1. Integrating Resilience into Disaster Medical Care CAPT David Morrissette, LCSW, Ph.D. MHT-1 Team Leader LCDR Meghan Corso, Ph.D., MHT-1 Wellness Coordinator

2. Operation Lone Star Annual joint military and civil humanitarian medical Training mission on the Tex-Mex border for 13 yrs Free medical services to Texas residents Fast pace and brief contact –6000 patients are seen in 1 week –Local services already oversubscribed

3. What is Resilience?

4. Why is Resilience Important

5. Why Resilience in a Disaster Response? Address the current needs of the population – Chronic diseases with psychosocial components – Unmet Behavioral Health needs Prevention through building Resilience – Stress Reactions to Disaster – Accomplished at any age including children

6. Current Needs of a Population The 14 most common physical complaints have no identifiable organic etiology 1 Most Behavioral Health disorder do not get treatment 2 Prescriptions for anti-hypertensives in youth age 19 and younger could hit 5.5 million this year, up 17% from 2007 to 2010

7. Current State of the Population

8. What happens to the population’s medical and behavioral health needs when there is a disaster?

9. In a disaster response… Access to needed medical items is limited Access to behavioral or medical treatment is limited or closed Symptoms are exacerbated Change in routine/ environment Tx adherence to self care Decrease in support system Compassion Fatigue Opportunity for Disaster Behavioral Health Intervention

10. How do you Build Resilience in a Disaster Response Habits FOCUS ON WELLNESS Emotions Behaviors

11. What is Wellness? Body Mind Emotions Exercise Diet Physical and Mental Health

12. Building Resilience through Wellness Establish relationship with Survivors and Responders and teach: – Stress – Self Care – Communication – Grief – Compassion Fatigue

13. With education and engagement comes the opportunity to screen Assessing difficulty with adjusting to the disaster conditions – Coordinating care as needed – Providing brief counseling as appropriate Assessing individual who may be having an acute reaction to the disaster – Prevent further complication and development of PTSD

14. What does this look like in a deployed setting Operation Lone Star July 2011

16. Previous Behavioral Health In 2010, Providers referred one tenth of one percent of OLS patients to mental health. Texas Guard’s study estimated mental health needs among 12-21% percent of patients (Morecook, et al, 2010)

17. Wellness Approach Education and Counseling on: Tobacco Support System Stress Diet & Nutrition Exercise Alcohol and Sleep Crisis Counseling

18. Physician Referrals

19. Self- Referrals

20. What About Children?

21. Ringgold Clinic Palm View ClinicMandazo Clinic  LCDR Beaulieu Psychologist SITE LEAD  LCDR McLellan Nurse SITE LEAD CDR Grogan DTL LT Henderson LCSW Lt Tanya Rincon LCSW Spanish LCDR Gripper Nurse LCDR Hatch Psychologist Spanish LCDR Saunders IT Spanish LCDR Cochran LCSW SITE LEAD MHT-1 OLS 2011 Assignments LCDR Barnes Psychologist LT Hayes PLANNING LT Burns Psychologist LCDR Guzman- Zammaron, OT Spanish CAPT Fletcher Epidemiologist CAPT Morrissette Team Leader PSJA Clinic LCDR Corso Psychologist SITE LEAD CDR Ohuoha Psychiatrist CDR Hall Nurse LCDR Bodart Psychologist LCDR Lucio LCSW LT Franks Psychologist LCDR Skipton Psychiatrist CAPT Shine Psychiatrist Mission Leads CDR Buckingham LCSW Wellness Center: LCDR Corso Wellness Center: LCDR Corso Let’s Move: LCDR Cochran Self Referral: LCDR Beaulieu Provider Referral: LCDR McLellan

22. Most patients received education and counseling on two or three topics 28% of patients came in for counseling on nutrition, sleep, exercise, stress, community connection, support, and crisis

23. Referral by Topic

24. Screening and Referrals 14 patients were referred by providers for crisis screening and care 4 patients referred themselves for crisis counseling 29 cases were screened and referred to local mental health providers for on-going behavioral health care.

25. Over 1000 children engaged

26. Force Protection The Wellness Approach allowed responders to talk about normal problems and how to solve them. MHT provided 466 preventive contacts and 167 responsive contacts. FORCE PROTECTION