Workshop: Prevention & Response to Mass Trauma & DisasterFrancis R. Abueg, Ph.D.

TraumaResourceClinical & Forensic PsychologySunnyvale, Californiadrfrancis@traumaresource.com

Overview of Presentation

•Trauma organization websites•Provider education•Patient education

•Thank you to Josef Ruzek, Ph.D. of the National Center for PTSD and colleagues for presentation content.

Some Challenges in Resource AccessExplosion of resourcesChallenge of centralizing resourcesChallenge of simplifying resource

locationDo resources affect practice?Resource validation/accuracy

Accuracy of Information Bremner, Quinn, Quinn, and Veledar (2006) Review of 80 Internet websites

42% of sites had inaccurate information 82% did not provide a source of content 41% did not use a mental-health professional in

the development of the content

Websites providing information about traumatic stress are often not useful, and can sometimes provide inaccurate and potentially harmful information to consumers

NCPTSD Websitewww.ptsd.va.gov

• Resources to support patients and public

• Resources to support research and practice▫ PILOTS database▫ Iraq War Clinician Guide▫ PTSD 101▫ Psychological First Aid Manual▫ CTU-Online▫ PTSD Research Quarterly▫ Videos

Trauma Organizations• International Society for Traumatic Stress Studies (ISTSS)

▫ www.istss.org • Center for the Study of Traumatic Stress

▫ http://www.centerforthestudyoftraumaticstress.org /index.php

▫ Includes resource listing, includes service members, families, and children

• Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury▫ http://www.dcoe.health.mil/

Trauma Organizations

•National Child Traumatic Stress Network▫http://www.nctsn.org/▫National Child Traumatic Stress Network is a

comprehensive resource for the public, consumers, and professionals

•APA Division 56▫http://www.apatraumadivision.org/resources.ph

p▫Doctoral and internship training resources▫Division 56 Research Wiki

•David Baldwin’s Trauma Pages▫http://www.trauma-pages.com/

Clinical Practice Guidelines

• International Society for Traumatic Stress Studies▫ http://www.istss.org/Content/NavigationMenu/ISTSSTre

atmentGuidelines/PTSDTreatmentGuidelines/default.htm

• National Institute for Clinical Excellence (UK)▫ http://guidance.nice.org.uk/CG26/NICEGuidance/pdf/En

glish

• VA-DOD▫ https://www.qmo.amedd.army.mil/ptsd/CompleteGuidelin

e.pdf• Australian Center for Posttraumatic Mental Health

▫ http://www.acpmh.unimelb.edu.au/resources/resource-asdptsd_guidelines.html

PILOTS : Published International Literature on Traumatic Stress

• 35,000 citations of articles on traumatic stress

• Includes reports and foreign-language materials

• Trauma-specific thesaurus

• CSA platform (like PsycInfo)

• Links to online sources

• Articles by NCPTSD authors provided as PDFs

CTU-Online: Clinician’s Trauma Update

• Summarizes clinically relevant articles on treating Veterans & military personnel

• Summaries presented in brief format with links to the full article

• Emailed every 2 months

• Subscribe at: http://www.ptsd.va.gov/professional/newsletters/ctu-online.asp

Assessment Tools Online• PTSD Checklist-Civilian Version (PCL-C)

http://www.pdhealth.mil/guidelines/appendix3.asp • PTSD Checklist-Military Version (PCL-M)

http://www.pdhealth.mil/guidelines/appendix3.asp • PTSD Checklist– Stressor Specific Version (PCL-S)

http://www.pdhealth.mil/guidelines/appendix5.asp • NCPTSD provides information about a variety of trauma-

specific and more general assessment tools▫ http://www.ptsd.va.gov/professional/pages/assessments/

assessment.asp

• ISTSS▫ http://www.istss.org/AM/Template.cfm?Section=Resourc

esforClinicians&Template=/CM/ContentDisplay.cfm&ContentID=1549

Online Courses for Providers: PTSD 101▫ Background and

Assessment

Assessment

What is PTSD?

