1. Challenges in Developing and Implementing Disaster Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and Intervention Lisa M. Brown, Ph.D. Department of Aging and Mental Health Florida Mental Health Institute University of South Florida

2. Florida Older Adult Hurricane Study Use of Disaster Mental Health Service in Long-Term Care Facilities Research Program

3. Hurricane season is June 1 through November 30 Florida was impacted by 5 major storm systems during a 44 day period Bonnie, Charlie, Frances, Ivan, Jeanne 2004 Hurricane Season

5. 2004 was the most intense hurricane season in Floridas history $60 billion damage 117 deaths Affected all 67 counties 2004 Hurricane Season

6. National Hurricane Center predicted that Hurricane Charley would make landfall in Tampa as a category 2 hurricane early afternoon on August 13 Less than two hours later, the storm strengthened in intensity and veered 70 miles south, arriving unexpectedly in Charlotte County as a category 4 storm Sustained winds of 145 miles per hour Wind gusts that exceeded 180 miles per hour Killed 34 people (2 older adults died by suicide) $6.8 billion in damage Florida Older Adult Hurricane Study

7. Pre-Hurricane Data 1997 – 466 participants 2002 - 236 participants 60 to 84 years Comprehensive battery of measures: Cognition Medical & Physical Mood Personality Social support Mastery Religion Demographics QoL Florida Older Adult Hurricane Study

8. Post-Hurricane Data 2 months – 167 participants 8 months – 160 participants 14 months – 153 participants 23 months – 140 participants* (*anticipated) Florida Older Adult Hurricane Study

9. Few studies have pre-disaster data (only 11 studies have pre-disaster data) – single measure of mood Majority of disaster studies start 12 to 14 months after the event How people recovery after a disaster is unclear Why people dont use disaster mental health services is unknown Florida Older Adult Hurricane Study

10. Compare pre-disaster levels of mood and well-being to post-disaster levels Examine posttraumatic stress disorder (PTSD) and posttraumatic growth Study mental health service use Evaluate use of social marketing to improve outreach efforts Florida Older Adult Hurricane Study

11. Disaster questionnaire assessed: Damage to home and community Physical injuries to self or family members Feelings of safety, panic, danger, ability to cope, confidence, fear of future hurricanes Experience with previous disasters Attitudes toward media, government, and recovery services Florida Older Adult Hurricane Study

12. Would you describe yourself as a victim of Hurricane Charley? (friends and relatives description?) Were you well prepared to deal with Hurricane Charley? (general public, federal, state, local government?) If you evacuated, why, where, how long, what did you take? Did you apply for assistance? Received? Pending? Adequate? Florida Older Adult Hurricane Study

13. Did you receive help from a counselor or mental health professional to help you deal with your reaction to the hurricane or for an emotional or mood problem? Who provided these services? How many times did you received mental health services? If you received mental health services, were they helpful? Florida Older Adult Hurricane Study

14. 98% reported damage to home or property 51% reported major structural damage 88% lost electricity 43% lost furniture or furnishings 12% lost keepsakes Florida Older Adult Hurricane Study

15. 31% feel less safe now than before Hurricane Charley 28% felt a sense of panic during the hurricane 20% felt their life was in danger during the hurricane Florida Older Adult Hurricane Study

16. 2 months -14% reported significant levels of depression (5% in 1997) 8 months -16% reported significant levels of depression 30% were out of the area when the hurricane struck but reported levels of depression that was equal to the group that experienced the hurricane Florida Older Adult Hurricane Study

17. 2 months - 2% over cutoff on PTSD Checklist 8 months - 11% over cutoff on PTSD Checklist 2 months – 27% rated their mental health as worse or much worse since the hurricane 8 months -28% rated their mental health as worse or much worse since the hurricane Florida Older Adult Hurricane Study

18. 2 months – 1% were using disaster mental health services 8 months – 4% were using mental health services Use of disaster mental health services was not commensurate with disaster related mental health distress Florida Older Adult Hurricane Study

19. Disaster Mental Health Outreach and Service Empirical evidence from our study, along with reports from community and state agencies (AAA and DCF) who provided disaster mental health services, reveals that a substantial gap exists between those who are psychologically distressed and use of mental health services.

20. Disaster Mental Health Outreach and Service It is not well understood why few older adults used disaster mental health services despite: Aggressive outreach efforts In-home services Groups held in community centers Free or low-cost programs Psychological distress

21. Disaster Mental Health Outreach and Service Older adults are less likely to use mental health services in traditional mental health settings due to a complex set of help-seeking factors: Problem recognition Symptom misattribution Readiness to change Knowledge about services Preferences for services Barriers to treatment However, none of these studies were conducted with older adults who had survived a disaster and were contending with disrupted social networks, destroyed communities, and damaged homes.

22. LTC and Disaster Mental Health Services Survey of 168 Nursing homes 88% LTC facilities were affected by the 2004 or 2005 hurricanes Residents were mentally or emotionally distressed 17.5% reported none 43.7% reported 1% to 19% 12.5% reported 20% to 39% 11.3% reported 40% to 59% 1% reported 60% to 79% 1% reported 80% - 100%

23. LTC and Disaster Mental Health Services Residents were depressed 26.2 % Reported none 40% reported 1% to 19% 12.5% reported 20% to 39% 11.2% reported 40% to 59% 1% reported 60% to 79% 1% reported 80% - 100%

24. LTC and Disaster Mental Health Services Residents were anxious 21.2 % reported none 38.7 % reported 1% to 19% 20 % reported 20% to 39% 1% reported 40% to 59% 1% reported 60% to 79% 1% reported 80% - 100%

25. LTC and Disaster Mental Health Services Residents anxious about upcoming hurricane season 32.5 % reported none 32.5 % reported 1% to 19% 11.2 % reported 20% to 39% 1% reported 40% to 59% 1% reported 60% to 79% 1% reported 80% - 100%

26. LTC and Disaster Mental Health Services 6% facilities would have used, but did not have available disaster mental health services 27% used disaster mental health services Services were provided by social workers (23.3%) and psychologists (12.4%) nurses (5.4%) psychiatrists (1%)

27. LTC and Disaster Mental Health Services What percentage of residents found disaster mental health services helpful? 35% reported none 31% reported 1% to 19% 17.3% reported 20% to 39% 1% reported 40% to 59% 1% reported 60% to 79% 1% reported 80% - 100%

28. Implications Research is needed to evaluate existing outreach efforts More effective marketing of disaster mental health services Many elders dont want to be known as needing mental health services Many elders dont consider themselves as special needs Responders who provide care to elders should have training specific to older adults

29. Implications Cooperative planning should occur at local, state, and federal levels Special needs shelters Education about disaster planning – advance directive format Programs to enhance resilience and disaster preparedness of community dwelling elders Training or protocols for home health aids Programs for institutionalized adults

30. Lisa M. Brown, Ph.D. Department of Aging and mental Health Florida Mental Health Institute, MHC 1441 University of South Florida 13301 Bruce B. Downs Blvd. Tampa, Florida 33612 813 – 974 – 0098 lmbrown@fmhi.usf.edu