DISASTER CRISIS INTERVENTION IN GEORGIA

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DISASTER CRISIS INTERVENTION IN GEORGIA

• Past, Present and Future

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What is a disaster?

• An event which results in great harm, damage or
  death, or serious difficulty (Cambridge)

A sudden calamitous event bringing great damage,
loss, or destruction (Merriam-Webster)
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Why disaster crisis intervention?
Disasters can be overwhelming, and they can cause
strong emotional reactions
Georgia is required to have a plan that provides
for the mental health aspects associated with
disasters
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Natural disasters since 1990

• Two 500-Year floods in south Georgia
• 1994 and 1998
• Hurricanes Opal (1995) Floyd (1999), and Frances
  and Ivan (2004)
• Ice storms 1993 and 2000
• Tornadoes

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Other events
Heritage High School shooting in Rockdale County
Tri-State Crematory in Walker County
Fulton County Courthouse shooting
Olympic Park bombing
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What are the numbers?

• State Mental Health Authorities Response to
  Terrorism report January 2004 The expected
  ratio of behavioral to physical casualties is
  41.
• WMD/T Diane Myers - Experience with past events
  indicates that there may be from 4 to 20
  psychological victims for every physical victim
  in a mass casualty situation.

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What are the numbers?

• American Journal of Psychiatry - Approximately
  25-30 of individuals exposed to unusually
  traumatic events such as disasters, combat,
  violence, and accidents develop chronic PTSD or
  other psychiatric disorders.
• FEMA CCP 37 of individuals experiencing loss
  due to disaster will access mental health
  services.

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National Bioterrorism Cooperative Agreement CDC
and HRSA

• Critical Benchmark 2-8 Establish a system that
  provides for a graded range of acute psychosocial
  interventions and longer-term mental health
  services to 5,000 adult and pediatric clients and
  health care workers per 1,000,000 population
  exposed to a biological, chemical, radiological
  or explosive terrorist incident.

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An outpouring of support

• Active volunteers
• Resurgence of those already training
• Spontaneous volunteers

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Weve Only Just Begun
1-4-05 Disaster Preparedness Planner joins PH
BT team
9-11-01

2002 HRSA and CDC grants
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Georgias vulnerabilities

• Interstates
• Railroads
• 100 miles of coastline
• Hartsfield-Jackson Atlanta Intl Airport
• CDC
• Port of Savannah
• Military bases
• Nuclear power plants
• Weather

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Whats Happening Now?

• Critical Incident Stress Debriefing and Peer
  Support classes to support hospital emergency
  workers and other first responders
• Participation in exercises and drills
• Disaster Crisis Intervention Training Advisory
  Committee
• Who will be trained?
• Develop broad training objectives
• December 2005
• Georgia Crisis Consortium will serve as a
  steering committee that will guide the state and
  local planning process

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Community Response
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Community Mental Health Response

• Georgias community disaster crisis intervention
  plan will grow out of an already existing network
  of government, private and non-profit agencies
  and organizations who currently provide disaster
  behavioral health counseling.

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Community Response

• The goal of this plan is to link all of these
  providers into a chain of response designed to
  meet the behavioral health needs of the entire
  community

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Already existing providers of Disaster Crisis
Intervention
Georgia Critical Incident Stress Management Team
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DJ DeWOLFSPOPULATION EXPOSURE MODEL

• A - Seriously injured, bereaved family
• B - Victims with high exposure
• C Bereaved extended family and friends rescue
  and recovery workers, medical staff service
  providers directly involved with bereaved

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DJ DeWOLFSPOPULATION EXPOSURE MODEL

• D People who lost homes, jobs, pets, valued
  possessions mental health providers clergy,
  chaplains, spiritual leaders emergency health
  care providers school personnel involved with
  survivors families of victims media personnel

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DJ DeWOLFSPOPULATION EXPOSURE MODEL

• E Government officials groups that identify
  with target victim groups businesses with
  financial impacts
• F Community-at-large

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The Crisis Counseling Assistance and Training
Program

• Robert T. Stafford Disaster Assistance and
  Emergency Relief Act (P.L. 93-288 as amended)
• Interagency Federal Partnership
• Federal-State-Local Partnership

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The FEMA/CMHS Crisis Counseling Program
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Elements of the CCP

• Mental Health Interventions
• Needs Assessment
• Cultural Sensitivity
• Activating a Response Strategy
• Special Populations
• Outreach Model
• Accurate Reporting

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Examples of Crisis Counseling Program
Services

• Outreach
• Screening and Assessment
• Counseling
• Information and Referral
• Public Education

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Program limitations

• Medications
• Hospitalization
• Long-term Therapy
• Providing Childcare or Transportation
• Fundraising activities
• Advocacy
• Case Management

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Crisis Counseling and Traditional Mental Health
Practice
Traditional Practice
Crisis Counseling

• Primarily Home Community Based
• Assessment of Strengths, Adaptation Coping
  Skills
• Seeks to Restore Pre-Disaster Functioning
• Accepts Content at Face Value
• Validates Appropriateness of Reactions and
  Normalizes Experience
• Psycho-educational focus