▫ Treatment

Cognitive-Behavioral Interventions

Cross-Cultural Considerations (CE)

Group Therapy (CE)

Increasing Effectiveness of PTSD Treatments

Overcoming Barriers (CE)

Pharmacotherapy

Smoking Cessation

Substance Abuse

VA/DoD Clinical Practice Guideline (CE)

PTSD 101 (Cont)

• Specific Trauma ▫ Combat Stress Injuries (CE) ▫ Military Sexual Trauma ▫ Traumatic Brain Injury

• Special Populations ▫ African-American Veterans (CE) ▫ Asian American & Pacific Islander Veterans (CE) ▫ Hispanic Veterans (CE) ▫ Military Culture ▫ Older Veterans (CE)

• General Healthcare ▫ Physical Health Effects (CE)

Center for Deployment Psychology www.deploymentpsych.org

Health Care Toolbox•Guidance for

pediatric health care providers

•http://www.healthcaretoolbox.org/

Medical University of South Carolina TF-CBTWeb• Free web-based training course for learning Trauma-

Focused Cognitive-Behavioral Therapy• Developed and tested by Drs. Esther Deblinger, Judy

Cohen, and Anthony Mannarino• Found in multiple research studies to be an effective

treatment for children with trauma-related problems and their families

• Provides 10 hours of CE training that teaches the procedures of TF-CBT

• Includes streaming video demonstrations, clinical scripts, cultural considerations, clinical challenges and many other learning resources

http://tfcbt.musc.edu/

Cognitive Processing Therapy:Evidence-Based PTSD Treatment for Adults

Coming Soon to NCPTSD

•Online training in Prolonged Exposure treatment

•Online training in STAIR (Skills Training in Affect and Interpersonal Regulation)

•Online training in CBT skills ▫Goal-setting▫Motivation enhancement▫Behavioral task assignment (homework)

Afterdeployment.org

•????

Provider Portal Content

•Overview of afterdeployment.org (tour)•Using afterdeployment.org with your

patients•Continuing education for providers

▫DoD and VA CEU courses•Connecting with other providers•Self-help for providers

▫Burnout

Online CEUs• International Society for Traumatic Stress Studies:

Sessions from the organization’s annual meeting, including master clinician sessions▫ http://www.istss.org/RecordedSessions/2297.htm

• The Center for Deployment Psychology has interactive online courses designed for clinicians caring for military service members, veterans and family members ▫ Working with Service Members and Veterans with PTSD

http://www.essentiallearning.net/student/content/sections/lectora/VeteransPTSD/index.html

Online CEUs (Cont)

• Prolonged Exposure for the Treatment of PTSD

http://www.essentiallearning.net/student/content/sections/lectora/ProlongedExposureTherapyVets/index.html

▫Cognitive Processing Therapy for PTSD in Veterans and Military Personnel http://www.essentiallearning.net/Student/con

tent/sections/Lectora/CognitiveProcessingTherapyforPTSDinVeteransandMilitaryPersonnel/index.html

Online CEUs

• Learning Center of the National Child Traumatic Stress Network: Online catalog developed for mental health professionals, parents and caregivers, policymakers, and others▫http://learn.nctsn.org/course/category.php?id=

3

• The Anxiety Disorders Association of America provides a free podcast on treatment of PTSD▫http://www.adaa.org/resources-professionals/p

odcasts/treatment-ptsd

Information for Survivors/Patients: Fact Sheets

• David Baldwin’s Trauma Information Pages ▫ http://www.trauma-pages.com/support.php

• National Child Traumatic Stress Network • NIMH fact sheets

▫ What is PTSD? ▫ Who gets PTSD? ▫ What are the symptoms of PTSD? ▫ Do children react differently than adults? ▫ How is PTSD detected? ▫ Why do some people get PTSD and others do not? ▫ How is PTSD treated? ▫ What efforts are under way to improve detection and treatment of

PTSD? ▫ How can you help a friend or relative with PTSD? ▫ Where can one go for help? ▫ http://www.nimh.nih.gov/health/publications/post-traumatic-stress-diso

rder-ptsd/complete-index.shtm

Fact Sheets• NCPTSD

▫ Research on Women, Trauma, and PTSD http://www.ptsd.va.gov/professional/pages/women-trauma-ptsd.asp

