Disaster Mental Health Institute The University of South Dakota September 30, 2002 The Development of a Regional Disaster Mental Health Response Plan Using

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)


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


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


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


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


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


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


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



Academic Medical Center, cont’d



III. Multi-specialty mental health team orientation (clergy not sufficiently included)

IV. Commitment to and focus on expertise building for career development



Academic Medical Center, cont’d



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



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




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


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



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



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



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



External Strategy (cont.)

Sought legitimacy and certification American Red Cross Disaster Psychiatry Outreach



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



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



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



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



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



Systems principles, cont’d

Synergy: sum of parts greater than parts added together

System meta-analysis facilitated by being inside and outside the system



Chaos

Serves evolutionary function Helps systems explore entire range of

behaviors available Crisis and opportunity



Negotiation principles

Prepare

Probe

Propose

The Power of Nice, Ron Shapiro



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



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



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



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



A Comforting Thought…

“the…capacity to learn may be more important than experience” (L. Douglas Kiel, Ph.D)



Slides will be provided on…

www.fasap.org


Documents

Disaster Mental Health Institute The University of South Dakota September 30, 2002 The Development of a Regional Disaster Mental Health Response Plan Using