Introduction                     1

Distribution                     3

Geographic and Demographic Information                 4

Potential disasters                    5

Distinction of Disaster Types                   8

Role of Mental Health                  10

Service Delivery Sites                  12

Chain of Command for Mental Health Services within a Disaster Response          13

Referrals, Outside Agencies, and Other Support Agencies             15

Involuntary Psychiatric Hospitalization Procedures              16

Causalities                   17

Training of Mental Health Professionals               17

Training, Drills and Implementation                18

References                    20

Appendix A                   22

Appendix B                   23

Introduction

Disasters can be classified into several categories such as: natural disasters and major disease outbreaks, mass violence and human-made disasters, and technological disasters (Neria, Galea, & Norris, 2009). The American Red Cross reported that they respond to around 70,000 disasters per year, which emphasizes the need to have effective disaster plans in place. In order to better prepare for and respond to these disasters, disaster mental health services have become integrated with emergency medicine as a way to more effectively treat survivors and other disaster responders. Since individuals who seek medical attention following a disaster are also at risk for developing negative mental health consequences and experiencing functional impairment, interventions have been developed to identify those in need of immediate mental health services (Ruzek, Young, Cordova, & Flynn, 2004). The primary objective of disaster behavioral health is to “anticipate and provide immediate and appropriate services for emotional and physical symptoms and cognitive dysfunctions that may occur” (Framingham & Teasley, 2012, p. xxv). The desired goal is to provide immediate relief of symptoms of traumatic stress and minimize any potential long-term maladaptive psychological consequences following a disaster (Framingham & Teasley, 2012). This is achieved by normalizing the survivor’s stress reactions, promoting healthy coping skills, connecting survivors with community resources and social support, providing emotional support, offering practical assistance, and identifying recovery options while encouraging self-efficacy (Framingham & Teasley, 2012; Ruzek et al., 2007). Research has demonstrated that early psychological interventions can be effective at minimizing long term aversive health consequences (Boscarino, Adams, & Figley, 2011). While most disaster survivors experience acute fear and psychological distress, most will experience a decline in their psychological distress within 2-6 weeks and return to their pre-disaster psychological and behavioral functioning as they utilize coping skills and social support Framingham & Teasley, 2012). However, studies have shown that some disaster survivors experience moderate to severe disaster mental health problems such as depression, anxiety, panic, acute stress disorder, post-traumatic stress disorder (PTSD), complicated bereavement, and substance abuse (Foa, Stein, McFarlane, & 2006; Neria et al., 2009). In addition to utilizing mental health interventions with disaster survivors, there is also a focus on providing mental healthcare to first responders and other disaster relief volunteers so that they can continue to be effective in their roles (Benedek, Fullerton, & Ursano, 2007). Overall, disasters can cause acute and long-term psychological consequences in disaster survivors, first responders, and other disaster relief personnel. The first step of having an effective disaster response is to have a plan in place, prior to the experience of a disaster. Developing and implementing a disaster mental health plan allows for the opportunity to mitigate the negative impact a disaster can have on the mental health of individuals and the community. It is recommended that this mental health provision be included in the already existing disaster plan in Plymouth County, Iowa. This provision will promote healthy psychological recovery and facilitate positive adaptive coping.

Plymouth County Disaster Mental Health Plan

This plan was developed to meet the need for a disaster MH plan for Plymouth County, Iowa.

Distribution

This plan should be distributed to the following individuals:

1. Any potential Incident Commanders.

2. All members of the Plymouth County Emergency Management System.

3. Any members of the Emergency Management System who could interact with Plymouth County members such as the Iowa Emergency Management Association.

4.  Iowa Homeland Security & Emergency Management

5. Any potential assisting government agencies such as law enforcement, fire/rescue, and Emergency Medical Services.

6.  Non Governmental Agencies (NGO’s) such as The American Red Cross.

7. Any MH professional or agency which might be involved in a disaster response including Mental Health Centers that have jurisdiction within Plymouth county.

8. Any Critical Incident Response Team members assigned for disaster response to Plymouth County.

9. Government leadership should have access to the plan which should be placed in the county courthouse and state governor’s office.

