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Gordon, Norma S.,
The immediate community response to disaster
h [electronic resource] :
b the East Bay Hills fire /
by Norma S. Gordon, Carl A. Maida.
i Title on cover:
Immediate response to disaster :
the East Bay Hills fire
[Boulder, Colo.] :
Natural Hazards Research and Applications Information Center,
13 p. ;
Quick response research report ;
[Tampa, Fla. :
University of South Florida Libraries,
n Digitized from copy owned by Natural Hazards Center, University of Colorado at Boulder, in a joint project with the Louis de la Parte Florida Mental Health Institute (FMHI) Research Library's disaster mental health initiative.
x Psychological aspects.
Maida, Carl A.
University of Colorado, Boulder.
Natural Hazards Research and Applications Information Center.
t Natural Hazards Center Collection
1HE.IMMEhll\TEJDb'SAC;,ER:BAy l\...Ls FIRE.S;.GordonC-a.f"\ A. MofC"loraho,:Be..'"1il\J" 0 ra\\e.Y'lC e) N'a.tu...ra\H-a.t'a..f'chanaA-pp\Ce...Y\-te.,y-199c
THEIMMEDIATECOMMUNITY RESPONSETO DISASTERTHE EASTBAY HILLS FIRE ByNormaS.Gordon,M.A.ThePublicHealthFoundationofLosAngelescounty,Inc.CarlA.Maida,Ph.D.UniversityofCalifornia,LosAngeles QUICK RESPONSERESEARCHREPORT #51 1992... rt f the Natural Hazards This publicationISpa0Information Center's on90109 Research&Applications S. Quick Response Research Report enes. http://WWW. colorado. edu/hazardsTheviewsexpressedinthisreportarethoseoftheauthorsandnotnecessarilythoseoftheNaturalHazardsCenterortheUniversityofColorado.
A THEPUBLICHEALTHFOUNDATION13200CrossroadsParkwayNorth,Suite135CityofIndustryCalifornia91746310-699fax310-699-8856THEIMMEDIATECOMMUNITYRESPONSETO DISASTER: THEEASTBAYHILLSFIRENormaS.Gordon, M.A. The Public Health FoundationofLos Angeles County, Inc. Carl A. Maida, Ph.D. UniversityofCalifornia, Los Angeles Submitted October 1992A private, non-profit. charitable, educational. research, serviceanddemonstration corporation.
THEIMMEDIATECOMMUNITYRESPONSETODISASTER:THEEAST BAYHILLSFIREThisstudy examines the immediate community responsetothe East Bay Hills Fires. It investigates how mental health and other human services were mobilized and delivered in the disaster-affected communities in Alameda County during the initial post-impact period withinonemonthofthe frrestorm, with respectto:(1)the extentofservice delivery; (2) the providers and recipientsofthese services; (3) obstacles to service delivery; (4) the levelofcoordination; and (5) the timelinessofresponse. THEEVENTOnOctober 20, 1991, a frrestorm destroyed more than 3,000 homes and took 25 lives in the hillside residential neighborhoodsofOakland and Berkeley, California. A brush frre that had burned, and was extinguished the day before, and reignited. Gustsofhot,dryairswirled through the hillside grovesofMonterey pines and eucalyptus trees that were damaged by fiveyearsofdrought and a freeze the previous winter. Manyofthe homes, built before frre codes existed, used highly-flammable wood shake siding and roofing in their designs. On many properties brush and overhanging branches were allowed to accumulate.Thefire, spread by winds gustingupto65miles per hour destroyed 2,777 single-familyhomesand 433 apartments in the 1,600 acre fire zone. The East Bay Hills Fire was declared officially under control on October 23,1991at 8:00 a.m., some seventy hours after it began.Tosubdue the frrestorm, an estimated25million gallonsofwater were used by 1,844 frre fighters. The costofproperty damage has been put at $2 billion. The Red Cross reportedover4,500 people were homeless and 444 ill or injuredasa resultofthe worst residential frre inAmerican history. METHODS Instrument Design and Expert Panel ReviewWedevelopedaninstrumenttoassess the immediate post-disaster needs using criteria developed by the Federal Emergency Management Agency (FEMA) and the National InstituteofMental Health (NIMH) in ordertodetermine:1)Who is delivering and receiving direct services, outreach, consultation and education?2)What typesofservices are being offered?3)How are specific cultural, ethnic and geographical needs being met?4)What is the professional perceptionofimmediate service needs?Theinstrument was critically reviewed by three disaster mental health experts from NIMH,theStateofCalifornia, DepartmentofMental Health, and the Suicide Prevention Center/Family ServiceofLos Angeles. We assembled a panelofexperts, composedof25countydisaster coordinators in California, who received a copyofthe original instrument andabrief Disaster Expert Panel Review assessment form which asked the following questions:1
