Integrating Resilience into Disaster Medical Care

• CAPT David Morrissette, LCSW, Ph.D. MHT-1 Team Leader

• LCDR Meghan Corso, Ph.D., MHT-1 Wellness Coordinator

Operation Lone Star • Annual joint military and civil humanitarian

medical Training mission on the Tex-Mex border for 13 yrs

• Free medical services to Texas residents • Fast pace and brief contact – 6000 patients are seen in 1 week– Local services already oversubscribed

What is Resilience?

Why is Resilience Important

Why Resilience in a Disaster Response?

• Address the current needs of the population– Chronic diseases with psychosocial components– Unmet Behavioral Health needs

• Prevention through building Resilience– Stress Reactions to Disaster– Accomplished at any age including children

Current Needs of a Population

• The 14 most common physical complaints have no identifiable organic etiology1

• Most Behavioral Health disorder do not get treatment 2

• Prescriptions for anti-hypertensives in youth age 19 and younger could hit 5.5 million this year, up 17% from 2007 to 2010

Current State of the Population

What happens to the population’s medical and behavioral health

needs when there is a disaster?

In a disaster response…

• Access to needed medical items is limited

• Access to behavioral or medical treatment is limited or closed

• Symptoms are exacerbated• Change in routine/ environment• Tx adherence to self care• Decrease in support system • Compassion Fatigue

Opportunity for Disaster Behavioral Health Intervention

How do you Build Resilience in a Disaster Response

Habits

FOCUS ON WELLNESSEm

otion

s Behaviors

What is Wellness?

BodyMind

Emotions

Exercise

Diet

Physical and Mental Health

Building Resilience through Wellness

• Establish relationship with Survivors and Responders and teach:– Stress– Self Care– Communication – Grief– Compassion Fatigue

With education and engagement comes the opportunity to screen

• Assessing difficulty with adjusting to the disaster conditions– Coordinating care as needed– Providing brief counseling as appropriate

• Assessing individual who may be having an acute reaction to the disaster– Prevent further complication and development of

PTSD

What does this look like in a deployed setting

Operation Lone StarJuly 2011

Previous Behavioral HealthIn 2010, • Providers referred one

tenth of one percent of OLS patients to mental health.

• Texas Guard’s study estimated mental health needs among 12-21% percent of patients (Morecook, et al, 2010)

Wellness Approach

Education and Counseling on:• Tobacco• Support System• Stress• Diet & Nutrition• Exercise• Alcohol and • Sleep • Crisis Counseling

Physician Referrals

Self- Referrals

What About Children?

Ringgold Clinic Palm View Clinic Mandazo Clinic

LCDR BeaulieuPsychologist

SITE LEAD

LCDR McLellan Nurse

SITE LEAD

CDR GroganDTL

LT HendersonLCSW

Lt Tanya RinconLCSW

Spanish

LCDR GripperNurse

LCDR HatchPsychologist

Spanish

LCDR Saunders IT Spanish

LCDR CochranLCSW

SITE LEAD

MHT-1 OLS 2011Assignments

LCDR BarnesPsychologist

LT HayesPLANNING

LT BurnsPsychologist

LCDR Guzman-Zammaron, OT

Spanish

CAPT FletcherEpidemiologist

CAPT MorrissetteTeam Leader

PSJA Clinic

LCDR CorsoPsychologist

SITE LEAD

CDR OhuohaPsychiatrist

CDR Hall Nurse

LCDR BodartPsychologist

LCDR LucioLCSW

LT FranksPsychologist

LCDR SkiptonPsychiatrist

CAPT ShinePsychiatrist

Mission Leads

CDR BuckinghamLCSW

Wellness Center: LCDR CorsoLet’s Move:

LCDR Cochran

Self Referral: LCDR Beaulieu

Provider Referral: LCDR McLellan

Most patients received education and counseling on two or three topics

28% of patients came in for counseling on nutrition, sleep, exercise, stress,

community connection, support, and crisis

Referral by Topic

Diet an

d nutrition

Exerc

ise

Stress

man

agem

ent

Sleep

Tobac

co

Alcohol

Support

Syste

mOther

Crisis M

ental

Health

Consults

0%

5%

10%

15%

20%

25%

30%

35%

Provider ReferralSelf Referral

Screening and Referrals

• 14 patients were referred by providers for crisis screening and care

• 4 patients referred themselves for crisis counseling• 29 cases were screened and referred to local

mental health providers for on-going behavioral health care.

Over 1000 children engaged

Force Protection

• The Wellness Approach allowed responders to talk about normal problems and how to solve them. MHT provided 466 preventive contacts and 167 responsive contacts.

FORCE PROTECTION