Workshop: Prevention & Response to Mass Trauma & Disaster

1. Workshop: Prevention & Response to Mass Trauma & Disaster Francis R. Abueg, Ph.D. TraumaResource Clinical & Forensic Psychology Sunnyvale, California drfrancis@traumaresource.com

2. Overview of Presentation • Trauma organization websites • Provider education • Patient education • Thank you to Josef Ruzek, Ph.D. of the National Center for PTSD and colleagues for presentation content.

3. Some Challenges in Resource Access • Explosion of resources • Challenge of centralizing resources • Challenge of simplifying resource location • Do resources affect practice? • Resource validation/accuracy

4. Accuracy of Information • Bremner, Quinn, Quinn, and Veledar (2006) • Review of 80 Internet websites • 42% of sites had inaccurate information • 82% did not provide a source of content • 41% did not use a mental-health professional in the development of the content • Websites providing information about traumatic stress are often not useful, and can sometimes provide inaccurate and potentially harmful information to consumers

5. NCPTSD Websitewww.ptsd.va.gov • Resources to support patients and public • Resources to support research and practice • PILOTS database • Iraq War Clinician Guide • PTSD 101 • Psychological First Aid Manual • CTU-Online • PTSD Research Quarterly • Videos

6. Trauma Organizations • International Society for Traumatic Stress Studies (ISTSS) • www.istss.org • Center for the Study of Traumatic Stress • http://www.centerforthestudyoftraumaticstress.org/index.php • Includes resource listing, includes service members, families, and children • Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury • http://www.dcoe.health.mil/

7. Trauma Organizations • National Child Traumatic Stress Network • http://www.nctsn.org/ • National Child Traumatic Stress Network is a comprehensive resource for the public, consumers, and professionals • APA Division 56 • http://www.apatraumadivision.org/resources.php • Doctoral and internship training resources • Division 56 Research Wiki • David Baldwin’s Trauma Pages • http://www.trauma-pages.com/

8. Clinical Practice Guidelines • International Society for Traumatic Stress Studies • http://www.istss.org/Content/NavigationMenu/ISTSSTreatmentGuidelines/PTSDTreatmentGuidelines/default.htm • National Institute for Clinical Excellence (UK) • http://guidance.nice.org.uk/CG26/NICEGuidance/pdf/English • VA-DOD • https://www.qmo.amedd.army.mil/ptsd/CompleteGuideline.pdf • Australian Center for Posttraumatic Mental Health • http://www.acpmh.unimelb.edu.au/resources/resource-asdptsd_guidelines.html

9. PILOTS : Published International Literature on Traumatic Stress • 35,000 citations of articles on traumatic stress • Includes reports and foreign-language materials • Trauma-specific thesaurus • CSA platform (like PsycInfo) • Links to online sources • Articles by NCPTSD authors provided as PDFs

10. CTU-Online: Clinician’s Trauma Update • Summarizes clinically relevant articles on treating Veterans & military personnel • Summaries presented in brief format with links to the full article • Emailed every 2 months • Subscribe at: http://www.ptsd.va.gov/professional/newsletters/ctu-online.asp

11. Assessment Tools Online • PTSD Checklist-Civilian Version (PCL-C) • http://www.pdhealth.mil/guidelines/appendix3.asp • PTSD Checklist-Military Version (PCL-M) • http://www.pdhealth.mil/guidelines/appendix3.asp • PTSD Checklist– Stressor Specific Version (PCL-S) • http://www.pdhealth.mil/guidelines/appendix5.asp • NCPTSD provides information about a variety of trauma-specific and more general assessment tools • http://www.ptsd.va.gov/professional/pages/assessments/assessment.asp • ISTSS • http://www.istss.org/AM/Template.cfm?Section=ResourcesforClinicians&Template=/CM/ContentDisplay.cfm&ContentID=1549

12. Online Courses for Providers: PTSD 101 • Background andAssessment • Assessment • What is PTSD? • Treatment • Cognitive-Behavioral Interventions • Cross-Cultural Considerations (CE) • Group Therapy (CE) • Increasing Effectiveness of PTSD Treatments • Overcoming Barriers (CE) • Pharmacotherapy • Smoking Cessation • Substance Abuse • VA/DoD Clinical Practice Guideline (CE)

13. PTSD 101 (Cont) • Specific Trauma • Combat Stress Injuries (CE) • Military Sexual Trauma • Traumatic Brain Injury • Special Populations • African-American Veterans (CE) • Asian American & Pacific Islander Veterans (CE) • Hispanic Veterans (CE) • Military Culture • Older Veterans (CE) • General Healthcare • Physical Health Effects (CE)

