Medical Reserve Corps Disaster Mental Health Work Group Update

Medical Reserve CorpsMedical Reserve Corps

Disaster Mental HealthDisaster Mental Health

Work Group UpdateWork Group Update


Workgroup Overview Workgroup Overview and Purposeand Purpose

John K. Hickey, DSW, LCSW-RMental Health Lead, Nassau County MRCNassau County, N.Y. Department of Health

Work Group Overview and PurposeWork Group Overview and Purpose

This time last yearThis time last year

The surgeon generalThe surgeon general

The MRC Mental Health Work GroupThe MRC Mental Health Work Group

Purpose and goalsPurpose and goals

The power of networking and collaborationThe power of networking and collaboration


Core Core CompetenciesCompetencies

Ed Kantor, MDEd Kantor, MDAssistant Professor of Psychiatric MedicineAssistant Professor of Psychiatric Medicine

University of Virginia School of MedicineUniversity of Virginia School of Medicine

Disaster Mental Health Disaster Mental Health Core CompetenciesCore Competencies

Goals of this section:Goals of this section:

Gain Awareness of Competency MovementGain Awareness of Competency Movement

Understand Concept of Understand Concept of

‘‘Core Competencies’Core Competencies’

Learn about MH Work Group EffortsLearn about MH Work Group Efforts


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.


Understanding the Concept of ‘Competencies’

– Competency implies an acceptable minimum standardCompetency implies an acceptable minimum standardCan aim higher, but must define the lowest acceptable pointsCan aim higher, but must define the lowest acceptable pointsRequires measurement to determine acceptable performanceRequires measurement to determine acceptable performance

– Expectations can vary with role and position– Levels: Awareness, Technician, Practitioner, Master (trainer)

– Competencies require a minimum level of :Competencies require a minimum level of :KNOWLEDGEKNOWLEDGE - An - An UnderstandingUnderstanding of requisite information of requisite informationSKILLSKILL - - AbilityAbility to perform activities acceptably to perform activities acceptablyATTITUDEATTITUDE - - AppreciationAppreciation of roles, expectations and limits of roles, expectations and limits

– Cover Six Core Areas (some variations exist)Cover Six Core Areas (some variations exist)Medical Knowledge, Patient Care, Interpersonal & Communication Skills, Professionalism, Systems-Based Practice, Practice-Based Learning & Improvement


Understand Concept of ‘Competencies’Understand Concept of ‘Competencies’(cont…)(cont…)

Six Core AreasSix Core Areas

-Professionalism-Professionalism

-Systems-Based Practice-Systems-Based Practice

-Practice-Based Learning-Practice-Based Learning

and Improvementand Improvement

-Patient Care-Patient Care

-Medical Knowledge-Medical Knowledge

-Interpersonal and Communication Skills-Interpersonal and Communication Skills

Six Core AreasSix Core Areas

-Professionalism-Professionalism

-Systems-Based Practice-Systems-Based Practice

-Practice-Based Learning-Practice-Based Learning

and Improvementand Improvement

-Patient Care-Patient Care

-Medical Knowledge-Medical Knowledge

-Interpersonal and Communication Skills-Interpersonal and Communication Skills

*Some minor variation exists in core subject areas between professions


Learn about MH Work Group EffortsLearn about MH Work Group EffortsIdentifying and Defining Core Competencies for DMH

– Examples: Position statement on Psychological Debriefing

Linking Competency to Curricula, Training and Evaluation

Defining Prerequisites, Minimum Standards, Reciprocity


Identifying and Defining Competencies for DMHIdentifying and Defining Competencies for DMH

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


Identifying and Defining Competencies for DMHIdentifying and Defining Competencies for DMH

– Identify minimum areas of expected Knowledge, Skill and Identify minimum areas of expected Knowledge, Skill and AttitudeAttitude

Principles of Disaster and Disaster Mental (Behavioral) HealthPrinciples of Disaster and Disaster Mental (Behavioral) Health

Communicating and Educating in a Crisis Communicating and Educating in a Crisis (risk communication, psychoeducation)(risk communication, psychoeducation)

Normal Reactions and Common Psychological EffectsNormal Reactions and Common Psychological Effects

Abnormal Psychological ReactionsAbnormal Psychological Reactions

Intervention and Treatment Strategies Intervention and Treatment Strategies (prevention, early, intermediate, late)(prevention, early, intermediate, late)

Scenario Specific MH Concerns Scenario Specific MH Concerns (natural, industrial, violence, etc…)(natural, industrial, violence, etc…)