1)Are the questions stated clearly? 2) Would this questionnaire be usefulasa planning tool? 3) Would this questionnaire be usefulasa needs assessment tool? 4) Would this questionnaireassist you in identifying the potential demand for mental health services after a disaster? 5) What additional information would you want to have included in this questionnaire? Key Informant Interviews We developed a sampleofkey agencies that provided services to the disaster victims through a reviewoflocal newspaper notices, and phone contacts with staffofthe American Red Cross, the NIMH, the StateofCalifornia DepartmentofMental Health, and the East Bay Community Foundation. Letters were then written to key administrators, soliciting their cooperation in the study. The sampleoftwelve key informants was selected to represent public mental health agencies, United Way agencies, the Red Cross and other community-based organizations that responded to fIre victims. The interviews were conducted by a teamofinterviewers six weeks after the disaster. The key informants helped to identify other administrators and clinicians who took part in the immediate emergency response for inclusion in our survey sample. The Survey The sample consistedof40 respondents within the following classifIcations:1)sixteen administrative and clinical staff from seven agencies representing public mental health and hospital-based mental health; 2) fourteen clinicians fromthe private sector who volunteered services to public mental health agencies and to the American Red Cross; and 3) ten administrative staff from human services organizations in the non-profIt sector who provided a wide rangeofservices to disaster victims.RESULTSExpert Panel Review The questionnaire was critically well-received, with 20ofthe25expert respondents indicating positive viewsofits usefulness. The respondents, in general, regarded the questionnaire they reviewed as usefulfor planning and conducting a needs assessment and for identifying the potential demand for disaster mental health services. Those who were critical (fIve respondents) made positive suggestions for improvementsofthe questionnaire, most citing that it was too specifIc to the disaster. Someexpert respondents questioned whether the exact numbersofindividuals served, their marital status and their ethnicity, would be available to agency respondents one month after the disaster. Some suggestions were directed toward longer term objectives than were the focusofour investigation, e.g.:1)the coordinationofclinicians in private practice who may be willing to volunteer services; 2) any contingency plans that mental health agencies may have to re-allocate and re-assign staff to disaster duties; and 3) the need for mental health resources in the recovery phase, 312 months after a disaster. 2
Key Infonnant Interviews Disaster Coordinator, Alameda County DepartmentofMental Health (ACDMH): The Alameda County DepartmentofMental Health was the initial mental health agency to coordinate with the State DepartmentofMental Health in this disaster. The agency responded immediately, mobilizing staff and resources for disaster interventions as a resultofrecent experience in managing the Loma Prieta Earthquake response. The agency worked collaboratively with other community agencies, including the American Red Cross and the mental health systems in Santa Clara, Contra Costa, San Mateo and Santa Barbara Counties.Asthe key mental health agency, the ACDMH was responsible for staffmg the Disaster Assistance Center (DAC) when it opened. Its own staff and volunteers provided a varietyofservices, including outreach at the coroner's office, "ride-alongs" with safety personnel, escorting disaster victims to the fire zone, and debriefingsofemergency service workers. Agency personnel staffed a hotline and mailed infonnation to 4,000 victims on the FEMA mailing list. The volunteers whom they mobilized for this disaster had previously received training by the agency staffaspartofthe NIMH-funded training program implemented following the Loma Prieta Earthquake. The agency was able to mobilize outreach efforts, including staff support andconsultation,tothe schools in the peripheral area becauseofa previous contract with the Oakland Schoolstoprovide training after the major earthquake. Disaster Coordinator, CityofBerkeley, Mental Health Services (BMHS): This city mental health department had recently (since July1,1991) gained jurisdictional status, and elected to launch disaster response efforts independentofAlameda County activities. A parallel effort, therefore, was being made to provide disaster mental health services, including outreach and drop-in services to fire victims, andconsultation, training and critical incident stress debriefings to emergency service workers within its jurisdiction. BMHS also implemented a crisis intervention program, including a 24-hour crisis telephone service and a mobile crisis team. This provided on-site crisis intervention and supportive counseling at the evacuation center, at Alta Bates Hospital emergency room and at the baseofthe devastated area in the Berkeley Hills. Debriefing sessions were offeredtostaff and volunteers but were reportedasbeing poorly attended. BMHS is crisis-oriented and receptivetovolunteers and participation from other sectorsofthecommunity. Previous collaborative efforts with the UniversityofCalifornia Student Health Service to mobilize resources in response to community-scale crises have afforded opportunities for the networking and coordination necessary for managing a large-scale disaster response. What is unique about Berkeley Mental Health's response is the utilization of large numbersofprofessionally-trained volunteers, called the Mental Health Volunteer Project Disaster Response Team. Activationofthe volunteer cadre enabled this relatively small agency to offer a large arrayofservices, including a considerable outreach effort. Chief, DepartmentofPsychiatry, Children's Hospital-Oakland: The DepartmentofPsychiatry's outreach effortsfollowing the fire were directed towards school systems, and were targeted solely to the children affectedinthe fire zone. Services included school consultations, classroom intervention and parent groups. The hospital Psychiatry Departmenthasanongoing interest in children affected by community-wide traumatic events. It has3
