A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

2020 | VOLUME 16 | ISSUE 1

Supporting U.S. Territories and 

Island Populations After Disasters

The Dialogue
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.

IN THIS ISSUE

3 In This Issue

4 Contributors

5 Technical Assistance Snapshot

6 Island CCP Draws on Close-knit Community in Support of Typhoon Recovery

9 A Holistic Approach to Supporting Survivors After Disasters

12 Preparing to Train Island Populations

16 Recent Technical Assistance Requests

Cover photo provided by Brian Beck.
2020 | VOLUME 16 | ISSUE 1 | PAGE 3

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Island populations face unique challenges preparing 

for, responding to, and recovering from disasters. Island 

communities tend to be isolated and more reliant on 

their own resources and community members for daily 

needs. Assistance in the form of supplies, materials, and 

personnel may take more time to arrive after a disaster 

due to logistical difficulties after an incident. Cultural 

and societal roles and values differ between islands even 

if they are in close proximity to each other. Disaster 

planners and responders need to keep this in mind when 

working with island populations. 

According to the Federal Emergency Management 

Agency website, since 2010 American Samoa, Guam, 

Hawaii, the Northern Mariana Islands, Puerto Rico, 

and the U.S. Virgin Islands had a total of 45 disaster 

declarations including emergency declarations, major 

disaster declarations, and fire management grant 

declarations.

The Substance Abuse and Mental Health Services 

Administration (SAMHSA) Disaster Technical 

Assistance Center (DTAC) has several planning and 

responding resources for disaster behavioral health 

professionals working with island populations:

• The Dialogue: Cultural and Population Sensitivity 

in Disaster Behavioral Health Programs

• Helping Older Adults After Disasters: A Guide to 

Providing Support

• Stronger Together: An In-Depth Look at Selected 

Community-Level Approaches to Disaster 

Behavioral Health

This issue of The Dialogue focuses on programs 

delivered to island populations after disasters. We start 

the issue with an interview from a Crisis Counseling 

Assistance and Training Program (CCP) staff member 

in the Commonwealth of the Northern Mariana Islands. 

He shares his experiences working with the survivors 

In This Issue

after Super Typhoon Yutu. Our next article focuses on 

training efforts undertaken in the U.S. Virgin Islands 

after Hurricanes Irma and Maria. The concluding 

article was submitted by a clinician working in Puerto 

Rico after Hurricanes Irma and Maria. 

Do you have any experience responding to disasters 

affecting island populations? Other disaster responders 

can learn from your efforts. We encourage you to 

contact us to share your stories. ■

Captain Erik Hierholzer, B.S.N. Program 

Management Officer, Emergency Mental Health and 

Traumatic Stress Services Branch

erik.hierholzer@samhsa.hhs.gov

Nikki Bellamy, Ph.D. Public Health Advisor, 

Emergency Mental Health and Traumatic Stress 

Services Branch

nikki.bellamy@samhsa.hhs.gov

Shannon Loomis, M.A. Director, SAMHSA DTAC

dtac@samhsa.hhs.gov
2020 | VOLUME 16 | ISSUE 1 | PAGE 4

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

also worked as a research assistant with the Carlos 

Albizu University and the Department of Justice, for the 

identification of the psychosocial characteristics of sex 

offenders in Puerto Rico.

After the passage of Hurricanes Irma and María, Dr. 

Maldonado worked as a mental health services facilitator 

and as a team leader of the ASSMCA “Anímate” Project, 

offering the first psychosocial assistance to community 

members.

Jenny Wiley, M.S.W., LCSW brings 

16 years of disaster mental health 

experience, including overseeing 

the Missouri disaster mental health 

response to disasters, administering 

the mental health portion of the 

Centers for Disease Control and Prevention public 

health grant and the Hospital Preparedness Program. 

Ms. Wiley has completed numerous Federal Emergency 

Management Agency (FEMA) incident command courses 

and works collaboratively across agency boundaries in the 

completion of plans and guides including the Behavioral 

Health Emergency Template for Health Care Agencies.

She led three CCPs for Missouri.

Ms. Wiley now consults and teaches throughout the 

United States and its territories. She is certified to teach 

the FEMA CCP required curriculum and in 2017 cotaught the Train-the-Trainer CCP course. She also teaches 

Skills for Psychological Recovery (SPR), Psychological 

First Aid (PFA), the FEMA Planning for the Needs of 

Children (G366) course, and children’s disaster mental 

health courses. In 2017, Ms. Wiley was a facilitator 

and presenter for the SAMHSA All-Hazards Disaster 

Behavioral Health State Planning Meeting. Between 2017 

and 2019, Ms. Wiley made eight trips to the U.S. Virgin 

Islands teaching the CCP courses, PFA, and SPR.

