1. Building Disaster Health and Well-being Susan Earley State Disaster BehavioralHealth Coordinator Hurricane Conference 2011 Pawtuxet Village 1938

2. Protect Your Health and Safety After a Hurricane or FloodPrevent illness from FOODIdentify and throw away food that may not be safe to eat. Prevent illness from WATERListen to and follow public announcements.Avoid floodwater and mosquitoes.Follow all warnings about water on roadways.If you are caught in an area where floodwater is rising, wear a life jacket, or use some other type of flotation device. 3. Prevent and treat OTHER ILLNESS and INJURIESPrevent carbon monoxide poisoning. Dont use a gasoline- or charcoal-burning device inside your home, basement, or garage.Dont run a car inside a garage attached to your house, even if you leave the door open.Dont heat your house with a gas oven.Beware of electrical and fire hazards.NEVER touch a fallen power line.If electrical circuits and equipment have gotten wet or are in or near water, turn off the power at the main breaker or fuse on the service panel. 4. Avoid unstable buildings and structures.Beware of wild or stray animals. Take appropriate precautions to avoid animal bites and rabies exposure.Get rid of dead animals according to local guidelines. If possible, use flashlights or other battery-operated lights instead of candles. Beware of hazardous materials. Wash skin that may have come in contact with hazardous chemicals.Clean up and prevent mold growth. Clean up and dry out the building quickly. 5. To prevent mold growth, clean wet items and surfaces with detergent and water. Throw away porous items (for example, carpet and upholstered furniture) that cannot be dried quickly. Fix any leaks in roofs, walls, or plumbing.Pace yourself and be alert to physical exhaustion or strain. Set priorities for cleanup tasks. Try not to work alone or get exhausted. Ask your family members, friends, or professionals for support. Prevent musculoskeletal injuries. Use teams of two or more people to move bulky objects. Avoid lifting any material that weighs more than 50 pounds (per person). 6. Treat wounds. Clean out all open wounds and cuts with soap and clean water. Apply an antibiotic ointment. Use soap and water to wash your hands. If water isnt available, you can use alcohol-based products made for washing hands.Stay cool. When its hot, stay in air-conditioned buildings; drink water and nonalcoholic fluids often.Wear protective gear for cleanup work. Wear hard hats, goggles, heavy work gloves, and watertight boots with steel toes and insoles.Wear earplugs or protective headphones to reduce risk from equipment noise. 7. Whats wrong? Mental health issues are among the largest public health issues following a disaster. This must be considered in all phases of disaster planning and management . 8. Objectives

• Identify typical disaster reactions.

• Describe the key concepts of disaster mental health.

• Describe resilience.

• Explain the importance of survivors connections to social networks and to accurate, current information.

• Identify current communication resources andtools.

• Recognize Rhode Islands strengths in support of disaster health and well-being.

9. Weather-related disaster: A disaster is the result of a vast ecological breakdown in the relation between humans and their environment, a serious and sudden event (or slow, as in a drought) on such a scale that the stricken community needs extraordinary efforts to cope with it, often with outside help. 10. Key Concepts

Risk FactorsPopulation Exposure Model

Injured survivors; bereaved family members

Survivors with high exposure to disaster trauma or evacuated from disaster zones

Bereaved extended family and friends; first responders

People who lost homes, jobs, and possessions; people with preexisting trauma and dysfunction; at-risk groups; other disaster responders

Affected people from the larger community

Adapted from DeWolfe, 2002.

11. Key Concepts (cont.)

• Everyone who experiences a disaster is affected by it in some way.

• People pull together during and after a disaster.

• Stress and grief are common reactions to uncommon situations.

• Peoples natural resilience will support individual and collective recovery.

12. Key Concepts (cont.)

Vulnerability Factors

• Poverty

• Race

• Age

• Ethnicity

• Unemployment

• Gender

13. Key Concepts (cont.)

Typical Outcomes of Disaster

• Some will have severe reactions.

• Few will develop diagnosable conditions.

• Most do not seek help or treatment.

• Survivors often reject help.

• Outreach and public

• education play important roles.

14. Fundamentals of Disaster MH

• Work to help people foster their natural resilience and develop positive coping skills.

• Most disaster survivors have never received traditional mental health or substance abuse services.

