∙

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

the Dialogue

2016 | VOLUME 13 | ISSUE 1

Public Health Emergencies
∙

TABLE OF CONTENTS

1 In This Issue

2 Data Snapshot

3 Contributors

4 The Dialogue Reader Responses

5 Recent Technical Assistance Requests

6 The Flint Water Crisis: Q&A About the Behavioral Health Response Efforts

9 Rural Indiana Town Responds to HIV Cluster Driven by Drug Abuse

11 Zika Behavioral Health Resources: Turning Anxiety Into Action

13 Recommended Resources

Cover photo: Veronica Acevedo (left) and Manuel Amador (right), biologists from Dengue Brach at the 

Centers for Disease Control and Prevention (CDC), participated at a municipality fair in Salinas. They 

provided guidance about mosquito reproduction, zika virus and prevention against different illnesses 

that mosquitoes carry. Photo: Yuisa Rios/FEMA.

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 

page (http://www.samhsa.gov), click the “Sign Up for SAMHSA Email Updates” button, 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 http://www.samhsa.gov/dtac.

The Dialogue is not responsible for the information provided by any webpages, 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.
2016 | VOLUME 13 | ISSUE 1 | PAGE 1

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue

In This Issue

In disasters and other emergencies, everything is 

in short supply—most of all time. To expedite and 

coordinate our work, we all rely to some degree on 

organizational structures, relationships, and chains of 

command, as well as emergency operations plans and 

broader approaches. All of this is good. Disasters—

including public health emergencies, the focus of this 

issue—are by their nature disorganized and chaotic, 

and approaches to increase organization and efficiency 

of response are indispensable. But a key lesson of 

this issue is that they are not necessarily where we as 

responders should begin.

Instead of beginning with what we have done and with 

the tools we know and structures we have, it is crucial 

to begin with finding out where the community is and 

meeting them there. As we work to ensure the best 

possible physical and behavioral health for communities 

following disasters, we should start by assessing the 

community, its strengths and challenges, its history, 

and, most importantly, where it is now.

This theme is woven through all of this issue’s articles, 

which cover several public health emergencies: an 

outbreak of HIV and hepatitis C in Indiana associated 

with oxymorphone dependence; the water crisis in Flint, 

Michigan; and the Zika virus and the risk of contracting 

it among particular groups in the United States. In 

behavioral health responses to community needs—in 

Indiana, Michigan, and across the United States among 

pregnant women and people who work outdoors—

professionals dedicated time to seeking or tapping into 

an in-depth understanding of the issues communities 

faced; the strengths they possessed as well as barriers 

confronting them; and the systems of care, information, 

and community they interacted with. From there, they 

developed plans for helping people take positive steps 

toward ensuring their own health, responding to mental 

health and substance use needs, working with external 

entities, and building community capacity to meet 

physical and behavioral health needs in the future.

Have you taken a community-centered approach to 

emergency response? Are there unique aspects of public 

health emergencies, and important lessons learned, that 

we can highlight in future issues of this newsletter? 

Please let us know. And if we can support your response 

processes, we welcome your input on that front as well.

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

Brenda Mannix

SAMHSA DTAC Project Director

dtac@samhsa.hhs.gov

[W]e should start by assessing the 

community, its strengths and 

challenges, its history, and, most 

importantly, where it is now.

Wyoming Office of Homeland Security Director Guy Cameron Attends Mile 

High DICE in Aurora, Colo with Aimee Binning of Albany County, Wyoming. 

