# Presentation: 116792

## Medical Reserve Corps

- Disaster Mental Health
- Work Group Update

## Disaster Mental HealthWorkgroup Overview and PurposeJohn K. Hickey, DSW,  LCSW-RMental Health Lead, Nassau County MRCNassau County, N.Y. Department of Health

## Work Group Overview and Purpose

- This time last year
- The surgeon general
- The MRC Mental Health Work Group
- Purpose and goals
- The power of networking and collaboration

## Disaster Mental HealthCore CompetenciesEd Kantor, MDAssistant Professor of Psychiatric MedicineUniversity of Virginia School of Medicine

## Disaster Mental Health Core Competencies

**Goals of this section:**
- Gain Awareness of Competency Movement
- Understand Concept of
- 			***‘******Core Competencies’***
- Learn about MH Work Group Efforts

## Disaster Mental Health Core Competencies

**Gain awareness of the Core Competency Movement**
- Arose in response to increased attention to the idea of Educational Outcomes in the ‘80s:
*	**Dept of Education*
*	**JCAHCO **(‘Joint Commission’)*
*	**Medical Boards and State Legislatures*
*	**Institute of Medicine Report*
- This has taken hold, not only in Medicine, but Nursing, Public Health
- 	and other clinical disciplines.
- There are similarities in structure, although some slight differences
- 	in execution and terminology between each discipline.

## Disaster Mental Health Core Competencies

**Understanding the Concept of ‘Competencies’**
- Competency implies an acceptable minimum standard
- Can aim higher, but must define the lowest acceptable points
- Requires measurement to determine acceptable performance
*Expectations can vary with role and position*
*Levels: Awareness, Technician, Practitioner, Master (trainer)*
- Competencies require a minimum level of :
*KNOWLEDGE** - An **Understanding** of requisite information*
*SKILL** - **Ability** to perform activities acceptably*
*ATTITUDE** - **Appreciation** of roles, expectations and limits*
- Cover Six Core Areas (some variations exist)
- Medical Knowledge, Patient Care, Interpersonal & Communication Skills,
- 	Professionalism, Systems-Based Practice, Practice-Based Learning & Improvement

## Disaster Mental Health Core Competencies

- Understand Concept of ‘Competencies’(cont...)

***Six Core Areas***
- -Professionalism
- -Systems-Based Practice
- -Practice-Based Learning
-     and Improvement
- -Patient Care
- -Medical Knowledge
- -Interpersonal and Communication Skills

**Some minor variation exists in core subject areas between professions*

## Disaster Mental Health Core Competencies

**Learn about MH Work Group Efforts**
**Identifying and Defining Core Competencies for DMH**
*Examples: Position statement on Psychological Debriefing*
**Linking Competency to Curricula, Training and Evaluation**
**Defining Prerequisites, Minimum Standards, Reciprocity**

## Disaster Mental Health Core Competencies

- Identifying and Defining Competencies for DMH
- General Areas of Attention:
-  Roles, Credentials and Job Actions in DMH
-  Link Competencies to existing and developing curricula
-  Identify and compare standard training programs &  reciprocity
-  Identify strategies and resources for assessment and evaluation
-  Identify minimum areas of expected Knowledge, Skill and Attitude

## Disaster Mental Health Core Competencies

- Identifying and Defining Competencies for DMH
- Identify minimum areas of expected Knowledge, Skill and Attitude
- Principles of Disaster and Disaster Mental (Behavioral) Health
- Communicating and Educating in a Crisis *(risk communication, psychoeducation)*
- Normal Reactions and Common Psychological Effects
- Abnormal Psychological Reactions
- Intervention and Treatment Strategies *(prevention, early, intermediate, late)*
- Scenario Specific MH Concerns *(natural, industrial, violence, etc...)*
- Responder and Self-care MH issues

## Disaster Mental Health Core Competencies

*-Taught in course*
*-Expected from certif.*
*-Acquired under*
*            **supervision*

- Disaster Mental Health **Core Competencies**

-  Linking Competency to Curricula, Training and Evaluation

*Evaluation (certif., field obs, drills,) *

- Attitude

- Skill

- Knowledge/Skill

- Interacts in a neutral
- & non-judgmental manner

- Understands MH Role and respects usual boundaries

- Exhibits behaviors needed to work as a member of a team

*Specific*
*Competency*
**Client**
**Assessment**

## Disaster Mental Health Core Competencies

- Prerequisites, Minimum Standards, Reciprocity
- What are is the minimum training expectations?
- Integrating Disciplines (LPC, LCSW, Psychiatrist, Psychologist, etc)
- Crediting Experience (work history, specialty certification, etc...)
- Course Completion (reciprocity, continuing education, etc...)
- Licensure (state specific)
- Privileging and Supervision (local ?, integrating students and  other trainees)