▫ Sexual Trauma: Information for Women's Medical Providers http://www.ptsd.va.gov/professional/pages/ptsd-womens-providers.as

p

▫ Effects of Disaster on People with Severe Mental Illness http://www.ptsd.va.gov/professional/pages/effects-disaster-mental-ill

ness.asp

▫ PTSD in Children and Adolescents http://www.ptsd.va.gov/professional/pages/ptsd_in_children_and_ado

lescents_overview_for_professionals.asp

▫ PTSD in Refugees http://www.ptsd.va.gov/professional/pages/ptsd-refugees.asp

▫ Trauma, PTSD, and Attachment in Infants and Young Children http://www.ptsd.va.gov/professional/pages/trauma_ptsd_attachment.

asp

Fact Sheets: Disaster

• Centers for Disease Control: Issues related to emergency preparedness and response▫http://www.bt.cdc.gov/masscasualties/copingpu

b.asp

▫http://www.bt.cdc.gov/masscasualties/copingpro.asp

• American Psychiatric Association: Information about disaster psychiatry▫http://www.psych.org/Resources/DisasterPsychi

atry.aspx

Disaster

•Psychological First Aid Manual (phone app coming!)▫ http://www.ptsd.va.gov/professional/manuals/psych-first-aid.asp

•Includes handouts for survivors…▫ Connecting with Others: Seeking Social Support▫ Connecting with Others: Giving Social Support’▫ When Terrible Things Happen▫ Tips for Helping Infants and Toddlers’▫ Tips for Helping Preschool-Age Children▫ Tips for Helping School-Age Children▫ Tips for Helping Adolescents▫ Tips for Adults▫ Basic Relaxation Techniques▫ Alcohol and Drug Use after Disasters

Self-Help Reading for Adults• Courage after fire: Coping strategies for returning soldiers and

their families. (2005). K. Armstrong, S.Best, & P. Domenici. Ulysses Press.

• Down range: To Iraq and back. (2005). B. Cantrell & C. Dean. Washington: WordSmith Books.

• I Can't Get Over It: a handbook for trauma survivors (1992). by Aphrodite Matsakis, PhD. New Harbinger Publications.

• Back from the brink: A family guide to overcoming traumatic stress. (1992). D. Catherall. Bantam Books.

• Trust after trauma: A guide to relationships for survivors and those who love them. (1988). A. Matsakis. Oakland, CA: New Harbinger.

• Recovering after the war. (1990). P. Mason. New York: Penguin Books.

• Vietnam wives: Facing the challenges of life with veterans suffering from post-traumatic stress disorder. (2nd ed.) (1998). A. Matsakis. Sidran Press.

Self-Help Reading for Teenagers

• Finding my way: A teen’s guide to living with a parent who has experienced trauma. (2005). M. D. Sherman & D.M. Sherman. Edina, MN: Beaver’s Pond Press.  

• I’m not alone: A teen’s guide to living with a parent who has a mental illness. (2006). M. D. Sherman & D.M. Sherman. Edina, MN: Beaver’s Pond Press.

Online Patient Education: www.ptsd.va.gov

• Fact sheets, handouts, videos

• War-zone Guides• Links to other relevant

websites▫ MyHealtheVet▫ afterdeployment.org▫ Nationalresourcedirector

y.gov

•Common features ▫Multiple sessions/workshops▫Multiple components▫Stand alone components▫Can also be used as an adjunct to face-to-

face therapy. Assign on-line homework assignments Track patient progress Clinician contact time

Self-Guided Change Programs

Self-Guided Therapist check-in Fully integrated

http://www.beatingtheblues.co.uk/

Considering Professional Help• https://www.myhealth.va.gov/mhv-portal-web/anonymous.p

ortal?_nfpb=true&_pageLabel=mentalHealth&_nfls=false• 30 minute interactive course consisting of:

▫ 5 Sections: Do I Need Help? (includes a brief self-assessment) What is Stopping Me? What Can I Expect Who Can Help Me? Where Can I Find Help?