Responder and Self-care MH issuesResponder and Self-care MH issues

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


Linking Competency to Curricula, Training and EvaluationLinking 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

Professionalism

SpecificCompetency

ClientAssessment


Prerequisites, Minimum Standards, ReciprocityPrerequisites, Minimum Standards, Reciprocity

– What are is the minimum training expectations?What are is the minimum training expectations?Integrating Disciplines Integrating Disciplines (LPC, LCSW, Psychiatrist, Psychologist, etc)(LPC, LCSW, Psychiatrist, Psychologist, etc)

Crediting Experience Crediting Experience (work history, specialty certification, etc…)(work history, specialty certification, etc…)

Course Completion Course Completion (reciprocity, continuing education, etc…)(reciprocity, continuing education, etc…) Licensure Licensure (state specific)(state specific) Privileging and Supervision Privileging and Supervision (local ?, integrating students and other trainees)(local ?, integrating students and other trainees)


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)


Response Interventions cont….

– Individual Interventions (Patient Care)Assessment and ReferralEmergent Interventions Acute Interventions Longer Term InterventionsChild Specific Interventions"At-Risk” and Special PopulationsUnique needs of responders

– Community Interventions (Systems)

Surveillance and OutreachConsultation on programming and interventionsGeneral Support to Command and Community


TrainingTraining

Jack Herrmann, MSEd, LMHCJack Herrmann, MSEd, LMHCAssistant ProfessorAssistant Professor

University of Rochester School of Medicine & DentistryUniversity of Rochester School of Medicine & Dentistry

Disaster Mental Health TrainingDisaster Mental Health Training

Selection of Team MembersSelection of Team Members– Recruitment of Mental Health ProfessionalsRecruitment of Mental Health Professionals

Selection of Training CurriculaSelection of Training Curricula– Matched against a set of core competenciesMatched against a set of core competencies– Evidence-informedEvidence-informed

‘‘One size fits all’ vs ‘Training Menu’One size fits all’ vs ‘Training Menu’One time vs. on-goingOne time vs. on-goingAcute – Intermediate – Long Term InterventionsAcute – Intermediate – Long Term Interventions


A variety of disaster mental health trainings A variety of disaster mental health trainings available in the public and private domainavailable in the public and private domain– On-siteOn-site– On-lineOn-line– HybridHybrid


American Red Cross/ICRC

DHHS/SAMHSA


New York State/University of Rochester Commonwealth of Virginia

Disaster Mental Health TrainingDisaster Mental Health TrainingCenter for Disaster Epidemiology and Emergency

National Rural Behavioral Health Center at the University of Florida

Harvard Medical International


PsychologicalPsychologicalFirst AidFirst Aid

Patricia Santucci, MDAssociate Professor of Psychiatry

Stritch School of Medicine

Psychological First Aid Psychological First Aid Field Operations GuideField Operations Guide

Medical Reserve Corps Medical Reserve Corps National Child Traumatic Stress NetworkNational Child Traumatic Stress Network

National Center for PTSDNational Center for PTSD

What is Psychological First AidWhat is Psychological First Aid

An evidence-informed modular approach to An evidence-informed modular approach to assist children, adolescents, adults and family in assist children, adolescents, adults and family in the immediate aftermath of disaster or terrorismthe immediate aftermath of disaster or terrorism

Designed to reduce the initial distress caused by Designed to reduce the initial distress caused by traumatic eventstraumatic events

Foster short and long term adaptive functioning Foster short and long term adaptive functioning and copingand coping

PFA disclaimerPFA disclaimer

Has received considerable support from disaster mental health Has received considerable support from disaster mental health experts as the experts as the “acute intervention of choice“acute intervention of choice””

Many of the components have been tested and validated Many of the components have been tested and validated

Consensus is at this time should Consensus is at this time should at worse, produce no harm– at at worse, produce no harm– at bestbest, , provide effective ways to manage post-disaster stress and provide effective ways to manage post-disaster stress and identify those that need additional psychological supportidentify those that need additional psychological support

No model to date has empirically validated or rigorously tested the No model to date has empirically validated or rigorously tested the efficacyefficacy of this supportive intervention and resultant outcomes are of this supportive intervention and resultant outcomes are unknownunknown

Who is PFA For ? Who is PFA For ? Individuals experiencing acute stress Individuals experiencing acute stress reactions or who appear to be at risk for reactions or who appear to be at risk for significant impairment in functioningsignificant impairment in functioning

Who Delivers PFA?Who Delivers PFA?

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

When Should PFA be used?When Should PFA be used?