Geographic and Demographic Information

Plymouth county is located in the northwestern part of Iowa.  The county’s total area was estimated to be 862.29 square miles, making it the fourth largest county in Iowa. This converts to a population density of about 29 people per square mile. The county seat is Le Mars, and the county is made up of 24 townships such as Akron, Westfield, Remsen, Brunsville, Struble, Oyens, Kingsley, Craig, Hinton and Merrill. These towns are rural and primarily agricultural and are consisted of mainly small populations, with Le Mars being the largest city with a population of approximately 9,967. The county reported 10,818 housing units and 713 employer establishments. The geography of the county is relatively flat with mild hills. The highest point in the county is in Sioux Township and has an elevation of 1,501 ft. Plymouth County also contains the northern portion of the Loess Hills, which are hills that were formed by deposits of windblown loess soil.

The 2017 census reported that the estimated population of Plymouth County, Iowa was 25,220. 50.4% indicated that they were female and 50.3% were between the ages of 18 and 65. On the younger end of the age range 6.3% of the population were under the age of 5, while on the older end, 18.5% were 65 years of older. Approximately 25,463 (86%) individuals indicated that they were white and 1,337 (5.3%) reported that they were of Hispanic or Latino decent. The census reported that the population of Plymouth County, IA was .7% Black or African American, 1.0% American Indian and Alaska Native, .8% Asian, .2% Native Hawaiian and other Pacific Islander. 1.3% of the people who responded to the census reported that they were multi-racial.  There were 10,008 households with an average of 2.46 people per household. The median income for a household was $60,339. The per capita income in the past 12 months (2016) for the county was $28,975. Approximately 8.4% of the population were below the poverty line (United States Census Bureau, 2017).

Plymouth County, IA includes locations of individuals who may be more vulnerable to trauma in the aftermath of a disaster. There are 17 public schools in the county that serve 4,148 students. Akron-Westfield, Le Mars, Hinton, Kingsley, and Remsen each have elementary, middle, and high schools. In addition to schools, Plymouth County also has a host of nursing homes that take care of the physically disabled elderly. Le Mars has six nursing homes: The Abbey of LeMars, the Good Samaritan Society, Plymouth Manor Care Center, Park Place Estates Assisted Living, Plymouth Life Inc, and Pride Group Inc. In addition, Akron has Akron Care Center, Ramsen has Happy Siesta Nursing Home, and Kingsley has Kingsley Nursing and Rehab Center. There are also three main hospitals in Plymouth County that care for those with serious injuries and physical disabilities. These hospitals are Akron Mercy Medical Clinic, Floyd Valley Healthcare, and Kingsley Medical Center. These locations will need special accommodations in place in order to better care for these vulnerable and at risk populations.

Potential Disasters

While the likelihood of some disaster situations are greater compared to others, it is important to acknowledge and provide disaster plans for various incidents that may occur within Plymouth County.

Historically, weather-related incidents have been most common within Plymouth County, where elevated water levels and the potential for flooding are of the most significant concern. The Perry Creek Basin serves as a left-bank tributary to the Missouri River and impacts significant portions of Plymouth County. This county utilizes this fertile basin as a chief source of agriculture and livestock operations, thus, quickly rising water elevations can have a significant impact within the community. While drainage networks are well-developed, a history of flooding has been experienced in this area with over twenty-five separate incidents documented dated from 1892 (Eash, 1996). Additional flooding and water contributions from the Big Sioux River intensify concern for flooding in this county. Currently, flood warnings, planning, and disaster responses are occurring within the area due to above average rain fall (Plymouth County Iowa, n.d.; Plymouth County, Iowa: Iowa Genealogy Trails, 2018). Impacts of this flooding may reduce crop production, displace livestock, decrease accessibility to roads and highways, and may displace individuals in rural areas. Additionally, flooding within close proximity to sewage treatment facilities may result in sewage leakage and backflow into homes, communities, and other natural bodies of water.

The potential for other natural disasters, including tornados, hailstorms, blizzards, ice storms, wildfires, and droughts are observed within Plymouth County, given the region’s location in the Midwest plains (Tornado History Project, 2018). Similar to concerns associated with floods, the potential impact of these natural disasters on agricultural livelihood would likely create incredible financial burdens on individuals within the community. Access to communication in the wake of these incidents are also of significant concern. Power outages related to these disasters can greatly limit access to electricity, resources, and communication between farms, local agencies, and emergency services, highlighting an important concern related to disaster planning efforts.

