the Dialogue 2015 | VOLUME 11 | ISSUE 1

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

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IN THIS ISSUE

 2 Special Feature: Aurora Strong: 

A Colorado Community’s Experience 

With the SAMHSA Emergency 

Response Grant

 8 Planning for a Disaster Mental Health 

Response to Ebola in New York State

11 Recommended Resources

12 Upcoming Events

13 SAMHSA DTAC Webcasts and 

Webinars

15 Additional Webinars and Podcasts

16 Trainings

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 

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

page (http://www.samhsa.gov), enter your email address in the “Mailing List” box on the 

right, 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 abuse 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 web pages, materials, or organizations referenced in this publication. Although The Dialogue

includes valuable articles and collections of information, SAMHSA does not necessarily endorse any specific products or services provided by public or private 

organizations unless expressly stated. In addition, SAMHSA does not necessarily endorse the views expressed by such sites or organizations, nor does SAMHSA 

warrant the validity of any information or its fitness for any particular purpose.
A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue

2015 | VOLUME 11 | ISSUE 1 | PAGE 1

In This Issue

Welcome to a new year of SAMHSA’s newsletter, 

The Dialogue. In this first issue of 2015, we are 

highlighting disaster preparedness and recovery efforts 

in two areas of the country. Our first article gives a 

glimpse into how the community of Aurora, Colorado, 

is doing 2 years after the tragic theater shooting. A 

SAMHSA Emergency Response Grant outreach team 

describes the efforts it made from 2013 to 2014 to 

support residents, many of whom still experienced 

stress and anxiety reactions a year after the event. The 

article emphasizes the importance of the intermediate 

phase of recovery and shows that providing people 

with an explanation of why they continue to feel 

stress responses can help the healing process. The 

second article focuses on New York State’s experience 

preparing for a unique challenge: responding to the 

mental health needs of those quarantined for Ebola. It 

describes why providing training and materials specific 

to Ebola were essential to preparing responders to 

support the unique dynamics involved in this event. If 

you have stories about disaster preparedness, response, 

or recovery that you would be willing to share in 

upcoming issues, please contact us! 

Warmest regards, 

CAPT 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

Photo: Aurora Mental Health Center
A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue

2015 | VOLUME 11 | ISSUE 1 | PAGE 2

continued on page 3

SPECIAL FEATURE

SERG Outreach Crisis Counselors Melissa Tucker and Matthew McGuire 

Photo: Aurora Mental Health Center

Aurora Strong: A Colorado Community’s 

Experience With the SAMHSA Emergency 

Response Grant

Contributed by Melissa Tucker, M.A., and Matthew McGuire, M.A., SERG Outreach Crisis Counselors, 

Aurora Mental Health Center; and Colin Martin, M.A., SERG and Federal Emergency Management Agency 

Crisis Counseling Assistance and Training Program Coordinator, Colorado Department of Public Health and

Environment

More than 2 years have passed 

since the July 20, 2012, Aurora 

theater tragedy that killed 12 and 

injured 70 individuals. In the early 

hours following the shooting, 

first responders acted quickly and 

heroically, and many lives were 

saved thanks to the immediate 

response during which injured 

people were sent to local hospitals 

or ad hoc first aid sites for acute 

treatment. The city of Aurora 

immediately came together to 

support affected individuals and 

families through donations, prayers, 

and remembrance. 

The nation followed suit. Within 

48 hours, President Barack 

Obama arrived to speak with the 

community and the survivors. 

The Aurora Mental Health Center 

established a 24-hour hotline 

and walk-in center to address the 

acute concerns and needs of the 

community. Nearly a year later, 

the Aurora Strong Community 

Resilience Center opened its 

doors, providing free therapy to all 

Aurora residents who have been 

affected by trauma or who want to 

learn resilience and coping skills 

to prepare for unexpected trauma. 

While these services were essential 

in the first days and months beyond, 

Aurora’s story has many layers that 

go beyond the theater shooting.

As a state, Colorado has experienced 

several tragedies over the past 3 

years:

• Drought conditions have led to 

devastating wildfires; the burn 

scars of these wildfires have 

abetted major flooding and 

erosion, leading to fatalities, 

displacement, and significant loss.

• The Denver metro area was 

shocked by the abduction and 

murder of 10-year-old Jessica 

Ridgeway in 2012.

• In 2012, Colorado’s suicide death 

rate was at its highest in the 

state’s recorded history1

.

• Most recently, in December 2013, 

another public shooting occurred 

at Arapahoe High School, 15 miles 

from Aurora’s Century 16 Theater. 

1 Colorado Department of Public Health and 

Environment, Office of Suicide Prevention. (2014, 

February). Suicide in Colorado, 2008–2012. Retrieved 

from https://www.colorado.gov/pacific/sites/default/files/

Suicide-in-Colorado-2008-2012.pdf [PDF - 625 KB].
A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue

2015 | VOLUME 11 | ISSUE 1 | PAGE 3

The frequency of these events, 

combined with the small geographic 

area in which they have occurred, 

has shaken a community that also 

experienced the Columbine High 

School shooting of 1999. 

Compounding the impact of these 

local events is the shadow cast by 

traumatic events in cities such as 

Newtown, Fort Hood, Pittsburgh, 

and Boston, and the events of 9/11, 

all of which serve as a constant 

reminder that the world we live in 

is an unpredictable and potentially 

unsafe place. While the nation as a 

whole suffers from the injustices of 

mass violence, each of these events 

has affected the Aurora community 

to some extent.

