Medical Reserve Corps Disaster Mental Health Work Group Update

Disaster Mental Health Workgroup Overview and Purpose Disaster Mental Health Workgroup Overview and Purpose John K. Hickey, DSW, LCSW-R Mental Health Lead, Nassau County MRC Nassau County, N.Y. Department of Health

Work Group Overview and Purpose This time last year The surgeon general The MRC Mental Health Work Group Purpose and goals The power of networking and collaboration

Disaster Mental Health Core Competencies Ed Kantor, MD Assistant Professor of Psychiatric Medicine University of Virginia School of Medicine

Disaster Mental Health Core Competencies Goals of this section: Gain Awareness of Competency Movement Understand Concept of ‘Core Competencies’ Learn about MH Work Group Efforts

Disaster Mental Health Core Competencies Gain awareness of the Core Competency Movement – –Arose in response to increased attention to the idea of Educational Outcomes in the ‘80s: Dept of Education JCAHCO (‘Joint Commission’) Medical Boards and State Legislatures Institute of Medicine Report – –This has taken hold, not only in Medicine, but Nursing, Public Health and other clinical disciplines. – –There are similarities in structure, although some slight differences in execution and terminology between each discipline.

Disaster Mental Health Core Competencies Understanding the Concept of ‘Competencies’ –Competency implies an acceptable minimum standard Can aim higher, but must define the lowest acceptable points Requires measurement to determine acceptable performance – –Expectations can vary with role and position – –Levels: Awareness, Technician, Practitioner, Master (trainer) –Competencies require a minimum level of : KNOWLEDGE - An Understanding of requisite information SKILL - Ability to perform activities acceptably ATTITUDE - Appreciation of roles, expectations and limits –Cover Six Core Areas (some variations exist) Medical Knowledge, Patient Care, Interpersonal & Communication Skills, Professionalism, Systems-Based Practice, Practice-Based Learning & Improvement

Disaster Mental Health Core Competencies Understand Concept of ‘Competencies’ (cont…) Six Core Areas -Professionalism -Systems-Based Practice -Practice-Based Learning and Improvement and Improvement -Patient Care -Medical Knowledge -Interpersonal and Communication Skills Six Core Areas -Professionalism -Systems-Based Practice -Practice-Based Learning and Improvement and Improvement -Patient Care -Medical Knowledge -Interpersonal and Communication Skills *Some minor variation exists in core subject areas between professions

Disaster Mental Health Core Competencies Learn about MH Work Group Efforts Identifying and Defining Core Competencies for DMH – –Examples: Position statement on Psychological Debriefing Linking Competency to Curricula, Training and Evaluation Defining Prerequisites, Minimum Standards, Reciprocity

Disaster Mental Health Core Competencies Identifying and Defining Competencies for DMH –General Areas of Attention: Roles, Credentials and Job Actions in DMH Roles, Credentials and Job Actions in DMH Link Competencies to existing and developing curricula Link Competencies to existing and developing curricula Identify and compare standard training programs & reciprocity Identify and compare standard training programs & reciprocity Identify strategies and resources for assessment and evaluation Identify strategies and resources for assessment and evaluation Identify minimum areas of expected Knowledge, Skill and Attitude Identify minimum areas of expected Knowledge, Skill and Attitude

Disaster Mental Health Core Competencies Identifying and Defining Competencies for DMH –Identify minimum areas of expected Knowledge, Skill and Attitude Principles of Disaster and Disaster Mental (Behavioral) Health Communicating and Educating in a Crisis (risk communication, psychoeducation) Normal Reactions and Common Psychological Effects Abnormal Psychological Reactions Intervention and Treatment Strategies (prevention, early, intermediate, late) Scenario Specific MH Concerns (natural, industrial, violence, etc…) Responder and Self-care MH issues

-Taught in course -Expected from certif. -Acquired under supervision Disaster Mental Health Core Competencies Linking Competency to Curricula, Training and Evaluation Linking Competency to Curricula, Training and Evaluation Evaluation (certif., field obs, drills,) Attitude Skill Knowledge/Skill Interacts in a neutral & non-judgmental manner Understands MH Role and respects usual boundaries Exhibits behaviors needed to work as a member of a team Professionalism Specific Competency Client Assessment

