- 1. Texas Department of State Health Services (DSHS) Disaster
Behavioral Health (DBH) Presented By: Behavioral Health In a
Disaster
2. Tokyo Sarin Attack
- Ratio of behavioral: medical casualties was 5:1
- Five years post event PTSD was at approximately 14%
3. Hurricane Katrina
- 85% of individuals directly impacted experienced two or more
stressors
- PTSD which normally decreases several months after a disaster
has increased
4. What do you expect to learn from this overview? 5. OUR GOAL
Provide a useful overview of Disaster Behavioral Health in Texas 6.
Objectives Participants will be able to:
- Identify the phases of a disaster
- Identify six emotional concepts of a disaster
- Identify common stress reactions
- Identify how DBH fits into response framework
7. Phases of Disaster 1 to 3 Days ------------------- TIME-
------------------------------1 to 3 Years Warning Threat
Pre-disaster Heroic Honeymoon (Community Cohesion) (Coming to
Terms) Working Through Grief Reconstruction A New Beginning
Disillusionment Trigger Events and Anniversary Reactions Impact
Inventory Zunin/Meyers 8. Psychological Consequences of a Disaster
From IOM publicationPreparing for the Psychological Consequences of
Terrorism www.nap.edu NOTE:Indicative only; not to scale Distress
Responses 9. What is Disaster Behavioral Health (DBH)
- DBH is a specialized field of mental health expertise
- It is the primary goal of DBH to decrease the stress of an
event
- DBH modalities may include Psychological First Aid, Pastoral
Care, Substance Abuse services, CISM, Crisis Counseling and, other
disaster specific support
10. What is Disaster Behavioral Health (DBH) Cont..
- Focus on strengths & coping skills
- Confirms reactions are normal
11. Department of State Health Services Disaster Behavioral
Health Services During a Disaster
- DSHS is responsible for DBH preparedness, response and recovery
in Texas
- Preparedness and response are housed in the Community
Preparedness Division
- Recovery is housed in the Mental Health/Substance Abuse
Division
12. Why Disaster Behavioral Health?
- The effects of a disaster, terrorist attack, or other public
health emergency can be long-lasting. The resulting trauma can
affect even with those not directly affected by the disaster
13. Emotional Concepts of a Disaster
- No one who sees a disaster is untouched by it
- Everyone experiences stress
- Everyone responds differently to stress
- Stress and grief are normal reactions to trauma
- Reactions often relate to survival and recovery issues
- People do not seek out mental health services
- Support systems are crucial to recovery
14. Normal Reactions to a Disaster
- Difficulty making decisions
- Preoccupation with the disaster
- Frequent dreams or nightmares
- Increased alcohol/drug use
- Feeling depressed, sad, irritable or angry
- Tiredness or low energy for no reason
- Increase or decrease in appetite
15. Coping with Stress
- Set realistic limits and daily goals
16. Coping with Stress cont..
- Get back into or establish new daily routines
- Do physical exercise every day
- Children are particularly susceptible to stress and dont know
how to tell you. Spendtime each day with your child and reassure
them that they are safe(Note: Playtime works for
childrenandadults!)
17. Psychological First Aid (PFA)
- An approach designed to provide basic comfort and support, to
reduce the initial stress caused by traumatic events and to foster
short and long term adaptive functioning
18. Psychological First Aid Who?When?Where?
- Used during and immediately after trauma/disaster
- PFA can be used by anyone
- May be used for everyone, adults and children
- Provides immediate emotional and practical support
19. Psychological First Aid Basic Objectives
- Offer practical assistance
- Connect to social supports
- Provide information on response, recovery, stress and
coping
20. Psychological First Aid Delivery
-
- Operate within your organizational rules of survivor
engagement
-
- Be calm, courteous, organized and helpful
-
- Be sensitive to cultural, ethnic and community concerns
-
- Operate within your comfort level
21. Psychological First Aid Behaviors To Avoid
-
- Neverpresume to know what the person is experiencing
-
- Do not assume that everyone is traumatized
-
- Do not label/diagnose or patronize
22. Spiritual Counseling
- Often, amongst first on scene
- Often provides an array of services
- Provides secular and spiritual First Aid and emotional
support
23. Why Disaster Spiritual Care?
- 43-50% of people with emotional problems turn first to
religious/spiritual leaders for help
- Prayer, faith and spiritual practices are the most widely
reported methods for coping with traumatic life events
- 96% of Americans state that they believe in God or a Higher
Power
-
- Koenig,Spirituality in Patient Care
24. Who me?
- Responders also experience stress.
