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FEMA
Crisis Counseling Assistance and
Training Program Guidance
CCP Application Toolkit, Version 5.0, July 2016
Note: Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Mental Health Services (CMHS) Project Officers are available to provide technical assistance and consultation on the Crisis Counseling Assistance and Training Program (CCP). If you would like to speak with a CMHS Project Officer, please contact the SAMHSA Disaster Technical Assistance Center (DTAC) at 1-800-308-3515 (Monday–Friday 9 a.m.–5 p.m. eastern time), and a staff member will forward your request to the appropriate Project Officer.
You may obtain CCP applications, supplemental instructions, and guidance documents by calling SAMHSA DTAC as indicated above or by emailing SAMHSA DTAC at DTAC@samhsa.hhs.gov
CCP Guidance, Version 5.0 | Page i
Table of Contents
Introduction 1
Section I: Program Overview 1
The Crisis Counseling Assistance and Training Program (CCP) ............................................................. 1 Eligibility Requirements 2 CCP Timeline 3 Crisis Counseling Definition 4 Services Funded Through the CCP 4 Providers of CCP Services 4 CCP Primary and Secondary Services 4 Primary CCP Services 4
Secondary CCP Services 6
Section II: CCP Model 6
Typical Individual Reactions to a Disaster 7 Typical Community Reactions to a Disaster 7 The Crisis Counseling Approach 8 The Value of the Crisis Counseling Approach 9 The Significance of the Needs Assessment 9 The Goal of the CCP 10 The CCP Model 10 Identifying People in Need of Crisis Counseling 11 Differences among CCP Resource Linkage, Case Management, and Advocacy 12 CCP Sub-recipients and Staff 13 The Number of Visits Allowed by a Crisis Counselor 13 How Crisis Counselors Are Trained 14 The Differences between Crisis Counseling and Traditional Mental Health Treatment 14 How the CCP Addresses Severe Disaster Reactions 15
Section III: Program Management and Implementation 15
Main Components of a Program Management Plan 16 Media and Marketing and the CCP 16 Effective Staffing of the CCP 17
CCP Guidance, Version 5.0 | Page iii
Objections/Appeals of Decisions Regarding Allowable Costs .................................................... 30 ................................................................... ........................................................................... .............................................................................................................................................. .............................................................................................................................................
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Objections/Appeals of Termination or Suspension 31 Closeout and Retention Requirements for Records 31 ISP 31 RSP 31
Section VI: Budget and Fiscal Management 32
The Influence of the CCP Model (Fundable Costs) 32 The Budget Narrative 33 Requests for Budget Adjustments 34 Pre-award Costs (ISP Phase) 34 Indirect Costs 35 Cost Sharing, In-kind Resources, or Matching 35 Transfer of Funds 36 ISP 36 .............................................................................................................................................
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RSP 36
Appendix Section 37
Appendix A. Definitions 37 Appendix B: CCP Services, Positions, and Job Descriptions 39 Appendix C: Instructions for the Budget Narrative 44 Required Supporting Documentation To Be Maintained by the CCP 51 Appendix D: SF-424 Tip Sheet 53 Appendix E: Federal Financial Report (FFR) SF-425 56 Appendix F: Federal Financial Report (FFR) SF-425 Instructions 57 FFR Instructions 57 Reporting Requirements 57 Line-item Instructions for the FFR 58
Introduction
The Crisis Counseling Assistance and Training Program (CCP) is a federally funded supplemental program administrated by the U.S. Department of Homeland Security (DHS) Federal Emergency Management Agency (FEMA). Section 416 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act, 42 U.S.C. § 5183 authorizes FEMA to fund mental health assistance and training activities in areas that have been declared a major disaster by the President. The Center for Mental Health Services (CMHS), within the Substance Abuse and Mental Health Services Administration (SAMHSA), works with FEMA through an interagency agreement to provide technical assistance, consultation, grant administration, program oversight, and training for state mental health authorities, U.S. territories, and designated tribal authorities.
The mission of the CCP is to assist individuals and communities in recovering from the effects of natural and human-caused disasters through the provision of community-based outreach and psycho- educational services. The CCP supports short-term interventions that involve assisting disaster survivors in understanding their current situation and reactions, mitigating stress, developing coping strategies, providing emotional support, and encouraging linkages with other individuals and agencies that help survivors in their recovery process.
