Occupational Therapists' Role on U.S. Army and U.S. Public Health Service Commissioned Corps Disaster Mental Health Response Teams

More than 30 disasters that require an emergency response are declared each year by the federal government [Federal Emergency Management Agency [FEMA], 2007]. Several recent disasters have tested our nation’s preparedness, and media attention in their aftermath has increased public awareness of disaster response. How has the profession of occupational therapy responded to this public need and what can be learned from our efforts to date? In recognition of the important contribution occupational therapy practitioners can make in times of disaster, our profession has issued a call to action that will involve practitioners in disaster preparedness, response, and recovery. In reply to this call to action, the American Occupational Therapy Association (AOTA), the American Occupational Therapy Foundation (AOTF), and the World Federation of Occupational Therapists (WFOT) have collaborated to define occupational therapy’s role in crisis situations (AOTA, 2007). WFOT has developed models for disaster response and has encouraged AOTA and other member countries to develop and enact a targeted disaster response plan (WFOT, 2007). AOTF (2007) has set the goal of gaining recognition for occupational therapy as a community resource in disaster relief in its 2005–2006 and 2006–2007 strategic plans. In collaboration with the AOTA Commission on Practice, the AOTF Taskforce on Occupation in Societal Crisis prepared an official document (Scaffa, Gerardi, Herzberg, & McColl, 2006) on the role of occupational therapy in disaster preparedness, response, and recovery. The document makes a “cogent case that occupational therapy practitioners have the skills to work in disaster response” (Scaffa et al., 2006, p. 642) and presents examples of potential occupational therapy contributions. Although they have been called to become involved in disaster response, practitioners are challenged with how and where to do so. Little information has been published on the roles practitioners have actually played in disaster response, what those roles entail, and the potential barriers faced and overcome. This article describes how we applied our disaster response skills in their roles on U.S. Army and U.S. Public Health Service Commissioned Corps (PHS) disaster mental health response teams. We present personal examples from our deployment experiences to illustrate how to address the barriers occupational therapy practitioners may face in responding to AOTA’s call to action. It was not until the early 1990s that the need to address disaster mental health was formally recognized, prompting the formation of disaster mental health networks among agencies such as the American Red Cross, the National Organization for Victim Assistance, and the International Critical Incident Stress Foundation (Everly & Langlieb, 2003). Victims of a disaster commonly experience a range of normal stress reactions such as intrusive thoughts, substantial emotional upset, nightmares and other sleep disturbances, poor concentration, or angry outbursts (Landesman, 2005; Nemuth, 2004). After the September 11, 2001, terrorist attacks on New York and Washington, DC, 44% of adults and 35% of children reported experiencing one or more symptoms of stress (Nemuth, 2004). The Army has a long history of deploying occupational therapists on mental health teams (Ellsworth, Sinnott, Laedtke, & McPhee, 1993). For example, Army occupational therapists are members of Special Medical Augmentation Readiness Teams–Stress Management (SMART–SM) teams and provide time-limited mental health and critical incident stress management to soldiers, their families, and civilians caught in the turmoil of peacetime operations (Cozza, Huleatt, & James, 2002). Army occupational therapists are also members of Combat Stress Control detachments that deploy with the troops in the field to “maintain the health of the command” (Reyes & Hicklin, 2005, p. 483) and conduct critical incident debriefings after a soldier has been killed or injured (Gerardi & Newton, 2004). PHS, one of the seven uniformed services, consists of health care professionals and scientists whose mission is to “protect, promote, and advance the health and safety of the nation” (U.S. Public Health Service Commissioned Corps, 2007). Occupational therapists, physical therapists, respiratory therapists, speech–language pathologists, and audiologists are commissioned in the PHS and make up the therapist category. Under the purview of the Secretary of Health and Human Services and the Surgeon General of the United States, therapist officers can be mobilized through the Office of Force Readiness and Deployment during disasters, strife, or other public health emergencies. From a roster of identified roles, therapist officers must select a role for deployment mobilization for which they are qualified. Originally, the Office of Force Readiness and Deployment did not recognize occupational therapists under its mental health provider role. Two of us (Captain Oakley and Captain Parks) successfully advocated for including occupational therapist as a qualifier for the mental health provider role, thus enabling occupational therapists to serve on PHS disaster mental health response teams (“Agency Recognizes,” 2004). Since September 2004, PHS occupational therapists have regularly deployed as members of disaster mental health teams, typically serving for 2 weeks at time. PHS officers deploy under a variety of administrative umbrellas, including FEMA and the American Red Cross. The American Red Cross does not include occupational therapists among its mental health providers. However, because we are recognized as mental health providers by our own service, the PHS, we are able to deploy and work in that capacity with the Red Cross. Our disaster mental health work has occurred in nonclinical settings, such as shelters, schools, community centers, or the frontline of a battlefield. Our teams arrive at the disaster site during the postimpact phase. During the postimpact phase (which usually lasts from 4 to 30 days after a disaster strikes), roads may be impassable; telephone lines and cell phone towers may be downed; and businesses such as banks, hospitals, and pharmacies may be inaccessible. The community may be without electricity, and water sources may be contaminated. Citizens are faced with the common realities of the disaster, including long lines of people waiting for basic necessities like food, water, and ice (Landesman, 2005; Young, Ford, Ruzek, Friedman, & Guzman, 2005). Note that although we are occupational therapists, we deploy as members of a disaster response team. This is a subtle but important distinction. The goal of disaster mental health teams is to assist people experiencing normal reactions to abnormal situations by providing practical intervention designed to promote recovery, prevent the adverse impact of acute stress reactions, limit disaster-related mental health problems (e.g., posttraumatic stress reactions, depression, substance abuse), and restore psychological and social functioning (Landesman, 2005; Young et al., 2005). Assistance takes the form of advocacy, problem solving of immediate issues, stress management education about normal reactions to disaster-related stress and handling acute stress reactions, and referring those in need for further evaluation and care (Galea et al., 2002; Landesman, 2005; Waits & Waldrep, 2002; Young et al., 2005). When we deploy as members of disaster mental health teams, we have found that the goal of each team, facilitating normalization of the situation, is the same, but how our role is implemented depends on the circumstances encountered at the site. The following paragraphs provide examples of our recent mental health disaster deployments.