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Presented by Mrs. Rosalie Kwong Sr. Clinical Psychologists Certified Traumatologist Corporate Clinical Psychology Services

Sr. Clinical Psychologists Certified Traumatologist ... · Sr. Clinical Psychologists Certified Traumatologist Corporate Clinical Psychology ... Ship wreck. Aircraft ... Eventful

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  • Presented by Mrs. Rosalie Kwong

    Sr. Clinical PsychologistsCertified Traumatologist

    Corporate Clinical Psychology Services

  • Examples of Major DisastersNov 96 : Fire Incident of Garley buildingJan 97: Top One Karaoke Fire IncidentApril 97: Mei Foo Fire IncidentJan 98: Electric Road Fire IncidentJan 98: City Bus overturn Incident Feb 98: Kam Sheung Road Coach AccidentMay 98: Shipwreck Accident Aug 99: Aircraft overturnSept 01: 911Mar 03: SARSDec 04: TsunamiNov 05: WTO

  • Fire Incidents

    Garley buildingNov 96 Top One Karaoke

    Jan 97Mei FooApril 97

  • Traffic Accidents(1998)

    Bus overturn Coach Accident

    Ship wreck

  • Aircraft overturn(1999)

  • 911 (2001)

  • SARS(2003)

  • Tsunami(2004)

  • WTO(2005)

  • Victims

    Hospitalized/ discharged victims

    Families/ relatives of the victims/deceased

    Rescuers/ emergency personnel

  • Objectives of Disaster Management(Psychological Services)

    Primary Goals

    Mitigate impact of event

    Facilitate normal recovery processes

    Restoration to adaptive function

  • Phases of Disaster

    Warning or

    Threat Phase

    Reconstruction /

    Recovery Phase

    (Continue for years)

    Disillusionment

    Phase

    Inventory

    Phase

    Remedy /

    Honeymoon Phase

    (Week - Months)

    Rescue /

    Heroic Phase

    (Immediate Aftermath)

    Impact Phase

  • Intervention Timeline

    Incident

    Crisis Intervention

    Counseling

    Psychotherapy

    HospitalizationRehab

  • Critical Incident Support Teams (CIST)Clinical Director

    IV. 2002-present

    Oasis Center for Personal Growth & Crisis Intervention

    Center Director

    III. 2001

    Disaster Psychosocial Services Teams (DPST)Chief Coordinator, HAHO Trainer

    II. 1999/20

    Civil Disaster Management Committee (CDMC) (Clinical Psychology Services)Network among CPsChairman, Chief Coordinator

    I. 1996/97

    Implementation mechanisms

  • Psychological Management of Disaster

    III. Oasis Center for Personal Growth & Crisis Intervention

    IV. Critical Incident Support Teams

    Rescuers /

    Emergency Personnel

    HA Staff

    I. Civil Disaster Management Committee

    (Clinical Psychology Services)

    II. Disaster Psychosocial Services Teams

    1. Hospitalized /

    Discharged Victim

    2. Family members /

    Bereaved relatives

  • Civil disaster contingency plan (clinical psychology service)

    Coordinators: Clinical psychologists/ senior clinical psychologists

    Better coordination of clinical psychology Services in the event of a major disaster

    Network among clinical psychologists working in different clusters (not only those working in acute general hospitals)

    I. Civil Disaster Management Committee (Clinical Psychology Services) (CDMC)

  • I. Civil Disaster Management Committee (Clinical Psychology Services) (CDMC)

    Objectives:Objectives:

    To minimize the severity and duration of emotional trauma

    To prevent development of further mental disturbance

  • I. Civil Disaster Management Committee (Clinical Psychology Services) (CDMC)

    Scope of ServicesScope of Services

    Consultation on therapeutic intervention

    Psycho diagnostic assessment

    Psychological intervention

    Group support session

    Group debriefing

    Development of psycho educational materials

    Training

    Liaison with other agencies

  • I. Civil Disaster Management Committee (Clinical Psychology Services) (CDMC)

