A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

2021 | VOLUME 16 | ISSUE 3–4

The Dialogue

CCP and Disaster Recovery
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

6 Contributors

7 Crisis Counseling Assistance and Training Program (CCP)

8 Needs Assessment in the Crisis Counseling Program

12 Staying Connected: CCP Fosters Community During COVID-19

15 CCPs Get Creative

16 Crisis Counselors Support Communities and Individuals through 

Disaster Anniversaries

19 Tips for Working With Tribal Communities During a Disaster Response

22 Crisis Counseling in Rural Wisconsin

27 Recent Technical Assistance Requests

Cover photo: Missouri Show Me Hope CCP staff hand out materials at a community 

COVID-19 testing event.
2021 | VOLUME 16 | ISSUE 3–4 | PAGE 3

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

The Crisis Counseling Assistance and Training Program 

(CCP) helps individuals and communities recover from 

natural and human-caused disasters through community 

outreach, psycho-educational materials, and facilitating 

access to mental health services when needed. CCPs 

work to reach large numbers of people affected by 

disasters through face-to-face outreach at convenient 

In This Issue

locations such as shelters, homes, faith-based 

organizations, and local community events. Teams 

work to identify tangible needs and link survivors to 

community resources and disaster relief services. CCP 

activities are designed to leave behind a permanent 

legacy of improved coping skills, educational and 

resource materials, and enhanced community linkages 

States and Territories With Active CCP Grants as of January 2021

COVID Grant Natural Disaster 

and COVID Grant
2021 | VOLUME 16 | ISSUE 3–4 | PAGE 4

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

to improve community and individual resilience in the 

event of future disasters.

Currently, nearly all states, several territories, and tribal 

nations have CCPs running for disasters including 

flooding, wildfires, hurricanes, and the COVID-19 

pandemic, just to name a few. The Substance Abuse 

and Mental Health Services Administration (SAMHSA) 

and the SAMHSA Disaster Technical Assistance Center 

(DTAC) work with states, territories, and tribes to apply 

for, set up, and run the CCP grant.

This double issue of The Dialogue focuses on topics that 

may help current and future CCPs. The issue provides 

helpful tips and lessons learned on several topics that 

may be useful during a CCP or other disaster recovery 

effort. We start with background information on what 

a CCP is and who can apply for the grant. We then 

move on to an article that talks about the importance 

of the initial needs assessment and continued needs 

assessments to help guide disaster recovery programs. 

Our next several articles touch on topics that all CCPs 

usually address at some point during service delivery. 

These topics include working with rural and tribal 

communities, how to address disaster anniversaries, 

as well as an interview discussing the challenges of 

running a CCP during the COVID-19 pandemic. This 

issue also features a helpful self-care poster for outreach 

workers. Please share it with your team. 

Have you recently worked on or run a CCP or other 

disaster recovery program? Other disaster responders 

can learn from your efforts. We encourage you to contact 

us to share your stories and lessons learned. ■

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

CCPs 

Across the 

Nation

Images from upper left, clockwise: Nebraska Strong CCP staff conducting outreach with children. Arkansas Promoting Positive Emotions CCP staff and 

children at an art event. Missouri Show Me Hope CCP staff at a community vaccination event. Arkansas CCP staff in a nursing home blanket drive. 

Nebraska CCP staff conducting physically distant outreach. 
2021 | VOLUME 16 | ISSUE 3–4 | PAGE 5

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Images in collage from top to bottom, left to right, row by row: Arkansas CCP honors child mask challenge winners. Missouri CCP staff offer messages of 

gratitude to hospital workers. Missouri CCP spotlights staff member Hajal Patel on Facebook. Missouri CCP distributes Super Bowl COVID-19 survival kits. 

Puerto Rico’s Proyecto Conéctate CCP offers a virtual workshop about emotional self-care for young children. Missouri CCP staff visit testing site with Missouri 

National Guard to provide resources to families.
2021 | VOLUME 16 | ISSUE 3–4 | PAGE 6

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Contributors

Beckie Gierer, M.S. is the Director for 

Continuity of Operations Planning with 

the Missouri Department of Mental 

Health (DMH) Office of Public and 

Legislative Affairs/Office of Disaster 

Services (ODS). She has an M.S. from the University 

of Central Missouri and has worked with the State of 

Missouri for 18 years. Gierer started her career with 

the Department of Public Safety and worked for the 

Department of Social Services, but she has spent the 

majority of her years of service (13) with the DMH. 

She also serves as grants manager for the Hospital 

Preparedness Program and Public Health Emergency 

Preparedness grants with ODS and supervises Federal 

Emergency Management Agency (FEMA) Crisis 

Counseling Assistance and Training Program (CCP) 

grants. Gierer is also a contracted trainer with SAMHSA

for the FEMA CCP and has trained crisis counselors in 

Missouri, North Carolina, and California. 

Denise Bulling, Ph.D., LIPC is a Senior 

Research Director with the University 

of Nebraska Public Policy Center. She 

joined the university in 2003 after an 

over-20-year career as a mental health 

practitioner. Her Ph.D. is in human science with her 

dissertation focusing on exploration of training needs 

for disaster chaplaincy. Bulling uses her extensive field 

experience in mental health to create bridges between 

practitioners, academicians, and policymakers. She is a 

leader in Nebraska’s development of disaster behavioral 

health response capacity, consults and speaks about the 

role of disaster behavioral health within an integrated 

response and recovery system, and is a national 

trainer for the FEMA CCP. She has served as lead for 

several CCPs including one of the first projects in the 

nation conducted on tribal land. Bulling is a licensed 

independent professional counselor (LIPC) and a 

Certified Threat Manager through the Association of 

Threat Assessment Professionals. She has numerous 

publications related to mental health, disaster, and 

violence. 

Jane Gaffney is an Independent 

Contractor with the State of Wisconsin, 

Wisconsin Community Action Program 

Association, Inc. (WISCAP). She has 

been involved in crisis counseling 

for over 20 years with roles in crisis intake, refugee 

resettlement, domestic violence, and disaster crisis 

counseling. She started her career working for Sauk 

County Human Services in Wisconsin as a crisis 

intake worker. Gaffney has worked with Project 

Recovery, a grant-funded CCP, after the disasters in 

Wisconsin in 2007, 2008, 2010, and 2018. Gaffney is 

a trainer for the CCP and for the Dementia Friendly 

program in Wisconsin. Her training has included 

topics such as trauma, self-care and team care, disaster 

preparedness, Skills for Psychological Recovery, and 

suicide prevention. Gaffney is currently working with 

WISCAP to develop a community-based statewide crisis 

counseling program for survivors of disasters, small or 

large.

Karen Hyatt, M.S.W. is the Emergency 

Mental Health Specialist for the 

Division of Mental Health and Disability 

Services within the Iowa Department 

of Human Services and serves as the 

Disaster Behavioral Health Coordinator for the State 

of Iowa. Hyatt attended the University of Iowa for her 

undergraduate degree and Iowa State University for 

her master’s degree. She is a licensed social worker in 

the State of Iowa and a Certified Resource Specialist 

and holds certifications as a Mental Health First Aid 

and Youth Mental Health First Aid Instructor. Hyatt 

administers the state’s Disaster Behavioral Health 

Response Team and provides training for the FEMA 

CCP and in areas including Psychological First Aid, 

compassion fatigue, and disaster behavioral health. 

Hyatt serves on the Iowa Council of Homelessness, ESF 

6 Derecho Council, and Preparedness Advisory Council 

for the Iowa Department of Public Health. She has work 

emphases in crisis stabilization services, peer support, 

and the Office of Consumer Affairs.
2021 | VOLUME 16 | ISSUE 3–4 | PAGE 7

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

What is the CCP?

The CCP is a short-term disaster 

relief grant for states, U.S. 

territories, and federally recognized 

tribes designed to help individuals 

and communities recover from 

natural and human-caused disasters 

through community-based outreach 

and psycho-educational services. 

These entities may apply for a CCP 

grant after a Presidential disaster 

declaration.