developed interventions for victimsoftrauma, including community violence and the effectsoftheLomaPrieta Earthquake, offered training programs for school personnel, and is engagedinongoing research in this area. Alloftheseactivities were supported by a private endowment provided by Children's Hospital, and were essentially separate from other mental health activities in the community. The staff's most successful efforts, however, were with the counselors from one particular school. The Department offered group sessions to parents and school personnelata private schoolinthe disaster area. Children's Hospital staff worked closely with the parent association in this close-knit school. Follow-up activities involved consultation with school counselorsoverthe next several weeks. The counselors reported that manyofthe children indicated emotional disturbances. The parent groups, however, were not well attended after the first session and were subsequently canceled. The hospital staff continued their consultation activities over the next several weeks, with teachers and counselors in three schools in the impacted area. Staff observed that parents were not identifying traumatized children. Therefore, in collaboration with the school counselors, hospital staff employed case-finding techniques such as children's drawings to identify those at risk. DirectorofDisaster Services,ChiefofDisaster Health Service, and CoordinatorofMental Health Services/Crisis Intervention Team, The American Red Cross: The Red Cross, a volunteer-driven organization, played an outstanding role in this disaster through its Oakland and Golden Gate chapters. The Red Cross assembled a volunteer cadre, provided by the naval and coast guard personnel from locally stationed ships and commands. This cadre staffed the Disaster Welfare Inquiry Unit (OWl) phone bank. It processedover3,000 inquiries after the fire. The deliveryofmental health services is not ordinarily a partofthe missionoftheRedCross in a disaster. TheRedCross mass care workers will often observe considerablegriefandbereavement among the disaster victims in the shelters. The Red Cross makes referralstolocal departmentsofmental health. Major changes in mental health policy at theRedCross have taken place over the past two years, through the establishmentofa National Disaster Mental Health Task Force, as partofits concern for emotional support not only to victims but, also toRedCross volunteers and other emergency service workers. The American Psychological Association, through an agreement with the Red Cross, has been providing emergency mental health training to Red Cross volunteers who are also licensed mental health professionals. This was thefirst disaster where the mental health componentofthe Red Cross was utilized. A large numberofprofessional therapists volunteered their services to the Red Cross, however, only experienced clinicians and Red Cross-trained therapists were utilized. Conflicts emerged between the Red Cross and the public mental health agency in the early daysofthe disaster regarding the useofmental health volunteers. In the first daysfollowing the fire,ACDMHworkers lacked proper identification to enable them access to the service centers. The Red Cross assisted them by issuing name badges used by Red Cross crisis teams.Turfissues emerged, however, between mental health staff from theACDMHand 4
RedCross volunteer counselors who were assignedtothe scene by the Red Cross mental health coordinator. The Red Cross crisis teams encountered immediate rejection from ACDMH staff inasmuchasthe directorofthat agency's disaster response regarded her agencyashaving the sole jurisdiction in assisting the fire victims at the DAC. After some days, these turf issues were resolved, but essentially the Red Cross-trained counselors were limitedtoserving only Red Cross volunteers. Red Cross debriefing teams scheduled sessions for volunteer workers, which however, were poorly attended. We were informed that this mayhavebeen due to the fact that manyofthe volunteers were exhausted from excessively long (l2-hour) shifts and often returned to their homes, a considerable distance away, after their shifts ended. Overall, the effortsofthe crisis intervention teams were well-received, appropriately utilized, and much appreciated by Red Cross personnel in the field. There were difficulties, however,inthe organizationofthe mental health response. A shortageoftelephones and cellular phones made it difficult to obtain informationinthe field and to provide an organized response. Senior Vice President, Alameda County United Way: Several United Way agencies provided counseling services to disaster victims, specifically Catholic Charities, Lutheran Social Services, Jewish Family Services, and Family Serviceofthe East Bay. Services provided