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Disaster Behavioral Health

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Title: Disaster Behavioral Health


1
Disaster Behavioral Health
Randal Beaton, PhD, EMT
  • Tools and Resources for Idaho Emergency
    Responders

2
Southeastern Health District 6
3
What type of organization do you work for?
Participant Poll
  • A. Hospital
  • B. EMS, pre-Hospital
  • C. Health District
  • D. Other

4
Research Professor Schools of Nursing and
Public Health and Community Medicine
Randal Beaton, PhD, EMT
Faculty Northwest Center forPublic Health
Practice University of Washington

5
Relevant Clinical Experience
  • Volunteer EMT
  • Counseled victims of 9/11 who lostco-workers
  • Psychological casualties of Nisqually
    earthquake (2001)
  • Stress management for First Responders mostly
    firefighters and paramedics in private practice

6
You can observe a lot by watching
Berra, 1998
7
Relevant teaching and research background
  • Published studies on benefits of disaster
    training and drills
  • NIOSH funded research into cause and effects of
    PTSD in firefighters
  • Core faculty of HRSA funded BT Curriculum
    Development Grant(UW 03 present)
  • Helped to write and drill UWSchool of Nursing
    Disaster Plan 2002

8
NMDS drill (May 13, 2004)
9
Preamble/Assumptions
  • Disasters generally refer to natural or human
    caused events that cause property damage and
    large numbers of casualties.

Community wide disasters generally require
outside assistance and/or assets.
10
Tsunami Disaster
Photo by Dr. Mark Oberle, Phuket, Thailand
11
Effects on Victims Care Givers
  • Disasters can also affect the psychological,
    behavioral, emotional and cognitive functioning
    of the disaster victims (primary, secondary,
    tertiary, etc.) and rescue workers, first
    responders and first receivers.

12
Tsunami Disaster Victims
Photo by Dr. Mark Oberle in Phuket
13
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
  • These training modules will address
  • behavioral health aspects of disasters

14
Disaster Cycle
There are a number of distinct conceptual stages
in the disaster cycle
Pre-event warning threat stage
Preparedness Planning
Disaster Cycle
Impact/Response
Evaluation
Recovery
15
NMDS drill (May 13, 2004)
16
Disaster Behavioral Health
Disaster behavioral health interventions differ
from traditional behavioral health practice by
  • Addressing Incident-specific, stress reactions
  • Providing outreach andcrisis counseling to
    victims
  • Working hand-in-hand with paraprofessionals,
    volunteers, community leaders, and survivors
    ofthe disaster

Source http//www.disastermh.nebraska.edu/state_
plan/Appendix20D.pdf
17
Aims of Disaster Behavioral Health
  • To prevent maladaptive psychological and
    behavioral reactions of disaster victims and
    rescue workers
  • and/or
  • To minimize the counterproductive effects such
    maladaptive reactions might have on the disaster
    response and recovery

18
Questions
19
Disaster Behavioral Health

Randal Beaton, PhD, EMT
  • Modules 1,2 4
  • Psychological phases of a disaster Temporal
    patterns of mental/behavioral response to
    disaster (Resilience briefly) Signs symptoms
    of disaster victims

20
Learner Objectives Modules 1 - 4
  • Identify the psychosocial phases of a
    community-wide disaster and to describe the
    behavioral health tasks of disaster personnel
    during each phase
  • Describe the various temporal patterns of
    behavioral health outcomes following a disaster,
    including resilience
  • Identify the signs and symptoms of disaster
    victims, first responders and first receivers who
    may need a psychological evaluation

21
Module 1 Psychosocial Phases of a Disaster

From Zunin Myers (2000)
22
Implications/Tasks of each Phase for Disaster
Personnel - Pre-disaster
  • Warning e.g. weather forecast
  • Educate
  • Inform
  • Instruct
  • Evacuate or stay put

23
Pre-Disaster
  • Threat, e.g., impending terrorist activity
  • Risk communication To reduce anxiety, must also
    tell people what they should do (without jargon)

24
TopOff 2 Seattle, May 2003
25
Impact
  • Prepare for surge
  • Advise/instruct/give directions
  • Risk Communication update
  • Leadership

26
Heroic
  • Disaster survivors are true First Responders

27
Honeymoon (community cohesion)
  • Survivors may be elated and happy just to be
    alive
  • Realize this phase will not last

