Idaho Public Health & Health Care Mental 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:

“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 most reference materials are from online sources

Mental Health: Are we ready?

Public Health Preparedness Competencies Links to competency sets at

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)

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 self  Signs 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 drugs  Marital problems, domestic violence  Hypersomnia or insomnia  Disorientation – dazed, not oriented X 3

Topic 5:  Mental Health Risks of Disaster workers including EMS and Rescue personnel

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 process  monitored by mental health professionals  Peers 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 Mental Health 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 disasterSTATEFEDERAL 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 AidLOCAL

Captain Andrew C. Stevermer Emergency Coordinator CDC Region X ATSDR 1200 Sixth Avenue Room 1930 (ATS-197) Seattle, WA Telephone: (206) Cell: (206) Fax: (206) 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 Natural Man-made TechnologicalBiological Unintentional Floods, 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 patients ii. Prior psychological disorders iii. Prior traumatic exposures iv. The very young v. The elderly vi. Chronically ill vii. Native American tribes

Supporting Children at Times of Disaster Hot Topics in Preparedness archive by David J. Schonfeld, MD, Head of Developmental- Behavioral Pediatrics Yale University School of Medicine Online at URL:

Topic 12: What are the goals of an All-Hazards Mental Health State Disaster Plan Reference URL: 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 – momentary  Derealization – not real/feels surreal  Depersonalization – “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” anger  Temporary 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 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 issues  Potential for terror induction may be greater

Topic 17:  Benefits of Training and Drills for First Responders and Disaster Personnel

Pre-training 4 mo. Post-training Results of Domestic Preparedness Questionnaire From Beaton & Johnson (2002) Topic 17: Benefits of Training and Drills for First Responders and Disaster Personnel Total DPQ Score DP Trained?

Pre-training 4 mo. Post-training Topic 17: Benefits of Training and Drills for First Responders and Disaster Personnel Results of Domestic Preparedness Questionnaire From Beaton & Johnson (2002) Perceived Competency to Respond to Biological Disaster 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”

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!