• Overcoming stigma is a challenge

15. Fundamentals (cont.)

• Based on an assumption of natural resilience and competence

• Strengths based

• Culturally competent

• Conducted in nontraditional settings

• Be calm, kind and, above all,

• available

16. Goals of Disaster Mental Health Work with Individuals

Serve as a supportive presence

• Understand their own situations and reactions

• Regain a sense of mastery and control

• Identify, label, and express emotions

• Adjust to the disaster and losses

• Manage stress

• Make decisions and take action

• Develop coping strategies

• Use community resources

• Refer for MH treatment as needed

17. Community Support and Networking

• Foster community resilience through improved connectivity

• Promote familiarity with disaster relief resources

• Create a seamless system for referral

• Create opportunities for shared resources and training

18. Individual Reactions

Types of Individual Reaction

• Physical

• Emotional

• Cognitive

• Behavioral

These are normal and expected reactions to an abnormal event. 19. Individual Reactions (cont.)

Physical Reactions

• Gastrointestinal problems

• Headaches, aches, and pains

• Weight change

• Sweating or chills

• Tremors or muscle twitching

• Clumsiness, increased accidents

• Eased startle (more easily startled)

• Chronic fatigue or sleep disturbances

• Immune system disorders

• Sexual dysfunction

Positive responses can include alertness.

20. Individual Reactions (cont.)

Emotional Reactions

• Heroic, euphoric, or invulnerable feeling

• Denial

• Anxiety or fear

• Depression

• Guilt

• Apathy

• Grief

Positive responses can include feeling challenged, involved, and pressured to act.

21. Individual Reactions (cont.)

Cognitive Reactions

• Disorientation and confusion

• Poor concentration

• Difficulty setting priorities or making decisions

• Loss of objectivity

• Recurring dreams, nightmares, or flashbacks

• Preoccupation with disaster

Positive responses can include group identification and sharpened perception.

22. Individual Reactions (cont.)

Behavioral Reactions

• Change in activity level

• Alcohol and drug use or abuse

• Increased use of over-the-counter medications

• Difficulty communicating or listening

• Irritability, anger, or frequent arguments

• Declining job performance

• Frequent crying

• Difficulty sleeping

• Avoidance of triggering places or activities

Positive responses can include unselfish and helping behavior.

23.

• The severity of reactions is affected by the type of, level of exposure to, and casualties associated with the disaster.

• Preexisting trauma may increase the risk of severe reaction.

• People experiencing severe reactions should be referred for treatment.

• Preexisting levels of support will affect the severity of reactions.

Individual Reactions (cont.) 24. Collective Reactions

Typical Phases of Disaster

Adapted from CMHS, 2000. 25. Resilience is:

an ability to recover from or adjust easily to misfortune or change

one of the most important factors in fostering individual and community recovery

26. Factors Affecting Resilience

• Life situation

• Individual traits and coping styles

• Disaster and trauma experience

• Family and social support

• Spiritual beliefs

• Taking action to prepare and protect can help reduce fear, anxiety, losses and if onlys

27. Factors Affecting Resilience (cont.)

• Perceived presence of control and hope

• Availability of accurate information

• An effective and caring emergency response

• There is strong evidence that the experiences of the population subsequent to the disaster have direct relevance to recovery.The more problems and life difficulties the affected persons experience during the recovery phase, more persistent the emotional reactions will be.

28. Objective

• Identify at-risk populations

29. At-Risk Populations

• Children and youth

• Parents or caregivers of children

• Older adults

• People with prior trauma history

• People with serious mental illnesses

• People with disabilities

• People with a history of substance abuse

• Low-income groups

• Public safety workers (PSWs)

30. At-Risk Populations (cont.)

Children and Youth

• Developmental factors

• • Less-developed cognitive skills

• • Limited experience coping with adversity

• • Lack of coping skills for managing stress

• • Limited verbal skills

• • Dependence on adults for resources and psychological support

• Risk factors

• • Separation from family

• • Evacuation and relocation

• • Loss of a family member or a close friend

• • High levels of parental distress

• • Family members at risk (such as first responders)

31.

Older Adults

• Risk factors

• • Physical limitations

• • Previous loss

• • Relocation trauma

• • Dependence on medications

• • Disaster-related health risks

• • Reluctance to accept support

• • Lack of social supports

At-Risk Populations (cont.) 32. At-Risk Populations (cont.)

