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Introduction Welcome to the 2017 PHEP/HPP Full Scale Exercise (FSE) Guidance for Community Mental Health Centers (CMHCs). We have developed this document to further support your planning for the exercise, which takes place June 15th through 17th. As part of your deliverables you are to:

1. Participate in all regional full scale exercise planning meetings through the healthcare coalitions or through your local public health agency.

2. Identify planning components as part of the full scale exercise: a. Your role within the full scale exercise b. Three activities that you will test and measure during the full scale exercise.

3. Participate in the full scale exercises completed by the healthcare coalitions which you are affiliated with.

4. Participate in your local After Action meeting and contribute to your local report. 5. Evaluate your three activities and provide to OEPR your lessons learned.

This document is designed to provide you with guidance that will support you getting the most out

of this planning and exercising event. However, in addition to activities written within work plans,

what you and your agency get out of these efforts is completely up to you. While these activities

are associated with the contract between your agency and CDPHE, the only reason for these

processes is to improve your readiness to respond to real community crisis. It is way better to learn

during an exercise than it is to learn while people's lives are at stake.

Exercise Planning

The Colorado Department of Public Health & Environment has prepared a variety of Public

Health Emergency Dispensing Exercise (PHED Ex) documents. These documents can be scanned

to find out more details regarding the Full Scale Exercise (FSE). However, we also know that

there is a lot of information out there, so we wanted to funnel this down to what we thought

would be most crucial to you, our partners.

Exercise Rules

The following general rules govern exercise play:

Real-world emergency actions take priority over exercise actions.

Exercise players will comply with real-world emergency procedures, unless otherwise directed by the control staff.

All communications (including written, radio, telephone, and e-mail) during the exercise will begin and end with the statement “This is an Exercise.”

Exercise players who place telephone calls or initiate radio communication with the SimCell must identify the organization or individual with whom they wish to speak.

Exercise Play What can you expect from your HCC Partners? HCC leadership and partners are also all required to participate in this exercise, so they should be providing the primary goals of the HCC (What do you collectively want to test? What do you collectively want to learn?) to be achieved during the FSE. And, working together, they can help you determine what aspects of response would be best for you to test as well. Getting the most out of a FSE requires that we thoroughly plan for what we want to find out - we cannot effectively achieve this in silos.

What can you expect from the OEPR BH Team?

1. This guidance document. 2. We are here to answer questions and help you articulate what may be best for you to

test within the FSE - so always feel free to call or email us with your questions (Example – after the survey was completed in Denver, Curt had a conversation with Chantal and Jennifer at Community Reach Center to refine the goals they wanted to achieve through the exercise. The conversation helped all three to better understand their systems and the exercise process as a whole).

3. We will also be participating in the FSE at the State Level - so you are not alone in this effort. We will be available the days that you are actively exercising, just like we would be in a real event - our primary duties are to support your efforts and coordinate the larger response effort.

4. We will provide an overview/presentation/training on resource requests at the April Disaster Coordinators meeting.

5. We will hold a FSE Q&A during the April DC meeting.

Exercise Objectives

There are three overarching objectives of this exercise (below), and you are also free to

exercise other elements as you see fit. The activities to the right of the table below are some

possible ways of engaging in the exercise within the three primary objectives. You do not

have to select activities from this table if you have identified needs more relevant to your

agency. These are just suggestions.

Exercise Objectives

Suggested Options of Activities to Consider Exercising

Demonstrate the ability to effectively collect, synthesize, and share information with local and state partners throughout the duration of the incident.

Establishing effective internal communications (email, phone, text or radio, and the ability to reach staff when needed)

Establishing effective external communications. Are redundant communication methods in place, such as email, phone, text, or radio, and the ability to engage external stakeholders (emergency management, law enforcement, EMS, public health, CoCERN partners)?

Are you clearly communicating between yourself and the ESF-8 lead available BH missions, including identified need, number of personnel requested, length of deployment (if known), and process of integration with ESF systems?

Do you have information or feedback about the response from the community your agency serves that you could practice sharing with response partners (i.e. consumers who are having difficulty reaching the POD location)?

Are you clearly communicating to behavioral health response teams their mission, parameters, time in the field, who to report to, and what to do when their shift is over?

Do you have a way to maintain situational awareness with staff at all deployed sites?

Do you have a PIO that is engaged with an established Joint Information Center (JIC) to ensure continuity of messaging?

Can you contribute to the development of community messaging through your behavioral health lens?