The Emergency Mental Health and 

Traumatic Stress Services Branch 

of the SAMHSA Center for Mental 

Health Services (CMHS) and the 

Federal Emergency Management 

Agency (FEMA) work together 

to provide technical assistance, 

consultation, and training for state 

and local mental health personnel 

involved in the CCP. 

How does the CCP help 

disaster survivors?

The CCP helps people recover 

and rebuild their lives after a 

disaster. The CCP supports shortterm interventions that involve the 

following counseling goals:

• Helping disaster survivors 

understand their current situation 

and reactions

• Reducing stress and providing 

emotional support

• Assisting survivors in reviewing 

their disaster recovery options

• Promoting the use or development 

of coping strategies

• Connecting survivors with other 

people and agencies who can help 

them in their recovery process

The CCP follows key principles 

that make it different from 

other survivor support 

programs. The CCP is:

• Strengths-based: CCP services 

promote resilience, empowerment, 

and recovery.

• Anonymous: Crisis counselors 

do not classify, label, or diagnose 

people. No records or case files are 

kept.

• Outreach-oriented: Crisis 

counselors deliver services in the 

communities rather than wait for 

survivors to seek their assistance.

• Conducted in nontraditional 

settings: Crisis counselors make 

contact in homes and communities, 

not in clinical or office settings.

• Designed to strengthen existing 

community support systems: The 

CCP supplements, but does not 

end or replace, existing community 

systems. 

The CCP offers services to 

disaster survivors in their 

homes, shelters, temporary 

living sites, or houses of 

worship. Funded CCP services 

include the following:

• Individual and group crisis 

counseling

• Basic supportive or educational 

contact

• Community networking and 

support

• Assessments, referrals, and 

resources

• Development and distribution of 

educational materials

• Media and public service 

announcements

To learn more about the CCP, visit 

the CCP toolkit at https://www.

samhsa.gov/dtac/ccp-toolkit. ■

Crisis Counseling Assistance and 

Training Program (CCP)
2021 | VOLUME 16 | ISSUE 3–4 | PAGE 8

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Needs Assessment in the Crisis 

Counseling Program

By Denise Bulling, Ph.D., LIPC 

Conceptualizing and conducting 

mental health and substance userelated needs assessments after a 

disaster can be daunting. This is 

particularly challenging for state 

level personnel who are charged with 

determining the need for a Crisis 

Counseling Assistance and Training 

Program (CCP) grant. The current 

CCP needs assessment schemas 

are guided by research (Norris, 

Friedman, & Watson, 2002; Norris 

et.al., 2002; North & Pfefferbaum, 

2013). The literature points to 

individual and community level 

indicators of need related to mental 

health after a disaster. Much of our 

CCP needs assessment activities 

center on understanding who is in the 

community and is most vulnerable 

to the effects of disaster, and what 

resources and capacities for response 

are accessible after the disaster. 

Individual level needs assessments 

for the CCP focus on identifying 

psychosocial stressors, individual 

connections, and vulnerabilities. An 

entire special issue of the Journal of 

Psychiatric Research (Volume 17, 

Issue S2) focuses on post-disaster 

mental health needs assessments for 

individuals at the clinical level. From 

all of these sources we know there 

are key activities that state-level 

personnel can take early to ensure 

mental health and substance userelated needs in the affected area are 

assessed and monitored. 

Assessing Needs Before a 

Disaster Declaration

Many disasters never rise to the 

level of receiving a Presidential 

disaster declaration. Each state 

has its own disaster behavioral 

health plan to guide how local- and 

state-level mental health resources 

respond to the disaster. Most states 

have capabilities for immediate 

outreach but few can sustain it over 

time. Building needs assessment 

in all smaller disaster behavioral 

health outreach activities will make 

it easier to pull together data for 

large responses that are eligible for 

the CCP application. The most basic 

data to collect is the number of 

disaster mental health responders 

deployed, and their impressions of 

what is going on in the community. 

If possible, ask these responders to 

count the number of people they talk 

to and the materials they distribute. 

Some states and localities are 

organized enough to ask deployed 

mental health responders to collect 

additional data about the type of 

reactions they are seeing in the field. 

Set the stage early and expect local 

providers to use incident command 

principles where deployed personnel 

report up to a team leader who can 

collect and report data to the state 

lead. Asking deployed personnel to 

write a short paragraph about what 

they experienced in the field can 

paint a picture of what survivors 
2021 | VOLUME 16 | ISSUE 3–4 | PAGE 9

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

are experiencing. These paragraphs 

can sometimes be more informative 

than check boxes on a form for risk 

factors or reactions. Ask for the 

same information from the lead of 

the American Red Cross Disaster 

Mental Health function or other 

agencies that have deployed mental 

health in the disaster area. 

State leaders should be 

simultaneously asking someone 

to collect news stories from and 

about the disaster area. Pull out 

information from the articles that 

illustrates the effect on individuals 

and communities and cite the source. 

This will position you to write the 

CCP application if needed and 

you will be better informed about 

the potential strain on survivors, 

responders, and the mental 

health and substance use disorder 

treatment workforce. Cultivate good 

relationships locally and at the state 

level with emergency management 

ahead of any disaster so they know 

who you are when you call and ask 

for information about the disaster 

(e.g., damage, areas affected). 

Assessing Needs for the CCP 

Immediate Services Program 

(ISP) Application 

We all know the hallmark of disaster 

is chaos. Responders and emergency 

managers are busy keeping people 

safe and assessing damage so they 

may not prioritize assessment of 

social or emotional issues when you 

need it the most. State mental health 

program directors often experience 

challenges getting meaningful data 

in the days immediately following a 

disaster (Elrod, Hamblen, & Norris, 

2006). You are ahead of the game if 

you started collecting news stories at 

the disaster onset and have a system 

for collecting basic data from mental 

health personnel who are already 

in the field. If you have not been 

collecting this data, now is the time 

to start. 

There is no single formula that 

captures all of the mental health 

needs after a disaster. In the past the 

CCP application included tables that 

helped organize effects by reporting 

losses such as the number of deaths, 

injuries, and homes destroyed. The 

most recent application form for 

the ISP is less prescriptive. Instead, 

applicants are asked to describe 

current services and explain why 

they can’t meet the disaster-related 

mental health needs caused or 

aggravated by the disaster. There is 

also a box to describe any special 

circumstances affecting the need 

for crisis counseling services. In 

the early days after a disaster, it is 

often difficult to get exact numbers 

and data that illustrate these needs. 

However, you can often get ballpark 

estimates of how many communities 

are affected from the state, Federal 

Emergency Management Agency 

(FEMA), and via news reports. 

Community Assessment for Public Health Emergency Response (CASPER)

Federal Emergency Management Agency Damage Assessment Manual

Comprehensive Disaster Assessment and Readiness Tools (CDART)

Rapid Environmental Assessment Tool (REA)

Needs Assessment

 The following are helpful resources for conducting a needs assessment:
2021 | VOLUME 16 | ISSUE 3–4 | PAGE 10

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Identify census information for 

each county in your area ahead of 

any disaster, or be ready to have 

someone look up census information 

using the Census Data website 

(https://data.census.gov/cedsci). 

This website provides community-, 

county-, or state-level data about 

the population in the disaster area. 

Consider pulling out data about 

groups most vulnerable to the effects 

of disaster (e.g., number of youth, 

seniors, households in poverty, 

renters, people with limited English 

proficiency, different cultural groups, 

veteran status). This data coupled 

with the narratives you have from 

the field and news reports will help 

you tell the story about the social, 

emotional, and psychological needs 

of survivors and responders. 

Estimating the population to be 

served by your ISP starts with the 

overall census numbers for the 

disaster areas. Estimate the effect 

in each area you intend to serve by 

reviewing (1) the characteristics 

of the disaster (e.g., warning, 

displacements, damage, deaths, 

and injuries) side by side with 

(2) the census information about 

the populations most vulnerable 

to the influences of disaster and 

(3) the impressions or data you 

have from those in the field. 