▫ Videos of veterans who have had to overcome concerns and challenges before seeking help Transcripts were made of real veterans and then

presented by actors with similar features

Considering Professional Help

Considering Professional Help

Other Resources for Military Personnel/Veterans

Realwarrriors.net• The Real Warriors Campaign is an initiative launched

by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE)

▫ Build resilience, facilitate recovery, support reintegration

▫ Decrease stigma to seeking psychological care through Media outreach Print materials Interactive web site Social media

▫ Website features stories of real service members who have sought treatment and are continuing to maintain successful military or civilian careers

http://www.realwarriors.net

VA OEF/OIF Page

•www.OEFOIF.va.gov •OEF/OIF webpage on VA mental health•Overview of benefits available to recent

returnees•Descriptions of different venues where

returnees and families may seek help•Social Media

▫Blogs

http://www.OEFOIF.va.gov

MilitaryOneSource.com• Target audience: Service members from all

branches, family members, service providers▫ Web resources▫ Supplements existing installation services▫ Provides free help and information, by phone with a

professionally trained consultant, or online▫ Wide range of issues from budgeting and investing to

relationships and deployment▫ Available 24 hours a day, 365 days a year ▫ Free counseling services (up to 12 sessions per person,

per issue), face-to-face in the local community, by telephone, and online

http://www.militaryonesource.com/

DCoE Outreach Center• Provides an authoritative source of

information and resources on psychological health (PH) & traumatic brain injury (TBI) issues

• Helps service members, veterans, and their families by connecting them with the resources they need to promote their resilience, recovery, and reintegration

• Assists service members, veterans, families, leaders, healthcare providers navigate the system of care

• Responds to information requests about the DCoE

• Serves:▫ Service Members, Veterans, Families,

Military Leaders, Clinicians, Researchers, Educators, Support personnel, Chaplains

• Capability/Availability:▫ 24/7 availability of Health Resource

Consultants (most have masters or doctoral level degrees and healthcare experience)

▫ Respond by phone, email, instant messaging, chat, fax

▫ Respond to specific research requests

Chat

Or e-mail resources@dcoeoutreach.org

Call

45

http://www.mentalhealth.va.gov/College/

Student Veterans of America www.studentveterans.org

Three primary missions:

• Develop student veteran groups on college and university campuses and coordinate by region between existing groups.

• Connect student groups with resources.

• Advocate on behalf of student veterans at the state and national level.

Online Toolkits Coming

•Community-Based Healthcare Providers•Educators•Employers•Chaplains•Primary Care Practitioners•Disaster Mental Health

VA PTSD PRO (Practitioner Resources Online)

•One-stop shopping for busy clinician•All materials selected for relevance to clinical

care•Personal shopping basket function•Search function by kind of resource (e.g., fact

sheets, videos, articles)

PTSD Coach Overview

PTSD Coach is a mobile phone application for people with PTSD and those interested in learning more about PTSD

This application provides: Education about PTSD A self-assessment tool Portable skills to address acute

symptoms Direct connection to crisis support

and Information about treatment

aimed at guiding those who could benefit into care

Used to augment face-to-face care or as a stand-alone education and symptom management tool

Home Screen• From the home screen (seen

here), users can choose from the four main actions of the application

• Users may also use “Setup” to personalize the app with media from their own phone. Users are guided through this process automatically on their first time through the app

• The “About” button provides users with information about the application and access to the team that built it.

Coming Phone Apps

• PTSD Family Coach• Mindfulness• PE Coach• CPT Coach• Behavioral Activation• Acceptance and Commitment Therapy• Cognitive Behavioral Therapy for Insomnia• Psychological First Aid• TBI• Safety Plan• Problem-Solving• Parenting• Skills for Psychological Recovery

Improving Resources?

• Organizing and vetting resources for specific audiences?

• Proactive outreach to audiences?• More interactive resources?• Evidence-based resources?• Supplementing training resources with

consultation?

Questions and Comments?

•drfrancis@traumaresource.com