A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

2018 | VOLUME 14 | ISSUE 3–4

Cultural and Population Sensitivity in Disaster Behavioral Health Programs
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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 behavioral health (mental health and substance 

misuse) response to disasters. To receive The Dialogue, please go to SAMHSA’s home 

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enter your email address, and mark the checkbox for “SAMHSA’s Disaster Technical 

Assistance newsletter, The Dialogue,” which is listed in the Newsletters section.

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, 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

1 In This Issue

2 Contributors

5 Technical Assistance Snapshot

6 Ask, Respect, Empower—Letting the Community Guide Cultural Sensitivity

9 After the Hurricanes: Culturally Appropriate Disaster Behavioral Health in 

the U.S. Virgin Islands

13 Cultural Sensitivity in Disaster Preparedness and Response

21 New Relationships With First Responders

23 Supporting People With Functional Needs

Cover photo: MARICAO, Puerto Rico, Nov. 27, 2017 - The National 

Guard and FEMA supply meals and water to the Montoso community. 

Photo by Eduardo Martinez.
2018 | VOLUME 14 | ISSUE 3–4 | PAGE 1

In This Issue

Leading off this issue is an article submitted by a 

contributor from Colorado who discusses the importance 

of culturally sensitive disaster behavioral health 

programs. Our next piece is an interview with two mental 

health professionals in the U.S. Virgin Islands who are 

working on the current Crisis Counseling Assistance and 

Training Program grant followed by an article talking 

about populations in Hawaii. Both articles provide 

readers with tips on how to work with two very different 

island populations after a disaster. In another article, the 

author provides information for first responders working 

with tribal communities. We also have two articles that 

discuss the concerns of populations with access and 

functional needs such as the hearing impaired.

Do you have experience working with diverse or special 

populations? What lessons have you learned from your 

efforts? We encourage you to contact us to share your 

experiences.■

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 Disaster 

Technical Assistance Center

dtac@samhsa.hhs.gov

The United States is becoming more racially and 

ethnically diverse each year. According to the Pew 

Research Center, by 2055, the United States will 

not have a single racial or ethnic majority. Disaster 

responders, state planners, and disaster response 

volunteers need to have strategies and plans in place to 

work with diverse populations.

In addition to the cultural diversity of this country, 

disaster workers need to understand and address the 

needs of people with access and functional needs. 

According to the 2010 United States Census Bureau, 

about 19 percent of the population (56.7 million people) 

are living with a disability. Disaster responders and 

planners should consider not only the logistical side (i.e. 

making sure a shelter is wheelchair accessible) but also 

whether service animals for posttraumatic stress disorder 

or vision will be allowed, or if there will be beds that 

are accessible to people with mobility issues. These are 

just two examples of needs that can greatly affect the 

recovery of survivors with special needs.

Developing comprehensive plans that consider the needs 

of these populations is an important step in reducing 

the behavioral health effects of disasters. This special 

double issue of The Dialogue focuses on working with 

special populations before, during, and after a disaster as 

well as building culturally sensitive disaster behavioral 

health programs. We have compiled articles from several 

different organizations covering various topics related to 

special populations and disaster response and recovery.

Orlando, Fla., October 1, 2004 -- Gary and Ima Peper from FEMA community relations hands out water and information at the Orange County Convention 

Center. Photo by Michael Rieger/FEMA.
2018 | VOLUME 14 | ISSUE 3–4 | PAGE 2

A special thanks to the Institute for Disaster Mental 

Health at State University of New York, New Paltz 

and the New York State Office of Mental Health and 

Department of Health for their contribution. The article 

“Supporting People With Functional Needs” was 

published in the summer 2017 issue of the New York 

DMH Responder.

Randal Beaton, Ph.D. is 

Research Professor Emeritus 

on the faculty of the Schools of 

Nursing and Public Health at 

the University of Washington 

in Seattle, Washington. Dr. 

Beaton has served as a consultant on issues related to 

disaster preparedness and response for the Centers for 

Disease Control and Prevention, the Department of 

Homeland Security, the Washington State Department of 

Health, the Substance Absue and Mental Health Services 

Administration, and the International Association of Fire 

Fighters. In 2011, Dr. Beaton was honored as an invitee 

to the Institute of Medicine of the National Academies to 

present his research findings on workforce resiliency in 

emergency responders.

A.B. de Castro, Ph.D., 

M.S.N./M.P.H., RN, FAAN, 

is Professor and Associate 

Dean for Diversity, Equity and 

Inclusion at the University of 

Washington School of Nursing 

in Seattle, Washington. He also directs a hazardous 

materials disaster preparedness training program, 

funded by the National Institute of Environmental 

Health Sciences, that focuses on capacity-building in 

underserved populations and communities throughout 

federal Region X. His research focuses on occupational 

and environmental health disparities.

Contributors

Vincentia Paul-Constantin, 

Ph.D. is the Founder of 

Beautiful Dreamers, a not-forprofit organization focused on 

working with families to meet 

their physical, educational, and 

psychological needs. Dr. Constantin is the Executive 

Director of CW Educational and Behavioral Center, 

a private practice providing community-based mental 

health services to disadvantaged and at-risk populations 

in the U.S. Virgin Islands. Dr. Constantin works with 

school districts, community leaders, and families in 

meeting the specialized needs of both gifted and special 

education students in the U.S. Virgin Islands and the 

Caribbean region. Dr. Constantin holds a bachelor’s in 

psychology, master’s in student personnel administration 

and mental health counseling, master’s in special 

education, and a Ph.D. in educational leadership 

and policy. 

Mark Fridovich, Ph.D. is the Adult Mental Health 

Division (AMHD) Administrator with the state of 

Hawaii’s Department of Health. Dr. Fridovich is a 

doctoral-level licensed psychologist and holds a master’s 

degree in public administration. He has decades of 

experience nationally and in Hawaii in state systems of 

mental health and human service delivery, at community 

mental health centers and state psychiatric hospitals, in 

overseeing contracted services and at the interface of 

mental health, human services systems, and other state 

agency partners. Dr. Fridovich is responsible for the 

day-to-day leadership and management of AMHD and 

for repositioning and revitalizing the adult mental health 

system of services, through collaborative planning and 

public outreach; partnering with other state agencies, 

providers, and other stakeholders; and focusing on 

integration, coordination, and program improvement. He 

is also Adjunct Assistant Professor in the Department of 

Psychiatry of the John A. Burns School of Medicine at 

the University of Hawaii.
2018 | VOLUME 14 | ISSUE 3–4 | PAGE 3

Pedro Reyes works at a law 

firm in commercial law. 

He specializes in business 

litigation. He is also active in 

the community and volunteers 

as a mentor for youth who have 

been affected by domestic violence. He is former active 

military and deployed for 15 months to Baghdad, Iraq, 

in support of Operation Enduring Freedom. For the 

last 6 years, he has worked with tribes, mostly in the 

Southwest. He attended Stanford University for his B.A. 

and currently attends the University of Minnesota, where 

he is a J.D./M.B.A. candidate. He also has contributed to 

The Hennepin Lawyer, a bar association magazine in the 

Twin Cities.

Roger Williams, M.S.W., LMSW 

is the Executive Director of 

the Spartanburg Area Mental 

Health Center with the South 

Carolina Department of Mental 

Health. For the previous decade 

he has been the Director of Services for the Deaf and 

Hard of Hearing with the department. He received his 

B.S.W. from the Rochester Institute of Technology, 

and his M.S.W., specializing in community mental 

health, from the University of Illinois, and he completed 

coursework toward a doctorate at the University of 

South Carolina College of Social Work. Mr. Williams 

is a South Carolina licensed master social worker and 

holds a Registry of Interpreters for the Deaf Certificate 

of Transliteration and a South Carolina Association of 

the Deaf/National Association of the Deaf Interpreter 

ACCESS Project Level 5 Interpreting Certificate. He has 

been recognized at the state and national level for his 

leadership in mental health services within the 

Deaf community.

Carla S. Perkins, M.S.S.W., 

LCSW is a Mental Health 

Therapist and Crisis Counseling 

Assistance and Training 

Program Team Lead with Island 

Therapy Solutions, Inc. in St. 

Croix, U.S. Virgin Islands. She has 20 years of social 

work experience, including the provision of individual, 

family, and group therapy; case management; crisis 

intervention; and social service administration. Ms. 

Perkins has a strong belief in continuing the legacy of 

cultural competence in social service practice, and as 

such she received education and training in Africana 

studies, as well as strengths-based and empowerment 

perspectives, and she has studied abroad and traveled 

throughout South America and the Caribbean.