Potential disasters involving hazardous materials must also be planned for within this county. Given the agricultural nature of Plymouth County, businesses and farms may employ the use of various insecticides, fertilizers, and pesticides. Accidental spills or waste runoff associated with the use of these chemicals may place individuals at risk of exposure and injury. Additionally, the presence of Plymouth Energy, an ethanol processing plant north of Sioux City, increases risk of accidental chemical spills and fires, due to the potential for explosion with these materials. Lastly, hazardous materials are frequently transported via railroad systems within Plymouth County, introducing concern should vehicular or locomotive accidents occur.

Located within Plymouth County is the La Mars Municipal Airport, and while this is a minor airport, it is important to plan for potential aviation disasters that may occur. Given this airport’s proximity to, and potential aviation trajectory to larger airports located in Sioux City and Sioux Falls, this airport may offer an emergency route for planes seeking services. The potential for this type of disaster could place hundreds of community members and individuals within Le Mars at risk of injury, and would likely necessitate the activation of disaster responses within the area and county. Additionally, given the airport’s close vicinity to community middle and high schools, vulnerable minor populations would be at increased risk of exposure and subsequent mental health services in the wake of aviation disasters.

With increased incidence of school-related violence, schools within Plymouth County are at risk of these disasters (i.e. bombing, school shootings), comparable to risk observed in schools across the country. Recreation activities within the county can include pheasant and deer hunting, which may result in greater accessibility to firearms among community members, who then have access to schools. Careful awareness of these considerations must be planned for among the community.

It is important to note that the preceding list of potential disasters within Plymouth County is not exhaustive or exclusive. Additional disaster situations that arise should be included in subsequent versions of this plan. Additionally, this county represents a rural region with small, supportive communities. Disasters that are comparatively short in duration and less severe than others can have lasting impacts among these tight-knit communities, which may require further disaster mental health relief. Disaster plans must incorporate mental health services while responding in culturally appropriate and sensitive ways. This will promote and build on resilience factors among the community while addressing specific community needs.

Disaster Classification System

The following are descriptions for categorizing disasters in Plymouth County, Iowa. These descriptions are consistent with the South Dakota Emergency Management Association, Planning Task Force as a suggestion for national standardization of categorization.

Type One

Type one disasters are those that can be managed via local law enforcement, fire departments, mental health professionals, and emergency medical staff and organizations. Local is defined as all of the services based in one or two towns or cities. For a disaster occurring outside of town or city jurisdiction, the response of services from one or two nearby towns or dispatch centers would meet this definition of a type one disaster. Activation of the National

Incidence Command System (NICS), via Iowa Homeland Security and Emergency Management, may or may not occur and will be decided upon the discretion of the initial responding agency.

Type one disasters are considered to be small and containable in nature, affecting a relatively small number of individuals. Examples include, but are not limited to: local storms, fires, vehicular accidents, isolated floods, and some containable hazardous material spills.

Type Two

Type two disasters are those where “mutual aid” must be utilized from more than one surrounding community, county, or state, and are not declared a disaster by the governor of the state of Iowa. Type two disasters typically do not receive government disaster relief and are

managed by resources available in the region, normally referred to as “mutual aid.” When a disaster requires the responding agencies to contact and notify more than one other community,

county, or state dispatcher center, that response is considered a type two disaster. It is recommended the Iowa Homeland Security and Emergency Management system be notified and utilized for management of multiple responding agencies. Examples include, but are not limited to: large scale collisions with multiple injuries, regional storms resulting in extensive damage or injury, hazardous material spills that are not easily contained and require equipment and assistance from several other agencies outside of local jurisdiction, and large scale wildfires and floods that require additional assistance and manpower, exceeding that of local resources.