    1.1.Trauma VictimsTrauma Victims

    (Adult, Children)Chinese & Eng versions

    2. 2. Bereaved Relatives Bereaved Relatives

    (Adult, Children, Staff)Chinese & Eng versions

    Psycho educational materialsPsycho educational materials

  • I. Civil Disaster Management Committee (Clinical Psychology Services) (CDMC)

    33. . Emergency personnelEmergency personnel-- Critical Incident Stress Management Critical Incident Stress Management

    Request FormsRequest FormsOasis website :

    http://www.ha.org.hk/oasis

  • I. Civil Disaster Management Committee (Clinical Psychology Services) (CDMC)

    Training

    1. Workshops on Disaster Psychosocial Services e.g. Pre-incident Preparation

    Phases of disaster

    Impact of disaster

    Assessment of the needs of survivors

    Management of disaster victims/ familiesService Guidelines

  • Assessment FormsDisaster Psychosocial Services

    Record Form

    Incident :

    Date :

    Name :

    ID No.

    Sex : F M Age :

    Marital Status : S M D W Education : Nil P S U P

    Contact No. :

    Address :

    Physical Injury :

    Mental Condition :

    Major Concern :

    Social Support :

    Services Rendered :

    Action Plan :

    Referral :

    Prepared by (Rank )

    Assessment Checklists For Disaster Victims

    A. Acute Symptoms

    Affective Dimension 1. Affective Flooding e.g. panicked, enraged 2. Affective Numbness e.g. absence of emotional responsiveness,

    reduction in awareness of the surrounding

    Congnitive Dimension 1. Memory Impairment e.g. inability to recall personal information 2. Concentration Difficulties e.g. train of thought is often interrupted 3. Denial e.g. demand the dead relative gets up and returns home 4. Ruminations & Intrusions e.g. obsess with the details, repet the same

    answered questions

    5. Guilt and Hopelessness e.g. self-blame and expressed suicidal thoughts

    Physiological Dimension 1. High Arousal Level e.g. flushed, sweating 2. Somatic Discomfort e.g. dizziness, palpitation

    Behavioural Dimension 1. Withdrawal & Avoidance e.g. turn away from people 2. Regression e.g. speak and act like a child 3. Aggression to self or others

    Severe Moderate Mild

    C. Trauma Risk Factors Trauma Factors 1. Life threatening danger, extreme violence, or sudden death of others 2. Personal injury 3. Loss of Loved ones 4. Injury of loved ones 5. Extreme loss or destruction of their homes normal lives, and community 6. Exposure to traumatic sights, sounds, or experiences 7. Witness of mass destruction or death 8. Histories of prior exposure to trauma

    Support

    1. Low levels of emotional / social support or high levels of social demand

    Coping

    1. Coping via avoidance, self-blame, or rumination 2. Coping via substance abuse

    Comorbidity

    1. Previous experience of adverse life events 2. Eventful developmental history and family instability 3. Prior psychiatric / severe emotional disturbance 4. History of substance abuse 5. History of suicidal attempt 6. Major life stressors (e.g. divorce, job loss, financial losses) 7. Prior significant loss (e.g. death of a loved one in the past year), unresolved

    bereavement

    8. Loss of job 9. Toxic contamination 10. Serving as an emergency worker (e.g. police, fire, healthcare, professionals,

    emergency workers)

    11. Elderly

    Severe Moderate Mild

    Grief Risk Factors(Adult)

    Risk Factors

    1. Having young Children 2. Low socio economic status 3. Unemployed or with financial difficulties 4. Presence of rage 5. Blaming others 6. Blaming self 7. Poor social Support 8. Inadequate coping skills 9. Multiple losses 10. Prior psychiatric / severe emotional disturbance

  • I. Civil Disaster Management Committee (Clinical Psychology Services) (CDMC)

    2. Training for HA staff who are required to provide direct

    services to disaster victims or their relatives e.g.