14. Center for Deployment Psychology www.deploymentpsych.org

15. Guidance for pediatric health care providers http://www.healthcaretoolbox.org/ Health Care Toolbox

16. Medical University of South Carolina TF-CBTWeb • Free web-based training course for learning Trauma-Focused Cognitive-Behavioral Therapy • Developed and tested by Drs. Esther Deblinger, Judy Cohen, and Anthony Mannarino • Found in multiple research studies to be an effective treatment for children with trauma-related problems and their families • Provides 10 hours of CE training that teaches the procedures of TF-CBT • Includes streaming video demonstrations, clinical scripts, cultural considerations, clinical challenges and many other learning resources

17. http://tfcbt.musc.edu/

18. Cognitive Processing Therapy:Evidence-Based PTSD Treatment for Adults

19. Coming Soon to NCPTSD • Online training in Prolonged Exposure treatment • Online training in STAIR (Skills Training in Affect and Interpersonal Regulation) • Online training in CBT skills • Goal-setting • Motivation enhancement • Behavioral task assignment (homework)

20. ???? Afterdeployment.org

21. Provider Portal Content • Overview of afterdeployment.org (tour) • Using afterdeployment.org with your patients • Continuing education for providers • DoD and VA CEU courses • Connecting with other providers • Self-help for providers • Burnout

22. Online CEUs • International Society for Traumatic Stress Studies: Sessions from the organization’s annual meeting, including master clinician sessions • http://www.istss.org/RecordedSessions/2297.htm • The Center for Deployment Psychology has interactive online courses designed for clinicians caring for military service members, veterans and family members • Working with Service Members and Veterans with PTSD • http://www.essentiallearning.net/student/content/sections/lectora/VeteransPTSD/index.html

23. Online CEUs (Cont) • Prolonged Exposure for the Treatment of PTSD • http://www.essentiallearning.net/student/content/sections/lectora/ProlongedExposureTherapyVets/index.html • Cognitive Processing Therapy for PTSD in Veterans and Military Personnel • http://www.essentiallearning.net/Student/content/sections/Lectora/CognitiveProcessingTherapyforPTSDinVeteransandMilitaryPersonnel/index.html

24. Online CEUs • Learning Center of the National Child Traumatic Stress Network: Online catalog developed for mental health professionals, parents and caregivers, policymakers, and others • http://learn.nctsn.org/course/category.php?id=3 • The Anxiety Disorders Association of America providesa free podcast on treatment of PTSD • http://www.adaa.org/resources-professionals/podcasts/treatment-ptsd

25. Information for Survivors/Patients:Fact Sheets • David Baldwin’s Trauma Information Pages • http://www.trauma-pages.com/support.php • National Child Traumatic Stress Network • NIMH fact sheets • What is PTSD? • Who gets PTSD? • What are the symptoms of PTSD? • Do children react differently than adults? • How is PTSD detected? • Why do some people get PTSD and others do not? • How is PTSD treated? • What efforts are under way to improve detection and treatment of PTSD? • How can you help a friend or relative with PTSD? • Where can one go for help? • http://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder-ptsd/complete-index.shtm

26. Fact Sheets • NCPTSD • Research on Women, Trauma, and PTSD • http://www.ptsd.va.gov/professional/pages/women-trauma-ptsd.asp • Sexual Trauma: Information for Women's Medical Providers • http://www.ptsd.va.gov/professional/pages/ptsd-womens-providers.asp • Effects of Disaster on People with Severe Mental Illness • http://www.ptsd.va.gov/professional/pages/effects-disaster-mental-illness.asp • PTSD in Children and Adolescents • http://www.ptsd.va.gov/professional/pages/ptsd_in_children_and_adolescents_overview_for_professionals.asp • PTSD in Refugees • http://www.ptsd.va.gov/professional/pages/ptsd-refugees.asp • Trauma, PTSD, and Attachment in Infants and Young Children • http://www.ptsd.va.gov/professional/pages/trauma_ptsd_attachment.asp

27. Fact Sheets: Disaster • Centers for Disease Control: Issues related to emergency preparedness and response • http://www.bt.cdc.gov/masscasualties/copingpub.asp • http://www.bt.cdc.gov/masscasualties/copingpro.asp • American Psychiatric Association: Informationabout disaster psychiatry • http://www.psych.org/Resources/DisasterPsychiatry.aspx

28. Disaster • Psychological First Aid Manual (phone app coming!) • http://www.ptsd.va.gov/professional/manuals/psych-first-aid.asp • Includes handouts for survivors… • Connecting with Others: Seeking Social Support • Connecting with Others: Giving Social Support’ • When Terrible Things Happen • Tips for Helping Infants and Toddlers’ • Tips for Helping Preschool-Age Children • Tips for Helping School-Age Children • Tips for Helping Adolescents • Tips for Adults • Basic Relaxation Techniques • Alcohol and Drug Use after Disasters

29. Self-Help Reading for Adults • Courage after fire: Coping strategies for returning soldiers and their families. (2005). K. Armstrong, S.Best, & P. Domenici. Ulysses Press. • Down range: To Iraq and back. (2005). B. Cantrell & C. Dean. Washington: WordSmith Books. • I Can't Get Over It: a handbook for trauma survivors (1992). by Aphrodite Matsakis, PhD. New Harbinger Publications. • Back from the brink: A family guide to overcoming traumatic stress. (1992). D. Catherall. Bantam Books. • Trust after trauma: A guide to relationships for survivors and those who love them. (1988). A. Matsakis. Oakland, CA: New Harbinger. • Recovering after the war. (1990). P. Mason. New York: Penguin Books. • Vietnam wives: Facing the challenges of life with veterans suffering from post-traumatic stress disorder. (2nd ed.) (1998). A. Matsakis. Sidran Press.

