Florida s Disaster Behavioral Health Response: Escambia County Floods (May, 2014) Governor s Hurricane Conference Orlando, Florida May 15, 2015

Transcription

1 Florida s Disaster Behavioral Health Response: Escambia County Floods (May, 2014) Governor s Hurricane Conference Orlando, Florida May 15, 2015

2 Presenters Michael L. Haney, PhD, NCC, CISM, LMHC Florida Department of Health Robert J. Rotunda, PhD Professor & Counseling Program Coordinator Department of Psychology University of West Florida Mark A. O Neill, PhD, CPM College of Public Health University of South Florida

3 Objectives Discuss the 2014 Escambia County DBH Mission Describe the Florida Crisis Consortium s role & structure Define how DBH, Psychological First Aid, etc. differ from traditional mental health practice Recognize the need for DBH expertise in all-hazards preparedness, response & recovery planning Recognize the role of DBH in long-term disaster recovery

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5 Responder Safety & Health Over 50% of disaster workers can be expected to develop significant posttraumatic distress (Wee & Myers, 2001) 5 5

6 Florida Crisis Consortium (FCC)

7 Florida Crisis Consortium (FCC) Formed May 2005 to develop Florida s Disaster Behavioral Health (DBH) response system FCC Partners & DBH Consultants Brings together Subject matter experts Stakeholders Created Florida s DBH Response Plan (11/16/2006) DBH Standard Operating Guideline (SOG)--2015

8 DBH Response Plan Mission: To mitigate adverse effects of disaster-related trauma Purpose: Provides support services, including psychological, social, behavioral, & educational, to facilitate recovery

9 Old DBH Model EOC Emergency Management

10 New DBH Model EOC Emergency Management ESF 8 Public Health & Medical Coordinates with ESF-6, -15, etc. FCC/DBHT 1. Assessment 2. Request 3.Management of assets Responders CISM Red Cross NOVA-FCRT Faith-Based FCC Others Local Mental Health service providers

11 FCC Partners Department of Health Department Children & Families Department of Education Private sector behavioral health providers University of Miami University of South Florida National Crisis Response Canine Team American Red Cross Florida Crisis Response Team (FCRT) Florida Interfaith Networking in Disaster (FIND) Other public/private behavioral health stakeholders 11

12 FCC Responsibilities Maintain & update Florida s DBH plan Maintain standard operating guidelines & protocols Establish competencies for training Recruit, credential & train team members Conduct exercises & review after action reports Develop & maintain DBH public information materials 12

13 DBH Consultants & Disaster Response Ensure safety of DBH responders Conduct Global Assessment (GA) Provide trained DBH Consultants or teams Provide immediate crisis intervention if indicated or requested prior to other resources arriving Manage DBH resources & monitor daily activities Support the information needs of local & state responders

14 Emergency Support Function-8 & DBH DBH is a key component of Community Resiliency Assigned to ESF-8 DBH Consultants or Teams are deployed as ESF-8 assets Local EOCs request support & State ESF-8 fills the mission

15 Florida DBH Standard Operating Guidelines (SOG) State Public Health & Medical: Emergency Support Function (ESF)-8 Florida Crisis Consortium Dept. of Health Dept. of Children & Families Red Cross DBH Technical Specialists & Assessment Teams

16 Mission #132 May 5 th Dr. John Lanza & Dr. Susan Turner DOH in Escambia County State ESF-8 ECO, Plans/Logistics Dr. Rob Rotunda (FCC) & Dr. Michael Haney (FCC/DOH)--Triage Eric Gilmore (Escambia County ESF-8) Four-Person DBH Strike Team from FCC DCF & Disaster Recovery Centers (DRCs)

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20 Dr. Rotunda s Initial Plan Develop outlines & handouts to conduct small & large (up to 25) group stress management meetings with specified groups of employees 7 or 8 separate employee work units that will require minute meetings Team Leader/Clinician will meet with & triage any individuals who request individual support throughout the week Team Deployment May th