Photo: Cynthia Hunter/FEMA
2016 | VOLUME 13 | ISSUE 1 | PAGE 2

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue

DATA SNAPSHOT

Within the past 6 months, these are the percentages 

of people who have read, seen, or heard information 

on how to better prepare for a specific disaster:

Awareness of Preparedness Information

34%

Flood 30%

Wildfire

50% 

Earthquake

53%

Tornado

68%

Hurricane 42%

Winter 

Storm

Source: U.S. Department of Homeland Security, Federal Emergency Management Agency (FEMA), 2016.
2016 | VOLUME 13 | ISSUE 1 | PAGE 3

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue

Contributors

Jody Lewis, M.A., LLP is the Behavioral Health 

Liaison for Michigan’s Community Health Emergency 

Coordinating Center (CHECC) and Specialist in the 

Behavioral Health and Developmental Disabilities 

Administration of the Michigan Department of Health 

and Human Services. She had been part of a team 

effort to assist with the Flint water emergency, to 

developing a comprehensive behavioral health response 

to the emergency. The other members of this team 

include Price Pullins, M.A., LLP, Chief Psychologist 

Consultant, Office of Medical and Psychiatric Services, 

Behavioral Health and Developmental Disabilities, 

Michigan Department of Health and Human Services, 

and Kenyetta Jackson, M.P.H., Analyst, Behavioral 

Health and Developmental Disabilities Administration, 

Michigan Department of Health and Human Services.

Sara K. Cozad, M.S.W., LCSW 

is the Assistant Deputy Director 

of Adult Services with the 

Indiana Division of Mental 

Health and Addiction. In her 

role, Mrs. Cozad works to 

oversee programming areas including serious mental 

illness and co-occurring disorders, problem gambling 

services, older adult services, housing assistance, 

emergency preparedness, and forensic treatment services 

including the Recovery Works program.

Stephanie L. Spoolstra,

LCSW is the Director of 

Addiction Recovery Services 

for the Indiana Department of 

Correction. She was the lead 

representative from the Division 

of Mental Health and Addiction during the Scott County 

HIV outbreak. She joined the Department of Correction 

in March 2015 and oversees all department initiatives 

related to the provision of addiction recovery services.

Kristin Blank, M.F.A. is the 

Materials Development 

Manager for SAMHSA DTAC. 

She is a writer and editor who 

has worked in the public health 

field for nearly 10 years.
2016 | VOLUME 13 | ISSUE 1 | PAGE 4

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue

The Dialogue Reader Responses

In this section, read selected responses from readers about their thoughts on previous issues of The Dialogue. 

Find past issues at http://www.samhsa.gov/dtac/resources/dialogue. If you have a comment about an article, 

send it to dtac@samhsa.hhs.gov.

In response to the previous 

issue, “Stress Management and 

Self-Care,” Debra S. writes:

I’m self-employed but share office 

space with a psychiatrist/energy 

healer. Meditation, meals, liters of 

water are part of every day. Also 

have a therapy dog wandering the 

office spaces. We all get over the top 

sometimes but we are lucky to have 

others around to help decompress. ■

To read more tactics for self-care, 

visit https://www.samhsa.gov/sites/

default/files/dtac/dialogue-vol-12-

issue-3.pdf.

TIPS FOR EFFECTIVE

Risk Communications

■ Use simple messages and provide updates regularly.

■ Release information in a timely manner. Late release of crucial 

information could cause mistrust in the community.

■ Be honest and open. Address any rumors that may be going around.

■ Show expertise. It will help reduce anxiety and uncertainty in the 

community.

■ Express empathy to build trust and rapport in the community.

Source: SAMHSA DTAC, 2016. Behavioral health resources on Zika. http://www.samhsa.gov/dtac/zika
2016 | VOLUME 13 | ISSUE 1 | PAGE 5

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue

Recent Technical Assistance Requests

In this section, read about recent questions SAMHSA DTAC staff have answered, technical assistance (TA) requests 

received, and responses to past articles in The Dialogue. Send your questions and comments to dtac@samhsa.hhs.gov.

Request: SAMHSA DTAC received a TA request 

from a behavioral health professional dealing with an 

active wildfire. The individual inquired about the Crisis 

Counseling Assistance and Training Program (CCP) and 

requested resource materials for wildfire survivors.