30. Self-Help Reading for Teenagers • Finding my way: A teen’s guide to living with a parent who has experienced trauma. (2005). M. D. Sherman & D.M. Sherman. Edina, MN: Beaver’s Pond Press.   • I’m not alone: A teen’s guide to living with a parent who has a mental illness. (2006). M. D. Sherman & D.M. Sherman. Edina, MN: Beaver’s Pond Press.

31. Online Patient Education: www.ptsd.va.gov • Fact sheets, handouts, videos • War-zone Guides • Links to other relevant websites • MyHealtheVet • afterdeployment.org • Nationalresourcedirectory.gov

32. Self-Guided Change Programs • Common features • Multiple sessions/workshops • Multiple components • Stand alone components • Can also be used as an adjunct to face-to-face therapy. • Assign on-line homework assignments • Track patient progress • Clinician contact time Self-Guided Therapist check-in Fully integrated

33. http://www.beatingtheblues.co.uk/

34. Considering Professional Help • https://www.myhealth.va.gov/mhv-portal-web/anonymous.portal?_nfpb=true&_pageLabel=mentalHealth&_nfls=false • 30 minute interactive course consisting of: • 5 Sections: • Do I Need Help? (includes a brief self-assessment) • What is Stopping Me? • What Can I Expect • Who Can Help Me? • Where Can I Find Help? • Videos of veterans who have had to overcome concerns and challenges before seeking help • Transcripts were made of real veterans and then presented by actors with similar features

35. Considering Professional Help

36. Considering Professional Help

37. Other Resources for Military Personnel/Veterans

38. Realwarrriors.net • The Real Warriors Campaign is an initiative launched by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) • Build resilience, facilitate recovery, support reintegration • Decrease stigma to seeking psychological care through • Media outreach • Print materials • Interactive web site • Social media • Website features stories of real service members who have sought treatment and are continuing to maintain successful military or civilian careers

39. http://www.realwarriors.net

40. VA OEF/OIF Page • www.OEFOIF.va.gov • OEF/OIF webpage on VA mental health • Overview of benefits available to recent returnees • Descriptions of different venues where returnees and families may seek help • Social Media • Blogs

41. http://www.OEFOIF.va.gov

42. MilitaryOneSource.com • Target audience: Service members from all branches, family members, service providers • Web resources • Supplements existing installation services • Provides free help and information, by phone with a professionally trained consultant, or online • Wide range of issues from budgeting and investing to relationships and deployment • Available 24 hours a day, 365 days a year • Free counseling services (up to 12 sessions per person, per issue), face-to-face in the local community, by telephone, and online

43. http://www.militaryonesource.com/

44. DCoE Outreach Center Call • Provides an authoritative source of information and resources on psychological health (PH) & traumatic brain injury (TBI) issues • Helps service members, veterans, and their families by connecting them with the resources they need to promote their resilience, recovery, and reintegration • Assists service members, veterans, families, leaders, healthcare providers navigate the system of care • Responds to information requests about the DCoE • Serves: • Service Members, Veterans, Families, Military Leaders, Clinicians, Researchers, Educators, Support personnel, Chaplains • Capability/Availability: • 24/7 availability of Health Resource Consultants (most have masters or doctoral level degrees and healthcare experience) • Respond by phone, email, instant messaging, chat, fax • Respond to specific research requests Chat Or e-mail resources@dcoeoutreach.org

45. http://www.mentalhealth.va.gov/College/

46. Student Veterans of America www.studentveterans.org • Three primary missions: • Develop student veteran groups on college and university campuses and coordinate by region between existing groups. • Connect student groups with resources. • Advocate on behalf of student veterans at the state and national level.

47. Online Toolkits Coming Community-Based Healthcare Providers Educators Employers Chaplains Primary Care Practitioners Disaster Mental Health

48. VA PTSD PRO (Practitioner Resources Online) • One-stop shopping for busy clinician • All materials selected for relevance to clinical care • Personal shopping basket function • Search function by kind of resource (e.g., fact sheets, videos, articles)

50. PTSD Coach Overview PTSD Coach is a mobile phone application for people with PTSD and those interested in learning more about PTSD This application provides: • Education about PTSD • A self-assessment tool • Portable skills to address acute symptoms • Direct connection to crisis support and • Information about treatment aimed at guiding those who could benefit into care Used to augment face-to-face care or as a stand-alone education and symptom management tool