Following the Aurora theater 

tragedy, the Colorado Department 

of Public Health and Environment’s 

Office of Emergency Preparedness 

and Response, along with the 

Aurora Mental Health Center, 

continued on page 4

continued from page 2 received a SAMHSA Emergency 

Response Grant (SERG), paving 

the way for a community-based 

outreach team to connect with 

businesses, schools, faith-based 

organizations, and residents through 

an ongoing public awareness 

campaign. The collaboratively 

designed campaign took a response 

and recovery approach, as the 

team was tasked with educating 

community members about their 

own response and recovery, and 

with connecting individuals with 

available mental health services. 

The program educated the 

community on ways to facilitate 

healing and growth, and informed 

people on how to identify others’ 

needs for additional support. 

COMMON RESPONSES 

TO TRAUMA

Everyone reacts differently to 

traumatic experiences, and many 

common reactions exist. Some 

examples include:

■ Extreme anxiety or fear

■ Numbness and detachment

■ Denial

■ Anger, sadness, or guilt

■ Physical reactions like shaking, 

nausea, or elevated heartbeat

■ Sleep disturbances or 

persistent fatigue

■ Difficulty concentrating

■ Avoidant behaviors

■ Intrusive thoughts or memories

■ Strong identification with the 

victims

■ Flashbacks

SERG outreach team members assemble materials 

Photo: Aurora Mental Health Center

A Community Needing Support

Given that the immediate response 

to the community after the theater 

tragedy was so extensive, the 

SERG outreach team anticipated 

encountering individuals who had 

been inundated with information 

and would no longer want more. 

Accompanying this anticipation 

was the fact that the team did not 

begin work until 16 months after 

the tragedy, in December 2013. 

The team encountered, however, 

a highly interested, informationseeking community that was 

receptive to its presence and 

services. 

The team offered counseling and 

education services in schools to 

students, staff, and parents, and 

they contacted many businesses 

and faith-based organizations in 

the area. Through these services, 

the team quickly learned that in 
A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue

2015 | VOLUME 11 | ISSUE 1 | PAGE 4

continued from page 3

the intermediate stage of recovery, 

individuals were no longer as 

overwhelmed as they might have 

been during the immediate stage 

of response. Yet, the team still 

encountered many people who were 

“not over” the theater shooting. 

More surprisingly, the theater 

shooting is no longer a singular 

event in the minds of residents, but 

part of a collection of events.

The outreach team’s initial 

approach was to gauge the 

“temperature” of the community. 

Mindful that revisiting the past 

might stir up severe or acute 

reactions, the team was unsure 

how to frame their response 

to the shooting. The team was 

also concerned that it might be 

perceived as “just another entity” 

offloading information. The team 

discovered that recent traumatic 

events, local and national, have 

been linked in the minds of 

individuals. Because of this, the 

weight of impact has intensified. 

The immediate response to the 

theater shooting offered acute care 

and psychiatric stabilization for 

what some had experienced, but 

there was no way to anticipate the 

fallout this “collection of multiple 

events” would have on Aurora in 

the intermediate recovery stage. 

As a result, the SERG team bore 

witness to a variety of individual 

responses to these events: Some 

people required ongoing specialized 

mental health care, some became 

desensitized and “shut down,” some 

avoided the community or the news 

out of fear of what they might see 

or encounter, and others became 

hypervigilant.

continued on page 5

Aurora community members gather at the Aurora Strong Resilience Center on the annual Day of Remembrance. 

Photo: Aurora Mental Health Center

Relief Grounded in the 

Medical Model of Trauma

These discoveries about the 

Aurora community became the 

team’s “in.” Outreach workers 

talked about individual reactions 

to trauma on a much wider scale. 

Several educational events helped 

the team navigate conversations 

to inform, educate, and provide 

resources while not activating or 

further harming individuals still 

struggling with mental health issues 

related to the events. The team 

also discovered that presenting 

information on the biology of 

trauma made people more open to 

learning about the effects of trauma 

and mental health.

Where there was no prior explanation 

or understanding of the disorienting 

and negative changes people were 
A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue

2015 | VOLUME 11 | ISSUE 1 | PAGE 5

continued from page 4

experiencing daily, the team was able

to educate, normalize, and inform

individuals about what was

happening within their body and

mind. Using the medical model 

opened the doors to jump-start a 

dialogue around current levels of

distress and individuals’ understanding

of mental health (see “What Is the

Medical Model of Trauma?”). The

team then openly discussed topics

such as the psychobiology of trauma,

suicide within the community, how

trauma affects relationships, and how

to foster growth and resilience.

Schools gave the team an amazing 

platform to gauge the community’s 

current level of functioning. 

Many students, teachers, and 

school administrators have felt 

profound fear knowing that gunmen 

have entered more than one of 

Colorado’s schools and murdered 

unarmed, vulnerable, unsuspecting 

people. There was a commonly 

reported heightened awareness, 

and the team found that explaining 

the biological sources of this 

heightened awareness and other 

survival mechanisms of the body 

provided incredible relief. 

The team also hosted parent groups 

in local schools. Presenting at these 

informal and interactive meetings 

provided an opportunity for parents 

to ask questions about normal child 

development, ways to identify if 

a child or teen had been severely 

affected by these events or other 

stressors, ways of communicating 

with children, and an opportunity to 

WHAT IS THE MEDICAL MODEL OF TRAUMA?

The team presented information on how traumatic experiences and stress 

affect the brain and body. When the brain experiences trauma, it defaults 

to operating under the exclusive direction of the limbic system. With this 

system in control, chemicals such as adrenaline and cortisol are released, 

the body is put into a heightened state of arousal, and the individual feels 

stressed until he or she once again begins to feel “safe.”

gain a better understanding of how 

their own stress can affect children. 

