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In the aftermath of Hurricane Helene, two McNabb Center locations put boots on the ground to assist survivors and their families in overcoming devastating challenges from a disaster like no other. Within days of the storm’s wake, Cocke County Center staff and Hamblen County Center staff set up shop with the Federal Emergency Management Agency (FEMA) and Tennessee Emergency Management Agency (TEMA) for a Tennessee Immediate Services Program (ISP). The ISP is a short-term grant program to provide states, territories, and tribes with additional support to address the behavioral health needs of disaster survivors. Tennessee’s ISP, which ran from October 2, 2024, to February 6, 2025, was set up to restore a sense of stability to the lives of those who had survived the hurricane.

Since the majority of the survivors in both counties were also farmers, it created another barrier for services—isolation from people and needed resources. Today, McNabb staff members continue to drive the distance to the homes, farms, and businesses of survivors since starting its Regular Services Program (RSP) services, which began on February 17, 2025, and will continue until November 16, 2025. The RSP is another grant program to provide state-level supplemental support to address disaster behavioral health needs. The ISP and RSP are part of the Crisis Counseling Assistance and Training Program (CCP).

For both Hamblen and Cocke counties, this population is unique not only because survivors have lost family homes, but many have also experienced the loss of millions of dollars of crop income and livestock revenue that cannot be replaced quickly, if at all. The investment of their future crop income remains uncertain and varies depending on the storm’s extremity of rainfall and swelling of riverbeds in the designated disaster areas.

In preparation for aiding disaster response and recovery, McNabb Center staff received FEMA training and CCP online training, which was a first for the Hamblen Center staff. “CCP’s mission is to assist individuals and communities in recovering from the psychological effects of disasters through the provision of community-based outreach and educational services. Services are provided at no cost and are available to any survivor who has been impacted by the disaster,” explained Shellie Hall, Executive Director, Sevier and Cocke County Services. With the information gleaned during CCP training and understanding their specific service areas, the McNabb Center developed specific program plans of action.

For the Hamblen County Center, their plan reached each of its surrounding counties of Hawkins, Greene, Claiborne, Jefferson, and Grainger. The Cocke County staff also began serving its surrounding counties and those areas hit hardest of all: Bybee, Denton, Del Rio, downtown Cocke County, Edwina, Fugate, Mosheim, Parrottsville, Hartford, Cosby, and the Highway 73 area.

 “Resources are so hard to find because it is so rural,” said Jerri Little, Master’s Level Team Lead, explaining the lack of resources as the biggest obstacle for Cocke County area survivors during and following the storm. Yet for McNabb Hamblen, the largest difficulty is getting information about its services in front of storm-torn residents because of their widespread geographical distance away from the McNabb Center and even their own friends and neighbors.

Since the majority of people living in these devastated areas are older adults (approximately 80 percent for Cocke County), it compounds their need for help from others. Many farmers are unable to remove debris or restore areas alone because of their aging-related physical limitations, which increases the hardship of living in rural areas with few resources.

“The farms affected in our area were generational farms,” said Patricia Saylor, Comp. Child and Family Treatment (CCFT) Team Leader. Farm owners who are older adults, many of whom are raising their grandchildren, are often unwilling to ask for mental health services due to the stigma it carries. An older adult population of farmers brings additional challenges to the mental health spectrum such as “farmer pride,” a work ethic that does not ask for help; “survivor pride,” the belief that others need help more than themselves; and “storm triggers,” the fear of a devastating storm every time it rains. Finding emotional stability is why “our focus is building the relationship, and then making sure they have the correct resources,” explained Saylor.

Initially in the ISP timeframe, the TDMHSAS (Tennessee Department of Mental Health and Substance Abuse Services) requested that the McNabb Center provide the CCP to Cocke and Hamblen Counties. Once the TDMHSAS notified the Center of the award, its leadership worked with the Human Resources department to promote employees working PRN (pro re nata), or “as needed,” who could work on call and extra hours to serve those impacted by the floods. For Hamblen County, a joint effort took place at the Disaster Recovery Center (DRC) located in the old Morristown power building. The DRC staffed McNabb employees who worked 12-hour days 7 days a week with FEMA and TEMA personnel.

One Hamblen staff member created a web page that included every resource available in the county, mental health or otherwise, to combat the lack of information in remote areas. In addition to the resource web page linked to a QR code, a printed community resource booklet and magnetic chip clips made to hold Center informational brochures were distributed.