- Responders often try to justify the warning signs of stress
within themselves.
Common expressions: Im fine Dont worry about me, I will be okay
I have been doing this for a long time; I can handle anything 25.
Job-Related Stressors
- Repeated exposure to traumatic stories
- Exposure to survivors reaction to disaster
- Away from family/friends for extended periods
26. Signs of Burnout
- Loss of concentration at work
- Feeling overwhelmed with job
- Feeling of inadequate reward/recognition
- Desire to seek other employment
27. Responder Self-Care Plan
- Be realistic in job expectations
- Dont over identify with survivors
- Learn about compassion fatigue
- Meet regularly with others to discuss problems
- Exercise and relax regularly
28. Critical Incident Stress Management (CISM) CISM is a
comprehensive, integrative, multi-component crisis intervention
system CISM is considered comprehensive because it consists of
multiple crisis intervention components, which functionally span
the entire temporal spectrum of a crisis 29. CISM THE SEVEN CORE
COMPONENTS of CISM( Adapted from: Everly and Mitchell, 1997) 30.
ELEMENTS OF CISM
- Pre-incident education, preparation
- Large Group Crisis Intervention:
-
- Demobilizations (large groups of rescue/ recovery)
-
- Crisis Management Briefings(CMB)
31. ELEMENTS OF CISM
- Small Group Crisis Intervention:
-
- Debriefing Models :Critical Incident Stress Debriefing (CISD);
HERD; NOVA; Multi-stressor debriefing model; CED
- One-on-one crisis intervention, including individual PFA
- Organizational/ Community intervention, consultation
- Pastoral crisis intervention
- Follow-up and referral for continued care
32. Crisis Counseling Program (CCP)
- Two FEMA funded grants to the State Mental Health
authority
- Funds immediate, short-term crisis counseling and support for
the emotional recovery of all those impacted by the disaster
- CCP services include outreach, stress management, individual
and group crisis counseling, education, and referral
33. CCP continued
- Not Diagnostic and no medication
- Targets special populations
- Case management, fund raising, transportation not allowed
34. Work in Progress
- DMH Emergency Management Plan
- Building DMH Provider Capacity
35. QUIZ
- Question 1.What does DBH Stand for?
- Disaster Behavioral Health
- Question 2. Consuming alcohol is a healthy way to deal with
stress?
- Question 3. How many components does CISM consist of?
- Seven. Pre-crisis preparation, Demobilization, Defusing,
Critical Incident
- Stress Debriefing, Individual crisis intervention, Family CISM,
and follow-
- Question 4. Stress and grief are _________ emotional
reactions.
- Question 5.Who can benefit from Psychological First Aid
(PFA)?
36. Contact Information
- Community Preparedness Section
- Public Health Preparedness Unit
- Disaster Behavioral Health Services
- Melva Richardson - Ext. 3093
- 1100 W. 49 thStreet, G-310
- Office (512) 458-7111 Fax: (512) 458-7231
- For more complete information and printable brochures, forms,
etc
- http://www.dshs.state.tx.us/comprep/dmh/default.shtm
37. Contact Information cont.. Public Health Preparedness Unit
CISM (Critical Incident Stress Management) Paul Tabor(512) 458-7111
Ext. 7128 Fax: (512) 458-7472
http://www.dshs.state.tx.us/comprep/cism/default.shtm Crisis
Counseling Program North Star & Special InitiativesChance
Freeman /Yelena Brodkorb 909 W 45 th Austin, TX 78751 Office (512)
206-5516 Fax: (512) 206-5019