Aimee Voth Siebert received 

a master’s in international 

disaster psychology at the 

University of Denver in 

2012. She is the Community 

Inclusion Coordinator and a 

Disaster Behavioral Health Specialist for the Colorado 

Department of Public Health and Environment’s Office 

of Emergency Preparedness and Response (CDPHE 

OEPR). Ms. Voth Siebert has cultivated multidisciplinary emergency knowledge and experience 

in both domestic and international settings, including 

leading Colorado’s first disaster mental health team 

under the Emergency Management Assistance Compact 

to support Puerto Rico’s response to Hurricane Maria. 

Ms. Voth Siebert enthusiastically weaves cross-cultural 

psychology, community engagement, behavioral and 

public health, crisis communication, and neuroscience 

into the broader disaster conversation. The Community 

Inclusion in Colorado mapping project, which she 

developed, was recognized as a “promising practice” 

for Emergency Management Inclusive of People with 

Disabilities by FEMA and the ADA National Network 

in 2015.
2018 | VOLUME 14 | ISSUE 3–4 | PAGE 4

Recent Technical Assistance Requests

In this section, read about recent questions the Substance Abuse and Mental Health Services Administration 

(SAMHSA) Disaster Technical Assistance Center (DTAC) staff have answered and technical assistance requests 

to which they have responded. Send your questions and comments to dtac@samhsa.hhs.gov.

Request: SAMHSA DTAC received an email from a 

behavioral health professional requesting resources on 

children’s mental health.

Response: SAMHSA DTAC provided the following 

resources:

• Helping Children and Youth Cope in the Aftermath 

of Disasters: Tips for Parents and Other Caregivers, 

Teachers, Administrators, and School Staff Podcast

is designed to help parents, caregivers, teachers, 

and other school staff to identify common reactions 

of children and youth to disaster and trauma, and 

discover helpful approaches to support immediate 

and long-term recovery. This podcast is available at 

https://youtu.be/O4GftUhGAtc.

• Psychological First Aid is available at https://learn.

nctsn.org/enrol/index.php?id=38. This 6-hour 

online training is available free of charge from the 

National Child Traumatic Stress Network (NCTSN). 

This training gives an overview of how to help 

those experiencing crisis or trauma associated with 

a disaster. Psychological First Aid for Schools, a 

supplemental training available from NCTSN, is an 

evidence-informed approach for assisting children, 

adolescents, adults, and families in the aftermath of a 

school crisis, disaster, or terrorism event.

• Resources for School Personnel is a resources toolkit 

for teachers and school administrators from NCTSN at 

https://www.nctsn.org/audiences/school-personnel.

Request: SAMHSA DTAC received a technical 

assistance request from a behavioral health professional 

requesting resources on disaster preparedness and 

recovery planning.

Response: SAMHSA DTAC provided the following 

resources:

• TAP 34: Disaster Planning Handbook for Behavioral 

Health Treatment Programs provides broad guidance 

on creating a disaster preparedness and recovery 

plan for programs that provide treatment for mental 

illness and substance use disorders. The handbook is 

available at https://store.samhsa.gov/product/TAP34-Disaster-Planning-Handbook-for-BehavioralHealth-Treatment-Programs/SMA13-4779.

• Disaster Behavioral Health: Resources at Your 

Fingertips has a section on disaster behavioral 

health planning tools and guidance. The document is 

available at https://asprtracie.s3.amazonaws.com/

documents/aspr-tracie-dbh-resources-at-yourfingertips.pdf.

• The Centers for Medicare & Medicaid Services 

webpage on the Emergency Preparedness Rule 

is available at https://www.cms.gov/Medicare/

Provider-Enrollment-and-Certification/

SurveyCertEmergPrep/Emergency-Prep-Rule.html.

Request: SAMHSA DTAC received a technical 

assistance request for speakers to provide information on 

mass shooting incidents.

Response: SAMHSA DTAC provided a list of possible 

speakers from SAMHSA DTAC’s Cadre of Consultants. 

SAMHSA DTAC also provided the following list of 

resources about this topic:
2018 | VOLUME 14 | ISSUE 3–4 | PAGE 5

1. SAMHSA DTAC Supplemental Research Bulletin

The Supplemental Research Bulletin highlights articles, 

research, and literature reviews on topics of interest for 

disaster responders. Our most recent issue focused on 

mass violence and behavioral health.

2. SAMHSA Disaster Behavioral Health 

Informational Series (DBHIS) on Mass Violence/

Community Violence

This installment of the SAMHSA DBHIS features 

materials for the public, college students, parents and 

other caregivers, managers, school personnel, and 

responders on these topics:

• Common reactions to incidents of mass violence, 

community violence, and terrorism, and tips for 

coping with these reactions

• Common reactions in children and adolescents after 

incidents of violence and terrorism, and ways to help 

them cope and recover

• Signs of the need for professional mental health 

support

• Trauma, traumatic stress, posttraumatic stress disorder, 

and acute stress disorder

• Resilience building

• Incidents of workplace violence, and dealing with and 

recovering from these incidents

TECHNICAL ASSISTANCE SNAPSHOT

After the Adult Assessment and Referral Tool was added to the CCP mobile application, 

use of the tool among crisis counselors increased.

CCP Grant Adult Assessment and Referral Tool Usage 

JULY 2017 THROUGH JANUARY 2018

The trend of sum of Number of Records for Date of Service Month

160

140

120

100

80

60

40

20

0

July 2017 August 2017 September 2017 October 2017 November 2017 December 2017 January 2018

Month of Date of Service

Number of Records
2018 | VOLUME 14 | ISSUE 3–4 | PAGE 6

Ask, Respect, Empower—Letting the 

Community Guide Cultural Sensitivity

By Aimee Voth Siebert

Disasters are intensifying. 

Communities grow increasingly 

culturally diverse across 

demographics, identities, and 

behaviors. Building a culturally 

sensitive disaster behavioral health 

(DBH) program has become an 

important, if daunting, task.

I want to relieve the intimidation that 

comes from thinking that cultural 

sensitivity means having to know 

everything about your community’s 

diversity.

Instead, the hallmark of cultural 

sensitivity is humility: a process of 

continually recognizing where our 

own knowledge ends and honoring 

where other people’s expertise about 

their own lives begins.

While conducting a Psychological 

First Aid (PFA) course with Asian 

Pacific Development Center, a 

Colorado DBH trainer invited 

participants to teach one another 

about how their culture and 

ethnicity would inform the first 

two core actions of PFA: contact 

and engagement, and safety and 

comfort. Not only did the group 

enjoy sharing their community and 

cultural knowledge, they highlighted 

the lesson that a responder who 

doesn’t know their culture just needs 

to remember to ask, respect, and 

empower.

Cultural sensitivity is not a box that 

we check; it’s a way we interact.

Ask

A key PFA principle during disasters 

is to support “self and community 

efficacy.” We are told “never do 

for someone what they can do for 

themselves.” Asking is one way we 

promote survivors’ participation in 

Calep Mack, a survivor with disabilities, is helped by Karin Agritelly, FEMA Disability Integration Advisor, at a Disaster Recovery Center. Photo by 

Steve Zumwalt/FEMA.
2018 | VOLUME 14 | ISSUE 3–4 | PAGE 7

their own recovery. Secondarily, 

asking helps us as responders when 

we feel stuck or worried about 

offending people.

Asking can be practiced during oneon-one DBH interactions. People 

from different cultural communities 

can tell us how they would like to 

be addressed, what comforts them, 

who supports them, what is most 

important to them right now.

We can also build collective 

opportunities to ask within DBH 

teams and program structures.

A local fire department in Denver 

serves a neighborhood that is home 

to recently arrived refugees, many of 

whom practice Islam. The fire chief 

made a point to build relationships 

with the local masjid, not only to 

be able to reach the community 

in familiar spaces, but also to find 

a local leader who could answer 

questions about Islam and educate 

his fire and emergency medical 

services crews.

Start by understanding who makes 

up the community you serve. Then 

ask, in terms of personnel, “Is 

your team representative of your 

community makeup?” Who are 

the connectors, organizations, and 

cultural brokers who hold cultural 

knowledge and you can intentionally 

engage? How can you make space 

for them to educate your responders 

and inform your practices and 

systems?

Asking, like cultural sensitivity, 

is not a one-off. Insights should 

be sought many times, from many 

people in the same community. 

There is both difference within 

groups and difference between 

groups.

Respect

DBH seeks to promote a 

community’s adaptive functioning. 

Therefore, it is important for 

responders to respect that diverse 

communities function differently.

