Disaster Mental Health InstituteThe University of South Dakota
September 30, 2002
The Development of a Regional Disaster Mental Health Response
Plan Using Academic Medical Center, Local and State
Governments: A Maryland Consortium Effort
September 30, 20022
A Collaborative Presentation
Kathi Beauchesne, Ph.D, MBA, LCSW-C Director, Faculty and Staff Assistance, Student
Assistance, and WORKlife Programs—Johns Hopkins University/Johns Hopkins Hospital
Carrie Burmaster, LCSW-C Director, University of Maryland Baltimore Counseling
Center
Michael Kaminsky, M.D., MBA Vice Chairman for Clinical Affairs, Department of
Psychiatry, Johns Hopkins Hospital Chair, Mental Health Disaster Planning Committee
Disaster Mental Health Institute, The University of South Dakota
September 30, 20023
What we will do today…
I. Setting the stage: Why Academic Medical Center? (Kaminsky)
II. The story of a disaster plan process (Beauchesne)
III. A systems analysis of a planning process (Burmaster)
Disaster Mental Health Institute, The University of South Dakota
September 30, 20024
Special thanks for the guidance of…
Clete DiGiovanni, M.D., Consultant for DOD and FBI
George S. Everly Jr., Ph.D, Co-founder and Board Chair Emeritus, International Critical Incident Stress Foundation
Tony Ng. M.D., Medical Director, Disaster Psychiatry Outreach
Elizabeth Monahan-Gibson, Region III, FEMA Voluntary Agency Liaison
Disaster Mental Health Institute, The University of South Dakota
September 30, 20025
The usual situation
Hopkins and Maryland are institutional rivals
Hospital Disaster Plans tend to be internal, to meet the needs of patients who present at the Emergency Room door
Governmental bodies develop their own plans
Disaster Mental Health Institute, The University of South Dakota
September 30, 20026
Wise Charges:
Develop plans to meet the needs of faculty, staff, and students as well as their dependents in the event of a disaster
Disaster Mental Health Institute, The University of South Dakota
September 30, 20027
Goals:
Develop plans to minimize the impact of a disaster on the target populations
Ensure that psychological sequela do not not impair the functioning of the institutions
Train qualified professionals in state of the art disaster mental health response and management principles
Provide a continuum of services from pre-event prevention through acute psychological first-aid and triage to post-event long-term surveillance and referral
Disaster Mental Health Institute, The University of South Dakota
September 30, 20028
Goals cont’d:
Participate in disaster response and relief locally and regionally
Contribute research which evaluates the effectiveness of the plan and provides new insights into psychological responses to disasters and their management
Integrate the plans of Hopkins and Maryland with the city of Baltimore and the State of Maryland
Disaster Mental Health Institute, The University of South Dakota
September 30, 20029
Integration:
Leadership has accepted Baltimore City mental health disaster training and have become volunteers
Joint planning with the State of Maryland Department of Health and Mental Health is in process
Projected appointments to MEMA ESF-8 with the creation of a subcommittee on mental health
Disaster Mental Health Institute, The University of South Dakota
September 30, 200210
Academic Medical Center
Potential strengths of involvement in local and
regional disaster planning
I. Ready access to large numbers of professionals in mental health
II. Experience in emergency mental health, and the mental health of significant physical illness and injury
Disaster Mental Health Institute, The University of South Dakota
September 30, 200211
Academic Medical Center, cont’d
Potential strengths of involvement in local and
regional disaster planning
III. Multi-specialty mental health team orientation (clergy not sufficiently included)
IV. Commitment to and focus on expertise building for career development
Disaster Mental Health Institute, The University of South Dakota
September 30, 200212
Academic Medical Center, cont’d
Potential strengths of involvement in local and
regional disaster planning
V. Historic mission of service, education and research
Education and training strengths to achieve uniform standards of performance
Critical assessments of knowledge and experience to determine best practices to employ
Research orientation, aggressive seeking of funding to support research and dissemination of new knowledge
Disaster Mental Health Institute, The University of South Dakota
September 30, 200213
Examples of research questions and needs
Clarification of the relationship between normal responses to disaster trauma and standard DSM IV pathological nomenclature
Is it appropriate; is it confusing to use the same language for people who will become patients and those who won’t?
Use of standardized assessment tools in the field to correlate responses and risk factors
Comparison trials of intervention techniques Evaluating the effectiveness of training
Disaster Mental Health Institute, The University of South Dakota
September 30, 200214
Disaster Mental Health Institute, The University of South Dakota
The Story Begins… Collegial relationships September 11th, 2001 Two plans Hospital request Early Crisis Response training University invitation
The Story of the Disaster Plan Process
September 30, 200215
Internal Strategy and Process
Formed the Mental Health Disaster Planning Committee
Partnership FASAP and Psychiatry Physician leader Institution-wide key group representation Literature review Developed a rationale Frequent meetings/subcommittee meetings Identified new members continuously Sought permission to respond
Disaster Mental Health Institute, The University of South Dakota
September 30, 200216
Internal Strategy (cont.)
