crisis-advancing-equity-disastercontinuum
2024 | VOLUME 19 | ISSUE 2 | PAGE 25 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

Recent Technical Assistance Requests 

In this section, read about responses SAMHSA Disaster Technical Assistance Center (DTAC) staff have provided to

recent technical assistance requests. Send your questions and comments to dtac@samhsa.hhs.gov.

Request: SAMHSA DTAC received an email from

an individual describing mental and physical health

challenges after experiencing a disaster and falling ill

with COVID-19. The individual further asked SAMHSA

DTAC for housing and financial assistance resources.

Response: SAMHSA DTAC provided the individual

with resources, including federal web pages to assist in

finding resources within the individual’s state. Below are

some of the resources shared:

4 Benefits.gov—This federal web page provides access

to a wide range of government benefit programs

and resources, including unemployment assistance,

healthcare resources, and COVID-19 resources.

Visitors to this web page are also provided with

hotline support for assistance with their benefit-related

inquiries.

https://www.benefits.gov/help/faq/Coronavirusresources

4 DisasterAssistance.gov—This web page is an

official resource provided by the U.S. Department

of Homeland Security to assist individuals in the

aftermath of disasters. It offers guidance on applying

for Federal Emergency Management Agency disaster

assistance, finding open shelters, accessing resources

for disaster recovery, and checking the status of

disaster assistance applications.

https://www.disasterassistance.gov

4 Need Housing Assistance?—This U.S. Department

of Housing and Urban Development web page

offers resources for individuals seeking assistance

with housing, food, health, safety, disaster relief,

employment, and other kinds of support. It provides

links to local agencies, helplines, and programs,

making it a valuable tool for those in need of various

types of assistance and support.

https://www.hudexchange.info/housing-and-homelessassistance

4 SAMHSA Disaster Distress Helpline—The Disaster

Distress Helpline is a national 24/7 crisis support

service offering toll-free and multilingual assistance

to individuals experiencing emotional distress related

to natural or human-caused disasters. The helpline

connects callers with trained counselors who provide

crisis counseling, information on recognizing distress,

and referrals to local crisis call centers.

https://www.samhsa.gov/find-help/disaster-distresshelpline

Request: SAMHSA DTAC received a call from

an individual seeking a list of substance use-related

research and resources to aid in completion of their

certified alcohol and drug counselor credential.

Response: To assist the individual in identifying

topical information, SAMHSA DTAC arranged a list of

various resources. A sample of the provided resources is

included below:

4 People With Substance Use Disorders and

Disasters—Several subsections within the SAMHSA

Disaster Behavioral Health Information Series

(DBHIS) collection feature resources on including

and supporting people with substance use disorders

through processes of disaster planning, response,

and recovery. These collections include tip sheets,

guides, and other resources that can help with disaster

preparedness, response, and recovery for people

with substance use disorders, people in recovery,
2024 | VOLUME 19 | ISSUE 2 | PAGE 26 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

and people at risk of substance use disorders. The

following are parts of the SAMHSA DBHIS focused

on people with substance use disorders:

• People with substance use disorders

• People with alcohol use disorder

• People with opioid use disorder

• People with co-occurring disorders

(one of which is a substance use disorder)

4 Substance Misuse Prevention for Young Adults—

This guide is designed to assist healthcare

professionals, systems, and communities in their

efforts to deter substance misuse among young

adults. It encompasses research findings, explores

best practices, and provides an array of resources for

reference.

https://store.samhsa.gov/product/Substance-MisusePrevention-for-Young-Adults/PEP19-PL-Guide-1

4 TIP 33: Treatment for Stimulant Use Disorders—

This guide reviews evidence regarding the

management of medical, psychiatric, and substance

use disorder issues linked to the use of cocaine,

methamphetamine, and the improper use of

prescription stimulants. It provides suggestions for

treatment methods, including involvement in treatment

optimization and continuity.

https://store.samhsa.gov/product/treatment-forstimulant-use-disorders/PEP21-02-01-004

4 TIP 64: Incorporating Peer Support Into Substance

Use Disorder Treatment Services—This guide assists

readers in learning about the essential elements, roles,

and applications of peer support services as part of

the recovery process for people with substance use

disorders. It is designed to aid peer workers, as well

as substance use disorder treatment professionals and

treatment program administrators, in understanding the

roles peer support workers can play in recovery and

in involving peer support workers more completely in

recovery programs.

https://store.samhsa.gov/product/tip-64-incorporatingpeer-support-substance-use-disorder-treatmentservices/pep23-02-01-001

4 Treating Concurrent Substance Use Among Adults—

This guide provides insight to clinicians and other

professionals regarding three evidence-based practices

for treatment involving people with concurrent

substance use disorders (CSUDs). It provides an

overview of approaches and challenges involved in

connecting people with CSUDs who are interested in

treatment to available resources, as well as exploring

the three evidence-based practices, offering guidance

for selection among practices, and describing

examples of treatment programs that include the

practices.