included individual counseling, support groups for survivors, community debriefings, telephone crisis counseling and information and referral services. Among other services offered by United Way agencies were legal, financial and housing assistance, clothing andfood.An outstanding service that United Way provided was the preparation and distribution of the newsletter,From the GroundUp,that included comprehensive information regarding community resources. This newsletter was senttothe entire listofDAC registrants.TheUnited Way served,aswell,asa focal point for coordinating the effortsof50 new and pre-existing neighborhood groups, collectively entitled Phoenix Associations. The primarytaskofits organ,The Phoenix Journal,was "to help rebuild the East Bay and to maintain communication between the people who lost their homes on October 20, 1991, and among those whose homes survived."TheUnited Way participated,aswell, in planning emergency preparedness activities, including spearheading the East Bay Fire Emergency Fund collaboratively with the Red Cross. A Mental Health Task Force had been formed at the timeofthe fire within the UnitedWayplanning structure, specifically the Oakland Community Fund. Task force members identified mental health needsoffire victims and discussed strategies for allocating needs for services to school children in the impacted area. Associate Director, University Health Service, UniversityofCalifornia, Berkeley: The University's mental health response was directedtothe university community. Approximately 500 students, faculty and staff lost their homes and were displaced by the fire. Crisis services were immediately made available under the University's emergency plan. University Health Service (UHS) staff integrated with Berkeley Mental Health (BMHS) personnel as partoftheir community crisis efforts. This mechanism was developed over thepastyears in response to the Lorna Prieta Earthquake, a campus residential fire and a hostage event. As a result, both agencies were abletomobilize collaborative efforts for fire victims. 5
Although the campus was closed on the day following the fIre, the UHS was fully staffed and functionedasa crisis center. Staff initiated crisis services, offeredphone counseling and organized the University's response. The UHS has established linkages with local counseling resourcesasa resultofthe prior crises on the Berkeley campus. Their efforts on behalfofthe fIre victims in the university community were provided through NIMH funding as a subcontractor with BMHS. The Survey The following information was derived from the survey:PriorClinical Experience The respondents, on the whole, had prior clinical experiences with all age groups, and with emergency service workers. The human service organization respondents worked with a broad rangeofgroups in the community, including representativesofbusiness and industry, and they participated in emergency preparedness activities. Services Delivered The public mental health agencies, with funds providedbyFEMA/NIMH to the StateofCalifornia, delivered a wide rangeofdisaster mental health services to fIre victims, including crises counseling, outreach to disaster victims, individual and group counseling, critical incident stress debriefIng, assistanceto fIre and law enforcement personnel, school-based and hospital-based interventions,community organization, training and education. The volunteers provided clinical support in allofthe activitiesofthe mental health agencies where they donated their time. The organizations in the voluntary sector also provided a wide rangeofservicesto fIre victims, including crisis and bereavement counseling, information and referral, assistance to families with young children and to older adults, housing assistance, and the coordinationofvolunteer efforts. The public mental health providers were reimbursed by federal funds. Hospital-based services, however, did not receive special federal reimbursement. The non-profit agencies had a varietyofsourcesofreimbursement, which however, were not governmental ones. They received reimbursement from the Red Cross, the Oakland Community Fund and the United Way. Service Providers In the public mental health sector, services were providedbyboth paid professional staff and volunteer psychologists, social workers, trained counselors, and psychiatrists. In the non profit sector, service providers included nurses, health educators, social workers and administrative personnel. Professionals in both sectors were predominately Anglo, but also included Latino, Asian/Pacific Islanders and African-American staff. Someofthe agencies in our sample hired additional stafftomeet their disaster service needs:1)the public mental health agencies added staff and contracted with consultants;2)the Red Cross hired a disaster 6