## Disaster Mental Health Core Competencies

_**Disaster Preparedness**__ __**and Public Health**_** **
- Credentialing, Privileging and Supervision
- Systems-Based Practice of Care
- Public Education and Preparedness
- Recognition of Training and Reciprocity Between Courses
- Teaching and Mentoring
_**Response Interventions **_
**Professionalism, Boundaries and Attitudes**
**Awareness of Standards and Practices (Knowledge)**
**Possession of Minimal Skills (Patient Care)**

## Disaster Mental Health Core Competencies

***Response Interventions cont....***
**Individual Interventions **(Patient Care)
- Assessment and Referral
- Emergent Interventions
- Acute Interventions
- Longer Term Interventions
- Child Specific Interventions
- "At-Risk” and Special Populations
- Unique needs of responders
**Community Interventions**** **(Systems)
- Surveillance and Outreach
- Consultation on programming and interventions
- General Support to Command and Community

## Disaster Mental HealthTrainingJack Herrmann, MSEd, LMHCAssistant ProfessorUniversity of Rochester School of Medicine & Dentistry

## Disaster Mental Health Training

- Selection of Team Members
- Recruitment of Mental Health Professionals
- Selection of Training Curricula
- Matched against a set of core competencies
- Evidence-informed
- ‘One size fits all’ vs ‘Training Menu’
- One time vs. on-going
- Acute – Intermediate – Long Term Interventions

## Disaster Mental Health Training

- A variety of disaster mental health trainings available in the public and private domain
- On-site
- On-line
- Hybrid

## Disaster Mental Health Training

- American Red Cross/ICRC

- DHHS/SAMHSA

## Disaster Mental Health Training

- New York State/University of Rochester

- Commonwealth of Virginia

## Disaster Mental Health Training

- Center for Disaster Epidemiology and Emergency

- National Rural Behavioral Health Center at the University of Florida

- Harvard Medical International

## Disaster Mental HealthPsychologicalFirst AidPatricia Santucci, MDAssociate Professor of Psychiatry Stritch School of Medicine

## Psychological First Aid Field Operations GuideMedical Reserve Corps National Child Traumatic Stress NetworkNational Center for PTSD

## What is Psychological First Aid

- An evidence-informed modular approach to assist children, adolescents, adults and family in the immediate aftermath of disaster or terrorism
- Designed to reduce the initial distress caused by traumatic events
- Foster short and long term adaptive functioning and coping

## PFA disclaimer

- Has received considerable support from disaster mental health experts as the “acute intervention of choice”
- Many of the components have been tested and validated
- Consensus is at this time should at worse, produce no harm– at best, provide effective ways to manage post-disaster stress and identify those that need additional psychological support
- No model to date has empirically validated or rigorously tested the efficacy of this supportive intervention and resultant outcomes are unknown

## Who is PFA For ? 

- Individuals experiencing acute stress reactions or who appear to be at risk for significant impairment in functioning

## Who Delivers PFA?

- All members of the MRC who provide acute assistance as part of the organized disaster response

## When Should PFA be used?

- Supportive behavioral intervention for use in the immediate aftermath of disasters and other traumatic events
- Intended to blend into the MRC response structure early in stabilization and recovery efforts

## Where Should PFA Be Used?

- Designed for delivery in diverse settings

## MRC Delivery Sites and Settings

- Shelters
- Respite Centers
- Hospital-ER, Field
- Service Centers
- Emergency Operations Centers
- Community Outreach Teams
- First Aid Stations
- Phone banks- hotlines
- PODS
- Staging Areas

- Family Reception Centers
- Family Assistant Centers
- First Responders and Disaster Relief Personnel units
- Schools
- Following WMD events:
- Mass casualty collection points
- Field  post decontamination sites
- Mass prophylaxis sites

## Strengths of PFA

- Relies on field tested, evidence-informed strategies
- Includes basic information gathering techniques to help make rapid assessment of what is needed and what to do
- Guidelines for delivery and concrete examples
- Developmentally and culturally appropriate  interventions for survivors of various ages and backgrounds
- Includes important elements of risk communication, behaviors to avoid  and education via use of materials and handouts
- Easy access- on line