The information presented in the program guidance is organized into seven sections: Program Overview, CCP Model, Program Management and Implementation, Pre-Award Requirements, Post- Award Requirements, Budget and Fiscal Management, and the Appendix Section. The program guidance should be used in conjunction with the following:
- Immediate Services Program (ISP) and Regular Services Program (RSP) applications and supplemental instructions
- 44 Code of Federal Regulations (CFR) §206.
- Super Circular Requirements 2 CFR Part 200
Section I: Program Overview
The Crisis Counseling Assistance and Training Program (CCP)
The CCP consists of services focused on preventing or mitigating adverse repercussions of a disaster. This goal is achieved with a public health approach. Beginning with the most severely affected group and moving outward, the program seeks to serve a large portion of the population affected by the disaster. CCP services are community based and take place anywhere survivors are, including, but not limited to, survivor homes, shelters, temporary living sites, and churches and other places of worship.
application decision. The Regional Director shall review the material submitted, and after consultation with the Secretary, notify the state, territory or tribe, in writing within 15 days of receipt of the appeal, of his/her decision.^4
(^4) §206.171 (f)(5)(i)
The Regular Services Program: The RSP application must be submitted by the Governor or his/her authorized representative to the Assistant Administrator for the Recovery Directorate through the Regional Administrator, and simultaneously to the Secretary no later than 60 days following the declaration of the major disaster. The RSP will not exceed 9 months from the date of the Notice of Award (NOA), except that upon the request of the state, territory or tribe to the Regional Administrator and the Secretary, the Assistant Administrator for the Recovery Directorate may extend the program period for more than 90 days where he or she deems it to be the public interest.^5
(^5) §206.171 (g)(4)(i)
The state, territory or tribe may appeal the Assistant’s Administrator’s decision, in writing, within 60 days of the date of notification of the decision. The Assistant Administrator, in consultation with the Secretary and Regional Administrator, shall review the material submitted and notify the state, territory or tribe, in writing within 15 days of receipt of the appeal, of his/her decision.^6
(^6) §206.171 (5)
CCP Timeline
Crisis Counseling Definition
Crisis Counseling means the application of individual and group treatment procedures which are designed to ameliorate the mental and emotional crises and their subsequent psychological and behavioral conditions resulting from a major disaster or its aftermath.^7
(^7) §206.171 (b)(3)
Services Funded Through the CCP
The CCP funds the following services:
- Individual crisis counseling
- Basic supportive or educational contact
- Group crisis counseling
- Public education
- Community networking and support
- Assessment, referral, and resource linkage
- Development and distribution of educational materials
- Media and public service announcements
Providers of CCP Services
CCP services can be provided by the state, territory or tribe or through a contract with local mental health service providers that are familiar with the communities affected by the disaster. The CCP encourages the use of mental health professionals and trained paraprofessionals, preferably people who live and work in the community and reflect the cultural makeup of the community served.
CCP Primary and Secondary Services
There are two types of CCP services: primary and secondary. Primary CCP services are higher in intensity, as they involve personal contact with individuals, families, or groups. Secondary CCP services have a broader reach and less intensity with a focus of reaching as many people as possible.
Primary CCP Services
Individual Crisis Counseling Individual crisis counseling involves a process of engagement lasting at least 15 minutes. It focuses on helping disaster survivors understand their reactions, review their options, and connect with other individuals and agencies that may assist them in improving their situations. Staff members who provide individual crisis counseling are active listeners who offer reassurance, practical assistance,
needs. The crisis counselors who provide assessment and referral services need to be knowledgeable about local resources and work diligently to engage community organizations.
Community Networking and Support Crisis counselors build relationships with community resource organizations, faith-based groups, and local agencies. They often attend community events to provide a compassionate presence and to be available to provide crisis counseling services when needed. They may initiate or attend unmet-needs committee or long-term recovery group meetings, or other disaster relief-oriented gatherings. It is important to note that communities, families, and survivors should “own” their community events. Crisis counseling staff can provide useful consultation during the planning process and valuable information and services at these events to demonstrate their support for members of the community.
Secondary CCP Services
Development and Distribution of Educational Materials Crisis counselors distribute flyers, brochures, tip sheets, and web-based materials to educate survivors and the community. Topics include basic disaster information, typical reactions to disaster, coping skills, and individual and community recovery and resilience. Materials that address the needs of at-risk populations, as well as materials developed in multiple languages, should be available. Materials may be handed out or left in public places, published in local newspapers, or mailed to survivors in areas most affected by a disaster. Examples of these materials can be obtained from the SAMHSA Disaster Technical Assistance Center (DTAC).