Supportive behavioral intervention for Supportive behavioral intervention for use in the immediate aftermath of use in the immediate aftermath of disasters and other traumatic eventsdisasters and other traumatic events

Intended to blend into the MRC Intended to blend into the MRC response structure early in stabilization response structure early in stabilization and recovery effortsand recovery efforts

Where Should PFA Be Used?Where Should PFA Be Used?

Designed for delivery in diverse settingsDesigned for delivery in diverse settings

MRC Delivery Sites and SettingsMRC Delivery Sites and Settings

SheltersSheltersRespite CentersRespite CentersHospital-ER, FieldHospital-ER, FieldService CentersService CentersEmergency Operations Emergency Operations CentersCentersCommunity Outreach TeamsCommunity Outreach TeamsFirst Aid StationsFirst Aid StationsPhone banks- hotlinesPhone banks- hotlinesPODSPODSStaging AreasStaging Areas

Family Reception CentersFamily Reception Centers

Family Assistant CentersFamily Assistant Centers

First Responders and Disaster First Responders and Disaster Relief Personnel unitsRelief Personnel units

SchoolsSchools

Following WMD events:Following WMD events:– Mass casualty collection pointsMass casualty collection points

– Field post decontamination Field post decontamination sitessites

– Mass prophylaxis sitesMass prophylaxis sites

Strengths of PFAStrengths of PFARelies on field tested, evidence-informed strategiesRelies on field tested, evidence-informed strategies

Includes basic information gathering techniques to help make rapid Includes basic information gathering techniques to help make rapid assessment of what is needed and what to doassessment of what is needed and what to do

Guidelines for delivery and concrete examplesGuidelines for delivery and concrete examples

Developmentally and culturally appropriate interventions for Developmentally and culturally appropriate interventions for survivors of various ages and backgroundssurvivors of various ages and backgrounds

Includes important elements of risk communication, behaviors to Includes important elements of risk communication, behaviors to avoid and education via use of materials and handoutsavoid and education via use of materials and handouts

Easy access- on lineEasy access- on line

PFA Core ActionsPFA Core Actions

Contact and engagementContact and engagementSafety and comfortSafety and comfortStabilization ( if needed)Stabilization ( if needed)Information gathering: Current needs and concernsInformation gathering: Current needs and concernsPractical assistancePractical assistanceConnection with social supportsConnection with social supportsInformation on copingInformation on copingLinkage with collaborative servicesLinkage with collaborative services

Contact and EngagementContact and Engagement

Establish a connection in a non-intrusive Establish a connection in a non-intrusive compassionate mannercompassionate manner– Adult/caregiverAdult/caregiver

Hi, my name is Pat. I’m with the Medical Reserve Corps. We’re checking 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.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, 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 before we talk, is there something right now that you need, like water or juice?juice?

– Adolescent/ childAdolescent/ childAnd is this your daughter? ( Get on child’s eye level, smile and greet 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 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? 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 There is some water and juice over there , and we have a few blankets with toys in those boxestoys in those boxes

Safety and ComfortSafety and Comfort

Enhance immediate and ongoing safety, Enhance immediate and ongoing safety, and provide physical and emotional and provide physical and emotional comfortcomfort– Basic NeedsBasic Needs

StabilizationStabilization

Calm and orient emotionally overwhelmed Calm and orient emotionally overwhelmed or disoriented survivorsor disoriented survivors– Signs and symptomsSigns and symptoms– What to doWhat to do

Information Gathering: Information Gathering: Current Needs and ConcernsCurrent Needs and Concerns

Identify immediate needs and concernsIdentify immediate needs and concernsGather additional information as appropriate to Gather additional information as appropriate to the situationthe situationGoals of informal Goals of informal assessmentassessment

Assessment caveatsAssessment caveatsEducational pointsEducational pointsDifferences in family Differences in family reactionsreactionsTrauma remindersTrauma remindersLoss remindersLoss remindersTrauma developmentTrauma developmentEducational caveatsEducational caveatsContent areasContent areas

Information Gathering:Information Gathering:Current Needs and ConcernsCurrent Needs and Concerns

Provider alertsProvider alerts– ExamplesExamples

Avoid asking for in-depth descriptions of traumatic Avoid asking for in-depth descriptions of traumatic experiences, as this may provoke unnecessary additional experiences, as this may provoke unnecessary additional stressstress

Avoid “blanket” reassurance that stress reactions will Avoid “blanket” reassurance that stress reactions will disappear. This may set up unrealistic expectations, resulting disappear. This may set up unrealistic expectations, resulting in negative views of self if reactions persists.in negative views of self if reactions persists.