Our Plan Integrate mental health disaster planning at
the highest level of the institutions Incorporate mental health disaster planning
within the Hopkins community Involve IT Intense focus on FEMA Region III
Disaster Mental Health Institute, The University of South Dakota
September 30, 200217
Internal Strategy (cont.)
Ensure allocation of resources and leverage resources
Crisis Management for Supervisors class Work fluidly with both the administrative and
academic communities, interlinking the two Understand collegial relationships and
methods of communication
Disaster Mental Health Institute, The University of South Dakota
September 30, 200218
External Strategy and Process
Guided by external experts Developed a network of professional collaborations
Academic medical centers Departments of Psychiatry Employee Assistance Programs Student Counseling and Student Assistance Programs
Developed community relationships MD and DC VOADs Baltimore City State of Maryland FEMA SAMHSA
Disaster Mental Health Institute, The University of South Dakota
September 30, 200219
External Strategy (cont.)
Sought legitimacy and certification American Red Cross Disaster Psychiatry Outreach
Disaster Mental Health Institute, The University of South Dakota
September 30, 200220
Co-evolving plans
Two Organizations The Hopkins Institutions University of Maryland Baltimore
Veterans Administration Medical Center
The Ultimate Plan A Consortium of Academic Medical Centers
working in concert with local and regional agencies and organizations
Disaster Mental Health Institute, The University of South Dakota
September 30, 200221
What we have learned…
Join and create communities of mental health disaster practice
Develop, generalize and normalize the rationale Nurture co-evolving plans Identify and reach out to potential communities
of practice Continuously connect and reconnect with those
communities
Disaster Mental Health Institute, The University of South Dakota
September 30, 200222
What we have learned…(cont.)
Offer mutual aid and support Maximize and leverage resources Include a broad spectrum of mental health
professionals Emphasize civic responsibility Create goodwill Relationships count
Disaster Mental Health Institute, The University of South Dakota
September 30, 200223
Defining the Task
Disasters represent non-linear human events—the systems perspective
Existing statewide disaster plans and response agencies have wide variations in levels of organization and readiness
Inclusion in the statewide disaster response system is dependent upon value of your contribution and ability to establish connections
Disaster Mental Health Institute, The University of South Dakota
September 30, 200224
Systems principles
Permeable boundaries allow for exchange of information and energy > increased levels of differentiation (expert functions)
System behavior: steady state > stable oscillation > chaos
System chaos increases a system’s response options and forces the system to renew itself > new learning
Disaster Mental Health Institute, The University of South Dakota
September 30, 200225
Systems principles, cont’d
Synergy: sum of parts greater than parts added together
System meta-analysis facilitated by being inside and outside the system
Disaster Mental Health Institute, The University of South Dakota
September 30, 200226
Chaos
Serves evolutionary function Helps systems explore entire range of
behaviors available Crisis and opportunity
Disaster Mental Health Institute, The University of South Dakota
September 30, 200227
Negotiation principles
Prepare
Probe
Propose
The Power of Nice, Ron Shapiro
Disaster Mental Health Institute, The University of South Dakota
September 30, 200228
Relationship building principles
Be valuable—knowledge, attitudes, ability Build on interdisciplinary collaboration experience
Have resources—time, money, personnel, intellectual resources
Know your responsibilities1. Participate in chain of command
2. Use established communication and documentation protocols
3. Understand national disaster declaration process and protocols
4. Be familiar with the roles and missions of other organizations
Disaster Mental Health Institute, The University of South Dakota
September 30, 200229
Relationship building principles, cont’d
Show humility—”This is what I know—teach me more”
Baltimore Mental Health Systems training (ICISF)
UMMC Freestate Mock Disaster Drill National Center for PTSD training DHMH Training—Trauma, Disaster and
Resiliency MD VOAD Media Training Risk Communication Training
Disaster Mental Health Institute, The University of South Dakota
September 30, 200230
Potential process contributions to disaster response system
Contribute to the continuing development of a shared vision
Participate in designing and supporting a system-wide learning architecture—learning feedback loops
Provide safe space to incubate, hatch, and nurture new proposals
Demonstrate value of rapid capacity to learn
Disaster Mental Health Institute, The University of South Dakota
September 30, 200231
Using your contributions: Plant flowers rather than moving mountains!
Use established relationships to nurture natural innovators
Encourage early adopters Stand by the early majority Let nature take its course
Disaster Mental Health Institute, The University of South Dakota
September 30, 200232
A Comforting Thought…
“the…capacity to learn may be more important than experience” (L. Douglas Kiel, Ph.D)
Disaster Mental Health Institute, The University of South Dakota
September 30, 200233
Slides will be provided on…
www.fasap.org
Disaster Mental Health Institute, The University of South Dakota