Type Three

Type three disasters are those in which the governor of the state of Iowa issues a disaster declaration. This declaration may also be deemed a Presidentially Declared National Disaster, but is not required for classification of a type three disaster. Type three is the most severe rating for disasters likely to occur in Plymouth County and indicates extreme destruction that cannot be managed by regional resources and manpower. These disasters may become federally and/or state funded due to their large scale and high monetary cost. The NICS should be utilized and relied upon heavily due to the large amount of interagency involvement and anticipated chaos. Examples include, but are not limited to: large scale fires requiring federal government and firefighter involvement; instances of nuclear, biological, or chemical weapons of mass destruction; statewide storms with substantial loss of life and resources, and floods covering a large area, such as continual and current flooding that is impacting communities and vast amounts of farm and agricultural land in Plymouth County.

Role of Mental Health

As exposure to disaster events can be associated with, precede, or exacerbate significant emotional, cognitive, and behavioral difficulties among individuals, families, and communities, disaster mental health services are an essential facet of disaster response. Those impacted by disasters may employ ineffective coping strategies when faced with extraordinary circumstances and could benefit from assistance in appropriate referrals, resources, and adaptive coping strategies. Disaster mental health responders can assist individuals in this task and effectively facilitate a return to pre-disaster level of functioning. Mental health responders can also work to prevent the development of major psychological difficulties, promote general well-being, and disseminate critical information among both individuals impacted by the disaster events and other disaster relief responders.

Mental health responders are qualified to meet these primary goals and will effectively do so by fulfilling various roles during disaster response. Notably, disaster mental health responders’ responsibilities differ from that of prolonged psychotherapy interventions, as mental health responders are actively involved in pre-disaster planning and preparation. Collaboration with local and state agencies will promote organization in implementing effective and succinct psychological support, crisis interventions, referrals, advocacy roles, and distribution of psychoeducation materials.

Specifically, disaster mental health response will involve relatively short crisis interventions, debriefing, and defusing groups. Generally, responders will provide psychological support via psychological first aid, directed toward individuals exposed to the disaster event, families impacted by the event, and disaster relief responders. These intervention strategies are designed to normalize psychological stress reactions for those affected, and assist in effectively coping with emotional reactions occurring within the aftermath of the disaster event. Adaptive strategies that can be used to cope with and return to pre-disaster level of functioning are also provided. Importantly, during disaster response, mental health responders will ensure basic needs are met (i.e. food, water, shelter, clothing, medication), assess psychological needs, provide immediate support, and instill hope for the future.

In the event that an individual should experience significant medical emergencies or psychiatric reactions that would necessitate prolonged psychotherapy or use of medication (i.e. psychosis, risk of harm to self or others), mental health responders will utilize appropriate referral resources. As such, prior communication and familiarity with medical and mental health agencies within the impacted area is critical during this time. Should an individual pose an immediate threat to themselves or others, involuntary hospitalization may be necessary. Mental health responders should be familiar with local and state procedures associated with this process to facilitate smooth and safe transitions. For emergency committal procedures, see the section entitled “Involuntary Psychiatric Hospitalization Procedures.”

In addition to these referrals, mental health responders will also serve to advocate for individuals impacted by the disaster event. This will include services of meeting individuals’ basic needs, establishing contact with service agencies within the area, transportation, and housing. While providing services to individuals impacted by disasters is the primary goal, mental health responders will also advocate and provide services to fellow disaster relief workers. These services will include implementing debriefing and defusing sessions, in addition to advocating for appropriate workplace conditions and fulfillment of emotional and physical needs (i.e. allocated break time, break space separate from service centers, appropriate conflict resolution strategies, encouragement to implement self-care plans, and basic needs are met).

Lastly, disaster mental health responders will also provide education for the community at large. This education will focus on the detrimental effects of disaster on emotional, physical, cognitive, and social well-being. This education will serve to normalize reactions, reduce stigma associated with mental health services, prepare for potential future disaster events, and work to instill hope for the future. Dissemination of these education materials will be achieved through brochures, radio/television stations, local newspapers, and telephone hotlines. Additionally, social media outlets represent an effective method of distribution. A mental health responder will be appointed to field, monitor, and update relevant social media outlets as a method of education dissemination.