Public Safety Workers (PSWs)

• Risk factors

• • Exposure to the disaster event

• • Threat of injury or harm

• • Separation from family

• • View of selves as helpers, not persons who need help

• • Demanding work schedule

33. Intervention Strategies for At-risk Adults

• Be aware of unique needs.

• Canvass communities to locate isolated survivors.

• Educate those who work with at-risk populations about disaster reactions.

• Collaborate with community leaders and cultural brokers.

• Partner with organizations that serve at-risk populations.

• Consider cultural factors.

• Reconnect individuals to pre-trauma treatment services (e.g., substance abuse, mental health, medical).

• Ensure that services and materials are appropriate and accessible.

34. Tools for Survivors

Ten Ways To Build Resilience

• Make connections.

• Avoid viewing crises as insurmountable problems.

• Accept change as a part of living.

• Move toward goals.

• Take decisive actions.

• Look for opportunities for self-discovery.

• Nurture a positive view of self.

• Keep things in perspective.

• Maintain a hopeful outlook.

• Practice effective self-care.

Adapted from APA, 2006.

35.

• Anger around the limits of governmental assistance and insurance (e.g., the system, red tape)

• Increased substance use

• Unaddressed trauma leading to diagnosable conditions such as depression or posttraumatic stress disorder (PTSD)

• Stress from financial hardship as resources diminish

• Frustration and disillusionment at the lack of resources and pace of repairs

• Continued anxiety around dislocation and separation

Anticipated Reactions: Anticipated Reactions: 36.

• The severity of reactions is affected by the type of, level of exposure to, and casualties associated with the disaster.

• Preexisting trauma may increase the risk of severe reactions.

• Stress can negatively impact physical health.

• Preexisting levels of support will affect the severity of reactions.

Anticipated Reactions: 37. Factors that affect survivors resilience:

• Life situation

• Individual traits and coping styles

• Disaster and trauma experience

• Spiritual beliefs

• An effective and caring emergency response

• Confidence that stress can be managed

• Presence of perceived control, and hope

• Family and social support

• Availability of accurate information

38. Information Sharing and Social Networking as Recovery Tools 39. Follow FEMA, NOAA and American Red Cross on Facebook to learn more about hurricanes and the steps you can take to ensure your family or business is prepared.Post comments, share your stories and keep track of the latest information.www.facebook.com/fema www.facebook.com/redcross www.facebook.com/usnoaagov 40. In 140 characters or less, brief messages (aka tweets) provide followers with specific information in a timely manner. Those who tweet can stay up-to-date and by following on-going developments in a disaster situation via their cell phones.www.twitter.com/femainfocuswww.twitter.com/craigatfema www.twitter.com/usnoaa.gov www.twitter.com/usoceangov 41. Watch online video webisodes on topics such as how to prepare a disaster kit, what to do and where to go in an emergency, how to apply for disaster assistance and more. Tune in for informational videos produced by FEMA, NOAA, and American Red Cross. www.youtube.com/fema www.youtube.com/usnoaagov www.youtube.com/user/AmRedCross 42. Cell phone users with internet connectivity can access a basic easy-to-load webpage designed specifically for fast downloads.Log on for information on what to do before, during and after a disaster by visitingfema.govon your mobile phone. For a complete list of social media links offered by each agency/organization, visit www.fema.gov, www.redcross.org/connect, www.noaa.gov/socialmedia 43. Add a WIDGET or badge to your website which allows your audience to find specific hurricane-related information .These predesigned tools which include direct links, videos and updated disaster information. www.fema.gov/help/widgets www.nhc.noaa.gov/widgets 44. 45. Available FEMA Widgets 46. Search for Red Cross Shelters Found on website or iPhone app! Shows capacity and current use. 47. www.rihope.ri.gov 48. www.nhc.noaa.gov 49. Health and Human Services, Office of the Assistant Secretary for Preparedness and Response (ASPR) 50. www.riema.ri.gov 51. Safe and Well site 52. Questions?

Susan Earley

Disaster Behavioral Health Coordinator

RI Department of Behavioral Healthcare, Developmental Disabilities and Hospitals

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