mentalhealth specialist; and3)the UniversityofCalifornia, Berkeley contracted with consultants.Service RecipientsTherecipientsofthese services were predominantly Anglo adults. The children served represented a more diverse populationasa resultofoutreach activities to the schools. The UniversityofCalifornia, Berkeley population served was demographically representativeofthecampus population.Useof MediaThemedia were instrumental in disseminating information about available services. All thementalhealth agencies prepared press releases and public service announcements for the printandelectronic media. The United Way had the primary responsibilityofpreparing an information and referral newsletter that was mailed to all FEMA registrants. ACDMH disseminated information at the Disaster Assistance Center and prepared posters that were distributed community-wide.MobilizationofServicesAllagencies began deliveryoftheir services immediately or during the first week after thefire.All the mental health agencies activated their disaster plans and mobilized their staffs.Boththe public mental health and the voluntary sector organizations had developed mechanisms for alerting and recruiting staff inanemergency. Muchofthis seems to havebeenput in place since the Lorna Prieta Earthquake. These agencies used telephone trees andotherrapid mobilization techniques to alert their staff and volunteers.Allof the public and non-profit agency respondents perceived their effortsaseffective or very effective in the immediate aftermathofthe fires. The volunteers self-ratingsofeffectivenessvaried,and appeared to be dependent upon whether their assignment enabled them to use their clinical skills. Twoofthe agencies planned detailed evaluationoftheir services. BMHS intended to carry out preand post-testingofvictims, evaluationofthe volunteer response, follow-upofoutreach efforts, and overall evaluationofservices. The UniversityofCalifornia, Berkeley planned a needs assessment and a detailed record studyofthe 500 firevictimswho were either students or university personnel.Demand for ServicesThedemand for services varied. There were fewer demands than expected at the DAC andvariousoutreach locations. There was less demand than expected at the support groupmeetingsheld in the community. Clinical services for children were lower than expected atcliniclocations, with more requests for services at the schools. The university hospital-basedprogramreported more demand than expected. The volunteers in the mental health system reported disappointment with the demand for their services. The Red Cross respondents reported a greater than expected demand for crisis counseling but lower participation thantheyhad expected for debriefings offeredtoRed Cross personnel. Non-profit agencies7
reported a rangeofresponses in their expected demand for services, with the majority stating either a greater or as expected demand for services.PreparednessAll respondents reported being well-prepared for this disaster becauseoftheir participation in previous community-scale crises. All agencies reported having a disaster plan, and except for the hospital-based programs, participating in county-wide planning activities. The public mental health agencies had received formal training in disaster interventions, including critical incident stress debriefmg training. They had participated,aswell, in prior NIMH-funded training programs. The University hospital-based program reported having received no formal training in disaster interventions. The volunteers reported having received "some" or "extensive" training. The non-profit sector respondents had not received specific disaster training; however, all had received crisis intervention trainingasit was relevant to their work. Respondents from nine public and United Way agencies reported offering critical incident stress debriefings, support groups and stress management workshops to help mitigate the stressoftheir workers. One-halfofthe volunteers in the sample reported having received such interventions.CoordinationAll respondents reported familiarity with the rangeofcrisis services available in the community; however, coordination among providers varied. The public mental health systems reported good coordination with other providers during the fire. This included deployment across jurisdictional lines,asthere had been long-standing coordination with city emergency services. The hospital-based programs reported limited coordination. The non-profit agencies reported limited coordination with public mental health agencies, although they reported extensive coordination among themselves. The respondents reported the following cooperative arrangements: UniversityofCalifornia, Berkeley worked with BMHS and Red Cross staffs; campus-wide crisis teams worked with fire and police. ACDMH shared resources with Solano, Santa Barbara, San Mateo and Santa Clara county mental health departments, and the Red Cross. Children's Hospital-Oakland offered evaluation and consultationtolocal school districts. Family Serviceofthe East Bay cooperated with the Red Cross and United Way community-based organizations. The ChamberofCommerce provided staff support and materials, assisted the CityofOakland at the DAC, and participated in the Fire Coalition. Berkeley-Oakland Support Services worked closely with other relief agencies suchasthe Red Cross and the Salvation Army. Alta Bates Hospital-Older Adults Services Center networked with other services for the elderly. The United Way Information and Referral servedasaninformation clearinghouse and published daily updates. Eden Information and Referral cooperated with other agencies, including the Red Cross, in providing housing lists and housing referrals. The Volunteer Center, Inc. was the clearinghouse for volunteers to many other organizations and agencies, and served as the liaison to the Red Cross, the Salvation Army, CityofOakland, and OfficeofEmergency Services. Bananas, a child care resource agency, shared resources with other childcare providers.8