Access and functional needs is 

a framework used for inclusive 

emergency preparedness and 

response. It holds that there are five 

things that everyone needs to be able 

to do (function) and get (access) 

during emergencies, regardless of 

who they are:

• Communication

• Maintain Health

• Independence

• Safety, Support, & Services

• Transportation

Cultural and functional communities 

meet these needs differently. Unmet 

access and functional needs cause 

stress and fear during disasters, 

such as when interpreters are not 

available in someone’s language, 

when a family has no vehicle 

to evacuate, or when people are 

separated from caregivers or 

their durable medical equipment. 

Emergency systems are intended to 

support everyone, but the inclusion 

of diverse community strategies for 

meeting these needs is incomplete.

As we continue to ask about our 

community’s inclusive access and 

functional needs, we show respect 

by acting on what is shared. We can 

champion our community’s needs 

with other responder groups, budget 

for inclusive services and resources, 

expand our networks and references 

to find partners who can help to meet 

these needs, and. . .

Nearly 59 million immigrants have arrived in 

the United States in the past 50 years.

In 2015, 14% of the country’s population was foreign 

born compared with just 5% in 1965.

Source: Pew Research Center, March 31, 2016, 10 demographic trends that are shaping the U.S. 

and the world, http://www.pewresearch.org/fact-tank/2016/03/31/10-demographic-trends-that-areshaping-the-u-s-and-the-world
2018 | VOLUME 14 | ISSUE 3–4 | PAGE 8

...Empower the community to

do what they can for themselves.

Disasters are a catalyst for starting 

community conversations. A couple 

years ago, Colorado’s DBH team 

wanted to see if our way of talking 

about disaster behavioral health was 

engaging to diverse language and 

cultural communities. We invited 

partners from those communities to 

help us trans-create our key disaster 

behavioral health messages.

Beyond simple word-for-word 

translation, trans-creation for us 

meant finding out how culturally 

diverse communities might frame or 

talk about disaster behavioral health 

topics differently. We learned that 

emphasizing individual behavioral 

health might not connect as strongly 

with communities that prioritize 

the family unit. In some languages, 

there were several words and 

metaphors for resilience, depending 

on what aspect you wanted to 

stress. And who was holding the 

conversation mattered—whether 

the messenger was trusted or not. 

It showed how valuable not just 

bilingual, but bicultural or bi-literate 

responders would be to a team. As 

usual, it brought us back around to 

relationship building.

The hallmark of cultural sensitivity is humility:

a process of continually recognizing where our own knowledge ends and 

honoring where other people’s expertise about their own lives begins.

At some point, a disaster behavioral 

health team’s mission will end, and 

care for the community’s needs will 

return to the people who are part of 

the community. So how do DBH 

teams leave seeds that empower 

diverse communities to support their 

functioning and resilience? How 

can we support the teachers, nurses, 

faith leaders, case managers, and 

whole neighborhoods in continuing 

culturally sensitive disaster 

behavioral health work?

Let’s go ask our community...■ 

The changing face of America, 1965-2065 Percent of the total population.

 

  Note: Whites, blacks and Asians

include only single-race nonHispanics; Asians include Pacific 

Islanders. Hispanics can be of 

any race.

SOURCE: PEW Research Center
2018 | VOLUME 14 | ISSUE 3–4 | PAGE 9

INTERVIEW

In September 2017, two hurricanes 

hit the U.S. Virgin Islands as 

Category 5 storms: Hurricane Irma 

struck St. Thomas and St. John 

early in the month, and Hurricane 

Maria swept over St. Croix 2 weeks 

later. The hurricanes damaged and 

destroyed buildings; knocked out 

electricity, Internet, and phone 

service; and stripped so much 

vegetation that satellite photos of 

the islands went from green to 

brown. Five deaths were linked to 

the storms.

Since the hurricanes, a Crisis 

Counseling Assistance and Training 

Program (CCP) in the U.S. Virgin 

Islands has customized services 

for the islands’ diverse population. 

Five months into the recovery 

process, The Dialogue talked with 

Dr. Vincentia Paul-Constantin and 

Ms. Carla Perkins, leaders in the 

U.S. Virgin Islands’ CCP, about 

island cultures, how they approach 

their work, and best practices for 

providing culturally appropriate 

services.

What are some distinctive aspects 

of the culture in the U.S. Virgin 

Islands?

Dr. Vincentia Paul-Constantin:

Each of the three main islands—St. 

Thomas, St. John, and St. Croix—

is different from the others, from 

population to historical influences 

to education to language to attitudes 

and mindsets regarding crisis and 

how to raise a family.

St. Croix is heavily influenced by 

Puerto Rican culture and has lots 

of individuals from surrounding 

Caribbean islands. We have so 

many influencing cultures; however, 

there is also this dogmatic attitude 

regarding staying true to the Crucian 

culture. The island has several 

historic areas. As a people, Crucians 

have felt left back through history, 

health awareness, even from the 

tourist industry. They need to know 

you understand how important 

history is to them and what that 

means to them today.

On St. Thomas, you find more 

mixing or willingness to mix. The 

culture is more avant-garde and 

forward-thinking, and St. Thomians 

are more open to differences. They 

also feel left back, but in different 

areas. We have representation 

of other cultures on St. Thomas, 

including Haitians and more 

After the Hurricanes: Culturally Appropriate 

Disaster Behavioral Health in the U.S. Virgin 

Islands

By Vincentia Paul-Constantin and 

Carla S. Perkins

Fredericksted, St. Croix, USVI--Contractors work to put fiber-reinforced blue plastic sheeting to cover a 

roof damaged by Hurricane Maria. Photo by Jocelyn Augustino/FEMA.
2018 | VOLUME 14 | ISSUE 3–4 | PAGE 10

Spanish. That has been a great help, 

as has having bilingual staff in the 

Disaster Recovery Centers (DRCs).

What do the islands have 

in common from a cultural 

standpoint?

Dr. Paul-Constantin: On the 

islands, religion and spirituality are 

like drawing breath. It’s always the 

opener in getting people to listen. 

As a clinician, I generally don’t 

bring up religion unless the client 

mentions it, but for people here, 

everything centers on trust in G-d.

Within this common element, 

there are differences. We have a 

Rastafarian population, especially 

on St. Croix, and they are very into 

acknowledgement of Haile Selassie 

and religion. Westernized viewpoints 

will be dismissed immediately. We 

have to be careful about how we 

approach and speak to them.

For a small territory (the U.S. Virgin Islands are 

twice the size of Washington, DC, with about one-sixth 

the population), the islands boast rich diversity.

foreigners, who are more part of the 

community on St. Thomas than on 

St. Croix.

St. John is very small. There 

are more foreigners on St. John, 

and schools, health care, and 

infrastructure are all different. The 

locals feel overshadowed, and not as 

wealthy or as validated.

Ms. Carla Perkins: In the Virgin 

Islands many people speak English, 

and there are also many Spanish 

speakers, especially on St. Croix; 

many on St. Thomas speak French 

Creole. Most people speak English, 

but some of what you’re discussing 

in connecting people to resources 

and helping them identify their 

feelings gets lost in translation 

if they speak another primary 

language. On the CCP team we 

have at least one crisis counselor 

who is fully bilingual in English and 

Also, I usually don’t say “mental 

health.” We stay away from the 

word “mental” altogether in the 

U.S. Virgin Islands. “Mental” means 

alienation and isolation. For the 

Haitian and St. Lucian populations 

with Voodoo belief, it means a curse, 

something someone did to you. 

I come from a place of wellness, 

and, with Rastafarians, natural 

wellness. We talk about their food 

intake, lifestyle, and variables in 

their environment. What are things 

you do to support your wellness and 

natural living? Then they are eager 

to share their thoughts and beliefs. I 

learn a lot from them, and they learn 

a lot in the exchange, but it must be 

individual to them—not what I think 

is effective based on work I’ve been 

doing elsewhere.

We had a situation where a disabled 

individual from Dominica was not 

able to get to the DRC. The family 

REFERENCES

U.S. Census Bureau. (2011, August 24). U.S. 

Census Bureau releases 2010 Census population 

counts for the U.S. Virgin Islands. Retrieved from 

https://web.archive.org/web/20121101063104/

https://2010.census.gov/news/releases/

operations/cb11-cn180.html

U.S. Census Bureau, Population Division. (2017, 

December). Table 1. Annual estimates of the 

resident population for the United States, regions, 

states, and Puerto Rico: April 1, 2010 to July 1, 

2017 (NST-EST2017-01). Retrieved from https://

www2.census.gov/programs-surveys/popest/

tables/2010-2017/state/totals/nst-est2017-01.xlsx

U.S. Central Intelligence Agency. (2018, February 

22). Central America and Caribbean: Virgin Islands. 

