Webinar: State Disaster Behavioral Health Concepts...Universal Emotions: “Disasters may evoke a...
29
Jim Harvey, LCSW NE DHHS Division of Behavioral Health Webinar: State Disaster Behavioral Health Concepts March 9, 2011
Transcript of Webinar: State Disaster Behavioral Health Concepts...Universal Emotions: “Disasters may evoke a...
Jim Harvey, LCSWNE DHHS Division of Behavioral Health
Webinar: State Disaster Behavioral Health Concepts
March 9, 2011
DOROTHY: How can you talk if you haven't got a brain?
SCARECROW: I don't know. But some people without brains do an awful lot of talking, don't they?
Presenter
Presentation Notes
Wizard of Oz, The (1939) movie script by Noel Langley, Florence Ryerson and Edgar Allen Woolf. Based on the book by L. Frank Baum. Last revised March 15, 1939. =====\ Screenplays for You - free movie scripts and screenplays http://sfy.ru/sfy.html?script=wizard_of_oz_1939 accessed on Feb 10, 2011
Mental Health: A Report of the Surgeon General Chapter 2 – “The Fundamentals of Mental Health and Mental Illness”
http://www.surgeongeneral.gov/library/mentalhealth/home.html
The Brain: Organ of the Mind
BRAIN/BODY CONNECTIONMind and Body are Inseparable …
• Brain and Body Are Connected Using– 1) BLOODSTREAM (chemical molecules)– 2) NEURON PATHWAYS (electrochemical signals)
• The brain is 2% of the body's mass … it receives 20% of blood flow …
All brains are based on a common blueprint
… the human genome sequence is almost exactly the same (99.9%) in ALL people.
The Genetic Code is the Common Blueprint …
Unique Individual Brain
• 0.1% of genetics not common to all humans.• Brain Plasticity: Genetics responding to the
environment.
• Genetic Code – The Common Blueprint … the human genome sequence is almost
exactly the same (99.9%) in ALL people.
Anger …Disgust … Fear Joy … Sadness … Surprise
Universal Emotions:
Presenter
Presentation Notes
“Disasters may evoke a broad spectrum of reactions in survivors, as well as responders. The cause and phase of the disaster, whether natural or human caused, may influence the intensity of emotions.” From: "Understanding, Accepting, and Managing Anger in Disasters" Contributed by Gladys Padro, M.S.W., LSW1 and Steven Crimando, M.A. The Dialogue2011VOLUME 7, ISSUE 1 http://www.samhsa.gov/dtac/dialogue/Dialogue_Vol7_Issue1.pdf accessed on 01/31/2011 =====\ Virtual Faces Created With Emotions, Moods And Personality ScienceDaily (Dec. 5, 2008) — A team of researchers from the University of the Balearic Islands (UIB) has developed a computer model that enables the generation of faces which for the first time display emotions and moods according to personality traits. http://www.sciencedaily.com/releases/2008/12/081204133855.htm Accessed on January 31, 2011 (graphic Credit: Arellano et al) “The aim of this work has been to design a model that reveals a person's moods and displays them on a virtual face”, SINC was informed by one of the authors of the study, Diana Arellano, from the UIB’s Computer and Artificial Intelligence Graphics and Vision Unit. “In the same 3-D space we have integrated personality, emotions and moods, which had previously been dealt with separately”, Arellano explained to SINC. =====\ Mona Lisa: Smiling? Computer Scientists Develop Software That Evaluates Facial Expressions August 1, 2006 — Computer vision software can now map a person's face onto a mesh computer model and calculate facial expressions based on facial points such as lip curvature, eyebrow position, and cheek contraction. The software detects happiness, disgust, fear, anger, surprise and sadness with 85 percent accuracy, but researchers don't yet have the technology to detect more subtle emotions. AMSTERDAM, Netherlands -- Computers are becoming more and more like humans! Now, new technology allows them to detect what we're feeling! You've heard the good and the bad about the Da Vinci Code. Now, cutting-edge technology helps unleash another Da Vinci mystery -- what the famous Mona Lisa was feeling. Have any guesses? Actually, the Mona Lisa's expression is 83-percent happy, 9-percent disgusted, 6-percent fearful, and two-percent angry. http://www.sciencedaily.com/videos/2006/0811-mona_lisa_smiling.htm Feb 24, 2011
The Fear ResponseFREEZE, FIGHT OR FLIGHT RESPONSE
• a universal reaction a to life threatening event • We will remember this response …
A memory has been formed
Emotionally Traumatic Event(s) • By exposure for … survivors, on-scene response
workers, witnesses, residents of area, & others. – One single event’s impact … – Event may serve as a “trigger” for the Pre-existing
problems due to history of traumatic exposures …– Cumulative effect (series of traumatic exposures)
• A person may not be aware of the impact this emotionally traumatic exposure may have.