Disaster mental health responders offer a unique contribution to disaster relief and can provide supervision and services across a number of roles. The importance of pre-disaster planning and preparation cannot be understated, and mental health responders can assist in these processes. Familiarity and communication with local mental health agencies will facilitate effective disaster responses, clarify specific roles across agencies, and serve to employ distinct disaster plans during an otherwise chaotic time.

Service Delivery Sites

The Incident Commander will be in charge of determining the service delivery sites. Service delivery sites will be selected based on the severity and type of disaster. The service delivery sites will be facilities that can handle the personnel, their equipment, and their survivors. Options for service delivery sites include community facilities, government buildings, religious buildings, schools, or other appropriate locations. These locations should be close enough to the disaster area to minimize travel time, while also remaining in a relatively safe location. Since disasters can be unpredictable and continue in their destruction, a back-up site will also be selected. The incident commander will contact the facility following the disaster and will appoint a coordinator for each delivery site.

Chain of Command

Given the complex communication system between individuals, local, state, and federal agencies, it is critical a chain of command is identified. This will streamline distribution of services and facilitate an effective disaster relief response. The following is a suggested mental health structure for Plymouth County, Iowa.

For Plymouth County, the organization tasked with disaster mental health services following a type one, type two, or type three disasters is the Incident Commander (IC). The IC, recruited via the Iowa Homeland Security and Emergency Management, will establish contact with the Plains Area Mental Health Center, which will serve as the primary source of mental health management for all disasters within Plymouth County. Plains Area Mental Health Center provides integrative health services, including psychiatric, psychological, and medical needs while utilizing community outreach programs to assist individuals with everyday needs (i.e. transportation, monitoring symptoms, attending appointments, obtaining medication and crisis intervention). Additionally, this agency offers a voluntary, inpatient crisis shelter, serving those in need of significant crisis interventions. During a type one disaster, the on scene agency or IC will determine if mental health services are recommended, and subsequently contact the Plains Area Mental Health Center. In the case of a type two or three disaster, the IC, or a liaison designated by the IC, will determine the need for mental health services and contact the Plains Area Mental Health Center. The Iowa Divisions of Mental Health will also be contacted by the IC in case of a type three disaster event. Contact information for these local entities is provided in Appendix A.

Once the IC has established contact with Plains Area Mental Health Center, the agency will designate a Lead Mental Health Professional (LMHP), who will coordinate the disaster mental health response. The LMHP will contact the IC and obtain information regarding the type of disaster, scope of the impacted population, estimated length of response, and recommendations for service delivery sites within the impacted area. Communication between the IC and LMHP will continue throughout the duration of the disaster relief response.

Following information obtained from the IC, the LMHP will develop a response team consisting of available mental health professionals within the county. This may include mental health professionals working in the private sector, within hospital settings, and community mental health agencies. In the event the available mental health professionals does not meet the needs designated by the severity, type, and duration of the disaster, the LMHP may contact and request aid from outside organizations. These agencies include the Lutheran Social Services, Salvation Army, County Public Health, and Catholic Charities USA. Alternative services within the area (i.e. diversity centers, religious affiliations) can also be contacted. Additionally, the regional disaster officer of the American Red Cross can be contacted, where additional mental health professionals and disaster response teams can be requested. The contact in this capacity will be Julie Struck. Contact information for these entities is provided in Appendix B.

The LMHP will provide supervision of these agencies throughout the duration of the disaster response. Specifically, the LMHP will designate responsibilities to the respective mental health response team. For severe disasters, the team may usually take on a more administrative role in coordinating outside agencies to provide direct services to those impacted by the disaster, rather than providing direct mental health services. Across all disasters, the LMHP is also responsible for establishing contact with the Critical Incident Stress Management Team (CISMT) to ensure they have been notified and placed on alert for their potential services. The CISMT will work with emergency personnel only and will not serve other survivors unless otherwise dictated by the LMHP.

Given the intense emotional, physical, and psychological strain associated with disaster mental health coordination efforts, it is recommended the LMHP serve for no more than two weeks. The LMHP will assign a new professional to lead, supervise, and coordinate mental health efforts at this time, to avoid burnout syndrome and secondary trauma symptoms.

Throughout the response, the LMHP will remain in continual contact with the IC regarding the progress and specific needs of the response. In the event that a mental health professional in any capacity determines an individual is in need of continued and significant mental health services, appropriate referrals will be made.

