Partnerships for PreparednessFaith Community & Local Health Department Collaboration
Key Themes for Today • Faith Community Role in Disaster • Faith Community as Local Mental Health Surge • CBPR and PHSR on the Eastern Shore of MD • Perceptions of Faith Community Nurses • About Emergency Services • About Governmental Agencies • Volunteerism – too much & too little • 10 Principles of Code of Conduct of the ICRC & Red Cross/Crescent
Immediate DISTRESS Responses • Cognitive- Confusion, disorientation, worry, intrusive thoughts • Emotional- Shock, sorrow, grief, sadness, fear, frustration • Interpersonal- Withdrawal, anger, reticence • Physiological- Fatigue, headache, muscle tension, increased BP, HR • Spiritual- Challenge to faith, anger at God Watson PJ. Shalev AY. (2005). Acute Responses to Traumatic Stress Following Mass Traumatic Events CNS Spectrum, 10 (2) 123-131
Role of Faith Communities • Place for worship and prayer • Spiritual support • Bereavement support • Social Support • Basic Needs: • Food, water, first aid, and/or shelter • Clean up, repairs, charity giving, etc • Mission trips to other disaster communities
New Roles and Responsibilities • Share information on disasters and referral service links within your community and local residents once validated information received • Teach individual and family preparedness • Provide psychological and/or medical first aid • Supplement agency services (i.e., distribute “prophylaxis" or countermeasure education) • Serve as a volunteeror coordinate outreach
Faith Community & Spiritual Health • In Disaster Relief Faith Communities provide: • Food and Shelter • Volunteers • Spiritual Support and a • Caring Presence • But is Spiritual Health an “Emergency Services Function”?
Transportation Communications Public Works, Engineering & Damage Assessment Fire Services Information, Warning, and Notification Mass Care Resource Support, Direction, and Control Health and Medical Services Search, Rescue, and Recovery Hazardous Materials and CBRNE Agents Law Enforcement and Investigation Energy and Utilities Evacuation 13 Emergency Services Functions Defined by PL93-288 as amended, “the Stafford Act”
NIMS and NRP • NIMS • Aligns command, control, organization structure, terminology, communication protocols, and resources • Used for all events Resources Expertise Federal Abilities Local Response/Support • NRP • Integrates and applies Federal resources, knowledge, and abilities before, during, and after an incident • Activated only for Incidents of National Significance Response State State Response Response/Support or Support Federal Local Response or Support Response Incident
ICS Structural Organization • I SAIL FLOP
What are Critical Incidents for you? • Has your church directly experienced an emergency, disaster, or significant crisis in your community? • …events which significantly affected your faith community’s ability to function, or required exceptional response by your faith community.
Presbytery of Baltimore (46 of 74 churches) • Tornado in Frostburg • Sanctuary Fire last year • Hurricane blew pieces off church roof anddamaged homes of members living in low-lying areas • Member’s house flooded by Hurricane Katrina • During a storm, housed residents of troubled youth center • Homeless population and those without food • 15-20 years ago the main employer closed down • Prominent member committed suicide 3 years ago • 12 teenage suicides in community since January 2009 • Child in church-run day-care had possible meningitis
After a Crisis, people look for: • Social Cohesion • Trusted/Validated Information • Action Plan • To protect people from harm; • To serve people after an event by continuing essential services; • To provide needed new services; and • To assure resiliency and recovery
Research is Overwhelming • Following disasters, • particularly after terrorist attacks, • there is a surge in demand for health services, • including mental health. (North, Nixon, Shariat, Malonee, McMillen, et al., 1999; Galea, Ahern, Resnick, Kilpatrick, Bucuvalas, et al., 2002; Schlenger, Caddell, Ebert, Jordan, Rourke, et al., 2002; Shalev & Solomon, 1996; Bowler, Murai, & True, 2001; Ursano, Norwood, Fullerton, Holloway, & Hall, 2003; Watts, 1999)
Emotional Needs Furthermore, these reports have revealed that, following such events, psychological symptoms are more common than physical injuries…
National Center on PTSD Guide 2006 • “ … disaster survivors and others affected by such events will experience a broad range of early reactions (for example, physical, psychological, behavioral, spiritual). • “Some of these reactions will cause enough distress to interfere with adaptive coping, and recovery may be helped by support from compassionate and caring disaster responders.”