• Primarily Office-Based
• Focus on Diagnosis Treatment of Mental Illness
• Attempt to Impact Personality Functioning
• Examines Content
• Encourages Insight into Past Experiences
  Influence on Current Problems
• Psychotherapeutic Focus

Source ESDRB Program Guidance, December, 1996
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Disaster Mental Health InterventionsKey
Principles

• Do no harm
• Assume resilience
• Everyone who experiences a terrorist event is
  affected by it
• Simple human presence is powerful and reassuring

From Helping to Heal A Training Manual on
Mental Health Response to Terrorism
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Disaster Mental Health InterventionsKey
Principles

• Be culturally competent
• Terrorist attacks affect both individuals and
  communities
• Respect individual differences in moving through
  traumatic reactions
• Services are enhanced by a flexible approach
  ongoing assessment, evaluation and revision

From Helping to Heal A Training Manual on
Mental Health Response to Terrorism
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Disaster Mental Health InterventionsKey
Principles

• Development of a team approach is vital to
  effective functioning
• Mental health services must be coordinated with
  the larger response-recovery team which may
  include fire, police, rescue, and recovery
  agencies

From Helping to Heal A Training Manual on
Mental Health Response to Terrorism
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Disaster Mental Health Interventions

• Psychological First Aid
• protect, direct and connect
• Crisis Intervention
• Promote safety and security
• Invite person to share their experiences
• Identify current priority needs, problems and
  possible solutions

From Helping to Heal A Training Manual on
Mental Health Response to Terrorism
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Disaster Mental Health Interventions

• Crisis Intervention (cont.)
• Assess functioning and coping
• Provide reassurance, normalization,
  psychoeducation and practical assistance
• Informational Briefing
• Work with Public Information Officers and
  other officials on messages

From Helping to Heal A Training Manual on
Mental Health Response to Terrorism
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Disaster Mental Health Interventions

• Psychological Debriefing
• Group intervention used with emergency
  responders and first receivers
• Respite Center
• Where volunteers and emergency service workers
  can receive supplies, food, cots and informal
  crisis intervention

From Helping to Heal A Training Manual on
Mental Health Response to Terrorism
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Disaster Mental Health Interventions

• Psychoeducation
• Post-trauma reactions
• Grief and bereavement
• Effective coping strategies
• Indications of when to seek professional help
• Community Outreach
• Sites where survivors and family members
  gather, Internet, telephone hotlines, PSAs,
• Meetings of pre-existing groups,Memorials

From Helping to Heal A Training Manual on
Mental Health Response to Terrorism
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Disaster Mental Health Interventions

• Brief Counseling Interventions
• Cognitive-behavioral therapy
• Phase-oriented treatment
• Bereavement counseling
• Eye movement desensitization and reprocessing
• Brief therapies
• Psychopharmacology

From Helping to Heal A Training Manual on
Mental Health Response to Terrorism
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Disaster Mental Health Interventions

• Support and Therapy Groups
• Telling ones trauma story
• Mental Health Consultation
• Work with decision-making and planning teams
• Rituals and memorials
• Anniversary events

From Helping to Heal A Training Manual on
Mental Health Response to Terrorism
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Disaster Mental Health Interventions

• Death Notifications
• Mothers Against Drunk Driving
• Provide support to the family receiving the
  news and to those conducting the notifications
• Specific culture and ethnic customs regarding
  grief

From Helping to Heal A Training Manual on
Mental Health Response to Terrorism
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Other training topics

• Family Emergency Preparedness
• District EOP/State EOP
• Self-Care
• Strategic National Stockpile
• Introduction to Emergency Preparedness
• (What is the mental health role?)
• Weapons of Mass Destruction
• National Incident Management System and Incident
  Command System
• Incident Awareness Training

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What it takes

• Ability to remain focused
• Function well in confused and chaotic
  environments
• Have common-sense and can think on your feet
• See problems as challenges not burdens
• Can monitor and manage your own stress

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What it takes

• Comfortable with value systems different from
  your own
• Initiative and stamina
• Sensitive to cultural issues
• Adept and creative
• Establish rapport easily
• Shares history with person in the incident area
  (indigenous workers)

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Getting involved
Contact your local American Red Cross chapter at
www.redcross.org
404-634-6272 
or http//www.gapsychology.org/
GCATSGeorgia Crisis Assistance Teams for Schools
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Acknowledgements

• Substance Abuse and Mental Health Services
  Administration Mental Health All-Hazards Planning
  Guidance
• DeWolfe, DJ. Mental Health Response To Mass
  Violence and Terrorism A Training Manual
• Arlington Community Resilience Project. Helping
  to Heal A Training on Mental Health Response to
  Terrorism
• FEMA Crisis Counseling Grant Program Course
  Student Manual
• Georgia Office of Homeland Security, Georgia
  Emergency Management Agency
• Georgia Department of Human Resources
• American Red Cross
• Lacy and Benedek. Terrorism and Weapons of Mass
  Destruction Managing the Behavioral Reaction in
  Primary Care
• State Mental Health Authorities Response to
  Terrorism 2004
• American Journal of Psychiatry
• United State Health Resources and Services
  Administration