Describing the interplay of these 

factors is especially important for 

rural areas with low population 

numbers but high effects. A fourth 

(4) consideration is to realistically 

describe the capabilities of mental 

health providers to do extended 

outreach and psychosocial education 

in the affected areas. Usually this 

capacity is limited to the immediate 

response period. Project how many 

outreach workers you need to serve 

an area, recognizing that two people 

are deployed together for safety 

reasons. If you propose to fund one 

full-time equivalent (FTE) or less, 

be ready to describe how you plan 

to meet this safety standard. Consult 

with your proposed provider of 

CCP services during the writing 

of the grant so they can give you 

information about their local area, 

its disaster related needs, and their 

staffing capabilities. Local providers 

can also add to the needs assessment 

by describing how damage to local 

gathering places and culturally 

important places may affect 

community cohesion and recovery. 

Regrouping for the CCP 

Regular Services Program 

(RSP) Application

It is not unusual for the ISP training 

to coincide with due dates for the 

RSP grant. Ideally, you will have 

ISP outreach data to substantiate 

your need for the RSP. However, 

this data may not yet be available to 

you. Between the ISP and the RSP 

applications, you should continue 

to monitor news sources and focus 

on strengthening your connections 

with emergency management and 

voluntary organization partners 

who are still in the field. The FEMA 

joint field office will likely be set 

up by now and there will be a lead 

identified for individual assistance. 

This person will have access to 

information that can help you 

direct local mental health outreach 

activities to areas most affected by 

the disaster. You should be getting 

regular reports from any local 

mental health assets still responding 

to the disaster. SAMHSA and 

the SAMHSA Disaster Technical 

Assistance Center will likely be 

working with the state contact now 

CCP staff conduct outreach, identify local needs. Photo provided by Puerto Rico Proyecto Conéctate CCP.
2021 | VOLUME 16 | ISSUE 3–4 | PAGE 11

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

REACTIONS

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

AUG 18 – 

SEP 17

SEP 18 – 

OCT 17

OCT 18 – 

NOV 18

NOV 19 –

DEC 18

DEC 19 (2019) – 

JAN 18 (2020)

JAN 19 – 

FEB 18

REACTIONS OVER TIME – PROVIDER A

Behavioral Emotional Physical Cognitive

August 18, 2019 through February 18, 2020

as the next grant is taking shape. 

The RSP grant package contains 

supplemental instructions about 

the needs assessment including a 

worksheet to help you consider how 

the impacts of the disaster affect the 

risk of trauma for the population. 

I recommend revisiting the four 

factors you considered in the ISP 

application and updating it as new 

information comes in. Damage 

assessments will be done or in 

progress, so emergency management 

contacts should be able to provide 

more precise information about 

which neighborhoods or areas were 

hit the hardest. This enables you to 

describe the mental health influences 

on facilities and populations with 

more detail. 

Using CCP Data to Adjust 

Programming

Needs assessment never stops. The 

CCP data collection tools provide a 

wealth of information to help you 

adjust programming as the program 

unfolds. The reports generated by 

the data system are helpful, but not 

the only way to view data. Consider 

downloading the data into an Excel 

spreadsheet so you can view it in 

different ways. For example, you can 

create graphs showing the trajectory 

of the four reaction types tracked 

in individual and group crisis 

counseling contacts to show how 

reactions change over time. Program 

managers and team leads can 

respond by creating different types 

of educational materials based on 

emerging trends or guide training 

for crisis counselors. Consider 

asking crisis counselors in the field 

to supplement the data with regular, 

brief paragraphs about their 

experiences in the field. This helps 

provide context for the numbers 

and simultaneously helps identify 

situations that are stressful and 

rewarding for the CCP workforce. 

All of the data helps the state and 

local providers identify next steps 

and crucial partners to move the 

community through recovery when 

the CCP ends.■

An example of how a CCP might illustrate reactions over time to understand community needs and guide programming.
2021 | VOLUME 16 | ISSUE 3–4 | PAGE 12

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Staying Connected: CCP Fosters Community 

During COVID-19

By Karen Hyatt, M.S.W.

In 2020, a historic number of 

states launched Federal Emergency 

Management Agency (FEMA) Crisis 

Counseling Assistance and Training 

Program (CCP) grants related to 

the COVID-19 pandemic. At the 

same time, to reduce the spread of 

the disease, states and localities 

implemented physical distancing 

guidelines and orders, and much of 

the nation spent a lot more time at 

home. The CCP is based on inperson contact, as well as helping 

communities tap into and strengthen 

existing social networks. What does 

such a program look like during a 

pandemic? 

To find out, The Dialogue recently 

spoke with Karen Hyatt, Iowa’s 

State Disaster Behavioral Health 

Coordinator, who leads the COVID 

Recovery Iowa CCP. Since 2008 

Hyatt has worked on six Iowa CCPs, 

many branded as Project Recovery 

Iowa. She described how COVID 

Recovery Iowa is different, including 

innovations in staffing, virtual 

services, and creative ways the 

program has found to reach disasteraffected communities.

How is your current COVID-19 

grant structured?

We have five providers and 105 staff 

members. As in past CCPs, we have 

tried really hard to hire people from 

all over the state, and with all kinds 

of different backgrounds, so we can 

honestly say to people across the 

state that we’re just like you.

Many of our staff have worked on 

a Project Recovery Iowa CCP from 

2008 to today. I’m proud of that, that 

they have such a good association 

with the grant. 

How have you adapted typical 

CCP services to a virtual 

environment? 

I recruited our social media liaison, 

who has done wonderful things. 

She held Zoom sessions with staff 

to teach them to use social media. 

Even if staff said they didn’t like 

Facebook, we told them to like 

our program page (https://www.

facebook.com/covidrecoveryIowa) 

and the groups we set up there. 

We have a website (https://www.

covidrecoveryiowa.org) with 

information in over 60 languages 

and materials about our program. 

The website includes a contact 

form. When someone fills it out, the 

request comes to me. I send requests 

to team leaders and we disseminate 

them to staff, so no request sits for 

more than 2 hours, except overnight. 

We have over 20 groups on social 

media. The Media page of our 

website (https://covidrecoveryiowa.

org/media-center) links to a lot 

of the Facebook groups. We have 

groups on meditation and yoga, 

music, and a book club for older 

adults. 
2021 | VOLUME 16 | ISSUE 3–4 | PAGE 13

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Have there been other staffing 

changes for the CCP during 

the pandemic?

We have the social media staff 

member I mentioned on this grant, 

along with a great graphic designer, 

who is also a high school teacher. 

He has taken our print material and 

given it a really strong, consistent, 

professional look.

We added a layer to our CCP that’s 

unique; it’s the only one in the 

country right now with specialty 

coordinators, who are subject matter 

experts in six categories: agriculture 

and rural mental health; domestic 

violence, homelessness, and urban 

mental health; children and families; 

military families and veterans; 

older adults and individuals with 

developmental disabilities; and 

workforce. Also, one person works 

exclusively on self-care for staff. 

The specialty coordinators don’t 

supervise—we have team leads who 

do that—but we ask all of our staff 

to select a specialty area when they 

are hired. The specialty coordinators 

come up with programming and 

guide and give assignments to other 

staff. 

This structure is new, and it’s 

worked so well that I think I will 

do it again. The specialty areas help 

staff focus. Staff are not limited to 

one specialty area; they can serve 

people outside of their area. The 

reality is that a lot of families have 

members who fall into all of the 

categories.

What have staff done in the 

specific specialty category 

areas?

In the area of older adults and 

individuals with developmental 

disabilities, we have a pen pal 

program. Since the program started 

a few months ago, staff have sent 

well over 400 handwritten letters, 

and people in nursing homes have 

started writing back. One of our staff 

has legacy training, which helps 

with asking questions to get a person 

to tell his or her story, and then they 

transcribe it and give it back to the 

individual. Especially for people 

who are isolated, this work gives 

them a purpose, reminding them that 

their life has meaning and someone 

wants to hear about it. 

We have a book club focused on 

older adults. We partnered with the 

library association to send copies 

of the first book to nursing homes. 