Response: SAMHSA DTAC explained the CCP 

grant process, mentioning that the state must receive 

a Presidential disaster declaration with individual 

assistance in order to be eligible. SAMHSA DTAC 

connected the requestor with the state disaster 

behavioral health coordinator as well as providing a list 

of resources related to wildfires, including the following. 

Wildfire-Specific Information

• Disaster-Specific Resources Disaster Behavioral 

Health Information Series Installment

This installment is a collection of resources focused 

on preparedness and response for specific types of 

disasters, including wildfires. 

http://www.samhsa.gov/dbhis-collections/disasterspecific-resources?term=Disaster-SpecificResources-DBHIS&filter%5b0%5d=Wildfire

• Centers for Disease Control and Prevention 

(CDC): Wildfires 

The CDC Emergency Preparedness and Response 

website provides information on a host of hazards, 

including wildfires. 

https://www.cdc.gov/disasters/wildfires/index.html

General Disaster Response and Recovery Information

• Tips for Survivors of a Disaster or Other Traumatic 

Event: Managing Stress

This SAMHSA tip sheet gives stress prevention 

and management tips for dealing with the effects of 

disasters. It lists tips to relieve stress, describes how 

to know when to seek professional help, and provides 

accompanying resources. 

http://store.samhsa.gov/shin/content/SMA13-4776/

SMA13-4776.pdf

Spanish version: http://store.samhsa.gov/shin/

content//SMA13-4776SPANISH/SMA13-

4776SPANISH.pdf

• Psychological First Aid (PFA)

Developed jointly by the National Center for 

Posttraumatic Stress Disorder and the National Child 

Traumatic Stress Network, PFA is an evidenceinformed approach for assisting people in the 

immediate aftermath of disaster and terrorism: to 

reduce initial distress, and to foster short- and longterm adaptive functioning. 

http://www.ptsd.va.gov/professional/materials/

manuals/psych-first-aid.asp

Request: A state disaster behavioral health 

coordinator contacted SAMHSA DTAC to request 

trainer recommendations. The state was planning a 

training for employees on self-care and compassion 

fatigue as well as Psychological First Aid.

Response: SAMHSA DTAC sent the state a list of 

potential trainers who have the requested skills and are 

capable of conducting a training class. The state selected 

a trainer and scheduled the training. ■
2016 | VOLUME 13 | ISSUE 1 | PAGE 6

The Flint Water Crisis: Q&A 

About the Behavioral Health Response Efforts

SAMHSA DTAC interviewed Jody Lewis, M.A., LLP, Behavioral Health Liaison, Community Health Emergency 

Coordinating Center and Behavioral Health and Developmental Disabilities Administration, at the Michigan 

Department of Health and Human Services (MDHHS) about the status of the Flint water crisis, behavioral health 

effects seen among affected residents, and lessons learned during the public health response efforts to help.

DURING APRIL 25, 2014–OCTOBER 15, 2015, approximately 

99,000 residents of Flint, Michigan, were affected by changes in drinking 

water quality after their water source was switched from the Detroit Water 

Authority, sourced from Lake Huron, to the Flint Water System, sourced 

from the Flint River.

Source: CDC. (2016, July 1). Morbidity and Mortality Weekly Report.

SAMHSA DTAC Questions:

• How has the behavioral health 

response changed over the course of 

the crisis, from the immediate phase to 

the long-term response?

• At what point during the crisis did 

behavioral health responders become 

involved?

Did pre-existing trauma play a role in 

behavioral health responses that some 

people experienced?

Did behavioral health responders face 

any barriers when trying to work with 

community members?

• Were responders able to successfully 

work with the diverse cultures and 

communities in Flint? If so, what 

strategies did they use to reach 

specific populations?

• How has your team worked to foster 

resiliency in the community?

• What long-term behavioral health 

effects, if any, are you seeing in Flint 

residents?

• What lessons learned would you 

communicate to other responders who 

may face a similar crisis in the future?

• From your experience, is there 

anything you would recommend 

communities do to better prepare for 

a disaster from a behavioral health 

response perspective?

