Medical Reserve Corps

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Medical Reserve Corps

• Disaster Mental Health
• Work Group Update

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Disaster Mental HealthWorkgroup Overview and
PurposeJohn K. Hickey, DSW, LCSW-RMental
Health Lead, Nassau County MRCNassau County,
N.Y. Department of Health
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Work Group Overview and Purpose

• This time last year
• The surgeon general
• The MRC Mental Health Work Group
• Purpose and goals
• The power of networking and collaboration

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Disaster Mental HealthCore CompetenciesEd
Kantor, MDAssistant Professor of Psychiatric
MedicineUniversity of Virginia School of Medicine
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Disaster Mental Health Core Competencies

• Goals of this section
• Gain Awareness of Competency Movement
• Understand Concept of
• Core Competencies
• Learn about MH Work Group Efforts

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Disaster Mental Health Core Competencies

• Gain awareness of the Core Competency Movement
• Arose in response to increased attention to the
  idea of Educational Outcomes in the 80s
• Dept of Education
• JCAHCO (Joint Commission)
• Medical Boards and State Legislatures
• Institute of Medicine Report
• This has taken hold, not only in Medicine, but
  Nursing, Public Health
• and other clinical disciplines.
• There are similarities in structure, although
  some slight differences
• in execution and terminology between each
  discipline.

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Disaster Mental Health Core Competencies

• Understanding the Concept of Competencies
• Competency implies an acceptable minimum standard
• Can aim higher, but must define the lowest
  acceptable points
• Requires measurement to determine acceptable
  performance
• Expectations can vary with role and position
• Levels Awareness, Technician, Practitioner,
  Master (trainer)
• Competencies require a minimum level of
• KNOWLEDGE - An Understanding of requisite
  information
• SKILL - Ability to perform activities acceptably
• ATTITUDE - Appreciation of roles, expectations
  and limits
• Cover Six Core Areas (some variations exist)
• Medical Knowledge, Patient Care, Interpersonal
  Communication Skills,
• Professionalism, Systems-Based Practice,
  Practice-Based Learning Improvement

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Disaster Mental Health Core Competencies

• Understand Concept of Competencies(cont)

• Six Core Areas
• -Professionalism
• -Systems-Based Practice
• -Practice-Based Learning
• and Improvement
• -Patient Care
• -Medical Knowledge
• -Interpersonal and Communication Skills

Some minor variation exists in core subject
areas between professions
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Disaster Mental Health Core Competencies

• Learn about MH Work Group Efforts
• Identifying and Defining Core Competencies for
  DMH
• Examples Position statement on Psychological
  Debriefing
• Linking Competency to Curricula, Training and
  Evaluation
• Defining Prerequisites, Minimum Standards,
  Reciprocity

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Disaster Mental Health Core Competencies

• Identifying and Defining Competencies for DMH
• General Areas of Attention
• Roles, Credentials and Job Actions in DMH
• Link Competencies to existing and developing
  curricula
• Identify and compare standard training programs
  reciprocity
• Identify strategies and resources for assessment
  and evaluation
• Identify minimum areas of expected Knowledge,
  Skill and Attitude

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Disaster Mental Health Core Competencies

• Identifying and Defining Competencies for DMH
• Identify minimum areas of expected Knowledge,
  Skill and Attitude
• Principles of Disaster and Disaster Mental
  (Behavioral) Health
• Communicating and Educating in a Crisis (risk
  communication, psychoeducation)
• Normal Reactions and Common Psychological Effects
• Abnormal Psychological Reactions
• Intervention and Treatment Strategies
  (prevention, early, intermediate, late)
• Scenario Specific MH Concerns (natural,
  industrial, violence, etc)
• Responder and Self-care MH issues

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Disaster Mental Health Core Competencies

• Linking Competency to Curricula, Training and
  Evaluation

Evaluation (certif., field obs, drills,)
Interacts in a neutral non-judgmental manner
Specific Competency Client Assessment
Skill
Understands MH Role and respects usual boundaries
Knowledge/Skill
-Taught in course -Expected from
certif. -Acquired under supervision
Exhibits behaviors needed to work as a member of
a team
Attitude
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Disaster Mental Health Core Competencies

• Prerequisites, Minimum Standards, Reciprocity
• What are is the minimum training expectations?
• Integrating Disciplines (LPC, LCSW, Psychiatrist,
  Psychologist, etc)
• Crediting Experience (work history, specialty
  certification, etc)
• Course Completion (reciprocity, continuing
  education, etc)
• Licensure (state specific)
• Privileging and Supervision (local ?, integrating
  students and other trainees)