28
Disillusionment
  • Reality of disaster hits home
  • Provide assistance for the distressed
  • Referrals to disaster mental health professionals

29
Inventory
  • Psychological community needs assessment
  • Short-term
  • Mid-range
  • Downstream needs

30
Working Through Grief (coming to terms)
  • This is when disaster victims actually begin to
    need psychotherapy and/or medications (only a
    small fraction)
  • Trigger events reminders
  • Anniversary reactions set back

31
Reconstruction (a new beginning)
  • Still, even following recovery, disaster victims
    may be less able to cope with next disaster

32
Behavioral Health Tasks, by Phase
Disaster Phase Pre-event warning Impact Heroic Honeymoon
Behavioral Health Tasks - Implications Risk Comm., Educate, Inform, Forecast, Instruct, Evacuate Advise, Risk Comm., Mitigate First responders are often disaster survivors, citizens and rescue workers rise to the occasion Realize it will not last
Available at http//www.nwcphp.org/edu/dbh/Disa
sterPhases.doc
33
Behavioral Health Tasks, by Phase, Continued
Disillusionment Inventory Working through Grief Reconstruction
Assistance for distressed Psychosocial needs assessment, short-term, mid-range, and down-stream needs Psychotherapy and/or medications Psychoeducational Need to re-establish sense of safety Anniversaries Triggers Reminders can rekindle dormant trauma/symptoms Even when this is completed, survivors are still more susceptible to trauma from future disasters.
Available at http//www.nwcphp.org/edu/dbh/Disa
sterPhases.doc
34
Module 2 Temporal Patterns of Mental/Behavioral
Responses to Disaster
35
Resilience
  • Differs from recovery
  • Individuals thrive
  • Relatively stable trajectory

36
Module 2 Temporal Patterns of Mental/Behavioral
Responses to Disaster
37
Acute Distress and Recovery
  • Post-disaster recovery usually occurs within
  • Days
  • Weeks
  • A few months

38
Module 2 Temporal Patterns of Mental/Behavioral
Responses to Disaster
39
Chronic Distress
  • Acute/Chronic Distress and/or Lasting Maladaptive
    Health Behavior Outcomes

40
Module 2 Temporal Patterns of Mental/Behavioral
Responses to Disaster
Delayed Onset Distress
41
For more information
  • Coping With a Traumatic Event
  • CDC Publication
  • Available at http//www.bt.cdc.gov/masstrauma/co
    pingpub.asp

42
Module 4 Signs Symptoms Suggesting Need for
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

43
TopOff 2 Seattle, May 2003
44
Signs and Symptoms, continued
  • Disoriented, dazed not oriented x 3 recall of
    events impaired (R/O TBI)
  • Clinical depression profound hopelessness and
    despair, withdrawal and inability to engage in
    productive activities

45
Signs and Symptoms, continued
  • Severe anxiety restless, agitated, inability to
    sleep for days, nightmares, overwhelming
    intrusive thoughts of the disaster
  • Problematic use of alcohol or drugs

46
Signs and Symptoms, continued
  • Domestic violence, child or elder abuse
  • Family members feel their loved ones are acting
    in uncharacteristic ways

47
For more information
  • Field Manual for Mental Health and Human Service
    Workers in Major Disasters
  • Available at
  • http//www.mentalhealth.org/publications/
  • allpubs/ADM90-537/default.asp

48
Disaster Behavioral Health
Randal Beaton, PhD, EMT
  • Module 10
  • Post-Disaster Assessment

49
Learner Objective Module 10
  • To identify and describe some basic principles of
    a post-disaster assessment of community
    psychosocial needs.

50
Principles of Psychological Needs Assessment
Post-disaster
  • Type of Disaster
  • Vulnerable populations
  • Scope of the disaster
  • Downstream factors

51
TopOff 2 Dirty Bomb Scenario
52
Disaster Typology
Natural Man-made Technological Biological
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
53
It is not the event but the effect that makes
the disaster.
54
Vulnerable Populations(Community Composition)
  • Psychiatric populations
  • Children/infants Schonfeld Hot Topic Archive
  • Elderly
  • Pregnant Women
  • Women with young children
  • Native American Tribes

55
Population Exposure Model
DeWolfe, see SAMHSA publication
56
Population Exposure Model (DeWolfe)
  1. Seriously injured victims bereaved family
    members
  2. Victims with high exposure to trauma victims
    evacuated from the disaster zone
  3. 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

