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Idaho Public Health & Health CareMental Health Preparedness Needs Assessment
Randal Beaton, PhD, EMT
NWCPHP Faculty
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Overarching Goal
Enhance the networking capacity and training of State of Idaho healthcare professionals to recognize, treat and coordinate care related to behavioral health consequences of bioterrorism and other public health emergencies.
HRSA critical benchmark #2-8
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Overview and Caveats
This session will repeat some of the material covered in the June 2004 Hot Topics presentation
Mental Health: Are We Ready?
Archived at URL: http://www.nwcphp.org/htip/20040623/
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“A bite of” approach
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Overview and Caveats (continued)
This session will help guide later iLinc trainings to be offered on a district-by-district basis
This and subsequent trainings are not designed to give participants disaster mental health counseling skills.
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Specific objectives of these trainings
To facilitate the integration of behavioral/mental health with overall disaster preparedness and response
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Specific objectives of these trainings
To facilitate the integration of behavioral/mental health with overall disaster preparedness and response
To assist ID state health professionals in planning for individual and community mental and behavioral reactions to disasters
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Specific objectives of these trainings
To facilitate the integration of behavioral/mental health with overall disaster preparedness and response
To assist ID state health professionals in planning for individual and community mental and behavioral reactions to disasters
To identify partners and resources for public health, EMS and hospital responders in ID for disaster mental health preparedness and response
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References mentioned today
Reference List is online at
www.nwcphp.org/edu/idaho_mh_prep.html
most reference materials are from online sources
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Mental Health: Are we ready?
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Public Health Preparedness Competencies
Links to competency sets atwww.nwcphp.org/comps
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Columbia Public Health Competency #7 indirectly addresses mental health preparedness---
Identify limits to own knowledge/skill/authority and identify key systems resources for referring matters that exceed these limits
Public Health Preparedness Competencies
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Mental Health Preparedness Competencies
Competencies for mental health preparedness and response for health professionals have not been defined at the national level to date
A CDC Mental health exemplar group is likely to address this deficit over the coming year
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Some Training Issues to Consider
Training needs of Public Health Workers, EMS, and Hospital Personnel are likely to be (considerably) different
Educational and experiential backgrounds of participants in this content arena are also likely to differ.
I have elected to initially cover some basic material for all trainees.
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iLinc Q&A tool using the following definitions for a 4 point response:
High = Topic should definitely be included Medium = Topic could be included, but lower priority Low = Topic is relevant, but need not high None = Topic not relevant
How we’ll collect your feedback
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Polling Results:
We will display the aggregate results for all participants anonymously
But Dr. Beaton will know who (i.e. which district) votes for each answer so that he can customize future trainings for the needs of each Idaho health district
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After collecting feedback on the prepared list of topics, a whiteboard will be used to create a list of any additional training needs & any district-specific needs
Using the Whiteboard
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Training Topics
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Topic 1: Psychological Phases of a Disaster
From Zunin & Myers (2000)
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i. Pre-disaster – threat/warning
ii. Impact – shock and recoil
iii. Rescue – heroic – (lasts days)
iv. Early recovery – honeymoon – (lasts 1 to 2 weeks)
Topic 1: Psychological Phases of a Disaster(continued)
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v. Mid-term recovery – disillusionment – (weeks to months)
vi. “Working through grief” – grief/set-backs – (months to years)
vii. Reconstruction – (years)
Topic 1: Psychological Phases of a Disaster(continued)
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Adapted From Bonanno (2004)
0
10
20
30
40
50
60
70
80
90
100
Event 2 Years
Dis
rupt
ion
ResilienceAcute/RecoveryAcute/ChronicDelayedCyclic
Topic 2: Temporal Patterns of Mental/Behavioral Responses to Disaster
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Topic 3: Resilience
Definition – ability to maintain relatively stable physical and psychological functioning (not the same as recovery)
Risk factors that deter: Job loss and economic hardship, loss of sense of safety, loss of sense of control, loss of symbolic or community structure
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Topic 3: Resilience (continued)
Protective factors that promote: social support and core ties, sense of self-efficacy, problem solving approaches to coping, positive belief system and successful search for meaning
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Topic 4: Signs and symptoms of Disaster Victims (and Rescue Personnel) who need a psychological evaluation
Suicidal or homicidal thoughts or plan(s) Inability to care for selfSigns of psychotic mental illness –
hearing voices, delusional thinking, extreme agitation
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Topic 4: Signs and symptoms of Disaster Victims(and Rescue Personnel) who need a psychological evaluation (continued)
Problematic use of alcohol or drugsMarital problems, domestic violenceHypersomnia or insomniaDisorientation – dazed, not oriented X 3
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Topic 5:
Mental Health Risks of Disaster workers including EMS and Rescue personnel
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0.00% 5.00% 10.00% 15.00% 20.00% 25.00%
US Urban Fire Fighters and Paramedics
British Ambulance Drivers
9/11 Rescue Workers
Wounded Combat Vietnam Vets
Canadian Fire Fighters
Iraq Combat Veterans (2004)
Vietnam Era Vets Overall
Crime Victims (US 1980's)
Community Male (Canada, 1990's)
Series2
Topic 5: Exemplar PTSD Rates
Modified from Corneil & Beaton, 1999
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Symptoms of stress that may be experienced during or after a traumatic incident
(from NIOSH Publication # 2002 – 107)
Topic 6:
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Physical
Chest pain*Difficulty Breathing*Shock symptoms*Fatigue
* Seek medical attention immediately
Topic 6: Symptoms of stress that may be
experienced during or after a traumatic incident
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Topic 7:
What are CISM and CISD? What are the risks and benefits?