The World Factbook. Retrieved from https://www.

cia.gov/library/publications/the-world-factbook/

geos/vq.html

DID YOU KNOW

U.S. Virgin Island Residents:

• Speak several 

languages other 

than English;

• Are of black, white, 

Asian, mixed and 

other races (with 

about 17 percent 

identifying as Latino);

• Are of Protestant, 

Roman Catholic, 

Muslim, and 

other faiths.

ST. THOMAS

ST. JOHN

ST. CROIX
2018 | VOLUME 14 | ISSUE 3–4 | PAGE 11

called in for support, and I went with 

a colleague to the home. I thought to 

remove my shoes before entering the 

home, but the person I was with did 

not, and he didn’t allow her to come 

in. It is related to spirituality and 

belief. In Dominican, Haitian, and 

St. Lucian culture, you’re bringing 

outside spirits into my home on 

your shoes. If you leave your shoes 

outside my door, those spirits are 

not becoming part of my personal 

intimate space.

Ms. Perkins: Sometimes people are 

leery to talk about how they feel. 

Also, even though crisis counseling 

is not traditional treatment, 

sometimes people get put off by the 

word “counseling” due to stigma. 

Some counselors ask people “Do 

you need to talk?” not “Do you 

need to see a counselor?” Given the 

cultural context, people may choose 

to keep things within the family. 

They may also be more likely to 

turn to prayer and other spiritual 

practices versus going to an outsider 

for support.

In the Virgin Islands it’s a closeknit, family-oriented community. 

Even if people come to talk to the 

counselors about themselves, they 

may recognize that someone they’re 

close to could benefit too and bring 

the person back or tell the person 

about the service they received. Also 

because the culture is close-knit, 

people are handling stress not only 

as part of their household, but also 

the stress of neighbors and relatives.

The cultures in the U.S. Virgin 

Islands and on other Caribbean 

islands emphasize pride and 

resilience, and so asking for help 

is not always easy. We have heard 

people say that they have gone this 

long without something, or they 

have been accustomed to doing 

things for themselves, so now that 

the storm happened, they’re not 

going to beg anyone for anything. 

We tell them that services are 

available to them by virtue of their 

being disaster survivors.

What would you recommend 

disaster workers not native to the 

community do before working with 

people in the U.S. Virgin Islands?

Dr. Paul-Constantin: The biggest 

thing I would tell people is this: 

we are all about helping, but if we 

don’t know how to access people, 

we will not be effective. Know 

who the community leaders and 

gatekeepers are. They may not be 

the people you’d expect. In certain 

communities you need permission 

from gatekeepers to gain access.

Ms. Perkins: Learning something 

about the Virgin Islands would be 

important to help you understand 

the perspectives you encounter. It’s 

important to understand what it 

means to be a territory of the United 

States versus what things might look 

like on the mainland.

Generally speaking, is there a 

strong “insider-outsider” mentality 

on the islands, and if so, how can 

outsiders respect and work within 

this paradigm?

Dr. Paul-Constantin: There is, but 

people are open to those who are 

genuinely invested in improvement. 

When they believe people are 

simply there to capitalize on them, 

are insensitive to their needs and 

closed-minded to their culture and 

what makes them unique, then they 

see people as outsiders.

San Juan, P.R., September 8, 2017--VA Task Force 2 Urban Search & Rescue team gather commodities 

and prepare for transport to St. Johns and St. Thomas to aid Hurricane Irma survivors. Photo by 

FEMA/K.C.Wilsey.
2018 | VOLUME 14 | ISSUE 3–4 | PAGE 12

Ms. Perkins: It does show up at 

times, but what I have seen is if 

you’re open and willing to learn 

and you’re genuinely caring and 

empathetic, people are happy to 

have the help regardless of where 

you come from.

In Caribbean culture, when people 

walk into a room, they say good 

morning or good afternoon to each 

other. If you greet people, it’s a sign 

that you are trying to get established 

in the culture and you understand 

that greetings are a sign of respect 

within the culture.

If tourism is a big part of the 

economy, does that affect disaster 

survivors in a unique way? 

How has tourism been since the 

hurricanes?

Dr. Paul-Constantin: Tourism does 

affect survivors here, generally in a 

positive way. When tourism began to 

start back up recently, some believed 

we weren’t quite ready for it and 

that there should be more focus on 

family and community rebuilding. 

But for others it signaled hope, a 

return to normalcy, progress, and 

resiliency.

Ms. Perkins: Tourists are 

continuing to come, even with the 

storm damage. I think the U.S. 

Virgin Islands wants people to know 

that we are down but not out. We 

have been through two Category 5 

storms, but we are a resilient people. 

People still desire tourism, and 

people here are open and friendly 

and want others to learn about the 

Virgin Islands.

Is there anything else you would 

like to add?

Dr. Paul-Constantin: For those 

coming in to provide services, it’s 

wonderful to use your training, 

but it’s important to truly consider 

the individual in front of you and 

be sensitive to him or her. If you 

come from a place of unknowing 

and openness, that works. We need 

to ask before we come in believing 

this is the way it should be done. 

People here are okay with response 

workers’ not knowing things about 

their cultures; they’re not okay with 

workers’ believing that they know. 

Training and learning have to be 

ongoing.

Ms. Perkins: If you’re not sure 

about something related to culture, 

find a respectful way to ask. In most 

of my cross-cultural interactions, 

things have gone well because I can 

approach situations with an open 

mind, being respectful and asking 

questions as needed. It’s also very 

important to understand that because 

people are proud and resilient, as 

much as you want to lend a helping 

hand, they will want to be part of 

that process, extending a helping 

hand to them and others. ■ 

Cruz Bay, US Virgin Islands, US--A Disaster Recovery Center is open at the Legislature of the Virgin 

Islands St. John Annex. Photo by Jocelyn Augustino.
2018 | VOLUME 14 | ISSUE 3–4 | PAGE 13

Cultural Sensitivity in Disaster Preparedness 

and Response

By Randal Beaton and A.B. de Castro

there has been little research to date 

that has documented the benefits 

and potentially harmful outcomes 

of psychosocial interventions across 

cultures (Beaton and Murphy, 2002; 

Beaton et al., 2009). One such study, 

a cross-cultural investigation of 

non-Western survivors in a rural 

sample of Indian villagers following 

the 2004 Indian Ocean tsunami, 

found that prolonged grief disorder 

(PGD)—and not posttraumatic 

stress disorder (PTSD)—was the 

most common psychopathological 

Following major disasters, survivors 

may experience a variety of 

distressing emotional, behavioral, 

and cognitive symptoms or, most 

commonly, resilience. The acute and 

longer-term reactions of affected 

disaster survivors depend, in part, 

on the type and scope of the disaster 

or public health emergency as 

well as the extent of their injuries 

and fate of their kin. Importantly, 

their psychological reactions are 

influenced by sociocultural factors, 

including their worldview, history, 

spiritual beliefs, and cultural 

norms. These all affect the ways 

survivors experience and manifest 

symptoms in the aftermath of 

specific types of disaster-related 

events (for example, the death of 

a child or spouse) or hardships 

such as long-term unemployment. 

Thus, cultural sensitivity is an 

important consideration for disaster 

preparedness and response personnel 

since it plays a major role in how 

people behave and cope, as well as 

their long-term recovery trajectories 

in the aftermath.1

Although disaster behavioral health 

is considered a key component of 

disaster preparedness and response, 

1 Cultural awareness and sensitivity is defined as, “the knowledge and interpersonal skills that allow providers to understand, appreciate, and work with individuals from 

cultures other than their own. It involves an awareness and acceptance of cultural differences, self-awareness, knowledge of a patient’s culture, and adaptation of skills.” 

(The American College of Obstetricians and Gynecologists, 2011) Cultural sensitivity thus relies upon a sophisticated understanding of a peoples’ history, their beliefs, their 

ways of coping, strengths and views of mental illness which, together, can inform the assessment and treatment of disaster survivors.

At least 350 different languages

are spoken in homes across the United States.

SOURCE: United States Census Bureau, November 15, 2015, 

https://www.census.gov/newsroom/press-releases/2015/cb15-185.html
2018 | VOLUME 14 | ISSUE 3–4 | PAGE 14

outcome and was associated with 

a different set of risk factors than 

PTSD. Such a finding has important 

implications since the identified risk 

for PTSD and PGD factors may 

be of a heuristic value for disaster 

personnel in terms of assessment 

and screening and because widely 

accepted treatment approaches for 

these distinctive disorders—which 

may co-occur—differ.

Another important disaster 

preparedness and response 

implication of cultural sensitivity 

is that cultural adaptations and 

modifications of crisis therapies 

such as Psychological First Aid 

may improve their acceptability and 

outcomes (Kumpfer et al., 2002). 