Presenter
Presentation Notes
Diagnostic and Statistical Manual IV-TR of the American Psychiatric Association (American Psychiatric Association, 2000) Traumatic event … involve actual or threatened death or serious injury, or a threat to physical integrity of self or others. Pg 467, 471 - Single Blow event (sudden, strong, one-time event) - Repeated event (ongoing, cumulative events) Vicarious trauma … Felt the trauma as if one were taking part in the experience or feelings of another. Natural events, human cause (deliberate effort to harm, technology failure) Acute Stress Disorder (308.3) disturbance lasts for a minimum of 2 days up to 4 weeks within 4 weeks of traumatic event. Posttraumatic Stress Disorder (PTSD) (309.81) – symptoms last more than one month … -- PTSD may be especially severe or long lasting when the stressor is of human design (e.g. torture, rape) -- the likehood of developing PTSD may increase as the intensity of and physical proximity tothe stressor increases. =====\=====\=====\=====\=====\ prevalence of Post-Traumatic Stress Disorder (PTSD) diagnosis in Adult Mental Health Outpatient (AOP) programs in Department of Mental Health (DMH) designated community agencies during FY 1995-2010. The proportion of AOP service recipients who had a PTSD diagnosis increased from 2% in FY1995 to 8% in FY2002 and 16% in FY2010. PTSD diagnosis was much more prevalent (two to three times as prevalent) among female service recipients as compared to male service recipients. The overall rate of increase in the PTSD diagnosis for women, was more than twice as great as the rate of increase in PTSD diagnosis for men. source: Vermont Mental Health Performance Indicator Project Vermont Agency of Human Services, Department of Mental Health 103 South Main Street, Waterbury Vermont 05671 FROM: John Pandiani and Katie JonesDATE: March 4, 2011 RE: Adult Outpatient Clients with PTSD Diagnosis by Gender FY1995 – 2010 http://mentalhealth.vermont.gov/report/pip Performance Indicator Project Reports: By Date
Disaster• NATURAL (tornado, flood, earthquake)
• HUMAN-CAUSED (explosion, hazardous materials spill, transportation accident, war)– Technology Failure– Mass Shooting (many people fatally shot or injured)– Terrorism
Presenter
Presentation Notes
NATURAL (tornado, flood, earthquake) -- without evil intent … an “Act of God” HUMAN-CAUSED (explosion, hazardous materials spill, transportation accident, war) -- Technology Failure - unintended consequences … from human error … incidental victims … “It was an accident” -- Terrorism - hostile intent … deliberate human violence … personally traumatized … “Why did they do this? … What did I ever do to them?” IT’S PERSONNAL! DSM-IV-TR (Text Revision), page 464 under Anxiety Disorders 309.81 Posttraumatic Stress Disorder - “The disorder may be especially severe or long lasting when the stressor is of human design (e.g., torture, rape). 2011 Tucson shooting http://en.wikipedia.org/wiki/2011_Tucson_shooting On January 8, 2011, a mass shooting occurred near Tucson, Arizona. Nineteen people were shot, six of them fatally, with one other person injured at the scene[3][5] during an open meeting that U.S. Representative Gabrielle Giffords was holding with members of her constituency in a Casas Adobes Safeway supermarket parking lot. A 22-year-old Tucson man, Jared Lee Loughner, was arrested at the scene.