## PFA Core Actions

- Contact and engagement
- Safety and comfort
- Stabilization ( if needed)
- Information gathering: Current needs and concerns
- Practical assistance
- Connection with social supports
- Information on coping
- Linkage with collaborative services

## Contact and Engagement

- Establish a connection in a non-intrusive compassionate manner
_***Adult/caregiver***_
*Hi, my name is Pat.  I’m with the Medical Reserve Corps. We’re checking with people to see if we can be of any help.*
*Is it ok if I talk to you for a moment? May I ask your name? Mrs. Williams, before we talk, is there something right now that you need, like water or juice?*
_***Adolescent/ child***_
*And is this your daughter? ( Get on child’s eye level, smile and greet child , using his/her name and speaking softly) Hi Lisa, I’m Pat and I’m here to try to help you and your family. Is there anything you need right now? **	*
*There is some water and juice over there , and we have a few blankets with toys in those boxes*

## Safety and Comfort

- Enhance immediate and ongoing safety, and provide physical and emotional comfort
- Basic Needs

## Stabilization

- Calm and orient emotionally overwhelmed or disoriented  survivors
- Signs and symptoms
- What to do

## Information Gathering: Current Needs and Concerns

- Identify immediate needs and concerns
- Gather additional information as appropriate to the situation

- Goals of informal assessment
- Assessment caveats
- Educational points
- Differences in family reactions
- Trauma reminders
- Loss reminders
- Trauma development
- Educational caveats
- Content areas

## Information Gathering:Current Needs and Concerns

- Provider alerts
- Examples
- Avoid asking for in-depth descriptions of traumatic experiences, as this may provoke unnecessary additional stress
- Avoid “blanket” reassurance that stress reactions will disappear. This may set up unrealistic expectations, resulting in negative views of self if reactions persists.

## Practical Assistance

- Offer practical assistance and information to address survivor’s immediate needs and concerns
- 	Identify
- 	Clarify
- 	Discussion action
- 	Act

## Connection with Social Supports

- Connect survivors as soon as possible to social support providers, including family , friends and community helping resources
***“******The most positive results from early interventions are usually for those that mobilize community support and address survivor’s human affiliation needs ( eg. helping survivors establish contact with relatives) rather than interventions that focus on individual psychological reactions.”***
***Orner, Kent, Pfefferbaum, Watson The Context of Providing Immediate Post Intervention In: Ritchie, Watson, & Friedman (eds) Intervention Following Mass Violence and Disaster. New York: The Guildford Press, 2006***

## Information on Coping

- Provide the individual with information that may help him/her with the event and its aftermath

## Information on Coping

- Provide information about stress and coping to reduce distress and promote adaptive functioning
- Basic information about stress reactions
- Ways of coping
- Positive coping
- Negative coping
- Demonstrate Simple Relaxation Techniques
- Developmental issues
- Highly negative emotions
- Sleep
- Hygiene
- Anger management
- Substance abuse

## Linkage with Collaborative Services

- Possible indications for referral
- Making a referral

## Appendix MRC Debriefing Position Statement

- Recommendations:
- Because of the possibility of harm to individual participants ,’Psychological Debriefing ‘ should NOT be a standard part of the mental health response in crisis and disaster situations
- Mandatory or “required” psychological interventions should not be applied across the board to survivors or responders following disaster

## Appendix Resources 

- Training Resources
- Issues and populations of special consideration
- Disaster relief organizations, agencies and programs
- Planning tools and technical resources
- Risk communication

## AppendixHandouts

- Tips for helping preschool children
- Tips for helping school age children
- Tips for helping adolescents
- Connecting with others- seeking social support
- Connecting with others- giving social support
- When Terrible Things Happen
- Basic Relaxation exercises
- Alcohol and Drug use after disasters

## Additional Appendices

**Special Considerations for Acutely Bereaved Individuals**
**Service Site Challenges**
**More to come.....**

## Take Home Message

- PFA is the “acute intervention of choice”
- Supported by the MRC as a basic teaching resource for ALL MRC MEMBERS !
- Supports  position paper:  do not “debrief ”
- Easy access- MRC website
- Can be carried in GO BAG as a Field Manual
- Will be continuously updated and expanded
- MRC feedback critical

## The End

- If you are interested in learning more about the  National Disaster Mental Health Work Group :
- Please visit the mental health table at the Conference
- E-mail: _[santucci@pol.net](mailto:santucci@pol.net)_
- _[drjohnkhickey@optonline.net](mailto:drjohnkhickey@optonline.net)_
- Special acknowledgement to Jim Shultz PhD, Director of DEEP, for graphic assistance