Findings from international crosscultural post-disaster interventions 

suggest that cultural sensitivity is 

key (Rajkumar et al., 2015). Lipinski 

et al., (2016), for example, note 

that, while offering psychosocial 

intervention for disaster survivors 

is a common “reactionary strategy,” 

caution should be exercised because: 

(1) Western-centric interventions 

are typically employed without 

adapting them to specific cultures 

and (2) such interventions may 

not be provided by qualified 

practitioners. To assess the benefits 

and potentially harmful effects 

of post-disaster psychosocial 

interventions, Lipinski et al., (2016) 

conducted a systematic review of 

psychosocial interventions (n = 10) 

offered to both children and adult 

survivors of the 2004 Asian tsunami 

drawn from a variety of cultural and 

ethnic groups in the affected regions 

of India, Sri Lanka, and Thailand. 

While the authors concluded that 

most of the interventions reviewed 

had been adapted to the target 

cultural group and possessed a high 

degree of cultural specificity, they 

expressed some concerns and cited 

outcome data from a minority of 

reviewed investigations suggesting 

potentially harmful outcomes 

such as an increase in post-trauma 

symptomatology (Lipinski et al, 

2016). This finding touches on 

another compelling reason for 

cultural sensitivity—that is, the 

ethical imperative to ensure that 

Snapshot of Race and Hispanic Origin in the United States

[July 1, 2016]

Hispanics may be of any race, so also are included in applicable race categories. 

SOURCE: United States Census Bureau, July 1, 2016, https://www.census.gov/quickfacts/fact/table/US/AGE765210

76.9%

13.3%

1.3%

5.7%

0.2%

2.6%

17.8%

White alone

Black or African American alone

American Indian and 

Alaska Native alone

Asian alone

Native Hawaiian and Other 

Pacific Islander alone

Two or More Races

Hispanic or Latino*
2018 | VOLUME 14 | ISSUE 3–4 | PAGE 15

post-disaster interventions that are 

developed by the dominant culture 

do not negatively affect a disaster 

survivor’s cultural values, practice, 

and identity (Sanders, 2000).

Closer to home, being mindful 

of a community’s cultural needs 

anywhere in the United States can 

help reduce psychological distress 

in those affected during disaster 

response and recovery periods. The 

U.S. Department of Health and 

Human Services (https://www.

phe.gov/Preparedness/planning/

abc/Pages/linguistic-facts.aspx) 

notes five principles that disaster 

response personnel need to consider 

to better communicate with, and 

deliver services to, diverse groups. 

Awareness and acceptance of 

differences facilitates a recognition 

that response personnel are often 

different from and may not represent 

community groups with regard to 

sociodemographic characteristics, 

such as race, ethnicity, language, 

gender identity, and ability. 

Assessing one’s own cultural 

values helps identify and examine 

personal biases and stereotypes that 

can hinder communications and 

service quality. Understanding 

and managing the dynamics of 

difference encourages cultural 

humility and informs methods 

regarding how various cultures 

receive, interpret, and express 

information. Development of 

cultural knowledge provides 

insight into customs and values 

relevant to preparedness, response 

procedures, and health and illness 

beliefs. Moreover, the ability to 

adapt preparedness and response 

activities to fit different cultural 

contexts is crucial to assure that 

community cultural needs are 

respected and disaster management 

procedures align with an affected 

community’s cultural values.

As a complement to these principles, 

the following additional practical 

strategies and tactics can enhance 

cultural sensitivity in disaster 

preparedness and response: 

• To the degree possible, the makeup of disaster preparedness staff 

and teams should be diverse as 

well as reflect representation of the 

communities served in the area.

• Disaster planning and 

preparedness efforts should 

actively engage with community 

groups to assess needs related 

to culture and language, guide 

policies and procedures that are 

culturally sensitive, embrace the 

types of resources that support 

cultural beliefs and practices, 

and direct outreach efforts so 

that all community members are 

equitably informed. These can be 

achieved by meeting with formal 

and informal community leaders, 

collaborating with communitybased organizations, and holding 

community forums in accessible 

locations and communicating in 

local languages.

• When possible, prepare members 

of diverse community groups 

to mobilize and play an active 

role during disaster events. Done 

in advance, these planning and 

preparedness strategies can 

enhance effectiveness in executing 

disaster response and management 

procedures.

These recommended planning and 

preparedness efforts, based on 

cultural sensitivity considerations, 

will better address the recovery 

needs of diverse community 

groups.■

References:

The American College of Obstetricians and 

Gynecologists. (2011). Cultural sensitivity and 

awareness in the delivery of health care. Women’s 

Health Care Physicians.

Beaton, R. & Murphy, S. (2002). Psychosocial 

responses to biological and chemical terrorist 

threats and events: Implications for the 

workplace. Journal of the American Association of 

Occupational Health Nurses, 50(4), 182–189.

Beaton, R., Murphy, S., Houston, B., Gilbert Reyes, 

G., Bramwell, S., McDaniel, M., Reissman, D., & 

Pfefferbaum, B. (2009). The role of public health 

in mental and behavioral health in children and 

families following disasters. Journal of Public 

Health Management and Practice, 15(6), 1–11.

Kumpfer, K.L., Alvarado, R., Smith, P., & Bellamy, 

N. (2002, September). Cultural sensitivity 

and adaptation in family-based prevention 

interventions. Prevention Science, 3(3), 241.

Lipinski, K., Liu, L. L., & Wong, P. W. C. (2016). 

The effectiveness of psychosocial interventions 

implemented after the Indian Ocean tsunami: A 

systematic review. International Journal of Social 

Psychiatry, 62(3), 271–280.

Rajkumar, A. P., Mohan, T. S. P., & Tharyan, P. 

(2015). Lessons from the 2004 Asian tsunami: 

Nature, prevalence and determinants of prolonged 

grief disorder among tsunami survivors of South 

Indian coastal villages. International Journal of 

Social Psychiatry, 61(7), 645–652.

Sanders, M. R. (2000). Community-based 

parenting and family support interventions and the 

prevention of drug abuse. Addictive Behaviors, 

25(6), 929–942.

U.S. Department of Health and Human Services, 

Office of the Assistant Secretary for Preparedness 

and Response. Cultural and linguistic competency 

in disaster preparedness and response fact 

sheet. Retrieved from https://www.phe.gov/

Preparedness/planning/abc/Pages/linguisticfacts.aspx.
2018 | VOLUME 14 | ISSUE 3–4 | PAGE 16

Island states and nations pose 

a unique challenge for disaster 

preparedness and response efforts. 

Many islands are located in areas at 

particular risk for certain types of 

disasters, such as tropical storms, 

tsunamis, and earthquakes. Island 

populations also have distinct 

cultures and values that must be 

honored in any disaster response 

situation.

Hawaii’s unique features are 

prominent in preparing for, 

responding to, and mitigating 

psychological and behavioral risk 

in disaster mental health. We are a 

state of islands, 2,500 miles distant, 

over ocean, from our nearest land 

neighbors, with very substantial 

physical, social, and economic 

diversity and differentiation from 

mainland United States. The 

physical boundary of the shore and 

the distance to our nearest neighbor 

may be internalized among the 

population as self-reliance or, more 

problematically, as insularity: “What 

is happening on the mainland is not 

our problem.”

We are eight main islands, with no 

group having an ethnic or cultural 

majority, but rather a cultural mix 

of native Hawaiians and their 

descendants, Asian Americans, North 

Americans, military and former 

military, and many others reflecting 

the history of Hawaii. Our population 

also is bolstered year-round by 

tourists. Our tropical and generally 

comfortable, beautiful setting may 

lull recent arrivals into a sense of 

complacency about risk or need for 

preparedness for emergencies or 

disasters. Some questions to consider 

include the following:

• How would we communicate with 

family on the mainland if cell 

phones didn’t work and land lines 

were overwhelmed?

• How do we connect with our 

family or local community if there 

is no electronic media?

• If the island is dependent on 

outside sources for food, fuel, and 

medical supplies, how will that 

need be met?

As seen through the experiences 

of Puerto Rico and the U.S. Virgin 

Islands during the disasters of 

2017 and the subsequent months of 

recovery, concerns about physical 

and economic dependency, the 

dynamic of self-reliance, and the 

need for additional resources are 

paramount for island populations.

Preparedness and Response 

in Hawaii

For the most familiar hazards, 

Hawaii’s native population is 

accustomed to a well-practiced set 

of routines: here are the risks, these 

are the steps that mitigate risk, these 

are the local resources available, and 

this is what constitutes reasonable 

preparedness. The routine of 

preparing for a known threat 

Working With Island Populations

By Mark Fridovich

Kapa’au, Hawaii, November 1, 2006 - Federal and State disaster officials work together at this Disaster 

Recovery Center to register resident Timothy Kern. Photo by Adam DuBrowa.
2018 | VOLUME 14 | ISSUE 3–4 | PAGE 17

provides a degree of security and 

lessens anxiety. This is probably 

true for many of our inhabitants 

even in the case of threats that do 

not materialize, such as a storm that 

veers away or loses strength, or a 

tsunami that arrives at the predicted 

time but at a much lower magnitude. 