A Disaster Is Always a Bureaucratic and Political Event …
• Think political event first … the politics involves decision making on the use of resources …
• Bureaucratic means how things are organized and the chain of command …
• Both are always in play …
Disaster is always a Local Responsibility First
Under NE’s Emergency Management System:• all local jurisdictions are responsible for initial
response to a disaster. • each local government shall participate in a
full-time emergency management program. • These local or regional emergency
management jurisdictions are responsible to the city, county or both.
Presenter
Presentation Notes
Disaster is always a local responsibility first: Nebraska’s Emergency Management System Under state law: - all local jurisdictions are responsible for initial response to a disaster. - each local government shall participate in a full-time emergency management program. - These local or regional emergency management jurisdictions are responsible to the city, county or both. The state agency has no supervisory role over local jurisdictions. source: About NEMA (Nebraska Emergency Management Agency) http://www.nema.nebraska.gov/index_html?page=content/about.html accessed on Feb 1, 2011
Emergency Management
Presenter
Presentation Notes
Supplemental Content: Disaster Assistance—State Responsibilities: Commit resources to augment local efforts; Take appropriate action under State law; Execute State emergency plan; Verify information from local governments; Request Federal assistance, if needed; and Governor can request individual, public, and hazard mitigation assistance. Instructor’s Notes: Exercise Suggestion: “Disaster Sequence Flowchart” Sequence of disaster response 1. Local government responds. 2. Local requests assistance from State. (if needed) 3. Government implements State emergency plan. 4. State requests assistance. (if needed) 5. FEMA conducts a joint preliminary damage assessment. 6. Governor requests a Presidential declaration. 7. FEMA regional office reviews declaration request. 8. FEMA headquarters makes recommendations. 9. President makes declaration decision. Adapted from FEMA/SAMHSA CCP ISP Training Package
Four Phases Emergency Management
Emergency management in the United States has been divided into four phases –
1. Mitigation2. Preparedness3. Response4. Recovery
Presenter
Presentation Notes
Emergency management in the United States has been divided into four phases – mitigation, preparedness, response, and recovery. MITIGATION - Hazard mitigation is designed to lessen, reduce or mitigate the impacts of future disasters. Most mitigation activities involve warning systems or structural improvements needed to prevent floods, the impact of tornadoes or related activities. PREPAREDNESS - develop state and local emergency operations plans, conduct training programs, public awareness campaigns, monitoring the situations, and related duties. RESPONSE - - In the event of an emergency, the local jurisdiction is responsible for first response. If local resources are inadequate to deal with the situation, the local political leader declares an emergency and requests state assistance. - the Governor can proclaim a state emergency and sign a declaration. This declaration formalizes the state response and authorizes use of state resources. - If the Governor determines state resources are not sufficient to deal with the emergency, a federal disaster declaration can be requested. RECOVERY A "Presidential Disaster Declaration" can be for public assistance, individual assistance or both. - Public Assistance (PA) is used to help local and state governments recover their disaster expenses. *It is used to pay for roads, bridges, public buildings and other facilities damaged in the disaster and to pay for costs such as employee salaries and other costs. * Normally, the Federal Government pays 75 percent of all eligible public costs. Traditionally, the state and local governments equally split the remaining 25 percent. -INDIVIDUAL ASSISTANCE (IA) is provided to the survivors of the disaster. FEMA Crisis Counseling is under IA. source: About NEMA (Nebraska Emergency Management Agency) http://www.nema.nebraska.gov/index_html?page=content/about.html accessed on Feb 1, 2011
MitigationPreparedness
Response Recovery
Phases of Disaster
Presenter
Presentation Notes