Referrals, Outside Agencies, and Other Support Agencies

When more extensive  mental health services and interventions are necessary, appropriate referrals will be made. Plains Area Mental Health Center, located in Le Mars, the largest city within Plymouth County, represents the primary referral source within this county. This agency also has nine other locations throughout northwestern Iowa, representing an effective referral source that may extend into other counties. Floyd Valley Healthcare, also located in Le Mars, is designed to provide mental health services for individuals across Plymouth County. See Appendix A for specific county contact numbers. Additional referral sites can be directed to mental health and hospitals in Akron and Kingsley. Nursing home referrals will be made via local hospitals. School counseling and referrals will be directed to Plains Area Mental Health Center. See Appendix Bfor a list of outside referral agencies and phone numbers.

In addition to these specific county services, Plymouth County’s proximity to Sioux City, located in Woodbury County, relevant referral resources may be utilized via Sioux City. Specifically, Siouxland Mental Health Services, Siouxland Mental Health Center, and Associates for Psychiatric Services can provide additional services should specific county referrals be inefficient. Hospitals located within the Sioux City area, including Mercy Medical Center and UnityPoint Health – St. Luke’s represent additional referral sources. Similarly, Plymouth County’s proximity to Clay County, South Dakota offers additional referral information. This may include the Disaster Mental Health Institute, the Student Counseling Center, the Psychological Services Center, and Lewis and Clark Mental Health Counseling.

Involuntary Psychiatric Hospitalization Procedures

Involuntary psychiatric hospitalization procedures will follow the procedure that the State of Iowa has outlined. A verified application signed by a notary public with the clerk of court in Plymouth County must be filed. The application includes the approved form in Chapter 12 and 13 of the Iowa Court Rules. In addition, there must be one or more supporting affidavits that confirm the application and a statement of a licensed physician in support of the application. Once the application has been filed, a judge will review the application and a sheriff will serve the named respondent. The sheriff will take the respondent into immediate custody if requested. The judge will determine if the respondent has a serious mental impairment or has a substance-related disorder and is likely to hurt themselves or others. If the judge deems it necessary, the respondent will be detained until the hearing. After the hearing the judge will either dismiss the case or order that the person be committed for treatment (as outlined in Iowa Code chapters 125 and 229) (Legislative Services Agency, 2013). A qualified mental health professional can also be consulted in this process should the court, sheriff’s office, respondent, or person filing the application request it.

Casualties

In the event of causalities, families must be notified. The local police department will inform families of the loss of life. A mental health professional will accompany the local law enforcement officers during the death notification process should the law enforcement officer request assistance or if they consent to having a mental health professional join them. The Plymouth County coroner and medical examiner will remove the bodies from the disaster site. They will provide the information on death reports and perform medical autopsies if needed. They will be responsible for transporting the bodies to the Plymouth County morgue that is located in Le Mars, IA. A mental health professional will be stationed at the morgue in order to provide mental healthcare to families in need of services.

Training of Local Mental Health Professionals

In order to better respond to disasters, local mental health providers need to be trained in disaster mental health. Disaster mental health interventions differ from traditional services such that disaster mental health interventions are short-term, does not require formal assessments or diagnoses, occurs immediately following a potentially traumatic event, and takes place out in the community rather than in an office. Therefore, local mental health providers need specific training in disaster mental health so that they are better prepared to use interventions and strategies that are appropriate to a disaster setting. Mental health providers should also be aware that informed consent and confidentiality still apply to a disaster scenario, thus services are voluntary, and individuals need to consent to receiving those services. In addition, mental health providers need to continue to adhere strict confidently principles. Local mental health providers can participate in training by completing the course “Disaster Mental Health Services” that is offered by the American Red Cross. Local mental health providers who are interested in more extensive training can receive a graduate certificate in disaster mental health from the University of South Dakota. These courses are offered online and prepare mental health professionals to serve their communities in preparing for, responding to, and recovering from disasters. It should be noted that individuals who receive the disaster mental health graduate certificate from the University of South Dakota are not eligible to receive the American Red Cross Disaster Mental Health Services certificate. Another option for further training is to seek training in psychological first aid. The National Child Traumatic Stress Network’s Learning Center has a 6- hour interactive online course that reviews the core goals of psychological first aid and educates mental health providers on how to use psychological first aid when responding to a disaster.