Contributors

Brian Beck, M.S. is the Program 

Manager for the CCP Y.U.T.U. 

(You, Us, Together, United) within

the Commonwealth Healthcare 

Corporation’s Community Guidance

Center. This CCP provides services

to Super Typhoon Yutu survivors on the islands of Saipan

and Tinian, two of three inhabited islands in the U.S. 

Commonwealth of the Northern Mariana Islands. Mr. 

Beck holds a B.S. in psychology from the University 

of Pittsburgh, an M.S. in management from Colorado 

Technical University, and has spent a large part of his 

career in collegiate academic advising and management 

consulting for small businesses. From Denver, Colorado,

he moved to Saipan alone to start a new chapter in 

life just 12 days prior to Super Typhoon Yutu making 

landfall—the strongest typhoon to hit U.S. soil since 

1935. Mr. Beck is a survivor himself and gratitude and 

humility form the foundation of his flexibility after a 

disaster. He spends his free time kayak fishing, scuba 

diving, and swimming with his dog, Cato. 

Jonathan Maldonado, Psy.D. is a 

licensed clinical psychologist who 

works as a Clinical Supervisor of 

the SAMHSA Emergency Response 

Grant Project of La Administración

de Servicios de Salud Mental y 

Contra la Adicción (ASSMCA), the Mental Health and 

Anti-Addiction Services Administration in Puerto Rico. 

Dr. Maldonado obtained his Psy.D. at The Carlos Albizu 

University, where he got certified and trained to work 

with survivors of domestic violence.

Dr. Maldonado completed his internship at the Office 

of Rehabilitation and Treatment of the Department of 

Correction and Rehabilitation of Puerto Rico, where he 

offered individual therapy, group therapy, and personality 

assessment services to the inmates. Dr. Maldonado 
2020 | VOLUME 16 | ISSUE 1 | PAGE 5

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

TECHNICAL ASSISTANCE SNAPSHOT

SAMHSA Support After Hurricanes Irma and Maria

Clinical Services in U.S. Virgin Islands and Puerto Rico by Year

SAMHSA funded additional support to help Puerto Rico and the U.S. Virgin Islands after Hurricanes 

Irma and Maria. Funding was made available for disaster behavioral health, trauma, and other capacitybuilding trainings, as well as clinical disaster behavioral health treatment services for remote and 

underserved areas affected by hurricanes. The trainings and services were offered during 2018 and 2019. 

 

 

 

 

 

 

 

 

 

 

 

 

Types of Natural Disasters Experienced in Island Communities

 
2020 | VOLUME 16 | ISSUE 1 | PAGE 6

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Island CCP Draws on Close-knit Community in 

Support of Typhoon Recovery

An interview with Brian Beck, M.S. 

In October 2018, Super Typhoon 

Yutu swept over the Commonwealth 

of the Northern Mariana Islands 

(CNMI), with major effects on the 

islands of Saipan and Tinian. With 

winds reaching 180 miles per hour, 

Yutu was the strongest tropical 

cyclone to hit the United States since 

1935 (Masters, 2018; Dwyer, 2018; 

Mooney, Eilperin, & Chiu, 2018). 

Yutu took 2 lives, injured more than 

130 people, knocked out water and 

power, and damaged or destroyed 

significant portions of the island’s 

buildings and critical infrastructure 

(FEMA 2018; Eugenio, H., 2018; 

Eugenio, H. V., 2018; Fortin, 2018).

INTERVIEW

A CCP grant was established to help 

the CNMI recover from Yutu. The 

Dialogue recently spoke with its 

program manager about the program 

and challenges it has faced, as well 

as strengths the program has built 

upon in enhancing the local area’s 

ability to endure difficult conditions.

What was your experience 

of Yutu?

I moved to Saipan on October 12, 

2018, 12 days before Yutu hit. I had 

been planning to teach at Northern 

Marianas College, but it was 

destroyed in the typhoon. I helped 

bring water to villages and clear 

debris off roads. We did that almost 

until Christmas, and during that time 

most of us didn’t have a place to 

live. Most of us were without water 

or power for at least 2 months.

