Anticipated Controversies Critical Incident Stress Debriefing (CISD) – and efficacy of early intervention Rural Mental Health Preparedness Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org

Rural Mental Health Preparedness Lower perceived risk of BT (vs. we are the perfect demonstration project for a terrorist incident) Evacuation issues – coming and going Potential for terror induction may be greater Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org

HOW DO YOU DEVELOP RESILIENT COMMUNITIES? Treat the public as a capable ally (pre-event) Education – Public Service announcements Risk Communication (post-event) Provide training/drills/education for “First Responders” Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org

First Responder and Provider Disaster Training/Drills/Education enhances knowledge and confidence. Good News Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org

“You can observe a lot by watching” (Berra, 1998) Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org

Dress rehearsal at Harborview NDMS drill (May 13, 2004) Dress rehearsal at Harborview Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org

NDMS drill (May 13, 2004) DeCon at Harborview Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org

DOD Preparedness Training for First Responders Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org

From Beaton & Johnson (2002) Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org

From Beaton & Johnson (2002) Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org

Systems Issues Gaps include: Currently may not be able to meet community psychological needs in the event of a disaster Gaps include: Training and preparedness of mental health providers Coordination of agencies and services Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org

Systems Issues continued Identification of mental health preparedness competencies Knowledge and evidence based services Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org

“Relationships are primary, all the rest is derivative.” (David, 2000) Interagency Cooperation Coordination Communication Collaboration Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org

And Planning Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org

Level 1 Disaster Localized disaster, the effects of which can be managed within existing resources (<20 referrals) Caller referred to current provider or appropriate resource -walk-in appt -next day appt -outreach Red Cross responds & notifies Crisis Services Red Cross provides services & victims referral information Victim calls Crisis Clinic Needs Assessment: -numbers? -walk-ins? -on site response? -phone support? Teams of 2-3 people dispatched to identified sites Resource information communicated to Crisis Clinic Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org

Level 2 Disaster MH needs exceed existing MH resources Presidential Disaster Declaration, FEMA grants State MHD collects info on scope of disaster & needed response Data collected: MH infrastructure damage; # of people served; # or visits provided; Types of referrals Multi-county disaster, EOC activated Needs assessment via EOC, Red Cross, State MH, etc Providers mobilized, response teams assembled Are out-of facility services needed? Teams dispatched to identified sites-shelters, recovery centers, churches, clinics, schools Services provided at designated provider sites (1-3 visit model) Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org

And Drills Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org

TopOff 2 State-Local-Federal Coordination Law Enforcement vs. Human Services Response Risk/Benefit Analysis Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org

TopOff 2 Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org

A View from the Bottom Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org