Parents have the desperate desire to 

know how to protect their children 

from these events, and if they 

can’t, they want resources that will 

facilitate growth and healing.

The team offered tools to help 

residents manage increased stress. 

Simple breathing exercises gave 

individuals something to take 

from presentations, adding another 

component of relief. For the first 

time, individuals realized they 

could change some of the unhelpful 

continued on page 6

Photo: Aurora Mental Health Center
A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue

2015 | VOLUME 11 | ISSUE 1 | PAGE 6

stress responses they developed. 

Learning about the neurological 

and biological processes of the 

limbic system’s “fight-flight-freezefaint” response provided important 

insight into how a person’s biology 

operates after a traumatic event. 

This normalizing helped people 

regain an element of control as they 

came to realize that they were not 

doing anything wrong. Instead, 

people understood that their bodies 

and minds simply reacted naturally 

to a situation they had no control 

over in order to survive. Letting 

people know that their body did 

this incredible thing to keep them 

from shutting down helped reduce 

the pressure and anxiety around 

newer trauma responses. Informing 

people that their bodily adaptation 

is not permanent but a built-in 

mechanism that is no longer 

beneficial encouraged people to 

seek additional care for healing. 

During these discourses, individuals 

began drawing upon personal 

examples of traumatic experiences. 

Residents of all kinds began to 

speak about the impact that past 

tragedies like 9/11 and Columbine 

had on them. These experiences 

have become a common, shared 

history that has changed the 

community’s view of the world and 

its response to community violence.

Despite the presentations’ inherent 

gravity, there was often an observed, 

collective sigh of relief at the end. 

This public education campaign 

was the only outreach and recovery 

initiative to help intermediate 

mental health recovery from 

the theater shooting. Residents 

expressed that having this basic, 

previously unknown information 

allowed them to move forward with 

their lives and understand the type 

of healing required to reestablish 

feelings of safety and security 

within the community.

continued from page 5 OUTREACH BY 

THE NUMBERS

The SERG Outreach Team 

reported the following number 

of contacts with individuals by 

project end:

■ In-person brief: 161

■ Telephone: 379

■ Email: 735

■ Community networking: 64

■ Group encounters: 1,424

■ Total number of contacts with 

individuals: 2,763

The Importance of 

Intermediate Response

As the team continued to engage 

the community, they found that 

people began to understand how 

these events compound over time. 

Some gained greater awareness 

of the goings-on within their 

community, some noticed increased 

stress or problems within their 

relationships, and some experienced 

much graver problems, such as a 

lasting traumatic stress response. 

The question, then, is why did some 

people not use resources made 

available during the immediate 

stage of response? 

One answer is that at the time, 

because of overwhelming shock 

and fear, people no longer had the 

capacity to absorb information. 

The SERG team found that months 

later, some people’s lives continued 

on, but others still struggled with 

new or chronic trauma responses. 

As people encountered challenges 

resolving mental health problems 

on their own, individuals appeared 

more open to learning about the 

impact traumatic experiences can 

have on their physical and mental 

health. They came to understand 

that some of these issues will not 

resolve themselves without help.

The dialogue opened up many 

people to discussing challenges in 

their lives outside the scope of mass 

violence, and allowed them to think 

in new ways about other stressful or 

continued on page 7

SERG Outreach Crisis Counselor Matthew 

McGuire performing community outreach 

Photo: Aurora Mental Health Center
A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue

2015 | VOLUME 11 | ISSUE 1 | PAGE 7

traumatic events that have affected 

them. People discussed surviving 

house fires, witnessing domestic 

violence, or losing loved ones 

through deportation. Parents talked 

about their children’s responses, 

and how they, as parents, struggle 

with what to say, or how to react to 

their children and their constantly 

changing community. Through the 

SERG, the outreach team created a 

legacy of open dialogue on “taboo” 

topics that are heavy on the minds 

of Aurora residents. 

A Lasting Impact

Although the SERG ended in 

October 2014, and the Aurora 

theater shooting trial that is still yet 

to begin may re-trigger reactions 

in the community, it has been the 

outreach team’s sincerest hope 

that individuals will reflect on the 

growth they have experienced, 

and that the community will feel 

reassured about its ability to react 

to, respond to, and recover from 

future events. 

Most community members 

welcomed the team’s information 

on access to mental health services. 

Parents expressed many thanks 

to the team for providing them a 

community support phone number 

and encouragement regarding 

service acquisition during a time of 

helplessness and hopelessness. The 

community as a whole expressed 

gratitude and relief at having had 

someone from the Aurora Mental 

Health Center SERG team reach out 

to them to provide a bridge to mental 

health services because one of the 

largest barriers to gaining services 

had been not knowing what services 

exist. The outreach team was in 

the perfect position to provide the 

community with the information 

that led to psychiatric stabilization 

and mental health support. By using 

the medical model of trauma in 

the intermediate phase of recovery, 

the team directly mitigated the 

potential for long-term, complicated, 

psychiatric conditions.

The team’s hopeful legacy will 

be one of ongoing community 

support. They operated under the 

understanding that being aware 

of available help and gaining 

an explanation of the unknown 

decreases levels of stress. The team 

aimed to become a more integral 

part of the community support and 

response network by using their 

psycho-education and outreach 

campaign to drive that point home. 

