Idaho Public Health & Health CareMental Health Preparedness Needs Assessment

Randal Beaton, PhD, EMT

NWCPHP Faculty

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

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/

“A bite of” approach

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.

Specific objectives of these trainings

To facilitate the integration of behavioral/mental health with overall disaster preparedness and response

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

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

References mentioned today

Reference List is online at

www.nwcphp.org/edu/idaho_mh_prep.html

most reference materials are from online sources

Mental Health: Are we ready?

Public Health Preparedness Competencies

Links to competency sets atwww.nwcphp.org/comps

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

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

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.

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

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

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

Training Topics

Topic 1: Psychological Phases of a Disaster

From Zunin & Myers (2000)

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)

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)

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

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

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

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

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

Topic 5:

Mental Health Risks of Disaster workers including EMS and Rescue personnel

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

Symptoms of stress that may be experienced during or after a traumatic incident

(from NIOSH Publication # 2002 – 107)

Topic 6:

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

Topic 7:

What are CISM and CISD? What are the risks and benefits?

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

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)

Topic 8:

Role of the Red Cross in Disaster Mental Health

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

Topic 9: Federal Response for MentalHealth Support

Captain Andy Stevermer

Emergency Coordinator

Office of Emergency Preparedness

U.S. Public Health Service, Region X

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

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: stevermer.andrew@epa.gov

Contact for Federal Response – Mental Health Support

Topic 10:

Principles of Psychological Needs Assessment Post-disaster

i.

Nature – Psychological Typology of Disasters,

ii. Scope and severity of the disaster

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

Topic 10: Principles of Psychological Needs Assessment Post-disaster (continued)

DeWolf’s “Bulls-eye” Exposure Model

DeWolfe, see SAMHSA publication

Topic 10: Principles of Psychological Needs Assessment Post-disaster

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)

Topic 11: Vulnerable populations

i. Current psychiatric patientsii. Prior psychological disordersiii. Prior traumatic exposuresiv. The very youngv. The elderlyvi. Chronically illvii. Native American tribes

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/

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

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.

Topic 13: Basic Principles of Post-Disaster Approaches to Mental Health

NORMALIZE – most psych/behavioral reactions are “normal” and transient

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

“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

Topic 14:

Basic principles of early interventions – PIE: proximity, immediacy, expectancy

Traumatic Incident Stress:

Information for Emergency Workers:

NIOSH Guidelines

http://www.cdc.gov/niosh/unp-trinstrs.html

Topic 15: Psychological “First Aid”

Topic 15: Psychological “First Aid”

i. Support and presence

ii. Screen/refer

iii. Keep families together

Topic 16:

Rural Mental Health Preparedness versus Urban Settings

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

Topic 17:

Benefits of Training and Drills for First Responders and Disaster Personnel

DP Trained?

YesNo

DP

Q T

ota

l S

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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

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PQ

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DP Trained?

DP Trained?

YesNo

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Bio

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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

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Res

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to B

iolo

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DP Trained?

Topic 18:

Multiple Unexplained Physical Symptoms (MUPS) in the Aftermath of Trauma and Disaster

Idaho Health Districts

District-Specific

Training Needs?

Any Other Topics?

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

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

Thank You!