Disaster Mental Health Institute The University of South Dakota September 30, 2002

1. Disaster Mental Health InstituteThe University of South DakotaSeptember 30, 2002 The Development of a Regional Disaster Mental Health Response Plan Using Academic Medical Center, Local and State Governments: A Maryland Consortium Effort

2. Disaster Mental Health Institute, The University of South Dakota A Collaborative Presentation • Kathi Beauchesne, Ph.D, MBA, LCSW-C • Director, Faculty and Staff Assistance, Student Assistance, and WORKlife Programs—Johns Hopkins University/Johns Hopkins Hospital • Carrie Burmaster, LCSW-C • Director, University of Maryland Baltimore Counseling Center • Michael Kaminsky, M.D., MBA • Vice Chairman for Clinical Affairs, Department of Psychiatry, Johns Hopkins Hospital • Chair, Mental Health Disaster Planning Committee

3. Disaster Mental Health Institute, The University of South Dakota What we will do today… • Setting the stage: Why Academic Medical Center? (Kaminsky) • The story of a disaster plan process (Beauchesne) • A systems analysis of a planning process (Burmaster)

4. Disaster Mental Health Institute, The University of South Dakota Special thanks for the guidance of… • Clete DiGiovanni, M.D., Consultant for DOD and FBI • George S. Everly Jr., Ph.D, Co-founder and Board Chair Emeritus, International Critical Incident Stress Foundation • Tony Ng. M.D., Medical Director, Disaster Psychiatry Outreach • Elizabeth Monahan-Gibson, Region III, FEMA Voluntary Agency Liaison

5. Disaster Mental Health Institute, The University of South Dakota The usual situation • Hopkins and Maryland are institutional rivals • Hospital Disaster Plans tend to be internal, to meet the needs of patients who present at the Emergency Room door • Governmental bodies develop their own plans

6. Disaster Mental Health Institute, The University of South Dakota Wise Charges: • Develop plans to meet the needs of faculty, staff, and students as well as their dependents in the event of a disaster

7. Disaster Mental Health Institute, The University of South Dakota Goals: • Develop plans to minimize the impact of a disaster on the target populations • Ensure that psychological sequela do not not impair the functioning of the institutions • Train qualified professionals in state of the art disaster mental health response and management principles • Provide a continuum of services from pre-event prevention through acute psychological first-aid and triage to post-event long-term surveillance and referral

8. Disaster Mental Health Institute, The University of South Dakota Goals cont’d: • Participate in disaster response and relief locally and regionally • Contribute research which evaluates the effectiveness of the plan and provides new insights into psychological responses to disasters and their management • Integrate the plans of Hopkins and Maryland with the city of Baltimore and the State of Maryland

9. Disaster Mental Health Institute, The University of South Dakota Integration: • Leadership has accepted Baltimore City mental health disaster training and have become volunteers • Joint planning with the State of Maryland Department of Health and Mental Health is in process • Projected appointments to MEMA ESF-8 with the creation of a subcommittee on mental health

10. Disaster Mental Health Institute, The University of South Dakota Academic Medical Center Potential strengths of involvement in local and regional disaster planning • Ready access to large numbers of professionals in mental health • Experience in emergency mental health, and the mental health of significant physical illness and injury

11. Disaster Mental Health Institute, The University of South Dakota Academic Medical Center, cont’d Potential strengths of involvement in local and regional disaster planning III. Multi-specialty mental health team orientation (clergy not sufficiently included) • Commitment to and focus on expertise building for career development

12. Disaster Mental Health Institute, The University of South Dakota Academic Medical Center, cont’d Potential strengths of involvement in local and regional disaster planning V. Historic mission of service, education and research • Education and training strengths to achieve uniform standards of performance • Critical assessments of knowledge and experience to determine best practices to employ • Research orientation, aggressive seeking of funding to support research and dissemination of new knowledge

13. Disaster Mental Health Institute, The University of South Dakota Examples of research questions and needs • Clarification of the relationship between normal responses to disaster trauma and standard DSM IV pathological nomenclature • Is it appropriate; is it confusing to use the same language for people who will become patients and those who won’t? • Use of standardized assessment tools in the field to correlate responses and risk factors • Comparison trials of intervention techniques • Evaluating the effectiveness of training

14. The Story of the Disaster Plan Process Disaster Mental Health Institute, The University of South Dakota • The Story Begins… • Collegial relationships • September 11th, 2001 • Two plans • Hospital request • Early Crisis Response training • University invitation

15. Disaster Mental Health Institute, The University of South Dakota Internal Strategy and Process • Formed the Mental Health Disaster Planning Committee • Partnership FASAP and Psychiatry • Physician leader • Institution-wide key group representation • Literature review • Developed a rationale • Frequent meetings/subcommittee meetings • Identified new members continuously • Sought permission to respond