BIOTERRORISM • It possesses the highest degree of psychological toxicity…it is the most powerful form of terrorism.
The Need… Challenges … may require Expanding the base of disaster MH service providers Reaching populations difficult to access with MH intervention • Natural Disasters • Threat of Pandemic Influenza • Threat of Terrorism
Inadequate capacity • “The nation’s mental health, public health, medical, and emergency public health systems currently are NOT able to meet the psychological needs that result from terrorism.” Institute of Medicine, 2003, Preparing for the Psychological Consequences of Terrorism, abstract
Compounding the problem… • Public health and emergency services personnel may be available in numbers lower than originally anticipated!! Balicer, RD, Omer, SB, Barnett, DJ., and Everly, GS, Jr.. Local public health workers' perceptions toward responding to an influenza pandemic. BioMed Central Public Health, 6:99, doi:10.1186/1471-2458-6-99, 2006. http://www.hschange.org/CONTENT/991/
One Approach… • “A broad spectrum of professional responders is necessary to meet…psychological needs effectively • Those outside the mental health professions, who may regularly interface with the public, can contribute substantially to community healing … • However, these professionals will require knowledge and training in order to provide effective support” Institute of Medicine, 2003, Preparing for the Psychological Consequences of Terrorism, p. 15
Solution Mobilize the faith-based community!
Why the Faith Community? • Up to 50% of people report significant distress after a trauma/ disaster (Norris, 2001, SAMHSA) • 94% Americans believe in God (Tix & Frazier, 1998, J. Cons. & Clin. Psyc.) • 59% likely to seek support from a spiritual counselor, compared to 45% primary care MDs, 40% mental health professionals (ARC, 2001, Ripple Effect)
Being Caring People…. How does the faith community minister in Times of Trouble? Do No Harm … ?
How well do we do? At caring for those in distress?
When Disaster Strikesby Beverley Raphael • “…in the hours after a disaster, at least 25% of the population may be: • stunned and dazed, • apathetic and wandering • suffering from the disaster syndrome • “…especially if impact has been sudden and totally devastating, • At this point, psychological first aid and triage…are necessary…” Raphael, 1986, p.257.
Continuum of Care Psychotropic Meds & Psychotherapy Psych First Aid Crisis Intervention Counseling Basic Life Support Advanced Life Support Medicine & Surgery Physical First Aid
What Is Psychological First Aid? • Psychological first aid (PFA) may be defined as: • A compassionate and supportive presence, • Designed to: • mitigate (reduce) acute distress and • assess the need • for continued mental health care. (Everly & Flynn, 2005)
Psychological First Aid • Is • NOT a TREATMENT • for • Posttraumatic Stress Disorder!
HopkinsRAPID-PFA JHU RAPID-PFA Overview • Reflective Listening • Assessment Of Need (Maslow) • Prioritization • Triage severe vs. mild reactions • Planning: Acute & Sub-Acute • Intervention – Cognitive-behavioral • Disposition • Can the person function adequately? • Can he/she advocate/link with resources? (friends, family, community or workplace)
All 5 steps involve 3 basic skills: • Communications • Basic assessment and triage • Behavioral intervention & stress management
Psychological First Aid Recognizingdistressvs.dysfunction = Dysfunctionmay be defined as the inabilityof an individual to recognize and successfully attend to his/her responsibilities.