Disaster Mental Health Core Competencies Prerequisites, Minimum Standards, Reciprocity –What are is the minimum training expectations? Integrating Disciplines (LPC, LCSW, Psychiatrist, Psychologist, etc) Crediting Experience (work history, specialty certification, etc…) Course Completion (reciprocity, continuing education, etc…) Licensure (state specific) Privileging and Supervision (local ?, integrating students and other trainees)

Disaster Mental Health Core Competencies Disaster Preparedness and Public Health – –Credentialing, Privileging and Supervision – –Systems-Based Practice of Care – –Public Education and Preparedness – –Recognition of Training and Reciprocity Between Courses – –Teaching and Mentoring Response Interventions – –Professionalism, Boundaries and Attitudes – –Awareness of Standards and Practices (Knowledge) – –Possession of Minimal Skills (Patient Care)

Disaster Mental Health Core Competencies Response Interventions cont…. – –Individual Interventions (Patient Care) Assessment and Referral Emergent Interventions Acute Interventions Longer Term Interventions Child Specific Interventions "At-Risk” and Special Populations Unique needs of responders – –Community Interventions (Systems) Surveillance and Outreach Consultation on programming and interventions General Support to Command and Community

Disaster Mental Health Training Jack Herrmann, MSEd, LMHC Assistant Professor University of Rochester School of Medicine & Dentistry

Disaster Mental Health Training Selection of Team Members –Recruitment of Mental Health Professionals Selection of Training Curricula –Matched against a set of core competencies –Evidence-informed ‘One size fits all’ vs ‘Training Menu’ One time vs. on-going Acute – Intermediate – Long Term Interventions

Disaster Mental Health Training A variety of disaster mental health trainings available in the public and private domain –On-site –On-line –Hybrid

Disaster Mental Health Training American Red Cross/ICRC DHHS/SAMHSA

Disaster Mental Health Training New York State/University of RochesterCommonwealth of Virginia

Disaster Mental Health Training Center for Disaster Epidemiology and Emergency National Rural Behavioral Health Center at the University of Florida Harvard Medical International

Disaster Mental Health Psychological First Aid Disaster Mental Health Psychological First Aid Patricia Santucci, MD Associate Professor of Psychiatry Stritch School of Medicine

Psychological First Aid Field Operations Guide Medical Reserve Corps National Child Traumatic Stress Network National Center for PTSD

What is Psychological First Aid An evidence-informed modular approach to assist children, adolescents, adults and family in the immediate aftermath of disaster or terrorism Designed to reduce the initial distress caused by traumatic events Foster short and long term adaptive functioning and coping

PFA disclaimer Has received considerable support from disaster mental health experts as the “acute intervention of choice” Many of the components have been tested and validated Consensus is at this time should at worse, produce no harm– at best, provide effective ways to manage post-disaster stress and identify those that need additional psychological support No model to date has empirically validated or rigorously tested the efficacy of this supportive intervention and resultant outcomes are unknown

Who is PFA For ? Individuals experiencing acute stress reactions or who appear to be at risk for significant impairment in functioning

Who Delivers PFA? All members of the MRC who provide acute assistance as part of the organized disaster response

When Should PFA be used? Supportive behavioral intervention for use in the immediate aftermath of disasters and other traumatic events Intended to blend into the MRC response structure early in stabilization and recovery efforts

Where Should PFA Be Used? Designed for delivery in diverse settings

MRC Delivery Sites and Settings Shelters Respite Centers Hospital-ER, Field Service Centers Emergency Operations Centers Community Outreach Teams First Aid Stations Phone banks- hotlines PODS Staging Areas Family Reception Centers Family Assistant Centers First Responders and Disaster Relief Personnel units Schools Following WMD events: –Mass casualty collection points –Field post decontamination sites –Mass prophylaxis sites

Strengths of PFA Relies on field tested, evidence-informed strategies Includes basic information gathering techniques to help make rapid assessment of what is needed and what to do Guidelines for delivery and concrete examples Developmentally and culturally appropriate interventions for survivors of various ages and backgrounds Includes important elements of risk communication, behaviors to avoid and education via use of materials and handouts Easy access- on line