Their initiative was a model of 

community outreach that connected 

individuals to community entities, 

and community entities to other 

entities, creating a well-developed 

and supportive foundation for a 

community that has been exposed 

to large-scale traumatic events for 

over a decade. ■

continued from page 6

SERG Outreach Crisis Counselors Melissa Tucker and Matthew McGuire

Photo: Aurora Mental Health Center
A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue

2015 | VOLUME 11 | ISSUE 1 | PAGE 8

Planning for a Disaster Mental Health 

Response to Ebola in New York State

Contributed by Steven N. Moskowitz, LMSW, Director, Bureau of Emergency Preparedness and Response, 

New York State Office of Mental Health

continued on page 9

Passenger being screened for Ebola at an airport

Photo: Melissa Maraj/U.S. Customs and Border Protection

major arrival point for health care 

personnel returning from work in 

West Africa. These actions, in turn, 

began to shape a role for our mental 

health response. 

Typically, when a disaster leads to 

the utilization of our state disaster 

mental health (DMH) resources, the 

event is large in scale and affects 

significant numbers of people 

across numerous communities. As 

we began planning our DMH 

response efforts for Ebola in 

November 2014, however, it was 

already becoming clear that the 

Ebola public health crisis would not 

Our disaster response training 

reminds us that “no two events are 

the same.” This maxim had special 

meaning as my bureau at the Office 

of Mental Health prepared for a 

potential mental health response 

to the Ebola health challenge in 

New York State. The particular 

dimensions of this event included

very specific direction regarding the 

public health response on both the 

federal and state levels, included 

the identification of a limited 

number of regional hospitals for 

treatment and the screening process 

at John F. Kennedy International 

Airport in New York City—a 

lead to large-scale DMH activity or 

deployments. Given the small 

number of infected individuals and 

the public health strategies being 

instituted, we identified individuals 

in isolation or quarantine as being 

the primary population in need of 

mental health support. Through our 

preparation for pandemic flu we 

were aware that the highly 

restricted environment of isolation 

and quarantine can lead to 

considerable distress, and those 

placed under such constraints may 

struggle with feelings of anger, 

depression, anxiety, loneliness, fear, 

and grief. In those instances, DMH 
A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue

2015 | VOLUME 11 | ISSUE 1 | PAGE 9

counselors may be of great value in 

providing mental health assistance 

to individuals or small groups. To 

respect the infection controls in 

place for this virus, we planned for 

counseling to be delivered remotely 

via telephone or Skype. 

Support for Quarantined 

Individuals

Under the New York State 

enhanced screening guidelines,1

individuals who have had direct 

contact with people infected 

with the Ebola virus but are 

asymptomatic are asked to selfquarantine in their homes for up to 

21 days. In most cases, quarantined 

individuals are able to receive 

support for food and personal 

care items, which helps with 

maintaining emotional stability. 

However, such support may not 

be sufficient to overcome the high 

degree of fear, anxiety, and stress 

associated with being quarantined. 

In addition, there may be situations 

in which some individuals will not 

have sufficient support networks 

or have other vulnerabilities 

or challenges that may lead to 

greater emotional or mental 

health impacts. Prior emotional or 

psychological challenges, the lack 

of social supports, or even trauma 

experienced in the setting that 

led to the quarantine may all be 

1 Office of Governor Andrew M. Cuomo. (2014, 

October 26). New York State releases fact sheet on 

state screening protocols at JFK International Airport. 

http://www.governor.ny.gov/news/new-york-statereleases-fact-sheet-state-screening-protocols-jfkinternational-airport

exacerbated by the combination of 

both physical and social isolation 

experienced during quarantine. 

Over the past 3 years, New York 

State has responded to major tropical 

storm and hurricane events and, as 

such, our cadre of DMH responders 

is fairly well practiced in their basic 

mental health response skills and the 

mechanics of deployment. We were 

mindful, however, that the Ebola 

response would include dynamics 

not encountered when assisting in 

sheltering in place following storm 

damage or supporting a Disaster 

Recovery Center in the days and 

weeks after flooding. Among the 

most prominent differences that we 

took into consideration was that 

many of the potential individuals 

in quarantine would be health care 

professionals who were subject 

to an unusual degree of stress and 

anxiety because of their experiences 

in Africa addressing a disease with 

a high mortality rate and one that 

exposed them to a high degree of 

risk in carrying out their professional 

duties. Such experiences could be 

expected to generate a wide range 

of concerns from fear for their own 

health to the safety of colleagues, 

friends, and family.

To ensure that our counselors 

were prepared to respond to this 

event, we constructed a toolkit of 

information and resources built to 

fill some of those gaps. We sought 

to enhance their understanding of 

the Ebola outbreak by providing 

credible information about the 

virus: how it is contracted, its 

spread, and what was (and was 

not) being done by federal and 

state authorities to address the 

outbreak. We included material 

that described the psychosocial 

challenges faced by individuals 

in quarantine and isolation, 

along with a review of ways to 

address potential presentations of 

fear, anxiety, loneliness, anger, 

and stigma. We also strongly 

encouraged counselors to assess 

their own personal preparedness—

to consider thoughtfully the impact 

continued from page 8

continued on page 10
A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

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2015 | VOLUME 11 | ISSUE 1 | PAGE 10

participating in this response might 

create for themselves and their 

families. 

Our toolkit was not built from 

scratch. Instead, we sought the 

knowledge and experience of disaster

behavioral health directors in other 

states to help us stitch together 

a comprehensive collection of 

straightforward information on the 

Ebola virus, additional sources for 

reference on the psychological and 

emotional challenges individuals 

faced in isolation or quarantine, and 

supplemental sources for training 

material that they could tap to 

enhance their skills and knowledge in 

advance of a possible deployment. 