Resilience is built into the culture 

here. Everyone tried to pitch in to 

help, and no one was really sad or 

complaining. 

Many Americans know very 

little about the CNMI, even 

though it’s part of the country. 

What are the islands like?

The CNMI consists of 14 islands. 

Saipan is the capital. The CNMI 

Photo provided by Brian Beck.
2020 | VOLUME 16 | ISSUE 1 | PAGE 7

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

was part of the Trust Territory of 

the Pacific Islands before becoming 

a commonwealth. 

Previously, the CNMI 

has been part of Spain, 

Germany, and Japan.

Saipan is about 200 

miles north of Guam, 

and about 45 square 

miles in size. The 

2017 census said that 

approximately 48,000 people live in 

Saipan. I would guess that there are 

fewer now. Tinian has about 

1,500 people.

The CNMI is fascinating culturally. 

Chamorros trace evidence of their 

ancestry back to 3500 BC, and 

Carolinians arrived in the mid to late 

1700’s. Both cultures are officially 

considered to be the only indigenous 

people of the CNMI. In addition to 

Chamorros and Carolinians, people 

here are Filipino, Chinese, Korean, 

Russian, and Japanese.

Have you faced challenges in 

your CCP? If so, how have you 

addressed them?

It’s not easy to plan outreach work 

on Saipan and Tinian, because 

the islands haves no house or lot 

numbers. To help with this, we’ve 

partnered with Central Statistics 

to get aerial maps and draw 

deployment plans. 

We do not have many mental 

health and substance use treatment 

professionals on the islands. I’ve 

had to do a lot of homework and 

networking. I have been fortunate 

to make a couple of good friends 

here and in Guam who are licensed 

clinicians. I get good technical 

assistance from them, and from 

SAMHSA DTAC.

We have undergone pretty severe 

economic austerity. The central 

government lost revenue from 

tourism, and this has affected just 

about everyone in the CNMI from 

the businesses sustained by tourism, 

to the employees in both the public 

and private sector who’ve lost their 

jobs or had their hours cut. It has 

been challenging, but everyone is 

pointed in the right direction, toward 

recovery and building local capacity.

There is a huge stigma around 

asking for help here. Many don’t 

seem to want to ask for help because 

they don’t want to appear to be a 

burden to others. We have had to get 

creative in how we help survivors. 

When we work with survivors, 

we often arrange for after-hours 

appointments or use back-door 

entrances to homes or temporary 

shelters. We have met survivors in 

third party, neutral locations as well.

We have been careful in our 

messaging to be culturally 

appropriate. We try to get away 

from the term “mental health.” 

“Mental” doesn’t have a good 

connotation. We replace that with 

“behavioral health.” It is important 

that our messaging is congruent with 

normalizing the common reactions 

these survivors may have. 

What should disaster workers 

keep in mind when working 

with island populations?

The most important thing is to be 

sincere and respectful. You may 

not understand the nuances of the 

Super Typhoon Yutu passes over Tinian on October 24, 2018. Satellite image by Satellite image by 

National Oceanic and Atmospheric Administration (NOAA).

SAIPAN

TINIAN

Yutu was 

stronger than 

Hurricanes 

Katrina, Harvey, 

and Maria
2020 | VOLUME 16 | ISSUE 1 | PAGE 8

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

culture, but if you approach people 

with an open mind, they will be 

glad. People are warm and accepting 

of outsiders here. It’s a collectivist 

culture that revolves around respect 

and family.

It’s difficult to find marginalized 

communities on islands. Although 

we identified special populations 

for our CCP grant application, we 

discovered another one: unemployed

contract workers in immigration 

limbo who have been fired or laid 

off and overstayed visas. They were 

hesitant to interact with us. They 

are largely Mandarin-speaking 

Chinese and Taiwanese people. To 

reach them, we had our materials 

translated into Mandarin, worked 

with a local Falun Dafa group, and 

networked with Chinese private 

schools.

What are some unique 

strengths of residents in the 

CNMI?

I would say that respect and 

gratitude form the practical basis of 

most local capacity here. Lifestyle 

also plays a role. Living without 

running water or electricity literally 

is the baseline for some survivors on 

our islands. There is an idea in the 

field of disaster behavioral health 

that survivors don’t make good first 

responders. Here survivors make 

the best first responders, because 

of how integrated the community 

is. Our team has varying levels of 

education in disaster behavioral 

health, but they can be very effective

because they show sincere empathy, 

and because they come across not 

as clinicians, but more as neighbors 

or concerned friends or relatives. 

