Course Pediatric Disaster Behavioral Health (PDBH) Toolkit

Children’s hospitals are central to their communities’ disaster resilience, yet without administrative preparedness, including clear policies, legal frameworks, financial systems, and partnerships, DBH programs cannot scale when crises occur. Strengthening these systems protects children and families while reducing operational and financial strain on hospitals by minimizing delays, mitigating liability, and preventing costly long-term impacts.

Administrative preparedness is the difference between a foreseeable surge the institution metabolizes and one that erodes capacity for 12 to 24 months afterward. Funded as a baseline cost of doing pediatric business, it is among the highest-leverage risk-mitigation investments available given the current trajectory of climate, infectious disease, and mass-violence events. If deferred, it converts every future disaster into a balance-sheet event, a regulatory event, and a workforce event.

This section outlines key administrative actions to support DBH response and recovery, offers strategic talking points for hospital executives, policymakers, and philanthropic partners, and identifies sustainable funding pathways to ensure long-term readiness.

STRATIFIED ADMINISTRATIVE ACTIONS BY HOSPITAL PROFILE

Children’s hospitals vary widely in their size, resources, and disaster exposure. For the purposes of this toolkit:

• “Low resource” refers to hospitals with limited pediatric behavioral health staffing or funding relative to their community’s potential needs.
  • Even a standalone children’s hospital can be “low resource” in relation to its catchment area.
• “High resource” refers to hospitals with infrastructures that can manage brief surges in volume without delays in care, have diversified funding, and maintain greater existing integration into regional or state systems.

While actions are stratified below, all hospitals should consider progressive adoption across profiles. These strategies should be informed by Hazard Vulnerability Analyses (HVAs) and After-Action Reports (AARs). These profiles are based on your local judgment. Ideally, hospitals can incorporate some preparedness actions from every profile.

Funding & Sustainability

Integrate DBH Into Standard Reimbursement Models

• Ensure coding/capture for trauma-informed care, group therapy, family-based interventions, and tele-psychiatry services. Train clinicians and revenue cycle teams to maximize reimbursement for disaster-related MH services. See the CPT/HCPCS Coding Reference for Pediatric Disaster Behavioral Health appendix.
• Value-Based Care Contracts: Include disaster MH outcomes (e.g., reduced ED boarding hours, decreased psychiatric readmissions) as quality metrics eligible for incentive payments.
• Bundled Payments: Embed DBH services into episode-based or bundled payments for pediatric trauma, mass casualty, or post-disaster recovery care.

Create a Behavioral Health Disaster Preparedness Cost Center

• Track avoided costs (ED throughput, staff turnover, extended LOS) to demonstrate return on investment to leadership.

Engage with Philanthropy and Social Impact Investing

• Explore endowed funds or community benefit investments earmarked for pediatric DMH surge and recovery.
• Partner with large local employers, insurers, and health foundations who have a vested interest in workforce stability and family resilience.

Structure Cost-Sharing with Adult Hospitals

• Regional Pooled Funds: Leverage hospital associations to structure a regional disaster MH fund that can be activated by multiple hospitals during an event, specifically for sustained community support.

Consider Revenue-Generating Programs

• Offer continuing education, workforce training (such as the TEEX Pediatric Disaster Response and Emergency Preparedness training), consultancy, and simulation exercises in pediatric disaster MH for other hospitals, schools, and agencies (fee-for-service model).
• Consider regional cost-sharing models for digital platforms and telehealth surge capacity, structured to ensure equitable access across resource-stratified facilities.

TALKING POINTS: WHY ADMINISTRATIVE PREPAREDNESS MATTERS

Communicate the value of disaster behavioral health administrative preparedness to different stakeholders:

Hospital Executives
Elevator pitch: “Behavioral health surge drives cost across the enterprise. Preparedness reduces ED boarding, improves throughput, lowers staff burnout, and protects reputation. Families value hospitals that recognize behavioral health as part of whole care. Investment now reduces avoidable long-term financial strain.”

Deeper dive: Behavioral health impacts the whole system of care. A prepared hospital avoids throughput delays, legal liability, mounting disruptions, and reputational risks while ensuring continuity of high-quality care. The operational cost of disaster behavioral health unpreparedness is most clearly understood through surges. CDC syndromic surveillance documented that the proportion of mental health–related ED visits rose approximately 24% among children aged 5 to11 and 31% among adolescents aged 12 to 17 during the COVID-19 pandemic compared with 2019. Hospitals that had pre-positioned pediatric behavioral health surge protocols, defined activation triggers, regional transfer agreements, and ED-embedded telepsychiatry navigated this surge with measurably better operational continuity. Hospitals without these preparations absorbed the same surge as unbudgeted overtime, locum coverage, lost elective margin, adverse events, and reputational exposure in pediatric markets where families exercise choice. Patients and their families respond positively to systems that prioritize their concerns, particularly during times of crisis, and assist their capacity to restore healthy functioning in the community. This will translate to stable patient growth and reliable care provision in the post-disaster business environment.

Public Policymakers

Elevator pitch: “Children’s hospitals are critical disaster infrastructure. With the right financial and regulatory tools, they prevent downstream costs in education, juvenile justice, and chronic illness, delivering a return on investment beyond the health care system.”

Deeper Dive: Because children’s hospitals are uniquely positioned to navigate the inherent complexity of an acute disaster, they are a key infrastructure in disaster response. When they have the appropriate regulatory and financial tools and policy, including Medicaid 1135 waivers, parity enforcement, state-level insurance, and scope of practice flexibility, they can promote behavioral health resiliency through access to effective care, while preventing downstream costs in education, juvenile justice, and chronic illness.

Philanthropic Partners

Elevator pitch: “Preparedness is a force multiplier. Administrative investments ensure donor dollars create real-world, scalable impact, strengthening equity and resilience. Supporting pediatric mental health after disasters is not only lifesaving; it positions donors as champions of community healing.”

Deeper dive: Strategic administrative investment ensures your dollars translate to real-world impact, to enhance equity and promote resilience. Communities reflect positively on major donors that prioritize their concerns, especially when the challenge is as urgent as pediatric behavioral health after an acute disaster. Actively funding care solutions that allow families to overcome traumatic events and emerge stronger post-disaster is a laudable achievement.

For additional resources and references, see the Crisis Services compiled by the National Association of State Mental Health Program Directors (NASMHPD) ⁴, this workshop summary from the Forum on Medical and Public Health Preparedness for Catastrophic Events⁵, this publication on Supporting Children’s Mental Health Needs in Disasters⁶, and this list of healthcare pediatric preparedness resources from the National Pediatric Disaster Coalition.