21 Initial Situation May 9 th Employees are dispersed to other clinics & the W. Gregory St. office building Employees adjusting to close proximity, slow computer connections, change to personal & work routines, etc. This has caused significant stress to all, some more than others Some staff have to manage client overload Preparations for further expected rains increasing DOH staff & community stress/anxiety

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23 West Gregory St. Alternate Work Site

24 What s in a Name? Critical Incident Stress Management = Disaster Behavioral Health Emergency Mental Health = = Psychological First Aid 24

25 Why is Psychological First Aid Important? Because over 80% of Americans will be exposed to a traumatic incident, & as many as 45% of those directly exposed may develop a Post Traumatic Stress Disorder or Depression. (North, et al., 1999, JAMA)

26 What Makes Disasters Stressful?

27 What Makes Disasters Stressful? Separation from loved ones Loss of loved ones Witnessing harm to loved ones & others Personal harm or injury Threat of harm Exposure to noxious agents Encounter with death & destruction Exposure to the grotesque Loss of home & shelter Dislocation & relocation Loss of personal & valued items Loss of job or workplace Loss of schools Loss of community & social support Fostering dependency Inactivity Lack of food & water Loss of health care Loss of utilities Lack of information

28 Psychological vs. Medical Footprint psychological footprint medical footprint 28

29 World Trade Center, 9/11/2001 Medical Impact Killed 3,000 Psychological Impact Injured with Medical Care 7,500 7,500 Environmental exposures Downtown workers 100, ,000 Residents close to WTC 100, ,000 Rescuers 17,500 17,500 Loss of workplace WTC 32,000 Loss of workplace other 31,000 Displaced/property damage 100,000

30 World Trade Center, 9/11/2001 (cont.) Medical Impact Psychological Impact Family members of: Killed 12,000 Injured 30,000 Rescuers 70,000 Manhattan residents below 110th St (800,000) 200,000 NYC residents (7 million) 1,000,000 US Residents (5-80 years) (206,000,000) 10,300,000 Total 228,000 12,000,000

31 WTC Psychological vs. Medical Footprint WTC Medical footprint = 228,000 citizens Psychological footprint = 12,000,000 Citizens >50 times Greater! 31

32 Psychosocial Impact of Disasters Fear and Distress Response Behavior Change Sources: Ursano, 2002; Institute of Medicine, 2003 Psychiatric Illness

33 Can Rescuers be Impacted? Over 50% of disaster workers can be expected to develop significant posttraumatic distress (Wee & Myers, 2001) 33

34 So what do we do to help?

35 So what do we do to help? Critical Incident = Stress Management Disaster Behavioral Health = Emergency = Mental Health Psychological First Aid

36 What is Psychological First Aid/ Disaster Behavioral Health? A supportive and compassionate presence designed to reduce acute psychological distress &/or facilitate continued support, if necessary. Everly & Flynn (2005) Consensus on Best Practices: U.S. Departments of Health and Human Services, Defense, Veterans Affairs, Justice, and American Red Cross

37 Psychological First Aid Guidelines The Goals of PFA: to reduce distress to assist with current needs to promote adaptive functioning NOT to elicit details of traumatic experiences and losses NOT to expect disclosure or the expression of emotion NIMH/SAMHSA conference (2002)

38 Psychological First Aid (PFA) PIES P roximity Support on-scene I mmediacy Support right away E xpectancy Expect return to full function S implicity Rest, food, hygiene & reassurance BICEPS B revity < 72 hour admission I mmediacy Support right away C entrality Treatment close to unit or base camp E xpectancy Expect return to full function P roximity Support on-scene S implicity Rest, food, hygiene and reassurance

39 Mental Health & PFA Traditional Mental Health Site-based Diagnosis and treatment Impacts personality Probes content Historical issues Psycho-therapeutic focus Psychological First Aid Community-based Adaptation/coping Restores functioning Accepts at face value Normalizes the present Psycho-educational (Adapted from Extreme Behavior Risk Management, 2005)