MDHHS Response:

Early in the response to the Flint 

water crisis, much of the effort 

focused on providing information to 

residents about obtaining and using 

safe bottled and filtered water, and 

setting up crisis hotlines and crisis 

counseling to address immediate 

Left to Right: Price Pullins, M.A., L.L.P.; 

Jody Lewis, M.A., L.L.P., and Kenyetta 

Jackson, M.P.H.

Early in the emergency, 

there was a lot of focus 

on the behavioral health 

needs of children and 

families. As the crisis 

continued, the needs of 

adults—especially those 

who were underserved 

and vulnerable—began 

to emerge.
2016 | VOLUME 13 | ISSUE 1 | PAGE 7

Importantly, the community has preexisting trauma—

movement of the well-paying auto industry jobs out of 

the community, the financial crisis, increasing poverty, 

racial tensions, and the accompanying complex 

traumas that occur as a result.

behavioral health needs. Over time, 

as the immediate need to provide 

safe, clean water was addressed 

through filtered and bottled water, 

the response transitioned into one 

where the Michigan Department of 

Health and Human Services focused 

on ensuring resources and services 

were in place for the long-term 

support of the community. From our 

perspective, those services included 

things such as expanding health 

care under Medicaid to all residents 

under age 21, pregnant women and 

their children, and those under 400 

percent of the federal poverty level. 

This health care expansion included 

the extension of behavioral health 

services to a greater percentage 

of the population, both through 

additional Child and Adolescent 

Health Centers, and direct support 

to primary care physicians and 

pediatric offices. We continue to 

provide Psychological First Aid 

and crisis counseling, and provide 

support to those with behavioral 

and developmental disabilities. We 

have also expanded efforts to test for 

and abate lead, provide individual 

medical and psychological support 

to children with elevated blood lead 

levels, and provide nutrition support 

to the community both through 

education and the delivery of 

millions of pounds of healthy food. 

We have also increased the number 

of Pathways to Potential social 

workers in Flint’s schools.

In addition, the newly developed 

Flint Community Resiliency Group 

has helped MDHHS develop direct 

community dialogue and establish 

an open, collaborative relationship 

with local leaders. Additionally, 

we have focused on increasing our 

outreach efforts to underserved 

and vulnerable populations. For 

example, the Michigan School for 

the Deaf is located in Flint, and 

many students and their families 

have settled there. Although some 

individuals who are deaf or hard 

of hearing have closed-captioning 

available on their televisions and 

media devices, many of those 

who do not read well rely on 

INCOME & POVERTY

Median household income 

(in 2014 dollars), 2010–2014

FLINT CITY, MI

$24,679

UNITED STATES 

$53,482

People living in poverty

FLINT CITY, MI 

41.6%

UNITED STATES 

13.5%

EDUCATION

Bachelor’s degree or higher, 

percentages of people age 

25 years+, 2010–2014

FLINT CITY, MI

11.3%

UNITED STATES 

29.3%

HEALTH

People without health

insurance, under age

65 years, percentages*

FLINT CITY, MI

14.1% UNITED STATES 

10.5%

* This geographic level of poverty and health estimates are not comparable to other geographic levels of these estimates.

Source: United States Census Bureau, 2016. Quick facts for Flint city, Michigan, 2010–2015. http://www.census.gov/quickfacts/table/PST045215/2629000
2016 | VOLUME 13 | ISSUE 1 | PAGE 8

sign language interpreters for 

communication. So we have worked 

with the community to increase the 

number of interpreters and produce 

video with interpretation.

Based on what we have learned 

so far, we recommend that any 

community faced with a declared 

emergency or disaster utilize 

SAMHSA as an excellent resource 

for experienced subject matter 

expertise, grant opportunities, and 

even moral support. Thanks to 

SAMHSA, we had solid additional 

resources and tools available to us 

to help navigate our response. Other 

national organizations and centers 

have been helpful as well, such as 

the Centers for Disease Control 

and Prevention, National Child 

Traumatic Stress Network, National 

Center for Trauma-Informed 

Care, and National Center for 

Posttraumatic Stress Disorder.