Out of that group came a lot of 

discussion that kind of turned into 

a support group. It’s a Zoom group, 

and people can also attend by phone. 

They have met several times.

The developmental disabilities 

area has a program, Chat Buddies, 

that has really taken off. Staff 

communicate, mainly by text, 

with people with developmental 

disabilities who are isolated because 

of the pandemic from their normal 

support groups or work clubs. Our 

staff had to set limits on how much 

time they spent, because participants 

really wanted to interact with them. 

We had to bring in additional staff 

and train them, because staff we had 

couldn’t handle all the requests. We 

put together a training on adaptive 

technologies to help our staff in this 

area.

We also have song-o-grams, where 

a person can ask for someone’s 

favorite song. We recently had a 

request from a gentleman for a songo-gram for his wife, who was in a 

nursing home and on a ventilator, 

for their 63rd anniversary. A phone 

was brought to the woman on the 

ventilator, and our staff sang the song 

that the woman and her husband had 

danced to at their wedding. 

In agriculture and rural mental 

health, we have support groups for 

families of farmers. Staff have done 

a lot of work with suicidal ideation in 

farming. We partner with Iowa State 

University Extension and Outreach, 

including hiring some of their staff to 

help with rural programming, such as 

Stress on the Farm sessions. 

Staff in this area have done a lot of 

work with the meat packing plants, 

where high numbers are testing 

positive for COVID, and the majority 

of workers do not speak English. It’s 

been hard to reach this population. 

Many don’t have internet access, and 

Special populations are groups 

who may be at greater risk in and after 

a disaster. Special populations vary by 

disaster. They may include:

 ̈ Children and youth

 ̈ Older adults

 ̈ People with past trauma

 ̈ Public safety workers

 ̈ People experiencing homelessness
2021 | VOLUME 16 | ISSUE 3–4 | PAGE 14

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

they’re not going to do something 

other than work while they’re at 

work, so we try to go to places they 

naturally would go for information, 

like laundromats and small grocery 

stores. The staff that work there are 

in the know, and they get in over 

their head because people come to 

them for everything. We tried at 

first to work through the two big 

employers in the state, and we didn’t 

make an impact at all. By partnering 

with other agencies we have done 

more, and we have hired people 

from Somalia and other countries 

that plant workers also come from.

In the area of children and families,

we have a series of readings of 

children’s books by our staff and 

others. The readings are recorded 

and posted each day at 10 a.m. 

(https://www.facebook.com/

groups/1581970971987124). We 

have had famous people in Iowa, 

or with a connection to the state, 

including Ashton Kutcher, reading 

children’s books. His first cousin 

is married to one of the executive 

directors of a provider organization 

for our grant. Miss Iowa has read, 

and all the university coaches, and 

now we’re moving on to mascots. 

We’re offering virtual visits with 

Santa through Facebook. In two 

weeks we served 248 kids, and 

another 100 are already scheduled 

for the upcoming week and a half. 

Both Santas are staff, counselors 

with backgrounds in disaster, and 

both are married to wives who are 

also counselors for us. The kids 

tell Santa the real deal about their 

families. One child said, “I don’t 

want anything for me, but if you 

could bring my mom a box of 

Kleenex, because she cries every 

night, that would be good.” The 

mom didn’t know the child knew 

that, but kids do know. One of the 

wives and the mom separately from 

Santa had their own conversation. 

Out of the Santa visits, we have 

gotten 40 requests for one-on-one 

counseling for parents.

In the military families and veterans 

category, two people share the 

specialty coordinator position—one 

with a husband in the military, the 

other a Vietnam War veteran. A lot 

of veterans with disabilities and 

older veterans are involved, and they 

participate in the pen pal and legacy 

programs, as well as some Facebook 

groups. We found that military 

families didn’t always know about 

resources available to them outside 

of the military. We’ve been letting 

them know about community-based 

services where they are.

In the workforce category, staff have 

been holding 1- to 1.5-hour sessions 

on self-care and anxiety reduction. 

We started these sessions because 

Homeland Security and Emergency 

Management staff asked for them, 

and they really liked them. We 

have had sessions for staff in other 

state departments. We have also 

developed sessions for nursing home 

staff, breaking the full session into 

10-minute recordings that staff can 

listen to over six to eight days to 

cover the material. These sessions 

have been well-received, and some 

are reaching out in their private time 

to schedule counseling sessions. 

How have you gotten the word 

out about your CCP? 

We have engaged the media in some 

of our groups. Then they promote 

our program on the radio for free. 

Celebrity involvement has also been 

helpful. 

The Governor has regular press 

conferences. She recently invited 

me to one, held at the Iowa public 

television station, to talk briefly 

about our work. By the time I got to 

my car after the press conference, I 

already had calls from five agencies 

wanting more information. By the 

time I got back to my computer, 45 

people had gone to our website and 

asked for one-on-one counseling, 

and by the next morning it was 212. 

I emailed the Governor’s Office staff 

and told them what had happened 

and how many people had contacted 

me. Later the Governor mentioned 

our CCP again, and I noticed an 

increase in requests through our 

website. She said they would 

have us back after the holidays, in 

February.■

Video posted to Facebook by COVID Recovery 

Iowa of a reading of Salam Alaikum by Harris J.
2021 | VOLUME 16 | ISSUE 3–4 | PAGE 15

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Offer resources, a hotline 

number, and virtual groups 

as needed for department of 

corrections staff in places 

where COVID-19 cases have 

spread rapidly within these 

environments.

CCPs Get Creative!

Across the country, CCPs are coming up with creative ways to 

provide outreach and services to people struggling during the 

COVID-19 global pandemic. The virtual nature of the current 

programs has encouraged CCP leadership to explore new ways 

to reach their target audience. Here are a few of their strategies.

Identify warming locations for 

individuals who are homeless 

during the winter months and 

use those sites to distribute 

resources and connect with 

them.

Partner with utility companies to 

include program information in 

their customer communications 

such as billing statements or 

payment receipts.

Start or participate in a pen pal 

program between CCP staff and 

residents in nursing homes and 

assisted living facilities.

Collaborate with retired 

educators to establish response 

teams that can be deployed to 

schools affected by COVID-19, 

taking help directly to educators 

and school support staff. Partner with professional sports 

teams to mention the program 

or promote the program when 

airing games.

Convene collaborative 

conference calls with other 

states in the region to discuss 

best practices, brainstorm, and 

share resources.

Coordinate with an in-state 

emergency rental assistance 

program to distribute resources 

and reach out to individuals and 

families served by the program.

Partner with state department of 

transportation (DOT) divisions 

to include program messaging 

on DOT electronic billboards.

CCPs Get Creative

 CALL YOUR LOCAL CCP TO CONNECT TO SUPPORT SERVICES
2021 | VOLUME 16 | ISSUE 3–4 | PAGE 16

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Crisis Counselors Support Communities and 

Individuals through Disaster Anniversaries

By Beckie Gierer, M.S.

In every disaster, there comes a 

time to commemorate the event that 

led an individual or community to 

where they are in their recovery 

journey. Anniversaries are met with 

many emotions, celebrated in a 

variety of ways, and held at various 

points. In Missouri, there have been 

several federally declared disasters 

in the last 8 years. Missouri has seen 

tornadoes in 2011, severe flooding in 

2015, 2017, and 2019, and tornadoes 

in 2019. 

In 2011, one of the deadliest 

tornadoes (an EF-5) went through 

Joplin. On the same day, 

8 years later, in 2019, a 

storm system went through 

Missouri that produced several 

tornadoes. Three tornadoes 

went through communities 

right outside of Joplin that took 

the lives of three people and 

brought back many painful 

emotions and memories on the 

disaster anniversary. Anxiety 

was already at a heightened 

state when the storm system 

pushed through the area in 

the late evening. Loved ones were 

frantically texting each other to 

check on their safety and people 

were rushing to their safe locations; 

the fear and anxiety was evident as 

the storm system mounted. While 

response was happening in these 

areas on the eighth anniversary, 

some 143 miles away, another round 

of tornadic activity was starting in 

central Missouri. That same storm 

system produced a tornado in Eldon 

and Jefferson City that left a trail of 

damage in those communities. 