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Disaster Mental Health Core Competencies

• Disaster Preparedness and Public Health
• Credentialing, Privileging and Supervision
• Systems-Based Practice of Care
• Public Education and Preparedness
• Recognition of Training and Reciprocity Between
  Courses
• Teaching and Mentoring
• Response Interventions
• Professionalism, Boundaries and Attitudes
• Awareness of Standards and Practices (Knowledge)
• Possession of Minimal Skills (Patient Care)

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Disaster Mental Health Core Competencies

• Response Interventions cont.
• Individual Interventions (Patient Care)
• Assessment and Referral
• Emergent Interventions
• Acute Interventions
• Longer Term Interventions
• Child Specific Interventions
• "At-Risk and Special Populations
• Unique needs of responders
• Community Interventions (Systems)
• Surveillance and Outreach
• Consultation on programming and interventions
• General Support to Command and Community

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Disaster Mental HealthTrainingJack Herrmann,
MSEd, LMHCAssistant ProfessorUniversity of
Rochester School of Medicine Dentistry
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Disaster Mental Health Training

• Selection of Team Members
• Recruitment of Mental Health Professionals
• Selection of Training Curricula
• Matched against a set of core competencies
• Evidence-informed
• One size fits all vs Training Menu
• One time vs. on-going
• Acute Intermediate Long Term Interventions

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Disaster Mental Health Training

• A variety of disaster mental health trainings
  available in the public and private domain
• On-site
• On-line
• Hybrid

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Disaster Mental Health Training
American Red Cross/ICRC
DHHS/SAMHSA
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Disaster Mental Health Training
New York State/University of Rochester
Commonwealth of Virginia
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Disaster Mental Health Training
Center for Disaster Epidemiology and Emergency
Harvard Medical International
National Rural Behavioral Health Center at the
University of Florida
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Disaster Mental HealthPsychologicalFirst
AidPatricia Santucci, MDAssociate Professor of
Psychiatry?Stritch School of Medicine
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Psychological First Aid Field Operations
GuideMedical Reserve Corps National Child
Traumatic Stress NetworkNational Center for PTSD
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What is Psychological First Aid

• An evidence-informed modular approach to assist
  children, adolescents, adults and family in the
  immediate aftermath of disaster or terrorism
• Designed to reduce the initial distress caused by
  traumatic events
• Foster short and long term adaptive functioning
  and coping

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PFA disclaimer

• Has received considerable support from disaster
  mental health experts as the acute intervention
  of choice
• Many of the components have been tested and
  validated
• Consensus is at this time should at worse,
  produce no harm at best, provide effective ways
  to manage post-disaster stress and identify those
  that need additional psychological support
• No model to date has empirically validated or
  rigorously tested the efficacy of this supportive
  intervention and resultant outcomes are unknown

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Who is PFA For ?

• Individuals experiencing acute stress reactions
  or who appear to be at risk for significant
  impairment in functioning

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Who Delivers PFA?

• All members of the MRC who provide acute
  assistance as part of the organized disaster
  response

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When Should PFA be used?

• Supportive behavioral intervention for use in the
  immediate aftermath of disasters and other
  traumatic events
• Intended to blend into the MRC response structure
  early in stabilization and recovery efforts

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Where Should PFA Be Used?

• Designed for delivery in diverse settings

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MRC Delivery Sites and Settings

• Shelters
• Respite Centers
• Hospital-ER, Field
• Service Centers
• Emergency Operations Centers
• Community Outreach Teams
• First Aid Stations
• Phone banks- hotlines
• PODS
• Staging Areas

• Family Reception Centers
• Family Assistant Centers
• First Responders and Disaster Relief Personnel
  units
• Schools
• Following WMD events
• Mass casualty collection points
• Field post decontamination sites
• Mass prophylaxis sites

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Strengths of PFA

• Relies on field tested, evidence-informed
  strategies
• Includes basic information gathering techniques
  to help make rapid assessment of what is needed
  and what to do
• Guidelines for delivery and concrete examples
• Developmentally and culturally appropriate
  interventions for survivors of various ages and
  backgrounds
• Includes important elements of risk
  communication, behaviors to avoid and education
  via use of materials and handouts
• Easy access- on line

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PFA Core Actions

• Contact and engagement
• Safety and comfort
• Stabilization ( if needed)
• Information gathering Current needs and concerns
• Practical assistance
• Connection with social supports
• Information on coping
• Linkage with collaborative services