Do you have any behavioral health resources to contribute to your partner agencies? (https://www.phe.gov/Preparedness/legal/boards/nprsb/Documents/abc_factsheet_calm3-09.pdf)

Demonstrate the ability to activate an operations center, develop a coordinated response strategy, and

Practice soliciting availability of agency responders and creating teams for deployment to various sites?

What sites are (or would be) in need of behavioral health response support? (PODs, County EOCs, RTP/LTPs, Hospitals, Community Clinics, Schools?), can you establish teams to deploy to these sites?

Secure and provide “Just in Time” Field Response training to your behavioral health responders? (OEPR has a PowerPoint/PDF available, if needed)

manage and sustain response to a public health incident.

How long of shifts would you set up for responders and how long could you sustain these shifts with your available personnel?

Can you set up an org chart within your agency, if needed, and is your agency located on the emergency operations center org chart?

Have you communicated internally and externally who your agency’s primary and secondary points of contact are?

Could you sustain normal agency operations and services, or would a plan need to be created to temporarily delay some community services?

Through a representative at the EOC, has your agency been made aware of the Incident Action Plan (IAP) and the primary incident objectives?

If unable to sustain an agency response, would you first call and coordinate directly with other behavioral health disaster coordinators and their agencies, or would you make a formal resource request through your local ESF-8 lead to initiate communication to another county ESF-8 lead, or to the state ESF-8 representative for a coordinated CoCERN response? If you needed to active CoCERN and the State EOC was not activated, do you know the 24-hour emergency number? (1-877-518-5608)

How are you coordinating with other regional behavioral health coalition members?

How will you have staff check-in and check-out to deployed sites and what types of debriefing will supervision provide?

How are you tracking all activities by your agency and have you recruited assistance to ensure that you have a thinking partner and scribe?

Demonstrate the ability to support and participate in Colorado’s medical supply chain procedures.

Do partner agencies know what support roles you can provide to the incident? (greeters, crowd control, overseeing the worried well, managing crowd anxiety, education/messaging coordination, and patient medication education, if requested*)

Have behavioral health responders to POD sites been given appropriate information on the situation and what to expect?

Is communication maintained with the POD sites for situational awareness?

Are there regular internal briefings within the POD that behavioral health is a part of to ensure that calm is being maintained and measures being introduced to alleviate any unnecessary burdens?

If not obtained elsewhere, have medical countermeasures been secured for behavioral health responders to ensure their safety?

*Many licensed behavioral health professionals have strong pharmacological backgrounds, and are

capable of educating the public on antibiotics, antivirals and vaccines.

Participating Organizations and Operational Sites

Participating Organizations

Federal

Centers for Disease Control and Prevention

Statewide

Colorado Department of Public Health & Environment (CDPHE)

Local Public Health Agencies (LPHAs)