This by itself helps break down the 

cultural stigma of asking for and 

receiving help.

Have you worked on building a 

program legacy?

We’re doing our best through 

messaging campaigns to break down 

the stigma that keeps people from 

asking for help. We’ve created a 

pre-typhoon messaging protocol 

to let people know that it’s okay if 

they need help and that, to be strong 

enough to help others, they need to 

first take care of themselves. 

We try to create an environment 

where it will be easier for folks to 

endure future typhoons. Yutu was 

stronger than Hurricanes Katrina, 

Harvey, and Maria. We had another 

typhoon in February of this year, a 

super typhoon, and then three more 

after that. We’ll have more; it’s part 

of life here. We’re working on our 

messaging, videos, teaching coping 

skills, and normalizing reactions, 

all as much as possible in native 

languages.

What would you recommend 

disaster workers new to the 

community do before working 

with island populations?

Obviously, try to get as well versed 

as you can in the local culture. When 

I was planning on moving here, I 

did a lot of research. But even if you 

know nothing, if you come with an 

open heart and mind and respectful 

approach, people here are very warm 

and generous and will treat you very 

well. 

A lot of love is shown through food 

here. The best I was ever fed was 

doing cleanup work right after Yutu. 

That was one of the first things I 

noticed about my team. We were at 

a buffet, and several of them made 

plates of food to share with the rest 

of the table. It’s a very automatic 

thing for residents here to take care 

of each other. It makes you feel so 

grateful.■

 
2020 | VOLUME 16 | ISSUE 1 | PAGE 9

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

After Hurricanes Irma and María 

hit Puerto Rico in 2017, I worked 

as a Mental Health Services 

Facilitator and as Team Leader of 

the San Juan region of the Mental 

Health and Anti-Addiction Services 

Administration (ASSMCA) 

“Anímate” Project, offering the 

first psychosocial help to members 

of the community. After several 

months conducting relief and 

crisis intervention sessions in the 

community, I began providing 

additional clinical treatment and 

services in mental health, as part of 

the recovery efforts for Puerto Rico. 

At first, the idea was to work in 

collaboration with the ASSMCA, 

which would provide us with office 

space in which to offer these mental 

health services to the community 

members who were referred to us. 

Because of the experience gained 

during the months of community 

service through the “Anímate” 

Project, we knew that many people 

affected by the hurricanes did not 

have access to transportation or 

the ability to reach an office due 

to advanced age, lack of financial 

resources, or lack of a family support 

network.

Because of these factors, we 

realized that our services would 

have a greater reach and provide 

more benefits if we could take them 

directly to the community. We 

agreed to cover the entire island, 

including Vieques and Culebra 

Islands, which are accessed by 

ferry. We directed all Mental 

Health Services Facilitators of 

the “Anímate” Project teams and 

the ASSMCA Social Assistance 

Program line to refer to us those 

participants who needed clinical 

mental health interventions. Soon, 

we began receiving referrals from 

other agencies, community leaders, 

social workers, and case managers 

located in FEMA Disaster Recovery 

Centers and Community Recovery 

Centers.

Although in general, Hurricanes 

Irma and María resulted in many 

cases of posttraumatic stress, 

the greatest effect we saw in the 

participants we helped was the 

A Holistic Approach to Supporting Survivors 

After Disasters

By Jonathan Maldonado, Psy.D.

Photo by Yuisa Ríos/FEMA.

 
2020 | VOLUME 16 | ISSUE 1 | PAGE 10

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Photos provided by Dra. Monserrate Allende Santos.

exacerbation of symptoms of 

preexisting conditions, such as 

major depression, panic disorder, 

and generalized anxiety. Issues 

such as the separation of the family 

due to emigration and Puerto 

Rico’s political and social situation 

caused emotional instability among 

the survivors. Some of the most 

concerning social problems were 

the loneliness and lack of a family 

support network in older adults and 

the difficulty in accessing FEMA 

assistance for reconstruction. 

For many participants, it was 

very hard to reach the FEMA 

Disaster Recovery Centers due to 

transportation problems or lack of 

knowledge about the centers, while 

others had difficulty in providing 

ownership title of their properties, 

giving up on the process. Situations 

like these resulted in feelings 

of hopelessness, sadness, and 

frustration in many people.