What is an anniversary event?

When thinking about anniversaries, 

an important thing to remember is 

that it can mean different things to 

different people. The community 

may decide to host an event to 

remember what happened or the 

community may decide to let the 

anniversary pass with each person 

doing their own unique thing. An 

anniversary event may be held at 

different times depending on the 

community and the disaster. One 

community may choose to not do 

anything formal for an anniversary 

Crisis Counseling Assistance 

and Training Program (CCP) staff 

participate in a required disaster 

anniversary training that focuses 

on helping crisis counseling 

staff anticipate and respond 

to possible individual and 

community reactions, including 

adapting public education and 

media messaging to match 

changing needs.
2021 | VOLUME 16 | ISSUE 3–4 | PAGE 17

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

while another community may do 

multiple events over the course of 

several days.

Events range in size, location, type, 

and formality. The type of event a 

community holds depends on what 

works for that community. Crisis 

counselors participate in anniversary 

events by providing much needed 

emotional support. This is done in 

a variety of ways and often requires 

crisis counselors to think outside 

the box. For example, in Joplin, 

crisis counselors participated in 

the anniversary unity walk where 

staff were stationed at several 

locations along the walking route to 

offer water and emotional support 

to both volunteers and citizens 

participating in the event. Crisis 

counselors have also participated 

in less formal events like a fish fry 

where a community just wanted 

to come together to be in a central 

location during a hard time. 

Missouri CCP staff have also been 

a part of anniversary riverfront 

events, children’s block parties, 

and neighborhood lunches. These 

events present a unique opportunity 

for the crisis counselors to become 

a part of the event without actually 

hosting. This can create challenges 

for the counselors as they determine 

how to best reach the community 

members at an anniversary event. 

As most mental health professionals 

will tell you, people don’t typically 

walk up to a mental health table and 

reach out for assistance. However, 

if the crisis counselors are standing 

or walking in the crowd, among the 

survivors and community members, 

they are more likely to be able to 

reach that population.

How can outreach staff help 

during an anniversary event?

When communities start 

planning the anniversary events, 

crisis counselors should start 

brainstorming ideas for how they 

will reach out to the community 

members attending. This could 

be something as simple as doing 

games or activities, giving away 

information on reactions while 

walking around the crowd, giving 

a presentation, or setting up a 

table with information about 

anniversary reactions. During one 

of the Joplin anniversary events, 

CCP staff collaborated with other 

organizations to provide assistance 

at a children’s block party. The 

children talked about the school they 

lost, their memories, and shared 

stories while having a fun time on 

what was a sad day for many of 

the parents. The crisis counselors 

handed out pinwheels and bubbles to 

the kids to help ease the stress of the 

anniversary and the reactions by the 

adults. The pinwheels and bubbles 

were used to help promote positive 

thoughts about wind and weather. 

Another area that CCP staff need to 

consider is what types of reactions 

they may see around an anniversary. 

In Joplin, referrals and calls to 

the hotline increased when storm 

systems moved through the area and 

when the anniversary approached. 

As the anniversary passed, staff 

began to see a decrease in contacts 

and referrals. As anniversaries 

approach, survivors may have more 

Examples of anniversary 

events include:

 ̈ Anniversary unity walk

 ̈ Children’s block party

 ̈ Neighborhood lunches

 ̈ Fish fry event

 ̈ Anniversary riverfront event
2021 | VOLUME 16 | ISSUE 3–4 | PAGE 18

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

startled reactions and an increase 

around fear. The anniversary may 

also bring back memories around 

possessions or loved ones that were 

lost during the event. Depending 

on the time of the anniversary (1 

month, 6 months, 1 year, etc.), these 

reactions may be more difficult 

depending on where the survivor 

is in their recovery journey. For 

someone who isn’t fully recovered 

emotionally, anniversaries can be 

more difficult. Other survivors 

may use the anniversary as a time 

to reflect and remember what they 

have lost, what they experienced, 

and look at where they are at now. 

As anniversaries approach in 

and partners remain sensitive to 

these reactions in the survivors and 

themselves. ■

Recognize and 

acknowledge 

feelings you may 

experience. 

Understand that your 

feelings are part of the 

recovery process.

Find healthy 

ways to cope with 

your distress. 

Share memories and 

feelings with someone 

you trust or just spend 

time with friends and 

family. Avoid negative 

ways to cope such 

as drinking or using 

drugs.

Remember and 

celebrate the 

lives of your 

loved ones. 

Anniversaries of a 

lost loved one can 

be a difficult time for 

friends and family, but 

it can also be a time 

for remembrance and 

honoring them.

Use your 

support system. 

Reach out to friends 

and family. Don’t 

isolate yourself.

Disaster anniversaries

Coping strategies to help people through traumatic anniversaries include the following:

Source: https://www.apa.org/topics/anniversary-traumatic-event

Missouri, we see reactions around 

fear, anxiety, and frustration in the 

survivors. Community members 

Total Reactions Reported Across CCPs During COVID-19 Pandemic

A spike in disaster reactions in early 2021 corresponds to the anniversary of the start of 

pandemic impacts in different parts of the country.

200K

180K

160K

140K

120K

100K

80K

60K

40K

20K

0K

JANUARY 20, 2020

FIRST CASE OF 

COVID-19 REPORTED 

IN THE U.S.

MAR 

2020

APR 

2020

MAY 

2020

JUN 

2020

JUL 

2020

AUG 

2020

SEP 

2020

OCT 

2020

NOV 

2020

DEC 

2020

JAN 

2021

FEB 

2021

MAR 

2021

APR 

2021

TOTAL REACTIONS REPORTED

YEAR 

ANNIVERSARY 

OF FIRST CASE

MARCH 2020

LOCKDOWN AND 

RESTRICTIONS BEGIN
2021 | VOLUME 16 | ISSUE 3–4 | PAGE 19

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Tips for Working With Tribal Communities 

During a Disaster Response

By SAMHSA Tribal Training and Technical Assistance Center 

Applying cultural considerations is 

recommended when working with 

American Indian and/or Alaska 

Native (AI/AN) communities. 

Cultural considerations are 

especially important when 

responding to emergency or disaster 

situations affecting AI/AN people. 

Five Principles of Cultural 

Proficiency 

Cultural Competency for 

Emergency Management (EM) and 

Consequence Management (CM) 

(Bergeron) defines the following five 

principles of cultural proficiency: 

1. Culture is the predominant force

in people’s lives. 

2. The dominant culture serves 

people in various ways.

3. People have both personal

identities and group identities. 

4. Diversity within cultures can be

vast and significant.

5. Each individual and each group

have unique cultural values and 

needs. 

This information is important 

for disaster behavioral health 

coordinators, disaster technical 

assistance providers, and/or anyone 

providing support or working with 

AI/AN communities before, during, 

or after a disaster or emergency. 

Keeping these principles in mind, 

the following considerations can be 

helpful when working with AI/AN 

communities.

Engage and request support 

from tribal governments and 

leadership.

There are 573 federally recognized 

and 63 state-recognized tribes in the 

United States:

 Each tribe is a sovereign 

government. 

 Each tribe is different, even if 

there are similarities in culture or 

cultural values. 

 Engage tribal leadership first, 

especially for EM or when 

responding to disaster.

 Tribal leadership may be an 

elected chairperson and/or board 

of directors.

 Develop a relationship with 

leadership prior to a disaster or 

emergency.

Image courtesy of SAMHSA Tribal Training and Technical Assistance Center.
2021 | VOLUME 16 | ISSUE 3–4 | PAGE 20

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

 Inquire if the tribe has a current 

EM plan or needs support 

developing one.

 Many tribes have various 

departments, programs, 

and resources to assist with 

emergency response and/or crisis 

management. 

Engage in effective 

communication, using multiple 

methods.

One of the most important areas to 

address is effective communication. 

Emergency responders and other 

CM officials must be prepared to use 

multiple communication methods 

and consider different levels of 

literacy: 

 Information should be conveyed 

in languages other than English, 

including sign language, as 

needed.