RESPONSE: Warning of Threat: Ranges from no advance notice (suicide bomber) to weeks (hurricane) Impact: Actual onset of disaster Varies. BT has fuzzy beginning/end; bombing is precise Rescue or Heroic: People watch out for, protect, even risk own safety to save strangers Remedy or Honeymoon: People initially pitch in and collaborate for the collective good Inventory: External resources begin to come online—people watch what goes where Disillusionment: Resource allocation often seen as too little too late, poorly distributed RECOVERY Reconstruction and Recovery: People move beyond self interests and start to rebuild Source: Centers for Disease Control and Prevention Disaster Mental Health Primer: Key Principles, Issues and Questions http://www.bt.cdc.gov/mentalhealth/primer.asp Accessed January 6, 2011
SEVERITY OF PSYCHOLOGICAL REACTION AFTER A TRAUMATIC EVENT
Some
Presenter
Presentation Notes
Centers for Disease Control and Prevention Disaster Mental Health Primer: Key Principles, Issues and Questions http://www.bt.cdc.gov/mentalhealth/primer.asp Accessed January 6, 2011
POPULATION EXPOSURE
MODEL
A
BC
DE
F
A. Injured survivors & bereaved family membersB. Survivors with high exposure C. Bereaved extended family or friends, coworkersD. People in community with pre-existing trauma; and
other responders (Red Cross; dispatchers; clergy; media); as well as people who lost homes, jobs, pets, valued possessions
E. Affected people from community at largeF. Community-at-large
Presenter
Presentation Notes
Mental Health All-Hazards Disaster Planning Guidance http://store.samhsa.gov/shin/content//SMA03-3829/SMA03-3829.pdf RECOMMENDED CITATION U.S. Department of Health and Human Services. Mental Health All-Hazards Disaster Planning Guidance. DHHS Pub. No. SMA 3829. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 2003. page 12 FIGURE 1: POPULATION EXPOSURE MODEL (DeWolfe) from: DeWolfe, D. J. (unpublished manuscript). Population Exposure Model and text excerpted from Mental Health Interventions Following Major Disasters: A Guide for Administrators, Policy Makers, Planners and Providers. Rockville, MD: Substance Abuse and Mental Health Services Administration. In the priority-setting process, both research and practical experience points to exposure as a prime predictor of the development of psychological sequelae. Figure 1 is an illustration of exposure categories. - It generally is agreed that all who experience a disaster are somehow affected by it. - However, a number of groups warrant specialized approaches and services, even if they’re not at great risk, including, but not limited to, children, those with pre-existing mental disorders, disaster and emergency workers, the frail elderly, and racial and cultural minorities.
DISASTER MENTAL HEALTH PRIMER: GUIDING PRINCIPLES
• No one who experiences a disaster is untouched by it. • Most people pull together and function during and after a disaster, but
their effectiveness is diminished. • Mental health concerns exist in most aspects of preparedness, response
and recovery.
• Disaster stress and grief reactions are “normal responses to an abnormal situation.”
• Survivors respond to active, genuine interest and concern.
• Disaster mental health assistance is often more PRACTICAL than psychological in nature (offering a phone, distributing coffee, listening, encouraging, reassuring, comforting).
• Disaster relief assistance may be confusing to disaster survivors. They may experience frustration, anger, and feelings of helplessness related to federal, state, and non-profit agencies’ disaster assistance programs. They may reject disaster assistance of all types.
Presenter
Presentation Notes
source:"Disaster Response and Recovery: A Handbook for Mental Health Professionals" by Diane Myers, R.N., M.S.N. U.S. Department of Health and Human Services, Public Health Service, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services; August 1994; publication number (SMA) 94-3010 “NO ONE WHO SEES A DISASTER IS UNTOUCHED BY IT” Source: Centers for Disease Control and Prevention Disaster Mental Health Primer: Key Principles, Issues and Questions http://www.bt.cdc.gov/mentalhealth/primer.asp Accessed January 6, 2011
No One Who Experiences A Disaster Is Untouched By It.… and … These Reactions are Normal Responses …
these Guiding Principles apply toLow Trust … High Concern situations … leading to
—Perception = Reality—Mental Noise Theory—Negative Dominance Theory—Trust Determination Theory
Risk Communication Principles of:
Presenter
Presentation Notes
