Federal Agencies Have Awarded Grants to States to Support Preparation for Psychological Consequences of Catastrophic Disasters, and SAMHSA Has Assessed States’ Disaster Plans

Federal grants have helped states prepare for the psychological  consequences of catastrophic and other disasters, and SAMHSA has  conducted an assessment of disaster plans from many state mental health  and substance abuse agencies. CDC, HRSA, and DHS have also provided  preparedness funding that states may use for mental health or substance  abuse preparedness, but the agencies’ data-reporting requirements do not  produce information on the extent to which states used funds for this  purpose. In 2007, SAMHSA completed an assessment of mental health and  substance abuse disaster plans developed by states that received its  preparedness grant. SAMHSA found that these plans showed  improvements over those that had been submitted by states as part of their  application for the preparedness grant. The agency also identified several  ways in which the plans could be improved. Federal Grants Have Supported States’ Mental Health and Substance Abuse Preparedness for Catastrophic and Other Disasters

SAMHSA awarded $6.8 million over fiscal years 2003 and 2004 specifically  to help state mental health and substance abuse agencies prepare for the  psychological consequences of catastrophic and other disasters. Two of the six states  in our review, New York and Texas, received a SAMHSA grant. SAMHSA also reported that although  states were more likely to incorporate substance abuse services into their  disaster planning, about half the plans still did not indicate specific  planning and response actions that substance abuse agencies should take. States Experienced Several Difficulties in Applying for and Implementing Their CCPs Following Catastrophic Disasters

State officials told us they experienced difficulties in applying for CCP  funding and implementing their programs, particularly in the wake of  catastrophic disasters. States also  experienced lengthy application reviews, and FEMA and SAMHSA officials  said they had taken steps to improve the submission and review process. In addition, state officials told us they experienced problems  implementing their CCPs, such as difficulties resulting from FEMA’s policy  of not reimbursing state CCPs for indirect program costs. SAMHSA  officials said that allowing indirect cost reimbursement would promote  participation of a broader array of local service providers. In November 2006, FEMA and SAMHSA allowed Louisiana and Mississippi  to plan for providing expanded crisis counseling services, known as  “specialized crisis counseling services,” to supplement CCP services  offered to people affected by Hurricane Katrina. These officials did not know when the review would be completed. Other FEMA disaster  response grant programs allow reimbursement for such costs. Although  FEMA had been examining this issue for over a year, an agency official did  not know when the agency would reach a decision on whether to revise  CCP policy to allow coverage of indirect costs. Recommendations for Executive Action

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, we recommend that the Secretary  of Homeland Security direct the Administrator of FEMA, in consultation  with the Administrator of SAMHSA, to expeditiously take the following  two actions:    determine what types of expanded crisis counseling services should be  formally incorporated into CCP and make any necessary revisions to  program policy, and revise CCP policy to allow states and service providers that receive CCP  funds to use them for indirect costs. GAO staff who made major contributions to this report are  listed in appendix V.

Appendix I: Scope and Methodology

To do our work, we obtained program documents and interviewed  officials from the Department of Health and Human Services (HHS),  including the Administration for Children and Families, Centers for  Disease Control and Prevention (CDC), Centers for Medicare & Medicaid  Services (CMS), Health Resources and Services Administration (HRSA),  National Institutes of Health, Office of the Assistant Secretary for  Preparedness and Response, and Substance Abuse and Mental Health  Services Administration (SAMHSA); the Department of Education; the  Department of Homeland Security (DHS), including the Federal  Emergency Management Agency (FEMA); the Department of Justice; and  the Department of Veterans Affairs (VA), including the National Center for  Posttraumatic Stress Disorder (NCPTSD). To examine states’ experiences in obtaining and using federal Crisis  Counseling Assistance and Training Program (CCP) grants to respond to  the psychological consequences of catastrophic disasters, we reviewed  program documentation, including the applicable statute, regulations,  guidance, and grantee reports.
Why GAO Did This Study

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.

What GAO Found

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.