This experience, from a state 

perspective, shows the importance of 

working with the local community 

mental health agencies on basic 

disaster preparedness, training, and 

exercises to address the immediate 

aftermath and consequences of a 

crisis. This includes establishing 

partnerships and policies; 

using formal memoranda of 

understanding; and assisting local 

agencies in developing a roster of 

local, state, and federal resources 

and subject matter expertise. ■

FEDERAL RESPONSE

Up to 106 

federal staff at the 

height of the response 

were on the ground 

in Flint working with 

residents, community 

leaders, and officials 

from state and county 

agencies. Federal staff 

continue to support the 

community.

In Flint 100%

of residents have access to 

bottled water and water filters.

More than 26.9 million

liters of water were provided to 

the state of Michigan by FEMA, plus

50,000+ water and pitcher filters, and

243,842 filter replacement cartridges

between January 19 and August 14, 2016.

A $1 million grant is helping Genesee Health System increase patient 

capacity and provide additional comprehensive primary and preventive 

health services. The grant is one of 10 in Michigan totaling $10 million.

FEDERAL BEHAVIORAL HEALTH RESPONSE

With an additional $500,000 in emergency funding from the 

U.S. Department of Health and Human Services (HHS), two 

Flint health centers were able to hire more people and provide the following:

• 10,000+ people with information about preventing lead exposure

• 3,100+ people with lead testing

• About 1,200 people with behavioral health services in the first few

months of the funding

A SAMHSA Emergency Response Grant is providing $475,194

in funding for behavioral health and other services including special outreach 

to people with limited English proficiency or hearing or vision impairments.

U.S. Public Health 

Service Commissioned 

Corps officers taught basic 

Psychological First Aid 

(PFA) skills training to

183 members of 

the community.

These officers also 

taught a Train the 

Trainers course to 

32 providers so 

that they, in turn, can provide PFA 

training to over 

500 community 

members in Flint.

Source: HHS, 2016. Office of the Assistant Secretary for Preparedness and Response (ASPR) website.
2016 | VOLUME 13 | ISSUE 1 | PAGE 9

Rural Indiana Town Responds to HIV Cluster 

Driven by Drug Abuse

By Sara K. Cozad, M.S.W., LCSW, Assistant Deputy Director of Adult Services, Indiana Division of Mental Health 

and Addiction and Stephanie L. Spoolstra, LCSW, Director of Addiction Recovery Services, Indiana Department of 

Correction

In December 2014, the small rural 

town of Austin, Indiana, realized 

they had a problem after a sudden 

uptick of individuals tested positive 

for HIV. By March 23, 2015, Indiana 

Governor Mike Pence declared a 

public health emergency in response 

to the rapidly growing numbers of 

HIV positive tests in the town of 

approximately 4,200 people.

By the conclusion of the emergency 

response, led by the Indiana 

State Department of Health, 182 

individuals were diagnosed as HIV 

positive, 282 individuals were 

positive for hepatitis C (with a 92 

percent co-infection rate), and 

there existed a network of at 

least 500 people who injected 

prescription drugs within the 

town. Further outreach efforts 

revealed the spread of HIV was 

directly correlated to the injection 

drug use of the opioid prescription 

pain reliever oxymorphone (trade 

name: Opana). The ease of access 

to the prescription opioid resulted 

in oxymorphone becoming 

the substance of choice. The 

high experienced from abusing 

oxymorphone through intravenous 

use is similar to heroin; thus, Austin 

saw an increase in needle use. 

Without access to clean needles, 

people who inject drugs will reuse 

and share needles, potentially 

resulting in the rapid transmission 

of communicable diseases. As 

opposed to the HIV outbreaks of 

the 1980s, which were linked to 

unsafe sexual practices, Austin’s 

outbreak demonstrated the impact 

of overprescribing of opioids and 

the overwhelming consequences of 

prescription drug abuse.