Hospitals and other healthcare entities

Behavioral Health Agencies

Colorado Division of Homeland Security and Emergency Management

Colorado National Guard/Wyoming National Guard

Operational Sites

Northwest Region

RTP/LTP: Steamboat Springs POD: Frisco

RTP/LTP: Grand Junction POD: Garfield Fairgrounds

North Central Region

RTP/LTP: Lafayette POD: University of Colorado - Boulder

RTP/LTP: Golden POD: George Town

RTP/LTP: Brighton POD: Idaho Springs

RTP/LTP: Aurora POD: Broomfield

RTP/LTP: Castle Rock POD: Denver Health Clinic

Northeast Region

RTP/LTP: Fort Collins POD: Cheyenne Public Health

RTP/LTP: Greely

RTP/LTP: Sterling

RTP/LTP: Hugo

RTP/LTP: Burlington

South Central Region

RTP/LTP: Colorado Springs POD: Rampart High School

POD: Fairplay Community Center

POD: Lake County High School

Southeast Region

RTP/LTP: Swink POD: Kiowa County Fairgrounds

POD: Rock Ford Fairgrounds - Otero

South Region

RTP/LTP: Pueblo POD: Pueblo West High School

POD: Trinidad Community Center

San Luis Valley

RTP/LTP: Alamosa POD: Alamosa County Public Health

POD: Ski Hi Multipurpose Bldg

Southwest Region

RTP/LTP: Durango POD: County Annex

POD: La Plata County Fairgrounds

West Region

RTP:LTP: Grand Junction POD: Gunnison Public Health

POD: Delta

Acronyms

Acronym Term Acronym Term

ACS Alternate Care Site ICS Incident Command System

AAR After Action Report IP Improvement Plan

CDC Centers for Disease Control and Prevention

JIC Joint Information Center

CDPHE Colorado Department of Public Health & Environment

JOC Regional Transfer Point/Local Transfer Point

CIAC Colorado Information Analysis Center

JPIC Joint Public Information Center

CONG Colorado National Guard LPHA Local Public Health Agency

CSP Colorado State Patrol MAA Mutual-Aid Agreement

CVM Colorado Volunteer Mobilizer MCM Medical Counter Measure

DHSEM Department of Homeland Security and Emergency Management

MOU Memorandum of Understanding

DOC Department Operations Center NIMS National Incident Management System

EEG Exercise Evaluation Guide OEPR Office of Emergency Preparedness and Response

EMS Emergency Medical Services RSS Receipt, Store and Stage Warehouse

EMT Emergency Medical Technician RTP/LTP Regional Transfer Point/Local Transfer Point

EO Executive Orders PHED

Ex

Public Health Emergency Dispensing Exercise

EOC Emergency Operations Center PIO Public Information Officer

ESF Emergency Support Function POD Point of Dispensing

FEMA Federal Emergency Management Agency

FSE Full Scale Exercise

HSEEP Homeland Security Exercise and Evaluation Program

Behavioral Health Mission Sets

Behavioral health missions utilize trained behavioral health response assets to engage survivors and decrease stress reactions and promote adaptive functioning. These actions allow survivors to more effectively address immediate response and recovery needs and comply with response and recovery procedures.

Behavioral Health Missions

Disaster Assistance Center (DAC) Support Behavioral health personnel at Assistance Centers informally engage survivors to identify needs, provide appropriate support, and referrals. They provide recommendations to survivors and Assistance Center management that assist residents to decrease stress levels that may be inhibiting healthy functioning.

Resource recommendation: Provide a minimum of 2-6 behavioral health personnel for 6-10 hour shifts.

Community/Town Meeting Support Behavioral health personnel at community/town meetings assist residents by decreasing stress levels and identifying individuals exhibiting limited functioning because of stress exposure. Behavioral health personnel engage informally with survivors and provide appropriate support and referrals to enhance individual functioning by meeting needs and promoting effective compliance with emergency response/recovery procedures.

Resource recommendation: Have 1 behavioral heath responder to 100 community members with a minimum of 2 behavioral health responders to provide a “buddy” system.

Shelter Support Behavioral health personnel assist shelter residents by decreasing their stress levels. They identify individuals exhibiting inhibited healthy functioning because of stress exposure. Behavioral health personnel engage survivors informally to identify needs and provide appropriate support and referrals. They provide recommendations to survivors and shelter management to enhance individual functioning and movement toward recovery.

Resource recommendation: Provide a minimum of 2-6 behavioral health personnel for 6-10 hour shifts.

School Support

Although schools frequently have their own crisis support teams that can be deployed following a school crisis or emergency, external behavioral health teams have been called upon when needs exceed the school’s resources. Behavioral health teams provide assistance as students return to school following an event. They work closely with the school crisis teams to engage students in informal settings to assess needs and provide appropriate support and referral. Behavioral health personnel can also help support parents/guardians at reunification centers as they wait for their children following a school-wide evacuation.

Resource recommendation: Provide a minimum of 2-6 behavioral health personnel, based upon request from school, for shift covering the school day.

Damage Assessment Teams Support Behavioral health support assist damage assessment teams by engaging survivors to process experiences and any stress responses after damage assessors complete their assessment. This activity allows damage assessors to progress while supporting survivors with their needs. Behavioral health responders paired with damage assessment teams following the 2008 Windsor Tornado was identified as a best practice.

Resource recommendation: Pair 2 behavioral health responders with each damage assessment team entering the field.

Community Re-entry Support During re-entry processes behavioral health responder pairs can partner with re-entry teams to provide support to residents returning to their homes. Behavioral health responders can assist individuals with stress-related needs and work to support individuals in identifying needs to maintain healthy functioning. Behavioral health responders have been successfully paired with re-entry teams following the 2012 and 2013 wildfires.

Resource recommendation: Pair 2 behavioral health responders with each re-entry team.

EOC Support Behavioral health personnel assist EOC operations by informally or formally engaging response personnel to identify stress reactions and intentionally monitor EOCs to provide recommendations aimed at decreasing stress levels in EOCs and increasing response personnel’s capacity to maintain response operations for extended periods. Behavioral health personnel can provide education and other resources to assist with stress management.