Media and Public Service Announcements CCP staff engage in media activities and public messaging in partnership with local media outlets, state and local governments, charitable organizations, or other community brokers of information. Media activities and messaging are designed to reach a large number of people in order to promote access to CCP services and educate survivors and the community about disaster reactions, coping skills, and individual or community recovery and resilience. Venues for this messaging vary and may include media interviews with CCP spokespeople, television or radio public service announcements, use of websites or email, or advertising.
Section II: CCP Model
Section I of the CCP guidance provides an overview of the CCP. Brief descriptions of the services provided by the CCP and eligibility and application requirements are discussed. Some information on key elements of the needs assessment process for service provision and on program reporting requirements is also included. This section is intended to provide an overview of the program model and the importance of understanding how the model works in coordination with the program plan the assessment process and the budget to have a cohesive CCP program that meets the mental health needs of disaster survivors.
Typical Individual Reactions to a Disaster
Typical reactions to a disaster include physical, emotional, cognitive, and behavioral responses that may be experienced by individuals and families. Each category of disaster response includes a diverse set of reactions that may change over time. For example, one may experience hyper vigilance immediately after a disaster and then, over time, lapse into a state of chronic fatigue. Whether the reactions are adaptive or become distressing, people who are affected by a disaster may experience more than one type of reaction, and these reactions may change over time. Many people may experience anxiety, loss of sleep or appetite, stress, grief, irritability, hopelessness, and family conflict.
Typical Community Reactions to a Disaster
While each survivor experiences the disaster as an individual, he or she also experiences it as part of a community. The following figure illustrates six phases of a community’s response to a disaster.
- Phase 1, the pre-disaster phase, is characterized by fear and uncertainty. The specific reactions a community experiences depend on the type of disaster. Disasters with no warning can cause feelings of vulnerability and lack of security; fears of future, unpredicted tragedies; and a sense of loss of control or the loss of the ability to protect oneself and one’s family. On the other hand, disasters with warning can cause guilt or self-blame for failure to heed the
reactions, teaching them coping skills, assessing them for individual needs, and linking them to appropriate community resources.
Crisis counseling is considered strengths-based because it assumes most disaster survivors are naturally resilient. By providing support, education, and linkage to needed community resources, survivors will be better equipped to recover from the negative consequences of disaster.
While crisis counseling assumes a natural resilience in the majority, it also includes screening and assessing for severe reactions in the minority. Crisis counselors know that few people will develop diagnosable conditions. They are trained to identify disaster survivors experiencing severe reactions and refer these individuals to appropriate treatment services and community resources.
The Value of the Crisis Counseling Approach
Although a disaster may leave most people physically unharmed, it affects everyone who experiences it. A key step to recovery is regaining a sense of control. Crisis counseling provides survivors with the support, education, and skills they need to regain a sense of control and rebuild their lives.
Crisis counseling assistance is practical in nature. Many survivors will not seek help, and some may even reject it. While survivors may not want “psychological counseling” or “mental health services,” they usually will welcome the genuine concern and concrete support offered by crisis counselors.
Crisis counseling also is valuable because it addresses the needs of the community as a whole, in addition to those of the individual. During a disaster, both individuals and communities experience a range of emotional highs and lows that typically are associated with the phases of disaster recovery. Communities may move from a sense of heroism and altruism to a sense of hopelessness and abandonment, all in a short period of time. Crisis counselors provide support, education, and resource linkage that empower individuals and communities, and assist them in reaching the reconstruction phase of recovery.
The Significance of the Needs Assessment
Ongoing needs assessment is the foundation of the CCP. It is a continuous process necessary to ensure the relevance of the program for the duration of the effort. Formal sources for needs assessment might include analysis of damage assessments and registrants for services from FEMA or the CCP, and may involve other data sources including special use surveys and assessment tools. A needs assessment also might rely on corroborative data including anecdotal evidence from crisis counselors or feedback from other disaster relief providers. These sources may be especially important to inform adaptation of program outreach and services to meet changing needs in communities affected by disaster.
The application and needs assessment provide an opportunity for the state, territory or tribe to demonstrate the nature and extent of behavioral health needs resulting from a disaster and how those needs surpass local resources and capabilities.
The needs assessment identifies populations who should be targeted to receive crisis counseling services. In most disaster situations, children, adolescents, older adults, and persons with disabilities or other access and functional needs are considered special populations. The needs assessment may reveal additional groups who are vulnerable to disaster effects or who have been particularly affected by the disaster.