The routines of preparedness 

are supportive, even if these are 

not utilized. There may be some 

diminished trust in warning systems 

if the prediction is always wrong or 

very far off in terms of magnitude, 

scope, or timing.

Life gets more complicated with 

our substantial tourist and military 

populations, the former because 

obviously they are neither familiar 

with the routines, nor do they 

have the informational resources 

necessarily available to prepare 

effectively. Our military personnel 

may similarly have shorter tenure 

than others and therefore less 

familiarity with local knowledge, 

although they are members of 

supportive communities, with 

substantial independent resources 

even if these communities are 

significantly distinct from other 

aspects of island or community life.

In addition, Hawaii has the highest 

per capita homeless population of 

any state. These individuals lack 

fundamental resources at the best of 

times. While they have strengths (for 

example, local knowledge) the lack 

of shelter can put them immediately 

at risk in many of the most common 

disasters.

Disaster Responders and 

Their Approach to Island 

Populations

When disaster responders go to 

an island nation with which they 

are not familiar, it is important for 

them to keep several things in mind, 

including the following:

• Island communities are distinct, 

and it is important not to 

generalize. Living and working on 

an urbanized Pacific island (such 

as Oahu), part of the United States, 

is different from living on an atoll 

a few degrees north of the equator 

in the Pacific. In addition, the 

extent of social cohesion (degree 

of sharing a common history, 

linguistic, cultural, and ethnic 

heritage) will vary from island to 

island and possibly even within 

islands.

• Disaster responders must make an 

effort to understand the character 

of an island’s population during 

response and recovery. This 

includes not making assumptions 

about the importance of 

relationships, family group, the 

relative importance of physical 

items, and the significance of 

relationship to a particular place 

or parcel of land. Listen to and 

respect where survivors are at.

• Disaster responders coming 

from outside the island should 

engage a local informant who 

will potentially be invaluable in 

establishing linkage, promoting 

effective communication, and 

serving as a resource regarding 

values.

• Historical and contemporary 

objective information and 

social or cultural information 

about the location will be 

helpful. Preparation in advance 

of deployment will increase 

effectiveness. However, we 

all must remember that human 

communities, cultures, and 

languages are constantly changing.

• Though the physical environment 

may appear uniform to the 

responder, do not presume a 

uniformity across an island or 

within a community. These may be 

more diverse than it would appear.

There can be no substitute for 

genuine and deep openness to 

learning from the people who you 

are with, and learning from them 

in ways that, prior to the encounter, 

could not be anticipated about who 

they are and what will be helpful to 

them during and after a disaster.

Honolulu, Hawaii, September 

26, 2012 -- Tom Ridgeway of 

the FEMA Region IX, Pacific 

Area Office participating in 

Preparedness Month activities 

at the Honolulu Federal 

Building in September 2012. 

Photo by Gen Tamura.
2018 | VOLUME 14 | ISSUE 3–4 | PAGE 18

Communication is the Key: Before, During, and 

After Disasters

By Roger Williams

All too often, deciding how 

to respond to individuals with 

functional needs happens during 

or even after a disaster strikes. 

The recent spate of Internet videos 

showing unqualified sign language 

interpreters all too clearly illustrate 

the potential peril that this lack of 

forethought invites. All of those 

situations could have been prevented 

with relatively little effort during 

the planning stages. The solution 

is neither original nor unique: meet 

with the community before the event 

and, as always, “plan for the best, 

prepare for the worst.”

When planning to meet the needs 

of any community, start with 

the community. “Nothing about 

us without us” has long been 

the rallying cry of the disability 

community but frequently that credo 

has not been the hallmark of disaster 

response. This means meeting with 

the individuals who have functional 

needs, not just with those who 

provide services. While this may 

seem both simple and obvious, let’s 

look at what changes that has meant 

in South Carolina:

• A working relationship between 

deaf consumer-led civic 

organizations, state agencies 

serving the deaf community, and 

private interpreter agencies has 

resulted in deaf American Sign 

Language (ASL) interpreters 

(Certified Deaf Interpreters) for 

statewide announcements, an 

ongoing public education program 

for deaf community activities, 

and a new project to provide fully 

accessible notifications for fixed 

nuclear facilities.

• Deaf community members have 

taken Community Emergency 

Response Team (CERT) training 

offered by qualified CERT 

instructors who are deaf or fluent 

in ASL with support from their 

local county CERT.

• Trained behavioral health 

responders fluent in ASL are 

prepared to respond to disaster 

needs, large and small, across the 

state, in cooperation with the state 

mental health authority.

• Shelters with enhanced 

communication options such 

as videophone access and 

sign language interpreters 

have been identified as well as 

the development of standard 

messaging in ASL using recorded 

media.

These changes have required an 

investment of time and money from 

the state emergency management 

agency as well as from other 

stakeholders. For interactions 

with the deaf community, the cost 

of translation and interpretation 

can often be seen as an obstacle, 

especially if the expense is not 

anticipated. However, failing to 

invest in the planning stage can 

often result in a response which is 

ineffective and, ultimately, more 

expensive. At the Department of 

Mental Health, representatives 

from the Deaf Services Program are 

June 12, 2017, Neosho, MO - FEMA Disaster Recovery Centers (DRCs) are accessible to people with 

a wide range of disabilities, including deaf, hard of hearing, sight impaired, and blind. Photo by Howard 

Greenblatt/FEMA.
2018 | VOLUME 14 | ISSUE 3–4 | PAGE 19

involved at multiple points and in all 

phases of disaster response.

In the mitigation phase, staff from 

the Deaf Services Program provide 

workshops to meetings of the deaf 

community regarding resilience and 

coping strategies.

As part of preparedness, deaf staff 

participate in the cross-agency 

Emergency Planning Committee for 

People With Functional Needs to 

identify resources available to meet 

the needs of clients in the event of an 

emergency. This includes working 

with the deaf community and 

Emergency Management personnel 

to ensure that messaging includes 

consideration of the potential mental 

health impact. Within the agency, 

Deaf Services staff are involved in 

developing the agency response plan 

and ensuring that interpreters, ASLfluent staff, and assistive equipment 

are a part of the planning process.

During the response phase, senior 

staff from the Deaf Services 

Program are in contact with disaster 

mental health (DMH) representatives 

at the Emergency Operations Center, 

as well as with partner agencies 

in Emergency Support Function 

6 and 8. In addition, there is an 

ongoing functional needs network 

spearheaded by Portlight Inclusive 

Disaster Strategies, Federal 

Emergency Management Agency, 

and ABLE, the local Center for 

Independent Living. This enables 

us to provide immediate crisis 

counseling support for individuals in 

shelters or at a disaster scene.

Once the department initiates the 

crisis counseling operation in the 

recovery phase, counselors are 

provided basic information about the 

deaf community and advised how to 

contact the Deaf Services Program 

as needs arise.

Working with functional needs 

communities should be viewed 

from a cultural lens, as a group of 

people with shared experiences 

and characteristics rather than from 

a medical perspective, as a group 

needing to be treated. The Deaf 

community, in particular, is like an 

immigrant community in terms of 

the language and cultural awareness 

needed to effectively provide 

services. But the same perspective 

can be helpful in understanding 

other communities as well. The 

vast majority of individuals with 

functional needs live independently 

in the community and want that 

same independence in a disaster. 

Within that framework, it is 

also important to remember that 

individuals with functional needs 

are no more monolithic than any 

other community. Within the 

Deaf community, for example, 

individuals range from graduate 

level competence in English and 

ASL to functional illiteracy in 

any language, from active in the 

community to social isolation, and 

from proud identification of deaf 

identity to denial of a hearing loss. 

For this reason, communication 

needs to utilize as many modes 

and modalities as possible. This 

includes messages that are signed 

Midway, GA, September 26, 2017 -- A FEMA Disaster Recovery Center has opened to assist survivors 

affected by Hurricane Irma. Photo by Liz Roll/FEMA.
2018 | VOLUME 14 | ISSUE 3–4 | PAGE 20

People in the oldest age 

group—80 and older—were about 

8 times more likely 

to have a disability than those 

in the youngest group—younger 

than 15 (71% compared with 8%).

The probability of having a severe 

disability is only 1 in 20 for those 

15 to 24 while it is 1 in 4 for those 

65 to 69.

in ASL, captioned into English with 

options for reduced vocabulary, use 

of social media, and text messaging 

and captioned phone compatibility. 

