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Partnerships for PreparednessFaith 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 MSN Candidate

Charlene Perry RN MPH

Hannah Lee MPH Suzanne Straub Moore

Joanna Tang MPH

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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 little4. 10 Principles of Code of Conduct of the

ICRC & Red Cross/Crescent

Key Themes for Today

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Cognitive - Confusion, disorientation, worry, intrusive thoughtsEmotional - Shock, sorrow, grief, sadness, fear, frustrationInterpersonal - Withdrawal, anger, reticence Physiological - Fatigue, headache, muscle tension, increased BP, HR Spiritual - Challenge to faith, anger at God

Immediate DISTRESS Responses

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 prayerSpiritual supportBereavement supportSocial SupportBasic Needs:

Food, water, first aid, and/or shelter

Clean up, repairs, charity giving, etcMission 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 preparednessProvide psychological and/or medical first aidSupplement agency services (i.e., distribute

“prophylaxis" or countermeasure education) Serve as a volunteer or coordinate outreach

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In Disaster Relief Faith Communities provide:

• Food and Shelter

• Volunteers

• Spiritual Support and a

• Caring Presence

But is Spiritual Health an “Emergency Services Function”?

Faith Community & Spiritual Health

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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

Defined by PL93-288 as amended, “the Stafford Act”

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NIMS and NRPNIMS and NRPNIMS• Aligns command, control,

organization structure, terminology, communication protocols, and resources

• Used for all events

Expertise

Abilities

Resources

NRP• Integrates and applies Federal

resources, knowledge, and abilities before, during, and after an incident

• Activated only for Incidents of National Significance

LocalResponse

StateResponse or Support

FederalResponse or Support

LocalResponse

StateResponse/Support

FederalFederalResponse/SupportResponse/Support

Incident

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ICS Structural Organization

I SAIL FLOPIncident CommanderIncident Commander

&&Deputy CommanderDeputy Commander

Finance &Finance &AdministrationAdministration

SectionSection

LogisticsLogisticsSectionSection

OperationsOperationsSectionSection

PlanningPlanningSectionSection

Safety OfficerSafety Officer AgencyAgencyRepresentativesRepresentatives

Information/Information/IntelligenceIntelligence

OfficerOfficer

LiaisonLiaisonOfficerOfficer

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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.

What are Critical Incidents for you?

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• 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

Presbytery of Baltimore (46 of 74 churches)

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After a Crisis, people look for:

Social CohesionTrusted/Validated InformationAction Plan

To protect people from harm;

To serve people after an event by continuing

essential services;

To provide needed new services; andTo assure resiliency and recovery

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Following disasters, particularly after terrorist attacks,

there is a surge in demand for health services,

including mental health.

Research is Overwhelming

(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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“ … 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.”

National Center on PTSD Guide 2006

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It possesses the highest degree of psychological toxicity…it is the most powerful form of terrorism.

BIOTERRORISM

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The Need…

ChallengesNatural Disasters

Threat of Pandemic Influenza

Threat of Terrorism

… may requireExpanding the base of disaster MH service providers

Reaching populations difficult to access with MH intervention

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“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

Inadequate capacity

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Public health and emergency services personnel may be available in numbers lower than originally anticipated!!

Compounding the problem…

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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“A broad spectrum of professional responders is necessary to meet…psychological needs effectivelyThose 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”

One Approach…

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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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

Why the Faith Community?

(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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“…in the hours after a disaster, at least 25% of the population may be:

stunned and dazed, apathetic and wanderingsuffering from the disaster syndrome

“…especially if impact has been sudden and totally devastating,At this point, psychological first aid and triage…are necessary…”

When Disaster Strikes by Beverley Raphael

Raphael, 1986, p.257.

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Continuum of Care

Basic Life Support

Advanced Life Support

Medicine & Surgery

Physical First Aid

Psych First Aid

Crisis Intervention Counseling

Psychotropic Meds & Psychotherapy

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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.

What Is Psychological First Aid?

(Everly & Flynn, 2005)

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Is NOT a TREATMENT

for Posttraumatic Stress Disorder!

Psychological First Aid

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1. Reflective Listening

2. Assessment Of Need (Maslow)

3. Prioritization• 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)

JHU RAPID-PFA Overview

HopkinsRAPID-PFA

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Communications

Basic assessment and triage

Behavioral intervention & stress management

All 5 steps involve 3 basic skills:

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Psychological First Aid

=RecognizingRecognizing distressdistress vs. dysfunctiondysfunction

DysfunctionDysfunction may be defined as the inabilityinability of an individual to recognize and successfully attend to his/her responsibilities.

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Eustress

Eustress (positive, motivating)

No Action Needed

Dysfunction (severe, incapacitating)

Identify, Assess, & Take action

- Dysfunction

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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.

Crisis Triad

(Everly & Mitchell, 2008)

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May be defined as • anyone unable to function • in a normal manner • due to psychological distress.

A “psychological casualty...”

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Death, injury, & destruction

Functional impairment

Benign, mild, distress

CONTAGION:

Impact on families

Impact on work

The Iceberg Effect: 80/20 rule

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People’s perceptions of • vulnerability, • fear, and • distress are subjective states…and they are contagious

CONTAGION:

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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. Background & AssumptionsII. Defining the Target PopulationIII. Roles and ResponsibilitiesIV. SWOT AnalysisV. Community Resources and Potential

Sources of SupportVI. CommunicationsVII. Plan Review, Evaluation, & Sustainability

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5 Basic Assumptions

1. Importance of Partnerships2. Importance of Prioritizing3. Preparedness for “All Hazards”4. Anticipation of Mental Health Surge5. Protect Vulnerable Populations

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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

Importance of Partnerships

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Enhancing Surge Capability (Knebel and Trabert 2004)

a) Within a county (Tier 2)b) Across disciplines in County EOC (Tier 3)c) Within a geographic region (Tier 4) d) 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)

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

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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

General Study Design

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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

FBOs and Emergencies

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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 Questions

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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

Basic Answers

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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

Background Search

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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.

Partnerships Do Exist

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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

Next Step – Ask More Questions

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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

Research Methods

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Past experience in partnering with LHDs Whether they had participated in any

emergency planning activitiesExperience in ministering to people with special

needsExpectation of LHD in forming a partnershipViews 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

What was Asked

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Interviewed a total of 11 FCNS10 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 – non-statistical sampling, some bias, but experiences and ideas are important

Basic Results

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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 listsParticipated in emergency drills run by countyOften focused on pandemic flu preparedness as

a way to introduce topic of emergency planning

Networked with other community organizations

Preparedness Activities

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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.

Vulnerable Populations

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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

Vulnerable Populations Cont’d

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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

Mutuality of Partnerships

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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

Difficulties of Partnerships

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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

Conclusions

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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

Conclusions Continued

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Volunteerism

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3 Local Health Departments in Maryland40% might be unable to respond to workFunction 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

Willingness to Respond

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To feel better about themselvesTo improve attitude through helping othersWant to do something worthwhile for societyReturn good fortuneMake a difference and sense of achievement

Motivation for Spontaneous Surge

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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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1. The humanitarian imperative comes first2. 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.

International Code of Conduct

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6. … build … response on local capacities.7. … involve program beneficiaries in the

management of relief aid8. … strive to reduce future vulnerabilities to

disaster as well as meeting basic needs9. … 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.

International Code of Conduct – 2

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Bible Study

Part 6 of 6