Resource recommendation: 1 to 2 behavioral health response personnel for 6-10 hour EOC shifts

JIC/PIO Support Behavioral health personnel assist PIO staff and JIC/JIS operations by assessing public information and crisis communication through a behavioral health lens. BH personnel monitor social media and other public communication for fear responses; provide education, messaging and resources to support community coping and functioning; and inform communication practices to moderate fear responses and better promote safety, calm, connection, self/community efficacy and hope.

Resource recommendation: 1 to 2 behavioral health response personnel for 6-10 hour PIO/JIC shifts.

POD Support Points of Dispensing are bound to be wrought with high anxiety, from both the public and from public health responders. Generally, most people do not have a sophisticated understanding of disease processes, the anti-biotic/anti-viral medications used to treat outbreaks or the vaccinations used to prevent/contain an outbreak. This lack of understanding only fuels fear responses further.

Resource recommendation: Provide a minimum of 2-6 behavioral health personnel for 6-10 hour shifts.

● Greeters – Active engagement in greeting people at the doors has a distinct impact on quieting fears. But behavioral health professionals can also glean a great deal of information from simple interactions – how impacted is the individual by their fear? Are they trusting the process or not? Are they angry or casting blame on public health or other government officials?

● Education – Many behavioral health professionals have significant knowledge of biology as well, or may even have medical backgrounds. Most importantly however, a major role in the mental health field is in psycho-education. Therefore, they can play and active role in the education process of those coming to receive medications/vaccinations, increasing the likelihood that the educational material will actually be heard, processed and understood.

● Dispensers – Often you will find that psychiatric nurses have a great combination of skills. Too often people fear the vaccination needle. Having a psychiatric nurse available to work with those needle phobic individuals can make the dispensing process significantly smoother.

Quarantine and Isolation Support We know from experience with SARS and Ebola that those who have been exposed to a contagion (patients and caregivers/medical personnel) are likely to react with a wide range of behaviors and emotions. We also know that often individuals who are exposed to a contagion are often ostracized by their support systems because of fear of spreading of the contagion. Therefore, behavioral health support to both of these groups are critical to assure positive coping, to assure the strength of the health system, to assure compliance with quarantine processes and to assure a healthy return to daily living once quarantine or isolation is lifted. Behavioral health professionals can implement a wide variety of interventions to support exposed individuals across the community throughout the process of the public health emergency.

Resource recommendation: Q & I support always requires a team in order to support a system of intervention and psychosocial support to the exposed individuals. A team of 4-6 can support 1-50 exposed individuals and possibly more.

Behavioral Health Intervention Whether a public health emergency, a community crisis, or a natural disaster, when people are involved there will be cognitive, emotional and spiritual impacts. Therefore, your disaster behavioral health resources are available to address a wide variety of individual and community impacts with a wide variety of interventions, including but not limited to:

● Drama mitigation and rumor control: People attempt to gain control over chaotic experiences by understanding the event. If we know what has happened, we know how to react to it. Therefore, if there is a void of information, people create information to fill the void. BH professionals actively engage groups around this natural process to help re-direct and properly inform them of reality, even if that means stating “no one knows right now”.

● Fear management: Fear is the base emotion and cognitive process happening in times of crisis and emergency. Fear shuts down an individual’s capacity to think clearly, focus, problem solve, make decisions and communicate. BH intervention is directly focused on addressing fear and improving cognitive functioning.

● Trauma education: Psychological trauma has a unique biology. Providing psychosocial education to individuals about the trauma experience can have an immediate impact on behavior and functioning in the face of ongoing emergencies.

● Emotional triage: Recognizing the difference between a normal and functional response, compared to a normal and dysfunctional response, compared to a abnormal and dysfunctional response is a key aspect of behavioral health interventions and the key to psychological triage.

● Psychological First Aid: PFA is a key set of tools in the tool belt of the disaster behavioral health responder. This tool kit guides the responder on how best to support and individual, couple, family or group to adapt in the face of the current emergency or crisis.