Obstacles to Service DeliveryPublic Mental Health Agencies The major obstacles reported by public mental health systems were the lackofcoordination and cooperation with other mental health jurisdictions and with other emergency services providers. There were also problems in disseminationofinformation about services and lackofimmediate publicity about services offered. There was a time-lag in implementing services for school children, difficulties in determining where to locate mental health services, and staffing problems. BMHS was burdened with calls from private practitioners volunteering their services. There were problems integrating these volunteer services with those provided by the staff. Hospital-Based Mental Health Children's Hospital-Oakland reported a lackofcoordinationofservice delivery, stating that the needsofchildren were neglected becauseofthe trauma being experienced by the adults. The respondent also reported organizational problems in service delivery duetoa lackofrecognitionofchildren's needs and where services for them should be located. He observed,aswell, resistance by officials to early intervention efforts on behalfofchildren. Vol unteer Clinicians The major obstacles reported by the volunteer clinicians were: the lackoforganizationofthe public mental health agencies, their staffing problems and confusion about the locationofservices. The overabundanceofvolunteers created confusion in making assignments and problems in the allocationofvolunteers to sites in the community. Volunteers also cited general communication problems between the public mental health agencies, and poor information dissemination to the public. Respondents from neighboring Solano and Marin counties reported ACDMH's resistance to placing professional volunteers in the field after the disaster. American Red Cross volunteers reported poor organization within the Red Crossaswell, stating that they were not informed about the availability and roleofstress counselors. Voluntary Sector Agencies Major obstacles were also reported by respondents from the United Way agencies. Family Servicesofthe East Bayreported that the ACDMH was unresponsivetotheir offersofassistance and that Red Cross administrators appeared disorganized. The Alameda County United Way reported that there seemed tobeconsiderable confusion and lackoforganization among all parties concernedinthe response. Bananas reported that the large numberofvolunteers offering help overburdened their system. Respondents reported a lackofsensitivitybythe Red Cross and the CityofBerkeley to the needsofthe homeless in the city, when priority was being giventothe fire victims. The issueofthe competitive needsofthese two populations surfaced specifically in relation to providing emergency sheltertofire victims, and apparently neglecting such needs in the homeless. The fire victims, however, represented a different socioeconomic class than the 9
homeless, and there was strong community reaction to assigning priority statustothis "privileged" groupofdisaster victims. Recommendations From Survey Respondents Public mental health agency respondents recommended that their planning efforts for future disasters should take into account a numberofproblem areas:1)better integrationofmental health efforts into the city disaster plan through ongoing coordination with city officials;2)better assessmentofmental health needs to determine where services are to be located and personnel reassigned; 3) integrationofsupport groups with existing community institutions suchasthe PTA and Senior Citizens centers;4)provisionofmore comprehensive information to mental health workers regarding where services are available in the community; and 5) clarification so that mental health workers can gain access to shelters, the DAC and other locations where access is limited to emergency services personnel. Respondents in United Way agencies recommended the following planning areas:1)increased disaster planning, training and availabilityoffunds for survivors; 2) fuller access to underserved and vulnerable populations through better coordination with the lead agency; 3) substantive cooperation and mobilizationofinteragency networking capacity by the lead mental health agency; 4) better community-wide coordination and integrationofcrisis services; 5) rapid assessmentoftechnical needs, including phone, FAX and other formsofcommunication at the timeofthe emergency and in the immediate aftermath; and6)a phone line at the United Way Information and Referral set aside exclusively for disaster victims and their needs. Respondentsinboth public and non-profit agencies reported the need for moreofthe following services:1)individual services, case management and household advocacy; 2) outreach, home visits and aftercare; 3) planning for children's needs and services to schools; 4) practical assistance and advocacy for victims; 