    Acute grief handling

    Breaking bad news

    Understanding critical incident stress

  • I. Civil Disaster Management Committee (Clinical Psychology Services)

    Liaison with other agenciesIndirect peripheral victims

    Victims without physical injury

    Who are in need of psychological treatment

    Referral to other relevant agencies for FU services

    SWD

    NGOs

    Universities: Psychological services unit

  • II. Disaster Psychosocial Services Teams(DPST) (14 Acute General Hospitals)

    TMHNTWCAHNH, NDH, PWHNTEC

    CMC, KWH, PMH,YCHKWCTKOH, UCHKEC

    QEHKCCQMH, RHTSKHKWC

    PYNEHHKEC-HAHO

    HospitalsCluster

  • II. Disaster Psychosocial Services Teams(Coordinators)

    Clin. Psy.Ms. Ide ChanTMHNTWC

    PR&PASMs. Terry WuNDH

    MSWMr. Victor TamAHNH

    MSSUMs. Tam Chui-kingPWHNTEC

    Clin. Psy.Dr. Kitty WuCMC

    MSSMs. Kitty FuYCH

    MSSMs. Lee Mee-ling FlorenceKWH

    PSDMs. Kitty SiuPMHKWC

    MSSMs. Tsoi Yuen-kanUCH

    Psychological Spiritualf Reh. Center

    Mr. S. Y. LiTKOHKEC

    Clin. Psy.Ms. Mary LeeQEHKCC

    MSWMr. Tse Heung SangRHTSK

    Clin. Psy.Dr. Amy FungQMHHKWC

    Clin. Psy.Ms. Jeanie NganPYNEHHKEC

    PS&OMs. Rosalie Kwong-HAHO

    DepartmentNameHospitalsCluster

  • II. Disaster Psychosocial Services Teams (DPST)

    Members:

    Clinical Psychologists

    Medical Social Workers

    Pastoral care workers

    Chaplains

    Patient relation officers

    Community nurses

    etc.

  • II. Disaster Psychosocial Services Teams

    Disaster Psychosocial Services Team (DPST) (MSWs, Clinical Psychologists, Chaplains, Pastoral Care Workers, PROs, Nurses, etc)

    Initial Assessment

    Immediate Intervention

    Identification of Patient at Risk

    ReferralFU

  • II. Disaster Psychosocial Services TeamsScope of services (Psycho social spiritual care)Scope of services (Psycho social spiritual care)

    Assessment

    Crisis intervention

    Assisting in help Desk

    Bereavement counseling

    Spiritual care, sacramental services, religious services/rituals

    Follow up services (including home based Fu visits)

    Making referral

    Consultation services to other health care workers

    Liaison with other departments

  • Critical Incident Support Teams (CISTs)Crisis Intervention

    IV.

    Oasis Center for Personal Growth & Crisis InterventionPsychological services for staff

    III.

    Disaster Psychosocial Services Teams (DPST)II.

    Civil Disaster Management Committee (CDMC) (Clinical Psychology Services)

    I.

    Emergency Personnel

    Implementation mechanisms

  • Hidden Victims

    Emergency personnel

    Health care workers

    Secondary/ Tertiary victims

    Vicarious traumatization

    Empathy : suffering and distress

    Exposure

    Normal reaction to abnormal situation

  • Possibility of developing PTSD

    Emotional SymptomsEmotional Symptoms: Depressed mood, anxiety, irritation, hypervigilance, etc.

    Cognitive SymptomsCognitive Symptoms: Sense of detachment, recurrent thoughts or dreams of the incident, poor concentration, difficulty in making decisions, etc.

    Behavioural SymptomsBehavioural Symptoms: sleeping difficulty, avoidance behaviours, poor appetite, loss of interest in work, substance abuse, etc.

    Physical SymptomsPhysical Symptoms: Headaches, fatigue, dizziness, etc.

    Impact: Individual Level

  • Impact: Organizational Level

    absenteeism

    U.S. : lost workdays per nonfatal assault = 5

    work performance

    sense of organizational commitment

    staff turnover

    number of accidents at work

    long-term treatment cost

  • Post-incident Support

    Proper support to staff: Standard of care

  • Care for staff

    Care for Patients

  • Service Providers

    III. III. OasisOasis Center for Personal Growth & Crisis InterventionCenter for Personal Growth & Crisis Intervention

    Corporate Clinical Psychologists

    Psychological services to HA staff

    Website:http://www.ha.org.hk/oasis

    Psychological Wellness

  • 1. Direct Clinical Services2. Crisis intervention-- psychological first aid3. Professional Training4. Research/ Stress Audit5. Consultation Services6. Personal Development Programs7. Oasis at Workplace8. Development of Resources9. Volunteer Services10. Facilities of Oasis: bookstore, resources Library