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Topic 7: Critical Incident Stress Management
(CISM)
A multipart program that works to decrease the effects of Critical Incident Stress such as that stemming from a disaster
CISM’s benefits: emergency service peer-driven processmonitored by mental health professionalsPeers and mental health professionals are
cross-trained
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Debriefing Debriefing is a complex process led by
specially trained personnel and typically occurs 2-14 days after the event
Debriefing takes approximately 2-3 hours
This peer-driven process focuses on psychological and emotional aspects of the event.
Topic 7: Critical Incident Stress Debriefing (CISD)
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Topic 8:
Role of the Red Cross in Disaster Mental Health
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American Red Cross
American Red Cross “Counselors” do not provide treatment
Make Mental Health referrals Several Thousand American Red Cross
Counselors are available Serve as a support Agency
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Topic 9: Federal Response for MentalHealth Support
Captain Andy Stevermer
Emergency Coordinator
Office of Emergency Preparedness
U.S. Public Health Service, Region X
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Topic 9: Federal Response for Mental Health Support
Blueprint for Disaster Response
Declares a federal disaster
STATESTATE FEDERALFEDERAL
Request county aid
Local Healthcare Systems
Engaged
Governor
Mayor/County Executive
President
FEMA
Federal Response Plan Activated
Request state aid
Proclaims a state disaster and requests
federal aid
Disaster occurs
Local Mutual Aid
Implemented
Immediate Response through
DoD or DVA
Inter-County
Mutual Aid
LOCALLOCAL
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Captain Andrew C. StevermerEmergency Coordinator
CDCRegion X ATSDR1200 Sixth AvenueRoom 1930 (ATS-197)Seattle, WA 98101
Telephone: (206) 553 1698Cell: (206) 396 1180Fax: (206) 553 2142E-mail: [email protected]
Contact for Federal Response – Mental Health Support
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Topic 10:
Principles of Psychological Needs Assessment Post-disaster
i.
Nature – Psychological Typology of Disasters,
ii. Scope and severity of the disaster
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Topic 10: Principles of Psychological Needs Assessment Post-disaster
NaturalMan-made
Technological Biological
UnintentionalFloods, Hurricanes, Earthquakes, etc.
e.g., Bhopal, Haz-Mat, Nuclear Power plant accident
Epidemic e.g., 1918 Influenza Pandemic
Intentional“Act of God” Chemical,
Nuclear, Radiological, Explosion, Acts of Terrorism
Bioterrorism
Types of Disasters
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Topic 10: Principles of Psychological Needs Assessment Post-disaster (continued)
DeWolf’s “Bulls-eye” Exposure Model
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DeWolfe, see SAMHSA publication
Topic 10: Principles of Psychological Needs Assessment Post-disaster
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A. Seriously injured victims bereaved family members
B. Victims with high exposure to trauma victims evacuated from the disaster zone
C. Bereaved extended family members and friends rescue and recovery workers with prolonged exposure medical examiner’s office staff service providers directly involved with death notification and bereaved families
DeWolfe: A - C
Topic 10: Principles of Psychological Needs Assessment Post-disaster (continued)
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Topic 11: Vulnerable populations
i. Current psychiatric patientsii. Prior psychological disordersiii. Prior traumatic exposuresiv. The very youngv. The elderlyvi. Chronically illvii. Native American tribes
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Supporting Children at Times of Disaster
Hot Topics in Preparedness archive
by David J. Schonfeld, MD, Head of Developmental-Behavioral PediatricsYale University School of Medicine
Online at URL:
http://www.nwcphp.org/htip/20040913/
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Topic 12:
What are the goals of an All-Hazards Mental Health State Disaster Plan
Reference URL: http://media.shs.net/ken/pdf/SMA03-3829/All-HazGuide.pdf
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Topic 12: Goals of an All-Hazards State Mental Health Disaster Plan?