Since Cocke County was awarded the 2024 CCP after the 2016 Gatlinburg wildfires and after the 2020 pandemic, the Center had prior experience to providing community-focused survivor support. McNabb Cocke leadership responded to the TDMHSAS request by providing immediate support with Cocke County PRN employees at the Multi-Agency Resource Center (MARC), which opened days after the catastrophe. Some residents who were disabled, unable to drive, had lost everything they owned, or were homeless due to flooded rental homes came to the MARC and received support and help from McNabb staff members.

Additionally, many rural areas, such as Del Rio, lost cell service. “The Tech Backpack was provided to McNabb staff at the MARC to allow access to the internet,” stated Little. The battery-operated backpack provided Wi-Fi at the MARC and later in the community when Cocke staff used it to connect survivors to services and resources when service was out of range or down due to the storm.

Although the focus of the Centers’ staff stayed on mitigating stress, promoting the use or development of coping strategies, and providing emotional support, they also supplied resources with information about temporary housing; cleanup efforts; construction projects; transportation; health care; food pantries; and financial, insurance, and legal services.

Once the MARC and DRC buildings closed and the RSP program period began, staff based in Hamblen and Cocke began driving to the homes and farms of the flood-affected residents. Their solution to the rural landscape and the distance between McNabb Centers and those needing assistance was to connect with survivors, often going door to door. “Many people are not willing to come into our Center for services but will gladly speak to someone if they stop by,” said Saylor.

For those homeowners who were not present when McNabb staff visited, the team took steps to bridge the information gap. “We stuffed the chip clips with information in them, and they stuck on the front doors of homes,” said Saylor.

Besides home visits for the CCP program, the Hamblen McNabb staff have set up at local community events to distribute informational pieces too. They have created events and participated in community activities, such as the local farmers’ market and Department of Human Resources (DHR) Fun Day, to publicize Center services.

Currently, eight staff members from Hamblen County Outpatient Center are designated to talk with people in the community and work to find and schedule resources and services for residents.  All case managers of McNabb Hamblen have a copy of the QR code and give it to their clients, survivors or otherwise, who are in need. Staff members continue to update information on the community resource website knowing that healing from a natural disaster is a process. “Eventually the busyness stops, and our services will pick up,” said Saylor. “Once you have recouped what you can, and things have slowed down, then your mind has slowed down enough to be able to process the devastation.”

Following the closure of the MARC, McNabb Cocke staff formed teams of two to visit survivors house by house and provide them with emotional support, assist them with accessing resources, and work with them to support their recovery. “Our teams use walkie-talkies in the areas with no cell service when making visits because we just don’t stop, we meet them where they are . . . our team will sit and provide emotional support, continue to build rapport with them, and then they are not afraid to ask for assistance,” explained Little. This process takes time, but it is worth the effort if it can change the mindset of those unwilling to ask for help, especially for older generations.

McNabb Cocke ran a billboard campaign (one digital and two printed billboards running from between 3 and 12 months); made a Facebook page; created a public service announcement with Kate Orem, Cocke County Services Coordinator; and distributed flyers listing its information and services to reach those in the county and the surrounding areas. “We would hand flyers out and take them to businesses and fire departments in the devastated areas,” said Little. “One woman said, ‘I held onto this flyer for 3 weeks my neighbor gave me and finally decided to call.’ She had taken in her grandchildren before the floods. Then they lost everything in a rental being affected by the floods . . . and we helped, and she had no heat, no air in a donated camper,” continued Little.

The McNabb Mobile Clinic offers another solution to rural barriers by serving some of the Cocke County survivors through meeting with them in their homes at least once a week. Staff are also involved in joining community events and creating a survivors’ group. “Getting these people together so that they know they are not alone and have some kind of communication with other like-minded individuals who have struggled with the same thing is so important,” said Little.

A large success in McNabb Hamblen has come from the use of a digital and printed resource booklet. “More and more people are using the QR code, the food pantry use has increased, and we use our work phones to show people information and screen shot our services,” said Saylor, who added they have received phone calls and visits because of residents scanning the code and using the booklets.

McNabb staff continues to locate resources and link community members together, in turn creating a stronger community in the devastated areas. For example, staff linked farm owners together to share equipment with one another. “Neighbors helping each other with equipment . . . they check on each other to make sure they are okay, they connect by a fence or a strip of land, one farm affected another farm, but they are all out there working together,” explained Saylor.

Sixteen CCP staff are working with 237 survivors located in Cocke County and its surrounding counties. To date, 14 survivors are receiving therapy services. For others on the survivor list, the staff is assisting with providing resources for food, clothing, cleaning supplies, utility resources, FEMA and Red Cross information, and even finding land tractors and farm equipment.

“We are trying to get their needs met. We are not miracle workers, we are difference makers. Whether it is big or small, all of our staff members make a difference,” said Little.