 EM and CM officials may need 

to quickly identify key leaders 

and communicators who are able 

to deliver culturally appropriate 

messages (in the correct language 

and cultural context) to inform the 

affected population and prompt 

desired actions and results. 

 Education and literacy, as well as 

socio-economic status, may play a 

role in effective CM, particularly 

in the mid- to long-term recovery 

phases.

Remember the importance 

of culturally specific funeral 

rituals and/or ceremonies. 

Funeral ceremonies help people 

cope with the loss of their family 

members. These practices have 

been developed and refined over 

generations. Dealing with casualties 

and death can be where cultural 

proficiency has the most effect:

 Religious and cultural beliefs and 

death practices will be important 

to survivors.

 There may be a strong 

psychological need to quickly 

identify lost loved ones and to 

grieve for them in specific cultural 

ways.

There may be conflicts concerning 

the following:

 Autopsies, timeframe, and 

handling of the body 

 Ceremonial washing of the 

deceased and other customs or 

rituals

 Cultural items left or placed with 

the dead

Understand the importance of 

family roles, responsibilities, 

and support structures.

Traditional cultures may use 

matriarchal or patriarchal decisionmaking methods and include 

extended family or clans:

 Officials may need to specifically 

engage these individuals or 

familial leaders. 

 During a mandated evacuation 

or emergency shelter situation, 

keeping all members of extended 

families together may prove to be 
2021 | VOLUME 16 | ISSUE 3–4 | PAGE 21

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

a critical component in families’ 

compliance with CM official’s 

instructions.

 Ask or rely on tribal leadership 

to share the importance of these 

practices.

 Each AI/AN community may be 

different or have varying cultural 

values.

Learn how others define 

“household” and gender roles.

AI/AN communities may have 

differing or opposing definitions 

depending on culture. These 

definitions can affect the following:

 Distribution of relief supplies in 

the immediate aftermath of the 

incident and/or the disbursement 

of longer-term recovery funds.

 Culturally, “household” may be 

defined by family ties related 

to the eldest male member, 

depending on AI/AN tribe:

 This can be problematic when 

considering single mothers with 

children or newly widowed 

women, with no remaining male 

family ties.

 Example influencing resource 

support: The “Household Rule” 

and the aftermath of Hurricane 

Katrina.

 Cultural gender roles may also 

cause additional complications. 

Female survivors may not feel 

comfortable receiving treatment 

from male first responders. 

 Work directly with individual 

tribes to address these topics and 

ask questions.

In summary, consider the following: 

 Encourage incorporating cultural 

considerations into everyday 

efforts and interactions, as well as 

crisis response operations.

 Include crisis responders and 

cultural brokers (e.g., community 

leaders) from the affected cultural 

groups before, during, and in the 

aftermath of any crisis. 

 Community-based groups 

can provide an important 

communication link with the 

cultural groups they represent.

 EM and CM officials may have 

the ability to enhance the readiness 

and flexibility of the populations 

they protect and serve through a 

culturally appropriate dialogue.

Cultural considerations allow 

individuals and organizations to 

interact effectively. It is an approach 

for addressing the issues that emerge 

in diverse environments. Taking 

cultural considerations into account 

in your approach is proactive and 

can provide framework for seamless 

sustainable interactions and 

partnerships. ■
2021 | VOLUME 16 | ISSUE 3–4 | PAGE 22

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Crisis Counseling in Rural Wisconsin

By Jane Gaffney 

In Wisconsin, residents have a 

bootstrap mentality, meaning 

that they “pull themselves up by 

their bootstraps”—an old saying, 

but very applicable today. Rural 

Wisconsinites take care of what 

needs to be done and continue to 

try to make a living, no matter 

how challenging the times. The 

State of Wisconsin applied for 

Federal Emergency Management 

Agency (FEMA) Crisis Counseling 

Assistance and Training Program 

(CCP) grant funding in 2007, 

2008, 2010, and 2018 due to 

severe storms and flooding. In 

2020, the state applied for a grant 

for assistance in coping with the 

COVID-19 pandemic. The CCP was 

implemented to help all residents of 

Wisconsin, with a focus on areas that 

had a surge in cases of the disease. 

The CCP in each of the disasters was 

branded as Project Recovery. In all 

of the CCPs, crisis counselors have 

been hired, trained, and deployed 

to the areas included in Presidential 

disaster declarations for storms and 

the pandemic. 

Storms Hit Hard

Flooding, straight-line winds, and 

tornadoes have severely affected 

rural communities in Wisconsin. 

The COVID-19 pandemic has 

further broken down the fabric 

of communities in the state. 

Resources have been depleted. In 

rural communities, many roads 

were washed out, homes flooded, 

According to the U.S. Census 

Bureau in 2017, 1 in 5 

Americans lives in a 

rural area.

Source: U.S. Census Bureau, Population 

Division, 2018
2021 | VOLUME 16 | ISSUE 3–4 | PAGE 23

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

and animals stranded when storms 

hit. Some survivors were trapped 

in their homes for days because 

of road closures. Vehicles and 

possessions were washed away 

in the floodwaters. Wisconsinites 

now face isolation, depression, and 

anxiety due to the need for physical 

distancing and risk of infection 

during the pandemic.

Survivors often tell crisis counselors,

“I’m fine, but my neighbor got a lot 

of damage.” Since the pandemic 

hit, we are hearing “I’m fine, but 

my friend/relative/coworker is 

really depressed or has the virus.” 

Crisis counselors are trained to 

listen to each person’s story. As 

crisis counselors spend time with 

survivors, they hear more about 

the struggles survivors are facing. 

The crisis counselors help with 

goal setting and suggest ways to 

handle stress. Crisis counselors 

have learned that listening to 

the survivor’s story is crucial to 

emotional healing. With patience 

and diligence, crisis counselors are 

able to correct misinformation and 

give survivors a sense of hope. 

Challenges Faced in Rural 

Areas

Although survivors are flexible and 

resilient in Wisconsin, storms and 

flooding have continued to affect 

the same areas of the state. Crisis 

counselors report that survivors are 

worn out physically, emotionally, 

and financially. Following are 

some of the major challenges crisis 

counselors have faced and worked to 

overcome:

Weather. One of the biggest 

challenges in Wisconsin has always 

been the weather. Winters can be 

very harsh. In November 2018, crisis 

counselors deployed in response 

to late August flooding faced low 

temperatures and heavy snowfall, 

making outreach very difficult. In 

January 2019, the polar vortex hit 

Wisconsin. Crisis counselors were 

unable to perform canvassing for 

over a week with windchill factors 

of -30 to -60 degrees. The threat of 

flooding in the spring and summer of 

2019 was also daunting. 

Distrust. At times, survivors will 

not answer the door due to mistrust. 

Crisis counselors connect with 

local and county law enforcement 

to introduce themselves to the area 

where they are working to help 

build trust. Crisis counselors in 

Wisconsin became very resourceful 

in reaching out to survivors prior to 

the pandemic. They attended church 

services and talked to survivors 

before and after services. They 

went to feed mills and co-ops where 

farmers regularly gathered. Flyers 

were put in bags at food pantries, 

grocery stores, and thrift stores. 

The crisis counselors attended local 

events, including “coffee with a 

cop” gatherings; county fairs; town, 

city, and county meetings; and 

anniversary events. They reached 

out to schools and libraries to 

perform puppet shows that focused 

on hope and flexibility after a 

disaster. They held after-school 

programs as well as day camps in 

the summer and fall.

Difficulty in contacting survivors. 

Farmers and rural survivors were 

sometimes very difficult to reach. 

Two crisis counselors attended a 

farm auction to try to connect with 

as many farmers as they could. 

Rural residents, communities, local governments, and others 

involved in emergency preparedness and response face 

challenges that can include:

• Resource limitations, such as equipment and

supplies, training, and infrastructure

• Access to health care for higher levels of care

• Remoteness and geography

• Low population density

• Communication issues

Source: https://www.ruralhealthinfo.org/topics/emergency-preparedness-and-response
2021 | VOLUME 16 | ISSUE 3–4 | PAGE 24

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Though this was very resourceful, 

there was only one farmer at the 

auction. The crisis counselors 

engaged with the businesspeople 

attending and were able to make 

connections with those survivors. 