The Goal of the CCP
The goal of the CCP is to help disaster survivors recover from the adverse reactions to disaster and begin to rebuild their lives. The CCP focuses on helping them understand their personal reactions, helping them plan action steps and solutions to resolve losses and overcome adversities, and linking them to other community resources.
The CCP helps survivors prioritize their needs and connect with organizations or people who can assist them. Although the CCP is a temporary disaster relief program, it leaves behind a permanent legacy of more adaptive coping skills, educational and resource materials, and enhanced community linkages.
The CCP Model
The CCP is designed to provide immediate behavioral health support, primarily relying on face-to-face contacts with survivors in their communities. The CCP provides these support-centered services to survivors over a specific period of time. Eight key principles guide the CCP approach.
CCP services can be described as follows:
Strengths-based: Crisis counselors assume natural resilience in individuals and communities, and promote independence rather than dependence on the CCP, other people, or organizations. Crisis counselors help survivors regain a sense of control.
Outreach-oriented: Crisis counselors take services into the communities rather than wait for survivors to come to them.
More practical than psychological in nature: Crisis counseling is designed to prevent or mitigate adverse repercussions of disasters rather than to treat them. Crisis counselors provide support and education, listen to survivors, and accept the content at face value. Crisis counselors help survivors to develop a plan to address self-identified needs and suggest connections with other individuals or organizations that can assist them.
Diagnosis-free: Crisis counselors do not classify, label, or diagnose people; they keep no records or case files. The CCP does not provide mental health or substance use treatment, or critical incident stress debriefing. Services are supportive and educational in nature.
A properly performed needs assessment is particularly important for identifying populations at greatest risk for behavioral problems. A thorough and thoughtful needs assessment will help the state, territory or tribe identify vulnerable groups and understand how they are most affected by the specific disaster.
Differences among CCP Resource Linkage, Case Management, and Advocacy
CCP services include referrals and linkage to health and mental health services, disaster recovery resources, and tangible goods. Linkage may occur as a result of a single visit and includes limited or informal follow-up. The intent of CCP resource linkage services is to assist disaster survivors in accessing resources without developing the expectation of a long-term relationship and a structured case plan. The emphasis for the crisis counselor is on empowering survivors to make plans, to become familiar with local resources, and to act on their own behalf to connecting with the resources they need.
Case management, as traditionally practiced by human service agencies, often involves more accountability on the part of the worker to ensure clients successfully access needed resources and supports. In a traditional case management model, it is common for a formal case plan to be established and for regular follow-up to occur. Traditional advocacy emphasizes a worker representing the needs and interests of the population served to ensure access to resources. In some cases, advocacy can be an adversarial process directed toward influencing a system, resource, or local mental health agency to serve a client.
The CCP model emphasizes empowerment and collaboration. For circumstances in which longer term, more intensive services are needed, a crisis counselor may provide some extra assistance or limited, short-term follow-up to a survivor who is particularly overwhelmed or who has literacy or language barrier issues. A crisis counselor, in the presence of a disaster survivor, may role-play making phone calls and show how asking important questions facilitates obtaining resources for the survivor and his or her family. The crisis counselor then encourages the survivor to accomplish these tasks on his or her own. With reinforcement and guidance from the crisis counselor, often provided during a single visit, the survivor is then empowered to act independently to access resources. Whenever possible, the crisis counselor encourages disaster survivors to utilize resource lists and information to make their own phone calls, fill out their own forms, and set up their own appointments. Should advocacy for an individual or community be needed, crisis counselors should seek out faith-based organizations or other agencies to help respond to these needs.
Traditional Case Management CCP Resource Linkage
Provides services to individuals who may have a serious and persistent mental illness or other disability of indefinite duration.
Provides services to disaster survivors, regardless of level of functioning.
Advocates for and influences the provision of services for clients.
Empowers disaster survivors to advocate for their own services and resources. Includes filling out forms and arranging appointments for clients.
Assists disaster survivors in accessing services by guiding them through typical application and referral processes. Assumes responsibility for ensuring clients access needed services, and may follow up with local mental health agencies to ensure compliance with appointments.
Assists disaster survivors in identifying services, and may follow up with survivors, while empowering them to be responsible for accessing their own services. Has a responsibility to ensure continuity of care for clients.