Key elements of our toolkit 

included the following:

• SAMHSA’s Ebola-related

resources: http://samhsa.gov/

dtac/ebola_intro

• A summary of mobile apps for

disaster behavioral health and

emergency responders, including:

> SAMHSA Disaster App: 

http://store.samhsa.gov/apps/

disaster

> Responder Self-Care: http://

sph.umn.edu/ce/perl/mobile/

selfcare

•

continued from page 9 Elements from the New York State 

Office of Mental Health’s Ebola toolkit

1 Toll-Free: 1-877-SAMHSA-7 (1-877-726-4727) | Info@samhsa.hhs.gov | http://store.samhsa.gov

How To Cope With Sheltering in Place

·

Introduction

Sheltering in place means people are asked by 

local officials to stay where they are for a period 

of time. You may be at your own or a relative’s 

home, school, or work. Sheltering in place may 

be required because of an emergency such as a 

threat of violence, a weather situation such as a 

tornado or hurricane, or a public health situation 

like an infectious disease outbreak. You may hear 

shelter in place also referred to as a “lockdown.”

This tip sheet describes reactions often 

associated with sheltering in place. It also 

suggests ways to care for yourself and your 

family during the experience and provides 

additional resources you may find helpful. 

What To Expect: Typical Reactions 

Sheltering in place can be stressful. If you are 

sheltering because of an immediate threat of 

violence or severe weather, your first priority is 

to ensure that you and those in your care are 

safe—lock the doors, stay away from windows, 

and stay in interior rooms if possible.

Everyone reacts differently to stressful situations. 

Typical reactions to sheltering in place because 

of an immediate problem include: 

 Anxiety about the situation

 Fear and worry about your own safety and 

that of your loved ones from whom you may 

be temporarily separated

 Concern about being able to effectively care 

for children or others in your care

 Uncertainty, anger, or frustration about how 

long you will need to remain sheltered, and 

uncertainty about what is going to happen 

In shelter in place situations lasting longer than 

a few hours, you may also experience:

 Feelings of isolation, loneliness, sadness, or 

boredom

 Guilt about not being able to perform normal 

work or parenting duties

 Fear over loss of income

 Changes in sleep or eating patterns

Ways To Cope During 

Sheltering in Place

UNDERSTAND THE RISK

Consider the real risk of harm to yourself and 

others around you. For example, during a 

situation such as an infectious disease outbreak, 

the public perception of risk is often inaccurate. 

Media coverage may create the impression that 

people are in immediate danger when really the 

risk for infection may be very low. Take steps to 

get the facts:

 Stay up to date on what is happening, but avoid 

watching or listening to news reports 24/7 since 

this can increase anxiety and worry. Remember 

that children are especially affected by what 

they hear and see on television.

 Look to credible sources for information 

about the situation.

Pandemic Influenza: Quarantine, 

Isolation, and Social Distancing

produced by the Colorado Disaster 

Behavioral Health Response 

System, which offers guidance 

regarding psychological and social 

ramifications of implementing 

large-scale quarantine and 

isolation within a community: 

https://www.colorado.gov/

pacific/sites/default/files/OEPR_

Influenza-quarantine-isolationField-Guide-2010.pdf

• Centers for Disease Control and

Prevention information sheets:

> Facts About Ebola in the U.S.:

http://www.cdc.gov/vhf/ebola/

pdf/infographic.pdf 

> Ebola: http://www.cdc.gov/vhf/

ebola/pdf/ebola-factsheet.pdf

With the knowledge that our crisis 

counseling interventions would 

most likely be done remotely, we 

also sought resources that could be 

accessed by counselors trained in 

disaster mental health, but not 

necessarily experienced in offering 

remote support. Once again, we 

reached out to those who already 

had experience in providing training

in such skills to identify resources 

our responders could use to gain 

additional knowledge. In this regard,

our colleagues at SAMHSA’s

Disaster Distress Helpline and the

Colorado Office of Emergency

Preparedness and Response

provided both background and

direct training material that we

passed along to our counselors.

The initial feedback from counselors

on their preparation has been positive. 

While no formal evaluation of our 

response has taken place, we already 

can appreciate both the value of 

providing our DMH responders with 

event-specific briefings prior to 

mobilizing and the effectiveness of 

reaching out to the disaster behavioral 

health field to take advantage of the 

practice wisdom and expertise others 

have accumulated and are willing to 

share. ■
A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue

2015 | VOLUME 11 | ISSUE 1 | PAGE 11

 RECOMMENDED RESOURCES

Coping With Grief After Community Violence: 

Tips for Survivors

This tip sheet offers information on coping with grief after an incident of 

community violence. It introduces some of the signs of grief and anger, 

provides useful information about how to cope with grief, and offers tips for 

helping children deal with grief.

Download this tip sheet at http://store.samhsa.gov/product/Coping-WithGrief-After-Community-Violence/SMA14-4888.

Mass Casualty: Support and Response Webinar

This 45-minute webinar shares information about emotional reactions to 

mass casualty events; addresses what Medical Reserve Corps team members, 

United States Public Health Service Commissioned Corps Officers, and other 

responders may encounter in the field during a crisis event; and familiarizes 

participants with related disaster behavioral health resources available from 

SAMHSA.

Watch this webinar at http://bit.ly/MassCasualty.

Taking Care of Your Behavioral Health During 

an Infectious Disease Outbreak: Tips for Social 

Distancing, Quarantine, and Isolation 

This tip sheet explains social distancing, quarantine, and isolation in the 

event of an infectious disease outbreak, such as Ebola. It discusses feelings 

and thoughts that may arise during this time and suggests ways to cope and 

support oneself during such an experience.

Download this tip sheet at http://store.samhsa.gov/product/Taking-Careof-Your-Behavioral-Health-During-an-Infectious-Disease-Outbreak/

SMA14-4894.