Bringing our clinical services to the 

community opened our eyes to the 

social needs many survivors faced. 

I often felt that the psychotherapy 

fell short of the pressing needs 

of people who did not have a 

Hurricane Maria resulted in 

the longest blackout in U.S. history—

it took 328 days for power to be restored in all 

neighborhoods in Puerto Rico (FEMA, 2018).
2020 | VOLUME 16 | ISSUE 1 | PAGE 11

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

family support network, economic 

resources, or transportation to obtain 

medical services, in addition to the 

deterioration of their residences, 

which in many cases only had a 

blue awning as a ceiling. On many 

occasions, as a clinical psychologist, 

I also had to perform the role of a 

social worker and refer several older 

adults living in unsafe conditions 

to the appropriate agencies, for 

relocation to a safer home. We 

encountered other needs in patients 

that went beyond a major problem 

at the psychological level. In the 

work we carry out in the community, 

we cannot ignore the more pressing 

needs, and we have committed 

ourselves to intercede.

The challenge of our own physical 

security also arose. On many 

occasions, we visited areas with a 

high incidence of crime or that were 

very remote and hard to reach. For 

these cases, we accompanied social 

workers of the zones or sought the 

support of the work team of the 

“Anímate” Project.

During this transformative 

experience, I was able to reaffirm 

Hurricane Maria approaching Puerto Rico. Photo by NOAA GOES-16. Retrieved from https://www.climate.gov/news-features/understanding-climate/hurricanemarias-devastation-puerto-rico.

 

 

 Source: https://www.ncdc.noaa.gov/billions/dcmi.pdf

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

the importance of seeing the 

human being in a holistic way, 

with a biopsychosocial approach. 

Hurricanes Irma and María 

uncovered a preexisting social 

reality in Puerto Ricans and 

aggravated it by destroying their 

residences and separating many 

families. A survivor’s mental health 

needs could not be adequately 

addressed separate and apart from 

the physical and social needs such as 

lack of adequate housing. It is only 

when treating the whole person can 

true progress be made. ■
2020 | VOLUME 16 | ISSUE 1 | PAGE 12

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Preparing to Train Island Populations

By Jenny Wiley, M.S.W., LCSW

The U.S. Virgin Islands experienced 

back-to-back category 5 hurricanes 

in September 2017. On September 6, 

St. Thomas and St. John had a direct 

hit from Hurricane Irma while St. 

Croix had less damage from the 185 

mile per hour winds. However, on 

September 19, 2017, St. Croix was 

also battered by the 165 mile per 

hour winds from Hurricane Maria. 

After Hurricane Irma, St. Croix had 

responded to St. Thomas and St. 

John with supplies including food 

and water leaving them ill-equipped 

to deal with a devastating hurricane 

2 weeks later. 

Both hurricanes caused significant 

destruction and affected the lives 

of all residents of the U.S. Virgin 

Islands. Electricity was knocked 

out on all the islands forcing many 

to depend on generators for months 

or go without power. There were 

long lines to get water, food, and 

medicine. Pregnant women about 

to give birth were evacuated from 

St. Thomas to St. Croix and, 

unfortunately, endured the wrath 

of both hurricanes. The most 

serious patients from the damaged 

hospitals were evacuated to Alabama 

without family support. For most 

island residents, evacuation before 

the storm was not an option and 

therefore going to shelters or 

sheltering in place were their only 

choices. At the beginning of 2019, 

some families still had blue tarps on 

their roofs and belongings stored in 

plastic bags for protection from the 

elements. 

 
2020 | VOLUME 16 | ISSUE 1 | PAGE 13

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

The level of damage to the islands 

was such that St. John, St. Thomas, 

and St. Croix received major 

disaster declarations allowing them 

to be eligible to apply for a CCP. 

I was invited to provide all the 

required CCP trainings as well as 

Psychological First Aid (PFA) and 

Skills for Psychological Recovery 

(SPR). The first of the required CCP 

trainings, Core Content Training, 

occurred in December 2017. Two 

providers, Beautiful Dreamers 

serving St. Thomas and St. John, 

and Island Therapy Solutions 

serving St. Croix, were engaged by 

the government of the U.S. Virgin 

Islands to provide crisis counseling 

services to the residents. The grant 

was managed through Lutheran 

Social Services (LSS) of the U.S. 

Virgin Islands. 