Ron Edmond Risk Communication Workshop Feb 18 2011 Risk Communication Principles - Perception = Reality; Mental Noise theory; Negative Dominance theory; Trust Determination theory Factors causing Low Trust … High Concern involves a sense by the audience member of control over the situation, and experience of the audience member with the messenger, the organization of the messenger and familiarity with the issue. Some situations and issues, if miscommunicated could create high concern, low trust and outrage within a stakeholder group. Perception = Reality. What people believe to be real is real to them in their consequence. In discussing risk, address three components: Hazards: What can go wrong? Probability: How likely is it to go wrong? Consequences: What are the consequences? Mental Noise theory - Effect: blocks communication & Solution: Use clear, concise messages and active listening. - Implications of the Mental Noise theory: Limited number of messages; Time limitations of communication; Repetition of Message Negative Dominance theory - Effect: Distorts communication; Solution: develop positive messages. - Implications of the Negative Dominance theory - People who are upset tend to think negatively; One negative = three positives (1N=3P); Repetition of a negative reinforces and reaffirms the negative; Avoid using negatives such as: No, Not, Can’t, Don’t, Never, Nothing, None. four Trust Determination factors: 1. caring and empathy; 2. dedication and commitment; 3. competence and expertise; and 4. honesty and openness. A common thread in all risk communication strategies is the need to establish trust. Only when trust has been established can other goals, such as education and consensus-building, be achieved. Trust can only be built over time and is the result of ongoing actions, listening, and communication skill. Source: Vincent T. Covello, PhD; Richard G. Peters, DrPH, MBA, MSc; Joseph G. Wojtecki, MA; Richard C. Hyde, MSc. (2001). Risk Communication, the West Nile Virus Epidemic, and Bioterrorism: Responding to the Communication Challenges Posed by the Intentional or Unintentional Release of a Pathogen in an Urban Setting. Journal of Urban Health: Bulletin of the New York Academy of Medicine (Volume 78, No. 2, pg. 382-391, June 2001). Center for Risk Communication, Box 210, 545 Eighth Avenue, Suite 401, New York, NY • (646) 602-9509 http://www.centerforriskcommunication.com/pubs/crc-p1.pdf accessed on Feb 20, 2011
SURVIVOR’S NEEDS & REACTIONS • a concern for basic survival• grief over loss of loved ones and loss of valued/meaningful
possessions• fear and anxiety about personal safety and physical safety of
loved ones• sleep disturbances, often including nightmares and imagery
from the disaster• concerns about relocation and the related isolation or crowded
living conditions• a need to talk, often repeatedly, about events and
feelings associated with the disaster• a need to feel one is a part of the community and its recovery
efforts
State Level Planning and Policy Development Supports Local Response and
Recovery Efforts
BHERT
Hospital Readiness
Tornados
Ice Storms
Shootings
Volunteers – MRC –ESAR VHP – BHERT
All Hazards Plans State & Local Response &
Recovery
Research & Policy
Development
WorkforceDevelopment
&
InteragencyCoordination
Planning
Volunteers
Public Health
Behavioral Health
Emergency Management
Presenter
Presentation Notes
State level planning and policy development in behavioral health is designed to support local response efforts. Planning, workforce development and research / policy development support and drive response and recovery activities. The Nebraska Behavioral Health Emergency Response Team is a result of policy decisions grounded in statutory authority. It emerged because a need was identified during the planning process which has been tested and reinforced after real world response activities. A great deal of interagency coordination has already been done and will continue to be done. We are now in the process of developing the workforce through familiarization with policies and procedures.
Emergency Support Function (ESF) #8Situation and Assumptions
1. A significant natural or manmade incident may incur temporary or long term psychological consequences.
2. Behavioral health resources within the affected area may be inadequate to address the needs of the first responders and the public who are involved.
3. Disaster behavioral health services can help mitigate the severity of adverse psychological effects, promote resilience, and help to restore social and psychological functioning of individuals, families, and communities.
Presenter
Presentation Notes
Emergency Support Function (ESF) #8, the Nebraska Department of Health and Human Services (DHSS) BEHAVIORAL HEALTH RESPONSE & RECOVERY
What does BHERT do?• Provide support and consultation to local response
personnel relevant to behavioral health needs that arise following a disaster– Conduct behavioral health needs assessments following a
disaster – Assist Regional Behavioral Health Authorities to coordinate
an all-hazards behavioral health response in their geographic areas
– Organize a response to meet behavioral health needs of state agencies following a disaster
NE Behavioral Health Emergency Response Team
How is BHERT organized?