In conjunction with the public health 

response, the Indiana Family and 

Social Services Administration’s 

Division of Mental Health and 

Addiction (DMHA) led efforts to 

increase the community’s access 

to meaningful treatment and longterm addiction recovery. While 

many articles have been written 

about the efforts to stop the spread 

of infectious disease and the causes 

(both economic and cultural) of this 

outbreak, little has been documented 

about the long-term interventions 

to help people recover from drug 

addiction. The following represents 

key lessons learned by Indiana’s 

Single State Agency for Substance 

Abuse—Indiana DMHA—in 

combating an outbreak of this 

magnitude.

4,200

residents in 

 Austin, IN 182 residents 

infected with HIV; 

4.3% of total 

population

282 residents 

with positive tests for 

hepatitis C virus with a 

co-infection rate 

of 92%.

AUSTIN, INDIANA
2016 | VOLUME 13 | ISSUE 1 | PAGE 10

During the emergency response, 

DMHA provided subject matter 

expertise to the Indiana State 

Department of Health to address 

the behavioral health needs of the 

community in the following ways:

• Providing training for the 

disease intervention specialists 

on culturally relevant treatment 

information

• Working with preventionists and 

treatment providers to create a 

continuum across interventions, 

programming, and initiatives

• Providing financial and technical 

assistance to local treatment 

providers to increase access to 

immediate detoxification services, 

as well as long-term coordinated 

physical and behavioral health care 

These efforts did not come without 

significant barriers, which resulted 

in key lessons learned about 

working with rural communities 

to both address and prevent 

behavioral health crises. During 

the time of response, it is important 

to keep the following in mind: 

1. The primary role of the state in a 

crisis is to remove unnecessary 

barriers and bring stakeholders 

together.

2. Well-coordinated, collaborative 

efforts that use a whole-person 

framework and encourage personcentered recovery are essential.

3. It is critical to empower the local 

community by listening to their 

concerns and letting them take the 

lead in decisions.

For those hoping to increase 

community resilience and prevent 

future health/behavioral health 

crises, consider these takeaways:

• Remember to apply micro-level 

social work principles at the macrolevel: Meet the community where it 

is. A community-centered approach 

recognizes where the community is 

despite where you think they need 

to be. Start there.

• Build the capacity of local service 

providers and coalitions before, 

during, and after a crisis happens.

• Take a critical look at the available 

data and what it’s telling you.

• Link the community together for 

support and sustainability. The state 

response will end—the community 

must continue the work together.

• Remember to make room for all 

opinions at the table.

• Don’t just address the substance 

use—there are often critical mental 

health needs to address at the same 

time.

Here are some key questions you 

should ask yourself to help you 

determine the state of your state or 

community:

• What is the level of communication 

with rural communities and are 

their needs clear?

• What is the status of the 

communication amongst key 

organizations (state and local 

level)?

• What does your local/area/regional 

data tell you? Does it make sense?

• Who is the local leadership? What 

are the local leadership agencies?

• Do you know who provides 

prevention efforts? Treatment 

services?

• Do your local health department(s), 

treatment providers, and 

preventionists have the capacity to 

meet the community’s needs?

• Is there a local coalition/

collaboration that brings the key 

people together to strategize needs/

intervention regularly?

By the end of the behavioral health 

response efforts, key stakeholders in 

Austin had received two leadership 

summits to bring them together, a site 

for integrated behavioral and physical 

health care within the town, and a 

better understanding of the impact 

of behavioral health on the entire 

community. The local community 

members continue to move toward a 

collaborative plan, and the spread of 

HIV has slowed significantly. ■

Link the community 

together for support 

and sustainability. 

