Integrating Resilience into Disaster Medical Care

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 etiology1 • 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 FOCUS ON WELLNESS Emotions Behaviors Habits

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

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

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

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