Partnerships for Preparedness
Faith Community & Local Health Department
Collaboration
Presenters
Co-Authors
Collaborators
Henry G Taylor MD MPH
O Lee McCabe PhD
Kris Holmes RN MA
Geetika Nadkarni MPH
Shirley Lee MPH
Charlene Perry RN MPH
MSN Candidate
Hannah Lee MPH
Suzanne Straub Moore
Joanna Tang MPH
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Key Themes for Today
1. Faith Community Role in Disaster
Faith Community as Local Mental Health Surge
CBPR and PHSR on the Eastern Shore of MD
2. Perceptions of Faith Community Nurses
About Emergency Services
About Governmental Agencies
3. Volunteerism – too much & too little
4. 10 Principles of Code of Conduct of the
ICRC & Red Cross/Crescent
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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
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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
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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 volunteer or coordinate outreach
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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”?
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13 Emergency Services Functions
1. Transportation
2. Communications
3. Public Works,
Engineering & Damage
Assessment
4. Fire Services
5. Information, Warning,
and Notification
6. Mass Care
7. Resource Support,
Direction, and Control
8. Health and Medical
Services
9. Search, Rescue, and
Recovery
10. Hazardous Materials and
CBRNE Agents
11. Law Enforcement and
Investigation
12. Energy and Utilities
13. Evacuation
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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
Response/Support
Local
Response
State
State
Response
Response/Support
or Support
Federal
Local
Response or Support
Response
Incident
Abilities
NRP
• Integrates and applies Federal
resources, knowledge, and
abilities before, during, and after
an incident
• Activated only for Incidents of
National Significance
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ICS Structural Organization
I SAIL FLOP
Incident Commander
&
Deputy Commander
Safety Officer
Information/
Intelligence
Officer
Finance &
Administration
Section
Logistics
Section
Agency
Representatives
Liaison
Officer
Operations
Section
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Planning
Section
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.
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Presbytery of Baltimore (46 of 74 churches)
• Tornado in Frostburg
• Sanctuary Fire last year
• Hurricane blew pieces off church roof and
damaged 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
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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
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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)
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EMOTIONAL NEEDS
Furthermore, these reports
have revealed that,
following such events,
psychological symptoms
are more common than
physical injuries…
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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.”
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BIOTERRORISM
It possesses the highest degree of
psychological toxicity…it is the most powerful
form of terrorism.
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The Need…
Challenges
Natural Disasters
Threat of Pandemic
Influenza
Threat of Terrorism
… may require
Expanding the base of
disaster MH service
providers
Reaching populations
difficult to access with
MH intervention
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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
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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.
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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
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SOLUTION
Mobilize the
faith-based
community!
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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)
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BEING CARING PEOPLE….
How does the faith
community minister
in Times of Trouble?
Do No Harm … ?
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HOW WELL DO WE DO?
At caring for those
in distress?
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When Disaster Strikes by 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.
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Continuum of Care
Psych
First Aid
Physical
First Aid
Crisis
Intervention Counseling
Basic
Life
Support
Advanced
Life
Support
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Psychotropic
Meds &
Psychotherapy
Medicine
&
Surgery
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)
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Psychological First Aid
Is
NOT a TREATMENT
for
Posttraumatic Stress Disorder!
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JHU RAPID-PFA Overview
1. Reflective Listening
2. Assessment Of Need (Maslow)
3. Prioritization
Hopkins
RAPID-PFA
• Triage severe vs. mild reactions
• Planning: Acute & Sub-Acute
4. Intervention – Cognitive-behavioral
5. Disposition
• Can the person function adequately?
• Can he/she advocate/link with resources?
(friends, family, community or workplace)
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All 5 steps involve 3 basic skills:
Communications
Basic assessment and triage
Behavioral intervention & stress management
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Psychological First Aid
=
Recognizing
distress vs.
dysfunction
Dysfunction may be defined as the inability of
an individual to recognize and successfully
attend to his/her responsibilities.
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Eustress
Eustress
(positive, motivating)
- Dysfunction
No Action Needed
Monitor
Dysfunction
(severe, incapacitating)
Identify, Assess,
& Take action
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Crisis Triad
1. Tendencies for impulsive behavior;
2. Diminished cognitive capabilities (insight,
recall, problem-solving), but most
importantly a diminished ability to
understand the consequences of one’s
actions; and,
3. An acute loss of future orientation, or a
feeling of helplessness.
(Everly & Mitchell, 2008)
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A “psychological casualty...”
May be defined as
• anyone unable to function
• in a normal manner
• due to psychological distress.
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The Iceberg Effect: 80/20 rule
Death, injury, & destruction
Functional impairment
Benign, mild, distress
Impact on families
Impact on work
CONTAGION:
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CONTAGION:
People’s perceptions of
• vulnerability,
• fear, and
• distress
are subjective states…
and they are contagious
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Having a Plan
Mitigates Stress
Prevents Contagion
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7 Key Components of a Community And
Mental Health Disaster Plan
I.
II.
III.
IV.
V.
Background & Assumptions
Defining the Target Population
Roles and Responsibilities
SWOT Analysis
Community Resources and Potential
Sources of Support
VI. Communications
VII. Plan Review, Evaluation, & Sustainability
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5 Basic Assumptions
1.
2.
3.
4.
5.