Challenges to Providing 

Training on the Islands

Prior to delivering training, it 

was important to consult with the 

CCP management staff and local 

disaster behavioral health leadership 

regarding the conditions on the 

islands and their citizens. Power was 

restored in the main areas, but brown 

outs still occurred and preparing 

to proceed without PowerPoint 

projection was essential. SAMHSA 

DTAC supplied the handout 

materials as even making copies was 

challenging. 

Providing disaster behavioral 

health support and training meant 

continually being aware of the 

conditions in which the crisis 

counselors found themselves. Their 

homes were damaged or destroyed. 

Some had family members living 

with them or they were living with 

others. Many were living in their 

damaged homes. They had to adjust 

hours for the beginning and ending 

of school as students went to school 

in shifts. A few developed health 

conditions. Recovery is drawn out 

due to the dynamics of island living. 

Everything must be shipped in and 

Photo provided by Dra. Monserrate Allende Santos.

 

 
2020 | VOLUME 16 | ISSUE 1 | PAGE 14

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

getting the supplies necessary for 

repairs has taken months and for 

some nearly 2 years. And yet, the 

empathy and flexibility displayed 

by the crisis counselors for others 

while living in the same conditions 

was remarkable. All exercises within 

the CCP training have purpose 

and meaning, but it emerged that 

the crisis counselors appreciated 

those that demonstrated self-care, 

particularly the visualization activity 

in Section 4 of the CCP Disaster 

Anniversary Training Guide. 

This visualization exercise was 

designed to promote relaxation and 

identify some things that would be 

helpful to enhance personal stress 

management. Feedback regarding 

the PFA and SPR courses indicated 

that the skill building within the 

courses would immediately help 

the participants in their various 

fields and these courses were highly 

valued. 

Lessons Learned When 

Training on the Islands

Call on the experts. I had never 

been to the U.S. Virgin Islands 

so I learned as much as I could 

about the makeup of the islands, 

culture, and customs before going. 

Island culture is different from 

living in the states and each island 

is unique in its history, religious, 

ethnic, and cultural makeup. In 

St. Thomas, Dr. Vincentia PaulConstantin graciously taught a 

segment about the culture of the 

islands. She and Carla S. Perkin 

were interviewed about culture 

awareness by SAMHSA DTAC for 

an article in Volume 14, Issue 3–4 of 

The Dialogue, available at https://

www.samhsa.gov/dtac/disasterbehavioral-health-resources/

dialogue. Another invaluable 

resource was the CCP teams who 

were community members and 

reflected the languages, culture, and 

religions in the islands. 

Don’t pretend to be who you 

aren’t. As disaster behavioral health 

professionals, we appreciate the 

importance of being genuine. CCP 

teams related that some responders 

desiring to be accepted would try to 

speak the lingo or use island accents. 

Unfortunately, it only served to 

make relationships more difficult 

to establish. Social graces such 

as saying good morning or good 

evening value respect and the island 

culture.

Be prepared to adjust presentation 

times. Depending on the audience, 

agenda start times and the 

commencement of the training 

may be different. Although some 

audiences are timely, others are 

more laid back and training may be 

delayed as much as 30 minutes to 

an hour. Food is also an important 

part of the U.S. Virgin Islands’ 

culture. The CCP does not provide 

food but LSS, the providers, and 

crisis counselors generously shared 

their local dishes despite their 

hardships. Knowing this helps one to 

adequately prepare.

Flexibility is always needed by 

trainers. Through no fault of the 

providers, things happen such as 

equipment failure, materials not 

arriving, last minute room and/

or complete location changes. 

The ability to adjust on the fly is 

crucial when training in any disaster 

affected area. 

Lift the mood with humor 

and activities. Lightening the 

atmosphere with humor, appropriate 

fun activities, candy, and small 

prizes also assisted in lifting the 

mood. Again, it was the astute local 

leadership that brought it to my 

attention. I think I resisted adding 

activities due to having to carry 

extra supplies as things are not 

readily available on the islands. It 

was a lesson learned: just don’t carry 

chocolate to a warm island. ■

 
2020 | VOLUME 16 | ISSUE 1 | PAGE 15

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

RECOMMENDED RESOURCES

Developing Cultural Competence in Disaster 

Mental Health Programs: Guiding Principles and 

Recommendations

This manual from the SAMHSA Store gives guidance, 

recommendations, and additional resources for 

developing a disaster mental health response that is 

culturally appropriate and effective. Taking the time 

to properly understand an area’s culture can help 

strengthen communication and support the efforts of a 

disaster recovery plan.