Resource Request Process: To request behavioral health support for identified missions contact the local ESF 8 or 8a (behavioral health) lead. CDPHE-OEPR behavioral health unit personnel are also available to facilitate effective resource coordination:

Curt Drennen curt.drennen@state.co.us O (303) 691-4941 C (303) 915-8115

Aimee Voth Siebert aimee.vothsiebert@state.co.us O (303) 692-2686 C (720) 666-5298

Keith Schemper keith.schemper@state.co.us O (303) 692-2643 C (303) 945-1204

Lynn Garst lynn.garst@state.co.us O (303) 692-2586 C (720) 990-9491

Standard 800 MHz Radio Programming

ZONE 1 CH 1 CHD NE County Health Department Northeast CH 2 CHD NC County Health Department North Central CH 3 CHD SC County Health Department South Central CH 4 CHD S County Health Department South CH 5 CHD SE County Health Department Southeast CH 6 CHD NW County Health Department Northwest CH 7 CHD W County Health Department West CH 8 CHD SW County Health Department Southwest CH 9 CHD SL County Health Department San Luis CH 10 MRC Central Medical Reserve Corps (MRC)

ZONE 2 CH 1 MAC 1 MET MUTUAL AID CHANNEL #1 DENVER METRO CH 2 MAC 2 MET MUTUAL AID CHANNEL #2 DENVER METRO CH 3 MAC 3 MET MUTUAL AID CHANNEL #3 DENVER METRO CH 4 MAC 4 MET MUTUAL AID CHANNEL #4 DENVER METRO CH 5 MAC 5 NE MUTUAL AID CHANNEL #5 NE AREA CH 6 MAC 6 NE MUTUAL AID CHANNEL #6 NE AREA CH 7 MAC 7 NE MUTUAL AID CHANNEL #7 NE AREA CH 8 MAC 8 NE MUTUAL AID CHANNEL #8 NE AREA CH 9 MAC 9 SE MUTUAL AID CHANNEL #9 SE AREA CH 10 MAC 10 SE MUTUAL AID CHANNEL #10 SE AREA CH 11 MAC 11 SE MUTUAL AID CHANNEL #11 SE AREA CH 12 MAC 12 SE MUTUAL AID CHANNEL #12 SE AREA CH 13 MAC 13 NW MUTUAL AID CHANNEL #13 SW AREA CH 14 MAC 14 NW MUTUAL AID CHANNEL #14 SW AREA CH 15 MAC 15 NW MUTUAL AID CHANNEL #15 SW AREA CH 16 MAC 16 NW MUTUAL AID CHANNEL #16 SW AREA

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CH 1 MAC 17 SW MUTUAL AID CHANNEL #17 NW AREA CH 2 MAC 18 SW MUTUAL AID CHANNEL #18 NW AREA CH 3 MAC 19 SW MUTUAL AID CHANNEL #19 NW AREA CH 4 MAC 20 SW MUTUAL AID CHANNEL #20 NW AREA CH 5 MAC 21 MUTUAL AID CHANNEL #21 STATEWIDE CH 6 ICALL INTEROPERABILITY CONV CALLING CH CH 7 ITAC 1 INTEROPERABILITY CONV CHANNEL #1 CH 8 ITAC 2 INTEROPERABILITY CONV CHANNEL #2 CH 9 ITAC 3 INTEROPERABILITY CONV CHANNEL #3 CH 10 ITAC 4 INTEROPERABILITY CONV CHANNEL #4 CH 11 STAC5 INTEROP PORTABLE CONV CHANNEL #5

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CH 1 RETAC MI-HI (EMS MH) Mile-High RETAC Coordinator

CH 2 RETAC NE (EMS NE) Northeastern Colorado RETAC Coordinator

CH 3 RETAC PLANS (EMS PP) Plains to Peaks RETAC Coordinator

CH 4 RETAC SE (EMS SE) Southeast Colorado RETAC Coordinator

CH 5 RETAC SOUTH (EMS S) Southern Colorado RETAC Coordinator

CH 6 RETAC FOOT (EMS FH) Foothills RETAC Coordinator

CH 7 RETAC EMS (EMS MAC) Statewide EMS mutual aid RETAC EMS statewide

CH 8 RETAC CENMT (EMS CM) Central Mountain RETAC Coordinator

CH 9 RETAC ST WD (ER MAC) Statewide ER mutual aid RETAC Hospital Statewide

CH 10 RETAC NW (EMS NW) Northwest Colorado RETAC Coordinator

CH 11 RETAC SLVLY (EMS SLV) San Luis Valley RETAC Coordinator

CH 12 RETAC SW (EMS SW) Southwest RETAC Coordinator

CH 13 RETAC WEST (EMS W) Western RETAC Coordinator