The state response 

will end—

the community 

must continue the 

work together.
2016 | VOLUME 13 | ISSUE 1 | PAGE 11

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue

Zika Behavioral Health Resources: 

Turning Anxiety Into Action

By Kristin Blank, M.F.A., Materials Development Manager, SAMHSA DTAC

When I found out I was pregnant with my second child 

in February 2016, one of the earliest thoughts I had was 

“Great, now I have to worry about Zika.” I’m prone to 

anxiety in the best of circumstances, and pregnancy, 

with all of its unknowns and what-ifs, raises my anxiety 

level on a good day. Throw in the threat of a littleunderstood infectious disease that causes devastating 

birth defects and you’ve got a recipe for stress.

My anxiety over Zika dovetailed with my work with 

SAMHSA DTAC. Our team aimed to create resources 

that could help alleviate some of the fear and stress that 

news about Zika may cause pregnant women, people 

who work primarily outdoors, and their families. As 

our team developed messaging, we saw my situation 

as a pregnant person during mosquito season as an 

opportunity to make our resources stronger—I am part 

of the target audience we hoped to reach. It also was 

helpful to me on a personal level; I channeled some of 

my own anxiety to help others. 

In brainstorming sessions, I let team members know tips 

that helped me and those that did not. Here are some 

examples:

Helpful: Research safe and effective mosquito repellents 

and wear them whenever you are outside. 

Not Helpful: “Stay indoors as much as possible.” In the 

summer, with an active 5-year-old at home? Nope. 

Helpful: Stay informed, but limit the amount of time 

you spend reading media reports about Zika.

Not Helpful: “When you go outside, wear pants and 

long-sleeved shirts.” In 95-degree heat? Not going to 

happen.

While the not-helpful examples are valid ways to avoid 

mosquito bites, they can increase anxiety in several 

ways. Not only would they disrupt my daily life, but they 

Strategies for Pregnant Women to manage Stress 

and Worry Related to Zika

• Take a break from hearing or reading 

about news and media coverage of Zika.

• Find activities that bring you joy.

• Manage stress with online tools,

such as mobile apps available for stress 

management, meditation, and healthy 

pregnancy tips such as Breathe2Relax.

• Reach out to family and friends.

• Be proactive. Consider utilizing 

preventive measures from the Centers 

for Disease Control and Prevention 

(CDC) for Zika for the whole family.

• For additional information,

visit trusted sources such as CDC’s 

Zika website, Mother to Baby, March 

of Dimes, SAMHSA DTAC: Behavioral 

Health Resources on Zika, and 

text4baby (Text BABY to 511411).

Source: HHS, Office of the Assistant Secretary 

for Preparedness and Response, 2016. 2016 | VOLUME 13 | ISSUE 1 | PAGE 11
2016 | VOLUME 13 | ISSUE 1 | PAGE 12

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue

would lead to overthinking, self-doubt, and blame—if 

I don’t do x or y, then I obviously don’t care enough to 

prevent myself from getting Zika. The reality is, even 

doing all of the things recommended by public health 

officials will not guarantee that I will not be bitten by a 

mosquito, or that that mosquito will not have the Zika 

virus. I, and every other pregnant person out there, 

can only stay informed and do our best to set realistic 

expectations for our behavior.

Our team kept all of these factors in mind as we 

developed a robust suite of resources that brings together 

the most helpful and reliable information from SAMHSA 

and other institutions, such as the Centers for Disease 

Control and Prevention. They include the following:

Behavioral Health Resources on Zika

http://www.samhsa.gov/dtac/zika

Zika Virus Resources Disaster Behavioral 

Health Information Series Installment

http://www.samhsa.gov/dbhis-collections/zikavirus?term=Zika%20Virus-DBHIS

Coping With Stress During Infectious 

Disease Outbreaks

http://store.samhsa.gov/product/Coping-with-StressDuring-Infectious-Disease-Outbreaks/SMA14-4885

Spanish version: http://www.store.samhsa.gov/

product/Coping-with-Stress-During-InfectiousDisease-Outbreaks-Spanish-/SMA14-4885SPANISH

As professionals in the field, we may be more effective 

in reaching our target audiences if we reflect on what 

would be most helpful to us and our own families in a 

given situation. Using our own personal experiences 

and tapping into our capacity for empathy can lead to 

stronger resources and a greater sense of understanding 

of what disaster survivors and responders experience. 

