Federal Efforts Help States Prepare for and Respond to Psychological Consequences, but FEMA's Crisis Counseling Program Needs Improvements
GAO-08-22: Published: Feb 29, 2008. Publicly Released: Feb 29, 2008.
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 for Executive Action
Status: Closed - Implemented
Comments: In April or May 2008, FEMA and Substance Abuse and Mental Health Services Administration (SAMHSA) met to discuss the status of the Crisis Counseling Program (CCP) and future plans. 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. By July 2009, SAMHSA had completed a draft white paper outlining recommendations for policy changes to the CCP model, for implementing and managing CCPs, and for working with survivors. As of August 2010, the white paper was still in draft form and FEMA was reviewing it. FEMA indicated that it had drafted a response to the paper's recommendations as well as action steps for each item. Once reviewed by FEMA management, FEMA will meet with SAMHSA to address the issues raised and any appropriate plans of action.In September 2011, FEMA officials said specialized crisis counseling services (SCCS), a type of expanded crisis counseling services, have now been implemented as a standard part of CCP. Officials said that state officials are made aware of the availability of such services following a disaster. FEMA provided text from CCP guidance provided to states following a disaster suggesting that the states consider additional training depending on the specific needs of that state. When a state requests SCCS, FEMA directs them to training developed by the National Child Traumatic Stress Network. FEMA provided an example of slides from a training on SCCS. As an example of recent use of SCCS, FEMA officials indicated that SCCS were used in response to the tornados that affected Missouri in 2011.
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: Closed - Not Implemented
Comments: As of July 2008, the Crisis Counseling Program (CCP) had received agreement from FEMA division management to incorporate indirect costs into CCP. At this point, the indirect costs proposal was shared with DHS's financial and grants management office, and officials said that it was expected to be approved. The CCP program office had already revised the necessary program guidance to reflect any changes related to the inclusion of indirect costs, which were expected to be effective by October 1, 2008. However, in June 2009, FEMA indicated that its grants office had decided that it would not take steps to authorize indirect costs for CCP. It said that the rule under which indirect costs would be added was in the process of being finalized and adding an amendment related to CCP would have delayed the release of the final rule. In August 2010, FEMA indicated that it was still examining how indirect costs could be covered in a way that meets the needs of the states and falls within FEMA guidelines. In August 2011, FEMA indicated that the agency had drafted a proposed rule that would allow for the payment of indirect costs through all FEMA grant programs, including CCP. In June 2014, FEMA indicated that this proposed rule was under review in its Office of Chief Counsel and was expected to be sent to DHS for review this fiscal year (2014). In April 2015, FEMA indicated that the proposed rule had not been finalized and that the agency was still reviewing the CCP and other programs to determine what changes, if any, were needed to incorporate indirect costs. FEMA did not have a timeframe for next steps.
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