57
Population Exposure Model (DeWolfe) (continued)
  1. People who lost homes, jobs,pets, valued
    possessions mental health providers clergy,
    chaplains, spiritual leaders emergency health
    care providers school personnel involved with
    survivors, families, of victims media personnel
  1. Government officials groups that identify with
    target victims group businesses with financial
    impacts
  2. Community-at-large

58
Downstream Factors
  • Economic impact on community
  • Job loss
  • Housing needs
  • Community Disruption
  • Loss of symbols

59
Red Cross Role (in needs assessment)
  • Can assist disaster victims
  • Make appropriate referrals

60
Disaster Response and Recovery
  • Disaster Response and Recovery A Handbook for
    Mental Health Professionals available at
    http//www.empowermentzone.com/disaster.txt

61
Disaster Behavioral Health
Randal Beaton, PhD, EMT
  • Module 13
  • Providing Post-Disaster Behavioral Health
    Assistance

62
Learner Objective Module 13
  • To describe some basic approaches to (early)
    post-disaster behavioral health assistance for
    disaster victims

63
TopOff 2
64
Key Principles of Post Disaster Behavioral Health
Approaches
  • No one who experiences a disaster first hand is
    unfazed
  • Disaster stress and grief reactions are normal
    and expected normalize these reactions

65
Key Principles of Post Disaster Behavioral Health
Approaches (continued)
  • Many emotional reactions of disaster survivors
    stem from problems of living brought about by the
    disaster
  • Most disaster survivors do not see themselves as
    needing behavioral health services following a
    disaster

66
Key Principles of Post Disaster Behavioral Health
Approaches (continued)
  • Disaster survivors may reject all forms of
    disaster assistance
  • Disaster behavioral health assistance is more
    practicalthan psychological
  • Disaster behavioral health services need to be
    uniquely tailored to the communities they serve

67
Therapy by just walking around
Things to Remember
68
Highest priority for counseling efforts
Disaster workers
Things to Remember
Disaster counselors assume a variety of roles
carry water, pitch tents, serve meals and
listen.
69
Helping Survivors in the Wake of Disaster Resource
  • A National Center for PTSD Fact Sheet Available
    at http//www.ncptsd.org/facts/disasters/fs_help
    ing_survivors.html

70
Disaster Behavioral Health
Randal Beaton, PhD, EMT
  • Module 16 Rural Issues

71
Learner Objective Module 16
  • To identify some special considerations for rural
    settings in terms of disaster behavioral health
    preparedness, response and recovery

72
Module 16
  • Rural Mental Health Preparedness versus Urban
    Settings

73
Rural America
  • 65 million Americans
  • Frontier/Small towns
  • Transportation/highway systems
  • Rural attitude

74
(No Transcript)
75
Rural America
  • Sites of Farms (food supply)
  • Sites of power facilities (including nuclear)
  • Sites of headwaters and reservoirs (water supply)

76
Rural Emergency Preparedness
  • Rural health departments have less
    capacity/resources/range of personnel.
  • Downsizing of rural hospitals has
    decreased/eliminated infrastructure.
  • EMS systems rely on volunteers.
  • General lack of funding and equipment.

77
Rural Preparedness
  • Several preparedness planning challenges are
    relatively unique to rural areas (e.g.
    coordination between state bioterrorism staff and
    Tribal nations).

78
Rural Preparedness
  • Rural areas are affected by weather, tourism, a
    fragile financial and economic based and are
    geographically isolated, making it difficult to
    support medical systems.

79
Rural Preparedness Barriers
  • The main barrier to rural preparedness is lack of
    funding.

80
Rural Preparedness
  • The Federal Government and the States must be
    financial partners but implementation must occur
    at a local level.

81
Rural Mental Health Preparedness
  • Not much good research
  • Perceived risks terror vectors
  • Agri-terrorism water sources
  • Paucity of resources personnel and PPE
  • Evacuation issues
  • Communication
  • Pathogens will not spare rural communities
  • Native Alaskan Flu of 1918

82
Rural Risk Communication
  • Local news broadcasters viewed as more credible
  • Perception is that terrorists will target urban
    population centers
  • Terrorists might target rural settings so no
    one feels safe!

83
Rural Health Concerns Resource
  • Bridging the Health Divide The Rural Public
    Health Research Agenda available at
    http//www.upb.pitt.edu/crhp/Bridging20the20Heal
    th20Divide.pdf
  • University of Pittsburgh publication
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