5) public information services; and6)debriefing and support for crisis intervention workers. DISCUSSION The Immediate Response The major firestorm spread through affluent hillside communities and resulted in almost total residential loss. The population was composedofpredominantly long-term residents who owned homesinthe East Bay Hills: There were also apartments burned and renters displaced. Taking into account the scaleofthe fire, there were relatively few fatalities or injuries requiring hospitalization. Public mental health agencies, namely Alameda County DepartmentofMental Health (ACDMH) and CityofBerkeley Mental Health Services (BMHS), were involved immediately in offering crisis services to disaster victims. They mobilized and dispatched stafftothe sceneofthe fires, providing assistancetoemergency service workers and to fire victims. Although the public mental health response was timely, there were problems with coordination, allocationofresources and utilizationofprofessional volunteers. These10
problems were often a resultofthe absenceofpre-disaster planning and networking among mental health providers, city and other emergency preparedness agencies. Leaders within the public mental health systems were confounded by jurisdictional vagaries, and this affected adequate service delivery in the early phasesofdisaster response. Funding for mental health services following a disaster becomes available through FEMA and the NIMH. These funds are allocated to the local county mental health agencies. The designated county agency has the authority to contract for additional services from local providers. ACDMH was the key agency in this disaster and was responsible for staffing the DAC, Red Cross shelters and servingasprimary liaison to the emergency services network. The fire destroyed areasofBerkeley, and citymental health officials mobilized their disaster response based upon their perceived jurisdictional responsibilities to their constituency. ACDMH, however, initially received exclusive program consultation from the disaster coordinatorofthe StateofCalifornia DepartmentofMental Health. Confusion occurred because BMH was only recently assigned jurisdictional independenceasa free-standing mental health department. Because BMH had been overlooked initially by the State officials, conflicts surfaced between city and county systems. This created problems in service delivery, and turf issues emerged in the early aftermathofthe fire. The city agency ultimately was included in the StateofCalifornia/NIMH loop and prepared a request for funding. Both systems had the experience and the training necessary to mobilize their resources for the fire victims. Alameda County had dealt with a major natural disaster, the Lorna Prieta Earthquake, that occurred two years priortothe firestorm. The CityofBerkeley had considerable experience with smaller-scale crises events, including a hostage crisis and a fraternity fire in the university area. The major problems, then, wereinthe areasofcommunication between the two systems,funded by NIMH,aswellastheir coordination with the other organizations providing counselingtofire victims. There was an abundanceofmental health and counseling services offered by the non-profit sector. United Way agencies, becauseoftheir administrative structure, customarily operated separately from publicly funded mental health agencies. However, a disaster implies a unique setofcircumstances. There were problems in the delivery andutilizationofcounseling services. Although information regarding the availabilityoftheir services was well disseminated, there were several factors that contributedtotheir underutilization. In the first weekortwo, disaster victims were primarily concerned with their basic needs. Mental health workers assisted in these early efforts, including escorting victims to the disaster zone and providing a presence at the DAC.Ashas been reported in other disasters, "counseling" services offered at the DAC were poorly utilized. The debriefing efforts offered by mental health professionals to the Red Cross volunteers were also poorly utilized due to fatigue and by the desireofthe volunteerstoreturn home after long shift times. Awarenessofthese problems eventually led to the formationofa mental health committee within the United Way planning structure, specifically within the Oakland Community Fund. The committee, formed in the wakeofthe fires, set about to address issuesofneed and resource allocationofpublic and private mental health servicestoresidentsofAlameda County.11