Eustress - Distress - Dysfunction Eustress (positive, motivating) No Action Needed Distress (benign, mild) Identify, Assess, & Monitor Identify, Assess, & Take action Dysfunction (severe, incapacitating)
Crisis Triad • Tendencies for impulsive behavior; • Diminished cognitive capabilities (insight, recall, problem-solving), but most importantly a diminished ability to understand the consequences of one’s actions; and, • An acute loss of future orientation, or a feeling of helplessness. (Everly & Mitchell, 2008)
A “psychological casualty...” • May be defined as • anyone unable to function • in a normal manner • due to psychological distress.
The Iceberg Effect: 80/20 rule Death, injury, & destruction Functional impairment Benign, mild, distress Impact on families Impact on work CONTAGION:
CONTAGION: • People’s perceptions of • vulnerability, • fear, and • distress • are subjective states… • and they are contagious
Having a Plan Mitigates Stress Prevents Contagion
7 Key Components of a Community And Mental Health Disaster Plan • Background & Assumptions • Defining the Target Population • Roles and Responsibilities • SWOT Analysis • Community Resources and Potential Sources of Support • Communications • Plan Review, Evaluation, & Sustainability
5 Basic Assumptions • Importance of Partnerships • Importance of Prioritizing • Preparedness for “All Hazards” • Anticipation of Mental Health Surge • Protect Vulnerable Populations
Importance of Partnerships • No faith community, or other organization, has infinite resources • Important to develop partnerships with other organizations to supplement and share resources in times of need • Ultimate goal is to formalize partnerships with mutual aid agreements • As a minimum, identify contact people within those agencies and organizations
Enhancing Surge Capability (Knebel and Trabert 2004) • Within a county (Tier 2) • Across disciplines in County EOC (Tier 3) • Within a geographic region (Tier 4) • Partnering experts with county health departments and FBOs trained in previous projects (another dimension of Tier 4). • Stimulates relationships between FBOs and faith-based networks, such as denominations or associations (Tier 4)
Assessing The Need For & Mutuality Of Partnerships Between Faith-based Organizations and Local Health Departments for Emergency Preparedness Geetika Bector Nadkarni MPH Capstone Project for Johns Hopkins
General Study Design • An exploratory investigation into the types of and possibilities for partnerships between faith-based organizations (FBOs) and local health departments (LHDs) in Maryland • Faith community nurses (FCNs) were interviewed as representatives of FBOs to get their views on working with LHDs
FBOs and Emergencies • Emergency Preparedness: phase of emergency management in which plans of action are set up for when a disaster strikes • FBOs long associated with disasters – initial response, recovery, rebuilding, providing spiritual support, often in coordination with other voluntary organizations • Capacity to act in emergencies can extend beyond response into planning, and helping those with special needs
Basic Questions • How can these two organizations work together for emergency planning? • What are the mutual benefits of working together? • Has anyone done this before? • If so, can we learn from these existing partnerships?
Basic Answers • Partnerships between FBOs and LHDs do exist in Maryland • Some are already working on emergency preparedness, in several ways • There is great potential benefit to each other and to the community in working together • BUT, there is little information available to learn from these collaborations
Background Search • Systematic literature review - help from Donna Hesson at the Lilienfeld Library • Searched for articles on FBOs and LHDs working together – only one published article (Zahner et al.) • Grey literature – government reports, papers from committees or focus groups – yielded little more information
Partnerships Do Exist • National Association of City and County Health Officials in a national survey of LHDs found that over 80% of all LHDs do collaborate with FBOs in their areas(but no detailed info) • Zahner et al. found that in Wisconsin 89% partner with at least one FBO • Third most-common focus area was “emergency/bioterrorism preparedness” • Zahner SJ, Corrado SM. Local health department partnerships with faith-based organizations. J Public Health Management Practice. 2004; 10(3): 258-265.
Next Step – Ask More Questions • Chose to interview FCNs because they often interface between the FBO and LHD as health professionals who work with congregations – i.e., “boundary leaders” • However, no comprehensive list of FCNs in Maryland, no way to know who they are or how to get in touch with them • Often volunteers and/or part-time, so difficult to reach even with contact info