Assists disaster survivors in accessing disaster- related services, as prioritized by survivors. Involves long-term relationships with clients. Involves short-term relationships with disaster survivors.
CCP Sub-recipients and Staff
CCP sub-recipients usually are community behavioral health organizations that have an existing relationship with the state, territory or tribe. The CCP requires training of paraprofessional staff who understand the cultures of the community and reflect the ethnic groups they serve.
CCP staff typically work in teams of two or more to perform outreach services. Typically, teams include a mix of behavioral health professionals and trained paraprofessionals. Each team should have a team leader who has the clinical expertise needed to supervise staff. Trained professional staff members also are responsible for assessing survivors for severe reactions. Remote communication devices, such as a mobile phone, are essential to ensure outreach worker safety.
The Number of Visits Allowed by a Crisis Counselor
The CCP does not limit the number of times crisis counselors may meet with individuals or families. However, a crisis counselor should be cautious about establishing expectations of long-term services or relationships, given the program’s temporary nature. Typically, crisis counselors are trained to consider assessing survivors they have seen on three or more occasions for referral to other kinds of resources or behavioral health care if needed. Crisis counselors may see survivors more than three times to work on coping strategies, stress management activities, or other crisis counseling interventions.
Key differences between the two approaches are summarized below.
Traditional Mental Health Crisis Counseling Is office based. Is home and community based. Diagnoses and treats mental illnesses. Assesses strengths and coping skills. Focuses on personality and functioning. Seeks to restore or improve functioning. Examines content. Accepts content at face value. Explores past experiences and their influence on Validates common reactions and experiences. current problems. Has psychotherapeutic focus. Has psycho-educational focus. Keeps records, charts, case files, etc. Does not collect any identifying information.
How the CCP Addresses Severe Disaster Reactions
Severe reactions to a disaster may include depressive disorders, suicidal behavior, substance use, acute stress disorder, posttraumatic stress disorder, dissociative disorders, and anxiety disorders. The treatment of severe reactions is beyond the scope of the CCP. However, assessing for severe reactions and making appropriate referrals are crucial parts of the program. Through training, crisis counselors know that few survivors will develop diagnosable conditions, but they must be able to identify those who do and refer them to the appropriate levels of care.
Section III: Program Management and Implementation
CCP supervisory staff must ensure that services are delivered effectively to meet the needs of disaster survivors and at-risk individuals and groups. Training, supervision, regular meetings, analysis of service and fiscal data, and quality assurance systems are essential elements for effective program management. CCP staff collaborate to ensure that the resource and service components of the CCP work together in a manner consistent with the program model. FEMA and SAMHSA project officers have federal oversight responsibility for the CCP and will work with the state, territory or tribe to ensure administrative consistency at all levels. Ongoing analysis ensures program services meet the changing needs brought on by the phases of community reactions to the disaster and aspects of disaster recovery.
The ISP and RSP grant applications provide details on how the state, territory or tribe will provide training, manage and deploy resources, and ensure quality and accountability.
Main Components of a Program Management Plan
The components of the program management plan vary given the needs of the state, territory or tribe and the reach of the disaster. The interrelated components promote effective delivery of services, and evolve to meet new identified disaster needs.
Typical components of a program management plan include the following:
- Performing ongoing needs assessment
- Developing and effecting outreach strategies to identify and serve affected individuals, groups, and the community
- Ensuring supervision and quality assurance at the state, territory or tribe and sub-recipient levels
- Employing program media and marketing strategies
- Recruiting and hiring staff
- Providing training
- Providing staff stress management
- Ensuring effective fiscal management
- Accomplishing program evaluation
Media and Marketing and the CCP
Establishing identity and public awareness are key components of program management. It is important for the program to select a name in order to develop a cohesive identity among the sub-recipients. All CCP staff need to share a group identity. This is achieved through training and through the use of media and marketing strategies that define program services and inform the community about the CCP.
Strategies to build a program identity and to market services include the following:
- Developing a brand for the program: This involves establishing a clearly recognizable program name and logo, or design elements to appear on all program materials. Staff members are provided with items, such as t-shirts, business cards, hats, or badges, with the specific program name and logo.
- Using media outlets: Television, print, radio, and the Internet can be used to increase awareness and accessibility of the CCP. Programs may develop public service announcements, interviews, articles, advertisements, letters to the editor, or educational materials.
- Establishing toll-free numbers or hotlines: A toll-free line may be established purely for informational purposes, or a hotline that provides counseling via phone may be incorporated into the program.