When reaching out to farmers in 

the spring, the crisis counselors 

found many were out working in 

the fields. Crisis counselors held a 

Farmer Appreciation Day in 2019 

in conjunction with the University 

of Wisconsin Division of Extension 

(UWEX) in two rural areas. The 

UWEX is a resource that helps 

to connect people in and across 

rural communities. Local high 

school students volunteered to help 

serve food from the agriculture 

department.

Financial difficulties and unmet 

needs. Crisis counselors came upon 

flood survivors that had mold in 

their homes and had not dealt with 

the cleanup for many reasons. At 

times, the survivors were not willing 

to give out financial information and 

did not apply for assistance from 

FEMA. Survivors did not apply 

for Small Business Administration 

loans, even when they might have 

qualified and could not afford 

another loan payment. Many farmers 

in Wisconsin have had to file for 

bankruptcy. Numerous small farms 

are unable to continue to “weather 

the storm.” Renters face threat of 

eviction due to being laid off and the 

lack of jobs available.

Lack of cell phone and internet 

service. As part of the CCP, grantees 

collect non-personally identifiable 

data on disaster survivors and the 

services they receive. This supports 

ongoing evaluation of the CCP and 

tailoring of programs to meet local 

needs. In rural areas, it is difficult 

to enter data electronically because 

of lack of cell phone and internet 

service. The lack of service means 

having to duplicate work—crisis 

counselors have to use paper forms 

and then enter the information into 

the CCP data collection website or 

mobile app. The lack of service for 

crisis counselors was difficult, and 

the survivors they worked with faced 

challenges in applying online for 

needed resources. 

Although there have been many 

challenges in Wisconsin, the crisis 

counselors have done an amazing 

job of reaching out and connecting 

to as many survivors as possible. 

Should another disaster hit in 

Wisconsin, we have many dedicated 

individuals who are ready and 

willing to serve as crisis counselors 

to help survivors recover and build 

resilience. ■

The following page is an 

informational pullout poster 

that you can print and post. It 

provides examples of stress 

reduction techniques.
2021 | VOLUME 16 | ISSUE 3–4 | PAGE 25

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Disaster response and recovery work can be rewarding;

however, it can also have negative effects. Compassion fatigue

is the stress that outreach workers may feel after repeatedly

helping traumatized people. Symptoms can include feeling

as though you are failing at your job, overwhelming exhaustion

or depression, cynical thoughts, and hopelessness. 

Practicing self-care, such as simple stress reduction

activities, can help you feel better while working

with disaster survivors.

The following are examples of stress

reduction techniques you can try:

▪ Listen to music.

▪ Use aromatherapy.

▪ Play with a pet.

▪ Take a nap. 

▪ Take a walk.

▪ Meditate.

▪ Write in a journal.

▪ Do deep breathing exercises.

▪ Do tai chi or yoga.

▪ Do other kinds of exercise.

For more on compassion fatigue, check out Tips for 

Disaster Responders: Understanding Compassion 

Fatigue and other disaster behavioral health resources 

on the Substance Abuse and Mental Health Services 

Administration (SAMHSA) Disaster Technical Assistance 

Center website at https://www.samhsa.gov/dtac or call 

1–800–308–3515. 

Having a hard time facing your 

work responsibilities?

2018 | VOLUME 15 | ISSUE 1 | PAGE 1

Have you experienced a disaster?

Disasters, both human-caused and natural, may cause behavioral, emotional, and physical 

reactions in the people who are affected. Most people who experience 

a disaster, whether it’s through direct or indirect exposure, are 

affected in some way.

Here are some common reactions to disasters: 

Disaster Distress Helpline

TOLL-FREE: 1-800-985-5990 (English and español) 

TTY: 1-800-846-8517

TEXT: “TalkWithUs” (or “Hablanos” for español) to 66746

Mental Health Treatment Facility Locator 

TOLL-FREE: 1-800-789-2647 (English and español) 

TDD: 1-866-889-2647

National Suicide Prevention Lifeline 

TOLL-FREE: 1-800-273-TALK (1-800-273-8255)

TTY: 1-800-799-4TTY (1-800-799-4889)

Substance Abuse Treatment Facility Locator 

TOLL-FREE: 1-800-662-HELP (1-800-662-4357) 

(24/7 English and español) 

TDD: 1-800-487-4889 

FOR MORE INFORMATION on common disaster 

reactions as well as ways to cope with stress, check out 

the Tips for Survivors of a Disaster or Other Traumatic 

Event: Managing Stress and other disaster behavioral 

health resources on the Substance Abuse and Mental 

Health Services Disaster Technical Assistance Center 

website at https://www.samhsa.gov/dtac or call us at 

1-800-308-3515.

• Having trouble falling asleep, staying asleep, sleeping too much, or

trouble relaxing

• Noticing an increase or decrease in your energy and activity levels

• Having difficulty talking about what happened or listening

to others

• Feeling anxious or fearful

• Being overwhelmed by sadness

• Feeling angry, especially if the event involved violence

• Having headaches or other physical pains for no

clear reason

• Being jumpy or easily startled

• Having trouble thinking clearly and concentrating

• Having difficulty making decisions

Are you or a loved one 

experiencing any of these or other 

reactions to a recent disaster?

THERE ARE PLACES TO GO FOR HELP.

SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities. 

1–877–SAMHSA–7 (1–877–726–4727) • 1–800–487–4889 (TTY) • https://www.samhsa.gov

THERE ARE PLACES TO GO FOR HELP.

SAMHSA Behavioral Health Disaster Response Mobile App

WEBSITE: https://store.samhsa.gov/product/samhsa-disaster

SAMHSA Disaster Distress Helpline

TOLL-FREE OR TEXT: 1–800–985–5990 (English and español) 

TTY: 1–800–846–8517

TEXT: “TalkWithUs” (or “Hablanos” for español) to 66746

SAMHSA’s National Helpline

TOLL-FREE: 1–800–662–HELP (1–800–662–4357) 

TTY: 1–800–487–4889

National Suicide Prevention Lifeline 

TOLL-FREE: 1–800–273–TALK (1–800–273–8255)

TTY: 1–800–799–4TTY (1–800–799–4889)

Substance Abuse Treatment Facility Locator 

TOLL-FREE: 1–800–662–HELP (1–800–662–4357) 

(24/7 English and español)

TTY: 1–800–487–4889

Are you or a coworker 

experiencing reactions to working 

with disaster survivors?
2021 | VOLUME 16 | ISSUE 3–4 | PAGE 26

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

RECOMMENDED RESOURCES

Helping Older Adults After Disasters: A Guide to 

Providing Support

This guide was developed by SAMHSA to help 

outreach workers, crisis counselors, and other workers 

or volunteers providing support to older adults after 

a disaster. It can help you prepare for encounters and 

common disaster reactions, including emotional, 

cognitive, and physical reactions. The guide also 

provides tips and resources.

Find the guide at the SAMHSA Store at https://bit.

ly/2v32zLv. 

Tips for Disasters Responders: Cultural Awareness 

When Working in Indian Country Post Disaster

This tip sheet from SAMHSA is for disaster response 

workers supporting American Indians and Alaska 

Natives before, during, and after a disaster or other 

traumatic event. It reviews several general cultural 

values that are shared by a majority of Native American 

communities, how to support and respect the values of 

a tribe, possible reactions after a traumatic event, and 

more.

Find the fact sheet at https://bit.ly/32nUIV1. 

Anniversary Reactions to a Traumatic Event: The 

Recovery Process Continues

This tip sheet is from the New York State Office of 

Mental Health. It discusses the emotions that can come 

with the anniversary of a disaster or traumatic event. 

These emotions can include anxiety, anger, fear, or 

flashbacks. However, a disaster anniversary can also 

provide an opportunity to heal emotionally. 

You can download the tip sheet at https://on.ny.

gov/2T31ufu. 

