Summary
Catastrophic disasters, such as Hurricane Katrina, may result in trauma and other psychological consequences for the people who experience them. The federal government provides states with funding and other support to help them prepare for and respond to disasters. Because of congressional interest in these issues, GAO examined (1) federal agencies' actions to help states prepare for the psychological consequences of catastrophic disasters and (2) states' experiences obtaining and using grants from the Crisis Counseling Assistance and Training Program (CCP) to respond to the psychological consequences of catastrophic disasters. CCP is a program of the Department of Homeland Security's (DHS) Federal Emergency Management Agency (FEMA). GAO reviewed documents and interviewed program officials from federal agencies and conducted additional work in six states with experience responding to catastrophic disasters: Florida, Louisiana, Mississippi, New York, Texas, and Washington.
Federal agencies have awarded grants and conducted other activities to help states prepare for the psychological consequences of catastrophic and other disasters. For example, in fiscal years 2003 and 2004, the Department of Health and Human Services' (HHS) Substance Abuse and Mental Health Services Administration (SAMHSA) provided grants to mental health and substance abuse agencies in 35 states for disaster planning. In 2007, SAMHSA completed an assessment of mental health and substance abuse disaster plans developed by states that received a preparedness grant. SAMHSA found that, for the 34 states with plans available for review, these plans generally showed improvement over those that had been submitted by states as part of their application for its preparedness grant. The agency also identified several ways in which the plans could be improved. For example, about half the plans did not indicate specific planning and response actions that substance abuse agencies should take. Similarly, GAO's review of the plans available from six states found varying attention among the plans to covering substance abuse issues. SAMHSA officials said the agency is exploring methods of determining states' individual technical assistance needs. Other federal agencies--the Centers for Disease Control and Prevention, the Health Resources and Services Administration, and DHS--have provided broader preparedness funding that states may use for mental health or substance abuse preparedness, but these agencies' data-reporting requirements do not produce information on the extent to which states used funds for this purpose. States in GAO's review experienced difficulties in applying for CCP funding and implementing their programs following catastrophic disasters. CCP, a key federal postdisaster response grant program to help states deliver crisis counseling services, is administered by FEMA in collaboration with SAMHSA. State officials said they had difficulty collecting information needed for their CCP applications and experienced lengthy application reviews. FEMA and SAMHSA officials said they have taken steps to improve the application submission and review process. State officials also said they experienced problems implementing their CCPs. For example, they said that FEMA's policy of not reimbursing states and their CCP service providers for indirect costs, such as certain administrative expenses, led to problems recruiting and retaining service providers. Other FEMA postdisaster response grant programs allow reimbursement for indirect costs. A FEMA official said the agency had been considering since 2006 whether to allow indirect cost reimbursement under CCP but did not know when a decision would be made. States also cited difficulties assisting people who needed more intensive crisis counseling services than those traditionally provided through state CCPs. FEMA and SAMHSA officials said they plan to consider options for adding other types of crisis counseling services to CCP, based in part on states' experiences with CCP pilot programs offering expanded crisis counseling services. The officials did not know when they would complete their review and reach a decision.
Recommendations
Our recommendations from this work are listed below with a Contact for more information. Status will change
from "In process" to "Implemented" or "Not implemented" based on our follow up work.
Director:
Team:
Phone:
Cynthia A. Bascetta
Government Accountability Office: Health Care
(202) 512-7207
Recommendations for Executive Action
Recommendation: To address gaps identified by federal and state officials in the federal government's ability to help states respond to the psychological consequences of catastrophic disasters, the Secretary of Homeland Security should direct the Administrator of FEMA, in consultation with the Administrator of SAMHSA, to expeditiously determine what types of expanded crisis counseling services should be formally incorporated into CCP and make any necessary revisions to program policy.
Agency Affected: Department of Homeland Security
Status: In process
Comments: In late April or early May 2008, FEMA and SAMHSA met to discuss the status of the Crisis Counseling Program (CCP) program and future plans. The various CCP staff also met with staff from VA's National Center for Post Traumatic Stress Disorder (NCPTSD) and the National Child Traumatic Stress Network to learn about an expanded services model that they were developing. Based on these meetings, FEMA asked SAMHSA to utilize its Disaster Technical Assistance Center (DTAC) to conduct additional research on possible expanded service models that could be incorporated into CCP. In addition, FEMA is still waiting for Louisiana to complete its CCP before moving ahead any further. Currently, Louisiana is scheduled to end its CCP on December 31, 2008, but may request an extension to March 2009.
Recommendation: To address gaps identified by federal and state officials in the federal government's ability to help states respond to the psychological consequences of catastrophic disasters, the Secretary of Homeland Security should direct the Administrator of FEMA, in consultation with the Administrator of SAMHSA, to expeditiously revise CCP policy to allow states and service providers that receive CCP funds to use them for indirect costs.
Agency Affected: Department of Homeland Security
Status: In process
Comments: As of 7/16/2008, the Crisis Counseling Program (CCP) had received agreement from its division management to incorporate indirect costs into CCP. At this point, the indirect costs proposal was being shared with DHS's financial and grants management office. It is expected that the incorporation of indirect costs would be approved. CCP had already revised the necessary program guidance to reflect any changes related to the inclusion of indirect costs. It is expected that the indirect revisions would become effective October 1, 2008 (i.e., states applying for funds after that date will be able to use CCP funds for indirect costs). Therefore, discussion of indirect costs would be incorporated into training programs for states that DHS planned to hold prior to that.