• Incident command structure is followed
• The team leader is under the command of the operations branch of local incident command once deployed
Operations
Emergency Support Function (ESF) #6, #8, & #11 DHHS Liaison
State Emergency Operations Center (SEOC) Manager
NDHHS Emergency Coordination Center
(ECC)
Division of Behavioral Health All-Hazards Coordinator
NBHERT (Team Leader)
ARC CISM FEMA Local Region
Persons Served
ARC Workers Clients
First Responders
Survivors in the area Everybody else
Workers Used Lic MH Prof MH Prof & Peers
Trained Indigenous
Workers
Locally Determined
Phase of Disaster Response Response Recovery
Preparedness, Response, Recovery
Mental Health Workforce
in Disaster Preparedness, Response, Recovery
For the local Preparedness, assume a Response capacity that operates for 72 hours before national resources arrive
ARC means American Red Cross / CISM means Critical Incident Stress Management Program
FEMA means Federal Emergency Management Agency (Crisis Counseling Program)
Presenter
Presentation Notes
There is a basic core assumption that Red Cross does what Red Cross does, CISM does what CISM does … ARC means American Red Cross CISM means Critical Incident Stress Management Program If the event is large enough, there may be FEMA Crisis Counseling Funds to help support recovery efforts. FEMA means Federal Emergency Management Agency (Crisis Counseling Program) All other functions that need to be covered is the responsibility of Local / Regional Officials.
Five Essential Elements of Mass Trauma Intervention
Promote:• a sense of safety - by minimizing rumors• calming—by disseminating information about
normal reactions to trauma• sense of self– and collective efficacy—by creating
opportunities to regain prior roles • connectedness—by making it possible for loved ones
to locate one another • hope—by making services to help people get their
lives back in place a highly visible priority
Presenter
Presentation Notes
source: Commentary on “Five Essential Elements of Immediate and Mid–Term Mass Trauma Intervention: Empirical Evidence” by Hobfoll, Watson et al. Mass Trauma Intervention: A Case for Integrating Principles of Behavioral Health with Intervention to Restore Physical Safety, Order, and Infrastructure by Farris Tuma Psychiatry 70(4) Winter 2007 page 358 • Promote a sense of safety—by minimizing gatherings, discussions, and events that serve only to share rumors and horror stories about the event or that provide unbalanced information and exaggerate potential additional stressors/threats. • Promote calming—by disseminating information about normal reactions to trauma,making self-help and assisted programs available to teach skills for: problem solving and for recognizing/validating and normalizing stress responses; avoiding expectations and situations that require people to rehash their ordeal immediately after an event; and making information about obtaining material resources available. • Promote sense of self– and collective efficacy—by creating opportunities to regain prior roles (in family, work, community) and resources to accomplish this (e.g., points of entry for housing assistance, lists of job openings, public transportation, basic materials to help restore a valued community institution). • Promote connectedness—by making it possible for loved ones to locate one another and communicate as soon as possible. If make–shift communities of displaced persons are created, create meaningful roles for people that will promote interaction, taking steps to identify and assist those who lack support (near or far) and are likely to be socially isolated before, for example, they are the last ones remaining in temporary shelters. • Promote hope—by making services to help people get their lives back in place a highly visible priority (housing, employment, relocation, replacement of essential household items). Create places and processes for volunteer advocates to aid survivors in working through the red tape involved in obtaining services and benefits available to them. January 31, 2008
Disaster Behavioral Health• The work is a different model from other Behavioral
Health services. Example:– In office practice, assume a mental disorder is present until it
is specifically ruled out.– In disaster behavioral health response, assume mental
disorder is not present until it is specifically ruled in.• Promote resilience - help support people impacted by
the disaster– Services are delivered via in a manner where the worker
appears to mingle and shmooze with the people impacted. – The job is to de-escalate, defuse, and to normalize the
reactions people are experiencing.
For more information see …
Centers for Disease Control and Prevention (CDC)
Disaster Mental Health Primer: Key Principles, Issues and Questions
http://www.bt.cdc.gov/mentalhealth/primer.aspAccessed on January 6, 2011
Jim Harvey, LCSWNebraska Department of Health and Human Services Division of Behavioral Health301 Centennial Mall South, Third FloorPO Box 95026, Lincoln, NE 68509phone: 402-471-7824 e-mail: [email protected]
State Disaster Behavioral Health ConceptsMarch 9, 2011