Find the manual at https://bit.ly/33MJzgp. 

U.S. Virgin Islands Territorial Emergency 

Management Agency: Tsunamis

This web page from the U.S. Virgin Islands Territorial 

Emergency Management Agency covers information 

on tsunamis and the importance of acting quickly in 

the event of one. The page provides links to evacuation 

maps for St. Croix, St. John, and St. Thomas. It also 

includes a link to an alternate resource where you can 

learn to understand the difference between various terms 

that identify a tsunami hazard.

Find the web page at https://bit.ly/2ph9eib. 

Psychological First Aid Field Operations Guide: 2nd 

Edition

The Psychological Fist Aid (PFA) Field Operations 

Guide provides guidance on how to assist children, 

adolescents, adults, and families in the aftermath of a 

natural or human-caused disaster. This downloadable 

guide from the National Child Traumatic Stress Network 

provides more in-depth information, handouts for 

survivors, and handouts to distribute and copy.

Download the guide at https://bit.ly/2Q2fLZ7. 

Effective Coordination of Recovery Resources for 

State, Tribal, Territorial and Local Incidents 

This resource from FEMA was developed for state, 

tribal, territorial, and local government officials to 

better understand their role in the recovery process 

after a natural or human-caused disaster. This guide 

highlights the various tasks of the recovery process that 

are often challenging and how coordination can be better 

developed and recovery plans enhanced.

This resource is available at https://bit.ly/2PL3eck.
2020 | VOLUME 16 | ISSUE 1 | PAGE 16

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 DTAC staff have provided to recent technical assistance (TA) requests. 

Send your questions and comments to dtac@samhsa.hhs.gov.

Request: SAMHSA DTAC received a TA request 

from a member of the New York City Police Department 

(NYPD) interested in suicide awareness and prevention 

resources and trainings to help train the civilian 

members of the NYPD.

Response: SAMHSA DTAC provided the following 

resources:

 Suicide Prevention Resource Center—Developed by

SAMHSA, this website offers several trainings for any

professional interested in improving their knowledge

and skills in suicide prevention. Their trainings are

free, self-paced, and open to anyone. You can find

them at https://www.sprc.org.

 Applied Suicide Intervention Skills Training

(ASIST)—This 2-day training program teaches

participants how to assist those at risk for suicide.

Although many healthcare professionals use ASIST,

anyone 16 years or older can use the approach,

regardless of professional background. Find the

training program at https://www.livingworks.net/

asist.

 QPR (Question, Persuade, Refer)—This suicide

prevention training helps participants to recognize the

warning signs of suicide and question, persuade, and

refer people at risk for suicide for help. Individuals

do not need particular educational or professional

background to complete QPR training and use QPR.

Learn more at https://qprinstitute.com.

 SafeTALK—This half-day training teaches individuals

steps to identify people with suicidal thoughts and

connect them to resources for help and support. Learn

more about the training at https://www.livingworks.

net/safetalk.

Request: SAMHSA DTAC received a TA request 

from a disaster behavioral health professional requesting 

resources on working with children during the 

anniversary of Hurricane Michael. 

Response: In addition to sending information for 

the CCP currently operating in Bay County, Florida, 

SAMHSA DTAC provided the following resources:

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/dtac/dbhis-collections
2020 | VOLUME 16 | ISSUE 1 | PAGE 17

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

 Tips for Talking with and Helping Children and

Youth Cope After a Disaster or Traumatic Event:

A Guide for Parents, Caregivers, and Teachers—

This fact sheet helps parents and teachers recognize

common reactions and highlights helpful ways to

respond. The fact sheet is available at https://store.

samhsa.gov/product/sma12-4732.

 Tips for Families on Addressing Anniversaries—This

tip sheet developed by the National Child Traumatic

Stress Network (NCTSN) offers parents and caregivers

ways to help children cope with the anniversary of a

disaster or traumatic event. The tip sheet is available

at https://www.nctsn.org/resources/tips-familiesaddressing-anniversaries.

 Teacher Guidelines for Helping Students After a

Hurricane—This tip sheet developed by the NCTSN

offers guidance to teachers on how to help students

recover and cope after a hurricane. The tip sheet

is available at https://www.nctsn.org/resources/

teacher-guidelines-helping-students-afterhurricane.