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Contact and Engagement

• Establish a connection in a non-intrusive
  compassionate manner
• Adult/caregiver
• Hi, my name is Pat. Im with the Medical Reserve
  Corps. Were checking with people to see if we
  can be of any help.
• Is it ok if I talk to you for a moment? May I ask
  your name? Mrs. Williams, before we talk, is
  there something right now that you need, like
  water or juice?
• Adolescent/ child
• And is this your daughter? ( Get on childs eye
  level, smile and greet child , using his/her name
  and speaking softly) Hi Lisa, Im Pat and Im
  here to try to help you and your family. Is there
  anything you need right now?
• There is some water and juice over there , and we
  have a few blankets with toys in those boxes

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Safety and Comfort

• Enhance immediate and ongoing safety, and provide
  physical and emotional comfort
• Basic Needs

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Stabilization

• Calm and orient emotionally overwhelmed or
  disoriented survivors
• Signs and symptoms
• What to do

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Information Gathering Current Needs and Concerns

• Identify immediate needs and concerns
• Gather additional information as appropriate to
  the situation

• Goals of informal assessment
• Assessment caveats
• Educational points
• Differences in family reactions
• Trauma reminders
• Loss reminders
• Trauma development
• Educational caveats
• Content areas

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Information GatheringCurrent Needs and Concerns

• Provider alerts
• Examples
• Avoid asking for in-depth descriptions of
  traumatic experiences, as this may provoke
  unnecessary additional stress
• Avoid blanket reassurance that stress reactions
  will disappear. This may set up unrealistic
  expectations, resulting in negative views of self
  if reactions persists.

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Practical Assistance

• Offer practical assistance and information to
  address survivors immediate needs and concerns
• Identify
• Clarify
• Discussion action
• Act

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Connection with Social Supports

• Connect survivors as soon as possible to social
  support providers, including family , friends and
  community helping resources
• The most positive results from early
  interventions are usually for those that mobilize
  community support and address survivors human
  affiliation needs ( eg. helping survivors
  establish contact with relatives) rather than
  interventions that focus on individual
  psychological reactions.
• Orner, Kent, Pfefferbaum, Watson The Context of
  Providing Immediate Post Intervention In
  Ritchie, Watson, Friedman (eds) Intervention
  Following Mass Violence and Disaster. New York
  The Guildford Press, 2006

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Information on Coping

• Provide the individual with information that may
  help him/her with the event and its aftermath

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Information on Coping

• Provide information about stress and coping to
  reduce distress and promote adaptive functioning
• Basic information about stress reactions
• Ways of coping
• Positive coping
• Negative coping
• Demonstrate Simple Relaxation Techniques
• Developmental issues
• Highly negative emotions
• Sleep
• Hygiene
• Anger management
• Substance abuse

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Linkage with Collaborative Services

• Possible indications for referral
• Making a referral

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Appendix MRC Debriefing Position Statement

• Recommendations
• Because of the possibility of harm to individual
  participants ,Psychological Debriefing should
  NOT be a standard part of the mental health
  response in crisis and disaster situations
• Mandatory or required psychological
  interventions should not be applied across the
  board to survivors or responders following
  disaster

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Appendix Resources

• Training Resources
• Issues and populations of special consideration
• Disaster relief organizations, agencies and
  programs
• Planning tools and technical resources
• Risk communication

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AppendixHandouts

• Tips for helping preschool children
• Tips for helping school age children
• Tips for helping adolescents
• Connecting with others- seeking social support
• Connecting with others- giving social support
• When Terrible Things Happen
• Basic Relaxation exercises
• Alcohol and Drug use after disasters

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Additional Appendices

• Special Considerations for Acutely Bereaved
  Individuals
• Service Site Challenges
• More to come..

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Take Home Message

• PFA is the acute intervention of choice
• Supported by the MRC as a basic teaching resource
  for ALL MRC MEMBERS !
• Supports position paper do not debrief
• Easy access- MRC website
• Can be carried in GO BAG as a Field Manual
• Will be continuously updated and expanded
• MRC feedback critical

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The End

• If you are interested in learning more about the
  National Disaster Mental Health Work Group
• Please visit the mental health table at the
  Conference
• E-mail santucci_at_pol.net
• drjohnkhickey_at_optonline.net
• Special acknowledgement to Jim Shultz PhD,
  Director of DEEP, for graphic assistance