While this list may be overwhelming, 

if not bewildering, it illustrates both 

the communication heterogeneity 

of this community and the need 

for community involvement in 

identifying which channels to utilize.

In summary, working with 

functional needs communities 

requires creativity, thoughtful 

planning and, above all, partnership 

with the community itself. ■

About 7.6 million people 

experienced difficulty hearing, 

including 1.1 million whose 

difficulty was severe. About 

5.6 million 

used a hearing 

aid.

About 56.7 million people— 19% of the population—had a disability in 2010, according to 

a broad definition of disability, with more than half of them reporting the disability was severe.

Being frequently depressed or anxious such that it interfered with 

 ordinary activities was reported by 7 million adults.

 About 8.1 million 

people had difficulty seeing, 

including 2 million who were 

blind or unable to see.

Roughly 30.6 million had 

difficulty walking or climbing stairs, 

or used a wheelchair, cane, crutches, 

or walker.

SOURCE: United States Census Bureau, July 26, 2012, https://www.census.gov/newsroom/releases/archives/miscellaneous/cb12-134.html

Disability 

by the 

Numbers
2018 | VOLUME 14 | ISSUE 3–4 | PAGE 21

New Relationships With First Responders

By Pedro Reyes

Native Americans have long 

understood that being in relationship 

with nature and people is a part of 

life. Being in relationship means 

an identification with the land as 

well as with the people in it. For 

Californian tribal members facing 

current natural disasters, being in 

relationship extends to the first 

responders who are in close contact 

with Native American tribes and 

the sites that they value for their 

traditional significance.

The Tuolumne Me-Wuk tribe was 

affected by the 2013 Rim Fire. The 

Rim Fire decimated homes while 

threatening lives and sacred sites. 

The first responders tasked with 

battling the fourth largest wildfire 

in California’s history paid special 

attention to the traditional sites of 

the tribe. They kept tribal members 

informed by including them in 

weekly briefings. In turn, the tribe 

provided support for the first 

responders. This support came in 

the form of delivering care packages 

that included simple, daily amenities 

that the firefighters no longer had. 

Moreover, the tribe provided homecooked meals to the first responders 

on several occasions.

The Tuolumne Me-Wuk tribe drew 

from their traditional practices. 

Traditionally, Native American 

tribes provided feeds and feasts 

for marking important moments. 

This practice extended to events 

such as disasters. The result was a 

relationship that revolved around 

more than just the disaster that had 

occurred. In this case of the Rim 

Fire, the relationship included the 

responsibility of the tribe to serve 

the firefighters, and the firefighters 

recognized the value of keeping 

tribal members informed about their 

sacred sites.

The reciprocity that occurred during 

the Rim Fire also included the first 

responders safely escorting tribal 

Hughes, AK, September 19, 2013 -- The California Hoopa Tribe volunteers work to repair this flooded home by removing old wet insulation and replacing it with 

new. Photo by Adam DuBrowa.
2018 | VOLUME 14 | ISSUE 3–4 | PAGE 22

members through the ashes to visit 

their sacred sites after the fire had 

been extinguished. This provided an 

opportunity for the first responders 

and the tribal members to continue 

their interactions. It was the 

beginning of the rebuilding process, 

both physically and psychologically. 

Many tribal members related 

that their inclusion, as well as 

transparency by the first responders, 

assuaged the anxiety of not knowing 

what damage had been done to the 

tribal sites.

Sacred sites have healing power. 

Even maintaining sacred sites 

provides a psychological benefit for 

tribes that their culture is still intact. 

For this reason, Native American 

tribes often hold the preservation 

of these sites as paramount, the 

importance of which cannot be 

overstressed for the identity of tribal 

members. Often, these sacred sites 

describe the values of a tribe. These 

values differ based on geographical 

location as well as tribal philosophy. 

From the grinding rocks of 

California tribes to the sacred 

mountains of tribes in Arizona, 

sacred sites are as unique as the 

tribes themselves. 

Increased natural and human-caused 

disasters threaten the identity, 

psychology, and physical well-being 

of impacted tribes. For Californian 

Natives in particular, wildfires 

have become an increasing threat 

to sacred tribal sites. Traditionally, 

many tribes have used burning 

strategies to tend the land. This 

included starting fires to clear brush 

from the forest floor. However, the 

controlled burns of the past have 

given way to modern wildfires that 

erode the soil and choke the land.

As the frequency of wildfires in 

California increases, the impact 

on tribes will increase as well. 

Formerly, tribes viewed the burning 

of forests as destructive and 

beneficial. However, the fires that 

tribes now contend with have the 

potential to be more destructive 

than the fires of the past. The 

challenge is how to incorporate 

traditional paradigms of destruction 

and rebirth with the changing 

landscape. For the Tuolumne MeWuk tribe, destruction of the land 

gave way to a new relationship 

with first responders, and vice 

versa—the major benefit of which 

is not wholehearted acceptance of 

every fire that occurs, but rather 

the psychological benefit for those 

impacted by fires that even after a 

major disaster there is the potential 

for new growth. ■

Nearly 65,000 people 

who spoke English 

less than “very well” 

spoke Navajo or 

another Native North 

American language.

Source: United States Census 

Bureau, October 2015, https://www.

census.gov/data/tables/2013/

demo/2009-2013-lang-tables.html

Ya’at’eeh

Hello

Above: Exterior road sign for FEMA – Tribal 

Nations Disaster Recovery Center at the SuAnne 

Big Crow Boys and Girls Club on the Pine Ridge 

Reservation in Pine Ridge, South Dakota. Photo 

by Christopher Mardorf / FEMA. Right: External 

view of the Seminole Tribe of Florida Disaster 

Recovery Center on the Immokalee Reservation in 

Florida. Photo by J.T. Blatty / FEMA.
2018 | VOLUME 14 | ISSUE 3–4 | PAGE 23

No one is immune to disaster, but it 

has long been recognized that there 

are certain groups whose disabilities, 

age, or other characteristics can 

create particular difficulties for 

them during and after events. They 

may have limited ability to protect 

themselves during a disaster, more 

complex sheltering needs, or more 

barriers to recovery. In recent years 

there’s been a national policy shift 

from segregating people with these 

issues into “special needs shelters” 

and instead determining how to 

address their requirements within 

general population shelters and 

services through “functional needs” 

planning. This is admirable in terms 

of showing respect for individuals 

and adhering to the spirit of the 

Americans with Disabilities Act, 

but in actual practice, the change 

has revealed some significant gaps 

in preparedness as responders must 

learn how to adapt to complex and 

often unforeseen situations.

State, territory, and tribal plans 

usually cover logistical guidance 

for incorporating functional needs 

into pre-disaster planning as well 

as the response and initial recovery 

phases of a disaster. However, 

these may not contain information 

on addressing the psychosocial 

reactions of disaster survivors 

whose functional needs place them 

at higher risk—nor do they address 

the stressors responders themselves 

may face in trying to meet those 

sometimes intense demands. Here’s 

a broad overview of a few of the 

factors we all need to consider in 

completing this shift. Many of the 

actions needed to address functional 

needs can also benefit the general 

survivor population, as we’ll 

discuss.

Who Are These Groups?

Much of the planning for integrating 

people with functional needs 

focuses on individuals with physical 

disabilities and mental health 

conditions. Federal Emergency 

Management Agency’s (FEMA’s) 

2010 Guidance on Planning for 

Integration of Functional Needs 

Support Services (FNSS) in 

General Population Shelters states 

that “children and adults requiring 

FNSS may have physical, sensory, 

mental health, and cognitive and/or 

intellectual disabilities affecting their 

ability to function independently 

without assistance. Others that 

may benefit from FNSS include 

women in late stages of pregnancy, 

elders, and people needing bariatric 

Supporting People With Functional Needs

By the Institute for Disaster Mental Health at State University of New York, New Paltz, published as a joint 

venture with the New York State Office of Mental Health and Department of Health

JAYUYA, Puerto Rico, December 8, 2017 - Abdiel Reyes and Alex Aldarondo from FEMA Disability Integration help unload medical equipment provided by 

FEMA, for survivors in Jayuya. Photo by Yuisa Rios/FEMA.
2018 | VOLUME 14 | ISSUE 3–4 | PAGE 24

equipment.” Other groups who may 

present particular functional needs 

post-disaster include unaccompanied 

minors who need to be reunited with 

family, people who cannot speak 

or read English, and pre-disaster 

homeless individuals.