https://store.samhsa.gov/product/treating-concurrentsubstance-use-among-adults/PEP21-06-02-002

4 PFA: Alcohol, Medication, and Drug Use after

Disaster—Part of the Psychological First Aid (PFA)

Field Operations Guide developed by the National

Child Traumatic Stress Network (NCTSN) and

National Center for Posttraumatic Stress Disorder, this

handout provides information that disaster survivors

can use to avoid increased use of alcohol and misuse

of prescription medications and other drugs after a

disaster. It also provides tips for survivors in recovery

from substance use disorders to avoid restarting

substance use after a disaster. 

https://www.nctsn.org/resources/pfa-alcohol-and-druguse-after-disasters

Check out the new and updated 

SAMHSA DTAC Disaster Behavioral Health Information Series (DBHIS) installments. 

Are you looking for disaster behavioral health resources?

https://www.samhsa.gov/resource-search/dbhis 
2024 | VOLUME 19 | ISSUE 2 | PAGE 27 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

4 PFA: Alcohol, Medication, and Drug Use after

Disaster—Part of the Psychological First Aid (PFA)

Field Operations Guide developed by the National

Child Traumatic Stress Network (NCTSN) and

National Center for Posttraumatic Stress Disorder, this

handout provides information that disaster survivors

can use to avoid increased use of alcohol and misuse

of prescription medications and other drugs after a

disaster. It also provides tips for survivors in recovery

from substance use disorders to avoid restarting

substance use after a disaster.

https://www.nctsn.org/resources/pfa-alcohol-and-druguse-after-disasters

4 Recovery Is Possible for Everyone: Understanding

Treatment of Substance Use Disorders—This web

page, developed by the Centers for Disease Control

and Prevention (CDC), offers useful information

on substance use disorders, as well as the available

treatment and recovery options. These options include

medication, outpatient counseling, and behavioral

health care. The web page highlights the significance

of reducing the stigma that comes with substance use

disorders by promoting treatment.

https://www.cdc.gov/drugoverdose/featured-topics/

recovery-SUD.html

4 Reducing Stigma: Understanding Addiction and

Supporting Recovery—This CDC-developed fact

sheet highlights how common substance use disorders

are, the fact that substance use disorders are illnesses,

and options for treatment. It details the effects of drug

use on the brain, the treatability of addiction as a

disease, and the importance of supporting individuals

in their recovery journey. 

https://www.cdc.gov/stopoverdose/stigma/pdf/Stigma_

Fact_Sheet_508c.pdf

Request: SAMHSA DTAC received an emailed

inquiry from a St. Louis behavioral health therapist

about available training courses to aid in the support

of victims of mass violence and natural disasters. The

therapist reported hoping to share any provided training

with their team of professional mental health therapists

and social workers.

Response: In response to the inquiry, SAMHSA

DTAC suggested the therapist visit the National Mass

Violence Victimization Resource Center’s website, as

the organization holds town hall meetings of potential

interest. SAMHSA DTAC further provided a list

compiled of trainings and resources on mass violence

for disaster behavioral health professionals. The

following resources are a sample of those sent:

4 Resilience and Coping Intervention (RCI)—

This intervention can be used to help children and

adolescents cope with disasters and other forms of

community trauma. RCI is designed for groups of 5

to 10 people and can be delivered in one or several

sessions. RCI groups can be implemented in programs

based in schools and other settings and led by teachers,

counselors, or other professionals who have been

trained in the intervention.

https://dcc.missouri.edu/rci.html

4 Helping Victims of Mass Violence & Terrorism

Toolkit—Available through the website of the

Office for Victims of Crime Training and Technical

Assistance Center, this toolkit includes information

and resources to help communities prepare for and

respond to incidents of mass violence and terrorism.

While some parts of the toolkit focus on steps to take

before an incident, other sections are designed to

support responders in participating in and managing

effective response and recovery processes.

https://www.ovcttac.gov/massviolence/?nm=sfa&ns=

mvt&nt=hvmv

4 Improving Community Preparedness to Assist

Victims of Mass Violence and Domestic Terrorism:

Training and Technical Assistance (ICP TTA)

Program—Funded by the Office for Victims of Crime

within the U.S. Department of Justice, the ICP TTA

program works to equip U.S. communities to respond
2024 | VOLUME 19 | ISSUE 2 | PAGE 28 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

effectively to incidents of criminal mass violence and

domestic terrorism. The program’s website features a

resources page, which offers vetted resources to help

emergency managers, victim service professionals,

and others make victim services part of emergency

operations plans, as well as a trainings page, which

includes freely available trainings to help build local

capacity.