New Webcast Post-Disaster Violence Against Women

Disasters can disrupt individual, family, and community routines, leading to 

stress and an increase in all types of violent crime. The podcast shares recent 

research on post-disaster violence against women.

Watch this webcast at http://bit.ly/ViolenceWomen.
A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue

2015 | VOLUME 11 | ISSUE 1 | PAGE 12

UPCOMING EVENTS

Call for Papers and Reports on Long-Term Effects 

of Disaster

Professor Dean Ajdukovic with the Department of 

Psychology at the University of Zagreb, Croatia, and his 

team are looking for published and unpublished papers 

and reports that provide data on the long-term effects of 

disasters using any psychosocial or/and mental health 

indicator of people’s functioning. They are interested 

in individual, community, and societal-level effects 

that can be reasonably attributed to disasters. “Long 

term” is defined as at least 6 months after an event at 

the individual level, and at least 18 months after an 

event at the community and societal levels. Professor 

Ajdukovic’s team is especially interested in accessing 

studies that use pre-post or comparative groups 

designs, and repeated measures over time. The study 

should have been produced between 1980 and 2013. 

Such studies will be included in a systematic review 

by the team and, if possible, in a meta-analysis of the 

long-term effects of disasters.

Please submit materials to Professor Ajdukovic via 

email at dajdukov@ffzg.hr.

International Disaster Conference & Expo; 

February 10–12, 2015; New Orleans, Louisiana

The primary goal of this event is to reduce loss of life 

and property to the greatest extent possible when 

disasters occur around the world. It will involve plenary 

and breakout sessions about lessons learned from 

disasters and responses to them, best practices, and 

policy. Attendees will include professionals in a broad 

range of fields and sectors, including emergency 

management; federal and local government; resiliency 

and business continuity; police, fire, and rescue; and 

nonprofits.

http://internationaldisasterconference.com

National Emergency Management Agency 

(NEMA) 2015 Mid-Year Forum; March 13–17, 2015; 

Alexandria, Virginia

This event will take place soon after the President 

releases the budget request for the next fiscal year. It 

will feature NEMA’s analysis of the proposed budget 

and opportunities to learn about the budget and its 

potential effects on emergency management. It will 

also involve decision-making about NEMA affairs, 

including its organizational structure and finances, as 

well as discussions of how emergency managers from 

across the country can support disaster preparedness, 

response, and recovery.

http://www.nemaweb.org/index.php?option=com_

content&view=article&id=97&Itemid=453

Disaster Recovery Journal Spring World 2015; 

March 22–25, 2015; Orlando, Florida

This annual event focuses on business continuity in 

the event of a disaster or other emergency, as well as 

disaster response. In 2015, it will include a session on 

a joint information center, or place that communications 

professionals within an organization can use to plan 

and manage messages and provide information about 

disasters and other emergencies. It will also include 

other sessions, hands-on exercises, workshops, 

courses, and networking events.

http://www.drj.com/events/spring-world-2015/

homepage.html

Preparedness, Emergency Response, and 

Recovery Consortium; March 24–26, 2015; 

Orlando, Florida

This event attracts health care, public health, and 

volunteer emergency management personnel involved 

in disaster preparedness, response, mitigation, and 

recovery. It will focus on cooperation across industries, 

professions, and sectors to ensure the best possible 

preparation, response, and recovery from disasters. 

Professionals who may find this event beneficial 

include those in emergency management, fire services, 

hospital emergency administration and management, 

law enforcement, local government, housing and 

human services, the military, health care, social work, 

nonprofits, and volunteer management. 

http://www.perrc.org continued on page 13
A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue

2015 | VOLUME 11 | ISSUE 1 | PAGE 13

National Hurricane Conference; March 30–April 2, 

2015; Austin, Texas

This 3-day conference will feature sessions on 

preparedness, response, and recovery from hurricanes. 

It will cover topics such as lessons learned, model 

programs, and new ideas in the field of hurricane 

emergency management. People who may be 

interested in attending include emergency management 

officials, city and county managers and commissioners, 

armed forces disaster preparedness officials, 

emergency medical services personnel, and public 

health professionals. 

http://hurricanemeeting.com

12th Hawai’i Training Summit: Preventing, 

Assessing, and Treating Child, Adolescent, and 

Adult Trauma; March 31–April 2, 2015; Honolulu, 

Hawai’i

This summit will focus on current research and 

practice related to trauma, long-term effects of 

trauma experienced early in life, and techniques for 

helping individuals and families recover from trauma. 

Workshops and breakouts will be offered within nine 

training summit tracks that include prevention and early 

intervention; trauma in military personnel, veterans, 

and their families; criminal justice; and health care 

professionals dealing with abuse and trauma.

http://www.ivatcenters.org/Hawaii.html

Partners in Emergency Preparedness Conference; 

April 14–16, 2015; Tacoma, Washington

Attended by almost 700 people each year who work 

in emergency management, emergency medical 

services, government, and other areas, this conference 

covers topics such as planning for business continuity 

in the event of a disaster, homeland security, and 

public health preparedness. In 2015, the event will 

include presentations about various recent disasters, 

using computer simulations in reviewing emergency 

management plans, and urban flood management, as 

well as a neighborhood mapping tabletop exercise. 

Anyone whose work involves emergency management 

and planning may benefit from this conference.

https://www.cm.wsu.edu/ehome/piepc/Program

Preparedness Summit; April 14–17, 2015;

Atlanta, Georgia

Sponsored by the National Association of County and 

City Health Officials, this annual summit’s theme is 

“Global Health Security: Preparing a Nation for Emerging 

Threats.” Topics will include infectious disease, health 

effects of climate change, and cybersecurity threats. 