16. Disaster Mental Health Institute, The University of South Dakota Internal Strategy (cont.) • Our Plan • Integrate mental health disaster planning at the highest level of the institutions • Incorporate mental health disaster planning within the Hopkins community • Involve IT • Intense focus on FEMA Region III

17. Disaster Mental Health Institute, The University of South Dakota Internal Strategy (cont.) • Ensure allocation of resources and leverage resources • Crisis Management for Supervisors class • Work fluidly with both the administrative and academic communities, interlinking the two • Understand collegial relationships and methods of communication

18. Disaster Mental Health Institute, The University of South Dakota External Strategy and Process • Guided by external experts • Developed a network of professional collaborations • Academic medical centers • Departments of Psychiatry • Employee Assistance Programs • Student Counseling and Student Assistance Programs • Developed community relationships • MD and DC VOADs • Baltimore City • State of Maryland • FEMA • SAMHSA

19. Disaster Mental Health Institute, The University of South Dakota External Strategy (cont.) • Sought legitimacy and certification • American Red Cross • Disaster Psychiatry Outreach

20. Disaster Mental Health Institute, The University of South Dakota Co-evolving plans • Two Organizations • The Hopkins Institutions • University of Maryland Baltimore • Veterans Administration Medical Center • The Ultimate Plan • A Consortium of Academic Medical Centers working in concert with local and regional agencies and organizations

21. Disaster Mental Health Institute, The University of South Dakota What we have learned… • Join and create communities of mental health disaster practice • Develop, generalize and normalize the rationale • Nurture co-evolving plans • Identify and reach out to potential communities of practice • Continuously connect and reconnect with those communities

22. Disaster Mental Health Institute, The University of South Dakota What we have learned…(cont.) • Offer mutual aid and support • Maximize and leverage resources • Include a broad spectrum of mental health professionals • Emphasize civic responsibility • Create goodwill • Relationships count

23. Disaster Mental Health Institute, The University of South Dakota Defining the Task • Disasters represent non-linear human events—the systems perspective • Existing statewide disaster plans and response agencies have wide variations in levels of organization and readiness • Inclusion in the statewide disaster response system is dependent upon value of your contribution and ability to establish connections

24. Disaster Mental Health Institute, The University of South Dakota Systems principles • Permeable boundaries allow for exchange of information and energy > increased levels of differentiation (expert functions) • System behavior: steady state > stable oscillation > chaos • System chaos increases a system’s response options and forces the system to renew itself > new learning

25. Disaster Mental Health Institute, The University of South Dakota Systems principles, cont’d • Synergy: sum of parts greater than parts added together • System meta-analysis facilitated by being inside and outside the system

26. Disaster Mental Health Institute, The University of South Dakota Chaos • Serves evolutionary function • Helps systems explore entire range of behaviors available • Crisis and opportunity

27. Disaster Mental Health Institute, The University of South Dakota Negotiation principles • Prepare • Probe • Propose The Power of Nice, Ron Shapiro

28. Disaster Mental Health Institute, The University of South Dakota Relationship building principles • Be valuable—knowledge, attitudes, ability • Build on interdisciplinary collaboration experience • Have resources—time, money, personnel, intellectual resources • Know your responsibilities • Participate in chain of command • Use established communication and documentation protocols • Understand national disaster declaration process and protocols • Be familiar with the roles and missions of other organizations

29. Disaster Mental Health Institute, The University of South Dakota Relationship building principles, cont’d • Show humility—”This is what I know—teach me more” • Baltimore Mental Health Systems training (ICISF) • UMMC Freestate Mock Disaster Drill • National Center for PTSD training • DHMH Training—Trauma, Disaster and Resiliency • MD VOAD Media Training • Risk Communication Training

30. Disaster Mental Health Institute, The University of South Dakota Potential process contributions to disaster response system • Contribute to the continuing development of a shared vision • Participate in designing and supporting a system-wide learning architecture—learning feedback loops • Provide safe space to incubate, hatch, and nurture new proposals • Demonstrate value of rapid capacity to learn

31. Use established relationships to nurture natural innovators Encourage early adopters Stand by the early majority Let nature take its course Disaster Mental Health Institute, The University of South Dakota Using your contributions: Plant flowers rather than moving mountains!

32. Disaster Mental Health Institute, The University of South Dakota A Comforting Thought… • “the…capacity to learn may be more important than experience” (L. Douglas Kiel, Ph.D)

33. Disaster Mental Health Institute, The University of South Dakota Slides will be provided on… • www.fasap.org