https://icptta.com

4 Psychological First Aid (PFA) Online, offered by

the NCTSN, is a free course that includes a 5-hour

interactive training.

https://learn.nctsn.org/enrol/index.php?id=596

4 Skills for Psychological Recovery (SPR) is an

intervention to help survivors gain skills to manage

distress and cope with post-disaster stress. The

NCTSN offers SPR Online training.

https://www.nctsn.org/treatments-and-practices/

psychological-first-aid-and-skills-for-psychologicalrecovery/about-spr

4 Tips for Survivors: Coping With Grief After a

Disaster or Traumatic Event—In this tip sheet,

SAMHSA defines and describes grief, discusses

ways of coping with grief, and explains complicated

or traumatic grief. The tip sheet also offers relevant

resources for additional support.

https://store.samhsa.gov/product/tips-survivorscoping-grief-after-disaster-or-traumatic-event/sma17-

5035

4 Mass Violence/Community Violence—This part of

the SAMHSA DBHIS resource collection focuses on

incidents of mass violence, community violence, and

terrorism and their effects. Resources discuss common

reactions to incidents of mass violence, tips for coping,

and ways to support children and youth in coping.

https://www.samhsa.gov/resource-search/

dbhis?rc%5B0%5D=type_of_disaster%3A21219

4 Unexpected Challenges for Communities in the

Aftermath of a Mass Violence Incident—This tip

sheet from the National Mass Violence Victimization

Resource Center lists some unexpected issues a

community may encounter after experiencing a

mass violence incident. The document also provides

suggested solutions for managing these challenges and

prioritizing a community’s safety and recovery.

http://nmvvrc.org/media/301cm3if/tipsheet2.pdf

4 Recovery From Large-Scale Crises: Guidelines for

Crisis Teams and Administrators—In this tip sheet,

the National Association of School Psychologists

(NASP) describes what to expect in schools after

disasters and other crises and how school crisis teams

and administrators can support the school community

in coping and recovery. NASP identifies steps

administrators and crisis teams can take at different

points after the crisis, from immediately after the crisis

to more than a year later.

https://www.nasponline.org/resources-andpublications/resources-and-podcasts/schoolsafety-and-crisis/school-violence-resources/

recovery-from-large-scale-crises-guidelines-for-crisisteams-and-administrators
2024 | VOLUME 19 | ISSUE 2 | PAGE 29 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

REFERENCES 

Emergency Partners Information

Connection (EPIC). (2023, March

14). Inclusivity is key for emergency

planning and response. EPIC 

Exchange. Centers for Disease

Control and Prevention. https://

emergency.cdc.gov/newsletters/

epic/2023/031423.htm

Herman, J. L., Flores, A. R., & O’Neill,

K. K. (2022, June). How many adults 

and youth identify as transgender 

in the United States? The Williams

Institute, UCLA School of Law.

https://williamsinstitute.law.ucla.edu/

publications/trans-adults-united-states

Johnson, S. R. (2022, June 22).

The demographics of disaster.

U.S. News & World Report. 

https://www.usnews.com/news/

health-news/articles/2022-06-22/

disaster-disparities-natural-hazardsclimate-change-threaten-underservedcommunities 

National Alliance on Mental Illness.

(2023, April). Mental health by the 

numbers. Retrieved December 1,

2023, from https://www.nami.org/

mhstats

Substance Abuse and Mental Health

Services Administration. (2020).

Key substance use and mental health 

indicators in the United States: 

Results from the 2019 National Survey 

on Drug Use and Health (HHS

Publication No. PEP20-07-01-001,

NSDUH Series H-55). SAMHSA

Center for Behavioral Health Statistics

and Quality. https://www.samhsa.

gov/data/report/2019-nsduh-annualnational-report

The Partnership for Inclusive Disaster

Strategies. (n.d.). Facts. https://

disasterstrategies.org/facts

U.S. Census Bureau. (2000). “SEX

BYAGE [79].” Decennial Census,

DEC Summary File 3, Table

P008, 2000. Retrieved October

20, 2023, from https://data.census.

gov/table/DECENNIALSF32000.

P008?q=Age+and+Sex

U.S. Census Bureau. (2022). Population

estimates, July 1, 2022 (V2022)—

United States [Data table]. Quick

Facts. https://www.census.gov/

quickfacts/fact/table/US/PST045222

Washington, E. F. (2022, November–

December). Diversity and inclusion:

The five stages of DEI maturity.

Harvard Business Review. https://hbr.

org/2022/11/the-five-stages-of-deimaturity

The views, opinions, and content 

expressed in this publication do 

not necessarily reflect the views,

opinions, or policies of the Center for 

Mental Health Services (CMHS), the 

Substance Abuse and Mental Health 

Services Administration (SAMHSA), 

or the U.S. Department of Health and 

Human Services (HHS). 

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