Serve as the basis for effective response to any hazard that threatens any jurisdiction;
Facilitate the integration of mitigation into response and recovery activities
Facilitate coordination with the federal government during catastrophic disaster situations.
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Topic 13: Basic Principles of Post-Disaster Approaches to Mental Health
NORMALIZE – most psych/behavioral reactions are “normal” and transient
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Shock/recoil/denial – momentaryDerealization – not real/feels surrealDepersonalization – “out of body”Difficulties concentrating, staying on task “Some” anxiety and apprehension
What are Normal Reactions to Disasters?
Topic 13: Basic Principles of Post-Disaster Approaches to Mental Health
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“Some” distress and dysthemia “Some” angerTemporary increase in “Achilles heel”
medical stress symptoms, e.g. headache, GI
Posttraumatic reactions – re-experiencing and staying away from reminders
What are Normal Reactions to Disasters?(continued)
Topic 13: Basic Principles of Post-Disaster Approaches to Mental Health
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Topic 14:
Basic principles of early interventions – PIE: proximity, immediacy, expectancy
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Traumatic Incident Stress:
Information for Emergency Workers:
NIOSH Guidelines
http://www.cdc.gov/niosh/unp-trinstrs.html
Topic 15: Psychological “First Aid”
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Topic 15: Psychological “First Aid”
i. Support and presence
ii. Screen/refer
iii. Keep families together
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Topic 16:
Rural Mental Health Preparedness versus Urban Settings
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Topic 16: Rural Mental Health Preparedness
Lower perceived risk of BT (vs. rural areas are the perfect demonstration project for a terrorist incident)
Evacuation issuesPotential for terror induction may be greater
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Topic 17:
Benefits of Training and Drills for First Responders and Disaster Personnel
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DP Trained?
YesNo
DP
Q T
ota
l S
co
re
18
17
16
15
14
13
12
11
10
Pre-training
4mo. Post-training
Pre-training
4 mo. Post-training
Results of Domestic Preparedness QuestionnaireFrom Beaton & Johnson (2002)
Topic 17: Benefits of Training and Drills for First Responders and Disaster Personnel
To
tal D
PQ
Sco
re
DP Trained?
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DP Trained?
YesNo
Pe
rce
ive
d c
om
pe
ten
cy "
Bio
log
ica
l" 30
20
10
0
Pre-training
4mo. Post-training
Pre-training
4 mo. Post-training
Topic 17: Benefits of Training and Drills for First Responders and Disaster Personnel
Results of Domestic Preparedness QuestionnaireFrom Beaton & Johnson (2002)
Pe
rce
ive
d C
ompe
tenc
y to
Res
pon
d
to B
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DP Trained?
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Topic 18:
Multiple Unexplained Physical Symptoms (MUPS) in the Aftermath of Trauma and Disaster
![Page 64: Idaho Public Health & Health Care Mental Health Preparedness Needs Assessment Randal Beaton, PhD, EMT NWCPHP Faculty](https://reader035.vdocuments.site/reader035/viewer/2022062714/56649d4e5503460f94a2d516/html5/thumbnails/64.jpg)
Idaho Health Districts
District-Specific
Training Needs?
![Page 65: Idaho Public Health & Health Care Mental Health Preparedness Needs Assessment Randal Beaton, PhD, EMT NWCPHP Faculty](https://reader035.vdocuments.site/reader035/viewer/2022062714/56649d4e5503460f94a2d516/html5/thumbnails/65.jpg)
Any Other Topics?
![Page 66: Idaho Public Health & Health Care Mental Health Preparedness Needs Assessment Randal Beaton, PhD, EMT NWCPHP Faculty](https://reader035.vdocuments.site/reader035/viewer/2022062714/56649d4e5503460f94a2d516/html5/thumbnails/66.jpg)
Please evaluate today’s session
Please complete an online evaluation of this session – go to web page below & look for “Online Evaluation”
www.nwcphp.org/edu/idaho_mh_prep.html
![Page 67: Idaho Public Health & Health Care Mental Health Preparedness Needs Assessment Randal Beaton, PhD, EMT NWCPHP Faculty](https://reader035.vdocuments.site/reader035/viewer/2022062714/56649d4e5503460f94a2d516/html5/thumbnails/67.jpg)
Wrap-Up & Next Steps
Anonymous results of today’s needs assessment survey will be shared with all health districts
Dr. Beaton will use these results and work with local health districts to plan a series of Mental Health & Preparedness trainings in first part of 2005
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Thank You!