The most recent annual Preparedness Summit attracted 

more than 1,600 attendees from across the United 

States and around the world.

http://preparednesssummit.org

National Council Conference; April 20–22, 2015; 

Orlando, Florida

Sponsored by the National Council for Behavioral 

Health, this conference will benefit people who work for 

community mental health and substance use treatment 

organizations. Conference tracks include crisis 

response, trauma-informed care, clinical practices, 

addictions and co-occurring disorders, and other topics 

in behavioral health and organizational management.

http://www.thenationalcouncil.org/events-andtraining/conference

SAMHSA DTAC WEBCASTS 

AND WEBINARS

 Great news! All SAMHSA DTAC webcasts and 

webinars can now be found on SAMHSA’s YouTube 

page (http://www.youtube.com/user/SAMHSA) and 

the SAMHSA DTAC playlist (http://bit.ly/DTACVideos). 

On the following pages, we provide summaries of and 

links to all SAMHSA DTAC webinars and podcasts.

NEW! Post-Disaster Violence Against Women

This webcast describes how disasters can disrupt 

individual, family, and community routines, leading to 

stress and an increase in all types of violent crime. The 

purpose of this webcast is to share recent research 

on post-disaster violence against women with disaster 

responders and disaster behavioral health service 

providers. 

http://bit.ly/ViolenceWomen

UPCOMING EVENTS continued from page 12

continued on page 14
A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue

2015 | VOLUME 11 | ISSUE 1 | PAGE 14

Disaster Substance Abuse Services: 

Planning and Preparedness

This podcast helps disaster substance abuse 

coordinators and others who work with people 

who have substance abuse issues understand the 

importance of disaster planning and preparedness.

http://bit.ly/DisSubAbuse

Introduction to Disaster Behavioral Health

The goal of this webinar is to educate participants 

about the mental health, substance abuse, and stress 

management needs of people who have been exposed 

to human-caused, natural, or technological disasters.

http://bit.ly/introDBH

Applying Cultural Awareness to Disaster 

Behavioral Health

Participants in this webinar will learn more about tools that 

they can use to assess and strengthen cultural awareness 

practices in disaster behavioral health services.

http://bit.ly/cultureDBH

Cultural Awareness: Children and Youth 

in Disasters

Information provided in this 60-minute podcast can help 

disaster behavioral health (DBH) responders provide 

culturally aware and appropriate DBH services for 

children, youth, and families affected by natural and 

human-caused disasters.

http://bit.ly/YouthInDisaster

Deployment Supports for Disaster Behavioral 

Health Responders

Disaster behavioral health responders and their family 

members can use the guidelines in this podcast to help 

prepare for the stress of deployment and reintegration 

into regular work and family life.

http://bit.ly/DBHresponders

Helping Children and Youth Cope in the Aftermath 

of Disasters: Tips for Parents and Other Caregivers, 

Teachers, Administrators, and School Staff

This podcast was designed to inform parents and 

other caregivers, teachers and other school staff, 

and behavioral health professionals about the kinds 

of responses to expect in children and youth in the 

aftermath of disasters, such as school shootings, and 

to help determine when a child or youth exposed to a 

disaster may need mental health services.

http://bit.ly/HelpingYouthCope

Disaster Planning: Integrating Your Disaster 

Behavioral Health Plan

The speakers explain how states, territories, and tribes 

can update and integrate their disaster behavioral health 

plans with their overarching disaster response plans.

http://bit.ly/DBHplan

Self-Care for Disaster Behavioral Health Responders

Disaster behavioral health responders can learn about 

best practices and tools that could enable them and 

their supervisors to identify and effectively manage 

stress and secondary traumatic stress in this 60-minute 

podcast.

http://bit.ly/DBHselfcare

Mass Casualty: Support and Response

This webinar shares information about emotional 

reactions to mass casualty events; addresses what 

Medical Reserve Corps team members, Commissioned 

Corps officers, and other responders may encounter 

in the field during a crisis event; and familiarizes 

participants with related disaster behavioral health 

resources available through SAMHSA.

http://bit.ly/MassCasualty

Introduction to Promising Practices in Disaster 

Behavioral Health Planning

Participants in this webcast will learn about promising 

practices in disaster behavioral health planning, and 

speakers will share successful examples that have 

been implemented in the field.

http://bit.ly/DBHpractices

Promising Practices in Disaster Behavioral Health 

Planning: Building Effective Partnerships

Participants in this webcast will learn about building 

effective working relationships with federal, state, and 

WEBCASTS AND WEBINARS continued from page 13

continued on page 15
A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center the Dialogue

2015 | VOLUME 11 | ISSUE 1 | PAGE 15

local government, as well as nongovernment partners, 

when developing a comprehensive disaster behavioral 

health plan.

http://bit.ly/EffectivePartnerships

Promising Practices in Disaster Behavioral Health 

Planning: Financials and Administration Operations

The speakers in this webinar identify policies, procedures, 

and promising practices in financial and administrative 

operations in disaster behavioral health before, during, 

and after a disaster.

http://bit.ly/FinanceAndAdmin

Promising Practices in Disaster Behavioral Health 

Planning (DBHP): Implementing Your DBHP

The speakers explain how states, territories, and tribes 

can update and integrate their disaster behavioral health 

plans with their overarching disaster response plans.

http://bit.ly/DBHPimplementation

Promising Practices in Disaster Behavioral Health 

Planning: Plan Scalability

In this webinar, speakers provide information and 

examples about the elements of a scalable disaster 

behavioral health plan and identify promising practices 

in process development, standard operating procedures, 

and instructions that should be in place before a disaster.