Request: SAMHSA DTAC received a TA request 

for resources and tools to assist in providing disaster 

behavioral health services in emergency shelters.

Response: SAMHSA DTAC provided the following 

resources:

 Disaster Behavioral Health Interventions

Inventory—This SAMHSA DTAC Supplemental

Research Bulletin includes Psychological First Aid as

an important disaster behavioral health model as well

as specific assessment instruments such as Screening,

Brief Intervention, Referral to Treatment (SBIRT),

and Psychological Simple Triage and Rapid Treatment

(PsySTART). Find it at https://www.samhsa.gov/

sites/default/files/dtac/supplemental-researchbulletin-may-2015-disaster-behavioral-healthinterventions.pdf.

 Psychological First Aid (PFA) Field Operations

Guide—Developed by NCTSN and the National

Center for PTSD, this guide provides core actions of

PFA and handouts for survivors. It can be found at

https://www.nctsn.org/sites/default/files/resources/

pfa_field_operations_guide.pdf.

 Helping Survivors: Early Interventions Following

Disaster and Mass Violence—This National Center

for PTSD web page provides early interventions

following disaster and mass violence. The web page

is available at https://www.ptsd.va.gov/professional/

treat/type/disaster_earlyintervention_tx.asp. ■
2020 | VOLUME 16 | ISSUE 1 | PAGE 18

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Dwyer, C. (2018, October 24). 

Super Typhoon Yutu, ‘strongest 

storm of 2018,’ slams U.S. Pacific 

territory. National Public Radio. 

Retrieved from https://www.npr.

org/2018/10/24/660224741/supertyphoon-yutu-strongest-storm-of2018-slams-u-s-pacific-territory

Eugenio, H. (2018, October 30). 

Second death reported as a result of 

Super Typhoon Yutu. Pacific Daily 

News. Retrieved from https://amp.

guampdn.com/amp/1804553002

Eugenio, H. V. (2018, October 26). 

Humanitarian crisis looms after Super 

Typhoon Yutu flattens parts of Saipan 

and Tinian. USA Today. Retrieved 

from https://www.usatoday.

com/story/news/2018/10/25/

super-typhoon-yutu-leaves-1-

dead-crisis-looms-saipan-andtinian/1771400002

Federal Emergency Management 

Agency (FEMA). (2018, July). 2017 

hurricane season FEMA after-action 

report. Retrieved from https://

www.fema.gov/media-librarydata/1531743865541-d16794d43d30

82544435e1471da07880/2017FEMA

HurricaneAAR.pdf

FEMA. (2018, October 31). Northern 

Mariana Islands Super Typhoon Yutu 

(DR-4404). Retrieved from https://

www.fema.gov/disaster/4404

Fortin, J. (2018, October 24). 

‘Catastrophic’ super Typhoon Yutu 

slams into U.S. commonwealth in 

the Pacific. The New York Times.

Retrieved from https://www.nytimes.

com/2018/10/24/us/super-typhoonyutu-pacific-mariana.html

Masters, J. (2018, October 24). Category 

5 Super Typhoon Yutu pounding U.S. 

Northern Mariana Islands. Category 

6TM. Weather Underground. Retrieved 

from https://www.wunderground.

com/cat6/Category-5-SuperTyphoon-Yutu-Pounding-USNorthern-Mariana-Islands

Michael, N., Valmond, J. M., Ragster, 

L. E., Brown, D. E., & Callwood, 

G. B. (2019, February). Community

needs assessment: Understanding

the needs of vulnerable children

and families in the U.S. Virgin

Islands post Hurricanes Irma and

Maria. Retrieved from https://cfvi.

net/wp-content/uploads/2019/03/

CFVI-CERC-CommunityNeeds-Assessment-E-Report_

February-2019_Bookmarked.pdf

Mooney, C., Eilperin, J., & Chiu, 

A. (2018, October 25). Category 

5 typhoon Yutu devastates the

Northern Marianas in worst storm to 

hit any part of U.S. since 1935. The

Washington Post. Retrieved from

https://www.washingtonpost.com/

energy-environment/2018/10/25/

category-typhoon-devastatesnorthern-marianas-worst-stormhit-us-since

REFERENCES

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 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).

Ramphal, L. (2018). Medical and 

psychosocial needs of the Puerto 

Rican people after Hurricane Maria. 

Baylor University Medical Center 

Proceedings, 31(3), 294–296. doi: 

10.1080/08998280.2018.1459399
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