Practical AssistancePractical Assistance

Offer practical assistance and information Offer practical assistance and information to address survivor’s immediate needs and to address survivor’s immediate needs and concernsconcerns

IdentifyIdentify

ClarifyClarify

Discussion actionDiscussion action

ActAct

Connection with Social SupportsConnection with Social Supports

Connect survivors as soon as possible to Connect survivors as soon as possible to social support providers, including family , social support providers, including family , friends and community helping resourcesfriends and community helping resources

““The most positive results from early interventions are usually The most positive results from early interventions are usually for those that mobilize community support and address for those that mobilize community support and address survivor’s human affiliation needs ( eg. helping survivors survivor’s human affiliation needs ( eg. helping survivors establish contact with relatives) rather than interventions that establish contact with relatives) rather than interventions that focus on individual psychological reactions.”focus on individual psychological reactions.”

– Orner, Kent, Pfefferbaum, Watson The Context of Providing Immediate Post Orner, Kent, Pfefferbaum, Watson The Context of Providing Immediate Post Intervention In: Ritchie, Watson, & Friedman (eds) Intervention Following Mass Intervention In: Ritchie, Watson, & Friedman (eds) Intervention Following Mass Violence and Disaster. New York: The Guildford Press, 2006Violence and Disaster. New York: The Guildford Press, 2006

Information on CopingInformation on Coping

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

Information on CopingInformation on Coping

Provide information about stress and coping to reduce Provide information about stress and coping to reduce distress and promote adaptive functioningdistress and promote adaptive functioning– Basic information about stress reactionsBasic information about stress reactions– Ways of copingWays of coping

Positive copingPositive copingNegative copingNegative copingDemonstrate Simple Relaxation TechniquesDemonstrate Simple Relaxation Techniques

Developmental issuesDevelopmental issuesHighly negative emotionsHighly negative emotionsSleepSleepHygieneHygieneAnger managementAnger managementSubstance abuseSubstance abuse

Linkage with Collaborative ServicesLinkage with Collaborative Services

Possible indications for referralPossible indications for referral

Making a referralMaking a referral

Appendix Appendix MRC Debriefing Position StatementMRC Debriefing Position Statement

Recommendations:Recommendations:

– Because of the possibility of harm to individual Because of the possibility of harm to individual participants ,’Psychological Debriefing ‘ participants ,’Psychological Debriefing ‘ should NOT should NOT be a standard part of the mental health response in be a standard part of the mental health response in crisis and disaster situationscrisis and disaster situations

– Mandatory or “required” psychological interventions Mandatory or “required” psychological interventions should not be applied across the board to survivors or should not be applied across the board to survivors or responders following disasterresponders following disaster

AppendixAppendix Resources Resources

Training ResourcesTraining ResourcesIssues and populations of special Issues and populations of special considerationconsiderationDisaster relief organizations, agencies and Disaster relief organizations, agencies and programsprogramsPlanning tools and technical resourcesPlanning tools and technical resourcesRisk communicationRisk communication

AppendixAppendixHandoutsHandouts

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

Additional AppendicesAdditional Appendices

Special Considerations for Acutely Special Considerations for Acutely Bereaved IndividualsBereaved Individuals

Service Site ChallengesService Site Challenges

More to come…..More to come…..

Take Home MessageTake Home Message

PFA is the “acute intervention of choice”PFA is the “acute intervention of choice”

Supported by the MRC as a basic teaching resource for ALL MRC Supported by the MRC as a basic teaching resource for ALL MRC MEMBERS !MEMBERS !

Supports position paper: do not “debrief ”Supports position paper: do not “debrief ”

Easy access- MRC websiteEasy access- MRC website

Can be carried in GO BAG as a Field ManualCan be carried in GO BAG as a Field Manual

Will be continuously updated and expandedWill be continuously updated and expanded

MRC feedback criticalMRC feedback critical

The EndThe End

If you are interested in learning more about the If you are interested in learning more about the National Disaster Mental Health Work Group :National Disaster Mental Health Work Group :– Please visit the mental health table at the ConferencePlease visit the mental health table at the Conference– E-mail: E-mail: [email protected]@pol.net

[email protected]@optonline.net

Special acknowledgement to Jim Shultz PhD, Director of DEEP, for graphic assistanceSpecial acknowledgement to Jim Shultz PhD, Director of DEEP, for graphic assistance

Documents

Medical Reserve Corps Disaster Mental Health Work Group Update