Training, Drills, and Implementation

In order to have a successful and effective response, it is recommended that Plymouth County mental health providers participate in trainings and hold drills. Mental health services will need to plan, prepare, and attend each drill. Drills will involve scenarios related to a wide variety of disasters. These drills can be held at the local or county level and can include relevant supporting agencies as well as outside agencies who agreed to participate in the disaster response plan. The drills can include a forum that involves the coordination of emergency preparedness, response, and recovery activities/issues during a simulated exercise that tests the capabilities of each organization’s response plan. Following the completion of a drill, participants will be able to address issues in their plans and identify any short-coming in their response plan. In addition, those who participate will evaluate the exercise and will provide feedback for improvement to those who plan the disaster drill. If the feedback provided elicits change to the mental health disaster response plan, the mental health services response team will be notified immediately. In addition to drills, the Iowa Homeland Security and Emergency Management Department holds trainings related to a variety of disaster response topics throughout the state of Iowa. It is recommended that the mental health services team participate in the relevant trainings. For example, there is a Mass Care Tabletop Exercise that provides a forum for district-wide, local, private and public partners to coordinate emergency preparedness, response and recovery activities/issues during a simulated interactive exercise that helps test the capabilities of each organization’s response plan on August 7, 2018. The mental health services team should strive to participate in disaster related trainings throughout the year.

References

Benedek, D. M., Fullerton, C., & Ursano, R. J. (2007). First responders: mental health consequences of natural and human-made disasters for public health and public safety              workers. Annu. Rev. Public Health, 28, 55-68.

Boscarino, J. A., Adams, R. E., & Figley, C. R. (2011). Mental health service use after the World              Trade Center disaster: utilization trends and comparative effectiveness. The Journal ofnervous and mental disease, 199(2), 91-99.

Eash, D. A. (1996). Flood of May 19, 1990, along Perry Creek in Plymouth and Woodbury

counties, Iowa (96-476). Retrieved from Iowa City, IA: http://pubs.er.usgs.gov/publication/ofr96476

Foa, E. B., Stein, D. J., & McFarlane, A. C. (2006). Symptomatology and psychopathology of              mental health problems after disaster. J Clin Psychiatry, 67(Suppl 2), 15-25.

Framingham, J., & Teasley, M. L. (2012). Behavioral health response to disasters. Boca Raton, FL: CRC Press.

Legislative Services Agency. (2013, November). Involuntary Hospitalization of Persons with Mental Illness. Retrieved July 19, 2018, from https://www.legis.iowa.gov/docs/Legis_Guide/2013/LGRBH000.PDF

Neria, Y., Galea, S., & Norris, F. H. (Eds.). (2009). Mental health and disasters. Cambridge University Press.

Plymouth County Iowa. (n.d.). Retrieved from http://www.co.plymouth.ia.us/about/about.aspx

Plymouth County, Iowa: Iowa Genealogy Trails. (2018). Retrieved from

http://genealogytrails.com/iowa/plymouth/town_ships.htm#PLYMOUTH

Reed, A. (2018). Template DMH Plan [PowerPoint]. Retrieved from https://d2l.sdbor.edu/d2l/le/content/1073591/viewContent/6055870/View

Ruzek, J. I., Brymer, M. J., Jacobs, A. K., Layne, C. M., Vernberg, E. M., & Watson, P. J.              (2007). Psychological first aid. Journal of Mental Health Counseling, 29(1), 17-49.

Ruzek, J. I., Young, B. H., Cordova, M. J., & Flynn, B. W. (2004). Integration of disaster mental              health services with emergency medicine. Prehospital and disaster medicine, 19(1), 46              53.

Tornado History Project. (2018). Retrieved from http://www.tornadohistoryproject.com/tornado/Iowa/Plymouth

United States Census Bureau. (2017). Quick Facts Plymouth County. Retrieved July 12, 2018,              from https://www.census.gov/quickfacts/fact/table/plymouthcountyiowa/PST045217