Post on 22-Aug-2018
transcript
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