    III. Oasis III. Oasis Center for Personal Growth & Center for Personal Growth & Crisis InterventionCrisis Intervention

    Scope of Services Scope of Services Personal Development Crisis Intervention

  • 1. Contingency Plans of Major Critical incidentsPsychological services for staff (e.g. SARS, WTO, Avian Flu Pandemic)

    2. Phases of intervention:Pre-event StageEvent StagePost-Event Stage

    3. Pre-incident training: Psychological preparedness

    4. Critical Incident Stress Management (CISM): various intervention approaches

    III. III. OasisOasis Center for Personal Growth & Center for Personal Growth & Crisis InterventionCrisis Intervention

    Crisis interventionCrisis intervention---- psychological psychological first aidfirst aid

  • Different hospitals

    Staff volunteers from different disciplines (e.g. physicians, nurses, allied health professionals, administrative, support services,)

    Trained under the Critical Incident Stress Management model

    Supported by Corporate Clinical Psychology Services

    Peer-led support system

    IV. Critical Incident Support TeamsPsychological First Aid

  • Critical Incident Support Team

    Physicians, Nurses, AHSSP, Admin P

    Assessment

    Intervention Oasis(Corporate Clinical Psy

    Services)

  • NTW

    Mr Victor Tam

    40

    NTE

    Ms Canice CheiuMs Becky Ho

    28

    Ms Florena Yau21

    Ms Grace Wan8Ms Josephine Chu

    19KEC

    Ms Maicy Ho

    29

    16

    Ms Liu Hung-yee

    31

    Ms Pamela Chan

    21KWC

    Ms Kwok Wai Han18

    Ms Ann Chan26HKE

    Critical Incident Support Teams (CIST)

  • Crisis Intervention Services

    Model of Critical Incident Stress Management (CISM) (Everly & Mitchell, 1997, 1999)

    A comprehensive integrated, multi-component continuum approach to crisis intervention

  • Scope of Services Scope of Services

    I. I. PrePre--ExposureExposure

    Formulation of CISM team

    Stress Education

    II. II. During Traumatic ExposureDuring Traumatic Exposure

    On Scene Support Services

  • III. Post Stress InterventionIII. Post Stress Intervention

    1. Crisis Mx Plan/ Strategic Response to Crisis

    Assess service needs

    Psychological triage

    Set expectations

    Advice and plan suitable crisis intervention services

    Scope of Services

  • 2. Individual crisis intervention

    3. Small group crisis intervention

    a. Defusing

    b. Critical Incident Stress Debriefing (CISD)

    Scope of Services

  • 4. Large group crisis intervention

    a. Demobilizations

    b. Crisis Management Briefings

    5. Consultation

    Scope of Services

  • It helps to build up a harmonious atmosphere among staff

    The group meeting can relieve my anxiety

    I can get professional advice from the facilitator

    It is good for my mental health

    I realise that I am not alone

    I do not have to face the problem alone

    Members can know more about each others feeling

    It helps to understand the impact of this incident on mypsychological well being

    Feedback from Staff

  • Psychological Services for Other Government Personnel

    Lan Kwai Fong Incident (firefighters, ambulance men)

    Aircraft overturn (air traffic controllers)

    Immigration Tower Incident (officers)

    Tsunami (government personnel)

  • Psychological Services for Other Government Personnel

    Immigration Dept.Hong Kong Police Force Auxiliary Medical ServicesCivil Aid Services Hospital AuthorityDepartment of HealthGovernment Information Service Security Bureau Social Welfare Department

  • Consultation to management

    Group Crisis Intervention (Critical Incident Stress Debriefing)

    Psycho education class

    Individual follow up

    Psycho educational material on Coping with Critical Incident Stress

    Scope of ServicesScope of Services(For Government Personnel)(For Government Personnel)

  • Scope of Services(For victims and their relatives)

    Consultation to management

    Client advocate

    Supportive therapy

    Grief counselling

    Provision of additional resources