http://bit.ly/PlanScalability

Promising Practices in Disaster Behavioral Health 

Planning: Assessing Services and Information

Participants will learn about promising practices in 

assessing services, resources (e.g., equipment and 

personnel), and information before, during, and after 

a disaster.

http://bit.ly/AccessingServices

Promising Practices in Disaster Behavioral Health 

Planning: Logistical Support

This webinar features a presentation on effective 

logistical support systems, including identification 

of training mechanisms for response personnel and 

utilization of volunteers.

http://bit.ly/LogisticalSupport

Promising Practices in Disaster Behavioral Health 

Planning: Legal and Regulatory Authority

Participants will learn about the elements of legal 

and regulatory authority at the federal, state, and 

local levels, including issues of responders’ liabilities, 

informed consent, confidentiality, development of 

memoranda of understanding, and/or mutual aid 

agreements.

http://bit.ly/LegalAuthority

ADDITIONAL WEBINARS 

AND PODCASTS

A Culturally Competent Preparedness Model for 

Reaching Limited English Proficient Communities

This 1-hour webinar provides an overview of how to reach 

limited English proficiency populations as part of public 

health preparedness. It reviews the conceptual framework 

of cultural competency and the need to understand 

diversity and differences as well as adapt to them.

http://www.nwcphp.org/training/opportunities/

webinars/a-culturally-competent-preparednessmodel-for-reaching-limited-english-proficientcommunities

Mental Health and Preparedness: Are We Ready? 

This 1-hour webinar talks about how frontline public 

health practitioners can help respond to the mental 

health needs of the community following a disaster. 

Knowing what to plan for and what types of adaptive 

behaviors follow disasters is essential. Promoting 

community resilience and mitigating maladaptive 

behavior are the goals of such a plan.

http://www.nwcphp.org/training/opportunities/

webinars/mental-health-and-preparedness-are-weready

Responding to Disasters: Mental Health 

Crisis Management 

This 1-hour webinar describes how first responders 

may assist with the emotional needs of disaster 

survivors by being able to anticipate the reactions of 

WEBCASTS AND WEBINARS continued from page 14

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disaster survivors, identify those at risk, and connect 

survivors to appropriate resources.

http://www.nwcphp.org/training/opportunities/

online-courses/responding-to-disasters-mentalhealth-crisis-management

Children’s Disaster Mental Health and Child Mental 

Health Screenings

This two-part webinar session is made up of two 1.5-

hour webinars that assist participants in understanding 

child mental health issues related to trauma, disaster, 

and terrorism to establish a foundation for disaster 

mental health research. They also provide a rationale 

for child mental health screenings and consider some 

limitations and problems with screening.

http://www.nwcphp.org/training/opportunities/

webinars/childrens-disaster-mental-health-andchild-mental-health-screenings

Coping and Resilience for Youth in Traumatic Events

This two-part webinar session is made up of two 

1.5-hour webinars intended to identify and define key 

concepts related to stress, coping, and resilience. They 

also help participants understand the transactional 

nature of coping and resilience processes.

http://www.nwcphp.org/training/opportunities/

webinars/coping-and-resilience-for-youth-intraumatic-events

Early Interventions and Psycho-Educational Group 

Interventions With Children

This two-part webinar is made up of two 1.5-hour 

webinars that consider key components of early (postdisaster) interventions such as Psychological First Aid 

as well as outcomes studies of psycho-educational and 

group interventions with children.

http://www.nwcphp.org/training/opportunities/

webinars/early-interventions-and-psychoeducationalgroups-interventions-with-children

Disaster Research Ethics: Gaps, Challenges, and 

Team Sustainability

This two-part webinar is made up of two 1.5-hour 

webinars that identify significant gaps in knowledge 

about harmful effects of disasters on children’s 

psychosocial functioning.

http://www.nwcphp.org/training/opportunities/

webinars/disaster-research-ethics-gaps-andchallenges-and-team-sustainability

Disaster Research for Children and Families: 

Universal Training Module

This webinar series is made up of two 1.5-hour 

webinars intended to enhance the infrastructure and to 

provide the skills, information, and resources needed to 

conduct disaster mental health research with children 

and families. The overall goal is to enhance the 

capacity and infrastructure to conduct rigorous disaster 

mental health research on children and families. 

http://www.nwcphp.org/training/opportunities/

webinars/universal-training-module-disasterresearch-for-children-and-families

TRAININGS

Disaster Behavioral Health 

This 1-hour online course discusses the psychological 

phases of a community-wide disaster, common 

patterns of immediate and long-term public response, 

mental health risks that rescue workers and victims 

face, signs that might indicate that a survivor needs a 

mental health evaluation, and the importance of local 

preparedness. The course bases its case studies on 

Washington State agencies and plans.

http://www.nwcphp.org/training/opportunities/

online-courses/disaster-behavioral-health

During and After a Disaster

This 45-minute online course provides information 

about individual and organizational resiliency in the face 

of stress, emergencies, and disasters. It details steps 

that organizations can take to maintain and restore 

resiliency during and after a disaster or emergency.

http://www.nwcphp.org/training/opportunities/

online-courses/during-and-after-a-disaster

WEBINARS AND PODCASTS continued from page 15
∙

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), 

enter your email address in the “Mailing List” box on the right, 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 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 

CONTACT US website at http://www.samhsa.gov/dtac/dbhis-collections to access these materials.

SAMHSA Disaster Technical 

Assistance Center

Toll-Free: 1-800-308-3515

DTAC@samhsa.hhs.gov

http://www.samhsa.gov/dtac