Importance of Partnerships
Importance of Prioritizing
Preparedness for “All Hazards”
Anticipation of Mental Health Surge
Protect Vulnerable Populations
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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
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Enhancing Surge Capability (Knebel and
Trabert 2004)
a)
b)
c)
d)
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).
e) Stimulates relationships between FBOs
and faith-based networks, such as
denominations or associations (Tier 4)
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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
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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
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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?
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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
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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
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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.
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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
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Research Methods
Chose method of referral (snowball) sampling –
began with initial contacts from Health
Ministries Association
Asked each contact if they could refer other FCNs
to the study – limited to nurses in MD
Conducted phone interviews or emailed
questionnaires (as preferred by participant)
Performed qualitative analysis on responses to
identify common ideas and themes
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What was Asked
Past experience in partnering with LHDs
Whether they had participated in any emergency
planning activities
Experience in ministering to people with special needs
Expectation of LHD in forming a partnership
Views on the potential benefits of such a partnership
(for emergency planning)
Particular resources their organization had that they
felt would benefit the community/LHD during an
emergency
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Basic Results
Interviewed a total of 11 FCNS
10 out of 11 had worked with their LHD in some way –
often through health promotion activities, with
grant funding
7 out of 11 had engaged in emergency planning
activities
4 out of 11 had an established contact person with the
LHD to partner with them for emergency planning
activities (2 FCN)
Not necessarily a representative sample – nonstatistical sampling, some bias, but experiences and
ideas are important
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Preparedness Activities
Several had attended (or even helped organize) a
focus group for FCNs on emergency planning,
conducted by one county health dept
Conducted preparedness education in their
congregations: had guest speakers, articles in
their newsletters, displayed emergency kits
Created emergency contact lists
Participated in emergency drills run by county
Often focused on pandemic flu preparedness as a
way to introduce topic of emergency planning
Networked with other community organizations
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Vulnerable Populations
According to the CDC, “effective planning for
emergency preparedness and response requires the
capacity to reach every person in a community”
but “research indicates that many jurisdictions
have not defined or located their at-risk
populations”
Include: elderly, isolated, physically or mentally
disabled, limited proficiency in English, have
chronic diseases, poor, homeless, are of ethnic
minorities, or single-parents
Simon C. Locating and reaching at-risk populations in an emergency. Department of Health and
Human Services, Centers for Disease Control. Coordinating Office for Terrorism Preparedness
and Emergency Response.
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Vulnerable Populations Cont’d
Likely to be even less safe than the general
population during an emergency
Also, disasters can create new at-risk populations:
injury, loss of home, loved one, or income
FCNs reported many ways in which FBOs identify
and minister to those with special needs
This is a valuable asset for emergency planning
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Mutuality of Partnerships
FCNs expected that the LHD would organize,
communicate and educate
In working together for emergency planning, LHDs
often initiated partnership, provided training,
educational materials, guest speakers,
sometimes funding or other resources
In turn FBOs felt they had much to offer for
emergency planning – eagerness to help,
volunteer base, ability to disseminate
information to the community, use of their
facilities, and experience in running large
programs
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Difficulties of Partnerships
Emergency planning may not be considered a
priority for FBOs
LHDs may not feel the importance of working with
FBOs
There could be limitations in resources, funding,
staff
Difference in working cultures: FBO is mostly made
up of part-time volunteers while LHD is full-time
staff
If more information was published on what others
have done, these potential difficulties could be
more easily overcome
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Conclusions
FBOs and LHDs have many resources they
can share, and much they can learn from
each other, all to the benefit of the
community
Working together can help protect
vulnerable populations in emergencies
Some already collaborate for health
promotion activities, which can serve as a
foundation for other types of partnerships
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Conclusions Continued
Some have already pursued partnerships for
emergency planning, often with the help of
FCNs
More information needs to be available so
other areas can learn from these experiences
– not start from scratch each time
Recommend LHDs to get in touch with their
community FBOs – as one county did with
their focus group
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Volunteerism
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Willingness to Respond
3 Local Health Departments in Maryland
40% might be unable to respond to work
Function of
- Having a clear role and personal safety
- View that role as important
- Sense of duty and obligation
- Having contingency plan for dependents
- Communication procedures & equipment
- Drills and After-Action Reports
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Motivation for Spontaneous Surge
To feel better about themselves
To improve attitude through helping others
Want to do something worthwhile for society
Return good fortune
Make a difference and sense of achievement
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#2 FOSTERING COORDINATED MENTAL
HEALTH PREPAREDNESS PLANNING
Hopkins Preparedness and
Emergency Response
Research Center
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CODE OF CONDUCT
Useful for:
• Agency Training
• Personal Preparation
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International Code of Conduct
1. The humanitarian imperative comes first
2. Aid is given regardless of the race, creed
or nationality ... adverse distinction of any
kind. [Priorities based on need alone]
3. Aid will not be used to further a particular
religious or political standpoint.
4. We shall endeavor not to act as
instruments of government foreign policy.
5. We shall respect culture and custom.
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International Code of Conduct – 2
6. … build … response on local capacities.
7. … involve program beneficiaries in the
management of relief aid
8. … strive to reduce future vulnerabilities to
disaster as well as meeting basic needs
9. … accountable to both those we seek to
assist and those from whom we accept
resources.
10. … we shall recognize disaster victims as
dignified humans, not hopeless objects.
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Bible Study
Part 6 of 6
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