If you have a story about or tip for helping to relieve 

anxiety in people at risk for Zika, please let us know. 

Email dtac@samhsa.hhs.gov. ■

To reduce stress and anxiety 

specifically related to Zika, 

TRY THESE TIPS

Stay informed.

Get your information from reliable sources.

• Talk to your health care provider for accurate health 

information.

• Turn to knowledgeable, trustworthy sources, 

such as a state or local health department; 

U.S. government agencies, such as the CDC; 

or a global organization like the World Health 

Organization.

• If the media coverage raises your stress and anxiety, take 

time away from the news to focus on things in your life 

that are going well and that you can control.

Know the symptoms of Zika,

and speak to a health care provider 

immediately if you believe you may have 

contracted the virus.

Take action to protect yourself

and others from possible Zika exposure.

• Use insect repellent and wear clothing that covers your 

arms, legs, and feet to protect 

yourself from mosquito bites.

• Get rid of sources of standing 

water, which are breeding areas 

for mosquitoes.

 Source: SAMHSA DTAC. (2016). Behavioral health resources on Zika. 

http://www.samhsa.gov/dtac/zika
2016 | VOLUME 13 | ISSUE 1 | PAGE 13

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue

RECOMMENDED RESOURCES

Public Health Emergencies 

Resource Collection

Part of the SAMHSA Disaster Behavioral Health 

Information Series, this collection includes resources 

to help individuals and communities to cope with 

infectious disease outbreaks, contamination crises, and 

other emergencies that can compromise public health. 

Materials relate to pandemic influenza preparedness and 

response; the response to the Ebola outbreak in Africa; 

water crises like the one in Flint, Michigan; and best 

practices in public health emergency communication.

View the installment at http://www.samhsa.gov/dbhiscollections/public-health-resources?term=Public%20

Health%20Emergencies-DBHIS.

Promising Practices in Disaster 

Behavioral Health Planning: 

Building Effective Partnerships

Partnerships are crucial to successful behavioral health 

planning—especially for public health emergencies, 

which may be handled by several departments and 

divisions within a state, territory, or tribal or local 

government. This SAMHSA DTAC webcast covers 

key elements of effective partnerships, steps to take in 

creating and strengthening partnerships, and a real-world 

example of partnerships in disaster preparedness and 

response in the state of Colorado.

View the webcast at http://bit.ly/2cpYphL.

Access the presentation at http://bit.ly/2clBLbK.

CERC Online Training

Developed by the CDC, Crisis and Emergency 

Risk Communication (CERC) is an evidence-based 

approach to communicating with individuals, leaders, 

and communities during crises, including public 

health emergencies. CERC Online Training covers 

CERC principles and provides guidance for successful 

communication during emergencies with government 

organizations, community leaders, and the general public.

Access the training at http://bit.ly/2cCjIhu.

Pandemic Flu Fact Sheet: 

A Parents’ Guide to Helping Families 

Cope With a Pandemic Flu

The National Child Traumatic Stress Network describes 

different types of influenza (flu) and lists effects these 

types may have on communities. It also offers tips for 

flu outbreak preparedness and coping, and for supporting 

children and teens of various ages in dealing with a flu 

outbreak.

Access the fact sheet at http://bit.ly/2cnPNgX. 

The fact sheet is also available in Spanish at http://bit.

ly/2c9mCYT. ■

http://www.samhsa.gov
∙

Behavioral Health is Essential To Health

Prevention Works • Treatment is Effective • People Recover

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 (http://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.”

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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. To subscribe, please enter 

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

website at http://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 http://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

http://www.samhsa.gov/dtac