An important point to remember 

in considering these groups’ 

psychosocial needs are some of 

the co-occurring issues that may 

compound the main disability. The 

World Health Organization points 

out that relative to people without 

disabilities, those with them may 

also live with poorer general health, 

lower educational achievements, less 

economic and social participation, 

and higher rates of poverty. All 

of those co-factors are likely to 

lead to less ability to prepare for 

emergencies, leading to worse 

exposure during the event, and 

providing fewer economic and social 

resources to support their recovery. 

That makes it all the more important 

that every effort be made to address 

their immediate requirements 

post-disaster in an effort to remove 

barriers and provide a supportive 

early recovery environment.

What Do They Need?

Consistent with the basic premises 

of disaster mental health, meeting 

survivors’ practical and logistical 

needs promptly is the best way 

to prevent extreme and lasting 

emotional reactions. Emergency 

plans usually include many pages of 

specifics on addressing a wide range 

of physical and medical functional 

needs, so we’ll focus on the more 

mental health-related aspects of a 

few key points.

Replace missing assistive devices 

and medications: In some cases, 

restoring access to medications 

or life-sustaining treatments is a 

medical emergency that should 

of course be prioritized. Other 

clients risk a return of physical 

or psychiatric symptoms, as well 

as uncomfortable or dangerous 

withdrawal symptoms, if access to 

needed prescription medications 

isn’t restored promptly.

But in many cases the need appears 

far less urgent to response organizers 

than it feels to the survivor. How 

many of us would instantly become 

disabled and dependent if we merely 

lose our eyeglasses or hearing aids? 

That’s not a matter of life or death, 

but it shifts that individual from 

the category of general survivor 

to person with special needs, 

potentially making them feel helpless 

and frustrated and preventing them 

from participating actively in their 

recovery. While triaging these needs 

clearly should focus first on people 

with the most pressing problems, 

try to widen the focus as soon as 

possible to restore functionality to 

those less urgent cases.

Address dietary needs: Shelter 

managers should generally try to 

ensure that meals and snacks are as 

healthy as possible, with items that 

are low fat, low sodium, and low 

sugar to meet the broadest range of 

dietary needs. FEMA recommends 

striving to meet more specific 

needs such as meal options that are 

vegetarian, gluten-free, kosher, and 

safe for people who are allergic to 

peanut oil and by-products.

On the emotional side, we also 

recommend taking residents’ ethnic 

Baton Rouge, La., September 3, 2005 -- This is a special needs shelter for those with disabilities, senior 

citizens, and people seeking medical attention during Hurricane Katrina. Photo by Liz Roll.
2018 | VOLUME 14 | ISSUE 3–4 | PAGE 25

and regional preferences into 

consideration whenever possible. 

Food is a main source of comfort 

for many people, so providing meals 

that are familiar and palatable is a 

small but powerful way to show you 

recognize their situation and want to 

support their needs.

Improve communication:

Obviously people with severe 

sensory impairments may have 

trouble receiving warnings before 

an event and informational briefings 

afterward, so bringing in supports 

like sign language interpreters and 

scribes may be necessary. Other 

clients who may need assistance 

with communication include nonnative English speakers (and note 

that even people who are generally 

adept in a second language may 

lose fluency in stressful situations), 

people with dementia or cognitive 

impairment, some people with 

mental illness, and people with 

autism. Incorporating technology, 

like translation or voice recognition 

programs on a smart phone or tablet, 

may be beneficial in communication 

with some of these groups.

Also remember that survivors 

with none of those obvious 

communications barriers are likely 

to have trouble focusing on and 

retaining information if they’re 

very stressed, as is likely soon after 

a disaster. Try to use simple and 

direct language, repeat yourself as 

necessary, provide printed materials 

as reminders, and don’t assume a 

message has been fully absorbed.

Address negative perceptions:

As experiences from a number 

of recent disasters in New York 

State have demonstrated, this can 

be one of the most challenging 

elements of integrating people 

with functional needs into a 

general setting. Largely because 

of sensationalized or exaggerated 

depictions of mental illness in both 

entertainment and news media, 

many community members have 

wildly distorted perceptions about 

who has every right to be there, 

while that individual faces the added 

stress of feeling unwelcome.

Negative perceptions may also 

be directed towards individuals 

who are visibly ill (even if they’re 

not contagious), or appear to be 

homeless or otherwise “different.” 

We should acknowledge that shelter 

staff and other responders are 

not immune to feeling anxiety or 

mistrust about clients who they fear 

may become disruptive, or staffers 

simply may not want to deal with 

the conflict these clients can produce 

among other shelter residents. DMH 

helpers may need to balance efforts 

to provide psychoeducation and 

calming to anxious residents and 

staff members while respecting the 

privacy and access rights of the 

person with mental illness.

Clearly there are many more specific 

aspects of integrating people with 

functional needs into disaster 

response that we don’t have room 

to address here. This article is just 

an overview of a policy shift whose 

ramifications are still emerging for 

disaster mental health helpers, but 

we hope it will encourage you to 

start thinking about members of 

your community whose functional 

needs should be incorporated into 

your plans, and in your staff and 

volunteer trainings. Ensuring that 

everyone involved in disaster 

response understands those needs 

and develops basic skills to address 

them can help to minimize excess 

anxiety and conflict in an already 

stressful situation. ■

Consistent with the 

basic premises 

of disaster 

mental health,

meeting survivors’ 

practical and logistical 

needs promptly is the 

best way to prevent 

extreme and lasting 

emotional reactions.

people with mental illness being 

dangerous. Their personal tolerance 

and patience is not likely to be 

at its highest in a shelter or other 

post-disaster setting, where the 

general conditions may also be 

activating stress reactions in the 

person with mental illness who 

has just experienced the disaster 

and may be dealing with their own 

traumatic memories. The resulting 

combination of behaviors on both 

sides can lead to shelter residents 

protesting the presence of someone 
2018 | VOLUME 14 | ISSUE 3–4 | PAGE 26

RECOMMENDED RESOURCES

Understanding Historical Trauma When Responding 

to an Event in Indian Country: Tips for Disaster 

Responders

This SAMHSA tip sheet serves as a resource for 

disaster response workers to learn about working with 

and supporting Native Americans through a disaster or 

other traumatic event. It defines historical trauma and 

its effects on the community, as well as how to take 

historical trauma into consideration when responding to 

the needs of the community.

Find the tip sheet at http://bit.ly/2E8gvms. 

Cultural Awareness When Working in Indian 

Country Post Disaster: Tips for Disaster Responders

This tip sheet from SAMHSA provides disaster response 

workers with a better understanding of the cultural 

values and traumatic events that are shared by many 

Native American communities. This information can 

be used to tailor response efforts and better aid the 

community. The tip sheet also provides guidance on how 

to build connection with the community in an effort to 

show respect and provide an effective response to any 

disaster.

Find the tip sheet at http://bit.ly/2GVsu8T.

Individuals With Disabilities

This resource from Ready.gov lists steps for individuals 

with disabilities that can help them plan for a disaster 

so they can be better prepared if the resources they are 

used to are suddenly unavailable or limited. It includes 

tips for those that are deaf or hard of hearing, blind or 

have low vision, and individuals who have a mobility 

or speech disability. First responders can use these 

tips to learn what to look for or develop ways of better 

communicating with those with a disability.

Read the planning steps at http://bit.ly/1Uup6nF.

Emergency Preparedness: Including People With 

Disabilities

This page from the Centers for Disease Control and 

Prevention website lists a variety of resources for first 

responders including tip sheets on assisting people with 

different disabilities. Emergency personnel may use 

them to develop emergency response plans that include 

people with disabilities. It also has resources for people 

with disabilities and their caregivers, communities, and 

more.

Find the page at http://bit.ly/2EvTfPm.

Preparing for Disaster for People With Disabilities 

and Other Special Needs

This booklet provided by the Federal Emergency 

Management Agency and the American Red Cross 

was developed to aid individuals with disabilities 

in preparing in case of an emergency. It provides a 

checklist of what should be done before a disaster, 

including considerations for people with disabilities. 

The booklet walks through the process of making a plan 

in case of a disaster, building a disaster kit, and how to 

maintain the preparation work you have done. 

Find the booklet at http://bit.ly/2EvcEzZ. 
SUBSCRIBE

The Dialogue is a publication for professionals in the disaster behavioral health field to 

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

receive The Dialogue, please go to SAMHSA’s home page (https://www.samhsa.gov), 

click the “Sign Up for SAMHSA Email Updates” button, enter your email address, and 

select the box for “SAMHSA’s Disaster Technical Assistance newsletter, The Dialogue.”

SHARE INFORMATION

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. To subscribe, please enter 

your email address in the “SAMHSA DTAC Bulletin” section of the home page of our 

website at https://www.samhsa.gov/dtac.

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

Behavioral Health is Essential to Health

Prevention Works • Treatment is Effective • People Recover