40 PFA: Goals Self-regulation skills & other, interpersonal interventions Reduce the impact, improve the recovery time, & prevent the onset of additional or worsening symptoms

41 PFA: Core Actions Establish a human connection: non-intrusive & compassionate Enhance immediate & on-going safety; physical & emotional comfort Help survivors to articulate immediate needs & concerns Offer practical assistance & information

42 PFA: Core Actions (cont.) Connect survivors to social support networks, including family, friends, & community helping resources Support positive coping, acknowledge coping efforts & strengths Provide psycho-education Refer to higher levels of care, as necessary ---National Center for PTSD

43 Crisis Intervention Core Competencies Planning & integration into local, county & state emergency response plans Assessment/ Triage: Benign vs. Malignant Symptoms One-on-One Crisis Intervention Small Group Crisis Intervention Large Group Crisis Intervention Follow-up & Referral

44 DBH Planning Formula Target Who should receive services? ID target groups, including first responders. Type Which interventions should be used? Timing When should the interventions be implemented and with what groups? Themes What issues are likely to come up? Team Which DBH resources would best fit?

45 Crisis Intervention Elements Assessment / triage benign vs. malignant symptoms Strategic Planning - utilizing an integrated multi - component crisis intervention system within a response structure Large Group Crisis Intervention: Demobilizations (large groups of rescue / recovery) Respite / Rehab Sectors Crisis Management Briefings (CMB)

46 Crisis Intervention Elements (cont.) Small Group Crisis Intervention: Defusings (small groups) Crisis Management Briefing (small groups) Debriefing Models: CISD/CISM; National Organization for Victim Assistance (NOVA) ; Multistressor debriefing model; Critical Event Debriefing (CED) One-on-one crisis intervention, including individual PFA

47 Recovery Planning Most DBH Issues Will Manifest During the Months After the Initial Response Mental health issues may manifest in other health issues, drug & alcohol abuse, lack of productivity, etc. Responders

48 Psychological & Emotional Recovery Address the full range of psychological & emotional needs of the community Help individuals cope with shock, stress & recovery challenges, Consequences of individuals harming themselves or others through substance, physical & emotional abuses Acknowledge the link among the recovery of individuals, families & communities --National Disaster Recovery Framework (2011), p. 11

49 Pre-Disaster Recovery Planning Develops strategies to address recovery issues for health, behavioral health & social services particularly the needs of response & recovery workers, children, seniors, people living with disabilities, people with functional needs, people from diverse cultural origins, people with limited English proficiency & underserved populations.

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52 Post-Disaster Redevelopment Plan

53 Local Healthcare Coalition a collaborative network of healthcare organizations & their respective public & private sector response partners that serve as a multi-agency coordinating group to assist with preparedness, response, recovery, and mitigation activities related to healthcare organization disaster operations. --Healthcare Preparedness Capabilities: National Guidance for Healthcare System Preparedness

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55 Missouri Plan Template Address fears with education & risk communication Grief & bereavement education Pre-plan for anger, fear, exhaustion & resolving ethical issues Identify staff care strategies Provide grief & self-care information on Fact Sheets Plan for recovery & support groups

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58 Resources Parent Guidelines for Helping Children after Hurricanes Florida Department of Health Disaster Behavioral Health Florida Department of Children & Families Disaster Mental Health U.S. Health & Human Services Disaster Behavioral Health Concept of Operations Florida Healthcare Coalitions

59 Resources (cont.) Integration of Mental & Behavioral Health in Federal Disaster Preparedness, Response, and Recovery: Assessment & Recommendations. Psychological First Aid (PFA) Field Operations Guide (FOG) Medical Surge Capacity and Capability: The Healthcare Coalition in Emergency Response and Recovery Surge, Sort, Support

60 Questions? Mike Haney Florida Department of Health Mark A. O Neill USF College of Public Health moneil1@health.usf.edu