PFA Core Actions Contact and engagement Safety and comfort Stabilization ( if needed) Information gathering: Current needs and concerns Practical assistance Connection with social supports Information on coping Linkage with collaborative services

Contact and Engagement Establish a connection in a non-intrusive compassionate manner –Adult/caregiver Hi, my name is Pat. I’m with the Medical Reserve Corps. We’re checking with people to see if we can be of any help. Is it ok if I talk to you for a moment? May I ask your name? Mrs. Williams, before we talk, is there something right now that you need, like water or juice? –Adolescent/ child And is this your daughter? ( Get on child’s eye level, smile and greet child, using his/her name and speaking softly) Hi Lisa, I’m Pat and I’m here to try to help you and your family. Is there anything you need right now? There is some water and juice over there, and we have a few blankets with toys in those boxes

Safety and Comfort Enhance immediate and ongoing safety, and provide physical and emotional comfort –Basic Needs

Stabilization Calm and orient emotionally overwhelmed or disoriented survivors –Signs and symptoms –What to do

Information Gathering: Current Needs and Concerns Identify immediate needs and concerns Gather additional information as appropriate to the situation Goals of informal assessment Assessment caveats Educational points Differences in family reactions Trauma reminders Loss reminders Trauma development Educational caveats Content areas

Information Gathering: Current Needs and Concerns Provider alerts –Examples Avoid asking for in-depth descriptions of traumatic experiences, as this may provoke unnecessary additional stress Avoid “blanket” reassurance that stress reactions will disappear. This may set up unrealistic expectations, resulting in negative views of self if reactions persists.

Practical Assistance Offer practical assistance and information to address survivor’s immediate needs and concerns IdentifyClarify Discussion action Act

Connection with Social Supports Connect survivors as soon as possible to social support providers, including family, friends and community helping resources “The most positive results from early interventions are usually for those that mobilize community support and address survivor’s human affiliation needs ( eg. helping survivors establish contact with relatives) rather than interventions that focus on individual psychological reactions.” –Orner, Kent, Pfefferbaum, Watson The Context of Providing Immediate Post Intervention In: Ritchie, Watson, & Friedman (eds) Intervention Following Mass Violence and Disaster. New York: The Guildford Press, 2006

Information on Coping Provide the individual with information that may help him/her with the event and its aftermath

Information on Coping Provide information about stress and coping to reduce distress and promote adaptive functioning –Basic information about stress reactions –Ways of coping Positive coping Negative coping Demonstrate Simple Relaxation Techniques Developmental issues Highly negative emotions SleepHygiene Anger management Substance abuse

Linkage with Collaborative Services Possible indications for referral Making a referral

Appendix MRC Debriefing Position Statement Recommendations: –Because of the possibility of harm to individual participants,’Psychological Debriefing ‘ should NOT be a standard part of the mental health response in crisis and disaster situations –Mandatory or “required” psychological interventions should not be applied across the board to survivors or responders following disaster

Appendix Resources Training Resources Issues and populations of special consideration Disaster relief organizations, agencies and programs Planning tools and technical resources Risk communication

Appendix Handouts  Tips for helping preschool children  Tips for helping school age children  Tips for helping adolescents  Connecting with others- seeking social support  Connecting with others- giving social support  When Terrible Things Happen  Basic Relaxation exercises  Alcohol and Drug use after disasters

Additional Appendices Special Considerations for Acutely Bereaved Individuals Service Site Challenges More to come…..

Take Home Message PFA is the “acute intervention of choice” Supported by the MRC as a basic teaching resource for ALL MRC MEMBERS ! Supports position paper: do not “debrief ” Easy access- MRC website Can be carried in GO BAG as a Field Manual Will be continuously updated and expanded MRC feedback critical

The End If you are interested in learning more about the National Disaster Mental Health Work Group : –Please visit the mental health table at the Conference – Special acknowledgement to Jim Shultz PhD, Director of DEEP, for graphic assistance