The Volunteer ResponseAsin other recent disasters, there had beenanoutpouringofvolunteers to assist in the mental health effortsofboth the NIMH-funded public sector systems and the American Red Cross. Manyofthese volunteers had been trained by the local professional associations, the Red Cross and training provided by NIMH-funded programs in the Bay Area. Both public agencies reported difficulties in making effective useofthe overabundanceofvolunteers who offered their services after the fire. This was a problem that United Way agencies had to confront, as well. The major issues hadtodo with screeningofvolunteers and administering the volunteer effort. Although there was a clear need for counseling services, agencies had difficulties integrating the volunteers into their efforts.Anexample demonstrating the lackofeffective coordinationofformal and voluntary resources was the difficulties experienced by the American Red Cross in having their trained professional volunteers accepted by ACDMH in earlier phasesofthe disaster. That agency permitted the Red Cross mental health cadretoprovide services only to Red Cross volunteer emergency service workers and not to disaster victims. Other trained mental health professionals also reported frustrations with the lackofreceptivity by ACDMHoftheir offers to help. The United Way agencies reported being overwhelmed,aswell, by the volunteer response. These organizations lacked the administrative support which would have enabled them to utilize better this outpouringofhelp. This was particularly true in the earlydaysofthe disaster and its immediate aftermath. We saw in this disaster, then, the positive resultsofprior training efforts and the willingnessofthe private sectortooffer assistance and the negative resultsofinadequate planning which would have enabled these volunteers to be utilized more effectively. Community Organization Becauseofthe locationofthe fires inanaffluent area, contiguous to a major university, and impacting residents who had lived there for many years, the outpouringofresources and offersofassistance were greater thaninmost disasters. Community homeowner associations rapidly mobilized on behalfofdisaster victims. They developed a strong political voice to assure that the needsofthe community were met. Outstanding in these efforts was the Phoenix Coordinating Council,anumbrella organization established in the wakeofthe fire storm to coordinate a networkofexisting neighborhood organizations in the devastated hillside communities. The Phoenix Coordinating Council established a newsletter,The Phoenix Journal,to disseminate critical informationtoarea residents and to serveasa voice in influencing government agencies and insurers. The Phoenix organizations, for example, attempted to influence building codes and architectural policiesoflocal government development and planning councils.RECOMMENDATIONSThe resultsofthis study clearly indicate that mental health and other human services were delivered in a timely fashion in the aftermathofthe East Bay Fire. There were, however,12
problem areas that included:1)inadequate pre-disaster planning, 2) lackofcoordination, 3) communication difficulties between and within systems in the areaoftechnical communication, 4) information-sharing between systems regarding the timing and locationofthe mental health service response, and5)coordinationofvolunteer efforts.Onthe basisofour analysis,werecommend that:1)Public mental health agencies and non-profit organizations providing counseling should identify clearly in their pre-disaster planning activities their jurisdiction, role and activities.2)Better coordination is necessary within and between systems during the immediate period following a disaster to assure more effective allocationofresources and deliveryofservices to the community. 3) Inasmuch as all the agencies reported a lackoftelephone linkages within and external to these organizations, they should assess problem areas on the basisofall past disaster experiences and obtain technical assistance in order to improve emergency communications capabilities. 4) Pre-disaster guidelines shouldbeestablishedtoassure essential networking capabilities within the mental health system and optimal information-sharing regarding the allocationofresources and services during a disaster. 5) A volunteer coordinator position shouldbebuilt intoanorganization's disaster plan, and a screening committeeestablished that would include representatives from local professional organizations.ACKNOWLEDGMENTSThis study was supported by a grant from the Natural Hazard Research and Applications Information Center, the National InstituteofMental Health and the National Science Foundation. The authors gratefully acknowledge the assistanceofThe Public Health FoundationofLos Angeles County. Norman FarberowofSuicide Prevention Center/Farnily ServiceofLos Angeles assisted in the designofthe study and critically reviewed the research instrument and the final manuscript. Brian Flynnofthe National InstituteofMental Health critically reviewed the research instrument. Linda Fainofthe StateofCalifornia DepartmentofMental Health, William O'Callahanofthe American Red Cross, and Sandra Pyerofthe East Bay Community Foundation helpedusto develop our sampleofkey informants and the expert review panel. We would like to thank Nancy Fernandezofthe Alameda County DepartmentofMental Health, Sam Gerson and Chic Dabbyofthe Psychological Services Center/California SchoolofProfessional Psychology, Steve LustigofUniversity Health ServicelUniversityofCalifornia, Berkeley, Greg O'Ryon, Deborah Moore and Ruby Kamaka of the American Red Cross, Herbert Schreierofthe DepartmentofPsychiatry, Children's Hospital-Oakland, Carole Watsonofthe Alameda County United Way, David Weeofthe CityofBerkeley Mental Health Services, and Yigal Ben-HaimofAlta Bates-Herrick Hospital Bum Center for their cooperation during various phasesofthe research.13