integrating resilience into disaster medical care capt david morrissette, lcsw, ph.d. mht-1 team...
TRANSCRIPT
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