Disaster Behavioral Health

1. Disaster Behavioral Health Randal Beaton, PhD, EMT Tools and Resources for Idaho Emergency Responders

2. Health District 7

3. What type of organization do you work for? Participant Poll A. Hospital B. EMS, pre-Hospital C. Health District D. Other

4. Research ProfessorSchools of Nursing and Public Health and Community Medicine Randal Beaton, PhD, EMT Faculty Northwest Center forPublic Health Practice University of Washington

5. Relevant Clinical Experience • Volunteer EMT • Counseled victims of 9/11 who lostco-workers • “Psychological casualties” of Nisqually earthquake (2001) • Stress management for First Responders – mostly firefighters and paramedics – in private practice

6. “You can observe a lot by watching”* *Berra, 1998

7. Relevant teaching and research background • Published studies on benefits of disaster training and drills • NIOSH funded research into cause and effects of PTSD in firefighters • Core faculty of HRSA funded BT Curriculum Development Grant(UW ’03 – present) • Helped to write and drill UWSchool of Nursing Disaster Plan – 2002

8. NMDS drill (May 13, 2004)

9. Preamble/Assumptions Disasters generally refer to natural or human caused events that cause property damage and large numbers of casualties. Community wide disasters generally require outside assistance and/or assets.

10. Tsunami Disaster Photo by Dr. Mark Oberle, Phuket, Thailand

11. Effects on Victims & Care Givers Disasters can also affect the psychological, behavioral, emotional and cognitive functioning of the disaster victims (primary, secondary, tertiary, etc.) and rescue workers, first responders and first receivers.

12. Tsunami Disaster Victims Photo by Dr. Mark Oberle in Phuket

13. Overarching Goal Enhance the networking capacity and training of state of Idaho healthcare professionals to recognize, treat and coordinate care related to behavioral health consequences of bioterrorism and other public health emergencies. HRSA critical benchmark #2-8 • These training modules will address: • behavioral health aspects of disasters

14. Disaster Cycle There are a number of distinct conceptual stages in the disaster cycle: Pre-event warning threat stage Preparedness Planning Disaster Cycle Impact/Response Evaluation Recovery

15. NMDS drill (May 13, 2004)

16. Disaster Behavioral Health Disaster behavioral health interventions differ from traditional behavioral health practice by: • Addressing incident-specific, stress reactions • Providing outreach andcrisis counseling to victims • Working hand-in-hand with paraprofessionals, volunteers, community leaders, and survivors ofthe disaster Source : http://www.disastermh.nebraska.edu/state_plan/Appendix%20D.pdf

17. Aims of Disaster Behavioral Health • To prevent maladaptive psychological and behavioral reactions of disaster victims and rescue workers and/or • To minimize the counterproductive effects such maladaptive reactions might have on the disaster response and recovery

18. Questions

19. Disaster Behavioral Health Randal Beaton, PhD, EMT Modules 1-4 Psychological phases of a disaster; Temporal patterns of mental/behavioral response to disaster; Resilience; Signs & symptoms of disaster victims

20. Learner Objectives: Modules 1 - 4 • Identify the psychosocial phases of a community-wide disaster and to describe the behavioral health tasks of disaster personnel during each phase • Describe the various temporal patterns of behavioral health outcomes following a disaster, including resilience • Identify the signs and symptoms of disaster victims, first responders and first receivers who may need a psychological evaluation

21. Module 1: Psychosocial Phases of a Disaster * * From Zunin & Myers (2000)

22. Implications/Tasks of each Phase for Disaster Personnel - Pre-disaster • Warning – e.g. weather forecast • Educate • Inform • Instruct • Evacuate or “stay put”

23. Pre-Disaster • Threat, e.g., impending terrorist activity • Risk communication: To reduce anxiety, must also tell people what they should do (without jargon)

24. TopOff 2 – Seattle, May 2003

25. Impact • Prepare for surge • Advise/instruct/give directions • Risk Communication update • Leadership

26. Heroic • Disaster survivors are true “First Responders”

27. Honeymoon (community cohesion) • Survivors may be elated and happy just to be alive • Realize this phase will not last

28. Disillusionment • Reality of disaster “hits home” • Provide assistance for the distressed • Referrals to disaster mental health professionals

29. Inventory • Psychological community needs assessment • Short-term • Mid-range • Downstream needs

30. Working Through Grief (coming to terms) • This is when disaster victims actually begin to need psychotherapy and/or medications (only a small fraction) • Trigger events – reminders • Anniversary reactions – set back

31. Reconstruction (“a new beginning”) • Still, even following recovery, disaster victims may be less able to cope with next disaster

32. Behavioral Health Tasks, by Phase Available at: http://www.son.washington.edu/portals/bioterror/Table%201%20ID%20Needs%20assessment.doc

33. Behavioral Health Tasks, by Phase, Continued Available at: http://www.son.washington.edu/portals/bioterror/Table%201%20ID%20Needs%20assessment.doc

34. Module 2: Temporal Patterns of Mental/Behavioral Responses to Disaster

35. Resilience • Differs from recovery • Individuals “thrive” • Relatively stable trajectory

36. Module 2: Temporal Patterns of Mental/Behavioral Responses to Disaster

37. Acute Distress and Recovery Post-disaster recovery usually occurs within: • Days • Weeks • A few months

38. Module 2: Temporal Patterns of Mental/Behavioral Responses to Disaster

39. Chronic Distress Acute/Chronic Distress and/or Lasting Maladaptive Health Behavior Outcomes

40. Module 2: Temporal Patterns of Mental/Behavioral Responses to Disaster

41. Delayed Onset Distress Delayed Onset Distress

42. For more information: Coping With a Traumatic Event CDC Publication Available at:http://www.bt.cdc.gov/masstrauma/copingpub.asp

43. Module 3: Resilience Definition: The ability to maintain relatively stable physical and psychological functioning(not the same as recovery)

44. Module 3: Resilience (continued)Risk Factors Risk factors that deter resilience: • Job loss and economic hardship • Loss of sense of safety • Loss of sense of control • Loss of symbolic or community structure

45. Ways to Promote Community Resilience in the Aftermath of Disaster • Reunite family members • Engage churches and pastoral community • Ask teachers, community leaders and authorities to “reach out”

46. Environmental Factors That Promote Community Resilience • Availability of social resources • Community cohesion • Sense of connectedness

47. Individual Characteristics Associated with Resilience • Positive temperament • Ability to communicate • Problem-solving and problem-focused vs. emotion-based coping • Positive self-concept • Learned helpfulness vs. hopelessness

48. How Can First Responders and First Receivers Cope? Can emotional coping skills to deal with emergent disasters be taught? Doubtful, but some hints: • Stay focused on duties – out focused • Stay professional; maintain “professional boundaries” • Sort out family/roles/conflicts ahead of time

49. How can First Responders and First Receivers cope? (continued) • Drill, drill, drill – automatic, over-learned responses can be recalled under stress, also instills confidence • Self-talk – I will survive versus catastrophizing • Importance of social support – especially in aftermath

50. Pathways to Resilience • Denial/avoidance • Useful illusions/distortions • Disclosure – helpful for some