Idaho Public Health

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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/2004
0623/
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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 at www.nwcphp.org/comps
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Public Health Preparedness Competencies

• 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

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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 QA tool using the following definitions
for a 4 point response
How well collect your feedback

• 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

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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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Topic 1 Psychological Phases of a
Disaster(continued)

• Pre-disaster threat/warning
• Impact shock and recoil
• Rescue heroic (lasts days)
• Early recovery honeymoon (lasts 1 to 2 weeks)

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Topic 1 Psychological Phases of a
Disaster(continued)

• Mid-term recovery disillusionment (weeks to
  months)
• Working through grief grief/set-backs
  (months to years)
• Reconstruction (years)

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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 self
• Signs 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 drugs
• Marital problems, domestic violence
• Hypersomnia or insomnia
• Disorientation 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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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
Topic 6 Symptoms of stress that may
be experienced during or after a traumatic
incident

• Chest pain
• Difficulty Breathing
• Shock symptoms
• Fatigue
• Seek medical attention immediately

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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
• CISMs benefits
• emergency service peer-driven process
• monitored by mental health professionals
• Peers and mental health professionals are
  cross-trained

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Topic 7 Critical Incident Stress Debriefing
(CISD)

• 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.

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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
SupportBlueprint for Disaster Response
Declares a federal disaster
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Contact for Federal Response Mental Health
Support
Captain Andrew C. StevermerEmergency
Coordinator CDCRegion X ATSDR1200 Sixth
AvenueRoom 1930 (ATS-197)Seattle, WA
98101 Telephone [phone]Cell (206) 396
1180Fax [phone]E-mail
stevermer.andrew_at_epa.gov
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Topic 10

• Principles of Psychological Needs Assessment
  Post-disaster
• Nature Psychological Typology of Disasters,
• Scope and severity of the disaster

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Topic 10 Principles of Psychological Needs
Assessment Post-disaster
Types of Disasters
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Topic 10 Principles of Psychological Needs
Assessment Post-disaster (continued)
DeWolfs Bulls-eye Exposure Model
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Topic 10 Principles of Psychological Needs
Assessment Post-disaster
DeWolfe, see SAMHSA publication
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Topic 10 Principles of Psychological Needs
Assessment Post-disaster (continued)
DeWolfe A - C

• Seriously injured victims ? bereaved family
  members
• Victims with high exposure to trauma ? victims
  evacuated from the disaster zone
• Bereaved extended family members and friends ?
  rescue and recovery workers with prolonged
  exposure ? medical examiners office staff ?
  service providers directly involved with death
  notification and bereaved families

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Topic 11 Vulnerable populations

• Current psychiatric patients
• Prior psychological disorders
• Prior traumatic exposures
• The very young
• The elderly
• Chronically ill
• 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/SMA0
  3-3829/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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Topic 13 Basic Principles of Post-Disaster
Approaches to Mental Health
What are Normal Reactions to Disasters?

• Shock/recoil/denial momentary
• Derealization not real/feels surreal
• Depersonalization out of body
• Difficulties concentrating, staying on task
• Some anxiety and apprehension

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Topic 13 Basic Principles of Post-Disaster
Approaches to Mental Health
What are Normal Reactions to Disasters? (continued
)

• Some distress and dysthemia
• Some anger
• Temporary increase in Achilles heel medical
  stress symptoms, e.g. headache, GI
• Posttraumatic reactions re-experiencing and
  staying away from reminders

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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 WorkersNIOSH Guidelineshttp//www.cdc
.gov/niosh/unp-trinstrs.html
Topic 15 Psychological First Aid
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Topic 15 Psychological First Aid

• Support and presence
• Screen/refer
• 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 issues
• Potential 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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Topic 17 Benefits of Training and Drills for
First Responders and Disaster Personnel
Results of Domestic Preparedness
QuestionnaireFrom Beaton Johnson (2002)
Total DPQ Score
DP Trained?
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Topic 17 Benefits of Training and Drills for
First Responders and Disaster Personnel
Results of Domestic Preparedness
QuestionnaireFrom Beaton Johnson (2002)
Perceived Competency to Respond to Biological
Disaster
DP Trained?
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Topic 18

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

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Idaho Health Districts
District-Specific Training Needs?
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Any Other Topics?
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Please evaluate todays 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

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Wrap-Up Next Steps

• Anonymous results of todays 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!