We Can Do Better: Lessons Learned for Protecting 

Older Persons in Disasters

This guide from AARP was developed with the goal to 

better protect older adults during a disaster. It reviews 

important vulnerabilities to consider in the population, 

including chronic illnesses, prescription medicines, 

various levels of physical functioning, and more. It also 

provides additional resources. 

Find the report at https://bit.ly/3a2nLjw. 

MGT 415: Disaster Recovery in Rural Communities

This course, developed by the Rural Domestic 

Preparedness Consortium, teaches outreach workers 

and emergency managers in rural communities how to 

effectively plan and execute disaster recovery efforts. 

This course aims to help rural communities improve 

their recovery efforts.

The course is available at https://bit.ly/3p9RPBC.
2021 | VOLUME 16 | ISSUE 3–4 | PAGE 27

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 (TA) requests. Send your questions and comments to dtac@samhsa.hhs.gov.

Request: SAMHSA requested resource letters in 

response to a shooting at the Molson Coors campus in 

Milwaukee, Wisconsin.

Response: The resources below are a sample of those 

sent. For the complete resource list, please contact 

SAMHSA DTAC at 1–800–308–3515.

 Coping With Grief After Community Violence—This 

SAMHSA tip sheet introduces some of the signs 

of grief and anger after an incident of community 

violence, provides useful information about to how 

to cope with grief, and offers tips for helping children 

deal with grief. Find the tip sheet at https://store.

samhsa.gov/product/Coping-With-Grief-AfterCommunity-Violence/SMA14-4888. 

 Mass Violence/Community Violence—This SAMHSA 

Disaster Behavioral Health Information Series 

(DBHIS) installment is a collection of resources

about common reactions to incidents of mass

violence, community violence, and terrorism; tips 

for coping with such incidents; and ways to support 

children and youth in coping. Find the installment 

at https://www.samhsa.gov/dbhis-collections/

mass-violence?term=Mass%20Violence%20

2017-DBHIS. 

 The Impact of Disaster and Mass Violence Events on 

Mental Health—This online article from the National 

Center for Posttraumatic Stress Disorder (PTSD) 

describes common reactions that disaster survivors 

may experience. While most reactions lessen over 

time, some may turn into long-term and severe 

responses, such as PTSD. Find the article at https://

www.ptsd.va.gov/professional/treat/type/violence_

trauma_effects.asp.

Request: SAMHSA DTAC received a request from a 

staff person in a state senator’s office. They were looking 

for TA regarding support for a state fire department 

initiative to create a regional mental health resource for 

first responders.

Response: The resources below are a sample of those 

sent. For more information, please contact SAMHSA 

DTAC at 1–800–308–3515.

 First Responders and Disaster Responders Resource 

Portal—Learn more about signs of stress and stress 

management including additional resources and online 

trainings. Find the portal at https://www.samhsa.gov/

dtac/disaster-responders. 

 SAMHSA DBHIS Online Disaster Behavioral 

Health Trainings—This installment of the SAMHSA 

DBHIS focuses on online disaster behavioral health 

training opportunities available to people interested 
2021 | VOLUME 16 | ISSUE 3–4 | PAGE 28

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

in expanding knowledge and skills pertaining to 

psychological disaster response. Find the installment 

at https://www.samhsa.gov/dbhis-collections/

online-trainings?term=Online%20Training%20

2018-DBHIS. 

 SAMHSA DBHIS Disaster-related Funding 

Opportunities—This installment of the SAMHSA 

DBHIS focuses on the disaster-related funding 

opportunities available to state, territory, 

tribal, and local governments, as well as some 

nonprofit organizations. Find the installment at 

https://www.samhsa.gov/dbhis-collections/

funding-opportunities?term=Funding%20

Opportunities%202018-DBHIS. 

 Department of Homeland Security Grants Resource 

web page—This web page from the Department 

of Homeland Security lists resources where first 

responders can obtain grants for a range of needs, 

including firefighter grants, emergency medical service 

grants, and pre-disaster mitigation grants. Find the 

web page at https://www.dhs.gov/science-andtechnology/frg-grants. 

 Emergency Responders: Tips for Taking Care of 

Yourself—This Centers for Disease Control and 

Prevention web page provides information for 

emergency responders on taking care of their mental 

health as well as logistics before, during, and after 

a disaster response. Find the web page at https://

emergency.cdc.gov/coping/responders.asp. 

 Gary Sinise Foundation—The Gary Sinise 

Foundation’s First Responders Outreach provides 

critical funding for emergency relief, training, and 

essential equipment to ensure these first responders are 

equipped to perform to the best of their abilities. Learn 

more at https://www.garysinisefoundation.org/firstresponders-outreach. 

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
2021 | VOLUME 16 | ISSUE 3–4 | PAGE 29

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Bergeron, W. P. (n.d.). Cultural 

Considerations in Consequence 

Management and Emergency 

Response. Retrieved from https://

www.academia.edu/9506757/

Cultural_Considerations_in_

Consequence_Management_

and_Emergency_Response

Blumer, H. (1966). Sociological 

implications of the thought of 

George Herbert Mead. American 

Journal of Sociology, 71(5), 535-

544.

Elrod, C. L., Hamblen, J. L., & 

Norris, F. H. (2006). Challenges 

in implementing disaster mental 

health programs: State program 

directors’ perspectives. The 

Annals of the American Academy 

of Political and Social Science, 

604(1), 152-170.

Kohn, R., Levav, I., Donaire, I., 

Machuca, M., & Tamashiro, 

R. (2005). Psychological and 

psychopathological reactions in 

Honduras following Hurricane 

Mitch: Implications for service 

planning. Revista Panamericana 

de Salud Pública, 18(4-5), 287-

295.

Norris, F. H., Friedman, M. J., & 

Watson, P. J. (2002). 60,000 

disaster victims speak, part II: 

summary and implications of the 

disaster mental health research. 

Psychiatry, 65(3), 240-260.

Norris F. H., Friedman, M. J., 

Watson, P. J., Byrne, C. M., Diaz, 

E., & Kaniasty, K. (2002). 60,000 

disaster victims speak, part I: an 

empirical review of the empirical 

literature, 1981–2001. Psychiatry, 

65(3), 207-239.

North, C. S., & Pfefferbaum, B. 

(2013). Mental Health Response 

to Community Disasters: A 

Systematic Review. JAMA, 

310(5), 507-518. doi:10.1001/

jama.2013.107799

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).

Help Improve SAMHSA’s Disaster Services and Products

As a subscriber to this newsletter, you are invited to 

participate in a short, web-based survey to provide the 

SAMHSA Disaster Technical Assistance Center (DTAC) 

with feedback about your experiences with our products 

and services. The survey should take no more than 15 

minutes. Complete the survey by clicking on this link, or 

copy and paste the URL https://iqsolutions.qualtrics.com/

jfe/form/SV_bjYCSJDUQAGi1h3 into your web browser.
Prepare • Respond • Recover

Inform • Assist

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share information, resources, trends, solutions to problems, and accomplishments. Contact 

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Readers are invited to contribute to The Dialogue. To author an article for an upcoming issue, 

please contact SAMHSA DTAC at dtac@samhsa.hhs.gov.

ACCESS ADDITIONAL SAMHSA DTAC RESOURCES

The SAMHSA DTAC Bulletin is a monthly e-communication used to share updates in the field, 

post upcoming activities, and highlight new resources. Contact SAMHSA DTAC to be added 

to the SAMHSA DTAC Bulletin subscription list. 

The SAMHSA Disaster Behavioral Health Information Series contains resource collections 

and toolkits pertinent to disaster behavioral health. Installments focus on specific populations, 

specific types of disasters, and other topics related to all-hazards disaster behavioral health 

preparedness and response. Visit the SAMHSA DTAC website at 

https://www.samhsa.gov/dtac/dbhis-collections to access these materials.

CONTACT US

SAMHSA Disaster Technical 

Assistance Center

Toll-free: 1–800–308–3515 

dtac@samhsa.hhs.gov 

https://www.samhsa.gov/dtac